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Lactotransferrin is involved in the antibacterial defence of the host by virtue of its reversible iron-binding capacity. On the one hand, it participates in different molecular mechanisms displayed by immunocompetent cells which are known to synthesize or recognize the lactotransferrin. For instance, 1) during inflammation, apolactotransferrin released by the neutrophils captures the iron from serotransferrin which is accumulated by the macrophages, by means of their lactotransferrin membrane receptors; 2) lactotransferrin is an important component in the microbicidal activity of neutrophils by regulating the hydroxyl radical production; 3) lactotransferrin acts as a regulator of myelopoiesis by modulating activity of the colony stimulating factors; 4) lactotransferrin could be involved in the control mechanism of lymphoid cell migration. On the other hand, lactotransferrin participates to the non-specific local secretory immunity by being involved in antibacterial mechanisms together with secretory immunoglobulins sIgA and lysozyme. The different aspects of the participation of the lactotransferrin in the cellular and secretory mechanisms of antibacterial defence of the host show that the lactotransferrin plays a predominant role in the local immunity of any mucosa.

Significant gestational changes in red cell 2,3-DPG were found. No significant correlation was found between these pregnancy-related changes and alterations in the parameters of iron metabolism or red cell enzymes during the same gestational period. Possible reasons for the high concentration found at 21--24 weeks gestation are discussed.

An enzyme enhanced luminescence immunoassay has been developed using the determination of serum transferrin as a model. The assay has been compared with an established radioimmunoassay, the details of which have already been published (Wood, W. G. et al. (1980) Fresenius Z. Anal. Chem. 301, 120). After comparison, the luminescence immunoassay was introduced as the routine method for determining transferrin levels in human serum. The enzyme enhanced luminescence immunoassay uses a pyruvate kinase labelled transferrin as tracer, which, after the antibody-antigen reaction and subsequent bound-free separation, is used to generate adenosine triphosphate (ATP) from adenosine diphosphate(ADP) and phosphoenol pyruvate. The ATP is then monitored with a firefly luciferin-luciferase reagent, using a luminometer as detection system. The intra- and interassay coefficients of variation were under 10% and under 13% respectively in the range 0.6-4.5 g . liter-1. The stability of the lyophilised tracer was in excess of 5 months when stored at 4 degrees C, and the sensitivity of the assay lay under 0.1 micrograms per tube, although the detection limit of this type of assay system has not been fully explored.

The observations that malnutrition frequently affects cancer patients, that it adversely affects postoperative prognosis, and that it is amenable to intensive nutrition therapy, lead logically to the hypothesis that preoperative parenteral nutrition should have a salutary effect on many patients undergoing oncologic surgery. Available studies evaluating this hypothesis suggest that adequate preoperative intravenous feedings improve the postoperative course of malnourished patients and patients initially well nourished but in whom oral nutrition may be interrupted prior to operation.

Patients suffering severe trauma, including thermal injuries, demonstrate both a hypermetabolic response and an immunosuppressed state following the injury. Biochemically, these patients produce extremely large amounts of cyclooxygenase products, including prostaglandin E. We have investigated the effect of a drug, ibuprofen, which blocks the synthesis of prostaglandins in a burned rat model. Ibuprofen at high doses was found to significantly diminish the hypermetabolic response to burn injury and sepsis. The same dosage of ibuprofen increased the mortality rate in the same burn sepsis model. Prostaglandin E may therefore exert some beneficial effects in traumatized patients by altering their metabolism.

Resting energy expenditure (REE), nutritional parameters, and substrate levels were measured using a technique to minimize artifacts in 11 control patients, nine patients with localized, and four patients with diffuse neoplastic disease. Patients with diffuse disease had significantly increased percentage preillness weight loss (15.4 +/- 7.0%), decreased arm muscle circumference (21.9 +/- 2.1 vs. 26.2 +/- 3.5 cm), serum albumin (3.6 +/- 0.6 vs. 4.4 +/- 0.2 g/dl), total lymphocyte count (1024 +/- 613 vs. 1796 +/- 495 cells/mm3), and creatinine-height index (0.68 +/- 0.16 vs. 1.18 +/- 0.37) compared to controls. Both groups of cancer patients had significantly increased REE compared to controls: 25.6 +/- 3.7 (diffuse), 21.4 +/- 3.7 (localized), vs. 18.1 +/- 2.9 kcal/kg/d (controls). However, when REE was expressed as a function of metabolic body size, the significant difference persisted only in the patients with diffuse disease compared to controls: 71.8 +/- 16.4 vs. 53.9 +/- 8.1 kcal/kg3/4/d. Patients studied pre- and posttumor resection all had a postoperative drop in their REE, which was significantly correlated with the measured tumor volume. In this homogeneous, select group of patients, the tumor-bearing state exerts a moderate impact on nutritional and metabolic parameters, which are probably related to the extent of disease.

In has been suggested that monitoring of blood levels of serum proteins could be of value in order to assess the prognosis of trauma patients. A study was set up to assess the value of albuminaemia, prealbuminaemia, transferrin and ceruleoplasmin levels in intensive care unit patients admitted after multiple trauma including head injury. This study involved 43 patients (31 men and 12 women), with a mean age of 26 years (range: 15 and 71 years). Two patients had extradural haematoma. The other patients had brain contusion associated with extradural haematoma (5 cases), subdural haematoma (1 case) and open brain wound (1 case). All these patients were sedated with penthiobarbital, paralysed with pancuronium bromide and mechanically ventilated. Serum protein levels were measured on the first and eighth days of the stay in the intensive care unit. In these patients that survived, there was a significant decrease in albuminaemia and transferrin levels, no change in prealbuminaemia and a significant increase in ceruleoplasmin levels. Ten patients died during the study. They presented a greater decrease in albuminaemia and prealbuminaemia as compared with the survivors. There was no difference in the evolution of ceruleoplasmin and transferrin levels between the two groups. Thus, whilst the difference between survivors and non-survivors was significant for the group, for the individual patient the difference was too small to be of any prognostic value.

Postaggression metabolism is characterized by decisive, hormone dependent metabolic changes. All reactions are directed with top priority toward ensuring the energy supply. To this end glycogenolysis, gluconeogenesis and lipolysis are increased. Since this reaction of the organism can barely be influenced and it appears to be teleologically purposeful, many authors have repeatedly attempted to achieve a utilization of nutrients as high and economic as possible using an infusion regimen adapted to these conditions. We studied the efficiency of one such adapted nutritional regimen during the first four postoperative days in 10 patients who had undergone gastrectomy. The patients were given 1 g/kg B.W. daily of an amino acid solution adapted to postaggression metabolism, plus 4 g/kg B.W. carbohydrates. We found that clinically relevant parameters such as glucose in serum, triglycerides in serum and pre-albumin could be kept in the reference range. Amino acid homeostasis remained stable under the infusion of the stress adapted amino acid solution. A rise in urea production was not observed. We conclude that good conditions for an economic utilization of the amino acids were created by the infusion regimen selected by us. These results probably can still be optimized by targetted preoperative nutrition with the goal of improving the protein status of such patients already during the preoperative phase.

A screening study was conducted to identify malnutrition in gastroenterology outpatients and to ascertain whether poor food intake is a contributing factor. A 48-hour recall method was used to collect dietary data from 154 patients (87 women and 67 men). Fourteen (16%) of the women and 8 (12%) of the men were classified as having protein-energy malnutrition (PEM) on the basis of abnormal anthropometric measurements or low serum albumin concentration. PEM was found in several diagnostic groups, but 9 of the 14 malnourished women had Crohn's disease. Protein undernutrition was more evident in women; calorie undernutrition was more evident in men. More women than men had low serum albumin levels. Low hemoglobin levels were particularly prevalent among patients with Crohn's disease. Many of the patients, especially women, had "inadequate" and "marginal" intakes of folate, vitamin A, thiamin, and calcium according to Nutrition Canada interpretive standards. The intake of iron was particularly poor among women: 59% of the intakes of female patients were classified as inadequate (less than 10 mg/day). Ten of the 14 female patients with PEM had inadequate iron intakes. Serum folates of less than 5 ng/ml were present in 72% of the women and 77% of the men. The data suggest that gastrointestinal outpatients are at high risk of malnutrition and that one of the factors contributing to the problem is inadequate food intake.

The arthritis caused by iv injection of M. arthritidis in mice was found to be associated with neutrophilia and lymphopenia without a change in the total WBC concentration. A mild anemia developed which was characterized by hypoferremia and plentiful RE iron but with an increased plasma total iron-binding capacity. This anemia therefore differs from the anemia of chronic disorders and indeed from any anemia which occurs in man.

The erythrocyte ferritin content was measured in 183 healthy subjects in age from 4 to 68 years; 80 were male and 103 were female. In children between the ages of 4 and 12 years there is no significant difference in the mean value between boys and girls. In females the erythrocyte ferritin concentration is independent of age. After 12 years of age the erythrocyte ferritin content is higher in men. Reference intervals were determined by the two quantiles 0.05 and 0.95. The reference interval is 3-24 age by cell in boys between 4 and 12 and females between 4 and 63; the reference interval is 5-38 age by cell in males between 13 and 68 years of age.

The relation between the iron transmitted to infants by breast milk and the maternal iron stores was investigated in a group of 46 women. Total milk iron concentration was not correlated with the levels of serum ferritin or transferrin saturation. These results suggest that the iron transport from mother to the milk is irrespective to the maternal iron stores.

Haemoglobin concentration, serum iron, iron binding capacity, transferrin saturation, free erythrocyte protoporphyrin and serum ferritin (SF) were measured in 66 elite non-pregnant and 95 pregnant (27 elite and 68 non-elite) Nigerian women at Zaria, in the guinea savanna. Anaemia (as defined) was observed in 46% non-pregnant, 37% pregnant elite and 52% pregnant non-elite women. Iron deficiency (as defined) was diagnosed in 54, 30 and 25%, respectively. The mean SF in pregnant elite (28.9 micrograms l-1 was lower, but not significantly, than in pregnant non-elite women (33.6 micrograms l-1, either because of less inflammatory disease or because of more iron deficiency. The prevalence of anaemia tended to fall with increasing parity, being 52% in primigravidae and 40% in grande-multigravidae; this was probably due to greater risk of malaria-induced anaemia in primigravidae. In contrast, prevalence of iron deficiency increased with parity, being 18 and 35%, respectively, in primigravidae and grande-multigravidae. Anaemia and iron deficiency were seen most frequently in the third trimester. Pregnant women in the north of Nigeria require iron supplements irrespective of socioeconomic status or maternal parity.

Of patients referred to a geriatric service, 66 were identified who were clearly anemic (hemoglobin less than 12 g in men, less than 11 g in women) but whose cause of anemia was not readily identifiable by noninvasive measures. The difficulty in distinguishing iron deficiency from chronic disease as a cause of anemia by noninvasive means (serum iron, total iron binding capacity, transferrin saturation ratio, and serum ferritin), is highlighted by the poor power of these investigations when compared with bone marrow iron stores. A transferrin saturation ratio of less than 11% and a serum ferritin of less than 45 pg/L serve better than currently accepted values to identify iron deficiency in this population.

The half-lives of 35S-labelled L-methionine and of 3H-labelled L-fucose of serum transferrin of rats were measured in pulse-chase experiments in vivo. Both L-[35S]methionine and L-[6-3H]fucose disappeared from transferrin with nearly the same half-lives of 33.8 h and 36.5 h, respectively. The data show that in this major serum glycoprotein peripheral carbohydrates and the protein moiety are degraded as a unit.

We estimated analytical errors of the Calbiochem, Kallestad, Hyland, Meloy, Helena, and Beckman immunochemical methods for serum transferrin. Intermethod biases were determined by analysis of the "Reference Preparation for Serum Proteins" of the College of American Pathologists and by analysis of 106 patients' serum samples. We judged the acceptability of errors by comparing confidence limits for total errors with 1/4 of the normal reference intervals. The transferrin status of each patient's sample was interpreted by comparing the result of each method with the normal reference interval claimed by the corresponding manufacturer. We found that the combined effects of medically unacceptable analytical errors and inappropriate normal intervals caused results of the tested methods not to be interchangeable. The Calbiochem method identified 61 serum samples (57%) as having abnormally high transferrin concentrations. In contrast, for the same specimen, with the Meloy method we found abnormally high transferrin concentrations for only two samples (1.8%).

Serum ferritin, transferrin, haptoglobin, and iron were measured in well-trained middle- and long-distance runners, elite rowers of the West German national team, and professional racing cyclists during the summer training and the winter rest period. None of the male athletes examined, with the exception of the racing cyclists during the summer period, received oral or parenteral iron. The runners were found to have significantly lower ferritin (P less than 0.00001), iron (P less than 0.001), and haptoglobin values (P less than 0.01) than the controls. Their transferrin levels were elevated, however not significantly. Rowers showed significantly higher ferritin levels (P less than 0.01) than the controls. The reduced haptoglobin concentrations in runners are presumed to be caused by a running-induced hemolysis. It is speculated that a recurring hemoglobinuria produced diminished iron reserves in middle- and long-distance runners.

Nutritional status and socioeconomic characteristics of 49 men attending a soup kitchen in a residential neighborhood of Birmingham, Alabama were determined by interview, anthropometry and laboratory assays. Laboratory or anthropometric evidence of nutrient deficiency was present in 94 per cent of the subjects. Deficiency of ascorbate (63 per cent), folate (35 per cent), and thiamin (29 per cent) was higher in these men than in either patients or presumably healthy adults. Since soup kitchen meals provided insufficient vitamin C and folate, additional sources of these nutrients should be provided.

The iron status of nine female marathon runners was evaluated during 11 weeks of training for a marathon race and following a marathon race. Venous blood samples were obtained at the start of the training period, weekly during training, and 1, 2, 3, and 4 days post-race. The subjects completed menstrual and dietary histories, and the diet content of energy, protein, iron, and ascorbic acid was calculated. Serum iron, total iron binding capacity, and transferrin saturation showed no significant change at weeks 1, 7, and 11 during training. The mean values of serum iron and transferrin saturation were low. During training, eight of the nine women averaged serum ferritin levels below 50 ng/ml, one of the eight having values consistently less than 10 ng/ml. Ferritin values were significantly elevated for 3 days after the marathon. No subject reported abnormally heavy menstrual bleeding, and nutrient intakes were near recommended levels, except for iron. Thus, the iron status of these women marathon runners was poor, suggesting that women runners may have higher dietary needs for iron than sedentary women. Serum ferritin levels were also elevated after a marathon run and may not adequately reflect iron stores.

The hemoglobin concentrations during pregnancy in Filipinos belonging to the upper income group, who were prescribed 105 mg elemental iron daily, and who had acceptable levels of transferrin saturation, were examined in an attempt to define normal levels. The hemoglobin concentrations for each trimester followed a Gaussian distribution. The hemoglobin values equal to the mean minus one standard deviation were 11.4 gm/dl for the first trimester and 10.4 gm/dl for the second and third trimesters. Using these values as the lower limits of normal, in one group of pregnant women the prevalence of anemia during the last two trimesters was found lower than that obtained when WHO levels for normal were used. Groups of women with hemoglobin of 10.4 to 10.9 gm/dl (classified anemic by WHO criteria but normal in the present study) and those with 11.0 gm/dl and above could not be distinguished on the basis of their serum ferritin levels nor on the degree of decrease in their hemoglobin concentration during pregnancy. Many subjects in both groups, however, had serum ferritin levels less than 12 ng/ml which indicate poor iron stores. It might be desirable in future studies to determine the hemoglobin cut-off point that will delineate subjects who are both non-anemic and adequate in iron stores using serum ferritin levels as criterion for the latter.

Ferritin values for 250 selected sera were compared with values for iron, total iron-binding capacity (TIBC), and transferrin saturation, to assess the potential of the ferritin assay for the detection of latent iron deficiency. The specimens were grouped (50 in each group) according to their values for iron and TIBC. In Group 1 (low iron, high TIBC) the saturation and ferritin values both indicated iron deficiency in all but one. In the 100 specimens of Groups 2 (normal iron, high TIBC) and 4 (normal iron, high normal TIBC), the saturation values revealed 16 iron-deficient cases, the ferritin test 55. For Groups 3 (low iron, normal TIBC) and 5 (low iron, low TIBC), the ferritin test revealed fewer cases of iron deficiency than did the saturation values (37 cases vs 51 cases, in the 100 specimens). Evidently the ferritin test detects iron deficiency in many cases for whom the serum iron and TIBC tests are not positively indicative. The correlation of serum ferritin with iron, TIBC, and transferrin saturation in the five groups was good only in the case of specimens for which the TIBC was normal; if it was abnormal the correlation was very poor.

Status of iron nutrition along with demographic, anthropometric, dietary, and biochemical parameters were recorded in 98 pediatric cancer patients at the time of referral. Dietary intake in each patient was analyzed for calories, protein, and iron. Blood specimens were analyzed for hemoglobin (Hgb), hematocrit (Hct), iron, total iron-binding capacity (TIBC), transferrin, and ferritin. Dietary intake measures were assessed according to each subject's Recommended Dietary Allowance (RDA). The results were compared among three diagnostic groups, namely, benign, solid tumor, and hematopoietic. The nutrient lowest in intake was iron. The overall measures revealed significant differences between the benign and hematopoietic groups in all parameters except TIBC and transferrin. A correlation coefficient of 0.55 (p less than 10(-5) between transferrin and TIBC was generated in our patients. Significant differences were noted for ferritin in the acute lymphocytic leukemia (p = 0.0001) and lymphoma (p = 0.0007) groups when compared with the benign group. A correlation coefficient of 0.55 (p less than 10(-5) was generated in our patients. A 3-month follow-up assessment was conducted in order to document the effects of therapy. Tumor response and progression was compared to changes in ferritin levels from baseline to follow-up. Our results support the literature, that ferritin is a sensitive tumor marker in various malignancies.

We developed a method for the quantification of the different fractions of serum transferrin, based on an isoelectric focusing followed by immunofixation. We employed this technique to study whether or not the pattern of the serum transferrin was altered in the serum of drinkers. We established an increase of the fraction that focused at 5.7 (Tf5.7) and a concomittant decrease of the fraction that focused at 5.4 (Tf5.4) in the sera of drinkers. The separation between drinkers and controls was enhanced when using the ratio Tf5.7/Tf5.4, called Tf index. The predictive value of this test was 0.88, which means that 88% of the subjects were correctly classified as heavy drinkers or not.

1. Serum transferrin is a sensitive indicator for the establishment of a subclinical protein deficit. 2. When a diet moderately poor in protein was given (0.5-0.6 g/kg body weight/daily) was given the transferrin values (243 +/- 61 mg/100 ml) were significantly lower than in the control group (284 +/- 61 mg/100 ml), but they were altogether still in the lower normal region.

The relationship between the number of units of blood transfused and indicators of iron status in 37 patients with sickle cell anaemia (Hb SS), SC disease (Hb SC) or S beta-thalassaemia has been studied. The correlation coefficient between serum ferritin and the number of units transfused was good (r = 0.86), provided that ferritin samples taken within one week following a crisis were excluded. The relationship of transfusion history to serum ferritin in the steady state showed a similar relationship to that previously observed for other multiply transfused patients. The serum ferritin taken within 7 days of a painful crisis was significantly greater than the serum ferritin from the same patients in the steady state (p less than 0.025). The serum alanine transaminase did not rise as consistently as the serum ferritin during crises; it correlated with the serum ferritin but not the transfusion burden in the steady state. Transferrin iron saturation correlated less clearly with transfusion history than serum ferritin (r = 0.62). Patients who had received exchange transfusions were less likely to be iron-overloaded (ferritin increment per unit of blood = 9.9 +/- 3.8 micrograms/l) than patients who had received an equivalent number of units by conventional transfusion (ferritin increment per unit of blood transfused = 25.1 +/- 2.42 micrograms/l).

Since its identification about 30 years ago transferrin has attracted the interest of many investigators concerned with its structure, metal-binding properties, genetic polymorphism, and especially its role in the transport of iron within the body. Transferrin's two iron-binding sites appear to be structurally identical with equivalent iron binding after addition of iron in vitro. However, since the experiments of Fletcher and Huehns, the functional homogeneity of transferrin-bound iron has been questioned. Understanding of the precise mechanism of iron release from transferrin to receptor sites on reticulocytes and other tissues active in iron exchange is incomplete. Considerable evidence has been assembled from rats to support the Fletcher-Huehns hypothesis of selective release of A-site iron to erythrocyte precursors and placenta while B-site iron is delivered to hepatocytes. Results of experiments in rabbit and human systems remain controversial. Reasons for this controversy include: variations in the technique of iron addition to transferrin with the possibility of non-specific binding; variations in reticulocytes used in preparing selectively labelled transferrin and in its biological assay; and artifacts introduced in mixed-species experiments. Until methods are more refined and the transferrin-iron receptor interaction is better understood, the controversy about transferrins's iron transport function will persist.

This study was designed to compare the effectiveness of laboratory tests for iron deficiency (mean corpuscular volume, erythrocyte protoporphyrin, transferrin saturation, and serum ferritin) in predicting hemoglobin response to iron therapy in infants found to have low Hgb concentrations. Screening for anemia was performed on capillary blood of 1,128 healthy 1-year-old infants of United States Air Force personnel. The 25% who had Hgb values less than 11.5 gm/dl were asked to return for tests on venous blood before therapy and again after three months of therapy. Of the 188 infants completing therapy, 66 (35%) had a rise in Hgb concentration greater than or equal to 1.0 gm/dl and were designated responders. None of the confirmatory tests on venous blood reliably distinguished responders from those who subsequently showed no response. By using any one of the tests in combination with a capillary Hgb value less than 11.5 gm/dl, more than half of the infants with an abnormal value responded. But well over half of the responders would have been missed if treatment had been restricted to infants with abnormal values. Neither changes in the criteria for normality nor combinations of tests substantially improved our ability to distinguish the two groups. Because of the difficulty in distinguishing responders from nonresponders with additional laboratory tests and because of the simplicity, low cost, and relative safety of iron therapy in infants, we favor an initial therapeutic trial of iron first for determining the cause of low Hgb values in similar high-risk populations. Further costly workup can then be reserved for the small number of infants who still have unexplained Hgb concentrations less than 11.0 gm/dl after a therapeutic trial.

Microcytic anemia, long considered an effect of lead poisoning, may in fact result from coexisting iron deficiency. In this study, how RBC size, hemoglobin, and zinc protoporphyrin vary as a function of iron status in a group of children with high lead levels was examined. Charts of all children (N = 51) admitted to Cook County Hospital for treatment of lead poisoning in 1981 to 1983 were reviewed for data on age, blood lead level, hemoglobin concentration, MCV, transferrin saturation and zinc protoporphyrin level. The mean lead level was 86 micrograms/dL and the range was 63 to 190 micrograms/dL. Children with transferrin saturation values less than 7% had a mean MCV of 56 microL, hemoglobin of 8.9 g/dL, and zinc protoporphyrin of 693 micrograms/dL; for those with saturations of 7% to 16%, the values were 61 microL, 10.1 g/dL, and 581 micrograms/dL, respectively; the children with saturations greater than 16% had normal mean MCVs and hemoglobin concentrations (74 microL and 11.4 g/dL) and a mean zinc protoporphyrin value of 240 micrograms/dL (P less than .0005). Multiple linear regression was used to correct for effect of age, and transferrin saturation remained the most important predictor of MCV, hemoglobin, and zinc protoporphyrin levels; the addition of lead did not improve the models. Results of this study suggest that iron deficiency is strongly associated with some of the observed toxicities of lead. Also, lead poisoning can exist without producing microcytosis or anemia, and zinc protoporphyrin concentration may not be a sensitive indicator of lead level in the absence of iron deficiency.

The effects of different types of dietary lipids were tested in burned guinea pigs. All diets were identical except for the type of lipid, with total energy intake from lipids equaling 10%. All animals received a 30% total body surface area (TBSA) flame burn and were fed identically by pump-controlled gastrostomy feedings for 14 days. When compared to safflower oil (74% linoleic acid) as well as linoleic acid alone, fish oil (18% eicosapentaenoic acid or EPA) administration resulted in less weight loss, better skeletal muscle mass, lower resting metabolic expenditure, better cell mediated immune responses, better opsonic indices, higher splenic weight, lower adrenal weight, higher serum transferrin, and lower serum C3 levels. With the exception of better cell mediated immune responses in the animals fed linoleic acid, the administration of indomethacin made little difference. These findings can be explained by a reduction in the synthesis of the dienoic prostaglandins that are derived from the omega 6 series of fatty acids, some of which are significantly immunosuppressive. Regulation of dietary lipids may be an important therapeutic advance in nutritional support after burn injury, and controlled trials should be considered.

The purpose of this prospective study was to re-examine the relative importance of various factors in the pathogenesis of angular cheilitis. Sixty-four patients with cheilitis were examined clinically and microbiologically. In addition, a subsample of 23 patients was examined for serum iron and transferrin. The clinical appearance of the lip lesions fell into 4 categories. A ground rhagad at the corner of the mouth involving adjacent skin, was the most frequent type among dentate patients, whereas among denture wearers a deep lesion following the labial marginal sulcus was frequently observed. Dentate patients and denture wearers with cheilitis often had atopic constitution or cutaneous diseases. Pathogenic microorganisms were cultured from the lesions in all 64 patients; Staphylococcus aureus in 40 patients and Candida albicans in 45. The results of this study indicate a correlation between angular cheilitis and pathogenic microorganisms. Furthermore, among dentate patients, a correlation exists between cutaneous discomfort and angular cheilitis. Other etiological factors suggested for this disorder were found to be of subordinate importance.

A prospective, randomized, double-blind trial of the nutritional effects of branched chain modified amino acid solutions was undertaken in 23 surgical patients within 24 hours of the onset of major general surgery, polytrauma, or sepsis. The effects were evaluated in the absence of abnormalities of oxygen transport and perfusion in an isocaloric/isonitrogenous setting where the major difference between the groups was the amount of branched chain amino acids received. Both groups received balanced parenteral nutrition with 1.5 gm/kg/day of amino acids, 30 calories/kg/day of glucose, and 7 calories/kg/day of fat. At the end of the 7-day study interval, the group receiving the branched chain enriched therapy at 0.7 gm/kg/day of branched chain amino acids had improved nitrogen retention; an elevation of their absolute lymphocyte count from 800 to 1800/mm3, a reversal of anergy to recall skin test antigens in 60% of the patients, and improved plasma transferrin levels (p less than 0.03). Nutritional support using the modified amino acid metabolic support solutions has beneficial effects during the stress interval that do not seem as achievable with current commercially available nutritional support regimens.

The clinical significance of the measurement of plasma transferrin (Tf) in patients with hypophysial disorders was reported in our previous paper. In the present study, we determined plasma Tf levels in 55 patients with various endocrine states and considered their clinical significance compared with plasma somatomedin-C (SM-C) levels. Plasma Tf levels decreased significantly in patients with anorexia nervosa (P less than 0.02), hyperthyroidism (P less than 0.05), primary hypothyroidism (P less than 0.05), and Cushing's syndrome (P less than 0.05), while they were elevated significantly in pregnancy (P less than 0.01) or females using estrogens (P less than 0.05). The former two declines were considered a reflection of the malnutritional state since a significant negative correlation was observed between plasma Tf levels and the percentile deficit from the ideal body weight in patients with anorexia nervosa (P less than 0.01), or between plasma Tf and elevated T3 levels which induce hypermetabolism in patients with hyperthyroidism (P less than 0.01). A significant correlation was observed between the SM-C and Tf levels in these subjects (including normal controls and patients with hypophysial disorders) as a whole (r = 0.79, P less than 0.001). These data indicate that plasma Tf is changeable according to the endocrine and nutritional conditions with good correlation to the SM-C, and it is suggested that Tf also operates as a growth factor in vivo.