Current concepts in nutrition: enteral tube feeding.
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Biomedical subjects
Publications and source records attributed to S R Newmark.
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Five obese women were studied before and at the end of a prolonged fast to determine the effect on luteinizing hormone (LH) and follicle-stimulating hormone (FSH) and on the response to luteinizing hormone--releasing factor (LRF). Although baseline serum LH values declined from a mean value of 9.1 to 6.5 m.I.U. per milliliter measured at the end of the fast, these changes in mean serum level were not statistically significant. However, the integrated LH secretion did decline when measured at the end of the fasts (p less than 0.05). FSH secretion did not change. LRF-stimulated LH and FSH values showed augmented stimulation at the end of the fast. Pulsatile gonadotropin secretion patterns remained normal. Prolonged fasting appears to alter the baseline LH secretion and the pituitary response to exogenous LRF.
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The authors evaluated the gonadotropin-testosterone-estradiol profiles of four homosexual men and four heterosexual men by a multiple-sampling technique. Although there was extensive overlap between the two groups, the homosexual subjects had higher estradiol levels than the heterosexuals (70.3 +/- 19.8 versus 56.8 +/- 10.7 pg/ml) and lower FSH values (5.1 +/- 1.0 versus 13.2 +/- 3.4 mIU/ml). Testosterone and luteinizing hormone levels were comparable in the two groups. These observations suggest that there may be subtle differences in gonadotropin and estradiol secretion in homosexual subjects that can be detected only by repeated sampling.
Twenty-seven patients with nonpuerperal breast secretion were evaluated for the presence of casein and lactose in the secretions. Only two of seven patients with brownish or greenish secretions were positive for both lactose and casein although an additional six patients were positive for casein alone. Two patients with clear breast secretions were positive for both casein and lactose. However, 16 of 17 patients with milky or white secretions were positive for both casein and lactose. Although casein and lactose are more likely to be present in white breast secretions, other types of breast secretions may also contain these constituents.
A 20-yr-old female with congenital lipoatrophic diabetes was studied, with the following findings: (1) Serum insulin levels increased after both oral glucose and intravenous arginine administration; there was no growth hormone response to the latter. (2) The infusion of insulin (0.1 units and 0.5 units/kg) during the fed state and following at 110-hr fast produced only minimal changes of various fuels measured, with the exception of a decrease in the branched-chain amino acids. (3) There was a minimal production of ketones during the 110-hr fast. (4) Matabolic expenditure was markedly increased during the postabsorptive state (65-75 kcal/hr/sg m); it fell into the normal range during the 110-hr fast (31-35 kcal/hr/sq m). (5) Following meals, the patient experienced complaints ranging from cold and shivering to feeling hot with gross diaphoresis. These findings were associated with intermittent lability of her skin temperature, which varied 1 degree - 2 degrees F during a 3-hr period. (6) Progressive increases in doses of regular insulin before each meal resulted in up to a total of 9000 units/day being required before normal blood glucose levels were achieved. (7) A 2-wk therapeutic trial of pimozide provided no significant changes in a variety of hormones and fuels in the basal state or following insulin perturbations. (8) A variety of pituitary hormones and pituitary target organ hormones were studied in both the hypothyroid (Hashimoto's thyroiditis) and euthyroid state (following thyroid replacement). All the hormone responses were normal except that growth hormone did not rise during the slow wave sleep in either thyroid state.
Peripheral blood levels of testosterone, estradiol, luteinizing hormone, and follicle-stimulating hormone and the metabolic clearance rates of testosterone and estradiol, as well as the peripheral conversion of testosterone into estradiol, were measured in 16 patients with hypertension. Six of these patients were treated with spironolactone and developed gynecomastia. The other 10 patients served as control subjects. The blood testosterone level in the spironolactone-treated group (2.7 +/- 0.5 ng/ml) was significantly less (P less than 0.02) than in the control group (4.4 +/- 0.4 ng/ml). On the other hand, blood estradiol levels in the spironolactone group (30 +/- 4 pg/ml) were significantly greater (P less than 0.01) than in the control group (13 +/- 2 pg/ml). These changes were primarily due to significant increases in the metabolic clearance rate of testosterone (P less than 0.02) and in the rate of peripheral conversion of testosterone into estradiol (P less than 0.001) in the spironolactone-treated group. Thus, spironolactone does alter the peripheral metabolism of testosterone resulting in changes in the ratio of testosterone to estradiol, which could contribute to the production of gynecomastia.
To investigate the possible occurrence of partial 11- or 21-hydroxylase deficiences in acne, an androgen-dependent disorder, 11 women with chronic nodulocystic acne were subjected to a 24-hr infusion of ACTH and their urine analyzed for tetrahydro S and pregnanetrio. The results obtained were compared to those found in 8 control women. Seven of the patients exhibited elevated excretion of either tetrahydro S or pregnanetriol, probably indicative of partial 11- or 21-hydroxylase deficiencies, respectively.
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Lipoproteins and lipoprotein profiles were determined in 96 adult nephrotic patients. The serum cholesterol-serum albumin, serum triglycerides-serum albumin and 24-hour urine protein loss-serum albumin values were all significantly inversely correlated. The serum triglycerides and serum cholesterol levels were not significantly lower in the group of lupus nephrotic patients compared to the nonlupus nephrotics. All lipoprotein types except type I were observed. The lipoprotein types fell into three nearly equal groups--IIa, IIb, and V. Type IV, the most common lipoprotein abnormality in uremic patients, was distinctly uncommon.
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