Michael Muggia-Sullam

A possible beneficial effect of metronidazole in reducing TPN-associated liver function derangements.

Cholestasis and fatty infiltration of the liver are common complications of total parenteral nutrition (TPN). Following a recent suggestion that TPN-associated liver function derangements may be related to intestinal overgrowth of anaerobic bacteria, the effect of metronidazole on hepatic dysfunction during TPN in rats was investigated. After 5 days of TPN with either amino acids and glucose or amino acids with glucose and fat, all groups exhibited a mild weight gain, positive nitrogen balance, increased liver weight, increased liver:body weight ratio, increased levels of liver enzymes, and increased hepatic lipid content. The administration of metronidazole at 15 mg/kg/day significantly decreased the hepatic lipid content from 0.077 g fat/g liver for controls to 0.053 g fat/g liver. The efficacy of metronidazole in reducing hepatic fat accumulation during nutritionally effective and adequate TPN in rats suggests the possible involvement of anaerobic bacterial flora of the intestinal tract, at least in part, in the pathogenesis of TPN-associated liver function derangements. However, the various biochemical and morphological expressions of these changes and the discrepancy between unchanged liver weight, liver:body weight ratio, liver enzymes, and the improved hepatic fat content suggest multifactorial mechanisms for TPN-related liver damage.

Paracecal hernia: A cause of intestinal obstruction

During a two-year period, five patients were treated by us for acute intestinal obstruction caused by an incarcerated paracecal hernia. All patients underwent surgery early, so none required bowel resection. The possibility of an internal hernia as a cause of intestinal obstruction and a profound knowledge of the pericecal anatomy, however, are necessary for successful diagnosis and treatment of paracecal hernias.

Efficacy of Two Elemental Diets: A Pair Feeding Study

The efficacy and side effects of two elemental diets were studied. Twenty young Sprague-Dawley rats were fed one of three different diets. Group I (n = 7) was fed Vivonex-HN (VIV) ad lib; group II (n = 7) was given Criticare-HN (CRI), pair-fed to group I (the two elemental diets were given in glass bottles); group III was fed regular rat chow and served as control (CON). Body weight (WT), food intake, and nitrogen balance (NB) were measured daily. After 21 days, change in body weight was similar in the three groups (VIV = 64.9 +/- 3.2%; CRI = 59.6 +/- 3.3%; CON = 63.9 +/- 4.8%). Cumulative nitrogen balance was also similar in the two groups fed elemental diets (VIV = 4788 +/- 277 mg N; CRI = 4690 +/- 118 mg N), but in both these groups it was less than the control group fed chow (8060 +/- 85 mg N). Blood urea nitrogen (BUN) on the last day was higher in the VIV group (12.9 +/- 1.22 mg/dl) than in the CRI group (9.43 +/- 0.43 mg/dl), but in both study groups it was lower than in the CON group (17.2 +/- 1.08 mg/dl), although nitrogen intake was higher in the control (ad lib) group. SGPT was similar in the two elemental diets but higher than in CON. Liver weights were higher in the CRI group, probably abnormally so and likely due to increased fat content. Both diets had similar efficacy in nutritional support.

The effect of different intravenous nutritional regimens on renal function during acute renal failure in the rat.

Acute renal failure in the surgical patient is accompanied by a state of hypermetabolism and increased catabolism. Nutritional therapy is therefore directed at the preservation of body cell mass and protein synthesis for repair of wounds and damaged renal tubuli and for maintenance of host defense mechanisms. We examined the effect of two levels of protein intake (18.4 +/- 1.4 and 30.8 +/- 2.4 mg N/100 g BW/day) and three different amino acid formulations (Freamine III, Nephramine, and a made-up mixture of Nephramine + Freamine HBC) on renal function following mercury chloride-induced acute renal failure in the rat. All animals suffered severe renal failure manifested by increased plasma urea and creatinine levels, decreased creatinine clearance, and increased fractional excretion of sodium. On day 4 of acute renal failure, rats receiving low dose amino acids had better-preserved renal function than those receiving high dose amino acids. However, the type of solution infused did not affect recovery of renal function.

Renal prostaglandin production is increased during abdominal sepsis in the rat and unaffected by the infusion of different amino acid formulations

Renal prostaglandin (PG) production was studied in 32 laparotomized (control) and 33 septic rats (cecal ligation and puncture). Control and septic rats were infused for 18 hr with 5% glucose or 5% glucose and one of three amino acid formulations containing 22, 35, or 45% branched chain amino acids. When comparing renal PG production from endogenous precursors in septic versus control rats, significant increases (P less than 0.01) could be detected for PGE2, 6-keto-PGF1 alpha, and TxB2. The infusion of either 5% glucose alone or 5% glucose with 4.25% of any of the three amino acid formulations tested did not change renal PG production in either control or septic rats.

The effect of different intravenous nutritional regimens on renal regeneration during acute renal failure in the rat

Abstract Acute renal failure in the surgical patient is accompanied by a state of hypermetabolism and increased catabolism. Nutritional therapy is therefore directed at the preservation of body cell mass and protein synthesis for repair of wounds, repair of the damaged renal tubuli and maintenance of host defense mechanisms. We examined the effect of two levels of protein intake (18.4 ± 1.4 and 30.8 ± 2.4 mg N/100 g BW/day) and three different amino-acid formulations (Freamine III®, Nephramine® and a made-up mixture of Nephramine® ± Freamine® HBC) on renal regeneration following mercury chloride-induced acute renal failure in the rat. All animals suffered severe renal failure manifested by increased plasma urea and creatinine levels, decreased creatinine clearance and increased fractional excretion of sodium. Incorporation of 3H-thymidine into renal DNA on day 4 of acute renal failure was similar in all six groups studied, irrespective of the amount or composition of amino-acids infused. Renal regeneration during acute renal failure in the rat seems not to be affected either by the quantity or quality of amino-acids infused. However, although not reaching statistical significance, increased amounts of a standard TPN formulation may depress renal regeneration.