bluuebunny/crossref_metadata_2025 huggingface dataset:
Cardiac Cachexia: Preoperative and Postoperative Nutrition Management
Authors: Paccagnella Agostino , Calò Mauro A. , Caenaro Gianfranco , Salandin Valeria , Jus Paolo , Simini Giuseppe , Heymsfield Steven B.
Published: May 2008

The present study examined the hemodynamic and metabolic effects of nutrition support in patients with malnutrition secondary to severe mitral valve disease and congestive heart failure. Pulmonary artery pressure measurements, echocardiographic studies, gas exchange measurements, immune function tests, and clinical evaluations were made on hospitalized patients 2 weeks before and 3 weeks after surgery for valve replacement or annuloplasty. All patients received a total daily energy intake of 20 to 30 kcal/kg, four of the patients preoperatively as a combination of oral food plus parenteral nutrition and these four patients plus two additional patients as only parenteral nutrition in the early postoperative period. All six patients received nutrition support as oral food plus parenteral nutrition in the late postoperative period. Compared with baseline, nutrition support was associated with stable hemodynamic function, unchanged whole‐body oxygen consumption and carbon dioxide production, and improved clinical indices both before and after surgery. Comprehensive hemodynamic, metabolic, and clinical studies thus indicate that acceptable levels of nutrition support can be provided to malnourished patients with severe congestive heart failure, which improves their clinical status and does not adversely influence cardiac function. (Journal of Parenteral and Enteral Nutrition 18:409–416, 1994)
Glutamine‐Enriched Enteral Diet Increases Renal Arginine Production
Authors: Houdijk Alexander P.J. , Van Leeuwen PAUL A M. , Teerlink Tom , Flinkerbusch Eveline L. , Boermeester Maria A. , Sauerwein Hans P. , Wesdorp Robert I.C.
Published: May 2008

Background: Arginine (Arg) is generated in the kidney by the conversion of circulating citrulline. The most important source for circulating citrulline is the metabolism of glutamine (Gln) by the gut. In this study, we investigated the influence of an enteral diet enriched with Gln on renal Arg synthesis in the rat. Methods: Rats were fed a 12.5% Gln‐enriched diet or an isocaloric, isonitrogenous control diet for 14 days. Kidney plasma flow and arterial and renal venous plasma levels of a number of amino acids were measured, and kidney amino acid fluxes were calculated. Results: Compared with the control diet, Gln enrichment resulted in significantly higher arterial plasma levels of circulating citrulline (30%, p <.0001) and Arg (31%, p <.0005). The uptake of circulating citrulline and the subsequent production of Arg by the kidneys were significantly higher in the Gln‐enriched group (40% and 38%, respectively) and showed an equimolar relationship in both the control (r =.84, p <.0001) and the Gln‐enriched group (r =.83, p <.0001). Conclusions: The findings indicate that enteral Gln supplementation caused significantly increased arterial plasma levels of Arg as a result of increased renal Arg production from circulating citrulline. Considering the multiple important biologic properties of Arg, the reported beneficial effects of Gln in catabolic states might be explained in part by increased renal Arg production. (Jouynal of Parenteral and Enteral Nutrition 18:422–426, 1994)
Effect of Ketone Bodies on Hyperglycemia and Lactic Acidemia in Hemorrhagic Stress
Authors: Katayama Masami , Hiraide Atsushi , Sugimoto Hisashi , Yoshioka Toshiharu , Sugimoto Tsuyoshi
Published: May 2008

Background: To investigate the effect of hyperketonemia on altered glucose metabolism under stress conditions, we infused sodium D‐3‐hydroxybutyrate (3‐OHB) into rats in hemorrhagic hypotension and evaluated the plasma concentration of substrates related to glucose metabolism. Methods: Three groups of anesthetized rats (weight, 280 g to 320 g) were bled acutely, and their mean arterial pressures were maintained at 40 mm Hg. From 1 hour before hemorrhage to the end of the experiment, rats in the first group (n = 10) were infused with 3‐OHB at a rate of 30 μmol/kg·min (3‐OHB group), those in the second group (n = 10) received glucose and sodium bicarbonate (glucose group), and the remaining 10 rats received only sodium bicarbonate and no energy substrates (control group). Sodium bicarbonate was used to control the alkalizing effect of 3‐OHB. Results: Hyperketonemia(1158± 30 μmol/L ‐ 1618 ± 154 μmol/L) occurred only in the 3‐OHB group. Hyperglycemia and lactic acidemia during hemorrhagic shock were suppressed significantly compared with the control group. Plasma concentration of alanine was also lower compared with the control group. In the glucose group, although plasma lactate concentration was lower, plasma glucose concentration was not suppressed, and plasma alanine concentration was higher in comparison with the control group during hemorrhagic shock. There was no significant difference in plasma insulin concentration among the three groups. Conclusions: These results suggest that administered 3‐OHB may suppress glycolysis during hemorrhagic shock. (Journal of Parenteral and Enteral Nutrition 18:442–446, 1994)
Comparison of Intravenous Nutrients on Gut Mucosal Protein Synthesis
Authors: Stein T.P. , Yoshida S. , Schluter M.D. , Drews D. , Assimon S.A. , Leskiw M.J.
Published: May 2008

Background: Total parenteral nutrition (TPN) is associated with atrophy of the intestinal mucosa. This study compared the relative effectiveness of a short‐chain fatty acid (butyrate), a physical mixture of medium‐chain and long‐chain triglycerides, structured lipid, and glutamine as components of a TPN regimen, and their ability to support mucosal protein synthesis. Methods: Rats were parenterally fed one of six isocaloric (1003 kJ/kg·d−1) and isonitrogenous (1.5 g·kg−1·d−1 of nitrogen) diets for 5 days. Diet 1, glucose 90% and long‐chain triglycerides 10% (standard TPN); diet 2, glucose 50% and long‐chain triglycerides 50%; diet 3, glucose 50% and a 50/50 physical mixture of long‐chain and medium‐chain triglycerides 50%; diet 4, glucose 50% and structured lipid 50%; diet 5, glucose 91% and sodium butyrate 9%; and diet 6, same as group 1 except that some of the amino acids were replaced with glycyl glutamine. A control group of rats also underwent catheter placement and were instead fed diet 1 orally for 5 days. Five days after catheterization, all rats were given a 4‐hour constant infusion of [U‐14C]leucine to determine the mucosal fractional protein synthesis rates. Results: (1) Mucosal fractional protein synthesis rates were much higher with the oral diet (control) than with any of the intravenous diets. (2) Diet‐related differences in the mucosal fractional synthesis rates were found with the jejunum and the proximal and distal colon but not with the ileum. (3) Standard TPN was the least effective diet in supporting mucosal protein synthesis. (4) Structured lipid and butyrate were most effective for the jejunum. (5) For the colon, medium‐chain triglycerides and structured lipid were most effective. Conclusion: Standard TPN leads to a decrease in gut mucosal protein synthesis in rats, and this decrease can be partially attenuated by adding nutrients for the gut to the TPN mixture. (Journal of Parenteral and Enteral Nutrition 18:447–452, 1994)
Percutaneous Adipose Tissue Biopsy by Mini‐Liposuction for Metabolic Studies
Authors: Bastard Jean‐Philippe , Cuevas Javier , Cohen Sophie , Jardel Claude , Hainque Bernard
Published: May 2008

Background: Large fat‐biopsy samples are necessary for extensive simultaneous assays. Subcutaneous adipose tissue is generally obtained either by needle‐biopsy aspiration (∼1 g) or by open surgical biopsy for larger samples. We propose a reliable technique that permits the removal of large adipose tissue samples percutaneously. Methods: A vertical 5‐mm slit was made in the abdominal skin of 15 obese patients, and a liposuction mini‐cannula (10 cm x 3 mm) attached to a 20‐mL sterile plastic syringe was inserted. A vacuum was created by withdrawing the syringe plunger and fixing it with a specially adapted clamp. Results: We obtained 3‐ to 15‐g samples of adipose tissue without conspicuous scarring or visible contour changes. A significant correlation between the body mass index and the amount of adipose tissue was observed (r =.50, p <.05). Isolated adipocytes remained highly viable, as evidenced by glucose transport under both basal and maximal insulin‐stimulated conditions. The mini‐liposuction procedure was fast, and once the mini‐cannula was removed from the wound, patients could immediately move about freely. Conclusion: The new technique described here for fat biopsy using a mini‐cannula is less traumatic than open surgical biopsy, and it permits the removal of larger adipose tissue samples than do the usual biopsy techniques. Furthermore, adipose cells are removed intact, and the simplicity of the method facilitates repeat biopsies. (Jouynal of Parenteral and Enteral Nutrition 18:466–468, 1994)
New Experimental Model of Acute Renal Failure and Sepsis in Rats
Authors: Kuhlmann Martin K. , Shahmir Ehsan , Maasarani Essam , Akhtar Salman , Thevanayagam Vasuki , Vadgama Jaydutt V. , Kopple Joel D.
Published: May 2008

Background: A rat model of acute renal failure (ARF) with sepsis (ARF+S) was developed to simulate the clinical syndrome of hypercatabolic illness in patients with ARF. Methods: Sepsis was created by ligation and needle puncture of the cecum; ARF was created by left renal artery clamping and contralateral nephrectomy. Results: Two studies were performed. In study 1, rats with sham surgery, sepsis, ARF, and ARF+S were examined for 48 hours. During the first 24 hours after surgery, ARF and ARF+S rats displayed increased urea and ammonia nitrogen appearances and abnormal plasma amino acid levels. These abnormalities were exaggerated in ARF+S rats. In study 2, sham, ARF, and ARF+S rats were injected with sodium bicarbonate or normal saline. During the first 24 hours after surgery, the ARF and ARF+S rats showed an increase in urea nitrogen appearance to 210% and 293%, respectively, of sham values, which was greater than the levels that have been previously reported. Sodium bicarbonate treatment did not influence nitrogen output. Conclusions: Rats with ARF+S may be a useful model for studying catabolic patients with ARF. The lack of effect of sodium bicarbonate on nitrogen balance merits additional study. (Journal of Parenteral and Enteral Nutrition 18:477–485, 1994)
Reduction in Diarrhea Incidence by Soluble Fiber in Patients Receiving Total or Supplemental Enteral Nutrition
Authors: Homann H.‐H. , Kemen M. , Fuessenich C. , Senkal M. , Zumtobel V.
Published: May 2008

Background: Gastrointestinal side effects, particularly diarrhea, are still the main reasons for discontinuation of enteral nutrition. Although the causes of diarrhea are diverse, the enteral nutrition solution is frequently suspected of playing a leading role in causing diarrhea. Methods: Our randomized, prospective, double‐blind trial with 100 patients assessed the effects of feeding a standard diet (Nutrodrip Standard) vs the same diet supplemented with 20 g of soluble fiber, containing partially hydrolyzed guar gum (Sunfiber), per 1000 mL. Thirty patients received total enteral nutrition postoperatively, and 70 patients received enteral supplementation. Results: The patients receiving total enteral nutrition with soluble fiber had decreased diarrhea but increased flatulence. In none of these patients did enteral feeding have to be discontinued because of gastrointestinal side effects, whereas in four patients who were on a standard diet, enteral feeding had to be interrupted because of diarrhea (p <.05). Similar observations were made in patients receiving enteral supplementation. In both groups, the incidence of diarrhea decreased significantly with the soluble fiber diet compared with the standard diet (6 vs 15, p <.05). Conclusions: Enteral feeding with a formula supplemented with partially hydrolyzed guar gum reduces the incidence of diarrhea in patients receiving total enteral nutrition as well as in those receiving enteral supplementation, regardless of the cause of diarrhea. The increased hydrogen production and the significantly higher rate of flatulence are likely to result from fermentation of the soluble fiber in the colon, with concomitant production of short‐chain fatty acids, which leads to increased absorption of short‐chain fatty acids, sodium, and water by the colonocytes. This effect, together with the observed cholecystokinin‐mediated decrease in colonic transit time with partially hydrolyzed guar gum, may explain the reduction in the incidence of diarrhea in this study. (Journal of Parenteral and Enteral Nutrition 18:486–490, 1994)
Feeding‐Induced Changes in Energy Expenditure in Children With Cystic Fibrosis
Authors: Horswill Craig A. , Kien C. Lawrence , Zipf William B. , McCoy Karen S.
Published: May 2008

Seven children with cystic fibrosis (aged 7 to 12 years) were studied in the fasted and fed states. Using a primed, constant, intravenous infusion of NaH13CO3, the rate of appearance of CO2 (RaCO2) was estimated. Net CO2 excretion (VCO2) was also measured. Energy expenditure was calculated using the food quotient. RaCO2 (mean ± SD) (μmol·kg−1·min−1) in the fasted and fed states (297 ± 59 and 359 ± 67) was 117% and 105% of VCO2 (259 ±48 and 352 ± 72). Feeding induced a 23% and a 37% increase in RaCO2 and VCO2, respectively, and respective 19% and 33% increases in energy expenditure (p <.05). Measurement of CO2 production by isotopic dilution is a useful index of group changes in energy expenditure, including those induced by feeding. (Journal of Parenteral and Enteral Nutrition 18:497–502, 1994)
Comparison of Four Bedside Indicators Used to Predict Duodenal Feeding Tube Placement With Radiography
Authors: Welch Susan K. , Hanlon Nlaureen D. , Waits Margie , Foulks Charles J.
Published: May 2008

The validity of four indicators to predict successful duodenal feeding tube placement was evaluated in a prospective trial. Data were collected on each indicator at prepyloric (≤ 65 cm) and postpyloric (≥ 75 cm) feeding tube lengths. Feeding tubes were placed in 106 patients. Eighteen feeding tubes were located in the stomach, and 88 were in the duodenum. Auscultation (progression of loudest sound locations from the left to the right abdomen) had a positive predictive value of 85% (negative predictive value, 31%). The vacuum effect (a change from 40 mL of aspirated air to ≤ 10 mL after 60 mL of air instillation) had a positive predictive value of 86% (negative predictive value, 45%) and was significantly correlated with duodenal placement (p =.02). Aspirate was present at prepyloric and postpyloric lengths in 35 cases. Ten of these 35 cases had the defined change in pH from ≤ 4.0 to ≥ 6.0 (positive predictive value, 100%; negative predictive value, 28%). The positive predictive value of color (a change to yellow) was also 100% (n = 11); the negative predictive value was 29%. The low negative predictive values of the indicators suggest that the absence of defined changes is of no assistance in discriminating between stomach and duodenal placement. A positive auscultation or vacuum effect test is not conclusive for duodenal placement. A positive pH or color change test may obviate the need for a confirmatory radiograph. However, because 40% of the positive pH‐test feeding tubes and 36% of the positive color‐test feeding tubes were located in the proximal duodenum, we believe refinement of placement techniques and further studies are warranted before elimination of the radiograph is recommended when the pH or color change occurs. (Journal of Parenteral and Enteral Nutrition 18:525–530, 1994)
Review: Gut‐Derived Proteolysis During Insulin‐Induced Hypoglycemia: The Pain That Breaks Down the Gut
Authors: Molina Patricia E. , Abumrad Naji N.
Published: May 2008

The metabolic events associated with early response to injury have received little attention because of the confounding effects of the hemodynamic alterations that normally occur during this early phase. We have used a well established and reproducible model of insulin‐induced hypoglycemia in the conscious dog to define the glucose and amino acid kinetic alterations as well as the hormonal and interorgan amino acid and gluconeogenic precursor flux characteristics of the “ebb” phase of postinjury metabolism. The results from our whole‐body response have demonstrated an enhanced rate of whole‐body proteolysis and amino acid oxidation. The site of the majority of the proteolytic response has been demonstrated to be the extra‐hepatic splanchnic tissues or gut. These findings have been supported by studies focusing on the specific organ changes, which have demonstrated alterations compatible with impaired proliferation at the level of the gut mucosa. Furthermore, the regulation of this gut‐derived proteolysis has been demonstrated to be mediated by the glucopenia at the level of the central nervous system. The specific site of this response is still elusive; however, the mediators seem to involve not only the traditional hormonal and neurotransmitter pathways but also the release of endogenous opioids and opiates. Although a cause‐effect relationship has not yet been demonstrated for the control of gut‐derived proteolysis by opioids and opiates, we present evidence that leads us to hypothesize that relationship as a possible regulatory mechanism. (Journal of Parenteral and Enteral Nutrition 18:549–556, 1994)
Effect of Equimolar Amounts of Long‐Chain Triglycerides and Medium‐Chain Triglycerides on Small‐Bowel Transit Time in Humans
Authors: Ledeboer M. , Masclee A.A.M. , Jansen J.B.M.J. , Lamers C.B.H.W.
Published: May 2008

Background: The use of medium‐chain triglycerides in diets is limited by the frequent occurrence of diarrhea or crampy abdominal pain. Because these symptoms may result from an accelerated transit time induced by medium‐chain triglycerides, we investigated the effect of equimolar amounts of long‐chain triglycerides and medium‐chain triglycerides on small‐bowel transit time in 10 healthy subjects. Methods: Small‐bowel transit time was measured by the lactulose hydrogen breath test after intraduodenal administration of lactulose. Results: Intraduodenal administration of 20 mmol of long‐chain triglycerides per hour for 90 minutes did not alter small‐bowel transit time compared with control (77 ± 11 minutes vs 77 ± 10 minutes, respectively), whereas intraduodenal infusion of an equimolar dose of medium‐chain triglycerides significantly accelerated small‐bowel transit time (59 ± 6 minutes) compared with long‐chain triglycerides and control (p <.05). In six individuals, small‐bowel transit time was shorter during the administration of medium‐chain triglycerides compared with control, and three of these subjects experienced abdominal symptoms. Plasma cholecystokinin levels increased significantly (p <.05) during the administration of long‐chain triglycerides, from 2.6 ± 0.3 pmol/L to a maximum of 4.3 ± 0.6 pmol/L. No significant alterations were observed in plasma cholecystokinin levels during administration of medium‐chain triglycerides or in the control experiment. Conclusions: Although it significantly increases cholecystokinin secretion, the intraduodenal infusion of long‐chain triglycerides does not affect small‐bowel transit time, whereas the infusion of medium‐chain triglycerides accelerates small‐bowel transit time, independent of cholecystokinin. (Journal of Parenteral and Enteral Nutrition 19:5–8, 1995)
Amino Acid Losses During Hemodialysis: Effects of High‐Solute Flux and Parenteral Nutrition in Acute Renal Failure
Authors: Hynote Eleanor D. , McCamish Mark A. , Depner Thomas A. , Davis Paul A.
Published: May 2008

Background: During standard hemodialysis, amino acid losses are substantial, amounting to 6 to 9 g per treatment. When these nutritional supplements are infused during dialysis, losses are increased, but a net positive balance can be achieved if the infusion rate is high enough. High‐flux dialyzers, used with increasing frequency in modem dialysis centers because of their more permeable synthetic membranes, should cause further amino acid losses; however, the increase has not been measured, and the effect on plasma levels has not been examined. Assessment of net balance requires measurement of blood concentrations as well as of clearance. Methods: To quantitate the effect of high‐flux dialysis on amino acid balance, we measured clearances, plasma levels, and losses of individual amino acids during hemodialysis in patients with acute renal failure who required daily parenteral nutrition. Results: Nearly all predialysis amino acid levels in plasma were within the normal range, probably because of control of uremia with prior dialyses and from continuous infusion. In paired studies, clearances were higher (150 ± 15 mL/min vs 107 ± 11 mL/min, p <.01), and levels fell more at mid‐dialysis with high‐flux membranes (28% ± 5%) than with conventional cellulosic membranes (4 ± 5%, p <.05). Mean losses of amino acid were 5.2 ± 0.6 g per conventional dialysis, representing 60% of the total infused, and 7.3 ± 1.8 g per high‐flux dialysis, or 80% of the simultaneous infusion. Fractional losses decreased at higher infusion rates, but losses of individual amino acids varied from one fourth to more than 10 times the amount infused. Compared with other small solutes, plasma levels were relatively well maintained even during high‐flux dialysis, a factor that enhanced removal by the dialyzer. Total balance depended more on the infusion rate than on the dialysis membrane. Conclusions: These studies show that positive balance can be achieved with concurrent infusion during dialysis, especially at higher amino acid delivery rates. High‐flux dialysis causes a greater disturbance of amino acid equilibrium than conventional dialysis does, but 24‐hour gains far exceeded losses in the dialysate for most of the amino acids. (Journal of Parenteral and Enteral Nutrition 19:15–21, 1995)
The Effect of Growth Hormone on Nutritional Markers in Enterally Fed Immobilized Trauma Patients
Authors: Behrman Stephen W. , Kudsk Kenneth A. , Brown Rex O. , Vehe Kathryn L. , Wojtyslak Stacey L.
Published: May 2008

Background: Earlier clinical studies have demonstrated improved nitrogen balance in nonstressed patients receiving hypocaloric feedings and growth hormone (GH). This study investigates the effect of GH on nitrogen balance, on serum protein concentrations, and on other indices of nutrition when combined with enteral feeding in immobilized patients after closed‐head injury or spinal cord injury. Methods: Sixteen patients who tolerated enteral feedings and remained nonseptic were randomized to receive either placebo or 0.2 mg/kg recombinant human GH for 7 to 13 days. Nitrogen balances were collected daily, and serum proteins were measured at study entrance and exit. Results: GH treatment resulted in higher GH and insulin‐like growth factor‐1 concentrations but did not improve nitrogen balance. GH treatment also resulted in increased transferrin and serum albumin levels and total lymphocyte count during the study period. Conclusions: Adjuvant recombinant human GH has no effect on nitrogen balance in highly stressed, totally immobilized patients after head or spinal cord injury, but it significantly enhances constitutive serum protein concentrations and other indices of nutritional repletion. (Journal of Parenteral and Enteral Nutrition 19:41–46, 1995)
Influence of Three Different Fiber‐Supplemented Enteral Diets on Bowel Function and Short‐Chain Fatty Acid Production
Authors: Kapadia S.A. , Raimundo Ana H. , Grimble G.K. , Aimer P. , Silk D.B.A.
Published: May 2008

Background: Dietary fiber is known to influence bowel habit and gastrointestinal mucosal cell morphology and function. Large‐bowel function is particularly influenced by insoluble, poorly fermentable fiber sources, whereas mucosal function is affected by fiber sources that are soluble and highly fermentable. The aim of the present study was to compare bowel function during consumption of a self‐selected diet, a fiber‐free enteral diet, and three polymeric enteral diets, each supplemented with a fiber with different fermentation characteristics. The fiber sources used were oat, soy oligosaccharide, and soy polysaccharide. Methods: Seven healthy subjects consumed four diets in random order for 4 to 7 days. These were a self‐selected diet, a 2‐L polymeric enteral diet, and a 2‐L polymeric enteral diet supplemented with 15 g of total dietary fiber per liter derived from either soy oligosaccharide fiber (75 g/L) or oat fiber (15 g/L). An additional six healthy subjects were randomly assigned to three diets (4 to 7 days): a self‐selected diet, a 2‐L polymeric enteral diet, or the same 2‐L polymeric enteral diet supplemented with 20 g of soy polysaccharide fiber per liter (15 g of total dietary fiber per liter). Bowel function was assessed by measuring whole‐gut transit time, mean daily stool wet weights, and bowel movement frequency per day. Fermentation characteristics of the different fiber sources were determined quantitatively and qualitatively by measuring short‐chain fatty acids produced during in vitro stool culture. Results: Total short‐chain fatty acid and butyric acid production with soy oligosaccharide fiber were significantly higher compared with values observed for soy polysaccharide fiber (p <.003), oat fiber (p <.005), and self‐selected (control) diet (p <.003). Compared with the fiber‐free diet, consumption of the soy polysaccharide, oat, and soy oligosaccharide‐fiber‐supplemented enteral diets did not significantly (p >.05) alter whole‐gut transit time or stool wet weight. However, bowel frequency was significantly improved by consumption of the soy polysaccharide‐fiber‐supplemented diet but not the oat fiber or soy oligosaccharide‐fiber‐supplemented diets. Conclusion: Compared with a fiber‐free polymeric enteral diet, the daily consumption of an enteral diet supplemented with 30 g of total dietary fiber per day derived from a poorly fermentable oat fiber, a highly fermentable soy oligosaccharide fiber, or a moderately fermentable soy polysaccharide fiber has little impact, if any, on bowel function. (Journal of Parenteral and Enteral Nutrition 19:63–68, 1995)
Are Clinical Signs Accurate Indicators of the Cause of Central Venous Catheter Occlusion?
Authors: Stephens Lana C. , Haire William D. , Kotulak Gail D.
Published: May 2008

Background: Two hundred dysfunctional central venous catheters used for total parenteral nutrition and administration of cancer chemotherapy were radiographically examined in order to objectively identify thrombotic occlusions as the cause of catheter dysfunction. Methods: Outcomes of radiographic dye injections were compared with factors such as the inability to aspirate blood or to infuse fluids, catheter type, and duration of catheter placement. Results: Catheter type and duration of placement were not significant factors for predicting the type of dysfunction. Failure to withdraw blood was associated with 96% of the thrombosed catheters; this was also associated with 65% of the catheters with nonthrombotic dysfunctions. Once the cause of catheter occlusion was correctly identified, 90% of the catheters were restored to normal function. Conclusions: Inability to withdraw blood from a catheter does not necessarily mean it is occluded by thrombus. Mechanical complications account for a significant portion of dysfunctional catheters. (Journal of Parenteral and Enteral Nutrition 19:75–79, 1995)
The Effect of Dietary Protein Depletion on Hepatic 5‐Fluorouracil Metabolism L. E. DAVIS, R. E. LENKINISKI, M. A. SHINKWIN, ET AL CANCER 72:3715–3722, 1993
Authors: Christensen Michael L.
Published: May 2008

This study investigated the mechanism of protein depletion and its effect on host toxicity to 5‐fluorouracil. The effects of protein malnutrition on the hepatic metabolism of 5‐fluorouracil were examined using 19F‐nuclear magnetic resonance spectroscopy, pharmacokinetic disposition of 5‐fluorouracil, and hepatic dihydropyrimidine dehydrogenase activity. Harlan Sprague‐Dawley rats were given 5‐fluorouracil (150 mg/kg) by intraperitoneal injection after receiving normal (21.5%) or low (2.5%) protein diets for 19 to 30 days (mean, 25 days). Toxicity was assessed by weight loss, lymphocyte count, and survival. Hepatic fluorine spectra were used to evaluate the time to achieve maximum 5‐fluorouracil concentration, apparent hepatic 5‐fluorouracil half‐life, duration of detectable 5‐fluorouracil concentrations, and time to reach peak fluoro‐β‐alanine concentration (the main 5‐fluorouracil degradation product). Parallel experiments determined the pharmacokinetic disposition of 5‐fluorouracil and the hepatic dihydropyrimidine dehydrogenase activity.

In the low‐protein group, the initial detection of the degradation product fluoro‐β‐alanine and the mean duration of 5‐fluorouracil signal in the liver were significantly prolonged: time to reach peak fluoro‐β‐alanine (minutes) 62 ± 39 vs 24 ± 12 (p <.05) and apparent 5‐fluorouracil half‐life (minutes) 96 ± 63 vs 42 ± 22 (p <.001). The 5‐fluorouracil clearance and the hepatic dihydropyrimidine dehydrogenase activity were also significantly lower in the low‐protein group: 1.8 ± 0.8 L/h/kg vs 7.3 ± 2.1 Llhlkg (p <.05) and 0.29 ± 0.04 U/mg of protein vs 0.37 ± 0.04 U/mg of protein (p <.05), respectively. Compared with animals fed a normal diet, animals in the low‐protein group sustained greater weight loss (g) 36 ± 17 vs 16 ± 17 (p <.05), lower lymphocyte count (mm3) 1767 ± 993 vs 5575 ± 2239 (p <.05), and greater mortality 7 days after 5‐fluorouracil (8/9 vs 1/10) (p <.01).
Peripherally Inserted Central Catheters: A Report of 2506 Catheter Days
Authors: Loughran Stephen C. , Borzatta Marcello
Published: May 2008

Background: The establishment of reliable central venous access is essential in the management of patients with major complications, including pneumothorax and hemopneumothorax. Although peripherally inserted central catheters (PICCS) offer advantages over traditional central venous approaches, PICC lines are associated with a number of insertion and maintenance problems, including clotting and catheter fracture. These complications often result in catheter removal before completion of prescribed therapy. Methods: We conducted a retrospective descriptive study in a convenience sample of 322 consecutively placed PICC lines. Study variables included size of catheter, tip placement, infused solutions, patient diagnosis, and unit of line placement. The rationale for line discontinuance as well as for complication rates is described. Results: Complication rates for infection and central venous thrombosis were less than 1%. Phlebitis occurred in 9.7% of patients, and catheter fracture occurred in 9.7% of patients. Two distinct clusters of phlebitis, early and late development, were observed. Early phlebitis is attributable to the mechanics of insertion, and late phlebitis is attributable to chemical and patient‐specific causes. Catheter fractures were primarily related to tearing of the catheter during insertion or traction on the catheter‐hub junction (51.6%). Conclusions: The majority of published data about PICC lines is in the area of chemotherapy or antibiotic infusion. Our study supports the use of PICC lines in patients receiving a variety of solutions, primarily parenteral nutrition. With an experienced, team approach to catheter placement and maintenance, PICC lines provide reliable, cost‐effective venous access and reduce many of the complications of central venous access in a variety of clinical settings. (Journal of Parenteral and Enteral Nutrition 19:133–136, 1995)
Functional and Metabolic Changes in Intestinal Mucosa of Rats After Enteral Administration of Ornithine α‐Ketoglutarate Salt
Authors: Raul Francis , Gosse Francine , Galluser Michel , Hasselmann Michel , Seiler Nikolaus
Published: May 2008

Background: Ornithine α‐ketoglutarate salt efficiently improves the nutritional status of protein‐depleted patients. Our aim was to explore the effects of ornithine α‐ketoglutarate supplementation on intestinal physiology in healthy animals. Methods: Rats were given a nutritive mixture supplemented with ornithine α‐ketoglutarate (1 g·kg−1 per day) by enteral route for 7 days. Controls received the diet supplemented with casein acid hydrolysate under isoenergetic and isonitrogenous conditions. Results: An adaptive hyperplasia of the villi and an increase in the brush‐border hydrolase activities were observed in rats receiving ornithine α‐ketoglutarate. Because of the high ornithine aminotransferase activity, ornithine α‐ketoglutarate‐derived ornithine was extensively transaminated with a concomitant enhancement of ornithine decarboxylation. Surprisingly, with glutamate and putrescine, the products of ornithine transamination and decarboxylation, γ‐aminobutyric acid accumulated (10‐fold to 16‐fold) dramatically in the intestinal mucosa of rats treated with ornithine α‐ketoglutarate. Because γ‐aminobutyric acid formation was completely prevented by the diamine oxidase inhibitor aminoguanidine but was not modified after inactivation of ornithine aminotransferase by 5‐fluoromethylornithine, it is evident that γ‐aminobutyric acid is formed in the mucosa from ornithine via putrescine as an intermediate. Conclusions: It is assumed that enhanced γ‐aminobutyric acid formation in the intestinal mucosa by ornithine α‐ketoglutarate treatment might be of physiologic importance in the regulatory processes of cell growth and differentiation. (Journal of Parenteral and Enteral Nutrition 19:145–150, 1995)
Review: Bacterial Translocation and Enteral Nutrition in Humans: An Outsider Looks In
Authors: Lipman Timothy O.
Published: May 2008

Purpose: To assess the literature documenting the existence of bacterial translocation in humans, the effects of enteral nutrition on bacterial translocation in humans, and the hypothesis that enteral nutrition prevents bacterial translocation in humans. Data Identification: Sources included Medline search, references from review articicles, and references from animal and human studies. Study selection: The goal was to include all animal and human studies directly addressing questions of bacterial translocation and nutritional status or nutritional support. Data Extraction: An attempt was made to briefly summarize methodology and findings of relevent studies. No general attempt was made to assess quality of individual studies. Results of Data Synthesis: Bacterial translocation is a well documented phenomenon in animal models. Starvation and malnutrition of themselves do not induce bacterial translocation, but may facilitate translocation in the presence of other systemic insults. Parenteral nutrition and many forms of enteral nutrition may induce and/or facilitate bacterial translocation. Chow and certain fiber sources seem protective. Moderate direct and several lines of indirect evidence support the existence of bacterial translocation in humans. There is no direct evidence and questionable indirect evidence suggesting that enteral nutrition prevents or modifies bacterial translocation in humans. Conclusions: The hypothesis relating enteral nutrition and bacterial translocation in critically ill patients remains attractive, but unproven. (Journal of Parenteral and Enteral Nutrition 19:156–165, 1995)
Catch‐Up Growth in Children With Chronic Renal Failure Treated With Long‐Term Enteral Nutrition
Authors: Claris‐Appiani A. , Ardissino G.L. , Daccò V. , Funari C. , Terzi F.
Published: May 2008

Growth retardation commonly complicates chronic renal failure in children. Although the etiology of this growth impairment is multifactorial, inadequate nutrition is considered an important cause in infants and young children. An “aggressive” nutritional approach has been repeatedly suggested in children with early onset chronic renal failure and poor feeding habits, but the possibility of inducing catch‐up growth by energy supplementation is still controversial. The nutritional effects of a long‐term, home‐based enteral feeding program were studied in two infants and three children with moderate to severe chronic renal failure and impaired growth associated with persistent anorexia. In all patients, renal failure had developed during the first year of life due to congenital diseases. Enteral feeding was performed at home, during the night, through a silicone rubber nasogastric tube. The treatment lasted for 1 year. The energy intake ranged between 101% and 116% of the recommended dietary allowance (RDA), and the protein intake between 96% and 113% of the RDA in all patients but one, in whom proteins were restricted to 75% of the RDA. All children showed a substantial improvement in deviation score for both weight (mean increase +1.76), height (mean increase +1.52) and in the general metabolic condition, irrespective of age, severity of osteodystrophy, or degree of renal failure. The treatment was well tolerated and, apart from a few episodes of vomiting, no complications arose during the treatment. Tube feeding may be an effective therapeutic option for overcoming malnutrition when chronic renal failure is associated with persistent anorexia. In infants and young children, growth retardation can be opposed and catch‐up growth obtained. (Journal of Parenteral and Enteral Nutrition 19:175–178, 1995)
Localization of Rat Small Intestine Glutamine Synthetase Using Immunofluorescence and In Situ Hybridization
Authors: Roig J.C. , Shenoy Vivek B. , Chakrabarti Ratna , Lau Johnson Y.N. , Neu Josef
Published: May 2008

Glutamine is an important energy source for small intestinal epithelial enterocytes and serves as a key precursor for de novo synthesis of purines and pyrimidines in these rapidly dividing cells. Although glutamine synthetase (GS) is known to be the major enzyme of glutamine biosynthesis, the precise localization of this enzyme in the small intestine is not known. Because glutamine is an important precursor for nucleic acids biosynthesis, we hypothesized that GS is preferentially expressed in the crypt region, which contains the rapidly proliferating cells in the small intestine. Accordingly, immunofluorescence with a specific polyclonal antibody and in situ hybridization using a riboprobe were performed to localize GS protein and mRNA, respectively, in adult rats. Both GS protein and GS mRNA were detected primarily in the crypt region. This finding suggests that GS is located in the region with the highest nucleotide synthesis and cell proliferation. This finding is in support of the use of parenteral glutamine in patients with severe mucosal injury affecting the crypts. (Journal of Parenteral and Enteral Nutrition 19:179–181, 1995)
Comparative Evaluation of the Quantitative Utilization of Parenterally and Enterally Administered Leucine and L‐[1–13C,15N]Leucine Within the Whole Body and the Splanchnic Region
Authors: Yu Yong‐Ming , Young Vernon R. , Tompkins Ronald G. , Burke John F.
Published: May 2008

Background: The purpose of this study was to quantify the kinetic aspects of leucine metabolism in the whole body and within the splanchnic region when an amino acid mixture is administered by the enteral route as compared with administration by the parenteral route. Methods: Seven chronically catheterized dogs were studied during an intragastric infusion of L‐[1‐13C,15N]leucine with 0.24 g of complete amino acid mixture (kg—1·h—1) for 6 hours. The results are compared with those previously reported for nine dogs studied under essentially identical experimental conditions except that the tracer and amino acid mixtures were given by vein. Results: At the whole body level, the various parameters of leucine metabolism (flux, oxidation, and disappearance into and release from proteins) were not significantly different among animals that were infused enterally and those that were infused parenterally. Leucine metabolism within the splanchnic region and gut was more extensive for enteral administration than for parenteral administration. For the splanchnic region, 31.4%, 27.9%, and 6.0% of enterally administered leucine was used for protein synthesis, deamination, and oxidization, respectively, compared with respective mean values of 19.5% (p <.001), 13.4% (p <.001), and 4.1% (p <.05) for parenterally administered leucine. For liver, 4.8% of enterally administered leucine was oxidized compared with 2.3% (p <.001) of parenterally administered leucine. These findings are qualitatively similar to those reported previously by us when comparing enteral and parenteral amino acid intakes but with an IV tracer infusion. Conclusion: Enteral administration seems to be more effective than an acute parenteral feeding regimen, at least in maintaining leucine (protein) balance in gut tissues. (Journal of Parenteral and Enteral Nutrition 19:209–215, 1995)
Tissue Manganese Concentrations and Antioxidant Enzyme Activities in Rats Given Total Parenteral Nutrition With and Without Supplemental Manganese
Authors: Malecki Elise A. , Lo Hui‐Chen , Yang Huan , Davis Cindy D. , Ney Denise M. , Greger J.L.
Published: May 2008

Background: Manganese is an essential but potentially toxic mineral. Parenteral administration of manganese via total parenteral nutrition (TPN) bypasses homeostatic mechanisms (intestinal absorption and presystemic hepatic elimination). Our objective in this study was to determine the effect of supplemental manganese in TPN solutions on manganese status in a rat model. Methods: Male Sprague‐Dawley rats underwent jugular catheterization and were given 61.0 ± 0.4 g/d TPN solution providing 0.5 ± 0.2 nmol manganese/g (Mn‐; n = 6) or 16 ± 3 nmol manganese/g (Mn+; n = 7) for 7 days. Reference rats (RF; n = 8) were fed a purified diet containing 1.3 mmol manganese/g. Results: Liver manganese decreased in both TPN groups, but tibia, spleen, and pancreas manganese concentrations were greater in Mn+ rats than in Mn‐ or RF rats. Although no treatment differences were seen in heart or liver manganese superoxide dismutase activity, heart copper‐zinc superoxide dismutase activity was lower in the Mn+ rats than in Mn‐ or RF rats (p <.05). Glutathione peroxidase activity was depressed in livers of both Mn‐ and Mn+ rats relative to RF rats (p <.0001), which was not due to selenium deficiency. Conclusions: Supplemental parenteral manganese is taken up to a greater extent by peripheral tissues than the liver. In this first report of antioxidant enzyme activities in animals maintained with TPN, we found that TPN as well as supplemental manganese can influence antioxidant enzyme activities. We conclude that it is generally unnecessary and potentially toxic to supplement TPN solutions with manganese during short‐term usage. (Journal of Parenteral and Enteral Nutrition 19:222–226, 1995)
Essential Fatty Acid Status in Patients on Long‐Term Home Parenteral Nutrition
Authors: Abushufa Ramadan , Reed Paul , Weinkove Cyril , Wales Shona , Shaffer Jon
Published: May 2008

Background: Patients on total parenteral nutrition are known to be at risk of the development of essential fatty acid deficiency, presenting as a syndrome with scaly skin lesions and characterized by low plasma and erythrocyte linoleic acid concentrations. The essential fatty acid status of patients on long‐term home parenteral nutrition who do have access to oral feeds has not been studied. Methods: With the use of an isocratic high‐performance liquid chromatography method, fatty acids were measured in the erythrocytes and plasma of 25 nonfasting patients on long‐term home parenteral nutrition and the findings compared with those of 46 hospital outpatients not on nutrition support and five laboratory staff. Results: Statistically significant differences in the two groups were limited to the erythrocytes. Linoleic acid was significantly lower (25.2 vs 40.7 μmol/106 red blood cells, p <.0001) and showed a significant correlation with triceps skinfold thickness (r =.52, p =.013). Palmitoleic and oleic acids were higher in patients than controls (10.8 vs 8.4 μmol/106 red blood cells, p =.009; 61.2 vs 51.7 μmol/106 red blood cells, p =.003). Conclusions: Despite IV linoleic acid administration, patients on long‐term home parenteral nutrition have low erythrocyte stores of this essential fatty acid. This appears to be related to their low body fat stores. We suggest that they may be using much of the infused linoleic acid as an energy source and therefore are at risk of subclinical essential fatty acid deficiency. (Journal of Parenteral and Enteral Nutrution 19:286–290, 1995)
Practical Aspects of Enteral Nutrition in the Management of Crohn's Disease
Authors: Teahon Kathy , Pearson Morag , Levi A. Jonathan , Bjarnason Ingvar
Published: May 2008

Background: Enteral nutrition regimens achieve remission from active Crohn's disease at rates comparable to steroids and total parenteral nutrition. Despite their increasing use there has to date been no assessment of patient tolerance or practical difficulties involved. Methods: We investigated 147 treatments with elemental diet in 89 patients and followed this with an anonymous questionnaire. Results: Sip feeding was successfully introduced in 85% with nasogastric feeding being necessary in 22 (15%). Nausea and postural hypotension were common in the first week of treatment but vomiting was only seen in three patients who were sensitive to the formula used. Two patients each had caffeine withdrawal symptoms and hypoglycemia and a further four had food‐related night terrors. Our experience suggests that caution is necessary if this treatment is used in elderly subjects. Although the diets are perceived as being unpalatable, only six patients found taste to be a problem after the first week of treatment. The main problem with long‐term treatment was the large daily volume requirement, which was overcome by increasing the concentration of the feed. Eighty percent of patients responded to the questionnaire, and 65% stated that they would opt for treatment with elemental diet again in the case of a further relapse. Conclusions: Elemental diet seems to be an acceptable and well‐tolerated form of treatment in Crohn's disease. (Journal of Parenteral and Enteral Nutrition 19:365–368, 1995)
Diminished Protection Against Copper‐Induced Lipid Peroxidation by Cord Blood Plasma of Preterm and Term Infants
Authors: Lindeman J.H.N. , Lentjes E.G.W.M. , Berger H.M.
Published: May 2008

Background: Blood plasma of neonates is less able to inhibit iron induced lipid peroxidation than plasma of older patients. Copper, also a powerful pro‐oxidant, may accumulate in ill babies because of excess intake or decreased excretion. We assessed in vitro the ability of plasma of neonates to inhibit copper induced peroxidation damage. Methods: Peroxidation of phospholipid liposomes, induced by CuCl2, was measured with a thiobarbituric acid assay. The ability of plasma from venous blood of adults and cord blood of babies to inhibit peroxidation was compared. The levels of the copper binding plasma proteins, albumin and ceruloplasmin, were also measured. Results: Protection against copper induced lipid peroxidation was much higher with adult plasma compared to neonatal plasma. Despite their lower albumin and ceruloplasma levels the protection by the plasma of preterm babies was higher than that of the term babies. Conclusions : At birth, babies have a limited ability to inhibit copper induced oxidative damage in vitro. Postnatal studies are needing to assess the influence of maturation and nutrition on these findings and their relevance in diseases induced by reactive oxygen species. (Journal of Parenteral and Enteral Nutrition 19:373–375, 1995)