N-Acyl-methionine derivatives have been proposed as replacements for methionine in supplementing food products low in this amino acid. We studied the effects of N-acetyl-L-methionine, N-acetyl-D-methionine and L-methionine loads (2 mmol/kg body weight) on portal and vena caval plasma amino acid concentrations in young pigs (n = 4). L-Methionine loading significantly increased mean (+/- SD) portal and vena caval plasma methionine concentrations from baseline values of 6.44 +/- 1.03 and 6.63 +/- 0.99 mumol/100 ml, respectively, to mean peak values of 340 +/- 75.0 and 265 +/- 49.8 mumol/100 ml, respectively. N-Acetyl-L-methionine loading increased mean peak portal and vena caval plasma methionine concentrations to 291 +/- 85 and 220 +/- 51.6 mumol/100 ml, respectively. N-Acetyl-L-methionine could not be detected in either portal or vena caval plasma. In contrast, N-acetyl-D-methionine loading produced only a small rise in mean peak portal and vena caval plasma methionine concentrations (13.0 +/- 4.31 and 8.62 +/- 1.71 mumol/100 ml, respectively). Concentrations of N-acetyl-D-methionine increased from baseline values of 0 mumol/100 ml to mean peak values of 251 +/- 32.0 and 234 +/- 72.3 mumol/100 ml, respectively, in portal and vena caval plasma. These data explain the poor utilization of N-acetyl-D-methionine as a methionine source.
Fifty‐five patients with periampullary caicinoma have been treated during a period of 32 years. This tumor represents only 0.01% of our solid tumor cases. Contrary to widely accepted opinion, periampullary carcinoma is not painless in many patients, and a palpable gallbladder is present in only 20% of patients.
Twenty‐four patients had a palliative operation with a 13% immediate mortality; the mean survival of this group was 13 months. Out of 26 patients who had a radical curative operation, 18 survived the procedure; the mean survival for this group was 31 months.
We believe that nearly every patient harboring a periampullary carcinoma should be considered a candidate for pancreaticoduodenectomy unless the disease is so far advanced that survival is unlikely.
Utilization of intravenously administered oligosaccharides was evaluated in postsurgical patients by infusing oligosaccharides simultaneously with glucose, amino acids, and lipid emulsion for 4 d postoperatively. Seven patients were infused with a nutritional regimen providing glucose, amino acids, lipid emulsion, and oligosaccharides and seven patients received a similar regimen without oligosaccharides. Patients infused with oligosaccharides received an overall mean (+/- SD) of 144 +/- 41.0 g oligosaccharides per day. The mean overall excretion of total glucose (free plus oligosaccharide-bound) was significantly greater in patients infused with oligosaccharides (65.1 +/- 33.2 g/d) than in controls (1.83 +/- 1.55 g/d). Overall oligosaccharide utilization for the 4-d period was 48.7 +/- 10.1%. Plasma oligosaccharide concentrations increased from a baseline value of 2.43 +/- 1.90 mg/dL to 58.1 +/- 42.3 mg/dL after 4 d of oligosaccharide infusion, suggesting accumulation.
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