bluuebunny/crossref_metadata_2025 huggingface dataset:
Influence of Parenteral Nutrition on Serum Levels of Proteins in Patients with Crohn's Disease
Authors: Meryn S. , Lochs H. , Pamperl H. , Kletter K. , Mulac K.
Published: May 2008

Parenteral nutrition (PN) is commonly used in the management of inflammatory bowel disease. Previously we reported about the serum protein levels in Crohn's disease before and after treatment with PN; in that study we found an increase of some indicators of nutritional status and a decrease of some acute phase reactants after treatment. We have now completed the trial determining the concentration of 19 serum proteins in 25 patients with Crohn's disease before and after treatment with PN and 8 wk thereafter. The concentration of albumin, retinol‐binding protein, prealbumin, and transferrin were found to rise in parallel with the body weight during PN, whereas 8 wk after treatment only albumin and transferrin showed a further significant rise. α‐1‐Glycoprotein, α‐2‐chymotrypsin, α‐1‐antitrypsin, CRP, and haptoglobin decreased during and 8 wk after PN, α‐1‐glycoprotein, α‐2‐chymotrypsin, and α‐1‐antitrypsin showed a positive correlation to the Crohn's Disease Activity Index. The serum IgM‐levels were found to be significantly increased during and after PN with a negative correlation to the Crohn's Disease Activity Index. Our data indicate that PN not only improves nutritional status in the active phase of Crohn's disease during therapy but reduces the grade of inflammatory activity during and even after treatment with PN. (Journal of Parenteral and Enteral Nutrition 7:553–556, 1983)
Fat Elimination in Parenterally Fed Low Birth Weight Infants during the First Two Weeks of Life
Authors: Paust H. , Schröder H. , Park W. , Jakobs C. , Frauendienst G.
Published: May 2008

Eighteen low birth weight infants (27–34 wk gestation) were given supplementary parenteral nutrition via peripheral veins of a maximal dose of 8.5 g glucose, 2.5 g amino acids (Aminovenös päd 10%) and 2 g soybean oil egglecithin emulsion (Intralipid 10%)/kg body weight/24 hr. The fat emulsion was infused continuously at a rate of 0.084 g/kg body weight/hr. The elimination of Intralipid from the blood stream was controlled by enzymatic determination of serum triglyceride concentrations, and the fatty acid pattern of the serum lipids was determined by gas chromatography. The serum triglyceride concentrations were 0.60 ± 0.16 mmol/liter on the 1st day, increased to 0.96 ± 0.29 mmol/liter up to the 5th day, and approached a level around 0.90 mmol/liter in the further course. No hypertriglyceridemia was noted. The fatty acid pattern of the serum lipids showed a linoleic acid fraction of 8.1 ± 4.0% in the beginning, which was followed by a continuous increase up to 27.8 ± 4.8% on the 7th day. No significant changes were noticed thereafter. The levels were within the normal limits as found in 2‐wk‐old enterally fed preterm infants of comparative maturity (25.6 ± 3.4%). We conclude that the preterm infants can eliminate Intralipid from the blood stream if maximal dosage and infusion rate, as described above, are applied. (Journal of Parenteral and Enteral Nutrition 7:557–559, 1983)
Hypocupremia in Patients Receiving Total Parenteral Nutrition
Authors: Bozzetti Federico , Grazia Inglese Maria , Terno Giovanni , Pupa Alessandro , Sequeira Carmen , Migliavacca Silvana
Published: May 2008

Although hypocupremia is a well‐known consequence of long‐term total parenteral nutrition (TPN), its incidence as well as the duration of TPN necessary to induce it are still unsettled. The purpose of this study is to review the changes in serum copper level in 25 patients receiving TPN for a period longer than 2 wk (mean duration 6 wk) at the Istituto Nazionale Tumori of Milan and to evaluate the possible relationship of cupremia with the basic disease. Main indications for TPN included enterocutaneous fistulas (11 patients), cancer cachexia (10 patients), radiation enteropathy (two patients), and severe postoperative stricture following esophagogastric resection (two patients). Mean value of serum copper at the beginning of the study was 143 μg/100 ml (normal value 65–165 μg/100 ml), and the regression analysis showed a mean fall of 5.64 μg/100 ml/wk. Hypocupremia occurred in four patients (three with intestinal fistulas and one with radiation obstructive enteritis) at 5th, 6th, 9th, and 6th wk of TPN. respectively. No patient with cancer cachexia developed hypocupremia. No patient with hypocupremia had clinical evidence of a copper deficiency syndrome. We conclude that 1) hypocupremia does not occur within the first month of TPN; 2) its incidence is about 16% in patients intravenously fed for period longer than 2 wk; 3) it is more frequent in patients with enterocutaneous fistulas, whereas it never occurs in patients with cancer cachexia, and 4) it is not necessarily associated to a clinicometabolic syndrome of copper deficiency. Finally, the “nutritional” meaning of serum copper should be questioned in cancer patients since it could represent a “tumor marker.” (Journal of Parenteral and Enteral Nutrition 7:563–566, 1983)
Total Parenteral Nutrition in the Mouse: Development of a Technique
Authors: Sitren Harry S. , Heller Patricia A. , Bailey Lynn B. , Cerda James J.
Published: May 2008

A method for total parenteral nutrition in the mouse was developed using commercially available supplies and equipment. The mouse's inferior vena cava was catheterized and the catheter was exteriorized from the tail. Mice (average body weight 22.5 g) were not tethered but instead were partially restrained by immobilizing the tail to protect the infusion tubing. A solution was formulated to contain 40% dextrose and 4.3% amino acids plus vitamins, electrolytes, and trace elements. It was administered via pump in graded fashion for the first 3 days to allow the mice to adapt, and then at a rate of 8 ml/day thereafter. This volume provided approximately 12 kcal and 54 mg nitrogen per day and was calculated to meet the needs of the mouse fed per os according to guidelines of the National Research Council. During the adaptation period mice lost weight but they were in positive N balance thereafter. At the end of 12 days body weight was not different than at the start, indicating the adequacy of nutrient input. Further, there were no differences in nitrogen balance or body weight in total parenteral nutrition fed mice in comparison with tail‐restrained mice given the same solution per os. All mice appeared to tolerate the partial restraint without incidence and showed no untoward side effects. The rationale and validity of this technique is discussed in detail. (Journal of Parenteral and Enteral Nutrition 7:582–586, 1983)
Improved N‐retention during L‐Carnitine‐Supplemented Total Parenteral Nutrition
Authors: Bohles H. , Segerer H. , Fekl W.
Published: May 2008

The influence of intravenously administered L‐carnitine on lipid‐ and nitrogen‐metabolism was studied during total parenteral nutrition of piglets (mean weight 4077 g; n = 9). The infusion protocol was divided into three isocaloric and isonitrogenous 48‐hr periods. Amino acids (3 g/kg day) were administered throughout all three periods: 140 cal/kg/day were given as nonprotein calories, consisting only of glucose during period 1; during periods 2 and 3, an amount of glucose calorically equivalent to 4 g fat/kg/day was substituted with a lipid emulsion, and L‐carnitine (1.5 mg/kg/day) was added in period 3. Key parameters of fat‐ and nitrogen‐metabolism were determined during the entire regime. Indirect calorimetry was performed and the respiratory quotient calculated during all three periods. The results demonstrate a more effective lipolysis and oxydation of fatty acids during L‐carnitine supplementation. These changes produce an increased energy gain from exogenously administered fat and a distinct improvement in nitrogen balance. (Journal of Parenteral and Enteral Nutrition 8:9–13, 1983)
Efficient Gastroduodenal Decompression with Simultaneous Full Enteral Nutrition: A New Gastrostomy Catheter Technique
Authors: Moss Gerald
Published: May 2008

A gastrostomy tube was designed that provides efficient supplemental aspiration of the proximal duodenum to remove gas that escapes gastric removal, utilizing an extension of the gastric suction channel. A separate lumen delivers elemental diet 7.5 cm more distally, for safe postoperative feeding. On clinical testing, patients consistenly achieved immediately postoperative enteral absorption of 3000 kcal/day and positive protein balance. Supplemental insulin was required for optimum utilization, maintaining plasma glucose within the physiologic range. Oral barium motility study during the second 24 hr demonstrated prompt gastric emptying and spontaneous anastomotic passage. We noted decreased clogging with mucus, attributable to “self‐cleansing” by the aspirated duodenal juices. This was returned with the feedings to prevent depletion. There were no complications attributable to this regimen. Patients were discharged uneventfully as early as 48 hr following colectomy. (Journal of Parenteral and Enteral Nutrition 8: 203–207, 1984)
Human Gradient‐Layer Calorimeter: Development of an Accurate and Practical Instrument for Clinical Studies
Authors: Mcmanus Clifford , Newhouse Howard , Seitz Susan , Nixon Daniel , Poppendiek Heinz , Heymsfield Steven
Published: May 2008

A whole body gradient‐layer calorimeter was designed for thermophysiologic studies in hospitalized patients. The instrument was assembled in a room adjoining a metabolic ward. The patient lies recumbent on a stretcher which is wheeled into the calorimeter on tracks. Once inside, the patient's head extends through one wall into a clear plastic canopy. The canopy is partially open on one side and is the entry point for fresh air into this open‐circuit system. Heat flux transducers in the calorimeter walls, a thermopile in the exit air stream, and a platemeter in conjunction with wet and dry bulb thermometers allow measurement of total, wet, and dry heat losses from the subject. All calorimeter output signals are routed to a microcomputer system which processes the data and provides real‐time output of results. A mannequin heat source is used to calibrate the gradient layer. Testing with a variety of wet/dry heat sources indicate total, wet, and dry heat measurements are accurate to within 2–3%. A typical study of resting energy expenditure requires 1 hr, and protocols of up to 6 hr are well tolerated. The calorimeter has proven to be reliable, accurate, and easy to operate. These qualities, combined with good patient tolerance, make it ideal for metabolic studies. (Journal of Parenteral and Enteral Nutrition 8:317–320, 1984)
Home Parenteral Nutrition Using Shunts
Authors: Havill J.H. , Blair R.D.
Published: May 2008

Most workers have found use of shunts unworkable as a means of access for home parenteral nutrition. Our experience using arteriovenous loop vein grafts for this purpose is described including any problems encountered. One shunt could not be established. In four other patients arteriovenous loop vein grafts have been used successfully. They are in our opinion superior to indwelling catheters as a means of access in long‐term patients. (Journal of Parenteral and Enteral Nutrition 8:321–324, 1984)
The Effects of Intralipid and Heparin on Human Monocyte and Lymphocyte Function
Authors: Fraser Ian , Neoptolemos John , Darby Helen , Bell P.R.
Published: May 2008

A group of patients was studied during the infusion of Intralipid as part of a parenteral nutrition regimen. Peripheral blood lymphocyte function was unaffected, but monocyte function (chemotaxis) was significantly depressed. A group of healthy volunteers received an intravenous bolus of 20% Intralipid. Blood was taken before and 15 min afterward for immunological studies, and the same changes were seen following Intralipid. Prior subcutaneous injection of 5000 U of heparin did not affect either immunological parameter, but completely prevented the changes in monocyte function caused by Intralipid. Electronmicrographs of monocytes from volunteers after injection of Intralipid, and autoradiographs of cells incubated with 14C‐Intralipid in vitro, showed phagocytosis of fat particles by monocytes. These data suggest that Intralipid can have potentially serious side effects on the immune system, and that they may be alleviated by the use of subcutaneous heparin. (Journal of Parenteral and Enteral Nutrition 8:381–384, 1984)
Effects of Exogenous Catecholamines on Glucose and Fat Metabolism and on Triglycerides in the Rat Liver during Total Parenteral Nutrition
Authors: Iriyama Keiji , Teranishi Tadashi , Mori Hiroshi , Nishiwaki Hiroshi , Kusaka Noriko
Published: May 2008

An experiment was undertaken to investigate the effects of a continuous infusion of catecholamines on glucose and fat metabolism as well as on nitrogen balance and the amount of triglycerides in the rat liver. The animals were nourished by total parenteral nutrition for 5 days and divided into six groups (n = 5 in each group) on the basis of nonprotein calories given with or without an infusion of catecholamines: group G received 100% of nonprotein calories with glucose, group F received 50% of nonprotein calories with glucose, and the remaining 50% with lipid emulsion, groups Epi‐G and Epi‐F received epinephrine (1 μg/kg body weight/min) in addition to the same total parenteral nutrition solution as group G or F, and groups Nor‐G and Nor‐F received norepinephrine (1 μg/ kg/min) in a similar manner. Each group was administered the same number of total calories (252 cal/kg/day) and the same amount of nitrogen (1.49 g/kg/day). Nitrogen balance was better in group G than in group F. Under catecholamine infusion, there were no significant differences in nitrogen balance between groups Epi‐G, Nor‐G, Epi‐F, and Nor‐F, but this parameter improved significantly in group Nor‐F in comparison to group F. Liver triglycerides was higher in groups Epi‐G and Nor‐G than in groups Epi‐F and Nor‐F. Liver triglycerides was directly related to the blood sugar level. These results indicate that nitrogen conservation is improved with lipid emulsion and that glucose rather than lipid plays a significant role in the genesis of fatty liver, when they are administered under catecholamine‐induced stress. (Journal of Parenteral and Enteral Nutrition 8:412–415)
Total Parenteral Nutrition in Experimental Uremia: Studies of Acute and Chronic Renal Failure in the Growing Rat
Authors: Takala Jukka
Published: May 2008

The effects of total parenteral nutrition (TPN) on experimental acute and chronic renal failure were studied with special reference to age in the rat. TPN prolonged survival in acute renal failure. The young experimental animals benefitted more from the TPN. The accumulation of urea in the body was inhibited during TPN. In chronic renal failure, the low nitrogen TPN with essential amino acids as the source of nitrogen had no advantages over a regular diet fed ad libitum. Instead the TPN‐rats had a markedly less positive nitrogen balance than the uremic and healthy controls. This difference was accentuated in the rapidly growing young animals. The results of this study suggest that TPN has a crucial role in the treatment of acute renal failure at an early age and are against the use of low protein diets in chronic renal failure if rapid growth is expected. (Journal of Parenteral and Enteral Nutrition 8:427–432, 1984)
Cost‐Effectiveness of Preoperative Parenteral Nutrition in Patients Undergoing Major Gastrointestinal Surgery
Authors: Detsky Allan S. , Jeejeebhoy Khursheed N.
Published: May 2008

We used cost‐effectiveness analysis to compare three strategies for reducing the incidence of severe nutrition‐associated complications (eg, wound dehiscence) in patients undergoing major gastrointestinal surgery: treat all patients with parenteral nutritional support for 10 days before surgery, treat no patients with preoperative parenteral nutritional support, or perform a test which stratifies patients (treating only the “high risk” or “malnourished” patients). The “test” strategy results in the lowest total hospital complication rate when the overall incidence of postoperative nutrition‐associated complications is greater than 4% and less than 39%. However, the cost minimizing strategy is “treat none” as long as the overall incidence is less than 78%. In moving from the “treat none” to the “test” strategy, the incremental cost per complication avoided varies from $11,515 (for a 20% overall incidence), to $1,031 (for a 60% overall incidence). These cost‐effectiveness ratios for incidence rates above 20% compare favorably to the use of routine screening tests performed on preoperative patients. However, the cost‐effectiveness ratios are quite sensitive to the assumptions made concerning the effectiveness of parenteral nutritional support and the predictive properties of the test (derived from previous clinical studies). We conclude that further research is needed to study the overall incidence of severe postoperative nutrition‐associated complications for various surgical procedures, to confirm the accuracy of stratification techniques and to confirm previous studies of the effectiveness of preoperative parenteral nutritional support in order to permit third party payers to evaluate the consequences of adopting this intervention as a standard clinical practice. (Journal of Parenteral and Enternal Nutrition 8:632–637, 1984)
Glucose Handling in Morbid Obesity and the Effects of Surgically Induced Weight Loss
Authors: Dooner Jim , Burget D. , Cleator I.G.M.
Published: May 2008

Morbid obesity is associated with glucose intolerance. We studied the rate of glucose turnover in 18 morbidly obese individuals and compared the results to 10 normal weight controls using the technique of the hyperglycemic clamp. Rate of glucose turnover (mg/kg/min) was defined as metabolic clearance of glucose and corresponding plasma immunoreactive insulin values were determined. The ratio of metabolic clearance of glucose to plasma insulin is a reflection of endogenous insulin sensitivity. Patients were studied again 3 months following jejunoileal bypass and gastroplasty. Fasting glucose was similar for all groups. Fasting immunoreactive insulin was 16.8 ± 5 μU/ml in preoperative obese, 4.3 ± 0.2 in controls, 6.8 ± 0.6 in postoperative jejunoileal bypass, and 6.2 ± 0.3 in postoperative gastroplasty. The difference between postoperative groups was not significant at 3 months. The jejunoileal bypass group at 1 yr gave similar results to the immediate postoperative findings. In normals the value of metabolic clearance of glucose was 3.9 ± 0.7 mg/kg/min and in the obese it was 2.05 ± 0.2 (p < 0.05). No significant improvement occurred postoperatively. Mean of the immunoreactive insulin values from 60 to 120 min was greater in preoperative obese than controls, 44.0 compared to 13.6 μU/ml (p < 0.05). A highly significant postoperative lowering occurred in both groups, jejunoileal bypass 20.7 μU/ ml, gastroplasty 22.4 μU/ml, but the difference between the surgical groups (jejunoileal and gastroplasty) is not significant. The ratio of metabolic glucose clearance to plasma insulin followed a similar pattern due primarily to the substantial decrease in insulin levels. At 1 yr after jejunoileal bypass the patients had similar findings to their immediate postoperative results. There appears to be a defect in glucose metabolism in morbidly obese individuals which does not respond to weight loss even though insulin levels drop. When the ratio of metabolic clearance of glucose to plasma insulin is compared to weight loss no correlation exists suggesting that the defect in glucose handling is not completely reversible with weight loss. (Journal of Parenteral and Enteral Nutrition 8:660–664, 1984)
Hub Colonization as the Initial Step in an Outbreak of Catheter‐Related Sepsis Due to Coagulase Negative Staphylococci during Parenteral Nutrition
Authors: Sitges‐Serra A. , Puig P. , Liñares J. , Pérez J.L. , Farreró N. , Jaurrieta E. , Garau J.
Published: May 2008

A prospective study was carried out to determine the pathogenesis of coagulase negative staphylococci catheter‐related sepsis during parenteral nutrition. Forty‐three catheters were cultured by semiquantitative and quantitative methods. The skin around the puncture site was cultured at the time of catheter removal and three segments of the catheter were cultured apart: the hub, the proximal subcutaneous segment, and the tip. Skin cultures were negative (89%) or yielded different coagulase negative staphylococci from those recovered in catheter and/or blood. Seventeen catheters were the source of sepsis. In 15 cases an infected hub was associated with an infected tip. In two cases the hub was negative (one sepsis due to mixture contamination and the other due to hematogenous seeding of the catheter tip). Sixteen cases of sepsis were due to coagulase negative staphylococci. Staphylococcus epidermidis has been the species most commonly isolated, followed by Staphylococcus haemolyticus, Staphylococcus saprophyticus, and Staphylococcus hominis. In our patients most catheter sepsis have their origin in an infected hub and are not due to migration of skin bacteria along catheter subcutaneous tunnel. (Journal of Parenternal and Enteral Nutrition 8:668–672, 1984)
Bacterial Contamination of Tube‐Feeding Formulas
Authors: Anderson K.R. , Norris D.J. , Godfrey L.B. , Avent C. Kirk , Butterworth C.E.
Published: May 2008

Bacterial cultures were made on tube‐feeding formulas provided to 35 unselected adult patients on termination of the infusion. Bacteria were counted and identified using routine procedures. Formulas were classified as nonmanipulated, manipulated, or locally prepared. Medical records were reviewed to determine if diarrhea was present during the period that included 2 days on either side of the sampling day. A significant association was observed between the extent of bacterial contamination and the presence of diarrhea (p = 0.027). Locally prepared and manipulated formulas contained a significantly greater number of organisms when compared to nonmanipulated formulas (χ2 = 17.81, p < 0.001). Counts for two baseline and four termination cultures on locally prepared formulas exceeded the acceptable limit for coliform organisms in pasteurized milk according to public health standards. Eight additional cultures on commercial feeding formulas which were presumably sterile initially, exceeded these standards at the end of the administration period. Thus 12 of 35 formulas (34%) would not meet public health standards applicable to pasteurized milk. Use of sterile nonmanipulated formulas in a closed administration set is recommended, along with routine, periodic bacteriologic surveillance of enteral feeding programs. (Journal of Parenteral and Enteral Nutrition 8:673–678, 1984)
Selenium Depletion in Burn Patients
Authors: Hunt Deborah R. , Lane Helen W. , Beesinger David , Gallagher Karen , Halligan Rekha , Johnston Dennis , Rowlands Brian J.
Published: May 2008

Victims of major burns may be at risk for selenium (Se) depletion because increased postinjury nutrient needs are often met by total parental nutrition and tube feedings which contain little Se. This study compared Se status of 17 burn patients and 191 healthy control subjects. Se intake of burn patients was lower than the intake of control subjects when total parenteral nutrition or tube feedings were used as primary nutrient sources but was comparable to the control intake when burn patients consumed oral diets. Serial determinations each 10 days during recovery showed that burn patients had lower plasma Se, erythrocyte Se, and erythrocyte glutathione peroxidase levels, and lower 24‐hr urine Se excretion. These results provide biochemical evidence of Se depletion despite exogenous Se intake within the range recommended for healthy adults. Further studies are indicated to determine if Se depletion in burn patients can be prevented by Se supplementation of total parenteral nutrition and tube feeding solutions. (Journal of Parenteral and Enteral Nutrition 8: 695–699, 1984)
Clinical Effect of Nonthrombotic Total Parenteral Nutrition Catheters
Authors: Fabri Peter J. , Mirtallo Jay M. , Ebbert Mary Lou , Kudsk Kenneth A. , Powell Carla , Ruberg Robert L.
Published: May 2008

Radiographic evidence of subclavian vein thrombosis has been shown to occur in 33% of total parenteral nutrition patients. This incidence can be significantly reduced to 8% when heparin is administered concomitantly in total parenteral nutrition solutions. To evaluate the thrombotic risk of a newly developed polyurethane catheter, 20 concurrent patient pairs were prospectively cannulated with either a standard polyethylene catheter plus heparin or a polyurethane catheter without heparin in a sequential statistical study. Radionuclide venograms (Tc99m) were performed within 72 hr of catheterization, at biweeky intervals, and at termination of total parenteral nutrition administration. No patient in either group developed clinical (pain, arm swelling, collateral veins) or venogram evidence of thrombosis after catheterization during an overall cannulation period of 820 days. Use of polyurethane catheters and elimination of heparin in total parenteral solutions may be particularly important since contraindications to heparin use are common. Additionally, heparin elimination can decrease admixture work and confusion (ie, subcutaneous heparin double dosing) without increasing the risk of subclavian vein thrombosis. (Journal of Parenteral and Enteral Nutrition 8:705–707, 1984)
Cardiac Tamponade Caused by Pulmonary Artery Perforation after Central Venous Catheterization
Authors: Hunt Lyle B. , Olshansky Brian , Hiratzka Loren F.
Published: May 2008

We report a case of pulmonary artery perforation with resultant cardiac tamponade after central venous catheterization and review six previously reported cases. Tamponade may be an acute or late complication and is usually associated with the effusion of intravenous fluid into the pericardium. Three cases actually occurred after catheterization through the “safer” peripheral venous access route (basilic vein). The diagnosis of perforation and tamponade as well as the treatment can be accomplished using the catheter. Recognition and appropriate treatment of this rare complication may avoid significant morbidity and mortality. (Journal of Parenteral and Enteral Nutrition 8:711–713, 1984)
Serial Measurement of Plasma Cholesterol and Lecithin:Cholesterol Acyl Transferase Activity in Adults Receiving Total Parenteral Nutrition
Authors: Innis Sheila M. , Frohlich Jiri , Mcleod Roger , Allardyce Duncan B. , Hahn Peter
Published: May 2008

The effect of total parenteral nutrition (TPN) containing approximately 800 ml Nutralipid daily on plasma cholesterol and lecithin:cholesterol acyl transferase (LCAT) activity was studied in 11 adult hospital patients. LCAT was assayed using an endogenous (S/N) and an artificial (ASA) substrate to differentiate between altered plasma substrate composition (which would influence the S/N method) and enzyme quantity (measured by the exogenous ASA method). Total cholesterol levels increased significantly during TPN, but generally remained within normal range. In comparison to laboratory reference values, free cholesterol was elevated and high‐density lipoprotein cholesterol and ASA LCAT activity was reduced in patients before the start of TPN and remained unaltered by the TPN regime. S/N LCAT activity was normal and not altered by TPN. Since changes in plasma high‐density lipoprotein and free cholesterol and ASA LCAT were present in patients before TPN, it must be concluded that they resulted from the underlying disease rather than the TPN per se. Longitudinal analyses showed that during the first 21 days of TPN nine patients showed a further fall in ASA LCAT and a rise in free cholesterol, thereafter ASA LCAT activity rose and free cholesterol fell despite continuation of TPN. It is suggested that ASA is a more reliable indicator of cholesterol esterification than S/N and that change in LCAT activity, although not caused by TPN, was related to the altered plasma lipid profile in the patients studied. (Journal of Parenteral and Enteral Nutrition 9:34–37, 1985)
Successful Fibrinolytic Therapy for Superior Vena Cava Thrombosis Secondary to Long‐Term Total Parenteral Nutrition
Authors: Smith Noel L. , Ravo Biagio , Soroff Harry S. , Ali Khan S.
Published: May 2008

Thrombosis of the superior vena cava and other major central veins is an unusual and infrequent complication of total parenteral nutrition. When it does occur, it may be life threatening and prompt therapy is indicated. A case of superior vena cava thrombosis secondary to an indwelling Broviac catheter for long‐term parenteral nutrition is presented, which was successfully treated with Streptokinase with reestablishment of flow through the catheter and veins. (Journal of Parenteral and Enteral Nutrition 9:55–57, 1985)
Guidelines for Evaluating and Categorizing Enteral Feeding Formulas According to Therapeutic Equivalence
Authors: Heimburger Douglas C. , Weinsier Roland L.
Published: May 2008

Because of the current rapid proliferation of commercially prepared formulas for use in supporting the nutritional status of patients, choosing among them is becoming progressively more difficult. There has been no unified discussion in the literature to date to help the clinician distinguish the important parameters of enteral feeding formula composition from the unimportant ones. Herein we stratify these parameters into three categories of relative importance, and classify the currently available formulas into categories of therapeutic equivalence. Together, the stratified parameters and the classification scheme may be used to evaluate new products in the future and establish a hospital enteral feeding formulary, which can simplify the clinician's choice of formulas and decrease patient costs. (Journal of Parenteral and Enteral Nutrition 9:61–67, 1985)
The Optimal Branched‐Chain to Total Amino Acid Ratio in the Injury‐Adapted Amino Acid Formulation
Authors: Gimmon Zvi , Freund Herbert R. , Fischer Josef E.
Published: May 2008

Several recent studies have suggested that solutions containing increased amounts of branched‐chain amino acids (BCAA) might be useful in the treatment of patients with trauma and/or sepsis. In this study we investigated the optimal amount of BCAA in a balanced nutritional solution in an injured rat laparotomy model. The amino acid content of a standard BCAA‐enriched amino acid solution was enriched to 40, 45, and 50% by the addition of equimolar amounts of the three BCAA. Rats were infused with either 3.6 cal/100 g body weight/24 hr or with 18 cal/100 g body weight/24 hr with either a 40, 45, or 50% BCAA mixture and evaluated for nitrogen balance, plasma amino acid levels, and levels of plasma blood urea nitrogen, creatinine, glucose, albumin, and blood ammonia. Nitrogen balance was negative in rats receiving only 3.6 cal/100 g body weight/24 hr, but was least negative in the group receiving 45% BCAA. Nitrogen balance was positive in groups receiving 18 cal/100 g body weight/24 hr, but was most positive in groups receiving 40 or 45% BCAA‐containing solutions. Plasma amino acid patterns were least distorted in the 40 and 45% formulations. Blood ammonia was highest in the 40% BCAA group and plasma albumin was best maintained in the 45% BCAA group regardless of the amount of caloric supply. The results suggest that a 45% BCAA‐enriched solution is the most appropriate in this injured rat model. (Journal of Parenteral and Enteral Nutrition 9:133–138, 1985)
Systemic Appearance of Nutrients Placed into the Peritoneal Cavity
Authors: Gilsdorf R.B. , Selby R. , Tillach Peter
Published: May 2008

The use of the peritoneal cavity as a route for delivery of nutrients in patients on continuous ambulatory peritoneal dialysis as well as patients not in renal failure has been proposed. In earlier studies we found dogs could be maintained for 30 days through continuous peritoneal infusion of a solution of amino acids, glucose, and lipids. We then conducted experiments to observe the rate of absorption of nutrients from the gut compared to the peritoneal cavity, the relative rate of absorption of amino acids, sugars, and fats, and the absorption of glucose polymers from the peritoneal cavity. These latter experiments are the subject of this report. In a dog model we observed D‐xylose was more rapidly absorbed through the peritoneal cavity than through the gut, but amino acids were absorbed at the same rate. Glucose and amino acid are absorbed at the same rate through the peritoneal cavity, but lipids do not appear in the system circulation for 2½ hr. Intraperitoneal glucose polymer produces an increase in serum glucose concentration that is lower and more sustained than what occurs after giving an equal amount of plain glucose. It is concluded that the peritoneal cavity rapidly transports glucose, amino acids, and glucose polymers and slowly transports lipids into the systemic circulation. Consideration of this route for delivery of nutritional support seems reasonable, but further studies of appropriate concentrations and rates of delivery will be required. (Journal of Parenteral and Enteral Nutrition 9: 148–152, 1985)
An Analytical Approach To Creation of Parenteral Feeding Solutions: Implementation on a Microcomputer
Authors: Krasner Jay B. , Marino Paul L.
Published: May 2008

The creation of a parenteral feeding regimen can be described in mathematical terms by a system of algebraic equations. An example of such a system having clinical applicability is discussed in detail. Since the system is too cumbersome for use by hand or calculator, a microcomputer program incorporating the system was developed, and is also discussed. (Journal of Parenteral and Enteral Nutrition 9:226–229, 1985)
Disease‐Specific Amino Acid Infusion (F080) in Hepatic Encephalopathy: A Prospective, Randomized, Double‐Blind, Controlled Trial
Authors: Cerra Frank B. , Cheung Nae K. , Fischer Josef E. , Kaplowitz Neil , Schiff Eugene R. , Dienstag Jules L. , Bower Robert H. , Mabry Charles D. , Leevy Carroll M. , Kiernan Thomas
Published: May 2008

Seventy‐five patients with acute hepatic decompensation superimposed on chronic alcoholic cirrhosis were prospectively randomized for a blinded trial of the treatment of hepatic encephalopathy. The control group received 4 g of enteral neomycin daily along with 25% dextrose by a central venous catheter. The experimental group received a placebo resembling neomycin and isocaloric dextrose plus a modified amino acid mixture enriched with branched‐chain amino acids to 36% and deficient in aromatic amino acids and methionine. Thirty patients in the F080 group and 29 in the control group completed the trial. The group receiving the modified amino acid mixture demonstrated a statistically significant improvement in encephalopathy as compared to the neomycin group, while maintaining nitrogen equilibrium. Survival and discharge from the hospital were statistically greater in the group treated with the modified amino acid solution and hypertonic dextrose. Treatment of hepatic encephalopathy in the presence of hepatic decompensation with an amino acid solution formulated for its treatment seems to produce faster, more complete recovery with improved capacity for nutritional support. (Journal of Parenteral and Enteral Nutrition 9:288–295, 1985)
Correlation between Electroencephalogram, Hepatic Encephalopathy Grade, and Biochemical Indices in Beagles with Portacaval Anastomosis
Authors: Okamoto Hiroh , Fujimura Takao , Yashiro Kazuhiro
Published: May 2008

The EEG, grades of hepatic encephalopathy, and biochemical indices of 16 beagles with portacaval anastomosis were recorded throughout their lives and correlations between these parameters were investigated. The degree of deterioration of some biochemical indices, such as the ammonia concentration, glutamate oxaloacetate transaminase and alkaline phosphatase activities in the plasma, and percentage loss of body weight showed a progressive increase parallel to the severity of the hepatic encephalopathy (HE) grade (grading scale 0‐IV), but other biochemical indices such as the concentrations of aromatic or branched‐chain amino acids, the molar ratio of branched‐chain to aromatic amino acids, or the total protein concentration in the plasma did not show such relationship. The SW ratio, an index of the incidence of slow‐waves in the EEG, was calculated from frequency distribution histograms which were obtained by frequency analyses of EEG recordings. A slight but significant correlation was found between the SW ratio and the plasma ammonia concentration. In addition, the SW ratio consistently increased with increase in the HE grade, although the SW ratio in HE grade IV was below the normal range for beagles. These results show that only the ammonia concentration in the plasma correlates with deterioration of the HE grade and of the SW ratio, suggesting that changes in ammonia concentration in the plasma should be of diagnostic value in assessing changes in mental state and the EEG in patients with liver cirrhosis. The importance of ammonia in pathogenesis of HE is stressed. (Journal of Parenteral and Enteral Nutrition 9:326–333, 1985)
Flushing of Spigotted Silicone Central Venous Feeding Catheters—How Often?
Authors: Glynn M.J.
Published: May 2008

Fourteen patients no longer requiring parenteral feeding but retaining the central venous feeding catheter while being assessed for adequate oral intake of nutrients, were included in a study to determine how long these catheters could be left without flushing and without becoming occluded. The catheters were left for between 2 and 6 days without flushing and none was occluded when tested. All the catheters were sterile on final withdrawal. (Journal of Parenteral and Enteral Nutrition 9:375–376, 1985)
Total Parenteral Nutrition with and without Fat as Substrate for Growth of Rats and Transplanted Hepatocarcinoma
Authors: King Walter W.‐K. , Boelhouwer Roelof U. , Kingsnorth Andrew N. , Weening Jan J. , Weber George , Young Vernon R. , Malt Ronald A.
Published: May 2008

Differential effects of total parenteral nutrition (TPN) on host nutrition and growth of cancer are unclear. Growth of adult ACI‐N rats bearing transplanted Morris hepatocarcinoma no. 3924A given TPN with or without fat was studied in comparison with Purina Chow‐fed, fasting, and semifasting (either amino acid or dextrose alone) rats over 5 days. The isocaloric, isonitrogenous TPN regimens with or without fat maintained body weight and nitrogen balance of cancer‐bearing rats equally well. When compared with Chow‐fed rats, the volume of the cancer, its weight, doubling time, protein content, and incorporation of thymidine into DNA were similar in rats given TPN either with or without fat. Although the volume of the cancer decreased in fasting and semifasting rats, the nutritional status of the host was also impaired. Administration of TPN to cancer‐bearing rats was associated with an abnormal increase in serum lactic acid level, which was not ameliorated by the use of fat to reduce the carbohydrate load. Although TPN with and without fat maintains the nutritional status, hepatomegaly and hepatic steatosis limit the administration of carbohydrate and fat as energy substrates in this system. (Journal of Parenteral and Enteral Nutrition 9:422–427, 1985)
Administration of Fat Emulsions with Nutritional Mixtures from the 3‐Liter Delivery System in Total Parenteral Nutrition
Authors: Grimble G.K. , Rees R.G. , Patil D.H. , Keohane P.P. , Attrill H.A. , Frost P.G. , Cribb A.R. , Silk D.B.A.
Published: May 2008

A series of studies was performed to test the efficacy and safety of a parenteral lipid emulsion, Lipofundin S, when given as part of a complete nutritive mixture from the three‐liter bag total parenteral nutrition (TPN) delivery system. In vitro stability studies with mixtures corresponding to high and low nutritional intakes showed the fat emulsion to be stable during refrigerated storage for at least 6 days. The clinical use of Lipofundin S in 3‐liter TPN bags was studied in 39 consecutive patients requiring TPN, and there were no untoward side‐effects. Nitrogen balance was maintained in patients with pancreatitis, those recovering postoperatively, and those with miscellaneous conditions. However, patients with multiple trauma remained in negative balance. The ability of sera, from patients on TPN to agglutinate Lipofundin S was compared to that from healthy controls, and acutely ill patients not on TPN. Patients on TPN showed a higher degree of in vitro creaming than acutely ill controls, and this may have been related to the severity of the underlying illness. These studies suggest that this parenteral lipid emulsion can be safely administered to patients requiring TPN when given from the 3‐liter bag delivery system. (Journal of Parenteral and Enteral Nutrition 9:456–460, 1985)
Visceral Protein Increase Associated with Interrupt versus Continuous Enteral Hyperalimentation
Authors: Pinchcofsky‐Devin Gayle D. , Kaminski Mitchell V.
Published: May 2008

Periodic parenteral hyperalimentation, the interruption of feeding for a period of time each day, parallels the fasted vs fed state in the meal eater. The fasted state appears to be more physiologic and seems to be associated with an increase of visceral proteins. Intravenous hyperalimentation data that have been published seem to confirm this fact. The purpose of this study was to compare the effect of continuous enteral hyperalimentation and interrupt enteral hyperalimentation on the visceral protein compartment. Two groups of 10 afebrile matched control patients (group 1) were on continuous enteral hyperalimentation for 19 ± 6 days with no improvement in serum albumin or serum transferrin levels. No changes were made in the feeding schedules of 10 of the patients. Feeding schedules of the other 10 patients were changed to an 8‐hr interrupt enteral hyperalimentation with calories, protein, and volume being provided remaining the same. Repeat serum albumin and transferrin levels were obtained after 10 days. There was a significant increase in albumin and transferrin levels (p < 0.005) in those patients changed to an interrupt feeding schedule. (Journal of Parenteral and Enteral Nutrition 9:474–476, 1985)
Self‐Administered Bolus Jejunostomy Feeding and Gastric Fluid Reinfusion in Patients with Gastric Atony
Authors: Rumley Thomas O. , Lineaweaver William , Goff Karen , Vogel Stephen
Published: May 2008

Twelve patients with profound gastric atony were taught to administer their own tube jejunostomy bolus feedings and, when necessary, to manage their gastric secretions by connecting their gastrostomy and jejunostomy tubes. These techniques allowed 11 of 12 patients to obtain reasonable nutrient intake and eight of the 12 to successfully reinfuse retained gastric secretions; alleviating the need for intravenous fluid replacement and expediting hospital discharge. Seven patients were able to resume some oral intake at home after resolution of their gastric atony. In the sufficiently motivated patient with gastric atony from multiple causes, these techniques provide alternatives to indefinite hospitalization with cumbersome and expensive intravenous hyperalimentation or constant infusion enteral alimentation. (Journal of Parenteral and Enteral Nutrition 9:626–629, 1985)
Requirement of Parenteral Fat in Infants with Biliary Atresia
Authors: Handa Noritoshi , Suita Sachiyo , Ikeda Kechi , Doki Tsunenori , Naito Kenichi
Published: May 2008

In a prospective study on infants with biliary atresia (BA) we measured the composition of the plasma fatty acid to determine the requirement of fat emulsion. In 14 infants who underwent initial operation for treatment of BA, a trend toward essential fatty acid (EFA) deficiency was evident before the surgery. Fourteen infants given parenteral nutrition (PN) after surgery were grouped into three according to the dose of fat emulsion, fat free in 4, 10% of the total calories in 5 and 20% of the total calories in 5. After operation, EFA deficiency gradually progressed when on fat free PN. Improvement in EFA deficiency occurred with the administration of fat which corresponded to 20% of the total caloric intake. During PN including fat emulsion, abnormal changes in liver function tests and serum lipid values due to fat emulsion were nil. Infusion of fat which supplies 20% of the total calories is thus recommended for correction of EFA deficiency and is tolerable in infants with obstructive liver disease. However, clinical and biochemical monitoring should be carefully done. (Journal of Parenteral and Enteral Nutrition 9:685–690, 1985)
Hand Grip Strength—A Simple Prognostic Indicator In Surgical Patients
Authors: Hunt Deborah R. , Rowlands Brian J. , Johnston Dennis
Published: May 2008

This study evaluates hand grip strength as an indicator of nutritional status and a predictor of postoperative complications. Hand grip strength and other parameters of nutritional status, namely, midarm muscle circumference, forearm muscle circumference, triceps skinfold, percentage ideal body weight, serum albumin, and percent usual weight were determined preoperatively in 205 patients. Complications occurred in 28 patients (14%). Patients with at least one abnormal nutritional parameter had a higher incidence of postoperative complications. Their length of total and postoperative hospitalization was greater by 6.2 and 4.6 days, respectively (p< 0.01). Grip strength was the most sensitive single parameter, but forearm muscle circumference and percentage ideal body weight were the most specific indices. Hand grip strength is a simple measure of nutritional status and an accurate prognostic indicator that requires further clinical evaluation.(Journal of Parenteral and Enteral Nutrition9:701–704, 1985)
The Clinical Evaluation of Plasma Fibronectin as a Marker for Nutritional Depletion and Repletion and as a Measure of Nitrogen Balance
Authors: Kirby Donald F. , Marder Robert J. , Craig Robert M. , Eskildsen Rebecca , Middaugh Patricia
Published: May 2008

Plasma fibronectin has been suggested as a possible marker for nutritional repletion or depletion. This study was undertaken to evaluate the usefulness of plasma fibronectin in patients who received intense nutritional support. Twenty‐seven patients referred to our Nutritional Support Services were followed for 3 to 5 wk; 22 received parenteral hyperalimentation alone, two received enteral alone, and three received a combination of both. Plasma fibronectin, serum albumin, serum transferrin, total lymphocyte counts, and 24‐hr urine nitrogen balance studies were performed weekly; anthropometric measurements were performed every other week. Plasma fibronectin concentration, measured by laser nephelometry, showed a significant rise (p < 0.005) in all patients after 1 wk of nutritional therapy; however, there was no significant difference among the subsequent weeks. Plasma fibronectin did not correlate with nitrogen balance studies, serum albumin, or total lymphocyte counts. A correlation between serum transferrin and plasma fibronectin was found not to be clinically useful. Thus, plasma fibronectin is sensitive to nutritional repletion after 1 wk of therapy, but is not useful thereafter. The relationship among nutritional status, immunologic function, plasma fibronectin, and other serum proteins are discussed (Journal of Parenteral and Enteral Nutrition 9:705–708, 1985)
Chylothorax—A Complication of Subclavian Vein Catheterization
Authors: Ruggiero Robert P. , Caruso Garcon
Published: May 2008

Insertion complications of subclavian vein catheter placement are well documented. Thoracic duct injury is a potential problem which has rarely been reported. A patient with duct injury and resultant chylothorax is presented. The management of this problem is discussed with emphasis placed on chyle leakage from both the nutritional and mechanical aspect. The anatomy and function of the thoracic duct as well as the pathophysiology and treatment of chylothorax are detailed. (Journal of Parenteral and Enteral Nutrition 9:750–753, 1985)