bluuebunny/crossref_metadata_2025 huggingface dataset:
Hormonal and Metabolic Responses to Glucose Infusion in Sepsis Studied by the Hyperglycemic Glucose Clamp Technique
Authors: White Roger H. , Frayn Keith N. , Little Roderick A. , Threlfall Cedric J. , Stoner H.B. , Irving Miles H.
Published: May 2008

Although nutritional support is vital to treatment of severe sepsis, the septic patient does not respond normally to glucose infusion. We have used the hyperglycemic glucose clamp technique to investigate the initial hormonal and metabolic responses of the septic patient to glucose under controlled conditions. The plasma glucose concentration was raised to and maintained at 12 mmol/liter for 2 hr in 12 septic patients and 11 normal controls. Glucose utilization, assessed from the amount infused, was significantly depressed in the patients, despite similar plasma insulin concentrations in the two groups. Forearm glucose uptake was similarly impaired. Despite very similar plasma free fatty acid concentrations in the two groups, which were suppressed equally by the glucose infusion, whole‐body fat oxidation was elevated in the patients compared with the controls, and suppressed to a lesser extent in response to glucose. Glycerol and ketone body concentrations were elevated in the patients in keeping with a picture of accelerated release, clearance, and oxidation of fatty acids.

Plasma cortisol, epinephrine, and norepinephrine concentrations were elevated in the septic patients in a severity‐related manner, but not to high levels compared with experimental work. Norepinephrine showed no response to the glucose infusion in either group. Plasma glucagon concentrations were not significantly elevated in the septic patients.

We conclude that the hyperglycemic glucose clamp provides a useful model for studying glucose intolerance in sepsis. Impaired glucose utilization in septic patients is associated with increased fat oxidation, although the hormonal basis for these changes is still unclear. (Journal of Parenteral and Enteral Nutrition 11: 345–353, 1987)
Relation of Serum Albumin Concentration to Death Rate in Nursing Home Men
Authors: Rudman Daniel , Feller Axel G. , Nagraj Hoskote S. , Jackson Daniel L. , Rudman Inge W. , Mattson Dale E.
Published: May 2008

Serum albumin was measured in 126 men (average age 70.6; range 40 to 96) of a Veterans Administration Nursing Home, and was correlated with other items in an extensive clinical data base, including death or survival during the year after the analysis. The reason for institutionalization was chronic neurologic disease or other disabling physical condition in 63 men (group A), and psychiatric disorder in 63 men (group B).

In group A, the proportions of men with albumin <3.5, 3.5–4.0, and >4.0 g/dl were 6%, 37%, and 57%, respectively. In this group, the serum albumin level was significantly (p < 0.05) correlated with death rate, hemoglobin, hematocrit, serum cholesterol, and serum lactic dehydrogenase. The death rate in group A during the year after the albumin analysis was 25%. For the patients with albumin level <3.5, 3.5–4.0, and >4.0 g/ dl, the death rates were 50%, 43%, and 11 % respectively (p < 0.01 for comparison of the former two groups with the latter). The subgroup with albumin 3.5–4.0 g/dl represented only 37% of the men in group A, but accounted for 63% of the group's deaths.

In group B, serum albumin level was not significantly correlated with any other clinical variable. Death rate during the year after the albumin analysis was only 2% in group B, and did not correlate with the albumin level.

These data indicate that, in nonpsychiatric Nursing Home men, the desirable level for the serum albumin concentration is higher than 3.5 g/dl. (Journal of Parenteral and Enteral Nutrition 11:360–363, 1987)
Hypomagnesemia: A Multifactorial Complication of Treatment of Patients with Severe Burn Trauma
Authors: Cunningham John J. , Anbar Ran D. , Crawford John D.
Published: May 2008

Hypomagnesemia is reportly a common complication of care during the early period of recovery from major trauma. Aminoglycoside treatment, by provoking inappropriate renal magnesium wasting, may contribute to the frequency of hypomagnesemia. We examined the magnesium (Mg) status of six severely burned adolescents during the early phase of recovery. Although provision of Mg met recommended levels, hypomagnesemia occurred in every patient. Two of five of our patients were hypomagnesemic during gentamycin treatment, and five of five during subsequent tobramycin therapy (including the three not affected by gentamycin). Additional episodes occurred in five patients in the absence of aminoglycosides. An interrelationship between Mg status and efficacy of potassium repletion is detailed for one patient. Hypomagnesemia during tobramycin treatment was associated with refractoriness to potassium repletion. Recurrence of hypokalemia during a subsequent diuresis‐induced hypomagnesemia was prevented by Mg supplementation. The Mg requirement is increased during recovery from severe burns and appears to exceed that provided by commercially available enteral formulations. (Journal of Parenteral and Enteral Nutrition 11:364–367, 1987)
Clinical Efficacy and Design Changes of “Fine Bore” Nasogastric Feeding Tubes: A Seven‐Year Experience Involving 809 Intubations in 403 Patients
Authors: Silk D.B.A. , Rees R.G. , Keohane P.P. , Attrill H.
Published: May 2008

We report here our clinical experiences of “fine bore” nasogastric feeding tubes. Data have been collated over a 7‐year period (1978–1985). A total of 403 patients were intubated on 809 occasions. In the first retrospective study, the clinical use of 491 unweighted tubes was compared with that of fifty 3.5‐g weighted tubes. No advantage was found in the use of the weighted tubes. In the second prospective controlled clinical trial, these results were confirmed. Forty‐six patients were intubated on 76 occasions with an 85‐cm open‐ended, unweighted nasogastric feeding tube (Prima, Portex UK), and 57 patients were intubated on 79 occasions with a 91‐cm 3.0‐g weighted tube (Entriflex, Biosearch, Raritan, NJ). Mean duration of placement was similar in each case, and 62% of both types of tubes were inadvertently removed. Without exception, all the tubes remained in the stomach throughout. Disappointed with the similar and overall performance of both types of tubes, we initiated a design program which resulted in the development of two new nasogastric tubes, one weighted and one unweighted. The tubes were manufactured with polyurethane, rather than polyvinychloride (PVC), which permitted an increase in diameter of the internal lumen which, in turn, was coated with water‐activated lubricant to ease removal of the introducer wire. A specially modeled outflow port was incorporated into the tips of both tubes. The performance of the two new polyurethane nasogastric feeding tubes was assessed under controlled trial conditions; as a reference, a widely used PVC unweighted open‐ended tube was used. Although intubation times were similar in patients without concurrent endotracheal intubation, it took a significantly shorter time to intubate patients with concurrent endotracheal intubation with the new weighted tube. After tube intubation, it was possible to aspirate gastric contents significantly more often through the new polyurethane tubes (p < 0.001) than through the PVC tube, and the unweighted polyurethane tube stayed in situ longer (p < 0.05) than the PVC tube. The newly designed polyurethane nasogastric feeding tubes are the first tubes that have been shown to have advantages over the simpler type of open‐ended, unweighted PVC nasogastric feeding tubes. (Journal of Parenteral and Enteral Nutrition 11:378–383, 1987)
Serum Lipoproteins in Home Total Parenteral Nutrition Patients
Authors: Levy Yishai , Shils Maurice E. , McNamara Donald J. , Shike Moshe
Published: May 2008

Patients maintained in our home total parenteral nutrition (HTPN) program receive very small amounts of cholesterol in their solutions. Because of the severe intestinal insufficiency which is characteristic of this group, they do not absorb significant amounts of cholesterol or bile salts from their intestines. We investigated the serum lipoproteins in nine patients maintained on HTPN for 36 ± 4 (mean ± SEM) months. Fat emulsions were given twice a week as a source of essential fatty acids. Mean serum cholesterol 110 ± 6.5 mg/dl, LDL‐cholesterol 75 ± 6 mg/dl, and HDL‐cholesterol 29 ± 1 mg/dl, were at or below the 5th percentile compared with age‐and sex‐matched Lipid Research Clinic controls. HDL‐cholesterol to serum cholesterol ratio was in the normal range (0.25 ± 0.30). The mean serum cholesterol did not rise, but the mean serum triglyceride rose significantly from 72 ± 4 to 104 ± 16 mg/dl (p > 0.05) immediately after completion of TPN infusions with fat emulsions. There was a negative correlation between the length of HTPN therapy and the total serum cholesterol (r = 0.43, p > 0.05). Thus, HTPN patients have markedly depressed concentrations of total serum cholesterol, LDL‐cholesterol, and HDL‐cholesterol, but the ratio of HDL cholesterol to total serum cholesterol is in the normal range. (Journal of Parenteral and Enteral Nutrition 11:471–474,1987)
Ambulatory Home Total Parenteral Nutrition
Authors: Gouttebel M. C. , Saint‐Aubert B. , Jonquet O. , Astre C. , Joyeux H.
Published: May 2008

Ambulatory total parenteral nutrition (TPN) at home was used in 85 patients within a 6‐yr period Indications include severe malabsorption, fistulas, anorexia nervosa, and malignancies. The median duration of home TPN (HPN) was 67 days (range: 30–4,155 days). HPN duration for patients with benign diseases was longer [357.12 days (range: 30–4,155 days)] than for cancer patients [93.54 days (range: 30–421 days)]. Under HPN, patients gained a good nutritional status with an increase of total protein (p > 0.001) and serum albumin levels (p > 0.001). Weight gain was also significant (p > 0.001). The rehospitalization rate was low (7.8%), but it was higher when HPN lasted for more than 3 months (10.87% ± 1.58%) compared with short‐term HPN (5.69% ± 1.25%). Metabolic complications were unusual, and rehospitalization was related to the oncological treatment and/or infectious complications. Therefore, ambulatory HPN is a nutritional support that can significantly improve the life of patients with alimentary failure. Moreover, HPN allows significant cost savings compared to the alternative of prolonged hospitalization. (Journal of Parenteral and Enteral Nutrition 11:475–479,1987)
Repeated Rescue of a Broviac Catheter: Fixation of Exposed Cuff by a Skin Flap
Authors: Pineschi A. , Perini R. , Faraguna D. , Loschi L. , Gazzola A. M.
Published: May 2008

A cutaneous infection exposed the cuff of a Broviac catheter employed for home‐TPN in a 3‐month‐old child with ultra‐short bowel syndrome. In order to avoid removal of the catheter, sepsis was abated by antibiotic administration through its lumen, then the exposed cuff was covered and fixed by a skin flap. The advantages proceeding from this sort of “emergency rescue” of the Broviac catheter have been: (1) to avoid a new cutdown in a child already submitted to several attempts of cannulation with sacrifice of major vessels; (2) to resume home total parenteral nutrition (TPN) in a short time, being the patient strictly dependent upon his parenteral intake and to spare a well‐functioning catheter. Ten months after the last cuff covering by skin flap, the catheter is safely fixed in place and currently employed for home TPN. (Journal of Parenteral and Enteral Nutrition 11:486–487,1987)
Intravenous Nutrition during a Twin Pregnancy
Authors: Karamatsu June T. , Boyd Alan T. , Cooke Jonathan , Vinall Peter S. , McMahon M. J.
Published: May 2008

A case is reported of a woman in the third trimester of a twin pregnancy who required intravenous nutrition because of inadequate absorption of nutrients due to a jejunoileal bypass. Weight gain was poor, and there was evidence of intrauterine growth retardation before commencement of intravenous feeding. She received overnight intravenous nutrition for 6 weeks and gained weight with ultrasound evidence of fetal growth. During the 33rd week of gestation, she was delivered of healthy twin males who were at appropriate birth weights and development for their age of gestation. The considerations in intravenous nutrition for a twin pregnancy after jejunoileal bypass are discussed. (Journal of Parenteral and Enteral Nutrition11:499–501,1987)
Subclavian Vein Puncture under Ultrasonic Guidance
Authors: Kawamura Ryoki , Okabe Masato , Namikawa Kazuo
Published: May 2008

Ultrasonically guided subclavian venipuncture is described. Since this method permits direct tapping of the subclavian vein and control of the insertion to the innominate vein under ultrasonic guidance, complications such as pneumothorax, accidental subclavian artery puncture, and malposition of the catheter, which often accompany the conventional method, can be avoided. As a result, this technique produces no radiation damage. (Journal of Parenteral and Enteral Nutrition 11:505–506,1987)
Transcutaneous Muscle Stimulation Promotes Muscle Growth in Immobilized Patients
Authors: Buckley Donald C. , Kudsk Kenneth A. , Rose Barry , Koettyng Carol A. , Schlatter Marc , Miller Carole A.
Published: May 2008

Muscular activity is a fundamental determinant of muscle mass. Transcutaneous muscle stimulation (TMS) may reverse muscle atrophy and lean mass loss in immobile patients by “artificial exercise.” Four paraplegic patients with upper motor neuron lesions entered The Ohio State University Clinical Research Center for a 21‐day metabolic balance study. After 6 days of baseline monitoring, each underwent isometric tetanic contractions (15 sec on; 45 sec off) of all major lower extremity muscle groups with TMS for 10 hr daily. Cross‐sectional areas of muscle plus bone were calculated with CAT scan planimetry at 7 levels in both lower extremities before and after the TMS period. Three patients completed the metabolic balance study. TMS produced significant growth of innervated thigh and calf muscles in all paraplegic patients. Little growth occurred where bone and tendon predominate. No significant changes in nitrogen balance (urine and stool excretion), potassium balance (urine excretion only), or phosphate balance (urine excretion only) could be demonstrated. Two possible explanations are (1) that the patients may have been underfed and (2) that perhaps due to an increase in metabolic rate owing to the stimulation, lean tissue in other locations may have been mobilized to meet leg muscle demands. Future studies will incorporate metabolic monitoring of oxygen consumption and CO2 production during the experiment. (Journal of Parenteral and Enteral Nutrition 11:547–551, 1987)
Effects of Intermittent Electrical Stimulations on Muscle Catabolism in Intensive Care Patients
Authors: Bouletreau P. , Patricot M.C. , Saudin F. , Guiraud M. , Mathian B.
Published: May 2008

To determine whether muscular contractions obtained by electrical stimulation in immobilized patients are able to reduce muscle catabolism, we studied 10 patients (65–79 yr old) hospitalized in the intensive care unit for postoperative ventilatory failure or cerebral infarction. Artificial nutrition was the same for each patient during the 9‐day study period. Two periods of 4 days were defined and randomized for each patient, separated by one day. During the muscular stimulation (MS) period, intermittent electrical stimulation of the muscles of the legs (external electrodes), were performed daily during 2 X 30 mn. During the other period, muscular stimulations were not performed.

Urinary excretion of nitrogen (micro‐Kjeldhal digestion and Nessler procedure), creatinine (Jaffe reaction), and 3‐methyl histidine (3‐MH) (gas phase chromatography) was measured every day.

a t‐test for paired data.

We conclude that a significant decrease in 3‐MH and creatinine excretion is observed during the MS period. In intensive care unit patients, muscle protein breakdown may be influenced by intermittent muscular electrical stimulation. (Journal of Parenteral and Enteral Nutrition 11:552–555, 1987)
Mechanical Properties of the Lungs of Posttraumatic Rats Are Improved by Including Fat in Total Parenteral Nutrition
Authors: Bahrami Soheyl , Strohmaier Wolfgang , Redl Heinz , Schlag Günther
Published: May 2008

Posttraumatic lung failure is often associated with alterations in lung surfactant composition and function. Our previous studies with total parenteral nutrition (TPN) have shown the effect of fat supply on phospholipid composition in pulmonary surfactant. Consequently, we attempted to determine whether fat supply would also improve the functional properties of the lung and surfactant. After polytrauma consisting of laparotomy, hypovolemia, and a single femur fracture, the animals were fed only parenterally for 14 days. Two groups of rats were infused via the jugular vein with isocaloric (260 kcal/kg/day) and isonitrogenous (5.62 gN/kg/day) regimens. The nonprotein calories were given either as glucose alone or 30% of calories as fat. Lung function was assessed by measurement of static lung compliance and total lung capacity. Surfactant isolated from lavage fluid was evaluated by means of a Wilhelmy balance. In agreement with our previous studies, in which we obtained a higher level of saturated lecithin in the fat groups, we found significantly (p < 0.05) increased compliance (2.93 ± 0.54 ml/cm H2O/kg BW) in the fat group compared to the carbohydrate group (2.02 ± 0.36 ml/cm H2O/kg BW). Furthermore, a significantly (p < 0.05) elevated total lung capacity was noted in the fat group (32.60 ± 3.90 us 26.00 ± 1.45 ml/kg BW). The relatively improved surface tension properties as expressed by stability index (S = 0.89 ± 0.24 vs 0.66 ± 0.22) and minimum surface tension (γ min = 18.5 ± 5.01 vs 20.75 ± 2.81) is a characteristic change, and was seen in the fat group. From these data, we conclude that it is possible to influence surfactant composition and to improve lung function properties with a lipid emulsion. Such an emulsion may prove useful in preventing posttraumatic lung complications. (Journal of Parenteral and Enteral Nutrition 11:560–565, 1987)
Review: Interorgan Ammonia Metabolism in Health and Disease: A Surgeon's View
Authors: Souba Wiley W.
Published: May 2008

Ammonia is a toxic molecule that is the principal by‐product of amino acid metabolism. Although the transport of ammonia in a nontoxic form protects the brain against high circulating levels, the interorgan transport of this molecule and the orchestration between tissues that has evolved is related primarily to the fact that the nitrogen molecule is an essential molecule for the maintenance of the body's nutrition economy and overall metabolic homeostasis. Efficient handling and disposal of ammonia requires a cooperative effort between tissues in order to maintain nitrogen homeostasis. The liver is the central organ of ammonia metabolism, but other organs also play a key role in the interorgan exchange of this molecule. Alterations in ammonia metabolism occur during critical illness. These changes are adaptive and are designed to maintain metabolic homeostasis. Interorgan cooperation in ammonia metabolism is necessary to insure the proper integration of the metabolic processes which contribute to and are essential for survival during critical illness. An understanding of these processes improves our knowledge of metabolic regulation and will lead to a rational approach to the nutritional and metabolic support provided to critically ill patients. (Journal of Parenteral and Enteral Nutrition 11:569–579, 1987)
Research Activities and Interests of Dietitians
Authors: Schiller M. Rosita
Published: May 2008

A survey was conducted to ascertain research involvement and interests of dietitians. The survey questionnaire was developed and mailed to 1200 dietitian members of The American Society of Parenteral and Enteral Nutrition (A.S.P.E.N.). Usable responses numbered 424 (35.3%); 84% were A.S.P.E.N. members 5 years or less. Currently 46% and previously 17% of respondents served on nutrition support (NS) teams. Two‐thirds of the group either completed or were enrolled in a graduate program. Only one‐half of the respondents had statistics and/or research methodology courses.

Half the group spent no time in research, 10% gave 10–50 hr/week and nearly 80% wanted to spend more time in this activity. One‐fifth were principal investigators (PI), 27% were co‐investigators and 29% had collected data for others. Although 16% wrote proposals, fewer than 10% had projects approved and/or funded; co‐investigators were more successful than PIs in this regard. Several (22.2%) presented research papers or posters and 36% gave seminars, case studies, or short presentations. One‐fifth (20.8%) published research articles and 20.3% published other works.

More than 80% expressed interest in collaborative research, perhaps because many felt they lacked skills needed to develop research designs, write proposals, analyze data, obtain funding, and get published. Most said research was not rewarded, of a low priority, and generally ignored by the dietetics department; 60.5% had great interest in research and 37.1% had adequate research opportunities. No significant differences were observed for those with graduate degrees or for members of NS teams but A.S.P.E.N. dietitians appeared to be more active in research than other dietitians (Journal of Parenteral and Enteral Nutrition 12:1–7, 1988)
Plasma Carnitine Alterations in Premature Infants Receiving Various Nutritional Regimes
Authors: Smith Rebecca B. , Sachan Dileep S. , Plattsmier Joan , Feld Neil , Lorch Vichien
Published: May 2008

Plasma carnitine, carnitine esters, and triglyceride concentrations were determined in 36 appropriate‐for‐gestational‐age (AGA) infants at various stages of prematurity throughout hospitalization to determine the effect of a carnitine‐free and carnitine‐containing diet on plasma carnitine and triglyceride concentrations. The infants were entered into one of three experimental groups based on birth weight: group I <1.0 kg; group II 1.0–1.51 kg; and group III 1.52–2.5 kg. Throughout the study subjects were placed on appropriate nutritional regimes which included hyperalimentation (HA), intravenous (iv) fat emulsion (Intralipid), Portagen, Enfamil‐24 Premature Formula, Enfamil‐20, and breastmilk. Blood samples were drawn from each infant at birth, days 1–5,7 then weekly, also before and after each nutritional intervention to determine carnitine and triglyceride concentrations. Results showed that plasma total carnitine and nonesterified carnitine decreased in all groups when the infants were maintained on a carnitine‐free diet (HA, Intralipid, Portagen). In general, the carnitine levels continued to decrease until a carnitine‐containing diet was initiated. Once a carnitine‐containing diet was begun, plasma total carnitine (TC) and nonesterified carnitine (NEC) levels increased at fairly similar rates in all groups. However, an inverse relationship between carnitine and triglyceride (TG) concentrations were not seen in these infants. This would indicate that most premature infants require exogenous carnitine to maintain the plasma concentration of carnitine. However, a decreased concentration of plasma carnitine was not correlated with an elevated TG level under the conditions of this study. (Journal of Parenteral and Enteral Nutrition 12:37–42, 1988)
Effects of Total Parenteral Nutrition with Nucleoside and Nucleotide Mixture on D‐Galactosamine‐Induced Liver Injury in Rats
Authors: Ogoshi Shohei , Iwasa Masato , Kitagawa Shiroshi , Ohmori Yoshinobu , Mizobuchi Shunji , Iwasa Yoshie , Tamiya Tatsuo
Published: May 2008

The effect of a nucleoside‐nucleotide mixture on liver injury of rats induced by D‐galactosamine was studied by examining changes in function and histopathology of the liver. Animals with liver damage received total parenteral nutrition with glucose and amino acids supplemented with a nucleoside‐nucleotide mixture containing inosine, cytidine, GMP, uridine and thymidine, or with uridine which inhibits galactosamine injury, or with liver cell extract containing flavin adenine dinucleotide and nucleic acid derivatives. As control, animals with liver damage received total parenteral nutrition with glucose and amino acids only. The serum GOT and GPT concentrations were significantly lower in the group supplemented with nucleoside‐nucleotide mixture than those in other groups. A large dose (1.2 g/kg) of uridine inhibited liver injury, but a lower dose (0.14 g/kg) did not have any effect, whereas nucleoside‐nucleotide mixture containing the same amount of uridine inhibited the injury. Liver cell extract also did not improve liver function. Thus infusion of a physiological and balanced mixture of nucleosides or nucleotides may improve liver function in rats with liver injury. (Journal of Parenteral and Enteral Nutrition 12:53–57, 1988)
Nutritional Support by Intraperitoneal Dialysis in the Rat: Maintenance of Body Weight with Normal Liver and Plasma Chemistries
Authors: Pessa M.E. , Sitren H.S. , Copeland E.M. , Talbert J.L. , Schmidt G. , Baumgartner T.G.
Published: May 2008

A rat model was developed to study intraperitoneal (ip) dialysis as a means of total nutritional support. Rats (200 g) were implanted ip with a catheter device and connected to a rodent infusion assembly. An automated system exchanged 10‐ml volumes of a 37°C solution containing 10% dextrose, 2% amino acid solution plus micronutrients. Rats were adapted over 3 days to a schedule of 16 1‐hr cycles/day, and continued on this regimen for another 4 days. Rats subjected to this program maintained similar body weight, nitrogen balance, plasma chemistries, and liver tests in comparison to control animals fed per os in isocaloric and isonitrogenous amounts. Efficiency of peritoneal absorption for both glucose and amino acid was 95%. Histological examination of intraabdominal organs revealed only mild inflammation. This model is applicable to studies involving nutritional support via the peritoneal cavity, a technique which may be of value in patients with sensitive fluid balances (cardiac, renal, or pulmonary failure). (Journal of Parenteral and Enteral Nutrition 12:63–67, 1988)
Successful Treatment of Superior Vena Cava Syndrome with Urokinase in an Infant
Authors: Wilson Claire M. , Merritt Russell J. , Thomas Daniel W.
Published: May 2008

An 11‐month‐old infant with a central venous catheter for total parenteral nutrition for short gut syndrome developed head and neck swelling. A thrombus at the catheter tip occluding the superior vena cava was demonstrated roentgenographically. A 48‐hr infusion of urokinase (4400 units/kg/ hr) was administered for thrombolysis. The thrombus cleared clinically and roentgenographically without adverse effects. There has been no recurrence of the superior vena cava syndrome. Urokinase infusion is an alternative to immediate catheter removal in selected patients. (Journal of Parenteral and Enteral Nutrition 12:81–83, 1988)
Effect of Starvation and Total Parenteral Nutrition on Electrolyte Homeostasis in Normal Man
Authors: Legaspi Adrian , Roberts John P. , Horowitz Glenn D. , Albert James D. , Tracey Kevin J. , Shires G. Tom , Lowry Stephen F.
Published: May 2008

Elemental balances, and skeletal muscle membrane potential (Em) and biopsy were utilized to evaluate electrolyte homeostasis and body composition in 11 healthy adult volunteers after 10 days of starvation. This controlled, acute malnutrition was followed by refeeding for 10 days with two different, commonly used, total parenteral nutrition (TPN) solutions. Six subjects were refed with crystalline amino acids and dextrose (dextrose group), while five subjects received amino acids, dextrose, and lipid (lipid group). During starvation, negative balances for potassium, phosphorous, magnesium, and nitrogen were observed in both groups. When compared to starvation, total parenteral nutrition produced statistically significant (p < 0.05) equilibrium or positive electrolyte and nitrogen balances for both, the dextrose and lipid groups. During TPN, there was a significantly (p < 0.001) positive chloride balance in the lipid group when compared to the dextrose group. At the conclusion of the 10‐day period of TPN, there was a decrease (p < 0.05) in skeletal muscle Em. This change, in concert with the electrolyte balance data obtained during parenteral repletion, lead us to postulate that restoration of lean tissue protein and cellular function does not occur at a rate which might be inferred from the positive nitrogen balance observed in this model. A persistent defect in cellular function which was evident after starvation, suggests that a brief period of TPN is insufficient to restore skeletal muscle integrity. (Journal of Parenteral and Enteral Nutrition 12:109–115, 1988)
Do Weighted Nasoenteric Feeding Tubes Facilitate Duodenal Intubations?
Authors: Levenson Robin , Turner William W. , Dyson Anne , Zike Lenora , Reisch Joan
Published: May 2008

A widely held assumption is that postpyloric intubations occur more often with weighted than with unweighted nasally inserted feeding tubes. This randomized, prospective study compared the frequency of duodenal intubations using weighted and unweighted nasoenteric feeding tubes. One hundred sixteen patients had either weighted (61 patients) or unweighted (55 patients) 10F silicone elastomer feeding tubes inserted nasally 85 cm. Tubes were placed with wire stylets. Tube positions were verified radiographically within 4 hr after insertions. Radiographs were repeated daily for 3 days or until duodenal intubation occurred. Successful duodenal intubations were achieved in 35 patients (57%) with weighted feeding tubes and in 37 patients (67%) with unweighted feeding tubes. This difference was not significant. Weighted nasoenteric feeding tubes offer no advantage over unweighted tubes in achieving duodenal intubations. (Journal of Parenteral and Enteral Nutrition 12:135–137, 1988)
Aluminum Contamination of Infant Formulas
Authors: Koo Winston W.K. , Kaplan Lawrence A. , Krug‐Wispe Susan K.
Published: May 2008

This study aims to determine the extent of aluminum (Al) contamination in whole milk, milk formulas, and other nutrient products commonly used for infants. Similar products from different manufacturers and different lots were measured for Al using electrothermal atomic absorption technique. Aluminum measurements were made directly from the samples or after reconstitution or dilution with Al‐free water. Aluminum content was lowest (<50 μg/liter) in human milk, whole cow milk, and products that appear to require minimal manufacture processing and have few additives such as skim milk, cow milk with 2% fat, bottled glucose water, and sterile water. Highest Al levels (up to 2346 μg/liter) were found in highly processed and modified formulas including soy formula, preterm infant formula, and formulas for specific metabolic disorders. Aluminum content of humanized cow milk formula and bottled glucose‐electrolyte solution were between the two ranges and usually <400 μg/liter. There were no significant differences in Al content of similar products from different manufacturers. Liquid formula stored in glass bottles has highest Al content compared to that stored in steel cans or powder preparation of the same product (p < 0.05). Thus there are marked differences in Al loading depending on the type of formula, whether it is a powder or liquid preparation and the type of storage container. We speculate that raw materials such as soybean, additives such as calcium and phosphorus, manufacturing processes and storage containers are potential sources of contamination of infant formulas. (Journal of Parenteral and Enteral Nutrition 12:170–173, 1988)
Effect of Emulsions of Medium and Long Chain Triglyceride on Human Adipose Tissue Prostaglandin Production in Vitro
Authors: Katz David P. , Rudick Jack , Knittle Jerome L.
Published: May 2008

Preliminary in vitro studies have been performed to assess the effect of experimental lipid emulsions of varying fatty acid composition on human adipose tissue metabolism. Subcutaneous human adipose tissue was obtained during elective surgery and placed in tissue culture. Physical mixtures of long chain triglyceride (LCT) and/or medium chain triglyceride (MCT) were added to the tissue culture medium so that the final concentration was 400 mg/dl. After a 3‐day incubation period the tissue was harvested, placed in buffer and used to determine in vitro production of the prostaglandins prostacyclin I2 (measured as its stable endproduct 6‐keto PGF1α), thromboxane A2 (measured as TXB2), and prostaglandin E2. Measurements of the fatty acid profile found in the neutral‐ and phospholipid fraction of the adipose tissue and fat cell size were also made. The results demonstrate that samples incubated in 100% MCT had the most significant increase in prostaglandin production whereas those incubated in 100% LCT had the most significant decrease in activity of the three prostaglandins assayed, when compared to controls. The addition of LCT to MCT caused a dose‐related decrease in adipose tissue prostaglandin production. There were no significant changes in the profile of fatty acids found in the neutral‐ or phospholipid fraction of adipose tissue. The results indicate that the relative level of MCT/LCT incubated with human adipose tissue has a significant effect on prostaglandin production. (Journal of Parenteral and Enteral Nutrition 12:178–184, 1988)
Antibiotic‐Lock Technique: A New Approach to Optimal Therapy for Catheter‐Related Sepsis in Home‐Parenteral Nutrition Patients
Authors: Messing Bernard , Peitra‐Cohen Sophie , Debure Alain , Beliah Martine , Bernier Jean‐Jacques
Published: May 2008

During a cumulated survey of 286 months, covering 11 gastroenterological patients under nocturnal‐cyclic home parenteral nutrition, 24 cases of catheter‐related sepsis were observed (one/11.9 months). None of these were associated with focus of infection at the cutaneous entry point or at the subcutaneous tunnel of the catheters. In this study attempt was made to control sepsis without removal of the surgically implanted siliconed lines (Vygon code 180–20 with an internal filling volume of 1 ml). The first two catheter‐sepsis were conventionally treated with systemic antibiotics for 3 weeks which meant a 1‐month hospital admission each time. Consequently, we used a new antibiotic therapy consisting of locking 12 hr/day 2 ml of highly concentrated antibiotic solution within the catheter. After identification of bacterial strains by blood cultures, the antibiotic lock‐technique was daily applied either alone for 16 days (group I, n = 11) or for 12 days following a 3‐day course of systemic antibiotics (group II, n = 11). After starting antibiotics via the infected line, the time taken for fever abatement and for obtaining negative in‐line blood cultures were 2 and 4 days, respectively, and identical in group I and II. Failure of antibiotic treatment leading to catheter withdrawal was observed once in each group (9%) and was due to secondary candida catheter‐sepsis. The time for hospital stay was shorter p < 0.02 in group I (4 days) than in group II (7 days). Antibiotic‐lock technique was then applied by trained patients at home. This study demonstrates that catheter‐related sepsis due to septic manipulation of the nutritive line is nearly always successfully treated by antibiotic‐lock technique. Therefore this new approach represents an improved therapy avoiding hazards of catheter change and systemic antibiotic therapy. (Journal of Parenteral and Enteral Nutrition 12:185–189, 1988)
Branched‐Chain Amino Acids Metabolic Support in Surgical Patients: A Randomized, Controlled Trial in Patients with Subtotal or Total Gastrectomy in 16 Japanese Institutions
Authors: Okada Akira , Mori Shozo , Totsuka Morio , Okamoto Kazumi , Usui Sadahito , Fujita Hideharu , Itakura Takeo , Mizote Hiroyoshi
Published: May 2008

A prospective, randomized, controlled trial of nutritional effects of branched‐chain‐enriched amino acid (BCAA) solution was undertaken in 173 surgical patients with gastric cancer. Eighty‐six and 87 patients underwent subtotal and total gastrectomy, respectively. The effects were evaluated in total parenteral nutrition (TPN) in an isocaloric/isonitrogenous setting where the major difference between the group was the amount of BCAA received. Each 80 patients in the control and the BCAA groups completed the trial. The group receiving BCAA‐enriched amino acid solution demonstrated a statistically significant improvement on days 2 and 3 in nitrogen balance in patients with total gastrectomy. Three‐methylhistidine excretion gradually decreased after day 1, and the values on day 7 were significantly lower than those on day 1 in the BCAA group in both those receiving subtotal and total gastrectomy. There were no significant differences of serum albumin and rapid turnover proteins between the control and BCAA groups in both those receiving subtotal and total gastrectomy. Plasma BCAA level and BCAA to aromatic amino acid (AAA) ratio were significantly higher, and AAA level was significantly lower in the BCAA group than in the control group. There were no serious complications encountered during the observation period in both groups. These results indicated that a BCAA‐enriched amino acid solution can improve metabolism and maintains good nitrogen retention without increasing side effects as compared with a conventional amino acid solution for nutritional support of patients who have received subtotal or total gastrectomy. (Journal of Parenteral and Enteral Nutrition 12:332–337, 1988)
Activity of Natural Killer Cells after Postoperative Amino Acid Infusion
Authors: Nissilä Markku , Salo Matti , Granberg Christer , Perttilä Juha , Neuvonen Pekka
Published: May 2008

Effects of postoperative infusion of a 3% amino acid solution on natural killer (NK) cell activity were studied in 10 patients undergoing major abdominal surgery. Eight additional patients formed the control group. Preoperative NK cell activity against K562 target cells determined in a short‐term 51Cr release assay was similar in patients of both groups. After the operation, in general the patients of both groups showed a decrease in NK cell activity (p < 0.01) but without differences between the groups. There were no changes in the percentages of Leu‐7 positive cells (NK cells) between or within the two groups. However, the number of Leu‐7 positive cells in blood was lower in the amino acid than in the control group patients during the postoperative days 3–7 (p < 0.05 and 0.01).

In vitro, the amino acid solution proved to be nontoxic both for effector and target cells and no depression of NK cell activity was observed. A 16‐hr preincubation of mononuclear cells with the amino acid solution did not affect NK cell activity.

The results suggest that postoperative infusion of an isotonic amino acid solution does not routinely offer any advantages over glucose containing electrolyte solution as to its effects on NK cell activity. (Journal of Parenteral and Enteral Nutrition 12:346–350, 1988)
Comparison of the Effects of Continuous and Cyclic Nocturnal Parenteral Nutrition on Energy Expenditure and Protein Metabolism
Authors: Lerebours Eric , Rimbert Agnés , Hecketsweiler Bernadette , Hellot Marie‐France , Denis Philippe , Colin Raymond
Published: May 2008

Although cyclic nocturnal total parenteral nutrition is a widely used technique, its metabolic consequences have not been fully investigated. During two successive 7‐day periods, 12 patients received randomly either standard continuous (infusion 24 hr/day) or cyclic (infusion between 5 pm and 9 am) total parenteral nutrition (TPN). Calorie and nitrogen intakes were identical during both periods. Energy expenditure was investigated by indirect calorimetry and showed practically no difference between continuous standard (1383 ± 41 kcal/ day−1) and cyclic total parenteral nutrition (1428 ± 46 kcal/ day−1). However, in the cyclic regimen, when compared with continuous infusion, energy expenditure was higher between 5 pm and 9 am and lower between 9 am and 5 pm. At the end of the noninfusion period, the 24‐hr profile of the nonprotein respiratory quotient showed a slight decrease in patients receiving the cyclic infusion, in contrast with the stability of the quotient in the standard regimen. However, the nitrogen balance and variations in nutritional status did not differ significantly. In conclusion cyclic TPN is efficient for achieving a positive energy and nitrogen balance and in addition it induces a metabolic profile closer to physiological conditions. (Journal of Parenteral and Enteral Nutrition 12:360–364, 1988)
Guillain‐Barré Syndrome due to Hypophosphatemia following Intravenous Hyperalimentation
Authors: Hoff Stuart D. , Rowlands Brian J.
Published: May 2008

This case report documents the additive effects of pregnancy, hyperemesis, cholecystitis, and intravenous nutrition in causing profound hypophosphatemia. This led to severe reversible neurological sequelae for the mother and fetal demise. The etiology of hypophosphatemia and management are discussed. (Journal of Parenteral and Enteral Nutrition 12:414–416, 1988)
Percutaneous Alternatives in Nutritional Support: A Radiologic Perspective
Authors: Lambiase Robert E. , Dorfman Gary S. , Cronan John J. , Paolella Landy P. , Caldwell Michael E.
Published: May 2008

As alternatives to per os feeding and nutritional support increase in number and complexity, the interventional radiologist has come to play a more significant role in the creation and maintenance of nutritional access. In very difficult access cases, the concerted effort of the nutritional surgeon and the radiologist is often required. We describe several such situations which have been successfully managed at our institution. The indications for and techniques of percutaneous reestablishment of surgically placed jejunostomy tubes, the percutaneous conversion of gastrostomy to jejunostomy tubes with retention of the gastrostomy tube, and percutaneous placement of an inferior vena caval Hickman catheter are all described in detail. (Journal of Parenteral and Enteral Nutrition 12:513–520, 1988)
Linseed and Cod Liver Oil Induce Rapid Growth in a 7‐Year‐Old Girl with N‐3 Fatty Acid Deficiency
Authors: Bjerve Kristian S. , Thoresen Lene , Børsting Sigurd
Published: May 2008

N‐3 fatty acid deficiency is described in a 7‐year‐old girl who had been fed solely by gastric tube from the age of 3 years. She had received the same nutrient during the last 22 months, supplying 16.2% of calories from linoleate and 0.07% from α‐linolenate. She weighted 9.5 kg at the age of 3, and 10.3 kg at the start of the study, the weight being constant the last 15 months. She was now supplemented daily with 1.2 ml of a linseed‐ and cod liver‐oil mixture (5:1, v/v), thereby increasing her α‐linolenate intake to 0.71% and total N‐3 fatty acids to 0.74% of total energy. Two months later, her rate of weight gain was 0.43 kg/month. After 5 months, the fatty acid supplement was changed to 7.5 ml of cod liver oil daily, thereby changing α‐linolenate and total N‐3 acid intake to 0.10% and 1.3% of total energy, respectively. Her rate of weight gain now increased to 0.64 kg/month, and her length increased from 117 to 122 cm in 5 months. The results indicate that the optimal dietary requirement for N‐3 fatty acids in this child is higher than 0.74%, and extrapolation estimated the optimal requirement to be 1.1%‐1.2% of total calories. The results suggest that N‐3 fatty acids are required for normal growth in man. (Journal of Parenteral and Enteral Nutrition 12:521–525, 1988)
Catheter Fracture and Embolization in a Totally Implanted Venous Access Catheter
Authors: Franey Thomas , Demarco Linda C. , Geiss Alan C. , Ward Robert J.
Published: May 2008

A totally implanted venous access system was placed in a 24‐year‐old male patient with Hodgkins disease for chemotherapy. Twelve months after implantation it was noted on chest x‐ray that the catheter had fractured and the distal fragment embolized to the right ventricle. Catheter separation and embolization is a recognized but uncommon complication of Hickman catheters. It is an even rarer complication of implanted central venous catheters. With the increasing use of these new venous access systems this complication may become a more prevalent, but an avoidable complication. (Journal of Parenteral and Enteral Nutrition 12:528–530, 1988)
Obligate Nasal Breathing in an Elderly Woman: Increased Risk of Nasogastric Tube Feeding
Authors: Hernandez Oscar G. , Nelson Steve , Haponik Edward F. , Lopez Alfredo , Summer Warren
Published: May 2008

The initiation of oronasal breathing when the nasal pathway becomes obstructed requires a complex interaction of neuromuscular responses which are normally present in all but very young infants. We describe an elderly lady who developed respiratory failure partially due to an inability to initiate oral breathing when her nasopharynx was compromised by a nasogastric tube. (Journal of Parenteral and Enteral Nutrition 12:531–532, 1988)
Effects of L‐carnitine supplemented total parenteral nutrition on lipid and energy metabolism in postoperative stress
Authors: Pichard C , Roulet M , Rossle C , Chiolero R , Schutz Y , Temler E , Boumghar M , Schindler C , Zurlo F , Jequier E , et al.
Published: May 2008

During episodes of trauma carnitine‐free total parenteral nutrition (TPN) may result in a reduction of the total body carnitine pool, leading to a diminished rate of fat oxidation. Sixteen patients undergoing esophagectomy were divided randomly in two equal isonitrogenous groups (0.2 g/kg.day). Both received TPN (35 kcal/kg.day; equally provided as long‐chain triglycerides and glucose) over 11 days without (group A) and with (group B) L‐carnitine supplementation (12 mg/kg.day = 75 mumol/kg.day). Compared with healthy controls, the total body carnitine pool prior to the operation was significantly reduced in both groups, suggesting a state of semistarvation and muscle wasting. In group A the plasma levels of total carnitine and its subfractions (free carnitine, short‐ and long‐chain acylcarnitine) remained stable during the study whereas in group B the total plasma carnitine concentration rose mainly due to an increase in free carnitine. In group A the cumulative urinary carnitine losses were 11.5 +/‐ 2.6 mmol (= 15.5 +/‐ 3.1% of the estimated total body carnitine pool). In group B 3.1 +/‐ 1.9 mmol (= 11.1 +/‐ 7.6%) of the infused carnitine was retained in the immediate postoperative phase until day 6, but this amount was completely lost at completion of the study period. No significant differences in the respiratory quotient or in the plasma levels of triglycerides, free fatty acids, and ketone bodies were observed, between or within the groups, before the operation and after 11 days of treatment. It is concluded that the usefulness of carnitine supplementation during postoperative TPN was not apparent in the present patient material.