bluuebunny/crossref_metadata_2025 huggingface dataset:
Cardiac beta‐adrenergic responsiveness is well preserved in moderate protein calorie malnutrition from semistarvation
Authors: Stahl TJ , Alden PB , Madoff RD , Ring WS , Cerra FB
Published: May 2008

Twenty‐one dogs underwent instrumentation of the left ventricle with ultrasonic dimension to study the effects of acute protein‐calorie malnutrition on the adrenergic responsiveness of the heart. This study allowed a chronic and dynamic measurement of the major cardiac axes and the ventricular wall thickness, which in turn can be used to derive sophisticated measurements of global and intrinsic left ventricular function. Of the 21 dogs, 11 received a protein‐ and calorie‐deficient diet designed to achieve a mean weight loss from a baseline of 20–25% over a 4‐week period. The other 10 dogs received a normal diet. Dogs were also randomized to receive either acute propranolol beta‐receptor blockade (n = 9) or acute isoproterenol beta‐receptor stimulation (n = 12) during their baseline studies. Of the nine dogs given propranolol, five were subsequently malnourished and four served as controls. Of the 12 given isoproterenol, six were rendered malnourished and six were controls. All dogs were studied at both baseline and 4 weeks and received drugs in an identical fashion during both studies. The significant changes with malnutrition consisted of decreases in heart rate, cardiac mass, and left ventricular wall thickness. The degree of change in stroke volume, ejection fraction, cardiac output, dp/dt, and Emax (index of left ventricular contractility), with the administration of propranolol or isoproterenol was unaltered by malnutrition. These data support the contention that moderate protein‐calorie malnutrition is well tolerated in instrumented, unstessed dogs and that the left ventricle's capacity to respond to beta‐stimulation and to tolerate beta‐blockade is largely unimpaired.
Differences in the Serum Amino Acid Pattern of Injured and Infected Children Promoted by Two Parenteral Nutrition Solutions
Authors: Maldonado J. , Gil A. , Faus M.J. , Periago J.L. , Loscertales M. , Molina J.A.
Published: May 2008

The effects of two parenteral nutrition (PN) amino acid solutions (FreAmine II and F080) on the serum amino acid levels of 51 children, 27 affected by multiple trauma and 24 by bacterial sepsis, and aged from 1 month to 12 years, were studied. Serum amino acids were determined on day 1 immediately before administrating PN, and on day 5 during PN. Trauma patients on F080 exhibited higher levels of alanine, aspartate, asparagine, leucine, isoleucine, valine, total branched‐chain amino acids (BCAA) and total essential amino acids than those on FreAmine II; in contrast septic children showed similar levels of serum amino acids on both PN solutions. BCAA were lower in septics than in trauma patients, probably as a consequence of an increased utilization of these amino acids in sepsis because of the higher organ protein synthesis typical of this situation. The phenylalanine/tyrosine ratio was found elevated both in septic and trauma children, but it decreased after PN in the latter when using an enriched BCAA solution. Utilization of this solution, partly corrects the metabolic disturbances induced by stress, but the metabolical responses induced either by sepsis or trauma are partially different which may have important implications for patient care. (Journal of Parenteral and Enteral Nutrition 13:41–46, 1989)
Effects of Nucleosides and a Nucleotide on DNA and RNA Syntheses by the Salvage and De Novo Pathway in Primary Monolayer Cultures of Hepatocytes and Hepatoma Cells
Authors: Ohyanagi Harumasa , Nishimatsu Shinichi , Kanbara Yoshihiro , Usami Makoto , Saitoh Yoichi
Published: May 2008

Studies were made on the effects of inosine, guanosine 5′‐monophosphate (GMP), cytidine, uridine, thymidine, and their mixture (4:4:4:3:1, OG‐VI) on DNA and RNA syntheses in primary monolayer cultures of normal hepatocytes and cultures of hepatoma cells, AH130, to use these compounds for total parenteral nutrition. Addition of an appropriate amount of inosine, GMP, uridine, or thymidine to primary cultures of hepatocytes enhanced both DNA and RNA syntheses by the salvage and de novo pathways. Cytidine appeared to have lower optimal concentration for enhancing these pathways. The OG‐VI mixture also enhanced the syntheses of DNA and RNA, but the composition of the mixture was not optimal. Additions of inosine, GMP, uridine, and thymidine to cultured hepatoma cells also enhanced their DNA and RNA syntheses, but the cells consumed more of the added nucleic acid compounds than hepatocytes did. Addition of cytidine had no effect on proliferation of the cells. The OG‐VI mixture at relatively higher concentration inhibited the syntheses of DNA and RNA by hepatoma cells. Addition of high concentrations of nucleic acid compounds was found to suppress the proliferation of both hepatocytes and hepatoma cells. These results suggest that addition of optimal amounts of nucleic acid compounds such as nucleosides and nucleotides would enhance growth of hepatocytes, particularly during liver regeneration, but that they may also enhance proliferation of tumor cells in the liver. (Journal of Parenteral and Enteral Nutrition 13:51–58, 1989)
Serotonin Metabolism in the Central Nervous System in Portacaval Shunted Rats Infused with Fat Emulsion
Authors: Bengtsson Finn , Bugge Mogens , Herlin Per , Nobin Anders , Jeppsson Bengt
Published: May 2008

Increased brain concentrations of tryptophan, and presumably thereby increased brain serotonin metabolism, have been observed following liver impairment and implicated in the etiology of portal‐systemic encephalopathy (PSE). Increased plasma‐free tryptophan (ie, not albumin‐bound) concentrations can be expected after exogenous fat administration. This might further increase the brain serotonin metabolism in liver failure and negatively influence the PSE.

We treated rats 2 weeks after end‐to‐side portacaval shunt (PCS) with continous intravenous infusion of fat emulsion (Intralipid 20%) for 24 and 72 hr, respectively. The regional serotonin turnover was determined in different regions of the central nervous system (CNS) by measuring 5‐hydroxyindole concentrations after NSD 1015 decarboxylase inhibition. The results revealed no further increase of the CNS serotonin turnover after fat infusion to PCS rats, compared with PCS rats given equal amounts of glucose. Thus, continuous infusion of a fat emulsion caused no major alteration of the CNS serotonin metabolism in PCS rats. (Journal of Parenteral and Enteral Nutrition 13:65–70, 1989)
Impact of Medicare Prospective Reimbursement System on Nutritional Support Service Patients: The Importance of Pass Throughs
Authors: Clemmer Terry P. , Orme James F. , Thomas Frank O. , Peterson Marilee , Merrow Linde , Peterson Helene
Published: May 2008

The financial data of all patients (535) admitted to the Nutritional Support Service (NSS) during 1985, including charges, true care costs, and actual reimbursement including pass‐through payments (which are Medicare funds given directly to hospitals for education and capital equipment, and vary significantly from hospital to hospital), were analyzed. The NSS Medicare patients fell into 98 diagnostic related groups (DRGs). All 3,939 Medicare patients admitted in 1985 with the same DRGs as the NSS patients were also identified and their financial data analyzed. The NSS patients lost $999,643 because the 266 medicare reimbursed NSS patients sustained high losses which overwhelmed the modest profits of the 269 non‐Medicare patients. When data from all Medicare patients (which includes both NSS and non‐NSS patients) with the same DRGs are analyzed, large profits are realized. These profits are totally due to pass‐through payments received. Without pass throughs the loss for all 3,939 Medicare patients in these 98 DRGs would have been $1,641,273. The impact of eliminating pass throughs in the next few years needs to be determined. NSS patients represent a group that generates high financial losses under the federal prospective reimbursement system. However, present Medicare reimbursement of other less seriously ill patients with similar DRGs more than compensate these losses if pass throughs are used in determining reimbursements. (Journal of Parenteral and Enteral Nutrition 13:71–76, 1989)
Clearing Obstructed Feeding Tubes
Authors: Marcuard Stefan P. , Stegall Karen L. , Trogdon Sidney
Published: May 2008

This is a report of an in vitro study evaluating the ability of six solutions to dissolve clotted enteral feeding, which can cause feeding tube occlusion. The following clotted enteral feeding products were tested: Ensure Plus, Ensure Plus with added protein (Promod 20 g/liter), Osmolite, Enrich, and Pulmocare. Clot dissolution was then tested by adding Adolf's Meat Tenderizer, Viokase, Sprite, Pepsi, Coke, or Mountain Dew. Distilled water served as control. Dissolution score for each mixture was assessed blindly. Best dissolution was observed with Viokase in pH 7.9 solution (p < 0.01). Similar results were obtained when feeding tube patency was restored in eight in vitro occluded feeding tubes (Dobbhoff, French size 8) by using first Pepsi (two/eight successful) and then Viokase in pH 7.9 (six/six successful).

We also report our experience in the first 10 patients with occluded feeding tubes using this Viokase solution injected through a Drum catheter into the feeding tube. In seven patients, this method proved to be successful, and the reasons for failure in three patients include a knotted tube, impacted tablet powder, and a formula clot of 24 hr duration and 45 cm in length. (Journal of Parenteral and Enteral Nutrition 13:81–83, 1989)
In Situ Breakage of a Totally Implanted Venous Access System
Authors: Kirvelä Olli , Satokari Kauko
Published: May 2008

Totally implantable systems for venous access are now in wide clinical use. They have been shown to have several advantages when compared with earlier systems. However, the advantages of total implantation also contain risks for new complications. In situ breakages may have disastrous results when unnoticed. In situ separations have been reported with systems consisting of a separate reservoir and catheter. A case is reported where in situ breakage occurred in a system with prefixed catheter. The catheter migrated into pulmonary artery and was removed with Odman catheter and foreign body extractor. The precise cause for the separation could not be ascertained. It is emphasized that during insertion the silicone catheter should not be handled with surgical instruments and that the continuity of the system should be checked prior to use. (Journal of Parenteral and Enteral Nutrition 13:99–101, 1989)
Attenuation of the Febrile Response in Guinea Pigs by Fish Oil Enriched Diets
Authors: Pomposelli James J. , Mascioli Edward A. , Bistrian Bruce R. , Lopes Sarah M. , Blackburn George L.
Published: May 2008

The influence of dietary lipid manipulation on the fever response to an injection of murine recombinant Interleukin‐1 (rIL‐1) in guinea pigs was examined. The animals were fed diets identical except for the lipid source for periods of 5 and 6 wk. In vitro thromboxane B2/B3 (TxB2/B3) production in collagen‐stimulated whole blood was also measured. One diet was enriched with menhaden oil, high in the omega‐3 series of fatty acids. The other diet contained safflower oil, consisting primarily of the omega‐6 fatty acid linoleic acid (74%). Animals fed the fish oil‐enriched diet for 6 wk not 5 week had a blunted fever response after rIL‐1 injection. This was associated with a 27% increase (p < 0.05) in total omega‐3 fatty acids in plasma phospholipids between weeks 5 and 6 in fish oil‐fed animals. Safflower oil‐fed animals produced a “normal” febrile response regardless of the duration of feeding. Safflower‐fed guinea pigs demonstrated a significant increase in TxB2/B3 production in whole blood after 6 wks that was associated with a 25% increase (p < 0.05) in plasma phospholipid arachidonic acid levels between weeks 5 and 6. Despite significant reductions in phospholipid linoleic acid in animals fed fish oil, arachidonic acid levels remained unchanged.

In the guinea pig model used, long‐term menhaden oil feeding can significantly blunt the febrile response induced by exogenous Interleukin‐1. Also, a high intake of linoleic acid as seen in safflower oil feeding can significantly increase thromboxane production in stimulated whole blood. Thus, the type of fatty acids available at the substrate level could affect the physiologic response to injury and/or infection. (Journal of Parenteral and Enteral Nutrition 13:136–140, 1989)
A Mortality Risk Index for Men in a Veterans Administration Extended Care Facility
Authors: Rudman Daniel , Mattson Dale E. , Feller Axel G. , Nagraj Hoskote S.
Published: May 2008

The purpose of this study was to develop (phase I) and validate (phase II) a mortality prognostic index, based on the annual clinical data base, for the men of this Veterans Administration extended care facility.

The study population during phase I consisted of 123 men who were residing in three of the seven wards of the facility in August 1984. Sixty‐six of these individuals were institutionalized because of a chronic neurologic (50) or medical (15) disorder (“nonpsychiatric group”). In 57 men, the reason for institutionalization was a chronic psychosis (schizophrenia, 53; manic depressive illness, 4) (“psychiatric group”). During August to October 1984, a comprehensive clinical data base comprising 70 attributes (including diagnoses and drugs) was collected. Deaths were recorded during the next 14 months. Death rate during the 14 months of observation was 33.3% in the nonpsychiatric group, and only 1.7% in the psychiatric group. In the nonpsychiatric men, univariate analysis yielded six attributes significantly correlated with death rate: serum cholesterol level, hematocrit, hemoglobin, midarm muscle circumference, triceps skinfold, and number of morbidity episodes. After serum cholesterol and hematocrit had been entered into a multivariate analysis model, none of the other four attributes contributed significant information about death rate. The multivariate analysis led to a mortality risk index (MRI) for nonpsychiatric patients, MRI = [hematocrit in %] + 10% [serum cholesterol in mg/dl]. As MRI varied from <50 to >65, death rate in the nonpsychiatric group varied in parallel from 86–11%. At the cut‐off level MRI = 60, sensitivity was 0.86, specificity was 0.66, positive predictive accuracy was 0.56 and correct classification was 0.73. The odds ratio for the same cut‐off level was 12.2.

In phase II, the study population was 116 nonpsychiatric men residing in the remaining four wards of the Extended Care Facility in August 1984. Mortality rate during the 14 months after August 1984 was 31%. The relation of death rate to MRI was generally similar to that observed for the nonpsychiatric men in phase I of the study.

When data of phases I and II were combined and cut‐off point of 60 on the MRI was chosen, the odds ratio was 6.45. (Journal of Parenteral and Enteral Nutrition 13 :189–195, 1989)
Patterns of Care: An Analysis of the Quality of Nutritional Care Routinely Provided to Elderly Hospitalized Veterans
Authors: Sullivan Dennis H. , Sha Moriarty Mary , Chernoff Ronni , Lipschitz David A.
Published: May 2008

To assess the adequacy of the nutritional care provided, a prospective noninterventional study was carried out on 250 randomly selected patients aged 65 and over who were admitted to a Veterans Administration Hospital. Of this group, 97 patients (39%) were found to be at high risk of having clinically significant protein‐energy malnutrition. In 43 cases (17%), an assessment of the patient's nutritional status was not possible because the available data were inadequate. No patient had a diagnosis of malnutrition recorded on the problem list. Only 13 percent of the high‐risk patients received some form of nutrition support therapy; 10 (10%) received oral supplements, and four (4%) were started on enteral feedings. Patients who received enteral feedings experienced a high rate of complications resulting from use of the feeding tubes. Over all, none of the high risk study patients received optimal nutrition support therapy. These findings indicate that elderly patients hospitalized in the Veterans Administration hospital in this study are usually not screened appropriately for protein‐energy malnutrition, the diagnosis is frequently missed or ignored, and nutrition support therapy is underutilized and often ineffectually managed. (Journal of Parenteral and Enteral Nutrition 13:249–254, 1989)
Survey of Home Nutritional Support Patients
Authors: Herfindal Eric T. , Bernstein Linda R. , Kudzia Kathryn , Wong Alvin
Published: May 2008

Patients receiving home parenteral nutritional services from a major corporate provider were surveyed using a written questionnaire. The survey questioned the patients about use of home parenteral nutritional services and the quality of life while receiving home parenteral therapy. Patient satisfaction with home nutritional support services, and the impact home therapy has on patient medical, financial and psychosocial status were examined. Life satisfaction measures were compared with that of end stage renal disease patients and the overall United States population.

Of the 1140 patients sent the written questionnaire, 347 (30.4%) returned the survey. Half the patients had been placed on home parenteral nutrition services because of short bowel syndrome. The mean length of time respondents had been receiving home parenteral nutrition services was 35 months, reporting approximately one hospitalization per year due to complications of their home parenteral nutrition. Blood infection with catheter as focus was most frequently reported as being responsible for hospitalization. The number of hospitalizations due to complications of home parenteral nutrition therapy was positively correlated with length of time on the program. Overall, respondents were satisfied with their home nutrition services, but were less satisfied with life as a whole when compared to the overall United States population and to end stage renal disease patients. (Journal of Parenteral and Enteral Nutrition 13:255–261, 1989)
Subjective Distress during Continuous Enteral Alimentation: Superiority of Silicone Rubber to Polyurethane
Authors: Herrmann Maria‐E. , Liehr Ralf‐Marco , Tanhoefner Heike , Riecken Ernst Otto
Published: May 2008

A small‐bore feeding tube of silicone rubber was developed in order to improve the acceptance of enteral feeding. The insertion procedure was facilitated by providing a double guidewire which allows continuous adjustment of tip rigidity. The usefulness of this tube was tested in a short‐term and a long‐term volunteer study as well as in a prospective follow‐up of patients receiving enteral nutrition. The volunteer study showed that the newly developed tube significantly reduced subjective distress (rank value 14) when compared to a conventional tube made of polyurethane (rank value 20). In the patient study, 131 silicone rubber tubes were used in 85 patients who received enteral nutrition for a total period of 2080 days and complained about foreign‐body feeling and rhinorrhea in only 3.7% and 0.5% of the days, respectively. The rate of inadvertent removals was relatively low (32%), mainly due to restricted mental status of the patients. (Journal of Parenteral and Enteral Nutrition 13:281–285, 1989)
Review: Neonatal Parenteral Nutrition with Medium‐Chain Triglycerides: Rationale for Research
Authors: Lima L.A.M.
Published: May 2008

With the advances in technology stable fat emulsions containing medium‐chain triglycerides (MCT) became available. Intravenous MCT are readily utilizable energy source because they reach the liver rapidly and their medium‐chain fatty acids (MCFA) are oxidized through carnitine‐independent mechanisms. However the MCFA can also be deviated to alternative oxidation pathways which results in urinary excretion of metabolites. The metabolic effects of intravenous MCT containing fat emulsions are discussed and emphasis is given in the possible role of these fats in parenteral nutrition of preterm infants, who are carnitine depleted. Directions of future research are speculated. (Journal of Parenteral and Enteral Nutrition 13:312–317, 1989)
A Modified Method of Vascular Access System Implantation Using the Subclavian Vein
Authors: Sweeney W. Brian
Published: May 2008

A new method of implanting vascular access systems using the Arrow Percutaneous Sheath Introducer Kit is described. The surgeon who frequently inserts these systems may find this technique to be a useful alternative in those patients in whom cutdowns were unsuccessful or in whom the percutaneous technique with a peel‐away sheath is found to be difficult. (Journal of Parenteral and Enteral Nutrition 13:329–330, 1989)
Catabolic Effect of Dexamethasone in Patients with Major Head Injuries
Authors: Greenblatt Samuel H. , Long Calvin L. , Blakemore William S. , Dennis Robert S. , Rayport Mark , Geiger John W.
Published: May 2008

In the records of our extensive metabolic studies on trauma victims, we found 16 head injured patients who had no other major injuries. Among them, nine had been given dexamethasone for at least 6 days. The other seven had not received any corticosteroids. There was no significant difference in the Glasgow Coma Scales of the treated and untreated groups. Metabolic balance studies were carried out for at least 3 days, including the periods when the treated patients were receiving dexamethasone. Mean nitrogen balance was ‐0.296 ± 0.03 g/kg/day for the treated group and ‐0.182 ± 0.03 g/kg/ day for the untreated group. This difference was significant (p = 0.02, t‐test). Our metabolic data are also consistent with those of other published studies, which used other corticosteroids and somewhat different methodologies. Thus, it is clearly established that corticosteroids cause significant degrees of catabolism in head injured patients, beyond what would “normally” be expected in such patients if they did not receive these drugs. (Journal of Parenteral and Enteral Nutrition 13:372–376, 1989)
Review: Effects of Artificial Nutrition on the Nutritional Status of Cancer Patients
Authors: Bozzetti Federico
Published: May 2008

The paper critically analyzes available data on the nutritional and metabolic effects of total parenteral nutrition (TPN) and enteral nutrition (EN) in cachectic cancer patients. Only papers dealing with adult cancer patients and providing data regarding type of tumor, duration of the nutritional support, and administration rate of calories and amino acids, validated by statistical analysis of the results, are included. The main conclusions are the following: (1) No nutritional variable worsened in cancer patients receiving TPN or EN, in conditions in which progressive deterioration of the nutritional status is the rule. (2) The nutritional variables improved by TPN and EN were body weight, fat mass, and some indicators of lean body mass (nitrogen balance and whole body potassium). Thyroxin‐binding prealbumin and retinol‐binding protein increased only with TPN, whereas some immunologic indexes (complement factors and lymphocytes) improved only with EN. (3) The daily regimens which improved lean body mass and visceral proteins ranged from 35 to 55 kcal/ kg and from 1.2 to 2.0 g of amino acids/kg for TPN; for EN it was 35 kcal/kg and 1.3 g of amino acids/kg. However, the enteral regimen capable of improving some immune responses included at least 42 kcal/kg and 2.3 g of amino acids/kg. (4) Only three randomized studies were performed to compare TPN and EN, and conflicting results were obtained. Only TPN showed some significant advantages with regard to weight gain, nitrogen balance, maintenance of serum albumin levels and some mineral balances. However, the advantage of TPN was not clear enough to recommend its indiscriminate use. The choice between TPN and EN should always consider the functionality of the GI tract, the need for hospitalization to start a TPN regimen, and the higher cost of intravenous feeding. (5) When comparing TPN to a standard oral diet, the following variables improved with the nutritional support: body weight, nitrogen balance, 3‐methylhistidine, urinary excretion, and serum levels of transferrin, cholinesterase, thyroxin‐binding prealbumin, and retinol‐binding protein. (6) When comparing TPN with glucose vs TPN with glucose‐lipids, no major difference was found with regard to most nutritional variables. In conclusion, nutritional support alone probably has a small role in managing a limited number of advanced cancer patients dying primarily because of malnutrition or mainly suffering from nutritional deterioration. It can also have a “permissive” role in those patients potentially candidate to an oncologic treatment which cannot be delivered because of a poor nutritional status. In this category of patients the risk/benefit ratio should be carefully evaluated in protocols in which a poor performance status and cachexia represent the limiting factors for performing adequate treatment. (Journal of Parenteral and Enteral Nutrition 13:406–420, 1989)
Five Years of Experience in Patients Receiving Home Nutrition Support with the Implanted Reservoir: A Comparison with the External Catheter
Authors: Howard Lyn , Claunch Christine , Mcdowell Richard , Timchalk Maryann
Published: May 2008

This study examines 5 years (1983–1988) of home parenteral nutrition (HPN) experience in 27 patients using the implanted reservoir for venous access. Their catheter‐related complications are compared to two control populations using the external catheter. Group I compares the 46 patients who all started HPN in the same 5‐year period, group II compares 17 patients with experience of both types of venous access. For the entire 58 patients the average infusion time was 22 months (1 month‐8.2 yr) and the average complication rate was about one complication every 2 years. Analyzing the separate groups however, group I implanted reservoir patients did better than those with the external catheter (p < 0.05) and group II external catheter patients did better than those with the implanted reservoir (p < 0.05). A possible explanation for this discrepancy is the greater medical competence of group I patients selecting the reservoir. The data show a clear separation of patients into those who have minimal complications with either device and others who have several complications with both. Two‐thirds of the complications were infectious, one third mechanical. The infectious complications were similar with both catheters; clotting was more common with the external catheter and skin erosion was seen only with the reservoir. Eighty % of patients with experience with both type of venous access preferred the implanted reservoir. (Journal of Parenteral and Enteral Nutrition 13:478–483, 1989)
Effect of Total Parenteral Nutrition with Intravenous Fat on Lipids and High Density Lipoprotein Heterogeneity in Neonates
Authors: Forte Trudy M. , Genzel‐Boroviczeny Orsolya , Austin Melissa A. , Kao Lily C. , Scott Charles , Albers John J. , D'Harlingue Arthur E.
Published: May 2008

Plasma lipid concentrations and high density lipoprotein (HDL) sublcass distributions were evaluated in 22 newborn infants nourished with intravenous (iv)‐fat. The majority of infants were premature with respiratory distress syndrome. Based on baseline (prior to iv‐fat) HDL subclass profiles determined by gradient gel electrophoresis (GGE), infants fell into two classes, one with two or more pronounced peaks within the normal HDL spectrum (group I, 17 subjects) and the other with highly unusual HDL distribution (group II, five subjects). Total plasma cholesterol increased in both groups during low and high fat intravenous feeding. HDL‐cholesterol, however, did not change with iv‐fat where mean values for groups I and II at baseline, iv‐low fat and ‐high fat were: group I, 31.2 ± 7.1, 30.0 ± 8.8, and 36.6 ± 16.7 mg/dl, respectively; and group II, 20.0 ± 7.8, 20.2 ± 7.4, and 19.8 ± 8.8 mg/dl, respectively. Unlike HDL‐cholesterol levels that remained constant with iv‐fat, apolipoprotein (apo)AI concentrations increased significantly: group I, 73.0 ± 11.0, 88.3 ± 15.9, and 93.1 ± 21.9 mg/dl, respectively; and group II, 31.8 ± 10.5, 41.0 ± 12.8, and 59.3 ± 18.5 mg/dl, respectively. In group I infants, iv‐fat is associated with an increase in larger‐sized particles, particularly in the (HDL2b)gge range; in group II there is an increase in (HDL3b)gge and (HDL3c)gge components and a disappearance of particles that fall outside of the size range of normal HDL. In both groups, enteral feeding is associated with a further normalization of HDL subclass distribution. The aberrant GGE profiles and very low apoAI levels of group II infants at baseline were associated with unusual HDL morphology determined by electron microscopy where discoidal structures were prominent. With iv‐fat, discoidal particles decline in number while normal spherical structures increase. Prevalence of discoidal HDL at baseline was associated with low concentrations of lecithin:cholesterol acyltransferase (LCAT) (1.12 ± 0.5 μg/ml); with iv‐fat this enzyme rose to 1.61 ± 0.18 μg/ml. Increased LCAT is associated with the normalization of HDL morphology. It is likely that iv‐fat improves the nutritional status of premature infants, thereby stimulating increased liver synthesis of important proteins, including apoAI and LCAT, associated with HDL metabolism. (Journal of Parenteral and Enteral Nutrition 13:490–500, 1989)
Intracardiac Thrombus Complicating Prolonged Parenteral Nutrition in an Adult
Authors: Mcculloch I. , Pennington C.R.
Published: May 2008

Calcified intracardiac thrombi were identified in a 23‐year‐old man who had received home parenteral nutrition (HPN) for 4 years on account of Crohn's disease. (Journal of Parenteral and Enteral Nutrition 13:557–559, 1989)
Influence of Preoperative Intravenous Nutrition upon Hepatic Protein Synthesis and Plasma Proteins and Amino Acids
Authors: Young Gerald A. , Chem C. , Zeiderman Michael R. , Thompson Mandy , Mcmahon Michael J.
Published: May 2008

The influence of 3 and 7 days of preoperative intravenous nutrition (IVN) on the capacity for protein synthesis in liver and on concentrations of plasma proteins and amino acids were investigated in patients with gastrointestinal malignancy. Thirty patients with gastrointestinal neoplasms who had lost more than 5 kg of weight over 3 months were randomized into three groups to receive preoperatively: (a) no IVN, (b) IVN for 3 days (0.18 gN/kg/day as amino acid; 30 kcal/kg/day as glucose), or (c) IVN for 7 days. Free access to a hospital diet was available to all patients including 10 patients who had not lost weight who served as controls. In the three groups of patients who had lost weight, median transferrin and fibronectin were lower than for controls, whereas other proteins and amino acids were comparable. After feeding, samples of liver were obtained peroperatively and the potential rates of protein synthesis were calculated from the in vitro incorporation of (14C)‐leucine, into protein. Preoperative IVN significantly increased the potential rate of protein synthesis in liver after 3 days. Plasma amino acids were comparable with controls whereas in the unfed‐group concentrations suggested utilization of alanine and breakdown of muscle. Three days of IVN also increased plasma fibronectin and IgA but increases of prealbumin, IgM, and complement C3 were only significant in the group fed for 7 days. On the 7th postoperative day plasma proteins were decreased similarly in each group. This study shows that concentrations of several plasma proteins, in preoperative patients reflect net rates of hepatic protein synthesis and are susceptible to depletion during starvation and repletion by 3 or 7 days of IVN. (Journal of Parenteral and Enteral Nutrition 13:596–602, 1989)
Effects of Long‐Chain Triglyceride Emulsions on Reticuloendothelial System Function in Humans
Authors: Seidner Douglas L. , Mascioli Edward A. , Istfan Nawfal W. , Porter Kathaleen A. , Selleck Kelley , Blackburn George L. , Bistrian Bruce R.
Published: May 2008

Parenteral administration of long‐chain triglyceride emulsions has been shown to have deleterious effects on reticuloendothelial system function in animal models. It is unknown whether this interference occurs in humans with clinically relevant doses of intravenous fat. Two studies were done. Eighteen patients were prospectively enrolled for study. Patients received full feeding by continuous total parenteral nutrition (amino acids 1.5 g/kg/day and dextrose 4.5 g/kg/day) with 33.1 kcal/kg/day. Forty‐three % of the nonprotein calories were provided as soybean oil emulsion (Travamulsion 20%) and was administered intravenously over 10 hr (0.130 g/kg/hr). Reticuloendothelial system function was determined by measuring the change in the clearance rate of intravenously injected 99mTc‐sulfur colloid (TSC) in each patient. In study 1 (n = 10), one day of lipid (10 hr) was infused, with the clearance of 99mTcsulfur colloid measured before the lipid was infused and then during the last hour of the 10‐hr infusion. In study 2 (n = 8), the clearance rates were measured before the lipid emulsion was begun, and then during the last hour of the infusion on the 3rd day.

Clearance rates for TSC after 10 hr of lipid infusion in study 1 did not differ (0.27 ± 1/min to 0.26 ± 0.1/min, p > 0.10). However, after 3 days of lipid infusion (10 hr/day), a statistically significant reduction in TSC was seen (0.46 ± 0.08/min‐0.27 ± 0.03/min, p < 0.05). A decrease in the clearance rate of TSC after 3 days of intravenous lipid infusion but not after 1 day suggests that reticuloendothelial system function is impaired in a dose‐response fashion when long‐chain triglyceride emulsions are infused at clinically conventional rates. Long‐term administration of intravenous long‐chain triglyceride emulsion may be deleterious to optimal reticuloendothelial system function. (Journal of Parenteral and Enteral Nutrition 13:614–619, 1989)
Effects of Intravenous Fat Infusion on Neonatal Neutrophil and Platelet Function
Authors: Herson Victor C. , Block Charlotte , Eisenfeld Leonard , Maderazo Eufronio G. , Krause Peter J.
Published: May 2008

Intravenous fat (Intralipid) is used extensively as a major component of parenteral nutrition for patients in the neonatal intensive care unit. Abnormalities of polymorphonuclear leukocyte (PMN) and platelet number or function related to Intralipid infusion have been reported although conflicting results exist. In order to examine potential adverse hematologic effects of Intralipid, 10 ill neonates were studied before and after a 16‐hr infusion of 1 g/kilo of Intralipid. PMN count, chemokinesis, chemotaxis, and aggregation were unchanged pre‐ and post intralipid infusion. Platelet count, bleeding time, and platelet aggregation were also unchanged. Similar results were obtained in vitro when neonatal and adult PMNs and platelets were incubated in Intralipid and their function analyzed. These findings suggest that short‐term, low‐dose Intralipid has no measurable impact on neonatal PMN or platelet activity and support its use in neonates even in the presence of infection or thrombocytopenia. (Journal of Parenteral and Enteral Nutrition 13:620–622, 1989)
Reversible Cardiomyopathy Due to Selenium Deficiency
Authors: Reeves William C. , Marcuard Stefan P. , Willis Stephen E. , Movahed Assad
Published: May 2008

Selenium is an essential trace element and a component of glutathione peroxidase, an enzyme that may help to prevent oxidative damage to cells. Selenium deficiency has been linked to the development of Keshan disease, a dilated congestive cardiomyopathy occurring primarily in children living in rural China.1 Sporadic cases have been reported in the United States in individuals with poor nutritional intake,2–5 mostly in individuals on long‐term home parenteral nutrition. This report describes a young black woman with Crohn's disease in whom a congestive cardiomyopathy developed and was subsequently reversed following administration of selenium. (Journal of Parenteral and Enteral Nutrition 13:663–665, 1989)
An Alternative Placement of Implantable Central Venous Access Systems
Authors: Krog Michael , Gerdin Bengt
Published: May 2008

A modified technique of inserting an implantable venous access system in the inferior epigastric vein is described. This route can be used in cases where the jugular or subclavian veins are unsuitable. After exposure of the inferior epigastric vein in the lower part of the rectus sheath, the catheter is placed in the vein with its tip at the junction to the iliac vein, with the aid of fluoroscopy and x‐ray contrast. Protrusion of the tip into the lumen of the iliac vein is avoided. The technique was successful in four of the five patients where an attempt was made to insert the catheter. In the fifth case the vein was too narrow to allow catheterization. In the four cases where the catheter was successfully inserted there were no complications. This technique may allow use of the inferior vena cava for venous access without the high risk of intravenous thrombosis which is inherent with current methods. (Journal of Parenteral and Enteral Nutrition 13:666–667, 1989)
Dietary nucleotide effects upon murine natural killer cell activity and macrophage activation
Authors: Carver JD , Cox WI , Barness LA
Published: May 2008

Weanling mice fed chow or chow plus water supplemented with 3.5 mg of nucleotides per 100 ml of water for 6 weeks exhibited increased natural killer cell (NK) activity and lower macrophage activation compared to mice fed chow plus nonsupplemented water. In a dose‐response study, NK activity, macrophage activation and spleen weight (as a percentage of body weight) were higher in mice fed up to 0.035% w/w nucleotides, however macrophage activation was decreased by feeding over 0.35% w/w compared to those receiving basal purified diet (BPD). Nucleotides in human milk may affect the immune response in breast‐fed infants.
Thrombosis of the superior vena cava due to a central catheter for total parenteral nutrition
Authors: Belcastro S , Susa A , Pavanelli L , Guberti A , Buccoliero C
Published: May 2008

Total parenteral nutrition (TPN) today is a fundamental procedure in the treatment of critically ill patients, especially if they have serious gastrointestinal diseases. However, use of the central venous catheter is connected with a very important morbidity. At the “Istituto di Patologia Chirurgica” and at the “Intensive Care Unit” of the University of Ferrara, we analyzed 59 cases of deaths from different diseases, on whom a postmortem examination had been performed. Twenty‐seven patients had had no central venous catheter: none of them presented thrombosis of the central veins. Thirty‐two patients had had a central venous catheter for TPN: five of them presented thrombosis of the central veins at the post‐mortem examination. Except for one case who had thrombosis connected with a carcinoma of the right main bronchus, four cases (12.9%) presented thrombosis due to the central venous catheter. The subclavian vein seems to be more commonly connected with thrombosis than the jugular vein.
Nutritional support of the dysphagic patient: methods, risks, and complications of therapy
Authors: Sitzmann JV
Published: May 2008

The indications, methods, and complications of nutritional support of 90 patients admitted with a primary complaint of dysphagia were reviewed. Patients were divided into two groups based on etiology of dysphagia (central neurologic vs local mechanical dysfunction). All patients on admission exhibited marked malnutrition with an average weight loss of 12 +/‐ 9.8% body weight, serum transferrin 165 +/‐ 60.1 mg/dl, and albumin 3.2 +/‐ 0.85 mg/dl. All patients were placed on either enteral (63%) or parenteral (37%) nutrition. Twenty‐seven percent of all patients suffered a complication of nutritional therapy. Patients with nasoenteric tubes had a 10% complication incidence (aspiration or endotracheal placement of tube) resulting in a 30% mortality rate; significantly higher (p less than 0.05) than seen with other modalities. Any form of upper enteric feeding (nasoenteric or gastrostomy) was associated with significantly increased (p less than 0.01) risk of aspiration pneumonia. It is concluded that patients admitted to hospital with dysphagia as the major complaint suffer from severe malnutrition, and that upper gastrointestinal intubation should not be employed for feeding until the dysphagia has resolved.
Vitamin A sorption to polyvinyl and polyolefin intravenous tubing
Authors: Henton DH , Merritt RJ
Published: May 2008

The loss of vitamin A to plastic infusion tubing from a total parenteral nutrition solution was studied using an in vitro infusion system and HPLC quantification of vitamin A. Polyolefin tubing was compared to polyvinyl chloride at varied vitamin A concentration, infusion temperature, and flow rate. Significantly enhanced recovery of vitamin A was found with the polyolefin tubing compared to that of the polyvinyl chloride under all conditions tested. After 24 hours under the varied conditions of the study, vitamin A availability ranged from 47 to 87% with polyolefin and 19 to 74% with polyvinyl chloride. These differences may be expected to result in significantly greater vitamin A delivery from polyolefin compared to polyvinyl chloride tubing to patients treated in neonatal intensive care units.
Catheter‐related complications in 35 children and adolescents with gastrointestinal disease on home parenteral nutrition
Authors: Schmidt‐Sommerfeld E , Snyder G , Rossi TM , Lebenthal E
Published: May 2008

A 7‐year experience with home parenteral nutrition (HPN) in 35 children and adolescents suffering from severe gastrointestinal diseases is reported. The average duration of HPN was 577 days with a mean of 2.9 catheters per patients. There was a total of 82 episodes of proven catheter‐related sepsis, an average of 1.5 septic episodes per patient year. In about half of these instances, the catheter had to be removed. Coagulase‐negative and ‐positive staphylococci were the most common organisms isolated. All four Candida infections led to removal of the catheter. Children requiring HPN from early infancy had a higher frequency of catheter‐related infections than those started on HPN after the first year of life. In four cases, clinically significant thrombotic complications occurred. The results suggest that even under optimal conditions of catheter placement and with extensive education in aseptic catheter handling, infection is still relatively common in children receiving HPN. However, there was no mortality related to this complication.
Intravenous glycerol infusions: effect on free fatty acid metabolism
Authors: Pesola GR , Sauerwein HP , Vydelingum NA , Carlon G , Brennan MF
Published: May 2008

The plasma‐free fatty acid response to intravenous glycerol infused at 250 and 500 mumol/min was determined in five normal volunteers in the postabsorptive state. There was a drop in free fatty acid concentration in all five subjects (one‐way ANOVA, p less than 0.01) after the glycerol infusion with no change in insulin concentration compared to the post‐absorptive state. These results suggest that intravenous glycerol infusions decrease free fatty acid concentrations in the post‐absorptive state by an insulin‐independent mechanism. When pharmacologic nonisotopic glycerol infusions are used to determined lipolytic rate, simultaneous measurement of free fatty acid concentrations should be interpreted with caution.
Effect of fat infusions on platelet concentration in premature infants
Authors: Spear ML , Spear M , Cohen AR , Pereira GR
Published: May 2008

Critically ill premature infants often require lipid emulsions with parenteral nutrition until enteral feedings can be safely initiated. Because thrombocytopenia has been listed as a potential side effect of fat emulsions, we examined the effect of varying doses of intravenous fat infusions on platelet concentrations in premature infants. An initial validation study demonstrated no artifactual effect of fat infusions on the electronic cell counter method of platelet enumeration. We observed no adverse effect of fat emulsions administered at doses of 0.8 to 3.3 g/kg/day on platelet concentration either during short‐term (48 hr) or long‐term study periods (4 weeks).
Short‐term infusion of azelaic acid vs intralipid in healthy subjects evaluated by indirect calorimetry
Authors: Tacchino RM , Mingrone G , Marino F , Arcieri‐Mastromattei E , Greco AV , Castagneto M
Published: May 2008

Medium‐chain dicarboxylic acids (MCDA) are usually considered byproducts of beta‐oxidation when omega‐oxidizable medium‐chain monocarboxylic acids are accumulated, as in beta‐oxidation impairment. However, evidence exists of a mitochondrial and cytoplasmatic peroxisomal carnitine independent beta‐oxidation of these diacids. Our purpose was to evaluate whether MCDA could be used as source of calories. The metabolic response to intravenous administration of azelaic acid (AA) vs Intralipid (IL) was evaluated in six healthy overnight fasting male volunteers who received an infusion of 10 g of AA over 80 min and as a control 10 g of IL. AA reached a peak concentration at 80 min, (589 +/‐ 61 micrograms/ml) and was rapidly cleared from plasma (82 +/‐ 5 micrograms/ml at 240 min). Respiratory and metabolic parameters were evaluated by indirect calorimetry from the beginning of the infusion for 240 min. In both groups the CO2 production (VCO2) remained unchanged with no significant change from basal values. The O2 consumption (VO2 ml/min/m2) increased over basal values reaching a peak at the end of the infusion in both groups (AA from 119.4 +/‐ 16.9 to 143.0 +/‐ 27.6; IL from 124.7 +/‐ 16.8 to 152.3 +/‐ 29.5). Respiratory quotient (RQ) consequently decreased significantly (AA from 0.85 +/‐ 0.06 to 0.76 +/‐ 0.06; IL from 0.89 +/‐ 0.06 to 0.78 +/‐ 0.03) and calories derived from lipids increased. Metabolic rate (MR kcal/hr/m2) showed a slight increase (AA from 34.0 +/‐ 4.4 to 40.3 +/‐ 6.8; IL from 35.9 +/‐ 5.1 to 41.3 +/‐ 10.5). There was no significant difference between AA and IL treatment in all measurements.(ABSTRACT TRUNCATED AT 250 WORDS)
Measurement of elemental nitrogen by chemiluminescence: an evaluation of the Antek nitrogen analyzer system
Authors: Dechert RE , Cerny JC , Bartlett RH
Published: May 2008

Application of indirect calorimetry has aided nutritional support and management in critically ill populations. However, knowledge of resting energy expenditure is only one‐half of the nutritional profile. Knowledge of protein losses and requirements are also important. Attainment of positive protein balance is believed to play an important role in wound healing, host defenses, morbidity, and mortality. Previous limitations of the measurement of protein losses (time and cost) have limited its application to the ICU patient. This report describes a relatively new technology which measures elemental nitrogen in biologic samples. We have found this instrument to be fast, accurate, easy to calibrate and use. Its application in the critically ill patient allows us to monitor daily changes in protein losses and balance.