Proposal of a new formula to calculate total urinary nitrogen from urea urinary nitrogen.

Urea urinary nitrogen (UUN) and total urinary nitrogen (TUN) were determined in 15 patients to study their relationship mainly in highly catabolic patients. The subjects were: 7 multiple trauma, 3 autologous bone-marrow transplant, 1 tetanus, 4 postcholecystectomy patients; 180 determination were made, 111 of which in highly catabolic phase (TUN > 15 g/day). TUN and UUN are well correlated (r = 0.9742; p < 0.001) in the range 3 to 52 g/ day of TUN. Urea represents the 83.2 +/- 9.4% (M +/- SD). A double-linear formula to calculate TUN from UUN is proposed (for UUN 15 g/ day: TUN = UUN x 1.17 + 0.7; for UUN > 15 g/ day: TUN = UUN + 4). The least square procedure was used to compare the differences between measured and calculated TUN, and the results obtained with the proposed double-linear formula were compared with that obtained employing pre-existing formulas (Lee's and Mackenzie's). Considering all ranges of values studied (3-52 g of TUN) the results obtained were significantly different (p < 0.005); dividing the levels of TUN in 15 g; 16-29 g and 30 g, the results were always better, but the statistical significancy was not always reached.

[Estimation of total body water from routine urea kinetics]. / La stima dell'acqua corporea totale per la cinetica dell'urea di routine.

The comparison of total body water obtained by Watson formula with results of bioelectrical impedance (BIA) shows a fair approximation (Delta% = 1.0 +/- 8.45). However, when compared to other literature formulas the BIA values are higher (8 divided by 23%), and this discrepancy needs further analysis. Urea kinetics was computed using as input data for distribution volume both the Watson anthropometrical and the BIA TBW values: the clearance results do not differ significantly (Delta% = 0.74 +/- 8.35). The Kt/V index results are nearly identical (Delta% = 0.12 +/- 1.17), due to a mathematical loop: a wrong input of volume induces a comparable error of the clearance result, while their ratio is unchanged. For practical routine to monitoring dialysis adequacy the Watson anthropometrical formula has proven as a satisfactory simple approach. Periodical BIA determination provides useful informations mainly when the anthropometrical estimation are doubtful and the comparison of data may increase the kinetic reliability.

[Trace nutrients in total enteral nutrition: the basal status and longitudinal course]. / Oligonutrienti in nutrizione enterale totale: stato basale e andamento longitudinale.

INTRODUCTION: Previous studies demonstrated deficiencies of selenium and other micronutrients in patients receiving total enteral nutrition (TEN). The content and bioavailability of trace elements in enteral formulas can be suboptimal. MATERIAL AND METHODS: Basal blood levels of some trace elements (copper, iron, selenium, zinc) and vitamins (B12, folic acid) were determined in twenty patients at the beginning of TEN. Vitamin E was measured in 7 patients. Primary diagnosis was cancer (no. = 13) and organic brain syndromes (no. = 7). Commercially available polymeric and oligomeric enteral formulas were used, containing respectively, as a percent of RDA in 1500 kcal, 65-39% of copper, 180-135% of iron, 80-100% of zinc. Selenium was not indicated; determinations in our laboratory gave a content of 78-63% of the minimum recommended intake. Blood levels of copper and zinc (no. = 6), selenium (no. = 5), iron, transferrin and ferritin (no. = 13) were measured after two months of TEN (mean intake of 30 +/- 3 kcal/kg/day). Copper, selenium and zinc were measured with atomic absorption; iron with the complessometric method: vitamin B12 and folic acid with RIA; vitamin E with HPLC. RESULTS: Mean values, expressed as mean +/- SD (range) were: copper: 129 +/- 23 (82-300) micrograms/dl; iron: 37 +/- 18 (16-89) mg/dl; selenium: 53 +/- 20 (22-93) micrograms/dl; zinc: 85 +/- 34 (44-185) micrograms/dl; vitamin B12: 632 +/- 450 (140-1575) pg/ml); vitamin E: 5.4 +/- 1.5 (3.3-7.8) mg/dl; folic acid: 11 +/- 8 (2-20) ng/ml. Values below the lower normal limit were found in 100% (vitamin E), 89% (selenium), 60% (iron), 35% (zinc), 24% (vitamin B12) and 14% (folic acid) of the patients studied. Copper was higher than the upper normal limit in 31% of cases; no data below normal range was found. Mean blood levels of depleted subjects were at the 28%, 43%, 54% and 63% of the mean normal value respectively for iron, selenium, vitamin E and zinc. Blood iron (p < 0.05) and selenium (p < 0.001) were significantly lower in more malnourished patients (weight loss > 20% vs < 20% on usual body weight). After two months of TEN, a reduction of 33% of mean blood selenium was observed in 4 of 5 patients studied. Blood copper and zinc remained stable in 6 subjects with initial normal or higher than normal values. Blood iron increased nonsignificantly, ferritin remained stable, transferrin increased significantly (p < 0.05). No clinical deficiency syndromes were observed. CONCLUSIONS: A careful monitoring of micronutrients during TEN is recommended. Selenium content of enteral formulas, unless supplemented by the producers, seems to be insufficient to maintain the initial blood level in two months of TEN.

[Nutritional assessment of aged patients with fractures of the proximal epiphysis of the femur]. / Valutazioni nutrizionali in pazienti anziani con frattura dell'epifisi prossimale del femore.

Forty-two patients (M/F 9/33; age 78 +/- 10 years) were studied during Hospital stay for femoral neck fractures (16 neck, 26 pertrochanteric fractures). All underwent fracture surgery (internal fixation in 30, arthroplasty in 12 patients). Food intake was evaluated daily, supplemented with specific recipes. Biochemical assessment of nutritional status (hemoglobin, hematocrit, total proteins, albumin, prealbumin, Na, K, Ca, Fe, P, Mg) was performed before and after surgery. Nitrogen balance was evaluated in 8 patients in the post-operative period (40 determinations). The study group was compared for post-surgical complications and mortality during Hospital stay with a historical control group without any nutritional survey. Mean daily caloric intake was (M +/- DS) 1014 +/- 360 in the preoperative period, 960 +/- 210 and 1036 +/- 185 postoperatively (5-9 and 10-15 days post-surgery, respectively). Mean nitrogen intake was, respectively, 7.5 +/- 2.6, 7 +/- 2.1, 6.9 +/- 1.6 gN/day. No significant differences were found. In the preoperative period, the following tests were found below the normal range: iron (median 30 micrograms/dL), albumin (median 3.1 g/dL), hemoglobin (median 12 g/dL) hematocrit (median 35%). After surgery, they decreased significantly; also prealbumin, in normal limits before surgery (20 +/- 0.7 mg/dl), decreased significantly 5-9 days after surgery. After 10-15 days from surgery, only prealbumin and iron reached the preoperative level.(ABSTRACT TRUNCATED AT 250 WORDS)

[Aneurysm of the splenic artery. A clinical case and review of the literature]. / Gli aneurismi dell'arteria splenica. Caso clinico e revisione della letteratura.

The Authors report a case of splenic artery aneurysm (ASA) in a 64 years old woman. Most of patients affected by ASA are asymptomatic. Rupture represents a rare complication with high mortality rate. Finally the clinical, etiopathogenetic and anatomo-pathological aspects are considered.