bluuebunny/crossref_metadata_2025 huggingface dataset:
Skeletal Muscle Function and Metabolism in Obese Women
Authors: Lennmarken C. , Sandstedt S. , Von Schenck H. , Larsson J.
Published: May 2008

A possible mechanism to regulate body weight during a high calorie intake may be an increased metabolic rate in skeletal muscle. To approach this hypothesis the energy metabolites, ATP, phosphocreatine, creatine, glycogen and lactate were measured in biopsies from the quadriceps femoris muscle. Concomitantly the function of the adductor pollicis muscle was studied as assessed after electrical stimulation of the ulnar nerve. The muscle function variables were, force of contraction at 5, 10, 20, and 50 Hz of stimulation, relaxation rate, and endurance. Eight obese women were studied before gastroplastic surgery and 6 months postoperatively and a weight loss of 19.4 ± 3.4% (mean ± SEM). Preoperatively ATP, phosphocreatine, glycogen, and lactate were significantly decreased and the same pattern was found postoperatively. These findings can be related to a low production of energy‐rich phosphates or a high energy utilization. Both pre‐ and postoperatively there was, a decreased force of contraction at 10 Hz of stimulation(p< 0.001), a faster relaxation rate(p< 0.01) and a normal endurance. These functional results indicate a high metabolic rate. At admission a decreased serum insulin level indicated a moderate insulin resistance which was normalized after the weight loss.The triiodothyronine concentration was normal before and after operation.

In conclusion our findings of changed muscle energy metabolite concentrations and altered muscle function indicate a high metabolic rate in skeletal muscle in obese women. This may be an adaptation in skeletal muscle energy metabolism to a high body weight.(Journal of Parenteral and Enteral Nutrition10:583–587, 1986)
Effects of Infused Intralipids on Neutrophil Chemotaxis during Total Parenteral Nutrition
Authors: Escudier Estelle F. , Escudier Bernard J. , Henry‐Amar Michel C. , Lobut Jean‐Bruno , Bernaudin Françoise , Leclercq Bernard P. , Nitenberg Gérard M. , Bernaudin Jean‐Francois
Published: May 2008

A number of previous studies have suggested that the fat emulsion, Intralipid, might compromise human host defenses, due mainly to impairment of neutrophil functions. The aim of this study was to evaluate the effects of Intralipid on neutrophil chemotaxis in cancer patients receiving total parenteral nutrition including 500 ml of 20% Intralipid over 6 hours (83 ml/hr). No impairment of neutrophil chemotaxis was found during or after lipid infusion. Further investigations are necessary to determine whether, in routine clinical practice, intralipids are responsible for impairment of other neutrophil functions and whether side treatments have a protective effect for neutrophil functions. (Journal of Parenteral and Enteral Nutrition 10:596–598, 1986)
Transperitoneal Absorption of Intralipid in Rats: Total Serum Fatty Acids and Triglyceride after Absorption
Authors: Moran Jose , Cruz Gregorio , Nogue‐Rales Fernando , Requena Francisco , Vinagre Luis , Garcia‐Sancho Luis
Published: May 2008

Intralipid 20% was injected percutaneously into the peritotoneum of 58 female rats. The rats were divided into seven groups (with an additional control group of 35 rats). To measure transperitoneal absorption, we determined the serum fatty acid and triglyceride concentrations at 3‐hr intervals for 24 hr, and found a considerable increase in all of the levels measured, with a maximum at about 6 hr. The serum triglyceride levels never rose above a mean value of 200 mg/100 ml. A second and smaller rise was seen after 15 hr, declining again to the initial values. The relative proportions of the different fatty acids changed, but not drastically. (Journal of Parenteral and Enteral Nutrition 10:604–608, 1986)
Alteration of Lipoprotein Profile during Total Parenteral Nutrition with Intralipid 10%
Authors: Tashiro Tsuguhiko , Mashima Yoshiya , Yamamori Hideo , Okui Katsuji
Published: May 2008

Eight patients were studied for lipoprotein profiles over a period of 3–7 weeks. Four patients received total parenteral nutrition (TPN), including 1000 ml/day of Intralipid 10%. Three patients received fat‐free TPN, and one patient was tube fed 1000 ml/day of Intralipid 10% enterally.

Fat‐free TPN lowered plasma lipid, especially low density lipoprotein (LDL) and high density lipoproteins (HDL). On the other hand, intravenous administration of Intralipid 10% caused a marked increase of LDL, together with increases of phospholipid and cholesterol, especially free cholesterol. Triglyceride, VLDL, and HDL remained within the normal range in this group. Enteral administration of the same amount of Intralipid 10% did not cause a rise of LDL. Lipid composition of the increased LDL approximated that of lipoprotein X with the intravenous Intralipid 10%.

From these findings, we suggest that phospholipids in Intralipid 10% formed abnormal LDL as the result of mobilization of cholesterol from extravascular tissues, when administered intravenously. (Journal of Parenteral and Enteral Nutrition 10:622–626, 1986)
Plasma Phospholipid Fatty Acids and Urinary Excretion of Prostaglandins PGE 1 and PGE2 in Infants during Total Parenteral Nutrition, with Continuous or Sequential Administration of Fat Emulsion
Authors: Ghisolfi J. , Garcia J. , Thouvenot J.P. , Olives J.P. , Couvaras O. , Boyer M.J.
Published: May 2008

During total parenteral nutrition, using an identical supply of fat emulsion (350 mg/kg/24 hr) to correct essential fatty acid deficiency in children, the efficacy of two methods of administration was studied: continuous over 24 hr, or discontinuous 3 hr/day. At the beginning of the study, all the infants (1–4 months old) had proven essential fatty acid deficiency. After at least 1 month of one of the two nutritional protocols (continuous or discontinuous), plasma phospholipid fatty acid composition and PGE1 and PGE2 urinary excretion were measured. The results obtained indicate better utilization of the fat emulsion when it is administered almost every day, in continuous infusion over 24 hr (1 g/kg/24 hr of Intralipid 20%). (Journal of Parenteral and Enteral Nutrition 10:631–634, 1986)
Total Parenteral Nutrition Catheter Sepsis: Impact of the Team Approach
Authors: Faubion Walter C. , Wesley John R. , Khalidi Nabil , Silva Joseph
Published: May 2008

For a period of 32 months from the inception of the Parenteral and Enteral Nutrition (PEN) Team at the University of Michigan, the infection rate (IR) related to central venous catheters (CVCs) for total parenteral nutrition (TPN) was prospectively evaluated. Six hundred twenty‐two catheters were placed in 377 patients for a total of 9,200 patient days. The length of CVC stay ranged from 2 to 108 days with a mean of 14.5. CVC longevity was longer on units where certification of nurses by the PEN team was mandatory (mean 20.4 days, IR 3.5%) vs comparable units which utilized informal instruction (mean 14.4 days, IR 3.5%). Twenty‐two catheters led to patient sepsis for a rate of 3.5%, or 2.39 CVC‐related infections per 1000 patient days. The preteam infection rate was 24.0%, as determined by a 6‐month prospective study. Infection rates for CVCs used for TPN only and those used for parenteral nutrition (PN) plus blood products, antibiotics, and CVP measurements were identical, 3.5%. The team approach can effectively increase PN catheter longevity and reduce infection rates. Conservative cost accounting of best and worst case scenarios determined a range of $3,700 to $8,900 per episode of catheter sepsis. (Journal of Parenteral and Enteral Nutrition 10: 642–645, 1986)
The effect of route of nutrient administration on the nutritional state, catabolic hormone secretion, and gut mucosal integrity after burn injury
Authors: Saito H , Trocki O , Alexander JW , Kopcha R , Heyd T , Joffe SN
Published: May 2008

So that the efficacy of route of nutrient administration in thermal injury could be determined, a comparison was made between immediate enteral vs parenteral feedings in burned guinea pigs. Thirty‐five guinea pigs underwent both catheter gastrostomy and jugular vein catheterization. On postoperative day 8, burned animals [30% total body surface area (TBSA)] were divided into an intragastrically (ig) fed group (N = 14) and a parenterally (iv) fed group (N = 14). Animals in each group received 175 kcal/kg/day with a solution of identical nutrient value beginning 2 hr after burn. The body weight change until postburn day (PBD) 8 and the average nitrogen balance were significantly better in the ig group than in the iv group. Values were also higher for the iv group than for the ig group in the early postburn period for urinary vanillyl mandelic acid (VMA) (p less than 0.05), plasma cortisol (p less than 0.05), and plasma glucagon (p less than 0.05). Also, the iv group showed reduced mucosal weight and thickness compared to the ig group on PBD 1 (p less than 0.02). There were significant negative correlations between VMA excretion and body weight change, and between plasma cortisol and jejunal mucosal structure (thickness and weight). These findings suggest that immediate postburn enteral nutrition can provide better nutritional support than parenteral nutrition through the maintenance of gut mucosal integrity and the prevention of increased secretion of catabolic hormones.
What is subjective global assessment of nutritional status?
Authors: Detsky AS , McLaughlin  , Baker JP , Johnston N , Whittaker S , Mendelson RA , Jeejeebhoy KN
Published: May 2008

Presented and described in detail is a clinical technique called subjective global assessment (SGA), which assesses nutritional status based on features of the history and physical examination. Illustrative cases are presented. To clarify further the nature of the SGA, the method was applied before gastrointestinal surgery to 202 hospitalized patients. The primary aim of the study was to determine the extent to which our clinician's SGA ratings were influenced by the individual clinical variables on which the clinicians were taught to base their assessments. Virtually all of these variables were significantly related to SGA class. Multivariate analysis showed that ratings were most affected by loss of subcutaneous tissue, muscle wasting, and weight loss. A high degree of interobserver agreement was found (kappa = 0.78, 95% confidence interval 0.624 to 0.944, p less than 0.001). We conclude that SGA can easily be taught to a variety of clinicians (residents, nurses), and that this technique is reproducible.
Impact of nutritional status on DRG length of stay
Authors: Robinson G , Goldstein M , Levine GM
Published: May 2008

A prospective audit of 100 admissions to a general medical unit was performed to determine the relationship of the initial nutritional status of the patients to the actual length of stay and hospital charges. These data then were compared with the allowed length of stay and estimated reimbursement under the prospective payment system of diagnosis‐related groups (DRGs). Forty‐five percent of the malnourished patients were hospitalized longer than that allowed under DRGs, compared to 30% for normal patients and 37% in the borderline group. The average length of stay was 15.6 +/‐ 2.2 days in the malnourished group compared to approximately 10 days in the other two groups (p less than 0.01). Although the estimated base DRG reimbursement was similar in all three groups ($4352‐$5124), the actual hospital charges were significantly greater in the malnourished ($16,691 +/‐ 4389) and borderline ($14,118 +/‐ 4962) groups compared to normals ($7692 +/‐ 687), (p less than 0.01). The DRG system will have an adverse financial impact in the care of malnourished patients. It is suggested that early recognition of malnutrition and aggressive treatment may lead to a decrease in the length of stay and cost deficit incurred by malnourished patients.
Unstirred water layers in rabbit intestine: effects of guar gum
Authors: Cerda JJ , Robbins FL , Burgin CW , Gerencser GA
Published: May 2008

Guar gum has been shown to affect the absorption of several different nutrients in clinical studies; however, the mechanisms for decreased absorption have not been defined. A possibility not studied with regard to guar gum, but previously demonstrated to be important in absorption, is the effect of change in the unstirred water layer. As the unstirred water layer increases in thickness, the rate of absorption decreases for certain nutrients. The effect of guar gum on the unstirred water layer in the lumen of rabbit jejunum was examined by previously described techniques. It was observed that: increases in guar gum concentration resulted in an increased thickness of the unstirred water layer; for any stir rate, the addition of guar gum increased the thickness of the unstirred water layer; and stir rate is inversely related to the thickness of the unstirred water layer. It was concluded from these results that guar gum increases the thickness of the unstirred water layer in rabbit jejunum. This mechanism may explain, in part, the reduction of the rate of absorption of certain nutrients seen following guar gum ingestion.
Intravenous Branched Chain Amino Acid Trial in Marrow Transplant Recipients
Authors: Lenssen Polly , Cheney Carrie L. , Aker Saundra N. , Cunningham Beth A. , Darbinian Jeanne , Gauvreau Jean M. , Barale Karen V.
Published: May 2008

Branched chain amino acids (BCAA) improve nitrogen balance and end‐organ function in surgical patients, but are untested in marrow transplant recipients. We compared nitrogen balance, urinary 3‐methylhistidine‐to‐creatinine ratio, upper arm anthropometry, serum prealbumin, and day to peripheral engraftment in a randomized, double‐blinded trial between 45% (high‐leucine) and 23% BCAA intravenous solutions in 40 adult leukemia patients for 1 month following allogeneic marrow transplantation. Nutritional support, provided at approximately 30 nonprotein calories/kg and 0.21 g nitrogen/kg ideal weight, did not differ between groups. Despite greater nitrogen loss and muscle breakdown evidenced by increased 3‐methylhistidine‐to‐creatinine ratio and loss of arm muscle area by study end in the 45% BCAA, no statistical differences were observed when nitrogen balance was compared by week and within stress level as defined by organ and infectious complications. It is likely the patients in the 45% BCAA experienced greater metabolic stress by study end. Serum prealbumin and day posttransplant to peripheral engraftment also did not differ between groups. The chances (power) of this study exceeded 85% in detecting a difference in nitrogen balance of 2.5 g during study week 1 and 4.0 g during week 2. The power during week 3 was 77% for detecting a difference of 4.0 g, and it is unlikely that the true difference exceeds this magnitude. Thus, we did not find any evidence that intravenous BCAA‐enriched solutions improved nitrogen balance during the first month after marrow transplantation. (Journal of Parenteral and Enteral Nutrition 11: 112–118, 1987)
A Comparison of Serum Transferrin and Serum Prealbumin as Nutritional Parameters
Authors: Fletcher J.P. , Little J.M. , Guest P.K.
Published: May 2008

Serum transferrin and prealbumin levels were determined at intervals of 3 to 4 days in 16 patients requiring nutritional support. Caloric and nitrogen intake were measured and nitrogen balance calculated. There were 117 intervals available for analysis. A mean decrease in transferrin of 12.95 mg/ dl was associated with a mean decrease in nitrogen balance of 0.92 g/day, whereas a mean increase in transferrin of 21.04 mg/ dl was associated with a mean increase in nitrogen balance of 1.49 g/day; the correlation between changes in transferrin with changes in nitrogen balance was statistically significant (p = 0.02). Upward and downward changes in prealbumin were also associated with corresponding changes in nitrogen balance, but the changes were not statistically significant. Decreases in transferrin and prealbumin were also associated with a lower caloric intake. Operation caused a significant decrease in prealbumin (p = 0.003) and nitrogen balance (p = 0.05); a decrease in transferrin also occurred, but was not statistically significant. There was a highly significant correlation between serum transferrin and prealbumin (p = 0.001) and also between the interval changes in transferrin and prealbumin (p < 0.001). In conclusion, transferrin was found to correlate closely with prealbumin. Changes in transferrin were more significantly related to changes in nitrogen balance, and from the results of this study, measurement of serum transferrin can be recommended as a useful parameter in following the nutritional status of patients receiving nutritional support. (Journal of Parenteral and Enteral Nutrition 11:144–148, 1987)
The Effect of Selenium Supplementation on Selenium Status of Patients Receiving Chronic Total Parenteral Nutrition
Authors: Lane Helen W. , Lotspeich Cheryl A. , Moore Carolyn E. , Ballard Joyce , Dudrick Stanley J. , Warren Doris C.
Published: May 2008

Patients receiving long‐term total parenteral nutrition (TPN) are at risk for selenium deficiency. The purpose of this study was to determine the effect of parenteral selenium as selenious acid on the seledium status of seven long‐term TPN patients. Patients received a dosage of zero, 80, or 160 μg Se/day for 1 month each. The measures of selenium status used were selenium levels in plasma and glutathione‐peroxidase activities in erythrocytes and platelets. Urinary selenium excretion was measured. Control subjects were selected to match the sex, age, and weight of the patients. With increasing levels of parenteral selenium, there was increasing plasma selenium concentration as well as erythrocyte and platelet glutathione‐peroxidase activity. There was no statistical difference between the patients during the time they received the 160 μg parenteral selenium treatment and the control subjects for platelet glutathione‐peroxidase activity. At the 160 μg Se/day level, patient plasma selenium concentrations increased from 28% to 58% of the control levels. Four patients were studied after they returned to the 80μg parenteral selenium/day from the 160‐μg Se/day treatment. With decreasing parenteral selenium, three patients had decreasing platelet glutathione‐peroxidase activity, while plasma selenium concentration decreased in two patients. These data suggest that some patients receiving long‐term parenteral nutrition should receive parenteral selenium. (Journal of Parenteral and Enteral Nutrition 11:177–182, 1987)
A Technique for Positioning Nasoenteral Feeding Tubes
Authors: Raff Michele H. , Cho Sooho , Dale Robert
Published: May 2008

The use of nasoenteral alimentation in many neurologically depressed patients is a common practice. These patients are also at increased risk of sustaining feeding tube malplacement. The morbidity and mortality involving feeding tube malposition in these debilitated patients is high. In this paper, we present four case reports of morbidity, with one resultant mortality, associated with small‐bore nasoenteral tube malposition. We are also suggesting a nasoenteral intubation protocol which we feel will decrease the incidence of feeding tube malplacement. (Journal of Parenteral and Enteral Nutrition 11:210–213, 1987)
Body Cell Mass in Cancer‐Bearing and Anorexic Patients
Authors: Moley J.F. , Aamodt R. , Rumble W. , Kaye W. , Norton J.A.
Published: May 2008

We used a sensitive whole body counter which measures potassium‐40 (40K) to determine total body potassium and to estimate body cell mass (BCM) in 104 previously untreated patients with upper gastrointestinal malignancies, 233 normal volunteers, and 18 patients with anorexia nervosa. BCM was greater in normal males than in females. In both normal males and females, the BCM tended to decrease with age, both as an absolute measure and as a percentage of body weight. Anorexia nervosa patients experienced marked weight loss (30.5%), and had significant depletion of absolute BCM, but exhibited relative sparing of BCM as indicated by a rise in BCM as a percentage of body weight. This may reflect a normal adaptation and predominant fat utilization in chronic malnutrition. The cancer patients, on the other hand, had significant weight loss (12.7% for females, 13.9% for males) and demonstrated a proportional decline in BCM, with no change in BCM as a percentage of body weight. These findings support the contention that, in the cancer‐bearing patient, weight loss consists of a significant depletion of both fat and BCM. The challenge to the clinicians caring for cancer patients is repletion of this supremely functional body compartment. (Journal of Parenteral and Enteral Nutrition 11: 219–222, 1987)
Prospective Evaluation of Single and Triple Lumen Catheters in Total Parenteral Nutrition
Authors: Mccarthy M.C. , Shives J.K. , Robison R.J. , Broadie T.A.
Published: May 2008

The recent introduction of triple lumen catheters has facilitated the care of seriously ill patients by providing multipurpose central venous access through a single percutaneous 7 French catheter. This prospective study was performed to examine the complications associated with the use of these catheters in patients receiving long‐term total parenteral nutrition (TPN).

Seventy‐five patients undergoing catheterization were randomly separated into two groups: 36 patients underwent placement of a single lumen catheter (SLC), and 39 patients, a triple lumen catheter (TLC). The two groups were comparable with respect to concomitant infections, treatment with antibiotics, and need for intensive care. Patients in the SLC group received TPN for a mean of 9.7 days and in the TLC group, for a mean of 8.5 days (p = 0.427). However, after 5 days of catheterization, there was a marked increase in the number of TLC removed because of skin entry site infections. SLC were more likely to be used for the full duration of TPN administration (p = 0.025). Catheter tips were cultured by semiquantitative techniques. A higher incidence of catheter sepsis was seen with TLC, 12.8% vs 0% with SLC (p = 0.055).

TLC used for TPN are associated with higher rates of catheter entry site infections and systemic sepsis. SLC should be used for TPN administration. (Journal of Parenteral and Enteral Nutrition 11: 259–262, 1987)
Central Venous Catheter Guidewire Replacement According to the Seldinger Technique: Usefulness in the Management of Patients on Total Parenteral Nutrition
Authors: Bonadimani Bruno , Sperti Cosimo , Stevanin Anna , Cappellazzo Francesco , Militello Carmelo , Petrin Pietro , Pedrazzoli Sergio
Published: May 2008

While on total parenteral nutrition (TPN), 37 patients underwent replacement of a central venous catheter (CVC), during which a wire introducer was used, according to the Seldinger technique. In 25 patients, the CVC was placed in the superior cava via the subclavian, and, in 12, via the jugular vein.

Overall, 82 CVC changes were performed.: 74 for assumed CVC sepsis, 6 as preventive treatment, and 2 for partial catheter displacement. Catheter tip culture proved to be positive in 25 of 119 CVC examined.

The catheters were defined as sterile when the tip culture was negative; contaminated, when the tip culture was positive and peripheral blood culture was either negative or positive for different bacteria; septic when both tip and blood were positive for the same bacteria.

The results indicated that 10 catheters were contaminated and 17 were septic. Eight previously sterile CVC were found positive after the exchange: 3 were removed at the end of TPN in asymptomatic patients, and 5 were successfully resterilized by means of one more change.

Guidewire replacement allowed CVC sterilization of 22 of 24 catheters (91.6%). No complications due to the catheter‐changing method were seen. (Journal of Parenteral and Enteral Nutrition 11:267–270, 1987)
Hepatic Abnormalities Associated with Aluminum Loading in Piglets
Authors: Klein Gordon L. , Sedman Aileen B. , Heyman Melvin B. , Marathe Gopal , Battifora Hector A. , Worrall Jack L. , Horst Ronald L. , Brewer George J. , Miller Nancy L. , Alfrey Allen C.
Published: May 2008

Cholestasis is a common complication of total parenteral nutrition (TPN) in infants. A contributing factor to the hepatic dysfunction may be a contaminant of the TPN solution, such as aluminum, that accumulates in liver and may act as a hepatotoxin. To study the hepatic effects of aluminum, growing piglets were given daily intravenous injections of aluminum, 1.5 mg/kg, for 50 days; pair‐fed controls were given heparinized saline. At sacrifice, liver and serum were obtained. Liver was analyzed for histopathology and for aluminum content and localization. The hepatocyte lysosomes of the experimental group showed aluminum peaks by x‐ray microanalysis, whereas the control group did not. No differences in ultrastructure were noted between the two groups when examined by electron microscopy. Mean serum total bile acid levels (27.8 ± 15.9 SD vs 6.3 ± 1.5 μmol/liter, p < 0.05), mean alkaline phosphatase (309 ± 108 vs 180 ± 27 lU/liter, p = NS), and mean hepatic copper content (24.8 ± 4.5 vs 14.4 ± μg/g dry weight, p < 0.01), were elevated in the aluminum‐loaded piglets, indicating that cholestasis may have been produced. Also, a small but significant reduction in serum levels of 25 hydroxyvitamin D was found in the aluminum‐loaded piglets, suggesting that vitamin D hydroxylation may be impaired. Inasmuch as lysosomal contents are excreted into the bile, aluminum accumulation in lysosomes may alter lysosomal function and possibly affect bile flow or content. (Journal of Parenteral and Enteral Nutrition 11:293–297, 1987)
Current Concepts in Immune Derangement Due to Undernutrition
Authors: Garre Michel A. , Boles Jean M. , Youinou Pierre Y.
Published: May 2008

Protein‐calorie malnutrition (PCM) adversely affects more or less all immune competent cells. Nonspecific immunity is impaired, particularly adherence and chemotaxis of phagocytes, although the responsiveness of circulating cells may not be the same as that of noncirculating cells. PCM results in numerical and functional impairment in lymphocytes. PCM markedly affects IgG class antibodies which have the highest affinity when directed against T‐dependent antigens. These impairments are interrelated, since cooperation between T‐helper cell and B‐cells is depressed, and the antigen presentation to T‐helper cells by macrophages is deficient. (Journal of Parenteral and Enteral Nutrition 11:309–313, 1987)
Warfarin Resistance Associated with Intravenous Lipid Administration
Authors: Lutomski Dave M. , Palascak Joseph E. , Bower Robert H.
Published: May 2008

Intravenous lipids have been shown to have varying effects on coagulation parameters. A patient with short bowel syndrome and recurrent thrombotic episodes who required both intravenous lipids and anticoagulation is described. A constant infusion of a soybean oil emulsion (Intralipid) in his parenteral nutrient solution was demonstrated to interfere with the anticoagulant effect of warfarin. Termination of the infusion and rechallenge with warfarin resulted in prolongation of his prothrombin time to the therapeutic range. Reinstitution of a lipid‐free parenteral nutrition regimen has allowed for successful continuation of warfarin therapy. (Journal of Parenteral and Enteral Nutrition 11:316–318, 1987)
Resting Metabolic Rate: Measurement Reliability
Authors: Leff Mindy L. , Hill James O. , Yates Allison A. , Cotsonis George A. , Heymsfield Steven B.
Published: May 2008

Resting metabolic rate (RMR) usually is measured by indirect calorimetry for a brief interval, and the results are then extrapolated to 24‐hr resting energy production. The aim of the current study was to examine the validity of this approach by measuring the within‐ and between‐day variability in RMR. The RMR was measured hourly in 14 healthy adults from 8:00 am to 4:00 pm after an overnight fast on two separate days. The results indicated that, during day 1, RMR remained unchanged from early morning to late afternoon, and there was no significant difference between RMR measurements 1 through 8. Based upon analysis of variance and intraclass correlation coefficients, the averages of the first and the last three RMR measurements were found to be unreliable. RMR reliability was improved by averaging all measurements taken during the day, and maximum reliability was obtained by averaging the middle three RMR measurements. A similar pattern of results was observed during day 2, although the overall trend was for the reliability of RMR measurements to improve relative to day 1. The average RMRs on days 1 and 2 were not significantly different. These results indicate that the current practice of establishing a patient's RMR based upon a single measurement potentially can lead to large errors in determining energy needs. Measurement reliability can be improved by serially measuring RMR, eliminating the initial measurement, and averaging the remaining two to three values. (Journal of Parenteral and Enteral Nutrition 11:354–359, 1987)
The Growth of Microorganisms in Total Parenteral Nutrition Admixtures
Authors: D'Angio Richard , Quercia Robert A. , Treiber Nancy K. , McLaughlin James C. , Klimek Joseph J.
Published: May 2008

Total nutrient admixtures (TNAs) containing glucose, amino acids, and lipid emulsion in one container and amino acid/dextrose solutions [conventional total parenteral nutrition (TPN) formulations] were studied in a controlled laboratory experiment for their ability to support the growth of microorganisms. Both TNA and conventional TPN formulations for peripheral and central venous administration with standard additives were inoculated with microorganisms to provide 101‐102 colony‐forming units/ml (CFU/ml) of Staphylococcus epidermidis, Escherichia coli, Pseudomonas aeruginosa, Klebsiella penumoniae, and Candida albicans. The admixtures were stored at room temperature and samples for quantitative microbiology were taken at time 0, 6, 12, 24, 48, 72, and 96 hr. K. pneumoniae, E. coli, and P. aeruginosa were able to proliferate in central TNAs, but the growth of these organisms was retarded in conventional TPN solutions. In the peripheral formulations, K. pneumoniae and E. coli proliferated in both the TNA and conventional TPN systems, whereas P. aeruginosa grew well only in the peripheral TNA. S. epidermidis was not able to grow in any admixtures tested; however, C. albicans grew well in all admixtures, but growth was slower in the conventional central TPN. In conclusion, peripheral and central TNAs supported the growth of microorganisms significantly better than conventional TPN solutions. (Journal of Parenteral and Enteral Nutrition 11:394–397, 1987)
Nutrition Education in Schools of Nursing in the United States. Part 2: The Status of Nutrition Education in Schools of Nursing
Authors: Stotts Nancy A. , Englert Deann , Crocker Kathleen S. , Wiltz Bennum Nancy , Hoppe Mary
Published: May 2008

To explore whether nurses in academic institutions are being adequately educated to care for patients' nutritional needs, we conducted a survey of National League for Nursing accredited baccalaureate programs in the United States and their associated graduate programs. Data indicate that nutrition content is an integral part of baccalaureate nursing programs. Less emphasis is reported on nutrition content at the graduate level. Recommendations include revision of the substantive nutritive content and increased clinical experience in nutrition in both undergraduate and graduate nursing education. (Journal of Parenteral and Enteral Nutrition 11:406–411, 1987)
Treatment of External Gastrointestinal Fistulas by a Combination of Total Parenteral Nutrition and Somatostatin
Authors: Di Costanzo J. , Cano N. , Martin J. , Richieri J. P. , Mercier R. , Lafille C. , Lepeuch D.
Published: May 2008

Thirty‐seven patients with external gastrointestinal fistulas were treated with a combination of total parenteral nutrition (TPN) and somatostatin (ST). There was a significant fall in fistula output within the first day of treatment (p > 0.001). On the first day of combined therapy, the reduction of fistula output was 70%, and in 68% of the cases, the fistula output fell to less than 50% of the initial level. Spontaneous closure was observed in 82% of the cases, and the time taken to close the fistula ranged between 1 and 14 days of starting therapy [5.4 ± 0.7 days (mean ± SEM)]. The response to TPN‐ST treatment occurred irrespective of age and sex of patients, duration and daily output of the fistulas before ST use, and their location in the gastrointestinal tract. Infection of fistula output was a factor of adverse prognosis. In all cases, and in the absence of mechanical obstacles, treatment that combines TPN and ST could be tried and continued up to 14 days in cases in which the fistula output falls more than 50% on the first day of treatment. (Journal of Parenteral and Enteral Nutrition 11:465–470,1987)
The Metabolic Response to Brain Injury
Authors: Ott Linda , Young Bryon , McClain Craig
Published: May 2008

Every year several million people sustain brain injury. The development of an optimal metabolic and nutritional support program for brain‐injured patients relies on an understanding of the metabolic response and nutritional complications that occur with brain injury. Severely brain injured patients have increased serum and urine levels of norepinephrine, epinephrine, and Cortisol. These patients also have increased oxygen consumption and urinary nitrogen excretion. This group has observed hypozincemia, hyperzincuria, increased serum C‐reactive protein and copper concentrations, and hypoalbuminemia in nonsteroid‐treated severely brain‐injured patients. Experimental head injury produces interleukin‐1 (IL‐1) of brain origin. This cytokine mediates many of the aspects of the acute phase response, including all of the metabolic abnormalities reported by our group. IL‐1, when administered intracerebroventricularly to experimental animals, appears to have enhanced biological activity compared to that administered systemically. Interleukin‐1 activity has been found in significant amounts in the intraventricular fluid of head‐injured patients. We suggest that IL‐1 acts in concert with traditional stress hormones such as epinephrine, norepinephrine, and Cortisol to produce the profound metabolic disturbances observed in the head‐injured patient. (Journal of Parenteral and Enteral Nutrition 11:488–493,1987)
Ethanol Lock in the Management of Catheter Occlusion
Authors: Pennington C. R. , Pithie A. D.
Published: May 2008

Catheter occlusion by lipid material has been associated with the use of lipid containing “all‐in‐one” compounded solutions during prolonged parenteral nutrition. Previous experience indicated that urokinase is ineffective in clearing such occlusions. We report five patients who developed catheter occlusion with lipid mixes; catheter patency was restored in four by the use of an ethanol solution. No complications were observed, and treatment continued uneventfully in those four subjects. (Journal of Parenteral and Enteral Nutrition 11:507–508, 1987.
Effects of Fish Oil on Postburn Metabolism and Immunity
Authors: Trocki Orrawin , Heyd Timothy J. , Waymack J. Paul , Alexander J. Wesley
Published: May 2008

The metabolic effects and immune responses of different levels of fish oil in enteral formulas for postburn nutritional support were studied. Thirty‐seven burned guinea pigs with previously placed gastrostomy feeding tubes were given diets containing 5, 15, 30, or 50% of nonprotein calories as fish oil. These diets were isonitrogenous, isocaloric, and contained identical amounts of vitamins and minerals. After 14 days of enteral feeding, there were no significant differences in resting metabolic expenditure, serum transferrin, and albumin levels. Weight loss was significantly greater in groups receiving 30 and 50% of fish oil compared to groups which received 5 and 15% of fish oil. Carcass weights and liver weights of animals in the two groups that received diets with higher lipid content were also significantly lower. Cell‐mediated immunity, macrophage bactericidal indices, and opsonic indices were not different among the groups. This study confirms that diets containing lower levels of lipids are more effective for enteral nutritional support than those containing higher levels. In contrast to linoleic acid rich lipid sources, higher levels of fish oil did not show adverse effects on immunity possibly because it contained high concentrations of ω3 fatty acids which are not precursors of immunosuppressive prostaglandin E2. (Journal of Parenteral and Enteral Nutrition 11:521–528, 1987)
Free Amino Acid Formula: Nitrogen Utilization and Metabolic Effects in Normal Subjects
Authors: Heller Patricia A. , Shronts Eva , Akrabawi Salim , Heymsfield Steven B.
Published: May 2008

A previous study indicated increased urea production and low nitrogen (N) retention on a free amino acid elemental formula (FAA; Vivonex‐HN). The limitations of this earlier study were: irregular nitrogen absorption in the malabsorption patients, high nitrogen intake, and failure to match FAA to control formula (hydrolyzed casein; CAS; Criticare‐HN) with respect to kcal/nitrogen. A more critical test of FAA quality was sought in the current study. Four healthy males received the minimal daily nitrogen requirements (0.6 g protein/kg) from either FAA or CAS in a 10‐day balance study; a second balance on the alternate formula followed. Maintenance energy, minerals, and vitamins were supplied in each period. The results indicated a higher apparent nitrogen absorption (p < 0.05) from FAA relative to CAS in the first 5 days of the balance, although these differences were no longer present in the remaining 5 days of the period. Urinary total nitrogen increased on FAA, most of which could be accounted for by urea nitrogen; urinary creatinine nitrogen, ammonia nitrogen, and uric acid nitrogen were nearly identical between formulas. The unmeasured fraction of urinary nitrogen was markedly diminished on FAA while the urea nitrogen to total nitrogen ratio was significantly increased (p < 0.05) compared to CAS. During the initial 5 days of study nitrogen balance was lower on FAA than on CAS and this difference became significant during the last 5 days of the period (X ± SD for FAA = ‐0.42 ± 0.59 g/D vs CAS = 0.98 ± 0.30 g/day, p < 0.001). Hyperglycinemia was consistently present during FAA infusion. Hence the low biologic value of FAA and associated metabolic effects persist under stringent study conditions. (Journal of Parenteral and Enteral Nutrition 11:533–539, 1987)
Effects of Different Rinsing Regimen on Totally Implantable Vascular Access after 70 Days Infusion of Total Parenteral Nutrition in Vitro
Authors: Klem Wendy , Bentdal Eystein H. , Flaatten Hans , With Karin
Published: May 2008

Totally implantable vascular access catheters with injection ports (IP) have been used for total parenteral nutrition (TPN). It is well known that thrombosis may cause occlusion of catheters. Recently we have experienced occlusion of the vascular access chambers in TPN‐patients because of precipitation from the solutions.

Three different IPs were tested in vitro: Port‐A‐Cath (PAC), Vascular‐Access‐Port (VAP), and Implantofix (IMP). Each received a daily infusion of a 2.5‐liter solution consisting of fat emulsion, amino acids, glucose, and additives from a “3‐liter bag.” After infusions, the IPs were washed with three different rinsing methods, one including 45% v/v alcohol. After 70 days the ports were opened and examined for precipitation. Ports washed with alcohol showed no signs of precipitation, while four of six ports which were washed with conventional rinsing methods had precipitates. (Journal of Parenteral and Enteral Nutrition 11:566–568, 1987)
Venopulmonary Fistula: A Rare Complication of Central Venous Catheterization
Authors: Demey Hendrik E. , Colemont Luc J. , Hartoko Theo J. , Roodhooft Anne‐Marie I. , Ysebaert Dirk K. , Bossaert Leo L.
Published: May 2008

Venopulmonary fistula occurred in a 13‐year‐old girl, 2 weeks after insertion of a silicone parenteral nutrition catheter. “TPN pneumonia” evolved to life‐threatening respiratory failure. Complete resolution of the respiratory insufficiency followed removal of the catheter. (Journal of Parenteral and Enteral Nutrition 11:580–582, 1987)
Necrotizing Fasciitis as a Complication of Percutaneous Endoscopic Gastrostomy
Authors: Martindale Robert , Witte Michael , Hodges George , Kelley James , Harris Stanley , Andersen Charles
Published: May 2008

Necrotizing fasciitis of the abdominal wall is a rare clinical entity. The following case study is the first report of necrotizing fasciitis as a complication of percutaneous endoscopic gastrostomy. (Journal of Parenteral and Enteral Nutrition 11:583–585, 1987)
A Seldinger Technique for the Insertion of Tunneled Fixed‐Hub Total Parenteral Nutrition Catheters
Authors: Farquhar Iain
Published: May 2008

Total parenteral nutrition lines are commonly tunneled subcutaneously to decrease rates of sepsis. The history of line tunneling is discussed briefly, noting that to date a surgical approach, a detachable hub catheter or more recently a tunneling rod and ‘peel away’ introducer have been necessary for this form of central venous access. These systems have problems associated with cost, catheter type and insertion technique.

A simple technique for insertion of tunneled total parenteral nutrition catheters is described. The device used consists of a polyurethane catheter with a fixed‐hub. The applications of this approach are discussed. (Journal of Parenteral and Enteral Nutrition 11:590–593, 1987)
Declogging Small‐Bore Feeding Tubes
Authors: Nicholson Linda J.
Published: May 2008

Nine substances (Pancrease, Viokase, pork pancreatin, bromelain, papain, cranberry juice, Coca‐Cola, chymotrypsin, and distilled water) were tested every half‐hour for 4 hr using 900 mm of water pressure to determine their effectiveness in declogging small‐bore feeding tubes. At the end of 4 hr the tubes were irrigated with air using a 50‐cc syringe. None of the substances tested were effective within 4 hr. Three substances allowed for successful syringe irrigation at the end of 4 hr. They were: chymotrypsin, papain, and distilled water. (Journal of Parenteral and Enteral Nutrition 11:594–597, 1987)
Effects of L‐Carnitine Infusion on Intralipid Clearance and Utilization. Study Carried out in Septic Patients of an Intensive Care Unit
Authors: Gibault Jean‐Philippe , Frey Anny , Guiraud Michel , Schirardin Henri , Bouletreau Paul , Bach André C.
Published: May 2008

Endogenous and exogenous supplies of carnitine are decreased in septic patients under total parenteral nutrition, while carnitine urinary elimination is increased. But the increase of lipid role in the energetic cover requires a greater intervening role of tissue carnitine. So one may hope that in septic patients additional supply of L‐carnitine would increase the catabolism of infused lipids. Twenty‐eight septic patients, admitted in an intensive care unit were given parenteral nutrition (200 g of glucose, 12.5 g of N/24 hr). On the day of the study, 250 ml of Intralipid 20% (Kabi Vitrum) were administered in 4 hr. During the same period 13 patients were infused with 2 g of L‐carnitine (Sigma‐Tau). The remaining 15 patients constituted the control group. Basic plasma levels of triglycerides, nonesterified fatty acids, free glycerol, phospholipids, and ketone bodies remained within physiological limits. They increased during the lipid infusion and returned to initial values, 4 hr after the end of the infusion. Free and total carnitine levels and free/total carnitine ratio were comparable to healthy subjects' reference values. These parameters increased during L‐carnitine infusion. This infusion had no effect on exogenous lipid clearance. However, it seemed to increase the uptake and the hepatic oxidation of circulating fatty acids. It invalidated the increase of lactate and pyruvate that had been noticed when lipids were solely infused.(Journal of Parenteral and Enteral Nutrition12:29–34, 1988)
Carnitine Excretion: A Catabolic Index of Injury
Authors: Iapichino Gaetano , Radrizzani Danilo , Colombo Angelo , Ronzoni Giulio
Published: May 2008

In patients with trauma or sepsis, carnitine is known to be produced to a greater extent; deficient production could impair the energy management that is required in such patients. To clarify the requirements of carnitine after injury, we studied carnitine elimination (in 10 critically ill injured patients) both during fasting and early parenteral nutrition. Increased carnitine (mainly, free) output after injury (9.36 ± 1.63 μmol/kg p < 0.02 vs reference) was negatively related to nitrogen balance (p < 0.05) and positively to 3‐methyl‐histidine output (p < 0.01), acting as a market of body mass catabolism. The output of both total and free carnitine progressively decreased (p < 0.01) throughout the course of total parenteral nutrition. In conclusion, our data definitively suggest that carnitine loss after injury reflects body cell mass wastage and does not necessarily mean an increased need. (Journal of Parenteral and Enteral Nutrition 12:35–36, 1988)
Effect of Nucleotide Restriction and Supplementation on Resistance to Experimental Murine Candidiasis
Authors: Fanslow William C. , Kulkarni Anil D. , Van Buren Charles T. , Rudolph Frederick B.
Published: May 2008

The influence of dietary nucleotides on susceptibility to candidiasis in mice was studied using two criteria: animal survival and recovery of viable Candida albicans organisms from the kidney and spleen. One‐month‐old mice were placed on one of five diets with varying nucleotide content. The results show that mice maintained on a nucleotide‐free diet (NF) exhibit a significantly decreased mean survival time and a significantly increased viable organism recovery in the spleen following intravenous injection of graded inocula of C. albicans compared to mice fed diets containing RNA or uracil as a nucleotide source. (Journal of Parenteral and Enteral Nutrition 12:49–52, 1988)
Comparison of Metabolic Clearance Rates of MCT/LCT and LCT Emulsions in Diabetics
Authors: Wicklmayr M. , Rett K. , Dietze G. , Mehnert H.
Published: May 2008

In seven moderately overweight noninsulindependent diabetics with slightly elevated triglyceride levels, disappearance rates of infused medium chain triglyceride/long chain triglyceride (MCT/LCT) and long chain triglyceride (LCT) emulsions were compared. Five metabolically healthy volunteers served as controls. During a 3‐hr lipid infusion, serum triglycerides reached a steady state with both emulsions in the healthy controls, whereas, in diabetic patients, steady state triglyceride levels were seen only with MCT/LCT. After the end of the lipid infusion, the longest half‐life value in the decline of triglyceride levels was found with LCT in diabetics, whereas significantly shorter and quite similar half‐life values were found with LCT in healthy controls and with MCT/LCT in diabetics. As expected, the shortest half‐life for serum triglycerides was found in healthy controls after MCT/LCT‐infusion. Virtually the same differences in serum concentrations and in half‐life times were seen with free fatty acids. According to these data, if needed, parenteral nutrition with lipids in states of disturbed glucose and lipid metabolism may preferentially be done with MCT/LCT emulsions. (Journal of Parenteral and Enteral Nutrition 12:68–71, 1988)