bluuebunny/crossref_metadata_2025 huggingface dataset:
Equal Aspiration Rates From Postpylorus and Intragastric‐Placed Small‐Bore Nasoenteric Feeding Tubes: A Randomized, Prospective Study
Authors: Strong Richard M. , Condon Stanley C. , Solinger Michael R. , Namihas B. Nicholas , Ito‐Wong Lorna A. , Leuty Janet E.
Published: May 2008

Postpylorus delivery of enteral feeding is perceived by many experts to be safer than intragastric delivery. To test this assumption, patients with similar Glasgow Coma Scores were given identical enteral formulas continuously via a 10‐French nasoenteric tube, placed into the stomach or beyond the second portion of the duodenum. Observations were made for attainment of desired nutrition, bowel changes, and clinical signs of aspiration. Radiographs of the chest and abdomen were obtained every 3 days. If a tube migrated out of a chosen location, it was replaced. Thirty‐three patients were studied. Seventeen patients were fed into the stomach and 16 patients were fed postpylorus. The mean duration of enteral feeding was 11.8 days for the gastric group and 10.9 days for the postpylorus group (p = NS). The time to deliver the desired kilocalories was 3.33 and 2.77 days (p = NS) for gastric and postpylorus‐fed patients. Tubes displaced similarly in each group, gastric 0.647, postpylorus 0.750 per duration of feeding (p = NS). Chest radiographs met the criteria for aspiration pneumonia in 31.3% of gastric and 40% of postpylorus‐fed patients (p = NS). Together, these data indicate that complications from enterally fed patients are equally common whether the distal port of the feeding tube is in the stomach or beyond the second portion of the duodenum. (Journal of Parenteral and Enteral Nutrition 16:59–63, 1992)
Comparison of Enteral Nutrition and Drug Treatment in Active Crohn's Disease: Results of the European Cooperative Crohn's Disease Study IV H. LOCHS, H. J. STEINHARDT, B. KLAUS‐WENTZ, ET AL Gastroenterology 101:881–888, 1991
Authors: Demetriou Achilles A.
Published: May 2008

This study compares the effect of drug treatment for Crohn's disease with that of enteral nutrition alone as a therapeutic modality for this disease. Patients were randomly divided into two groups: One group (n = 52) was treated with 6‐methylprednisolone (48 mg/day, subsequently tapered) and sulfasalazine (3 g/day). The second group (n = 55) was treated with enteral nutrition consisting of an oligopeptide diet. The two groups were matched for severity of illness and demographic characteristics. Remission was defined as a decrease in Crohn's Disease Activity Index by 40% (or at least 100 points). Significantly more (p <.01, χ2) patients in the drug treatment group (41 of 52) achieved remission, compared with the dietary treatment group (29 of 55). The median time to remission for the drug treatment group was 8.2 days compared with 30.7 days for the dietary treatment group (p <.01; Mantel Cox). Further data analysis was carried out to determine whether certain subgroups within the dietary group might have benefited from this therapy (subgroups based on severity of initial disease activity or subgroups based on the anatomic location of the disease). This analysis did not demonstrate any influence of any of these factors on response to therapy in either group. This prospective randomized study demonstrates that enteral nutritional therapy alone is not as effective a therapeutic modality as drug therapy in patients with Crohn's disease.
Total Parenteral Nutrition and Tumor Metastases M. H. TOROSIAN, ROBERT B. DONOWAY Surgery 109:597–601, 1991
Authors: Nussbaum Michael S.
Published: May 2008

The authors studied the effect of total parenteral nutrition on primary tumor growth and spontaneous prostate adenocarcinoma (PA III) implants. Thirty‐four immature female Lobund/Wistar rats were inoculated subcutaneously with fragments of PA III tumor cells. This is a prostate adenocarcinoma that spontaneously metastasizes to the lungs and lymph nodes. After tumor inoculation all animals received a standard protein diet for 18 days, followed by a protein‐delayed diet from day 18 to day 25. On day 25 all animals underwent superior vena cava cannulation. Subsequently animals were randomized to receive one of five regimens: (1) 3% amino acid/9% dextrose/3.6% lipids parenterally, (2) 3% amino acids/18% dextrose parenterally, (3) 18% dextrose parenterally, (4) protein depleted food ad libitum enterally, (5) standard protein diet ad libitum enterally. All parenteral nutrient regimens were isocaloric (175 calories/ kg per day) and those containing amino acids were iso‐nitrogenous (1.16 g of nitrogen/kg per day). Tumor volume and doubling time were determined daily from day 25 to 35. Animals were killed 35 days later, the implanted tumors were completely excised, and carcass weights were determined. The lungs and trachea were excised for quantitative analyses of pulmonary metastases.

Animals given parenteral amino acids/dextrose/lipid, parenteral amino acids/dextrose, or central standard protein diet weighed significantly more at the time of death than did animals in the other two groups. Primary tumor volumes and tumor weights were greater in animals receiving either parenteral amino acids/dextrose/ lipid or enteral standard protein diet. Animals given either parenteral dextrose alone or protein‐depleted food enterally had the smallest primary tumors, as determined by volume and weight measurements. It was also noted that tumor doubling time correlated inversely with tumor volume and weight; thus, the longest tumor doubling time occurred in the animals with the smallest primary tumor volume and weight. The number of pulmonary metastases was greatest in animals receiving either the mixed substrate parenteral diet (amino acids/dextrose/ lipid) or the enteral standard protein diet. A significant increase in metastases occurred in animals given parenteral mixed substrate diet compared with animals receiving parenteral amino acids/dextrose or dextrose alone. Compared with the protein‐depleted group, animals given a standard protein diet enterally showed a significantly greater number of large tumor metastases.
Vitamin E Measurement in Patients Receiving Intravenous Lipid Emulsions
Authors: Henton Donaby H. , Merritt Russell J. , Hack Shirley
Published: May 2008

Two methods for the determination of plasma vitamin E—high—pressure liquid chromatography and spectrophotofluorometry—were compared on samples from four groups of pediatric patients: children and infants receiving lipid emulsion as part of their parenteral nutrition regimen, neonates receiving parenteral nutrition who were not receiving lipid emulsion at the time of blood sampling, and short admission surgery control subjects. In control subjects and patients not receiving lipid emulsions, both methods yielded similar results for vitamin E as α‐tocopherol. In contrast, in patients receiving lipid emulsion, the fluorometric method yielded values ranging from 200% to 300% greater than did high‐pressure liquid chromatography. The source of the discrepancy is most probably the presence of naturally occurring non‐α‐tocopherol isomers in the lipid products, which add to the fluorescent measurement but are resolved by high‐pressure liquid chromatography. This study confirms clinically that fluorescent measurement of vitamin E is no longer the method of choice for monitoring tocopherol status in intensive care nurseries. (Journal of Parenteral and Enteral Nutrition. 16: 133–135, 1992)
Energy Substrate for Liver Regeneration After Partial Hepatectomy in Rats: Effects of Glucose vs Fat
Authors: Lai Hong‐Shiee , Chen Wei‐Jao , Chen Kai‐Mo
Published: May 2008

This study evaluated the effects of glucose or fat on liver regeneration after partial hepatectomy in rats. Partial hepatectomy with resection of the median and left lateral lobes (67.31%) was performed on three rat groups. Two groups were infused with high‐glucose (HG) or high‐fat (HF) solutions intravenously 2 days before surgery. The control (C) group was allowed to eat instead of receiving intravenous infusions. Another group with sham operation only was also allowed to eat. Rats were killed 6, 24, 48, or 72 hours after the operation. Remnant liver weight, DNA synthetic rate, DNA content, and mitotic index were chosen as comparing indicators. Blood glucose, serum free fatty acid (FFA), total ketone bodies, and ketone body ratio were measured. Transmission electron microscopy was also used to observe the remnant liver. The results showed that the HG rat group had a better regenerative condition than did the HF rat group (p <.01). Glucose is the predominant energy substrate when enough is offered during the immediate posthepatectomy phase. FFA utilization occurred only very early after partial hepatectomy, and it was remarkable in the control group, moderate in the HF group, and low in the HG group. Shifting of the energy substrate to FFA occurred only when glucose was not available for utilization. The disappearance and reappearance of glycogen, and accumulation of fat in cytoplasm as shown by transmission electron microscope pictures support this conclusion. (Journal of Parenteral and Enteral Nutrition 16:152–156, 1992)
Endocarditis Complicating Parenteral Nutrition: The Value of Repeated Echocardiography
Authors: Leinhardt David J. , Ragavan Chakravarthy , O'Hanrahan Tim , Mughal Muntzer
Published: May 2008

Cardiac complications of parenteral nutrition are well recognized but the diagnosis of such complications may be difficult. Two‐dimensional echocardiography has been shown to be of value in establishing the diagnosis of valvular vegetations and right atrial thrombus. We describe two patients who developed endocarditis while receiving parenteral nutrition via central venous catheters. In both cases initial echocardiography was normal and the tricuspid valvular vegetations were only picked up after one or more additional echocardiograms. This highlights the necessity for repeated echocardiography in patients receiving parenteral nutrition in whom infective central venous catheter complications fail to resolve quickly after appropriate treatment. (Journal of Parenteral and Enteral Nutrition 16:168—170, 1992)
Priapism in a Patient Treated With Total Parenteral Nutrition
Authors: Hébuterne Xavier , Frere André Marie , Bayle Jacques , Rampal Patrick
Published: May 2008

Venous thrombosis is a common complication of total parenteral nutrition. We report a case of priapism in a 40‐year‐old man after administration of total parenteral nutrition for chronic idiopathic intestinal pseudo‐obstruction. The patient received glucose, amino acids, and 20% fat emulsion; 12 hours after administration, the patient complained of a persistent, painful penile erection lasting 5 hours. Bilateral corpora cavernosa spongiosum shunts achieved immediate and sustained detumescence, but the patient remained impotent. There was no history of penile or pelvic trauma, hemoglobinopathy, coagulopathy, venous thrombosis, or leukemia. The medical literature describes seven other cases of priapism related to total parenteral nutrition. All of the patients received 20% fat emulsion; two patients developed priapism during the weekly infusion of fat emulsion. Among the multiple factors that can favor thrombosis and therefore priapism during total parenteral nutrition, fat infusion appears to be the most important. Three different mechanisms have been postulated: increase in blood coagulability, effects on red blood cells, and fat embolism. In this patient, platelet function was estimated in vivo by the levels of antiheparin platelet factor 4 and β‐thromboglobulin. These two parameters were both elevated before 20% lipid emulsion and were even higher after the 20% fat‐emulsion infusion. Therefore, even if a direct thromboplastic effect is possible, 20% fat emulsion increases platelet activity, which was already high in our patient, and thereby favors priapism. (Journal of Parenteral and Enteral Nutrition 16:171–174,1992)
Metabolic Clearance of a Fat Emulsion Containing Medium‐Chain Triglycerides in Cirrhotic Patients
Authors: Fan S.T. , Wong J.
Published: May 2008

Medium‐chain triglycerides (MCTs) may be advantageous in cirrhotic patients, but data on the clearing capacity are lacking. Intravenous fat tolerance test (IVFTT) was performed on 28 cirrhotic patients (Child's A, n = 9; Child's B, n = 13; Child's C, n = 6) to determine the clearance rate of Lipofundin MCT 20%, which contains a physical mixture of MCT and long‐chain triglycerides (LCT). The mean fractional elimination rate (k2) of MCT/LCT physical blend in the cirrhotic patients (7.72%/min) was comparable with that of the healthy control subjects (n = 9, k 2 = 5.43%/min). Significantly higher serum free fatty acid (FFA) levels were found in the cirrhotic patients during IVFTT. The difference could be accounted for by their higher basal levels. In all patients, serum FFA concentrations returned to basal value at the end of 1 hour. Prompt appearance of glycerol and β‐hydroxybutyrate was seen during IVFTT, indicating that hydrolysis of triglycerides and release of ketone bodies from the liver were rapid. It was concluded that the ability to eliminate MCT/LCT physical blend was not impaired in the cirrhotic patients. (Journal of Parenteral and Enteral Nutrition 16:279–283, 1992)
Short‐Term Dietary Lipid Manipulation Does Not Affect Survival in Two Models of Murine Sepsis
Authors: Clouva‐Molyvdas Phyllis , Peck Michael D. , Alexander J. Wesley
Published: May 2008

Dietary lipid manipulation has been shown to have various effects on the immune system, depending on the amount of fat, degree of saturation, and type of fat used. In this study we investigated the role of different sources of fat at different levels on the survival of mice in two models of peritonitis, one with Pseudomonas aeruginosa and the other with Salmonella typhimurium. CF1 mice were pair‐fed diets with 5% or 40% of total calories as fat. The source of fat used was coconut oil, oleic acid, safflower oil, or fish oil. Three other diets were tested as well, one with no fat, one with only 0.5% of total calories linoleic acid as the only source of fat, and a control diet that had 12% of total calories as corn oil. At the end of 2 weeks of feeding the experimental diets, mice were challenged with Ps aeruginosa intraperitoneally and mortality was recorded over 1 week. After 3 weeks of feeding the experimental diets, mice were challenged with S typhimurium and mortality was recorded over 2 weeks. No significant differences were seen on survival among groups fed different levels of fat, as well as different sources of fat. We conclude that, overall, 2‐and 3‐week manipulation of dietary fat does not affect outcome from infection in these models. (Journal of Parenteral and Enteral Nutrition 16:343–347, 1992)
Safety and Efficacy of Glycerol and Amino Acids in Combination With Lipid Emulsion for Peripheral Parenteral Nutrition Support
Authors: Waxman Kenneth , Day Audrey T. , Stellin Gianna P. , Tominaga Gail T. , Gazzaniga Alan B. , Bradford Ronald R.
Published: May 2008

The safety and efficacy of administering lipid emulsion with ProcalAmine, a glycerol‐based parenteral nutrition solution, for peripheral nutrition has not been previously studied. Thirty‐four patients recovering from major trauma or surgery were studied while receiving a peripheral parenteral nutrition regimen of either ProcalAmine with 10% lipid emulsion (group 1) or ProcalAmine with 20% lipid emulsion (group 2) for up to 5 days postinjury. Daily dose was 45 mL/kg ProcalAmine, providing 1.35 g of amino acids/kg and 1.35 g of glycerol/kg, and 500 mL/day lipid emulsion. The mean daily nitrogen balance was ‐0.3 g/day in group 1 and ‐4.1 g/day in group 2. There was no progressive accumulation of circulating glycerol, and urinary glycerol excretion was minimal (<0.2 g/ day), indicating effective utilization of glycerol as an energy substrate. Our finding that nitrogen balance was better with 10% fat emulsion suggests a limitation in fat utilization in this setting. Both regimens were well tolerated; there were no adverse clinical reactions and no occurrences of phlebitis in either group. (Journal of Parenteral and Enteral Nutrition 16:374–378, 1992)
Full Protein Alimentation and Nitrogen Equilibrium in a Renal Failure Patient Treated With Continuous Hemodiafiltration: A Case Report of 67 Days of Continuous Hemodiafiltration
Authors: Neal Reynolds H. , Borg Ulf , Frankenfield David
Published: May 2008

Standard care for patients with renal failure while in an intensive care unit involves traditional hemodialysis or peritoneal dialysis and protein restriction. We present a case of a patient with renal failure supported with continuous arteriovenous hemofiltration with dialysis (CAVH‐D) who was given full protein alimentation. Total daily urea clearance was measured from the CAVH‐D output. Protein load was 196 ± 34 g/day while receiving total parenteral nutrition and 164 ± 30 g/day while receiving enteral alimentation. Serum blood urea nitrogen was controlled between 40 and 75 mg/dL, except during septic episodes. Nitrogen balance was estimated based upon known alimentation protein load and measurable and estimated nitrogenous losses. The patient was potentially in nitrogen equilibrium during most of the dialysis period. The cumulative nitrogen balance was positive by 5.2 g after 67 days of dialysis. Volume of alimentation was 3.49 ± 0.7 liters/day. With CAVH‐D, the renal failure patient can receive full alimentation without volume or protein load limitations. Furthermore, nitrogen balances can be estimated easily while the patient is on CAVH‐D. (Journal of Parenteral and Enteral Nutrition 16:379–383, 1992)
Colonic Fermentation of Ispaghula, Wheat Bran, Glucose, and Albumin to Short‐Chain Fatty Acids and Ammonia Evaluated in Vitro in 50 Subjects
Authors: Mortensen Per Brøbech , Clausen Mette Rye , Bonnén Helen , Hove Hanne , Holtug Klavs
Published: May 2008

The production of short‐chain fatty acids and ammonia was measured in 16.6% fecal homogenates from 50 subjects incubated at 37°C for 6 and 24 hours. All 50 homogenates produced ammonia and short‐chain fatty acids of any chain length (C2‐C5). Incubation for 24 hours with dietary fiber (ispaghula husk or wheat bran), albumin, or glucose (10 mg/ mL) increased the short‐chain fatty acid production (43.6 ± 2.8, 45.4 ± 2.0, 60.3 ± 3.2, and 65.8 ± 3.1 mmol/L, respectively) compared with controls (21.4 ± 1.3 mmol/L). The degradation of different substrates was associated with the production of different amounts of ammonia and short‐chain fatty acids. Ispaghula, wheat bran, albumin, and glucose were fermented to acetate (>2 mmol/L; 24‐hour incubations) in 86%, 96%, 98%, and 98% of the homogenates, to propionate in 80%, 76%, 100%, and 68%, and to butyrate in 32%, 94%, 88%, and 54% of the homogenates, respectively. Isobutyrate, valerate, and isovalerate were produced from albumin in all (100%) of the homogenates, but only in 2 to 4% of the homogenates incubated with ispaghula or glucose. Ammonia was always (100%) produced after the addition of albumin and always (98%) consumed (assimilated) when glucose was fermented. Surgery (sigmoid or right‐ or left‐sided colonic resection) did not change the pattern of ammonia and short‐chain fatty acid production from these substrates.

This study suggests that the different colonic flora from a large number of subjects share general biochemical characteristics, which metabolize different substrates to specific patterns of ammonia and short‐chain fatty acids. (Journal of Parenteral and Enteral Nutrition 16:433–439, 1992)
A Simple Technique to Redirect Malpositioned Silastic Central Venous Catheters
Authors: Warner Brad W. , Ryckman Frederick C.
Published: May 2008

A simple and noninvasive method to redirect malpositioned Silastic central venous catheters is described. A syringe is connected to the catheter hub, and burst injections of saline cause the tip of the catheter to flip into the correct intravascular position. The present technique has been applied to more than 30 pediatric patients with excellent results. A detailed description of the technique and case examples are presented. (Journal of Parenteral and Enteral Nutrition 16:473–476, 1992)
Ornithine α‐Ketoglutarate and Glutamine Supplementation During Refeeding of Food‐Deprived Rats
Authors: Ziegler Frédéric , Coudray‐Lucas Colette , Jardel Alain , Lasnier Elisabeth , Le Boucher Jacques , Ekindjian Ohvanesse G. , Cynober Luc
Published: May 2008

The aim of this study was to compare the efficiency of ornithine α‐ketoglutarate (OKG) and glutamine supplementation in an experimental model of denutrition that provides well‐characterized disturbances of amino acid patterns. Male Wistar rats (187 ± 11 g; five in each group) were starved for 3 days and then refed for 7 days with an oral diet (192 kcal kg−1 · day−1 and 2.25 g of nitrogen kg−1 · day−1), supplemented with 0.19 g of nitrogen kg−1 · day−1 in the form of OKG, glutamine, or casein (control group). Food deprivation induced a fall in most tissue amino acids, with the notable exception of muscle leucine and liver glutamate, which increased by 43% (p <.01), and 11% (p <.05), respectively. The main effect of OKG was seen in the viscera, with a normalization of most amino acid pools (including proline and branched‐chain amino acids) in the small bowel and liver. The main effect of glutamine was observed in the muscle, with a normalization of the glutamine and leucine pools. We conclude that, in this model and with the doses used, OKG and glutamine act in different target tissues, ie, splanchnic areas and muscle, respectively. (Journal of Parenteral and Enteral Nutrition 16:505–510, 1992)
Effect of Excess Xylitol on Nitrogen and Glucose Metabolism in Parenterally Fed Rats
Authors: Drews D. , Stein T.P.
Published: May 2008

The objectives of this study were to investigate the effects of an excess of xylitol on nitrogen balance and glucose metabolism in parenterally fed rats. Female Sprague‐Dawley rats (200–250 g, n = 17) were catheterized for total parenteral nutrition and then randomized into two groups based on subsequent diet. The two diets used were isonitrogenous (1.5 g of nitrogen per kilogram per day) and isocaloric, with half the calories (125 kcal/kg per day) being derived from lipid (125 kcal/kg per day) and the other half from either glucose or xylitol (125 kcal/kg per day). The rats were fed a half‐strength total parenteral nutrition diet for the day after surgery and a full‐strength total parenteral nutrition diet for the following 4 days. Urines were collected daily for the determination of nitrogen balance. On day 5, the rats were given a 7‐ to 8‐hour infusion of 6,6‐d2 glucose (6 mg/h and 2‐d1 glucose (12 mg/h). At the conclusion of the isotope infusion period, the rats were killed and blood was collected. Urine output was increased by 122% per day in the xylitol‐treated rats, and they excreted 46.5 mmol of xylitol per liter per kilogram per day (7.1 g/kg per day, ∼22.7% of dose). The xylitol group lost weight, had poorer nitrogen balance (341 ± 31 vs 83 ± 29 mg/kg per day [mean ± standard error of the mean], p <.05), and developed fatty livers. Analysis of the liver fat distribution pattern indicated that the source of the excess hepatic lipid was dietary fat. Substitution of xylitol for glucose had no effect on total glucose appearance as measured with 6,6‐d2 glucose (1238 ± 76 vs 1294 ± 113 mg/kg per day), but the rate of glucose cycling was markedly reduced (1518 ± 101 vs 764 ± 63 mg/kg per day, p <.05). The adverse effects of xylitol in this study were due to a caloric deficit secondary to a combination of (1) exceeding the renal threshold for xylitol and (2) hepatic steatosis. (Journal of Parenteral and Enteral Nutrition 16:521–524, 1992)
Effects of Different Lipid Sources in Total Parenteral Nutrition on Whole Body Protein Kinetics and Tumor Growth
Authors: Mendez Beatrice , Pei Ra Ling  , Istfan Nawfal W. , Babayan Vigen K. , Bistrian Bruce R.
Published: May 2008

This study examined the short‐term effects of three total parenteral nutrition solutions, each containing a different lipid source, on host and tumor protein metabolism in a rat cancer model. Each diet contained 220 kcal/kg per day, including 2 g of nitrogen/kg per day and 50% of nonprotein calories as either a structured lipid of medium‐chain triglycerides and fish oil, a physical mix of medium‐chain triglycerides and fish oil, or Liposyn II, a long‐chain triglyceride. A 3‐day intravenous feeding infusion began on day 7 after tumor implantation. Tumor growth rate, nitrogen balance, energy expenditure, and plasma albumin, glucose, and free fatty acids were measured, and whole body protein kinetics and fractional synthetic rates in liver, muscle, and tumor tissues were assessed using a constant infusion of 14C‐leucine. The results revealed that tumor growth rate was slowed in structured lipid‐fed animals (p =.06, one‐way analysis of variance) with significant increases in rates of tumor protein synthesis and tumor protein breakdown (p <.001, one‐way analysis of variance). Although muscle fractional synthetic rates were significantly decreased in tumor‐bearing animals (p <.05, two‐way analysis of variance), the rates in structured lipid‐fed animals were restored. Nitrogen balance improved significantly in structured lipid‐fed animals. The results demonstrate that the source of lipid in total parenteral nutrition solutions can influence tumor and host protein metabolism, and that a structured lipid composed of medium‐chain triglycerides and fish oil seems to improve protein metabolism in host tissue without stimulating tumor growth. (Journal of Parenteral and Enteral Nutrition 16: 545–551, 1992)
Microbial Contamination of Enteral Feeding Tubes Occurring During Nutritional Treatment
Authors: Bussy Véronique , Marechal François , Nasca Salvador
Published: May 2008

Enteral nutrition is an effective treatment for catabolic patients with normal intestinal absorption. However, tube‐fed patients are at risk from superinfection. Our study is the first to evaluate in vivo the microbial contamination of solutions staying in the nasogastric tube of cancer patients receiving nutritional preparations. After daily feeding, the tube was rinsed with nonsterile tap water. Tap water staying overnight in the tube was considered as tube‐rinsing solution. Microbial burden of nutritional preparations was determined on the fifth day of enteral nutrition, from opening the first container and throughout feeding. The next day, a sample of the tube‐rinsing solution was cultured. All bacterial species were identified and antibiotic susceptibility pattern was assessed. Thirty‐one cancer patients were included, 12 on the hospital's preparations and 19 on commercial feeding. Seven of the hospital—and none of the commercial—preparations were contaminated. Among the 48 samples collected during feeding, 16 were contaminated, including 10 hospital and 6 commercial preparations. All the 31 tube‐rinsing solutions were contaminated and 102 strains cultured. Their median concentration was 106 colony‐forming units/mL (range 10–1010). The strains were 48 Enterobacteriaceae, 20 group D streptococci, 9 Candida albicans, 9 Pseudomonas aeruginosa, and 16 others. Multiple antibiotic resistance was present in 12 of the 102 strains. Lower resistance was present in 33. The predominant microorganism of the tube‐rinsing solution caused a bacterial colonization for three febrile patients. In conclusion, the feeding tube is an important reservoir for multiple antibiotic‐resistant bacteria. (Journal of Parenteral and Enteral Nutrition 16:552–557, 1992)
The Role of Protein and Calorie Restriction in Outcome From Salmonella Infection in Mice
Authors: Peck Michael D. , Babcock George F. , Alexander J. Wesley
Published: May 2008

We studied the separate effects of protein and calorie restriction in mice challenged with Salmonella typhimurium, an intracellular pathogen eliminated by cell‐mediated immunity. Female A/J mice (n = 73) were placed on one of eight solid diets for 3 weeks. Animals were weighed at the beginning and the end of the feeding period. Diets were adjusted by two factors. The total amount of protein in the diet was 1%, 5%, 20%, or 40% by weight. The diets were fed to half the mice in quantities of 3 g and to the other half at 1.5 g per mouse per day. At the end of 3 weeks, mice were injected intraperitoneally with bacteria and mortality was observed for 2 weeks. Mortality was related to protein intake and was significantly higher in the 1% and 5% groups (χ2: p =.0021). However, mortality was lower in the calorie‐restricted groups (χ2: p =.0242). Although caloric intake did not affect cell‐mediated immunity, the response to 2,4‐dinitrofluorobenzene was greater in the low protein groups. Lymphoproliferative responses in the mixed lymphocyte response were not affected by either caloric or protein intake. Lymphoproliferative responses to both lipopolysaccharide and phytohemagglutinin were affected by dietary protein but not by caloric intake; proliferative responses were higher in the low‐protein groups. We conclude that protein restriction can increase mortality in this model. On the other hand, short‐term calorie restriction can improve survival. (Journal of Parenteral and Enteral Nutrition 16:561–565, 1992)
Volume of Blood Required to Obtain Central Venous Catheter Blood Cultures in Infants and Children
Authors: Shulman Robert J. , Phillips Sara , Laine Laura , Gardner Pat , Nichols Valerie , Reed Theresa , Hawkins Edith
Published: May 2008

To determine how much blood must be discarded before one can obtain a reliable central venous catheter blood culture, we prospectively cultured the blood (from 96 patients) that is ordinarily discarded before obtaining blood for such a culture. We then compared the prospective culture results with those of the actual blood culture. Three sequentially drawn aliquots of blood were aspirated from the central venous catheter and cultured. The culture results of the second aliquot were comparable to those of the third (the portion usually cultured) in overall sensitivity (94.4%), specificity (94.9%), and positive predictive value (80.9%). Thus, the amount of blood that must be discarded (infants: 0.3 mL; children: 1.0 mL) before one can obtain an accurate central venous catheter culture is less than was previously thought. (Journal of Parenteral and Enteral Nutrition 17:177–179, 1993)
Large‐Bore Feeding Tube Occlusion by Yeast Colonies
Authors: Marcuard Stefan P. , Finley James L. , Macdonald Kenneth G.
Published: May 2008

This is a first report of three patients with silicone feeding tubes (two with percutaneous endoscopic gastrostomies and one with a jejunostomy, all 20 French catheters) that have formed a thick yeast crust on the inner luminal surface causing tube occlusion in two cases. Candida species were isolated in all three tubes. The yeast crust could not be removed with a brush or with fungicidal drugs such as nystatin and amphotericin B. Histologic sections through these feeding tubes revealed yeast penetration through the silicone material, explaining the adherent nature of the crust. This complication may also explain the observed material deterioration with subsequent breakage. (Journal of Parenteral and Enteral Nutrition 17:187–190,1993)
Metabolic Bone Disease in Adults Receiving Long‐Term Parenteral Nutrition: Longitudinal Study With Regional Densitometry and Bone Biopsy
Authors: Saitta Joseph C. , Ott Susan M. , Sherrard Donald J. , Walden Carolyn E. , Lipkin Edward W.
Published: May 2008

A syndrome of bone pain and fractures has been described in patients receiving long‐term support from parenteral nutrition containing large quantities of aluminum or vitamin D2. Whether this same syndrome occurs in patients supported by current therapeutic regimens is controversial. In this study, bone health was longitudinally evaluated over 7 to 61 months in 14 subjects maintained on long‐term parenteral nutrition. The parameters of bone health evaluated included bone mass as measured by single and dual photon absorptiometry and quantitative histomorphometry of bone biopsies. There was a striking heterogeneity in baseline measures of bone health. Mean bone density of parenteral nutrition patients was significantly below expected values on entry into the study at both the distal radius (z score = ‐0.76 ± 0.27) and the lumbar spine (z score = ‐1.17 ± 0.27). Mean areal density at the forearm was less severely depressed (z score = ‐0.62 ± 0.34). The longitudinal changes in bone density and morphology were heterogeneous, with some subjects showing deterioration, others improvement, and still others no change. We conclude that patients already established on parenteral nutrition frequently have osteopenia. The group as a whole did not demonstrate normalization of the osteopenia, but our results also suggest that current parenteral nutrition formulations low in aluminum and vitamin D2 do not necessarily cause worsening of bone health. The etiology of this clinical syndrome merits additional study. (Journal of Parenteral and Enteral Nutrition 17:214–219, 1993)
The Effect of Increasing Levels of Fish Oil‐Containing Structured Triglycerides on Protein Metabolism in Parenterally Fed Rats Stressed by Burn Plus Endotoxin
Authors: Gollaher Catherine J. , Fechner Krista , Karlstad Michael , Babayan Vigen K. , Bistrian Bruce R.
Published: May 2008

This report investigates the effect of various levels of medium‐chain/fish oil structured triglycerides on protein and energy metabolism in hypermetabolic rats. Male Sprague‐Dawley rats (192 to 226 g) were continuously infused with isovolemic diets that provided 200 kcal/kg per day and 2 g of amino acid nitrogen per kilogram per day. The percentage of nonnitrogen calories as structured triglyceride was varied: no fat, 5%, 15%, or 30%. A 30% long‐chain triglyceride diet was also provided as a control to compare the protein‐sparing abilities of these two types of fat. Nitrogen excretion, plasma albumin, plasma triglycerides, and whole‐body and liver and muscle protein kinetics were determined after 3 days of feeding. Whole‐body protein breakdown, flux, and oxidation were similar in all groups. The 15% structured triglyceride diet maximized whole‐body protein synthesis (p <.05). Liver fractional synthetic rate was significantly greater in animals receiving 5% of nonprotein calories as structured triglyceride (p <.05). Muscle fractional synthetic rate was unchanged. Plasma triglycerides were markedly elevated in the 30% structured triglyceride‐fed rats. The 30% structured triglyceride diet maintained plasma albumin levels better than those diets containing no fat, 5% medium‐chain triglyceride/fish oil structured triglycerides, or 30% long‐chain triglycerides. Nitrogen excretion was lower in animals receiving 30% of nonnitrogen calories as a structured triglyceride than in those receiving 30% as long‐chain triglycerides, but this difference did not reach statistical significance (p =.1). These data suggest that protein metabolism is optimized when structured triglyceride is provided at relatively low dietary fat intakes. (Journal of Parenteral and Enteral Nutrition 17:247–253, 1993)
Kinetics and Thermogenesis of Medium‐Chain Monocarboxylic and Dicarboxylic Acids in Man: Sebacate and Medium‐Chain Triglycerides
Authors: Mingrone G. , Greco A.V. , Castagneto M. , De Gaetano A. , Tataranni P.A. , Raguso C.
Published: May 2008

The effects on oxygen consumption and carbon dioxide production of a constant intravenous infusion of 0.15 g of disodium sebacate (Sb), the sodic salt of a medium‐chain dicarboxylic acid with 10 carbon atoms, per kilogram of body weight per hour over 5 hours and of a 50% mixture of medium‐and long‐chain triglycerides (MCT/LCT) were compared in 10 healthy men. Oxygen consumption and carbon dioxide production were measured by indirect calorimetry. Mean oxygen consumption was about 19% higher than the basal oxygen consumption at the end of MCT/LCT infusion but was only 5% higher than the basal oxygen consumption when Sb was infused. There was an eightfold increase in plasma β‐hydroxybutyrate and acetoacetate concentrations and a threefold increase in serum insulin levels during MCT/LCT infusion, but no significant change in ketone bodies and insulin from basal values was observed during and after Sb infusion. Pharmacokinetic parameters were also computed, showing an average apparent volume of distribution of 167 mL/kg of body weight for MCTs and 112 mL/kg of body weight for Sb. The t½ of MCTs was 50 minutes and that of Sb was 78 minutes. Urinary excretion of Sb and its β‐oxidative by‐product, suberic acid, globally accounted for 48% of the given amount of Sb. In spite of its urinary loss and slower tissue uptake compared with MCTs, Sb avoided ketone body formation or elevation in insulin levels and did not induce a significant increase in oxygen consumption. The Sb caloric equivalent was 6.643 kcal/g, and the remaining amount of Sb administered (approximately 5.2 g/h in a 70‐kg subject) seemed to be energetically useful by furnishing 34.54 kcal/h, ie, 829 kcal over 24 hours. This caloric support is equivalent to or even higher than that usually given as MCTs; however, formation of ketone bodies and interference with glucose metabolism are avoided. (Journal of Parenteral and Enteral Nutrition 17:257–264, 1993)
Intestinal, Pancreatic, and Hepatic Effects of Gastrointestinal Hormones in a Total Parenteral Nutrition Rat Model
Authors: Mok King‐Tong , Meng H.C.
Published: May 2008

The adverse effects of long‐term total parenteral nutrition (TPN) are well documented. Lack of gastrointestinal (GI) stimulation from oral feeding, reduction of GI hormone secretion, and interruption of enterohepatic circulation of bile may be found. TPN results in atrophy of the digestive system, intestinal bacterial overgrowth and translocation, liver cell damage, and gallstone formation. In addition, the increase incidence of sepsis of gut origin may lead to an increase in mortality. In some studies, results of the administration of GI hormones to patients receiving prolonged TPN suggest the possibility of reducing some of the adverse effects of long‐term TPN. To evaluate the role of GI hormone in the prevention of adverse effects of TPN, we designed the following study: 50 young adult male Wistar rats, weighing approximately 200 g, were divided into five equal groups. All animals received identical TPN infusate for 7 days. GI hormone was added to the TPN infusate as follows: Group A (control) received no GI hormone, group B was given glucagon at a dosage of 330 μg/kg per day, group C was administered cholecystokinin 2 Ivy dog units twice a day, group D received secretin 2 clinical units twice a day, and group E was given both cholecystokinin and secretin at the dosages stated for groups C and D. Maintenance of mucosal brush‐border hydrolase activity was found in group B. Neither atrophy of the pancreas nor hypoplasia of intestinal villi was observed in groups C and D. Group C showed improvement of liver function‐associated tests, better weight gain, and acceleration of enterohepatic circulation of bile. Mucosal weight and DNA contents were increased in group D, and acceleration of cholesterol catabolism was found in group E. We concluded that cholecystokinin seems capable of preventing some adverse effects of 7‐day TPN treatment on the GI system. The benefit of glucagon or secretin administration was limited. (Journal of Parenteral and Enteral Nutrition 17:364–369, 1993)
Phenytoin Recovery From Percutaneous Endoscopic Gastrostomy Pezzer Catheters After Long‐Term In Vitro Administration
Authors: Seifert Charles F. , Lee McGoodwin Phyllis , Allen Loyd V.
Published: May 2008

Four in vitro administration techniques were evaluated to determine which method would produce the least amount of phenytoin lost with long‐term (14 days) dosing of Dilantin Kapseals (100 mg) or Dilantin suspension 125 mg/5 mL (92 mg) through 20 French percutaneous endoscopic gastrostomy Pezzer catheters. The four in vitro techniques were (1) no dilution or irrigation, (2) irrigation with 10 mL of deionized water, (3) dilution with 10 mL of deionized water, and (4) dilution with irrigation. Similar doses and volumes (3.68 mL) of suspension and capsules were delivered to three separate catheters for each method every 8 hours for 14 days. Each catheter was encased in a 200‐mm glass water jacket and maintained at 37°C for the entire 14 days. Samples were collected 1 hour after administration on days 1, 3, 7, 10, and 14 and analyzed by high‐performance liquid chromatography. The total mean percent change in initial phenytoin for each method was as follows (S = suspension, K = Kapseals, subscript number = method number): S1, ‐4.23 ± 20.20 (mean ± SD); S2, ‐7.63 ± 14.04; S3, ‐0.14 ± 2.31; S4, 3.33 ± 5.59; K1, ‐9.72 ± 4.60, K2, 1.43 ± 3.90; K3, ‐3.18 ± 5.59; and K4, 1.39 ± 4.57. These results show that (1) short‐term dosing does not reflect long‐term dosing; (2) the more inefficient the method is, the greater the variability and fluctuation between days; (3) there was no significant difference between Kapseals and suspension if the appropriate method for administration was used; (4) dilution is superior to irrigation for long‐term dosing of suspension; (5) irrigation is superior to dilution for long‐term dosing of Kapseals; and (6) additional dilution and/or irrigation to each dosage form adds little and only increases preparation time. (Journal of Parenteral and Enteral Nutrition 17:370–374, 1993)
Serious Renal Impairment Is Associated With Long‐Term Parenteral Nutrition
Authors: Buchman Alan L. , Moukarzel Adib , Ament Marvin E. , Gornbein Jeff , Goodson Blaine , Carlson Chris , Hawkins Randall A.
Published: May 2008

Thirty‐three current long‐term total parenteral nutrition (TPN) patients (13 men, 20 women) aged 21 to 79 years were prospectively studied to evaluate their change in glomerular filtration rate since beginning TPN. Creatinine clearance (CrCl) from the subject's initial home TPN clinic visit and at present were estimated from standard formulas and compared. The CrCl in 12 patients who had received home TPN for > 10 years was estimated retrospectively on a yearly basis. The estimated CrCl as an accurate measure of glomerular filtration rate was confirmed by measuring plasma indium‐111 diethylenetriamine pentaacetic acid clearance. The mean daily intravenous protein intake and days during which nephrotoxic medications were used and number of bacteremic/fungemic episodes were determined for each subject. CrCl declined by 3.5 ± 6.3% per year (p =.004). Twenty‐nine of 33 patients had decreases of 0.6% to 15.4% per year. Tubular function, as determined by the tubular reabsorption of phosphate, was impaired in 52% of the subjects. The intravenous protein load averaged 1.28 ± 0.32 g/kg per day, nephrotoxic drug use averaged 3.4 ± 4.0% of all days on home TPN, and each patient averaged 2.3 episodes of bacteremia or fungemia since home TPN was started (0.5 ± 0.5 episodes per year). When all factors were assessed simultaneously, nephrotoxic drug use, episodes of bacteremia/fungemia, and age accounted for approximately 46% of the variability in CrCl. When bacteremia/fungemia was expressed as a yearly rate, nephrotoxic drug use assumed no role in the glomerular filtration rate determination; infection rate and age alone accounted for 53% of the CrCl variability. We describe a profound decrease in renal function associated with long‐term TPN, most of which is largely unexplained. (Journal of Parenteral and Enteral Nutrition 17:438–444, 1993)
Serum Vitamin K Concentration in Pediatric Patients Receiving Total Parenteral Nutrition
Authors: Pettei Michael J. , Israel David , Levine Jeremiah
Published: May 2008

The only multivitamin preparation for total parenteral nutrition currently available in the United States that contains vitamin K is the pediatric formulation MVI‐Pediatric. The recommended dose provides 200 μg of vitamin K1 per day to term infants and children up to 11 years old. This dose is well above the recommended dietary allowance of approximately 1 μg/kg per day, but the losses of vitamin K during administration are unknown. We evaluated the stability of vitamin K1 in a standard total parenteral nutrition infusion and found that on average 72.7 ± 4.9% of the original vitamin K1 was present after 24 hours. By using high‐performance liquid chromatography with electrochemical reduction and fluorescence detection, we obtained the serum vitamin K1 concentrations in 11 pediatric patients receiving total parenteral nutrition with MVI‐Pediatric (Rorer Pharmaceuticals, Fort Washington, PA) supplementation and in control children. The serum vitamin K1 concentration (19.3 ± 12.2 ng/mL) in patients receiving MVI‐Pediatric is significantly higher than that in control children 1.9 ± 1.5 ng/mL (p <.001). Current practice results in excessive levels of vitamin K in pediatric patients. (Journal of Parenteral and Enteral Nutrition 17:465–467, 1993)
Influence of Fasting on Glutamine Transport in Rat Liver
Authors: Espat N. Joseph , Copeland Edward M. , Scuba Wiley W.
Published: May 2008

During starvation, the liver switches from an organ of net glutamine uptake to an organ of net glutamine release to help maintain blood glutamine levels. We hypothesized that this shift in hepatic glutamine exchange was regulated at the level of the hepatocyte plasma membrane by adaptive changes in glutamine transport. To test this hypothesis, adult rats (200 g) were allowed to consume regular rat food ad libitum (fed, n = 8) or were fasted for 72 hours (fasted, n = 8, access to water allowed). Livers were excised and hepatocyte plasma membrane vesicles were prepared by differential and Percoll density gradient centrifugation. Vesicle purity and functionality were assessed by marker enzyme measurements, classic “overshoots,” and time courses, which showed similar vesicle size. Uptake of 3H‐glutamine by hepatocyte plasma membrane vesicles in the presence and absence of sodium was assayed by a rapid mixing/filtration method, which reflects actual transport across the hepatocyte cell membrane in vivo. Fasted rats lost 15±2% of body weight; fed rats gained weight. Na+‐dependent glutamine transport (system “N,” mediates uptake into the hepatocyte) fell by 22% in the starved group, indicating a diminished rate of glutamine transport into the hepatocyte. In contrast, carrier‐mediated Na+‐independent glutamine transport (system “n,” mediates the release of glutamine out of the cell) doubled in the starved animals. Diffusion of glutamine across the vesicle membrane was unchanged by starvation. Unlike the activity of system N, which decreased in fasted animals, Na+‐dependent transport of the nonmetabolizable system A analog N‐methylaminoisobutyric acid was increased in fasted animals. Adaptive changes in both Na+‐dependent and Na+‐independent hepatic glutamine transport occur during fasting. These changes contribute to the net release of glutamine by the whole organ during starvation and may be designed to provide glutamine for other tissues during starvation. (Journal of Parenteral and Enteral Nutrition 17:493–500, 1993)