bluuebunny/crossref_metadata_2025 huggingface dataset:
100 Patient Years' Experience with the Broviac Silastic Catheter for Central Venous Nutrition
Authors: Pollack Paul F. , Kadden Mark , Byrne William J. , Fonkalsrud Eric W. , Ament Marvin E.
Published: May 2008

Use of the Broviac silastic catheter totalling 37,039 patient days' experience has been studied at UCLA Hospital. When combined with standardized protocol for performance of parenteral nutrition and line care, and consistently supervised, the Broviac catheter provided inpatient as well as home parenteral nutrition with minimal complications. Catheter‐related sepsis occurred once every 1,058 catheter‐use days; minor or major complications developed once every 330 days. The benefits of the Broviac catheter appear to stem from the reinforcement of the external portion of the catheter with an outer protective sheath of Teflon, the luer lock connecting apparatus at the end of the catheter, and the dacron cuff which served to anchor the catheter by stimulating adhesion formulation. The ability to repair the catheter by splicing avoided removal of 7% of all catheters. Particularly dramatic results were noted in infants younger than 2 yr; sepsis and dislodgement occurred only once every 1189 catheter‐use days. On the basis of these observations, the Broviac silastic catheter should currently be considered the catheter of choice for central venous alimentation.
Changes in Serum Calcium Caused by Supplementation of Low Protein Diets with Keto‐acid Analogues in Patients with Chronic Renal Failure
Authors: Jackson M.A. , Lee H.A.
Published: May 2008

Six patients with stable end stage chronic renal failure have been studied while receiving keto‐acid supplements that provided a daily calcium load of 42 ± 2 mM. None of the patients had intercurrent illness. All patients showed elevated serum calcium concentration levels while on keto‐acid supplements, reaching significance on 5 occasions. Reciprocal falls in serum phosphate concentrations were noted in all patients, and this observation was not due to an anabolic effect of the ketoacids. In 3 patients, the rise in serum calcium concentration was associated with marked clinical manifestations that required curtailment of treatment. The risk of hypercalcemia occurs early and certain high risk categories can be identified. Recommendations about the use of calcium salts of α‐keto‐acid analogues are given and it is suggested that a choice should be made available between calcium and sodium salt analogues.
Home Tube Feeding for Long‐term Nutritional Support
Authors: Newmark Stephen R. , Simpson M. Susan , Beskitt M. Patricia , Black Julianne , Sublett Diane
Published: May 2008

Twenty‐three adult patients with protein‐calorie malnutrition were referred for outpatient tube feeding. Initial nutritional support with hypercaloric supplemented diets did not prevent further catabolism and weight loss, as the mean protein intake was 35.2 g/24 hr and the mean calorie intake was 844 cal/24 hr. Outpatient tube feeding was then initiated to deliver a mean of 78.5 g protein/24 hr and 2248 cal/24 hr. Patients on tube feeding demonstrated an increase of serum albumin and total body weight compared to diet therapy alone. The patient and family members were instructed in the technique of outpatient enteral feeding, which included instructions in feeding tube intubation, formula aspiration, and monitoring methods to prevent gastric aspiration and pooling. No major complications were observed. Home tube feeding was concluded to be a safe, efficient, and relatively inexpensive method of hyperalimentation for selected patients.
Effect of Retrograde Electrical Pacing on Jejunal Absorption of Xylose and Vitamin C
Authors: Layzell Trevor , Collin Jack , Johnston Ivan D.A.
Published: May 2008

Does retrograde electrical pacing of a continuously perfused jejunal segment increase absorption of xylose and vitamin C? Proximal jejunal segments (75 cm) were isolated from the intestinal stream in 5 dogs, and recording and stimulating electrodes attached. A solution containing 139.9 mmol/ liter xylose, 0.57 mmol/liter vitamin C, and 79.9 mmol/liter sodium chloride was infused into the loop at a rate of 2.8 ml/ min. Effluent from the loop was collected in 5‐min aliquots during 3 consecutive periods of 30 min, and the composition of each analyzed. During the second period, when retrograde electrical pacing was performed, there was a significant decrease in water, xylose, and vitamin C output (p < 0.0001).
Essential Fatty Acid Status in Adult Patients Receiving Soybean‐base Formula
Authors: Tanphaichitr Vichai , Tangchurat Nitaya
Published: May 2008

Essential fatty acid (EFA) status was assessed in 48 normal Thai adults and 6 patients who required tube feeding for 2–4 wk with commercial soybean‐base formula (Sobel, Mead Johnson). Each 1000 kcal of this formula provided 40.2 g protein, 32.8 g fat, 136 g carbohydrate, 13.9 g linoleic acid, 2.9 g linolenic acid, and 0 g arachidonic acid. The linoleic acid status in these patients before receiving soybean‐base formula was inadequate, as evidenced by the significantly lower serum 18:2‐W6 percentage but higher serum 16:1‐W7 and 18:1‐W9 percentages than those in normal adults. These changes were reversed while receiving soybean‐base formula. A significant positive correlation between linoleic acid intake and its serum level was demonstrated. There was a significant decrease in serum 20:4‐W6 percentage while receiving soybean‐base formula. This could be related to the absence of this EFA in the formula and suppression of biotransformation of 18:2‐W6 to 20: 4‐W6 in the presence of a significant amount of 18:3‐W3. None of the patients had 20:3‐W9 in the serum or developed scaly dermatitis throughout the study.
Selenium Supplementation in Total Parenteral Nutrition
Authors: Van Rij Andre M. , Mckenzie Joan M. , Thomson Christine D. , Robinson Marion F.
Published: May 2008

Four adult patients with very low plasma selenium (Se) levels (≤1.5 μg/100 ml) were given Se supplements while receiving total parenteral nutrition. A comparison was made using the compounds selenomethionine and sodium selenite given either intravenously or by mouth. Urinary excretion and Se plasma responses differed, and indicated that selenomethionine retention was greater. However, the incorporation of Se into the erythrocyte and its enzyme glutathione peroxidase was unpredictable and delayed and was not a good indicator of supplement response. No deleterious effects of supplements were observed. Se supplements are indicated especially in patients with a high risk of developing low Se levels and are best monitored by plasma Se levels.
Hyperkalemia in Patients on Enteral Feeding
Authors: Primrose John N. , Carr Kathryn W. , Sim Andrew J.W. , Shenkin Alan
Published: May 2008

The amount of potassium (K) in proprietary enteral feeds varies considerably from 2.7–9.2 mmol K+/g N. It has been suggested that up to 7 mmol K+/g N is required by the anabolic patient. The aim of this study was to determine the effect of a proprietary feed (Triosorbon MCT), containing 6.9 mmol K+/g N, on serum and urinary K in 13 patients requiring nutritional support. Serum electrolytes in all patients and urinary electrolytes in 7 were measured both before feeding commenced and when they had achieved an intake of between 2.4 and 3.0 liter/day (102–127 mmol K+/day) of full strength feed for a period of 1 wk. The serum K rose in all patients from 4.2 ± 0.5 mmol/liter (mean ± SD) before feeding to 5.1 ± 0.5 after feeding for 1 wk (p < 0.001; pair‐difference t‐test). The daily urinary K excretion rose from 37.8 ± 24.2 mmol/day to 61.8 ± 26.6 over the same period (p < 0.001) The serum urea rose from 4.7 ± 2.0 mmol/liter to 6.3 ± 3.2 (p < 0.05). No significant change was observed in other serum electrolytes, creatinine, or urinary electrolytes. During the whole course of feeding (range 1–11 wk) it was necessary to discontinue Triosorbon in 2 patients whose serum K concentration became elevated to> 6 mmol/liter. We conclude that the recommended levels of K intake may be too high and that serum K should be carefully monitored during enteral feeding.
Low Plasma Cortisol and Hematologic Abnormalities Associated With Essential Fatty Acid Deficiency in Man
Authors: Bistrian Bruce R. , Bothe Albert , Blackburn George L. , Defriez Albert I.
Published: May 2008

A case of probable adrenal insufficiency (glucocorticoid only) with hematologic changes including eosinophilia, neutropenia, and red blood cell abnormalities developed in the course of prolonged, fat‐free feeding. The coincident development of essential fatty acid deficiency was confirmed by serum fatty acid profiles indicating the presence of abnormal amounts of eicosatrienoic acid, and a triene/tetraene ratio >0.4; all these findings responded to fat repletion. The association of glucocorticoid deficiency, neutropenia, and eosinophilia with essential fatty acid deficiency has not been previously reported in humans.
Candida Endophthalmitis Associated With Total Parenteral Nutrition
Authors: Nahata Milap C. , Davidorf Frederick H. , Caldwell James H. , Weiss Ester T.
Published: May 2008

Candida albicans is the most common fungal infection which can occur in patients receiving total parenteral nutrition therapy. While rare, Candida endophthalmitis also can occur and must be considered as a potential risk of this treatment. Early detection and management of this disorder can alter the visual outcome for these patients. Systemic administration of amphotericin B and fluocytosine is the most common form of treatment for Candida endophthalmitis. In cases not responsive to systemic administration of antifungal agents, surgical management through pars plana vitrectomy can potentially eradicate the infection and preserve vision. We present a case of bilateral Candida endophthalmitis treated with amphotericin B and fluocytosine, and also with pars plana vitrectomy with the intracameral injection of amphotericin B into the anterior vitreous cavity. Systemic and intracameral use of antifungal drug therapy combined with vitrectomy restored useful vision to the patient.
Home Parenteral Nutrition Programs
Authors: Schneider Philip J. , Mirtallo Jay M.
Published: May 2008

The technique of home parenteral nutrition (HPN) is becoming a more widely used method to treat patients who cannot eat for prolonged periods; to date, more than 500 patients have been trained nationwide. Training has been limited for the most part to larger centers which have more experience in providing this complex patient education. As this technique becomes more widely accepted, however, other less experienced health care professionals will be called upon to develop HPN training programs. For this reason, it is important to simplify these training programs, with initial attention directed toward the procedures used to prepare the total parenteral nutrition solution. The chance of potential errors can be reduced by using amino acid solutions with electrolytes included in the formulation. When possible, complexity can be reduced by administering vitamins and extra electrolytes orally. The teaching program can be simplified by developing or using existing training manuals, which standardize procedures so that consistent methods are taught and performed. The manual can serve as a reference for patient and teacher alike. Distribution of supplies can be simplified by employing commercially available shipment programs; but, while these are very convenient for the patient and pharmacy, the costs of such programs could be a limitation. Finally, the extensive work required to arrange reimbursement for services and supplies also can be simplified. Often a social worker can facilitate this process because of experience and training in dealing with payment problems. In addition, training fees should be negotiated with third party payors early in the development of HPN programs. By simplifying these basic elements in an HPN, the task of training patients is less imposing and can be made more widely available to those who need this treatment modality.
A Complication of Direct Right Atrial Catheterization for Total Parenteral Nutrition
Authors: Apelgren Keith N. , Rombeau John L. , Casey John J. , Treasure Robert L.
Published: May 2008

A markedly malnourished man with Crohn's disease and superior vena cava thrombosis required direct right atrial catheterization for total parenteral nutrition. After 3 wk the catheter had migrated to the right pleural space, necessitating removal. An inferior vena cava line via the left saphenous vein was then utilized until the patient's death 10 wk later from pneumonitis. Technical suggestions for avoiding this complication and alternative venous access sites are discussed.
Local Response of Muscle to Burns: Relationship of Glycolysis and Amino Acid Release
Authors: Shangraw Robert E. , Turinsky Jiri
Published: May 2008

The study examined the cause of, and relationship between, the increased rates of glucose utilization and amino acid release that are uniquely exhibited by skeletal muscle underlying the burn wound. Ether‐anesthetized rats were subjected to a 3‐sec one hind limb‐scald and 3 days later glucose and amino acid metabolism of soleus muscles from the burned and unburned limbs of burned rats as well as from controls was studied in vitro. Metabolism of the unburned‐limb muscle did not differ from control under any experimental conditions. In contrast, muscles from the burned limb took up to 3 times more glucose than controls in 10 mM glucose. Anoxia increased glucose uptake by all muscle groups but did not eliminate the relative enhancement exhibited by the burned‐limb muscles. Muscles from the burned limb also released 101% more alanine, 68% more glutamate, 110% more glutamine, and 163% more tyrosine in the presence or absence of medium glucose. With the exception of a uniform increase in glutamate release, anoxia did not alter amino acid releases by any muscle group. Inclusion of 1 mM iodoacetate in the glucose‐free medium reduced alanine release and raised glutamate release in all muscle groups, eliminating their relatively enhanced release by burned‐limb muscles. Iodoacetate markedly diminished glutamine release by muscles from the burned limb and caused a relatively depressed glutamine release by these muscles as compared to control. The fact that ATP‐MgCl2 reversed the depressed release of glutamine by burned‐limb muscles suggests that cellular ATP is the limiting factor for glutamine synthesis by these muscles in iodoacetate. It is concluded that muscle hypoxia is only partially responsible for the increased glucose utilization by muscle from the burned region, and does not contribute to the augmented release of amino acids. The stimulated alanine release by muscle from the burned region does, however, appear to depend upon the increased pyruvate supply evident in these muscles.
The Influence of Abdominal Surgical Trauma Upon the Turnover of Some Blood‐Borne Energy Metabolites in the Human Leg
Authors: Stjernström Hans , Jorfeldt Lennart , Wiklund Lars
Published: May 2008

A moderate elevation of blood sugar and a reduction of glucose tolerance occur in association with surgical trauma. This may be due to an increased release of glucose from the liver or a reduced peripheral uptake of glucose, or both. The present study was undertaken to investigate the peripheral exchanges of energy substrates. Twenty‐six patients undergoing cholecystectomy underwent turnover studies on blood‐borne energy substrates in the leg before, during, and immediately after surgery. Measurements of leg blood flow and femoral arteriovenous differences in oxygen, glucose, lactate, pyruvate, glycerol, β‐hydroxybutyrate, and alanine were made. After induction of general anesthesia, leg oxygen uptake decreased by 34%. Postoperatively, the oxygen uptake was 150% higher than the preanaesthetic level. During surgery, leg blood flow did not change significantly, but postoperatively it was increased by 50%. Arterial blood glucose concentration increased about 1 mmol/liter hr during the operation. Glucose uptake in the leg did not change significantly, although a large number of negative arteriovenous differences were obtained towards the end of surgery. Assimilated glucose was estimated to have accounted for 7% of the leg oxygen uptake before surgery. Toward the end of surgery, and in the immediate postoperative period, lactate release exceeded glucose uptake. During surgery, lactate and pyruvate release from the leg increased. Alanine release was also increased towards the end of the operation. As judged by the raised free fatty acids, glycerol, and β‐hydroxybutyrate levels, lipolysis was stimulated during surgery. There was a correlation between leg uptake and arterial concentration of β‐hydroxybutyrate. It is suggested that the increased lipolysis and increased uptake of β‐hydroxybutyrate contribute to the low glucose utilization during surgery.
Comparison of a New 10% and 20% safflower Oil Fat Emulsion in Pediatric Parenteral Nutrition
Authors: Coran Arnold G. , Drongowski Robert , Sarahan Teresa M. , Wesley John R.
Published: May 2008

A new 20% safflower oil fat emulsion was compared with its 10% counterpart in a small series of pediatric patients. Five infants and children, studied for a 2‐week period, received either the 10% or 20% emulsion for 1 week and the other emulsion the 2nd week. No serious toxicity or side effects were noted in any of the patients following the infusion of either emulsion. In addition, significant weight gain was noted in the children, and clinical improvement was apparent in all cases. This preliminary study suggests that the 20% Liposyn is as safe and effective as its 10% counterpart.
Central Vein Thrombosis Associated with Intravenous Feeding—A Prospective Study
Authors: Valerio David , Hussey Jeffrey K. , Smith Frank W.
Published: May 2008

Thirty consecutive patients receiving intravenous feeding according to a standard protocol were studied for possible central vein thrombosis by contrast venography. Twenty‐two patients had contrast venograms and 6 venograms revealed significant thrombus. Only 1 patient had any clinical evidence of thrombosis. It is suggested that prophylaxis of central vein thrombosis should be standard with intravenous feeding.
Home Total Parenteral Nutrition During Pregnancy: A Case Report
Authors: Cox Kenneth L. , Byrne William J. , Ament Marvin E.
Published: May 2008

A 26‐year‐old female was given total parenteral nutrition without complications during the last 2 months of her pregnancy. A partial small bowel obstruction caused by Crohn's disease prevented oral alimentation, necessitating parenteral nutrition. A term, female infant weighing 2680 grams was delivered vaginally without complications. At birth and 11 months of age, the infant's physical and developmental assessments were normal. This case report demonstrates that total parenteral nutrition can be administered during the last trimester of pregnancy to improve maternal nutrition so as to promote fetal growth.
Evaluation of Possible Causes of Delayed Hypersensitivity Impairment in Cancer Patients
Authors: Dominioni Lorenzo , Dionigi Renzo , Dionigi Paolo , Nazari Stefano , Fossati Giun S. , Prati Ubaldo , Tibaldeschi Carlo , Pavesi Franco
Published: May 2008

The separate roles of malnutrition, advanced age, and stage of tumor growth as causes of impairment of delayed hypersensitivity response (DHR) was studied in 111 patients with solid tumors and in 56 nonneoplastic control patients matched for age, anatomical site of disease, degree of illness, and nutritional status. Pretreatment DHR to recall antigens (tuberculin, Candida, streptokinase‐streptodornase, trichophyton) and to dinitrochlorobenzene in cancer patients was 9% anergic, 43% hypoergic, and 48% normoergic; the distribution of DHR in controls was not significantly different.

In cancer patients, the serum albumin level showed an inverse correlation with the stage of tumor (p < 0.01) and a positive correlation with the DHR (p < 0.001); the serum albumin level was also in the controls positively correlated with the DHR (p < 0.01), indicating that malnutrition in neoplastic or benign disease may cause depression of DHR. In well‐nourished controls, age was inversely correlated with DHR (p < 0.05), showing that aging itself may be another relevant cause of depression of DHR. The results of this study indicate that DHR in patients with solid tumors is similar to the DHR of nonneoplastic patients if matched for age, sex, and nutritional status. DHR impairment in cancer patients appears to be caused mainly by aging and by malnutrition due to the advanced progression of cancer.
Cluster Analysis of Nutritional and Immunological Indicators for Identification of High Risk Surgical Patients
Authors: Nazari Stefano , Comincioli Valeriano , Dionigi Renzo , Comodi Isabella , Dionigi Paolo , Capelo Antonio , Bonoldi Alberto Pietro , Bonacasa Roberto , Cozzi Mauro
Published: May 2008

In spite of the many anthropometric, biohumoral, and immunologic parameters employed in the nutritional assessment of hospitalized patients, it is difficult in clinical practice to evaluate accurately the degree and type of malnutrition and to assess the prognostic significance of this determination. The purpose of this study is to evaluate nutritional status of surgical patients by means of cluster analysis in order to identify different nutritional patterns and to evaluate their clinical and prognostic significance. Nutritional assessment of 71 surgical patients was carried out at admission, and the sets of data were evaluated by means of cluster analysis. Four clusters with different nutritional patterns were identified. The incidence of clinical variables (type of disease, postoperative sepsis, palliative procedures, mortality at 6 months, etc.) in each cluster was determined in order to evaluate their clinical and prognostic significance. Cluster 1 showed minor variations of the indicators, including most of the controls, presented the lowest incidence of sepsis, palliative procedures, and mortality at 6 months. It was then considered as a reference group representative of the normal nutritional condition at our institution. The other three clusters showed major variations of nutritional indicators and represent poorer risk clinical conditions. Sepsis, palliative procedures and mortality rate were significantly more frequent in these clusters (p < 0.05, p < 0.001, p < 0.05). A different distribution in the clusters was recorded in gastrointestinal tract cancers and other neoplasms. Only the incidence of gastrointestinal tract cancers increases progressively in the clusters with poorer prognosis, suggesting that this type of neoplasia is more frequently associated with major changes of nutritional status.
Metabolic Abnormalities in Patients Supported with Enteral Tube Feeding
Authors: Vanlandingham Sam , Simpson Susan , Daniel Patricia , Newmark Stephen R.
Published: May 2008

One hundred patients supported with enteral tube feeding were evaluated for biochemical abnormalities. The following metabolic complications were observed: hyperglycemia (29%), hypoglycermia (2%) hypernatremia (10%), hyponatremia (31%), hyperkalemia (40%) hypokalemia (8%), hyperphosphatemia (14%) hypophosphatemia (30%) hypomagnesemia (3%), hypozincemia (11%), and hypocupremia (3%). Because of the extensive range of biochemical problems, it is recommended that subjects on tube feeding be evaluated periodically for metabolic abnormalities.
New Technique for Placement of Long‐Term Venous Catheters
Authors: Vander Salm Thomas J. , Fitzpatrick Garry F.
Published: May 2008

A technique of permanent pacemaker insertion has been adapted to implantation of long‐term central venous cannulae. This new method allows large caliber cannula implantation while avoiding direct exposure of the vein to be cannulated.
Metabolism of Parenteral Glucose Oligosaccharides in Man
Authors: Young Eleanor A. , Fletcher John T. , Cioletti Louis A. , Hollrah Louise A. , Weser Elliot
Published: May 2008

Low molecular weight oligosaccharides of glucose may be utilized as a calorie source when given intravenously. Preliminary safety studies included the parenteral infusion of four healthy subjects with a solution of glucose oligosaccharides at a rate of 0.5 mg/kg/min for 1, 2, or 3 hours. Approximately 100% of the oligosaccharides was retained with only trace amounts of the glucose oligosaccharides recovered in the urine. In further studies, 12 healthy males, ages 22–31, were infused with a 10% solution of glucose oligosaccharides containing 25 μCi [U‐14C]glucose oligosaccharides/liter at a rate of 2.5 or 5.0 mg/kg/min for 12 hours with or without insulin (0.12 unit/g oligosaccharides) given subcutaneously in 3 equi‐divided doses. Four additional subjects received cold oligosaccharides at a rate of 1.75 mg/kg/min without insulin. Eighty percent of the glucose oligosaccharides consisted of 2 to 8 glucose chain lengths. Blood glucose and oligosaccharide glucose concentrations and 14CO2 were measured hourly. Paper chromatography of urine sugars was also performed to determine the sugars excreted. Serum glucose and insulin concentration did not change during the oligosaccharide infusion; insulin injections significantly depressed serum glucose and produced elevations in serum insulin concentration. Plasma FFA decreased in response to oligosaccharide infusion at both 2.5 and 5.0 mg/kg/ min rates, with and without insulin. At the 1.75, 2.5, and 5.0 mg/kg/min rates, 21, 43, and 62% of the infused oligosaccharides, respectively, was excreted into the urine. Only 7–15% of the infused oligosaccharide 14C was recovered as 14CO2. Insulin did not influence these parameters. Urine chromatography showed that approximately 20, 30, and 40% of excreted sugar was maltotriose, maltose, and higher oligosaccharide chains, respectively. These studies indicate that partial, but significant quantities of glucose oligosaccharides may be metabolized after intravenous infusion, particularly at low infusion rates.
Long‐Term Nutritional Support as an Adjunct to Chemotherapy for Breast Cancer
Authors: Elkort Richard J. , Baker Frances L. , Vitale Joseph J. , Cordano Angel
Published: May 2008

In recent years, the concept of nutritional support as a part of a comprehensive cancer management program has gained increasing acceptability. However, little data is available in regard to the effect of nutritional support programs on the chronic disease state represented by recurrent or persistent cancer that characterizes patients undergoing systemic chemotherapy.

In 1977 we undertook to study this problem in a randomized prospective study designed to evaluate the effects of long‐term (12 months) enteral nutritional support in a group of ambulatory breast cancer patients undergoining a standard cytotoxic chemotherapy treatment program, in an adjuvant or therapeutic setting.

The results of this study suggest that patients with breast cancer are overweight as compared to the general population and that any significant change in initial body weight, either a gain or a loss, is associated with an increased risk of recurrent disease.

Data are presented which show little or no correlation between standard parameters of nutritional assessment and risk of disease recurrence and/or response to chemotherapy.

These data also suggest that until we better understand the relationship between tumor and host in breast cancer patients, we offer nutritional support programs only in situations where there are specific clinical indications for such interventions.
Hemodynamic Effects of Intravenous Fat Emulsions in Patients with Heart Disease
Authors: Fisch Daniel , Abel Ronald M.
Published: May 2008

Two intravenous fat emulsions (Liposyn 10%, Abbott Laboratories, North Chicago, IL, and Intralipid 10%, Cutter Laboratories, Berkeley, CA) were evaluated in 13 adult patients following cardiopulmonary bypass procedures in a randomized, prospective, double‐blind study to determine their overall hemodynamic effects. The fat emulsions were administered for 30 minutes, and each patient was his own control.

Neither intravenous fat emulsion was observed to exert significant changes in left ventricular stroke work, left ventricular filling pressure, cardiac output, systemic vascular resistance, mean systemic arterial blood pressure, central venous pressure, or mean pulmonary artery pressure. This study confirms that the administration of 10% fat emulsions available in the United States does not exert significant untoward hemodynamic changes, even in patients with severe cardiac impairment recovering from recent open heart surgery.
Trace Metal Abnormalities in Adults During Hyperalimentation
Authors: Mcclain Craig J.
Published: May 2008

Trace metal deficiencies are now a well‐documented complication of total parenteral nutrition (TPN). Zinc deficiency may present in a variety of ways including acrodermatitis skin lesions, impaired immunity, poor growth or impaired wound healing, and mental disturbances. Copper deficiency presents a more uniform picture of hematologic abnormalities, usually anemia with leukopenia and neutropenia. Chromium and selenium deficiencies occur much less frequently, but well‐documented cases have been reported. We currently recommend regular monitoring and supplementation of these four trace metals during TPN administration. This article describes the clinical abnormalities that may develop when deficiencies of trace metals occur during TPN administration, and we present recommendations for trace metal supplementation during TPN administration.
Nutritional Abnormalities in Nonhospitalized Patients with Primitive Cardiomyopathy
Authors: Faintuch Jacob J. , Faintuch Joel , Américo Friedman Antonio , Do Serro Azul Luis Gastão , Venere Decourt Luiz
Published: May 2008

The present investigation was aimed at studying the influence of primitive myocardial disease on the nutritional status of nonhospitalized patients. In a group of 93 consecutive cases, without additional organic disabilities or known nutritional deficits, a simplified protocol of anthropometric and biochemical measurements was applied, including weight/ height, triceps skinfold, arm muscle circumference, albumin, cholesterol, hemoglobin, and creatinine excretion. All these findings were analyzed in the light of the left ventricular functional status, as assessed by phonomechanographic parameters. The conclusions were: (1) primitive cardiomyopathy with significant ventricular impairment is associated with some signs of malnutrition; (2) triceps skinfold is the most affected index in those cases.
Leukemoid Reaction Associated with Parenteral Nutrition
Authors: Kanematsu Takashi , Inokuchi Kiyoshi , Kohno Hitoshi , Kato Tetsuo
Published: May 2008

A hematological picture simulating that seen in cases of leukemia often occurs in a variety of conditions. We recently treated a patient who had a leukemoid reaction in the peripheral blood while he was on parenteral nutrition. Throughout the period of treatment with parenteral nutrition, an abnormal shift towards immaturity in the neutrophilic granulocytes was seen, and the degree of this shift appeared to depend on the caloric intake. Moreover, the hematological picture resembling that seen in cases of leukemia disappeared shortly after discontinuation of the parenteral nutrition, and immature cells were no longer apparent. We assumed that the excess glucose‐related calories included in parenteral nutrition produced the leukemoid reaction in this patient who was being surgically treated for carcinoma of the colon with hepatic metastasis.
An Improved Method for Blood Glucose Control During Nutritional Support
Authors: Woolfson Anthony M.J.
Published: May 2008

Hyperglycemia may be a considerable problem in ill patients receiving nutritional support. In these patients, the traditional 4‐ or 6‐hourly urine sliding scale responds too slowly to changes in blood glucose, and marked hyperglycemia can occur. Regular bedside measurement of blood glucose makes control easier, but if insulin requirements change, the scale of doses must be reassessed and rewritten frequently. The problems may be overcome by the use of a scale of instructions for changing the rate of intravenous infusion from a syringe pump and the insulin concentration in the syringe. The same scale applies at all blood glucose levels and insulin doses. This method has been used in patients at risk from hyperglycemia on the Intensive Care Unit for over a year and has proved remarkably successful. Thirty‐nine such patients had their blood glucose concentrations stabilized within a median time of 9 hours. In some patients, high doses of insulin were necessary, but no dangerous hyper‐ or hypoglycemia has occurred. A simple modification which improves safety without loss of good control has recently been included and used without difficulty in a further 12 patients.
Gastrointestinal Response to Nutrient Variation of Defined Formula Diets
Authors: Young Eleanor A. , Cioletti Louis A. , Traylor Jill B. , Balderas Vidal
Published: May 2008

The gastrointestinal response to oral alimentation of low residue commercial defined formula diets or a rat liquid formula was studied. Male Sprague‐Dawley rats (220–250 g) were fed isocaloric amounts (73 kcal/day) of Vivonex (V), Vivonex HN (VHN), Flexical (F), Vital (Vit), or a control Casein diet 116EC (C). Nitrogen (N) retention was calculated from N intake minus N excretion/day. After 2 weeks, rats were killed and the liver, pancreas, and small bowel removed and weighed. Pancreatic amylase activity (U g) and liver lipid were measured. The bowel was divided into eight equal segments, and mucosal weight, DNA, and protein concentration per centimeter were measured. Despite isocaloric feeding, body weight gain was lower in V and VHN groups, and higher in F and Vit groups compared to the C. Amylase specific activity was increased in V, VHN, and F groups, while the liver lipid was increased in the V and VHN groups when compared to C animals. The most proximal intestinal segment weight, mucosal weight, protein and DNA of V, VHN, and Vit groups were less than C animals, while distal segments were similar. F animals showed greater intestinal mass than C rats. These studies indicate statistically significant differences in gastrointestinal responses as a result of nutrient variation of defined formula diets.
Nutritional Indicators of Postburn Bacteremic Sepsis
Authors: Morath Michele A. , Miller Sidney F. , Finley Robert K.
Published: May 2008

The potential of nutritional assessment parameters in predicting sepsis in burn patients was investigated. Sixty‐two consecutive patients (mean age 41 years) with an average burn size of 19% were studied. Values were obtained on postburn day 10 for serum albumin, transferrin, nitrogen balance. total lymphocyte count, skin test reactivity. and nercentage of ideal body weight. Parameters predictive of an imminent septic episode included serum albumin <3.0 g/dl (p < 0.001), total lymphocyte count < 1500/MM3 (p < 0.001), anergy (p < 0.001), and serum transferrin < 150 mg/dl (p < 0.01). Nitrogen balance and percentage of ideal body weight were not found to contribute to group discrimination.
The Effect of Total Parenteral Nutrition or Elemental Diet on Pancreatic Proteolytic Activity and Ultrastructure
Authors: Traverso L. William , Abou‐Zamzam Ahmed M. , Maxwell David S. , Lacy Silas M. , Tompkins Ronald K.
Published: May 2008

Previous reports regarding the effect of an elemental diet (ED) on pancreatic secretion have been conflicting. This study was designed to assess the effect of a high‐nitrogen ED or total parenteral nutrition (TPN) on proteolytic activity in the pancreatic exocrine cell. Forty‐eight dogs were divided into 12 groups of 4 each. Group I (control) was fed commercial dog food. Groups II, III, and IV received 1, 2, and 3 days, respectively, of 25% glucose with 4.25% amino acids. Groups V, VI, and VII received 1, 2, and 3 days, respectively, of 25% glucose with 2.75% amino acids. Groups VIII, IX, and X received 3 days of ED given orally, via gastrostomy or jejunostomy, respectively. Groups XI and XII received 1 day each of either 2.75% amino acids or 25% glucose. The pancreas of each dog was then resected and processed for electron microscopy, or minced and analyzed for tryptic activity expressed as micro‐moles of benzoyl arginine ethyl ester (BAEE) digested per milligram of pancreatic protein. There were no significant differences in ultrastructure or in the levels of pancreatic tryptic activity between the control and the 11 experimental groups. It appears that during the short period of our treatment with TPN as well as with ED, the exocrine cell retains its normal content of proteolytic enzyme. Reports of others that pancreatic secretion volume decreases with TPN and ED, coupled with our findings of stable intracellular tryptic activity, indicate that the synthesis and release of proteolytic enzymes have actually been reduced by TPN and ED. Thus, TPN or ED should benefit the patient with pancreatitis by decreasing pancreatic secretion as well as pancreatic proteolytic enzyme synthesis.
The Effect of Intravenous Doxycycline Hyclate on Total Parenteral Nutrition in Protein Malnourished Rats
Authors: Lees C. Douglas , O'Neill Megan , Steiger Ezra
Published: May 2008

To study the effects of intravenous doxycycline hyclate on protein malnourished rats, 20 male Sprague‐Dawley rats, weighing 234 to 277 g, were protein depleted for 6 weeks then randomly assigned to one of two groups: group I (10 rats), total parenteral nutrition with intravenous doxycycline hyclate injections, group II (10 rats), total parenteral nutrition with normal saline injections. Both groups were then protein repleted for 7 days. Body weight; fluid intake; urine output; liver, spleen, and lung weights; nitrogen content; and serum proteins were measured. The antibiotic dosage given was 10 mg/kg body weight/day or 0.1688 ± 0.0046 mg/day. There was no significant difference in starting weight, weight after 6 weeks of protein depletion, weight at sacrifice, or weight gain between groups I and II. Average fluid intake/day for groups I (50 ± 2 ml) and II (51 ± 3 ml) were not statistically significant. There was no significant difference in average urine output/day nitrogen balance, liver weight, and liver nitrogen, spleen and lung weights, or serum albumin levels (Group I, 2.84 ± 0.48 g%, Group II, 2.72 ± 0.24 g%). Intravenous doxycycline hyclate does not appear to have a protein catabolic effect on protein malnourished rats receiving total parenteral nutrition.
Monitoring Intravenous Fat Emulsions in Neonates with the Fatty Acid/Serum Albumin Molar Ratio
Authors: Kerner John A. , Cassani Carla , Hurwitz Ruth , Berde Charles B.
Published: May 2008

Weekly determinations of the fatty acid/albumin molar ratio (FA/SA) were obtained 136 times on 50 neonates (birthweight range, 675–4300 grams; median, 1360 grams) to determine if our use of intravenous fat (IVF) was putting these newborns at risk for kernicterus. The FA/SA was measured using a convenient spectrophotometric technique which we have previously described (Berde CB, Kerner JA, Johnson JD: Clin Chem 26:1173–1177, 1980). Twenty‐nine infants received IVF with doses from 0.5 to 3.3 gram/kilogram/day (mean 1.5 gram/kilogram/day), given over 24 hours whenever possible, most commonly begun in the second week of life when the bilirubin level was less than one half of the potential exchange level. Twenty‐one infants received no IVF. Previous studies show that fatty acids do not begin to displace bilirubin from albumin until the FA/SA is >6 in vivo, and >4 in vitro. All our infants had safe values with mean FA/SA values of approximately 1.0. Continuous IVF as we administer it does not place neonates at risk for kernicterus. Centers administering IVF in the first week of life or by bolus should consider close monitoring of their infants with the FA/SA.
A Comparison of Triceps Skinfold and Upper Arm Circumference Measurements Taken in Standard and Supine Positions
Authors: Jensen Terri G. , Dudrick Stanley J. , Johnston Dennis A.
Published: May 2008

Because hospitalized patients are often unable to assume the upright position recommended for anthropometric measurements, the effect of patient position on accuracy of triceps skinfold and arm circumference measurements was investigated. Three measurements of triceps skinfold and arm circumference were taken on the right arm of 74 patients by trained technicians with extensive experience in anthropometric evaluation using a Lange caliper and Inser‐tape. Measurements were repeated in the supine position 5 hours later on the same day by the same observer. Mean triceps skinfold, arm circumference, and calculated arm muscle circumference values obtained in the upright position correlated highly with those obtained in the supine position. Differences were less than one measurement unit and not significant when compared using parametric (Student t‐test) and nonparametric (Wilcoxon Matched‐Pairs Signed‐Ranks Test) statistical analysis. This study indicates that triceps skinfold and arm circumference can be measured accurately, reproducibly, and comparably in the supine position when the patient is unable to assume the recommended upright stance.
Home Parenteral Nutrition with Full‐Time Home Care Nurses
Authors: Lyons Jane M. , Falkenbach Luann , Cerra Frank B.
Published: May 2008

A group of patients exists who cannot manage home parenteral nutrition (HPN) due to debilitating conditions and/or lack of family resources. They are limited to either nursing home placement or extended hospitalization unless home nursing care is provided. A 58‐year‐old single female with malabsorption secondary to scleroderma was sent home on cyclic HPN under the supervision of full‐time home care nurses. A comprehensive patient‐centered nurse training program was designed to teach nursing personnel from a private nursing service the theory and practice of HPN. Each nurse must achieve at least 80% in the theory posttest and demonstrate the competent performance of central venous catheter care, mixing of parenteral nutrition solutions, use of the infusion pump, and application of the heparin lock. The results of the pre‐ and posttests have shown that the home care nurses have been able to learn the theory necessary for implementing HPN. The mean pretest value was 46% while the mean posttest value was 90% (n = 12, p = 0.01). The patient has been doing very well at home for 5 months in this psychologically, medically, and financially effective program covered by third party payers. To the best of our knowledge, this program has never before been accomplished.
Effect of Insulin on Glucose and Amino Acid Uptake by Skeletal Muscle Following Burn Injury. Studies with 2‐Deoxyglucose and α‐Aminoisobutyric Acid
Authors: Nelson Karl M. , Turinsky Jiri
Published: May 2008

Basal and insulin‐stimulated uptake of 2‐deoxyglucose (2‐DG) and a‐aminoisobutyric acid (AIB) by cells of the intact soleus muscle were studied 3 days after a 3‐second scald on one hind limb of the rat. Soleus muscles from the burned and unburned limbs of burned rats, as well as from controls, were incubated with 1 mM [14C]2‐DG or 50 μM [14C] AIB and insulin (0, 0.1, 1.0, 10.0, or 100.0 mU/ml). Extracellular space was measured with [3H]inulin. Basal uptake of 2‐DG and AIB by the cells of the burned limb muscles were 68% (p < 0.001) and 40% (p < 0.05), respectively, higher than those of controls. The intracellular concentrations of 2‐DG and AIB of burned limb muscles were 112% (p < 0.01) and 72% (p < 0.01), respectively, higher than those in control muscles. Corresponding values in soleus muscles from the unburned limb of burned rats did not differ from controls. Addition of insulin increased both the rates of cellular uptake and intracellular concentrations of 2‐DG and AIB in control and unburned limb muscles but did not significantly affect those of burned limb muscles. It is concluded that thermal injury suppresses the insulin‐induced augmentation of 2‐DG and AIB uptake by skeletal muscle underlying the burn wound but does not alter the insulin sensitivity of skeletal muscle in the unburned region. Since glucose and amino acid uptakes are stimulated by insulin independently, the cellular mechanism of the burn‐induced unresponsiveness to insulin may be located at a site which is common to both processes.
Iron‐Deficiency Anemia in Childhood Inflammatory Bowel Disease: Treatment with Intravenous Iron‐Dextran
Authors: Halpin Thomas C. , Bertino Joseph S. , Rothstein Fred C. , Kurczynski Elizabeth M. , Reed Michael D.
Published: May 2008

A prospective protocol for iron replacement was used in six children with severe inflammatory bowel disease who had iron‐deficiency anemia. All were given a single total‐dose infusion of iron‐dextran after a taper of the parenteral nutrition solution. Each had hematologic and biochemical correction of their iron‐deficiency anemia. As outlined, intravenous iron‐dextran appears to be a safe, efficacious, and practical method of iron repletion in children with inflammatory bowel disease who require prolonged parenteral nutrition and bowel rest.
Malnutrition in Critically III Infants and Children
Authors: Pollack Murray M. , Wiley Jeannette S. , Kanter Robert , Holbrook Peter R.
Published: May 2008

The prevalences of acute and chronic protein‐energy malnutrition (PEM) and deficiencies in stores of fat and somatic protein have not been previously examined in a pediatric intensive care unit. One hundred eight nutritional assessments were performed using anthropometric techniques on infants and children in a multidisciplinary intensive care unit. Overall, the prevalence of acute PEM was 19% and chronic PEM was 18%. The prevalence of fat store depletion was 14% and somatic protein store depletion was 21%. In general, children <2 years had poorer nutritional status compared to children ≥2 years. There was not a statistically significant difference between medical and surgical patients. It is concluded that PEM and deficiencies in the macronutrient stores of fat and somatic protein are common in critically ill infants and children.
Thromboembolic Complications with Silicone Elastomer Subclavian Catheters
Authors: McLean Ross A.H. , Griffith C.D.M. , Anderson J.R. , Grieve D.C.
Published: May 2008

Central venous thrombosis is a well‐recognized complication of plastic catheters used during parenteral nutrition and occurs in up to 33% of cases if examined venographically. Silicone elastomer catheters, in addition to their favorable handling properties, are less thrombogenic than plastic varieties and are now increasingly used for parenteral nutrition. However, their use does not prevent the possibility of catheter‐related thrombosis as this study demonstrates. In a consecutive series of 118 silicone elastomer subclavian catheters, 83% of which were used for parenteral nutrition, two instances of clinically apparent catheter‐related thrombosis occurred and one of these was complicated by major pulmonary embolism. Catheter malplacement, catheter infection, and coagulation abnormalities were absent. Both catheters were used for parenteral nutrition and were in place for 20 and 28 days, respectively. Twenty‐eight consecutive silastic catheters used for parenteral nutrition were studied, prior to removal, by simultaneous bilateral ascending phlebography. One clinically inapparent nonocclusive, catheter‐related thrombus was detected which detached during catheter removal. This study suggests an incidence of symptomatic and asymptomatic silastic catheter‐related thrombosis to be around 4%. Silicone catheters therefore may reduce but cannot abolish catheter‐related thrombosis. Furthermore, when present, catheter‐related thrombosis may be a source of major pulmonary thromboembolism.
Fatal Paradoxical Air Embolism to the Brain: Complication of Central Venous Catherization
Authors: Michel Luc , Poskanzer David C. , McKusick Kenneth A. , Nardi George L. , Malt Ronald A.
Published: May 2008

A case of paradoxical air embolism to the brain via a patent foramen ovale after placement of a central venous catheter is reported. Diagnosis was facilitated by seeing punctate areas of lucency in the brain after computed tomography of the head. Presence of a right‐to‐left shunt was confirmed by radionuclide study of the brain after intravenous injection of 99mTc‐labeled albumin microspheres.