Ronald M. Abel

Catheter complications in total parenteral nutrition. A prospective study of 200 consecutive patients.

Abstract The complications related to central venous catheters for total parenteral nutrition were prospectively evaluated in 200 patients. Catheter sepsis was defined as an episode of sepsis, for which no anatomic locus could be identified, that resolved on removal of the catheter. The insertion of 355 catheters for 4492 days led to complications involving 4 per cent of the catheters and 6 per cent of the patients. Catheter sepsis was associated with 7 per cent of catheters and occurred in 11 per cent of patients. Eight cases of superior-vena-cava thrombosis and three of pulmonary embolism were found in 34 autopsied patients. Catheters used with strict aseptic technic were complicated by a sepsis rate of 3 per cent as compared to one of 20 per cent when breaks in the protocol were observed (p = 0.01). Thus, total parenteral nutrition can be employed with an acceptable risk, provided catheter care is according to protocol. (N Engl J Med 290:757–761, 1974)

Hyperalimentation as primary therapy for inflammatory bowel disease

Abstract In a series of thirteen patients with regional enteritis, granulomatous colitis, and ulcerative colitis, hyperalimentation was carried out with additional forms of therapy. The response in the group with regional enteritis and granulomatous colitis suggests the hyperalimentation may be of value as primary therapy. One patient with partial small bowel obstruction secondary to a stenotic segment avoided operation as the segment became dilated after three weeks of therapy. In ulcerative colitis total parenteral nutrition appears to be more of a supportive nature, as persistent bleeding necessitated operation in three of four patients.

Intravenous essential L-amino acids and hypertonic dextrose in patients with acute renal failure: Effects on serum potassium, phosphate, and magnesium☆

Abstract An intravenous diet of essential L-amino acids with a high carbohydrate source was administered to seventeen critically ill patients in acute renal failure. No serious untoward side effects associated with therapy occurred in any patient. Positive nutritional effects including weight gain and improved wound healing were attended by a blood urea nitrogen-stabilizing effect. Unanticipated salutary metabolic effects also occurred, consisting of lower serum concentrations of magnesium, phosphate, and potassium. An hypothesis to explain the presumed ionic shifts intracellularly is discussed.

Essential L-amino acids for hyperalimentation in patients with disordered nitrogen metabolism

Abstract One hundred thirty-nine patients with disordered nitrogen metabolism received an intravenous solution of essential L-amino acids and hypertonic dextrose to provide parenteral nutrition in the presence of either acute renal failure, “hepatorenal syndrome,” chronic hepatic insufficiency without renal failure, or azotemia resulting from a variety of other causes. Infusions were managed by routine hyperalimentation technics, modified somewhat to avert potential metabolic side effects. Clinical and metabolic results attributable to the therapy included improved nutritional status and salutary serum electrolyte changes. Complications of therapy were few in number; notable was hyperglycemia which was easily managed in most instances. The capacity to safely deliver intravenous nutrients to patients even with marked disturbances in hepatic or renal function is clearly established.

Amino Acid Metabolism in Acute Renal Failure: Influence of Intravenous Essential L-Amino Acid Hyperalimentation Therapy

A solution of 8 essential I-amino acids and hypertonic dextrose was administered to 5 patients in acute postoperative renal failure in a program of hyperalimentation designed to decrease the patients catabolic state and to accrue certain metabolic benefits. A sixth patient receiving intravenous glucose alone served as a control. The pretreatment plasma concentrations of amino acids in all 6 patients did not differ significantly from normal; following intravenous essential amino acids at a dose of approximately 12.6 gm/24 hours, no significant elevations out of the normal range of these substances occurred. Since urinary excretion rates did not dramatically increase, urinary loss was excluded as a possible cause for the failure of increase of plasma concentrations. The results suggest that the administration of an intravenous solution of 1-amino acids and hypertonic dextrose is associated with rapid clearance from the blood of these substances and, with a failure of increased urinary excretion, indirect evidence of amino acid utilization for protein synthesis has been obtained. Histidine supplementation in patients with acute renal failure is probably unnecessary based on the lack of significant decreases in histidine concentrations in these patients.

Survival Following Free Rupture of Left Ventricular Aneurysm: Report of a Case

A 50-year-old man sustained free rupture of the left ventricle four weeks following a massive anterior myocardial infarction. The rupture occurred at the junction between a bulging left ventricular aneurysm that was not yet fibrotic and normal myocardium without evidence of fresh myocardial infarction. Accurate preoperative diagnosis aided by echocardiography and right heart catheterization made possible a planned surgical approach. Postoperative support with intraaortic balloon pumping appeared to be beneficial in maintaining statisfactory cardiac function until an adequate stroke volume could be reestablished, presumably by an increase in left ventricular volume.

Giant Right Atrial Myxoma With Rheumatic Mitral Valve Disease

A patient with a 456 Gram right atrial myxoma is described. Associated rheumatic mitral valvular heart disease obscured the presence of the tumor and only with presentation of bradyarrhythmias leading to pacemaker implantation was the diagnosis suspected. Successful surgical removal of the tumor and correction of the intracardiac valvular dysfunction were performed. The role of echocardiography in the early detection of these tumors is reinforced.