Pancreatic insufficiency as the presenting feature of hyperparathyroidism.
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Adenoma↗
Biomedical subjects
W D Heizer
Publications and source records attributed to W D Heizer.
Protein-losing gastroenteropathy and malabsorption associated with factitious diarrhea.
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Adult↗
Effect of intravenous fat emulsion on experimental acute pancreatitis.
The known relationship of hyperlipidemia and pancreatitis raises the question whether intravenous fat emulsion is detrimental in acute pancreatitis. Pancreatitis was induced in 52 male Sprague-Dawley rats followed by placement of a jugular catheter which was anchored to the back with a Teflon button. The animals were placed NPO in metabolic cages and continuously infused, initially with normal saline. The 37 animals surviving 24 hr were randomly assigned to group I (mean iv intake: glucose 222 kcal/kg/day; amino acids 13.1 g/kg/day) or group II (glucose 191 kcal/kg/day; intravenous fat emulsion 10% 47 kcal/kg/day; amino acids 12.9 g/kg/day). Nine animals were eliminated from the study because of mechanical problems leaving 14 in each group for analysis. Per cent survival on days 3, 5, and 7 was 64, 50 and 36 in group I, and 50, 36 and 36 in group II. Mean urinary amylase excretion was 244 +/- 185 units/day in group I and 262 +/- 127 units/day in group II. There was no significant difference in survival or urine amylase excretion nor in pancreatic histology or gross appearance of the animals between the two groups. In this model of acute pancreatitis, intravenous fat emulsion was not detrimental as measured by survival, urinary amylase excretion, and pancreatic histology.
Acute Disease↗
Comparison of intravenous glucose and fat calories on host and tumor growth.
This study was undertaken to determine if the proportions of intravenous carbohydrate and fat calories influence the relative growth of a Walker 256 carcinosarcoma and its host. Rats injected intraperitoneally with Walker 256 carcinosarcoma cells were randomized into three total parenteral nutrition (TPN) groups, G/AA in which glucose provided all nonprotein calories, G/F/AA in which the nonprotein calories were 20% fat and 80% glucose, and F/AA in which all nonprotein calories were from fat. Except for the caloric source, TPN for each group was identical. A fourth group was sham operated, fed rat food, and was not given TPN. On the 6th day after inoculation, the tumor in each rat showed a dispersed ascites form as well as a solitary mass form involving the omentum. The total number of tumor cells in the ascitic fluid and the dry weight of the mass were determined. The three TPN groups did not differ in tumor cell count, solid tumor weight, ratio of tumor cell count to final host weight, or ratio of solid tumor to final host weight. The mean ratio of ascites tumor cell count to host weight was not different between the rat food-fed group and any of the TPN groups. The mean ratio of solid tumor to host weight was less for the TPN groups than for rat food-fed animals. We conclude that TPN had no adverse effect on the growth of tumor vs. host and that the source of intravenous calories (fat or carbohydrate) did not influence the relative growth of tumor and host in this TPN-tumor model.
Animals↗
Taste preferences for nutritional supplements: comparison of cancer patients and healthy controls using a wine-tasting scale.
Thirty-nine cancer patients (Ca) and 37 age-and sex-matched healthy controls (Co) evaluated 11 commercially available enteral supplements using a modified wine-tasting scale. The cancer patients were 19 males with lung cancer and 20 females with breast cancer, and their controls consisted of 17 males and 20 females, respectively. Mean evaluation scores for the individual supplements revealed no significant differences (NS) between lung cancer patients and controls. Ensure Plus (strawberry) received the highest score from both groups (Ca 16.0 +/- 3.0 vs Co 17.1 +/- 2.6, N.S.) while Vital received the lowest (Ca 6.3 +/- 4.8 vs Co 4.9 +/- 4.2, NS). Similar results were obtained for breast cancer patients and their controls except that chocolate Sustacal was rated significantly higher by breast cancer patients than by controls (16.6 +/- 2.6 vs 13.3 +/- 4.3, p less than 0.01). Again, Ensure Plus (strawberry) received the highest score from both groups (Ca 17.0 +/- 3.5 vs Co 17.8 +/- 2.3, NS), while Vital was rated lowest by both groups (Ca 5.6 +/- 4.7 vs Co 4.3 +/- 5.0, NS). The modified wine-tasting scale provides a method for quantitating taste preference for various dietary supplements. We report here the numerical rating of 11 supplements by patients with lung cancer and patients with breast cancer as well as their age- and sex-matched controls.
Breast Neoplasms↗
Efficacy of metoclopramide as an adjunct to duodenal placement of small-bore feeding tubes: a randomized, placebo-controlled, double-blind study.
We examined whether metoclopramide would improve the success rate of transpyloric intubation of a weighted Corpak feeding tube when fluoroscopic guidance is not used. Seventy patients were randomized in a prospective, double-blind fashion to receive either placebo (n = 35) or metoclopramide, 10 mg (n = 35) parenterally, administered immediately after the feeding tube was inserted. Tube location was determined independently by two observers who examined radiographs obtained after barium was instilled via the tube. There was no significant increase in the success rate of duodenal intubation in the total group following metoclopramide, 60%, compared to placebo, 49%. However, analysis of subgroups among the placebo-treated patients revealed that diabetes mellitus, but not other medical conditions, decreased the success rate for duodenal intubation, 20 vs 60% (p less than 0.05). Among diabetic patients, metoclopramide resulted in a significant increase in duodenal placement compared to placebo (p less than 0.05). We conclude that parenteral metoclopramide significantly increases the frequency of transpyloric intubation with small feeding tubes without fluoroscopic guidance in diabetic patients but not in nondiabetic patients.
Adult↗
Efficacy of tube feeding in supplying energy requirements of hospitalized patients.
During a 6-week period, all adult patients in a university hospital receiving ready-to-feed nasoenteric tube feeding formula were prospectively studied. The study objective was to determine each patient's caloric intake from tube feeding relative to their energy needs and to identify factors causing decreased feeding intake. Each of 35 patients was visited at least once daily to determine their volumetric intake of tube feeding formula. Daily review of patient care records and nursing interviews were used to identify interruptions in therapy. Patient's basal energy expenditures (BEE) were calculated using the Harris-Benedict equation. Calorie goals were set by members of the Nutrition Support Service or clinical dietitians. Intakes averaged 1095 +/- 41 Kcal (SEM) per day or 61% of their mean calorie goal of 1791 +/- 41 Kcal. Mean daily calorie intake was statistically different (p less than 0.05) from mean energy goal on patient study days 1 through 5, 7, and 8. Only 16 of the 35 patients achieved an intake of 100% of their energy goal on any day of therapy. Calorie goals averaged 1.4 times BEE. Mean daily calorie intake did not exceed BEE until study day 10. Eighteen % of potential feeding time was lost due to temporary feeding interruptions; primarily inadvertent extubation (4.6%), gastrointestinal intolerance (4.7%), medical procedures requiring discontinuation of feeding (2.8%), and feeding tube positioning difficulties (1.5%). In addition, physicians ordered only 75% of calculated energy goals. These data indicate that tube feeding therapy, when provided under usual hospital conditions, does not meet patient's energy requirements.
Energy Intake↗
Nutrition and respiratory disease.
Correlations between nutritional status and respiratory function, effects of nutritional substrates on respiration, and optimal nutritional support during respiratory failure are reviewed. Somatic protein depletion is common in patients with either acute respiratory failure or chronic obstructive pulmonary disease. The etiology of the malnutrition includes decreased nutrient intake, increased work of breathing, and increased metabolic rate caused by infections. Excessive administration of glucose or protein can have detrimental effects on respiratory status. Weaning patients from ventilators may be prolonged or even impossible secondary to increased carbon dioxide production in patients receiving high caloric loads of glucose. Excessive protein administration stimulates ventilatory drive and can be detrimental in patients who cannot increase their minute ventilation. Fat is the preferred substrate for energy in selected mechanically ventilated patients requiring total parenteral nutrition because it is oxidized at a lower respiratory quotient than glucose. Measurements of respiratory quotient, oxygen consumption, and carbon dioxide production can be useful in providing optimal nutritional support to the patient with respiratory compromise.
Calorimetry↗