bluuebunny/crossref_metadata_2025 huggingface dataset:
Reduction of the Plasma Levels of Tissue Plasminogen Activator After Infusion of a Lipid Emulsion in Humans
Authors: Altomare Donato F. , Semeraro Nicola , Colucci Mario
Published: May 2008

A lipid emulsion of soybean oil, egg lecithin, and glycerol, widely used as a standard component of parenteral nutrition regimens, has been reported to induce changes in some hemostatic parameters known to be associated with increased thrombotic risk. We studied the effect of a single infusion of this lipid emulsion (500 mL of a 10% emulsion, given over 5 to 6 hours) on the plasma levels of tissue plasminogen activator and plasminogen activator inhibitor 1 antigens in 12 patients with various diseases. Twelve matched patients, not treated with lipid, served as controls. In patients receiving the lipid emulsion, tissue plasminogen activator was markedly reduced at the end of the infusion (p <.001) and remained significantly lower than the basal levels 24 hours later (p <.05). By contrast, in control patients, the activator was slightly but significantly increased (p <.01) at the time interval corresponding to the postinfusion sample. Plasminogen activator inhibitor 1 was similar in control and treated patients at all intervals. The release of tissue plasminogen activator in response to 10 minutes of venous stasis, evaluated in six lipid‐treated patients at the end of the infusion, was not different from that observed in six control patients. It is concluded that the lipid emulsion induces a marked decrease in the circulating levels of tissue plasminogen activator. (Journal of Parenteral and Enteral Nutrition 17:274–276, 1993)
A Controlled Trial of Scheduled Replacement of Central Venous and Pulmonary Catheters D. K. COBB, K. P. HIGH, R. G. SAWYER, ET AL New England Journal of Medicine 327:1062–1068, 1992
Authors: Kearns Patrick J.
Published: May 2008

The study compares the incidence of infectious and mechanical complications associated with different maintenance protocols for central venous neck catheters. Patients were randomly assigned to either prophylactic catheter change or change for clinical reasons (PRN). Four groups resulted from additional grouping on the basis of guide‐wire or new venipuncture change. The prophylactic change was scheduled at 3‐day intervals. Clinical indications for PRN included unexplained fever, exit site infection, or catheter malfunction. One hundred sixty patients were randomized and had 523 catheters placed. There was a 5% catheter‐related bloodstream infection rate and a 9% significant mechanical complication rate. Insertion by a new puncture had a greater incidence of mechanical complications (p <.005). The infectious complication rate was not decreased with routine change either by new venipuncture or guide wire and was lowest with PRN change by a new venipuncture.
Alterations in Oropharyngeal Flora in Patients With a Nasogastric Tube: A Cohort Study S. THOMAS, R. RAMAN, J. IDIKULA, ET AL Critical Care Medicine 20:1677–1680, 1992
Authors: Demetriou Achilles A.
Published: May 2008

The authors undertook this prospective study to determine whether the presence of a nasogastric tube results in a change in the bacterial flora in the oropharynx. Patients scheduled to undergo an elective surgical procedure under general endotracheal anesthesia were studied. Sixteen patients had a nasogastric tube placed and 14 patients did not. The two patient groups were comparable in terms of age, gender, severity of underlying illness, and use of perioperative antibiotics. A commercially available, presterilized, clear plastic nasogastric tube was used in all patients. The tube was placed either for gastric decompression or feeding. All patients had a high oropharyngeal swab taken just before surgery. A similar swab was obtained 48 and 72 hours later. Patients were examined for evidence of otitis, sinusitis, and pharyngitis at the beginning of the study and 48 hours later. The authors found a significant increase in the frequency of oropharyngeal colonization by pathogenic Gram‐negative bacteria after 48 to 72 hours of nasogastric intubation as compared with the preintubation period (p <.01) as well as when compared with the nonintubated group (p <.001). Thirteen of 16 patients who had a nasogastric tube placed had growth of bacterial pathogens in their oropharynx within 48 to 72 hours. The pathogens included Pseudomonas, Klebsiella, Proteus, and Escherichia coli. There also seemed to be a tendencey to suppress the normal oropharyngeal flora. No significant change in the flora of the nonintubated group was seen postoperatively. The investigators concluded that the presence of a nasogastric tube predisposes to colonization by Gram‐negative bacterial pathogens within 48 to 72 hours.
Effect of Glutamine on Protein Synthesis in Isolated Intestinal Epithelial Cells
Authors: Higashiguchi Takashi , Hasselgren Per‐Olof , Wagner Kenneth , Fischer Josef E.
Published: May 2008

The influence of glutamine on protein synthesis in small‐bowel enterocytes was tested. Enterocytes were isolated from different levels of the villi of rat jejunum and were incubated in the presence of different glutamine concentrations, up to 3.4 mmol/L. Protein synthesis was determined by measuring incorporation of 3H‐phenylalanine into trichloroacetic acid‐precipitated proteins. Glutamine, but no other amino acids, stimulated protein synthesis in enterocytes from all levels of the villi. A maximal effect was noted at a glutamine concentration of 0.67 mmol/L, which is the normal plasma concentration. The amino acid stimulated the synthesis of both secreted and nonsecreted proteins. The stimulatory effect of glutamine on protein synthesis was blocked by the glutaminase inhibitor 6‐diazo‐5‐oxo‐L‐norleucine and was duplicated by equimolar concentrations of acetoacetate or 3‐hydroxybutyrate. The results suggest that glutamine stimulates protein synthesis in small‐bowel enterocytes and that this effect of glutamine is related to provision of energy. The findings are important because they suggest that increased protein synthesis may be one of the mechanisms by which glutamine exerts its protective effect on gut mucosa during critical illness. (Journal of Parenteral and Enteral Nutrition 17:307–314, 1993)
Direct Assay of Vitamins B1, B2, and B6 in Hospitalized Patients: Relationship to Level of Intake
Authors: Powers James S. , Zimmer Julie , Meurer Karen , Manske Eric , Collins J.C. , Greene Harry L.
Published: May 2008

High‐performance liquid chromatography assays for vitamins B1 by erythrocyte thiamine pyrophosphate, B2 by plasma and urinary riboflavin, and B6 by plasma pyridoxal phosphate and urinary pyridoxic acid were used to evaluate the B vitamin status of hospitalized patients. Over an intake range of up to 3.4 mg of thiamine per day and up to 4.1 mg of riboflavin per day, erythrocyte thiamine pyrophosphate and urine and plasma riboflavin increased proportionately with intake. There was no relationship between B6 intake and blood levels. Rather, a constant blood level was maintained with an intake range of 0.5 to 4 mg/d, and urinary pyridoxic acid showed a linear increase proportionate to intake. There were extremely variable blood and urine concentrations of B vitamins noted in our patient population. (Journal of Parenteral and Enteral Nutrition 17:315–316, 1993)
Xylitol Normalizes the Accelerated Hepatic Capacity for Conversion of Amino Nitrogen to Urea Nitrogen in Diabetic Rats
Authors: Almdal Thomas , Heindorff Hans , Hansen Bent A. , Vilstrup Hendrik
Published: May 2008

In diabetes, the capacity of urea nitrogen synthesis, ie, a substrate‐independent measure of the hepatic conversion of amino nitrogen to urea nitrogen, is increased. Xylitol decreases urea synthesis in normal rats. Capacity of urea nitrogen synthesis and nitrogen balance were measured during intravenous alanine loading in control rats, rats with experimental diabetes (streptozocin 75 mg/kg), and rats with experimental diabetes infused with xylitol to 1 mmol/L. In control rats, capacity of urea nitrogen synthesis was 9.4 ± 1.1 μmol/min per 100 g of body weight, and nitrogen balance ‐2.7 ± 1.2 μmol/ min per 100 g of body weight. In the diabetics, these values were markedly increased to 26.6 ± 1.9 and ‐16.3 ± 2.1 μmol/ min per 100 g of body weight, respectively (p < 0.01). The infusion of xylitol normalized these values to 11.2 ± 1.0 and ‐3.6 ± 2.1 μmol/min per 100 g of body weight for capacity of urea nitrogen synthesis and nitrogen balance, respectively. Xylitol did not change glucagon or insulin. Xylitol improved the nitrogen economy of uncontrolled diabetic rats by decreasing urea synthesis. The mechanism is not settled, but it does not involve insulin or glucagon. (Journal of Parenteral and Enteral Nutrition 17:345–347, 1993)
Comparison of Gas Exchange Measurements With a Mouthpiece, Face Mask, and Ventilated Canopy
Authors: Forse R. Armour
Published: May 2008

This study compared gas exchange measurements obtained by using a mask, mouthpiece, and ventilated canopy in 30 normal, healthy volunteers. The ventilated canopy and its gas analyzers had an accuracy for oxygen consumption of 98.0 ± 0.8% and for carbon dioxide production of 100.1 ± 1.1%. The study indicates that the apparatus used for gas exchange measurement will significantly affect the measurements. The magnitude of the effect is a significant 7.9% increase for oxygen consumption with a mouthpiece and a significant 7.1% increase with a face mask. Carbon dioxide production was significantly increased 10.2% with a mouthpiece and 4.1% with a face mask. There were no differences in the respiratory quotient. The specific purpose for collecting gas exchange measurements will determine whether these differences are of practical significance. (Journal of Parenteral and Enteral Nutrition 17:388–391, 1993)
Resting Energy Expenditure, Caloric Intake, and Short‐Term Change in HIV Infection and AIDS C. GRUNFELD, M. PANGE, L. SHIMIZU, ET AL American Journal of Clinical Nutrition 55:455–460, 1992
Authors: Bell Stacey J. , Chavali Sambasiva , Baumer Julie , Forse R. Armour
Published: May 2008

Patients with AIDS often develop malignancies and secondary infections that cause weight loss. To examine the etiology of this weight loss, the investigators examined patients with HIV, AIDS, and AIDS plus secondary infection (AIDS‐SI) for resting energy expenditure (REE), caloric intake, and short‐term weight change over a 28‐day period. Although caloric intake during that period for HIV positive and AIDS patients was similar to that of control subjects, it was 36% lower for AIDS‐SI patients. The HIV positive and AIDS subjects showed no short‐term change in weight, whereas the AIDS‐SI subjects demonstrated a 5% weight loss. The HIV positive, AIDS, and AIDS‐SI groups exhibited an increase over controls in REE of 11%, 25%, and 29%, respectively. Thus, the AIDS‐SI patients consumed 17% fewer calories than would be needed to support the elevated REE, which accounted for the weight loss over the 28 days. Consequently, a hypermetabolic effect caused by the existence of a secondary infection coupled with the HIV infection results in an increase of REE that is not counterbalanced with daily dietary intake. This causes significant weight loss over a short period of time.
Marked Resistance of Normal Subjects to Tube‐Feeding‐Induced Diarrhea: The Role of Magnesium H. E. KANDIL, F. H. OPER, B. R. SWITZER, ET AL American Journal of Clinical Nutrition 57:73–80, 1993
Authors: Heimburger Douglas C.
Published: May 2008

Because it is often assumed that feeding formulas are responsible for the diarrhea that commonly occurs in tube‐fed patients, the authors of this report sought to test the tolerance in normal subjects of a commonly used enteral feeding formula. They reasoned that if normal persons can tolerate substantial volumes of feeding without diarrhea, it may be patient‐specific factors and not the formulas themselves that cause diarrhea in sick persons. After five healthy male volunteers had undergone a 72‐hour acclimation to oral Ensure Plus (Ross Laboratories, Columbus, OH), the investigators administered Osmolite HN (Ross Laboratories) by continuous duodenal infusion, at progressively increasing infusion rates, until the subjects could no longer tolerate it.

The subjects were able to tolerate maximum infusion rates of between 198 and 340 mL/h (5000 to 8650 kcal/ d). In two subjects, the infusion was stopped for symptoms other than diarrhea (abdominal distention, bloating, heartburn, and headache in one, and abdominal distention with vomiting in the other). These subjects never developed diarrhea, defined as >300 g of stool per day, despite maximum infusion rates of 371 and 258 mL/ h. The diarrhea that developed in the other three subjects was modest (350 to 380 g/d) and occurred only at infusion rates exceeding 275 mL/h, or more than 400% of their estimated basal energy expenditures.

Blood and stool samples were analyzed to elucidate the mechanisms causing the diarrhea. The magnesium content of pooled diarrheal stools was significantly greater than that of nondiarrheal stools, suggesting that the magnesium load (mean 89 mmol/24 h, or more than 6 times the typical intake for US men) may have been the causal factor. There was no evidence that unabsorbed fat, carbohydrate, or protein contributed to the diarrhea.
Body Composition in Patients With Acquired Immunodeficiency Syndrome: A Validation Study of Bioelectric Impedance Analysis
Authors: Sluys T.E.M.S. , Van Der Ende M.E. , Swart G.R. , Van Den Berg J.W.O. , Wilson J.H.P.
Published: May 2008

The objective of this validation study was to explore bioelectric impedance analysis (BIA) as a way to assess nutritional status and body composition. The study was done in the outpatient department of the AIDS unit at University Hospital Dijkzigt, Rotterdam, The Netherlands. Eleven clinically stable patients with AIDS were studied. Total body water, body fat, lean body mass, and body cell mass were measured and calculated with multiple dilution techniques and BIA. With linear regression analysis, a strong correlation was found between total body water and lean body mass derived from BIA and multiple dilution techniques (r 2 =.96 and.98, respectively), and slightly weaker correlation was found for body cell mass and body fat (r 2 =.88 and.76, respectively). These results suggest that BIA is a suitable method for the assessment of body cell mass in HIV‐infected patients without opportunistic infections. The technique is safe, noninvasive, fast, and inexpensive. (Journal of Parenteral and Enteral Nutrition 17:404–406, 1993)
Total Parenteral Nutrition With Glutamine in Bone Marrow Transplantation and Other Clinical Applications (A Randomized, Double‐Blind Study)
Authors: Schloerb Paul R. , Amare Mammo
Published: May 2008

In a paper by Ziegler et al (Ann Intern Med 116:821–828, 1992), total parenteral nutrition supplemented with L‐glutamine (TPN/GLN) was reported beneficial in patients receiving bone marrow transplantation (EMT) for hematologic malignancies. By using a similar protocol, we studied 29 patients with both hematologic malignancies and solid tumors, and with both allogeneic and autologous BMTS. In a double‐blind, randomized approach, patients were given isocaloric, isonitrogenous TPN after BMT until they consumed 50% of their required diet orally. Total body water and extracellular water were measured before and after TPN in 10 patients. Total body water increased in patients receiving standard TPN and decreased significantly in patients receiving TPN/GLN. Length of hospital stay after BMT was significantly (5.8 days) less in patients receiving TPN/GLN. Incidence of positive bacterial cultures, clinical infections, and mortality did not differ significantly between the two groups. When the groups were subdivided into patients with hematologic malignancies and those with solid tumors, there were no significant differences in the above variables associated with TPN/GLN. In 17 of 30 additional hospitalized patients receiving standard TPN, substitution of TPN/GLN did not have discernible clinical or laboratory effects but appeared to be safe. Inclusion of patients with solid tumors and a higher mortality in our patients may have obscured beneficial effects of TPN/GLN observed by others. (Journal of Parenteral and Enteral Nutrition 17:407–413, 1993)
The Effect of Total Parenteral Nutrition on Gastrointestinal Hormones in Rats
Authors: Miyata Toshiko , Enrione Evelyn B.
Published: May 2008

Total parenteral nutrition (TPN) has been shown to alter the serum concentration of certain gastrointestinal hormones. However, the effects of surgical and nutritional techniques have not been evaluated adequately. This study examined the effects of those techniques on serum gastrin and secretin levels in Fischer 344 rats fed TPN. After aseptic superior vena cava cannulation and a 4‐day postoperative recovery period with ad libitum access to food and water, 18 rats were randomly and equally (n = 6) assigned to either (1) a baseline group, killed after the recovery period; (2) a TPN group fed sufficient nutrients (67% dextrose, 21.7% amino acid, 11.3% fat) and kilocalories (1.45 kcal/mL) for normal growth and development; or (3) an orally fed (OF) group fed ad libitum a powdered diet isocaloric and isonitrogenous to the TPN solution. Both the TPN and OF groups were fed for 5 days and then killed. Another set of six rats without surgery served as a control (CON) group and had the same diet protocol as the OF group. Serum was analyzed for gastrin and secretin by radioimmunoassay. The OF group had significantly (p <.01) lower gastrin levels than the CON group. Gastrin levels of OF rats were twofold lower (p <.04) than those of the TPN rats and were threefold greater (p <.02) than those of the baseline group. Secretin levels in OF rats were twice as high (p <.02) as those in CON rats. The OF group showed a trend toward significantly (p <.09) higher serum secretin levels when compared with the TPN group. These data indicate that surgery and route of nutrient intake affect gastrointestinal hormone levels. Surgery decreases gastrin and increases secretin, whereas the infusion of TPN tends to normalize these hormone levels in rats. (Journal of Parenteral and Enteral Nutrition 17:417–421, 1993)
The Button Jejunostomy for Long‐Term Jejunal Feeding: Results of a Prospective Randomized Trial
Authors: Gorman Robert C. , Morris Jon B. , Metz Cathleen A , Mullen James L.
Published: May 2008

Low profile, self‐retaining feeding conduits (“buttons”) inserted percutaneously through a mature gastrostomy stoma are ideal for prepyloric feeding. We tested the efficacy of a surgically inserted button (Button, C.R. Bard, Inc) in the jejunum for long‐term postpyloric feeding. Forty‐two aspiration risk patients were prospectively randomized to receive a standard No. 14 French red rubber catheter (n = 21, mean age 68 ± 17 years) or the button (n = 21, mean age 68 ± 18 years). Common indications for jejunal feeding were aphagia due to obtundation (41%) and esophageal dysmotility (41%). All feeding devices were inserted 20 cm distal to the ligament of Treitz via a serosal tunnel (catheter) or double pursestring (button) technique. No patient required reoperation, and cardiopulmonary failure was the most frequent cause of death, occurring in 11 patients (26%). Goal feedings were obtained in 91% of the catheter patients and 100% of the button patients by postoperative day 4.7 ± 1.9 and 4.2 ± 2.2, respectively. At a follow‐up of 43 ± 13 days, 12 (92.3%) of 13 catheter patients and 9 (81.8%) of 11 button patients were receiving goal feedings. Three patients in the catheter group and four patients in the button group had resumed an oral diet. Device‐related complications (dislodgment, occlusion, peritubular leak, or bowel obstruction) and total number of patients with complications were significantly lower in the button group (one [5%] vs eight [38%] for device‐related complications and one [5%] vs six [29%] for incidence of complications for the button and catheter groups, respectively). The jejunostomy button appears to be an attractive alternative for selected patients requiring long‐term postpyloric feeding. (Journal of Parenteral and Enteral Nutrition 17:428–431, 1993)
Hepatobiliary Complications in Healthy, Intra‐abdominally Infected, and High‐Output Fistula Rats Receiving Total Parenteral Nutrition
Authors: Mok King‐Tong
Published: May 2008

This study examines the pathophysiology of hepatobiliary complications induced by total parenteral nutrition (TPN) by using animal models that underwent cecal ligation to produce intra‐abdominal infection and received an enterostomy to mimic a high‐output fistula, which causes the interruption of enterohepatic circulation of bile salt. Aspartate transaminase was elevated after TPN (p <. 05). Alkaline phosphatase was increased in animals receiving TPN plus an enterostomy (p <.05). Serum albumin was significantly decreased in animals receiving TPN plus undergoing cecal ligation or enterostomy (p <.05). Liver weight and liver protein and water content decreased in animals receiving TPN alone (p <.05). Liver water content increased in animals receiving TPN plus undergoing cecal ligation (p <.05). Liver lipid content increased after TPN and to a significant degree in rats receiving TPN plus undergoing cecal ligation or enterostomy (p <.05). Bile flow diminished after TPN and to a level reaching significance in animals receiving TPN plus undergoing cecal ligation or enterostomy (p <.05). Reduction of bile flow, decrease of biliary cholesterol secretion, and increase of biliary bilirubin secretion, which may be the cause of TPN‐induced bilirubinate stones, were most significant in animals receiving TPN plus undergoing cecal ligation (p <.05). In conclusion, TPN can induce hepatic dysfunction and bilirubinate stones, but these complications are more common in animals with associated intra‐abdominal infection or high‐output fistula. (Journal of Parenteral and Enteral Nutrition 17:449–453, 1993)
Contamination of a Prefilled Ready‐to‐Use Enteral Feeding System Compared With a Refillable Bag
Authors: Donius Maggie A.
Published: May 2008

The contamination of a refillable bag enteral feeding system was compared with a prefilled, ready‐to‐use system on four stable patients with gastrostomies in a long‐term care facility. Samples were taken from the distal end of the tubing attached to the formula reservoir three times (just before administration to the patient, during the morning medication pass, and just before the reservoir change) during 24 hours for 3 days with use of the refillable bag, the ready‐to‐use system, and the ready‐to‐use system with a Y‐port added. A Y‐port was added to the ready‐to‐use system to facilitate administration of water, medications, residual checks, and specimen collection without disconnection of the gastrostomy tube from the formula reservoir tubing when it was apparent that the contamination levels of the refillable bag and the ready‐to‐use system were not different. Forty‐one (65%) of the 63 specimens collected while the Y‐port was not being used exceeded the acceptable contamination level for grade A pasteurized milk. Five (28%) of the 18 specimens collected while the Y‐port was in use exceeded this level. Use of a Y‐port is suggested when a prefilled ready‐to‐use system is used to decrease contamination as well as save nursing time. (Journal of Parenteral and Enteral Nutrition 17:461–464, 1993)
Parenteral Nutrition in Cancer Patients Receiving Chemotherapy: Effects on Toxicity and Nutritional Status
Authors: De Cicco Marcello , Panarello Giacomo , Fantin Dario , Veronesi Andrea , Pinto Antonio , Zagonel Vittorina , Monfardini Silvio , Testa Vinicio
Published: May 2008

The role of total parenteral nutrition (TPN) in reducing toxicity related to cancer chemotherapy (CT) is presently a controversial issue. To evaluate the effectiveness of TPN in reducing CT‐associated toxicity and correcting and preventing CT‐related impairments of nutritional status, a prospective crossover controlled study was performed in 43 cancer patients (19 normally nourished and 24 malnourished) randomly divided into two groups (A and B). Group A patients received TPN concomitantly with the first course of chemotherapy, and the second course was administered 21 to 28 days later without TPN support; group B patients were treated in the opposite sequence. The rates of myelotoxicities and gastrointestinal toxicities after CT courses with or without TPN were essentially similar in normally nourished and malnourished patients. No changes in nutritional indexes were detected in normally nourished subjects after each course. Conversely, in undernourished subjects, prealbumin, retinolbinding protein, and nitrogen balance increased in CT + TPN courses (p <.02). In CT‐only courses, undernourished subjects showed a decrease in prealbumin and nitrogen balance. Significant changes of nitrogen balance in CT vs CT + TPN courses were detected in malnourished subjects. TPN appears to be unable to reduce CT‐associated toxicity. CT administration does not result in any impairment of the nutritional status in normally nourished cancer patients. From our study, it appears that TPN should be limited to severely malnourished neoplastic patients undergoing CT, because of its ability to prevent further impairment of nutritional status and to improve the nitrogen balance and the levels of fast‐turnover visceral proteins. (Journal of Parenteral and Enteral Nutrition 17:513–518, 1993)
Odd‐Numbered Medium‐Chain Triglycerides (Trinonanoin) in Total Parenteral Nutrition: Effects on Parameters of Fat Metabolism in Rabbits
Authors: Linseisen Jakob , Wolfram Günther
Published: May 2008

Odd‐numbered medium‐chain triglycerides (MCTs) might combine the advantages of “usual” MCTs applied in clinical nutrition with lower ketogenic action and the release of three carbon units. To test subacute toxicity, trinonanoin/longchain triglyceride (LCT) (7/3 wt/wt) fat emulsions were given to rabbits (n = 8) for 11 days (7 h/d) within a total parenteral nutrition regimen at a dose of 46.5% of total daily energy. Comparisons were made with rabbits receiving equicaloric amounts of MCT/LCT (7/3, wt/wt) or pure LCT fat emulsions, as well as with orally fed controls. The trinonanoin/LCT emulsion was well tolerated by all animals. Body weight changes showed no statistically significant differences between groups. The enzymatic determination of triglycerides, non‐esterified fatty acids, and free glycerol concentrations in plasma samples revealed similar results for both MCT groups. However, ketone body concentrations (3‐hydroxybutyrate) were significantly lower after trinonanoin/LCT emulsion administration. In the trinonanoin/LCT group, the plasma concentrations of propionic acid as well as of other short‐chain fatty acids continuously increased; on days 10 and 11, elevated amounts of propionic acid were also detected in the urine. The histologic examination of the gut mucosa revealed no distinct differences between groups. On the basis of the presented data, the trinonanoin/LCT emulsion showed no inferiority to “usual” MCT/LCT emulsions. The lower ketogenic effect as well as the marked increase in plasma short‐chain fatty acid concentrations may encourage further testing of this substrate for total parenteral nutrition. (Journal of Parenteral and Enteral Nutrition17:522–528, 1993)
Supplemental Arginine and Ornithine Do Not Affect Splenocyte Proliferation in Surgically Treated Rats
Authors: Torre Patrick M. , Ronnenberg Alayne G. , Hartman Wilburta J. , Prior Ronald L.
Published: May 2008

The present study was designed to determine whether arginine or ornithine supplementation enhanced immune responsiveness in surgically stressed rats. Young rats (130 to 150 g; n = 72) were fed one of three nonpurified diets: control, arginine‐supplemented (30 g/kg of diet), or supplemented with ornithine on an equimolar basis to supplemental arginine. Control and ornithine‐supplemented diets were made isonitrogenous to the arginine‐supplemented diet with alanine. Food intake and body weight were monitored throughout the experimental period. Eight days after initiation of dietary treatments, 36 rats were given dorsal skin wounds. Rats were killed 7 days later. Blood was collected, spleen and thymus were weighed, and splenocytes were isolated to measure proliferation in response to mitogens and interleukin‐2 production. Food intake, body weight gain, and thymus weight were lower in rats subjected to surgery than in control rats (p <.01). Neither supplemental dietary arginine nor ornithine affected food intake, body weight gain, thymus weight, splenocyte proliferation, or splenocyte interleukin‐2 production in any treatment group (p <.1). These data suggest that low‐level dietary supplementation of arginine and ornithine did not ameliorate detrimental effects of minor surgery in rats. (Journal of Parenteral and Enteral Nutrition 17:532–536, 1993)
Glutamine Peptide‐Supplemented Long‐Term Total Parenteral Nutrition: Effects on Intracellular and Extracellular Amino Acid Patterns, Nitrogen Economy, and Tissue Morphology in Growing Rats
Authors: Babst R. , Hörig H. , Stehle P. , Brand O. , Filgueira L. , Marti W. , Fischer M. , Oberholzer M. , Gudat F. , Fürst P. , Heberer M.
Published: May 2008

Glutamine (GLN) is a nonessential amino acid that is not included in current regimens for parenteral nutrition because of its chemical instability. This study tested the hypothesis that GLN supplementation during long‐term total parenteral nutrition (TPN) (3 weeks) would enhance GLN availability, thereby improving nitrogen economy and growth in a growing rat model: Standard TPN delivering 300 kcal/kg per day (lipid:carbohydrate = 1:1) including 2.1 g of nitrogen per kilogram per day in an all‐in‐one solution was compared with an isonitrogenous, isocaloric, and isovolemic TPN regimen with 0.29 g of nitrogen per kilogram per day substituted by GLN derived from the dipeptides glycyl‐GLN and alanyl‐GLN (TPN GLN). Enterally fed controls were included. Analysis was confined to nonbacteremic animals with negative blood culture, in which extracellular and intracellular amino acid concentrations including GLN, nitrogen balance, serum protein concentrations, growth, and histologic sections of liver and small‐bowel mucosa (light and scanning electron microscopy) were evaluated. Hepatic intracellular GLN concentrations were significantly lower in animals receiving GLN‐free TPN (11.7 ± 1.6 nmol/mg fat‐free dry and solid tissue mass, n = 9) compared with both GLN‐supplemented TPN (16.0 ± 3.0, n = 7) and enteral feeding (18.2 ± 1.8, n = 6) (p <.001). Corresponding results were found for intracellular GLN concentrations in skeletal muscle (TPN standard 12.5 ± 3.1, TPN GLN 14.7 ± 3.1, enteral control 17.3 ± 2.3, p <.05), intestinal mucosa, and spleen as well as for plasma concentrations. GLN supplementation was associated with a significant improvement in nitrogen balance (cumulative nitrogen balance: 10.59 ± 1.42 g of nitrogen per kilogram per 20 days) compared with animals on standard TPN (4.18 ± 1.49). No differences were found for growth, serum proteins, and both liver and small intestinal histology. In this rodent model, long‐term standard TPN without GLN compared with GLN‐supplemented TPN was associated with reduced GLN concentrations affecting skeletal muscle, liver, and plasma. The GLN‐ containing dipeptides were adequately used in that they counteracted the decrease of extracellular and intracellular GLN concentrations and improved the nitrogen balance compared with the GLN‐free TPN regimen. (Journal of Parenteral and Enteral Nutrition 17:566–574, 1993)
Staphylococcus saprophyticus Sepsis Related to Total Parenteral Nutrition Admixtures Contamination
Authors: Llop Josep M. , Mangues Irene , Pérez José L. , López Pilar , Tubau María
Published: May 2008

The aim of this study was to report an outbreak of sepsis related to contamination of total parenteral nutrition (TPN) admixtures with Staphylococcus saprophyticus. A total of four patients developed fever after administration of contaminated TPN. Results of cultures of blood, catheter hubs and tips, and TPN admixtures are presented. The strain responsible for the outbreak was able to grow in vitro in two common TPN formulations. (Journal of Parenteral and Enteral Nutrition 17:575–577, 1993)
Pulmonary Embolism as a Complication of Long‐Term Total Parenteral Nutrition
Authors: Mailloux Richard J. , Delegge Mark H. , Kirby Donald F.
Published: May 2008

Although much has been written concerning the complications of long‐term total parenteral nutrition, little or no mention of pulmonary embolism is made in the literature. We present two patients maintained on home total parenteral nutrition who suffered pulmonary emboli, one while receiving standard heparin therapy. No potential source other than their indwelling total parenteral nutrition catheter was identified. Studies have revealed catheter‐related thrombosis in up to 50% of patients with indwelling central venous catheters. Although early surgical literature suggested that upper extremity deep vein thromboses rarely embolize, more recent investigations have proven this false. In fact, the risk of pulmonary emboli appeared to be greatest in those thrombi that were catheter related. Because of this risk, we suggest a hypercoaguable work‐up in any patient with a history of recurrent thrombosis. Heparin is central to the current preventive regimens; however, further study is needed to determine the most efficacious dose. Future development of less thrombogenic catheters will also be of assistance. Thrombolytic agents currently have an expanding role in the treatment of thrombotic complications. Whether they will have a future role in prevention remains unknown. (Journal of Parenteral and Enteral Nutrition 17: 578–582, 1993)
Octreotide as an Adjunct to Home Parenteral Nutrition in the Management of Permanent End‐Jejunostomy Syndrome
Authors: Stephen J.D. , O' Keefe , Peterson Maren E. , Fleming C. Richard
Published: May 2008

Intravenous fluid requirements for patients with permanent end‐jejunostomy syndrome often exceeds 3 L/d, making rehabilitation difficult. The effect of the somatostatin analogue, octreotide (100 μg TID, subcutaneously) in reducing requirements was measured in 10 patients established on home parenteral nutrition. After 10 days of treatment, 72‐hour balance measurements demonstrated significant reductions in stomal fluid and electrolyte losses from (mean ± SE) 8.1 ± 1.8 to 4.8 ± 0.7 L/d (p <.03), sodium from 510 ± 71 to 340 ± 41 mEq/d (p <.03), chloride from 533 ± 70 to 315 ± 32 mEq/d (p <.002), and potassium from 101 ± 41 to 79 ± 34 mEq/d (p <.02), permitting an average reduction in intravenous fluid requirements of 1.3 L/d (p <.0003), 118 mEq Na+/d (p <.03), 41 mEq K+/d (p <.02), and 178 mEq Cl−/d (p <.01). This meant that daytime intravenous infusions could be stopped in all patients. Fecal nitrogen losses were decreased (P <.05), but overall there was no significant change in fat and caloric absorption. In addition, hormonal stimulated gastric acid and pancreatic lipase secretions were significantly reduced (p <.05). The effect was most marked in those patients with massive stomal losses and uncontrollable thirst. Continuation of treatment for more than 1 year in 8 of the patients suggested preservation of potency and good tolerance, with the possible exception of accelerated gallstone formation and subacute intestinal obstruction. In conclusion, octreotide has the potential to improve the quality of life of those end‐jejunostomy syndrome patients with massive stomal losses, resistant to conventional medical treatment. (Journal of Parenteral and Enteral Nutrition 18:26–36, 1994)
Effect of Total Parenteral Nutrition on Amino Acid and Glucose Transport by the Human Small Intestine
Authors: Sax Harry
Published: May 2008

The perioperative use of total parenteral nutrition (TPN) as an adjunct to surgical treatment of severely nutrient‐depleted patients is appropriate. Potentially deleterious effects of TPN on the gut have been examined with regard to atrophy and gut mucosal barrier function.1 The specific alterations in nutrient transport, an energy‐dependent luminal mechanism, have not, however, been clearly defined. Active transport of specific amino acids across the brush‐border membrane is facilitated by a number of carriers, some of which are sodium dependent.2 The maintenance of a sodium gradient requires energy; it is hypothesized that down‐regulation of brush‐border membrane transport should result from periods of low availability of luminal nutrients. If specific nutrients are physiologically more important, transport would be maintained.

To study these changes, adult patients who were to undergo intestinal surgery were randomized to immediate operation or a 7‐day period of bowel rest with calorie and protein needs met by TPN. At celiotomy, segments of distal ileum were obtained and mucosa scraped for the preparation of brush‐border membrane vesicles. The brush‐border membrane vesicles were coincubated with labeled amino acids in the presence or absence of sodium. By determining the time course of uptake into vesicles, the maximum velocity as well as the affinity of the specific receptor can be determined. By expressing this data as an Eadie‐Hofstee transformation, the number of receptor sites can be extrapolated. Specific nutrients examined included glutamine (GLN), methyl‐d‐amino isobutyric acid (a system A analog), alanine, arganine, and glucose.

A period of no oral nutrition, even with adequate parenteral nutrition support, caused down‐regulation in the number of receptors for alanine, arginine, leucine, and glucose. GLN transport, however, was maintained. In a single patient in whom jejunum was available, nutrient uptake was decreased across the board; however, GLN was the least diminished.
Long‐Chain Predominant Lipid Emulsions Inhibit In Vitro Macrophage Tumor Necrosis Factor Production*†
Authors: Vazquez W. David , Arya G. , Garcia Victor F.
Published: May 2008

Intravenous lipid emulsions are an important component of parenteral nutrition. Despite their benefits, lipid emulsions have been associated with higher rates of bacteremia in neonates. Therefore we investigated the effect of lipid emulsions on the inflammatory response by examining their effect on in vitro macrophage tumor necrosis factor (TNF) production of two distinct macrophage populations. Through the use of endotoxin‐free phosphate buffered saline, peritoneal (PER) and alveolar (ALV) macrophages were isolated from male Sprague‐Dawley rats (weighing 125 to 150 g) with endotoxin‐free phosphate buffered saline. Cell counts were adjusted to 2 × 106 cells/mL in RPMI with 2% fetal calf serum. Three hundred microliters of the cells were incubated in a 24‐well culture dish with media or media with intralipid (100 μg/dL) for 16 hours. After washing each well three times, the cells were stimulated for 2 or 16 hours with Escherichia coli lipopolysaccharide (150 μL of 1 μg/mL). The supernatants were assayed for TNF using the WEHI 164:13 bioassay and TNF levels were expressed as picograms per milliliter. Student's unpaired t test was used for data analysis. Lipid‐exposed PER and ALV macrophages in vitro TNF levels were significantly lower after 2 hours (12,591 pg/mL ± 3837 vs 20,591 pg/mL ± 6344 for PER, 3894 pg/mL ± 1258 vs 13,177 pg/mL ± 3266 for ALV) and 16 hours (6427 pg/mL ± 3050 vs 12,353 pg/mL ± 4877 for PER; 131,6000 pg/mL ± 7317 vs 354,680 pg/mL ± 31,605 for ALV) of endotoxin stimulation. TNF production seems to be impaired in macrophages exposed to a.1% lipid emulsion for 16 hours. By impairing TNF production, lipid emulsions may mitigate an important proximal mediator of the immune response. (Journal of Parenteral and Enteral Nutrition 18:35–39, 1994)
Fracture and Embolization of a Peripherally Inserted Central Venous Catheter
Authors: Linz David N. , Bisset George S. , Warner Brad W.
Published: May 2008

A case is presented of the fracture and embolization of a peripherally inserted central venous catheter. This novel complication is discussed in the context of patients in alternate care settings with emphasis on retrieval of the embolized catheter fragment, morbidity of catheter embolization, and precautions against inadvertent fracture in the home care setting. (Journal of Parenteral and Enteral Nutrition 18:79–80, 1994)
Hydrolysis of Mixed Lipid Emulsions Containing Medium‐Chain and Long‐Chain Triacylglycerol With Lipoprotein Lipase in Plasma‐like Medium
Authors: Sato Nobuaki , Deckelbaum Richard J. , Neeser Gertraud , Carpentier Yvon A. , Kinney John M.
Published: May 2008

We explored the effects of plasma‐like conditions on hydrolysis of medium‐chain triglyceride (MCT) and long‐chain triglyceride (LCT) emulsions at different mixing ratios and the effect of the physical method of mixing on lipoprotein lipase hydrolysis of mixed emulsions in vitro. Mixed emulsions with two different mixing ratios, 50% MCTs with 50% LCTs and 70% MCTs with 30% LCTs by weight, were studied. Emulsions containing both MCT and LCT oils blended in the same emulsion particle were compared with mixtures of separate pure MCT emulsion particles and pure LCT particles. MCT hydrolysis was always greater than LCT hydrolysis. In a plasma‐free tris(hydroxymethyl)aminomethane‐albumin buffer at pH 8.5, the physical method of mixing had substantial effects on hydrolysis; blended emulsions of MCTs and LCTs were hydrolyzed better than separate mixes of pure MCT and pure LCT particles, ie, more total free fatty acids were released. In plasma‐free systems, there were no differences in rates of hydrolysis of LCTs or MCTs (as individual triglycerides) between the two different mixing ratios of 50:50 and 70:30. However, the presence of plasma markedly diminished the differences in hydrolysis between blended vs separately mixed emulsions at pH 7.4. Also, in plasma‐like incubation buffer, the rates of hydrolysis of MCTs and LCTs in emulsions with 50:50 or 70:30 MCT to LCT ratios reflected the respective amounts of MCT and LCTs in the emulsions. These data suggest that there are no significant differences in hydrolysis between blended and separately mixed MCT and LCT emulsions in plasma at pH 7.4, and that the rate of release of total free fatty acids during emulsion hydrolysis is largely dependent on the initial amount of MCT in the mixture. (Journal of Parenteral and Enteral Nutrition 18:112–118, 1994)
Biliary Amino Acid and Glutathione Secretion in Response to Amino Acid Infusion in the Isolated Rat Liver
Authors: Shattuck Karen E. , Grinnell Chali D. , Rassin David K.
Published: May 2008

The intravenous infusion of amino acid solutions has been associated with cholestatic liver injury in hospitalized patients and in laboratory animals. In the isolated rat liver, we recently showed that the acute decrease in bile flow, previously reported by other investigators, is dose related, reversible, and associated with dose‐related increases in total biliary amino acid concentrations. In the present study, we characterized the effects of graded infusions of amino acid solutions, with and without taurocholate, on biliary secretion of individual amino acids and glutathione, an important regulator of bile flow. Livers from young adult male rats were perfused with an amino acid solution for 1 hour and allowed to recover for 30 minutes. Infusion of the amino acid solution was associated with dose‐related increases in biliary concentrations of most amino acids included in the amino acid solution. Infusion of amino acid solutions resulted in a decreased bile/perfusate ratio of most amino acids, which were secreted into bile in amounts approximating their calculated uptake from the infusate. The inclusion of taurocholate in the infusate was associated with lower biliary concentrations of each individual amino acid and significant decreases in biliary total, reduced, and oxidized glutathione. Further investigation of the relationship between these changes in biliary amino acids and glutathione concentrations and the cholestasis associated with infusion of amino acid solutions may provide insights into the mechanism by which amino acids induce such cholestasis. (Journal of Parenteral and Enteral Nutrition 18:119–127, 1994)
Effect of Glutamine on Phagocytosis and Bacterial Killing by Normal and Pediatric Burn Patient Neutrophils
Authors: Ogle Cora K. , Ogle James D. , Mao Ju‐Xian , Simon Jodi , Noel John G. , Li Bing‐Guo , Alexander J. Wesley
Published: May 2008

Glutamine is essential for the function of lymphocytes and macrophages, where it serves, among other things, as a source of energy. Little information is available concerning the fuel that polymorphonuclear cells use for their metabolic and bactericidal functions. It was the purpose of this study to determine whether glutamine would enhance the in vitro bactericidal function of normal neutrophils and whether the amino acid would restore the observed impaired function in burn patients to or above the normal level. Twelve burn patients with total body surface area burns ranging from 32% to 87% were studied. At various postburn times, neutrophils were isolated and their ability to kill Staphylococcus aureus in the presence and absence of glutamine was determined and compared with that in normal subjects. Glutamine enhanced the bactericidal function of normal neutrophils. In every patient, at all but two postburn times, glutamine caused an improvement in the observed abnormal neutrophil bactericidal function and often restored it to or slightly above the normal level. Glutamine had no effect on the expression of C3b receptors (CR1 or CD35) or on phagocytosis by the cells. This study confirms the beneficial effects of glutamine in at least one arm of the immune system and adds evidence for the possible advantage of including this amino acid in the diets of burn and other trauma patients. (Journal of Parenteral and Enteral Nutrition 18:128–133, 1994)
Kinetics of Medium‐Chain Triglycerides and Free Fatty Acids in Healthy Volunteers and Surgically Stressed Patients
Authors: De Gaetano Andrea , Castagneto Marco , Mingrone Geltrude , Gangeri Giuliano , Sganga Gabriele , Tataranni Pietro A. , Raguso Comasia , Greco Aldo V.
Published: May 2008

To determine the hydrolysis rate of medium‐chain triglycerides (MCTs) to medium‐chain free fatty acids (MCFAs) and the disposition rate of MCFAs, five healthy volunteers (H) and eight surgically stressed patients (S) received 0.5 mL of Lipofundin 20% per kilogram body weight as an intravenous bolus. Serum MCTs (C8 and C10) and MCFAs were measured by high‐performance liquid chromatography during the 120 minutes postinjection. A linear two‐compartment model was found to be descriptive and robust: the apparent volumes of distribution were found to be similar in healthy and surgical subjects for both MCTs and MCFAs. The first‐order transformation rate constant (hydrolysis) from MCTs to MCFAs was not significantly different between the H and S groups (overall 0.112 ± 0.022/min, C8; 0.078 ± 0.020/min, C10). The rate constant for tissue MCFA uptake from plasma was significantly different between S and H subjects both for C10 alone (H: 0.0337 ± 0.0078; S: 0.1194 ± 0.0240; p =.020) and for C8 and C10 together (H: 0.0382 ± 0.0054; S: 0.1012 ± 0.0168; p =.008), whereas it failed to attain significance when C8 alone was considered (H: 0.047 ± 0.0077; S: 0.0829 ± 0.0230; p =.210). These results show that use of MCTs is increased in surgical patients because of enhanced tissue uptake of the corresponding free fatty acids, whereas there does not seem to be an increase of MCT hydrolysis in response to acute disease. This would indicate that the stressed patient is in fact able to effectively use this alternative lipid substrate in the face of increased metabolic demand. (Journal of Parenteral and Enteral Nutrition 18:134–140, 1994)