bluuebunny/crossref_metadata_2025 huggingface dataset:
Urogastrone Reduces Gut Atroprhy during Parenteral Alimentation
Authors: Bragg L.E. , Hollingsed T.C. , Thompson J.S.
Published: May 2008

Urogastrone (UG) exerts trophic effects on the intestine and may play a role in maintaining normal intestinal structure and function. Since administration of nutrients parenterally results in intestinal hypoplasia and hypofunction, the aim of this study was to determine the effects of UG on intestinal structure and function in parenterally fed rats. Central venous catheters were placed into 28 Sprague‐Dawley rats. Group I (n = 10) received TPN alone. Group II (n = 8) received TPN and 15 μg/day of UG and group III (n = 10) received rat chow ad libitum. The animals that received urogastrone had significantly greater (p < 0.05) intestinal weight (25.6 ± 2.5 mg/cm us 22.6 ± 3.0 mg/cm), mucosal weight (8.4 + 1.4 mg/cm us 6.2 ± 0.9 mg/cm), mucosal protein content (6.2 ±1.7 mg/ cm us 2.7 ± 0.6 mg/cm), villous height (427 ± 27 μm us 293 ± 75 μm), crypt cell production rate (14.5 ± 1.4 metaphases/hr us 12.3 ± 0.7 metaphases/hr) and sucrase specific activity (6.5 ± 2.6 us 3.7 ± 2.0) than animals receiving only TPN. However, these parameters remained less than in chow‐fed animals. Thus, simultaneous infusion of UG prevents, in part, intestinal hypofunction and hypoplasia which occurs during TPN. This may be due to maintenance of mucosal proliferative activity and brush border enzyme activity. (Journal of Parenteral and Enteral Nutrition 14:283–286, 1990)
Three‐in‐One Parenteral Nutrition: A Safe and Economical Method of Nutritional Support for Infants
Authors: Rollins Carol J. , Elsberry Victor A. , Pollack Kathy A. , Pollack Paul F. , Udall John N.
Published: May 2008

The medical records of 20 infants under 1 year of age who received parenteral nutrition (PN) for a minimum of 1 week were reviewed. Patients were divided into two groups based on the method of PN administration. One group received PN by the traditional two‐plus‐one method where lipid emulsion is given separately from the dextrose‐amino acid mixture. The second group received PN by the three‐in‐one method where lipid emulsion is admixed with the dextrose and amino acids. There were no statistically significant differences between the two groups in the amount of calories, lipid, dextrose, protein, calcium, and phosphorus received per kg of body weight. Average daily weight gain was not statistically different, and no obvious trends were noted in serum biochemical parameters between the two groups. Average total PN days for the groups (13 ± 7 days for the two‐plus‐one group vs 39 ± 35 days for the three‐in‐one group) were significantly different (p < 0.05). A cost comparison of the two methods of PN administration indicated that the two‐plus‐one method costs our hospital $11.78 more per day than the three‐in‐one solution. We conclude that the three‐in‐one method of PN administration is safe, efficacious, and cost effective for infants under 1 year of age. (Journal of Parenteral and Enteral Nutrition 14:290–294, 1990)
Evaluation of a Percutaneously Placed 27‐Gauge Central Venous Catheter in Neonates Weighing <1200 Grams
Authors: Nakamura Kenneth T. , Sato Yutaka , Erenberg Allen
Published: May 2008

A percutaneous 27‐gauge OD central venous catheter was inserted at 4 ± 3 (SD) days of age and left in place for up to 2 weeks in 20 neonates with birth weights <1200 g and >24 h of age. Parenteral nutritional solutions and medications were administered through these catheters. Twenty neonates matched for birth weight and gestational age served as paired controls.

In vitro studies demonstrate that the maximum infusion rate for parenteral nutrition solutions is about 20 ml/hr. Packed red blood cells could not be infused through these catheters. In vivo results demonstrate a significant (p < 0.05) reduction in number of peripheral iv catheters inserted during study (2 ± 1 us 7 ± 4, SD) with no difference in cost per day of iv access ($79.42 ± 113.51 vs $43.91 ± 15.99. SD). Two‐dimensional ultrasound assessment of catheter thrombosis was unsuccessful. Moreover, there was no correlation between angiographic and electron microscopic evaluation of catheter tip thrombosis. Electron microscopy of catheter tips revealed 33% with complete, partial and no occlusion, respectively, and 39% with sheath thrombosis. In summary, percutaneous insertion of a 27‐gauge OD Vialon central venous catheter is a feasible alternative in providing venous access in very low birth weight infants. (Journal of Parenteral and Enteral Nutritiun 14:295–299, 1990)
Vitamin E Suppresses Increased Lipid Peroxidation in Cigarette Smokers
Authors: Hoshino Etsuo , Shariff Riaz , Van Gossum Andre , Allard Johane P. , Pichard Claude , Kurian Regina , Jeejeebhoy Khursheed N.
Published: May 2008

Cigarette smoke contains many xenobiotics, including oxidants and free radicals, which can increase lipid peroxidation. Recently, breath pentane output (BPO) has been recognized as a good indicator of lipid peroxidation.

Vitamin E is known to be a potent free radical scavenger which can protect biological membranes against oxidative damage. We investigated the effect of vitamin E (dl‐alpha‐tocopherol) on lipid peroxidation in 13 healthy smokers. The results showed (1) smokers had increased BPO as compared with 19 healthy non‐smokers (16.3 ± 1.9 us 5.8 ± 0.5, pmol/kg body weight/min, p < 0.001) although both groups had comparable plasma vitamin E and selenium concentrations, (2) supplementation with vitamin E (800 mg/day for 2 weeks) decreased BPO in smokers, and (3) the concentration of plasma selenium‐dependent glutathione peroxidase was restored to normal in those smokers (five out of 13) in whom this was low initially.

We conclude that a normal plasma concentration of vitamin E does not prevent this increase of lipid peroxidation in smokers but that substantial doses of vitamin E will significantly reduce this increased lipid peroxidation. If a major function of vitamin E is to protect lipids from peroxidation, then smokers have a conditioned insufficiency of vitamin E on a normal diet. (Journal of Parenteral and Enteral Nutrition 14:300–305, 1990)
Dietary Fiber and Long‐Term Large Bowel Response in Enterally Nourished Nonambulatory Profoundly Retarded Youth
Authors: Liebl Birgit H. , Fischer Milton H. , Van Calcar Sandra C. , Marlett Judith A.
Published: May 2008

The objective of this year‐long research was to determine the effects of three levels of a purified dietary fiber source, soy polysaccharide, on the long‐term bowel function of 11 youth, aged 7 to 17 years, who were nonambulatory, profoundly disabled, constipated, and fed by gastrostomy. From day 1 to 60 the diet was a fiber‐free enteral feeding; from day 61 to 300, 12 to 20 g/day total fiber was added to the diet; and from day 301 to 360, 18 to 25 g/day. Complete stool collections were made from day 51 to 60, day 111 to 120, day 291 to 300, day 321 to 330, and day 351 to 360. The second fiber addition significantly increased mean (±SD) daily stool frequency from 0.6 ± 0.2 during the fiber‐free diet to 1.1 ± 0.5. The first addition of fiber compared to the fiber‐free diet significantly increased stool moisture from 70 ± 7% to 76 ± 8% and wet stool weight from 30 ± 13 g/day to 53 ± 21; mean stool weight during days 351 to 360 was 87 ± 45 g/day. Daily dry stool weight significantly increased with the second fiber addition. Soy polysaccharide fiber improved bowel function in this nonambulatory profoundly disabled population. (Journal of Parenteral and Enteral Nutrition 14:371–375, 1990)
Hemodynamic and Vascular Permeability Effects of Lipid Emulsion in the Isolated Canine Lung Lobe
Authors: Hall Joseph E. , Hofman Wendell F. , Ehrhart Ina C.
Published: May 2008

The isolated canine right lower lung lobe (RLL) perfused with autogenous blood at constant flow was used to study the effects of a parenteral lipid emulsion, Liposyn 10%, on pulmonary hemodynamics and vascular permeability. Lobes were placed into four groups: (1) control lobes (C; n = 6), which were infused via the lobar artery with normal saline at 1 ml· min−1 for 30 min; (2) lipid emulsion lobes (L; n = 6), which were infused via the lobar artery with Liposyn 10% at 1 ml· min−1 for 15 min; (3) lobes infused with both Liposyn 10% and 0.25 to 6.0 mg of lipoprotein lipase (LL; n = 4); and (4) lobes infused with 0.13 to 6.0 mg of lipoprotein lipase alone (LP; n = 6). Liposyn infusion alone caused no changes in lobar hemodynamics compared to group C. Over time there were no differences between groups C and L on venous Po2, PCO2, or pH. Post‐infusion weight gain (over 10 to 14 min) averaged 0.23 ± 0.08, 0.19 ± 0.07, 0.66 ± 0.23, and 3.00 ± 1.46 g· min−1· 100 g−1 RLL for groups C, L, LP, and LL, respectively (p < 0.05, for group LL compared to Group C). The pulmonary filtration coefficient (Kf) was determined as an index of vascular permeability. Groups C and L had Kf values of 0.07 ± 0.01 and 0.28 ± 0.22 ml · min−1· mm Hg−1· 100 g−1 (mean ± SE), respectively, which did not differ significantly (p > 0.05). Liposyn 10%, given in a concentration larger than that used clinically, produced no untoward pulmonary vascular effects. In the presence of Liposyn, liberation of free fatty acids by lipoprotein lipase is, however, rapidly damaging to lung microvessels. (Journal of Parenteral and Enteral Nutrition 14:376–380, 1990)
Transfer of Apolipoproteins between Plasma Lipoproteins and Exogenous Lipid Particles after Repeated Bolus Injections or during a Continuous Infusion of Fat Emulsion
Authors: Tonouchi Hitoshi , Iriyama Keiji , Carpentier Yvon A.
Published: May 2008

Recent studies on the metabolism of artificial lipid particles in a fat emulsion (exo TG) revealed that exo TG acquires apolipoproteins in vivo and in vitro. In particular, apolipoproteins C‐II and C‐III (apo C‐II and apo C‐III) are rapidly transferred from high‐density lipoprotein (HDL) to exo TG, and return to HDL after the hydrolysis of exo TG. The present study was undertaken to examine whether the movement of apo C‐II and apo C‐III between HDL and exo TG is influenced by a prior injection of fat emulsion. Two experiments were undertaken. In experiment 1, six male volunteers received three bolus injections of a fat emulsion at a dose of 0.1 g of TG/kg with intervals of 90 min between injections. In experiment 2, the plasma concentrations of triglycerides were maintained at approximately 500 mg/dl for 160 min by the continuous infusion of exo TG. Levels of apo C‐II and apo C‐III, and the elimination rate of exo TG were followed in each test. In experiment 1, the movement of apolipoproteins between exo TG and HDL was unchanged between the first, second, and third bolus. The elimination rate of exo TG after the third bolus was higher than that after the first bolus. In experiment 2, after the administration of exo TG, the levels of C apolipoproteins in the fraction of HDL began to decrease, and those in the fraction of very‐low‐density lipoprotein that contained exo TG began to increse. When the concentrations of triglycerides in plasma reached a plateau, the distribution of C apolipoproteins in the lipoprotein fraction also stabilized. These results indicate that the capacity of exo TG for binding apolipoproteins is not influenced by a prior injection of fat emulsion. Thus, the movement of apolipoproteins between exo TG and HDL appears to be continuous, and HDL can clearly supply newly infused exo TG with apo C‐II and apo C‐III insofar as a continuous infusion of fat emulsion for 160 min is concerned. (Journal of Parenteral and Enteral Nutrition 14:381–385,1990)
Nutritional Support after Liver Transplantation: A Randomized Prospective Study
Authors: Reilly James , Mehta Rekha , Teperman Lewis , Cemaj Samuel , Tzakis Andreas , Yanaga Katsuhiko , Ritter Pamela , Rezak Abdul , Makowka Leonard
Published: May 2008

Nutritional support in patients with advanced cirrhosis is difficult due to protein, fluid and salt restrictions. Successful liver transplantation should improve nutrient tolerance. We randomly assigned 28 hypoalbuminemic cirrhotic patients to receive, immediately after liver transplantation, one of three regimens: group 1, no nutritional support (n = 10); group 2, total parenteral nutrition (TPN) (35 kcal/kg/day) with standard amino acids (1.5 g/kg/day) (n = 8); or group 3, isocaloric isonitrogenous TPN with added branched‐chain amino acids (n = 10). Therapy was continued for 7 days post‐transplant. Jaundice resolution was unaffected by nutritional support. Nitrogen balance favored both TPN groups. Branched‐chain amino acid (BCAA)aromatic amino acid ratios were highest in group 3. Coma scores and serum ammonia levels were similar in all groups. Both TPN groups achieved respirator independence earlier; this difference was not statistically significant. Group 1 patients stayed longest in ICU; the difference was statistically significant. TPN with either standard or BCAA‐ enriched amino acids is tolerated well immediately after successful liver transplant. Positive nitrogen balance is achieved; large protein loads do not worsen encephalopathy. Nutritional support may improve respiratory muscle function, allowing earlier weaning from ventilatory support. A shortened length of ICU stay justifies the expense of TPN. (Journal of Parenteral and Enteral Nutrition 14:386–391, 1990)
Manganese Levels in a Jaundiced Long‐Term Total Parenteral Nutrition Patient: Potentiation of Haloperidol Toxicity?: Case Report and Literature Review
Authors: Mehta Rehka , Reilly James J.
Published: May 2008

Manganese is vital in human nutrition. When oral intake is precluded, the recommended parenteral supplementation is 0.15 to 0.8 mg/day. Manganese is excreted primarily in the bile; during cholestasis, serum manganese levels may rise, and manganese toxicity ensue. Neuropsychiatric symptoms are prominent. Phenothiazine‐derivative drugs may potentiate manganese toxicity. Serum or whole blood manganese levels should guide manganese therapy in jaundiced patients. (Journal of Parenteral and Enteral Nutrition 14 :428–430, 1990)
Inhibition of Immunoglobulin Synthesis In Vitro by Intravenous Lipid Emulsion (Intralipid)
Authors: Salo M.
Published: May 2008

Intravenous lipid emulsions depress lymphocyte proliferative responses and granulocyte function at concentrations found in the blood circulation during their administration. The effects of Intralipid, a widely used intravenous lipid emulsion, were measured on immunoglobulin production in vitro by pokeweed mitogen‐activated lymphocytes as a test of B‐cell function. Intralipid decreased IgG, IgM, and IgA production at soybean oil triglyceride concentrations of 2.5–20 mg/ml occurring in the blood circulation during Intralipid infusion. The effects on IgM and IgA production were highest and that on IgG production lowest. Hydrocortisone‐sensitive and concanavalin A‐inducible suppressor cells were more sensitive to Intralipid than other cell populations. In vivo Ig production may not be equally disturbed, inasmuch as Intralipid concentrations in the lymph nodes and the spleen may be lower than in the blood circulation. However, care should be taken to prevent Intralipid concentrations from becoming high enough to depress immune responses. (Journal of Parenteral and Enteral Nutrition 14:459–462, 1990)
Enteral Nutrition in the Early Postoperative Period: A New Semi‐Elemental Formula Versus Total Parenteral Nutrition
Authors: Hamaoui Elie , Lefkowitz Rose , Olender Lynda , Krasnopolsky‐Levine Elissa , Favale Maria , Webb Hueldine , Hoover Eddie L.
Published: May 2008

Several studies have reported that gastrointestinal (GI) intolerance symptoms are the limiting factor to enteral alimentation in the immediate postoperative period and often the reason for resorting to total parenteral nutrition (TPN). We postulated that Reabilan HN (a recently developed small peptide‐based formula, in part obtained by enzyme hydrolysis of proteins) might be better absorbed and better tolerated so as to avoid the need for TPN. Accordingly, 19 patients undergoing major abdominal surgery were randomly assigned to receive Reabilan HN via jejunostomy or an equicaloric isonitrogenous TPN regimen. Both were begun 6 hr postoperatively at 25 ml/hr and increased by 25 ml/hr at 12‐hr intervals up to the rate providing 1.5 times the calculated REE. GI tolerance to enteral feeding was excellent during the first three postoperative days, allowing the progression of the feeding rate to 99% of goal. During the next 3 days (starting on average 1.7 days after the return of bowel sounds), GI intolerance symptoms required a reduction in feeding rate to 52% on average. Subsequently, the symptoms resolved and the feeding rate reached 96% of goal. Although overall mean daily calorie and nitrogen intakes were lower for the enteral than for the TPN group (79.6 ± 10.2% vs 94.6 ± 3.8% of goal; p < 0.01), the enteral group was nevertheless in positive caloric and nitrogen balance, and maintained similar serum albumin, prealbumin, and plasma transferrin levels. Average daily cost of supplies was $44.36 for enteral us $102.10 for parenteral nutrition (p < 0.001). We conclude that enteral feeding using this formula is well tolerated and cost‐effective in the immediate postoperative period. Further studies of GI motility in the postoperative period, specifically during the 2 to 3 days following the return of bowel sounds, seem crucial to achieving further progress in postoperative enteral feeding. (Journal of Parenteral and Enteral Nutrition 14:501–507, 1990)
Bowel Function of Long‐Term Tube‐Fed Patients Consuming Formulae with and without Dietary Fiber
Authors: Shankardass K. , Chuchmach S. , Chelswick K. , Stefanovich C. , Spurr S. , Brooks J. , Tsai M. , Saibil F.G. , Cohen L.B. , Edington J.D.
Published: May 2008

Diarrhea, constipation and subsequent laxative use are chronic problems in long‐term enterally fed patients. We have conducted a double‐blind randomized crossover study to evaluate the effects of two enteral formulae (Enrich, 12.8 g of dietary fiber per 1000 kcal and Ensure, fiber‐free) on stool frequency, fecal weight, laxative use, gastrointestinal tolerance and bowel function in chronic care tube‐fed patients. Twenty‐eight subjects (24 male, 4 female) completed the study. Mean daily number of stools and mean daily fecal wet weight in Enrich‐fed patients were not significantly different from those of patients receiving Ensure. Ensure‐fed patients required significantly more laxatives (p = 0.02) than those receiving Enrich. There were 26 reports of diarrhea in the Ensure‐fed group as compared to 6 in the Enrich‐fed group, and this difference was significant (p = 0.006). Reporting rates for constipation were not significantly different in the two groups. At the end of the study, the bowel function of 57.1% of patients receiving Enrich was improved when compared with that of 14.3% of Ensure‐fed patients, and this difference was significant (p = 0.005). These results suggest that the addition of dietary fiber to enteral formulae improves gastrointestinal tolerance and bowel function, and reduces laxative use in long‐term enterally fed patients. (Journal of Parenteral and Enteral Nutrition 14:508–512, 1990)
Phenytoin Interaction with Enteral Feedings Administered through Nasogastric Tubes
Authors: Fleisher David , Sheth Neel , Kou Jim H.
Published: May 2008

Inadequate drug plasma levels have been associated with the administration of phenytoin with enteral feedings through nasogastric (NG) tubes. It is demonstrated in this study that loss of phenytoin to tubing is a function of pH. Nonionized phenytoin is irreversibly bound to NG tubing from solution at the pH of enteral nutrient solutions while this is not the case for anionic phenytoin in unbuffered water or saline. In experiments pulsing phenytoin through glass us NG tubing perfused with buffer at varying pH, reversible loss to tubing was observed at high pH while irreversible loss was observed at low pH. In addition, the irreversible loss of phenytoin was greater in NG tubing than glass particularly at low pH. It is suggested that in those cases where tubing is placed into the duodenum, inadequate gastrointestinal residence time for dissolution of phenytoin solid and suspension dosage forms coupled with irreversible drug loss from solution to NG tubing will result in decreased phenytoin absorption and subsequently lower drug plasma levels. (Journal of Parenteral and Enteral Nutrition 14:513–516, 1990)
Comparison of Three Methods for the Estimation of Total Nitrogen Losses in Hospitalized Patients
Authors: Velasco Nicolas , Long Calvin L. , Otto David A. , Davis Nancy , Geiger John W. , Blakemore William S.
Published: May 2008

Since the measurement of total nitrogen output (TNO) is not routinely determined in the clinical setting, its level is frequently estimated using formulas based on the urinary urea nitrogen excretion (UUN). We measured TNO in 124 surgical patients over 990 days (TNO, 19.22 ± 8.72 g N/ day; total urinary nitrogen (TUN) 18.17 ± 8.70 g N/day; UUN, 15.17 ± 7.70 g N/day; mean gastrointestinal nitrogen (MGIN) 0.68 ± 0.49 g N/day; integumental nitrogen (ITGN), 0.34 ± 0.08 g N/day) and compared the results with the daily estimations using three different formulas: formula A, UUN + 4; formula B, UUN x 1.20 + 1.05, where 1.20 is the reciprocal of the mean ratio UUN/TUN and 1.05 the mean extraurinary nitrogen losses; and formula C, UUN x 1.0986 + 2.55, derived from the regression analysis of UUN us TNO. TNO estimated by these formulas were 19.17 ± 7.70, 19.26 ± 9.24, and 19.22 ± 8.70 g N/day, respectively. The regression analyses of the estimated TNO from the three formulas versus the measured TNO indicated that formulas A, Band C were equally accurate in estimating TNO over the entire range of UUN. However, when only values of UUN ≥ 30 g N were considered, a modified formula A (UUN + 6) was the best predictor of TNO. Daily audits of the differences between the estimated and measured TNO showed comparable results for the three formulas. In 28.4 to 31.1 % of the observed days the differences were higher than ± 2 g N/day, an error which is not acceptable when estimating the protein requirements in many clinical conditions. Thus, the formulas for estimating TNO are only clinical approximations of the nitrogen losses. (Journal of Parenteral and Enteral Nutrition 14:517–522, 1990)
Is Exogenous Fructose Metabolism Truly Insulin Independent?
Authors: Fryburg David A. , Gelfand Robert A.
Published: May 2008

Although fructose is widely regarded as an insulin‐independent fuel source, its in vivo conversion to glucose represents a theoretical limitation to its clinical usefulness in diabetics, particularly if given in large doses. To determine whether small amounts of fructose can be well utilized in the setting of insulinopenia, we administered a low‐dose fructose infusion (4.2 g/hr) to a fasting type 1 diabetic patient receiving continuous subcutaneous insulin at a dose that had previously maintained stable euglycemia for 72 hr (plasma glucose = 80–110 mg/dl). Despite the low infusion rate (<20% of calorie requirement), fructose caused an immediate and marked rise in plasma glucose (to 370 mg/dl after 27 hr). Glucose loss in the urine and accumulation in plasma could account for fully half of the administered hexose load. Thus, the utilization of even small quantities of exogenous fructose is profoundly impaired under hypoinsulinemic conditions. It is misleading to regard fructose as a truly insulin‐independent fuel source. (Journal of Parenteral and Enteral Nutrition 14:535–537, 1990)
Review: A Clinical Application of Exercise Physiology and Nutritional Support for the Mechanically Ventilated Patient
Authors: Mcmahon M. Molly , Benotti Peter N. , Bistrian Bruce R.
Published: May 2008

A challenging problem facing the clinician is the management of critically ill patients in whom repeated attempts at weaning from mechanical ventilation are unsuccessful. The difficulty weaning these patients from the ventilator can be augmented in the presence of detraining of respiratory muscles, malnutrition, stress and the metabolic response to iniury, and/or immobilization. An understanding of basic concepts of established tenets of exercise physiology and of nutritional support will allow their application to respiratory muscle function with the goal of facilitating the endurance and strength of respiratory muscles needed to sustain spontaneous ventilation. (Journal of Parenteral and Enteral Nutrition 14:538–542, 1990)
Energy Balance in Elderly Patients after Surgery for a Femoral Neck Fracture
Authors: Jallut D. , Tappy L. , Kohut M. , Bloesch D. , Munger R. , Schutz Y. , Chiolero R. , Felber J.‐P. , Livio J.‐J. , Jéquier E.
Published: May 2008

To study energy and protein balances in elderly patients after surgery, spontaneous energy and protein intake and resting energy expenditure (REE) were measured in 20 elderly female patients with a femoral neck fracture (mean age 81 ± 4, SD, range 74–87 years; weight 53 ± 8, range 42–68 kg) during a 5–6 day period following surgery. REE, measured over 20–40 min by indirect calorimetry using a ventilated canopy, averaged 0.98 ± 0.15 kcal/min on day 3 and decreased to 0.93 ± 0.15 kcal/min on day 8–9 postsurgery (p < 0.02). REE was positively correlated with body weight (r = 0.69, p < 0.005). Mean REE extrapolated to 24 hr (24‐REE) was 1283 ± 194 kcal/day. Mean daily food energy intake measured over the 5‐day follow‐up period was 1097 ± 333 kcal/day and was positively correlated with 24‐REE (r = 0.50, p < 0.05). Daily energy balance was ‐235 ± 351 kcal/day on day 3 (p < 0.01 us zero) and —13 ± 392 kcal/day on day 8–9 postsurgery (NS us zero) with a mean over the study period of ‐185 ± 289 kcal/day (p < 0.01 us zero). When an extra 100 kcal/day was allowed for the energy cost of physical activity, mean daily energy balance over the 5‐day study period was calculated to be ‐285 ± 289 kcal/day (p < 0.01 us zero). Measurements of total 24‐hr urinary nitrogen (N) excretion were obtained in a subgroup of 14 patients. Calculated net protein oxidation was 56.0 ± 19.5 and 61.7 ± 25.6 g/day on day 3 and on day 8–9, respectively. Spontaneous protein intake on the other hand was only 38.1 ± 16.6 on day 3 and 36.9 ± 15.2 g/day on day 8–9 (p < 0.01 and p < 0.001 us protein oxidation for the two periods, respectively). Net protein balance averaged ‐17.3 ± 22.9 g/day on day 3 and ‐24.3 ± 16.5 g/day on day 8–9. It is concluded that elderly patients with a femoral neck fracture do not adequately adjust their spontaneous food intake to meet their energy and protein needs. The results support the view that such patients would benefit from an oral supplementation above their spontaneous food intake providing an extra 200–300 kcal/day containing 20 g of protein/day. (Journal of Parenteral and Enteral Nutrition 14:563–568, 1990)
Use of Internal Validity in the Construct of an Index of Undernutrition
Authors: Hall John C.
Published: May 2008

An index of undernutrition (IOU) has been developed from a crosssectional study of 200 general surgical patients. The IOU was constructed using a ranking method based upon the relative values of anthropometric measurements (weight loss, mid‐arm muscle area, mid‐arm fat area) and serum protein concentrations (albumin, transferrin). The IOU was derived without reference to the incidence of adverse clinical events and took the form of a boolean cluster.

A subsequent prospective longitudinal study evaluated the IOU in 367 general surgical patients at the time of admission to hospital. The results of this study supported the validity of the IOU. There was no association between gender and IOU scores. However, patients with high scores were more likely to be elderly (p < 0.02), have cancer (p < 0.001), stay in hospital longer (p < 0.001), or experience an adverse clinical event after surgery (p < 0.001). In accord with other published indices of undernutrition, the association between the extent of undernutrition and the incidence of adverse clinical events was only of moderate diagnostic potential (overall accuracy 68%). This study demonstrates that it is possible to derive an index of protein‐energy undernutrition that is independent of the incidence of adverse clinical events. (Journal of Parenteral and Enteral Nutrition 14: 582–587, 1990)
Effect of Dietary Nucleotides on Intestinal Repair in Rats with Experimental Chronic Diarrhea
Authors: Nunez Maria C. , Ayudarte Maria V. , Morales Daniel , Suarez Maria D. , Gil Angel
Published: May 2008

Nucleic acid synthesis in tissues of rapid growth is preferentially done using dietary purines and pyrimidines via the salvage pathway. In the case of a low protein intake, dietary nucleotides may be semiessential for cell replication of gut, lymphocytes, and bone marrow, and especially in those intestinal diseases in which the mucosa is altered, dietary nucleotides may have a role in intestinal development. The effect of dietary nucleotides on intestinal weight and length, gut mucosal weight, intestinal protein and DNA contents, and lactase, maltase, and intestinal mucosal activities was assessed in a controlled way. Weanling (21‐day‐old) rats were separated into two groups of 36, each receiving blindly a basal diet containing glucose polymers (C) or a basal diet with lactose as the main carbohydrate (L) for 15 days. Those fed with L developed a syndrome of chronic diarrhea and malnutrition. Ten rats of each group were sacrificed at that time. The rest of the animals of each group were separated into two subgroups. The first was fed with the C diet and the second with the C diet supplemented with 50 mg/100 g of each of the following nucleotides: AMP, GMP, CMP, UMP, and IMP (CN). Thus the subgroups CC, CN, LC, and LN were formed. Rats were sacrificed after 4 weeks and gut separated into three segments corresponding to duodenum, jejunum, and ileum. Analysis of variance was used to compare the effect of diet or segments. DNA and lactase, maltase, and sucrase activities increased in the LN group with respect to LC especially in jejunum and ileum but there were not any differences between CC and CN. After malnutrition recovery, total proteins and DNA were similar in all groups. Dietary nucleotides appear to be modulators of intestinal development after chronic diarrhea and may have important implications in the growth of enterocyte. (Journal of Parenteral and Enteral Nutrition 14:598–604, 1990)
Dietary Intake in Patients with Acquired Immunodeficiency Syndrome (AIDS), Patients with AIDS‐Related Complex, and Serologically Positive Human Immunodeficiency Virus Patients: Correlations with Nutritional Status
Authors: Dworkin Brad M. , Wormser Gary P. , Axelrod Fred , Pierre Natalie , Schwarz Eric , Schwartz Elizabeth , Seaton Tim
Published: May 2008

One of the major clinical manifestations of the acquired immunodeficiency syndrome (AIDS) and AIDS‐related complex (ARC) is the development of cachexia. This most likely results from a multifactorial interplay of poor diet, malabsorption, and altered metabolism. To assess the potential role of nutrient intake in the development or persistence of malnutrition, a detailed analysis was performed of a 72‐hr diet record in clinically stable patients with AIDS (N = 18), ARC (N = 12) and in human immunodeficiency virus (HIV) seropositive controls without significant manifestations of disease (N = 13). Total calorie intake was 39.1 ± 13.2 kcal/kg/day in AIDS patients us 34.6 ± 7.8 kcal/kg/day in ARC patients or 31.9 ± 17.7 kcal/kg/day in HIV seropositive cases (all p = NS). Likewise, mean protein intakes were similar among the groups and exceeded recommended daily dietary allowance (RDA) guidelines. The mean body weight changes from the inception of illness were ‐11 ± 1% in AIDS, ‐6 ± 7% in ARC, us +3 ± 2% in HIV‐seropositive‐only cases (p < 0.05 vs AIDS and ARC). Dietary vitamin and mineral analysis revealed that 88% of AIDS, 88% of HIV seropositive, and 89% of ARC patients were ingesting less than 50% RDA for at least one nutrient. The mean number of deficiencies per patient was 1.8 ± 1.3 in AIDS, 3.8 ± 3.5 in ARC, and 2.9 ± 2.5 in HIV‐seropositive‐only cases (p < 0.05 AIDS us ARC). There were no significant correlations between specific anthropometric measurements and dietary intakes of protein or fat. Absolute numbers of CD4 positive peripheral blood lymphocytes did not correlate with weight loss or dietary protein intake. It is concluded that protein and caloric intake in clinically stable AIDS, ARC, and HIV seropositive patients meets RDA standards and is similar among the groups. These data, in this population of patients, could lend further support to the importance of malabsorption or altered metabolism in the development or persistence of cachexia in AIDS. However, the intake of various vitamins and minerals may be inadequate, potentially leading to further compromise of organ functions. (Journal of Parenteral and Enteral Nutrition 14:605–609, 1990)
Chromium Content of Total Parenteral Nutrition Solutions
Authors: Ito Yasushi , Alcock Nancy W. , Shils Maurice E.
Published: May 2008

Chromium (Cr) present as contaminant was analyzed by flameless atomic absorption spectrometry in a variety of commercially produced solutions and additives commonly used in total parenteral nutrition (TPN) formulas. Total Cr likely to be administered unintentionally per day was estimated both by summing the Cr in appropriate volumes of each solution required for preparation of standard TPN formulas and by analyzing complete TPN solutions. Storage of TPN solutions in plastic bags for 14 days did not affect Cr concentrations. The amounts ranged from 2.4 to 8.1 μg/day for a high glucose formula and 2.6 to 10.5 μg for a high lipid formula. Amino acid solutions, especially when containing phosphate, or with phosphate salt additives and with lipid emulsions accounted for approximately 85 to 90% of the Cr found. (Journal of Parenteral and Enteral Nutrition 14:610–614, 1990)
Prevention of Stress‐Induced Erosive Gastritis by Parenteral Administration of Arachidonic Acid
Authors: Auguste Louis‐Joseph , Lackner Rudy , Ratner Lloyd , Stein Theodore A. , Bailey Beverly
Published: May 2008

Stress‐induced mucosal ulcerations are associated with a decreased synthesis of mucosal prostaglandin (PG) E2. This phenomenon is poorly understood. To investigate whether it is due to a decreased availability of the necessary substrates to the mucosa, four groups of 10 Holtzman rats were studied: group 1 received normal saline by intraperitoneal (ip) injection; group 2 also received ip normal saline, then were submitted to stress, by the cold restraint method; group 3 received a solution of arachidonic acid (AA) ip; and group 4 also received ip AA, then were submitted to stress. After sacrifice, the number of gastric ulcerations were counted and specimens of nonulcerated mucosa were assayed for PGE2 by high‐performance liquid chromatography; the mean numbers of ulcers were 0, 5.8, 0.8, and 3 and the mean levels of PGE2 were 55, 41, 125, and 62 pg/mg of wet tissue for groups 1, 2, 3, and 4, respectively. It is concluded that parenteral administration of AA reduces but does not completely eliminate stress‐induced gastric ulcerations and that the stressed animals synthesized half as much PGE2 as the nonstressed ones after ip administration of equal amounts of AA, suggesting that stress reduces the availability of AA to the gastric mucosa, possibly by vascular spasm. (Journal of Parenteral and Enteral Nutrition 14:615–617, 1990)
Liver Function Tests Abnormalities in Patients with Inflammatory Bowel Disease Receiving Artificial Nutrition: A Prospective Randomized Study of Total Enteral Nutrition vs Total Parenteral Nutrition
Authors: Abad‐Lacruz Agueda , Gonzalez‐Huix Ferran , Esteve Maria , Fernández‐Bañares Fernando , Cabré Eduard , Boix Jaume , Acero Doroteo , Humbert Pere , Gassull Miquel A.
Published: May 2008

Liver and biliary abnormalities are well‐known complications of inflammatory bowel disease (IBD). It has been suggested that using total parenteral nutrition (TPN) may further impair liver function in these patients; this seems not to be so with total enteral nutrition (TEN). However, prospective trials comparing the incidence of liver function test (LFT) abnormalities with either TPN or TEN have not been carried out. Twenty‐nine IBD inpatients with normal LFT, randomized to receive either TEN with a polymeric diet or isocaloric, isonitrogenous “all‐in‐one” TPN because of protein‐energy malnutrition and/or severe disease, were included in the study. Sixteen patients (five with ulcerative colitis and 11 with Crohn's disease) received TEN, and 13 patients (eight ulcerative colitis and five Crohn's disease) were on TPN. All patients were on systemic steroids, and nine of them were on oral metronidazole. Both groups were homogeneous regarding age, sex, diagnosis, disease activity, nutritional status, daily nutrient supply, and days on artificial nutrition. Serum albumin levels significantly increased with TEN (32 ± 1 to 38.2 ± 1.6 g/liter, p < 0.01), but not with TPN (32.1 ± 2.2 to 33.9 ± 1.4 g/liter, NS). Clinical improvement occurred in both groups of patients as shown by the change in the disease activity indexes. In all cases, measurements of serum alkaline phosphatase, serum bilirubin, aspartate aminotransferase, alanine aminotransferase, and γ‐glutamyltransferase were performed weekly. There were no significant differences in the initial LFT between both groups. Eight of 13 patients (61.5%) in the TPN group developed some LFT abnormalities, whereas this only occurred in one of 16 patients (6.2%) in the TEN group (p = 0.002). In most cases, LFT derangement was mild, the most frequent change being an increase of γ‐glutamyltransferase. However, TPN had to be withdrawn in one patient because of severe LFT derangement. The mean period of time on TPN between patients developing or not LFT derangement was not significantly different (16.9 ± 1.25 us 18.2 ± 2.97 days). In the TPN group, all patients with Crohn's disease developed LFT abnormalities, whereas this only occurred in three of eight patients with ulcerative colitis (p = 0.043). Possible causes—other than IBD or nutritional support—for LFT derangement did not significantly differ between TEN and TPN groups. These results confirm that LFT abnormalities are significantly more frequent in patients with IBD on TPN than in those on TEN. The maintenance of the integrity of the intestinal mucosa, promoted by the presence of nutrients in the gut lumen, may be necessary in preventing the development of liver damage. (Journal of Parenteral and Enteral Nutrition 14:618–621, 1990)
Microorganisms and Diarrhea in Enterally Fed Intensive Care Unit Patients
Authors: Belknap Dorothy C. , Davidson Lynda J. , Flournoy D.J.
Published: May 2008

Thirty‐six intensive care unit patients, receiving aseptic or manually (routine) reconstituted enteral feeding formulas, were evaluated prospectively for the relationship of microbial involvement, gastric pH, and antimicrobial therapy to diarrhea. The routine protocol group had a significantly higher incidence of bacterial contamination than the aseptic protocol group (Fisher's exact test, p < 0.05). There were no significant direct associations between isolate category (Gram‐negative bacilli, Gram‐positive cocci, Gram‐negative cocci, yeast), gastric pH, or antimicrobials and diarrhea. However, two organisms (Group D Enterococci and yeast) were indirectly implicated in some cases of diarrhea. (Journal of Parenteral and Enteral Nutrition 14:622–628, 1990)
Menstrual Cycle Factors Related to Increased Gastric Contractile Response to Tube Feeding
Authors: Heitkemper M.M. , Bond E.F. , Shaver J.F. , Georges J.M.
Published: May 2008

Evidence exists that the ovarian hormones have a modulating effect on gastrointestinal (GI) motility, yet details are sketchy and little attention has been paid to the effect that fluctuating hormone levels might have on women who are receiving enteral feedings. This study compared gastric motility indices in response to tube feedings at two points in the menstrual cycle, concurrently measured ovarian hormone levels, and described three potentially related factors (ie, GI symptoms, uterine cramping pain, reports of daily stressors). Intragastric motility responses to enteral feedings were obtained on 28 women (aged 19–37) during menses and midfollicular phases of two menstrual cycles. Intragastric pressure changes were monitored by an open‐tipped cannula method at rest, during and after tube feeding (Ensure, 240 ml at 8 ml/min). Serum estradiol and progesterone levels were measured by radioimmunoassay. Women completed a daily diary of symptoms and stressors throughout the two menstrual cycles. Results showed that intragastric pressure amplitudes and frequencies were higher at menses compared with midfollicular recordings. At menses, prefeeding and feeding gastric pressure amplitudes were positively correlated with uterine cramping pain and GI symptoms (ie, nausea). At menses, postfeeding contraction frequencies were also correlated with uterine cramping pain. At midfollicular phase, progesterone levels correlated with gastric motility indices; number of stressors indirectly correlated with gastric motility indices. These data suggest that gastric responses to enteral feeding are influenced by menstrual cycle phase. (Journal of Parenteral and Enteral Nutrition 14:634–639, 1990)
Alterations in Hepatic Mitochondrial Function during Total Parenteral Nutrition in Immature Rats
Authors: Katayama Tetsuo , Tanaka Mitsuru , Tanaka Koichi , Asonuma Katsuhiro , Uemoto Shinji , Okamura Ryuji , Utsunomiya Hirofumi , Fujita Shiro , Ueda Junichi , Tanaka Akira , Ozawa Kazue
Published: May 2008

To evaluate the effects of total parenteral nutrition (TPN) on hepatic mitochondrial function in immature rats, changes in hepatic energy charge levels and oxidative phosphorylation rates of hepatic mitochondria were studied along with the examination of serum chemical test. Male Wistar rats weighing 30 to 45 g were used and randomized into TPN (n = 8), enteral (n = 7), and control groups (n = 8). Parenteral and enteral groups were fed with TPN solution containing 19.3% dextrose, 3.19% amino acids, 1.05% fat emulsion, minerals and vitamins, and the control group with rat chow. The number of calories per kilogram per day was 550 × 1/4 on the 1st day, 550 × 1/2 on the 2nd, 550 × 3/4 on the 3rd, and 550 × 1 on the 4th day, based on the body weight on the 1st day. After the 5th day, 550 Kcal/kg/day was given, based on the body weight of the respective day. After 13‐day feeding, hepatic energy charge (EC), phosphorylation rate (PR) of hepatic mitochondria and serum chemical examination were carried out. EC was 0.871 ± 0.016 in the control group, 0.830 ± 0.019 in the enteral, and 0.785 ± 0.011 in TPN group (p < 0.001, compared with control group). PR was 138.9 ± 1.9, 133.0 ± 6.7, 111.0 ± 4.3, respectively, (p < 0.05, compared with control and enteral groups). There was no difference between the three groups on SGOT, SGPT, and total bilirubin. TPN group showed a deterioration of hepatic phosphorylation rate and energy charge in spite of normal serum transaminase levels. It is suspected that TPN has an adverse effect on hepatic mitochondrial function which may ultimately lead to hepatic dysfunction in infants. (Journal of Parenteral and Enteral Nutrition 14:640–645, 1990)
Cori Cycle Contribution to Plasma Glucose Appearance in Man
Authors: Hoffer L. John
Published: May 2008

The contribution of recycled glucose to gluconeogenesis and plasma glucose appearance (Cori cycle) has previously been calculated from liver balance studies and from infusions of labeled glucose. Both techniques resulted in the estimate that Cori cycle activity accounts for about 15% of plasma glucose appearance. However, it is now understood that the specific activity of gluconeogenic precursors, which is used to determine their contribution to glucose appearance in plasma, overestimates the true precursor specific activity. Using earlier published data on substrate utilization and glucose turnover kinetics in humans, an empiric correction factor of 2.7 is derived which may approximately account for label dilution in the precursor pool. Use of this factor confirms that the former estimate of the contribution of Cori cycle activity to glucose turnover should be revised substantially upwards. (Journal of Parenteral and Enteral Nutrition 14:646–648, 1990)
Total Parenteral Nutrition‐Induced Steatosis: Reversal by Parenteral Lipid Infusion
Authors: Reif S. , Tano M. , Oliverio R. , Young C. , Rossi T.
Published: May 2008

Prolonged use of total parenteral nutrition (TPN) may be associated with hepatic complications, primarily steatosis and cholestasis. A case is reported of an 18‐year‐old woman with chronic idiopathic intestinal pseudo‐obstruction syndrome who was on prolonged home parenteral nutrition without lipid supplementation and developed steatosis. This finding was reversed by addition of lipid emulsion, at a dose of 0.5 g/kg/day, to the parenteral nutrition solution. The lack of lipid supplementation as a possible cause of steatosis, as well as other mechanisms of liver steatosis associated with TPN, are discussed. (Journal of Parenteral and Enteral Nutrition 15:102–104, 1991)
Severe Lactic Acidosis Related to Acute Thiamine Deficiency
Authors: Oriot Denis , Wood Chantal , Gottesman Ronald , Huault Gilbert
Published: May 2008

The authors report a case of severe lactic acidosis in a 3‐year‐old boy, after 20 days of total parenteral nutrition without vitamin supplementation. This child with acute lymphoblastic leukemia underwent a period of severe refractory lactic acidosis (pH between 6.81 and 7.00 and a serum lactate level up to 38 mmol/liter) leading to cardiac arrest. After the initial resuscitation and the subsequent treatment of shock and vitamin K deficiency, acute peritoneal dialysis was instituted to correct the severe lactic acidosis. Initial low plasma thiamine levels confirmed the diagnosis of thiamine deficiency. An associated transient pancreatic dysfunction was also noted. The patient's overall course with thiamine replacement therapy led to a complete recovery within 5 days and no sequelae were noted after 12 months. (Journal of Parenteral and Enteral Nutrition 15:105–109, 1991)
Retrograde Tunnel: A Method for the Fixation of Long‐Term Pediatric Central Venous Catheters
Authors: Wheeler R.A. , Griffiths D.M. , Burge D.M.
Published: May 2008

The fashioning of a subcutaneous tunnel has become an integral part of the placement of central venous catheters (CVC). Several methods have been described, but the long‐term CVCs in pediatric practice pose special problems, particularly that of the patients continually testing the CVC's fixation. A polyurethane CVC is used that has not been previously described in pediatric usage and a retrograde tunneling technique has been developed which affords immediate and secure fixation. (Journal of Parenteral and Enteral Nutrition 15:114–115, 1991)
Tunneling the Long‐Term Central Venous and Right Atrial Catheter: A Simple Cost‐Effective Approach
Authors: Cronen Paul W.
Published: May 2008

Multiple techniques for tunneling right atrial catheters have been described. This is an atraumatic technique which involves using the introducer and sheath needed for venous access. (Journal of Parenteral and Enteral Nutrition 15:116–117, 1991)