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Biomedical subjects

M M Rothkopf

Publications and source records attributed to M M Rothkopf.

At least 19 recordsLinked to original sources
PubMed1998

Dietary restriction of energy and calcium alters bone turnover and density in younger and older female rats.

To determine the influence of weight loss with or without adequate calcium intake on bone turnover and density, we examined the influence of dietary restriction of calcium or energy on body weight (BW), bone mineral density (BMD) and bone turnover in both younger (3 mo) and older (10 mo) female rats (n = 66). Diets were designed to allow feeding at two levels of calcium intake (normal = 78 mg/d and low = 15 mg/d) and two levels of energy intake (normal and 40% restriction) while keeping the intake of protein, fat, fiber, vitamins and other minerals equal between groups. Thus rats received either a control diet (CNTL), a diet restricted in calcium, energy or both for 9 wk. Energy restriction reduced BW 5-21% (P < 0.01) and elevated bone formation 10-20% (P < 0.05) in both age groups. Bone resorption was 20-40% above CNTL values (P < 0.05), in rats fed all three restricted diets. In younger rats, BMD increased over time in all groups (P < 0.05), but final BMD was lower in calcium restricted groups compared with CNTL (P < 0.01). In older rats, CNTL had a significantly greater final BMD (P < 0.05) than diet-restricted groups. These data indicate that, in both younger and older rats, dietary restriction of calcium or energy results in an elevated rate of bone turnover. BMD is compromised by calcium restriction in both younger and older rats, whereas only older rats were negatively influenced by dietary energy restriction. Thus the present study indicates a detrimental effect of low-energy diets, as well as inadequate calcium intake, on bone density in mature rats.

Aging↗
PubMed1995

Early enteral administration of a formula (Impact) supplemented with arginine, nucleotides, and fish oil in intensive care unit patients: results of a multicenter, prospective, randomized, clinical trial.

OBJECTIVE: To determine if early enteral feeding, in an intensive care unit (ICU) patient population, using a formula supplemented with arginine, dietary nucleotides, and fish oil (Impact), results in a shorter hospital stay and a reduced frequency of infectious complications, when compared with feeding a common use enteral formula (Osmolite.HN). DESIGN: A prospective, randomized, double-blind, multicenter trial. SETTING: ICUs in eight different hospitals. PATIENTS: Of 326 patients enrolled in the study, 296 patients were eligible for analysis. They were admitted to the ICU after an event such as trauma, surgery, or sepsis, and met a risk assessment screen (Acute Physiology and Chronic Health Evaluation II [APACHE II] score of > or = 10, or a Therapeutic Intervention Scoring System score of > or = 20) and study eligibility requirements. Patients were stratified by age (< 60 or > or = 60 yrs of age) and disease (septic or systemic inflammatory response syndrome). INTERVENTIONS: Patients were enrolled and full-strength tube feedings were initiated within 48 hrs of the study entry event. Enteral feedings were advanced to a target volume of 60 mL/hr by 96 hrs of the event. One hundred sixty-eight patients were randomized to receive the experimental formula, and 158 patients were randomized to receive the common use control formula. MEASUREMENTS AND MAIN RESULTS: Both groups tolerated early enteral feeding well, and the frequency of tube feeding-related complications was low. There were no significant differences in nitrogen balance between groups on study days 4 and 7. Patients receiving the experimental formula had a significant (p = .0001) increase in plasma arginine and ornithine concentrations by study day 7. Plasma fatty acid profiles demonstrated higher concentrations of linoleic acid (p < .01) in the patients receiving the common use formula and higher concentrations of eicosapentaenoic and docosahexaenoic acid (p < .01) in the patients receiving the experimental formula. The mortality rate was not different between the groups and was significantly (p < .001) lower than predicted by the admission severity scores in both feeding groups. In patients who received at least 821 mL/day of the experimental formula, the hospital median length of stay was reduced by 8 days (p < .05). In patients stratified as septic, the median length of hospital stay was reduced by 10 days (p < .05), along with a major reduction in the frequency of acquired infections (p < .01) in the patients who received the experimental formula. In the septic subgroup fed at least 821 mL/day, the median length of stay was reduced by 11.5 days, along with a major reduction in acquired infections (both p < .05) in the patients who received the experimental formula. CONCLUSIONS: Early enteral feeding of the experimental formula was safe and well tolerated in ICU patients. In patients who received the experimental formula, particularly if they were septic on admission to the study, a substantial reduction in hospital length of stay was observed, along with a significant reduction in the frequency of acquired infections.

APACHE↗
PubMed1994

Short-term effects of lipid-based parenteral nutrition in patients with acquired immunodeficiency syndrome and Pneumocystis carinii pneumonia.

The human immunodeficiency virus (HIV) is surrounded by a rigid membrane rich in cholesterol. Extraction of cholesterol from the virus envelope reduces its infectivity in vitro. Large amounts of lipid emulsion phospholipids have the property of extracting cholesterol from cell membranes. The purpose of the present study was to observe the effects of high phospholipid loads on the lipid profile as well as HIV infectivity of patients with acquired immunodeficiency syndrome (AIDS). Fifty-nine patients with AIDS, weight loss, and presenting Pneumocystis carinii pneumonia (PCP) were included in a prospective, randomised, controlled study. In addition to standard therapy, patients received for 2 weeks 910 kcal of peripheral parenteral nutrition including 20% lipid emulsion (group 1) or a new 2% lipid emulsion with a high phospholipid/triglyceride ratio (1:1.7) (group 2). Activity level and biological, immune and HIV load and infectivity parameters were followed. Cholesterol increased from 113 +/- 44 to 228 +/- 103 mg/dl in the 2% group (P < 0.00001). Triglycerides also increased significantly (P < 0.02). IgA was decreased in the 2% group. HIV load and infectivity tests and leukocyte subsets did not demonstrate any effect of the lipid emulsions. It is concluded that the new 2% emulsion is a powerful cholesterol extractor. However, 2 weeks' administration failed to show any efficacy in modifying immune parameters or HIV infectivity in AIDS patients with PCP.

Journal Article↗
PubMed1992

Intensive home care in New Jersey.

Developments in home care will return many aspects of patient care to the home setting. The patient or his family members can be trained to perform many of the activities traditionally done by hospital personnel. Ongoing studies will result in further developments in techniques and equipment.

Acquired Immunodeficiency Syndrome↗
PubMed1990

Growth hormone and pulmonary disease. Metabolic effects in patients receiving parenteral nutrition.

Six severely malnourished patients with chronic obstructive pulmonary disease were maintained for 3 days with infusions of 5% dextrose in water followed by 12 days of eucaloric total parenteral nutrition. On days 8 through 11, they received 30 micrograms/d of growth hormone and twice this amount on days 11 through 15. Growth hormone had no significant effects on the plasma concentration of glucose, cortisol, or glucagon but caused a 50% increase in insulin and a 250% increase in somatomedin C concentrations. A positive nitrogen balance of 2 g/d due to growth hormone was probably mediated by insulin. Growth hormone-induced increases in energy expenditure and fat oxidation and decrease in glucose oxidation cannot be accounted for by insulin. The ability of growth hormone to improve nitrogen balance may be particularly important for malnourished patients with chronic obstructive pulmonary disease who, because of their pulmonary insufficiency, are intolerant of excess nutrients.

Aged↗
PubMed1989

Nutrition, the gastrointestinal tract and the acquired immune deficiency syndrome. Facts and perspectives.

Diarrhoea and malnutrition are common findings in patients with the Acquired Immune Deficiency Syndrome (AIDS). In this disease, enteropathy leads to fat and D-xylose malabsorption and chronic non-specific inflammation of the small bowel. Moreover, gastrointestinal infection can induce severe diarrhoea. Depletion in real body cell mass, body fat content, and weight loss have been observed. Nutritional therapy is mandatory when weight loss is 10% or greater. Enteral feeding is not easily achieved. Parenteral feeding including fat as a nonprotein calorie source improves general condition. The use of intravenous fat emulsions has been hypothesized to have several beneficial effects. Fluidisation of human immunodeficiency virus membranes by lipid emulsions through cholesterol extraction could decrease the infectivity of the virus. Long term intravenous nutrition may be more than a treatment for malabsorption and depletion; it may possibly have direct pharmacological effects.

Journal Article↗
PubMed1988

Intravenous fat emulsions and lung function: a review.

Numerous studies have reported varying degrees of apparent pulmonary dysfunction when iv fat emulsions (IVFE) are given. These changes have generally not been of sufficient magnitude to carry clinical significance. The lung dysfunction observed has been attributed to an associated hyperlipemia. Recent studies, however, suggest that the associated impairment in lung function is due to alterations in pulmonary vascular tone (which results in ventilation/perfusion inequalities) caused by an IVFE-related increase in prostaglandin (PG) production. The polyunsaturated fatty acids in the IVFE serve as precursors to the PGs. Due to the varied effects of PGs on inflammation and pulmonary vasomotor tone, infusion of IVFE could have profound physiologic and pharmacologic actions aside from the provision of lipid calories. In some circumstances, IVFE may, in fact, be beneficial to the lung via alterations in

Animals↗
PubMed1987

Improved exercise tolerance with long-term parenteral nutrition in cystic fibrosis.

Two cystic fibrosis (CF) patients with severe pulmonary disease and malnutrition were followed during a course of long-term home total parenteral nutrition (TPN), which included iv fat emulsion. They gained 7 and 12 kg in body weight, respectively, and their ability to participate in daily activities increased. Progressive exercise testing before and during TPN showed a marked increase in maximal work load: 100% and 30%, respectively. At any given work load, oxygen uptake was increased while the respiratory quotient remained lower after the course of TPN. We believe that the lower respiratory quotient and greater oxygen consumption during exercise were due to a reduction in anaerobic metabolism after TPN.

Adult↗
PubMed1987

Fat metabolism in injury and stress.

Fat metabolism is a complex mechanism involving energy production as well as various physiological and biochemical effects involved in a large spectrum of both normal and pathological phenomena. Many different paths are currently being investigated by different medical and basic science disciplines. These include lipoproteins, prostaglandins, leukotrienes, and more. This chapter is limited to the energy related facets of fat metabolism, though in the future interrelations may be found between the different fields of fat research and serve not only for better understanding of the human organism, but also better treatment in hypermetabolic states. Much has been learned about fat metabolism both in normal and stressed man. The finding that, in most hypermetabolic states, fat is being oxidized and used as the main caloric source is definitely a cornerstone in improving nutritional therapy in such cases. The development of safe fat solutions, together with the studies showing that exogenous fat is efficiently utilized, has led to increased use of fat in TPN regimens as well as in enteral nutrition. The possibility of tilting the energy source in nutritional therapy from a 50:50 ratio of carbohydrates:fat to a fat-dominant regimen in the steady flow state (thus approaching the actual metabolic preference in stress) requires further studies and may prove to be beneficial. On the other hand, an increasing number of observations show that in late severe stress states--the so-called multi-organ failure syndrome--significant alterations in fat metabolism occur both in liver and in muscle. Recognizing the situations in which fat oxidation is decreased, leading to liver failure with fat accumulation, necessitates a different mode of treatment. Providing glucose or amino acids, and possibly more BCAA, is one method of treatment to be pursued. On the other hand, the prospect of new fat solutions containing medium chain triglycerides, may lead to improved nutritional support and decreased complications in these extreme situations. Other treatment modalities, like carnitine, need further research as well. Furthermore, if and when the relationship between fatty acids used in nutritional support and the various mediators involved in trauma and sepsis can be elucidated, better treatment of critically ill patients may be possible and offered in a more comprehensive way.

Critical Care↗
PubMed1983

Pathogenicity of Eikenella corrodens in humans.

Eikenella corrodens is resident flora of the normal adult human oral cavity. Four cases of verified infection and previous case reports of infections caused by this organism were reviewed and analyzed. Rarely has this bacillus been found as the sole isolate to initiate infection in the host with normal immune status. In the immunocompromised host, this organism was observed as the sole isolate in cases of persistent empyemas and/or overwhelming pneumonias with bacteremias. The potential of the organism singly to perpetuate an established infection appears real. In the immunocompromised patients such potentials are accentuated and can result in fulminant pulmonary infections and death. The finding of E corrodens in an infection site of a compromised patient should indicate specific therapy.

Aged↗
PubMedDate not supplied

Risks and benefits of home parenteral nutrition in the acquired immunodeficiency syndrome.

The gastrointestinal tract is a major target of the human immunodeficiency virus. Many AIDS patients have weight loss and/or diarrhea. Parenteral nutrition can be used to treat malnutrition associated with malabsorption. We reviewed retrospectively the clinical course of 22 patients with AIDS and weight loss greater than 10% who received home parenteral nutrition (HPN) for 56.2 patient-months. Mean weight loss was 21.4%, mean duration of HPN 2.55 months, mean age 37.4 years. Fifteen patients gained weight, six stabilized and two continued to lose weight. Nine patients returned to previous activity. Five died. The rates of catheter-related sepsis, complications, and metabolic disturbances were 0.12, 0.25, and 0.12/100 catheter days, respectively, results identical to those reported in other patient populations where HPN is commonly applied. We found that HPN induced weight gain and clinical improvement in most patients without higher risks of sepsis than in patients with malignancies.

Acquired Immunodeficiency Syndrome↗