bluuebunny/crossref_metadata_2025 huggingface dataset:
Effects of Amino Acids in Mixtures Given by Enteral or Parenteral Route on Intestinal Morphology and Hydrolases in Rats
Authors: Czernichow Bella , Galluser Michel , Hasselmann Michel , Doffoel Michel , Raul Francis
Published: May 2008

This study compares the effects of amino acid addition to an elemental liquid diet containing carbohydrates and triglycerides given either intragastrically or intravenously on the morphology and on hydrolase activities in the jejunum and ileum of adult rats. The isocaloric mixtures were administered for 4 days and control rats received an isocaloric laboratory diet orally. Independent of their content in amino acid, all mixtures given intravenously caused a drop in mucosal weight and a shortening of the height of the villi in both the jejunum and ileum. By enteral route, the addition of amino acids to a carbohydrate‐triglyceride liquid diet led to the maintenance of normal villus height (this effect being prominent in the ileum) and to a significant increase of jejunal sucrase and aminopeptidase activities when compared with the carbohydrate‐triglyceride mixture. Feeding the mixtures by parenteral route caused a significant drop of both enzyme activities. In contrast, lactase activity was generally not modified by the route of nutrient administration or by the composition of the diets. However, the absence of amino acid in the mixture given intravenously caused a specific drop of lactase activity in the ileum. Ileal sucrase activity was lowered dramatically by intragastric or intravenous feeding of the elemental diets. This effect was not modulated by the presence of amino acids. The presence of amino acids caused a significant drop of aminopeptidase activity in the ileum independently of the route of administration when compared with animals receiving the carbohydrate‐triglyceride liquid diet. The present report shows that amino acids present in the liquid diet given by either enteral or parenteral route are able to modulate the morphology and hydrolytic functions along the small intestine. Because amino acids are preferentially absorbed by the jejunum, the effects observed at the level of the ileum might be related to hormonal and/or biliopancreatic regulations. (Journal of Parenteral and Enteral Nutrition 16: 259–263, 1992)
Duplex Doppler Ultrasound Identifies Veins Suitable for Insertion of Central Feeding Catheters
Authors: Mcintyre Alistair S. , Levison Rosemary A. , Srn Susanne Wood , Phillips Robin K.S. , Lennard‐Jones John E.
Published: May 2008

Central venous access for feeding catheters may prove difficult in patients who have had numerous previous central line insertions or complications. Duplex Doppler ultrasound was used to identify the anatomy and patency of major central veins in 11 patients in whom attempts at obtaining central venous access by an experienced operator had failed at least once and in 40 control subjects. Doppler ultrasound demonstrated the subclavian veins (diameter 12.5 ± 3.5 mm, mean ± SE) and internal jugular veins (11 ± 3.5 mm) in all the control subjects. In the patients, 18 of 44 veins were patent, 11 were small or had low blood flow, and 15 were thrombosed. In 7 patients who required central feeding catheter insertion, a suitable vein was identified and the catheter suitably placed, even in 3 subjects where no central vein was considered normal. Duplex Doppler ultrasonography is a useful technique for identifying veins suitable for the insertion of central venous lines when access has previously proved difficult. (Journal of Parenteral and Enteral Nutrition 16: 264–267, 1992)
Different Quantities of Two Commercial Liquid Diets Consumed by Weight‐Losing Cancer Patients
Authors: Ovesen Lars , Allingstrup Lene
Published: May 2008

Twenty ambulatory, weight‐losing patients with advanced cancer of the lung, breast, or ovary were randomized to supplement their diet for 2 months with either of two commercial complete liquid diets, one containing intact milk proteins and the other partially hydrolyzed soy proteins. Both products were prescribed as sip feeds in addition to normal food. The patients consumed more of the hydrolysate‐containing product than of that with intact (milk) protein. The difference was significant and was maintained during both months of the study. An increase in total energy and protein was obtained in both groups, but was significant only with the hydrolysate product. At the end of the study there was no group difference in measures of nutritional status, but weight loss was halted in both groups. (Journal of Parenteral and Enteral Nutrition 16:275–278, 1992)
Harry M. Vars Research Award: A New Model to Determine in Vivo the Relationship Between Amino Acid Transmembrane Transport and Protein Kinetics in Muscle
Authors: Biolo Gianni , Chinkes David , Zhang Xiao‐Jun , Wolfe Robert R.
Published: May 2008

The bidirectional transmembrane transport rates of leucine (Leu), valine (Val), phenylalanine (Phe), lysine (Lys), and alanine (Ala) were measured in vivo in the hindlimb muscle of five dogs and related to the rates of protein synthesis and degradation. The compartmental model was based on the systemic continuous infusion of stable isotopic tracers of the amino acids, and the measurement of the enrichment and concentration in the arterial and femoral vein plasma and the intracellular free water in muscle (obtained by biopsy). The transport rate from plasma to tissue (in micromoles per minute) was: Leu, 18.1 ± 1.8; Val, 26.9 ± 3.5; Phe, 10.5 ± 1.6 Lys; 12.2 ± 1.8; and Ala, 10.7 ± 3.4. The transport rate from tissue to plasma (in micromoles per minute) was: Leu, 25.5 ± 2.5; Val, 32.4 ± 2.8; Phe, 17.0 ± 2.8; Lys, 24.9 ± 3.4; Ala, 34.4 ± 9.0. When the transmembrane transport rate was normalized per unit of amino acid concentration in the source pool, we found that the transport of Leu, Val, and Phe was significantly faster (p <.05) than the transport of Lys and Ala. The calculated rates of incorporation into hindlimb muscle protein of Phe and Lys (in micromoles per minute) were 4.2 ± 1.3 and 19.4 ± 5.3, respectively, and the rates of intracellular appearance from breakdown were 10.7 ± 1.9 and 32.1 ± 6.6, respectively. We concluded, therefore, that (1) the transmembrane amino acid transport rate can be measured in vivo in muscle with a relatively noninvasive technique, (2) in the dog hindlimb the equilibration between tissue and plasma free amino acid pool is different for each amino acid depending on the kinetics of the transmembrane transport systems, and (3) the transport rates of amino acids and their rate of appearance from protein breakdown are roughly comparable, suggesting that variations in transport rates could play a role in controlling the rate of protein synthesis. (Journal of Parenteral and Enteral Nutrition 16:305–315, 1992)
Liver Test Alterations With Total Parenteral Nutrition and Nutritional Status
Authors: Leaseburge Lori A. , Winn Norma J. , Schloerb Paul R.
Published: May 2008

Liver test abnormalities are a well‐recognized complication in the parenterally fed population. Numerous etiologies for the development of elevated liver tests have been suggested. However, the etiology and clinical significance remain unclear. The aim of this retrospective study was to determine the extent of liver‐associated test (LAT) abnormalities in patients receiving total parenteral nutrition (TPN) and to investigate whether the composition of TPN solutions and the magnitude of malnutrition could be used to predict subsequent LAT abnormalities. Medical records of 78 adult patients who received TPN for at least 2 weeks were reviewed. All subjects had normal LAT results before TPN, were not receiving hepatotoxic drugs, and had no underlying liver disease. Aspartate aminotransferase peaked transiently during week 2 and returned to normal during week 4. Alkaline phosphatase and total bilirubin peaked during weeks 4 and 3, respectively. The average nonprotein kilocalorie distribution was approximately 80% dextrose and 20% lipid. Caloric intake ranged from 7% to 23% above estimated needs. The mean nutritional status score was 22 ± 15, with a possible range of 0 to 75 (0 indicates no malnutrition). The composition of TPN solutions was not significantly associated with the changes in the three LATs during any week of the 4‐week study. The nutritional status score was significantly associated (p <.05) with the change in alkaline phosphatase during week 1. This study confirms that LAT abnormalities occur during TPN, but the composition of the solution has no significant ability to predict subsequent LAT abnormalities. Factors associated with cholestasis may have contributed to the LAT abnormalities in this group of subjects because the pattern of LAT elevations suggested cholestasis more than hepatocellular damage. The magnitude of malnutrition before TPN may identify patients likely to develop early alkaline phosphatase abnormalities. (Journal of Parenteral and Enteral Nutrition 16:348–352, 1992)
Jejunal Mucosal Injury and Restitution: Role of Hydrolytic Products of Food Digestion P. R. KVIETYS, R. D. SPECIAN, M. B. GRISHAM, AND P. TSO American Journal of Physiology 24:G384‐G391, 1991
Authors: Demetriou Achilles A.
Published: May 2008

The authors examined the effects of hydrolytic products of carbohydrate, protein, and lipid digestion on jejunal injury and restitution in anesthetized rats. Mucosal epithelial integrity was assessed by measuring blood‐to‐lumen clearance of 51Cr‐labeled EDTA administered as a bolus into the femoral vein. When the intestinal lumen was perfused with 3% hydrolyzed casein or 150 mmol/L glucose there was no effect on 51Cr‐EDTA clearance when compared with saline controls. However, perfusion with emulsified lipids (20 mmol/L sodium taurocholate and 10 to 40 mmol/L oleic acid) resulted in a statistically significant (p <.05) increase in 51Cr‐EDTA clearance in a dose‐dependent fashion. When lipid infusion was terminated and saline perfusion resumed, 51Cr‐EDTA clearance returned to control levels.

Histologic examination of the jejunal mucosa revealed damage of the epithelial lining of the villous tips in animals treated with lipid infusion. The injury was characterized by gaps in the epithelial lining of the villous tips and the presence of exfoliated cells in the mucous layer overlying the disrupted epithelium. After termination of the lipid infusion, epithelial integrity was reestablished within 50 minutes. Nearly 50% of the villi show a discontinuous epithelium at their tips immediately after lipid perfusion is terminated. Subsequent perfusion with saline results in partial restitution with only 14% of the villi affected 30 minutes and 2.6% 50 minutes later.

In vitro studies using monolayer cultures of a rat intestinal epithelial cell line (IEC‐18) demonstrated that neither glucose nor hydrolyzed casein had a deleterious effect on cell integrity. However, oleic acid emulsified in rat hepatic bile produced a dose‐dependent disruption of the epithelial cell monolayer when added to the cultures.

Biochemical determinations of lipid peroxidation products both in vivo and in vitro did not reveal any significant differences among the various groups, suggesting that the lipid‐induced injury was not due to lipid peroxidation.

The authors conclude that because the concentrations of the various nutrients used in the present study are similar to those found in postprandial chyme, their findings suggest that intestinal epithelial injury and restitution take place during the course of digestion and absorption of a meal.
Effect of Body Positions and Splints in Bioelectrical Impedance Analysis
Authors: Pinilla Jaime C. , Webster Brenda , Baetz Marilyn , Reeder Bruce , Hattori Susan , Liyan Liu
Published: May 2008

The objective of this study was to evaluate body composition as measured by bioelectric impedance analysis using splints and body positions differing from the standard supine position. Forty‐three patients, randomized into two groups of different body positions, and 101 healthy volunteers were prospectively studied. Resistance and reactance of body tissues were measured by bioelectric impedance analysis. Body composition is described by a three‐compartment model composed of body fat, body cell mass, and extra cellular mass. The patients were measured in the standard supine position and then randomized into two groups. They were then remeasured with the appropriate splinting device or position change. Volunteers were measured in the standard supine position and all four alternative positions. There was a statistically significant difference demonstrated in whole body resistance, whole body reactance, body cell mass, and the ratio of extracellular mass to body cell mass in some body positions. The percentage of change with different body positions and splints, when compared with the standard supine position, was generally below 2%, a clinically insignificant difference. We conclude that the reliability of resistance and reactance as measured by bioelectric impedance analysis is clinically valid using any of the tested body positions and/or splints. The three‐compartment model may be a useful concept to measure body composition changes in both healthy and sick persons. (Journal of Parenteral and Enteral Nutrition 16: 408–412, 1992)
Parenteral Glutathione Monoester Enhances Tissue Antioxidant Stores
Authors: Robinson Malcolm K. , Ahn Min S. , Rounds Jan D. , Cook John A. , Jacobs Danny O. , Wilmore Douglas W.
Published: May 2008

Glutathione (GSH) is a potent endogenous antioxidant that protects major organs from oxidant injury. However, present nutrition regimens may inadequately support tissue stores of this tripeptide during critical illness. To determine whether GSH reserves can be enhanced in vivo with intravenous (IV) supplements, rats underwent central venous catheterization, were given chow and water ad libitum during a 2‐day recovery period, and were then randomized to receive one of three treatments as an IV bolus: (1) dextrose, (2) glutathione (GSH), or (3) glutathione monoethyl ester. GSH monoethyl ester is transported into cells more easily than is GSH. Tissue and plasma samples were analyzed for GSH at 2 and 4 hours after drug administration. Liver, renal, and ileal mucosal GSH were significantly increased in the GSH‐monoethyl ester rats compared with dextrose‐treated animals. In addition, plasma GSH was dramatically increased after monoester injection. In contrast, GSH administration depressed liver GSH stores and did not significantly affect GSH concentration in the other organs analyzed. Plasma GSH concentration was elevated 2 hours after GSH administration. We conclude that: (1) the monoethyl ester of glutathione can be used in vivo to enhance tissue and plasma GSH concentration and (2) IV GSH administration does not significantly increase tissue GSH levels and may paradoxically depress hepatic GSH in normal rats. Because the malnourished and critically ill are likely to have depleted GSH stores, nutrition strategies that include the provision of GSH monoester may lend additional support to those organs that are at risk for injury from oxygen free radicals during catabolic states. (Journal of Parenteral and Enteral Nutrition 16:413–418, 1992)
Gastroesophageal Reflux in Intubated Patients Receiving Enteral Nutrition: Effect of Supine and Semirecumbent Positions
Authors: Ibáñez Jordi , Peñafiel Albert , Raurich Joan María , Marse Pere , Jordá Ricard , Mata Felix
Published: May 2008

The incidence of gastroesophageal reflux (GER) in critically ill patients as well as the effect of a nasogastric tube (NGT) and body position as risk factors for GER were determined. Seventy patients with orotracheal intubation receiving enteral nutrition through a NGT for more than 48 hours were prospectively studied with two randomly assigned body positions: supine or semirecumbent. Detection of GER was achieved by scintigraphy after labeling gastric contents with 500 μCi of technetium‐99m sulfur colloid administered through the NGT. In 50 patients scintigraphy was performed after subjects had remained in the randomized position for 2 hours with the NGT pinched. Twenty additional patients were studied after the NGT had been removed.

In 50 patients with NGT, GER was present in 74% (37 of 50) and was higher in the supine position (81%, 21 of 26) than in the semirecumbent position (67%, 16 of 24), but this difference was not statistically significant (p =.26). In 20 patients without NGT, the incidence of GER was 35% (7 of 20) and it was also higher in the supine (50%, 6 of 12) than in the semirecumbent position (12%, 1 of 8, p =.16). There was a statistically significant difference between GER in patients with and without NGT (74% vs 35%, p =.0002). These data show that there is a high incidence of GER in patients with orotracheal intubation and NGT. The presence of a NGT is a risk factor for GER. Semirecumbency does not prevent GER, but there is less incidence than in the supine position. (Journal of Parenteral and Enteral Nutrition 16:419–422, 1992)
Arginine Enhances T‐Cell Responses in Athymic Nude Mice
Authors: Kirk Stephen J. , Regan Mark C. , Wasserkrug Hannah L. , Sodeyama Motohide , Barbul Adrian
Published: May 2008

Supplemental L‐arginine has been shown to enhance thymic and T‐cell responses in rodents. We examined the ability of supplemental dietary L‐arginine to induce T‐cell function in athymic nude mice that lack a normally developed T‐cell system. Groups of male nude (nu/nu) mice (Balb/c background) 7 to 8 weeks old were given for 2 weeks 1.2% arginine hydrochloride solution for drinking, whereas controls received acidified tap water. All mice ingested a standard laboratory chow. In the first experiment, the arginine‐supplemented animals had significantly greater number of T cells in the spleen (assessed by the number of Thy 1.2‐positive lymphocytes) and these cells had enhanced mitogenic responses to mitogenic stimulation (phytohemagglutinin and concanavalin A). In vivo delayed‐type hypersensitivity responses to 2,4‐dinitro‐1‐difluorobenzene were also significantly increased after the 2 weeks of arginine supplementation. In a second experiment, mice maintained under the same conditions were skin grafted with rat tail skin. Animals were observed for 100 days for rejection but no significant difference was noted in skin graft survival. We conclude that dietary arginine can increase extrathymic T‐cell maturation and function, but cannot induce in vivo allogeneic graft recognition in athymic nude mice. (Journal of Parenteral and Enteral Nutrition 16:429–432, 1992)
Hypermetabolism and Hypercatabolism in Guillain‐Barré Syndrome
Authors: Roubenoff Rebecca A. , Borel Cecil O. , Hanley Daniel F.
Published: May 2008

We studied 21 patients with Guillain‐Barré syndrome who demonstrated multiple nutritional risk factors upon admission to an intensive care unit: ventilator dependence (71.4%), adynamic ileus (23.8%), significant weight loss in the 2 weeks before admission (53.0%), antecedent viral illness with gastrointestinal sequelae (43.0%), cranial nerve deficits impairing oral intake and gastrointestinal motility (60%), and depressed serum transferrin (85.7%). Patients are hypermetabolic and hypercatabolic because of endocrine, infectious, and inflammatory components of the disease. High‐energy (40 to 45 nonprotein kcal/kg), high‐protein (2.0 to 2.5 g/kg) nutrition support appears to exert a favorable effect on visceral protein repletion, nitrogen balance, and resistance to pulmonary infection. Immediate attainment of positive energy balance in these hypermetabolic patients, ideally assessed by indirect calorimetry and followed by high‐energy, high‐protein feedings, may promote positive nitrogen balance early and attenuate muscle wasting in Guillain‐Barré syndrome. (Journal of Parenteral and Enteral Nutrition 16:464–472, 1992)
Improved Growth and Disease Activity After Intermittent Administration of a Defined Formula Diet in Children With Crohn's Disease
Authors: Polk D. Brent , Hattner Jo Ann T. , Kerner John A.
Published: May 2008

Growth failure is the most common extraintestinal manifestation of Crohn's disease in childhood, occurring in up to 50% to 88% of affected patients. Previous studies have shown malnutrition to be the most likely cause of the decrease in height and weight velocities in these children. The purpose of this study was to determine the effect of an intermittent defined formula diet on growth and disease activity in children with Crohn's disease and growth failure. Six Tanner stage I‐II patients, mean age 13.6 years with height less than the 5th percentile or height velocity less than the 3rd percentile were enrolled in a 1‐year prospective study. An isotonic, hydrolyzed whey, medium‐chain triglyceride formula was given by nocturnal nasogastric infusion at a caloric equivalent of 50th percentile for age, as the exclusive nutrient source 1 out of 4 months during a 1‐year period. A 2‐week exclusion diet and a 2‐week low‐residue diet followed the defined formula diet before resuming the regular diet for 2 months. Patients served as their individual control based on observations of at least 1 year before the study. Height and weight velocity significantly increased. Prednisone intake significantly decreased, and significant improvement was seen in disease activity, albumin, and somatomedin C. The results indicate that an intermittent defined formula diet can improve growth failure and significantly decrease disease activity in children with Crohn's disease. (Journal of Parenteral and Enteral Nutrition 16:499–504, 1992)
Polymyxin B Reduces Total Parenteral Nutrition‐Associated Hepatic Steatosis by Its Antibacterial Activity and by Blocking Deleterious Effects of Lipopolysaccharide
Authors: Pappo Itzhak , Bercovier Herve , Berry Elliot M. , Haviv Yosef , Gallily Ruth , Freund Herbert R.
Published: May 2008

Overgrowth of Gram‐negative bacteria as a result of total parenteral nutrition (TPN) and bowel rest could be responsible for the release of a variety of hepatotoxic substances such as endotoxin or tumor necrosis factor (TNF) and the ensuing TPN‐associated liver function derangements. Polymyxin B is an effective antimicrobial agent as well as a blocking agent for endotoxin (lipopolysaccharide) activity and TNF production. In the present study we compared the oral and intravenous effects of polymyxin in rats receiving TPN in an attempt to define these two possible mechanisms of action of polymyxin on TPN‐associated hepatic steatosis.

Both oral, as well as intravenous polymyxin B, significantly reduced total hepatic fat and triglyceride accumulation in TPN rats, more so in the intravenous group exhibiting close to control levels. Both polymyxin‐treated groups exhibited significantly lower Gram‐negative bacterial counts in the cecum, with the oral group exhibiting a lower count than the IV group. The spontaneous production of TNF by peritoneal macrophages was markedly increased in rats receiving TPN and very close to being undetected in both groups receiving TPN and polymyxin.

We believe polymyxin B protects the liver during TPN by both its antimicrobial effect which prevents overgrowth of gut Gram‐negative bacteria and the subsequent translocation of endotoxin, and by its specific antilipopolysaccharide activity which, in the present study, completely abolished hepatic steatosis and TNF production during TPN. (Journal of Parenteral and Enteral Nutrition 16:529–532, 1992)
Effect of a Single Oat Bran Cereal Breakfast on Serum Cholesterol, Lipoproteins, and Apolipoproteins in Patients With Hyperlipoproteinemia Type IIa
Authors: Bartram Peter , Gerlach Stefanie , Scheppach Wolfgang , Keller Franz , Kasper Heinrich
Published: May 2008

Serum cholesterol‐lowering effects of oat bran‐enriched diets have been indicated in several studies in which oat bran was given several times a day. Concomitant changes in the daily diet, ie, a diminished energy intake or changes in the composition of fats in the diet, also have been reported and used to explain the hypocholesterolemic effect of oats. The present study was designed to replace only the conventional continental breakfast by a single oat bran cereal muesli containing 60 g of oat bran and to measure the effects of this dietetic modification on serum lipids in 13 patients with hypercholesterolemia type IIa. Compared with a 3‐week baseline period, total serum cholesterol (7.38 ± 0.35 mmol/L, mean ± SEM) was reduced by 10.9, 8.4, and 9.7% in the first, second, and third week of oat bran ingestion (p <.01). High‐density lipoprotein and low‐density lipoprotein cholesterol as well as apolipoprotein A1 decreased to the same extent (8 to 11%; p <.05) during the oat bran period, whereas a pronounced reduction of 25.8% was seen for apolipoprotein B100 (p <.01), which is a major component of low‐density lipoprotein. Dietary data obtained by 3‐day food records at baseline, oat bran, and follow‐up period did not show any differences between the study periods except for dietary fiber, which was increased from 21.9 g/day to 42.4 g/day (p <.002) during the test period because of the daily oat bran intake. On the basis of these results the simple replacement of a conventional continental breakfast by an oat bran cereal muesli can be highly recommended to lower total serum cholesterol and other atherogenic lipid fractions in patients with hyperlipoproteinemia type IIa. (Journal of Parenteral and Enteral Nutrition 16:533–537, 1992)
Acute Phosphate Intoxication in Seven Infants Under Parenteral Nutrition
Authors: Biarent D. , Brumagne C. , Steppe M. , Bouton J.‐M.
Published: May 2008

After major surgery, seven infants aged 4 to 29 weeks, under parenteral nutrition, received monosodium phosphate (4.2 to 14.3 mEq/kg body weight) instead of prescribed calcium gluconate. The wrong solution was perfused during 16 hours. At the 15th hour, blood samples showed hyperphosphatemia in all (8.0 to 14.4 mg/100 mL) and hypocalcemia in four infants (6.1 to 8.0 mg/100 mL), but all were asymptomatic. Under a perfusion of glucose in water, calcemia and phosphatemia returned to normal within 24 hours. In a review of the pediatric literature, we found 11 subjects with symptomatic acute phosphate intoxication, who also presented with hypocalcemia and hyperphosphatemia. The differences were that they received high bolus doses of phosphate orally or rectally and showed symptomatic features. Normalization of the calcemia occurred only when hyperphosphatemia was corrected throughout intravenous hydration. (Journal of Parenteral and Enteral Nutrition 16:558–560, 1992)
Prevention of Catheter‐Related Sepsis During Parenteral Nutrition: Effect of a NeW Connection Device
Authors: Inoue Yoshifumi , Nezu Rchiro , Matsuda Hikaru , Fuj Makoto , Nakai Sumio , Wasa Masafumi , Takagi Yoji , Okada Akira
Published: May 2008

A prospective study was carried out to determine the clinical effect of a newly devised catheter connection method (I system) and piggyback access system. Previous studies have demonstrated that the I system avoided bacterial contamination in vitro during tubing change that Luer‐Lock connectors did not. The purpose of this study was to investigate the ability of this device coupled with a new closed‐system piggyback technique for multipurpose access to reduce catheter‐related sepsis in clinical practice. Two hundred and thirty patients receiving total parenteral nutrition were divided into two groups. Group I (n = 106) used the I system connector and group L (n = 124) used a Luer‐Lock connector. Catheters in both groups were used for multipurpose access for infusion and blood sampling. In group L, a three‐way stopcock and/or piggyback system was used for multiple access. In group I, a newly designed closed‐system piggyback was used. The incidence of catheter‐related sepsis was significantly lower in group I (1.89%/catheter) than in group L (12.10%/catheter) (p <.01, χ2 analysis), and the average duration of use of each catheter was significantly longer in group I than in Group L (p <.01 by generalized Wilcoxon test). The results of this clinical study suggest that the newly designed connection method and piggyback access system are able to reduce catheter‐related sepsis. (Journal of Parenteral and Enteral Nutrition 16:581–585, 1992)
Total Energy Expenditure in Patients With Crohn's Disease: Measurement by the Combined Body Scan Technique
Authors: Stokes Maurice A. , Hill Graham L.
Published: May 2008

A combined body scan technique for measuring total energy expenditure (TEE) from energy intake and changes in energy stores is presented. The TEE of 13 patients with Crohn's disease who required nutrition support over a 14‐day period was measured. They had a mean TEE of 33 kcal/kg per day. The components of the TEE in these 13 patients were also measured. Seventy percent of the TEE was made up by resting metabolic expenditure, 10% by diet‐induced thermogenesis, and the remaining 20% by activity energy expenditure. These patients had a mean activity energy expenditure of 369 kcal/day. The diet‐induced thermogenesis was a mean 12.6% increase on the resting metabolic expenditure. Each percent increase was caused by a mean of 210 kcal of energy in either the intravenous nutrition or the enteral nutrition. There was no difference in diet‐induced thermogenesis between those having enteral nutrition and those receiving intravenous nutrition. Decreased activity was significantly correlated with increased activity of the disease (r =.7, p <.01). This confirms the belief that patients with Crohn's disease require no more energy (ie, 33 kcal/kg per day) than other patients. If the resting metabolic expenditure is increased through illness, then the activity energy expenditure decreases. The combined in vivo neutron activation‐dual energy x‐ray absorptiometry technique has allowed for the first time measurements in ward patients with Crohn's disease. The measurements confirm that TEE is not raised and that 30 to 35 kcal/kg per day is sufficient to achieve energy balance in such patients. (Journal of Parenteral and Enteral Nutrition 17:3–7, 1993)
Evaluation of a Practical Technique for Determining Insulin Requirements in Diabetic Patients Receiving Total Parenteral Nutrition
Authors: Hongsermeier Tonya , Bistrian Bruce R.
Published: May 2008

A practical technique to provide central parenteral nutrition to insulin‐taking diabetic patients based on prehospitalization insulin requirements and insulin placed in the central parenteral nutrition was originally presented based on retrospective review. The present article confirms the safety and applicability of this method after a multiyear period of application. Particularly noteworthy are the absence of hypoglycemic episodes, the attainment of reasonable blood glucose control, and the relatively consistent relationship of insulin required in central parenteral nutrition to prehospitalization insulin requirements. (Journal of Parenteral and Enteral Nutrition 17:16–19, 1993)
Does Portal Nutrition Benefit Liver Protein Synthesis?
Authors: Bozzetti Federico , Regalia Enrico , Barbieri Angelo , Facchetti Giorgio , Bombardieri Emilio , Montalto Fabrizio , Cozzaglio Luca , Gennari Leandro
Published: May 2008

There are only a few experimental investigations on the feasibility and potential advantages of intraportal nutrition in animals and only two uncontrolled studies in humans. The purpose of this study was to compare some metabolic variables in patients who received portal or systemic nutrition after elective surgery for colorectal cancer. Twenty patients were randomized to receive postoperatively for a week a hypocaloric, “protein sparing” standard infusion via the portal (catheter in the gastroepiploic vein) (10 patients) or systemic (10 patients) route. We evaluated the basal concentrations of some visceral and acute‐phase proteins and their variations in the first postoperative week and the nitrogen balance. Statistical analysis was performed by the two‐tailed Student t test. There was no difference in the daily changes of the visceral and acute‐phase proteins after surgery in the two groups of patients, but in the portal group there was a significantly better recovery of the level of total protein, albumin, and cholinesterase at the end of the portal infusion vs the systemic group (p ≤.005,.03, and.02, respectively). In regard to the nitrogen balance, although there was no difference in the overall balance between portal and systemic nutrition, if we separate the acute phase of the injury from the later one we do not see any significant difference in the first period but we do see a highly significant advantage for the portal group during the last 2 days (p ≤.0001). These data suggest that short‐term portal nutrition is feasible and safe, with metabolic effects that are at least similar to and possibly better than those of systemic nutrition. (Journal of Parenteral Nutrition 17:20–24, 1993)
Effect of Glutamine‐Supplemented Intravenous Nutrition on Survival After Escherichia coli‐Induced Peritonitis
Authors: Inoue Yoshifumi , Grant John P. , Snyder Phyllis J.
Published: May 2008

Current solution formulations for total parenteral nutrition (TPN) do not contain glutamine (GLN). The purpose of this study was to examine whether GLN supplementation of TPN would improve survival in experimental Escherichia coli peritonitis in Fischer 344 rats (190–210 g). Initial experiments were performed to determine the degree of stress and to evaluate survival after intraperitoneal E coli injection. The E coli colony used was isolated from a culture of human blood. Graded doses were injected intraperitoneally in Fischer 344 rats (190–210 g). The response of white blood cell count, plasma insulin, glucagon, and corticosterone levels, and urinary excretion of vanillylmandelic acid reflected a significant stress response for at least 3 days. Survival was dose‐dependent, with 60% mortality at 3 days after injection of 5 × 105 colony forming units of E coli/200 g body weight. To determine whether GLN supplementation of TPN would alter survival in this E coli peritonitis model, Fischer 344 rats were randomized to receive TPN containing 4.25% standard amino acids (group STD, n = 38) or the same solution with 1.5% of the amino acid content replaced with L‐GLN (group GLN, n = 38). After 7 days of TPN, 5 × 105 colony forming units of E coli/200 g body weight were injected intraperitoneally under direct vision through a small laparotomy. Survival was monitored for 3 days. Surviving rats were killed to determine various nutritional parameters including plasma albumin and GLN concentration, the weight and nitrogen content of the gastrocnemius muscle, and biochemical and histological composition of the small intestine. Group GLN showed significantly improved survival (92.1%) compared with group STD (44.7%). There were no differences in the nutritional status. Mucosal weight, mucosal nitrogen content, villous height, and mucosal thickness, however, were significantly greater in group GLN than in group STD. These data demonstrate that GLN supplementation of TPN significantly improves tolerance to E coli‐induced peritonitis. Several possible mechanisms of action are discussed. (Journal of Parenteral and Enteral Nutrition 17:41–46, 1993)
A Prospective Randomized Trial Comparing the Silver‐Impregnated Collagen Cuff With the Bedside Tunneled Subclavian Catheter
Authors: Babycos Christopher R. , Barrocas Albert , Webb Watts R.
Published: May 2008

A prospective study was undertaken to compare the silver‐impregnated collagen cuff (Vitacuff) with the bedside tunneled catheter. Fifty patients were randomly assigned to three groups: group I received triple‐lumen catheters with Vitacuff application and a semiocclusive dressing material; group II received triple‐lumen tunneled catheters with a semiocclusive dressing; and group III received triple‐lumen tunneled catheters with collodion as a dressing material. In patients suspected of having central venous catheter sepsis, blood cultures were obtained through the catheter, the catheter was removed, and the tip was cultured semiquantitatively. Central venous catheter sepsis was defined as a positive catheter‐tip culture and blood culture for the same organism. No catheter‐related sepsis was seen in either the Vitacuff or the tunneled catheters with collodion dressing. In the tunneled catheters with semiocclusive dressing, there was one case of catheter‐related sepsis and one case of insertion‐site infection. There was also one insertion‐site infection in the Vitacuff group, but there was no statistical difference in infection rates between the three groups. (Journal of Parenteral and Enteral Nutrition 17:61–63, 1993)
Urinary Nitrogen Constituents in the Postsurgical Preterm Neonate Receiving Parenteral Nutrition
Authors: Helms Richard A. , Mowatt‐Larssen Christine A. , Boehm Kristi A. , Christensen Michael L. , Hughes Mariela A. , Fernandes Eduardo T. , Storm Michael C.
Published: May 2008

Minimal information is available defining urinary nitrogen constituents in preterm neonates receiving parenteral nutrition (PN). The study objective was to evaluate 24‐hour urine collections for total urinary nitrogen (TUN), urinary urea nitrogen (UUN), and the nitrogen content in creatinine, ammonia, free amino acids, protein, hippuric acid, and uric acid at baseline (days 1 to 2 of PN and days 1 to 3 after surgery) and 7 days later in eight preterm, postsurgical neonates. Calculation of undetermined nitrogen was also completed. Comparisons with historic, normal data were made for each urinary nitrogen constituent. At baseline, PN provided 59 ± 10 nonprotein kcal/kg·day−1 and 430 ± 54 mg/kg·day−1. At day 7, PN provided 106 ± 23 nonprotein kcal/kg. day−1 and 432 ± 30 mg/ kg·day−1. TUN, UUN, and protein nitrogen decreased significantly from baseline at day 7 (p <.05). The percentages of TUN as amino acids, creatinine, and uric acid nitrogen were calculated. Percent amino acid nitrogen (6.0 ± 2.3% vs 8.4 ± 1.5%, p <.05), percent creatinine nitrogen (1.6 ± 0.5% vs 2.9 ± 0.8%, p <.001) and percent uric acid nitrogen (1.7 ± 0.9% vs 3.6 ± 2.1%, p <.05) increased significantly at day 7. The observed urinary free amino acid nitrogen fraction represented a higher percentage of TUN both at baseline and at day 7 when compared with term neonatal reference data, whereas creatinine nitrogen, uric acid nitrogen, and protein nitrogen represented a lower percentage of TUN. However, amino acid and creatinine nitrogen as a percentage of TUN were similar to levels in milk formula‐fed preterm infants. The advancement of nonprotein calories and the likely decrease in physiologic stress at day 7 contributed to decreased TUN, UUN, and protein nitrogen excretion. Undetermined nitrogen remains a significant fraction of nitrogen losses in preterm neonates receiving PN. (Journal of Parenteral and Enteral Nutrition 17:68–72, 1993)
Influence of Glucose Infusion on Levels of Phosphomonoesters and Adenosine Triphosphate as Detected by Magnetic Resonance Spectroscopy in a New Model of Core‐Cooling of the Rat Liver In Situ
Authors: Iriyama Keiji , Azuma Takaaki , Osawa Tohru , Tsuchibashi Takashi , Kitagawa Tatsushi , Suzuki Hiroshi
Published: May 2008

This preliminary study was undertaken to ascertain whether our newly developed model of the cold ischemic rat liver in situ is applicable to studies designed to assess the metabolism of nutrients. Ischemia of the whole liver of 12 Wistar rats was induced by clamping all supply and drainage vessels. The ischemic liver was perfused in situ. The duration of ischemia of the liver was 20 minutes. Saline was infused into six rats throughout the experiment (group A). An intravenous infusion of glucose at a rate of 0.75 g/h per rat was begun immediately after the induction of blood‐reflow to the liver (group B, n = 6). Six rats (group C) did not undergo the procedure for induction of hepatic ischemia and received glucose at the same rate as rats in group B. Changes in hepatic levels of sugar phosphates (phosphomonoesters [PMEs]), inorganic phosphorus, and β‐positioned phosphorus in adenosine triphosphate (β‐ATP) were monitored by 31P magnetic resonance spectroscopy. Ischemia caused a significant increase in levels of PMEs and a decrease in levels of β‐ATP. The infusion of glucose caused a further increase in levels of PMEs and a further decrease in levels of β‐ATP in group B. In contrast, in group C such infusion did not induce any changes in levels of PMEs or β‐ATP. In group A, PMEs and β‐ATP returned to basal levels 5 hours after the induction of blood‐reflow to the liver. The changes in levels of PMEs were similar to those in levels of inorganic phosphorus in all groups. All rats in groups A and C regained consciousness and survived, whereas all rats in group B died 4 or 5 hours after the induction of blood‐reflow to the liver. Thus, it was demonstrated that the early supply of large amounts of glucose induces the accumulation of sugar phosphates and inhibits restoration of hepatic levels of ATP. The results suggest that our newly developed model of cold ischemia of the rat liver in situ can be applied to studies designed to elucidate appropriate nutrients for the liver recovering from cold ischemia. (Journal of Parenteral and Enteral Nutrition 17:77–81, 1993)
Review: Is Fetal Enteral Nutrition Important for Normal Gastrointestinal Growth?: A Discussion
Authors: Trahair Jeffrey F.
Published: May 2008

Long‐term total parenteral nutrition results in atrophy of small intestinal structure and function. Maintenance or re‐establishment of enteral nutrition can prevent or redress this loss. Paradoxically, the fetus develops in a total parenteral nutrition environment, but at the same time must achieve appropriate levels of gastrointestinal maturation in readiness for enteral feeding soon after birth. The fetus swallows large amounts of fluid during life in utero and growth is arrested if fetal ingestion is impaired. It is possible therefore that enteral nutrition provided by fetal swallowing is just as important in ensuring normal gastrointestinal homeostasis and growth in the fetus as it is in the adult. (Journal of Parenteral and Enteral Nutrition 17:82–85, 1993)
Complication of Parenteral Nutrition Composed of Essential Amino Acids and Histidine in Adults With Renal Failure
Authors: Nakasaki Hisao , Katayama Tokitaka , Yokoyama Seishichi , Tajima Tomoo , Mitomi Toshio , Tsuda Michio , Suga Takao , Fuj Koichi
Published: May 2008

This is a case report on six patients with hyperammonemia that developed while they were receiving total parenteral nutrition (TPN) as a component of renal failure therapy. Clinically, the hyperammonemia presented as mental status changes in all six cases. Four of the six patients with renal failure initially received 400 mL Amiyu in 1400 mL 17% glucose (total = 1800 mL TPN‐A) administered over each 24‐hour period. Two patients had been placed on 400 mL complete amino acid in 1400 mL 17% glucose (total = 1800 mL TPN‐C over each 24‐hour period) prior to therapy with TPN‐A. Approximately 3 weeks after initiation of TPN therapy with TPN‐A, episodes of mental status changes of increasing duration and paroxysms were documented in five of the six patients. In one of the patients receiving TPN‐C prior to TPN‐A therapy, toxicity was clinically evident only 4 days after initiation of TPN‐A. Serum ammonia levels were obtained and found to be elevated in the acute (ie, presenting) stage in all patients. With the discontinuance of TPN‐A, ammonia levels normalized uniformly. Mental status also improved in all cases except for the patient with rapid clinical presentation who died 2 weeks after first evidence of clinical toxicity. In cases 1, 2, and 6, serum amino acid analysis in the acute phase showed reduced levels of ornithine and citrulline, the substrate and product, respectively, of condensation with carbamyl phosphate at its entry into the urea cycle. Moreover, levels of arginine, precursor to ornithine, were found to be elevated. And, in cases 1 and 6, the serum concentration of orotic acid was 40 times and 23 times, respectively, the value expected in a normal healthy adult. This is presumably due to funneling of carbamyl phosphate into an alternate biosynthetic pathway as a result of inadequate ornithine needed as substrate for its entrance into the urea cycle. Thus, the common denominator in the hyperammonemia experienced in these cases appears to be a depletion of ornithine stores, which we hypothesize to have mainly resulted from inhibition of arginosuccinate synthetase by histidine. Consequently, in patients requiring long‐term TPN therapy (>3 weeks in our experience with TPN‐A), it may be necessary to supplement ornithine in addition to arginine. In all such patients, we feel it is necessary to monitor serum ammonia for toxicity or long‐term elevation. (Journal of Parenteral and Enteral Nutrition 17:86–90, 1993)
The Effect of Continuous Enteral Nutrition on Gastric Acidity in Humans D. ARMSTRONG, F. CASTIGLIONE, C. EMDE, ET AL Gastroenterology 102:1506–1515, 1992
Authors: Kearns Patrick J.
Published: May 2008

Abstract: This study examines 24‐hour gastric pH response under four nutritional conditions in 11 normal subjects. The conditions include: fasting, normal meals, and infusion of an equicaloric nutritional solution either parenterally or intraduodenally (i.d.). The volunteers underwent four 24‐hour intragastric pH measurement studies. Serum glucose, calcium, immunoreactive insulin, and gastrin levels were determined at various intervals. Median 24‐hour gastric pH values were significantly lower during i.d. infusion than during parenteral feeding but were not significantly different from fasting or normal diet values. Median 24‐hour serum glucose levels during i.d. infusion were higher than during fasting and lower than during parenteral nutrition. Median 24‐hour serum insulin levels during i.d. infusion were higher than during fasting but similar to levels during parenteral nutrition. Neither median 24‐hour gastrin levels nor calcium levels were altered by the various regimens. The authors conclude that continuous i.d. nutrient infusion produces gastric pH values similar to fasting or normal meal levels, whereas parenteral nutrition increases gastric pH. This suggests that under physiologic conditions, gastric acidity is under feedback control
Effects of Intravenously Infused Egg Phospholipids on Lipid and Lipoprotein Metabolism in Postoperative Trauma
Authors: Roulet Michel , Wiesel Paul H. , Pilet Marianne , Chapuis Germain , Carpentier Yvon A.
Published: May 2008

Lipid emulsions contain not only triglyceride (TG)‐rich particles but also phospholipid (PL)‐rich particles that are believed to trap free cholesterol and apoprotein E, when they are infused in excess. The present study was designed to evaluate the effects of such abnormal PL‐rich particles on lipid metabolism during a 5‐day infusion in man. Eighteen patients undergoing esophagectomy were evenly randomized to receive intravenously during 5 days 1.75 g·kg−1·d−1 long‐chain TG from either a 10% lipid emulsion with a PL/TG weight ratio of 0.12 (group A), a 10% emulsion with a PL/TG weight ratio of 0.06 (group B), or a 20% emulsion with a PL/TG weight ratio of 0.06 (group C). Plasma PL, free cholesterol, and apoprotein E increased progressively in group A (4.1 ± 0.3 mmol/ L, 2.4 ± 0.3 mmol/L, and 0.089 ± 0.012 g/L on day 5, respectively) but not in groups B (2.7 ± 0.3 mmol/L, 1.3 ± 0.2 mmol/ L, and 0.048 ± 0.007 g/L) and C (2.4 ± 0.2 mmol/L, 1.2 ± 0.1 mmol/L, and 0.050 ± 0.006 g/L). Free fatty acids and TGs remained constant and similar in each group postoperatively. After fat infusion had been stopped at the end of the fifth day, the elimination of plasma TGs over the next 4 hours was comparable in the three groups. We conclude that excess egg PLs induce alterations of plasma lipids even within a few days. (Journal of Parenteral and Enteral Nutrition 17:107–112,1993)