Biomedical subjects

M H Irving

Publications and source records attributed to M H Irving.

131 records · Page 8Linked to original sources

PubMedDate not supplied

Maintenance of pregnancy in a home parenteral nutrition patient.

A case is reported of successful conception and completion of pregnancy in a patient with intestinal failure due to Crohn's disease, nourished entirely by home parenteral nutrition. The nutritional regimen included both dextrose and lipid as calorie sources, together with synthetic amino acids and appropriate additives. Nutritional status was monitored by blood biochemistry, anthropometry, urinary nitrogen losses, and measured resting energy expenditure. Obstetric progress was monitored by standard methods, including abdominal ultrasound, maternal weight gain, and measurement of plasma hormone levels. Herein, particular attention is given to the use of intravenous lipid in pregnancy.

Adult↗

PubMedDate not supplied

Hormonal and metabolic responses to glucose infusion in sepsis studied by the hyperglycemic glucose clamp technique.

Although nutritional support is vital to treatment of severe sepsis, the septic patient does not respond normally to glucose infusion. We have used the hyperglycemic glucose clamp technique to investigate the initial hormonal and metabolic responses of the septic patient to glucose under controlled conditions. The plasma glucose concentration was raised to and maintained at 12 mmol/liter for 2 hr in 12 septic patients and 11 normal controls. Glucose utilization, assessed from the amount infused, was significantly depressed in the patients, despite similar plasma insulin concentrations in the two groups. Forearm glucose uptake was similarly impaired. Despite very similar plasma free fatty acid concentrations in the two groups, which were suppressed equally by the glucose infusion, whole-body fat oxidation was elevated in the patients compared with the controls, and suppressed to a lesser extent in response to glucose. Glycerol and ketone body concentrations were elevated in the patients in keeping with a picture of accelerated release, clearance, and oxidation of fatty acids. Plasma cortisol, epinephrine, and norepinephrine concentrations were elevated in the septic patients in a severity-related manner, but not to high levels compared with experimental work. Norepinephrine showed no response to the glucose infusion in either group. Plasma glucagon concentrations were not significantly elevated in the septic patients. We conclude that the hyperglycemic glucose clamp provides a useful model for studying glucose intolerance in sepsis. Impaired glucose utilization in septic patients is associated with increased fat oxidation, although the hormonal basis for these changes is still unclear.

Adult↗

PubMedDate not supplied

Serum carnitine levels in normal individuals.

Serum carnitine levels have been measured in 178 samples from 75 normal volunteers. We report a wide range of values (10-70 mumol/liter and 8-74 mumol/liter for free and acetylated carnitine, respectively) and a distinct difference between the ranges for males and females (p less than 0.001). There is also substantial, seemingly random fluctuation in any one individual's levels, when measured serially over several weeks.

Carnitine↗

PubMedDate not supplied

Mortality in patients on home parenteral nutrition.

Fifty out of 228 patients recorded on the U.K. Home Parenteral Nutrition Register have died. The earliest to die was at 10 days following the commencement of home parenteral nutrition (HPN), and the longest to die was after 5 1/2 years. Half of the patients who died, did so within 6 months of commencing HPN. Sixty % died of their underlying disease. Most patients with scleroderma or an underlying malignancy are dead within a year of commencing HPN. In contrast, patients with Crohn's disease or the short bowel syndrome due to volvulus do well. In only 14 patients was death attributable to the administration of HPN. In this group the main causes were septicemia, SVC thrombosis, and hepatic failure. Our study suggests that HPN should be used in patients with malignancy and scleroderma only in exceptional circumstances and that further work is necessary for the prevention of SVC thrombosis.

Adolescent↗

PubMedDate not supplied

Octreotide and postoperative enterocutaneous fistulae: a controlled prospective study.

Nineteen patients with postoperative enterocutaneous fistulae were randomised, in a double blind fashion, to receive either 12 days of octreotide (100 micrograms tds) by subcutaneous injection or 12 days of placebo injections. Fistula output for 7 days before and during all 12 days of treatment was recorded for each patient. Fistula losses before entering the trial were similar for both the placebo group (n = 8; range of daily medians: 202 mls to 400 mls) and the group of patients randomised to receive octreotide (n = 11; range of daily medians: 252 mls to 550 mls). There was no significant difference in fistula output between the two groups of patients while receiving either 12 days of placebo injections or 12 days of subcutaneous octreotide therapy. Fistula closure, defined as no fistula output for 2 successive days during the 12 days "therapy" period, was seen in only 1 patient given octreotide and in 3 patients given the placebo. In a double blind prospective study of 19 patients with enterocutaneous fistulae, octreotide therapy was neither associated with a significant reduction in fistula losses nor an increased rate of spontaneous fistula closure.

Adult↗