bluuebunny/crossref_metadata_2025 huggingface dataset:
Decreased Plasma Fibronectin during Starvation in Man
Authors: Howard Lyn , Dillon Bruce , Saba Thomas M. , Hofmann Susan , Cho Eshin
Published: May 2008

This study evaluated the effect of 5 days of starvation followed by 5 days of refeeding on immunoreactive plasma and serum fibronectin and associated opsonic activity as studied by peritoneal macrophage monolayer bioassay in 12 healthy women volunteers. The temporal alteration of fibronectin was compared with the serum albumin, total iron‐binding capacity, and retinol‐binding protein levels. Fibronectin concentration and opsonic activity were also determined in two cachectic patients who were 61 and 78% of their ideal body weight. Prior to starvation, plasma fibronectin was 292 ± 20 μg/ml and serum fibronectin was 182 ± 16 in all subjects. After 5 days of starvation, immunoreactive fibronectin decreased (p < 0.05) by 20–25%. This decrease was not great enough to impair opsonic activity as tested by the in vitro macrophage assay. Starvation caused no decrease in serum albumin or total iron‐binding capacity, although retinol‐binding protein decreased by 35%. During refeeding, subjects were randomized to a diet with (n = 6) and without (n = 6) carbohydrate. After 5 days of refeeding, fibronectin levels were normalized on the carbohydrate‐containing diet, but were still low (82% of normal) on the carbohydrate‐free diet. Retinol‐binding protein did not fully normalize after 5 days of refeeding. In the two cachectic patients, fibronectin levels prior to total parenteral nutrition were 25 and 75% of normal. Thus, starvation can lower fibronectin levels and this protein is rapidly restored with adequate nutrition. (Journal of Parenteral and Enteral Nutrition 8:237–244, 1984)
Delayed Hypersensitivity Skin Testing in Elective Colorectal Surgery and Relationship to Postoperative Sepsis
Authors: Griffith C.D.M. , McLean Ross A.H.
Published: May 2008

Delayed hypersensitivity skin testing to five common recall antigens (Varidase, Candida, PPD, Trichophyton, and Mumps) was performed on 50 patients undergoing elective colorectal surgery. Eighteen patients showed an altered response to skin testing (11 relative anergy, seven total anergy) and this group of patients had a significant increase in both total septic complications (p < 0.001) and major septic complications (p < 0.05) following operation. Anergy in these patients did not correlate with nutritional status, but it did relate to stage of the tumor in patients with cancer. The low specificity of abnormal delayed hypersensitivity skin testing and its failure to be related to malnutrition limits the practical application of this technique in patients undergoing elective colorectal surgery. (Journal of Parenteral and Enteral Nutrition 8:279–280, 1984)
Experimental Approach to Prevention of Catheter‐Related Central Venous Thrombosis
Authors: Di Costanzo J. , Sastre B. , Choux R. , Reynier J.P. , Noirclerc M. , Cano N. , Martin J.
Published: May 2008

The role of catheter material in the formation of deep venous thrombosis during parenteral nutrition has been widely emphasized. Systematic venograms show central venous thrombosis in 20 to 33% of cases with polyethylene catheters and in 4% of cases with silicone catheters. Heparin infusion through the catheter diminishes but does not totally eliminate the risk of thrombosis. The aim of this study was to define the conditions under which the risk of thrombophlebitis was minimal. Four series of experiments were carried out, each on five rabbits. Catheters were inserted into the vena cava and, after 10 days, venograms were performed. The animals were then sacrificed, and the vena cava was macroscopically and microscopically studied. Plastic catheters were used in the first series, heparin‐Benzalkonium‐bonded plastic catheters in the second, silicone catheters in the third, and heparin‐Benzalkonium‐bonded silicone catheters in the fourth. The results revealed thrombosis of the vena cava and a fibrin sleeve around the catheters in series 1; thrombosis of the vena cava in series 2; a fibrin sleeve around the catheters in series 3; and neither thrombosis nor a fibrin sleeve in series 4. In conclusion, heparin‐Benzalkonium‐bonded silicone catheters appear to provide the best protection against thrombophlebitis by reducing the damage caused to the intima by the catheters and by slowing down platelet‐aggregation around them. (Journal of Parenteral and Enteral Nutrition 8:293–297, 1984)
Restoring Patency of Thrombosed Catheters with Cryopreserved Urokinase
Authors: Gale Gordon B. , O'Connor Dennis M. , Chu Jen‐Yih , Stanley Darwin
Published: May 2008

In order to eliminate wasting vials of urokinase, 5000 U/ml aliquots were reconstituted and frozen. The urokinase remained effective for clearing thrombosed catheters for as long as 9 months. When catheters become occluded, patency can be restored by previously frozen urokinase. (Journal of Parenteral and Enteral Nutrition 8:298–299, 1984)
The Estimation of 24‐Hour Urine Urea Nitrogen Excretion from Urine Collections of Shorter Duration in Continuously Alimented Patients
Authors: Sorkness Ronald
Published: May 2008

Urine urea nitrogen excreted in 24 hr is used to estimate nitrogen balance in patients. Normal diurnal variation of urea excretion may be less pronounced in patients alimented continuously, and a urine collection of shorter duration may be representative of the 24‐hr excretion. Five stabilized trauma center patients on continuous enteral or parenteral alimentation were studied with six consecutive 4‐hr urine collections analyzed for urine urea nitrogen content. Excretion rates for various lengths of urine collection were compared with the 24‐hr excretion rate. Urine collections spanning 4 or 8 hr frequently exceeded an error of 10% in predicting 24‐hr urea nitrogen excretion, while collections of 12 hr or more had small errors. A comparison of three consecutive 8‐hr collections was suggestive of diurnal variation existing under these conditions. (Journal of Parenteral and Enteral Nutrition 8:300–301, 1984)
Dietary Compliance in the Short Bowel Syndrome
Authors: Gilchrist P.N. , Phillips P.J. , Heddle R. , Harley H.
Published: May 2008

Psychologic problems associated with the short bowel syndrome have received limited recognition. The literature has previously considered these problems as due to the underlying condition or its treatment. We present a case illustrating these as well as addressing the problem of compliance to treatment that has been previously neglected. The occurrence of metabolic acidosis in this patient whenever there was not strict dietary adherence to diet provide a ready marker to her noncompliance. (Journal of Parenteral and Enteral Nutrition 8:315–316, 1984)
Rapid Turnover Transport Proteins, Plasma Albumin, and Growth in Low Birth Weight Infants
Authors: Giacoia George P. , Watson Susan , West Kerstin
Published: May 2008

The purpose of this investigation was to establish normative data and to detemine the value of measuring rapid plasma turnover proteins in low birth weight infants during the neonatal period. Forty‐three premature, adequate for gestational age infants were divided in three groups according to their birth weight: group A <1000 g, group B 1001 to 1500 g, group C 1501 to 2000 g. Weekly anthropometric measurements and biochemical determinations were obtained. Anthropometric measurements included weight, crown heel length, midtricipital skinfold thickness, and midarm circumference. Biochemical studies in plasma included total proteins, albumin, prealbumin, and retinol‐binding protein. A significant increase in prealbumin concentration preceded weight gain. The elevation in prealbumin concentration was statistically significant (p < 0.02) for the combined data from all groups and for infants included in group B and C (p < 0.05). No concomitant changes were demonstrated in plasma retinol‐binding protein, albumin, or total proteins. The transient rise in prealbumin plasma concentrations remains unexplained, but may be related to the infant's nutritional status. (Journal of Parenteral and Enteral Nutrition 8:367–370, 1984)
Pancreatic Secretory Responses to Intravenous Hyperalimentation and Intraduodenal Elemental and Full Liquid Diets
Authors: Stabile Bruce E. , Borzatta Marcello , Stubbs Richard S.
Published: May 2008

Intravenous hyperalimentation and enteral elemental diets have both been advocated for the nutritional support of patients with acute pancreatitis, pancreatic fistula, and proximal small bowel fistula. The exocrine pancreatic responses to these nutrients compared to one another and to full liquid diet have been inadequately studied. Therefore, pancreatic protein, volume, and bicarbonate responses to graded doses of (1) intravenous hyperalimentation, (2) intraduodenal elemental diet, and (3) intraduodenal full liquid diet were compared in duplicate experiments in five dogs with chronic pancreatic fistulas. Both intraduodenal elemental and full liquid diets caused comparable and significant dose‐related increases in pancreatic protein, volume, and bicarbonate outputs over basal levels (p < 0.05). In contrast, there was no stimulation of pancreatic secretion by intravenous hyperalimentation. It therefore appears that of the methods studied, only intravenous hyperalimentation can provide full nutritional support while maintaining the pancreas at rest. (Journal of Parenteral and Enteral Nutrition 8:377–380, 1984)
Effect of Branched‐Chain Amino Acids and Insulin on Postinjury Protein Catabolism in Growing Animals
Authors: Maksoud João Gilberto , Tannuri Uenis
Published: May 2008

Muscle proteolysis continues to occur in hyper‐catabolic states despite the administration of carbohydrates and proteins. Recent clinical and experimental studies have demonstrated that, under catabolic conditions, treatment with either branched‐chain amino acids (BCAA) or insulin may decrease negative nitrogen balance. However, the use of BCAA‐enriched solutions to inhibit muscle proteolysis has never been tested in growing animals. A study was therefore undertaken to assess the effectiveness of such solutions, with or without insulin, as compared to a more balanced amino acid solution, in preventing or diminishing postinjury protein catabolism in growing animals. Fifteen‐day‐old rabbits, exposed to standard moderate trauma in the form of crushing the muscle mass of one rear thigh, received one of two amino acid formulations— a balanced amino acid solution (18.8% BCAA) or a 35% BCAA‐enriched solution—for 96 hr. Insulin was given to subgroups of both series. The results indicate that: (1) nitrogen balance in nontraumatized animals is clearly superior when balanced amino acids are administered; (2) BCAA‐enriched solutions may decrease postinjury muscle protein catabolism; (3) after trauma, insulin also has a nitrogen‐conserving effect, which is demonstrated when it is combined both with BCAA‐enriched (35%) and balanced amino acid (18.8%) solutions. However, a better nitrogen balance is achieved when insulin is associated with the balanced amino acid solution. (Journal of Parenteral and Enteral Nutrition 8:416–420, 1984)
Bleeding Disorder from the “Fat Overload” Syndrome
Authors: Campbell A.N. , Freedman Melvin H. , Pencharz P.B. , Zlotkin S.H.
Published: May 2008

The fat overload syndrome developed in a 7‐yr‐old girl receiving total parenteral nutrition with 20% Intralipid. She developed a bleeding disorder characterized by severe hematemesis that appeared to be due to abnormal platelet function associated with platelet phagocytosis of lipid demonstrable by electron microscopy. The platelet defect and bleeding reversed when the lipemia cleared. (Journal of Parenteral and Enteral Nutrition 8:447–449, 1984)
In Vitro Flow Rates of Enteral Solutions through Nasoenteric Tubes
Authors: Hearne Barbara E. , Besser Pamela M. , Groshen Susan , Daly John M.
Published: May 2008

Enteral solutions must flow freely through nasoenteric tubes selected for gravity drip administration particularly in outpatients receiving nutritional support. This study determined in vitro flow rates of solutions with intact protein and hydrolyzed protein sources with various caloric densities. Each solution was infused through silicone rubber and polyurethane tubes of various lengths and bore sizes. Flow rates were measured five times at 25°C using formula bags and drip sets hung at a uniform height and tubes uniformly positioned in a collecting vessel. Data are presented for tubes and formulas tested. Recommendations for selection of tubes for gravity drip administration are made based on flow rate data, patient comfort, administration convenience, and patient tolerance to osmolality. (Journal of Parenteral and Enteral Nutrition 8:456–459, 1984)
Specialized Nutrition Support: Patterns of Care
Authors: Seltzer Murray H. , Slocum Bernadette A. , Cataldi‐Betcher Emma L. , Seltzer David L. , Goldberger David J.
Published: May 2008

A prospectively studied series of 1072 patients who received specialized nutritional support are presented to evaluate the patterns of such care in a large nonuniversity teaching center. Age, service, materials used, routes of administration, complications, assessment parameters, duration of treatment, diagnoses, and survival statistics are presented. Such patterns are considered to be of importance to medical scientists, basic researchers, hospital administrators, governmental agencies, and members of the health care insurance industry. (Journal of Parenteral and Enteral Nutrition 8:506–510, 1984)
Mechanical Complications from Insertion of Subclavian Venous Feeding Catheters: Comparison of de Novo Percutaneous Venipuncture to Change of Catheter Over Guidewire
Authors: Newsome H.H. , Armstrong Carl W. , Mayhall Glen C. , Sugerman Harvey J. , Miller Kathy , Rich Alan , Dalton Harry
Published: May 2008

Since a percutaneous catheter insertion into the subclavian vein can be tedious, time consuming, and risky, we have compared the morbidity of 137 de novo subclavian catheter insertions to that of 93 reinsertions over guidewire. Mechanical complications were significantly higher (p < 0.03) in those with catheter insertions (8.8%) than in those with the guidewire insertions (2.2%). These included pneumothorax (4), arterial puncture (4), catheter‐size bleed (3), and hemothorax (1) in the catheter insertion group and local bleeding (1) and hydrothorax (1) in the guidewire insertion group. The difference in complications between methods is probably inherent in the techniques. Operator experience was not a factor: 55% of the physicians in each group had previously done less than 26 subclavian venous catheterizations. Preliminary analysis indicates that the infection rate, as determined by semiquantitative, cultures, is the same in each group. When considering the equal potential for infection, we conclude that change over a guidewire is an acceptable alternative to contralateral de novo percutaneous subclavian venipuncture for feeding catheter insertion. In view of fewer mechanical complications and greater ease of insertion, change of subclavian feeding catheters by guidewire is probably the method of choice. (Journal of Parenteral and Enteral Nutrition 8:560–562, 1984)
Cholelithiasis in Infants: Association with Parenteral Nutrition
Authors: Suita Sachiyo , Ikeda Kechi , Naito Kenichi , Doki Tsunenori , Handa Noritoshi
Published: May 2008

Reported herein are two cholelithiasis‐afflicted infants with a common inability to tolerate enteral feeding necessitating parenteral nutrition. One of the infants received parenteral nutrition for 5 months because of intestinal dysfunction and enterocolitis secondary to extensive aganglionosis, while the second child was premature and placed on parenteral nutrition because of bowel dysfunction after surgery to repair high jejunal atresia and a right diaphragmatic hernia. The relationship between parenteral nutrition and cholelithiasis is discussed. (Journal of Parenteral and Enteral Nutrition 8:568–570,1984)
Tissue Nitrogen and Potassium Variation in Trauma, Starvation, and Realimentation
Authors: Wood C.D. , Goumas W. , Pollard M. , Brinker J.E.
Published: May 2008

Total body or exchangeable potassium is used as an important indicator of body cell mass in the study of body composition. Body composition studies have been used extensively in the study of nutrition but recent work has questioned the validity of using changes in total body potassium as a measure of protein or nitrogen variation. To investigate the relationship between tissue nitrogen and potassium during nutritional manipulation 382 tissue samples from 100 surgical patients were analyzed by Kjeldahl analysis for nitrogen content and flame photometric analysis for potassium content. Nitrogen was related to potassium in parenchymous or cellular tissues by the relationship N (mg/g) = 14.7 + 0.17 K (μEq/g). The tissue content of the two elements was highly correlated (r = 0.80, p ≤ 0.001). For skeletal muscle a similar relationship existed N (mg/g) = 16.6 + 0.15 K (μEq/g) (r = 0.76, p ≤ 0.001). These relationships held for all nutritional states and degrees of trauma and nutritional manipulation. In sequential parenchymous tissue samples obtained from 15 subjects ΔN/ΔK = 0.17 ± 0.03 mg/uEq. Nonparenchymous or acellular tissue nitrogen and potassium were poorly correlated. The potassium content was very low in these tissues. Exchangeable potassium was a valid indicator of parenchymous tissue nitrogen and as such a legitimate measure of nutritional status. (Journal of Parenteral and Enteral Nutrition 8:665–667, 1984)
Gastric Relaxation prior to Enteral Feeding
Authors: Heitkemper Margaret , Hansen Barbara C.
Published: May 2008

The purpose of this investigation was to determine whether the observed gastric relaxation associated with the intragastric infusion of a liquid meal could be conditioned to the temporarily associated auditory cues to enteral feeding and thus produce decreased intragastric pressures under “sham” feeding conditions. Eight normal volunteers received either enteral feedings or sham feedings followed by enteral feedings on 72 separate trial days. The feedings were administered at a constant rate via a Harvard infusion pump. Intragastric pressure changes were monitored by an open tipped pressure cannula which was attached to the feeding tube. A sham feeding consisted of carrying out all preparatory procedures including activation of the feeding pump which was visually screened from the patient. Without the subjects' knowledge the liquid diet was diverted to another reservoir instead of through the nasogastric tube. This sham type infusion produced a gastric response similar to the response to a normal diet infusion as evidenced by a decrease in intragastric pressure and a suppression of irregular high amplitude contractions that are associated with hunger. This anticipatory response to enteral feeding indicative of prospective relaxation of the stomach may enhance the subsequent accommodation to a volume of diet. Additional studies are needed to investigate the importance of visual and auditory cues on patient tolerance of enteral feedings. (Journal of Parenteral and Enteral Nutrition 8:682–684, 1984)
Metabolic Bone Disease in a Patient on Long‐Term Total Parenteral Nutrition: A Case Report with Review of Literature
Authors: Seligman James V. , Basi Surinder S. , Deitel Mervyn , Bayley Theodore A. , Khanna Rokesh K.
Published: May 2008

A 38‐yr‐old woman with Crohn's disease and short bowel on home total parenteral nutrition was studied. Metabolic bone assessments were done prospectively. Daily total parenteral nutrition included 500 IU vitamin D2, 6 to 8 mmol calcium, 10 to 15 mmol phosphorus, 12 to 16 mmol magnesium, and trace elements including zinc, copper, and chromium. After 6 months, while asymptomatic, chemistries and x‐rays were normal. Calcium bone index was 0.79. The bone biopsy showed mild hyperkinetic picture. At 26 months, she had a spontaneous rib fracture and bone pains in the hands and lower back. Chemistries were normal except that calcium bone index was 0.75. Bone biopsy showed mild osteomalacia. Vitamin D2 was withdrawn for 2 months and then restarted at 1000 IU/wk. She improved symptomatically for 4 months, but then developed rib fractures, and the bone pains recurred. After 48 months, chemistries were normal, except that the calcium bone index was 0.57 and bone biopsy showed regression of osteomalacia toward normal. Vitamin D2 was now withdrawn for 6 months, resulting in loss of bone pain. Vitamin D2 may produce a metabolic bone disease, requiring prolonged withdrawal for improvement. (Journal of Parenteral and Enteral Nutrition 8:722–727, 1984)
Does Long‐Term Home Parenteral Nutrition in Adult Patients Cause Chronic Liver Disease?
Authors: Bowyer B.A. , Fleming C.R. , Ludwig J. , Petz J. , Mcgill D.B.
Published: May 2008

Sixty patients with gut failure were treated with home parenteral nutrition for 2000 patient months. Fifty‐one of these 60 patients had either no abnormalities or mild and transient elevations of their liver chemistries and did not have liver biopsies. Nine (15%) of 60 patients had abnormalities of liver tests that persisted from 8 to 95 months (median, 18 months) which prompted one or more liver biopsies per patient. Three patients had prolonged jaundice, one died of hepatic encephalopathy, and another with protracted intrahepatic cholestasis died following a biliary tract exploration. A third patient remains ill with signs and symptoms of chronic liver disease. Steatohepatitis was found in eight of the nine patients and was characterized by centrilobular and midzonal microvesicular and macrovesicular fatty changes with fat cysts, focal necrosis, and mixed inflammatory infiltrates. Centrilobular fibrosis was present in three patients and evidence of nodular regeneration in one. In the three patients demonstrating cholestasis, bile pigment was identified both in hepatocytes and canaliculi. Ceroid pigment in Kupffer cells was a consistent finding and much more severe than expected from the mildness of the hepatitis. Persistent abnormalities of liver chemistries in nine patients and progressive liver disease while receiving home parenteral nutrition in three patients are quite worrisome and suggest that home parenteral nutrition‐associated steatohepatitis with or without cholestasis may progress to chronic liver disease. (Journal of Parenteral and Enteral Nutrition 9:11–17, 1985)
Intestinal Consumption of Intravenously Administered Fuels
Authors: Souba Wiley W. , Scott Thomas E. , Wilmore Douglas W.
Published: May 2008

Total parenteral nutrition has been extensively used to feed patients with a variety of gastrointestinal diseases, but little attention has focused on the nutritional requirements of the gut. To investigate intestinal consumption of intravenously administered nutrients, uptake of three principal fuels determined from in vitro studies was quantitated in seven awake, unrestrained dogs. Portal blood flow was measured by a dye dilution technique and, simultaneously, substrate samples were obtained from chronic indwelling arterial and portal venous catheters. Studies were performed during a postabsorptive basal period and during separate infusions of glutamine (0.10 mmol/kg. min), glucose (0.10 mmol/kg·min), and β‐hydroxybutyrate, (0.40 mmol/kg·min). During the basal period there was a significant arterial‐portal vein gradient for glucose (144 ± 26 μmol/liter) and glutamine (49 ± 11 μmol/liter). These substances were taken up by the gut at rates of 4.11 ± 1.23 and 1.43 ± 0.19 μmol/kg·min, respectively. No significant uptake of β‐hydroxybutyrate was determined in the basal studies (0.27 ± 0.10 μmol/kg·min). During substrate infusion, gut glucose uptake was unchanged (2.68 ± 1.67 μmol/kg·min, NS), but consumption of glutamine (4.60 ± 0.66 μ mol/kg·min, p < 0.001) and β‐hydroxybutyrate (4.33 ± 0.71 μmol/kg·min, p < 0.001) increased significantly. During parenteral feedings in patients with gastrointestinal disorders, circulating levels of β‐hydroxybutyrate and glutamine are often low, and glutamine is absent from standard amino acid solutions. Current parenteral formulation may not provide appropriate fuels for the gastrointestinal tract. (Journal of Parenteral and Enteral Nutrition 9:18–22, 1985)
Multipurpose Central Venous Access in the Immunocompromised Pediatric Patient
Authors: Colombani Paul M. , Dudgeon David L. , Buck James R. , Miller David M. , Ghory Mary Jo , Buckloo Colleen , Haller J. Alex
Published: May 2008

During a 21‐month period, 50 consecutive pediatric oncology patients undergoing bone marrow transplantation and/or cytoreductive chemotherapy had 61 silastic central venous catheters placed to facilitate their therapy. All catheters were used for medications, routine blood sampling, and transfusions, with 45% also used for hyperalimentation and 57% used for bone marrow transplantation. Catheters were utilized during both inpatient and outpatient therapy periods. Total catheter days numbered 8455, an average of 139 days per catheter. Forty‐seven catheters (77%) were removed electively or were in place at time of patient death. Seven were removed for mechanical complications (1/1409 catheter days). Four additional episodes of presumed catheter sepsis were managed with antibiotics and did not require catheter removal (40% of septic episodes). One catheter is still in place after 585 days. Complication rates were not influenced by this multiple use protocol. With standardized catheter care and surveillance, multipurpose, long‐term central venous access can be safely utilized in the immunosuppressed pediatric patient. (Journal of Parenteral and Enteral Nutrition 9:38–41, 1985)
Intranasal Retraction of Nasogastric Feeding Tube: Case Report and Suggestion for Design Modification
Authors: Bohnker Bruce K. , Artman Lee E. , Hoskins William J.
Published: May 2008

A 61‐year‐old black woman was admitted with intermittent small bowel obstruction following multiple therapies for recurrent ovarian carcinoma. Conservative enteric therapy with central hyperalimentation was begun prior to surgical intervention. After approximately 3 wk without resolution, surgical bypass of the obstructed area was performed for palliation. With the return of bowel function, continuous enteral feeding was utilized. During placement of enteral feeding tube, the proximal end spontaneously retracted into the patient's nasal cavity with associated patient distress. After some difficulty, the feeding tube was removed. Simple design modification of the proximal portion of the nasogastric feeding tube should prevent such complication. The addition of “wings” to the proximal end should be considered as a modification to prevent similar occurrences. (Journal of Parenteral and Enteral Nutrition 9:53–54, 1985)
Nitrogen Utilization from Elemental Diets
Authors: Albina Jorge E. , Jacobs Danny O. , Melnik George , Settle R. Gregg , Stein T. Peter , Guy David , Rombeau John L.
Published: May 2008

Repletion experiments were performed in malnourished, chair‐adapted primates to explore recently reported differences in nitrogen utilization from elemental diets. Two elemental diets were fed consecutively for 8 days through a gastrostomy. Diet C (maltodextrins, peptides, crystalline amino acids) resulted in: larger weight gain (F1,6 = 17.93, p < 0.01); smaller decrease of serum albumin (F1,5 = 11.2, p < 0.015), larger increase in total iron binding capacity (F1,6 = 30.6, p < 0.002), and a more positive nitrogen balance (F1,6 = 30.4, p < 0.002) than diet V (glucose oligosaccharides, crystalline amino acids). Diet C was considered to be more effective in the nutritional repletion of the study animals. Additional experiments were performed in normal human volunteers to investigate the metabolic fate of ingested glutamine and whether the rapid catabolism and excretion of the amido nitrogen of this amino acid, which constitutes 11.56% of total nitrogen in diet V, could explain the differences observed in primates in our study and in human subjects by other authors. Six normal volunteers were fed 15N amino glutamine, 15N alanine, or 15N H4Cl. Similar amounts of 15N from Gln and Ala were excreted in 10 hr. The amido group of glutamine does not seem to be metabolized differently from the α‐amino group of alanine under the conditions of the study. The marked differences in nitrogen utilization from the study diets could not be explained by the presence of relatively large amounts of glutamine in one of them. (Journal of Parenteral and Enteral Nutrition 9:189–195, 1985)
Hyperalimentation during Pregnancy: A Case Report
Authors: Martin Ramon , Trubow Marshall , Bistrian Bruce R. , Benotti Peter , Blackburn George L.
Published: May 2008

Severe, prolonged hyperemesis gravidarum was managed with total parenteral nutrition throughout three trimesters. Reversal of maternal weight loss and adequate fetal growth were achieved. A viable, large for gestational age infant was delivered prematurely at 34 wk. Serum values for selected nutrients, taken at delivery from maternal and cord blood, suggest that present estimates of parenteral nutritional needs for vitamins and minerals during pregnancy are probably low. An important corollary to maternal weight gain and caloric intake is to provide adequate nutrition as early as possible for optimal fetal weight gain. (Journal of Parenteral and Enteral Nutrition 9:212–215, 1985)
Significance of Hypoalbuminemia in Pediatric Oncology Patients— Malnutrition or Infection?
Authors: Merritt Russell J. , Kalsch Maryse , Roux Lorraine Davis , Ashley‐Mills Judith , Siegel Stuart S.
Published: May 2008

Nutritional status was evaluated on 210 occasions in 90 pediatric oncology inpatients during a 7‐month period; 39 had solid tumors and 51 leukemia. Ages ranged from 3 months to 20 yr. Nutritional parameters were defined as normal, “at risk,” or “probably malnourished.” Fifty‐seven and 29% of assessments revealed at least one parameter “at risk” or “probably malnourished,” respectively. Prognosis was negatively related to the number of abnormal nutritional parameters. Serum albumin was most frequently abnormal. However, on most occasions, hypoalbuminemia was associated with weight/height, arm muscle area, and triceps skinfold measurements in the normal range. In order to further identify determinants of serum albumin, we analyzed dietary, chemotherapy, and temperature data in 10 prospectively studied leukemia patients, half of whom received parenteral nutrition. In these patients there was little relationship of serum albumin to chemotherapy or dietary intake. In all of these patients, especially those receiving total parenteral nutrition, low serum albumin was highly associated with fever (p < 0.0005). We concluded that febrile illness is an important determinant of abnormal serum albumin concentrations. In pediatric cancer patients, abnormal serum albumin may more often reflect the acute metabolic response to fever and infection than depletion of body mass. (Journal of Parenteral and Enteral Nutrition 9:303–306, 1985)
Effect of Nucleotide and Nucleoside Mixture on Rats Given Total Parenteral Nutrition after 70% Hepatectomy
Authors: Ogoshi Shohei , Iwasa Masato , Yonezawa Takeshi , Tamiya Tatsuo
Published: May 2008

After partial hepatectomy rats were used as a model of patients with liver tumor after extensive hepatectomy. Supplementation of a nucleotide and nucleoside mixture to the total parenteral nutrition solution in rats after 70% hepatectomy resulted in earlier restoration of the nitrogen balance in the first 3 days than the solution without this supplementation. This supplementation had no unfavorable effects on the compositions of the blood and urine, and particularly the metabolites of nucleic acids such as uric acid, β‐alanine, and β‐aminoisobutyric acid. A suitable ratio of nucleotides plus nucleoside to amino acids was tentatively concluded to be 1:2 g N with a calorie supply of 400 kcal. (Journal of Parenteral and Enteral Nutrition 9:339–342, 1985)
Zinc Deficiency in Surgical Patients: A Clinical Study
Authors: Fawaz Fawzi
Published: May 2008

Four stressed surgical patients who had different diseases are presented. They had dermatitis associated with low serum zinc levels but were not on total parenteral nutrition. The range of serum zinc varied between 25 and 56 μ/dl when first seen. All but one had hypoalbuminemia and anemia; one patient had diarrhea. When measured, other microelements were normal. These patients were thought to have zinc deficiency and all their symptoms responded favorably to oral zinc and nutritional support. A highlight of previous reported cases of zinc deficiency is presented along with a brief review of the subject. Acute stress including major operations will decrease the serum zinc level temporarily. Zinc deficiency may be the result of chronic zinc depletion caused by other conditions. Chronic leg ulcers are associated with low serum zinc levels and might precipitate zinc selectively. A zinc supplement will help in the healing of these ulcers and wounds in general. The possibility of an interrelationship of zinc and other microelements is raised but is not clear. (Journal of Parenteral and Enteral Nutrition 9:364–369, 1985)
A Technique for Enteral Feeding In Unrestrained Chronic Dogs
Authors: Langaniere Serge , Maestracci Dominic
Published: May 2008

A new apparatus for the continuous infusion‐feeding of unrestrained dogs is described. The swivel we designed, like the whole apparatus, is quite simple but has proven to be totally effective inasmuch as it needs no day‐to‐day care. The system has been satisfactorily used for jejunal feeding for periods of up to 33 days. Dogs were very easily acclimatized to this apparatus; the majority of animals lost weight at the beginning of enteral feeding but recovered their body weight after 19 days if a daily caloric intake fixed at a minimum of 100 kcal/kg body weight was provided. The mechanical complications secondary to catheterization of the gastrointestinal tract can be abolished by anchoring the vinyl tube to the intestinal wall. The dog appeared to be an excellent species for long‐term experiments as little attention was required during the infusion period; because general adaptation to Isocal was good, feeding hypercaloric amounts of diet was unnecessary to sustain adequate body weight. This model was found to be well suited for the surgical and feeding techniques required for a long‐term study of enteral nutrition. (Journal of Parenteral and Enteral Nutrition 9:370–374, 1985)
“Nutritional” Markers as Prognostic Indicators of Postoperative Sepsis in Cancer Patients
Authors: Bozzetti Federico , Migliavacca Silvana , Gallus Giuseppe , Radaelli Giovanni , Scotti Adriana , Bonalumi Maria Grazia , Ammatuna Mario , Sequeira Carmen , Terno Giovanni
Published: May 2008

A study was undertaken to identify the nutritional parameters associated with a high risk of postoperative sepsis. The nutritional status of 162 cancer patients subjected to clean or clean‐contaminated elective surgery was preoperatively evaluated according to the following parameters: percentage weight loss, arm circumference, triceps skinfold, arm muscle circumference, creatinine‐height index, total serum protein, serum albumin, total iron‐binding capacity, cholinesterase, peripheral lymphocytes, complement C3‐C4 components, and skin tests. Patients were followed postoperatively according to a precise protocol to classify them as infected or noninfected. Postoperative sepsis was present in 40 patients who had significantly different mean values for four nutritional parameters from those of 114 patients with no complications, ie, total serum protein, 6.60 vs 6.99 g/dl, p = 0.008; serum albumin, 3.39 vs 3.66 g/dl, p = 0.001; total iron‐binding capacity 301.32 vs 337.17 mmg/dl, p = 0.006; and cholinesterase, 2389.77 vs 2770.10 mU/ml, p = 0.005. Moreover, the relative risk and the attributable risk for these variables were evaluated and the significance was tested by the χ2 test. By using multiple logistic analysis it appeared that only total serum protein and total iron‐binding capacity gave an independent contribution to the risk of postoperative sepsis, while serum albumin disappeared and cholinesterase became non significant when the contribution of the first two variables was accounted for. It was also possible to identify, in a small number of patients, combinations of two variables that were associated with a very high risk of postoperative sepsis. Although these parameters appear to be reliable indicators of postoperative infections, we do not know if they are only simple nonspecific markers of malnutrition or whether they are directly involved in host defense mechanisms. This point warrants further discussion (Journal of Parenteral and Enteral Nutrition 9:464–470, 1985)
Blood Hemoglobin: A Possible Predictor of Central Venous Catheter‐Related Thrombosis in Parenteral Nutrition
Authors: Jacobson Stefan , Brismar Bo
Published: May 2008

The biochemical records of 43 patients given nutritional support via a central venous catheter (CVC) for between 7 and 111 days (mean 28 days) without anticoagulant therapy were reviewed. On completion of the parenteral nutrition, phlebography was performed via the CVC. Patients developing CVC‐related thrombosis (22/43, 51%) were assigned to group I and those without this phlebographic finding (21/ 43, 49%) to group II. The blood (B‐) hemoglobin concentration before catheterization was higher in group I than in group II, the values being 121 ± 16 (mean ± SD) and 106 ± 13 g/liter, respectively. An initial B‐hemoglobin level above 127 g/liter showed a high positive accuracy of prediction for CVC‐related thrombosis and on this basis 89% (8/9) of the patients were correctly assigned to group I, whereas an initial B‐hemoglobin level below 111 g/liter showed a lower accuracy of prediction for a normal phlebographic status and on this basis 71% (12/ 17) of the patients were correctly assigned to group II. The specificity of the test criteria—B—hemoglobin >127 and <111 g/liter—was high, with values of 95% (20/21) and 77% (17/22), respectively, whereas the sensitivity was low; only 36% (8/22) of group I had an initial B‐hemoglobin above 127 g/liter and in group II 57% (12/21) recorded a value below 111 g/liter. It is concluded that if a patient has an initial B‐hemoglobin concentration of more than 127 g/liter there is a high risk that CVC‐related thrombosis will develop during parenteral nutrition lasting 1 wk or more. (Journal of Parenteral and Enteral Nutrition 9:471–473, 1985)
A Technique for Tunneling Central Venous Catheters
Authors: Klein Michael D. , Coran Arnold G.
Published: May 2008

Tunneling the central venous catheter from the venous insertion site in the subclavicular or cervical area to the exit site on the chest wall can be difficult, especially in small children with a very convex chest wall. We present a technique which avoids many of the problems encountered with previously described methods.
Selenium and Vitamin E Stability in Parenteral Solutions
Authors: Mcgee C.D. , Mascarenhas M.G. , Ostro M.J. , Tsallas G. , Jeejeebhoy K.N.
Published: May 2008

Stability of α‐tocopherol acetate and selenium in amino acid/dextrose solutions with SoluZyme or MVI‐1000 vitamin injections was evaluated following exposure to fluorescent lighting and room temperature, and after flowing through an infusion apparatus. The stability of selenium in parenteral solutions for a 10‐wk period was also determined. In each condition no significant loss of α‐tocopherol acetate or selenium was observed. It was concluded that α‐tocopherol acetate and selenium as selenious acid are stable in parenteral solutions and no significant loss occurs during delivery to patients. (Journal of Parenteral and Enteral Nutrition 9:568–570, 1985)
Maintenance of Skeletal Muscle Intracellular Glutamine during Standard Surgical Trauma
Authors: Kapadia C. Raja , Colpoys Michael F. , Jiang Zhu‐Ming , Johnson Daniel J. , Smith Robert J. , Wilmore Douglas W.
Published: May 2008

Skeletal muscle glutamine (GLN) concentration falls following injury and infection. In an attempt to prevent this decline and to characterize its influence on the efflux of amino acid (AA) from skeletal muscle, we administered varying quantities of AA (0, 2, and 4 g/kg·day) as saline or AA solutions with or without GLN enrichment to 22 postoperative dogs. Plasma and muscle AA were determined before and 24 hr after standard laparotomy. Hindquarter AA efflux was measured at 6 and 24 hr. Skeletal muscle nitrogen declined in saline controls (69.8 ± 8.5 us 52.8 ± 8.4 mmol/liter; p < 0.01), largely due to the fall in intracellular GLN (21.48 ± 3.21 us 15.86 ± 3.80; p < 0.05). Similar alterations were seen in the animals receiving 2 g/kg. However, both intracellular nitrogen and GLN were maintained in animals receiving 4 g/kg, whether the AA solutions contained GLN or not (skeletal muscle nitrogen before 64.3 ± 8.6 mmol/l vs 65.4 ± 7.0 after, GLN 19.2 ± 3.4 vs 19.9 ± 3.0). Hindquarter AA efflux was reduced in those animals at 6 hr compared with saline‐treated animals (—6.52 ± 1.8 and ‐7.70 ± 5.90 vs ‐19.05 ± 4.06 μmol/kg·min; p < 0.05). Intracellular GLN can be maintained during operative stress with adequate nitrogen infusion. Replacing 50% of the balanced AA solution with GLN resulted in equally effective maintenance of intracellular GLN levels and a comparable reduction in skeletal muscle AA efflux. Preservation of normal intracellular GLN levels with adequate AA nutrition may be essential for the conservation of muscle protein. (Journal of Parenteral and Enteral Nutrition 9:583–589, 1985)
VA Cooperative Study on Alcoholic Hepatitis III: Changes in Protein‐Calorie Malnutrition Associated with 30 Days of Hospitalization with and without Enteral Nutritional Therapy
Authors: Mendenhall C. , Bongiovanni G. , Goldberg S. , Miller B. , Moore J. , Rouster S. , Schneider D. , Tamburro C. , Tosch T. , Weesner R. ,   VA COOPERATIVE STUDY GROUP ON ALCOHOLIC HEPATITIS
Published: May 2008

Patients with moderate to severe alcoholic hepatitis and features of protein‐calorie malnutrition were studied with respect to changes in their nutritional status during 30 days of hospitalization. Thirty‐four patients served as controls, were given a 2500 kcal hospital diet and allowed to eat ad libitum. Twenty‐three patients were given, in addition to the hospital diet, a nutrition supplement high in calories, protein, and branched‐chain amino acids (Hepatic Aid). Because of anorexia, the controls consumed lesser amounts of both calories and protein while those given the nutritional therapy exceeded their estimated energy requirements (116.1 %) and consumed a mean of 98.3 g of protein per day. This was well tolerated despite the fact that portal systemic encephalopathy was present in 72% of the patients. Mortality associated with the liver disease was comparable in both groups, 16.7% in the treated us 20.6% in the controls. In those patients that survived the 30 days of hospitalization, clinical and biochemical tests of liver injury improved in both groups. With respect to their nutritional status, those given nutritional therapy showed significant improvement in six of the nine parameters (67%) used to assess nutrition. In the controls significant improvement was observed in only two nutritional parameters (22%) while three parameters (33%) deteriorated further. These three were all associated with calorie deprivation (marasmus). This study suggests that patients with acute alcoholic hepatitis require additional nutritional therapy to maintain and improve their nutrition parameters, especially those related to marasmus; and that Hepatic Aid is well tolerated for this purpose. (Journal of Parenteral and Enteral Nutrition 9:590–596, 1985)
Monoclonal Gammopathy Associated with Crohn's Disease during Treatment with Total Parenteral Nutrition
Authors: Nanji Amin A.
Published: May 2008

A patient with Crohn's disease developed monoclonal gammopathy while receiving total parenteral nutrition. There was no evidence of worsening of the primary disorder or presence of infection or malignancy. (Journal of Parenteral and Enteral Nutrition 9:621–622, 1985)
Enriched Branched‐Chain Amino Acid Formula Versus a Casein‐Based Supplement in the Treatment of Cirrhosis
Authors: Christie Mary L. , Sack David M. , Pomposelli James , Horst Douglas
Published: May 2008

An orally administered branched‐chain amino acid (BCAA) rich supplement (T), Travasorb‐Hepatic was compared to a casein based supplement (E), Ensure, in a randomized double‐blind cross‐over study in eight malnourished, stable cirrhotics unable to achieve a daily dietary protein intake of 1.0 g/kg. Doses of antiportal systemic encephalopathy drugs remained constant and a baseline 1000 kcal, 40 g dietary protein intake was encouraged. To this diet, supplemental protein was added in daily 20‐g increments to a maximum of 60 g supplemental protein. Mental status, asterixis, and number connection tests were assessed daily and an antiportal systemic encephalopathy index calculated. There was no significant difference in the mean intake of dietary protein (T, 33.7 ± 4.0 g; E, 26.7 ± 10.8 g), supplemental protein (T, 43.1 ± 8.3 g; E, 47.9 ± 7.1 g), or N2 balance (T, 4.2 ± 3.7 g; E, 3.4 ± 4.4) between treatment trials. The antiportal systemic encephalopathy index improved on E, with no significant change in the BCAA:aromatic acid molar ratio. This ratio improved on T (1.02 ± 2.0 to 2.7 ± 1.1), but was not accompanied by improvement in the antiportal systemic encephalopathy index. The improved protein tolerance in both groups was not further increased by a highly enriched BCAA formula compared to one with a moderate BCAA content from a natural dietary protein source. Thus, both conventional casein‐based supplements and enriched BCAA formulas are well tolerated and can be safely and effectively used as an integral part of diet therapy. (Journal of Parenteral and Enteral Nutrition 9:671–678, 1985)
Fatty Acid Changes in Plasma Lipids and Lymphocyte Phospholipids after Infusion of Intralipid to Newborn Infants
Authors: Andersen G.E. , Christensen N.C. , Johansen K.B.
Published: May 2008

The fatty acid composition of the major plasma lipids and blood lymphocyte phospholipids was studied in four patients before and after 1 month of parenteral nutrition including 2 to 3 g/kg/day of Intralipid fat and in four matched controls before and after 1 month of breast‐feeding. After treatment with Intralipid the concentration of polyunsaturated fatty acids including linoleic acid increased in all plasma lipids. The total concentration of polyunsaturated fatty acids in lymphocyte phospholipids did not change. The increase of linoleic acid and decrease of arachidonic acid in lymphocyte phospholipids were not statistically significant.

In control infants the concentration of polyunsaturated fatty acids including linoleic and arachidonic acid in lymphocyte phospholipids increased after 1 month of breast‐feeding to almost the same values as in the patients. The study indicates that at least in lymphocytes the incorporation of polyunsaturated fatty acids is actively regulated. The present way of administering Intralipid does not seem to cause any abnormal fatty acid pattern of the plasma and lymphocyte lipids. The use of intravenous fat emulsion with high content of linoleic acid in term newborns should thus not be expected to result in changes of the physical‐chemical properties of membranes and membrane dysfunction. (Journal of Parenteral and Enteral Nutrition 9:691–694, 1985)