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[Effects of parenteral infusion of glycerol on glycerol kinase and adenosintriphosphate in rat kidneys (author's transl)].

Effects of intravenous glycerol infusions on glycerol kinase and adenosintriphosphate in rat kidneys. Intravenous infusions of glycerol with rates near and above the average maximal turnover capacity (0,74 g.kg-1.h-1) cause alterations of the kidneys such as weight increase, decrease of protein content and activity of glycerol kinase with excretion of this enzyme in the urine. At infusion rates of 0,6 g.kg-1.h-1 and more a decrease of the ATP-content of the kidneys is observed. Effects on the liver are not consistent and only demonstrable at infusion rates above the maximal turnover rate of glycerol. The results are discussed with regard to osmotic nephrosis. The appearance of glycerol kinase in the urine is discussed as an early symptom of kidney damage.

Adenine Nucleotides

[In vitro study on the problem of optimal gentamicin therapy in leukopenic patients: short injections or parenteral infusions?].

Killing curves of Pseudomonas aeruginosa were performed in an in vitro system simulating in-vivo gentamicin kinetics, i.e. decay of the antibiotic concentration with a 2.1 h halflife time. Minimal inhibitory concentrations (MIC) of gentamicin killed 99.999% of the initial Pseudomonas inoculum whereas 99.99% were killed at a continuously falling gentamicin concentration (starting from the MIC level) in the same period of time. Regrowth of persistent germs occurred only after 6 hours in cultures exposed to falling gentamicin concentrations, and after 8 hours in cultures kept at the MIC. Thus, a postulated superiority of gentamicin infusions over intermittent gentamicin therapy could not be demonstrated in vitro. Intervals between bolus injections of gentamicin should probably not be longer than 6 hours.

Colony-Forming Units Assay

[Studies on the metabolism of parenterally infused amino acids in healthy adults].

We studied the metabolic kinetics after short-time infusion of a 10% standardised L-amino-acid-mixture in 19 healthy adults. The following results were of special interest: 1. Nearly all amino-acids had half life times between 7 and 10 minutes. 2. The male adults showed averagely higher clearance and transfer rates in contrast to female. There was a statistical difference for serine and alanine in the transfer rates, for serine, methionine and glycine in the clearance. 3. The maximum of daily turnover could be calculated for about 5,6 g/kg body weight. Based on the measured transfer rates we discuss the composition of some standardised L-amino-acid-mixtures.

Adult

Absence of eicosatrienoic acid in plasma of sheep parenterally infused with a high glucose fat-free solution.

Five yearling wether sheep were maintained on total intravenous, fat-free feeding for periods in excess of 4 weeks. Analysis of plasma total lipid, neutral lipid, and phospholipid fatty acid patterns showed a decrease in linoleic acid during the first week, after which levels tended to stabilize. Rate of decrease in linoleic acid content of plasma phospholipids of two sheep was different. Changes in nonessential fatty acids were variable. 5,8,11- and 8,11,14-Eicosatrienoic acids were not detected in any of the sheep.

8,11,14-Eicosatrienoic Acid

L-alanyl-L-tyrosine as a tyrosine source during total parenteral nutrition. Infusion at 0.5 and 2 mmoles/kg/day in adult rats.

Tyrosine peptides, such as L-alanyl-L-tyrosine, have excellent solubility and are potential sources of iv tyrosine. Infusion of L-alanyl-L-U-14C-tyrosine as part of a total parenteral nutrition regimen in the rat at a level of 0.5 mmole/kg/day resulted in rapid labeling of tissue tyrosine pools, production of 14CO2, incorporation of 14C-labeled tyrosine into protein, and minimal urinary losses (7.7%). Plasma tyrosine levels, however, remained at fasting. Infusion of L-alanyl-L-tyrosine at 2 mmole/kg/day increased plasma tyrosine above fasting levels and maintained tissue tyrosine at levels seen in orally fed control animals without increasing the percent lost in urine (5.5%). Rapid utilization of L-alanyl-L-tyrosine was noted at both infusion levels with no accumulation of peptide noted in plasma. Plasma and tissue free tyrosine pools were rapidly labeled, as was tissue protein. Radioactivity incorporated in tissue protein was shown to be tyrosine after acid hyrolysis.

Alanine

Metabolism and distribution of exogenous histamine in cats.

1 The metabolism and disposition in blood and tissues of exogenous [(14)C]-histamine was examined in cats.2 The principal metabolites in blood of histamine instilled into the small intestine (directly or by transfer from the stomach) and colon were imidazoleacetic acid and t-methylimidazoleacetic acid, being present in approximately equal amounts although in individual cats one or other acid could predominate. Only small amounts of histamine entered the circulation although in two of four cats given the largest dose (82 mumol/kg) large amounts were recovered. The amount of (14)C radioactivity absorbed varied directly with the dose instilled. The chief metabolite in kidney and urine, whether histamine was instilled into the intestine or infused parenterally, was t-methylimidazoleacetic acid. Histamine was not absorbed from the stomach and its metabolism there was negligible.3 In contrast, when histamine was infused into blood leaving the intestine (portal vein) the main metabolite in blood and tissues was t-methylimidazoleacetic acid being found in approximately 5-fold the concentration of imidazoleacetic acid. The small amount of histamine which eluded inactivation/uptake by liver, lungs, heart during the infusion was halved on circulation through the intestine. When histamine was infused into blood supplying the intestine, (cranial mesenteric artery) t-methylimidazoleacetic acid while still the major metabolite in blood was now only 1.4 times the concentration of imidazoleacetic acid. Additionally, the blood concentration of histamine during the infusion exceeded that of the metabolites.4t-Methylimidazoleacetic acid was also the principal metabolite in blood and tissues following histamine infusion into a cannula carrying a replacement venous blood supply to the liver of abdominally eviscerated cats. Imidazoleacetic acid and t-methylhistamine were present in equal concentrations and in one-quarter to one-third that of the methylated acid. The latter was also the principal metabolite following intra-arterial histamine infusion to abdominally eviscerated cats without a hepatic blood supply, although initially t-methylhistamine predominated: a large peak of histamine was present during the infusion period. When additionally the renal vessels were ligated, t-methylhistamine predominated throughout the experiment.5 In conclusion, intraduodenally instilled histamine was metabolized equally by diamine oxidase and imidazole N-methyltransferase (followed by deamination by monoamine oxidase). In contrast, imidazole N-methyltransferase was the principal inactivator of parenterally infused histamine, deamination of t-methylhistamine by monoamine oxidase becoming progressively less efficient with the cumulative exclusion of the intestines, liver and kidney from the circulation.

Abdominal Muscles

[Practice in infusion therapy and parenteral feeding].

Today, the steadily growing selection of industrially produced infusion and nutritive solutions can hardly be overlooked by the clinician. It is therefore most important for him to limit himself to a number of modern, clinically approved solutions whose composition, maximal infusion rate, indications, contra-indications and side-effects are well known to him. Moreover, a successful infusion therapy and parenteral nutrition postulate the mastery of modern infusion techniques.

Acid-Base Imbalance

[Fundamentals of parenteral feeding in internal diseases].

A review of parenteral infusion therapy in internal medicine is given. The principles of total parenteral nutrition with fatty acids, ethanol, glucose, non-glucose-carbohydrates (fructose, sorbitol, xylitol) and amino acids are discussed. Problems such as indication and contraindication, metabolism and utilization of the applied substances as well as adverse effects are dealt with. The practice of infusion therapy and its form of application are shown on the basis of the author's own experience. Finally a scheme for total parenteral nutrition is presented.

Amino Acids

[The technic of infusion treatment and parenteral feeding in newborns and infants].

The various infusion techniques used in The Children's Hospital of the University Zurich are described. The undoubted advantages in the application of central venous catheters have to be weighed against some dangers, which exist even when using the best techniques. Infection is the most important danger. Central venous catheters should, therefore, be used only if and as long there is a definite indication. In pediatric medicine and surgery the most important indications are certain cases of pre- and postoperative infusion therapy, treatment of shock as well as long-term parenteral alimentation. The most effective measures for the prevention of catheter infections are an aseptic insertion technique and the removal of the catheter as soon as possible.

Blood Transfusion