Erythromycin in chronic intestinal pseudo-obstruction.
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Adult↗
Biomedical subjects
S Mobarhan
Publications and source records attributed to S Mobarhan.
Diarrhea complicating enteral feeding after liver transplantation.
In this case report we present in detail the complex nature of enteral feeding, diarrhea, hypoalbuminemia, and edema in a critically ill patient. We also discuss the use of a peptide-elemental formula in this patient, who suffered continuous diarrhea for 15 weeks after liver transplantation. Use of this formula was associated with cessation of the diarrhea and permitted adequate nutritional delivery. After 26 weeks of mechanical pulmonary ventilation, extubation was possible. This case illustrates the ineffectiveness of parenteral albumin infusions for treatment of enteral edema and demonstrates the restoration of normal intestinal absorptive capacity when ultrafiltration was instituted and the patient's generalized edematous state was corrected.
Diarrhea↗
In vitro stimulation of rat liver retinyl ester hydrolase by ethanol.
Retinyl ester hydrolase (REH), the enzyme which converts retinyl esters to retinol, was partially characterized from whole liver homogenates of rats using an HPLC method with quantitation of retinol product. Optimal results were obtained by incubation of 1 mg of whole homogenate protein with 900 microM all-trans-retinyl palmitate and 275 mM 3-[(3-cholamidopropyl)dimethylammonio]-1-propanesulfonate in a 0.1 M Tris-maleate buffer, pH 7.0, for 1 h at 37 degrees C. The enzyme assay proved to be sensitive and reproducible, with an interanimal coefficient of variation of 13% (n = 7). Because ethanol has been shown to mobilize vitamin A from the liver, we tested its effect on REH activity at several concentrations. In concentrations ranging from 0.01 to 0.5 M, ethanol added in vitro caused a concentration related increase in REH activity (from 20 to 86% above baseline activity). This increase was specific to ethanol as acetaldehyde, 1-propanol, and t-butanol either did not change or significantly decreased REH activity over the range of concentrations tested. The range of concentrations of ethanol causing stimulation in our assays was within the range of concentrations seen in the blood of rats after acute ethanol ingestion. Stimulation of REH activity could explain, in part, the well-known effects of ethanol on mobilization of vitamin A from liver stores.
Acetaldehyde↗
Normal serum response to oral beta-carotene in humans.
This study was performed to determine (1) the normal serum response to a single oral dose of beta-carotene (BC), (2) the effect of meal timing and serum response to meal lipids on serum BC, (3) the effect of administered BC on other serum carotenoids and retinoids, and (4) the relationship of body composition to serum BC response. Subjects consumed one BC dose with a liquid 500 kcal BC-free diet; fasting and hourly venous blood was collected for 8 hours and again at 24 hours. A second liquid BC-free meal was consumed 4 hours post-dosing; this midday meal was omitted in some subjects. Serum BC levels rose and peaked initially at 5 hours, but continued to be absorbed in most subjects, remaining significantly elevated at 24 hours as compared to baseline values (p less than 0.001), independent of BC dose. The area under the BC absorption curve (8-hr AUC) increased linearly with BC dose and correlated positively with peak serum triglycerides (TG) after a meal (n = 26 tests, r = 0.56, p less than 0.003). Omission of the midday meal significantly delayed the initial BC peak to 7 hours (p less than 0.0004). Serum levels of retinol, alpha-carotene, cryptoxanthin, lycopene, and lutein remained unchanged. Serum retinyl esters did not rise in all subjects following BC intake; when it did, retinyl esters rose and peaked concomitantly with BC, but declined within 8 hours. There was no correlation between the initial serum BC, peak BC, 24-hr BC, 8-hr AUC, or peak serum TG and the percentage of body fat. We conclude that: (1) the timing of the serum response to oral BC is independent of dose, (2) the serum BC response is greater in those with a greater serum triglyceride response to meal lipids, (3) BC at the doses given does not alter the levels of other serum carotenoids, and (4) there is no correlation between the serum BC parameters measured and adiposity.
Administration, Oral↗
Effects of acute starvation on vitamin A status in rats.
Maintenance of vitamin A stores in the body is dependent on a number of basic metabolic processes. These processes, such as protein and carbohydrate metabolism, are disrupted in acute starvation, and, as a result, alterations in vitamin A status may result. We investigated this possibility in 8-week-old Sprague-Dawley male rats. The rats were starved for 24, 48, and 72 hr but had free access to water. At 24 hours of starvation, the plasma retinol concentration was depressed, but not significantly so. After 48 and 72 hours of starvation, however, the plasma retinol concentration decreased to less than half of the control values (61 +/- 4 vs 124 +/- 12 nmol/dl at 72 hours, mean +/- SEM, (p less than 0.005). The hepatic retinoid (retinyl esters + retinol) concentration (nmol/g liver) was increased at 24 and 48 hours of starvation compared to controls (p less than 0.05), and by 72 hours the concentration was 56% greater in starved rats than in fed controls (p less than 0.001). The total hepatic retinoid content (mumol/total liver) was decreased moderately at all periods of starvation compared to controls (p less than 0.05). In both starved and fed animals, the total hepatic content per 100 g body weight, a measure of total vitamin A reserves, was statistically the same. These results demonstrate that acute starvation in rats alters the vitamin A equilibrium between the plasma and hepatic stores without affecting the overall vitamin A reserves.(ABSTRACT TRUNCATED AT 250 WORDS)
Acute Disease↗
Beta-carotene serum response in young and elderly females.
This study was designed to investigate the effects of aging and food intake on the serum beta-carotene (BC) response curve in humans. Ten elderly (71 +/- 4 years) and 17 young (28 +/- 7 years) healthy females were given 15 mg BC with a semi-solid test meal devoid of BC and vitamin A. All the elderly and 10 young subjects (control A) received a test meal of 500 kcal while the remaining 7 young subjects (control B) were given 700 kcal. Subsequently, blood was drawn hourly for 8 h and again at 24 and 48 h. Serum carotenoids and retinoids were measured by HPLC and triglycerides (TG) and cholesterol by enzymatic methods. Small intestinal transit time was determined in the elderly and in control group A by a breath hydrogen test following ingestion of lactulose (12 g) with the test meal. The area under the absorption curve (AUC) of serum BC over the first 8 h was higher in the elderly subjects than in either control group A or B (P less than 0.001). The slopes of the BC and TG curves were significantly higher as compared to control A, but similar to control B. There was a positive correlation between the ascending slopes of the BC and TG absorption curves of all groups (P less than 0.001). The AUC of the retinyl ester serum response of the elderly group was greater than that of control A (P less than 0.001). The slope of this curve was steeper (P less than 0.01) in the elderly group as compared to control A, but was similar to control B. Intestinal transit time was similar in all groups. In young subjects, the larger test meal of control group B appeared to increase the rate of absorption of BC. These data indicate that the rate of intact BC absorption and its conversion to retinyl esters may be enhanced in old age as compared to younger subjects receiving the same amount of food. Age-related alterations of enterocytes and the intestinal lumen could account for this phenomenon.
Administration, Oral↗
Analysis of retinoids by direct exposure probe mass spectrometry.
Recently, our laboratory has investigated the depletion of Vitamin A and its metabolites in experimental animals. High Pressure Liquid Chromatography (HPLC) was used to measure retinal oxidase activity by monitoring the conversion of retinaldehyde (RALD) to retinoic acid (ROIC). In order to obtain more information about these compounds, a Direct Exposure Probe mass spectrometric method was developed to confirm the presence of ROIC and RALD in HPLC peaks. A rapid negative ion chemical ionization (NICI) method using ammonia as reagent gas was developed to detect the presence of ROIC and RALD with picogram sensitivity. The ROIC and RALD peaks were collected from HPLC, extracted with hexane, evaporated under nitrogen and reconstituted in ethanol before placing onto a rhenium filament with current programmed from 0-1.3 A at 50 mA/sec. The instrument employed was a Finnigan 4510 operated in the NICI mode and scanned from m/z 100-650 with a source temperature of 80 C. Other parameters were electron energy 140 eV and filament current at 0.25 mA. Prominent ions were generated at m/z 284 and m/z 300 for RALD and ROIC which were subsequently monitored in the selected ion monitoring mode. In summary, we have developed a rapid retinoid identification method (2.5 minutes) which is more sensitive (pg vs ng) than HPLC and does not require elaborate sample preparation or derivitization. This method can be used as an important adjunct to HPLC enzyme studies.
Chromatography, High Pressure Liquid↗
The role of albumin in nutritional support.
Hypoalbuminemia is considered one of the hallmarks of protein-calorie malnutrition and chronic liver disease. Recently, serum albumin has also been proposed as a critical predictor of the response to nutritional support and tolerance to enteral feeding in critically ill patients. Albumin is essential for maintenance of plasma colloidal osmotic pressure, prevention of edema, and transport of certain drugs and nutrients. Experimental studies have shown that rapid plasma expansion and reduced plasma protein concentration and osmotic pressure induce a net secretion of sodium and water into the small intestinal lumen. However, the effects of chronic hypoalbuminemia per se on intestinal absorption, independent of malnutrition, have not been fully studied. It is documented that both chronic illness and malnutrition may profoundly affect intestinal anatomical structure and function, inducing some degree of malabsorption. In the last few years, some have advocated albumin infusion to improve clinical response to patients with hypoalbuminemia receiving parenteral nutritional support or to reduce intestinal intolerance and diarrhea in patients receiving enteral tube feeding. A review of the literature shows that both clinical and experimental data to support these suggestions are scarce and further investigations are needed. Hypoalbuminemia is one of many parameters of malnutrition, and it is unlikely that correction of a single parameter for a short time would lead to major clinical benefits.
Chronic Disease↗
Effect of zinc deficiency on hepatic enzymes regulating vitamin A status.
The elevation of hepatic vitamin A (VA) in zinc deficiency (ZD) is thought to be due, in part, to a reduced synthesis of plasma retinol-binding protein with a subsequent decrease in the release of retinol into the circulation. We hypothesized that the hepatic VA elevation may also be secondary to a change in the activity of enzymes that either regulate retinol degradation or affect the synthesis or hydrolysis of retinyl esters. To examine this question, 20 rats were divided into two groups and pair-fed for 3 wk. ZD rats received a ZD diet (zinc 2.3 mg/kg diet) and controls were fed a zinc-sufficient diet (zinc 50 mg/kg diet). The enzymes studied were retinyl ester hydrolase (REH) and microsomal acyl coenzyme A:retinol acyl transferase (ARAT), the principal enzymes regulating retinyl ester hydrolysis and synthesis. The activities of retinol (alcohol) dehydrogenase (ADH) and retinal oxidase (RO), enzymes regulating retinol degradation to polar metabolites, were also studied. ZD caused an increase in both total hepatic VA concentration and total hepatic VA content, but did not alter the ratio of retinol to retinyl esters. The specific activities of REH and ARAT were not affected by ZD. However, ZD caused a significant reduction in the activity of ADH, the enzyme that catalyzes the first step in retinol oxidation. In contrast, the activity of RO, the enzyme that regulates the irreversible oxidation of retinal to retinoic acid, was significantly increased in ZD rats. These findings indicate that the elevation in hepatic levels of VA in ZD rats may be, in part, secondary to decreased retinol degradation.
Acyl Coenzyme A↗
Habitual alcohol consumption and nutritional status of the elderly.
The interrelationship between habitual alcohol consumption, dietary intakes and vitamin status was examined in 393 elderly subjects (188 men, 205 women, age range 65-90 years) resident in seven retirement homes throughout Italy. Individual food intake was assessed by the 7-day precise weighing method. Fasting blood was tested for riboflavin (erythrocyte glutathione reductase activity coefficient), thiamine (erythrocyte transketolase activity), retinol (fluorimetry) and folic acid status. Alcohol contributed on average 12 per cent of total energy intake in men, and 6 per cent in women. Forty-eight per cent of males and 39 per cent of females were classified as heavy drinkers (HD) with 48 and 28 g/d average alcohol intakes respectively. There was a general tendency for women to add alcohol to their habitual diet, as revealed by the positive correlation between total energy intake and alcohol intake. The higher energy intakes of HD women were also reflected in their higher body weights. Men tended to displace food energy partially by alcohol. Dietary risk of malnutrition, high for vitamin A, and moderate to low for vitamins B1 and B2, did not increase with alcohol consumption. Biochemical evidence of malnutrition indicated a significant deterioration of folate status in HD of both sexes, and for B1 in HD males only; there was no change in riboflavin status. Plasma levels of retinol were higher, and prevalence of vitamin A deficiency lower, in HD, a finding that warrants further investigation.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Severe hypervitaminosis A in siblings: evidence of variable tolerance to retinol intake.
A 2-year-old boy had signs and symptoms of chronic hypervitaminosis A. A course of increasing severity led to eventual death. A younger brother later had similar clinical features. Chicken liver spread containing up to 420 IU/g vitamin A was the likely source of intoxication. Markedly elevated circulating retinyl ester levels have persisted in the surviving sibling for 3 subsequent years despite severe restriction of vitamin A intake. A therapeutic trial of the carbohydrate-derived complexing agent 2-hydroxypropyl-beta-cyclodextrin was initiated. Circulating retinyl esters transiently increased during the infusion (from 407 to 4791 micrograms/dL), and urinary total vitamin A excretion, undetectable before infusion, increased to 23 micrograms/dL after infusion. The frequency of hypervitaminotic episodes has decreased somewhat in the 2 years since the infusion, probably related to dietary vitamin A restriction. The occurrence of this syndrome in two brothers, while a sister ingesting the same diet remains completely healthy, suggests an inherited variance in tolerance to vitamin A intake.
2-Hydroxypropyl-beta-cyclodextrin↗
Endoscopic treatment of Dieulafoy hemorrhage.
Bleeding from a Dieulafoy lesion is an underdiagnosed source of upper gastrointestinal bleeding. The literature is almost universally in support of surgical therapy as its treatment. We report three patients with bleeding Dieulafoy lesions who were treated successfully with endoscopic therapy--two by bipolar electrocoagulation and one by endoscopic sclerotherapy.
Adult↗
Effect of restricting a balanced diet on rat intestinal disaccharidase activity and intestinal architecture.
The effects of malnutrition on the gastrointestinal tract have been previously investigated in animal models using dietary protein restriction. Because malnutrition is clinically a consequence of reduced dietary intake of all macronutrients, we investigated the effect of restricting a balanced diet on intestinal disaccharidases and histologic conditions of rats. Our diet-restricted animals gained less weight (13 +/- 9 gm) than the control animals (158 +/- 27 gm) over the 5-week study. The proximal, middle, and distal small intestinal segments from the experimental animals had reduced mucosal protein content (15 +/- 4 mg vs. 24 +/- 7 mg). In these segments the total amount of maltase was slightly decreased, whereas sucrase and lactase activities were normal or increased. The intestinal villus/crypt ratios were similar in the experimental and control animals. Mucosal cell height was significantly reduced in the diet-restricted groups; however, cell width was normal. We conclude that severely diet-restricted animals have mucosal protein loss caused in part by reduced cell height, but that the disaccharidase enzyme activities are normal. Diet-restricted animals appear to have sufficient intestinal enzymes to support a normal amount of disaccharide hydrolysis.
Animals↗
Effect of moderate prolonged ethanol ingestion on intestinal disaccharidase activity and histology.
A previous study has shown that long-term feeding of ethanol in high doses (36% of total calories) causes marked changes in intestinal mucosal disaccharidase activity as well as blunting of the intestinal villi. To determine whether similar damage occurs in response to a more moderate ethanol exposure, we pair fed rats a liquid diet that provided 15.5% of total calories from ethanol for 5 weeks. In the proximal segment of the intestine, we found that ethanol did not affect the total activities of maltase (8.0 +/- 2.4 U vs. control value of 6.7 +/- 1.8 U), sucrase (1.5 +/- 0.5 U vs. control of 1.2 +/- 0.3 U), or lactase (125 +/- 42 mU vs. control of 107 +/- 36 mU). Similarly, we found no differences from control values for the three disaccharidases in the middle or distal small bowel. The mucosal protein content of the experimental animals did not differ from values found in the control animals. In addition, no change in intestinal villus height or crypt depth was detected. The zinc content of hair and serum was not affected by the ethanol feeding. We conclude that prolonged ingestion of a moderate dose of ethanol does not damage the small intestinal disaccharidase enzymes, mucosal protein content, or intestinal architecture.
Animals↗
Does zinc deficiency affect intestinal protein content or disaccharidase activity?
Zinc deficiency has been associated with impared carbohydrate absorption in patients with intestinal disease; however, it is not known whether the carbohydrate malabsorption is caused by the zinc abnormality. Because zinc is needed for protein synthesis, we investigated the effect of zinc deficiency on the total and specific activities of the intestinal glycoprotein disaccharidases. We found that zinc deficiency impairs total body growth and causes marked reductions in intestinal mucosal protein content and disaccharidase activity. However, the protein content and disaccharidase activities were reduced to a similar degree, and both were proportional to the final total body weight. We also found zinc deficiency to have no effect on intestinal villus height or crypt depth. We conclude that zinc deficiency inhibits somatic growth but does not disproportionately affect intestinal mucosal protein content, disaccharidase activity, or intestinal architecture.
Animals↗
A new technique for ileoanal and coloanal anastomosis.
The following report includes a description of the technical details of a new surgical method for the total removal of the rectum while preserving the anal sphincter function. Seventeen patients including 11 patients with rectal carcinoma, two with diffuse polyposis involving the rectum, three with ulcerative colitis, and one with Crohn's disease of the colon and rectum have undergone operation by this method in the last 4 years. Clinical follow-up (mean 22 months) of these patients has demonstrated normal and continence for feces and gas. Postoperative manometric and electromyographic studies have also shown adequate sphincteric function. This method could be carried out either on patients in whom the total removal of the rectum is indicated or in patients with previous ileostomy or colostomy and a remaining rectal stump unsuitable for direct anastomosis.
Adult↗
Endoscopic control of upper gastrointestinal hemorrhage with a bipolar coagulation device.
It has been difficult to determine the real efficacy of endoscopic treatment for upper gastrointestinal tract bleeding sites for several reasons. First, since 80 per cent of an unselected group are expected to stop bleeding spontaneously, it is important to focus upon those individuals who continue to bleed instead of a group in whom bleeding would have stopped spontaneously in the majority. Second, it is difficult, if not impossible, to have comparable groups of patients with similar lesions and similar rates of bleeding who can be randomized into different treatment groups. This report describes the use of a bipolar endoscopic coagulation device in 28 patients with active massive upper gastrointestinal tract hemorrhage who represent 10 per cent of the patients with hemorrhage during a one year interval. Endoscopic treatment controlled bleeding initially in 23 of these patients. Another eight patients with recent hemorrhage who were at high risk for recurrent bleeding (visible vessels) had endoscopic coagulation without subsequent hemorrhage. Immediate operations were required in five of the 28 and delayed operations in another four. Mortality in the patients treated by endoscopic or surgical therapy was comparable (20 per cent), but no patient died of hemorrhage. The high mortality in this group of patients is explained by associated illnesses. B-C is as effective as other endoscopic treatments for nonvariceal sources of upper gastrointestinal tract hemorrhage. This modality is relatively cheap compared with other devices, is theoretically less complicated and has minimal risk to the individual patient. Because of these considerations, it is a technique which deserves wider application and may become the endoscopic treatment of choice for control of upper gastrointestinal tract hemorrhage. Patients with endoscopic control of upper gastrointestinal tract bleeding avoid perioperative morbidity, have a lower transfusion requirement and may have a shorter hospital stay than comparable individuals who require operative control of bleeding sites.
Clinical Trials as Topic↗
Vitamin E status in Italian children subsisting on a Mediterranean diet.
Serum vitamin E levels and food intake of 83 Italian children subsisting on a 'Mediterranean-type' diet were measured. Total fat intake was 66 g/d and polyunsaturated fatty acids (PUFA) intake was 7.6 g/d. The dietary ratio of polyunsaturated to saturated fatty acids (P/S) was 0.30. Vitamin E intake was estimated to be about 4.5 mg/d and the theoretical requirement, calculated on the basis of their PUFA intake was 4.6 mg/d. The mean serum concentration of vitamin E was found to be 1.02 mg/dl which is similar or higher than reported by others. No correlation was found between serum level of vitamin E and total or HDL cholesterol, while a slightly significant correlation was found between PUFA intake and serum vitamin E. We conclude that the Mediterranean type of diet, characterized by a relatively low P/S ratio and PUFA content, provides a satisfactory vitamin E status.
Body Height↗