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Lipid and lipoprotein levels were measured in 45 adult patients receiving parenteral nutrition for 10-14 days who were administered 20-50% of their daily total calorie requirement as Liposyn II. The study was an unblinded noncomparative multicenter investigation. Measurements were made on days 1, 3, 7, 10, and 14. Patients gained an average of 1.2 +/- 0.5 kg body wt during the study. No patient had to be removed from the study due to clinically significant adverse effects. Some changes in hematology, blood chemistry, and liver function parameters occurred, but these changes were consistent with alterations typically observed in patients receiving total parenteral nutrition. Total protein levels increased by an average of 0.30 +/- 0.13 g/dl (p less than 0.03). Plasma levels of phospholipid, triglycerides, total free fatty acids, very-low-density lipoprotein (VLDL) cholesterol and high-density-lipoprotein (HDL) cholesterol were normal or below normal at all times and did not change during the study. Significant increases occurred in total cholesterol (p less than 0.03) and low-density-lipoprotein (LDL) cholesterol (p less than 0.02) that were consistent with the mobilization of tissue cholesterol during intravenous lipid infusions. These increases do not infer any increased risk of coronary heart disease. The ratio of HDL to LDL cholesterol was 0.24-0.28 at all times.

Black women with established essential hypertension, without renal insufficiency or diabetes mellitus, were withdrawn from their usual antihypertensive therapy for 2-3 weeks prior to entry into a study to evaluate pertinent biochemical and mineral effects of indapamide treatment. Twenty patients with a sitting diastolic blood pressure greater than 90 mm Hg had baseline measurements of plasma total cholesterol, HDL cholesterol, triglycerides, glucose, uric acid, potassium, magnesium, calcium, selenium, renin, norepinephrine, whole blood ionized calcium, and glycosylated hemoglobin. Low-density lipoprotein (LDL) cholesterol was calculated by the Friedewald equation. The patients were placed on a fixed daily dose of 2.5 mg indapamide. Blood pressure and blood tests were repeated at 4, 8, and 12 weeks of treatment. The systolic and diastolic blood pressure were both lowered significantly at week 12. Plasma renin activity was significantly increased. There was no significant change in norepinephrine, glucose, glycosylated hemoglobin, uric acid, ionized calcium, calcium, triglycerides, potassium, magnesium, or selenium. Total cholesterol increased with an increase in both high-density lipoprotein (HDL) and LDL cholesterol; however, these increases did not alter significantly either the total/HDL cholesterol or LDL/HDL cholesterol ratios. It is concluded that 2.5 mg of indapamide per day effectively lowers blood pressure with no significant adverse metabolic effects.

Forty-three patients with mild weight loss were studied prospectively to determine whether the parenteral water-soluble vitamin doses in a commercially available preparation (MVI concentrate; USV Laboratories, Tarrytown, NY) maintained serum, red blood cell (RBC), and urinary concentrations of water-soluble vitamins in stressed cancer patients receiving total parenteral nutrition (TPN). Patients were divided into three groups: (1) oral diet, no intravenous vitamins given; (2) TPN plus 5 ml MVI; and (3) TPN plus 10 ml MVI. Vitamins C, B1, B2, B3, B6, and niacin were measured initially and weekly during a 6-week study period. Caloric and nitrogen balances were quantified. Most of the patients in all three groups had normal blood or urine levels of all water-soluble vitamins. No clinical evidence of vitamin deficiency or MVI toxicity was detected. The recommended parenteral dosages of vitamin C (100 mg/day) and B3 (15 mg/day) provided measurably adequate levels in all patients. Levels of vitamins B1, B2, B6, and niacin that were less than the normal range were noted in 4-40% of patients receiving the recommended daily dosages of 3 mg, 3.6 mg, 4 mg, and 40 mg, respectively. These deficiencies appeared to improve in group III patients who received twice the recommended parenteral vitamin dosages, although they did not completely disappear. Niacin deficiency appeared to be the most prevalent, occurring in 40% of patients studied. Since intravenous doses of B1, B2, B6, and niacin are safe and well tolerated, it appears that increased daily amounts of these vitamins should be given to cancer patients on parenteral nutrition.

This study represents an initial attempt to define intravenous vitamin requirements in adult patients receiving total parenteral nutrition (TPN). We have investigated two different vitamin formulations for their ability to maintain normal circulating blood levels of vitamins A, C, E, B12, folic acid and riboflavin. Administration of 1.1 ml of Multi-Vitamin Infusion (MVI) solution supplemented with 100 microgram of folic acid, 10 microgram of vitamin b12, and 100 mg of vitamin C, per liter of TPN infusate (patients received an average of about 3 liters/day), maintained normal or higher than normal levels of vitamins C, B12, and riboflavin, but resulted in less-than-normal levels of vitamins A, E, and folic acid. Increasing the amount of MVI to 1.4 ml and the folic acid to 200 microgram, and decreasing the ascorbic acid to 70 mg and vitamin B12 to 5 microgram/liter of TPN infusate, resulted in normal blood levels of all tested vitamins within two weeks after initiating TPN therapy, and normal blood levels were then maintained at this dosage for additional periods of time up to three weeks.

Rabbit antibody against lecine-binding protein isolated from Escherichia coli K-12 has been prepared. This antibody has been used in conjunction with enzyme-labeled antibody to allow an immunocytochemical localizati of leucine-binding protein in the Escherichil coli cell. This protein appears to be present only in the envelope and not in the cytoplasm.