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Biomedical subjects

J L Mullen

Publications and source records attributed to J L Mullen.

At least 91 records · Page 5Linked to original sources
PubMed1981

The efficacy of nutritional assessment and support in cancer surgery.

Malnutrition is common in cancer patients and may be an important determinant of operative morbidity and mortality. To determine whether preoperative nutritional assessment can be used to identify a group of high-risk patients, and whether preoperative TPN decreases morbidity and mortality in this group, retrospective, nonrandomized review of 159 patients who were subjected to major cancer surgery was performed. All patients underwent preoperative multiparameter assessment. A previously developed and validated nutritional assessment model (Prognostic Nutritional Index) was used to evaluate the probability of operative complications. Based on predicted outcome (PNI), patients were assigned to either a high-risk or low-risk group for statistical comparison with actual outcome. The effect of preoperative TPN was then analyzed in both risk groups for determination of efficacy of preoperative nutritional support. Substantial malnutrition was found to exist among patients undergoing major cancer surgery and was closely correlated with subsequent morbidity and mortality. This predictive nutritional assessment model accurately identifies a subset of cancer surgery patients at increased risk of operative morbidity and mortality. In this high risk group (PNI greater than or equal to 40%), preoperative nutritional support significantly reduces operative morbidity.

Aged↗
PubMed1981

Energy expenditure in patients with inflammatory bowel disease.

The basal energy expenditure (BEE) calculated from the Harris-Benedict equation was compared with the resting energy expenditure (REE) measured by indirect calorimetry in 12 consecutive hospitalized patients with inflammatory bowel disease. The BEE proved to be equivalent to the REE in the prediction of daily caloric requirements. Patients weighing less than 90% of their ideal body weight had significantly increased energy requirements on a per-kilogram-weight basis as compared with those weighing more than 90% of their ideal body weight. Daily caloric requirements based on 1.75 X BEE would provide 45 kcal/kg/24 hr, which is consistent with reported values necessary for anabolism.

Adolescent↗
PubMed1981

Endocarditis complicating home hyperalimentation.

Catheter sepsis remains a persistent, though infrequent, complication of intravenous hyperalimentation (IVH). Those select patients requiring home hyperalimentation delivered through Silastic catheters are subject to this serious problem. Reported in this article is a case of Enterococcus endocarditis of the tricuspid valve in a patient receiving home IVH; the endocarditis was recognized early using two-dimensional echocardiography and was treated successfully with catheter removal and IV antibiotic administration. Ideal conditions exist for the formation of endocarditis in the setting of catheter sepsis with parenteral nutrition. Routine echocardiography is indicated when catheter sepsis is documented, since early diagnosis and treatment may reduce invasive cardiac tissue infection and permanent injury. The right atrial catheter generates reflections during echocardiography that require special attention for accurate interpretation.

Adult↗
PubMed1981

Successful long-term percutaneous decompression of the biliary tract.

The efficacy of percutaneous transhepatic biliary drainage for long-term (greater than 3 months) decompression of biliary obstruction was evaluated in 35 patients with benign (10) and malignant (25) obstructing lesions. The results indicate that such drainage is a safe and effective means for long-term decompression of the biliary tract in selected patients, especially patients who are poor operative risks and those with metastatic or nonresectable malignancy. In addition, the procedure provides access to the biliary tract for percutaneous dilatation of selected common duct or anastomotic strictures.

Adult↗
PubMed1981

Effect of parenteral nutrition on protein synthesis in adult cancer patients.

The rate of whole body protein synthesis was measured with 15N glycine in three groups of subjects: 1) normal healthy adult controls, 2) semistarved adult patients with upper gastrointestinal tract malignancies and, 3) a group of patients similar to 2) except they were maintained parenterally on a regimen adequate in amino acids and glucose. By comparing the patient results with data obtained from rat studies with 15N glycine were concluded that the patients were protein rather than energy depleted.

Adult↗
PubMed1981

Protein and fat metabolism in rats during repletion with total parenteral nutrition (TPN).

UNLABELLED: We investigated the effect of non-protein calorie source on the repletion by total parenteral nutrition (TPN) of protein-depleted rats. Rats were depleted by feeding them a protein free diet for 4 weeks. Control (non-depleted) and depleted rats were given one of three isocaloric, isonitrogenous TPN regimens for 6 days. They differed in the proportion of non-protein calories given as glucose and fat: diet 1, 100% glucose; diet 2, 75% glucose, 25% fat; and diet 3, 100% fat. The liver, skeletal muscle and whole body protein synthesis and break-down rates were measured by using [15N]glycine as a tracer. The fatty acid distribution in the liver was measured by gas chromatography-mass spectrometry. RESULTS: (a) Omission of fat leads to a decrease in the fraction of linoleate in the liver. (b) Giving all the non-protein calories as a fat emulsion causes fatty acid accumulation in the liver and a significant increase in the liver protein fractional synthesis rate in the control rats and killed about half the depleted rats. (c) For TPN regimens 1 and 2 both the muscle and whole body synthesis rates were increased during repletion. (d) Of the three TPN regimens, the second one which contained both fat and glucose was superior to the other two.

Animals↗
PubMed1981

The treatment of anorexia nervosa with total parenteral nutrition.

Treatment outcome of 11 anorectic patients receiving total parenteral nutrition (TPN) is compared with outcome of anorectic patients receiving standard behaviorally oriented inpatient therapy. TPN resulted in significantly more rapid weight gain. Most patients could be successfully weaned from TPN to enteral feeding with continued weight gain. Complications during TPN were common including transaminase elevations and electrolyte imbalance. There was one death in the series. The role of TPN in the management of anorexia nervosa is discussed.

Adolescent↗
PubMed1981

The malpositioned subclavian catheter.

The results of a review of 524 consecutive infraclavicular subclavian vein catheterizations revealed inadvertent cannulization of the internal jugular vein to be a relatively common problem. No increased predilection for malpositioning was associated with either a right-sided or left-sided approach. The safety and efficacy of this repositioning technique using a guide wire, anatomic maneuvers and with and without the adjuvant use of fluoroscopy were investigated. The malpositioned subclavian vein catheter need not be removed and the patient need not undergo another percutaneous catheterization. The technique affords safe and simple repositioning of the catheter tip into the superior vena cava.

Catheterization↗
PubMed1980

Host-tumor interaction and nutrient supply.

Adequate parenteral nutritional support improves nutritional status in cancer patients, but its effect on tumor growth remains controversial. Using a transplantable mammary adenocarcinoma in a rat-TPN model, the relative effect of different exogenous intravenous nutrients on tumor growth and host maintenance was studied. Relative to chow controls, starvation increased host depletion without reducing tumor growth. Adequate carbohydrate calories alone neither improved host maintenance nor stimulated tumor growth, yet adequate amino acids alone did improve host maintenance but also stimulated tumor growth. Adequate amino acids and carbohydrates given simultaneously maximized both host maintenance and tumor growth. In contrast, an isocaloric, isonitrogenous, intravenous diet providing non-nitrogenous calories as fat promoted host maintenance equivalent to carbohydrate-based TPN with no tumor stimulation. This apparent differential utilization of fat calories by normal and malignant cells may permit manipulation of the relative benefit of parenteral nutrition to host or to tumor, permitting host repletion without tumor stimulation or alternatively tumor stimulation at appropriate times to increase sensitivity to phase-specific antineoplastic therapy.

Adenocarcinoma↗
PubMed1980

Effect of toal parenteral nutrition on gastric acid secretion.

While total parenteral nutrition is widely used, its effects on gastrointestinal function are not well understood. We measured acid secretion in 11 patients during total parenteral nutrition. Five of these patients were retested at least one month after resuming oral intake. Total parenteral nutrition significantly stimulated acid secretion compared to saline infusion (5.5 +/- 2.0 vs 1.8 +/- 0.6 mEq H+/hr, P less than 0.001) (mean +/- SEM), especially in those patients who are hypersecretors. There was no difference in pentagastrin-stimulated maximal acid output during TPN or saline infusion. Basal and pentagastrin-stimulated acid secretion were similar during and after a course of total parenteral nutrition, suggesting that gastric atrophy did not occur during total parenteral nutrition therapy.

Blood Glucose↗
PubMed1980

Prognostic nutritional index in gastrointestinal surgery.

Based on assessment of 161 nonemergency general surgical patients, a multiparameter index of nutritional status was defined relating the risk of postoperative complications to baseline nutritional status. When applied prospectively to 100 gastrointestinal surgical patients, this index provided an accurate, quantitative estimate of operative risk, permitting rational selection of patients to receive preoperative nutritional support.

Digestive System Surgical Procedures↗