bluuebunny/crossref_metadata_2025 huggingface dataset:
Contamination of Enteral Nutrition Systems during Prolonged Intermittent Use
Authors: Grunow John E. , Christenson John C. , Moutos Doris
Published: May 2008

Two related studies were done to determine the incidence of bacterial contamination in enteral delivery systems that were used for 15 and 7.5 hr, rinsed after each use, and reused daily in vitro for 7 and 5 days, respectively. In the first study, systems infusing either a premixed formula (Ensure) or a hand‐mixed formula (Vivonex) did not show bacterial growth until the 4th day, 1.0–2.0 × 10 colony‐forming units per milliliter (CFU/ml) of Staphylococcus epidermidis. Thereafter there was sporadic growth of different organisms but never increasing growth during the 7 days of infusion. In the second study, systems with Ensure were initially contaminated with Staphylococcus aureus and Escherichia coli and reused for 5 days. S. aureus was eliminated by rinsing, but E. coli persisted in the delivery system at concentrations of 103‐106 CFU/ml. We conclude that clean enteral nutrition systems can be rinsed after short‐infusion periods and reused up to 7 days in vitro without significant contamination; however, once a bag has become heavily contaminated some bacteria cannot be eradicated from the system by rinsing. (Journal of Parenteral and Enteral Nutrition 13:23–25, 1989)
Extraction of Diethylhexylphthalate from Total Nutrient Solution‐Containing Polyvinyl Chloride Bags
Authors: Mazur Helen I. , Stennett Douglass J. , Egging Paulette K.
Published: May 2008

Total nutrient solution (TNS) is a new method for delivering total parenteral nutrition (TPN) by admixing dextrose, amino acids, and lipids in a single container. Recommendations are to use nonpolyvinyl chloride (PVC) containers for admixture of these solutions. PVC is a hard, brittle, and inflexible substance, and plasticizers, predominantly diethylhexylphthalate (DEHP), are added to impart flexibility. DEHP is a lipid soluble suspected carcinogen, hepatotoxin, and teratogen which has been shown to leach from PVC products containing lipophilic admixtures. The purpose of this study was to quantitate the amount of DEHP which leaches from PVC bags containing TNS.

Six study groups, which contained three formulas stored at 25°C ± 2°C and 4°C ± 1°C, were assayed for DEHP at time 0, 12, 24, 48 and 72 hr, 1 wk, and 3 wk using high‐performance liquid chromatography. The control group contained an amino acid source, a carbohydrate source, and standard electrolytes, and the other groups contained a 10% lipid source or a 20% lipid source in addition to the constituents of the control group.

Lipid‐containing groups demonstrated detectable levels of DEHP at 48 hr, and DEHP content increased in these groups throughout the 21‐day study. DEHP concentrations were lower in lipid‐containing groups stored at 4°C than comparable groups stored at 25°C. (Journal of Parenteral and Enteral Nutrition 13:59–62, 1989)
Short‐Term Effects of Fat Emulsion on Serum Lipids in Postoperative Patients
Authors: Meguid Michael M. , Kurzer Martin , Hayashi Robert J. , Akahoshi Michael P.
Published: May 2008

The effect of short‐term infusion of intravenous fat on serum lipids was assessed in 23 patients who had elective cancer operations and were given 20% Intralipid for 5 days postoperatively as part of a standard total parenteral nutrition regimen. Serum lipids were measured prior to, during and after the 5‐day infusion period. The percentage of cholesterol as high‐density lipoproteins (HDL) fell from a mean preinfusion value of 34.7 ± 2.8 to 27.9 ± 2.5 (p < 0.05), while the percentage of cholesterol as low‐density lipoproteins (LDL) increased from 40.7 ± 2.2 to 46.8 ± 3.4 (p < 0.05). Serum triglycerides fell significantly (p < 0.01) from 106.2 ± 13.7 mg/dl to 64.6 ± 8.8 mg/dl at 3 days, being 85.3 ± 3.7 mg/dl at 5 days. No significant change in percent cholesterol as very low‐density lipoproteins (VLDL), or levels of serum total cholesterol or phospholipids occurred. Lipoprotein X was detectable in six patients after 5 days. To study triglyceride clearance 1.7 g/kg of fat emulsion was infused over 8 hr and serial blood samples obtained. Within 3 hr of stopping the fat infusion, triglyceride levels had fallen to preinfusion values. (Journal of Parenteral and Enteral Nutrition 13:77–80, 1989)
Stimulation of Intestinal Mucosal Growth with Intracolonic Infusion of Short‐Chain Fatty Acids
Authors: Kripke Scott A. , Fox Andrew D. , Berman Jeffrey M. , Settle R. Gregg , Rombeau John L.
Published: May 2008

Dietary fiber, which stimulates intestinal mucosal growth, is fermented by anaerobic bacteria in the rat hindgut to the short‐chain fatty acids (SCFA) acetate, propionate, and butyrate. Butyrate is the preferred oxidative fuel of the colonocyte in vitro, and the provision of preferred intestinal fuels has been shown to stimulate mucosal proliferation in vivo. This study determined whether chronic colonic infusion of butyrate or a combination of SCFA would stimulate intestinal mucosal growth in an animal deprived of its normal source of SCFA, fiber fermentation in the cecum. Adult male Sprague‐Dawley rats were fed a fat‐ and fiber‐free elemental liquid diet and underwent cecectomy, ileocolic anastomosis, and insertion of a proximal colonic infusion catheter. Rats were then assigned to receive either a continuous infusion of butyrate (20 mM, 40 mM, or 150 mM), SCFA (70 mM acetate + 35 mM propionate + 20 mM butyrate), or saline, or to receive no infusion. A seventh group underwent proximal colonic transection and reanastomosis. After 7 days, jejunal, ileal, and proximal colonic segments were analyzed for mucosal weight, protein, RNA, and DNA. In the colon, the 40‐mM butyrate infusion resulted in significant elevations in all mucosal parameters relative to all three control groups, saline infusion, no infusion, and transection. Both the 20‐mM butyrate and the SCFA groups showed increased colonic mucosal DNA compared to controls. In the jejunum and ileum, mucosal DNA content was significantly greater in the SCFA group than in the control groups. These data indicate that SCFA infused into the rat colon has a trophic effect throughout the intestinal tract, whereas butyrate appears to have its primary trophic effect locally in the colon. (Journal of Parenteral and Enteral Nutrition 13:109–116, 1989)
Lactose Digestion and Clinical Tolerance to Milk, Lactose‐Prehydrolyzed Milk and Enzyme‐Added Milk: A Study in Undernourished Continuously Enteral‐Fed Patients
Authors: Rosado Jorge L. , Morales Maria , Pasquetti Alberto
Published: May 2008

We investigated: (1) the capacity to digest and tolerate the lactose administered by continuous infusion of intact milk to undernourished tube‐fed patients, and (2) the effectiveness of lactose‐prehydrolyzed milk, and of the addition of exogenous lactase to milk at infusion time, to reduce lactose maldigestion and increase clinical tolerance. Carbohydrate digestion was evaluated in 10 subjects with the hydrogen breath analysis test during 8 hr of observation. Lactose intolerance was determined by evaluation of subject's symptoms. With the infusion of intact milk (IM), none of the subjects were able to efficiently digest the lactose infused (5.6 ± 0.35 g/hr, mean ± SEM) and 86% of them experienced major symptoms of intolerance. With the infusion of lactose‐prehydrolyzed milk (HM) and enzyme‐added milk (EM) there was a highly significant reduction in lactose maldigestion. More importantly, major symptoms were present in only 10% of subjects with EM, and were completely eliminated with HM. Lactose maldigestion and intolerance represent a major limitation for the application of milk‐based polymeric formula for liquid diets in undernourished subjects. The use of exogenous beta‐galactosidases represents an alternative to avoid such reactions. (Journal of Parenteral and Enteral Nutrition 13 :157–161, 1989)
Mortality in Patients on Home Parenteral Nutrition
Authors: Stokes M.A. , Irving M.H.
Published: May 2008

Fifty out of 228 patients recorded on the U.K. Home Parenteral Nutrition Register have died. The earliest to die was at 10 days following the commencement of home parenteral nutrition (HPN), and the longest to die was after 5½ years. Half of the patients who died, did so within 6 months of commencing HPN. Sixty % died of their underlying disease. Most patients with scleroderma or an underlying malignancy are dead within a year of commencing HPN. In contrast, patients with Crohn's disease or the short bowel syndrome due to volvulus do well. In only 14 patients was death attributable to the administration of HPN. In this group the main causes were septicemia, SVC thrombosis, and hepatic failure. Our study suggests that HPN should be used in patients with malignancy and scleroderma only in exceptional circumstances and that further work is necessary for the prevention of SVC thrombosis. (Journal of Parenteral and Enteral Nutrition 13:172–175, 1989)
Chemical Stability of Selenious Acid in Total Parenteral Nutrition Solutions Containing Ascorbic Acid
Authors: Ganther H.E. , Kraus R.J.
Published: May 2008

Reduction of selenious acid (H2SeO3) to elemental Se by ascorbic acid was investigated in regard to the stability of selenite in total parenteral nutrition (TPN) solutions. [75Se] H2 SeO3 (100 μg Se/liter) was incubated at 25°C with pure ascorbic acid (100 or 500 mg/liter) or added to complete TPN solutions containing similar levels of ascorbate. The mixtures were subjected to thin layer electrophoresis at pH 5.3 to separate HSeO3 − from Se°. In complete TPN formulas, little or no reduction of HSeO3 − to Se° occurred over a 24‐hr period, whereas complete reduction occurred with pure ascorbic acid. Further experiments showed that the amino acid component of the TPN formula was preventing the reduction of selenite, and that reduction of selenite by ascorbate did not occur in buffered solutions having a pH of 5 or greater. These results show that reduction of selenite is strongly influenced by pH. At the concentrations of H2SeO3 and ascorbic acid commonly used, reduction to elemental Se is unlikely to be a practical problem in TPN solutions in the near‐neutral pH range. (Journal of Parenteral and Enteral Nutrition 13:185–188, 1989)
Home Total Parenteral Nutrition in a Pregnant Diabetic after Jejunoileal Bypass for Obesity
Authors: Gray David S. , Cabaniss Micki L.
Published: May 2008

Pregnancy after jejunoileal bypass (JIBP) for obesity is generally well tolerated without serious complications. A 24‐yr‐old diabetic patient who had previously had a JIBP procedure presented during pregnancy with severe malnutrition. She was treated successfully with home total parenteral nutrition. Previously published experience with pregnancy after JIBP and the use of parenteral nutrition during pregnancy is reviewed. (Journal of Parenteral and Enteral Nutrition13:214–217, 1989)
Intravenous Fat Emulsion (Intralipid) Delays Gastric Emptying, but Does Not Cause Gastroesophageal Reflux in Healthy Volunteers
Authors: Casaubon Pablo R. , Dahlstrom Karl Anders , Vargas Jorge , Hawkins Randy , Mogard Matz , Ament Marvin E.
Published: May 2008

The impact of overnight intravenous lipid emulsion (ILE) infusion on upper gastrointestinal tract physiology was assessed in 10 healthy volunteers. No changes in lower esophageal sphincter pressure (before infusion: 28 ± 4 mm Hg; after infusion 20.5 ± 3; p:NS), plasma concentrations of gastrointestinal hormones (gastrin: preprandial before/after lipids: 14 ± 2.1/13 ± 1.4 pM; postprandial before/after lipids: 28 ± 2.7/30 ± 3.4 pM, CCK: preprandial before/after lipids: 69 ± 10/64 ± 10 pM; postprandial before/after lipids: 96 ± 11/95 ± 12 pM; neurotensin: levels less than 6 pM in all samples; somatostatin levels undetectable in all samples) nor on pathologic gastroesophageal reflux episodes (% of time of pH < 4, before/after lipids: 0.6 ± 0.4/0.15 ± 0.09), were found (p = NS). In contrast, technetium gastric emptying studies showed a significant delay when comparing pre‐ and postlipid infusion values (37 ± 4/54 ± 4%) (p < 0.005). The mechanism of this effect remains unexplained. (Journal of Parenteral and Enteral Nutrition 13:246–248, 1989)
Comparison of Urinary Urea Nitrogen Excretion and Measured Energy Expenditure in Spinal Cord Injury and Nansteroid‐Treated Severe Head Trauma Patients
Authors: Kolpek Jimmi H. , Ott Linda G. , Record Kenneth E. , Rapp Robert P. , Dempsey Robert , Tibbs Phillip , Young Byron
Published: May 2008

Severe head trauma patients (HT) exhibit markedly elevated energy expenditure and 24‐hr urinary urea nitrogen excretion (UUN) values. The objective of this study was to compare seven spinal cord injured patients (SCI) to seven HT for changes in UUN and measured energy expenditure (MEE) over the first 18 days following injury. Energy expenditure was measured by indirect calorimetry and compared to values predicted by the Harris Benedict Equation (PEE). There were six quadriplegics and one paraplegic in the SCI group. HT patients had peak Glasgow Coma Scale scores of 3 to 10 for the first 24 hr postinjury. Patients were studiec prospectively and matched for age, sex, and admitting weight Week 1 following the injury, SCI had mean UUN values of 0.18 ± 0.04 g/kg/day vs 0.18 ± 0.01 for HT patients. The mean MEE/PEE ratio was 0.56 for the SCI and 1.4 for HT (p < 0.01). Over the entire study period the mean UUN value for SCI was 0.23 ± 0.03 g/kg vs 0.21 ± 0.01 for HT. The mean MEE/PEE ratio for SCI was 0.94 while HT remained elevated at 1.5 (p < 0.05). Although the UUN was comparable in SCI vs HT, there was a significant difference in MEE/PEE between the groups. The elevation in UUN observed in SCI is not due to a hypermetabolic state. This suggests that different mechanisms promote the increased nitrogen excretion observed in these two populations. (Journal of Parenteral and Enteral Nutrition 13:277–280, 1989)
Fat Intake Is Low in Cystic Fibrosis Despite Unrestricted Dietary Practices
Authors: Lloyd‐Still John D. , Smith Alice E. , Wessel Hans U.
Published: May 2008

A prospective study of caloric intake and specific nutrient composition was performed in 64 cystic fibrosis patients aged 0.3 to 18 yr. Linear regressions and multiple stepwise regressions revealed no significant correlations between any individual dietary parameter and age, height, weight, percentile of weight or height, Shwachman Score, and pulmonary parameters. The caloric intake varied widely in individual patients and in different age groups. Despite unrestrictive dietary practices, the fat intake (33.7% ± 8) was below that recommended for these linoleate deficient patients. (Journal of Parenteral and Enteral Nutrition 13:296–298, 1989)
Preliminary Studies of a Dicarboxylic Acid as an Energy Substrate in Man
Authors: Mingrone G. , Tacchino R.M. , Greco A.V. , Arcieri‐Mastromattei E. , Marino F. , Finotti E. , Castagneto E.
Published: May 2008

Azelaic acid (Az), a straight saturated chain nine carbon dicarboxylic acid, was administered in saline form to six healthy male volunteers by iv route. Serum levels of Az and urinary amounts of both azelaic and pimelic (C7) acids were measured by an improved gas liquid chromatographic method. Stoichiometric analysis of Az metabolism was compared with that of glucose and palmitic acid. The respiratory quotient (RQ) as well as the ATP/CO2 ratio of Az were quite similar to that of palmitic acid. Therefore, Az oxidation is associated with a low cost of ATP synthesis in terms of carbon dioxide production. At the infusion rate used (7.5 g/hr) more than 50% of the administered dose was excreted in the urine. However, the remaining portion was cleared from the plasma in 200 min suggesting an uptake by body tissues which was also confirmed by indirect calorimetric analysis. (Journal of Parenteral and Enteral Nutrition 13:299–305, 1989)
Hazards of Small Amounts of Heparin in a Patient with Subclinical Vitamin K Deficiency
Authors: Shah M.C. , Schwarz K.B.
Published: May 2008

The use of small amounts of a dilute solution of heparin (≤100 IU) to keep indwelling intravenous needles or catheters patent for intermittent venous access either for intravenous therapy or timed blood sampling is a common clinical practice. It is considered safe since the amount of heparin required is much less than that required for heparinization. Herein, we describe a 13‐yr‐old patient with malabsorption who developed clinically significant bleeding shortly after a diagnostic test which required multiple small injections of heparin for intermittent venous access (total amount of heparin administered was 600 units over 5 hr). The coagulopathy was corrected by a single dose (10 mg) of parenteral vitamin K. As our patient had multiple risk factors for the development of vitamin K deficiency including malabsorption, decreased food intake, and antibiotic use, we postulate that the small amount of heparin precipitated the coagulopathy by increasing the anti‐protease activity of antithrombin III on abnormal factors X and II formed in the vitamin K deficient state. We would therefore recommend administration of vitamin K to patients who are at risk of developing vitamin K deficiency before using even small amounts of heparin. (Journal of Parenteral and Enteral Nutrition13:324–325, 1989)
A New Nasal Bridle for Securing Nasoenteral Feeding Tubes
Authors: Meer Jeffrey A.
Published: May 2008

A newly designed nasal bridle and rationale for its clinical use are described. Previous nasal bridles have been shown to reduce the 40 to 60% incidence of dislodgement of nasoenteral feeding tubes. Nasal bridles, however, are still not routinely used in nasoenteral feeding of patients who dislodge their feeding tubes. Instead, percutaneous gastrostomies and parenteral nutrition are increasingly being used in these patients who may otherwise be fed adequately with a secured nasoenteral tube. The newly designed nasal bridle described herein has the advantages of easy and rapid placement. Use of this bridle can promote safer and more effective enteral feeding while avoiding the complications and cost of parenteral nutritional and gastrostomies. (Journal of Parenteral and Enteral Nutrition 13:331–334, 1989)
Inhibited Amino Acid Uptake in Skeletal Muscle during Starvation
Authors: Warner Brad W. , Hummel Robert P. , Hasselgren Per‐Olof , James J. Howard , Fischer Josef E.
Published: May 2008

Amino acid uptake in skeletal muscle is reduced during different catabolic conditions such as sepsis, endotoxic shock, and uremia. The present study was designed to determine the effect of another catabolic condition, starvation, on amino acid transport in skeletal muscle. Male Sprague‐Dawley rats (40–60 g) were starved for 24, 48, or 72 hr and soleus (SOL) muscles were removed intact and incubated for 2 hr in a medium consisting of Krebs‐Henseleit bicarbonate buffer (pH 7.4) with glucose (5 mM), [14C]‐inulin, and [3H]‐α‐aminoisobutyric acid (AIB). Amino acid uptake was determined from intracellular to extracellular ratio of AIB following incubation. AIB uptake was significantly reduced after 24 hr of starvation and remained low with further fasting. After 72 hr the AIB distribution ratio was approximately 50% of initial value. Amino acid uptake returned to normal within 24 hr after refeeding of animals that had been starved for 72 hr. Plasma (0.25 ml) from starved rats, added to the incubation medium (2.75 ml) of muscles from nonfasted rats, significantly inhibited AIB uptake. The present results suggest that amino acid uptake in skeletal muscle is progressively reduced during starvation, an effect that may be mediated by a circulating factor(s) present in blood. (Journal of Parenteral and Enteral Nutrition 13:344–348, 1989)
Remission Induction in Refractory Crohns Disease Using a High Calorie Whole Diet
Authors: Afdhal N.H. , Kelly J. , Mccormick P.A. , O'Donoghue D.P.
Published: May 2008

Eleven patients with severe refractory Crohns disease were treated with a high calorie, whole diet. Eight patients achieved remission with a drop in DAS from 13 to 4 (t = 6.31, p < 0.001) and reversal of subacute obstruction in all cases. Nutritional parameters including weight, triceps skinfold thickness, arm muscle area, and serum albumin increased in all patients. The diet was well tolerated with a mean treatment period of 20 days. Clinical relapse of disease occurred in all cases within 9 months (mean 6 ± 2 months). The mechanism of action of a high calorie diet (HCD) is unclear and warrants further study but antigen or specific food exclusion does not appear to be required as judged by this study. (Journal of Parenteral and Enteral Nutrition 13:362–365, 1989)
Esophagogastric Decompression and Enteral Feeding Following Cholecystectomy: A Controlled, Randomized Prospective Trial
Authors: Elmore Michael F. , Gallagher S. Cathy , Jones Jeffrey G. , Koons Karl K. , Schmalhausen Ansel W. , Strange Paul S.
Published: May 2008

One hundred fourteen patients scheduled to undergo elective cholecystectomy were prospectively randomized into one of four treatment groups to study the potential benefits of esophagogastric decompression with and without immediate postoperative enteral nutrition. Group I was the control, and patients received only iv fluids and were allowed to eat as tolerated. Group II patients received iv fluids and esophagogastric decompression. Group III patients received esophagogastric decompression and enteral sterile water through the duodenal feeding lumen. Group IV patients received esophagogastric decompression and infusion of an elemental diet through the feeding lumen. The surgical techniques were standardized for all patients. The results of the study indicated no statistically or clinically significant differences among any of the treatment groups regarding; (1) need for parenteral analgesics or antiemetics, (2) tolerance of regular diet, (3) postoperative day of discharge, and (4) postoperative day that other discharge criteria were met. It is concluded that there is no objective benefit to the routine use of esophagogastric decompression with or without enteral nutrition in elective cholecystectomy patients. (Journal of Parenteral and Enteral Nutrition 13:377–381, 1989)
Efficacy of Tube Feeding in Supplying Energy Requirements of Hospitalized Patients
Authors: Abernathy Gill B. , Heizer William D. , Holcombe Beverly J. , Raasch Ralph H. , Schlegel Kay E. , Hak Lawrence J.
Published: May 2008

During a 6‐week period, all adult patients in a university hospital receiving ready‐to‐feed nasoenteric tube feeding formula were prospectively studied. The study objective was to determine each patient's caloric intake from tube feeding relative to their energy needs and to identify factors causing decreased feeding intake. Each of 35 patients was visited at least once daily to determine their volumetric intake of tube feeding formula. Daily review of patient care records and nursing interviews were used to identify interruptions in therapy. Patient's basal energy expenditures (BEE) were calculated using the Harris‐Benedict equation. Calorie goals were set by members of the Nutrition Support Service or clinical dietitians. Intakes averaged 1095 ± 41 Kcal (SEM) per day or 61% of their mean calorie goal of 1791 ± 41 Kcal. Mean daily calorie intake was statistically different (p < 0.05) from mean energy goal on patient study days 1 through 5, 7, and 8. Only 16 of the 35 patients achieved an intake of 100% of their energy goal on any day of therapy. Calorie goals averaged 1.4 times BEE. Mean daily calorie intake did not exceed BEE until study day 10. Eighteen % of potential feeding time was lost due to temporary feeding interruptions; primarily inadvertent extubation (4.6%), gastrointestinal intolerance (4.7%), medical procedures requiring discontinuation of feeding (2.8%), and feeding tube positioning difficulties (1.5%). In addition, physicians ordered only 75% of calculated energy goals. These data indicate that tube feeding therapy, when provided under usual hospital conditions, does not meet patient's energy requirements. (Journal of Parenteral and Enteral Nutrition 13:387–391, 1989)
Nutrition during Ten‐Week Life Support with Successful Fetal Outcome in a Case with Fatal Maternal Brain Damage
Authors: Nuutinen L.S. , Alahuhta S.M. , Heikkinen J.E.
Published: May 2008

A 31‐year‐old woman had fatal intracerebral bleeding at the beginning of the 21st week of gestation. After several days, there was evidence that the brain was dead. Combined enteral and parenteral nutrition was continued until the 32nd week of gestation when cesarean section was performed because of drug‐resistant hypotension. A full‐term normal 1600‐g male was delivered and the later development of the child was normal. This case report demonstrates the possibility of providing nutritional requirements to the fetus even if the mother has had a fatal injury. (Journal of Parenteral and Enteral Nutrition 13:432–435, 1989)
Steroids and Bowel Rest Versus Elemental Diet in the Treatment of Patients with Crohn's Disease: The Effects on Protein Metabolism and Immune Function
Authors: O'Keefe S.J.D. , Ogden J. , Rund J. , Potter P.
Published: May 2008

Recent studies have shown an elemental diet to be as effective as bowel rest plus steroids in the management of acute Crohn's disease. In order to investigate the metabolic and immunological effects of these two therapies, six patients with an acute inflammatory attack of ileal Crohn's disease were randomly assigned to receive steroids or elemental diet for 7 days. Immunological and protein metabolic studies were performed before and after therapy, protein kinetic rates being measured by the method of constant intravenous infusion of 14C‐labeled leucine tracer. Clinical and symptomatic improvement was noted in all six patients with significant falls in sedimentation rate and platelet counts and increases in albumin concentrations. Both forms of treatment increased plasma amino acid flux and oxidation rates, whole body protein turnover and rates of incorporation of amino acid into albumin. However, the increased rates of protein metabolism in the patients given steroids were at the expense of body protein stores with a net (average) loss of 58 g of nitrogen over 7 days. While both forms of therapy were associated with suppression of lymphocyte subsets, complement and circulating immune complexes only the steroid regimen was associated with suppression of in vivo IgG synthesis rates. The results indicated that both forms of therapy were associated with clinical improvement, increases in protein turnover and evidence of reduced inflammatory activity. However, the beneficial effects of steroid regimen must be balanced against the deleterious effects on body protein stores; steroids and bowel rest without nutritional support should be avoided in malnourised patients. (Journal of Parenteral & Enteral Nutrition 13:455–460, 1989)
Influence of Energy Source upon Body Composition in Patients Receiving Intravenous Nutrition
Authors: Almond D.J. , King R.F.G.J. , Burkinshaw L. , Laughland A. , Mcmahon M.J.
Published: May 2008

The influence of energy substrate upon body composition was investigated by measuring changes in the body composition of 24 patients who received intravenous nutrition for 2 weeks. The patients were randomly allocated to two groups. Twelve patients (the “glucose group”) received all ‘nonprotein’ calories as glucose, the remaining 12 (the “fat‐glucose group”) received 60% of ‘nonprotein’ calories as fat emulsion (Intralipid). Amino acids (FreAmine II) were supplied to give a calorie/nitrogen ratio of 150:1. Total calories were supplied at a rate of 1.4 times the measured resting energy expenditure of each patient. Body composition was measured using routine anthropometric techniques and in vivo neutron activation analysis. Significant increases in body fat and total body potassium (TBK) were recorded in the glucose group, but there was no significant change in total body water (TBW) or total body nitrogen (TBN) in either group. The initial value of the ratio of TBK:TBW had a significant negative correlation with the change of TBK in both groups, and with the change of TBN in the glucose group.

The study demonstrates the importance of considering nutritional status when analyzing the effects of intravenous nutrition. Glucose as the sole source of calories induced an increase in body potassium independent of protein synthesis; this effect was not observed in patients who received 60% of their energy supply as lipid emulsion. (Journal of Parenteral and Enteral Nutrition 13:471–477, 1989)
Plasma and Red Blood Cell Vitamin E Status of Patients on Total Parenteral Nutrition
Authors: Kelly F.J. , Sutton G.L.J.
Published: May 2008

Plasma and red blood cell (RBC) tocopherol isomer (α, β, δ, and γ) concentrations were measured prior to, and following total parenteral nutrition (TPN), with Intralipid. Before feeding, nine of 13 patients had plasma total tocopherol levels < 0.6 mg/dl (normal range 0.63–1.24 mg/dl) and 10 of 13 had total RBC tocopherol levels less than 0.2 mg/dl (normal range (0.20–0.39 mg/dl). Following 7 days TPN plasma vitamin E status increased significantly (p < 0.001). However, this was due mostly to increases in the circulating level of β + γ‐tocopherols. RBC vitamin E status was also significantly increased (p < 0.001) following TPN, however, this was again due to incorporation of non‐α‐tocopherols. In a second study a α‐tocopherol supplement, Vitlipid N, (9.1 mg α‐tocopherol/ day) was included in the feed. In these patients, large increases in plasma concentrations of non‐α‐tocopherol isomers were accompanied by an apparent improvement in α‐tocopherol status (0.64 us 0.44 mg/dl after 7 days). However, RBC α‐tocopherol concentration did not change appreciably in these patients following either 7 or 14 days feeding. It is concluded that RBC vitamin E status is markedly influenced by the available plasma tocopherol pool and that provision of a small supplement of α‐tocopherol is not sufficient to compete with the high concentration of non‐α‐isomers present in Intralipid. TPN utilizing fat emulsions containing high levels of non‐α‐tocopherol isomers (even when accompanied by α‐tocopherol supplements) does not improve α‐tocopherol status. (Journal of Parenteral and Enteral Nutrition 13:510–515, 1989)
Ultrasonography as a Method of Nutritional Assessment
Authors: Chiba Toshio , Lloyd David A. , Bowen A'Delbert , Condon‐Meyers Ann
Published: May 2008

The composition of the upper arms of five healthy individuals was measured by anthropometry (AN), ultrasonography (US), and computerized tomography (CT). Measurements of midarm fat area (MAFA) and midarm muscle area (MAMA) by CT correlated well with AN and US, but both AN and US overestimated MAMA by 22.8 ± 17% and 10 ± 12%, respectively, (mean ± SD). The overestimate was largest with AN because with this method bone area cannot be excluded. To evaluate the usefulness of US measurements, 10 patients with advanced liver disease were studied. Measurement of MAFA by US, using triceps skinfold thickness as the standard, was found to be an accurate index of fat stores. MAMA measured by US correlated well with lean muscle mass, using creatinine height index as the standard. Ultrasonography is a reliable method of measuring body fat and lean muscle status. (Journal of Parenteral and Enteral Nutrition 13:529–534, 1989)
Insulin Adsorption to Three‐Liter Ethylen Vinyl Acetate Bags during 24‐Hour Infusion
Authors: Doglietto G.B. , Bellantone R. , Bossola M. , Perri V. , Ratto C. , Pacelli F. , Sofo L. , Migliore A. , Manna R. , Crucitti F.
Published: May 2008

Insulin adsorption to ethylen vinyl acetate, 3‐liter bags injected with 10 insulin units, during 24‐hr infusion has been studied. Three different infusions systems (A, B, and C) were tested and eight bags for each system were used. An elevated insulin adsorption resulted in each system. The maximal insulin recovery, expressed as percentage of the original theoretical 3333 microIU/ml insulin concentration, was 19.54% (at time 6), 20.93% (at time 4), and 16.95% (at time 22) for system A, B, and C, respectively. “Dismissed insulin amount” after 24‐hr infusion was 1590 ± 279.5 microIU, 1505.8 ± 430.5 microIU, and 1253.3 ± 369.8 microIU for system A, B, and C, respectively. Comparison of insulin concentration values at different times revealed significant differences only at time 18 (if compared with times 0,2.4,6,8,12,14,16) ant at time 20 (if compared with time 4,6,8,10) for system A, and at time 4 (if compared with time 12,14,16,18,20,22,24) for system B. We conclude that a constant but low insulin delivery can be achieved using 3‐liter EVA systems and a 24‐hr infusion. (Journal of Parenteral and Enteral Nutrition 13:539–543, 1989)
The Absence of the Diet‐Derived 7‐Deazapurine, Queuine in Artificial Liquid Diets
Authors: Reyniers Jon P. , Katze Jon , Farkas W.R.
Published: May 2008

Queuine is a derivative of guanine found in the transfer RNAs of most organisms including man. Higher mammals cannot synthesize queuine and must obtain it either from their diets or intestinal microflora. Tumor cells often contain much less queuine in their transfer RNAs than do normal cells. Cancer patients are frequently fed artificial liquid diets or are nourished by chemically defined intravenously administered liquids. In this report we present the results of our examination of five common artificial nutrition preparations obtained from a hospital pharmacy with respect to their content of queuine. (Journal of Parenteral and Enteral Nutrition 13:542–544,1989)
Maintenance of Small Bowel Mucosa with Glutamine‐Enriched Parenteral Nutrition
Authors: O'Dwyer Sarah T. , Smith Robert J. , Hwang Tsann L. , Wilmore Douglas W.
Published: May 2008

Glutamine is an important fuel utilized by the intestinal mucosa that is not present in standard amino acid nutrition solutions. In order to determine the effects of glutamine on the intestine, glutamine enriched nutrition was administered intravenously to male Wistar rats. A standard amino acid solution was enriched with 1 and 2 g/100 ml of glutamine or glycine and used as part of a parenteral nutrition regime for 7 days. Intestinal samples were taken for measurements of jejunal weight, DNA, protein, mucosal thickness and villus height. Animals receiving 2 g glutamine/100 ml in the nutrition solution had increased intestinal weight, DNA, and villus height when compared to animals receiving 2 g/100 ml of glycine. No increase in the intestinal parameters was noted when 1 g/100 ml of glutamine was used. To investigate the dose‐response effects of glutamine, further studies were performed using iso‐nitrogenous and isocaloric solutions containing 0, 2, and 3 g of glutamine/100 ml. Animals receiving glutamine had a significant increase in mucosal weight, DNA, protein and villus height when compared to animals receiving no glutamine in the parenteral solutions. There was a dose‐response relationship between the increase in jejunal DNA and the increased intake of glutamine (r = 0.93, p < 0.01) but no correlation with the nitrogen content of the solutions (r = 0.18, p = 0.8). Total body nitrogen retention was greater in animals receiving 2 g/100 ml of glutamine (166 ± 12 mg, days 6/7) when compared to those receiving 0 and 3 g of glutamine/100 ml (126 ± 14 mg and 138 ± 16 mg, respectively, p < 0.05). These studies demonstrate that glutamine enriched nutrition protects against atrophy of the intestinal mucosa and when given at 2 g/100 ml improves nitrogen retention during intravenous feeding. (Journal of Parenteral and Enteral Nutrition 13:579–585, 1989)
Lipid Tolerance in the Very Low Birth Weight Infant on Intravenous and Enteral Feedings
Authors: Wells David H. , Ferlauto Jerry J. , Forbes Debbie J. , Graham Tony R. , Newell Robert W. , Wareham John A. , Wilson Catherine A.
Published: May 2008

Nutrition is of critical importance to very low birth weight (VLBW) survival. Intravenous (iv) lipid tolerance has been studied using a soybean or safflower‐based lipid emulsion. We studied lipid levels in a group of VLBW infants on both intravenous lipids (soybean‐safflower emulsion) and on enteral feedings (24 cal/oz premature formula). Levels were obtained on 1, 2, and 3 g/kg/day of iv lipid and after 3 and 10 days of feeding.

Triglyceride (TG) and free fatty acid (FFA) proved the most sensitive indicator of both iv and enteral tolerance. The higher the lipid dose, the more likely there would be elevated lipid levels, especially FFA. Mean lipid levels for the group of enteral‐fed infants were normal. Comparison of lipid levels on iv to those on enteral feedings showed significant differences in trough iv levels of TG compared to preprandial TG. FFAs tended to be significantly higher on iv feedings. Monitoring lipid levels on iv and enteral feedings is appropriate to document tolerance. (Journal of Parenteral and Enteral Nutrition 13:623–627, 1989)
Metabolic rate and weight loss in chronic obstructive lung disease
Authors: Wilson DO , Donahoe M , Rogers RM , Pennock BE
Published: May 2008

Although weight loss is a common problem in chronic obstructive pulmonary disease (COPD), the precise cause of malnutrition in COPD patients is not known. The purpose of this study was to measure and compare resting energy expenditure (REE) in stable undernourished and adequately nourished COPD. REE was measured in normal, adequately nourished, and undernourished COPD patients by indirect calorimetry and then compared to predicted basal metabolic rate (BMR) calculated from the Harris‐Benedict equation. We found that measured REE, compared to predicted, was significantly higher in the undernourished group, (1.15 +/‐ 0.02) and compared to the adequately nourished COPD (0.99 +/‐ 0.03) and normal groups (0.93 +/‐ 0.02) (p less than 0.0001). We conclude that there is a hypermetabolic state in stable malnourished COPD patients which may be a factor in weight loss. This elevated REE also needs to be taken into account when determining caloric requirements for COPD patients.
Pharmacological concentrations of lipid emulsions inhibit interleukin‐2‐dependent lymphocyte responses in vitro
Authors: Sedman PC , Ramsden CW , Brennan TG , Guillou PJ
Published: May 2008

Most immunological functions are accomplished by means of interactions between mediator molecules (cytokines or lymphokines) and their specific receptors on the lymphocyte surface. One particular lymphokine, Interleukin‐2 (IL‐2) is central to the generation of most immune responses including those with antitumor activity. Prompted by two clinical trials which have suggested distinct but apparently opposite effects of lipid emulsions on the production of and lymphocyte responses to IL‐2 we have examined the effects of pharmacological concentrations of three lipid emulsions currently in clinical use on IL‐2 related interactions in vitro. Mitogen‐stimulated and IL‐2 activated human lymphocyte proliferation were both inhibited in a dose‐dependent manner in the presence of all three lipid emulsions although the effects were less marked with the solution in which 50% of the calories are present as medium‐chain triglycerides (MCT) rather than long‐chain triglycerides (LCT). Similarly the LCT, but less so the MCT‐containing solutions inhibited the generation of cytotoxic lymphokine‐activated killer cells. These solutions did not inhibit the proliferation of cell lines which are not growth‐factor dependent but did inhibit the growth of an IL‐2‐dependent cell line. We conclude that lipid emulsions can upset IL‐2‐dependent lymphocyte responses. These observations may lead to parenteral feeding regimens which are less immunocompromising for the tumor‐bearing patient.
Growth response to enteral feeding by children with cerebral palsy
Authors: Sanders KD , Cox K , Cannon R , Blanchard D , Pitcher J , Papathakis P , Varella L , Maughan R
Published: May 2008

This study evaluated the growth of 51 children with cerebral palsy after the initiation of enteral tube feedings. The children were divided into three groups according to how soon after their central nervous system (CNS) insult they were started on enteral feedings. Group 1 consisted of 14 children who were within a year of their CNS insult; they were underweight for age, but had normal length as well as weight for length. Within 6 months of initiating enteral tube feedings, most children in this group had normalized their weights. Group 2 consisted of 27 children who were within 8 years of their CNS insult; they were stunted and were underweight for both their age and their length. Within 6 months of initiating enteral feeds, the group increased both weight and weight for length to near normal, but their gains in length reached a plateau at 90% of ideal for age. Group 3 consisted of 10 children who were more than 8 years after their CNS insult. This group was severely malnourished but had some improvement in their weight for age and for length but, length for age showed no significant change. We conclude that the earlier adequate nutritional management of children with severe cerebral palsy is initiated, the more readily the nutritional deficits will reverse.
Blood and tissue tocopherol levels in rats following intraperitoneally administered alpha‐tocopheryl acetate
Authors: McGee CD , Greenwood CE , Jeejeebhoy KN
Published: May 2008

The correction or maintenance of blood and tissue alpha‐tocopherol (alpha‐Toc) levels by intraperitoneally administered all‐rac‐alpha‐tocopheryl acetate (alpha‐Tac) was compared with RRR‐ alpha‐tocopherol (alpha‐Toc) in vitamin E‐depleted and control rats. Rats received 1.3 TE vitamin E daily for 7 days. alpha‐Tac was detected in plasma of one‐third of alpha‐Tac‐treated rats 24 hr after the first treatment, although not in subsequent samplings. Both alpha‐Tac and alpha‐Toc increased tocopherol levels in plasma and liver of E‐deprived rats, while little or no change was observed in adipose tissue and brain. Similarly, control rats treated with alpha‐Tac or alpha‐Toc had significantly greater (p less than 0.05) plasma and liver alpha‐Toc levels at day 3 and day 7 than did saline‐treated rats. There was no significant difference in adipose alpha‐Toc levels among treatment groups of control rats. The results of this study suggest that alpha‐Tac is rapidly hydrolyzed to its biologically active alcohol form and results in similar effects to that of intraperitoneally administered alpha‐Toc.
Serum iron, zinc, copper, selenium, and bromide concentrations after coronary bypass operation
Authors: Antila H , Salo M , Nanto V , Irjala K , Brenner R , Vapaavuori M
Published: May 2008

The effect of surgical trauma on serum trace elements was studied in 10 patients undergoing coronary bypass surgery. After the initial decrease due to the hemodilution during operation serum iron, zinc, copper and selenium remained depressed for the immediate postoperative period. Zinc was still at significantly lower level 2 months after the operation. Low serum iron values were also observed. Changes in trace element concentrations were parallel with changes in the concentrations of their transport and binding proteins in the serum. The multielemental technique also measured nonessential bromide, which returned to initial levels in 7 days. Effects of trauma on metabolism, acute phase reaction with redistribution of zinc and copper and losses via increased urinary excretion explain the above changes. Development of a subclinical deficiency of zinc and possibly iron is suggested by the persistence of low serum levels during recovery after operation.
Case report of an allergic reaction to parenteral nutrition in a pediatric patient
Authors: Bullock L , Etchason E , Fitzgerald JF , McGuire WA
Published: May 2008

We report a 34‐month‐old girl with stage IV neuroblastoma who developed hives when parenteral nutrition (PN) containing amino acids, dextrose, electrolytes, minerals, vitamins, and trace elements was infused. Administration of diphenhydramine resulted in disappearance of the rash. Infusion of the PN solution without intravenous fat emulsion produced a similar rash with itching. The pediatric multiple vitamin (PMV) preparation was removed from the PN formula and the formula was infused without incident. The patient was maintained on PN and an oral vitamin supplement with no further complaints. Inadvertent administration of a PN solution containing PMV resulted in a recurrence of hives. Absence of any adverse reactions when the PMV preparation was removed from the PN solution and an allergic reaction when the multivitamin was added to the PN solution support the possibility that the allergic reaction was related to the infusion of the multiple vitamin preparation.
Bioelectrical impedance analysis for body composition: clinical evaluation in general surgical patients
Authors: Schroeder D , Christie PM , Hill GL
Published: May 2008

Body composition was measured in 112 surgical patients and eight normal subjects by bioelectrical impedance analysis (BIA), and the results compared with our standard five‐compartment method utilizing in vivo neutron activation analysis and tritium dilution space to measure fat‐free mass and total body water. In a population with a mean fat‐free mass of 49.2 kg by the latter method, BIA underestimated fat‐free mass by 1.3 kg, with a standard deviation (SD) of 4.0 kg. Total body water was overestimated by 0.5 liter, with SD of 0.47 liter, when compared to a mean tritium dilution space of 36.7 liter. Changes in total body water which occurred over a treatment period of at least 1 week were also measured by the two methods. The change as measured by isotopic dilution could be estimated from the change as measured by BIA with a standard error of 2.25 liter. Although the results suggest that BIA should not be used as a research tool, it is concluded that in clinical practice, when nutrient requirements are being estimated, fat‐free mass measured by BIA may have a useful place.
Progressive bone loss during long‐term home total parenteral nutrition
Authors: Foldes J , Rimon B , Muggia‐Sullam M , Gimmon Z , Leichter I , Steinberg R , Menczel J , Freund HR
Published: May 2008

Metabolic bone disease occurs in patients receiving prolonged home total parenteral nutrition (HTPN). We studied bone‐mass status in 10 patients (seven males, three females, age 19–66 years) who had been receiving HTPN for 0 to 67 months (mean 24 months), mostly for short‐bowel syndrome. Four patients had spinal osteoporosis on radiograms. The density of various bone components at the wrist was measured noninvasively using a novel technique based on Compton scattering effect. The density of the cancellous and cortical bone was decreased in nine and six patients, respectively. During a follow‐up period of up to 19 months, a further significant decrease in the density of both bone components was found. We conclude that prolonged HTPN is associated with an ongoing bone diminution, affecting mainly the cancellous bone.
Incidence of arrhythmia with central venous catheter insertion and exchange
Authors: Stuart RK , Shikora SA , Akerman P , Lowell JA , Baxter JK , Apovian C , Champagne C , Jennings A , Keane‐Ellison M , Bistrian BR
Published: May 2008

The risk of complication during the insertion or exchange of central venous catheters has been well documented. The majority of complications involve mechanical problems associated with insertion. Although cardiac arrhythmia has been acknowledged as a possible complication, its incidence has never been quantified. We performed cardiac monitoring on patients during 51 central venous catheter insertions or exchanges to determine the incidence of cardiac arrhythmias during guidewire insertion. Forty‐one percent of procedures resulted in atrial arrhythmias and 25% produced some degree of ventricular ectopy, 30% of these were ventricular couplets or greater. Ventricular ectopy was significantly more common in shorter patients (160 +/‐ 8 vs 168 +/‐ 11 cm, p less than 0.05) and when the catheter was inserted from the right subclavian position (43% ventricular ectopy vs 10% at the other sites). Other variables such as age, cardiac history, serum potassium, type of procedure, and catheter brand were not significant. It is our conclusion that over‐insertion of the wire causes this cardiac stimulation. Despite the absence of morbidity or mortality in this study, this incidence of ventricular ectopy indicates that there is a distinct possibility of a malignant arrhythmia being precipitated by a guidewire. Some modification of the current protocol for these procedures seems indicated.