Advanced emphysema with bronchitis is associated with significant weight loss and malnutrition, the true cause of which has not been clearly identified. The purpose of this exploratory study was to compare plasma amino acids and related compounds and catecholamines in a group of patients with advanced end-stage emphysema with a control group of similar age and sex in an effort to further understand this malnourished state. Fasting blood samples were obtained by venipuncture after a rest period. Plasma amino acid levels were determined by ion exchange high pressure liquid chromatography with fluorometric detection. Plasma catecholamines were determined by radioenzymatic analysis. Anthropometric measurements, the usually accepted biochemical markers of nutrition, dietary analysis, pulmonary function tests, and a historical analysis of the state of health including drug use and smoking history in each subject were analyzed. Ages and heights were comparable, whereas weights were significantly decreased in the patients with emphysema. Total serum protein and serum albumin values were significantly lower in the patient group. Significant respiratory muscle weakness was indicated by reduced negative inspiratory force in these end-stage patients, contrasting with well-preserved muscle strength usually found in obstructive lung disease. The dietary caloric intake of the patients was comparable to that of the control subjects. We conclude that the fine balance of the amino acid pool in patients with bronchitis and emphysema is well preserved, except for significant elevations of aspartic acid, glutamine, and cystine, and a decreased level of leucine. In addition, norepinephrine levels were significantly increased. Weight loss in patients with emphysema and bronchitis is likely due to increased energy demands related to hypermetabolism.
We analyzed long-term trends in the incidence of a first acute myocardial infarction and in case-fatality rates among employees of the Du Pont Company from 1957 through 1983. A steady decline in incidence was observed among male employees. The annual age-adjusted rate in the 1957-1959 period was 3.19 per 1000, as compared with 2.29 per 1000 in the 1981-1983 period--a decline of 28.2 per cent. The rate of decline was higher among salaried (white-collar) employees than among production workers receiving hourly wages. No trend was seen among female employees, but the number of cases may have been to small to detect a decline. Beginning in 1969, the 24-hour case-fatality rate showed a moderate decline, but after 1975, there was a sharp drop in the 30-day case-fatality rate among persons who survived 24 hours after the attack. These declines did not begin until several years after the decline in incidence had begun. This study and others suggest that improved medical care probably made some contribution to the decline in mortality associated with coronary heart disease, but the major source of the decline has been a reduction in the incidence of the disease.
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