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Biomedical subjects

M Elia

Publications and source records attributed to M Elia.

At least 253 records · Page 14Linked to original sources
PubMed1985

Factors affecting maximal momentary grip strength.

Maximal voluntary grip strength has been measured in normal adults aged 18-70 years (17 f, 18 m) and compared with other indices of body muscle mass. Grip strength (dominant side) was directly proportional to creatinine excretion (r = 0.81); to forearm muscle area (r = 0.73); to upper arm muscle area (r = 0.71) and to lean body mass (r = 0.65). Grip strength relative to forearm muscle area decreased with age. The study of a subgroup of normal subjects revealed a small but significant postural and circadian effect on grip strength. The effect on maximal voluntary grip strength of sedatives in elderly subjects undergoing routine endoscopy (n = 6), and of acute infections in otherwise healthy individuals (n = 6), severe illness in patients requiring intensive care (n = 6), chronic renal failure (n = 7) and anorexia nervosa (n = 6) has been assessed. Intravenous diazepam and buscopan produced a 50 per cent reduction in grip strength which returned to normal within the next 2-3 h. Acute infections reduced grip strength by a mean of 35 per cent and severe illness in patients in intensive care by 60 per cent. In patients with chronic renal failure grip strength was 80-85 per cent of that predicted from forearm 'muscle area' (P less than 0.05). In anorectic patients the values were appropriate for their forearm muscle area. Nevertheless nutritional rehabilitation of one anorectic patient did not lead to a consistent improvement in grip strength.

Adolescent↗
PubMed1984

Mineral metabolism during short-term starvation in man.

Plasma and urine electrolytes were measured in five healthy non-obese young adults before, during and after a four-day period of total starvation (distilled water only). Plasma sodium, chloride and bicarbonate concentrations decreased in all subjects by a mean value of 4 mmol/l, whereas the sum of acetoacetate and hydroxybutyrate concentrations increased by 4-6 mmol/l. These changes occurred without alterations in the state of hydration or vascular volume. Hydroxybutyrate and ammonium ions became the main urinary ions during starvation, whereas sodium and chloride, which were quantitatively the most important urinary electrolytes before starvation, decreased four-fold, and potassium two-fold. Plasma zinc concentrations rapidly increased in all subjects by a mean of 4 mumol/1 (25%) and returned to normal on refeeding. The excretion of zinc in urine trebled and continued to rise on refeeding. There were no major changes in the excretion of calcium, magnesium, phosphate or sulphate during the starvation period. From knowledge of the intracellular concentrations of various minerals and extent of breakdown of lean tissues (N excretion), it is suggested that most of the urinary calcium, magnesium and phosphate probably originates from bone, and that the amount of zinc in urine is only a small fraction of that which is likely to be released from the breakdown of lean tissues. It is also suggested that the continued excretion of zinc on refeeding is due to release of zinc from tissues which 'buffered' it during the starvation period. This study provides useful data in non-obese individuals with which to compare changes which occur in post-traumatic and post-infective starvation.

Adolescent↗
PubMed1984

Flow and aspiration of artificial feeds through nasogastric tubes.

The physical characteristics of 12 nasogastric tubes (Clinifeed, Portex prima, Vygon 6 and 9, Dobbhoff, Nutriflex and 6 Ryles tubes) and 13 feeds (4 Clinifeed Preparations, Nutranel, Nutrauxil, Express, Triosorbon, Fortison, Enteral 400, Elemental 028, Complan and Complan + Caloreen have been assessed under laboratory conditions. The accuracy of the stated internal diameter of the tubes tested varied from 88-119%. The rate of flow was inversely related to the length of the feeding tube and was greatly affected by diameter (an increase from 1 to 2 mm increased flow 10-fold); and was virtually unaffected by the side holes at the end of the tube. Giving sets provide only a small resistance to flow. The viscosities of liquid feeds did not correlate with their osmolarities. The values ranged from 1.9-28 centipois (cps) at 24 degrees C and universally decreased to 1.4-19 cps at 37 degrees C. All enteral feeds except Clinifeed 500, flow satisfactorily through fine bore tubes under a low head of pressure. Undiluted Clinifeed 500 (a high protein feed) requires pumping. Feeds containing casein (e.g. Complan, Nutrauxil, Fortison, Triosorbon) curdle in the presence of acid which hinders aspiration through even widebore tubes. Foods containing whey protein (Express, Enteral 400) or no protein (Elemental 028) do not coagulate with change of pH. Batch to batch variations in liquid feeds are usually small but with one preparation were sufficiently large to cause problems in delivery. The results of these studies provide further data on which to base the choice of liquid feed and giving tubes in clinical practice.

Journal Article↗
PubMed1984

Effect of starvation and elective surgery on hand dynamometry and circulating concentration of various proteins.

The effect of 4 days total starvation (water only) in five normal subjects on the circulating concentrations of various proteins was studied. Changes in plasma albumin and total protein concentrations were compared with those of six patients undergoing elective abdominal surgery with partial starvation and six patients undergoing orthopaedic surgery with adequate feeding - (0.126-0.146 MJ/kg/day and 1.2-1.4 g protein/kg/day). In a companion study hand grip strength was measured daily in ten normal subjects during starvation and in 18 patients undergoing surgery for hernia repair (n = 6), cholecystectomy (n = 6) and major abdominal surgery (n = 6). Starvation produced marked reductions (approximately 30%) in the circulating concentrations of retinol binding protein and prealbumin but did not significantly affect the plasma concentration of immunoglobulins (IgG, IgA, IgM) acute phase reactants (orosomucoid, haptoglobin, alpha(1) antitrypsin), albumin and total protein. On the other hand both types of elective surgery produced significant reductions in plasma albumin and total protein concentrations irrespective of feeding. Grip strength was not significantly altered by four days of starvation but surgery produced a temporary reduction in grip strength, the extent and duration of which was related to the severity of operation. This study helps to separate the effect of surgery and starvation on hand dynamometry and circulating protein concentrations and indicates their limitations as indicators of nutritional state.

Journal Article↗
PubMed1984

Energy metabolism during exercise in normal subjects undergoing total starvation.

Energy expenditure and the circulating concentration of various intermediary metabolites, insulin and glucagon, were measured in five lean subjects at rest and during a 20-min period of a standardized exercise (50-75 watts). Measurements were made before starvation, at the end of a 4-d period of total starvation and 24-32 h after refeeding. The respiratory quotient decreased in all subjects during starvation from 0.85 +/- 0.03 (s.e.m.) to 0.70 +/- 0.01 (P less than 0.01), and rose again on refeeding to 0.85 +/- 0.04. Resting metabolic rate (RMR) was not significantly affected by starvation. 'Work efficiency' (mechanical work done X 100 divided by metabolic rate during work - RMR) decreased in all subjects from a mean value of 23.9 per cent before starvation to 22.2 per cent during starvation and rose again on refeeding to 23.9 per cent, but with small numbers these differences did not reach statistical significance. All subjects felt that the work load (assessed on the Borg scale for perceived exertion) was greater during starvation than either before or after starvation (P less than 0.01). During exercise the circulating concentrations of glucose and glucagon remained virtually unchanged whereas insulin tended to decrease. In contrast, concentrations of lactate, pyruvate and alanine increased. The changes in the concentration of lactate, pyruvate and alanine were greater during starvation than before starvation, and are consistent with inhibition of the pyruvate dehydrogenase complex by ketone bodies, the circulating concentrations of which were elevated 20-fold during starvation. It is suggested that this inhibition may increase glucose recycling between muscle and liver and cause a small increase in energy expenditure.

Adult↗
PubMed1982

The effects of nitrogen and energy intake on the metabolism of normal, depleted and injured man: considerations for practical nutritional support.

This article illustrates how the nutritional and metabolic effects of a range of protein and energy intakes depend on the clinical state of the patient and how these considerations may be used to provide guidelines for nutritional support. First, it is necessary to define states and mechanisms of malnutrition and then discuss the biochemical processes which underlie nutritional rehabilitation.

Journal Article↗
PubMed1982

Syndrome of osteoporosis with pseudoglioma.

a 12 1/2-year-old boy with the rare autosomal recessive syndrome of osteoporosis with pseudoglioma is reported. Pertinent laboratory findings included osteoporotic lesions of the skeleton and calcification of the left lens. He was hypotonic and presented atrophic globes with opacities of the lenses. His psychomotor development was normal. Parental consanguinity is not excluded.

Brain Diseases↗
PubMed1981

Clinical usefulness of urinary 3-methylhistidine excretion in indicating muscle protein breakdown.

Urinary excretion of the post-translationally modified amino-acid 3-methylhistidine, derived from the contractile proteins actin and myosin, was measured in patients with conditions associated with nitrogen loss. The ratio of 3-methylhistidine:creatinine excretion, a measure of the fractional catabolic rate of myofibrillar protein was increased in severe injury, thyrotoxicosis, neoplastic disease, prednisolone administration, and sometimes Duchenne muscular dystrophy. In myxoedema, osteomalacia, and hypothermia the ratio was decreased; and starvation, elective operations, and rheumatoid arthritis had little effect. Provided that the diet is meat free, measurement of urinary 3-methylhistidine may provide useful information on the cause of protein loss.

Adolescent↗
PubMed1980

Relationship between the basal blood alanine concentration and the removal of an alanine load in various clinical states in man.

1. Blood alanine was measured in six patients undergoing total hip replacement and in four normal subjects starved for 4 days. Hypoalaninaemia occurred in both groups and persisted in the surgical patients despite an adequate diet. The blood alanine was also low in four insulin-dependent diabetic patients and in four patients with muscular dystrophy; it was normal in four patients with cirrhotic liver disease. 2. The removal of an intravenous L-alanine load (12 g; 133 mmol) was significantly increased after surgery and in the diabetic patients, unaltered by starvation, and decreased in the cirrhotic patients. 3. Increases in blood glucose were observed when alanine infusion was performed 6 h after surgery and after 3 days' starvation. Increases in blood lactate and pyruvate always occurred after alanine infusion but were most marked 6 h after surgery. 4. These results show that the metabolic response to an alanine load and the ability of the body to remove it alter with change in physiological state, and that the hypoalaninaemia after surgery and in diabetes is related to an increased removal of intravenous alanine, whereas that during starvation is not.

Adolescent↗
PubMed1980

The removal of infused leucine after injury, starvation and other conditions in man.

1. To investigate the effects of starvation, elective surgery, accidental injury and other clinical conditions on the metabolism of branched-chain amino acids in man, we have measured the basal concentration of leucine and the removal of metabolic effects of infused L-leucine. 2. The blood concentration of leucine as significantly increased by surgery, starvation and accidental injury, and decreased in cirrhosis. It tended to increase in diabetes and was unaffected by muscular dystrophy. 3. The half-life of infused leucine was nearly doubled by 4 days of complete starvation, unaltered by surgery and decreased by severe accidental injury, Infusion with Intralipid, which increased free fatty acid and ketone-body concentrations, had no effect on the removal of a leucine load. The clearance rate of infused leucine was reduced in diabetes and muscular dystrophy and increased in cirrhosis. 4. The effects of infused leucine on blood glucose and ketone bodies differed according to the groups studied. 5. Since the traumatized patients were given sufficient energy and nitrogen and disposed of a leucine load at a different rate from the starved patients, the causes of the increase in blood concentration of leucine in these two conditions are different.

Adolescent↗
PubMed1980

The effect of 3-methylhistidine in food on its urinary excretion in man.

1. To establish whether 3-methylhistidine in food is quantitatively excreted in the urine, five normal adults on a vegetarian diet were given known amounts of 3-methylhistidine in meat or fish. The mean cumulative 5-day increment in 3-methylhistidine excretion in non-hydrolysed urine accounted for an average of 90% of the 3-methylhistidine given during the first 3 days of this period. 2. To define the variation in urinary 3-methylhistidine on a constant mixed intake, the daily 3-methylhistidine excretion was measured for 6 days in four patients on a metabolic "balance" diet. The mean daily variation was less than 10%. 3. The results show that under the conditions of this study the increase in urinary 3-methylhistidine above basal levels can be quantitatively accounted for by the 3-methylhistidine content of additional food; in subjects on a constant diet it should be possible to detect relatively small changes in 3-methylhistidine excretion.

Adult↗
PubMed1979

Changes in blood glucose and plasma insulin after intravenous galactose in human injury.

1. The increase in blood glucose after intravenous galactose was measured at 6--8 h and 14 days after hip replacement (14 patients) and accidental injury (14 patients). 2. After hip replacement there was a greater rise of glucose after galactose on the day of the operation than on recovery, despite basal hyperglycaemia. This earlier period was also associated with inappropriately low insulin concentrations for the prevailing glucose concentration, and hyperketonaemia (13 out 14 patients). 3. After accidental injury patients with initial hyperketonaemia (nine out of 14) also had a greater rise of blood glucose after galactose than on recovery and had relative insulin deficiency; in contrast those who were initially normoketonaemic (five out of 14) showed a rise in glucose comparable with that after recovery and basal insulin concentrations more appropriate to the existing glucose concentration. 4. It is concluded that in most subjects after injury hepatic glucose release after galactose administration is not suppressed despite hyperglycaemia.

Adolescent↗
PubMed1979

The 3-methylhistidine content of human tissues.

1. The amount of 3-methylhistidine (3-MeH) has been measured in eighty-eight samples of tissue taken post-mortem from five adults. 2. The highest concentration (mumol/g fat-free dry weight) of 3-MeH was in skeletal muscle (3.31 +/- 0.05); intermediate values (2-3) were found in cardiac muscle and those tissues containing smooth muscle; and low values (less than 1) occurred in parenchymal tissues such as liver and kidney. 3. There was little variation between the mean 3-MeH content of striated muscles in different individuals, and no significant difference between the 3-MeH concentrations of striated muscles taken from six different sites. 4. The results suggest that it is justifiable to use values obtained from single muscles to calculate the rate of myofibrillar breakdown from urinary 3-MeH excretion.

Adult↗