bluuebunny/crossref_metadata_2025 huggingface dataset:
Investigational Use of Tissue Plasminogen Activator (t‐PA) for Occluded Central Venous Catheters
Authors: Atkinson James B. , Bagnall Holly A. , Gomperts Edward
Published: May 2008

Urokinase and streptokinase are commonly used thrombolytic agents for fibrin obstructed central venous catheters. Although proven to be efficacious, these two agents have the potential to induce systemic fibrin breakdown and hemorrhage. We report our initial experience with tissue plasminogen activator (t‐PA) for the treatment of occluded central venous catheters which failed urokinase. Of 25 incidents of catheter occlusion in 142 right atrial catheters, six failed to clear after an initial bolus dwell of urokinase. Five of these six catheters cleared following treatment with 2 mg/2 cc of t‐PA with a mean of 1.5 bolus installations. The one catheter failure was due to catheter tip position and age of clot. No coagulation abnormalities or bleeding was observed. These data suggest that t‐PA may be a safe, effective thrombolytic agent in the treatment of occluded central venous catheters. (Journal of Parenteral and Enteral Nutrition 14:310–311, 1990)
Efficacy of Thrombolytic Therapy for Occlusion of Long‐Term Catheters
Authors: Monturo Cheryl Ann , Dickerson Roland N. , Mullen James L.
Published: May 2008

Nineteen ambulatory outpatients requiring a tunneled central venous access device with catheter occlusion were studied. Mean catheter life was 7.9 ± 8.2 months (range, from 1–36 months) at the time of the occlusion.

Urokinase (5000 units/ml) was injected in sufficient amount to fill the internal volume of the catheter and allowed to stay for 5 to 10 min before attempting to aspirate. Repeated aspiration attempts were performed every 5 to 10 min for a maximum of 30 to 60 min or patency. In the event catheter patency was not restored, the thrombolytic solution was aspirated from the catheter and a maximum of two additional trials were instituted. Results included clearance of four out of 15 withdrawal occlusions (27%) and two out of four resistance to infusion occlusions (50%). Overall, successful catheter clearance occurred in six out of 19 occlusions (32%).

The efficacy rate of thrombolytic therapy for successfully clearing occluded catheters at our institution using conventional low‐dose thrombolytic therapy is markedly lower than previously reported rates of 57 to 100%. The reasons for this discrepancy may reflect differences in dosage of thrombolytic agent, method of administration, frequency of monitoring of catheter patency, and catheter life. (Journal of Parenteral and Enteral Nutrition 14:312–314, 1990)
Glutamine or Fiber Supplementation of a Defined Formula Diet: Impact on Bacterial Translocation, Tissue Composition, and Response to Endotoxin
Authors: Barber Annabel E. , Jones William G. , Minei Joseph P. , Fahey Thomas J. , Moldawer Lyle L. , Rayburn Joseph L. , Fischer Eva , Keogh Christopher V. , Shires G. Tom , Lowry Stephen F.
Published: May 2008

Despite provision of adequate calories, defined formula diets in rats lead to bacterial translocation (BT), fatty infiltration of the liver, and an increased susceptibility to endotoxin. These deleterious effects may be due in part to a loss of intestinal barrier integrity resulting from bowel atrophy. Defined formula diets lack both glutamine and fiber, substances which may help maintain intestinal mass. To determine whether supplementation of defined formula diets with either glutamine or fiber might prevent bowel atrophy and, thus, BT, hepatic steatosis, and the altered response to endotoxin, Wistar rats were fed (1) defined formula diet ad libitum (DFD), (2) (DFD + 2% (w/v) glutamine, (GLUT), or (3) DFD + 2% (w/ v) psyllium (FIBER). Rats given standard food isocalorically pair‐fed to DFD were used as controls. Nutritional status was assessed by daily weight gain, as well as the ability to maintain serum albumin, hematocrit and white blood counts. After 2 weeks of these feeding regimens, animals were sacrificed, and organ weights and composition were determined, with rates of bacterial translocation determined bv mesenteric lymph node. abdominal viscera, and cecal cultures. Additional animals receiving the same experimental diets were subsequently challenged with endotoxin and observed for mortality with rates of post‐endotoxin BT and the responses of acute phase proteins and cytokines measured.

All dietary regimens resulted in equivalent weight gain and other nutritional parameters. Both glutamine and fiber supplementation maintained small bowel mass, but only GLUT preserved normal jejunal mucosal architecture. Neither fiber nor glutamine supplementation prevented cecal bacterial overgrowth or BT, resulting from the DFD. Mortality after endotoxin challenge was similar in all three groups receiving DFD regardless of supplementation, although GLUT was associated with a significantly (p < 0.01 vs DFD) lower incidence of bacteremia. Supplementation with glutamine or fiber did not result in differences in circulating acute phase protein or cytokine responses to endotoxin. Thus, although both glutamine and fiber supplementation of DFD prevent loss of bowel mass, neither substance resulted in effective protection against spontaneous BT, or endotoxin‐induced translocation or mortality. (Journal of Parenteral and Enteral Nutrition 14:335–343, 1990)
Effect of Early Postoperative Nutritional Support on Skin Wound and Colon Anastomosis Healing
Authors: Delany Harry M. , Demetriou Achilles A. , Teh Eutiquio , Levenson Stanley M.
Published: May 2008

Improved healing occurs in nutritionally depleted rats given early postoperative compared with delayed feeding. The present study was designed to test the hypothesis that delay in postoperative feeding of rats normally nourished at the time of operation would also be detrimental to wound healing. Fully nourished rats weighing 288 to 342 g were divided into three groups (10 rats per group). All rats had central vein catheters inserted, celiotomy with division and reanastomsis of the colon and dorsal skin incisions, under ip pentobarbital anesthesia. With no oral intake allowed postoperatively, groupl rats were maintained on iv 5% Dextrose electrolytes and vitamins (5% DSV); group 2 was given the 5% D/SV until the third postoperative day when they were placed on TPN (4.5% amino acids 15% Dextrose, 10% Intralipids); and group 3 was given TPN from the first postoperative day. Rats were sacrificed 6 days postoperatively and final weight, skin wound breaking strength (WBS) and colon anastomosis bursting pressure (CBP) were measured. Findings were % weight change —27.8 ± 1.5 for Group 1, —12.6 ± 1.0 for Group 2, and ‐6.9 ± 8 for group 3 (p < 0.0001). Wound measurements for STS on fresh specimens were 88.6 ± 10.0 g for group 1, 89.1 ± 8.4 g for group 2, and 87.1 ± 11.1 g for group 3. WBS for formalin‐fixed specimens were 313.5 ± 29.7 g for group 1, 323.4 ± 38.4 g for group 2, and 382 ± 25.2 g for group 3 (NS). CBP was 155.7 ± 6.2 mm Hg for group 1, 169.7 ± 2.7 mm Hg for group 2, and 192.3 ± 2.5 mm Hg for group 3 (p < 0.0001 for group 3 us groups 1 and 2). It can be concluded that early postoperative TPN has a significant beneficial effect on postoperative weight loss and colonic anastomotic healing. (Journal of Parenteral and Enteral Nutrition 14:357–361, 1990)
Enteral Feeding in the Hypoalbuminemic Patient
Authors: Patterson Mary Lou , Dominguez Jose M. , Lyman Beth , Cuddy Paul G. , Pemberton L. Beaty
Published: May 2008

Previous studies have correlated intolerance of isotonic, intact protein enteral solutions with hypoalbuminemia. The purpose of this retrospective study was to determine whether the level of serum albumin (SA) influenced tolerance of such an enteral nutrient solution (ENS). All patients who received Entrition during 1987 for a minimum of 48 hr were studied for the first 10 days of enteral feeding. Documentation included SA, medications, stool frequency, gastric residuals (GR), and daily caloric intake. ENS intolerance was defined as greater than 3 stools/day for greater than 48 hr or GR greater than twice the hourly infusion rate for greater than 48 hr. Patients were categorized into two groups: those with SA greater than or equal to 2.5 g/dl (group 1) and those with SA less than 2.5 g/dl (group II). Of 88 patients studied, 48 (86%) in group I and 28 (88%) in group II tolerated the ENS. Eight (14%) in group I and 4 (12%) in group II experienced ENS intolerance. There was no statistically significant difference in the frequency of ENS intolerance between these two groups (p < 0.05). Also, 97% of all those with a SA less than 2.5 g/dl were fed 80% or more of their estimated caloric requirements. We concluded that ENS tolerance was not affected by the SA level and patients with hypoalbuminemia (SA < 2.5 g/dl) could be fed enterally. (Journal of Parenteral and Enteral Nutrition 14:362–365, 1990)
Delayed Pneumothorax after Subclavian Vein Catheterization
Authors: Plaus William J.
Published: May 2008

One hundred fourteen patients having 121 subclavian venipunctures were studied retrospectively. Eight pneumothoraces occurred (6.6%) and were most frequent after the insertion of large catheters, or when the subclavian area was distorted by previous venipuncture or radiation.

Delayed pneumothorax occurred in five patients. This unusual diagnosis was made radiographically 8 to 96 hr postoperatively in response to the appearance of new pulmonary symptoms. Delayed pneumothorax required treatment with tube thoracostomy more frequently than immediate pneumothorax.

This study establishes the approximate incidence of delayed pneumothorax for the first time. The relative frequency of this complication may challange the cost effectiveness of pneumothorax diagnosis by chest films done within 1 or 2 hr of subclavian venipuncture. An alternative diagnostic protocol is considered. (Journal of Parenteral and Enteral Nutrition 14:414–415, 1990)
Review: The Phospholipid/Arachidonic Acid Second Messenger System: Its Possible Role in Physiology and Pathophysiology of Metabolism
Authors: Hartl Wolfgang H. , Wolfe Robert R.
Published: May 2008

The phospholipid/arachidonic acid second messenger system is a signaling system by which systemic regulators (hormones) and local mediators (tissue factors) control certain aspects of tissue metabolism. In vivo and in vitro evidence indicates that these effectors activate phospholipolytic enzymes in cellular membranes. The products of these enzymatic reactions (such as inositol phosphates or arachidonic acid metabolites) can serve as second messengers that can potentially influence glucose, lipid and protein metabolism at the cellular level. Alterations in this second messenger system could be involved in metabolic changes associated with some pathologic conditions as well as certain drug treatments, and thus, a better understanding of the system could reveal new possibilities for therapeutic interventions. (Journal of Parenteral and Enteral Nutrition 14:416–427, 1990)
Protein and Energy Metabolism with Biosynthetic Human Growth Hormone in Patients on Full Intravenous Nutritional Support
Authors: Ponting G.A. , Ward H.C. , Halliday D. , Sim A.J.W.
Published: May 2008

Our objective was to examine the effect of biosynthetic human growth hormone (BSHGH) on protein and energy metabolism in patients on full intravenous nutrition (IVN). Fifteen patients who had been established on IVN were allocated at random to receive either BSHGH (0.1 mg/kg/day) or placebo daily for 7 days. All patients received the same feeding regimen which contaminated 14 gN, 1000 kcal of glucose and 1000 kcal of fat (Intralipid) daily. The mean nitrogen balance for days 4 to 7 was significantly more positive with BSHGH (7.0 ± 0.6 gN/day) than with placebo (4.4 ± 0.7 gN/ day). The BSHGH group were lighter (53 ± 4.6 kg body weight) than controls (68 ± 5.1 kg), but the difference was not significant. Resting energy expenditure (expressed as percentage of day 1) increased throughout the study in patients receiving BSHGH (day 7, 120.8 ± 5.5%), whereas in patients receiving placebo it remained stable (day 7, 98.9 ± 2.7%). The nonprotein respiratory quotients were similar for BSHGH (mean days 4–7, 0.94 ± 0.04) and placebo (mean days 4–7, 0.93 ± 0.01) (p > 0.05). This study demonstrates more positive nitrogen balance, which may in part be due to different substrate loads, and an increase in energy expenditure in patients receiving BSHGH. (Journal of Parenteral and Enteral Nutrition 14:437–441, 1990).
Effect of Home Total Parenteral Nutrition on Body Composition in Patients with Acquired Immunodeficiency Syndrome
Authors: Kotler Donald P. , Tierney Anita R. , Culpepper‐Morgan Joan A. , Wang Jack , Pierson Richard N.
Published: May 2008

Malnutrition occurs commonly in patients with acquired immunodeficiency syndrome (AIDS). The efficacy of nutritional support is unknown. A prospective, longitudinal study was conducted to determine the effect of prolonged total parenteral nutrition on body composition in 12 AIDS patients. Five patients were malnourished because of problems with food intake or absorption, while seven had systemic infections, with or without a malabsorption syndrome. The AIDS patients gained body weight and body fat content in response to total parenteral nutrition, while mean body cell mass, estimated as total body potassium content, was unchanged. However, all five patients with altered intake or absorption had significant repletion of body cell mass which was significantly different from the patients with systemic infections. Calorie and nitrogen intake did not differ between the two groups. It is concluded that body mass repletion is possible in AIDS patients in whom malabsorption is the major pathogenetic factor in producing malnutrition and is less successful in patients with serious ongoing systemic diseases. Thus, the response to nutritional support is dependent on the particular clinical circumstances. (Journal of Parenteral and Enteral Nutrition 14:454–458, 1990)
Protein Metabolism Assessed by 1–13C Leucine Infusions in Patients Undergoing Bone Marrow Transplantation
Authors: Keller U. , Kraenzlin M.E. , Gratwohl A. , Thélin A. , Straumann E. , Arnaud M.J. , Speck B. , Stauffacher W.
Published: May 2008

Patients receiving cytoreductive therapy and bone marrow transplantation (BMT) are known to develop marked protein catabolism. To assess the contribution of whole body protein breakdown, amino acid oxidation and incorporation into proteins, plasma leucine kinetics (1‐13C‐leucine infusion technique) were determined in six patients five times within 14 days before and after cytoreductive therapy (Cyclophosphamide and total body irradiation) and marrow transplantation. Nitrogen balance became negative (—0.20 ± 0.04 g/ Kg/24 hr) after cyclophosphamide (p < 0.01) and was ‐0.25 ± 0.05 g/Kg/24 hr 7 days after BMT in spite of total parenteral nutrition.

Plasma leucine concentration increased after BMT by 67% (p < 0.0015). Leucine plasma appearance was 1.20 ± 0.15 μmol/ kg/min before treatment, it increased slightly and transiently after cyclophosphamide, and increased again from day 5 to day 7 after BMT (p < 0.01), suggesting increased protein breakdown. Leucine oxidation increased from 0.27 ± 0.07 before therapy to 0.97 ± 0.16 μmol/kg/min (p < 0.02) after cyclophosphamide and BMT. Nonoxidative leucine disappearance rate decreased slightly from 0.92 ± 0.08 to 0.75 ± 0.16 μmol/kg/min after BMT (ns). Leucine metabolic clearance rate decreased from 11.8 ± 1.65 before therapy to 6.9 ± 0.70 ml/kg/min (p < 0.02) after cytoreductive therapy. After BMT it increased again to 9.9 ± 1.5 ml/kg/min (p < 0.02). The results demonstrate that patients undergoing cytoreductive therapy and bone marrow transplantation develop negative nitrogen balance due to increased protein breakdown associated with increased leucine oxidation and increased metabolic clearance rate. Leucine incorporation into proteins (protein synthesis) was not altered inspite of an increase in plasma leucine concentration. (Journal of Parenteral and Enteral Nutrition 14:480–484, 1990)
Total Peripheral Parenteral Nutrition in Pregnancy
Authors: Watson Lydia A. , Bommarito Alexander A. , Marshall Joseph F.
Published: May 2008

Twenty pregnant patients needing nutritional support for various indications received hypercaloric, hyperosmotic, “3 in 1,” peripheral parenteral nutrition as a bridge to enteral therapy. This system, named total peripheral parenteral nutrition, was evaluated as to tolerance and efficacy in pregnant patients. Patients were in various stages of pregnancy and had an average weight loss of 10.4 pounds prior to admission. Patients were maintained on total peripheral parenteral nutrition for an average of 5 days and gained an average of 4.1 pounds. Good tolerance with minimal side effects of the treatment was noted. Intravenous sites were changed an average of 1.1 times per patient during the course of therapy and only one serious complication was noted in 20 patients. Patients were followed through delivery and this information is presented. Total peripheral parenteral nutrition appears to be an acceptable alternative to conventional total parenteral nutrition to pregnant patients needing nutritional support. These hypertonic solutions can supply total caloric/metabolic needs without unacceptable side effects. (Journal of Parenteral and Enteral Nutrition 14:485–489, 1990)
Nucleic Acid Labeling with [3H]Orotic Acid and Nucleotide Profile in Rats in Protein Deprivation, Enteral and Parenteral Essential Amino Acid Administration, and 5‐Fluorouracil Treatment
Authors: Jakobsson Birgitta , El Hag Imad Abdien , Andersson Marianne , Christensson Per‐Inge , Stenram Unne
Published: May 2008

Rats were fed a 0% casein diet for 1 week, with or without enteral or parenteral administration of essential amino acids, or a 25% casein diet, in one group supplemented with 5‐fluorouracil treatment. Ninety minutes before sacrifice the rats were given a tracer of [3H]orotic acid. Incorporation into the acid soluble fraction, RNA, and DNA was determined in liver, small intestine, bone marrow, and kidney. Nucleotide profile was examined in liver and intestine. Protein deficiency caused inter alia a decrease in body weight; a decrease in RNA/ DNA ratio and an increase in the specific RNA labeling in liver and kidney; an altered nucleotide profile in the liver; an increase in the nucleotide/DNA and RNA/DNA ratios and a decrease in the specific labeling of the acid soluble fraction, RNA, and DNA in the bone marrow. These changes were prevented to the same extent by giving essential amino acids, either orally or intravenously. The minor changes in intestinal nucleotide profile in protein deprivation were prevented to a slightly larger extent by amino acids orally than parenterally. 5‐Fluorouracil treatment gave a decrease in the RNA/DNA ratio in the liver and kidney but an increase in the nucleotide/DNA and RNA/DNA ratios in the bone marrow. Nucleotide profiles were unaltered. The amount of DNA per gram of tissue decreased in bone marrow and increased in kidney. Parenteral administration per se resulted in almost no changes. (Journal of Parenteral and Enteral Nutrition 14:490–496, 1990)
Effect of Tryptophan and Cyproheptadine on Food Intake
Authors: Kubota Akio , Yang Zhong‐Jin , Meguid Michael M.
Published: May 2008

Whether tryptophan in the usual dose found in total parenteral nutrition (TPN) solutions caused a decrease in food intake was investigated in 16 adult male Fischer 344 rats. A jugular venous catheter was placed, and patency was maintained with a continuous infusion of normal saline at 3 ml/hr. After a 10‐day recovery period, eight normal saline control rats were sacrificed and the remaining eight rats were given a parenteral nutrition solution (PN‐50) at 3 ml/hr, providing 50% of the rat's daily energy requirement as 5% dextrose and 2% Intralipid. On day 14, study rats were further divided into two subgroups. Subgroup A received tryptophan (180 mg/day) added to the solution for 5 days. Subgroup B received the serotonin‐receptor blocker, cyproheptadine 24 mg/kg/day, continuously for 5 days, and on day 16, tryptophan (0.25% = 180 mg/kg/day) was added to the solution for 3 days. Chow and water was continuously available and spontaneous food intake was measured daily. Study rats were sacrificed on day 19. Plasma amino acids and insulin and whole brain biogenic amines were compared with those in control rats using Student's t‐test. With administration of PN‐50, spontaneous food intake decreased to about 60% compared with the pre‐PN level. The addition of tryptophan to the continuous infusion of PN‐50 did not decrease spontaneous food intake further. Compared with pre‐PN levels there were no changes in plasma immunoreactive insulin, plasma tryptophan concentration, or plasma Trp/Val+Leu+Ile+Phe+Tyr ratio, even though the concentration of tryptophan (0.25%) which was added to the PN solution was four times higher than that usually found in standard TPN solution. Furthermore, the administration of cyproheptadine did not increase spontaneous food intake. The data thus question the role that tryptophan, in its usual doses in TPN solution, is thought to have in the regulation of spontaneous food intake. (Journal of Parenteral and Enteral Nutrition 14:497–500, 1990)
The In Vivo Availability of Gentamicin When Admixed with Total Nutrient Solutions: A Comparative Study
Authors: Kern Jack W. , Kum Ja Lee  , Martinoff James T. , Silberman Howard
Published: May 2008

The relative in vivo availability of gentamicin when administered by two different intravenous methods was evaluated in patients treated in a surgical intensive care unit in a randomized, prospective, crossover study. Each patient received gentamicin therapy via intravenous piggyback (IVPB) and in‐line burette (ILB) methods. In the IVPB method, the drug was mixed in 5% dextrose in water (D5W) and infused intermittently. In the ILB method, the drug was mixed using the patient's total nutrient admixture (TNA) solution as the diluent in an ILB, which was inserted between the TNA bottle and its administration set and infused intermittently. A serial sampling of four sets of serum concentrations of the gentamicin was obtained. Pharmacokinetic parameters (Kel, Vd, and a maximum serum concentration) were calculated from the four sets of concentrations collected per patient. The IVPB method yielded mean values of Kel, Vd, and C15mg/kg of 0.13 hr−1, 0.39 liter/kg, and 5.1 μg/ml, respectively. The ILB method yielded mean values of Kel, Vd, and C1.5mg/kg of 0.14 hr−1, 0.34 liter/kg, and 5.6 μg/ml, respectively. A t‐test for paired samples was applied to these mean values. Significant difference was not found (p > 0.05). The intermittent infusion of gentamicin, using TNA as the diluent and an ILB, produced equivalent serum concentrations when compared with D5W as the diluent. (Journal of Parenteral and Enteral Nutrition 14:523–526, 1990)
Rapid Spectrophotometric Determination of Plasma Carnitine Concentrations
Authors: Maeda Jun , Dudrick Stanley J.
Published: May 2008

A spectrophotometric enzymatic assay for plasma carnitine concentrations has been automated on the Monarch 2000. Prior to the assay, each plasma sample was divided into three fractions, ie, free carnitine, acid‐soluble carnitine and total carnitine, in order to determine the concentrations of both free and esterified carnitine. Using the method developed by Tachikawa et al (Seikagaku 56:998, 1984), each of the samples was then chromatographed on an anion exchange resin to eliminate those compounds which could adversely impact the accuracy of the enzymatic assay for carnitine. After the completion of these preparatory steps, 32 specimens were assayed in less than 16 min on the Monarch 2000 with a high degree of both accuracy and precision. The assay was linear over a wide concentration range (5.0–80 μmol/liter), with the lower limit of sensitivity being 5.0 μmol/liter. The coefficient of variation (CV%) of the within run precision was 2.1%, 2.8%, and 6.7% for the determinations of free carnitine, acid‐soluble carnitine, and total carnitine, and 17.4% and 27.8% for the calculated values of short‐chain and long‐chain acylcarnitines, respectively. The CV% of the between run precision for the same fractions was 6.5%, 2.7%, 3.8%, 14.2%, and 14.3%, respectively. When authentic L‐carnitine was added to the plasma, the mean recovery rate was 94.7 ± 11.0%. Reference values were determined using plasma obtained from 40 healthy adult volunteers. (Journal of Parenteral and Enteral Nutrition 14:527–532, 1990)
Use of Parenteral Medium‐Chain Triglyceride Emulsion for Maintaining Seizure Control in a 5‐Year‐Old Girl with Intractable Diarrhea
Authors: Rosenthal Elana , Weissman Barbara , Kyllonen Kay
Published: May 2008

Medium‐chain triglycerides (MCT) are an important component of an enteral ketogenic diet for seizure control. Previously, it was difficult to maintain ketosis when parenteral (iv) nutrition therapy was necessary. The use of iv MCT in a 5‐year‐old girl with Lennox‐Gastaut syndrome who had diarrhea and dehydration is reported. Conventional 20% iv fat emulsion (long‐chain triglycerides, LCT) and dextrose free hyperalimentation (HAL) in a 4:1 ketogenic ratio did not maintain adequate ketosis during bowel rest. Compassionate use of iv MCT (Clintec Nutrition) infused as a 70:30 MCT/ LCT ratio plus HAL maintained moderate ketosis. Seizures were well controlled during the iv MCT regimen, which allowed normal daily functioning. Complications included abnormal liver function tests and severe iron deficiency anemia of unknown etiology. Serum triglyceride and cholesterol levels increased to 1717 mg/dl and 614 mg/dl, respectively, but decreased with a reduction of lipid infusion and use of an antihyperlipemic drug. Nutritional status was maintained. In this case, iv MCT proved to be a relatively safe and effective short‐term method of continuing parenteral nutrition while maintaining ketosis for seizure control. (Journal of Parenteral and Enteral Nutrition 14:543–545, 1990)
A Cuffed Polyurethane Catheter for Long‐Term Central Venous Access: A Novel Technique Prevents Early Displacement
Authors: Moran B.J. , Sutton G.L.J.
Published: May 2008

A new method which provides immediate fixation of a cuffed central venous catheter is described. The cuffed polyurethane catheter has a detachable hub which allows the creation of a second small tunnel distal to the cuff using the wire and the vein dilator. As the catheter exits from a “pinhole,” immediate fixation is assured and is independent of tissue healing. (Journal of Parenteral and Enteral Nutrition 14:546–547, 1990)
Use of Human Growth Hormone Combined with Nutritional Support in a Critical Care Unit
Authors: Ziegler Thomas R. , Young Lorraine S. , Ferrari‐Baliviera Elisabetta , Demling Robert H. , Wilmore Douglas W.
Published: May 2008

The administration of growth factors may potentially accelerate recovery during critical illness by reducing body protein catabolism, enhancing wound healing, and improving skeletal muscle function. The purpose of this phase 1 study was to evaluate the safety and initial efficacy of a recombinant growth factor, human growth hormone (GH), combined with nutritional support in a critical care unit. Following an initial control week, 11 individuals received GH (10 mg/day) daily for 1–6 consecutive weeks. Near constant nutrient intake was provided via parenteral and/or enteral feedings throughout the study period. Vital signs and other clinical parameters, blood values, and nutrient excretion were monitored daily. GH administration was not associated with clinically significant adverse effects. During the first 2 weeks of study, nitrogen excretion decreased from 1356 ± 157 mmol/day (19.0 ± 2.2 g/ day) during control to 899 ± 107 mmol/day (12.6 ± 1.4 g/day) with growth hormone (p < 0.002) in association with markedly reduced urea generation. Significant reductions in potassium excretion (control 100 ± 11 mmol/day us 69 ± 6 with GH; p < 0.01) and phosphorus excretion (31 ± 5 mmol/day us 18 ± 3; p < 0.025) also occurred during GH. The protein‐conserving effects of GH were sustained during several weeks of treatment. Growth hormone enhanced the efficiency of administered protein and facilitated nitrogen retention without clinically significant adverse effects in this small patient group. Controlled trials are indicated to determine whether use of this anabolic hormone reduces hospitalization time and improves other clinical outcomes in severely injured patients when combined with appropriate nutritional support. (Journal of Parenteral and Enteral Nutrition 14:574–581, 1990)
Central Catheter‐Related Infections: Comparison of Pulmonary Artery Catheters and Triple Lumen Catheters for the Delivery of Hyperalimentation in a Critical Care Setting
Authors: Horowitz Harold W. , Dworkin Brad M. , Savino John A. , Byrne Daniel W. , Pecora Nanette A.
Published: May 2008

We prospectively studied the risk of catheter‐related sepsis (CRS) in 75 critically ill patients who received total parenteral nutrition (TPN) through 158 pulmonary artery catheters (PACs) and 214 triple‐lumen catheters (TLCs). We relied on semiquantitative cultures of the catheter tips, peripheral blood cultures in febrile patients and clinical response to catheter removal to diagnose catheter‐related sepsis. The infection rate was 2.5% (4/158) of PACs and 6.5% (14/214) of TLCs (p=0.124). Colonization rates were 29.1% for PACs and 32% for TLCs. PACs were left in place a significantly shorter length of time than TLCs, 3.1 vs 5.1 days (p<0.005). Guidewire exchanges and subclavian vein insertions were associated with a decreased rate of CRS when compared to new insertions and internal jugular vein insertions, respectively.

We conclude that pulmonary artery catheters can be used safely for the delivery of hyperalimentation in critically ill patients with no increased risk for catheter‐related sepsis compared to triple‐lumen catheters. The use of the PAC in this manner allows for the use of a single central venous catheter for the delivery of hyperalimentation and hemodynamic monitoring. (Journal of Parenteral and Enteral Nutrition 14:588‐592, 1990)
Internal Biliary Drainage, Parenteral Nutrition, and Variation in the Total Parenteral Nutrition Feeding Solutions: Influence on the Healing of Colon Anastomosis in Jaundiced Rats
Authors: Delemarre J.B.V.M. , Van De Velde C.J.H. , De Brauw L.M. , Vree R. , Giesberts M. , Hermans J.
Published: May 2008

The influence of preoperative internal biliary drainage and various types of total parenteral nutrition (TPN) on the healing of a colon anastomosis in 50 jaundiced rats was investigated. Jaundice was induced by division and ligation of the common bile duct. After 5 days a colon anastomosis was made. Ten days thereafter the bursting pressure of the anastomosis was measured as an assessment of wound healing. Bursting pressures were significantly lower in jaundiced rats compared with a sham‐operated nonjaundiced group. Preoperative internal biliary drainage significantly improved bursting pressure (p < 0.001) as did preoperative TPN (p < 0.001). In the second part of the study the influence of four different feeding solutions on the healing of a colon anastomosis was tested. Solutions with and without 20% fat emulsion and a solution with branched‐chain amino acids were tested as well as glucose only. No significant differences were observed among these four groups on the parameters tested. (Journal of Parenteral and Enteral Nutrition 14:629–633, 1990)
Twin Very Low Birth Weight Infants: A Study of Nutritional and Hormonal Status
Authors: Saini Jocelyn , Morgan Jane B. , Teale D. , Kovar I.Z.
Published: May 2008

Nonidentical twin male infants (twin 1, 950 g birth weight, twin 2 970 g) had their nutritional and hormone status studied for up to 59 days. Both infants received parenteral nutrition up to 32 days postnatally; enteral feeding was then established in twin 1; in twin 2 parenteral feeding was recommenced on day 35, for the remainder of the study. Serial 72‐hr metabolic balances were performed in both infants at 4, 32, 45, and 56 days postnatally. Insulin‐like growth factor I (IGF‐I) and growth hormone were assayed on day 2 of each balance. During the course of the study growth was similar in each infant. Overall mean daily energy intakes were 90 kcal/ kg/day and 84 kcal/kg/day and percentage nitrogen retention was 62% and 55% in twin 1 and twin 2, respectively. No differences were observed between the two infants in IGF‐I or growth hormone. Despite low energy intakes incremental weights were within an acceptable range for both infants. (Journal of Parenteral and Enteral Nutrition 14:657–659, 1990)
Intestinal Obstruction by Distension of a Foley Jejunostomy Catheter
Authors: Merrick Hollis W. , Howard John M.
Published: May 2008

Jejunostomies can be effective in permitting postoperative nutritional support, particularly in the patient with complicated gastrointestinal disease. In the case presented, however, distension of the Foley balloon catheter, used as the jejunostomy tube, led to intestinal obstruction which was not initially detected. Following radiographic identification of the problem, removal of the air from the Foley balloon allowed the patient to complete his convalescence from surgery. The possibility of obstruction from the Foley jejunostomy catheter should be recognized as a potential problem in the postoperative period. (Journal of Parenteral and Enteral Nutrition 14:660–661, 1990)
Effect of Simultaneous Ingestion of L‐Amino Acids and Whole Protein on Plasma Amino Acid and Urea Nitrogen Concentrations in Humans
Authors: Gropper Sareen S. , Acosta Phyllis B.
Published: May 2008

The effect of whole protein and L‐amino acid ingestion on plasma amino acid (PAA) and urea nitrogen (UN) concentrations was investigated. Ten males ingested equivalent amounts of nitrogen as (trial 1) cottage cheese, (trial 2) an L‐amino acid mixture, (trial 3) cottage cheese and L‐amino acids. Mean changes in total PAA between trials 1 (342 μmol/liter) and 2 (719 μmol/liter) and trials 1 (342 μmol/liter) and 3 (981 μmol/liter) at 30 min and trials 1 (547 μmol/liter) and 3 (143 μmol/liter) at 150 min differed significantly. Mean changes in essential PAA between trials 1 (180 μmol/liter) and 2 (420 μmol/liter) and trials 1 (180 μmol/liter) and 3 (500 μmol/liter) at 30 min differed significantly. Mean changes in essential PAA between trials 1 (247 μmol/liter) and 3 (334 μmol/liter) at 60 min and between trials 1 (252 μmol/liter) and 3 (80 μmol/liter) at 150 min differed significantly. Mean increments in total and essential PAA were higher and peaked faster but decreased more quickly after trials 2 and 3 than after trial 1. Mean changes in plasma UN did not differ between trials. Ingestion of either L‐amino acids, whole protein or the mixture of L‐amino acids and whole protein was equally effective in increasing total PAA over 4 hr. (Journal of Parenteral and Enteral Nutrition 15:48–53, 1991)
Effect of Various Lipid Emulsions on Total Parenteral Nutrition‐Induced Hepatosteatosis in Rats
Authors: Nakagawa Manabu , Hiramatsu Yoshifumi , Mitsuyoshi Kazuhiro , Yamamura Manabu , Hioki Koshiro , Yamamoto Masakatsu
Published: May 2008

The effect of various lipid emulsions on the development of fatty liver during total parenteral nutrition (TPN) was investigated in rats given TPN for 7 days. Medium‐chain triglycerides (MCT), long‐chain triglycerides (LCT), chemically defined triglycerides (CDT; structured lipid with a high purity of 94.3%), and a mixture of MCT and LCT (MIX) were prepared as the lipid emulsions. TPN provided 350 kcal/ kg/day, with a nonprotein calorie/nitrogen ratio of 160. The TPN‐1 group received 10% nonprotein calories and the TPN‐2 group received 30% nonprotein calories. MCT TPN was found to have some disadvantages, especially with regard to nitrogen balance and plasma albumin levels. Total cholesterol and phospholipids tended to be high in the MCT TPN group. The hepatic lipid content was higher in the lipid‐free TPN and the MCT TPN groups, and lower in the CDT and LCT TPN groups. Histologically, the livers of the MIX, CDT, and LCT TPN groups showed less fatty change than those of the FREE and MCT groups. (Journal of Parenteral and Enteral Nutrition 15:137–143, 1991)
Estimation of Nitrogen Excretion Based on Abbreviated Urinary Collections in Patients on Continuous Parenteral Nutrition
Authors: Candio Joseph A. , Hoffman Marian J. , Lucke Joseph F.
Published: May 2008

The physiologic response to stress can create a net loss of nitrogen, which is indicative of a catabolic state. Nitrogen balance has been demonstrated to be a useful clinical indicator of a patient's catabolic state and the effectiveness of parenteral nutrition, but requires an estimate of total urinary nitrogen excretion. The standard method for determining total urinary nitrogen excretion is 24‐hour urinary urea nitrogen excretion. Unfortunately, the 24‐hour urine collection is inconvenient, cumbersome, sometimes inaccurate, and induces a lag in response time to changes in therapy. Although shorter collection times have been proposed, the validity of shorter‐timed determinations remains open to question. To evaluate the estimation of 24‐hour urine urea excretion from shorter‐timed determinations, the urinary urea nitrogen excretion of 4‐, 8‐, and 12‐hour durations was regressed against the 24‐hour collection in 56 critically ill adult patients. The 12‐hour determination provided satisfactory estimates of the 24‐hour nitrogen excretion, but the 4‐hour and 8‐hour determinations did not. Thus, two times the 12‐hour urine urea nitrogen determination can be substituted for the 24‐hour determination in calculating nitrogen balance. A 12‐hour determination can provide a more rapid turnaround of biochemical analysis, allow more timely nutritional intervention, decrease nursing time, and reduce the frequency of inaccurate or lost specimens. (Journal of Parenteral and Enteral Nutrition 15:148–151, 1991)
Calcium Glycerophosphate as a Source of Calcium and Phosphorus in Total Parenteral Nutrition Solutions
Authors: Draper H.H. , Yuen D.E. , Whyte R.K.
Published: May 2008

Calcium glycerophosphate (CaGP) was tested as an alternative to calcium gluconate (CaGluc) and potassium mono‐ and dibasic phosphate (KPhos) as a source of Ca and P in total parenteral nutrition (TPN) solutions for piglets. Four‐day‐old piglets were infused for 7 days with a TPN solution that provided either 4.2 mmol Ca and 2.1 mmol P/kg/24 h as CaGluc and KPhos (the maxium quantities that can be provided using these sources), or 15.0 mmol Ca and 15.0 mmol P/ kg/24 h as CaGP. Ca and P retentions were more than six times greater (p < 0.01) in the piglets receiving CaGP (14.5 ± 0.2 vs 2.2 ± 0.3 mmol Ca/kg/24 h and 13.3 ± 0.4 vs 2.4 ± 0.1 mmol P/kg/24 h) (Mean± SEM). The ratio of Ca to fat‐free dry weight, an indicator of bone mineralization, was significantly higher (p < 0.05) in the humerus (174.8 ± 2.2 vs 147.2 ± 6.7) and femur (158.3 ± 4.8 vs 130.1 ± 7.8) in the CaGP group. This study showed that CaGP is efficiently used as a source of Ca and P in TPN solutions for piglets. The results suggest that the use of CaGP as the source of Ca and P in TPN solutions may prevent the development of the undermineralized bone seen in low‐birth weight infants nourished intravenously. (Journal of Parenteral and Enteral Nutrition 15:176–180, 1991)
Enteral Hyperalimentation with Continuous Subcutaneous Insulin Infusion Improved Severe Diarrhea in Poorly Controlled Diabetic Patient
Authors: Shimizu Hiroyuki , Shimomura Yohnosuke , Takahashi Masaki , Kobayashi Isao , Tomizawa Takashi , Kobayashi Setsuo
Published: May 2008

Little is known about effective treatment for severe diarrhea in the insulin‐dependent diabetic patient. A 41‐year‐old woman was admitted to our hospital because of hyperglycemia and dysuria. She had stopped insulin self‐injection therapy for 2 years and diarrhea had become worse, resulting in malnutrition. Following enteral alimentation by elemental diet (ED) with continuous subcutaneous insulin infusion (CSII), frequency of diarrhea remarkably decreased and general nutritional condition was improved. At the first step, the patient was given 600 kcal/d ED through the tube sustained in the jejunum. Total calorie intake for 24 hours was gradually increased to the level of 2400 kcal/d and this therapy continued for 5 months. During this period, blood glucose level was kept in almost normal range (between 100 and 200 mg/dL) through the continuous insulin infusion of regular insulin (1.0–1.5 U/h). Thereafter, general conditions were improved and frequency of diarrhea gradually decreased. When this treatment was stopped, watery diarrhea, steatorrhea, and hypoalbuminemia completely disappeared and she gained 12 kg of body weight. Furthermore, spontaneous urination appeared following this treatment. This case suggests that the enteral hyperalimentation combined with strict control of blood glucose, using the CSII, may be an effective therapy for such severe diarrhea with malnutrition in diabetes. (Journal of Parenteral and Enteral Nutrition 15:181–183, 1991)
Parenteral Nutrition for Marrow Transplant Recipients: Evaluation of an Increased Nitrogen Dose
Authors: Geibig Charles B. , PontingG Owens Julie , Mirtallo Jay M. , Bowers Diana , Nahikian‐Nelms Marcia , Tutschka Peter
Published: May 2008

The use of total parenteral nutrition in bone marrow transplant (BMT) recipients is well recognized. These patients as a result of treatment with chemotherapy and immunosuppressive agents undergo catabolic stress. The metabolic effect of an increased nitrogen dose during total parenteral nutrition (TPN) was studied in 28 BMT patients. Patients were given TPN formulas providing a nitrogen intake of either 267 ± 44 mg of N/kg/d or 330 ± 60 mg of N/kg/d. Total calories, nonprotein and protein, were held constant at 40 kcal/ kg/d for all patients. Data was collected for three periods posttransplant beginning at 3 days posttransplant through day 16. Both study TPN formulas improved patient weight and TIBC values over baseline. Nitrogen balance (NB) values were not significantly different at any study period. However, an overall group effect favored the H‐N formula (p < 0.01). BMT patients undergo catabolic stress which was reflected by average values of 24‐hour urine urea nitrogen increasing from 8.1 ± 4 g/d at baseline to 19.8 ± 7.2 g/d at period 3 (p < 0.01). The H‐N formula did not differentially increase blood urea nitrogen or serum creatinine levels. Metabolic cart measures also showed no increase in metabolic rate, oxygen consumption, carbon dioxide production, or percent contribution of protein to total metabolic expenditure. Providing a caloric intake of 40 kcal/ kg/d was excessive, where 30 to 35 kcal/kg/d would meet metabolic demands. Pertinent clinical outcomes including length of stay, relapse rate, and survival were monitored, but no conclusions could be drawn in this study. The H‐N formula was more effective in reducing loss of lean body mass without causing detrimental metabolic effects in BMT patients. (Journal of Parenteral and Enteral Nutrition 15:184–188, 1991)
Horner Syndrome: A Rare Complication of Internal Jugular Vein Cannulation
Authors: Zeligowsky Amir , Szold Amir , Seror Dan , Vromen Amos , Pfeffermann Reuven
Published: May 2008

Percutaneous cannulation of the internal jugular vein is a widely used and accepted method for central venous cannulation, used for parenteral alimentation, fluid administration, and measurement of pressures. A multitude of complications associated with this procedure have been described. Horner syndrome as a rare complication of internal jugular vein cannulation is presented.(Journal of Parenteral and Enteral Nutrition15:199, 1991)
Nutritional Influence on the Plasma and Urine‐Free Alkaline Ribonuclease Levels in Severe Trauma Victims
Authors: Jeevanandam Malayappa , Ramias Lois , Schiller William R.
Published: May 2008

The significance of free alkaline ribonuclease (RNase) activity as a criterion of protein metabolism and nutrition in traumatized man is evaluated in this report. Plasma and urinary levels of RNase were measured in severely injured, hypermetabolic patients and in normal controls. Significant increases in the plasma and urinary RNase levels were seen in these polytrauma victims and they were positively correlated. Plasma RNase levels were also significantly related to blood urea nitrogen and daily urinary nitrogen excretion. Urinary clearance of RNase was increased by 220% in trauma victims, although the creatinine clearance was not affected by trauma. In a subgroup of eight patients who were fed intravenously (1.4 times basal energy expenditure calories and 250–300 mg of N per kilogram per day) for 6 days, the daily excretions of urinary RNase, nitrogen, 3‐methylhistidine, creatinine, and catecholamines were measured. There was a significant negative correlation between daily urine RNase and nitrogen balance. A general increase in all the metabolic parameters on the first day of feeding was seen, suggesting a nutritional stress superimposed on the trauma‐induced metabolic stress. Excretion of RNase, 3‐methylhistidine, and creatinine peaked on the first day of feeding and then decreased. The normal levels could not be reached even after 6 days of adequate nutrition. The results suggest that RNase levels could be used as a biomarker of protein metabolism. (Journal of Parenteral and Enteral Nutrition 15:241–246, 1991)
Effect of Taurine on Total Parenteral Nutrition‐Associated Cholestasis
Authors: Guertin France , Roy Claude C. , Lepage Guy , Perea Aline , Giguère Robert , Yousef Ibrahim , Tuchweber Beatriz
Published: May 2008

A decrease in the formation/secretion of bile has been well documented in animals on total parenteral nutrition (TPN). Either an excess or an imbalance of amino acids (AA) has been most often implicated. In view of recent work showing that taurine promotes bile flow, bile acid secretion, and protects against hepatotoxic bile acids, the effect of adding taurine (15 mg/dL) to an AA solution was examined in guinea pigs on TPN for 3 days. The TPN‐taurine group had a larger bile flow than the group without taurine and had bile acid secretory rates (BASR) similar to those of controls who were on saline by central catheter and had free access to food. Bile composition showed an increase in the secondary bile acid, 7‐ketolithocholate and a concomitant decrease in chenodeoxycholate (CDC) in both experimental groups. Taurine led to a reversal of the usual predominance of glycine over taurine conjugated bile acids as well as to increases in HC03 in cholesterol secretion. In response to a challenge with a large load of CDC, the TPN‐taurine animals increased their BASR beyond those observed in the two other groups. These observations suggest that the addition of taurine to TPN solutions could play a role in the prevention of altered biliary function associated with AA solutions. (Journal of Parenteral and Enteral Nutrition 15:247–251, 1991)