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Biomedical subjects

M Roulet

Publications and source records attributed to M Roulet.

At least 55 records · Page 3Linked to original sources
PubMed1984

Constant rate enteral nutrition in bucco-pharyngeal cancer care. A highly efficient nutritional support system.

The incidence of protein and calorie malnutrition in bucco-pharyngeal cancer patients is high and therefore nutritional support is indicated. Two methods of tube feeding, fractioned enteral (FEN) versus constant rate enteral nutrition (CREN) have been compared in a prospective study. Based on anthropometrical, biological and immunological criteria, patients on CREN showed a significant improvement of their post-operative protein state in comparison with patients on FEN. This difference was due to a better tolerance to CREN, which allowed a more appropriate protein and calorie intake. Furthermore the time of intravenous infusion was reduced in patients on CREN. In conclusion, CREN is a highly efficient feeding method for patients with head and neck cancer. It has the great advantage of being simple and cheap.

Anthropometry↗
PubMed1984

[Symptoms and incidence of hypoglycemia in 100 insulin dependent diabetics].

The aim of this study was to discover the frequency and the symptoms of hypoglycaemic reaction and coma. One hundred type I diabetic patients answered an oral questionnaire and explained how they were awaken from their hypoglycaemicoma. The frequency of hypoglycaemic reaction was from one a day to one a year. 41 patients had nocturnal hypoglycaemic reactions. Our patients described 27 different symptoms of oncoming attack; however, not all of these symptoms was experienced by any one of the patients. Treatment of hypoglycaemic reaction was administered correctly but at the precise moment of the interview, 13% of patients had no carbohydrates with them. 42 patients had had hypoglycaemic reaction but no coma. Shared between 48 patients were 578 insulin years and 148 comas. Treatment of hypoglycaemic coma was variable: 20 patients remained at home receiving appropriate treatment; 33 were always hospitalised on attack and 20 were still comatous on each admission. The explanation of hypoglycaemic attack was variable; an emotional factor was given by 19% of patients. Both type I diabetic patients and their immediate entourage should be made aware of all the symptoms of oncoming attack and of the treatment of hypoglycaemic coma. Systematic glycemic auto control should testify to the existence of genuine hypoglycaemic reaction and perhaps diminish its supposed frequency.

Adolescent↗
PubMed1983

A controlled trial of the effect of parenteral nutritional support on patients with respiratory failure and sepsis.

Energy and protein metabolism was studied in 11 septic patients receiving ventilatory support while on three different intravenous regimens. They received 5% dextrose in water (D5W), and one of two different regimens of parenteral nutritional support (PNS); either amino acid and dextrose (PNA) or amino acid and dextrose and lipid (PNB). All patients were given D5W and PNS in random order. The energy intake was targetted to exceed by 50% the measured metabolic rate. On D5W the mean measured energy expenditure was only 15.2% above the expected energy expenditure (p<0.02). A respiratory quotient of 0.75 while on D5W showed that in the absence of PNS the major part of energy requirements came from fat oxidation. In addition, on D5W these patients were in negative nitrogen and protein (synthesis-catabolism) balance. With PNS the metabolic rate rose significantly (p<0.02). While on PNA, the CO2 production was significantly higher than with PNB, and despite receiving all non-protein energy as glucose, the patients continued to oxidise fat to meet about 30% of their energy requirements. Continued fat oxidation was found to be associated with insulin resistance and high catecholamine levels, suggesting a cause and effect relationship. PNS caused an increase in protein (synthesis - catabolism) and nitrogen balances, and reduced leucine oxidation. The fall in leucine oxidation was greater on PNB than on PNA. Protein and nitrogen balances, expressed per gram of amino acid infused, were significantly better with PNB than PNA. It was concluded that insulin resistance may make fat an efficient source of energy.

Journal Article↗
PubMed1983

[Protein requirements of mature newborns and premature infants].

Protein requirements and energy expenditure are closely related, especially in infants. As compared to adults, the very fast protein turnover in newborns is highly energy consuming. Considering protein requirements, quantity and quality have to be taken into account to avoid a metabolic stress, particularly in preterm infants.

Dietary Proteins↗
PubMed1981

Copper metabolism and requirements in total parenteral nutrition.

Copper metabolism and requirements in patients receiving total parenteral nutrition were studied in 28 patients with gastrointestinal diseases. During each of the 3 wk of the study period, each of 24 patients received in their total parenteral nutrition solutions, a daily dose of copper amounting to 0.25 mg, 1.05 mg, or 1.85 mg, in a random order. The other 4 patients received a fixed daily dose of 1 mg throughout the 3 wk. Increased losses of copper through the gastrointestinal tract occurred in patients with diarrhea or high-output stomas or fistulas. Patients with abnormalities of liver excretory functions had decreases in gastrointestinal copper losses. Urinary copper excretion was twice that of normal subjects. Copper infused in excess of the requirements was retained and not excreted. Plasma copper did not reflect the copper balance and cannot be used as a guide for copper supplementation. Copper requirements were found to be 0.3 mg/day in patients with normal amounts of gastrointestinal excretion. In the presence of diarrhea or increased fluid loss through gastrointestinal stomas or fistulas, the copper requirements for total parenteral nutrition are 0.4--0.5 mg/day.

Adolescent↗
PubMed1980

Gastric emptying and lingual lipase activity in cystic fibrosis.

To identify gastric factors likely to contribute to fat maldigestion and malabsorption in cystic fibrosis (CF), gastric emptying time, secretion rate, and preduodenal lipolytic activity were studied. Gastric emptying of a liquid test meal and gastric acid secretion were determined in five CF teenagers with pancreatic insufficiency and in five healthy controls. During the first hr, the rate of gastric emptying exhibited a linear pattern in both CF patients and controls. Neither the emptying time nor the gastric secretion rate was different. Lingual lipase activity was measured in eight other CF patients with pancreatic insufficiency and in eight controls. Lipase activity was higher (P less than 0.05) in CF patients than in controls with values (mean +/- S.E.) of 34.48 +/- 11.59 and 12.65 +/- 5.60 mumole butyric acid min-1 ml-1, respectively. No correlation with age or body surface was observed. Intragastric lipolysis of a butterfat triglyceride test meal was fast in both groups, but more extensive (P less than 0.05) in CF patients than in controls. The data show that in CF with pancreatic insufficiency, gastric factors contributing to the first step of fat digestion are preserved. In fact, lingual lipase activity was found to be increased, and a more complete intragastric lipolysis was documented.

Adolescent↗
PubMed1980

Pancreatitis in association with hypercalcemia in patients receiving total parenteral nutrition.

Six patients receiving total parenteral nutrition (TPN) developed hypercalcemia and acute pancreatitis. Four were long-term home TPN patients, and two were short-term hospital TPN patients. Causes of pancreatitis other than hypercalcemia were not found. The etiology of the hypercalcemia remained unclear and in particular was not due to calcium infusion or hyperparathyroidism. In 4 patients in whom it was measured, the plasma parathyroid hormone was normal (in 2) or nondetectable (in 2). Hypercalcemia and pancreatitis subsided with discontinuation of TPN. Thus, some patients receiving TPN develop hypercalcemia, and in some of these pancreatitis ensues.

Acute Disease↗
PubMed1980

Continuous elemental enteral alimentation in children with Crohn's disease and growth failure.

Four children aged (11.7-13.5 yr) with protracted growth retardation related to Crohn's disease, received a 6-wk period of continuous elemental enteral alimentation with no other form of treatment. Despite drug therapy the yearly height and weight gain velocities of these children (1.7 +/- 0.3 cm and -0.8 +/- 1.4 kg, respectively) had been abnormal during the previous 2 yr. All patients experienced a complete remission of symptoms, improved nutritional status, and significant height (1.8 +/- 0.3 cm) and weight (3.8 +/- 0.5 kg) gains during the 67 wk of treatment. After cessation of elemental enteral alimentation, 3 of the 4 patients continued to grow, and over a period of 4.5 mo from the beginning of this form of nutritional therapy, they gained an average of 5.0 +/- 1.6 kg and 3.5 +/- 0.3 cm. The disease became active thereafter, and the 3 children resumed their previously abnormal growth patterns during the ensuing year. The 4th patient had surgery 2 mo after elemental enteral alimentation and experienced a subsequent second spurt of growth and pubertal changes. This study suggests that a relatively short course of elemental enteral alimentation leads to a temporary resumption of growth in children with severe growth failure and Crohn's disease. The possibility that repeated courses of elemental enteral alimentation might be beneficial needs to be explored.

Adolescent↗
PubMed1979

The role of gastric lipolysis on fat absorption and bile acid metabolism in the rat.

In vivo studies were carried out in young Sprague-Dawley rats to examine the role of gastric lipolysis on fat absorption and bile acid metabolism. When fed by gastric perfusion 5 times (corn oil, 4 g/day) their usual dietary intake of fat, rats deprived of lingual lipase by the creation of an esophageal fistula had a significant degree of fat and bile acid malabsorption as well as a shortened bile acid half-life when compared to animals with a gastrostomy. The % fat absorption, bile acid loss and bile acid pool were normal in 2 groups of esophageal fistula rats fed the same quantity of corn oil or twice (8 g/day) that amount as a fine emulsion. In view of a negligible gastric lipase activity in animals with an esophageal fistula and of decreased hydrolysis of a triglyceride test meal, these data suggest that gastric lipolysis is of physiological importance in situations where lipolytic mechanisms are stressed by a large fat intkae. Its principal role is to potentiate intestinal lipolysis by facilitating the emulsification of dietary lipids through its formed products and, therefore, the contact of pancreatic lipase with its substrates.

Animals↗
PubMed1979

[Necrotizing enterocolitis in the neonatal period. Revue of 19 cases proved by anatomopathologic examination].

Nineteen newborn infants with necrotizing enterocolitis, proved by autopsy or surgical examination, are presented. In this study the absence of blood in the stools and of pneumatosis intestinalis did not exclude the diagnosis of necrotizing enterocolitis. The role of umbilical arterial and venous catheters and of exchange transfusion in the pathogenesis of the disease was less than has been previously reported. There was no evidence for emboli of thrombosis in the mesenteric vessels. On the other hand, the probable importance of nonocclusive mesenteric arterial insufficiency is supported by several observations, including the high incidence of antecedent hypoxaemic episodes, the time of onset of the subsequent gastrointestinal pathology and the localization of the lesions. An infectious component was demonstrated, but our results do not allow to state precisely the time of its occurrence.

Catheterization↗
PubMed1976

Psychological and neurodevelopmental outcome of high risk newborn infants.

Among 142 high-risk-newborns, 111 could be regularly followed-up to 3 years of age. 79 (71%) are normal, 6 (5.5%) have minor neurological sequels, 9 (8.1%) have major neurological sequels, associated in 4 cases with mental deficiency, 16 (14.5%) have developmental abnormalities (speech delay, behavioral problems, perceptual-motor and praxis disturbances), and one mental deficiency without neurological sequels. Neonatal cerebral distress proved to be the most dangerous clinical situation with regard to the ultimate neurodevelopmental prognosis (73.6% of neurological sequels or developmental abnormalities). The presence of transient abnormalities of tone in the course of the first year of life was associated with ultimate developmental abnormalities in 33.3% of the cases. Social and cultural status seemed to play a role in the intellectual, linguistic and perceptual-motor performance of this group of infants. In spite of these encouraging results, the need for a systematic long term follow-up of high risk newborns is stressed, since neurological sequels and developmental abnormalities are approximately 4 times more frequent in this group than in a normal infantile population.

Asphyxia Neonatorum↗
PubMedDate not supplied

Body composition by X-ray absorptiometry and bioelectrical impedance in chronic respiratory insufficiency patients.

Nutrition assessment is important during chronic respiratory insufficiency to evaluate the level of malnutrition or obesity and should include body composition measurements. The appreciation of fat-free and fat reserves in patients with chronic respiratory insufficiency can aid in designing an adapted nutritional support, e.g., nutritional support in malnutrition and food restriction in obesity. The purpose of the present study was to cross-validate fat-free and fat mass obtained by various bioelectric impedance (BIA) formulas with the fat-free and fat mass measured by dual-energy X-ray absorptiometry (DXA) and determine the formulas that are best suited to predict the fat-free and fat mass for a group of patients with severe chronic respiratory insufficiency. Seventy-five patients (15 women and 60 men) with chronic obstructive and restrictive respiratory insufficiency aged 45-86 y were included in this study. Body composition was calculated according to 13 different BIA formulas for women and 12 for men and compared with DXA. Because of the variability, calculated as 2 standard deviations, of +/- 5.0 kg fat-free mass for women and +/- 6.4 kg for men for the best predictive formula, the use of the various existing BIA formulas was considered not clinically relevant. Therefore disease-specific formulas for patients with chronic respiratory insufficiency should be developed to improve the prediction of fat-free and fat mass by BIA in these patients.

Absorptiometry, Photon↗
PubMedDate not supplied

Continuous elemental enteral alimentation in the treatment of children and adolescents with Crohn's disease.

Ten pediatric patients, aged 8.5-19 years, with active symptomatic Crohn's disease, received a three-week period of continuous elemental enteral alimentation with no other form of treatment. All patients in this study were selected according to the following criteria, which were applied consecutively: (1) newly diagnosed patients with no previous treatment for Crohn's disease, (2) disease activity index over 200, and (3) no complication requiring surgery. All patients experienced a clinical remission and improved their immunologic and nutritional status during the elemental enteral alimentation. The mean disease activity index for the whole group was 307.0 +/- 23.6 (range: 203 to 413) before and 69.2 +/- 11.4 (range: 15 to 114) after the feeding period. Significant increases in body weight, triceps skinfold, mid-arm circumference, serum transferrin and mean percentage of T lymphocytes were also observed. Following cessation of enteral alimentation, a small declining dose of prednisone was used during a one-year follow-up period. Eight of the ten patients were still in clinical remission three months after the feeding period and their nutritional status had continued to improve during that period of time.

Adolescent↗
PubMedDate not supplied

Effects of L-carnitine supplemented total parenteral nutrition on lipid and energy metabolism in postoperative stress.

During episodes of trauma carnitine-free total parenteral nutrition (TPN) may result in a reduction of the total body carnitine pool, leading to a diminished rate of fat oxidation. Sixteen patients undergoing esophagectomy were divided randomly in two equal isonitrogenous groups (0.2 g/kg.day). Both received TPN (35 kcal/kg.day; equally provided as long-chain triglycerides and glucose) over 11 days without (group A) and with (group B) L-carnitine supplementation (12 mg/kg.day = 75 mumol/kg.day). Compared with healthy controls, the total body carnitine pool prior to the operation was significantly reduced in both groups, suggesting a state of semistarvation and muscle wasting. In group A the plasma levels of total carnitine and its subfractions (free carnitine, short- and long-chain acylcarnitine) remained stable during the study whereas in group B the total plasma carnitine concentration rose mainly due to an increase in free carnitine. In group A the cumulative urinary carnitine losses were 11.5 +/- 2.6 mmol (= 15.5 +/- 3.1% of the estimated total body carnitine pool). In group B 3.1 +/- 1.9 mmol (= 11.1 +/- 7.6%) of the infused carnitine was retained in the immediate postoperative phase until day 6, but this amount was completely lost at completion of the study period. No significant differences in the respiratory quotient or in the plasma levels of triglycerides, free fatty acids, and ketone bodies were observed, between or within the groups, before the operation and after 11 days of treatment. It is concluded that the usefulness of carnitine supplementation during postoperative TPN was not apparent in the present patient material.

Adult↗
PubMedDate not supplied

Comparative clearance of two new fat emulsions--Hausmann Lipid 20% and Lipovenös 20%--versus intralipid 20%.

Intravenous fat tolerance tests (IVFTT) were performed in 13 healthy men volunteers once a day during three consecutive days in order to compare three different fat emulsions randomly administered (Intralipid 20%, Hausmann Lipid 20%, Lipovenös 20%). The amount of fat was 0.1 g/kg of body weight injected within 32 +/- 4 sec and the lipid clearance was determined over 40 min. The fractional removal rates k for the three different emulsions of fat were 5.38 +/- 1.67, 4.95 +/- 2.15, 3.92 +/- 1.31 %/min, respectively (mean +/- SD), and the half-life time of clearance T1/2 were 14.5 +/- 5.8, 16.9 +/- 7.4, 19.2 +/- 5.2 min, respectively. The highest fat particles values were observed 5 min after the bolus and all concentrations remained within the normal range (0-3 g/liter) during the study. In addition, no adverse effects were observed throughout the IVFTT. The nonparametric analysis of variance (Friedman's test) showed no significant differences between groups, even if Lipovenös 20% tended to be cleared more slowly than Intralipid 20%. These results suggest that the three fat emulsions are similarly eliminated from the blood stream and do not result in acute intolerance. Further studies based on prolonged infusion should be carried out to determine whether the two new emulsions might be alternatively used for intravenous nutritional support.

Adult↗
PubMedDate not supplied

Effects of intravenously infused egg phospholipids on lipid and lipoprotein metabolism in postoperative trauma.

Lipid emulsions contain not only triglyceride (TG)-rich particles but also phospholipid (PL)-rich particles that are believed to trap free cholesterol and apoprotein E, when they are infused in excess. The present study was designed to evaluate the effects of such abnormal PL-rich particles on lipid metabolism during a 5-day infusion in man. Eighteen patients undergoing esophagectomy were evenly randomized to receive intravenously during 5 days 1.75 g.kg-1.d-1 long-chain TG from either a 10% lipid emulsion with a PL/TG weight ratio of 0.12 (group A), a 10% emulsion with a PL/TG weight ratio of 0.06 (group B), or a 20% emulsion with a PL/TG weight ratio of 0.06 (group C). Plasma PL, free cholesterol, and apoprotein E increased progressively in group A (4.1 +/- 0.3 mmol/L, 2.4 +/- 0.3 mmol/L, and 0.089 +/- 0.012 g/L on day 5, respectively) but not in groups B (2.7 +/- 0.3 mmol/L, 1.3 +/- 0.2 mmol/L, and 0.048 +/- 0.007 g/L) and C (2.4 +/- 0.2 mmol/L, 1.2 +/- 0.1 mmol/L, and 0.050 +/- 0.006 g/L). Free fatty acids and TGs remained constant and similar in each group postoperatively. After fat infusion had been stopped at the end of the fifth day, the elimination of plasma TGs over the next 4 hours was comparable in the three groups. We conclude that excess egg PLs induce alterations of plasma lipids even within a few days.

Aged↗
PubMedDate not supplied

Effects of intravenously infused fish oil on platelet fatty acid phospholipid composition and on platelet function in postoperative trauma.

BACKGROUND: The aim of this study was to assess the short-term effect of IV infusion of fish oil emulsion on the fatty acid profiles of platelet phosphatidylcholine and phosphatidylethanolamine and on platelet function in postoperative patients. METHODS: Over a 7-day period, 10 patients received a 20% soybean fat emulsion with an added 10% marine fish oil emulsion, whereas 9 controls received only 20% soybean fat emulsion. RESULTS: By comparison with controls, in patients receiving fish oil, (1) a large increase in eicosapentaenoic acid (20:5n-3) was observed in both platelet phosphatidylcholine (1.55% +/- 0.17% vs 0.38% +/- 0.06% by weight, p < .01) and phosphatidylethanolamine 2.21% +/- 0.18% vs 0.66% +/- 0.08% by weight, p < .01); (2) eicosapentaenoic acid (20:5n-3)/arachidonic acid (20:4n-6) ratios doubled in both platelet phosphatidylcholine (p < .01) and phosphatidylethanolamine (p < .05); (3) with collagen as aggregating factor, maximal reaction speed decreased (p < .02) and latency increased (p < .002); and (4) no toxic effect, in particular no increase of postoperative bleeding and no perturbation of hepatic and renal function, was observed during the fish oil infusion. CONCLUSIONS: A short-term IV infusion of fish oil clearly modifies the platelet composition and changes some parameters of platelet function.

Blood Platelets↗