CONSIDERATIONS OF POSTOPERATIVE ELECTROLYTE AND FLUID REPLACEMENT

The most important postoperative fluid considerations are maintenance of adequate urinary output, of blood volume, and of extracellular and interstitial cell water and electrolytes.Normal urinary output is between 1,000 and 1,500 cc. daily. A fluid intake of 2,000 cc. of 5 per cent dextrose in distilled water, plus 500 cc. of normal saline solution, will insure this amount of urinary output.The use of 5 per cent dextrose solutions in distilled water provides fluid, retards the protein catabolism of the body, and spares electrolytes.Irradiated plasma is the only intravenous solution which will adequately supply protein in amounts to maintain nitrogen equilibrium. Protein hydrolysates in the absence of adequate caloric intake do not provide enough protein for nitrogen balance.The role of the potassium ion is ordinarily not a consideration in postoperative fluid management. It becomes a consideration in the presence of a large amount of drainage from wounds or abscess cavities, nasogastric suction, or intestinal fistulae. It also must be given attention in cases in which parenteral administration of fluids is necessary for a prolonged period.     

INTRAVENOUS NUTRITION—A Clinical Evaluation of a 50 Per Cent Dextrose in Water Solution,Containing 1 mg. of Hydrocortisone per 100 ml

A 50 per cent dextrose in water solution, containing 1 mg. of hydrocortisone per 100 ml., was used successfully in 70 patients for intravenous nutritional maintenance and repletion. There were no adverse systemic effects during or following 216 infusions. The only undesirable local reaction was the rare occurrence of pain in the arm when the concentrated solutions were given too rapidly. Glycosuria was minimal if the infusion rate did not exceed 0.85 gm. of glucose per kilogram of body weight per hour, particularly if 50 units of insulin were added to each 550 ml. bottle of 50 per cent dextrose. In patients without significantly elevated serum potassium content, 30 mEq. of potassium chloride, acetate or phosphate was added to each bottle to prevent hypokalemia.Preliminary observations suggest that this new solution may be given safely intravenously, without need for cutdowns or plastic catheters, if the needle is carefully inserted and well immobilized in the arm vein and the duration of the infusion is not too prolonged. Further studies on the effect of such high caloric supplementation plus protein hydrolysates in parenteral nutritional repletion and maintenance are indicated.     

THE TREATMENT OF METASTATIC BREAST CANCER IN BONE

The author report clinical experience with 212 cases of mammary cancer metastatic to bone, in 186 of which radiotherapy was given, and in 26 steroid hormone therapy.At least 70 per cent of patients with bone metastasis from breast cancer were relieved of pain by adequate roentgen therapy, the relief lasting for most of the survival time in many instances.About 25 per cent of patients had recalcification or reossification of bony lesions with roentgen therapy; while dramatic, this is not always an indication that relief of pain will continue or that survival time will be lengthened.If and when adequate radiotherapy has not been effective or cannot be administered (for example, in a patient with extremely widespread metastasis, or one residing at a considerable distance from radiotherapeutic service) steroid hormone therapy in adequate dosage is frequently beneficial. From 40 per cent to 75 per cent of patients with bone metastases from breast cancer are relieved of pain by steroid hormone therapy. In about 15 per cent of cases recalcification of the lesion occurs.Effective roentgen therapy may usually be given in a relatively brief period of time (one to two weeks). Effective steroid hormone therapy usually requires from 12 to 24 weeks.Complications of steroid hormone therapy are numerous. Some patients are made considerably worse by such therapy. These complications may only be controlled by reduction or discontinuation of the hormones. For this reason, it is recommended that irradiation always be used as the initial method of palliation.     

Effects of antioxidant vitamins A, C, E and trace elements Cu, Se on CuZn SOD, GSH-Px, CAT and LPO levels in chicken erythrocytes

The biologically damaging effects of reactive oxygen species are controlled in vivo by a wide spectrum of antioxidant defence mechanisms. Dietary constituents of antioxidant vitamins and trace elements may play an important role in protecting against oxidant damage. The effects of supplementation of vitamins A, C, E and trace elements Cu and Se on the activities of antioxidant enzymes and lipid peroxide levels in chicken erythrocytes were investigated depend on the time. CuZnSOD activity and plasma Cu levels in the Cu group were increased by 39 and 37 per cent respectively. CuZnSOD activity in vitamin C groups was also increased by 20 per cent. The GSH-Px activity in Se, Se+E and Se+Cu groups was raised by 35, 46 and 69 per cent respectively. Also, the GSH-Px activity in the vitamin C group was increased by 33 per cent. Catalase activity in all of these groups was not significantly different when compared with controls (p<0.01). The maximum decrease in LPO levels of 42 per cent was obtained for the Se+E group.     

The Carbohydrate Nutrition of Tomato Roots: VI. The Inhibition of Excised Root Growth by Galactose and Mannose and its Reversal by Dextrose and Xylose

The addition of 0.01–0.015 per cent. galactose or 0.005–0.01per cent, mannose reduces by 50 per cent, the linear growthof excised tomato roots cultured in a I per cent, sucrose medium.An addition of 0.03–0.04 per cent, of either sugar causesnot less than a 90 per cent, inhibition of growth. The survivalof meriste-matic activity is higher in presence of fully inhibitoryconcentrations of mannose than of galactose. Roots inhibitedby galactose are distinguishable from those inhibited by mannose. The inhibitory effect of concentrations of galactose up to 0.15per cent, and of mannose up to 0.4 per cent, can be fully antagonizedby the simultaneous addition to the culture medium of dextrose.The minimum ratio of dextrose: inhibitory sugar for maximumantagonism of the growth inhibition is with galactose 5: 1 andwith mannose 3.5: 1. Growth of roots in a dextrose-containingmedium does not protect them from subsequent inhibition by eithergalactose or mannose. d-xylose has significant activity as an antagonist of mannoseinhibition and even more so of galactose inhibition. However,the restoration of growth achievable from the addition of xyloseis not comparable with that resulting from the addition of dextrose.The inhibition of growth by xylose is not alleviated by thesimultaneous addition of dextrose. Maltose has low activityas an antagonist of galactose and mannose inhibition. All othersugars tested and the sugar alcohols corresponding to galactoseand mannose were quite inactive as antagonists of the growthinhibition by these two sugars. Mixtures of partially inhibitory concentrations of galactoseand mannose were less inhibitory than their more inhibitorycomponent. The concentration of dextrose required to reversethe inhibitory activity of such mixtures was not greater thanthe minimum concentration required to antagonize the actionof the more inhibitory component. The antagonism of galactose inhibition by dextrose is not dueto dextrose impeding galactose uptake.     

Free oxygen radical-induced lipid peroxidation and antioxidant in infants receiving total parenteral nutrition

OBJECTIVE: Increased oxygen-derived free radical activity has been reported during total parenteral nutrition (TPN) in infants particularly linked to the fat infusion. It is possible that partial enteral feeding can ameliorate some of the complications of TPN. By this study we aimed to investigate free radical formation and antioxidant activity in term and preterm infants during TPN and/or enteral feeding. STUDY DESIGN: We had 6 groups of term and preterm infants made up of 10 patients each. Group I had only enteral feeding, Group II enteral plus parenteral feeding, Group III only parenteral feeding. Plasma malondialdehyde (MDA), superoxide dismutase (SOD), vitamin E and vitamin C levels were measured in all infants. Blood samples of infants receiving only TPN and TPN plus enteral feeding were measured on the 1st and 5th days, and 3h after the end of lipid infusion. RESULTS: There was no difference between the term and preterm infants in terms of MDA, SOD, vitamin C and E levels taken baseline and after parenteral, and enteral plus parenteral feeding on the 1st and 5th days. When 3 groups of both term and preterm infants were compared with each other none of the parameters showed a statistically significant difference. In addition, we compared baseline and 1st and 5th days of TPN therapy in both term and preterm infants fed only parenterally and enteral plus parenteral feedings. In term infants fed both parenterally and parenteral plus enterally, the MDA levels before TPN were significantly higher than that of the levels of patients on parenteral nutrition on the 5th day. On the 1st and 5th days of TPN therapy, the levels of vitamin C was significantly decreased, in term and preterm infants fed only parenterally, levels of vitamin E was increased, in term and preterm infants fed both parenterally and parenteral plus enterally. Also, when compared to their base line the SOD levels of the term infants detected on the 1st and 5th days were significantly high. CONCLUSION: Free radical production is increased by the administration of TPN and may be linked to its adverse effects. It may be assumed that long-term complications of preterm infants receiving TPN may be reduced by further strengthening the antioxidant capacities of the TPN solutions.     

Der Vitaminbedarf der Regenbogenforelle (Salmo gairdneri)

The Vitamin Requirements of Rainbow Trout (Salmo gairdneri) A sufficient supply of vitamins is of major importance in Salmonidae feeding. Therefore considerable amounts of vitamins must be added to complete mixed feed for rainbow trout. The author gives a survey of the function of the various vitamins in the organism and describes the vitamin deficiency symptoms found on Salmonidae, especially on rainbow trout. Finally, recommendations are given for the vitaminization of mixed feed for rainbow trout.     

Radical Exchange Reactions between Vitamin E, Vitamin C and Phospholipids in Autoxidizing Polyunsaturated Lipids

Antioxidant reactions of mixtures of vitamin E, vitamin C and phospholipids in autoxidizing lipids at 90°C have been studied by ESR spectroscopy. When the phospholipid contained a tertiary amine (e.g. phosphatidylcholine), the vitamin C and the vitamin E radicals were successively observed as these two vitamins were sequentially oxidised during lipid oxidation. In the presence of the primary amine contained in phosphatidylserine, the vitamin E oxidation was delayed for a few hours. In this case neither the vitamin C, nor the vitamin E radicals but a nitroxide radical derived from the phospholipid was observed. Similar results to those obtained with PS were obtained in the presence of either phospha-tidylethanolamine or soybean lecithin. The participation in the radical reactions of phospholipids possessing a primary amine can therefore explain the synergistic effect of these phospholipids in a mixture of vitamins E and C.     

THE ADMINISTRATION OF ANTICOAGULANTS

Heparin is administered parenterally. Its therapeutic effect is measured by the clotting time of the whole blood, determined by the method of Lee and White. An excessive anticoagulant effect is controlled by the administration of specific antagonists, toluidine blue or protamine sulfate. Dicumarol^* is admintered orally in amounts sufficient to reduce the prothrombin activity of the plasma to between 10 and 30 per cent of normal. The prothrombin time, which represents such a reduction in prothrombin activity, will vary according to the method by which the determination is performed, the thromboplastin used, and the technique followed. Excessive prolongation of the prothrombin time is antagonized by the administration of vitamin K in large doses. Long-term therapy with Dicumarol is sufficiently hazardous to require considerable experience on the part of the physician. Where an immediate anticoagulant effect is necessary, yet prolonged administration anticipated, combined therapy with both heparin and Dicumarol may be used until the prothrombin time is prolonged satisfactorily, whereupon heparin may be discontinued.     

Vitamin production in transgenic plants

Plants are a major source of vitamins in the human diet. Due to their significance for human health and development, research has been initiated to understand the biosynthesis of vitamins in plants. The pathways that are furthest advanced in elucidation are those of provitamin A, vitamin C and vitamin E. There is little knowledge about the regulation, storage, sink and degradation of any vitamin made in plants, or the interaction of vitamin biosynthetic pathways with other metabolic pathways. Researchers as well as life science companies have endeavoured to manipulate levels of vitamins in order to create functional food with enhanced health benefits, and even with the goal of achieving levels worth extracting from plant tissues. Thus far, metabolic engineering has resulted in transgenic plants that contain elevated levels of provitamin A, vitamin C and E, respectively. Additional research is necessary to identify all relevant target genes in order to further improve and tailor plants with elevated vitamin contents at will.     

REACTIONS TO INSECT ALLERGENS—The Incidence of Response to Testing Among Allergic and Nonallergic Persons

Positive reactions to skin tests with extracts of various insects were found to be significantly higher in 200 patients with allergic disease than in 150 nonallergic controls.Forty-seven per cent of the allergic group had positive reaction to bee, 46 per cent to house fly, 39.5 per cent to moth, 29.5 to ant and 28.5 to aphid. Ant and house fly extract caused the greatest number of severe reactions (4+), with moth second and bee third.Because extracts of nonstinging insects caused reaction almost as often and as strong as stinging insects, it may be inferred that sensitization is due to inhaled insect particles. There appeared to be no necessary connection between a history of having been stung and a strong skin test reaction to bee protein.Testing for insect sensitivity appears a good way to get diagnostic information that can enhance the effectiveness of treatment.     

The Carbohydrate Nutrition of Tomato Roots: V. The Promotion and Inhibition of Excised Root Growth by Various Sugars and Sugar Alcohols

Iron is only consistently present in an available form in White'sroot culture medium if the inorganic salts are autoclaved withthe sugar. The substitution of ferric ethylenediamine-tetra-acetatefor the inorganic ferric salt of White's medium ensures ironavailability when the carbon source of the medium is renderedsterile by ether treatment and subsequently added to the remainderof the constituents which have been sterilized by autoclaving. The biological activity of sugars, and particularly of dextroseand laevulose, is altered by autoclaving them in presence ofthe inorganic salt solution of White's medium. The only sugar which supports a considerable growth of excisedtomato roots is sucrose. The activity of this sugar is not affectedby alcohol-precipitation nor is it dependent upon the simultaneouspresence of traces of its constituent mono-saccharides. Dextrose or laevulose or a mixture of the two sugars supporta low but sustained level of excised-root growth. All othersugars and sugar alcohols tested were inactive as carbon sources. The addition of sucrose at low concentration (0–2 percent.) to a medium containing dextrose as the main carbon compounddoes not make possible a level of growth comparable with thatobtained with an adequate sucrose supply. It has not been possibleto enhance the growth-rate of excised roots supplied with dextroseby previous presentation of this sugar under conditions permittingactive growth. Using media containing 'etherized' sucrose anddextrose, no evidence was obtained of any competitive inhibitionof sucrose utilization by dextrose. Certain sugars when added to a medium, containing the optimumconcentration of sucrose₁, markedly inhibited excised root growth.Thus l-sorbose, l- and d-arabinose, and d-xylose caused notless than 80 per cent, inhibition at a concentration of 0-5per cent. d-mannose and d-galactose completely inhibited growthat o-1 per cent. The oligosaccharides, dextrose, laevulose,and the sugar alcohols tested had, by contrast, very low inhibitoryactivity.     

Vitamin Deficiencies in Humans: Can Plant Science Help?

The term vitamin describes a small group of organic compounds that are absolutely required in the human diet. Although for the most part, dependency criteria are met in developed countries through balanced diets, this is not the case for the five billion people in developing countries who depend predominantly on a single staple crop for survival. Thus, providing a more balanced vitamin intake from high-quality food remains one of the grandest challenges for global human nutrition in the coming decade(s). Here, we describe the known importance of vitamins in human health and current knowledge on their metabolism in plants. Deficits in developing countries are a combined consequence of a paucity of specific vitamins in major food staple crops, losses during crop processing, and/or overreliance on a single species as a primary food source. We discuss the role that plant science can play in addressing this problem and review successful engineering of vitamin pathways. We conclude that while considerable advances have been made in understanding vitamin metabolic pathways in plants, more cross-disciplinary approaches must be adopted to provide adequate levels of all vitamins in the major staple crops to eradicate vitamin deficiencies from the global population.     

The vitamin requirements of Thermobacterium acidophilum

Summary The vitamin requirements of Thermobacterium acidophilum have been established. Five vitamins: Folic acid, nicotinic acid, pantothenate, pyridoxine and riboflavin have to be supplied. The vitamin concentrations necessary for the maximal growth were determined.     

INTRAVENOUS ETHER ANESTHESIA

From a study of intravenous ether anesthesia, it was concluded that ether diluted to a 5 per cent solution in 5 per cent dextrose and water may be used to induce and maintain a smooth and easily controlled anesthetic state similar to that obtained with inhalation ether but without the dependence of the latter technique on ventilation. Cough and laryngospasm were absent. Adequate spontaneous respiration can be maintained with this technique. The technique is particularly useful in endoscopy during which the airway is often not available for anesthetic administration.     

Vitamin‐regulated cytokines and growth factors in the CNS and elsewhere

There is a growing awareness that natural vitamins (with the only exception of pantothenic acid) positively or negatively modulate the synthesis of some cytokines and growth factors in the CNS, and various mammalian cells and organs. As natural vitamins are micronutrients in the human diet, studying their effects can be considered a part of nutritional genomics or nutrigenomics. A given vitamin selectively modifies the synthesis of only a few cytokines and/or growth factors, although the same cytokine and/or growth factor may be regulated by more than one vitamin. These effects seem to be independent of the effects of vitamins as coenzymes and/or reducing agents, and seem to occur mainly at genomic and/or epigenetic level, and/or by modulating NF‐κB activity. Although most of the studies reviewed here have been based on cultured cell lines, but their findings have been confirmed by some key in vivo studies. The CNS seems to be particularly involved and is severely affected by most avitaminoses, especially in the case of vitamin B₁₂. However, the vitamin‐induced changes in cytokine and growth factor synthesis may initiate a cascade of events that can affect the function, differentiation, and morphology of the cells and/or structures not only in the CNS, but also elsewhere because most natural vitamins, cytokines, and growth factors cross the blood–brain barrier. As cytokines are essential to CNS‐immune and CNS‐hormone system communications, natural vitamins also interact with these circuits. Further studies of such vitamin‐mediated effects could lead to vitamins being used for the treatment of diseases which, although not true avitaminoses, involve an imbalance in cytokine and/or growth factor synthesis.     

Vitamin neurotoxicity

Vitamins contain reactive functional groups necessary to their established roles as coenzymes and reducing agents. Their reactive potential may produce injury if vitamin concentration, distribution, or metabolism is altered. However, identification of vitamin toxicity has been difficult. The only well-established human vitamin neurotoxic effects are those due to hypervitaminosis A (pseudotumor cerebri) and pyridoxine (sensory neuropathy). In each case, the neurological effects of vitamin deficiency and vitamin excess are similar. Closely related to the neurological symptoms of hypervitaminosis A are symptoms including headache, pseudotumor cerebri, and embryotoxic effects reported in patients given vitamin A analogs or retinoids. Most tissues contain retinoic acid (RA) and vitamin D receptors, members of a steroid receptor superfamily known to regulate development and gene expression. Vitamin D3 effects on central nervous system (CNS) gene expression are predictable, in addition to the indirect effects owing to its influence on calcium and phosphorus homeostasis. Folates and thiamine cause seizures and excitation when administered in high dosage directly into the brain or cerebrospinal fluid (CSF) of experimental animals but have rarely been reported to cause human neurotoxicity, although fatal reactions to i.v. thiamine are well known. Ascorbic acid influences CNS function after peripheral administration and influences brain cell differentiation and 2-deoxyglucose accumulation by cultured glial cells. Biotin influences gene expression in animals that are not vitamin-deficient and alters astrocyte glucose utilization. The multiple enzymes and binding proteins involved in regeneration of retinal vitamin A illustrate the complexity of vitamin processing in the body. Vitamin A toxicity is also a good general model of vitamin neurotoxicity, because it shows the importance of the ratio of vitamin and vitamin-binding proteins in producing vitamin toxicity and of CNS permeability barriers. Because vitamin A and analogs enter the CNS better than most vitamins, and because retinoids have many effects on enzyme activity and gene expression, Vitamin A neurotoxicity is more likely than that of most, perhaps all other vitamins. Megadose vitamin therapy may cause injury that is confused with disease symptoms. High vitamin intake is more hazardous to peripheral organs than to the nervous system, because CNS vitamin entry is restricted. Vitamin administration into the brain or CSF, recommended in certain disease states, is hazardous and best avoided. The lack of controlled trials prevents us from defining the lowest human neurotoxic dose of any vitamin. Large differences in individual susceptibility to vitamin neurotoxicity probably exist, and ordinary vitamin doses may harm occasional patients with genetic disorders.(ABSTRACT TRUNCATED AT 400 WORDS)     

Gestation linked radical oxygen species fluxes and vitamins and trace mineral deficiencies in the ruminant

In mammals, radical oxygen species (ROS) are essential factors of cell replication, differentiation and growth (oxidative signal), notably during gestation, but are also potentially damaging agents. In Women, ROS play a role in remodeling of uterine tissues, implantation of the embryo, settlement of the villi and development of blood vessels characteristic of gestation. The body stores of vitamins and minerals of gestating females are used to keep ROS fluxes at a level corresponding to oxidative signals and to prevent an imbalance between their production and scavenging (oxidative stress), which would be detrimental to the mother and fetus. There is some evidence that, although based on different regulatory mechanisms, most of the effects of ROS reported in humans also occur in pregnant ruminant females, some of which have been actually reported. Many vitamins and trace elements have dual effects in the organism of mammals: (a) they are involved in the control of metabolic pathways or/and gene expression, (b) but most of the time they also display ROS trapping activity or their deficiencies induce high rates of ROS production. Deficiencies induce different disorders of gestation and can be induced by different kinds of stress. An example is given, corresponding to the decreased contents of cobalt of forages, when exposed to sustained heavy rains, so that the supply of vitamins B12 to the organism of the ruminant that grazes them is reduced and failure of gestation is induced. Outdoor exposure of ruminants to adverse climatic conditions by itself can increase the vitamin and trace element requirements. Adaptation of production systems taking into account these interactions between gestation and sources of stress or change of the quality of feeding stuffs as well as further developments of knowledge in that field is necessary to promote sustainable agricultural practices.     

Production of lactic acid by Lactobacillus rhamnosus with vitamin-supplemented soybean hydrolysate

Batch fermentation studies were performed to evaluate the potentials of a complex nitrogen source, soybean, as an alternative to yeast extract for the economical production of lactic acid by Lactobacillus rhamnosus. An enzyme-hydrolysate of soybean meal, Soytone, with an adequate supplementation of vitamins was found to be highly effective in supporting lactic acid production from glucose and lactose. The effects of seven selected vitamins: d-biotin, pyridoxine, p-aminobenzoic acid, nicotinic acid, thiamine, pantothenic acid, and riboflavin, on cell growth and lactic acid production were investigated to provide the basis for the optimization of vitamin supplementation to minimize the cost. Pantothenic acid was the most required compound while the other six vitamins were also essential for high lactic acid productivity. As a result of the optimization, 15 g/l yeast extract could be successfully replaced with 19.3 g/l Soytone supplemented with the vitamins, resulting in a production of 125 g/l lactic acid from 150 g/l glucose. The volumetric productivity and lactate yield were 2.27 g/l/h and 92%, respectively, which were higher than those with 15 g/l yeast extract. The raw material cost was estimated to be 21.4 cent/kg lactic acid, which was only approximately 41% of that with yeast extract.     

The role of vitamins in the prevention and treatment of thyroid disorders

Although vitamin deficiencies are uncommon in Poland or other developed countries, many patients take vitamin supplements. Despite the widespread availability of vitamins and the universal belief that vitamins offer health benefits, few publications have addressed their role in the prevention and treatment of thyroid diseases. There is some evidence to suggest that the administration of vitamins with anti-oxidant properties in patients with hyperthyroidism can decrease the severity of clinical symptoms, and that vitamin D supplementation can have a beneficial effect on the bone system for these patients. It has also been suggested that patients with autoimmune thyroid diseases should be periodically screened for vitamin B12 deficiency. There has been no data to support vitamin supplementation in the primary or secondary prevention of thyroid malignancies.