William R. Beisel

There can be no doubt that malnutrition has an adverse impact on immunological functions and can serve to suppress cell-mediated, humoral, and secretory immune competence. While most clinical studies have been performed in patients with generalized forms of malnutrition, immunosuppression has been found to occur with deficiencies of essential single nutrients. Rarely does even a severely malnourished child exhibit the degrees of impairment in any immune function comparable to those experienced in congenital, primary immunodeficiency states. Further, nutritional immunodeficiencies in human beings appear to respond will to dietary therapy, with improvement in some functions becoming evident within a few days of initiating a refeeding program. No entirely satisfactory animal model has yet been developed to replicate human forms of malnutrition. Nevertheless, animal models have considerable potential usefulness for probing the mechanisms of nutritional immunosuppression at the molecular level. (Author)

Article1 October 1967Metabolic Effects of Intracellular Infections in ManWILLIAM R. BEISEL, WILLIAM D. SAWYER, M.D., F.A.C.P., ERICH D. RYLL, DAN CROZIERWILLIAM R. BEISELSearch for more papers by this author, WILLIAM D. SAWYER, M.D., F.A.C.P.Search for more papers by this author, ERICH D. RYLLSearch for more papers by this author, DAN CROZIERSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-67-4-744 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptDuring the past 2 decades extraordinary advances have occurred in our understanding of the biology of normal cells. Dramatic progress has been made in defining the "molecular pathology" of diverse diseases; in particular, the molecular consequences of infection have been characterized extensively in bacterial and cultured mammalian cells infected by viruses. Much less is known, however, of the more complicated biochemical and metabolic events during infection of intact mammalian hosts. Studies in both experimental animals and man are limited in number. The human studies were conducted mainly during the preantibiotic era, and investigations generally were initiated only after illness was...References1. Army Regulation 70-25: Use of volunteers as subjects of research. Department of the Army, 1962. Google Scholar2. ISREELIPELAVINKESSLER JMG: Continuous automatic integrated flame photometry. Ann. N. Y. Acad. Sci. 87: 636, 1960. CrossrefGoogle Scholar3. LUNDGREN DP: Methods development for phosphate analysis with the autoanalyzer. Ibid., p. 904. Google Scholar4. HILL JB: An automated fluorometric method for the determination of serum magnesium. Ann. N. Y. Acad. Sci. 102: 108, 1962. CrossrefMedlineGoogle Scholar5. WALLACHSURGENORSODERBERGDELANO DFDMJE: Preparation and properties of 3,6-dihydroxy-2,4-bis-[N,N′-di-(carboxymethyl)-aminomethyl] fluoran. Anal. Chem. 31: 456, 1959. CrossrefGoogle Scholar6. FERRARI A: Nitrogen determination by a continuous digestion and analysis system. Ann. N. Y. Acad. Sci. 87: 792, 1960. CrossrefMedlineGoogle Scholar7. CHASSONGRADYSTANLEY ALHJMA: Determination of creatinine by means of automatic chemical analysis. Techn. Bull. Regist. Med. Techn. 30: 207, 1960. MedlineGoogle Scholar8. SKEGGS LT: An automatic method for colorimetric analysis. Amer. J. Clin. Path. 28: 311, 1957. CrossrefMedlineGoogle Scholar9. BROWN H: The determination of uric acid in human blood. J. Biol. Chem. 158: 601, 1945. CrossrefGoogle Scholar10. ZALLFISHERGARNER DMDMQ: Photometric determination of chlorides in water. Anal. Chem. 28: 1665, 1956. CrossrefGoogle Scholar11. MOORESTEIN SWH: A modified ninhydrin reagent for the photometric determination of amino acids and related compounds. J. Biol. Chem. 211: 907, 1954. CrossrefMedlineGoogle Scholar12. LOGSDON EE: A method for the determination of ammonia in biological materials on the autoanalyzer. Ann. N. Y. Acad. Sci. 87: 801, 1960. CrossrefMedlineGoogle Scholar13. BEISELBRUTONANDERSONSAWYER WRJKDWD: Adrenocortical responses during tularemia in humans. J. Clin. Endocr. 27: 61, 1967. CrossrefGoogle Scholar14. REIFENSTEINALBRIGHTWELLS ECFSL: The accumulation, interpretation, and presentation of data pertaining to metabolic balances, notably those of calcium, phosphorus, and nitrogen. J. Clin. Endocr. 5: 367, 1945. CrossrefMedlineGoogle Scholar15. SAWYERJEMSKIHOGGEEIGELSBACHWOLFEDANGERFIELDGOCHENOURCROZIER WDJVALHTEKHGWSD: Effect of aerosol age on the infectivity of airborne Pasteurella tularensis for Macaca mulatta and man. J. Bact. 91: 2180, 1966. CrossrefMedlineGoogle Scholar16. SAWYERDANGERFIELDHOGGECROZIER WDHGALD: Antibiotic prophylaxis and therapy of airborne tularemia. Bact. Rev. 30: 542, 1966. CrossrefMedlineGoogle Scholar17. EIGELSBACHDOWNS HTCM: Prophylactic effectiveness of live and killed tularemia vaccines. I. Production of vaccine and evaluation in the white mouse and guinea pig. J. Immun. 87: 415, 1961. MedlineGoogle Scholar18. OVERHOLTTIGERTTKADULLWARDCHARKESRENESALZMANSTEPHENS ELWDPJMKNDRMTEM: An analysis of forty-two cases of laboratory-acquired tularemia. Treatment with broad spectrum antibiotics. Amer. J. Med. 30: 785, 1961. CrossrefMedlineGoogle Scholar19. MCCRUMB FR: Aerosol infection of man with Pasteurella tularensis. Bact. Rev. 25: 262, 1961. CrossrefMedlineGoogle Scholar20. OVERHOLTTIGERTT ELWD: Roentgenographic manifestations of pulmonary tularemia. Radiology 74: 758, 1960. CrossrefMedlineGoogle Scholar21. SASLAWCARHART SS: Studies with tularemia vaccines in volunteers. III. Serologic aspects following intracutaneous or respiratory challenge in both vaccinated and non-vaccinated volunteers. Amer. J. Med. Sci. 241: 689, 1961. CrossrefMedlineGoogle Scholar22. GREISMANHORNICKCAROZZAWOODWARD SERBFATE: The role of endotoxin during typhoid fever and tularemia in man. I. Acquisition of tolerance to endotoxin. J. Clin. Invest. 42: 1064, 1963. CrossrefMedlineGoogle Scholar23. HUME EE: Sandfly fever, in Tice's Practice of Medicine, vol. 3, edited by TICE, F. W. F. Prior, Co., Hagerstown, 1925, pp. 649-662. Google Scholar24. TIGERTTBENENSON WDAS: Studies on Q fever in man. Trans. Ass. Amer. Physicians 69: 98, 1956. MedlineGoogle Scholar25. SMADEL JE: Rickettsial diseases, in Diagnostic Procedures for Virus and Rickettsial Diseases. American Public Health Association Press, New York, 1956, p. 513. Google Scholar26. TIGERTTBENENSONGOCHENOUR WDASWS: Airborne Q fever. Bact. Rev. 25: 285, 1961. CrossrefMedlineGoogle Scholar27. BEISELJOYGOLDMAN WRRJRF: Metabolic balance studies during induced hyperthermia in man. In preparation. Google Scholar28. BEISEL WR: Neutrophile alkaline phosphatase changes in tularemia, sandfly fever, Q fever and non-infectious fevers. Blood 29: 257, 1967. CrossrefMedlineGoogle Scholar29. BECQUERELRODIER AA: Recherches sur la composition du sang dans l'état de santé et dans l'état de maladie. Gaz. Med. France 12: 765, 1844. Google Scholar30. MORACZEWSKI WV: Ueber den Chlor- und Phosphorgehalt des Blutes bei krankhaften Zuständen. Virchow. Arch. Path. Anat. 146: 424, 1896. CrossrefGoogle Scholar31. HUTCHISON RJ: Chloride metabolism in pneumonia and acute fevers. J. Path. Bact. 5: 406, 1898. CrossrefGoogle Scholar32. GARRATT GC: Observations on metabolism in the febrile state in man. Med.-Chir. Trans. 87: 163, 1904. MedlineGoogle Scholar33. KILLIAN JA: Chemical blood changes in pneumonia. J. Biol. Chem. 50: xxxvii, 1922. Google Scholar34. SUNDERMANAUSTINCAMACK FWJHJG: Studies in serum electrolytes. I. Concentration of electrolytes and non-electrolytes in the serum during lobar pneumonia. J. Clin. Invest. 3: 37, 1926. CrossrefMedlineGoogle Scholar35. HADEN RL: The clinical significance of the chloride metabolism in lobar pneumonia. Amer. J. Med. Sci. 174: 744, 1927. CrossrefGoogle Scholar36. SOULEBUCKMANDARROW HCTEDC: Blood volume in fever. J. Clin. Invest. 5: 229, 1928. CrossrefMedlineGoogle Scholar37. WILDERDRAKE TSTG: Metabolism of chloride and total fixed base in pneumonia and the relation to salt and water retention. J. Clin. Invest. 7: 353, 1929. CrossrefMedlineGoogle Scholar38. TIERNEYYEOMANS NAA: Metabolic studies in louse-borne typhus. Observations on serum electrolyte pattern, serum protein partition, and nitrogen balance. J. Clin. Invest. 25: 822, 1946. CrossrefMedlineGoogle Scholar39. WOODWARDBLAND TEEF: Clinical observations in typhus fever with special reference to the cardiovascular system. JAMA 126: 287, 1944. CrossrefGoogle Scholar40. PEABODY FW: Studies of the inorganic metabolism in pneumonia with special reference to calcium and magnesium. J. Exp. Med. 17: 71, 1913. CrossrefMedlineGoogle Scholar41. GERSTENBERGERBURHANSSMITHWETZEL HJCWDNNC: The blood serum content of inorganic phosphorus and calcium in pneumonia. Amer. J. Dis. Child. 26: 329, 1923. Google Scholar42. HONAGA S: Klinische und experimentelle Studien über den Stoffwechsel von Kalzium, Kalium, und anorganischen Phosphor im Fieber. Jap. J. Exp. Med. 18: 225, 1940. Google Scholar43. MURCHINSON C: Treatise on Continued Fevers of Great Britain. Parker, Son & Bourn, London, 1862, pp. 116-170. Google Scholar44. SCHWARTZMCGILL HC: Blood urea determinations in 211 cases. Arch. Intern. Med. (Chicago) 17: 42, 1916. CrossrefGoogle Scholar45. WELLS CW: Blood chemistry studies in influenzal pneumonia. Arch. Intern. Med. (Chicago) 26: 443, 1920. CrossrefGoogle Scholar46. YEOMANSSNYDERMURRAYECKEZARAFONETIS AJCESRSCJ: Azotemia in typhus fever. Ann. Intern. Med. 23: 711, 1945. LinkGoogle Scholar47. SANFORDBELLI JPJA: The occurrence of azotemia in pneumococcal pneumonia. Amer. Rev. Resp. Dis. 83: 704, 1961. MedlineGoogle Scholar48. WAKEMANMORRELL AMCA: Chemistry and metabolism in experimental yellow fever in Macacus rhesus monkeys. I. Concentration of non-protein nitrogenous constituents in the blood. Arch. Intern. Med. (Chicago) 46: 290, 1930. CrossrefGoogle Scholar49. WAKEMANMORRELL AMCA: Chemistry and metabolism in experimental yellow fever in Macacus rhesus monkeys. II. Nitrogen metabolism. Ibid., p. 382. Google Scholar50. SBARRAWOODWARD AJJM: The host-parasite relationship in tularemia. II. A clinical study of the blood and urine of white rats infected with Pasteurella tularense. J. Bact. 69: 363, 1955. CrossrefMedlineGoogle Scholar51. WOODWARDSBARRAHOLTMAN JMAJDF: The host-parasite relationship in tularemia. I. A study of the influence of Bacterium tularense on the amino acid metabolism of white rats. J. Bact. 67: 58, 1954. CrossrefMedlineGoogle Scholar52. FARRMACLEODFUTCHEREMERSONMIRICKCURNEN LECMPHKGSEC: Hypoaminoacidemia in patients with pneumococcal pneumonia. Proc. Soc. Exp. Biol. Med. 44: 290, 1940. CrossrefGoogle Scholar53. FEIGINDANGERFIELD RDHG: Whole blood amino acid changes following respiratory acquired Pasteurella tularensis infection in man. J. Infect. Dis. In press. Google Scholar54. BEISELDIRAIMONDOCHAOROSNERFORSHAM WRVCPYJMPH: The influence of plasma protein binding on the extra-adrenal metabolism of cortisol in normal, hyperthyroid and hypothyroid subjects. Metabolism 13: 942, 1964. CrossrefMedlineGoogle Scholar55. MÜLLER F: Beobachtungen über Antipyrin. Z. Klin. Med. 5: 569, 1884. Google Scholar56. BENEDICT H: Ueber die Ausscheidung des Schwefels in pathologischen Zuständen. Z. Klin. Med. 36: 281, 1898. Google Scholar57. MORACZEWSKI WV: Stoffwechsel bei Lunggenentzundung und Einfluss der Salze auf denselben. Z. Klin. Med. 39: 44, 1900. Google Scholar58. BENEDICTSURANYI HN: Die Stoffwechselvorgänge während der Typhusreconvalescenz. Z. Klin. Med. 48: 290, 1903. Google Scholar59. KRAUS F: Fever and infection, in Handbuch der Pathologie des Stoffwechsels, edited by NOORDEN, C. VON. A. Hirschwald, Berlin, 1906, pp. 578-668. Google Scholar60. SHAFFERCOLEMAN PAW: Protein metabolism in typhoid fever. Arch. Intern. Med. (Chicago) 4: 538, 1909. CrossrefGoogle Scholar61. COLEMANDUBOIS WEF: The influence of the high-calorie diet on the respiratory exchanges in typhoid fever. Arch. Intern. Med. (Chicago) 14: 168, 1914. CrossrefGoogle Scholar62. COLEMANDUBOIS WEF: Clinical calorimetry. VII. Calorimetric observations on the metabolism of typhoid patients with and without food. Arch. Intern. Med. (Chicago) 15: 887, 1915. CrossrefGoogle Scholar63. MCCANNBARR WSDP: Clinical calorimetry. XXIX. The metabolism in tuberculosis. Arch. Intern. Med. (Chicago) 26: 663, 1920. CrossrefGoogle Scholar64. COLEMANBARRDUBOIS WDPEF: Clinical calorimetry. XXX. Metabolism in erysipelas. Arch. Intern. Med. (Chicago) 29: 567, 1922. CrossrefGoogle Scholar65. MCCANN WS: The protein requirement in tuberculosis. Ibid., p. 33. Google Scholar66. KRAUSE E: Untersuchungen über den minimalen Eiweissverbrauch des Menchen unter gesunden und krankhaften Bedingungen. Deutsch. Arch. Klin. Med. 150: 13, 1926. Google Scholar67. SUNDERMAN FW: Studies of serum electrolytes. IV. The chloride and nitrogen balances, and weight changes in pneumonia. J. Clin. Invest. 7: 313, 1929. CrossrefMedlineGoogle Scholar68. GROSSMANSAPPINGTONBURROWSLAVIETESPETERS CMTSBAPHJP: Nitrogen metabolism in acute infections. J. Clin. Invest. 24: 523, 1945. CrossrefMedlineGoogle Scholar69. PETERS JP: Nitrogen metabolism in acute and chronic disease. Ann. N. Y. Acad. Sci. 47: 327, 1946. CrossrefMedlineGoogle Scholar70. GANDRASCRIMSHAW YRNS: Infection and nutritional status. II. Effect of mild virus infection induced by 17-D yellow fever vaccine on nitrogen metabolism in children. Amer. J. Clin. Nutr. 9: 159, 1961. CrossrefMedlineGoogle Scholar71. WILSONBRESSANISCRIMSHAW DRNS: Infection and nutritional status. I. The effect of chicken pox on nitrogen metabolism in children. Ibid., p. 154. Google Scholar72. HOWARDBIGHAMMASON JERSRE: Studies on convalescence. V. Observations on the altered protein metabolism during induced malarial infections. Trans. Ass. Amer. Physicians 59: 242, 1946. Google Scholar73. MAY R: Der Stoffwechsel im Fieber experimentelle Untersuchung. Z. Biol. 30: 7, 1894. Google Scholar74. STÄHELIN R: Über Stoffwechsel und Energieverbrauch bei der Surraerkrankkung. Arch. Hyg. Bakt. 50: 77, 1904. Google Scholar75. COOKEWHIPPLE JVGH: Proteose intoxications and injury of body protein. IV. The metabolism of dogs with sterile abscess, pancreatitis, and pleuritis. J. Exp. Med. 28: 223, 1918. CrossrefMedlineGoogle Scholar76. LEAKEVICKERSBROWN CDJLTK: Observations on blood reaction in experimental pneumonia. J. Exp. Med. 39: 393, 1924. CrossrefMedlineGoogle Scholar77. SANSLONESQUIBB WRRL: Avian disease virus and nutrition relationships. III. Effect of Newcastle disease virus on nitrogen retention in the immature fowl. J. Nutr. 76: 86, 1962. CrossrefMedlineGoogle Scholar78. NEWBERNE PM: Overnutrition on resistance of dogs to distemper virus. Fed. Proc. 25: 1701, 1966. MedlineGoogle Scholar79. HOSSLIN HV: Experimentelle Beiträge zur Frage der Ernährung fieberuder Kranker. Virchow. Arch. Path. Anat. 89: 95, 1882. CrossrefGoogle Scholar80. DUBOIS EF: The absorption of food in typhoid fever. Arch. Intern. Med. (Chicago) 10: 177, 1912. CrossrefGoogle Scholar81. COLEMANGEPHART WFC: Clinical calorimetry. VI. Notes on the absorption of fat and protein in typhoid fever. Arch. Intern. Med. (Chicago) 15: 882, 1915. CrossrefGoogle Scholar82. UNRUH E: Ueber die Stickstoffausscheidung bei fieberhaften Krankheiten. Virchow. Arch. Path. Anat. 48: 227, 1869. CrossrefGoogle Scholar83. HOFMANN KB: Ueber Kreatinin in normalen und pathologishen Harne. Ibid., p. 358. Google Scholar84. LEATHES JB: On the excretion of nitrogen, creatinine, and uric acid in fever. J. Physiol. (London) 35: 205, 1907. CrossrefGoogle Scholar85. SHAFFER P: The excretion of kreatinin and kreatin in health and disease. Amer. J. Physiol. 23: 1, 1908. CrossrefGoogle Scholar86. EWINGWOLF JCG: The clinical significance of the urinary nitrogen. III. Nitrogenous metabolism in typhoid fever. Arch. Intern. Med. (Chicago) 4: 330, 1909. CrossrefGoogle Scholar87. MOOS S: Über Harnstoff und chloride im Harne verschiedener Krankheiten. Henle. Z. Rat. Med. 7: 291, 1855. Google Scholar88. PARKES EA: On the Urine. J. & S. Churchill Ltd., London, 1860. Google Scholar89. BUCHANAN G: Typhus fever, in A System of Medicine, vol. 1, edited by REYNOLDS, J. R. Macmillan & Co., London, 1866, pp. 527-557. Google Scholar90. ROBIN A: Essai d'urologie clinique. La Variole. Bull. Acad. Nat. Med. (Paris) 20: 442, 1888. Google Scholar91. MORACZEWSKI WV: Ueber die Ausscheidung der Harnbestandtheile bei Fieberbewegungen. Virchow. Arch. Path. Anat. 155: 1, 1899. CrossrefGoogle Scholar92. ERBEN F: Über die Verteilung der stickstoffhaltingen in Substanzen des Harnes bei einigen akuten Infektionkrankheiten. Z. Heilk. 25: 33, 1904. Google Scholar93. BECK O: Weitere Untersuchungen zum Fieberstoffwechsel des Säuglings. Die qualitativen Veranderungen des Sticksoffwechsels im Fieber. J. Kinderheil. 112: 184, 1926. Google Scholar94. JAKSCH RV: Weitere Mittheilungen über die Verteilung der stickstoffhaltingen substanzen in Harne des Kranken Menschen. Z. Klin. Med. 50: 167, 1903. Google Scholar95. REISS E: Protein metabolism in infection. I. Changes in certain visceral proteins studied with glycine-N15. Metabolism 8: 151, 1959. MedlineGoogle Scholar96. LIMBECK RV: Beitrage zur Lehre von der Saurevergiftung. Z. Klin. Med. 34: 419, 1889. Google Scholar97. GEE SJ: Scarlet fever, in A System of Medicine, vol. 1, edited by REYNOLDS, J. R. Macmillan & Co., London, 1866, pp. 333-357. Google Scholar98. HELLER JF: Chemische untersuchung des Harns, der Harnsedimente und Konkretionen am Krankenbette, uebst diagnostischan Beiträgen. Arch. Physiol. Path. Chem. Mikroskop. 4: 491, 1847. Google Scholar99. REDTENBACHER W: Beobachtungen am Harne bei Lungenentgündungen. Z. Gesells. Aerzte Wein 7: 373, 1850. Google Scholar100. SANDELOWSKY J: Blutkonzentration bei Pneumonie. Deutsch. Arch. Klin. Med. 96: 445, 1909. Google Scholar101. TERRAY PV: Ueber die Veranderung des Chlor-Stoffwechsels bei akuten febrilen Erkrankungen. Z. Klin. Med. 26: 346, 1894. Google Scholar102. AUSTINSUNDERMAN JHFW: Studies of serum electrolytes. V. Urinary electrolyte excretion in pneumonia. J. Clin. Invest. 7: 333, 1929. CrossrefMedlineGoogle Scholar103. JULLIARDHENAFF JM: Troubles du métabolisme hydro-chlorure au cours des typhus epidemique et murin. Rev. Serv. San. Milit. 110: 197, 1939. Google Scholar104. SALKOWSKI E: Untersuchungen über die Ausscheidung der Alkalisalze. Virchow. Arch. Path. Anat. 53: 209, 1871. CrossrefGoogle Scholar105. BOWERMORGANCHANEY AGFMAL: Nitrogen and potassium metabolism: the reaction pattern in poliomyelitis. Amer. J. Med. Sci. 223: 532, 1952. CrossrefMedlineGoogle Scholar106. ZUELZER W: Ueber die Ausscheidung der Phosphorsaure im Urin bei fieberhafter Krankheiten. Charite Ann. 1: 673, 1874. Google Scholar107. UNDERHILLHONEIJBOGERT FPJALJ: Studies on calcium and magnesium metabolism in disease. I. Calcium and magnesium metabolism in leprosy. J. Exp. Med. 32: 41, 1920. CrossrefMedlineGoogle Scholar108. SENATOR H: Ueber die Kalkausscheidung im Harn bei Lungenschwindsucht. Charite Ann. 7: 397, 1882. Google Scholar109. GABUZDAGOCKEJACKSONGRIGSBYLOVEFINLAND GJTMGGMEBDM: Some effects of antibiotics on nutrition in man including studies of the bacterial flora of the feces. Arch. Intern. Med. (Chicago) 101: 476, 1958. CrossrefGoogle Scholar110. FALOONNOLLPRIOR WWJWJT: Nitrogen metabolism and liver histology during aureomycin administration in patients with hepatic disease. J. Lab. Clin. Med. 41: 596, 1953. MedlineGoogle Scholar111. FALOON WW: Metabolic and histologic studies in patients with and without liver diseases receiving chloramphenicol and oxytetracycline. J. Lab. Clin. Med. 44: 75, 1954. MedlineGoogle Scholar112. FALOONDOWNSDUGGANPRIOR WWJJKJT: Nitrogen and electrolyte metabolism and hepatic function and histology in patients receiving tetracycline. Amer. J. Med. Sci. 233: 563, 1957. CrossrefMedlineGoogle Scholar113. SHILS ME: Renal disease and the metabolic effects of tetracycline. Ann. Intern. Med. 58: 389, 1963. LinkGoogle Scholar114. SQUIBB RL: Nutrition and of during Newcastle disease virus infection. I. and in J. Nutr. 1963. CrossrefMedlineGoogle G: Effect of infection on protein and acid in mammalian and Fed. Proc. 25: 1966. MedlineGoogle The role of the in J. Endocr. 8: 1952. MedlineGoogle of pneumococcal infection on a system. to the on 1966. Google BECK O: Weitere Untersuchungen zum Die im Fieber. J. 1926. Google proteins in bacterial infections. Ann. N. Y. Acad. Sci. 1961. CrossrefMedlineGoogle after New J. Med. CrossrefMedlineGoogle and after with the 17-D of virus. Ibid., p. Google Studies on in infected with virus. II. Changes in and weight of hepatic cells. Amer. J. Path. 1957. MedlineGoogle Some biochemical changes in the guinea during infection with J. Bact. 1964. CrossrefMedlineGoogle of infection in guinea Bact. Proc. p. 1966. Google during a infection in the Amer. J. Dis. 12: 1967. CrossrefMedlineGoogle The effects of virus on by mouse J. Biol. Chem. CrossrefMedlineGoogle Changes in protein by in virus infection. 8: 1962. CrossrefMedlineGoogle The metabolism of the in experimental poliomyelitis. J. Exp. Med. 76: CrossrefMedlineGoogle virus in mouse I. in infected and 9: 1959. CrossrefMedlineGoogle Metabolic aspects of virus in The of Virus of the for edited by W. Press, London, pp. Google of and relationship to Bact. Rev. 24: 151, 1960. CrossrefMedlineGoogle Changes in protein and acid content on infected with virus. Proc. Soc. Exp. Biol. Med. 1958. CrossrefMedlineGoogle acid and protein in cells infected with J. Exp. Med. 1959. CrossrefMedlineGoogle studies on I. of phosphorus acid and 9: 1959. CrossrefMedlineGoogle studies on II. of acid and protein in 13: 1961. CrossrefMedlineGoogle acid and protein changes in cells infected with virus. 15: 1961. CrossrefMedlineGoogle F: Ueber die Ausscheidung der Chloride im Fieber. Z. Klin. Med. 1: Google volume and in pneumonia. J. Clin. Invest. 24: 1945. CrossrefMedlineGoogle du dans la C. R. Soc. Biol. (Paris) 1904. Google retention in pneumonia. Amer. J. Dis. Child. 1920. Google Studies of in pneumonia. Arch. Intern. Med. (Chicago) 17: 1916. CrossrefGoogle 42: 313, 1957. MedlineGoogle to respiratory infections. Studies of total and blood J. Lab. Clin. Med. 1966. MedlineGoogle Metabolic studies in acute poliomyelitis. I. in nitrogen and J. Clin. Invest. 36: 942, 1957. Google Metabolic studies in acute poliomyelitis. II. in calcium and phosphorus metabolism. Ibid., p. Google S: in serum and urinary phosphorus in man in the of J. Clin. Endocr. 24: 1964. CrossrefGoogle The in man to acute experimental respiratory and J. Clin. Invest. 36: 1957. CrossrefMedlineGoogle in man. electrolyte changes and Arch. Intern. Med. (Chicago) 1961. CrossrefMedlineGoogle Clinical studies in Arch. Intern. Med. (Chicago) 31: 1923. CrossrefGoogle C: Ueber die im Fieber und zur Deutsch. Arch. Klin. Med. 8: 1871. Google The effects of virus on the of mouse J. Biol. Chem. CrossrefMedlineGoogle of phosphorus in as by infection with virus. Proc. Soc. Exp. Biol. Med. 1952. CrossrefMedlineGoogle Effects of on metabolism. I. Effects of virus on acids and phosphorus of cells. J. Infect. Dis. 1956. MedlineGoogle The effect of virus on the phosphorus metabolism of the J. Biol. Chem. 1957. CrossrefMedlineGoogle nitrogen and studies of nitrogen nutrition by means of Ann. CrossrefMedlineGoogle Nitrogen and weight in convalescence. Ann. CrossrefMedlineGoogle JE: Protein metabolism during after Arch. (Chicago) 50: 1945. CrossrefGoogle The Metabolic to 1952. Google The and in Health and W. Co., pp. Google The effect of infection, and injury on the metabolic and body Ann. N. Y. Acad. Sci. 110: 1963. CrossrefMedlineGoogle Studies on convalescence. IV. Nitrogen and during and in Bull. 1946. MedlineGoogle of certain changes in body water and electrolytes. Physiol. Rev. 1958. CrossrefMedlineGoogle content is on the Article, and Disclosure the S. Army of this study the of the American of N. for to R. S. Army on and with of in after to tularensis tularensis of amino acid on the in plasma and of in for tularensis and and Effects on of in patients with in the of the electrolyte and in with on and of and Nutrition and Effects of Infection on Protein and and and and in to in Blood Fever in of patients with A to the and and infection and and in patients with and without Effect of Infection on acid of plasma with are in and A effects of chronic in rats on protein induced by Changes in and bei und in Renal in of effects of infection on Nitrogen in of the and for Nutrition after in Fever or in of nutritional of on and absorption of metabolic in the during and tularemia in of nutritional in acute and blood during a infection and hyperthermia in metabolic to of and tularensis Infections on and in and in the responses of the and to infection in the of in of and and in to and and and the of Infection and in Nutrition and for und der of body metabolism in the normal and and The for and influence of protein in and of in Effect of Infection on und in der und während influence of nutrition on protein following of diseases of to and composition in and bacterial in and and metabolism during bacterial in rats and rhesus of Sandfly Fever on and and in of and in to of nutritional of and and Effects on and of Nutrition and Effect of in a the of A after of Nutrition and Infection in Clinical and of of and Effect on of in and of the of during on weight in a of and of and in and infection in a for the of and Effects on Metabolism and Renal M.D., N. J. of to of and Adrenocortical Metabolism during a of experimental infection on plasma and Metabolism and Protein in of the of to in plasma amino acids following induced fever virus protein and infection in Changes in of and in the Regulation of Protein of of to on Nutrition and the Clinical Adrenocortical and Changes in Protein in Fever in October October

INCREASED longevity has been paralleled by a rise in the number of patients afflicted with aneurysms of the abdominal aorta. The survival outlook for these patients is bleak unless aneurysmectomy is performed.1 A satisfactory technical surgical result is too frequently nullified by fatal acute renal failure.2 3 4 Crossclamping of the abdominal aorta below the renal arteries and manipulation of the aorta appear causally related to the high incidence of renal failure associated with aneurysmectomy.5 , 6 Suggested possible mechanisms vary from atheromatous embolization to reflex renovascular spasm.3 , 7 In the laboratory animal, trauma applied to areas distant from the kidneys can cause reflex renovascular . . .