The Effects of an Anabolic Steroid and Peripherally Administered Intravenous Nutrition in the Early Postoperative Period

Hansell, D. T.; Davies, J.W.L.; Shenkin, Alan; Garden, O. J.; Burns, H. J. G.; Carter, David C.

doi:10.1177/0148607189013004349

Cited by 23 publications

(11 citation statements)

References 40 publications

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“…Unlike this study, previous studies in critically ill patients did not measure clinical outcome; however, our study was not specifically powered to show a difference in clinical outcome. Also, our metabolic and nutritional findings are in contrast to some reports 4,5,17 and in agreement with others. 18 A prospective, randomized, double-blind study reported decreased urinary excretion of nitrogen and 3-methylhistidine in men receiving nandrolone 50 mg on day 3 and 25 mg on day 6 after trauma compared with similar patients receiving placebo.…”

Section: Discussionsupporting

confidence: 93%

supporting

confidence: 93%

“…17 Nitrogen balance improved in patients who received intramuscular stanozolol 50 mg 24 hours before colorectal surgery in a prospective, randomized, controlled trial. 5 Nonseptic patients had significant improvements in body weight, lean body mass, and body cell mass when given intramuscular nandrolone 50 mg/week. 18 It is interesting that septic patients in that prospective, randomized, unblinded study did not have significant improvement in nutritional markers.…”

Section: Discussionmentioning

confidence: 97%

“…Studies in trauma and thermally injured patients reported improved nitrogen retention and restored muscle mass, but therapy was limited by androgenic complications. 4,5 …”

Section: ! ! !mentioning

confidence: 99%

“…Studies in trauma and thermally injured patients reported improved nitrogen retention and restored muscle mass, but therapy was limited by androgenic complications. 4,5 Oxandrolone is a testosterone analog with reported anabolic activity 5-10 times that of older anabolic agents and with considerably fewer androgenic effects. It improved body cell mass in thermally injured patients during the recovery phase 6 and restored muscle mass in patients with acquired immunodeficiency syndrome.…”

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confidence: 99%

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Oxandrolone in Trauma Patients

et al. 2000

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Study Objective. To determine the effect of oxandrolone administration on nutritional and clinical outcomes after multiple trauma. Design. Prospective, randomized, double‐blind, placebo‐controlled study. Setting. Level 1 trauma center in a university teaching hospital. Patients. Sixty‐two patients requiring enteral nutrition, 60 of whom completed the study. Intervention. Patients were randomized to receive either oxandrolone 10 mg or placebo twice/day for a maximum of 28 days. Measurements and Main Results. Total urinary nitrogen, prealbumin, nitrogen balance, total body water, and body cell mass were measured on day 1 of enteral nutrition and then at day 7, day 10, and study exit. Patients were assessed daily for metabolic and infectious complications. The two groups were similar for demographics and dosage of enteral nutrition. Measurement of total urinary nitrogen at study entry showed both groups to be highly catabolic (oxandrolone 17.2 ± 4.9, placebo 19.1 ± 10.8 g/day, NS). On days 7 and 10, total urinary nitrogen increased in both groups; however, there was no significant difference between groups. Nitrogen balance was negative throughout the study in each group. Body cell mass decreased slightly in both groups over the study period. Prealbumin serum concentrations increased significantly in both groups at day 10 and study exit compared with study entry. The groups did not differ significantly for length of hospital stay (oxandrolone 30.8 ± 17.9, placebo 27.0 ± 25.7 days), length of intensive care unit stay (oxandrolone 17.1 ± 7.8, placebo 15.5 ± 9.7 days), and frequency of pneumonia or sepsis (oxandrolone 48, placebo 43 episodes). Conclusion. Oxandrolone 20 mg/day does not have obvious benefit in nutritional and clinical outcomes during the first month after multiple trauma.

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Section: Discussionsupporting

confidence: 93%

supporting

confidence: 93%

Section: Discussionmentioning

confidence: 97%

“…Studies in trauma and thermally injured patients reported improved nitrogen retention and restored muscle mass, but therapy was limited by androgenic complications. 4,5 …”

Section: ! ! !mentioning

confidence: 99%

mentioning

confidence: 99%

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Oxandrolone in Trauma Patients

et al. 2000

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Total Parenteral Nutrition in the Critically Ill Patient

Heyland,

MacDonald,

Keefe

et al. 1998

JAMA

512

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Context.-Nutritional support has become a standard of care for hospitalized patients, but whether total parenteral nutrition (TPN) affects morbidity and mortality is unclear.Objective.-To examine the relationship between TPN and complication and mortality rates in critically ill patients.Data Sources.-Computerized search of published research on MEDLINE from 1980 to 1998, personal files, and review of relevant reference lists.Study Selection.-We reviewed 210 titles, abstracts, and papers. Primary studies were included if they were randomized clinical trials of critically ill or surgical patients that evaluated the effect of TPN (compared with standard care) on complication and mortality rates. We excluded studies comparing TPN with enteral nutrition.Data Extraction.-Relevant data were abstracted on the methodology and outcomes of primary studies. Data were abstracted in duplicate, independently.Data Synthesis.-There were 26 randomized trials of 2211 patients comparing the use of TPN with standard care (usual oral diet plus intravenous dextrose) in surgical and critically ill patients. When the results of these trials were aggregated, TPN had no effect on mortality (risk ratio [RR], 1.03; 95% confidence interval [CI], 0.81-1.31). Patients who received TPN tended to have a lower complication rate, but this result was not statistically significant (RR, 0.84; 95% CI, 0.64-1.09). We examined several a priori hypotheses and found that studies including only malnourished patients were associated with lower complication rates but no difference in mortality when compared with studies of nonmalnourished patients. Studies published since 1989 and studies with a higher methods score showed no treatment effect, while studies published in 1988 or before and studies with a lower methods score demonstrated a significant treatment effect. Complication rates were lower in studies that did not use lipids; however, there was no difference in mortality rates between studies that did not use lipids and those studies that did. Studies limited to critically ill patients demonstrated a significant increase in complication and mortality rates compared with studies of surgical patients.Conclusions.-Total parenteral nutrition does not influence the overall mortality rate of surgical or critically ill patients. It may reduce the complication rate, especially in malnourished patients, but study results are influenced by patient population, use of lipids, methodological quality, and year of publication.

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Drug-Induced Changes to Nutritional Status

Gervasio¹

2004

Handbook of Drug-Nutrient Interactions

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The Effects of an Anabolic Steroid and Peripherally Administered Intravenous Nutrition in the Early Postoperative Period

Cited by 23 publications

References 40 publications

Oxandrolone in Trauma Patients

Oxandrolone in Trauma Patients

Total Parenteral Nutrition in the Critically Ill Patient

Drug-Induced Changes to Nutritional Status

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