0
November 18, 1950, Vol 144, No. 12 >
Other Articles | November 18, 1950

PROTEIN METABOLISM IN SURGICAL PATIENTS

I. S. RAVDIN, M.D.; NICHOLAS S. GIMBEL, M.D.
[+] Author Affiliations

Read in the General Scientific Meetings at the Ninety-Ninth Annual Session of the American Medical Association, San Francisco, June 27, 1950.


Philadelphia

From the Department of Surgery and the Harrison Department of Surgical Research, University of Pennsylvania School of Medicine.


JAMA. 1950;144(12):979-982. doi:10.1001/jama.1950.02920120003002
Text Size: A A A
Published online
Article
References

In the past two decades clinicians have placed heavy emphasis on the metabolic role of the proteins in health and in disease, as they have become convinced that malnutrition imposes a real handicap on the seriously ill patient. Adequate protein nutrition has been found essential to all types of wound healing, including the healing of fractures, the adequate functioning of intestinal anastomoses, the repair of regenerating parenchymal organs such as the liver, the resistance to hepatotoxins and other injurious agents and the maintenance of normal fluid distribution in the various compartments of the body. The capacity to form antibodies rapidly in large amounts, as well as the ability to provoke a normal phagocytic response, are also dependent on the state of protein nutrition. A proper protein intake is essential in maintaining a normal mass of erythrocytes and plasma protein, and these in turn are closely correlated with the capacity to

REFERENCES

1 +
Schoenheimer, R.: The Dynamic State of Body Constituents , Harvard University Monographs in Medicine and Public Health, no. (3) , Cambridge, Mass., Harvard University Press, 1942;.
2 +
Geiger, E.:  The Role of the Time Factor in Protein Synthesis , Science 111: 594, 1950;.
3 +
Borsook, H.:  Protein Turnover and Incorporation of Labeled Amino Acids into Tissue Proteins in Vivo and in Vitro , Physiol. Rev. 30:206, 1950;.
4 +
Cannon, P. R.:  Amino Acid Utilization in Surgical Patient , J. A. M. A. 135: 1043 ( (Dec. 20) ) 1947;.
5 +
Allison, J. B.:  Utilization of Protein Hydrolysates by Normal and Protein-Depleted Animals , Am. J. Med. 5:419, 1948;.
6 +
Cuthbertson, D. P., and Munro, H. N.:  The Relationship of Carbohydrate Metabolism to Protein Metabolism , B[ill]ochem. J. 33: 128, 1939;.
7 +
Ellison, E. H.; McCleery, R. S.; Zollinger, R. M., and Case, C. T.:  The Influence of Caloric Intake upon the Fate of Parenteral Nitrogen , Surgery 26:374, 1949;.
8 +
Riegel, C.; Kopp, C. E.; Drew, J.; Stevens, L. W., and Rhoads, J. E.:  The Nutritional Requireme ts for Nitrogen Balance in Surgical Patients During the Early Post-Operative Period , J. Clin. Investigation 26:18, 1947;.
9 +
Rose, W. C.:  Amino Acid Requirements of Man, in Symposium on Nutrition in Preventive Medicine , Federation Proc. 8:546, 1949;.
10 +
Hegsted, D. M.; Tsongas, A. G.; Abbott, D. B., and Stare, F. J.:  Protein Requirements of Adults , J. Lab. & Clin. Med. 31:261, 1946;.
11 +
Vars, H. M., and Gurd, F. N.:  Role of D[ill]etary Protein in Experimental Liver Regeneration in Nitrogen Balance Study , Am. J. Physiol. 151: 391, 1947;.
12 +
Adolph, W. H.:  The Protein Problem of China , Science 100:1, 1944;.
13 +
Ott, W. H.; Rickes, E. L., and Wood, T. R.:  Activity of Crystalline Vitamin B12 for Chick Growth , J. Biol. Chem. 174: 1047, 1948;.
14 +
Lillie, R. J.; Der.ton, C. A., and Bird, H. R.:  Relation of Vitamin B12 to the Growth Factor Present in Cow Manure , J. Biol. Chem. 176: 1477, 1948;.
15 +
Wetzel, N. C.; Fargo, W. C.; Smith, I. H., and Helikson, J.:  Growth Failure in School Children as Associated with Vitamin B12 Deficiency: Response to Oral Therapy , Science 110: 651, 1949;.
16 +
D[ill]etrick, J. E.; Whedon, G. D., and Schorr, E.:  Effects of Immobilization upon Various Metabolic and Physiologic Functions of Normal Men , Am. J. Med. 4:3, 1948;.
17 +
Cuthbertscn, D. P.:  Further Observations on the Disturbance of Metabolism Caused by Injury, with Particular Reference to the Dietary Requirements of Fracture Cases , Brit. J. Surg. 23: 505, 1936;.
18 +
Howard, J. E.:  Protein Metabolism During Convalescence After Trauma: Recent Studies , Arch. Surg. 50: 166 ( (March) ) 1945;.
19 +
Browne, J. S. L.; Schenker, V., and Steve::son, J. A. F.:  Some Metabolic Aspects of Damage and Convalescence , J. Clin. Investigation 23: 932, 1944;.
20 +
Albright, F.:  Cushing's Syndrome: Its Pathological Physiology, Its Relationship to the Adreno-Genital Syndrome, and Its Connection with the Problem of the Reaction of the Body to Injurious Agents ("Alarm Reaction" of Selye) , in Harvey Lectures, 1942-1943 , Baltimore, Williams & Wilkins Company, 1943;, p. 123.
21 +
Co Tui and others:  Studies in Surgical Convalescence: Sources of Nitrogen Loss Postgastrectomy and Effect of High Amino-Acid and High Caloric Intake on Convalescence , Ann. Surg. 120:99, 1944;.
22 +
Werner, S. C.:  The Use of a Mixture of Pure Amino Acids in Surgical Nutrition , Ann. Surg. 126: 169, 1947;.
23 +
Werner, S. C.; Habiv, D. V.; Randall, H. T., and Lockwood, J. S.:  Postoperative Nitrogen Loss , Ann. Surg. 130: 688, 1944;.
24 +
Cuthbertson.14 Howard.15
25 +
Schoenheimer, R.; Ratner, S.; Rittenberg, D., and Heidelberger, M.:  The Interaction of the Blood Proteins of the Rat with Dietary Nitrogen , J. Biol. Chem. 144:541, 1942;.
26 +
Levenson, S. M.; Birkhill, F. R.; Maloney, M. A., and Bell, J. A.:  The Metabolic Fate of the Infused Erythrocyte , Ann. Surg. 130: 723, 1949;.
27 +
Whipple, G. H.; Miller, L. I., and Robscheit-Robbins, F. S.:  Raiding of Body Tissue Protein to Form Plasma Protein and Hemoglobin , J. Exper. Med. 85:277, 1947;.
28 +
London, I. M.:  Studies on the Rates of Formation of Plasma Proteins in Man , read before the Sixth Annual Protein Conference, New Brunswick, N. J., January 27-28, 1950 .
29 +
Gimbel, N. S.; Riegel, C., and Glenn, W. W. L.:  Metabolic and Cardiovascular Studies of Prolonged Intravenous Administration of Human Serum Albumin , J. Clin. Investigation 29:998, 1950;.
30 +
Howland, J. W., and Hawkins, W. B.:  Protein Metabolism, Protein Interchange, and Utilization in Phlorhizinized Dogs , J. Biol. Chem. 123: 99, 1938;.
31 +
Gimbel, Nicholas S.: Unpublished data.
32 +
Terry, R.; Sandrock, W. E.; Nye, R. E., Jr., and Whipple, G. H.:  Parenteral Plasma Protein Maintains Nitrogen Equilibrium over Long Periods , J. Exper. Med. 87:547, 1948;.
33 +
Smyth, C. J.; Levey, S., and Lasichak, A. G.:  The Effects of the Rate of Administration of Amino Acid Preparations on Urinary Wastage of Amino Acid Nitrogen in Man , J. Clin. Investigation 27:412, 1948;.
34 +
Lewis, J. H.; Taylor, F. H. L., and Davidson, C. S.:  Tolerance to Intravenously Administered Protein Hydrolysate in Severe Human Liver Cirrhosis , Am. J. M. Sc. 214:656, 1947;.
35 +
Mok, W. T.; Kozoll, D. D., and Meyer, K. A.:  Studies in Nitrogen Metabolism , Surgery 24:952, 1948;.
36 +
Madden, S. C., and others:  Amino Acids in Therapy of Disease , Surg. Gynec. & Obst. 82:131, 1946;.

First Page Preview

First page PDF preview

Figures

Tables

Interactive Graphics

Video

Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Schoenheimer, R.: The Dynamic State of Body Constituents , Harvard University Monographs in Medicine and Public Health, no. (3) , Cambridge, Mass., Harvard University Press, 1942;.
2 +
Geiger, E.:  The Role of the Time Factor in Protein Synthesis , Science 111: 594, 1950;.
3 +
Borsook, H.:  Protein Turnover and Incorporation of Labeled Amino Acids into Tissue Proteins in Vivo and in Vitro , Physiol. Rev. 30:206, 1950;.
4 +
Cannon, P. R.:  Amino Acid Utilization in Surgical Patient , J. A. M. A. 135: 1043 ( (Dec. 20) ) 1947;.
5 +
Allison, J. B.:  Utilization of Protein Hydrolysates by Normal and Protein-Depleted Animals , Am. J. Med. 5:419, 1948;.
6 +
Cuthbertson, D. P., and Munro, H. N.:  The Relationship of Carbohydrate Metabolism to Protein Metabolism , B[ill]ochem. J. 33: 128, 1939;.
7 +
Ellison, E. H.; McCleery, R. S.; Zollinger, R. M., and Case, C. T.:  The Influence of Caloric Intake upon the Fate of Parenteral Nitrogen , Surgery 26:374, 1949;.
8 +
Riegel, C.; Kopp, C. E.; Drew, J.; Stevens, L. W., and Rhoads, J. E.:  The Nutritional Requireme ts for Nitrogen Balance in Surgical Patients During the Early Post-Operative Period , J. Clin. Investigation 26:18, 1947;.
9 +
Rose, W. C.:  Amino Acid Requirements of Man, in Symposium on Nutrition in Preventive Medicine , Federation Proc. 8:546, 1949;.
10 +
Hegsted, D. M.; Tsongas, A. G.; Abbott, D. B., and Stare, F. J.:  Protein Requirements of Adults , J. Lab. & Clin. Med. 31:261, 1946;.
11 +
Vars, H. M., and Gurd, F. N.:  Role of D[ill]etary Protein in Experimental Liver Regeneration in Nitrogen Balance Study , Am. J. Physiol. 151: 391, 1947;.
12 +
Adolph, W. H.:  The Protein Problem of China , Science 100:1, 1944;.
13 +
Ott, W. H.; Rickes, E. L., and Wood, T. R.:  Activity of Crystalline Vitamin B12 for Chick Growth , J. Biol. Chem. 174: 1047, 1948;.
14 +
Lillie, R. J.; Der.ton, C. A., and Bird, H. R.:  Relation of Vitamin B12 to the Growth Factor Present in Cow Manure , J. Biol. Chem. 176: 1477, 1948;.
15 +
Wetzel, N. C.; Fargo, W. C.; Smith, I. H., and Helikson, J.:  Growth Failure in School Children as Associated with Vitamin B12 Deficiency: Response to Oral Therapy , Science 110: 651, 1949;.
16 +
D[ill]etrick, J. E.; Whedon, G. D., and Schorr, E.:  Effects of Immobilization upon Various Metabolic and Physiologic Functions of Normal Men , Am. J. Med. 4:3, 1948;.
17 +
Cuthbertscn, D. P.:  Further Observations on the Disturbance of Metabolism Caused by Injury, with Particular Reference to the Dietary Requirements of Fracture Cases , Brit. J. Surg. 23: 505, 1936;.
18 +
Howard, J. E.:  Protein Metabolism During Convalescence After Trauma: Recent Studies , Arch. Surg. 50: 166 ( (March) ) 1945;.
19 +
Browne, J. S. L.; Schenker, V., and Steve::son, J. A. F.:  Some Metabolic Aspects of Damage and Convalescence , J. Clin. Investigation 23: 932, 1944;.
20 +
Albright, F.:  Cushing's Syndrome: Its Pathological Physiology, Its Relationship to the Adreno-Genital Syndrome, and Its Connection with the Problem of the Reaction of the Body to Injurious Agents ("Alarm Reaction" of Selye) , in Harvey Lectures, 1942-1943 , Baltimore, Williams & Wilkins Company, 1943;, p. 123.
21 +
Co Tui and others:  Studies in Surgical Convalescence: Sources of Nitrogen Loss Postgastrectomy and Effect of High Amino-Acid and High Caloric Intake on Convalescence , Ann. Surg. 120:99, 1944;.
22 +
Werner, S. C.:  The Use of a Mixture of Pure Amino Acids in Surgical Nutrition , Ann. Surg. 126: 169, 1947;.
23 +
Werner, S. C.; Habiv, D. V.; Randall, H. T., and Lockwood, J. S.:  Postoperative Nitrogen Loss , Ann. Surg. 130: 688, 1944;.
24 +
Cuthbertson.14 Howard.15
25 +
Schoenheimer, R.; Ratner, S.; Rittenberg, D., and Heidelberger, M.:  The Interaction of the Blood Proteins of the Rat with Dietary Nitrogen , J. Biol. Chem. 144:541, 1942;.
26 +
Levenson, S. M.; Birkhill, F. R.; Maloney, M. A., and Bell, J. A.:  The Metabolic Fate of the Infused Erythrocyte , Ann. Surg. 130: 723, 1949;.
27 +
Whipple, G. H.; Miller, L. I., and Robscheit-Robbins, F. S.:  Raiding of Body Tissue Protein to Form Plasma Protein and Hemoglobin , J. Exper. Med. 85:277, 1947;.
28 +
London, I. M.:  Studies on the Rates of Formation of Plasma Proteins in Man , read before the Sixth Annual Protein Conference, New Brunswick, N. J., January 27-28, 1950 .
29 +
Gimbel, N. S.; Riegel, C., and Glenn, W. W. L.:  Metabolic and Cardiovascular Studies of Prolonged Intravenous Administration of Human Serum Albumin , J. Clin. Investigation 29:998, 1950;.
30 +
Howland, J. W., and Hawkins, W. B.:  Protein Metabolism, Protein Interchange, and Utilization in Phlorhizinized Dogs , J. Biol. Chem. 123: 99, 1938;.
31 +
Gimbel, Nicholas S.: Unpublished data.
32 +
Terry, R.; Sandrock, W. E.; Nye, R. E., Jr., and Whipple, G. H.:  Parenteral Plasma Protein Maintains Nitrogen Equilibrium over Long Periods , J. Exper. Med. 87:547, 1948;.
33 +
Smyth, C. J.; Levey, S., and Lasichak, A. G.:  The Effects of the Rate of Administration of Amino Acid Preparations on Urinary Wastage of Amino Acid Nitrogen in Man , J. Clin. Investigation 27:412, 1948;.
34 +
Lewis, J. H.; Taylor, F. H. L., and Davidson, C. S.:  Tolerance to Intravenously Administered Protein Hydrolysate in Severe Human Liver Cirrhosis , Am. J. M. Sc. 214:656, 1947;.
35 +
Mok, W. T.; Kozoll, D. D., and Meyer, K. A.:  Studies in Nitrogen Metabolism , Surgery 24:952, 1948;.
36 +
Madden, S. C., and others:  Amino Acids in Therapy of Disease , Surg. Gynec. & Obst. 82:131, 1946;.

Letters

Submit a Letter
CME Course for:


You need to register in order to view this quiz.


To understand the clinical management of acute heart failure syndromes.
Accreditation Information The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
To view and print your certificate and access a summary of your CME courses go to My CME.
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s “Cited By” API will populate this tab (http://www.crossref.org/citedby.html).
Compression-Only CPR: Pushing the Science Forward
Cone
AAM 2010;304:1493-1495.
All you need to read in the other general journals
BMJ 2010;341:c5893-c1494.
Submit a Response

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

© 2012 American Medical Association. All Rights Reserved.
Powered bySilverchair Information Systems