bluuebunny/crossref_metadata_2025 huggingface dataset:
Quantification of Lipoprotein X and its Relationship to Plasma Lipid Profile during Different Types of Parenteral Nutrition
Authors: Rigaud D. , Serog P. , Legrand A. , Cerf M. , Apfelbaum M. , Bonfils S.
Published: May 2008

An abnormal lipoprotein (LP), detected in plasma during total parenteral nutrition, has been shown to be similar to LPX observed in cholestasis and in familial lecithin‐cholesterol‐acyl‐transferase (LCAT) deficiency. However, the conditions which facilitate the appearance of LPX during total parenteral nutrition are unclear; potential determining factors could be lipid input, plasma lipid levels, and/or inhibition of LCAT activity. An investigation was conducted on 12 patients receiving total parenteral nutrition for 3 wk by simultaneously evaluating plasma LPX (via a quantitative method) as well as total cholesterol, phospholipids (PL), triglycerides (TG), apolipoprotein B, and LCAT activity. Daily total nonprotein calories (40 kcal/kg body weight) and nitrogen input (250 mg/kg body weight) were fixed in this study. Three 7‐day periods were defined: during periods 1 and 3, lipid emulsion (10 or 20% Intralipid) and glucose were given as nonprotein calories (glucose‐lipid periods); in period 2, glucose was administered alone as the sole source of nonprotein energy (glucose period) so that the total energy input was not modified. During periods 1 and 3, the patients were randomly assigned to receive either 9 g (period 1) and 12 g (period 3) of PL/day for 7 days, or 12 and 9 g of PL/day. By infusing either 10 or 20% Intralipid, TG input was varied concomitantly so that the subjects received 75, 100, or 150 g/day in periods 1 and 3. During the glucose‐lipid periods, plasma LPX was measurable from the 2nd day and increased progressively. Its increment was closely related to a rise in unesterified cholesterol and PL (r = 0.7; p < 0.05). These increases in cholesterol and PL were largely incorporated into LPX. In contrast, TG was decreased independently of LPX levels. LPX concentrations were dependent on PL input since the LPX increment was significantly higher when 12 g rather than 9 g of PL were infused daily. TG input had no such effect. LPX was not correlated with either LCAT activity or apolipoprotein B levels which did not yield any significant variation during the entire study. In the glucose period, there was a significant decrease in LPX (half life: 2–4 days), cholesterol, and PL, while TG was increased. Our study suggests that different types of discontinuous total parenteral nutrition can induce varying patterns of the plasma lipid profile. The LPX level and the rise of cholesterol and PL were related to PL input but not to TG input or to inhibition of LCAT activity. The increase of unesterified plasma cholesterol was higher than expected after low cholesterol input, indicating that the excess cholesterol may be partly endogenous in origin. (Journal of Parenteral and Enteral Nutrition 8:529–534, 1984)
Suboptimal Selenium Status in Home Parenteral Nutrition Patients with Small Bowel Resections
Authors: Baptista Richard J. , Bistrian Bruce R. , Blackburn George L. , Miller Donald G. , Champagne Charlotte D. , Buchanan Lesley
Published: May 2008

The selenium status of 13 adult home parenteral nutrition (HPN) patients was evaluated using 12 healthy adult volunteers as controls. Patients had been maintained on HPN for a mean of 36 months and averaged 121 cm of residual small bowel. Prospective diet surveys in patients indicated a mean oral caloric intake of 902 kcal/day. The mean plasma selenium concentrations (μg/g) were 0.044 in patients and 0.117 in controls (p < 0.01). The erythrocyte glutathione peroxidase activities, as μmol of NADPH oxidized/g hemoglobin/min, averaged 11.01 in patients and 31.76 in controls (p < 0.01). Four patients exhibited myalgic symptomatology suggestive of clinical selenium deficiency. No correlations could be ascertained between plasma selenium levels and glutathione peroxidase activities in either patients or controls. Additionally, in the patient group, no significant correlations could be ascertained between selenium status and oral caloric intake, residual small bowel length, symptomatology suggestive of deficiency or HPN duration. However, since sample size was not large, lack of correlations might best be considered suggestive not conclusive. The data indicate that HPN patients with small bowel resections exhibit suboptimal selenium status and may be at risk of developing clinically evident selenium deficiency. HPN patients should be prophylactically supplemented with selenium regardless of oral intake, duration of HPN, or residual length of resected small bowel. (Journal of Parenteral and Enteral Nutrition 8:542–545, 1984)
Renal and Electrolyte Effects of Total Parenteral Nutrition
Authors: Batuman Vecihi , Dreisbach Albert , Maesaka John K. , Rothkopf Michael , Ross Elizabeth
Published: May 2008

Effects of short‐term (4–14 days) total parenteral nutrition on renal handling of water and electrolytes were studied retrospectively in 24 patients and prospectively in eight patients. There was 33% incidence of hyponatremia and significant reductions in serum creatinine (from 1.03 ± 0.06 to 0.88 ± 0.06 mg/dl, p < 0.001), phosphorus (from 3.2 ± 0.14 to 2.5 ± 0.17 mg/dl, p < 0.005) and uric acid (from 6.09 ± 0.38 to 3.66 ± 0.24 mg/dl, p < 0.001) were observed. Hypouricemia correlated with increased fractional excretion of urate (r = —0.81,p < 0.05). Hypophosphatemia was associated with increased tubular reabsorption of phosphate. Clearance studies in eight patients showed high urine flow rate (1.7 ± 0.2 ml/min), osmolar clearance (3.2 ± 0.7 ml/min), urinary nonelectrolyte, nonurea solute excretion (0.23 ± 0.14 mmol/min), and negative free water clearance (TcH2O = 1.5 ± 0.6 ml/min). These data suggest presence of compartmental shifts, expanded extracellular fluid volume, and possible direct effects on renal tubular transport functions during total parenteral nutrition. (Journal of Parenteral and Enteral Nutrition 8:546–551, 1984)
Human Plasma Lipoproteins and Total Parenteral Nutrition with Intravenous Fat Emulsion
Authors: Judd Robert H. , Freund Herbert , Deckelbaum Richard J.
Published: May 2008

Lipoprotein concentration and composition before and after Intralipid infusion were investigated in seven adult surgical patients receiving continuous total parenteral nutrition. Plasma samples were obtained prior to parenteral alimentation, after 7 days of glucose/amino acid solution without Intralipid, and again following 5 days of daily Intralipid. Cholesterol, triglyceride, protein, and phosopholipid concentrations were determined on very low‐, low‐, and high‐density lipoprotein from each specimen. After Intralipid very low‐density lipoprotein concentration fell to 29% (p < 0.015) of pre‐Intralipid levels. There was no substantial increase in low‐density lipoprotein phospholipid post‐Intralipid to suggest the presence of lipoprotein‐X. Plasma total triglyceride levels declined by 33% after Intralipid (p < 0.01) and plasma total cholesterol levels rose by 40% (p < 0.02). In our patients, in whom metabolic mechanisms were not saturated, it would appear that Intralipid was metabolized by activated lipoprotein lipase pathways, without the appearance of hyperlipidemia or abnormal lipoproteins. (Journal of Parenteral and Enteral Nutrition 8:552–555, 1984)
Prophylaxis and Treatment of Childhood Rickets with Parenteral Cholecalciferol
Authors: Bertino Joseph S. , Reed Michael D. , Halpin Thomas C.
Published: May 2008

The safety and efficacy of parenteral cholecalciferol was evaluated in the treatment and prevention of childhood rickets. Children with active disease, and those at high risk for developing rickets were treated either with intravenous or intramuscular cholecalciferol in dosages of 1000 to 1500 IU daily, for periods of 28 to 450 days. All children with rickets responded with radiographic evidence of healing. No child in the prophylaxis group developed bone disease. Side effects were minimal. Parenteral cholecalciferol is a safe and effective therapy for the treatment and prevention of childhood rickets. (Journal of Parenteral and Enteral Nutrition 8:556–559, 1984)
Delayed Pneumothorax: A Complication of Subclavian Vein Catheterization
Authors: Slezak Frederick A. , Williams Gary B.
Published: May 2008

Subclavian catheterization is a reliable, well‐described technique of central venous access for a variety of indications. Significant complications are associated with the procedure. Detection of the majority of complications is afforded by the postinsertion chest x‐ray. Delayed pneumothorax, a relatively unrecognized complication of subclavian catheterization, is caused by a slow pleural air leak which appears to be associated with the “difficult” insertion as illustrated by three case reports. A repeat or “delayed” chest roentgenogram should be considered in the following situations: (1) Difficult subclavian insertions requiring multiple attempts. (2) Suspicion of pleural injury such as aspiration of air during insertion or subcutaneous emphysema with a normal postinsertion chest x‐ray. (3) The presence of another major complication. (4) If the patient complains of persistent pleuritic or back pain after insertion. (5) Preoperatively after previous difficult insertion of a central venous line. (6) Postoperatively when a subclavian catheter is inserted intraoperatively. (Journal of Parenteral and Enteral Nutrition 8:571–574, 1984)
Neurologic Deficit following Gastric Partitioning: Possible Role of Thiamine
Authors: Villar Hugo V. , Ranne Richard D.
Published: May 2008

Gastric partitioning has been proposed as an alternative to jejunoileal bypass for the control of morbid obesity because of the relative ease of performance and the lack of metabolic complications. From our series of 250 patients who underwent gastric partitioning, one of them developed a neurologic syndrome consistent with Wernicke's disease. The clinical findings were characterized by ataxia, confusion, impaired extra‐ocular movements with diplopia, and weakness. A second patient with a similar condition was referred to us for evaluation and treatment. Pretreatment thiamine levels were normal in one case and revealed thiamine deficiency in the second. The study group of 15 patients had thiamine and red‐cell transketolase levels determined before, 6 wk, and 1 yr after gastric partitioning. A significant drop in values was seen at 6 wk postoperatively. Gastric partitioning is a safe and effective alternative to jejunoileal bypass in the control of morbid obesity. However, severe permanent neurologic deficits, probably related to thiamine deficiency, may occur. (Journal of Parenteral and Enteral Nutrition 8:575–578, 1984)
Optimal Lipid Content for Enteral Diets following Thermal Injury
Authors: Mochizuki Hidetaka , Trocki Orrawin , Dominioni Lorenzo , Ray Mukunda B. , Alexander J. Wesley
Published: May 2008

This study was performed to determine the effects of different amounts of lipid in enteral diets during the postburn period. Forty‐five guinea pigs with catheter gastrostomy received a 30% total body surface area full thickness flame burn. After burn they were given intragastric tube feedings using five diets at different dietary lipid composition: 0, 5, 15, 30, and 50% of nonprotein calories. Total calories administered (175 kcal/kg/day), protein content and composition (20% of total calories), total volume, and vitamin and mineral content were constant in all animals. At postburn day 14, body weight, carcass weight, and muscle weight were the greatest in 0 and 5% lipid groups, and the least in 30 and 50% lipid groups. Serum transferrin was highest in the 5 and 15% lipid groups, and lowest in the 30 and 50% lipid groups. Total nitrogen content in muscle and cumulative nitrogen balance were best in the 15% lipid group. Liver fatty infiltration, caused from a larger proportion of carbohydrate administration, was greater in the 0 and 5% lipid groups and less in 15 and 30% groups. It is concluded that dietary lipid levels between 5 and 15% of nonprotein calories are optimal for nutritional support after burn injury. The nutritional management of postburn patients with higher levels of dietary lipid should be reconsidered. (Journal of Parenteral and Enteral Nutrition 8 :638–646, 1984)
The Metabolism of an Exogenous Lipid Source during Septic Shock in the Puppy
Authors: Coran Arnold G. , Drongowski Robert A. , Lee Grace S. , Klein Michael D. , Wesley John R.
Published: May 2008

Septic shock induces physiologic and hemodynamic responses that may alter the host's ability to metabolize an exogenous source of lipids. The present study examined the metabolic changes occuring during septic shock in the young animal receiving an intravenous fat emulsion. Five 8‐wk‐old male Beagle puppies were studied. Each animal served as his own control twice, during which time 14C‐palmitic acid alone or with a 10% fat emulsion (Liposyn) was administered. Septic shock (cardiac output less than 50% of control) was induced with an intravenous bolus of live Escherichia coli. During shock the puppies received intravenous 14C‐palmitic acid and Liposyn. The mean respiratory quotient for the shock dogs (0.96 ± 0.01) was significantly (p < 0.05) higher than that of the controls (0.83 ± 0.06). The amount of expired 14CO2 was 25.0 ± 15.9% for the shock animals, 53.9 ± 28.1% for the Liposyn controls, and 75.7 ± 30.5% for the controls receiving only 14C‐palmitic acid (these differences are all significant, p < 0.05). After the onset of shock, serum triglyceride levels peaked within 2 min at 851 ± 540 mg/100 ml and remained elevated at 333 ± 213 mg/100 ml. Triglyceride levels in the Liposyn control animals returned to baseline values (54 ± 13 mg/100 ml) at the end of the 4‐hr experimental period. Free fatty acids in the shock dogs reached a maximal level of 1.44 ± 0.09 mEq/liter at 1 hr and remained at this elevated value for a significantly longer period of time than in the Liposyn control puppies. Glycerol value followed a similar pattern and cholesterol remain unchanged. Plasma insulin in the shock animals steadily rose to a peak of 826 ± 358 μU/ml at the end of the experimental period; control animals showed no plasma insulin changes. The results of this study suggest that exogenous lipids administered during septic shock may not be metabolized as well as during the nonshock state. (Journal of Parenteral and Enteral Nutrition 8:652–656. 1984)
Comparison of Intravenous Glucose and Fat Calories on Host and Tumor Growth
Authors: Hak Lawrence J. , Raasch Ralph H. , Benaim Hammer Vivian , Matthews Tim , Sandler Robert S. , Heizer William D.
Published: May 2008

This study was undertaken to determine if the proportions of intravenous carbohydrate and fat calories influence the relative growth of a Walker 256 carcinosarcoma and its host. Rats injected intraperitoneally with Walker 256 carcinosarcoma cells were randomized into three total parenteral nutrition (TPN) groups, G/AA in which glucose provided all nonprotein calories, G/F/AA in which the nonprotein calories were 20% fat and 80% glucose, and F/AA in which all nonprotein calories were from fat. Except for the caloric source, TPN for each group was identical. A fourth group was sham operated, fed rat food, and was not given TPN. On the 6th day after innoculation, the tumor in each rat showed a dispersed ascites form as well as a solitary mass form involving the omentum. The total number of tumor cells in the ascitic fluid and the dry weight of the mass were determined. The three TPN groups did not differ in tumor cell count, solid tumor weight, ratio of tumor cell count to final host weight, or ratio of solid tumor to final host weight. The mean ratio of ascites tumor cell count to host weight was not different between the rat food‐fed group and any of the TPN groups. The mean ratio of solid tumor to host weight was less for the TPN groups than for rat food‐fed animals. We conclude that TPN had no adverse effect on the growth of tumor us. host and that the source of intravenous calories (fat or carbohydrate) did not influence the relative growth of tumor and host in this TPN‐tumor model. (Journal of Parenteral and Enteral Nutrition 8:657–659, 1984)
Effect of High Percentage Medium‐Chain Triglyceride Diet on Mucosal Adaptation following Massive Bowel Resection in Rats
Authors: Vanderhoof Jon A. , Grandjean Carter J. , Kaufman Stuart S. , Burkley Karen T. , Antonson Dean L.
Published: May 2008

Patients undergoing massive small bowel resection for a variety of conditions develop severe nutrient malabsorption which gradually improves through mucosal hyperplasia in the remaining small intestine. Following massive small bowel resection, patients are generally fed elemental diets, often containing high concentrations of medium‐chain triglycerides. We evaluated the effect of high percentage medium‐chain triglyceride feeding on mucosal adaptation following massive small bowel resection in rats. Twenty 150‐g Sprague‐Dawley rats were subjected to 60% jejunoileal resection. Another 20 animals received sham operations. One‐half of each group were fed a diet containing 83% of the fat as medium‐chain triglycerides, the remainder were fed a diet containing 40% medium‐chain triglycerides. Animals were pair‐fed for 2 wk and subsequently killed. The remaining bowel was removed and unidirectional glucose and leucine uptake were measured using isolated sacs. Mucosal wet weight, protein, and sucrase content were determined. Animals fed medium‐chain triglycerides demonstrated decreased mucosal weight in the proximal bowel, decreased mucosal sucrase activity in the proximal bowel, and decreased mucosal leucine uptake in the distal bowel. While medium‐chain triglycerides offer an advantage to patients with short bowel syndrome because they are easily absorbed, they may not stimulate the same degree of mucosal adaptation following resection as long‐chain triglyceride feedings. (Journal of Parenteral and Enteral Nutrition 8:685–689, 1984)
Altered Immunologic Function and Nitrogen Metabolism associated with Depression of Plasma Growth Hormone
Authors: Dahn Michael S. , Mitchell Robert A. , Smith Stuart , Lange M. Patricia , Whitcomb M. Phyllis , Kirkpatrick John R.
Published: May 2008

The specific role of endogenous growth hormone in regulating nitrogen metabolism during surgical stress and infection remains unclear. We have studied splanchnic amio acid uptake and plasma concentrations in patient groups exhibiting growth hormone hypersecretion or relative growth hormone depression in response to stress. Splanchnic amino acid uptake was similar in both groups although plasma levels were significantly higher in the presence of depressed growth hormone production suggesting increased net peripheral proteolysis. In association with this latter observation, T lymphocyte subset analysis revealed a greater incidence of depressed helper to suppressor cell ratios in the presensce of depressed growth hormone suggesting a greater impairment of cellular immunity. (Journal of Parenteral and Enteral Nutrition 8:690–694, 1984)
L‐Leucine Prevents Ammonia‐Induced Changes in Glutamate Receptors in the Brain and in Visual Evoked Potentials in the Rabbit
Authors: Ferenci Peter , Pappas Chris S. , Jones E. Anthony
Published: May 2008

The effect of L‐leucine on glutamate receptors in the brain and on visual evoked potentials was studied in hyperammonemic rabbits. Hyperammonemia was induced by the iv infusion of 2.1 mmol NH4Cl/h over 3 hr. Hyperammonemia was followed by a 116% increase in the specific binding of 3H‐glutamate to synaptic membranes prepared from the hippocampus. This increase was due to both an increase in the affinity and in the density of the glutamate receptor. The simultaneous infusion of L‐leucine (6.7 mmol/hr) completely prevented the ammonia‐induced increase in the specific glutamate binding, whereas L‐valine and D‐leucine had no effect. Hyperammonemia was also associated with typical, reproducible, and reversible changes in visual evoked potentials. The amplitudes of the first negative and the second positive peak decreased, whereas the latencies of these peaks remained unchanged. The simultaneous infusion of L‐leucine completely prevented these changes. These findings indicate (1) that L‐leucine prevents ammonia‐induced changes in the glutamatergic excitatory neurotransmitter system and (2) that pharmacologic doses of L‐leucine modulate the effects of hyperammonemia on central neurotransmission as assessed by visual evoked potentials. A causal relationship between the effects of L‐leucine on ammonia‐induced changes in glutamate receptors and in visual evoked potentials cannot be inferred with confidence. These findings provide a potential alternative explanation for the apparent beneficial effects of infusions of branched‐chain amino acids on hepatic encephalography in patients with chronic liver disease. (Journal of Parenteral and Enteral Nutrition 8:700–704, 1984)
Effect of Injury, Sepsis, and Parenteral Nutrition on High‐Energy Phosphates in Human Liver and Muscle
Authors: Liaw Koung‐Yi
Published: May 2008

This study examined the effect of varying degrees of resting hypermetabolism and total parenteral nutrition on muscle and hepatic high‐energy phosphates. Twelve severely injured patients, five critically ill patients with normal blood pressure, and six severely ill patients on 1 wk of total parenteral nutrition were investigated, and the results were compared with those in 14 normal controls. High‐energy phosphates were not significantly changed in liver and muscle after severe injury; lactate and pyruvate levels in both tissues were increased; glycogen levels in the liver were decreased. In critical illness, muscle and hepatic adenosine triphosphate as well as adenosine diphosphate were decreased significantly; energy charge potential dropped; adenosine monophosphate, lactate, and the ratio of lactate to pyruvate were increased. Liver glycogen, but not muscle glycogen, dropped remarkably. The correlation coefficient between hepatic and muscle adenosine triphosphate was 0.61. In patients on 1 wk of total parenteral nutrition, hepatic and muscle high‐energy phosphates were not significantly changed before or during total parenteral nutrition. Alterations in the adenosine triphosphate‐adenosine diphosphate‐adenosine monophosphate system in liver and muscle suggest a low‐energy charge in severe injury and critical illness. This would indicate a decreased capacity for biosynthetic reactions and production of storage compounds. The changes of high‐energy phosphates in liver are always parallel to changes in muscle. (Journal of Parenteral and Enteral Nutrition 9:28–33, 1985)
Energy Requirements of Parenterally Fed Bone Marrow Transplant Recipients
Authors: Szeluga Debra J. , Stuart Robert K. , Brookmeyer Ron , Utermohlen Virginia , Santos George W.
Published: May 2008

To determine the energy intake (kcal/kg/day) necessary to maintain zero nitrogen balance (assuming adequate protein intake) during the first 30 days after transplant, we studied 91 bone marrow transplant recipients. Serial nitrogen balance and concomitant energy and protein intakes were determined prospectively on each patient. Eighty‐four (92%) of the patients (ages 4–49 yr) had sufficient data for evaluation. For each patient, a simple linear model (nitrogen balance us energy intake) was used to determine the patient's predicted individual energy requirement during the first 30 posttransplant days (EReq30). Weighted least squares multiple regression was used to determine the effect on EReq30 of such variables as age and sex. Energy requirements were significantly (p < 0.001) greater for children, males, and patients with acute graft‐us‐host disease, and when the percent of the total energy intake given by the intravenous route was high. An equation that incorporated these variables was developed to predict the energy requirements for bone marrow transplant recipients during their first 30 posttransplant days. Although individual energy requirements vary, this equation is a useful guide for initial energy prescriptions. (Journal of Parenteral and Enteral Nutrition 9:139–143, 1985)
Glucose and Insulin Infusion Directly after Cardiac Surgery: Effects on Systemic Glucose Uptake, Catecholamine Excretion, O2 Consumption, and CO 2 Production
Authors: Nilsson Folke , Bake Björn , Berglin W‐O Eva , Ekroth Rolf , Holm Jan , Milocco Italo , Svensson Sveneric , Waldenström Johan , William‐Olsson Göran
Published: May 2008

Systemic glucose uptake was studied in 31 patients during 4 hr starting 1 hr after open heart surgery, using the hyperinsulinemic “clamp” technique at different plasma insulin levels and at a glucose concentration of 6 or 10 mmol/ liter. Possible metabolic side effects related to the glucose uptake were studied by measurements of urinary catecholamine excretion, O2 consumption, CO2 production, and arterial PC02. A peak systemic glucose uptake of 7.0 ± 0.4 mg/kg body weight/ min was found at a plasma insulin concentration of 3192 ± 150 mU/liter and a blood glucose concentration of 10.2 ±0.1 mmol/ liter. No significant difference was found in urinary catecholamine excretion compared to control patients. O2 consumption was unaltered while a 15% increase in CO2 production was observed. (Journal of Parenteral and Enteral Nutrition 9:159–164, 1985)
Use of Urea Kinetics in the Nutritional Care of the Acutely III Patient
Authors: Kosanovich John M. , Dumler Francis , Horst Mathilda , Quandt Chris , Sargent John A. , Levin Nathan W.
Published: May 2008

In acutely ill patients nitrogen balance is often assessed clinically from measurements of protein intake and urinary urea nitrogen. We have utilized urea kinetic modeling to measure urea generation rates, protein catabolic rates and nitrogen balance in 19 acutely ill patients with varying degrees of renal dysfunction and have studied the effect of varying caloric intake on protein balance during a period of fixed protein intake. In patients with measured creatinine clearances equal to or greater than 50 ml/min there was a highly significant correlation between nitrogen balance estimates derived from urea kinetic modeling and those obtained from urinary urea nitrogen (R = 0.939; p < 0.001). When creatinine clearance measurements were between 20 to 50 ml/min the correlation between the two estimates was poorer (R = 0.337; p < 0.001). In patients whose creatinine clearance was below 20 ml/min the correlation between measurements was worse still (R = 0.229; p < 0.002). To determine the effects of increasing caloric intake on protein catabolic rate seven acutely ill patients were studied. When caloric intake was increased from 27.8 to 34.2 kcal/kg/day while on a fixed protein intake of 1.27 g/kg/day there was a significant fall in protein catabolic rate from 1.39 to 0.99 g/kg/day (p < 0.002). As urea kinetic modeling takes into account changes in blood urea nitrogen, extrarenal losses of urea and the urinary urea pool, it is the preferred method for measuring protein balance in acutely ill patients particularly those with poor renal function. Serial monitoring of protein catabolic rates permits easy continuous assessment of the effect of increasing caloric intake on protein sparing during parenteral hyperalimentation. (Journal of Parenteral and Enteral Nutrition 9:165–169, 1985)
The Value of Nutritional Assessment in the Surgical Patient
Authors: Roy Lori B. , Edwards Patsy A. , Barr Louis H.
Published: May 2008

The prevalence of malnutrition in Veterans Administration Hospitals has been well documented. Several methods have been proposed to assess nutritional status including prognostic nutritional index (PNI) and instant nutritional assessment (INA). A prospective study was done to evaluate the currently used nutritional assessments and determine their efficacy based on sensitivity and specificity in predicting surgical morbidity and mortality. Data on 46 patients were evaluated for the multiparameter index of PNI, total lymphocyte count and serum albumin for INA, and weight loss alone. In this analysis, intermediate and high risk PNI were combined as positive predictor of complications. Any abnormal value in INA was considered positive as was weight loss of greater than 6% of usual body weight. Sensitivity and specificity of each assessment method were determined by 2 x 2 contingency table, and significance of observed differences between methods was determined by X2 analysis. There were no complications or deaths in patients with less than 6% weight loss. All three patients with abnormal albumin and total lymphocyte count had complications as compared to only three of 32 patients when both of these parameters were normal. The PNI was also able to predict complications with an increasing incidence as the PNI increased. Only the difference between specificity of weight loss alone us INA was statistically significant, p < 0.05. Thus, weight loss alone can be used as a rapid, inexpensive assessment of nutritional status for predicting postoperative complications. (Journal of Parenteral and Enteral Nutrition 9:170–172, 1985)
Successful Management of Chronic Intestinal Pseudo‐Obstruction with Home Parenteral Nutrition
Authors: Warner Ellen , Jeejeebhoy Khursheed N.
Published: May 2008

Chronic intestinal pseudo‐obstruction is a disorder of gut motility resulting in severe abdominal pain, bloating, nausea, and vomiting after eating. The avoidance of food in order to minimize symptoms causes malnutrition. To date, no medical or surgical treatment has been shown to be of lasting benefit. We treated 10 patients disabled by chronic intestinal pseudo‐obstruction using home parenteral nutrition. All were rendered minimally symptomatic as long as they refrained from significant oral intake. Nine of the 10 patients were malnourished prior to the institution of treatment. Home parenteral nutrition increased mean total body weight from 74.7 ± 2.9 to 93.5 ± 3.7% (p < 0.001), mean lean body mass from 78.4 ± 6.5 to a mean of 92.7 ± 2.6 (p < 0.02), and mean body fat from 57.1 ± 8.8 to 83.8 ± 8.2% of expected values (p < 0.05). Mean total body potassium increased from 68.8 ± 13.1 to 80.5 ± 10.7 g (p < 0.05). We conclude that in chronic intestinal pseudo‐obstruction, home parenteral nutrition coupled with minimal oral intake effectively relieves symptoms and significantly improves the nutritional depletion. (Journal of Parenteral and Enteral Nutrition 9:173–178, 1985)
Pneumothorax Complicating Enteral Feeding Tube Placement
Authors: Olbrantz Keith R. , Gelfand David , Choplin Robert , Wu Wallace C.
Published: May 2008

Two cases are presented of pneumothorax complicating enteral feeding tube insertion. A previous report describing three similar cases is noted. Neurologically impaired patients appear to be particularly at risk for this complication, which may be encouraged by use of a guidewire during tube insertion. It is suggested that enteral feeding tubes in neurologically impaired patients be inserted under fluoroscopic guidance using a tube specifically designed for this purpose. (Journal of Parenteral and Enteral Nutrition 9:210–211, 1985)
Piggyback Compatibility of Antibiotics with Pediatric Parenteral Nutrition Solutions
Authors: Watson Dave
Published: May 2008

The compatibility of 28 parenteral antibiotics with a pediatric parenteral nutrition solution was tested using a piggyback injection technique. The parenteral nutrition solution, apparatus, and antibiotic doses simulated central venous administration to 5‐ and 30‐kg patients. All antibiotics were injected into a running parenteral nutrition solution, distal to an in‐line filter. After passing through a central venous catheter, immersed in a heated water bath, the effluent was collected, analyzed for pH, and visually inspected for precipitate formation. The effluent was not evaluated for the presence of microscopic precipitates. When given as piggyback injections, five of the 28 antibiotics increased the pH of the original parenteral nutrition solution. These were ampicillin, cefamandole, cephalothin, cephradine, and oxacillin. Two of these, ampicillin and cephradine, produced a heavy visible precipitate, found to consist of calcium and phosphorus. The injections of certain antibiotics promote the formation of an insoluble calcium phosphate precipitate. When calcium and phosphate are present in a parenteral nutrition solution, a flush procedure is recommended when injecting antibiotics which increase the pH of the original parenteral nutrition solution. (Journal of Parenteral and Enteral Nutrition 9:220–224, 1985)
Enteral Feeding in Burn Hypermetabolism: Nutritional and Metabolic Effects of Different Levels of Calorie and Protein Intake
Authors: Dominioni Lorenzo , Trocki Orrawin , Fang Cheng‐Hui , Mochizuki Hidetaka , Ray Mukunda B. , Ogle Cora K. , Alexander J. Wesley
Published: May 2008

Enteral nutrition was provided by continuous pump‐controlled gastrostomy tube feeding for 14 days in 97 guinea pigs bearing a 30% full thickness burn. Seven defined combinations of caloric and protein intake were studied. With a caloric intake of 175 kcal/kg/day, equaling the measured energy expenditure, the animals receiving 10% of calories as protein had a significantly greater postburn weight loss (p < 0.05) and muscle mass depletion (p < 0.05), and a significantly lower muscle nitrogen concentration (p < 0.05), serum albumin level (p < 0.01) and liver nitrogen content (p < 0.01). With the same caloric intake but with more than 20% of calories as protein, the weight loss and the muscle wasting were reduced, but not abolished, and the serum albumin level and liver nitrogen content were normalized. Also with the diets containing 200 kcal/kg/day the muscle tissue depletion could not be abolished. However, with this caloric intake, the animals given 20% of calories as protein had a lower weight loss and a higher serum albumin level (p < 0.01), but also a greater fat infiltration of the liver (p < 0.01). At both levels of caloric intake, the nitrogen balance correlated significantly with the level of nitrogen intake but did not correlate with the changes of body weight. The incidence of diarrhea was lowest in animals fed 20% protein calories at a caloric intake of 175 kcal/kg/day. All things considered, the best metabolic and nutritional results were obtained with diets containing 20 to 30% of calories as protein and providing a caloric intake that paralleled the measured energy expenditure. (Journal of Parenteral and Enteral Nutrition 9:269–279, 1985)
Peripheral Vein Infusion of Dextrose/Amino Acid Solutions ± 20% Fat Emulsion
Authors: Daly John M. , Masser Ellen , Hansen Laura , Canham J. Edward
Published: May 2008

The purpose of this study was to evaluate the incidence of phlebitis occurring during peripheral infusion of nutrient solutions with and without 20% fat emulsions. Eighty patients were randomly assigned to one of four groups: (1) dextrose/amino acids—630 mOsmol/liter; (2) dextrose/amino acids/fat emulsion—706 mOsmol/liter; (3) dextrose/amino acids—882 mOsmol/liter and; (4) dextrose/amino acids/fat emulsion—983 mOsmol/liter. The peripheral infusion site was examined daily and the number of changes in infusion sites were recorded and the degree of phlebitis encountered was graded. The four groups were similar in the mean number of iv site changes per patient and per day. The average grade of phlebitis was similar (0.23–0.27 events/day) among the four groups. Infiltration occurred more frequently with butterfly needle while phlebitis occurred more frequently with plastic angiocatheters. Patients appeared to tolerate peripheral infusion with high osmolar solutions just as well as lower osmolar solutions. Concurrent infusion with a 20% fat emulsion did not alter the number of iv site changes or the incidence or degree of phlebitis reported and thus, did not appear to have a protective effect on the vein when infused with dextrose/amino acid solutions. (Journal of Parenteral and Enteral Nutrition 9:296–299, 1985)
Bowel Function of Healthy Men Consuming Liquid Diets with and without Dietary Fiber
Authors: Slavin J.L. , Nelson N.L. , Mcnamara E.A. , Cashmere K.
Published: May 2008

The importance of the level of dietary fiber intake on bowel function was measured in 16 healthy young males consuming self‐selected and liquid enteral diets. Subjects consumed liquid Ensure as their sole nutrient source plus 0 (diet a), 30 (diet c), and 60 (diet d) g/day soy fiber, a fiber source high in hemicellulose that was added to the Ensure. Further, to examine whether heat processing affects the physiologic action of fiber, subjects consumed Enrich, an enteral formula similar to Ensure, which contains 30 g of the same soy fiber (diet b). The four diets were consumed in randomized order each for 10 days. Daily wet stool weight averaged 144.6 g on the self‐selected diet and decreased significantly to 67.3 g when Ensure was consumed alone. Average stool weights on diets (b), (c), and (d) were 114.6, 100.2, and 150.3 g/day, respectively. Average fecal dry weights for the four diets were 19.1, 28.7, 25.0, and 30.3 g/day for (a‐d), respectively. Gastrointestinal transit time, as measured with radiopaque pellets, was longest on the Ensure diet, 72.4 hr, and approximately 2 days on the fiber‐supplemented diets and the self‐selected diet. Thus, soy fiber's physiologic effect on laxation was not changed by heat processing. Also, although stool weights were larger on higher fiber intakes, transit rates were similar on all the fiber‐containing diets. (Journal of Parenteral and Enteral Nutrition 9:317–321, 1985)
A Randomized Trial on the Effect of Tubing Changes on Hub Contamination and Catheter Sepsis during Parenteral Nutrition
Authors: Sitges‐Serra A. , Liñares J. , Pérez J.L. , Jaurrieta E. , Lorente L.
Published: May 2008

In previous studies the contamination of the catheter hub was found to be a common portal of entry for bacteria causing catheter‐related sepsis. Since hub manipulations during tubing changes may increase the risk of contamination, a prospective trial was conducted to find out the effects of the frequency of tubing replacements on hub colonization and catheter sepsis rates. The results were compared with those obtained during an outbreak of coagulase negative staphylococci septicemia. Fifty‐two patients were randomly allocated into two groups. Group A (n = 20) had the line changes every 2 days while group B (n = 32) had it replaced every 4 days. When the catheter was removed, the catheter tip and the hub were cultured by a quantitative method. Sterile, colonized, or infected hubs were equally distributed in both groups (A: 80, 15, and 5% us B: 84, 6, and 10%). There were three episodes of catheter sepsis, one in group A and one in group B due to hub infection, and one in group B due to hematogenous seeding of the catheter tip. There were significant (p < 0.001) differences between the trial and the historic series in respect to rates of hub colonization infection (19 us 50%) and catheter sepsis (5.7 us 40%). Delaying tubing changes does not increase catheter sepsis or hub contamination rates and, together with adequate hub protection, has proved to be a valuable factor in controlling an outbreak of catheter sepsis due to the coagulase negative staphylococci. (Journal of Parenteral and Enteral Nutrition 9:322–325, 1985)
Nutritional Evaluation and Supplementation of Elderly Subjects Participating in a “Meals on Wheels” Program
Authors: Lipschitz David A. , Mitchell Carol O. , Steele Russell W. , Milton Kathy Y.
Published: May 2008

A nutritional assessment of 33 elderly subjects participating in a “meals on wheels” program revealed a high prevalence of nutritional deficiencies. Twelve of these subjects, who were considered to be at high risk for protein calorie malnutrition, received 240 ml of a polymeric dietary supplement three times daily for 16 wk. This resulted in a significant (50%) increase in total caloric and protein intake which was maintained for the entire 16 wk of study. In seven of the 12 subjects a weight gain of greater than 2 kg was found. Modest but significant elevations in serum albumin and highly significant elevations of the total iron binding capacity, serum and red cell folate, leukocyte ascorbate, and serum vitamin B12 provided strong evidence for improved nutritional status. In contrast no improvement in the hemoglobin, total lymphocyte count, T cell number, T suppressor cells, T helper, or B cells was noted. In no anergic subjects was skin test conversion found. In addition no increase in serum trace metals or vitamin B6 levels were noted. Thus this study demonstrates that nutritional supplementation results in significant improvement in selected nutritional parameters. The fact that the hematopoietic and immunological status of these patients was unchanged suggest that the abnormalities may be age rather than nutritionally related or that a critical nutritional deficiency was not corrected. (Journal of Parenteral and Enteral Nutrition 9:343–347, 1985)
Sinus Bradycardia Associated with Peripheral Lipids and Total Parenteral Nutrition
Authors: Traub Scott L. , Sheffield Alonzo D. , Meeran M.K.
Published: May 2008

This case report describes a 23‐yr‐old woman with Crohn's disease who developed sinus bradycardia 4 hr after initiation of total parenteral nutrition with lipids through a peripheral vein. The bradycardia persisted for 1 wk, with only slight improvement when the lipids were held for two 4‐hr periods. The heart rate began to improve when lipids were changed from 10 to 20%, and continued to rise after Synthroid was started. The possible relationships between nutritional and thyroid status, as well as lipids and heart rate are discussed. (Journal of Parenteral and Enteral Nutrition 9: 358–360, 1985)
An Evaluation of Total Parenteral Nutrition Using Vamin and Aminosyn as Protein Base in Critically III Preterm Infants
Authors: Sankaran Koravangattu , Berscheid Bruce , Verma Vinod , Zakhary Gamal , Tan Leonard
Published: May 2008

A total of 75 preterm infants with gestation less than 32 wk received total parenteral nutrition (TPN) using Vamin and Aminosyn as protein base lasting more than 20 days. They were monitored for signs of liver dysfunction, cholestatic jaundice, and TPN‐induced metabolic bone disease (osteopenia of prematurity). It was observed that severity of TPN‐induced cholestasis depends on the duration of TPN and quantity of protein infused. When used as a protein base, Vamin seemed to be superior to Aminosyn. TPN‐induced metabolic bone disease was strongly correlated to the duration of TPN. We suggest close monitoring of critically ill preterm infants on TPN for quantity of protein infusate, liver dysfunction, cholestatic jaundice, and TPN‐induced metabolic bone disease. Intravenous protein intake should be limited to less than 2.5 g/kg/day in preterm infants with gestation less than 32 wk. (Journal of Parenteral and Enteral Nutrition 9:439–442, 1985)
Effect of the Dietary Fatty Acid Component on the Release of 14C‐Taurocholate, 14C‐Bilirubin, Alkaline Phosphatase, and Aspartate Transaminase by Isolated Rat Liver Cells
Authors: Anderson F.H. , Patterson Christine , Burton A.F.
Published: May 2008

Rats were fed liquid diets for 7 days containing either triolein or Liposyn, which is rich in linoleic acid, as fat sources, and liver cell suspensions were prepared following collagenase perfusion. The release from isolated cells of alkaline phosphatase and aspartate transaminase during a 3‐hr incubation did not differ. The uptake and release of 14C‐taurocholate during a brief incubation was lower but not significantly in Liposyn‐fed rats (0.1 > p > 0.05): the uptake was 9.74 ± 1.58 vs 16.7 ± 3.3 nmol/mg protein in triolein‐fed rats; the release was 3.17 ± 0.65 vs 5.35 ± 1.01 nmol/mg protein in triolein‐fed rats. The uptake of 14C‐aminolevulinic acid was similar in both groups, but release of 14C‐bilirubin during a 30‐min incubation was 5,420 ± 1010 in the Liposyn group vs 12,030 ± 2,200 dpm/ mg protein in the triolein group (p = 0.02). It is concluded that a diet high in linoleic acid decreases bilirubin release in isolated liver cells consistent with the ability of this diet to cause cholestasis in vivo. (Journal of Parenteral and Enteral Nutrition 9:477–479, 1985)
Increased Cholesteryl Ester Content in Liver of Mice Fed Lipid Emulsion Diets High in Polyunsaturated Fats
Authors: Burton A.F. , Anderson F.H.
Published: May 2008

Mice were fed a liquid diet containing different fat sources for 6 days and several biochemical parameters in the liver were examined. Mice fed diets containing Nutralipid or Liposyn as 45% of total calories had 30.5 ± 2.5 and 25.8 ± 3.7 nmol cholesteryl esters per milligram liver protein, respectively, as compared with 13.14 ± 2.4 for those fed regular mouse food and 13.7 ± 2.45 for those fed an emulsion containing mostly triolein as fat source. A similar increase in liver cholesteryl esters resulting from estrogen treatment has been proposed as the basis for changes resulting in decreased bile flow in the rat. It is suggested that the high content of polyunsaturated fatty acids in nutrient emulsions might be responsible for cholestasis sometimes observed in patients receiving these preparations. This is further supported by the observation that, as in the case of estrogen treatment, the cholesteryl ester level returned to normal when mice were treated with the detergent Triton WR‐1339. (Journal of Parenteral and Enteral Nutrition 9:480–482, 1985)
Plasma Carnitine Levels and Urinary Carnitine Excretion during Sepsis
Authors: Nanni Giuseppe , Pittiruti Mauro , Giovannini Ivo , Boldrini Giuseppe , Ronconi Paolo , Castagneto Marco
Published: May 2008

Carnitine is an indispensable factor for the β‐oxidation of medium‐ and long‐chain fatty acids, and it plays a possible role in the oxidation of branched‐chain amino acids. Plasma and urinary levels of free carnitine and short‐chain acyl‐carnitines were studied in 67 surgical patients, after non‐septic surgical procedures or during sepsis. The septic state was associated with increased urinary excretion of free carnitine (p < 0.001), as well as with lower plasma levels of short‐chain acyl‐carnitines (p < 0.001); the latter feature correlated with the level of hypermetabolism, as evaluated by the metabolic rate and by the arterial‐mixed venous O2 difference. In 26 patients during total parenteral nutrition D, L‐acetyl‐carnitine was administered (100 mg/kg/24 hrs, in continous iv infusion) and was associated, in septic patients only, with a significant decrease in the respiratory quotient, suggesting enhanced oxidation of low respiratory quotient substrates (fatty acids and/ or branched‐chain amino acids). Carnitine supplementation during total parenteral nutrition might be of theoretical benefit in some clinical conditions, such as sepsis, in which the following conditions coexist (1) enhanced utilization of substrates whose oxidation is partially or totally carnitine dependent; (2) prolonged absence of exogenous intake of carnitine (as in long‐term total parenteral nutrition); (3) eventual impairment of carnitine synthesis due to hepatic dysfunction; (4) increased, massive urinary loss of carnitine. (Journal of Parenteral and Enteral Nutrition 9:483–490, 1985)