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Biomedical subjects

A Bothe

Publications and source records attributed to A Bothe.

70 records · Page 4Linked to original sources
PubMed1979

Nutritional assessment and patient outcome during oncological therapy.

Protein--calorie malnutrition is the single most common secondary diagnosis in patients with cancer, and is a direct consequence of the anorexia of malignancy and altered host metabolism induced by tumor. One hundred and sixty-one cancer patients were nutritionally assessed prior to receiving oncological therapy (surgery, chemotherapy, and/or radiation therapy). Eighty-four percent (27/32) of the patients who were initially anergic became immunocompetent with nutritional therapy and had a mortality rate of 11% as compared to 100% mortality in the 5 patients who remained anergic throughout their hospital stay. Thirty-nine percent (14/36) of the patients initially immune competent became anergic and had a concomitant mortality rate of 50% vs. a mortality rate of only 14% in the 22 patients whose immune function was preserved (p less than 0.05). Those patients who were discharged at the completion of their therapy also exhibited a higher initial serum albumin (3.5 +/- 0.1 vs. 3.1 +/- 0.1 g/dl, p less than 0.001) and serum transferrin (149 +/- 7 vs. 125 +/- 7 mg/dl, p less than 0.05). A significant increase (p less than 0.025) occurred in serum transferrin (delta 23 +/- 9 mg/dl) after 3 or more weeks of nutritional support. The detection and treatment of protein--calorie malnutrition prior to or in conjunction with oncological therapy has been associated with a decrease in mortality rate.

Body Constitution↗
PubMed1979

Energy regulation in morbid obesity by multidisciplinary therapy.

Regulation of energy expenditure should be directed toward fat mobilization and oxidation with concomitant preservation of lean body mass. This requires a multidisciplinary approach. The key surgical component of a gastric bypass is a properly sized pouch and stoma outlet. Compliance with a diet of approximately 800 to 1200 kcal per day, limited to three small meals and two snacks is the desired result. Weight loss should average 10 to 15 pounds monthly when surgery is added to intense medical, nutritional, and behavior therapy to ensure that the weight is reduced to desirable levels.

Diet, Reducing↗
PubMed1979

Nutritional assessment and treatment of hospital malnutrition.

A thorough awareness of the nutritional and metabolic status of the hospitalized patient is crucial for all persons directly involved in patient care. The catabolic nature of the body's response to illness or injury induces a serious drain on vital organs and tissues. Therefore, a complete assessment of the body's various compartments must be carefully taken, and any nutritional depletion must be quickly alleviated. Due to the alarming incidence of often undetected severe malnutrition in hospitalized patients, if becomes imperative that attention be paid to nutritional status, to decrease unnecessary morbidity and mortality.

Anthropometry↗
PubMed1979

Branched chain amino acid administration and metabolism during starvation, injury, and infection.

Branched chain amino acids were administered intragastrically in a septic-fractured rat model to determine the degree and mechanism of their protein-sparing ability. The septic injury model was first shown to produce a metabolic response characterized by hyperglycemia, reduced ketonemia and increased nitrogen loss. Branched chain amino acids were then administered either alone or as 25% or 50% (w/w) of a complete crystalline amino acid solution. L-(U-14C)-tyrosine was added to the diet to estimate protein synthesis in individual tissues. Branched chain amino acids, when given alone, spared total body nitrogen as compared with fasting by increasing the fractional synthesis of both mixed liver and muscle protein. Although the two complete amino acid mixtures produced similar nitrogen preservation and muscle synthesis in the septic animals, the crystalline amino acid diet containing 50% branched chain amino acids resulted in the greatest preservation of total liver nitrogen and the highest fractional synthetic rate. The effect of branched chain amino acids would not appear to be explained by their nitrogen content alone, and in starvation with injury and infection, increased intakes may have potential benefit. Clinical trials in starved, injured man appear to be indicated.

Amino Acids, Branched-Chain↗
PubMed1977

Nutritional support in cardiac cachexia.

A nutritional survey of 350 hospital patients reveals 50 with cardiac disease who had clinically significant protein-calorie malnutrition. Assessment criteria of malnutrition (per cent normal) included triceps skin fold (52 per cent), arm muscle circumference (88 per cent), and impaired delayed hypersensitivity skin testing (i.e., deficiency in cell-mediated immunity), the latter frequently observed in patients with concurrent weight loss. The functional category of cardiac status was not precise in predictin the morbidity and mortality of 14 patients undergoing cardiac valvuloplasty. By contrast, a nutritional/metabolic profile using weight loss, triceps skin fold (35 per cent), arm muscle circumference (27 per cent), and cell-mediated immunity (29 per cent) did identify high-risk patients who could be expected to benefit by concurrent nutritional support (4/4). Further studies are indicated to determine if nutritional support for cardiac cachexia can reduce the levels of morbidity and mortality during mitral and tricuspid valve surgery.

Adult↗
PubMedDate not supplied

Effect of combined modality therapy on the surgical management of locally advanced rectal carcinoma.

The treatment of locally advanced rectal carcinoma is one of the more complicated problems in the management of colorectal carcinoma. More than any other site successful treatment requires a multimodality approach as surgery alone is frequently insufficient to completely eradicate all disease. This review focuses primarily on the management of patients who present without prior treatment and discusses the role of preoperative radiation therapy as well as intraoperative radiation therapy. Although much less gratifying, patients who present after failing previous therapy may also benefit from an aggressive multimodality approach.

Carcinoma↗
PubMedDate not supplied

Intraoperative radiation therapy for carcinoma of the gallbladder.

The recognition of a high incidence of local failure following surgical management of adenocarcinoma of the gallbladder has led to the use of adjuvant radiation therapy. In order to deliver higher doses to the gallbladder bed, intraoperative radiation therapy (IORT) has been used both with and without external beam radiation. The experience to date is reviewed. Ten patients have been treated, all of whom had either gross residual or unresected disease. The median survival for the group was approximately 1 year. There were no long-term survivors. The IORT did not contribute to the overall morbidity. Because of the limited number of patients and the advanced nature of the disease, the role of IORT in the management of gallbladder carcinoma has yet to be determined. The utility of this modality will most likely reside in the treatment of minimal residual disease at the time of cholecystectomy rather than in the palliative treatment of unresectable tumors.

Adenocarcinoma↗
PubMedDate not supplied

Low plasma cortisol and hematologic abnormalities associated with essential fatty acid deficiency in man.

A case of probable adrenal insufficiency (glucocorticoid only) with hematologic changes including eosinophilia, neutropenia, and red blood cell abnormalities developed in the course of prolonged, fat-free feeding. The coincident development of essential fatty acid deficiency was conformed by serum fatty acid profiles indicating the presence of abnormal amounts of eicosatrienoic acid, and a triene/tetraene ratio greater than 0.4; all these findings responded to fat repletion. The association of glucocorticoid deficiency, neutropenia, and eosinophilia with essential fatty acid deficiency has not been previously reported in humans.

17-Hydroxycorticosteroids↗
PubMedDate not supplied

Low antithrombin III in morbid obesity: return to normal with weight reduction.

Morbidly obese adults are at increased risk for perioperative thrombotic complications. Antithrombin III (AT III) is a major endogenous anticoagulant and its deficiency is associated with more frequent thrombotic diseases. We measured AT III quantity and function in 23 morbidly obese adults and in 19 otherwise identical people who had reduced their mean weight to 160% of ideal body weight. Both groups were compared to normal weight controls (less than 120% ideal body weight). Serum and plasma AT III function and serum AT III antigenic concentration were significantly lower in the morbidly obese people compared to the weight reduced group in all three assays. The reduced group had values within the normal range of the normal weight group. In addition, three patients studied both before and after weight loss had similar significant changes in their AT III. We conclude that AT III is reduced in morbidly obese adults and normalizes as weight is reduced. Possible mechanisms of this deficiency and therapeutic approaches are considered.

Adult↗