bluuebunny/crossref_metadata_2025 huggingface dataset:
Hyperphosphatemia from Lipid Emulsion in a Patient on Total Parenteral Nutrition
Authors: Vernon Walter B. , Atkins Judy M. , Stewart Robert D.
Published: May 2008

The clinical course of a patient is described in whom hyperphosphatemia occurred on total parenteral nutrition with lipid emulsion providing half of the nonnitrogenous caloric support. Renal insufficiency, hypoparathyroidism, pseudohypoparathyroidism, and severe catabolism are excluded as causes of this hyperphosphatemia. Changes in serum phosphate are attributed to metabolism of phospholipid present in the lipid emulsion, the sole phosphate source in this patient. These observations suggest that the phosphate of phospholipids can contribute significantly to the metabolic pool of inorganic phosphate. Lipid emulsion, most commonly thought of as a major caloric source, should not be neglected when one is confrontec with hyperphosphatemia during total parenteral nutrition (Journal of Parenteral and Enteral Nutrition 12:84–87, 1988)
A New Apparatus for Chronic Intravenous Infusion in Unrestrained Rats
Authors: Takeyama Hiromitsu , Yura Jiro , Miyaike Hideo , Ishikawa Masakazu , Mizuno Hiroshi , Taniguchi Masaaki , Hanai Takumi , Mizuno Akira , Shinagawa Nagao , Kato Fumihiko
Published: May 2008

A new apparatus incorporating a unique type of swivel device was devised for chronic intravenous infusion in unrestrained rats. The swivel requires very little torque for rotation, ie, one‐fourth that of the standard swivel, yet is 1/30 as expensive. A coil spring tube, located between the swivel and the catheter, allows the rat unhampered movement within the metabolic cage. Because the catheter follows the rats' movements freely, only two silk sutures are required to secure it to the animal. No statistically significant differences between experimental and control rats were observed in terms of body weight gain, food intake, nitrogen balance, or caloric efficiency. This apparatus should prove useful in many areas of research. (Journal of Parenteral and Enteral Nutrition 12:93–99, 1988)
Nutrition Support Practice: A Study of Factors Inherent in the Delivery of Nutrition Support Services
Authors: Agriesti‐Johnson Clair , Dwyer Kathleen , Steinbaugh Maria
Published: May 2008

The purpose of this study was to determine the degree of intercorrelation among dietitian, physician, and team nutrition support functions. Eight hundred and eighty dietitians and physicians were asked to respond to a questionnaire describing nutrition support functions as reported in the literature and validated by a panel of nutrition support physicians and dietitians. Two hundred and fifty‐four completed questionnaires were included in the study, 84 from physicians and 170 from dietitians. Intercorrelations among function statements were subjected to factor analysis. The magnitude and consistency of factor loadings suggest that nutrition support is not perceived as independent components, but as a comprehensive pattern or structure. However, there was one important difference in perception. The sample tended to have an “enteral” orientation to the dietitian role and a “parenteral” orientation to the physician and team roles. The data support the contention that all members of nutrition support teams need a common core of knowledge and a set of highly developed process skills which can best be attained through an integrated, rather than segmented, approach to team training. (Journal of Parenteral and Enteral Nutrition 12:130–134, 1988)
Prognostic Role of Preoperative Nutritional and Immunological Assessment in the Surgical Patient
Authors: Braga Marco , Baccari Paolo , Scaccabarozzi Sergio , Fiacco Enrico , Radaelli Giovanni , Gallus Giuseppe , Dipalo Saverio , Dicarlo Valerio , Cristallo Marco
Published: May 2008

The utilization of delayed hypersensitivity response (DHR) for the identification of high‐risk patients with regard to postoperative septic complications is still discussed. The aim of this study was to clarify how much DHR may improve the prognostic capacity of nutritional assessment (NA). Nutritional and immunological evaluations were performed at admission on 405 patients undergoing elective general surgical procedures. Subjects with serum albumin ≤3.0 g/ dl or total iron‐binding capacity ≤220 μg/dl or weight loss ≥10% with respect to usual body weight were classified as malnourished. DHR was assessed by performing skin tests with four recall antigens: PPD, candida, trichophyton, sk‐sd. The incidence of postoperative complications resulted higher among the 187 malnourished patients (31.0%) than in the 218 well‐nourished ones (14.2%) (p < 0.001), and among the 213 anergic patients (29.6%) than in the 192 normal responders (13.5%) (p < 0.001). To determine how much skin tests may improve the prognostic ability of NA, the relationship between DHR and postoperative complications was also studied in the malnourished and in the well‐nourished patients, separately. In the malnourished group, the patients with an impairment of DHR had a higher incidence of postoperative infections than normal responders (p < 0.05). In the well‐nourished group, no significant differences were found between anergic patients and normal responders. In our study, DHR slightly improved the prognostic capacity of NA. Therefore, the first approach to identify the high‐risk patients seems to be the unexpensive, quick, and available determination of nutritional status. (Journal of Parenteral and Enteral Nutrition 12:138–142, 1988)
Prognostic Significance of Serum Cholesterol in Nursing Home Men
Authors: Rudman Daniel , Mattson Dale E. , Nagraj Hoskote S. , Feller Axel G. , Jackson Daniel L. , Caindec Norma , Rudman Inge W.
Published: May 2008

Serum cholesterol was measured in 129 men (average age 70.6; range 41–96) of a Veterans Administration Nursing Home, and was correlated with other items in an extensive clinical data base.

Serum cholesterol was less than 150 mg/dl in 13% of the subjects, and was less than 160 mg/dl in 18%. Cholesterol greater than 280 mg/dl occurred in 8%. Serum cholesterol varied directly (p < 0.02) with: body weight, serum albumin, serum total protein, serum sodium, ability to walk, and ability to feed oneself; and indirectly (p < 0.02) with death rate, degree of functional dependence, and serum SGOT and LDH. Nursing home men with cholesterol less than 150 mg/dl had a death rate of 63% during the 14 months after the cholesterol analysis, compared to a death rate of 9% in men with cholesterol greater than 150 mg/dl (p < 0.05). Death rate during the year after the analysis was 52% if cholesterol was below 160 mg/dl, compared to 7% if it was above this threshold (p < 0.05). (Journal of Parenteral and Enteral Nutrition 12:155–158; 1988)
Cord Blood Amino Acid Concentrations from Neonates of 23—41 Weeks Gestational Age
Authors: Pittard William B. , Geddes Kitty M. , Picone Thomas A.
Published: May 2008

Amino acid concentrations were measured in the cord blood serum from neonates following 23–41 weeks gestation. These values were then correlated with the gestational age of the newborns. A significant (p < 0.05) correlation was observed with the concentrations of six amino acids, and five of these correlations were negative. The significance of these normative data are discussed and compared with currently available cord blood aminogram data. (Journal of Parenteral and Enteral Nutrition 12:167–169, 1988)
Mechanism of Thrombogenesis during Total Parenteral Nutrition: Role of Catheter Composition
Authors: Di Costanzo Jacques , Sastre Bernard , Choux Règine , Kasparian Michel
Published: May 2008

Catheter material is considered as one of the main factors of deep venous thrombosis during parenteral nutrition. The effects of five types of catheters (polyethylene, polyurethane, silicone, TFE Teflon, and FEP Teflon) on the vein wall and on the blood flow were compared. Experiments were performed on rabbits in which catheters were inserted into the vena cava. Five series of experiments were performed, each including five animals with the same type of catheter. After 10 days, venograms of the vena cava were performed, animals were then killed and the vena cava was removed with the catheter in situ. The vein and the catheter were macroscopically examined; in cases with thrombosis the clot was weighed. The vein wall and the catheter were examined by conventional microscopy and by electron microscopy, respectively. Obstruction of the venous lumen were significantly more frequent with the rigid catheters than with the soft catheters (p < 0.001). The most extensive thromboses occurred with the Teflon catheters. The incidence of fibrin sleeves was significantly higher with the soft catheters than with the rigid ones (p < 0.01). The venographic and macroscopic findings were in agreement in 60–100% of the cases according to the degree of venous obstruction. Catheter surfaces remained unchanged in all cases. The polyethylene catheters induced the most severe intimal inflammatory reactions. Thrombus formation was caused by two mechanisms depending on catheter composition: (1) turbulence caused by the catheter in the blood stream, and (2) platelet aggregation and subsequently, fibrin deposition on the surface of the catheter. (Journal of Parenteral and Enteral Nutrition 12:190–194, 1988)
Plasma Vitamin Levels in Patients on Prolonged Total Parenteral Nutrition
Authors: Labadarios Demetre , O'Keefe Stephen J.D. , Dicker Joy , Van Stuijvenberg Liza , Visser Lizaan , Louw Maria E.J. , Shephard Gordon S.
Published: May 2008

Vitamins are essential in total parenteral nutrition (TPN), their importance being highlighted by repeated past documentation of various vitamin deficiencies particularly in patients on long‐term parenteral nutrition therapy. This study evaluated the efficacy of water‐ (Soluvit) and fat‐soluble (Vitalipid) vitamin supplementation in patients receiving total parenteral nutrition using the three in one 3‐liter bag system. All patients received water‐soluble vitamin supplements daily. Fat‐soluble vitamin supplements were administered on a daily or twice weekly basis. Twenty‐two patients were studied. In seven of the 22 patients vitamin status was assessed on more than one occasion during TPN support, thus bringing the total number of observations to 30. The mean duration of TPN support was 35 days. Eight of the observations were made during less than 10 days, three between 11–19 days, 15 between 20–60 days, and four during more than 60 days of TPN support. Biochemical deficiency as judged by subnormal enzyme activity or vitamin levels were present in 10% of the patients for thiamin, 3% for riboflavin, and 6% for nicotinic acid. By contrast 83% of the patients had low plasma vitamin C and B6 levels. Low plasma vitamin A and E levels were also present in 43 and 40% of the patients, respectively. According to the plasma concentrations of the vitamins studied it would appear that the commercial vitamin preparations used in this study are inadequate in maintaining optimal vitamin status. Our results indicate that on the basis of the low plasma concentrations found, vitamin deficiencies can occur in patients when commercial preparations are used that do not comply with the current guidelines of maintenance requirements. We further recommend that vitamin status assessment, when possible, is incorporated in the overall patient management. (Journal of Parenteral and Enteral Nutrition 12:205–211, 1988)
Conversion of Choledochojejunostomy Stents to Jejunal Feeding Tubes for Postoperative Enteral Alimentation
Authors: Burke Dana R. , Torosian Michael H. , Mclean Gordon K. , Meranze Steven G. , Rosato Ernest F.
Published: May 2008

The problem of protein calorie malnutrition following major gastrointestinal surgery can be treated with central venous or enteric alimentation, with the latter being preferred. The authors describe a simple technique for the conversion of biliary stents placed after pancreaticoduodenal surgery into jejunal feeding tubes when the stenting function is no longer needed. Three illustrative cases are presented. In each case, the procedure took less than 30 min and had no associated morbidity. This technique allows early conversion from central venous to enteric alimentation without the need to create a second surgical enterostomy. (Journal of Parenteral and Enteral Nutrition 12:225–226, 1988)
Artificial beta‐cell promotes positive nitrogen balance and whole body protein synthesis in insulin‐dependent diabetic subjects
Authors: Wesson DE , Black PR , Vlachokosta F , Aoki TT , Wilmore DW
Published: May 2008

To assess the effects of artificial beta‐cell‐directed insulin therapy on protein metabolism in patients with diabetes mellitus, nitrogen balance, urea production, and whole body protein turnover were determined in five type I insulin‐dependent subjects and five age‐ and sex‐matched controls. Each diabetic participant was studied over two 4‐day periods while receiving conventional insulin therapy (one or two daily injections of short and intermediate acting insulin) or insulin delivered by the artificial beta‐cell. While the diabetic participants received conventional insulin therapy, nitrogen balance, urea production, whole body protein turnover, and protein synthesis and breakdown rates did not differ significantly from the control group. However, when the same subjects were on artificial beta‐cell‐directed insulin therapy, they manifested a significant net positive nitrogen balance of over 2 g/day. This change in nitrogen balance was largely due to a fall in urea nitrogen production from 174 +/‐ 6 to 140 +/‐ 13 mg/kg body weight per day (p less than 0.05). In addition, while artificial beta‐cell therapy did not affect whole body protein turnover or breakdown rates, a significant rise (2.1 +/‐ 0.2 to 2.4 +/‐ 0.1 g/kg per day) in whole body protein synthesis was observed (p less than 0.05). Thus when compared to conventional insulin treatment, artificial beta‐cell‐directed insulin therapy was associated with a 14% increase in the rate of protein synthesis and a decrease of 20% in urea nitrogen production, leading to a net positive nitrogen balance.
Clinical evaluation of two‐liter prepacked enteral diet delivery system: a controlled trial
Authors: Rees RG , Ryan J , Attrill HA , Silk DB
Published: May 2008

Following a recent study in our Unit which showed that significantly more of prescribed enteral diet was administered from 2‐liter bags than 0.51 bottles, a controlled clinical trial was undertaken to investigate further the effectiveness of the 2‐liter prepackaged enteral delivery system. Forty patients with normal gastrointestinal function requiring enteral nutrition were randomized to receive nasogastrically 2‐liter/day of polymeric diet (2000 kcal, 12 g N) either from a presterilized 2‐liter PVC bag (Express EFI Ltd, UK) or from two 1‐liter rigid plastic containers filled with cans of Clinifeed 400 (Roussel Laboratories Ltd, UK). The actual volumes of feed infused were monitored in patients fed for 5 days or more. Both nursing and dietetic staff preferred the 2‐liter bags which were more convenient to prepare and use. Significantly larger quantities of prescribed diet were delivered from the 2‐liter bags than from the 1‐liter containers (p less than 0.001). It was concluded that the 2‐liter bag system was potentially more convenient and nutritionally efficacious than 1‐liter containers. Although the incidence of microbial contamination associated with the 2‐liter bags was low, measures to maintain the sterility of this system may need to be more stringent.
Intestinal absorption of elemental and standard enteral formulas in hypoproteinemic (volume expanded) rats
Authors: Granger DN , Brinson RR
Published: May 2008

We examined the influence of a peptide‐based enteral formula and a standard (intact protein) enteral formula on intestinal transcapillary and transmucosal water and protein fluxes during hypoproteinemia induced by plasma volume expansion. In 15 Sprague‐Dawley rats, net transmucosal water flux and net transmucosal and capillary albumin clearances were monitored in jejunal loops before and during intravenous infusion (2.5 ml/min/kg) of Tyrodes solution. This procedure resulted in a 60% reduction in plasma protein concentration and net water secretion into the bowel lumen. Luminal perfusion with the peptide‐based formula did not modify the magnitude of the reduction in plasma protein concentration, yet dramatically reduced transmucosal and transcapillary albumin clearances (p less than 0.05). In addition, a net absorptive water flux was maintained with the peptide‐based formula during volume expansion despite hypoproteinemia. The response to luminal perfusion with the intact protein formula were not different from controls. The results of this study are consistent with previous observations that enteral feeding with a peptide‐based formula significantly attenuates the diarrhea associated with acute hypoalbuminemia in the critically ill patient.
Cancer cachexia
Authors: Kern KA , Norton JA
Published: May 2008

Cancer cachexia describes a syndrome of progressive weight loss, anorexia, and persistent erosion of host body cell mass in response to a malignant growth. Although often associated with preterminal patients bearing disseminated disease, cachexia may be present in the early stages of tumor growth before any signs or symptoms of malignancy. A decline in food intake relative to energy expenditure (which may be increased, normal, or decreased) is the fundamental physiologic derangement leading to cancer‐associated weight loss. In addition, abnormalities of host carbohydrate, protein, and fat metabolism lead to continued mobilization and ineffective repletion of host tissue, despite adequate nutritional support. Mediators of cancer anorexia and associated abnormalities are unknown. Cachectin/TNF or other host‐derived cytokines (produced as a defense against malignancy) have been implicated as signal molecules in cachexia, based upon similar metabolic derangements produced by these cytokines in other chronic wasting illnesses. Nutritional support is effective in maintaining body weight of cachectic cancer patients, but ineffective in maintaining lean body mass. Although in one study parenteral nutritional support has improved operative morbidity and mortality in cancer patients, it has not yet improved response to chemotherapy or radiation therapy. Because of metabolic derangements seen in cancer cachexia, effective nutritional treatment regimens will probably require manipulation of host intermediary metabolism in addition to feeding. Insulin therapy or exercise are two such methods which appear to preserve host composition by preferential feeding of the host at the expense of the tumor. Future studies which more clearly define the role of signal molecules in producing cancer cachexia syndrome may lead to new treatment strategies, possibly involving modulation of the effects of such molecules on host metabolism.
Diarrhea in Tube‐Fed Burn Patients: Incidence, Etiology, Nutritional Impact, and Prevention
Authors: Gottschlich Michele Morath , Warden Glenn D. , Michel Maryann , Havens Pamela , Kopcha Robert , Jenkins Marilyn , Alexander J. Wesley
Published: May 2008

The hypermetabolic state observed in thermally injured patients warrants aggressive nutritional management. Enteral support is the preferred route of nutrient delivery, however diarrhea is reported to be a persistent complication of continuous nasogastric or nasoduodenal hyperalimentation. Diarrhea adds to problems in patient care, disturbs fluid and electrolyte balance, and worsens nutritional status. There has been the impression that tube feeding hyperosmolality, antibiotics, and low serum albumin induce diarrhea. However, in view of the sparsity of published work, a prospective study was undertaken to determine the incidence of diarrhea and to define factors associated with its cause. Of the 50 patients studied, 16 (32%) developed diarrhea. Stool cultures were negative for pathogenic organisms. Although the risk of diarrhea was associated with antibiotics (p < 0.005), several nutrients also had an impact. Results demonstrated a significant relationship between dietary lipid content (p < 0.05) or vitamin A intake (p < 0.001) and diarrhea. Implementation of tube feeding within 48 hrs postburn was also associated with a decreased incidence of diarrhea (p < 0.001). This paper describes a modular tube feeding program in which diarrheal frequency is lessened (p < 0.0001). Surprisingly, tube feeding osmolality, drugs used to prevent stress ulcers, or hypoalbuminemia did not have an adverse effect on intestinal absorption. The cause of diarrhea in burn patients is obviously multifactorial. It is concluded that a low fat (<20% of caloric intake), vitamin A enriched (>10,000 IU/day), early enteral support program maximizes conditions which promote tube feeding tolerance while minimizing nutrient malabsorption during the nutritional rehabilitation of thermal injury. (Journal of Parenteral and Enteral Nutrition 12:338–345, 1988)
Catheter Sepsis during Parenteral Nutrition: The Safety of Long‐Term OpSite Dressings
Authors: Young Graeme P. , Alexeyeff Masha , McR. Russell David , Thomas Robert J.S.
Published: May 2008

A prospective controlled study of the safety of various catheter dressing protocols was carried out in 168 patients receiving parenteral nutrition via an infraclavicular central venous catheter. Four protocols were compared: 36 patients received gauze dressings changed three times per week; 31 received OpSite dressings changed every 7th day (OpS‐7), 32 received OpSite changed every 10th day (OpS‐10), and 69 received OpSite changed twice weekly (OpS‐ICU). Mean duration of parenteral nutrition was approximately 2 weeks and all groups were well matched except that OpS‐ICU patients suffered more frequently from an acute illness. Catheter‐related sepsis was identified by clinical signs of systemic sepsis, positive peripheral venous blood and catheter‐tip cultures and/or defervescence of fever after catheter removal. Catheter‐related sepsis rates were low in all groups: 1/36 for Gauze, 0/31 for OpS‐7, 1/ 32 for OpS‐10, and 2/69 for OpS‐ICU. Septicemia attributable to causes apart from catheter sepsis occurred in two, two, three, and four patients, respectively. Bacterial colonization of skin beneath OpSite was no more common in the OpS‐10 than in the other groups. Signs of inflammation at catheter insertion sites were common in all groups but did not relate closely to skin colonization. OpSite can be safely applied to central venous catheters inserted under strict aseptic conditions, even in patients with open septic drainage. Dressings can be left in place for 7 days with a margin of safety lasting to 10 days, thus saving on cost of materials and nursing time. (Journal of Parenteral and Enteral Nutrition 12:365–370, 1988)
Zinc, Copper, Manganese, and Iron Balance of Parenterally Fed Very Low Birth Weight Preterm Infants Receiving a Trace Element Supplement
Authors: Friel J.K. , Penney S. , Reid D.W. , Andrews W.L.
Published: May 2008

To evaluate a pediatric trace element supplement (Ped‐El, Pharmacia) 18 metabolic balance studies were completed in 13 infants (mean birth weight 909 ± 67 g, × ± SEM; mean gestational age 27.2 ± 1 weeks) who received total parenteral nutrition. The supplement supplied 40 μg/kg/day of zinc resulting in negative retention of 226 μg/kg/day. Copper infused at 20 μg/kg/day led to a positive retention of 8 μg/kg/ day and an increase in serum Cu (p < 0.05) not related to Cu intakes. Manganese infused at 40 μg/kg/day was nearly all retained (88 ± 16% retention). Iron infused at 120 μg/kg/day led to a positive retention of 93 μg/kg/day. Although plasma ferritin and percent transferrin saturation were elevated, only plasma Fe values were correlated with Fe intake. This trace element supplement does not appear suitable for very low birth weight preterm infants. (Journal of Parenteral and Enteral Nutrition 12:382–386, 1988)
Home Teaching of Nocturnal Nasogastric Feeding
Authors: Berezin Stuart , Medow Marvin S. , Bernarducci Janet , Newman Leonard J.
Published: May 2008

Nocturnal nasogastric feeding (NGF) supplementation is an effective means of supplying calories to children with chronic diseases which may impair caloric and nutritional intake. Herein, we describe our experience with 18 patients who were taught NGF. They were divided into two groups: one group was instructed in the hospital which is the typical situation, whereas the second group was instructed at home. No complications were associated with NGF taught either at home or in the hospital. Our experience, therefore, indicates that nocturnal NGF can be successfully taught at home. (Journal of Parenteral and Enteral Nutrition 12:392–393, 1988)
Review: Neurological Complications of Central Venous Cannulation
Authors: Defalque Ray J. , Fletcher Mark V.
Published: May 2008

The reports of neurological damage after central venous cannulation over the past 20 yrs have been gathered, summarized, and analyzed. We found 59 cases of nerve lesions: 32 serious or even fatal, and 27 light or transient ones. They included: Lesions of the cervical sympathetic chain: needle trauma, compression by hematoma, anesthetic blockade; brachial plexopathies: needle trauma or compression by hematoma; phrenic or recurrent nerve palsies: anesthetic blockade, needle trauma, or compression by hematoma; cerebral damage following venous air embolism, carotid artery embolism or obstruction (thrombosis, compression), or internal jugular vein obstruction (thrombosis or catheter tip); lesions of the IX, X, XI, and XII cranial nerves by hematoma compression or spilling of histotoxic solutions; and, massive lesions of the anterior rami of the cervical nerves by spillage of histotoxic solutions.

We believe that the following simple and well‐known measures can substantially reduce the incidence of those serious complications.

1. Avoiding the subclavian or jugular central routes in patients with marked anatomical changes, coagulopathies, and carotid artery or lung diseases.

2. Using only small amounts of dilute concentrations of short‐acting local anesthetics before the puncture.

3. Using a small gauge “seeking” needle and placing a finger on the carotid artery during a jugular venipuncture to avoid accidental arterial puncture.

4. Using radiopaque catheters long enough to have their tip in midsuperior vena cava. The position of the catheter must be checked radiographically immediately after insertion and even at later periods. The catheter must be meticulously fixed to the skin to avoid its movement.

5. An experienced physician, familiar with the technique and its dangers and with the anatomy of the region will avoid the multiple, blind punctures in all directions which produce those complications.(Journal of Parenteral and Enteral Nutrition12:406–409, 1988)
Influence of Total Parenteral Nutrition on Tumor Growth and Polyamine Biosynthesis of Fibrosarcoma‐Bearing Rats after Induced Cachexia
Authors: Grossie V. Bruce , Ota David M. , Ajani Jaffer A. , Chang Tai‐Hwa , Patenia Domitila , Nishioka Kenji
Published: May 2008

The effect of a protein‐free diet (PF) or a restricted intake of chow (RI) and subsequent host repletion with total parenteral nutrition (PF‐TPN, RI‐TPN) on tumor growth and polyamine metabolism of fibrosarcoma‐bearing rats was examined. Host weight was significantly reduced by PF and RI. Tumor growth was reduced in malnourished rats with the PF regimen resulting in the greatest decrease. Rats receiving TPN after 14 days of the RI or PF regimens had higher host weight and plasma albumin levels than malnourished rats. Tumor growth during TPN was evaluated as the percent increase and compared with that of the respective malnourished rats. The percent increase for RI‐TPN rats was significantly greater although a trend toward an increase was also evident for PF‐TPN rats. Tumor ornithine decarboxylase (ODC) activity and putrescine levels were increased for PF rats and decreased for RI rats while tumor ODC activity was consistently increased by TPN. Tumor growth, ODC activity, and putrescine levels were simultaneously increased only for those rats fed the RI regimen prior to TPN. These results show a disparity in tumor ODC activity, putrescine levels, and tumor growth in malnourished rats. The results of this study suggest that the nutritional origin of cachexia influences the response of the tumor to TPN and emphasizes the importance of considering the methods to induce malnutrition in designing therapeutic regimens. (Journal of Parenteral and Enteral Nutrition 12:441–444, 1988)
Postsurgical Muscle Protein Turnover in Perfused Hindquarters of the Rat
Authors: Lee Virginia M. , Wolfe Bruce M. , Hansen Robert J. , Clifford Andrew J.
Published: May 2008

Skeletal muscle protein synthesis and degradation were measured simultaneously in perfused hindquarters of adult female rats 0, 2, and 4 days after surgical trauma. In order to explore the role of decreased postoperative nutrient intake on muscle protein turnover, a group of rats were pair‐fed to the level of food consumed by surgical traumatized animals. Protein synthesis was measured by the incorporation of 3H‐L‐phenylalanine into the myofibrillar (contractile) and sarcoplasmic (soluble) proteins of gastrocnemius muscle. Protein degradation rates were calculated from the release of myofibrillar 3‐methyl histidine (3MH) during the perfusion. Surgical trauma significantly depressed myofibrillar and sarcoplasmic protein synthetic rates by 33 and 29%, respectively. Protein degradation, as assessed by 3MH release into perfusate, increased 25% on the second postoperative day but returned to control levels by the 4th day after surgery. Food restriction of the pair‐fed control rats did not alter protein synthesis, however, protein degradation decreased significantly. In conclusion, the effect of trauma on protein turnover appears not to be due to decreased nutrient consumption. (Journal of Parenteral and Enteral Nutrition 12:452–456, 1988)
Effect of Frequent Guidewire Changes on Triple‐Lumen Catheter Sepsis
Authors: Powell Carla , Kudsk Kenneth A. , Kulich Patricia A. , Mandelbaum Jon A. , Fabri Peter J.
Published: May 2008

Frequent guidewire changes of single‐lumen (SLC) and triple‐lumen (TLC) catheters have been proposed to decrease catheter sepsis. We placed TLC in 126 patients needing total parenteral nutrition (TPN) and multiple venous access, prospectively randomizing them to two groups: group I received a guidewire change every 3 days, and group II received guidewire changes for mechanical or septic complications only. Tips were cultured at each line change and tips and blood for each septic episode. Catheter sepsis was defined by the criteria of the Association for Practitioners in Infection Control (APIC). There were 67 positive cultures in 52 patients, but most produced very few colonies or grew the same organisms in other infection sites. Forty‐seven% of all cultures grew Staphylococci, and 23% grew Candida. APIC‐defined catheter sepsis was detected in 12.7% of group I and 15.9% of group II. Although we observed no statistically significant difference in the two techniques, if we assume that a 20% difference in the incidence of catheter‐induced sepsis would be important to detect, the probability of failing to detect such a difference is 0.24 with an 0.05 level of significance (two‐sided). Prophylactic guidewire changes did not alter the incidence of catheter sepsis in patients with TLC who required TPN. The high rate of sepsis and Candida infection may be due to the critical illness of the immunocompromised population studied. (Journal of Parenteral and Enteral Nutrition 12:462–464, 1988)
Effect of Intralipid, Amino Acids, Container, Temperature, and Duration of Storage on Vitamin Stability in Total Parenteral Nutrition Admixtures
Authors: Smith J.L. , Canham J.E. , Kirkland W.D. , Wells P.A.
Published: May 2008

This study was designed to determine the stability of certain vitamins added to total parenteral nutrition (TPN) admixtures with or without Intralipid iv fat emulsion and with each of four amino acid solutions stored in either glass bottles or plastic bags at either ambient room (25°C) or refrigerator (5°C) temperature for a 48‐hr period. Riboflavin and folacin were not affected by the experimental conditions. The presence of Intralipid resulted in higher levels of vitamin E due to Intralipid's inherent vitamin E content; no other experimental conditions affected vitamin E. Thiamin levels decreased in admixtures containing the amino acid solution C and stored at 25°C. Vitamin A levels were lower in admixtures stored in plastic but were maintained in admixtures containing Intralipid and stored in glass bottles at either temperature. Vitamin C levels were maintained in admixtures stored at 5°C for all experimental conditions. The greatest vitamin C losses occurred in admixtures containing amino acid solutions C or D stored in plastic bags, or containing D stored in glass bottles at 25°C. (Journal of Parenteral and Enteral Nutrition 12:478–483, 1988)
Clinical Studies on a Newly Deviced Amino Acid Solution for Neonates
Authors: Imura Kenji , Okada Akira , Fukui Yuichi , Kawahara Hisayoshi , Yagi Makoto , Kubota Akio , Kanaya Shinobu , Kamata Shinkichi , Nagata Yoshio
Published: May 2008

In 97 neonates receiving total parenteral nutrition in the postoperative period, clinical assessment was made for a newly devised amino acid solution (PF‐I‐III) from the standpoint of plasma amino acid profile and nutritional effect. These amino acid solutions prepared are characterized by the high concentration of branched‐chain amino acids up to 40%, increased arginine and decreased glycine, phenylalanine and methionine as compared with commercially available solutions. In the PF group, each amino acid was kept within the range of standard value. Correlation between plasma amino acid profiles and the dose of each amino acid administered was obtained, from which minimum, standard, and maximum doses for each amino acid was determined. Based on these values, we proposed new formula for neonates which elicits no abnormal plasma amino acid pattern even when amino acids are administered at the dosage level of 1.5–2.5 g/kg/day. (Journal of Parenteral and Enteral Nutrition 12:496–504, 1988)
Subclavian Catheter Infections
Authors: Rose Scott G. , Pitsch Robert J. , Karrer F. William , Moor B.J.
Published: May 2008

We retrospectively studied subclavian catheter infection rates involving 481 patients from October 1983 to September 1985. Over this period of time 496 subclavian catheters including 252 single lumen catheters (SLC) and 244 triple lumen catheters (TLC) were inserted. These studies involved all catheters inserted during the 24‐month period. The Methodist Hospital IV Team regularly cared for and recorded catheter‐related problems. Charts were then retrospectively reviewed and data accumulated. The incidence of catheter tip infections in SLC was 4/248 (1.6%) compared to an incidence of 12/232 (4.9%) for TLC, p = 0.065. There was no significant difference between the incidence of infections at the insertion site of TLCs, 1/243 and SLCs, 1/251. We believe that the increase in catheter‐related infections in the TLC is related to the increased utilization afforded by the multiple injection ports. (Journal of Parenteral and Enteral Nutrition 12:511–512, 1988)
Effect of different energy sources on hepatic triglyceride secretion during parenteral nutrition
Authors: Burgess P , Johnston ID , Hall RI
Published: May 2008

This study examines the effect of parenteral nutrition on hepatic triglyceride secretion in postoperative patients. Five patients received fluids and electrolytes only (D/S), 10 received a 2000‐kcal total parenteral nutrition (TPN) formula with 25% of the nonprotein energy from lipid (LIPID‐TPN), and 11 received a similar regimen with all of this energy from dextrose (CHO‐TPN). After 7 days an intravenous bolus of 3H‐glycerol was given and hepatic triglyceride secretion measured from the decay curve of plasma radiolabeled triglyceride content. Plasma triglyceride concentrations were similar in each group. Hepatic triglyceride secretion was 16.3 mg/kg/hr after D/S, 10.7 mg/kg/hr after LIPID‐TPN, and 12.2 mg/kg/hr after CHO‐TPN (NS). There was no correlation between the rate of hepatic secretion and dextrose intake. Both TPN regimens resulted in significant reductions in plasma concentrations of apoproteins A1 and B but this did not appear to be related to triglyceride secretion rates. Despite the similar rates of hepatic secretion the quantity of labeled glycerol secreted in triglyceride was significantly greater after CHO‐TPN (17629 dpm/24 hr) than either D/S (10560 dpm/24 hr) or LIPID‐TPN (7264 dpm/24 hr, p less than 0.05), indicating that recycling of exogenous lipid may have occurred after LIPID‐TPN. This study indicates that hepatic triglyceride secretion is not suppressed by TPN, irrespective of the energy source, but suggests that the rate of secretion may have an upper limit.
Use of fibronectin and somatomedin‐C as markers of enteral nutrition support in traumatized patients using a modified amino acid formula
Authors: Mattox TW , Brown RO , Boucher BA , Buonpane EA , Fabian TC , Luther RW
Published: May 2008

The purpose of this study was to evaluate the use of serum fibronectin and serum somatomedin‐C as nutritional markers during enteral nutrition support (ENS) of critically ill, traumatized patients using an enteral product containing high concentrations of branched‐chain amino acids. Twelve critically injured patients received a standard enteral formula with 30 g of a 44% branched‐chain amino acid supplement added to each liter of formula. Fibronectin concentration, somatomedin‐C concentration, and nitrogen balance were measured on study days 1, 4, 7, 14, 21, 28 or until adequate oral intake began. Both fibronectin and somatomedin‐C concentrations increased significantly from baseline by day 7 of ENS. Nitrogen balance increased significantly from baseline by day 4. On days 14 and 21, only somatomedin‐C and nitrogen balance increased significantly from baseline. Nitrogen balance was significantly correlated with somatomedin‐C concentration (r = 0.53, p less than 0.01), cumulative caloric intake (r = 0.68, p less than 0.01), and cumulative nitrogen intake (r = 0.72, p less than 0.01). The results of this study suggest that serum somatomedin‐C is useful and serum fibronectin has potential in monitoring nutrition support response in critically ill, traumatized patients.
“High tech” metabolic measurements: useful in daily clinical practice?
Authors: Campbell SM , Kudsk KA
Published: May 2008

Metabolic carts (MC) for indirect calorimetry are expensive, require the use of meticulous technique by trained personnel, and impose conditions that are difficult to maintain in critically ill patients. Of 822 nutrition teams surveyed, 101 of 420 respondents had MC, and 47 were considering purchase. Forty‐one with MC never used them, and of the remaining 60 users, two‐thirds performed fewer than 10 measurements per month, citing calibration difficulties and clinical problems as frequent limiting factors. Sixty‐one% of users had no protocol for MC use. Although 95% of users would alter energy input, and 78% would modify nonprotein substrate based on MC results, 43% found O2 consumption and 33% found CO2 production significantly different from expected values. Five noted extremely inconsistent results with MC. Because of frequent dissatisfaction by MC owners due to expense, repairs, calibration difficulties, and technical limitations in critically ill patients most likely to benefit, and a 40% nonuse among teams with MC, MC do not seem to be a justifiable investment for most clinical nutrition practices, unless a suitable commitment is also made to provide skilled personnel, to institute protocols, and to implement frequent use.
Hepatic complications of total parenteral nutrition
Authors: Sax HC , Bower RH
Published: May 2008

Elevations in serum hepatic enzyme levels and alterations in hepatic morphology have been noted in patients on total parenteral nutrition, in some cases progressing to fatal hepatic failure. Various factors such as toxins, inappropriate substrates, overfeeding, deficiency states, and gut hormone alterations have been implicated. It would appear that the tailoring of nutritional support to meet patient needs and the maintenance of normal gut integrity will be of increasing importance in reducing the incidence of this potentially fatal complication.
Partial peritoneal alimentation in an infant
Authors: Merritt RJ , Atkinson JB , Whalen TV , Thomas DW , Sinatra FR , Roloson GJ
Published: May 2008

We provided partial peritoneal alimentation to a 1.69‐kg 11‐month‐old premature infant who had no available central venous access, depleted peripheral venous access, and gastrointestinal dysfunction. A cuffed silastic catheter was surgically inserted into the suprahepatic space. An alimentation solution was continuously infused into the peritoneum for 28 days to supplement peripheral venous and nasogastric alimentation and contributed 42 +/‐ 15% of total calories daily. Weight gain was achieved, but complications included hypoglycemia, hypophosphatemia, intravascular dehydration, catheter site leakage, ascites, and hydrocele. At autopsy 11 months later, lipid accumulation was present in the upper peritoneum and the hilar regions of the lungs secondary to preexisting lymphatic obstruction. Partial peritoneal alimentation may be feasible when other access routes are inadequate, but lymphatic obstruction is a contraindication to the peritoneal administration of lipid emulsions.
Guidewire catheter exchange with triple culture technique in the management of catheter sepsis
Authors: Porter KA , Bistrian BR , Blackburn GL
Published: May 2008

We report 70 total parenteral nutrition (TPN) patients who received guidewire catheter exchange for suspected sepsis during their hospitalization. To diagnose catheter‐related sepsis (CRS) and catheter infection (CI), we used a system of pre‐ and postexchange catheter blood cultures and a catheter tip culture. There were 27 catheter exchanges with positive cultures. The rate of definite CRS/CI (eight instances) was 6.8% of catheters exchanged and 3.5% of all catheters at risk. Probable CRS/CI (11 instances) was seen in 9% of exchanged catheters and 5% of at risk catheters. Thus, 19/27 positive cultures were presumed to represent definite or probable CRS/CI. Coagulase negative Staphylococcus (SCN) was the most frequently isolated organism. Simple catheter exchange was usually effective treatment of CRS/CI when SCN was the offending organism. The salvage rate of catheters exchanged for suspected sepsis or after a positive blood culture was 84%. Only 7% of exchanged catheters had to be removed. Guidewire exchange with triple culture technique was without mechanical complications. We recommend this technique to monitor central venous catheters in patients receiving TPN since it is simple, essentially painless to perform, and easily interpreted.
Hormonal and Metabolic Changes following Severe Head Injury or Noncranial Injury
Authors: Chioléro R. , Schutz Y. , Lemarchand TH , Felber J.‐P. , De Tribolet N. , Freeman J. , Jéquier E.
Published: May 2008

In order to evaluate the effect of head injury in severely traumatized patients on the response of plasma cortisol, glucagon, insulin, glucose, and FFA as well as urinary N and catecholamines excretions, 36 patients were prospectively studied over 5 consecutive days following injury. They were divided into three groups: group I, severe isolated head injury (n = 14); group II, multiple injury combined with severe head injury (n = 12); group III multiple injury without head injury (n = 10).

The results demonstrate similar hormonal and metabolic changes between these three groups of patients, characterized by elevated urinary adrenaline, noradrenaline excretion, increased cortisol, glucagon, insulin plasma levels throughout the study and elevated N urinary excretion with strongly negative N balances during the first 5 days postinjury. A significant correlation was observed between N intake and 5 day cumulated N balance (r = 0.63, p < 0.001). In addition, N balance was negatively correlated with urinary excretion of adrenaline (r = —0.47, p < 0.01) and noradrenaline (r = ‐0.44, p < 0.05) as well as plasma levels of glucagon (r = —0.44, p < 0.05). Isolated severe head injury seems to induce a full response in the secretion of the catabolic counterregulatory hormones comparable to that encountered in patients with multiple injury and associated with a marked increase in protein catabolism; additional noncranial major injury does not seem to enhance these responses. (Journal of Parenteral and Enteral Nutrition 13:5–12, 1989)
The Heated Dorsal Hand Vein: An Alternative Arterial Sampling Site
Authors: Brooks David C. , Black Preston R. , Arcangeli Michael A. , Aoki Thomas T. , Wilmore Douglas W.
Published: May 2008

Studies of substrate flux, isotope activity and metabolic balance frequently require arterial sampling. We evaluated: (1) whether substrate concentrations obtained from heated dorsal hand veins (HDHV) were comparable to samples obtained from the radial artery, (2) whether heat sufficient to arterialize HDHV altered contralateral forearm blood flow thus affecting flux calculations, (3) whether a $14 heating pad equaled a cumbersome $700 heating chamber, and (4) whether HDHV showed a dose‐response curve to varying heat loads. In 12 normals, dorsal hand temperature was raised from 31.8 ± 0.6°C to 39.8 ± 0.8°C (chamber) and 39.3 ± 0.3°C (pad). Basal contralateral forearm blood flow (3.37 ± 0.7 ml/100 ml tissue/ min) was not significantly altered in the chamber (3.39 ± 0.5 ml) or the pad (3.44 ± 0.5 ml). Skin temperature of the unheated hand, an index of superficial blood flow (31.5 ± 0.7°C) did not change significantly in the chamber (31.6 ± 0.7°C) or the pad (31.2 ± 0.7°C). Forearm blood flow did not change with heating in eight postoperative patients. Comparative arterial and HDHV blood gases and 10 metabolic substrates from simultaneously drawn samples at various temperatures showed HDHV PO2 approached but did not equal arterial PO2 at temperatures > 39°C. Glucose, amino acid, and substrate concentrations were comparable at 39°C and did not change with increasing temperature. HDHV can reliably determine arterial substrate concentrations using an inexpensive heating pad. In cool environments (20–22°C), contralateral forearm blood flow is not significantly altered. There is no benefit to heating the hand above 39°C. (Journal of Parenteral and Enteral Nutrition 13:102–105, 1989)
Microbial Contamination of Continuous Drip Feedings
Authors: Freedland Curtis P. , Roller Robert D. , Wolfe Bruce M. , Flynn Neil M.
Published: May 2008

We evaluated the extent and effects of bacterial contamination of an open continuous enteral feeding system. Eighty‐two quantitative enteral feeding cultures and clinical data were obtained during 8 days of observation on each of 33 patients. Cultures of appropriate sites were obtained on febrile patients and compared to the enteral feeding culture.

Gram negative bacilli (GNB) in the enteral feeding correlated with abdominal distension in the patients (10 of 12 patients with GNB compared to 5 of 21 without GNB; p < 0.01). Nine of the 10 patients with GNB and distension were receiving systemic antimicrobics to which the organism was resistant. Contamination of feeding with Serratia marcescens correlated with cultures for the same organism in patients' other body sites (p < 0.01). The feeding contaminant may have been the source of sepsis in one patient who expired from septic shock. No relationship was demonstrated between contamination and liquid stools or fever.

Undiluted, canned feedings were significantly less contaminated at 24 hr (15%) than those requiring mixing of powder (94%) (p < 0.0001). The canned feedings grew primarily enteric organisms, whereas the powder feedings grew flora typically resident on the skin.

Mixing or diluting feedings appears to represent an increased risk of contamination. Growth of GNB may produce adverse effects. Further investigation into methods to limit contamination and growth is warranted. (Journal of Parenteral and Enteral Nutrition 13:18–22, 1989)