bluuebunny/crossref_metadata_2025 huggingface dataset:
A New Method for Long‐Term Intravenous Alimentation in Unrestrained Rats
Authors: Abrahamian Vasken , Huk Igor , Kaminski Mitchel V.
Published: May 2008

Existing equipment for long‐term iv alimentation in small laboratory animals is somewhat cumbersome and quite costly. Although a one‐time expense, the cost of this equipment may not be economically viable for many researchers. Herein we present a novel method for long‐term iv alimentation in unrestrained rats that is practical, inexpensive, and easily assembled from readily available materials. This new “proxy” set was tested and compared with the standard swivel assembly set. Statistical analysis showed no difference in measured parameters in rats infused by either method. However, the cost of the new set (excluding pump) was almost 90 times less than its commercially available counterpart. This self‐constructed approach should bring small animal research within the economic means of most investigators. (Journal of Parenteral and Enteral Nutrition 8:581–584)
Home Parenteral Nutrition: A Hospital‐Based Program with Commercial Logistic Support
Authors: Wesley John R. , Khalidi Nabil , Faubion Walter C. , Ryan Michael L. , De Leon Richard F.
Published: May 2008

Since home parenteral nutrition was introduced in the 1970′s, a number of medical centers have formed successful home parenteral nutrition programs which have reduced expenses to the patient and third party payers by 50 to 73% over in hospital costs. However, the cost of maintaining these programs for training and follow‐up has largely been absorbed by the hospital as a nonreimbursable teaching expense. To offset the costs of our growing program in these times of budget “caps,” we have established an agreement between our hospital and commercial home care company which provides for patient instruction and follow‐up by the hospital parenteral and enteral nutrition team and logistic support by the home care company. We used the average cost of our first five patients to establish a fee schedule which the commercial company agreed to pay the hospital parenteral and enteral nutrition team for its services. This agreement reduces the number of nurses and pharmacists that the commercial company would otherwise have to hire for teaching and follow‐up of home care patients, and supports the concept of regional care in medical centers where parenteral and enteral nutrition teams maintain quality control, continuity of care, and efficient teaching programs for patients requiring home parenteral nutrition. (Journal of Parenteral and Enteral Nutrition 8:585–588, 1984)
High‐Branched Chain Amino Acid Solutions: Relationship of Composition to Efficacy
Authors: Bonau Roger A. , Ang S.D. , Jeevanandam Malayappa , Daly John M.
Published: May 2008

A prospective clinical trial was undertaken to determine the nitrogen‐sparing efficacy of three amino acid solutions with different concentrations of branched‐chain amino acids (BCAA) in 25 postoperative patients. The patients were a homogenous male population with stage I bladder cancer who underwent radical cystectomy. Administration rates of the intravenous solutions were designed to provide 30 kcal/kg/day and 1.5 g protein per kg per day during the 7‐day study period. A control group (n = 4) received 5% dextrose in water (150 g/ day). Nitrogen balance was determined daily and the whole body protein turnover was measured using a primed‐constant infusion of 15N glycine on postoperative days 3 and 4. The group receiving the 45% BCAA enriched (low leucine) amino acid solution exhibited a significant decrease in cumulative (7 day) nitrogen balance (7.6 ± 2.6 g) compared to the groups receiving either the standard 25% BCAA (19.9 ± 2.1 g) or the 45% BCAA enriched (high leucine) (21.6 ± 7.0 g) amino acid solution. The group receiving the 45% BCAA enriched (low leucine) amino acid solution exhibited a higher rate of mean whole body protein catabolism compared to the other groups. For patients undergoing major elective operations, the amount of leucine necessary for optimal daily nitrogen balance was 0.13 g/kg/day. These results demonstrate that the ratio of individual BCAA and the amount of leucine were more critical to nitrogen‐sparing efficacy than the percentage total BCAA infused. (Journal of Parenteral and Enteral Nutrition 8:622–627, 1984)
Observations on the Practice of Clinical Nutrition in Hospitals in China
Authors: Heimburger Douglas C.
Published: May 2008

Observations and interaction with physicians and surgeons in four Chinese medical institutions visited during 1983 are discussed in three broad areas: (1) teaching activities and discussions comparing modern Western theory and practice in clinical nutrition with that in China; (2) clinical rounds involving discussion of the nutritional problems of patients with a variety of diseases; (3) a survey of hospital nutrition support practices in China. Difficulties in auditing the prevalence of hospital‐associated malnutrition in these hospitals are discussed. Controlled, independent observations are required to estimate the incidence of hospital‐associated malnutrition in China. While clinical nutrition has received little attention in medical training in China, the Chinese are eager for more educational input. (Journal of Parenteral and Enteral Nutrition 8:628–631, 1984)
When Does Metoclopramide Facilitate Transpyloric Intubation?
Authors: Whatley Kathleen , Turner William W. , Dey Margaret , Leonard Jan , Guthrie Margaret
Published: May 2008

Postpyloric feeding probably reduces the incidence of tracheobronchial aspiration and improves feeding tolerance. However, duodenal intubation is often unsuccessful in critically ill patients due to gastric atony. Metoclopramide improves gastric emptying. In a pilot study, 12 adult patients were administered 10 to 20 mg of intravenous metoclopramide after weighted nasal feeding tubes had failed to spontaneously pass distal to the pylorus. In no patient did metoclopramide induce transpyloric passage of the tube. A randomized prospective study involving 10 adult patients was conducted to examine the effect of preinsertion intravenous metoclopramide on transpyloric intubation. All patients had failed to achieve spontaneous duodenal intubation. Five patients received 20 mg of metoclopramide 10 min prior to nasal insertion of a weighed feeding tube. Five control patients received no premedication. Four metoclopramide patients achieved duodenal intubation immediately. In none of the control patients did transpyloric intubation occur (p = 0.048). Metoclopramide, administered after nasogastric intubation, is ineffective in promoting transpyloric advancement of feeding tubes. There is a significant increase in transpyloric intubation when metoclopramide is administered prior to tube insertion. (Journal of Parenteral and Enteral Nutrition 8:679–681, 1984)
Periodic Reassessment for Improved, Cost‐Effective Care in Home Total Parenteral Nutrition: A Case Report
Authors: Baptista Richard J. , Lahey Margaret A. , Bistrian Bruce R. , Champagne Charlotte D. , Miller Donald G. , Kelly Susan E. , Blackburn George L.
Published: May 2008

Home parenteral nutrition (HPN) patients need periodic reassessment for compliance, appropriateness of parenteral formulation, infusion regimen, bowel adaptation, and effective oral nutrient intake. Additionally, new technological advances need to be considered for potential use in the home parenteral nutrition population. Since costs for home parenteral nutrition therapy are substantial, cost‐effective options should be exercised whenever reasonable. The following case illustrates our approach to the reassessment process, subsequent modifications, and resultant impact on the lifestyle, adequacy, and cost of home parenteral nutrition therapy. (Journal of Parenteral and Enteral Nutrition 8:708–710, 1984)
Feeding Tube‐Induced Pneumothorax
Authors: Saltzberg David M. , Goldstein Marjorie , Levine Gary M.
Published: May 2008

A case of accidental bronchial perforation by the metal stylet of a silastic feeding tube is reported. The misplacement of the feeding tube resulted in a pneumothorax. This is a previously unreported complication of enteral feeding in adults. Pulmonary complications of enteral feeding and recommendations for prevention of these complications are discussed. (Journal of Parenteral and Enteral Nutrition 8 :714–716, 1984)
Carnitine Balance and Effects of Intravenous L‐Carnitine in Two Patients Receiving Long‐Term Total Parenteral Nutrition
Authors: Worthley L.I.G. , Fishlock R.C. , Snoswell A.M.
Published: May 2008

Two patients requiring total parenteral nutrition for 34 and 39 months, had plasma and urinary carnitine assays and plasma lipid assays performed before and during intravenous administration of 400 mg (2500 μmol) of L‐carnitine for 7 days, followed by 40 mg (240 μmol) daily continuously. One patient had generalized lethargy and weakness which resolved within the first 5 days of carnitine administration. The plasma‐free carnitine levels in this patient rose significantly. The other patient was asymptomatic and while there was no significant change in the plasma‐free carnitine levels during carnitine administration, this patient remained in positive carnitine balance throughout the study. There were no significant changes in plasma lipid levels in either patient. In adult patients requiring long‐term total parenteral nutrition who are otherwise normal, intravenous L‐carnitine may be required to supplement the patients endogenous carnitine production. (Journal of Parenteral and Enteral Nutrition 8 :717–719,1984)
The Use of The World Health Organization's Oral Rehydration Solution in Patients on Home Parenteral Nutrition
Authors: Macmahon R.A.
Published: May 2008

Patients on home parenteral nutrition who have continuing excess fluid and electrolyte loss from the bowel can have difficulty in managing their fluid and electrolyte state because of the variability of such losses. Recently we have used the World Health Organization's oral rehydration solution to replace such losses in two patients with good effect. (Journal of Parenteral and Enteral Nutrition 8:720–721, 1984)
Immune Function during Intravenous Administration of a Soybean Oil Emulsion
Authors: Ota David M. , Jessup John M. , Babcock George F. , Kirschbaum Lynette , Mountain Clifton F. , Mcmurtrey Marion J. , Copeland Edward M.
Published: May 2008

The effect of a continuous infusion of a soybean oil emulsion on immune functon was evaluated in 40 malnourished patients who were randomized to receive preoperatively either a 25% glucose‐5% amino acid solution (group G) or a 15% glucose‐3.3% Intralipid‐5% amino acid solution (group G‐F). Average length of total parenteral nutrition (TPN) was 10.3 ± 0.9 days for group G and 9.0 ± 0.8 days for group G‐F. Initial nutritional status and response to TPN were similar for both groups. Immune function was assessed before TPN and after nutritional repletion prior to surgery for each patient. The levels of immunoglobulins, C3, C4, circulating B lymphocytes and T lymphocytes, suppressor T lymphocytes, natural killer cell activity, and monocytes were normal before TPN and after nutritional therapy. However, the total number of T cells and helper T cells were low before TPN and remained so after TPN. In addition, lymphocyte function measured by the lymphocyte blastogenic response to phytohemagglutinin and pokeweed mitogen was depressed prior to TPN and was not improved by either regimen. Neutrophil chemotaxis and bactericidal activity were not affected by either nutritional regimen while neutrophil phagocytosis was enhanced before TPN and remained elevated throughout TPN with either regimen. There were no differences in infection rates during TPN. The addition of Intralipid to the TPN regimen did not alter immune function in these patients who showed depressed cell‐mediated immunity before TPN compared with the standard glucose TPN regimen. (Journal of Parenteral and Enteral Nutrition 9:23–27, 1985)
Influence of Total Parenteral Nutrition on Protein Metabolism following Acute Injury: Assessment by Urinary 3‐Methylhistidine Excretion and Nitrogen Balance
Authors: Iapichino Gaetano , Radrizzani Danilo , Solca Maurizio , Bonetti Giovanni , Leoni Luisa , Ferro Antonella
Published: May 2008

The use of total parenteral nutrition after acute injury, either surgical or accidental, is widely accepted for its important benefits, although it is not yet completely understood whether a reduction of body protein catabolism can be effectively achieved. We applied total parenteral nutrition to 14 critically ill patients after either trauma or major surgery. Their daily nitrogen balance, urinary 3‐methylhistidine and creatinine excretion, and molar 3‐methylhistidine/creatinine ratio, during initial 24‐hr fasting period, were respectively ‐0.19 ± 0.01 (SEM) g kg−1, 5.46 ± 0.47 μmol kg−1, 27 ± 4 mg kg−1, and 0.030 ± 0.005. Daily nonprotein calorie intake of 31.11 ± 0.58 kcal kg−1, as glucose, and administration of nitrogen 0.350 ± 0.004 g kg−1, as 10% cristalline L‐aminoacids solution, and insulin 1 IU every 5.03 ± 0.14 g of glucose, resulted in progressive decline of urinary 3‐methylhistidine (4.21 ± 0.43 μmol kg−1, p < 0.001), creatinine (22 ± 2 mg kg−1, NS), and their molar ratio (0.022 ± 0.002, NS). Mean nitrogen balance resulted in 0.032 ± 0.008 g kg−1. Since urinary 3‐methylhistidine role as a marker of protein catabolism is well established, its decrease under total parenteral nutrition together with greatly improved nitrogen balance, demonstrates that our treatment can effectively quench protein catabolism, meanwhile enhancing protein synthesis. (Journal of Parenteral and Enteral Nutrition 9:42–46, 1985)
Total Parenteral Nutrition with Different Ratios of Fat/Carbohydrate at Two Energy Levels: An Animal Study
Authors: Martins F.M. , Wennberg A. , Kihlberg R. , Meurling S. , Lindmark L.
Published: May 2008

Different regimens of total parenteral nutrition were evaluated in 64 growing rats, during a 10‐day period. Thirty‐two rats were kept at a low energy regimen (270 kcal/ kg body weight per day), and the remaining rats were infused with a high energy solution (350 kcal/kg/day). At each energy level, four fat/carbohydrate (CHO) nonprotein energy ratios were tested: 0% fat/100% CHO (no fat); 6% fat/94% CHO (low fat); 30% fat/70% CHO (medium fat); 60% fat/40% CHO (high fat). A daily supply of 0.9 g nitrogen/kg of a well balanced amino acid solution was administered to all rats. Growth, nitrogen balance, net nitrogen utilization, and blood status were evaluated. Carcass, liver, and muscle composition were investigated with respect to protein, fat, and water content. Liver and body composition was similar between groups at the same energy level. At the higher energy level the fat deposition was increased. At the low energy level, rats from no fat and low fat groups lost weight during the first 3 days of the experimental period. The medium fat groups showed the highest weight gain at each energy level. This suggests the importance of the presence of fat in total parenteral nutrition programs. During the last days of the experimental period, all rats gained weight, and showed a positive nitrogen balance. All groups given 350 kcal/kg/day gained weight more rapidly and showed a better nitrogen balance and utilization than the corresponding group given 270 kcal/kg/day. This study emphasizes that a well‐balanced proportion of energy and substrates is important. (Journal of Parenteral and Enteral Nutrition 9:47–52, 1985).
Selenium Responsive Myositis during Prolonged Home Total Parenteral Nutrition in Cystic Fibrosis
Authors: Watson Robert D. , Cannon Robert A. , Kurland Geoffrey S. , Cox Kenneth L. , Frates R. Cory
Published: May 2008

The need for routine supplementation of total parenteral nutrition solutions with selenium (Se) has not been clearly defined. Although clinical selenium deficiency in patients on prolonged total parenteral nutrition has been reported, it is rarely observed in the United States. We report a 19‐year‐old woman with cystic fibrosis who developed muscle pain and weakness after 3 months on total parenteral nutrition which was not supplemented with Se. Coincident with her onset of symptoms, markedly elevated serum creatine kinase values were observed compared to baseline levels. Subsequent evaluations revealed undetectable (<0.02 μg/ml) serum and urine Se levels in this patient. In addition, electromyographic evidence of myositis and nonspecific membrane irritability was documented. Therapy with oral Se rapidly reversed her symptoms and normalized with serum creatine kinase values over a 10‐day period. Prolonged treatment with Se was required to achieve normal values of Se in the serum. Patients with severe pancreatic insufficiency, such as cystic fibrosis, may be at risk for clinical Se deficiency if on prolonged total parenteral nutrition without supplementation. Elevated creatine kinase levels should alert physicians to the possibility of Se deficiency in such patients. (Journal of Parenteral and Enteral Nutrition 9:58–60, 1985)
Percutaneous Needle Pharyngostomy
Authors: Bucklin Donald L. , Gilsdorf Robert B.
Published: May 2008

Pharyngostomy is a technique of proven usefulness in patients requiring extra oral enteric access. Techniques to perform this have required an operating room, general anesthesia, and the associated risks. We have developed a technique for needle pharyngostomy that can be performed at the bedside of an awake patient. We utilize a central venous catheter tray and a small bore feeding tube to do this procedure. We have performed this on 17 patients without a procedural complication. This form of enteric access has allowed total nutritional support for up to 2 yr. Two late infections at the pharyngostomy site have occurred; both were easily controlled with oral antibiotics. This technique is recommended for patients who repeatedly pull out feeding tubes or are planning home enteral nutrition. (Journal of Parenteral and Enteral Nutrition 9:68–70, 1985)
The Effect of 15‐Hour Fat Infusions of Varying Dosage on Bilirubin Binding to Albumin
Authors: Spear Michael L. , Stahl Gary E. , Paul Mary H. , Egler Joseph M. , Pereira Gilberto R. , Polin Richard A.
Published: May 2008

Intravenous fat emulsions (1, 2, and 3 g/kg) were administered over 15 hr to 20 appropriate for gestational age premature infants with physiologic hyperbilirubinemia to determine the effect of fat infusions on the serum free fatty acid:albumin molar ratio (F/A) and on unbound bilirubin. Significant increases (p < 0.05) in F/A occurred with each increase in lipid dose in infants < 30 wk gestation, but not in infants ≥ 30 wk gestation. There was a direct linear correlation (r = 0.65, p < 0.001) between F/A ratio and unbound bilirubin (estimated fluorometrically by the ratio of albumin‐bound bilirubin/reserve bilirubin binding capacity, B/R). The largest increases in unbound bilirubin (albumin‐bound bilirubin/reserve bilirubin binding capacity) were seen in infants with F/ A > 4.0. The gestational age of infants with F/A > 4.0 was significantly less (p < 0.01) than infants with F/A < 4.0 (28.7 ± 0.47 us. 31.1 ± 0.40 wk, mean ± SEM). In 10/58 infusions there was a fall in unbound bilirubin, unrelated to birthweight, gestational age, postnatal age, however, during these infusions the end‐infusion F/A was ≥ 3.0. We conclude that 1 g/kg of lipid emulsion infused over a 15‐hr period has minimal risk of decreasing bilirubin binding in premature infants < 30 wk gestation. As doses of 2 or 3 g/kg are used, these infants may be at risk of decreased bilirubin binding, due to elevations in the F/A ratio. Monitoring of the F/A ratio may identify infants at risk for decreased bilirubin binding during lipid infusion and provide guidelines for determining the appropriate lipid dose. (Journal of Parenteral and Enteral Nutrition 9:144–147, 1985)
The Effect of Major Thermal Injury on Plasma Ketone Body Levels
Authors: Abbott W.C. , Schiller W.R. , Long C.L. , Birkhahn R.H. , Blakemore W.S.
Published: May 2008

Eleven patients with more than 30% total body surface burns were studied during 3 days of starvation and three more days of unrestricted feeding following their injury. All patients developed marked protein mobilization as demonstrated by 3rd day urine nitrogen excretion of 17.1 g daily compared to control excretion of 11.8 g N daily. As a group, the patients failed to mount the expected ketonemic response during their initial period of starvation. Whereas normal fasted controls achieved plasma ketone body levels of 727 ± 81 μmol/ liter, the burn patients responded with an average level of 385 ± 77 μmol/liter (p < 0.01). (Journal of Parenteral and Enteral Nutrition 9:153–158, 1985)
Blood Vitamin Levels of Long‐Term Adult Home Total Parenteral Nutrition Patients: The Efficacy of the AMA‐FDA Parenteral Multivitamin Formulation
Authors: Shils Maurice E. , Baker Herman , Frank Oscar
Published: May 2008

Although the AMA‐FDA parenteral adult multivitamin formula is now widely used, there are no published data on the efficacy of this formulation in maintaining adequate vitamin nutriture in patients on long‐term parenteral nutrition. Blood levels of its constituent nutrients were determined in 16 clinically stable home total parenteral nutrition patients with severe gastrointestinal dysfunction, the majority of whom had been on home total parenteral nutrition for 1 to 9 yr and most of whom were ingesting some food orally. The daily formula (MVI‐12) was added to the basic total parenteral nutrition formula in 2‐day batches; the vitamins were thus infused approximately 3 hr after preparation on day 1 and after 27 hr on day 2. The duration of infusions was from 8 to 16 hr. Blood was drawn approximately 36 hr after completion of the last vitamin infusion. Plasma, trichloroacetic acid‐treated plasma, and whole blood were frozen until analyzed for the vitamins by microbiologic or chemical methods. All vitamin levels, except for vitamin D metabolites, were measured four times in each patient between the 4th and 36th wk while receiving daily MVI‐12. Single determinations of 25‐OH and 1:25 (OH)2 vitamin D were made in eight of the 16 patients between the 61st and 84th wk while on MVI‐12. Repeat values during this extended period were also made on five of the patients for vitamins A and E. These values were compared with serum vitamin levels obtained on an earlier formulation (MVI concentrate, Berocca C, and folate each given twice weekly and B12 given once weekly). The AMA‐FDA formula given daily maintained blood levels above the lower normal limits for most of its constituent vitamins and vitamin D metabolites for the great majority of stable home total parenteral nutrition adults with unexplained occasional exceptions. However, almost half of the vitamin A levels and some of the pantothenate and biotin values were above the normal range; these tended to be associated with the presence of renal disease. Ascorbic acid and thiamin levels tended to be clustered in the lower normal range. Because of evidence for loss of ascorbic acid standing in total parenteral nutrition solutions for 24 hr prior to infusion, it is recommended that the vitamin formulation be added to the total parenteral nutrition solution just prior to infusion. (Journal of Parenteral and Enteral Nutrition 9:179–188, 1985)
Postoperative Fall in Serum Zinc Concentrations Unaffected by Intravenous Zinc Therapy
Authors: Jiang Zhu‐Ming , Yang Nai‐Fa , Jiao Kai‐Sheng , Zhu Yu , Fei Li‐Min , Tseng Hsienchiu
Published: May 2008

The serum zinc levels and urinary zinc outputs before and after a middle severity operative trauma were investigated. The serum zinc concentration dropped markedly 6 hr after operation in both supplemented and nonsupplemented groups. It gradually returned to near normal without exogenous supplies of zinc. Provision of therapeutic doses of zinc could not prevent the abrupt dip of the serum zinc level. The possible mechanism of such changes are discussed briefly. (Journal of Parenteral and Enteral Nutrition 9:196–198, 1985)
Nutrition Support Teams—A 1983 Survey
Authors: McCrann McShane Carol , Fox Hazel M.
Published: May 2008

Nutrition support teams (NST) in a variety of public and private US hospitals were surveyed in the spring of 1983. A mailed questionnaire elicited information from 521 previously identified teams. The intent was to survey the characteristics of hospitals with NST, the structure and function of NST and the attitudes of coworkers regarding NST. The questionnaire was designed to facilitate individual team communication of successes and admonitions regarding team initiation and function. Nutrition support teams from 267 of 521 (51.6%) hospitals responded. Teams, multidisciplinary in composition, were located most frequently in 200 to 500‐bed private, non‐profit hospitals. Financial arrangements and the scope of service rendered varied. Attitudes about NST reflected some problems with attending physicians' skepticism, rivalry, and ignorance. Other hospital professionals' attitudes were reported as supportive with reservations. Comments, penned by 90% of respondents, indicated a solid, positive concern for developing nutritional expertise, productive teamwork, and support from fellow care‐givers. Generally, NST were found to be in a period of growth and essentially healthy. (Journal of Parenteral and Enteral Nutrition 9:263–268, 1985)
Total Parenteral Nutrition and Complete Bowel Rest in the Management of Crohn's Disease
Authors: Ostro M.J. , Greenberg G.R. , Jeejeebhoy K.N.
Published: May 2008

The role of parenteral nutrition with complete bowel rest in the management of active Crohn's disease was evaluated retrospectively in 100 patients who were otherwise refractory to conventional medical management. Ninety patients received complete nutrient replacement and 10 received protein‐sparing therapy. In 77 patients, a clinical remission was achieved. Analysis of subgroups revealed that the remission rate was equivalent in patients with subacute bowel obstruction (76%), inflammatory mass (82%), and otherwise uncomplicated severe active disease (89%). However, those patients with fistulae responded less well (63%). The location of the intestinal involvement with the disease did not influence the remission rate (73% in those with small bowel disease only and 78% in those with combined small and large bowel disease). All six patients with only large bowel involvement achieved a remission. In 81% of those patients with a remission, no corticosteroids were given, or the dose prior to TPN was maintained. The serum albumin improved significantly (p < 0.001) from 3.2 ± 0.1 to 3.6 ± 0.1 g/dl with total parenteral nutrition, but there was no significant effect on the hematocrit (p > 0.5). The percentage of patients still in remission after 3 months and 1 yr of follow‐up was 75 to 79 and 58 to 61 %, respectively, in the three nonfistulous groups, and 46 and 36%, respectively, in those with fistulous disease. Thus total parenteral nutrition with complete bowel rest appears to be an effective therapeutic modality in the primary management of complicated Crohn's disease. (Journal of Parenteral and Enteral Nutrition 9:280–287, 1985)
Sensitivity and Specificity of Liver Function Tests in the Detection of Parenteral Nutrition‐Associated Cholestasis
Authors: Nanji Amin A. , Anderson Frank H.
Published: May 2008

We carried out a study to determine which of the liver function tests was the most sensitive and/or specific in detecting parenteral nutrition associated cholestasis. The tests utilized were alkaline phosphatase, γ‐glutamyl transpeptidase, cholyglycine, sulfolithocholylglycine, and bilirubin. Fifty‐nine patients with no prior evidence of liver dysfunction were studied. We found γ‐glutamyl transpeptidase to be the most sensitive (89.5%) and also the least specific (61.9% specificity). Specificity of γ‐glutamyl transpeptidase was improved when it was combined with alkaline phosphatase. We recommend the combination of these two enzymes as the most cost effective way of detecting parenteral nutrition‐associated cholestasis. (Journal of Parenteral and Enteral Nutrition 9:307–308, 1985)
Nutritional Depletions in Critically Ill Children: Associations with Physiologic Instability and Increased Quantity of Care
Authors: Pollack Murray M. , Ruttimann Urs E. , Wiley Jeanette S.
Published: May 2008

The association of nutritional depletions with physiologic instability and quantity of care was examined in 60 critically ill children. Nutritional status was evaluated by anthropometric techniques. Physiologic stability was measured by the Physiologic Stability Index and quantity of care was measured by the Therapeutic Intervention Scoring System. Acute protein‐energy malnutrition was significantly associated with increased physiologic instability and increased quantity of care (p < 0.01). This association was present for the total group, children less than 24 months of age, and for these two groups with nonsurvivors excluded. Mortality was also significantly associated with acute protein‐energy malnutrition (p < 0.001). Physiologic instability and increased quantity of care were not associated with chronic protein‐energy malnutrition, fat store depletion, or somatic protein store depletion. We conclude that acute protein‐energy malnutrition in critically ill children is associated with increased physiologic instability and increased quantity of care. (Journal of Parenteral and Enteral Nutrition 9:309–313, 1985)
Analytical Assessment of Broviac Catheter Occlusion
Authors: Fleming C.R. , Barham S.S. , Ellefson Ralph D. , Beart R.W.
Published: May 2008

Eight of 92 consecutive silastic central venous catheters used for home parenteral nutrition occluded. Six of the eight had patency restored by the instillation of urokinase or streptokinase into the catheter. The thrombus in one of the two catheters that was not reopened with thrombolytic agents was studied in detail by electron microscopy, x‐ray dispersive analysis, solubility in isopropyl alcohol‐diethyl ether (1:1, v:v), and thin‐layer chromatography of extracted lipids. Electron microscopy found the clot to be an amorphous mass without features to suggest crystalline properties. The x‐ray dispersive analysis showed that the only elements which were significantly increased were chloride and silicon and the silicon detected was likely from the underlying catheter. Treatment with isopropyl alcohol‐diethyl ether left an insoluble, flaky residue that resembled protein from a thrombus. Thin‐layer chromatography detected a lipid profile suggestive of circulating endogenous fat instead of the fat that was infused through the catheter. (Journal of Parenteral and Enteral Nutrition 9:314–316, 1985)
Effect of Chemically Defined Formula Diets on Pancreatic Mass in the Rat
Authors: Callegari C. , Lami F. , Cornia G.L. , Pironi L. , Cocchi M. , Turchetto E. , Barbara L.
Published: May 2008

To establish the effect of chemically defined formula diets on pancreatic mass, 58 male Wistar rats, weighing approximately 200 g, were fed orally one of the following diets for 20 days: standard diet; partially hydrolyzed diet; elemental diet. The diets were isocaloric and provided 73 cal/day per rat. At the end of the experiment, the rats were killed and pancreas removed to assess wet weight and DNA and RNA content. Compared to the controls, the elemental diet caused a reduction in pancreatic wet weight (p < 0.005), pancreatic DNA (p < 0.001), and RNA content (p < 0.001). In the group fed partially hydrolyzed diet, only pancreatic DNA content showed an highly significant reduction when compared with the reference group (p < 0.001), whereas the value of RNA failed to reach the statistical significance. We found an increase of the ratio mg RNA/mg DNA in the partially hydrolyzed and elemental diet groups. These results suggest that long‐term nutrition with the partially hydrolyzed diet, and more strongly with the elemental diet, may induce pancreatic hypoplasia. (Journal of Parenteral and Enteral Nutrition 9:334–338, 1985)
Heparin Does Not Reduce Catheter Sepsis during Total Parenteral Nutrition
Authors: Kudsk Kenneth A. , Powell Carla , Mirtallo Jay M. , Fabri Peter J. , Ruberg Robert L.
Published: May 2008

Although it is recognized that the addition of heparin to total parenteral nutrition solutions reduces subclavian vein thrombosis from percutaneous polyethylene catheters, it does not affect the low thrombosis rate associated with polyurethane catheters. It has been suggested that heparin also reduces catheter sepsis during total parenteral nutrition. We reviewed the sepsis rate in 86 patients randomized to receive iv nutrition with or without heparin through polyethylene, polyvinyl, and polyurethane catheters. Blood was drawn from febrile patients for culture; if positive, catheters were removed and the tips cultured. Catheters were considered infected if blood and catheter tips were positive, or if fever disappeared within 48 hr after catheter removal, even if cultures were negative. Catheter sepsis occurred in two patients in both groups. It appears that heparin does not reduce sepsis from percutaneous subclavian vein catheters. Although its use may be indicated to reduce thrombosis associated with polyethylene catheters, there is no indication for its use to reduce sepsis with either type of catheter. (Journal of Parenteral and Enteral Nutrition 9:348–349, 1985)
Noninvasive Outpatient Nutritional Therapy in Inflammatory Bowel Disease
Authors: Neidich Gary , Schissel Kathleen , Sharp Harvey L.
Published: May 2008

Twelve courses of outpatient nutritional therapy using a specific defined formula, Precision High Nitrogen Diet, were given orally to nine malnourished patients with active inflammatory bowel disease. The regimen was continued for a 2‐month period on an outpatient basis. Patients had significant increases in weight, height, and nutritional status as evaluated by serum protein and albumin levels and anthropometric measurements of triceps and subscapular skinfold thickness. Patients with no alteration of pharmacologic therapy did not differ significantly from those with increases in pharmacologic therapy in any parameter evaluated. This regimen is an alternative to total parenteral nutrition and nasogastric delivery of defined formula in malnourished patients with active inflammatory bowel disease. (Journal of Parenteral and Enteral Nutrition 9:350–352, 1985)
Evaluation of the Effect of Arginine‐Enriched Amino Acid Solution on Tumor Growth
Authors: Tachibana K. , Mukai K. , Hiraoka I. , Moriguchi S. , Takama S. , Kishino Y.
Published: May 2008

To investigate the effect of arginine‐enriched solution on tumor growth and metastasis, rats were infused with solutions containing 5.5 and 0.66% arginine for 8 days. Infusions were started at the same time of subcutaneous transplant of Yoshida sarcoma. Arginine‐rich solution suppressed tumor growth at an early stage and prevented metastases. to the liver and kidney. In addition, arginine supplements enhanced the phagocytic activity of alveolar macrophages. It also resulted in maintenance of a positive nitrogen balance and prevented the increases in the levels of several amino acids observed in the control group. The suppressive effect of arginine‐enriched solution on tumor growth may be due to its activation of the immunologic system, in which the phagocytic activity of macrophages probably participates. (Journal of Parenteral and Enteral Nutrition 9:428–434, 1985)
The Response of Fibronectin to Differing Parenteral Caloric Sources in Normal Man
Authors: Horowitz Glenn D. , Groeger Jeffrey S. , Legaspi Adrian , Lowry Stephen F.
Published: May 2008

The relationship between circulating fibronectin concentration and nutritional status was examined in eight healthy male (31 ± 1 yr old) volunteers in three nutritional states: the postabsorptive state, after 10 days of protein‐caloric starvation, and during the 10th day of refeeding by total parenteral nutrition. Plasma fibronectin was significantly decreased from 330 ± 22 to 154 ± 11 μg/ml (p < 0.001) from the postabsorptive to starved state which was accompanied by appropriate changes in body weight, anthropometric measurements, and nitrogen balance. Plasma fibronectin levels were restored to 402 ± 39 μg/ml following 10 days of total parenteral nutrition. The plasma fibronectin response was greater (p < 0.05) during total parenteral nutrition with dextrose as the nonprotein calorie source as compared to a 50% dextrose/50% lipid regimen. These results suggest that the calorie source must be considered during interpretation of plasma fibronectin levels in patients undergoing parenteral nutrition. (Journal of Parenteral and Enteral Nutrition 9:435–438, 1985)
Standard or Branched‐Chain Amino Acid Infusions as Short‐Term Nutritional Support in Liver Cirrhosis?
Authors: Rocchi Emilio , Cassanelli Marco , Gibertini Paolo , Pietrangelo Antonello , Casalgrandi Giovanna , Ventura Ezio
Published: May 2008

The metabolic effects of selected and branched‐chain amino acid (BCAA)‐enriched parenteral solutions were studied in liver cirrhosis. After 3 days of an oral protein‐free diet with balanced amino acid (AA) infusion, 36 cirrhotic patients without encephalopathy were randomly divided into four groups. Groups A and B were infused for 5 days with BCAA (valine, leucine, isoleucine) at doses of 0.5 and 1.0 g/kg/ day, respectively, as the only nitrogen source. Group C received 0.8 g/kg of essential and nonessential AA solution with a prevalence of BCAA; the last group (D) continued the basic standard diet, as control. Routine chemistry, urinary nitrogen losses, nitrogen balance, and the whole plasma AA pattern were detected before and after the treatment period. BCAA alone led to an impressive and significant improvement in the basic AA pattern in both the A and B groups. The same results were obtained in group C for plasma AA. In particular, the ratio of BCAA to aromatic amino acids in groups A, B, and C was significantly increased (p < 0.01, <0.02, <0.02, respectively). In group D the AA pattern and the BCAA/aromatic amino acid ratio remained unchanged. The negative nitrogen balance of the base state remained unchanged after 0.5 g of BCAA (A); it improved significantly and became positive during and after the infusions of a double dose of BCAA (B), as it did in the case of selective solutions (C), although to a lesser extent; the negative nitrogen balance of the control group showed only a slight improvement. The beneficial effects of BCAA in arousal from hepatic encephalopathy are well documented; the present study confirms the same beneficial effects on nutritional parameters. For these reasons, adequate doses of BCAA are highly recommended in the short‐term nutritional support of chronic and severe liver disease. (Journal of Parenteral and Enteral Nutrition 9:447–451, 1985)
Whole Body Protein Turnover, Synthesis, and Breakdown in Patients Receiving Total Parenteral Nutrition before and after Recovery from Surgical Stress
Authors: Tashiro Tsuguhiko , Yamamori Hideo , Mashima Yoshiya , Okui Katsuji
Published: May 2008

This study was conducted to understand further the mechanisms underlying the loss of body nitrogen after trauma. Six patients who underwent abdominal surgery and six for control were studied. The measurement of whole body protein turnover was made on the 3rd and 10th postoperative day during total parenteral nutrition with constant infusion of [15N]glycine according to Picou and Taylor‐Roberts. The measurement was also made on six control patients during total parenteral nutrition in the nonstressed state. The rates of whole body protein turnover, synthesis, and breakdown were calculated from the plateau 15N enrichment of urinary total N, which was analyzed with a mass spectrometer. The values were compared with control by Student's t‐test, and the changes in the individual patients were examined by a paired t‐test. Immediately after the operation, whole body protein turnover and breakdown were significantly elevated (p < 0.05 and <0.02, respectively), and decreased with the improvement of N balance after recovery from stress by 0.95 ± 0.21 and 0.61 ± 0.13 g. protein/kg.day, respectively. The changes in whole body protein turnover and breakdown were statistically significant (p < 0.005 and <0.005, respectively). However, no tendency of alteration in whole body protein synthesis was found throughout the study. It is concluded that protein turnover rate increases in surgical stress, and that the increased protein catabolism rather than the alteration in synthesis could account for the postoperative nitrogen losses. (Journal of Parenteral and Enteral Nutrition 9:452–455, 1985)
Elimination of Lipofundin S during the Intravenous Fat Tolerance Test in Patients with Low, Medium, and High Fasting Triglyceride Concentrations
Authors: Leonhardt W. , Julius U. , Schulze J. , Hanefeld M. , Haller H.
Published: May 2008

The intravenous fat tolerance test with Lipofundin S (0.5 ml of 20% emulsion/kg body weight) was performed in 22 male nondiabetic patients. According to their fasting triglycerides (TG), the patients were arranged into three groups: low (<2.8 mmol/liter), medium (2.8–5.7 mmol/liter), and high (>5.7 mmol/liter) concentrations. Fractional elimination rates of injected Lipofundin S decreased from 11.08 in low TG to 4.57%/min in high TG; they were positively correlated with fasting levels of high‐density lipoprotein cholesterol but negatively with those of TG. The same pattern of correlations was observed with fractional catabolic rates of endogenous TG as measured after injection of tritium‐labeled glycerol. The intravenous Lipofundin S load effected transient TG and free fatty acid elevations which were delayed in high TG. The elimination mechanisms of injected Lipofundin S and of endogenous TG are compared.(Journal of Parenteral and Enteral Nutrition9:461–463, 1985)
Effect of Guar Gum Added to the Diet of Patients with Duodenal Ulcer
Authors: Harju Esko J. , Larmi T.K.J.
Published: May 2008

In a randomized, double‐blind, controlled clinical study, the effects of 5 g of guar gum, a dietary fiber composed of galactose and mannose, or placebo added to the diet of 20 patients with duodenal ulcer for 1 wk each were examined. Ten patients derived evident benefit and five some help from guar gum, on comparing symptoms during administration of guar gum with those experienced earlier or during the placebo week, whereas four patients found that neither guar gum nor placebo had any effect (p < 0.001). The beneficial effect was associated with increased feelings of repletion after meals. Patients with fewest symptoms benefited only slightly, or not at all, from guar gum. In one patient, guar gum abolished pain felt earlier and on placebo, but also caused severe gastric retention after meals. This patient had pyloric stenosis. In patients who were intolerant to berries, fruits, sugar, sweet rolls, and pizza these foodstuffs were better tolerated during guar gum administration. The diarrhea which occurs in some patients ingesting guar gum was avoided by giving low initial doses. In three patients unpalatability of guar gum was a minor complaint. It is concluded that guar gum is helpful to many patients with uncomplicated duodenal ulcer, but that it is harmful to those having increased gastric emptying, eg, pyloric stenosis patients, and that guar gum may exert its effects by increasing gastric emptying time. (Journal of Parenteral and Enteral Nutrition 9:496–500, 1985)
The Effect of Lipid Emulsions on Reticuloendothelial System Function in the Injured Animal
Authors: Hamawy Karim J. , Moldawer Lyle‐ L. , Georgieff Michael , Valicenti Anthony J. , Babayan Vigen K. , Bistrian Bruce R. , Blackburn George L.
Published: May 2008

Use of intravenous lipid emulsions in trauma and sepsis still remains controversial. In order to examine the impact lipid emulsions have on host defense against bacterial infection during total parenteral nutrition (TPN), 56 male Sprague‐Dawley rats underwent jugular cannulation and were randomly divided into three groups, each receiving one of three TPN regimens. All regimens delivered approximately 250 kcal/ kg·body weight/day, of which 12.5 g were as amino acids. Group 1 received 100% of the nonprotein calories as glucose (AA + G). Group 2 was given 50% of the nonprotein calories as a long‐chain triglyceride emulsion (100% LCT). Group 3 received 50% of nonprotein calories as a mixed lipid system, composed of medium‐ and long‐chain triglycerides (75% MCT/25% LCT). After 24 hr on intravenous nutrition, all animals received bilateral septic femur fractures and were continued on TPN for 3 days. On the last day, the level of bacteremia and the in vivo response to an intravenous challenge of 59Fe‐labeled Escherichia coli were examined. Three days following the septic injury, animals given MCT as part of their lipid calories were not bacteremic, whereas the other groups had greater than 102 cfu/ml of blood. Animals receiving TPN with MCT sequestered a greater percentage of exogenously administered bacteria in the liver and sequestered less in the lung compared to animals given 100% LCT (p < 0.05). From these data, we conclude that parenteral nutrition formulas where LCT has been partially replaced with MCT may better support host bactericidal capacity than similar regimens comprised of LCT as the sole lipid source. (Journal of Parenteral and Enteral Nutrition 9:559–565, 1985)
Acute Gastric Mucosal Lesions—A New Experimental Model and Effect of Parenteral Nutrition
Authors: Nakagawa Kimihiko , Okada Akira , Kawashima Yasunaru
Published: May 2008

Experiments were performed on 94 male Sprague‐Dawley rats to explore the influence of starvation and parenteral nutrition on the development of acute gastric mucosal changes under stress. Comparative assessments were made of lesions in the gastric mucosa of rats on 1‐ or 6‐day repeated exposure to the stress consisting of restraint with immersion in water. Marked hemorrhagic lesions over the extensive area of the glandular stomach and pronounced ulcerative changes in the nonglandular stomach were observed in 6‐day stress group as compared to 1‐day stress group where only a few hemorrhagic lesions were observed. Thus, this model has proven to provide an excellent experimental model suitable to the purpose of the present investigation. Parenteral nutrition significantly suppressed the development of mucosal damage either in the nonglandular or glandular stomach of rats under 6‐day stress. Furthermore, it has been demonstrated that lesions caused in the glandular stomach increase in severity via exposure to stress and starvation while those evoked in the nonglandular stomach rise in incidence even in the presence of starvation alone. (Journal of Parenteral and Enteral Nutrition 9:571–582, 1985)
Pleural Complications of Nasoenteric Feeding Tubes
Authors: Valentine R. James , Turner William W.
Published: May 2008

Pliable, small‐bore, feeding tubes are inserted frequently in critically ill patients. The use of wire stylets to facilitate passage of these tubes has increased the chances of unrecognized tracheal intubations, particularly in obtunded patients. Five patients with depressed sensoria had inadvertent transbronchial insertions of feeding tubes into their pleural spaces over a 28‐month period. The incidence of this complication among intensive care unit patients was 0.3%. Sequellae included pneumothoraces in four patients, pleural effusions in three patients, and pneumonia with a pulmonary abscess in one patient. The presence of cuffed endotracheal tubes did not prevent this complication in patients with depressed cough reflexes. Inexperience of feeding tube insertors may have contributed to pleural intubations in four of the patients. In patients with depressed sensoria, adequate confirmation of feeding tube location in the stomach or duodenum requires both chest and abdominal roentgenograms. (Journal of Parenteral and Enteral Nutrition 9:605–607, 1985)