bluuebunny/crossref_metadata_2025 huggingface dataset:
Energy Requirements for Cancer Patients and the Effect of Total Parenteral Nutrition
Authors: Merrick Hollis W. , Long Calvin L. , Grecos George P. , Dennis Robert S. , Blakemore William S.
Published: May 2008

Limited data are available concerning resting metabolic expenditure (RME) in cancer patients and the effect of RME by varying glucose intake. This study describes the measurements on 21 patients with colorectal cancer while fasting and with incremental levels of standard TPN‐glucose system by central vein. Following an overnight fast, the measured mean ± SEM percent difference from the predicted RME for the male group was 4.13 ± 1.67% and the female group, 2.09 ± 2.09%. The overall mean percent difference of 2.95 ± 1.45 suggests that colorectal cancer does not cause an increase in energy expenditure. Hepatic metastases in 11 of the patients did not influence RME. The data from the 21 patients indicate a statistically significant increase in RME with TPN compared to postabsorptive states in females of 37%, in males 21.88%, and combined of 29.88%. Progressively greater increases in RME were seen when calories provided incrementally exceeded the basal RME. Carbohydrate loading in excess of the patient's calorie need, as indicated by the respiratory quotient (RQ) greater than 1.0, results in fat synthesis and other energy‐costing processes. The basal RME demonstrates that these cancer patients are not hypercatabolic, but do respond to high‐level force‐feeding with markedly increased metabolic expenditures. (Journal of Parenteral and Enteral Nutrition 12:8–14, 1988)
Assessment of an Automated Chemiluminescence Nitrogen Analyzer for Routine Use in Clinical Nutrition
Authors: Grimble George K. , West Malcolm F.E. , Acuti Aldo B.C. , Rees Roger G. , Hunjan Manjit K. , Webster Joan D. , Frost Peter G. , Silk David B.A.
Published: May 2008

An automated method of chemiluminescence analysis of nitrogen used routinely for 4 yr. Liquid samples (urine, enteral, and parenteral feeds) required simple dilution, whereas feces required a modified acid‐digestion procedure, before analysis.

For urine samples, the coefficient of variation was within batch from 0.9–3.6%, and between batch 4.3–7.6%. At a sample injection rate of 2 μl/sec, the useful dynamic range, for urine diluted 1:200, was 0–14 g N/liter. Precision for fecal nitrogen analysis was 3.8–6.7% for samples of low to high nitrogen content. The correlation between this technique and an established Kjeldahl method for fecal analysis was studied (r = 0.96, slope = 1.30). The discrepancy between the methods was due to inefficient conversion of nitrogen to NH4 + during Kjeldahl digestion of feces, rather than systematic errors in chemiluminescence analysis.

Reliability was as good as for other automated clinical analyzers and sample cost was ca. £0.22. It has proved possible to analyze approximately 80 samples in the working day.

The efficiency of measuring 24‐hr urine urea‐nitrogen (UUN) and total urine nitrogen (TUN) in patients on general wards was measured. Results were obtained on 87% of TPN days, but large variations were noted in UUN/TUN from <30% to >90% (average 75.7%) in patients receiving TPN, and from <55% to 100% (average 83.8%) in patients receiving enteral nutrition. In contrast, UUN/TUN was 87.0% and 84.0% in healthy subjects, fasted or receiving iv nutrition, respectively.

We therefore expect that clinical nutritionists will find increasing applications for this method of nitrogen analysis. (Journal of Parenteral and Enteral Nutrition 12:100–106, 1988)
Calculation of Metabolic Expenditure and Substrate Utilization from Gas Exchange Measurements
Authors: Westenskow Dwayne R. , Schipke Constance A. , Raymond Janice L. , Saffle Jeffrey R. , Becker James M. , Young Elizabeth W. , Cutler Christopher A.
Published: May 2008

At least nine different equations have been published for calculating metabolic expenditure by indirect calorimetry. This study examined the differences between equations when they are used for the nutritional assessment in an intensive care unit (ICU). Oxygen consumption and carbon dioxide production were measured in 36 ICU patients and used to calculate metabolic expenditure with the nine equations. The equations produced differences in metabolic expenditure which averaged from 0.8–96 kcal/day. The largest difference produced by any two of the nine equations was 189 kcal/day. Although differences in original stoichiometric data have resulted in numerous different equations for the calculation of metabolic expenditure, these differences are not clinically important. It makes little difference which equation is used for nutritional assessment in an ICU. (Journal of Parenteral and Enteral Nutrition 12:20–24, 1988)
Nutritional Risk Factors in Major Hepatobiliary Surgery
Authors: Halliday A.W. , Benjamin I.S. , Blumgart L.H.
Published: May 2008

Preoperative nutritional assessment was performed for 32 patients undergoing surgery for malignant hepatobiliary and pancreatic disease. Weight, mid‐arm circumference, total body potassium (TBK), and skin test reactivity were significantly reduced in the seven patients who died after operation (p <.05, Student's t‐test and Fisher's exact test). Analyses of major life‐threatening complications indicated that those who had a complicated postoperative course (17 patients) had a significantly lower TBK (p <.05, Fisher's exact test). Using linear discriminant analysis (SPSS computer program), correct prediction of postoperative death or survival was possible in 85% of patients if measured by TBK alone, and in 83% if weight loss and serum albumin were used. Seventy three percent were correctly classified as complicated or uncomplicated by TBK alone, but serum albumin and weight loss were not helpful in predicting patients with complications. This study shows that malnutrition and operative risk may be identified preoperatively in patients with malignant hepatobiliary and pancreatic disease. Objective improvement may be achieved by intensive nutritional support. (Journal of Parenteral and Enteral Nutrition 12:43–48, 1988)
Apolipoprotein C‐II Modifications Associated with an Infusion of Artificial Lipid Particles
Authors: Iriyama Keiji , Nishiwaki Hiroshi , Terashima Hideki , Tonouchi Hitoshi , Miki Chikao , Suzuki Hiroshi , Carpentier Yvon A.
Published: May 2008

Artificial lipid particles used as parenteral nutrition solution do not contain any apolipoproteins when they are infused into the circulation. Despite the absence of apolipoproteins, the metabolism of artificial lipid particles is similar to that of chylomicrons which contain various kinds of apolipoprotein. Of the known apolipoproteins, apolipoprotein C‐II (apo C‐II) is important in the hydrolysis of triglyceride‐rich lipoproteins via involvement in the activation of lipoprotein lipase. Modifications of apo C‐II associated with intravenous infusion of a lipid emulsion were investigated in eight patients. Changes in apo C‐IIs in high density lipoproteins (HDL), low density lipoproteins (LDL) and very low density lipoproteins (VLDL) together with the plasma level of triglycerides, were quantified before and for 90 min after a bolus injection of a 10% lipid emulsion (1 ml/kg of body weight). Immediately prior to the injection, 54% of the total amount of apo C‐II was present in HDL, while 27% was present in VLDL. After 5 to 10 min, the amount of apo C‐II in HDL decreased to 29% of the total, while that in VLDL increased to 62%. Subsequently, the amounts of apo C‐II in HDL and VLDL began to return to the preinjection levels. These variations in apo C‐II were closely correlated with the plasma clearance of triglyceride. The result indicates that the injected lipids are not inert particles during their short intravascular life, but that they acquire apo C‐11 from HDL. (Journal of Parenteral and Enteral Nutrition 12:60–62, 1988)
Elimination and Metabolism of a Fat Emulsion Containing Medium Chain Triglycerides (Lipofundin MCT 10%)
Authors: Julius Ulrich , Leonhardt Wolfgang
Published: May 2008

Medium chain triglycerides (MCT) are supposed to be advantageous on account of rapid energy supply in parental nutrition. However, data on the elimination rate of MCT‐containing emulsions during an intravenous fat‐tolerance test (IVFTT) are scarce. We performed this test (0.1 g lipid/kg body weight) in 18 young healthy volunteers (nine females and nine males) using Lipofundin MCT 10% (50% MCT; egg phospholipids as emulsifier). Our results indicate that both elimination and metabolization of the emulsion are fast: a prompt decrease of light‐scattering index and of triglyceride concentrations in serum, an immediate appearance of post‐load fatty acids and of β‐hydroxybutyrate were observed. This was in good agreement with the findings obtained during 6‐hr infusions in the same probands.

Fractional elimination rates k2obtained from light‐scattering indices are 7.29 ± 2.73%/min in males and 11.59 ± 3.38%/ min in females, indicating a higher removal capacity in women. In the same subjects, the corresponding k2 values for Lipofundin S 10% (containing only long chain triglycerides) were higher, reflecting an elimination rate that is faster due to the use of soya bean phospholipids as emulsifier. In comparison, k2 values based on the course of the triglyceride concentrations are generally lower. (Journal of Parenteral and Enteral Nutrition12:116–120, 1988)
Fatty Acid Profiles in Response to Soybean Oil Lipid Emulsion Infusions in Essential Fatty Acid‐Deficient Miniature Swine
Authors: Cotter R. , Johnson R. , Tumbelson M. , Dexter J. , Young S. , Taylor C.A. , Cosmas F. , Rowe W.B. , Lin L.
Published: May 2008

The ability of soybean oil lipid emulsions to affect essential fatty acid deficiency (EFAD) and plasma fatty acid distribution was studied in neonatal pigs. The test animals were maintained on a fat‐free diet prior to administration of lipid emulsion. Plasma and red blood cell (RBC) membrane levels of essential [linoleic (C‐18:2ω6) and arachidonic (C‐20:4ω6)] and nonessential [palmitic (C‐16, palmitoleic (C‐16:1ω7), stearic (C‐18), and oleic (C‐18:1ω9)] fatty acids and the triene:tetraene ratio [5.8,11‐eicosatrienoic acid (C‐20:3ω9):arachidonic acid (C‐20:4ω6)] were monitored to ascertain the establishment of EFAD and its correction. Nonessential fatty acids were studied, as these components of lipid therapy have received little attention. Results indicate that soybean oil emulsions are effective in reversing fatty acid profiles found in EFAD, and both essential and nonessential fatty acids are under strict metabolic control. (Journal of Parenteral and Enteral Nutrition 12:121–126, 1988)
Risk of Infection Accompanying the Use of Single‐Lumen vs Double‐Lumen Subclavian Catheters: A Prospective Randomized Study
Authors: Powell Carla , Fabri Peter J. , Kudsk Kenneth A.
Published: May 2008

A prospective study was undertaken to compare the risks of a multiple‐lumen catheter to bilateral subclavian catheters in patients receiving total parenteral nutrition (TPN). All patients had one preexisting subclavian catheter. Patients were randomized into two groups: one group received a double‐lumen catheter via a guidewire change of the preexisting single‐lumen subclavian catheter. In the second group, a second single‐lumen subclavian catheter was inserted and the preexisting single‐lumen catheter was changed over a guidewire. Patients were followed by the Nutrition Support Service and were managed identically with regard to solutions given, catheter care, dressing changes, monitoring of mechanical complications, and evaluation of fever. Total infection rates in both groups were identical (22.7%). The difference in mechanical complication rates in the double‐lumen catheter group (9%) and the group with bilateral single‐lumen catheters (22.7%) was not significant by Fischer's exact test. The multiple‐lumen catheter is superior in convenience and as safe as bilateral single‐lumen catheters. (Journal of Parenteral and Enteral Nutrition 12:127–129, 1982)
Tissue Levels of Vitamin E (α‐Tocopherol) in Response to Continuous Intravenous Multivitamin Infusion
Authors: Gutcher Gary R.
Published: May 2008

Weanling rats were made vitamin E deficient over a 10‐week course. Vitamin E was then provided at 4 IU/ kg/day as a continuous infusion of the α‐tocopherol in Berocca PN. Tissue samples of heart, lung, liver, and perinephric fat and plasma were analyzed for vitamin E levels at 24 and 72 hr.

Compared to experimental controls that received a rat chow containing 372 IU/g mixed tocopherol, normal levels were achieved in the test group within 24 hr in plasma and liver. Lung and heart muscle levels were within the normal range by 24–72 hr, although significantly below the control level; fat levels did not normalize. Continuous infusion of vitamin E as tocopherol in a multivitamin preparation results in normal tissue levels in lung and liver in a fashion similar to that achieved by previously described methods of single bolus intravenous infusion or repeated subcutaneous injection. (Journal of Parenteral and Enteral Nutrition 12:152–154, 1988)
Evaluation of Transthyretin as a Monitor of Protein‐Energy Intake in Preterm and Sick Neonatal Infants
Authors: Thomas M. Rita , Massoudi Mahin , Byrne Joan , Mitchell Martha A. , Eggert Larry D. , Chan Gary M.
Published: May 2008

In the past, weight and weight gain have been the two parameters used frequently in neonatal units to monitor nutrition among high‐risk infants. Our investigation sought to assess how several anthropometric measures (weight, length, head circumference, arm:head circumference ratio, and tricep skinfold) and serum albumin, transthyretin, and transferrin concentrations reflect protein and energy intake. After monitoring 42 preterm and 40 sick infants over 3 consecutive weeks, we found that transthyretin concentration proved the only serum protein which accurately measured energy and protein intakes in less than 1 week from dietary manipulation. Among preterm infants, as protein and energy intakes rose, transthyretin concentration increased significantly (p < 0.001). Preterm infants ingested 79 ± 39 kcal/kg/day and 2.04 ± 1.02 g protein/ kg/day at the first assessment point after birth and rose to 103 ± 34 kcal/kg/day and 2.64 ± 0.94 g protein/kg/day. Likewise, transthyretin measured 10.83 ± 3.91 mg/dl at the initial measurement and rose to 14.80 ± 4.44 at the second measurement time. Although protein intakes measured slightly lower in the sick group, their intakes correlated to transthyretin concentration (assessment time 1, r = 0.39; time 2, r = 0.33; time 3, r = 0.33). Thus, transthyretin concentration in neonatal infants offers a rapid, accurate, and moderately inexpensive way to monitor protein‐energy adequacy. (Journal of Parenteral and Enteral Nutrition 12:162–166, 1988)
Preoperative Parenteral Nutrition in the High Risk Surgical Patient
Authors: Bellantone R. , Doglietto G.B. , Bossola M. , Pacelli F. , Negro F. , Sofo L. , Crucitti F.
Published: May 2008

In order to assess the significance of malnutrition in determining surgical complications and the possibility of their reduction by preoperative nutritional support (PNS), a randomized controlled trial is being performed at our institution. The results relative to 100 patients who underwent major surgery for gastrointestinal disease, are presented here.

In the treatment group 49 patients received 30 kcal/kg/day and 200 mg/kg/day of nitrogen for at least 7 days in the immediate preoperative period (nine patients were excluded from this group due to early surgery—seven cases; or refusal to accept PNS—two cases. Data analysis with their inclusion or exclusion showed similar results.) Fifty‐one patients constituted the control group. The observed septic complication rate was, respectively, 30 and 35.3% (p:NS). When the analysis was restricted to the patients with abnormal instant nutritional assessment (INA), as defined by Seltzer et al (serum albumin <3.5 g/dl and/or total lymphocyte count <1500 cells/mm3), a statistically significant difference was observed in the incidence of sepsis between the two subgroups (21% vs 53.3%, p < 0.05). Analogous results were obtained from the patients who underwent gastrectomy for gastric cancer: 16.7% of septic complications in the malnourished treated patients and 100% in the malnourished control ones (p < 0.05). The occurrence of serious sepsis (sepsis score ≥ 10, according to the scoring system developed by Elebute and Stoner) in the malnourished subgroups was 5.2% and 26.7%, respectively, (p = 0.09).

The postoperative mortality rate was not significantly changed by the PNS (reduction from 3.9% to 2.5%, p:NS). This result was expected since power analysis indicates a too large number of patients would be needed to show a statistically significant difference in this low mortality risk category of patients.

Our study suggests that malnourished patients waiting for major gastrointestinal surgery may benefit from an adequate PNS that seems to significantly reduce septic complication rate. (Journal of Parenteral and Enteral Nutrition 12: 195–197, 1988)
Urinary Excretion of 3‐Methylhistidine as an Index of Protein Nutrition in Total Parenteral Nutrition
Authors: Kim Chang‐Woong , Okada Akira , Itakura Takeo , Takagi Yoji , Nakao Kazuyasu , Kawashima Yasunaru
Published: May 2008

In 39 healthy adult volunteers and nine patients receiving total parenteral nutrition (TPN), determinations were made of the urinary excretion of 3‐methylhistidine (3‐Mehis) to estimate the degree to which the urinary output of 3‐Mehis reflects the status of protein nutrition.

In 19 males and 10 females of the former group, measurements were made of the amount of 3‐Mehis and of creatinine (Cr) in 24‐hr urine samples. The urinary output of 3‐Mehis was also measured in two subgroups of five healthy adult male subjects who were fed one of the two different diets prescribed: meat (M) and meat‐free (F) diet. Furthermore, in one of these subgroups which was fed on F diet, the urinary output of 3‐Mehis was measured both while the subject was kept at bed rest and while the subject was allowed to live a normal life.

From these measurements the standard value was determined for the urine 3‐Mehis level and the 3‐Mehis/Cr ratio in 24‐hr urine in healthy adult human subjects of both sexes.

In nine patients maintained on TPN these indices of nutritional status were measured before and at 4 weeks of TPN. The time course of the indices was also investigated.

The results obtained suggest that both the urinary output of 3‐Mehis and the 3‐Mehis/Cr ratio can provide a sensitive index of the status of protein nutrition. (Journal of Parenteral and Enteral Nutrition 12:198–204, 1988)
Role of Biochemical Mediators in Clinical Nutrition and Surgical Metabolism
Authors: Pomposelli James J. , Flores Enrique A. , Bistrian Bruce R.
Published: May 2008

Over the past several decades, research on the role of mediators in inflammation, immunity, repair processes, cell growth, and substrate metabolism have centered around the use of purified products of stimulated macrophages. With the current availability of recombinant mediators, the participation of individual monokines in cellular metabolism has been more clearly defined. Interactions among various mediators have been demonstrated, but their exact role in metabolism is currently under intense study. With the use of recombinant monokines, formal evidence for their participation in the acute phase response has been developed. Their use has also assisted in the reinterpretation of data gathered in older studies using purified preparations, which were almost certainly contaminated with several monokines. In this review we will try to give the reader insight into recent advances in the understanding of the role of cellular mediators in relation to nutrition and intermediary metabolism. With a clearer knowledge of the role of cellular mediators in the pathophysiology of disease, it may be possible to develop rationales for their therapeutic use as modulators of substrate metabolism during critical illness. (Journal of Parenteral and Enteral Nutrition 12: 212–218, 1988)
Inadvertent Catheterization of the Internal Thoracic Vein Mimicking Pulmonary Embolism: A Case Report
Authors: Brandi Luigi Severino , Oleggini Marco , Frediani Massimo , Lachi Sonia , Di Trani Massimo , Ferrannini Eleuterio
Published: May 2008

Although aberrant locations are typical complications of central venous catheterization, the right internal thoracic vein (mammary vein) is an exceptional one. A case of this unusual aberrant location occurring after right internal jugular venous cannulation for total parenteral nutrition, is described. This aberrant position caused signs and symptoms resembling pulmonary embolism.

This is the first known description of the symptoms induced by the infusion of parenteral solution into the right internal thoracic vein. (Journal of Parenteral and Enteral Nutrition 12:221–222, 1988)
A water‐sealed indirect calorimeter for measurement of oxygen consumption (VO2), carbon dioxide production (VCO2), and energy expenditure in infants
Authors: Dechert RE , Wesley  , Schafer LE , LaMond S , Nicks J , Coran AG , Bartlett RH
Published: May 2008

We have developed a water‐sealed infant calorimeter (IC) system which uses the techniques of closed‐circuit spirometry to measure oxygen consumption (VO2) in premature and full‐term infants. Carbon dioxide production (VCO2) is simultaneously calculated from the effluent mixed expired CO2 and the circulating flowrate. Respiratory Quotient (RQ) and Energy Expenditure (EE) are then calculated from the primary data. Measurement of VO2, VCO2, and calculation of RQ were +/‐ 5.0% of predicted values determined by burning ethyl alcohol or volume extraction and CO2 infusion in our bench model. Measurement in 11 premature infants produced mean values for VO2 and VCO2 of 8.5 +/‐ 2.5 ml/min/kg and 8.5 +/‐ 2.4 ml/min/kg, respectively. This system is noninvasive, does not interfere with infant tube feedings or iv infusions, and permits safe, long‐term monitoring of the infant's metabolic activity. It allows a more exact matching or oral or intravenous feedings to the actual energy expenditure of the infants, and offers potential advantages for the nutritional management of sick infants.
Impact of insulin on survival of cachectic tumor‐bearing rats
Authors: Peacock JL , Norton JA
Published: May 2008

The present study was performed to determine if a host nutritional treatment, insulin, in the absence of antitumor treatment could improve survival of cachectic tumor‐bearing (TB) rats. Initially food intake and host weight were correlated with survival of untreated rats with similar size sarcomas (45–50 cm3). TB rat food intake (r = 0.69, p less than 0.0001) and host weight (r = 0.47, p less than 0.004) correlated positively with subsequent survival. Once daily neutral protamine hagedorn (NPH) insulin treatment (2 units/100 g) significantly improved food intake (p less than 0.01) and host weight (p less than 0.01) of cachectic TB rats without increasing tumor growth. Twice daily NPH insulin (2 units/100 g) maintained normal food intake of cachectic TB rats and turned a host weight loss into a host weight gain which was significantly greater than untreated controls (p less than 0.001) and all other methods of insulin administration including once daily (p less than 0.001). Twice daily NPH insulin maintained mild hypoglycemia (glucose = 84 +/‐ 12 mg/dl) compared to once daily NPH insulin which resulted in hyperglycemia (glucose = 140 +/‐ 8 mg/dl, p less than 0.001) prior to next dose. In addition, twice daily NPH insulin did not increase tumor growth. Once daily NPH insulin for 5 days during cachectic decline was well tolerated (no treatment deaths), and improved median survival of TB rats randomized to insulin (15 days) compared to controls (13 days, p = 0.06). However, twice daily NPH insulin during cachectic decline failed to improve survival because of treatment deaths.(ABSTRACT TRUNCATED AT 250 WORDS)
Spontaneous retraction of indwelling catheters: previously unreported complications
Authors: Meranze SG , Burke DR , Feurer ID , Mullen JL
Published: May 2008

The development of totally implantable reservoir central venous access systems has been an important advance in patients requiring long‐term central venous access. With lower rates of infection and thrombosis than those with external catheters, they have potential for greater longevity and patient acceptance. Complications such as subcutaneous prosthetic infection, infusate extravasation, and difficulty in locating and puncturing the port have been reported. We present two cases of catheter migration and withdrawal from the subclavian vein. This presumably occurred from the action of the underlying pectoralis muscle on the reservoir, as well as a “jetting effect” during flushing. We make suggestions for prevention of similar problems in the future.
Phosphate depletion syndrome: case report with bone and muscle histology findings and review of the literature
Authors: Levy Y , Bansal M , Zackson DA , Lane J , Shike M
Published: May 2008

A 44‐yr‐old woman with a 16‐yr history of heavy antacid ingestion was evaluated for severe weight loss, weakness, bone pain, and multiple fractures. Laboratory investigation revealed severe hypophosphatemia with undetectable phosphate in the urine. Serum parathyroid hormone (PTH), 25‐hydroxyvitamin D, and 1,25‐dihydroxyvitamin D levels were normal. Transiliac bone biopsy revealed evidence of mineralization defect compatible with hypophosphatemic osteomalacia. Bone densitometry documented decreased bone density with a low mineral content. Management included withdrawal of antacids and provision of phosphate‐supplemented enteral nutrition, which resulted in prompt weight gain and resolution of the clinical and biochemical abnormalities. The pathogenesis, diagnosis and histological features of hypophosphatemic osteomalacia are discussed.
Economic Impact of Malnutrition: A Model System for Hospitalized Patients
Authors: Reilly James J. , Hull Sam F. , Albert Nick , Waller Alger , Bringardener Scott
Published: May 2008

A retrospective review of 771 patients' charts in two acute care hospitals was performed to determine likelihood of malnutrition (LOM) at admission and to assess the effect of LOM on costs and charges. Using accepted criteria, LOM was present in 59 and 48% of medical and surgical patients, respectively. Patients with LOM were 2.6 or 3.4 times as likely to have a predefined minor or major complication, respectively; and 3.8 times as likely to die as patients without LOM (all p < 0.001). In every diagnosis‐related group, the mean length of stay was longer for LOM patients (range 1.1–12.8 excess days).

Accountants converted charges to direct variable costs using departmental cost‐to‐charge ratios. LOM status increased excess costs and charges per patient by $1738 and $3557, respectively (p < 0.0001). When complications occurred, LOM patients incurred $2996 or $6157 excess costs and charges per patient (p < 0.01). Serum albumin was the strongest clinical predictor of cost.

The hospitals' cost of providing enteral or parenteral nutrition support was $18 or $102 per day, respectively. Too few patients received early nutrition support to assess efficacy. Nonetheless, the costs associated with malnutrition warrant early detection and aggressive treatment. (Journal of Parenteral and External Nutrition 12:371–376, 1988)
Metabolic Utilization of Linoleic Acid from Fat Emulsion in Infants during Total Parenteral Nutrition
Authors: Ghisolfi Jacques , Garcia Jésus , Couvaras Olga , Thouvenot Jean‐Paul , Olives Jean‐Pierre
Published: May 2008

The metabolic utilization of linoleic acid (C18:2w6) from intravenous (iv) soybean oil emulsion via its conversion to higher homologues and prostaglandin biosynthesis was studied in 21 infants. The infants were of normal birth weight, in good clinical and metabolic condition, and aged from 1–4 months. They all received total parenteral nutrition after birth for more than 1 month; the only lipid was provided by iv Intralipid 20%, at levels approximating 350 mg/kg/24 hr of linoleic acid (2.5% of the infants' total daily energy intake). Study of the fatty acids of plasma and erythrocyte phospholipids in these infants, compared to healthy controls of the same age (N = 26), showed that 350 mg/kg/24 hr of C18:2w6 supply resulted in normalization of erythrocyte phospholipid fatty acid distribution. This was particularly true of the higher homologues of C18:2w6 (C18:3w6, C20:3w6, and C20:4w6). This suggested that delta 6 and delta 5 desaturation activities are normal in these conditions with this C18:2w6 supply. These results were confirmed by the study of 24‐hr urinary excretion of prostaglandins PGE1 and PGE2. With 350 mg/kg/24 hr of C18:2w6 supply their urinary levels were not significantly different from those observed in normal children of the same age receiving an equivalent oral C18:2w6 intake. (Journal of Parenteral and Enteral Nutrition 12:387–391, 1988)
Effect of Phototherapy Light, Sodium Bisulfite, and pH on Vitamin Stability in Total Parenteral Nutrition Admixtures
Authors: Smith J.L. , Canham J.E. , Wells P.A.
Published: May 2008

The three sections of this study extend previous research into losses of vitamins A, C, E, thiamin, riboflavin, and folic acid from total parenteral nutrition (TPN) admixtures. First, phototherapy light on TPN admixtures containing one of four amino acid solutions was studied. Experimental conditions included presence or absence of Intralipid iv fat emulsion, plastic bag or glass bottle storage container, and storage time of up to 48 hrs. The second phase studied stability of the same vitamins (except vitamin E) for 48 hrs in admixtures containing the amino acid solution which has no bisulfite, in glass bottles; with or without Intralipid; and with added sodium bisulfite (final concentrations of 0, 1, 2, 3, 4, 5 and 10 mEq/liter). Third, vitamin C and thiamin levels were measured in admixtures containing the amino acid solution with no bisulfite, without Intralipid, stored in glass bottles with various bisulfite concentrations (0, 1, 2, or 3 mEq/liter) and three pH levels (5.5, 6.5, and 6.75 pH).

Exposure of TPN admixtures to phototherapy light caused losses of vitamins A, C, and riboflavin. Intralipid inclusion significantly reduced losses of vitamin A and riboflavin, but did not appear to affect vitamin C levels. The smallest vitamin C losses were noted in admixtures containing amino acid solutions A or B. Phototherapy light did not affect thiamin levels. Bisulfite had no affect on vitamin C, riboflavin, or folic acid levels. Vitamin A levels were maintained with bisulfite concentrations less than 3 mEq/liter. At 3 mEq/liter bisulfite, admixtures with Intralipid showed 50% loss of vitamin A. Significant losses of thiamin were noted at bisulfite concentrations of 3 mEq/liter and higher after 24 hrs, with or without Intralipid. Vitamin C loss was more pronounced as pH increased, especially at low bisulfite concentrations. Thiamin levels decreased as bisulfite concentration increased at 5.5 pH, but at higher pH thiamin levels were unchanged. (Journal of Parenteral and Enteral Nutrition 12:394–402, 1988)
Clogging of Feeding Tubes
Authors: Marcuard Stefan P. , Perkins Ann M.
Published: May 2008

This is a report of an in vitro study evaluating clotting ability of some formulas with intact protein and hydrolyzed protein sources in a series of buffers ranging from a pH of 1 thru 10. The following 10 products were tested: Ensure Plus, Ensure, Enrich, Osmolite, Pulmocare, Citrotein, Resource, Vivonex TEN, Vital, and Hepatic Acid II. Protein (10 and 20 g/liter) was added to Citrotein and Ensure Plus. All formulas were tested at full and some at half strength. Clotting occurred only in premixed intact protein formulas (Pulmocare, Ensure Plus, Osmolite, Enrich, Ensure) and in Resource. No clotting was observed for Citrotein (intact protein formula in powder form), Vital, Vivonex TEN, and Hepatic Aid II. Adding protein did not cause or increase clotting. In summary, clotting of some liquid formula diet appears to be an important factor causing possible gastric feeding tube occlusion. The following measures may help in preventing this problem: flushing before and after aspirating for gastric residuals to eliminate acid precipitation of formula in the feeding tube, advance the nasogastric feeding tube into the duodenum if possible, and avoid mixing these products with liquid medications having a pH value of 5.0 or less. (Journal of Parenteral and Enteral Nutrition 12:403–405, 1988)
Intestinal Obstruction by Overdistension of a Jejunostomy Catheter Balloon: A Salutary Lesson
Authors: Chester J.F. , Turnbull A.R.
Published: May 2008

Jejunostomy is an alternative method for feeding patients who cannot be fed orally.1 However, there may be an associated morbidity and potential mortality.2 In the case presented, overdistension of a jejunostomy catheter balloon led to intestinal obstruction and pressure necrosis (of the small bowel), with subsequent abscess formation leading to death from septicemia. (Journal of Parenteral and Enteral Nutrition 12:410–411, 1988)
Fetal Salvage with Maternal Total Parenteral Nutrition: The Pregnant Mother as Her Own Control
Authors: Stellato Thomas A. , Danziger Larry H. , Burkons David
Published: May 2008

Hyperemesis gravidarum affects both maternal and fetal well‐being by reducing maternal vascular volume (normally increased with pregnancy) and depleting maternal nutritional stores. Severe intractable hyperemesis may result in fetal demise. This report documents the ability to maintain maternal fluid and nutritional requirements during first trimester pregnancy in a female with intractable hyperemesis gravidarum. Additionally, this patient is unique in that her five prior pregnancies were complicated by hyperemesis with the last three resulting in fetal demise. Speculation regarding the relative importance of inadequate hydration and nutrition in first trimester fetal viability is given. When hyperemesis is unresponsive to conventional management, intravenous hydration should be instituted without delay to preserve maternal intravascular blood volume and thus placental blood flow. Consideration for total parenteral nutrition can then be given which, after adequate in‐hospital instruction, may in most cases be continued in the home. (Journal of Parenteral and Enteral Nutrition 12:412–413, 1988)
Obstructed Feeding Jejunostomy Tube: A New Method of Salvage
Authors: Bentz Michael L. , Tollett Charles A. , Dempsey Daniel T.
Published: May 2008

The jejunostomy tube is an important means of access for enteral feeding in the surgical and medical patient. A common complication of this technique is tube occlusion. Once a mature tract has formed the tube can be removed and replaced, following by contrast radiologic documentation of its intraluminal position. With an immature tract, this option is not available. We report a safe, simple, and cost‐effective method of unblocking a clogged jejunostomy using an arterial embolectomy catheter. (Journal of Parenteral and Enteral Nutrition 12:417–418, 1988)
Total Parenteral Nutrition and Tube Feeding for Elderly Patients: Findings of an OTA Study
Authors: Maslow Katie
Published: May 2008

A 1987 report by the US Office of Technology Assessment (OTA), Life‐Sustaining Technologies and the Elderly discusses current utilization of tube feeding and total parenteral nutrition (TPN) for elderly people and the related issues of patient access to treatment, decision making practices, and quality of care. Factors that limit access for some elderly patients include negative attitudes of some health professionals about whether elderly people can benefit from tube feeding and TPN, lack of adequate nutritional standards for the elderly and lack of staff in some treatment settings who are trained and have enough time to assess nutritional status in elderly patients, and payment problems. Public controversy about life‐sustaining technologies for elderly people now focuses on decisions about withholding or withdrawal of tube feeding, but debate about the legal and ethical issues involved in these decisions tends to obscure the relevant clinical considerations. Research issues and clinical practice concerns related to decision making and quality of care for elderly patients on tube feeding and TPN are discussed. (Journal of Parenteral and Enteral Nutrition 12:425–432, 1988)
Protein‐Sparing Effect of Substrate Infusion in Surgical Patients is Governed by the Clinical State, and Not by the Individual Substrate Infused
Authors: Shaw James H.F. , Holdaway Christopher M.
Published: May 2008

We have determined iostopically the effect of either glucose or lipid infusion on rates of glucose turnover, glucose oxidation, and net protein catabolism (NPC) in three groups of surgical patients. Kinetic measurements were performed using the primed constant infusion of 3H‐glucose, and either 14C‐glucose or “C‐urea. The three groups included patients with: (1) sepsis and/or trauma (ST); (2) upper gastrointestinal cancer (UGI); (3) lower gastrointestinal cancer (LGI). In each patient group the effect of either glucose infusion (approximately 4 mg/kg·min) or lipid infusion (20% Intralipid lipid emulsion infused to provide calories approximately iso‐caloric to the glucose infusion) was assessed.

The infusion of calories as either glucose or lipid was equally effective as a means of suppressing NPC in each individual patient group, and the degree of response was governed by the clinical disease state. In the LGI and ST patients the infusion of either glucose or fat resulted in a significant suppression of NPC (p < 0.005) of approximately 15%. However, the ongoing rate of NPC that occurred despite substrate infusion was more than twice as great in the ST patients as in the LGI patients. In contrast to what was seen in the ST and LGI patients, in the UGI patients neither glucose infusion nor lipid infusion significantly decreased NPC.

Glucose infusion resulted in at least a 55% suppression of endogenous glucose production in all three groups studied. In contrast, lipid infusion had only a minor effect on glucose metabolism: lipid infusion did not significantly decrease the rate of glucose oxidation in any of the patient groups, and although lipid infusion was associated with a decrease in glucose production in all groups, this effect was minor (<9% suppression).

The major hormonal response following glucose infusion was a significant increase in the plasma insulin level (plasma cortisol levels did not change), although in contrast lipid infusion did not significantly alter the plasma insulin level, but serum cortisol decreased significantly.

We conclude from these studies the following: (1) “calorie for calorie,” glucose and lipid are equally effective in decreasing NPC in severely ill patients; (2) following glucose infusion, the plasma insulin level increased, and serum cortisol levels did not change, whereas in response to lipid infusion plasma insulin levels did not change and the plasma cortisol level decreased. (3) In contrast to the profound effect of glucose infusion to suppress free fatty acid appearance and utilization, lipid infusion has a minor inhibitory effect on both glucose production and glucose oxidation. (Journal of Parenteral and Enteral Nutrition 12:433–440, 1988)
Hypocarotenemia in Patients Fed Enterally with Commercial Liquid Diets
Authors: Bowen Phyllis E. , Mobarhan Sohrab , Henderson Cynthia , Stacewicz‐Sapuntzakis Maria , Friedman Howard , Kaiser Robert
Published: May 2008

We have found that 12 patients requiring permanent enteral feeding secondary to cerebrovascular accident with adequate Vitamin A nutritional status had serum concentrations of various carotenoids which were only 8–17% of sex‐and age‐matched healthy controls. Their serum retinol levels were normal, but only 61% of their controls despite receiving two to three times the recommended daily allowance (RDA) in retinol equivalents. Commercial enteral formulas were found to contain only negligible quantities of the carotenoids and were the cause of the hypocarotenemia. To assess the ability of these patients to absorb beta‐carotene, nine tube‐fed patients were given 15 mg of beta‐carotene (2.5 times the RDA) in a single dose. Serum concentration time curves showed that only four patients absorbed significant quantities of the beta‐carotene and absorption was delayed compared to previously studied subjects taking enteral formulas as meals. These studies suggest that the efficiency of absorption of the fat soluble vitamins may be lower in tube‐fed patients and that patients receiving long‐term tube feeding are denied the possible protective effects of the carotenoids normally contained in the American diet. (Journal of Parenteral and Enteral Nutrition 12:484–489, 1988)
Intestinal Maturation in the Rat: The Role of Enteral Nutrients
Authors: Castillo Ricardo O. , Pittler Arlyn , Costa Françoise
Published: May 2008

In order to investigate the role of enteral nutrients in intestinal maturation, an animal model was developed consisting of provision of intravenous nutrient infusions to immature suckling rats over the period of weaning. Age‐ and litter‐matched controls were provided identical amounts of the parenteral solution by entered cannula using the same model. At the end of the period of weaning, animals were killed and the intestines removed for measurement of morphologic parameters and disaccharidase, DNA, and protein levels. The absence of enteral nutrients during weaning resulted in striking inhibition of intestinal growth, diminution in mucosal cell mass, and delayed development of lactase. Although the appearance of sucrase was not affected by the lack of enteral nutrients, sucrase levels rose to only one‐third of control levels. Jejunoileal gradients were not present in animals deprived of enteral nutrients but were present in animals receiving enteral nutrients. These results are distinct from adult animals treated in identical experimental fashion and indicate that major parameters of intestinal maturation are altered by the absence of intraluminal nutrients. A critical role for intraluminal nutrients in regulation of intestinal development is therefore suggested. The animal model developed for these studies is well suited for investigation of the interactions of the intraluminal environment with intestinal maturation. (Journal of Parenteral and Enteral Nutrition 12:490–495, 1988)
Gastric Pepsin and Acid Secretion during Total Parenteral Nutrition and Constant‐Rate Enteral Nutrition in Infancy
Authors: De Angelis G.L. , Poitevin C. , Cezard J.P. , Vatier J. , Foucaud P. , Navarro J.
Published: May 2008

Total Parenteral Nutrition (TPN) and constant rate enteral nutrition (CREN) are widely used: their effects on gastric function, especially pepsin secretion, are unknown. Basal and pentagastrin‐stimulated pepsin (BPO, MPO) and acid (BAO, MAO) secretions were measured in three groups of infants: controls (14 infants fed normally), TPN groups (seven infants on TPN), CREN groups (14 infants on CREN). The MAO and MPO of the TPN group were significantly lower than controls (p < 0.02), and the ratio of pentagastrin‐stimulated PO/AO did not change, suggesting a large decrease of acid gastric function in the TPN group. BPO was not different from controls and BAO was significantly higher because of amino acids perfusion. The data for CREN group were not different from those of the control group, despite the fact that 11 infants were on TPN before CREN. These results demonstrate that TPN causes decreases in both acid and pepsin secretions in human infants. When TPN children are placed on CREN, these secretions return to normal. (Journal of Parenteral and Enteral Nutrition 12:505–508, 1988)
Cortical Blindness after Subclavian Vein Catheterization
Authors: Acalovschi Iurie , Corbaciu Dumitru , Paraianu Ion
Published: May 2008

The occurrence of air embolism with neurologic complications during the insertion of central venous catheters is well known, but the development of a cortical blindness has not been stress.

The case of a woman patient is described, who, after the puncturing of the subclavian vein, developed a state of confusion and transient left hemiplegia, followed by the loss of sight. Blindness was associated with normal pupilary light reflexes and no observable changes in the fundi, features identifying it as cortical. Possible pathogenetic mechanisms are discussed. (Journal of Parenteral and Enteral Nutrition 12:526–527 1988)
Rhoads lecture‐‐1988. Bulk or bounce‐‐the object of nutritional support
Authors: Jeejeebhoy KN
Published: May 2008

Wasting of muscle and a negative nitrogen balance are obvious effects of malnutrition, and have led to the use of anthropometric measurements and nitrogen balance for its assessment. A positive nitrogen balance and an increase in limb muscle circumference are believed to be solid indices of the beneficial effects of nutritional support. In experiments with growing rats and in young children, nitrogen retention and growth are recognized to be the desirable effects of optimal nutritional intake. This concept has been applied to malnourished adult humans (nongrowing) who have been considered potentially able to “regrow” the lost tissue. Although it is true that patients receiving long‐term (greater than 6 months) home total parenteral nutrition (TPN), gain body weight and nitrogen over many months and years of observation, these processes are not seen during shorter (less than 40 days) periods of nutritional intervention given in hospital. Despite adequate intakes of nitrogen and calories, little or no significant increase in total body nitrogen is seen in a variety of patients receiving TPN in hospital over several weeks, but nutritional support does appear to improve outcome in the form of reduced complications after a period of support so short that body composition is barely altered. For example, Young and Hill showed that although amino acids and amino acids plus calories both resulted in equivalent sparing of body nitrogen, the latter was associated with quicker wound healing and fewer complications. Thus, the outcome and body composition data suggest that reversal of the adverse effects of malnutrition is not based on improvement of the traditional parameters of nutrition, such as gain in body nitrogen, or a demonstrable increase in muscle mass, or in plasma proteins. On the basis of the foregoing evidence, there are grounds for suspecting that functional abnormalities in adult humans may not be the result of simple loss of lean tissue and therefore may recover before such lean tissue is regained. This hypothesis is supported by the observation of Klidjian et al who showed that muscle force is a good measure of outcome. One of the major organ systems of the human body is the musculoskeletal system, and therefore it would seem important to determine the effect of malnutrition on that system. Previous studies of muscle function have been largely related to the examination of fatigue, myopathy, and endocrine‐metabolic abnormalities. Subsequently we undertook initial studies of muscle function in very malnourished patients as outlined below.