Interleukin-10 attenuates proinflammatory cytokine production and improves survival in lethal pancreatitis.

Given that interleukin (IL)-10 (IL-10) serves as a potent down-regulator of specific proinflammatory cytokines we reasoned that its administration should improve outcome in situations in which the biological response to a severe inflammatory challenge is the critical determinant of survival. To test our hypothesis we administered IL-10 in the setting of lethal pancreatitis to determine its effect on proinflammatory cytokine production and survival. We divided Sprague-Dawley rats into three groups. Controls (Group 1, n = 5) received a sham laparotomy. We induced pancreatitis in Group 2 (n = 9) and Group 3 (n = 9) via laparotomy and intrapancreatic infiltration of one mL of 5 per cent sodium taurocholate. Group 2 was treated only with saline, whereas Group 3 was treated with 10,000 units of IL-10 (in saline) at 30 minutes, 3.5 hours, and 6.5 hours after induction of pancreatitis. Serial blood samples were obtained at 6.5 hours for measurement of amylase, IL-1, and IL-6. The Kaplan-Meier method, Wilcoxon test, and Student's t test were used for analysis. Seven-day survival was 100, 0, and 45 per cent in Groups 1, 2, and 3, respectively. Production of amylase, IL-1, and IL-6 was lower in the IL-10-treated group (Group 3) compared with the group treated with saline alone (Group 2, P < 0.05). We conclude that administration of IL-10 in the setting of otherwise 100 per cent lethal experimental pancreatitis significantly reduces production of amylase, IL-1, and IL-6 and improves survival.

The therapeutic advantages of a balanced nutritional support system.

Twenty-two critically ill patients were entered into a 21-day prospective study to evaluate the feasibility of relying on a balanced nutritional support system to satisfy the needs of a diverse group of surgical patients. No patient sustained a serious complication related to glucose metabolism, and only two patients required insulin. Twenty-one of the patients achieved positive nitrogen balance during the study, and 13 had a significant weight gain not related to water retention. Documented sepsis was present in 50% of the patients but in spite of this, 91% had a successful course of therapy. The ease of management and metabolic efficiency of this approach encourages the use of fat as a primary energy substrate in a balanced nutritional support system to restore positive energy and nitrogen balance.

Anabolic steroid administration during nutritional support: a therapeutic controversy.

Nitrogen balance was determined in 48 patients who were entered into a randomized prospective double-blind study, comparing anabolic steroids versus placebo in our parenteral nutritional support system. The group included both young and old patients suffering from catabolic illnesses, in whom intravenous feeding ranged from 14-21 days. All participants received the active agent or placebo biweekly throughout the study. During the period of intravenous nutrition, there was statistically significant difference in nitrogen balance and protein conservation in the patients receiving the active agent.

Effects of dietary supplements of wheat bran and cellulose on faeces and bowel function.

In a study of bowel function in normal subjects wheat bran or cellulose was added to the diet for four weeks (16 g/day). Stool weight increased. Intestinal transit time did not significantly alter. Faecal bile acids did not increase but were diluted. It seems that the effect of these materials is to produce a bulky stool and that any symptomatic benefit they produce is secondary to this.