bluuebunny/crossref_metadata_2025 huggingface dataset:
Parenteral vs Enteral Nutrition in Tumor‐Bearing Rats
Authors: Stallion Anthony , Foley‐Nelson Teri , Chance William T. , Zhang Fu‐Sheng , Fischer Josef E.
Published: May 2008

The development of cachexia may complicate cancer therapy, yet controversy exists concerning its nutritional management. For example, use of total parenteral nutrition (TPN) may not be appropriate because of gut atrophy, possible stimulation of tumor growth, and lack of total host protein repletion. In the present experiment, host and tumor responses were compared after identical parenteral or enteral nutritional supplementation (EN). Eighteen days after subcutaneous inoculation of adult male Fischer‐344 rats with fresh methylcholanthrene‐induced sarcoma (tumor‐bearing [TB] rats), catheters were placed into either the external jugular vein or the stomach. Four days later, rats were started on an 11‐day course of either TPN or EN with a Freamine‐III‐based formula (amino acids = 6%, dextrose = 21.5%, lipid = 1.5%). When the rats were killed, there was no difference in tumor weight between the various TB groups. Carcass weight was increased significantly in both the TB‐TPN and TB‐EN groups, and there was an elevation in gastrocnemius protein content in both groups compared with the TB‐rat food group. Small intestine protein was preserved in the TB‐EN group to the level observed in the control‐rat food animals. Total lipids in the liver were increased in both TB‐TPN and TB‐EN groups; however, the magnitude of the increase was less in the TB‐EN animals. Neither treatment resulted in complete protein repletion of tumor‐bearing rats. EN may be more appropriate than TPN in that gut mass is preserved. The maintenance of gut mucosa may prove to be beneficial in the treatment of the depleted, immunocompromised, and metabolically stressed host. (Journal of Parenteral and Enteral Nutrition 18:148–153, 1994)
A Practical Equation to Predict Resting Metabolic Rate in Older Men
Authors: Bell Stacey J.
Published: May 2008

It is important to know the resting metabolic rate (RMR) of patients to devise a nutrition support regimen. Although there are numerous equations for predicting RMR, few (eg, the Harris Benedict equation [HBE]) are specific for elderly individuals over the age of 50 years. The purpose of this study was to (1) examine biologic predictors of RMR in healthy older men, (2) develop a practical equation to predict RMR from readily measurable variables, and (3) compare existing equations that predict RMR with the measured RMR values obtained in this study. Eighty‐nine healthy, elderly (aged 50 to 78 years) men had their RMR measured by a ventilated‐hood technique under meticulous conditions described in full detail. Other biologic data were obtained. A stepwise regression equation was computed by using the measured RMR as the dependent variable and the other data as independent variables. The best predictors of RMR were fat‐free mass (which accounted for 85% of the variability), free 3,5,3′‐triiodothyronine level, and maximal oxygen consumption; the latter two variables each accounted for 1% of the variability. RMR was estimated with a residual error of ±30 kcal/d by using these variables.
Parenteral Monoacetoacetin and Liver Regeneration Interaction After Partial Hepatectomy in the Rat
Authors: Birkhahn Ronald H. , Awad Salah , Thomford Neil R.
Published: May 2008

Parenteral nutrients can be used to manipulate cell proliferation after partial hepatectomy. The relationship among macronutrients—glucose, monoacetoacetin, amino acids— and liver regeneration after partial hepatectomy was investigated. Male rats were anesthetized, received a 70% hepatectomy, and received a low‐dose infusion of (1) glucose or (2) monoacetoacetin and a high‐dose infusion of (3) glucose, (4) glycerol‐glucose, or (5) monoacetoacetin‐glucose beginning 6 hours after surgery. The five nonprotein nutrient combinations were infused with and without amino acids. Rats were killed 48 hours after partial hepatectomy, and the label and mitotic indices were determined. Each of the five treatments had a higher label index with amino acids present than with amino acids absent. Low‐dose glucose and monoacetoacetin as well as high‐dose glucose and glucose‐glycerol had higher mitotic indices with amino acids than without amino acids. High‐dose monoacetoacetin‐glucose was associated with a greater mitotic index than was any other nonprotein substrate treatment, and this response was independent of amino acids being present or absent. In summary, (1) amino acids were needed for maximal cell proliferation rate; (2) the absence of amino acids and not the presence of glucose resulted in reduction of the label and mitotic indices for regenerating liver; (3) high‐dose monoacetoacetin increased mitosis with or without amino acids; and (4) monoacetoacetin activity was dose dependent. The results indicate that the best nutrient for treatment of patients with liver injury is acetoacetate. The second best nutrient would be the combination of high‐dose glucose and amino acids. The results further indicate that glucose should not be administered to patients with liver injury unless accompanied by amino acids. (Journal of Parenteral and Enteral Nutrition 18:219–224, 1994)
Long‐term Silastic Catheters and Chest Pain
Authors: Passaro Marian E. , Steiger Ezra , Curtas Susan , Seidner Douglas L.
Published: May 2008

There are multiple reports in the literature of vascular erosion in the innominate vein or superior vena cava from the use of temporary central venous catheters. Catheter malposition is likely to precede the development of superior vena cava perforations, a catastrophic complication of central venous catheters. Catheter malposition after initial adequate placement is a very unusual long‐term complication and delayed recognition of this complication may have disastrous consequences. Should the catheter change position so the tip is angled toward the sidewall, the repetitive movement of the catheter tip that occurs with respiratory excursion and the cardiac cycle may lead to endothelial injury and eventual erosion of the vein. These problems are thought to be alleviated in the patient receiving long‐term intravenous therapy by using a soft Silastic catheter, which may not cause as much damage to the endothelium of the vein. We report three patients with left‐sided long‐term indwelling Silastic catheters that had changed position over time who presented with chest pain upon infusion of their total parenteral nutrition solutions. In each case, chest x‐ray revealed that the tip of the catheter had migrated and was directed against the sidewall of the superior vena cava. In each case, catheter removal and replacement with a new catheter into the right side (subclavian and jugular systems) led to prompt relief of the patient's symptoms. (Jourual of Parenteral and Enteral Nutrition 18:240–242, 1994)
The Effect of the Hepatic Nerves on the Disposition of a Mixed Meal by Conscious Dogs
Authors: Moore Mary Courtney , Paguassotti Michael J. , Goldstein Richard E. , Asher Jordan , Murrell Joel , Neal Doss , Cherrington Alan D.
Published: May 2008

We examined the disposition of a mixed meal by nine conscious dogs fasted for 24 hours with surgical hepatic denervation. The results were compared with those from identical studies carried out previously in 13 hepatic‐innervated dogs. Net gut release of glucose and gluconeogenic precursors (assessed with the arteriovenous difference technique), the resulting blood glucose and plasma insulin concentrations, and the hepatic glucose load were remarkably similar in the two groups. Net hepatic glucose uptake was 4.8 ± 3.6 g in hepatic‐denervated and 7.7 ± 3.3 g in hepatic‐innervated dogs. Cumulative net hepatic lactate release in hepatic‐denervated dogs was 4.3 ± 1.4 g of glucose equivalents, half the value for hepatic‐innervated dogs. Net hepatic carbon intake was similar in the two groups. Hepatic lipogenesis, oxidation, and net glycogen synthesis were qualitatively similar between groups. In conclusion, the disposition of a mixed meal by hepatic‐innervated and hepatic‐denervated dogs was very similar. Subtle alterations in net hepatic balance of substrates (tendencies toward decreases in net hepatic glucose uptake and lactate release) made net carbon retention in denervated livers virtually identical with that in innervated livers. When other compensatory mechanisms are intact, hepatic denervation does not significantly alter hepatic disposition of a mixed meal. (Journal of Parenteral and Enteral Nutrition 18:248–255, 1994)
Recurrent Sepsis in Home Parenteral Nutrition Patients: An Analysis of Risk Factors
Authors: O'Keefe Stephen J.D. , Burnes Jan U. , Thompson Rodney L.
Published: May 2008

Septicemia is the major cause of morbidity in home parenteral nutrition patients, accounting for approximately 70% of rehospitalizations. To identify risk factors, the incidence of infection was examined in 41 current home parenteral nutrition patients, 30 with short‐bowel syndrome (including 16 with inflammatory bowel disease and 11 with bowel infarction) and 11 with chronic obstructive disorders. Management, which was followed for a mean duration of 78.6 months (range, 1 to 15 1/2 years), was standardized by protocol. Ten patients never experienced infection during the average follow‐up of 61 months (range, 14 to 174 months), whereas seven patients experienced frequent infections during the mean follow‐up of 77 months (range, 24 to 180 months). Significant distinguishing features in the frequent‐infection group were younger age (45 ± 12 vs 66.9 ± 14.3 years, P <.05), Crohn's disease (in five of seven vs zero of 10 subjects, P <.05), jejunostomies (in seven of seven vs one of 10 subjects, p <.0005), and central vein thrombosis (in five of seven vs zero of 10 subjects, P <.05). A greater proportion of the frequent‐infection group had poor catheter‐care technique and more were smokers. One hundred fifty septicemias were confirmed by blood culture, giving an average infection rate of one every 31 months, 52% caused by Gram‐positive organisms (chiefly coagulase‐negative staphylococci and Staphylococcus aureus), 30% caused by Gram‐negative organisms, and 16% caused by fungus (chiefly Candida albicans). In conclusion, these results indicate that catheter sepsis is not invariably associated with long‐term intravenous feeding but that a combination of host factors (Crohn's disease, jejunostomy, and central vein thrombosis) and environmental factors (catheter management technique) increase the risk of recurrent sepsis. The results suggest that early preventative measures, such as maintenance of hydration, long‐term anticoagulation, and decontamination of catheter hub and locking solution, should be considered in patients with the combination of Crohn's disease and jejunostomies to decrease the risk of frequent septicemias. (Journal of Parenteral and Enteral Nutrition 18:256–263, 1994)
Oral Candida Colonizes the Stomach and Gastrostomy Feeding Tubes
Authors: Gottlieb Klaus , Iber Frank L. , Livak Anne , Leya Jack , Mobarhan Sohrab
Published: May 2008

The lumen of gastrostomy tubes is frequently colonized with Candida. To investigate the source of this contamination, 20 consecutive malnourished patients undergoing placement of a percutaneous endoscopic gastrostomy tube and ten ambulatory controls having routine upper endoscopy performed had both their oral cavity and gastric antrum swabbed and cultured. Percutaneous endoscopic gastrostomy tube recipients who after several weeks were still under our care (9 of 20) had the lumen of their tubes cultured. Fungi were isolated from the stomach in 13 (65%) of 20 patients undergoing percutaneous endoscopic gastrostomy tube placement but in only 1 of 10 ambulatory patients (p <.01). The species isolated from the oral cavity, the stomach, and later the gastrostomy tube were identical in most cases. We conclude that gastrostomy tubes are probably colonized by oral organisms that have made their way into the stomach. (Journal of Parenteral and Enteral Nutrition 18:264–267, 1994)
L‐Glutamine Supplementation in Home Total Parenteral Nutrition Patients: Stability, Safety, and Effects on Intestinal Absorption
Authors: Hornsby‐Lewis Lynn , Shike Moshe , Brown Patricia , Klang Mark , Pearlstone David , Brennan Murray F.
Published: May 2008

A study was conducted to determine safety and efficacy of L‐glutamine when added to total parenteral nutrition (TPN) solutions of patients receiving TPN in the home. Stability studies were first performed on various concentrations of L‐glutamine in TPN solutions mixed by the Pharmix method. These showed that glutamine was stable in home TPN solutions for at least 22 days. The daily home TPN solutions of seven stable patients were then supplemented with glutamine at a dose of 0.285 g/kg of body weight for 4 weeks. The glutamine‐TPN solutions were prepared weekly. Five patients received the full 4 weeks of glutamine‐TPN. In two patients, administration of glutamine‐TPN mixtures was stopped at the end of week 2 and week 3 because of elevations in liver enzymes. A third patient's liver enzymes rose at the end of week 4. These abnormalities subsided after discontinuation of the glutamine‐TPN solution. Plasma levels of glutamine increased during the first 3 weeks of supplementation but these increases were not statistically significant. D‐Xylose absorption studies performed before and after the administration of glutamine‐TPN did not reveal any improvement in small‐bowel absorptive capacity. In conclusion, stable glutamine‐TPN solutions for use by home TPN patients can be formulated. However, supplementation of home TPN solutions at this dose was associated with apparent hepatic toxicity and did not demonstrate a beneficial effect on intestinal absorptive capacity as measured by D‐xylose absorption. Therefore, on the basis of this study, routine supplementation of home TPN solution with glutamine cannot be recommended. (Journal of Parenteral and Enteral Nutrition 18:268–273, 1994)
Failure of Topical Vegetable Oils to Prevent Essential Fatty Acid Deficiency in a Critically III Patient Receiving Long‐term Parenteral Nutrition
Authors: Sacks Gordon S. , Brown Rex O. , Collier Paige , Kudsk Kenneth A.
Published: May 2008

This case report describes the failure of topical vegetable oils containing esters of linoleic acid to prevent essential fatty acid deficiency in a critically ill patient with trauma. A 40‐year‐old black man injured in a motor vehicle accident developed essential fatty acid deficiency after being maintained on long‐term, fat‐free parenteral nutrition plus topical vegetable oil application because of the presence of severe hypertriglyceridemia. Biochemical evidence of this deficiency included a decrease in serum linoleic, a‐linolenic, and arachidonic acid levels with a corresponding increase in oleic and palmitoleic acid levels. Cutaneous manifestations consistent with this syndrome were also present. After 3 weeks of daily topical treatments with vegetable oils rich in linoleic acid, biochemical abnormalities of deficiency were still evident. Over the following 2 1/2 months, 4% to 22% of the total caloric intake was delivered as intravenous fat in addition to continued topical administration of vegetable oil. Only after supplementation with intravenous fat did the patient demonstrate clinical and biochemical signs of improvement. The results show that cutaneous administration of vegetable oils as the sole source of linoleic acid may be unable to prevent or treat essential fatty acid deficiency in a critically ill surgical patient. (Journal of Parenteral and Enteral Nutrition 18:274–277, 1994)
Correlation Between Measured Energy Expenditure and Clinically Obtained Variables in Trauma and Sepsis Patients
Authors: Frankenfield David C. , Oniert Laurel A. , Badellino Michael M. , Wiles Charles E. , Bagley Suzanne M. , Goodarzi Shirin , Siegel John H.
Published: May 2008

Background: Indirect calorimetry is the preferred method for determining caloric requirements of patients, but availability of the device is limited by high cost. A study was therefore conducted to determine whether clinically obtainable variables could be used to predict metabolic rate. Methods: Patients with severe trauma or sepsis who required mechanical ventilation were measured by an open‐circuit indirect calorimeter. Several clinical variables were obtained simultaneously. Measurements were repeated every 12 hours for up to 10 days. Results: Twenty‐six trauma and 30 sepsis patients were measured 423 times. Mean resting energy expenditure was 36 ± 7 kcal/kg (trauma) vs 45 ± 8 kcal/kg (sepsis) (p <.0001). The single strongest correlate with resting energy expenditure was minute ventilation (R 2 = 0.61, p <.0001). Doses of dopamine, dobutamine, morphine, fentanyl, and neuromuscular blocking agents each correlated positively with resting energy expenditure. In the case of the inotropics and neuromuscular blockers, there was a probable covariance with severity of illness. A multiple regression equation was developed using minute ventilation, predicted basal energy expenditure, and the presence or absence of sepsis: resting energy expenditure = —11000 + minute ventilation (100) + basal energy expenditure (1.5) + dobutamine dose (40) + body temperature (250) + diagnosis of sepsis (300) (R 2 = 0.77, p <.0001). Conclusion: Severe trauma and sepsis patients are hypermetabolic, but energy expenditure is predictable from clinical data. The regression equations probably apply only to severe trauma and sepsis. Other studies should be conducted to predict energy expenditure in other patient types. (Journal of Parenteral and Enteral Nutrition 18:398–403, 1994)
Amino Acid Solutions for Premature Neonates During the First Week of Life: The Role of N‐Acetyl‐L‐Cysteine and N‐Acetyl‐L‐Tyrosine
Authors: Van Goudoever J.B. , Sulkers E.J. , Timmerman M. , Huijmans J.G.M. , Langer K. , Carnielli V.P. , Sauer P.J.J.
Published: May 2008

Tyrosine and cyst(e)ine are amino acids that are thought to be essential for preterm neonates. These amino acids have low stability (cyst(e)ine) or low solubility (tyrosine) and are therefore usually present only in small amounts in amino acid solutions. Acetylation improves the stability and solubility of amino acids, facilitating a higher concentration in the solution. We compared three commercially available amino acid solutions, Aminovenös‐N‐päd 10%, Vaminolact 6.5%, and Primène 10%, administered to 20 low‐birth‐weight neonates on total parenteral nutrition from postnatal day 2 onward. Aminovenös‐N‐päd 10% contains acetylated tyrosine and acetylated cysteine; the other solutions do not contain acetylated amino acids and differ in the amount of tyrosine and cysteine added. On postnatal day 7, plasma amino acids were measured together with urinary excretion of amino acids and the total nitrogen excretion; 38% of the intake of N‐acetyl‐L‐tyrosine and 53% of the intake of N‐acetyl‐L‐cysteine were excreted in urine. Plasma levels of N‐acetyl‐L‐tyrosine (331 ± 74 μmol/L) and N‐acetyl‐L‐cysteine (18 ± 29 μmol/L) were higher than those of tyrosine (105 ± 108 μmol/L) and cystine (11 ± 9 μmol/L), respectively. Plasma tyrosine levels in the groups receiving small amounts of tyrosine remained just below the reference range. We showed a linear correlation of plasma cystine with the intake of cysteine (r =.75, p = 0.01), but not with N‐acetyl‐L‐cysteine. The estimated intake of cysteine should be 500 μmol·kg−1·d−1 in order to obtain levels comparable with those shown in normal term, breast‐fed neonates. Nitrogen retention did not differ among the three groups (247 to 273 mg·kg−1·d−1). We conclude that a large portion of parenterally administered acetylated amino acids is excreted in the urine of 1‐week‐old, preterm neonates, with higher plasma levels of the acetylated amino acids than of the deacetylated amino acids. (Journal of Parenteral and Enteral Nutrition 18:404–408, 1994)
Assessment of Body Composition by Skinfold Anthropometry and Bioelectrical Impedance Technique: A Comparative Study
Authors: Vansant G. , Van Gaal L. , De Leeuw I.
Published: May 2008

Both skinfold anthropometry and bioelectrical impedance are indirect, simple bedside methods to assess body composition. It is not clear, however, whether the results of these methods are comparable. In this study, body composition was determined in 449 subjects by skinfold anthropometry and by bioelectrical impedance. Percentage of body fat ranged from 8.0% to 47.5% with the skinfold technique and from 0.6% to 78.5% with bioelectrical impedance. Linear regression analysis showed a significant positive correlation (r =.84; p <.0001) between the results of both techniques. However, plot analysis showed that, in comparison with bioelectrical impedance, skinfold measurements overestimate fat mass in the lower weight range and underestimate it in obese subjects. We conclude that the results of skinfold anthropometry and bioelectrical impedance are not comparable, especially in the extreme ranges of body fat. At the present time, other, more rigorous techniques are necessary to assess body composition accurately, in the extreme ranges of body fat in particular. (Journal of Parenteral and Enteral Nutrition 18:427–429, 1994)
Evaluation of “Closed” vs “Open” Systems for the Delivery of Peptide‐Based Enteral Diets
Authors: Wagner David R. , Elmore Michael F. , Knoll Donna M.
Published: May 2008

Background: The study was designed to quantitate factors such as preparation time, waste, and contamination associated with three different feeding systems for peptide‐based diets, and to determine appropriate hang times. Methods: Intensive care unit patients were randomized to receive a peptide‐based diet in 1500‐mL prefilled, sterile closed‐system containers (CS) infused more than 24 hours, as open systems decanted from cans (OS‐Can), or as open systems mixed from powder (OS‐Powder). Open‐system groups were provided a 12‐hour supply twice daily in commercially clean 1‐L bags with preattached sets. Samples were taken for culture during preparation and after infusion. Preparation time, initial and final microbial concentrations, and total waste were quantified. Results: Preparation time was significantly shorter for CS than for OS‐Can or for OS‐Powder (2 minutes vs 7.5 minutes vs 13.0 minutes). Initially, 100% of the OS‐Powder and 30% of the OS‐Can bags were contaminated, with significant contamination exceeding 104 colony‐forming units/mL in 40% and in 5% of the bags, respectively. On final culture, significant contamination occurred in only 2% of the CS bags compared with 83% of the OS‐Powder and 60% of the OS‐Can bags. Average time from potential initial contamination to final culture in CS was 49.9 hours vs 38.8 hours for OS‐Can and 32 hours for OS‐Powder. Total waste was greater in CS than in OS‐Can or OS‐Powder but could be eliminated by extending allowable hang times. Conclusions: Nonvented closed‐delivery containers may be safely infused for up to 48 hours. They are associated with reduced labor and contamination. (Journal of Parenteral and Enteral Nutrition 18:453–457, 1994)
Dietary Fish Oil Supplementation Attenuates Myocardial Dysfunction and Injury Caused by Global Ischemia and Reperfusion in Isolated Rat Hearts
Authors: Nussbaum Michael E.
Published: May 2008

Diets supplemented with fish oil have been shown to protect against the complications of coronary heart disease with reduced atherogenesis, smaller infarcts, fewer arrhythmias, and a lower mortality rate. This has been attributed to the effect of fish oil on blood cells and plasma components, including an inhibition of platelets, a decrease in plasma fibrinogen, reduction in release of free radicals from neutrophils and myocytes, and enhancement of the endothelium‐derived relaxing factor. The current study was designed to compare the effects of a diet enriched with fish oil on myocardial ischemia and reperfusion, independent of blood cells and plasma components, using an isolated rat‐heart preparation. Rats were fed either a fish‐oil‐enriched or a butter‐enriched diet for 5 days, after which their hearts were removed and perfused according to the modified Langendorff procedure. The hearts were perfused with a bloodless (Krebs‐Henseleit buffer), oxygenated perfusate. Ischemia was induced by stopping perfusion for 15 minutes followed by 10 minutes of reperfusion. Cardiac contraction and coronary perfusion pressure were measured before and after ischemia/reperfusion. The hearts were analyzed for myocardial phospholipid content. Plasma from each rat was collected for lipid analysis, platelet aggregation studies, and malondialdehyde measurement. The coronary effluent was analyzed for creatine kinase and immunoreactive thromboxane B2 release. The myocardial and plasma phospholipid content revealed lower n‐6 essential fatty acids and higher n‐3 fatty acids in both myocardia and plasma in the fish‐oil‐fed rats when compared with the control animals. Platelet aggregation was markedly diminished in the fish‐oil group, whereas plasma malondialdehyde levels, reflecting lipid peroxidation, were significantly greater in the fish‐oil‐fed group. Ischemia/reperfusion caused a decrease in the force of cardiac contraction and an increase in coronary perfusion pressure in all hearts studied; however, these changes were less prominent in the fish‐oil‐fed hearts. Additionally, ventricular arrhythmias occurred in fewer of the fish‐oil hearts (three of eight hearts) compared with the control group (seven of nine hearts). Myocardial creatine kinase, which is a reflection of myocardial injury, increased five to seven times basal levels in the control hearts but only three to four times in the fish‐oil‐fed hearts (p <.05). Immunoreactive thromboxane B2 release was also lower in the fish‐oil‐fed group.
Arginine‐Enriched Solution Induces a Marked Increase in Muscle Glutamine Concentration and Enhances Muscle Protein Synthesis in Tumor‐Bearing Rats
Authors: Oka Toshinori , Ohwada Katsuo , Nagao Mitsuhiro , Kitazato Kenji , Kishino Yasuo
Published: May 2008

Using a transplantable Yoshida sarcoma in a rat model of total parenteral nutrition (TPN), we measured the effectiveness of an arginine‐enriched amino acid solution (AI‐82) on muscle glutamine concentration and muscle protein synthesis compared with that of a conventional amino acid solution (Proteaminl2). After tumor‐bearing rats had been given one of two isocaloric TPN regimens for 6 days, [15N]glycine (99 atom %) containing TPN solution was infused into animals at a constant rate of 8 mg of [15N]glycine per hour for 18 hours, after which the liver, skeletal muscle (gastrocnemius muscle), and tumor protein synthesis rates were measured. A significantly increased whole muscle protein synthesis rate was observed in the AI‐82 group; there was no difference in the whole liver and tumor protein synthesis rates between the two groups. When each TPN solution was administered for 1 week, muscle concentrations of arginine, ornithine, glutamine, and glutamate were considerably higher in the AI‐82 group than in the Proteamin12 group, and these differences were also accompanied by a decrease in the plasma branched‐chain amino acid (BCAA) (leucine, isoleucine, and valine) levels in the AI‐82 group. The high levels of muscle glutamine concentration in the AI‐82 group were investigated in connection with the high use of exogenous branched‐chain amino acids. (Journal of Parenteral and Enteral Nutrition 18:491–496, 1994)
Infectious Morbidity Associated With Long‐Term Use of Venous Access Devices in Patients With Cancer J. S. GROEGER, A. B. LUCAS, H. T. THALER, ET AL Annals of Internal Medicine 119:1168–1174, 1993
Authors: Kearns Patrick J.
Published: May 2008

This report summarizes infectious complications associated with all tunneled Silastic catheters and subcutaneous ports inserted in patients at Sloan‐Kettering Cancer Center during a 2‐year period. The data were from chart reviews and questionnaires. Statistical analysis included the first infection in the initial device of each patient. Analysis excluded 179 of 788 catheters on the basis of diagnostic exclusion. Of 680 ports placed, only 14 were excluded. A higher percentage of patients with catheters had a device‐related infection (43%) compared with patients with ports (8%). There was a longer infection‐free interval with ports as well. Forty‐two percent of the infections in catheters were due to skin flora, and 56% were due to Gram‐negative organisms. Of the port infections, 39% were due to skin flora, and 11% were caused by Gram‐negative organisms. The study found that patients with solid tumors accounted for 31% of the catheters and 83% of the ports that were placed. Infection occurred less frequently in both groups of patients with solid tumors.
Arginine Stimulates Wound Healing and Immune Function in Elderly Human Beings S. J. KIRK, M. HLRSON, M. C. REGAN, ET AL Surgery 114:155–160. 1993
Authors: Sax Harry C.
Published: May 2008

With the aging of the population, a larger number of elderly patients are undergoing more complex surgical procedures. In addition to advanced age, the general decline in metabolic reserve may lead to an increased risk of perioperative complications in these patients. Furthermore, their specialized nutritional needs remain unclear. Arginine, a semiessential amino acid, has been shown to enhance T‐cell‐mediated immune function both in healthy animals and in humans.1,2 The use of a specialized enteral feeding with supplemental arginine as well as with omega‐3 fatty acids and nucleotides significantly reduced complications and hospital stays in a series of patients undergoing upper gastrointestinal tract surgery for cancer.3

To study the effects of supplemental arginine on wound healing in an elderly but otherwise healthy group of patients, 45 patients were randomly assigned to receive 30 g of arginine (as a syrup) per day or no supplemental arginine (control group) for a total of 2 weeks. Immune function was measured by lymphocyte response to well known mitogens such as phytohemagglutinin, concanavalin A, or poke weed. Mixed‐lymphocyte culture quantified the response to alloantigens by noting the increase in thymidine uptake in the lymphocytes of the patients when they were exposed to other human lymphocytes. Wound healing was examined both as the deposition of hydroxyproline into a subcutaneously implanted polytetrafluoroethylene catheter and as the creation of a partial‐thickness wound on the anterior aspect of the thigh. The wound was then observed and photographed daily until re‐epithelialization had taken place.

All patients tolerated arginine supplementation without notable gastrointestinal tract dysfunction. There was a significant increase in serum insulin‐like growth factor (IGF‐I) levels (203 ± 18 ng/mL vs 140 ng/mL; p <.04). This is consistent with the role of arginine as a potent pituitary secretogogue. Arginine supplementation further increased collagen deposition into subcutaneous catheters as reflected by increased levels of hydroxyproline (17.4 ± 2 nmol/cm; p <.02). Despite this, there was no increase in the rate of epithelialization of the skin defect (12.5 days). The blastogenic effects of mitogens were significantly increased in all groups from day 1 through day 14. The increases in thymidine incorporation ranged from 15% to 80% for mitogens, with a 300% increase in the mixed‐lymphocyte response.
Cyclo‐oxygenase Blockade Abrogates the Endotoxin‐Induced Increase in Na+‐Dependent Hepatic Amino Acid Transport
Authors: Plumley Donald A. , Watkins Kevin , Bode Barrie P. , Pacitti Anthony J. , Souba Wiley W.
Published: May 2008

Background: Endotoxemia is characterized by a marked increase in the uptake of amino acids by the liver, but the regulation of this response has not been fully elucidated. In the current study, we investigated the potential role of prostaglandins as mediators of this response. We examined the in vivo effects of the anti‐inflammatory agent ketorolac, a cyclo‐oxygenase inhibitor that blocks prostaglandin synthesis, on hepatic amino acid transport activity in endotoxin‐treated rats. Methods: We assayed the activities of the Na+‐dependent transport systems A and N in hepatic plasma membrane vesicles prepared from endotoxemic rats that were pretreated with ketorolac or vehicle. Hepatic plasma membrane vesicles were prepared by differential centrifugation, and the transport of [3H]glutamine (system N) and [3H]2‐methylamino‐isobutyric acid (system A) was assayed. Hepatic plasma membrane vesicles were also prepared from normal rats that received prostaglandin E2, and glutamine and MeAIB transport were measured. Results: Endotoxin treatment resulted in a twofold to threefold increase in Na+‐dependent amino acid transport activity in hepatic plasma membrane vesicles secondary to an increase in the transport Vmax, which was consistent with the appearance of increased numbers of corresponding transporter proteins in the hepatocyte plasma membrane. Pretreatment with ketorolac almost completely abrogated the endotoxin‐induced increase in hepatic amino acid transport. Administration of prostaglandin E2 to normal rats resulted in a statistically significant increase in glutamine and alanine transport by hepatic plasma membrane vesicles prepared from these animals. Conclusions: Prostaglandins play a key role in mediating the accelerated hepatic amino acid transport that occurs during endotoxemia. (Journal of Parenteral and Enteral Nutrition 19:9–14, 1995)
A Comparison of Fat‐free Mass Estimates in Men Infected With the Human Immunodeficiency Virus
Authors: Risser J.M.H. , Rabeneck L. , Foote L.W. , Klish W.J.
Published: May 2008

Background: Loss of lean‐body mass has been found to be predictive of death from wasting in HIV‐infected individuals. Several clinically applicable, noninvasive methods for estimating body wasting are available, but the comparability of these methods is not known. The objective of this study was to assess the agreement between estimates of lean‐body mass in HIV‐infected men. Methods: Lean‐body mass was measured by bioelectrical impedance assessment, by prediction equations that used anthropometric measurements, and by total body electrical conductivity as the comparison method in 27 outpatient HIV‐infected men seen at the Houston Veterans Affairs Special Medicine Clinic. Agreement was assessed by comparing the difference between two methods (the bias) with the mean of those two methods. This statistical approach evaluates whether two methods are similar enough that measurements from one might accurately replace those of the other. Results: The mean ± SE for lean‐body mass were 55.98 ± 1.96 kg for total body electrical conductivity and 55.18 ± 1.27 kg for bioelectrical impedance assessment; they ranged from 55.18 ± 1.27 to 63.71 ± 1.89 kg for the prediction equations. Conclusions: In individual subjects, no alternate method gave estimates of lean‐body mass that were the same as estimates from total body electrical conductivity. One prediction equation (Brozek) gave estimates that might be useful for following changes in fat‐free mass over time because the bias did not change substantially for increasing values of lean‐body mass. On the other hand, because there were no statistically significant differences between the mean lean‐body mass estimates by total body electrical conductivity and those measured by bioelectrical impedance assessment or a prediction equation on the basis of body mass index, the latter two methods might be useful in assessing lean‐body mass in groups. (Journal of Parenteral and Enteral Nutrition 19:28–32, 1995)
Effects of Chemically Defined Structured Lipid Emulsions on Reticuloendothelial System Function and Morphology of Liver and Lung in a Continuous Low‐Dose Endotoxin Rat Model
Authors: Pscheidl Edgar , Hedwig‐Geissing Monika , Winzer Cornelia , Richter Sabine , Rügheimer Erich
Published: May 2008

Background: This study was undertaken to determine the effect of chemically defined structured lipids on nonspecific host defense and on histologic patterns of liver and lungs compared with a physical mixture of long‐chain triglycerides and medium‐chain triglycerides in a continuous low‐dose endotoxin rat model. Methods: Forty male Sprague‐Dawley rats, divided into four feeding groups (structured lipids, structured lipids + endotoxin, physical mixture, physical mixture + endotoxin), received total parenteral nutrition for 48 hours. During the first part of the study, 24 animals were given an injection of live Escherichia coli labeled with radioactive iron (59Fe) to investigate the function of the reticuloendothelial system. During the second part of the study, the liver and lungs of 16 animals were histologically examined using light and electron microscopy. Results: Despite the similar values in the control groups, the animals receiving structured lipids + endotoxin sequestered a significantly greater percentage of bacteria in the liver and spleen (p ≤.01) and a significantly lesser percentage in the lung (p ≤.05) compared with the animals given physical mixture + endotoxin as part of their diet. Moreover, rats in the physical mixture + endotoxin group showed a microscopically evaluated higher fatty infiltration in the liver than did the structured lipids + endotoxin group. Conclusions: The results of this study indicate that chemically defined structured lipids reduce fatty infiltration of the liver compared with a physical mixture of the same compounds in an animal model of metabolic stress. They were accompanied by a better function of the reticuloendothelial system and a lesser bacterial sequestration in the lungs. (Journal of Parenteral and Enteral Nutrition 19:33–40, 1995)
Luminal Glutamine Perfusion Alters Endotoxin‐Related Changes in Ileal Permeability of the Piglet
Authors: Dugan Michael E.R. , McBurney Michael I.
Published: May 2008

Background: The objective of this study was to investigate whether luminal perfusion with glutamine or with oxygenated glutamine solutions prevents endotoxin‐induced changes in mucosal permeability. Methods: Three 15‐cm segments of distal ileum were isolated in anesthetized 21‐day‐old piglets (n = 4) and perfused (50 mL/h) with Ringer's lactate solution, Ringer's lactate solution with 2% glutamine (wt/vol), glutamine, or glutamine purged with oxygen at 37°C for 280 minutes. Plasma‐to‐lumen clearances of 51Cr‐EDTA and urea were measured to assess mucosal permeability. At time 0 minutes, loading and maintenance IV infusions of markers were begun. Baseline permeabilities were obtained from time 60 to 80 minutes, and IV endotoxin (50 μg/kg) was introduced from time 80 to 140 minutes. Results: Results are expressed as the ratio of the clearances of the two probes (CEDTA/CUREA). Permeability increased from baseline in loops perfused with Ringer's lactate solution vs loops perfused with glutamine purged with oxygen and with glutamine alone (p <.01). Saturation with oxygen was without effect inasmuch as glutamine alone negated permeability increases. Intestinal myeloperoxidase activity did not differ with perfusate (p >.05). Conclusions: These data suggest that endotoxin‐induced permeability changes can be prevented or delayed by the supply of luminal glutamine at the time of insult. (Journal of Parenteral and Enteral Nutrition 19:83–87 1995)
Malabsorption and Villous Atrophy in Patients Receiving Enteral Feeding
Authors: Cummins Adrian , Chu Geoff , Faust Logan , Chandy George , Argyrides John , Robb Trevor , Wilson Peter
Published: May 2008

Background: The purpose of this study was to assess the structure and function of the small intestine before and after enteral feeding given via a percutaneous feeding gastrostomy (PEG). It is not known whether this method of feeding provides a good luminal drive to the small intestine. Methods: Studies were performed of patients at the time of PEG placement, in a cross‐sectional group after a period of feeding and in a smaller longitudinal subgroup. Enteral feeds were adjusted in volume and caloric content for each patient. Duodenal biopsies were taken during endoscopy for quantitative morphometry, and lactulose‐rhamnose permeability tests were performed during the next day. Duodenal fluid was cultured quantitatively in the first study, and disaccharidases determined in the second study. Results: The first study of 15 patients, who had enteral feeding for a median (range) period of 13 (8 to 104) weeks, showed partial villous atrophy with normal crypt length, no increase in duodenal bacteriology, and abnormal lactulose‐rhamnose sugar permeability due to rhamnose malabsorption. These changes were also present in 38 similar patients before enteral feeding. A second study before enteral feeding showed lowered maltase activity (24 patients), and similar intestinal permeability findings (22 patients). Twelve of these patients were followed longitudinally for 3 months of enteral feeding that maintained but did not improve nutrition, as assessed by body mass index and mid‐arm muscle circumference, and there was no change in duodenal morphometry (11 patients), rhamnose malabsorption (4 patients), or disaccharidases (11 patients). Conclusions: These studies suggest villous atrophy was not due to an inflammatory enteropathy but resulted from a poor luminal “drive” associated with the enteral feeding. Enteral feeding maintained but did not improve nutrition status. (Journal of Parenteral and Enteral Nutrition 19:193–198, 1995)
Prevention of Fatty Liver and Maintenance of Systemic Valine Depletion Using a Newly Developed Dual Infusion System
Authors: Nishihira Tetsuro , Komatsu Hiromichi , Sagawa Junji , Sihneha Ryusaburo , Mori Shozo
Published: May 2008

Background: Valine‐depleted amino acid imbalance, while having a suppressive effect on tumor growth, may induce fatty liver. Methods: We administered a valine‐depleted total parenteral nutrition (TPN) solution by the central venous route to non‐tumor‐bearing rats and examined the time course of the development of fatty liver. In an attempt to prevent this condition, we administered a continuous infusion of low concentrations of valine via the portal vein simultaneously with administration of central venous valine‐depleted nutrition for 4 days. Results: A marked accumulation of triglyceride was observed in the liver on day 4 of the administration of valine‐depleted nutrition. It is speculated that such accumulation is the cause of fatty liver. The level of valine in the peripheral blood began to decrease soon after administration was begun and resulted in a state of systemic valine deficiency. Rats given 25% or more of the valine concentration in the standard TPN solution via the portal vein simultaneously with the administration of central venous valine‐depleted nutrition, had a triglyceride level similar to that of the control group. The group given 50% or less of the valine concentration had a level of valine in the peripheral blood as low as that of the valine‐depleted group, indicating the maintenance of a valine‐deficient state. Conclusion: Administration of low concentrations of valine via the portal vein simultaneous with central venous administration of valine‐depleted TPN solution may prevent fatty liver. (Journal of Parenteral and Enteral Nutrition 19:199–203, 1995)
Protein Energy Malnutrition in Severe Alcoholic Hepatitis: Diagnosis and Response to Treatment
Authors: Mendenhall Charles L. , Moritz Thomas E. , Roselle Gary A. , Morgan Timothy R. , Nemchausky Bernard A. , Tamburro Carlo H. , Schiff Eugene R. , Mcclain Craig J. , Marsano Luis S. , Allen John I. , Samanta Arun , Weesner Robert E. , Henderson William G. , Chen Thomas S. , French Samuel W. , Chedid Antonio ,   THE VA COOPERATIVE STUDY GROUP #275
Published: May 2008

Background: Active nutrition therapy and the anabolic steroid oxandrolone (OX), in selected patients with severe alcoholic hepatitis, significantly improved liver status and survival. We report here on the changes in their nutritional parameters. Methods: Protein energy malnutrition (PEM) was evaluated and expressed as percent of low normal in 271 patients initially, at 1 month and at 3 months. Active therapy consisted of OX plus a high caloric food supplement vs a matching placebo and a low calorie supplement. Results: PEM was present in every patient; mean PEM score 60% of low normal. Most of the parameters improved significantly from baseline on standard care; the largest improvement seen in visceral proteins, the smallest in fat stores (skinfold thickness). Total PEM score significantly correlated with 6 month mortality (p=.0012). Using logistic regression analysis, creatinine height index, hand grip strength and total peripheral blood lymphocytes were the best risk factors for survival. When CD lymphocyte subsets replaced total lymphocyte counts in the equation, CD8 levels became a significant risk factor (p=.004). Active treatment produced significant improvements in those parameters related to total body and muscle mass (ie, mid arm muscle area, p=.02; creatinine height index, p=.03; percent ideal body weight, p=.04). Conclusion: Deterioration in nutritional parameters is a significant risk factor for survival in severe patients with alcoholic hepatitis. This deterioration is reversible with standard hospital care. Active therapy further improves creatinine height index, mid arm muscle area and total lymphocyte counts. Hence, these later parameters appear to be the best indicators for follow‐up assessments. (Journal of Parenteral and Enteral Nutrition 19:258–265, 1995)
The Accumulation and Energy Load of Exogenous Lipids in Cirrhotic Rat Liver After Partial Hepatectomy
Authors: Matsui Yoichi , Nakagawa Akihiko , Kasamatsu Satoshi , Nakagawa Manabu , Hiramatsu Yoshifumi , Kamiyama Yasuo
Published: May 2008

Background: The suitability of three energy substrates, glucose, medium‐chain triglycerides (MCT) and long‐chain triglycerides (LCT), was studied in cirrhotic rats after a partial hepatectomy. Methods: Rats with thioacetamide‐induced cirrhosis underwent a 70% hepatectomy, and were divided into three groups. Each group was then injected with 14C‐labeled glucose, 14C‐labeled MCT or 14C‐labeled LCT, respectively. The subsequent tissue distribution of 14C and the cumulative amount of expired 14CO2 were determined. In a second experiment, the 70%‐hepatectomized cirrhotic rats received total parenteral nutrition (TPN). The source of the nonprotein calories was 100% glucose (glucose group), 60% MCT + 40% glucose (MCT group), and 60% LCT + 40% glucose (LCT group). The adenylate energy charge and the glycogen content in the liver remnant were determined. Results: The tissue distribution of 14C revealed that the fat emulsions accumulated preferentially in the liver. One hour after the partial hepatectomy, the concentration of 14C‐labeled MCT in the liver remnants was threefold higher than in sham‐operated controls. Similarly, the concentration of 14C‐labeled LCT was twofold higher. The adenylate energy charge in the glucose group with TPN recovered to preoperative levels within 1‐hour after the partial hepatectomy, whereas the LCT group with TPN showed a 24‐hour delay in their recovery. The MCT group with TPN exhibited an intermediate time course. Conclusions: It is suggested that the specific accumulation of MCT and especially LCT emulsions in the cirrhotic liver remnant acts as an energy load rather than an energy substrate. Uournal of Parenteral and Enteral Nutrition 19:313–318, 1995)