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The effect of age on the response to total parenteral nutrition (TPN) was evaluated in 325 patients by measuring body composition by multiple-isotope dilution at the onset and at 2-wk intervals during the course of TPN. On the basis of their initial body composition, patients were divided into two groups: normally nourished and malnourished. TPN did not alter the body composition of the normally nourished patients. In the malnourished patients, a statistically significant correlation existed between the daily change in the dependent variable body cell mass (BCM) and the independent variables caloric intake, nutritional state, and age. With advancing age, more calories are required to maintain the BCM of malnourished patients. With a similar nutritional intake, a depleted BCM is restored more slowly in older patients. Age is a significant independent variable affecting the response to nutritional support.

We have treated 20 patients with multiple injuries and concomitant myocardial contusion. The diagnosis of myocardial contusion was based mainly on serial ECG tracings which showed arrhythmias, dynamic ischaemic patterns or conduction disturbances. The clinical and laboratory findings of cardiac contusion are sometimes indistinguishable from those found in multiple injuries. Furthermore, they are overshadowed by the overt manifestation of cerebral, thoraco-abdominal and skeletal injuries. Awareness and prompt diagnostic measures are essential in the diagnosis of cardiac injury. Strict cardiac monitoring following multiple trauma will prevent serious or even fatal outcome of cardiac injury.

A series of experiments in a rat injury model were designed to elucidate the role and mechanisms of branched-chain amino acids in the post-injury catabolism. Our results suggest that: 1. Nutritional support can maintain nitrogen equilibrium in the early post-operative state. 2. Branched chain amino acids exert a nitrogen sparing effect and thus prevent or minimise post-operative catabolism. 3. Increasing the amount of infused branched chain amino acids results in nitrogen retention. 4. A balanced amino-acid mixture containing 45 per cent branched chain amino acids seems to be optimal for nutritional support in the post-injury state.