J. Maeda

Efficacy of amino acid infusion for improving protein metabolism after surgery: a prospective randomized study in patients undergoing subtotal gastrectomy.

BACKGROUND Appropriate regimens of peripheral parenteral nutrition (PPN) have been proposed for the improvement of protein metabolism after surgery. When evaluating the efficacy of administered nutrients, it is vital to consider the severity of surgical stresses to avoid confounding effects of the trauma on the postoperative metabolism. This study was designed to evaluate protein-sparing regimens through PPN in patients who had undergone subtotal gastrectomy. STUDY DESIGN Patients hospitalized at our institutes for gastric cancer were randomly divided into the following five groups and received PPN for 7 days after surgery: 1. G group (n = 9), 200 g glucose (per day); 2. AG group (n = 10), 54 g amino acids + 150 g glucose; 3. AGG group (n = 9), AG + 110 g glucose; 4. AGF group (n = 10), AG + 40 g fat; and 5. AGL group (n = 7), 58 g amino acids + 60 g glycerol. Biochemical studies were done before and after surgery. RESULTS In comparison to G group patients, AG group patients showed less negative cumulative nitrogen balances. No significant differences in cumulative nitrogen balances were observed between AGG, AGF, and AGL groups. Restoration of the reduced serum rapid turnover protein occurred earlier in the AGL group than in either the AGG or the AGF groups. Hyperglycemia, glucosuria, and hyperinsulinemia were prominent in the AGG group, and less prominent in the AGL group. Marked ketosis together with an increase in serum-free fatty acid levels was found in the AGL group. CONCLUSIONS These results suggest that in patients who have undergone major elective surgery, infusion of amino acid solutions is advantageous for improving protein metabolism after surgery, and nonprotein energy source and intake are not essential when combined with amino acid solutions for improving nitrogen balance after surgery.

Effect of glutamine on acute lung injury in rats with endotoxemia

We administered endotoxin to rats to produce an acute lung injury model, and assessed the effect on respiratory function when glutamine was added to the solution for total parenteral nutrition. Rats given total parenteral nutrition with glutamine as 33% of the amino acid content were compared with rats given no glutamine. Endotoxin (500 microg/kg) was administered intravenously after 72 h of total parenteral nutrition. The survival rate and the nitrogen balance were significantly improved (P < 0.05) at 48 h after endotoxin administration as a result of glutamine treatment. In addition, the arterial oxygen partial pressure was significantly increased (P < 0.01) and the wet: dry lung weight ratio was decreased (P < 0.05) by glutamine. These results suggested that glutamine improved endotoxin-induced acute lung injury in rats.

Distribution of endogenous and exogenous carnitine inrats with sepsis and acute liver failure

The distribution of carnitine was investigated in male Wistar rats with sepsis or acute liver failure. Sepsis was produced by cecal ligation and puncture, while acute liver failure was induced by intraperitoneal injection of carbon tetrachloride. Then 14C-carnitine or L-carnitine was injected intravenously. In healthy control rats and rats with sepsis, both 14C-radioactivity and carnitine were increased in the liver and kidneys. When the carnitine fractions were investigated, it was found that free carnitine and short-chain acylcarnitine were increased. In the rats with acute liver failure, 14C-radioactivity decreased in the liver, but carnitine increased, with free carnitine and short-chain acylcarnitine levels rising. These findings suggested that exogenous free carnitine accumulated directly in the organs with carnitine deficiency in rats with sepsis and acute liver failure. In addition, there was differential regulation of the fractions of both exogenous and endogenous carnitine (free carnitine, short-chain acylcarnitine, and long-chain acylcarnitine). Furthermore, the distribution of exogenous carnitine differed between sepsis and acute liver failure.

Floating gallbladder associated with histologically distinct double cancers

A case of unusually hypermobile floating gall-bladder in a 79-year-old woman with histologically distinct double cancers of the gallbladder is described. The patient presented with an abdominal cystic mass, which was palpable with easy mobility from the right lower quadrant practically to the left upper quadrant. Exploratory laparotomy was performed and the cystic mass was found to be a floating gallbladder. The cystic duct was elongated and obstructed, and had a long mesentery. After the operation, latent double cancers of the gallbladder were discovered on histopathological examination. The obstruction of the cystic duct was due to chronic inflammation and had resulted in hydrops of the gallbladder. This was suspected to have played an important role in the carcinogenesis. We believe that this is the first report of a floating gallbladder associated with double gallbladder cancers.