Nutrition
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Several aspects on the effect of nutrients on small intestinal motility are not completely understood. We have analyzed changes of motor activity of the canine small bowel following intragastric administration of casein and soy protein. ⋯ Casein was followed by a statistically significant decrease of amplitude and frequency of small intestinal contractions, compared to soy protein. Pretreatment with naloxone suppressed the inhibitory effect of casein, suggesting that stimulation of opioid receptors by beta casomorphins, a product of digestion of casein, might be involved in the motility changes observed.
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Cytokines are produced in disease or during immunologic challenge. Some cytokines increase host resistance to disease whereas others trigger inflammatory processes. Interleukin 1 (IL-1) and tumor necrosis factor (TNF) are pro-inflammatory cytokines that affect nearly every cell either alone or in a synergistic fashion. ⋯ It is unclear whether these endogenous levels are sufficient to block IL-1 and TNF from triggering their respective cell-bound receptors in disease. IL-1 infusions into patients induce circulating levels of IL-1ra but not IL-1. TNF infusions into patients also induce high levels of soluble TNF receptors.
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Editorial Comment
Assessment of the operative risk: a challenge for the surgeon.
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A patient with acute intermittent porphyria is presented to emphasize the relevance of nutrition in its management. Clinical manifestations, diagnosis of acute intermittent porphyria, simplified heme biosynthetic pathway, the glucose effect, and the rationale for giving nutritional therapy for acute intermittent porphyria are discussed.