Convalescence: A Study in the Physiological Recovery of Nitrogen Metabolism and Liver Function

Article1 March 1948CONVALESCENCE: A STUDY IN THE PHYSIOLOGICAL RECOVERY OF NITROGEN METABOLISM AND LIVER FUNCTIONROBERT W. KEETON, F.A.C.P., WARREN H. COLE, NATHANIEL CALLOWAY, NATHANIEL GLICKMAN, H. H. MITCHELL, J. DYNIEWICZ, D. HOWESROBERT W. KEETON, F.A.C.P.Search for more papers by this author, WARREN H. COLESearch for more papers by this author, NATHANIEL CALLOWAYSearch for more papers by this author, NATHANIEL GLICKMANSearch for more papers by this author, H. H. MITCHELLSearch for more papers by this author, J. DYNIEWICZSearch for more papers by this author, D. HOWESSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-28-3-521 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptConvalescence embraces the recovery of a multitude of physiological processes in an individual who has suffered from trauma, disease, or an operation. These various physiological processes recover at different rates and the recovery of many is not manifested by any marked objective or subjective signs. There finally comes a time when the patient is conscious of his return to normal and is again ready for work. This transformation from illness to health is often dramatic and is frequently not accompanied by any sign which the physician can detect. The study of convalescence is concerned with the analysis of these disturbances...Bibliography1. COLEKEETONCALLOWAYGLICKMANMITCHELLDYNIEWICZHOWES WHRWNONHHJD: Studies in postoperative convalescence, Ann. Surg., 1947, in press. CrossrefGoogle Scholar2. KEETONCOLECALLOWAYGLICKMANMITCHELLDYNIEWICZHOWES RWWHNONHHJD: Studies in convalescence following herniorrhaphy: The effect of diet, supplements and ambulation on metabolic changes and on the performance of patients as measured by tests of cardiovascular efficiency and muscular fitness, Jr. Lab. and Clin. Med., 1947, xxxii, 316. Google Scholar3. CUTHBERTSON DP (a) : The disturbance of metabolism produced by bony and nonbony injury, with notes on certain abnormal conditions of bone, Biochem. Jr., 1930, xxiv, 1244. (b) CUTHBERTSON, D. P.: The distribution of nitrogen and sulfur in the urine during conditions of increased catabolism, Biochem. Jr., 1931, xxx, 236. (c) CUTHBERTSON, D. P.: Observations on the disturbance of metabolism produced by injury to the limbs, Quart. Jr. Med., 1932, i, 233. (d) CUTHBERTSON, D. P.: Further observations on the disturbance of metabolism caused by injury, with particular reference to the dietary requirements of fracture cases, Brit. Jr. Surg., 1936, xxiii, 505. (e) CUTHBERTSON, D. P.: Post-shock metabolic response (Arris and Gale lecture), Lancet, 1942, i, 433. (f) CUTHBERTSON, D. P., MCGIRR, J. L., and ROBERTSON, J. S. M.: The effect of fracture of bone on the metabolism of the rat, Quart. Jr. Exper. Physiol., 1939, xxix, 13. CrossrefGoogle Scholar4. HOWARDPARSONSTEINEISENBERGREIDT JEWKEHV (a) : Studies on fracture convalescence: Nitrogen metabolism after fracture and skeletal operations in healthy males, Bull. Johns Hopkins Hosp., 1944, lxxv, 156. (b) HOWARD, J. E., WINTERNITZ, J., PARSON, WM., BIGHAM, R. S., JR., and EISENBERG, H.: Studies on fracture convalescence; influence of diet on post-traumatic nitrogen deficit exhibited by fracture patients, Bull. Johns Hopkins Hosp., 1944, lxxv, 209. (c) HOWARD, J. E., BIGHAM, R. S., JR., EISENBERG, H., WAGNER, D., and BAILEY, E.: Nitrogen and mineral balance during starvation and graduated feeding in healthy young males at bed rest, Bull. Johns Hopkins Hosp., 1946, lxxviii, 282. (d) HOWARD, J. E.: Protein metabolism during convalescence after trauma, Arch. Surg., 1945, l, 166. Google Scholar5. SELYE H: The general adaptation syndrome and the diseases of adaptation, Jr. Clin. Endocrin., 1946, vi, 117. CrossrefGoogle Scholar6. EVANS G: The effect of low atmospheric pressure on the glycogen content of the rat, Am. Jr. Physiol., 1934, cx, 273. CrossrefGoogle Scholar7. BROWNESCHENKERSTEVENSON JSVJA (a) : Some metabolic aspects of damage and convalescence, Jr. Clin. Invest., 1944, xxiii, 932. (b) BROWNE, J. S. L., HOFFMAN, M., SCHENKER, V., VENNING, E. H., and WEIL, P. G.: Study of the metabolic aspects of damage and convalescence in acutely injured: Contrasting previously healthy subjects with previously debilitated: Conference on metabolic aspects of convalescence including bone and wound healing, Josiah Macy, Jr. Found., 1945, Feb. 2-3, ninth meeting. (c) Metabolic studies and cortin excretion following trauma in debilitated individuals, Josiah Macy, Jr. Found., 1946, Feb. 4, twelfth meeting. (d) SHIPLEY, R. A., DORFMAN, R. I., BUCHWALD, E., and ROSS, E.: The effect of infection and trauma on the excretion of urinary cortin, Jr. Clin. Invest., 1946, xxv, 673. (e) 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 body to injurious agents ("alarm reaction" of Selye), The Harvey Lectures, 1943, xxxviii, 123. Google Scholar8. GROSSMANSAPPINGTONBURROWSLAVIETESPETERS CMTSBAPHJP: Nitrogen metabolism in acute infections, Jr. Clin. Invest., 1945, xxiv, 523. CrossrefGoogle Scholar9. PETERS JP: Problems of nitrogen metabolism, Fed. Proc., 1944, iii, 197. Google Scholar10. MULHOLLANDCOWRIGHTVINCE JHTAMVJ (a) : Nitrogen metabolism, caloric intake and weight loss in postoperative convalescence, Ann. Surg., 1943, cxvii, 512. (b) CO TUI, WRIGHT, A. M., MULHOLLAND, J. H., CARABBA, V., BARDRAM, I., and VINCI, V. J.: Studies on surgical convalescence. I. Sources of nitrogen loss, postgastrectomy and effect of high amino-acid and high caloric intake on convalescence, Ann. Surg., 1944, cxx, 99. (c) RIEGEL, C., RHOADS, J. E., KOOP, C. E., GRIGGER, R. B., BULLITT, L., and BARRUS, D.: Dietary requirements for nitrogen equilibrium in the period immediately following certain major surgical operations, Am. Jr. Med. Sci., 1945, ccx, 133. (d) RIEGEL, C., KOOP, C. E., DREW, J., STEVENS, L. W., and RHOADS, J. E.: The nutritional requirements for nitrogen balance in surgical patients during the early postoperative periods, Jr. Clin. Invest., 1947, xxvi, 18. (e) WERNER, C.: Conference on metabolic aspects of convalescence including bone and wound healing, Josiah Macy, Jr. Found., 1945, Feb. 2-3, ninth meeting. CrossrefGoogle Scholar11. STRANGMCCLUGAGEEVANS JMHBFA: Nitrogen balance during dietary correction of obesity, Am. Jr. Med. Sci., 1931, clxxxi, 336. CrossrefGoogle Scholar12. KEETONDICKSON RWD: Excretion of nitrogen by obese patients on diets low in calories containing varying amounts of protein, Arch. Int. Med., 1933, li, 890. CrossrefGoogle Scholar13. KEETONBONE RWDD: Diets low in calories containing varying amounts of protein. Their effect on loss in weight and on the metabolic rate in obese patients, Arch. Int. Med., 1935, lv, 262. CrossrefGoogle Scholar14. BENEDICTMILESROTHSMITH FGWRPHM: Human vitality and efficiency under prolonged restricted diet, 1919, Carnegie Institution of Washington, Washington, D. C. Google Scholar15. LUSK G: The physiological effects of undernutrition, Physiol. Rev., 1921, i, 523. CrossrefGoogle Scholar16. KEYS A: Personal communication. Google Scholar17. MARTINROBISON CJR: The minimum nitrogen expenditure of man and the biological value of various proteins for human nutrition, Biochem. Jr., 1922, xvi, 407. CrossrefGoogle Scholar18. KENYON AT: Personal communication. Google Scholar19. WILKINSFLEISCHMAN LW: Studies in creatinuria due to methylated steroids, Jr. Clin. Invest., 1945, xxiv, 21. CrossrefGoogle Scholar20. TAYLORERICKSONHENSCHELKEYS HLLAA: The effects of bed rest on the blood volume of normal young men, Am. Jr. Physiol., 1945, cxliv, 227. CrossrefGoogle Scholar21. DEITRICKWHEDONSHORRBARR JEGDEDP: Conference on metabolic aspects of convalescence including bone and wound healing, Josiah Macy, Jr. Found., 1945, Feb. 2-3, 62, ninth meeting. Google Scholar22. DEITRICKWHEDONSHORR JEGDE: The effect of bed rest and immobilization upon various chemical and physiological functions of normal men. Their modification by the use of the oscillating bed, conference on metabolic aspects of convalescence including bone and wound healing, Josiah Macy, Jr. Found., 1946, Feb. 4, twelfth meeting. Google Scholar23. MANNBETTCHERCAMERONPETERS EBPGCMJP: Plasma α-amino-acids nitrogen and serum lipids of surgical patients, Jr. Clin. Invest., 1946, xxv, 701. CrossrefGoogle Scholar24. WHIPPLE GH: Plasma protein metabolism by isotope tracer technic, Nutr. Rev., 1945, iii, 137. Google Scholar25. FINKENNSKIMBALLSILBERSTEINBALEMADDENWHIPPLE RMTCPHEWFSCGH: Plasma protein metabolism—normal and associated with shock, Jr. Exper. Med., 1944, lxxx, 455. CrossrefGoogle Scholar26. BOYCE FF: The role of the liver in surgery, 1941, Charles C. Thomas, Springfield, Illinois. CrossrefGoogle Scholar27. SHAWSTEELELAMB JLBFCA: Effects of anaesthesia on blood oxygen. I. Study of the effect of ether anaesthesia on the oxygen in the central and in the venous blood, Arch. Surg., 1937, xxxv, 1. CrossrefGoogle Scholar28. GOLDSCHMIDTRAVDINLUCKE SKSB: Anaesthesia and liver damage. I. The protective action of oxygen against the necrotizing effect of certain anaesthetics on the liver, Jr. Pharm. and Exper. Therap., 1937, lix, 1. Google Scholar29. SHAWSTEELELAMB JLBFCA: Effect of anaesthesia on the blood oxygen. II. A study of the effect of spinal anaesthesia on the oxygen in the arterial and in the venous blood, Arch. Surg., 1937, xxxv, 503. CrossrefGoogle Scholar30. SNYDER CD: Recent advances in knowledge of the liver, Physiol. Rev., 1942, xxii, 54. CrossrefGoogle Scholar31. WATSON CJ: The average daily elimination of urobilinogen in health and disease with special reference to pernicious anemia, Arch. Int. Med., 1931, xlvii, 698. CrossrefGoogle Scholar32. WATSON CJ: Studies in urobilinogen. II. Urobilinogen in the urine and feces of subjects without evidence of disease of the liver or biliary tract, Arch. Int. Med., 1937, lix, 196. CrossrefGoogle Scholar33. WATSON CJ: Studies in urobilinogen. III. The per diem excretion of urobilinogen in the common forms of jaundice and disease of liver, Arch. Int. Med., 1937, lix, 206. CrossrefGoogle Scholar34. STEIGMANNDYNIEWICZ FJ: Studies in urobilinogen. I. The daily urobilinogen excretion, Gastroenterology, 1943, i, 743. Google Scholar35. WATSONHOFFBAUER CJFW: The problem of prolonged hepatitis with particular reference to the cholangiolitic type and to the development of cholangiolitic cirrhosis of the liver, Ann. Int. Med., 1946, xxv, 195. Google Scholar36. QUICK AJ: Conjugation of benzoic acid with glycine, a test of liver function, Proc. Soc. Exper. Biol. and Med., 1932, xxix, 1204. CrossrefGoogle Scholar37. QUICK AJ: Determination of prothrombin, Proc. Soc. Exper. Biol. and Med., 1939, xlii, 788. CrossrefGoogle Scholar38. BORGSTROM S: Prothrombin index after operation, Bull. War Med., 1943, iv, 217. Google Scholar39. EPSTEINGREENSPAN EZEB: Clinical significance of the cholesterol partition of the blood plasma in hepatic and in biliary disease, Arch. Int. Med., 1936, lviii, 860. CrossrefGoogle Scholar40. STUDENT: The probable error of a mean, Biometrica, 1908, vi, 1. Google Scholar41. STUDENT: New tables for testing the significance of observations, Metron, 1925, v, 105. Google Scholar42. HOAGLAND CL: The therapy of liver diseases, Bull. N. Y. Acad. Med., 1945, xxi, 537. Google Scholar43. WILSONPOLLOCKHARRIS CMRAD: Diet in the treatment of infective hepatitis, Lancet, 1946, i, 881. CrossrefGoogle Scholar44. HOAGLANDLABBYKUNKELSHANK CLDHHGRE: An analysis of the effect of fat in the diet on recovery in infectious hepatitis, Am. Jr. Pub. Health, 1944, xxxvi, 1287. Google Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: Chicago, Illinois*Presented before the meeting of the American College of Physicians, Chicago, May 2, 1947.From the Departments of Medicine and Surgery, Chicago, and the Division of Animal Nutrition, Urbana, University of Illinois.The experimental data reported in this paper were secured in the course of a project covered by a contract, recommended by the Committee on Medical Research, between the Office of Scientific Research and Development and the University of Illinois. Nextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byDigestive SystemSerum Enzymes after Cardiac SurgeryStudies on the Free Amino acids in Blood Plasma and Urine of the Patients Transfused with mixed Crystalline Amino Acids.METABOLIC RESPONSE TO SURGERY: SYSTEMIC, ADRENAL, AND COMPOSITIONALLiver Surgery in Relation to Diseases of the Colon and RectumTHE IMPORTANCE OF PROTEIN METABOLISM AND LIVER FUNCTION IN GERIATRIC SURGICAL PATIENTS†Clinical Aspects of the Metabolic Response to TraumaParenterale ErnährungLABORATORY TESTS IN THE DETERMINATION OF OPERABILITY IN THE AGED, WITH SPECIAL REFERENCE TO NUTRITION*ErnährungstherapieErnährungstherapieDie Krankheiten der Leber und der GallenwegeOVERNUTRITIONandOBESITYMetabolic Effects of Anesthesia in Man. IV. a Comparison of the Effects of Certain Anesthetic Agents on the Normal LiverThe Relation of Protein Metabolism to DiseaseVitamin Supplementation in Health and DiseaseThe Effects of Administration of Protein Hydrolysate (Amigen), Testosterone and Folic Acid on Nitrogen Balance in Patients with Chronic Pulmonary Tuberculosis 1 March 1948Volume 28, Issue 3Page: 521-551KeywordsChemical analysisConvalescenceLiverNitrogen metabolismNutritionResearch designSurgery ePublished: 1 December 2008 Issue Published: 1 March 1948 Copyright & PermissionsCopyright, 1948, by The American College of PhysiciansPDF downloadLoading ...