bluuebunny/crossref_metadata_2025 huggingface dataset:
Prevalence, Incidence, and Clinical Resolution of Insulin Resistance in Critically Ill Patients: An Observational Study
Authors: Saberi Farzad , Heyland Daren , Lam Miu , Rapson Dilys , Jeejeebhoy Khursheed
Published: May 2008

Background: The primary objective of this study was to measure the prevalence, incidence, and resolution of insulin resistance (IR) in critically ill patients. A secondary objective was to explore the relationship between IR and inflammatory cytokines, coagulation abnormalities, and clinical outcomes. Design: Prospective observational study. Methods: The setting was the medical/surgical intensive care unit (ICU). We enrolled consecutive patients within 24 hours of admission to the ICU. Blood samples were collected daily until discharge, death, or a maximum of 10 days, then sent for measurement of markers of IR, inflammation, and coagulation. Charts were reviewed retrospectively to determine clinical outcomes. The homeostasis model assessment method (HOMA) was used to determine IR; a score of ≥ 4 represents insulin resistance. Results: A total of 96 patients were enrolled. Upon admission, 64 (67%) patients had overt IR (glucose > 7 mmol/L or insulin use), 9 (9.4%) had non‐overt IR (normal glucose but HOMA> 4), and 23 (24%) were insulin sensitive (IS; normal glucose and HOMA < 4). During the course of ICU stay, an additional 16 patients developed overt IR, while 10 (10%) remained IS. There were no significant differences in inflammatory markers, coagulation tests, and clinical outcomes between IR and IS patients. There was no significant correlation between HOMA and inflammatory markers and coagulation markers. In a multivariable regression model, only interleukin‐6 levels were significantly associated with mortality. Conclusions: A high proportion of critically ill patients have IR. There may not be any significant relationship between IR and measures of inflammation, coagulation, and clinical outcomes in a heterogeneous population of critically ill patients.
D‐Methionine Utilization in Young Miniature Pigs, Adult Rabbits, and Adult Dogs
Authors: Cho Ei Soon , Andersen Dean W. , Filer L. J. , Stegink Lewis D.
Published: May 2008

Rats and chickens, unlike man, utilize D‐methionine efficiently. We have studied urinary excretion of methionine isomers in young miniature pigs, adult rabbits, and adult dogs given D‐methionine in an attempt to find an animal model that, like man, utilizes the D‐isomer poorly. Six‐week‐old miniature pigs ingesting a protein‐free diet were infused with 8.5% amino acid solutions differing only in methionine isomer content (L‐ VS DL‐) to supply amino acid requirements. Each solution was infused for a 2‐ or 3‐day period in a cross‐over design. Plasma methionine levels were significantly higher (p = 0.01) during infusion of the solution providing DL‐methionine, with 25% of total plasma methionine present as the D‐configuration. However, urinary methionine excretion was similar with both solutions, with D‐methionine utilization calculated as greater than 99%. Adult rabbits ingesting DL‐methionine (0.14 g/100 g food) showed good utilization of D‐methionine, excreting > 1.3% D‐isomer in the urine. Mixed breed dogs given 1.25 g D‐methionine in their drinking water excreted >0.4% of ingested D‐methionine in the urine. These data indicate that the pig, rabbit, and dog utilize D‐methionine efficiently, behaving like the rat and chicken rather than man.
Laboratory Monitoring of Parenteral Nutrition‐Associated Hepatic Dysfunction in Infants
Authors: Vileisis Rita A. , Inwood Richard J. , Hunt Carl E.
Published: May 2008

Hepatic dysfunction associated with parenteral nutrition (PN) is a well recognized occurrence. In order to define the temporal inter‐relationships of direct bilirubin to other laboratory parameters, total and direct bilirubin, serum glutamic‐pyruvic transaminase (SGPT), serum glutamic‐oxaloacetic transaminase (SGOT), and alkaline phosphatase were measured prior to beginning PN and then weekly throughout the duration of PN in 60 consecutive neonates. Cholestatic jaundice (ChJ), defined as a direct bilirubin ≥2.0 mg/dl, developed in 11 (33%) of 33 infants receiving PN for at least 2 weeks. Direct bilirubin was the most sensitive and earliest indicator of ChJ. SGOT and SGPT values in the ChJ group were not statistically different from the non‐ChJ group until 2 weeks after the onset of cholestasis. Although there was a progressive increase in alkaline phosphatase during the course of PN, the increase was not greater in the ChJ group. In summary, direct bilirubin is the only laboratory indicator of hepatic status that need be determined serially in parenterally alimented infants. Although SGPT and SGOT may be helpful in characterizing hepatic dysfunction once ChJ has occurred, alkaline phosphatase levels do not reliably assess PN‐associated liver injury.
Performance Evaluation of a New Nasogastric Feeding Tube
Authors: Crocker Kathleen S. , Krey Susanna H. , Steffee William P.
Published: May 2008

A performance evaluation of a new polyurethane nasogastric feeding tube and stainless steel stylette (Nutriflex, # 8 French) was conducted at University Hospital. Thirty‐eight tubes were successfully placed in 18 patients. Tubes remained in place less than 1–29 days and feedings were administered for a total of 196 patient days. Enteral formulas commonly available were administered via continuous drip. The tube use was surveyed for ease of insertion primarily; however, patency and comfort to the patient were felt to be positive with the use of this tube. With slight modifications the new feeding tube is a welcome addition to the expanding technology associated with enteral feedings.
Rate and Volume of Intermittent Enteral Feeding
Authors: Heitkemper Margaret E. , Martin Deborah L. , Hansen Barbara C. , Hanson Robert , Vanderburg Verlene
Published: May 2008

The purpose of this investigation was to determine the effects of the volume of enteral feedings and the rate at which they were administered on subject tolerance and gastric pressure changes. Fourteen normal volunteers received enteral feedings on 9 or 10 separate days. These feedings (Ensure) were administered in combinations of 3 volumes (250, 350, and 500 ml) and of 2 rates (30 and 85 ml/min). The effect on gastric motility was monitored by an open‐tipped catheter. Nine of the subjects also received 750 ml administered at 30 ml/min. Six of the 14 subjects experienced nausea and/or discomfort during the first feeding trial (250 ml at 30 ml/min); however, subsequent feedings were tolerated without this discomfort. The rate at which feedings were administered had little effect on the time following feeding until the return of regular motility or on the mean motility index when 250 ml were administered; however, when larger volumes were administered at the faster rate, longer time was taken for the return of regular motility. Feedings administered at the faster rate were associated with a greater number of subjective complaints of abdominal discomfort, nausea, fullness, and cramping. The volume of a feeding has a significant effect on both the time required for regular motility to return following feeding and on the mean motility index, with the larger feeding volumes suppressing activity progressively longer. The volume of feeding (up to 750 ml) had little effect upon symptomatic tolerance of subjects when these feedings were administered at 30 ml/min. There was no significant interaction effect of rate and volume on the time required for motility to return following feedings. The results of this study indicate that normal subjects can tolerate bolus feedings of (250–750 ml) administered at 30 ml/ min without distress. Additional studies are needed to compare bolus and continuous feedings in relation to patient tolerance, gastric emptying, and nutritional outcome.
Role of Home Total Parenteral Nutrition in Management of Obliterative Peritonitis
Authors: Lennard E. Stan , Miller Donald G.
Published: May 2008

Two patients with obliterative peritonitis complicating enterocutaneous fistulae received total parenteral nutrition prior to surgical closure. One patient managed on home parenteral nutrition for 8 mo experienced psychosocial and nutritional rehabilitation at a daily cost of $37. Experience with the other patient confirmed that a significant resolution of obliterative inflammatory changes can occur during a 4‐mon period of bowel rest when septic foci have been drained adequately. In‐hospital management was required by this patient, and daily charges greatly exceeded those accrued by the other patient who could be managed at home. A home parenteral nutrition program is a cost‐effective means of providing time for resolution of obliterative peritonitis.
Air Embolism: A Lethal But Preventable Complication of Subclavian Vein Catheterization
Authors: Coppa Gene F. , Gouge Thomas H. , Hofstetter Steven R.
Published: May 2008

Air embolism (AE) is a rare but lethal complication of subclavian vein catheterization (SVC). Although treatable, if recognized promptly, attention should be directed towards prevention. SVC has been used at New York University Medical Center since 1969 for parenteral nutrition; its safety and complications have been recognized and reported. Since 1976, 14 patients with AE from SVC have been observed. Thirteen occurred as a sudden catastrophic event associated with disconnection of the catheter; all had significant morbidity; 4 (29%) died; 9 (65%) had associated profound neurologic deficit from which 5 recovered completely. Five others had cardiorespiratory morbidity but also recovered. In 1 surviving patient air was aspirated from the right atrium with immediate improvement. Survivors had evidence of pulmonary AE characterized by hypoxia. AE is a syndrome of respiratory distress, hypotension, and neurologic deficit of sudden onset. Immediate treatment is aspiration through the catheter in the left lateral steep Trendelenberg position. Review of our experience with AE suggests that lack of integrity of the connection between the catheter and the intravenous tubing was the responsible mechanism in the majority of cases (93%). Secure fixation of these connections is vital for the prevention of AE.
Total Parenteral Nutrition in Cancer Patients
Authors: Dindogru Aydin , Pasick Sharon , Rutkowski Zachary , Leichman Lawrence P. , Vaitkevicius Vainutis K.
Published: May 2008

One hundred and twenty‐one cancer patients received 134 courses of total parenteral nutrition (TPN); almost all were treated with chemotherapy and/or radiotherapy. The average weight loss prior to TPN was 6.7 kg and albumin 3.1 g%/patient; 25% glucose solution with 4.25 g% amino acids was used as a calorie and nitrogen source. The average weight gain was 2.6 kg for those who received TPN <2 wk and 4.5 kg if TPN was given for >2 wk. Complications were low; 3% had proven TPN‐related septicemia. Mild to moderate reversible metabolic complications were common, although severe complications were rare; no one died because of TPN. Our experience confirms the previous reports that TPN can be given safely to malnourished compromised cancer patients.
Growth Failure in Crohn's Disease: An Approach to Treatment
Authors: Werlin Steven L.
Published: May 2008

Seven children with Crohn's disease and linear growth retardation were studied in order to determine the best method of treating this psychologically debilitating complication. No single therapeutic approach was successful in all patients. Three patients responded to enteral caloric supplementation, one to central venous alimentation, and one low dose corticosteroid therapy, and two responded to surgical extirpation of the involved segments of bowel.
Vitamin Status During Total Parenteral Nutrition
Authors: Stromberg Peter , Shenkin Alan , Campbell Rosalynd A. , Spooner Richard J. , Davidson John F. , Sim Andrew J.W.
Published: May 2008

Plasma concentrations of vitamins A and E, serum and erythrocyte folic acid, serum B12 and erythrocyte enzyme activations (to assess vitamins Bi, B2 and B6 status) were measured at the start and finish of 39 courses of total parenteral nutrition (TPN). The daily regimen was standard. Plasma vitamin A, E, and folate concentrations and vitamin B6 status improved significantly during TPN. Three patients developed low levels of vitamin A and two patients developed high transketolase activations (B1 depletion) during therapy. The adequacy of vitamin replacement and the monitoring of vitamin status during TPN is discussed.
The Use of a Computer in Parenteral Alimentation of Low Birth Weight Infants
Authors: Giacoia George P. , Chopra Raman
Published: May 2008

A computer program which aids in the formulation and preparation of parenteral nutrition fluids for low birth weight infants is described. The program performs a number of calculations for fluid and specific nutrient requirements taking into account environmental conditions, potential renal solute load, deficits, and surpluses. Safety and precipitation checks are also included in the calculations. Its use has considerably reduced the workload on both physician and pharmacy personnel involved in the formulation and preparation of individualized parenteral nutrition solutions for low birth weight infants.

A controlled study in 15 very low birth weight infants utilizing this program revealed a reduced incidence of hyperglycemia, decrease in fluctuations in serum sodium, a more physiologic urine osmolality, and a reduction of weight loss in the first days of life.
Influence of Lipid Infusion (0.4 g/kg/hr) and Positive End Expiratory Pressure (8 cm H2O) on Pulmonary Function and Hemodynamics in Healthy Anesthetized Pigs
Authors: Rosegger Hellfried , Trittenwein Gerhard , Metzler Hellfried , Tscheliessnig Karl‐Heinz , Hermann Wolfgang
Published: May 2008

Fat emulsions are used increasingly for parenteral nutrition in premature infants suffering from various disorders, including respiratory insufficiency necessitating artificial ventilation with positive end expiratory pressure (PEEP). Both PEEP and lipid infusions (LI) may alter pulmonary hemodynamics. The simultaneous effect of LI and PEEP were therefore investigated. Five adult anesthetized Göttinger mini‐pigs were infused with a 20% LI at a high rate of 0.4 g/kg/hr for 30 min, followed by PEEP of 8 cm H2O for 15 min. Catheters were inserted into the upper vena cava, the pulmonary artery, the right and left atrium, and the aorta, and pressures recorded continuously. Ventilation volume, respiratory fractional gas concentrations of O2 and CO2 (mass snectrometer). and blood gases were measured. The following parameters were calculated : total peripheral resistance, pulmonary arteriolar resistance, right‐to‐left shunt (Qs/QT) dead space ventilation (VD/ VT) and effective compliance.

Total peripheral resistance remained unchanged. Pulmonary arteriolar resistance increased significantly during PEEP, PEEP + LI, but not during LI alone. QS/QT increased significantly during LI and returned to normal when PEEP was applied. VD/VT and effective compliance did not change during LI. The increased right to left shunt, caused by LI, is reduced by means of PEEP, while the pulmonary arteriolar resistance increased with PEEP and LI.
Effect of Glucose and/or Branched Chain Amino Acid Infusion on Plasma Amino Acid Imbalance in Chronic Liver Failure
Authors: Rossi‐Fanelli Filippo , Angelico Mario , Cangiano Carlo , Cascino Antonia , Capocaccia Riccardo , Deconcils Daniela , Riggio Oliviero , Capocaccia Livio
Published: May 2008

The characteristic amino acid pattern observed in chronic liver failure with high aromatic and low branched chain amino acid levels is considered to be consequent to increased muscle protein catabolism. The main catabolic stimulus has been attributed to hyperglucagonemia and to a reduced insulin/glucagon molar ratio. Intravenous administration of a solution containing branched chain amino acids and glucose to patients with chronic liver cirrhosis rapidly normalizes the plasma amino acid pattern. This effect may result from either a change in the insulin/glucagon ratio, induced by glucose, or from the anticatabolic influence of branched chain amino acids on muscle protein turnover. To discriminate between these two possibilities, a crossover study was carried out to determine the effect of a 24‐hour infusion of either glucose alone, or glucose plus branched chain amino acids, in seven patients with chronic liver failure. Blood glucose, insulin, glucagon, free fatty acids, and amino acid levels were determined. Branched chain amino acids were much more effective than glucose (p < 0.01) in decreasing the levels of aromatic amino acids. Conversely, the insulin, glucagon, and free fatty acid levels with glucose alone were not altered with the addition of branched chain amino acids. These findings suggest an anticatabolic effect of branched chain amino acids on muscle protein turnover and suggest that factors other than insulin and glucagon may be responsible for the characteristic plasma amino acid pattern present in chronic liver failure.
Vitamin A and E Requirements During Total Parenteral Nutrition
Authors: Kishi Hiroe , Yamaji Akira , Kataoka Kazusaburo , Fuj Yasuko , Nishikawa Keiko , Ohnishi Noboru , Hiraoka Echi , Okada Akira , Kim Chang‐Woong
Published: May 2008

Studies were undertaken to determine rational dosages of vitamins A and E during long‐term total parenteral nutrition (TPN). Four kinds of vitamin prescriptions containing different amounts of vitamin A and E were prepared from commercially available products and/or hospital pharmacy products. Patients were divided into four groups according to the vitamin prescription used. Plasma vitamin levels of different patient groups were determined by a modified fluorimetric method and were compared with those of a normal subject group. The stability of vitamin A and E in TPN solution after admixing was determined by measuring the remaining vitamin contents by high pressure liquid chromatography. From the results, it was concluded that 1) about 50% of vitamin A was decomposed by sunlight (about 2000 lux) 3 hr after admixing and an organge‐colored vinyl cover could protect its photodecomposition; 2) vitamin E was stable at any condition tested; 3) 2500 IU of vitamin A and 15 IU of vitamin E could meet the daily requirements; 4) the plasma levels of vitamin A and E were correlative (p < 0.01); and 5) concomitant administration of vitamin E was essential to keep the proper level of vitamin A in plasma.
Computer Applications to Medical Nutrition Problems
Authors: Erhard Danford Darla
Published: May 2008

The uses and abuses of computers in relation to nutritional management of patients is reviewed. A standardized computer program is presented which can be applied to measuring nutrient intake for various age groups, for the control of outpatient intake, for intensive care units employing defined formulas for oral and parenteral nutrient intakes, for dietary management of chronic disease such as renal cases, and as an educational tool for instructing the operator in checking nutrient intakes. A single day's diet was submitted to 11 different computer programs for calculation of nutrient content. The wide range of values reported by different programs for certain nutrients in this menu (eg, copper, vitamin E, magnesium) warrants consideration by those using these values in research and for prescribing patient care. The system of dietary analysis provided in this publication offers advantages over more traditional coding systems with regard to ease of use, freedom from error, flexibility, and usable print‐out, all being related to the use of English words for entering and reading of data.
Prolonged Hyperalimentation in Catabolic Chronic Dialysis Therapy Patients
Authors: Piraino Anthony J. , Firpo John J. , Powers Donald V.
Published: May 2008

Plasma concentrations of 25 essential (EAA) and nonessential (NEAA) amino acids were measured pre‐ and postdialysis in 46 chronic hemodialysis therapy (CDT) patients. Sixteen of these patients with prior weight loss of 14.5 ± 2.37 pounds in 24 months were administered a GAA solution (EAA + NEAA + glucose) for 20 weeks during each dialysis. Eight of these patients (group 1) responded with improved appetite and weight gain; the remaining eight patients (group 2) with clinically advanced metabolic bone disease continued to lose weight. Five other patients (group 14), biochemically similar to group 1 but with shorter prior dialysis experience, who received EAA (plus glucose) hyperalimentation (including oral L‐histidine), experienced weight gain similar to group 1 but displayed significantly different plasma aminograms indicating a deficit of NEAA. When EAA and glucose hyperalimentation was administered without histidine (1 patient) no weight gain occurred and aminograms differed significantly from other groups. Plasma aminograms of 25 weight‐stable, nonhyperalimented CDT patients were obtained for comparison. Results indicate GAA hyperalimentation can promote weight gain in catabolic CDT patients with inadequate prior nutritional intake (as in groups 1 and 14) but cannot reverse weight loss when the primary clinical setting is advanced metabolic bone disease and myopathy due to hyperparathyroidism (group 2). Hyperalimentation with glucose and an amino acid solution specifically tailored to the needs of CDT patients may improve results. Plasma phosphoethanolamine levels, normal for weight‐stable and elevated in catabolic CDT patients, suggest a possible role for phosphoethanolamine as a marker for catabolism.
Maternal and Fetal Plasma Levels of 3‐Methylhistidine in Pregnant Nonhuman Primates
Authors: Stegink Lewis D. , Reynolds W. Ann , Pitkin Roy M.
Published: May 2008

Available data indicate little reutilization of 3‐methylhistidine (3‐MH) in the rat and man. These data led to the use of urinary 3‐MH excretion as a measure of muscle protein catabolism in those animal species. However, 3‐MH excretion does not accurately measure protein catabolism in the sheep, pig, and rabbit. This is due, at least in part, to the fact that renal amino acid (AA) transport systems reabsorb 3‐MH from the glomerular filtrate. The monkey differs from man in that its plasms contains significant quantities of 3‐MH, suggesting an active renal transport system for this AA. The present study measured maternal and fetal plasma 3‐MH levels in 33 pregnant rhesus monkeys to determine whether the nonhuman primate placenta contained transport sites concentrating this AA to the fetal plasma. Mean fetal plasma 3‐MH concentrations were 16.4 ± 6.71 μmol/100 ml, while maternal levels were 9.45 ± 3.69 μmol/100 ml. The fetal to maternal gradient was maintained between 1.6 to 1.7 during the course of maternal infusions of various AA. Since placental AA transport systems are similar to those in the kidney and intestine, the data also suggest the presence of AA transport systems for 3‐MH in the monkey, indicating that urinary 3‐MH excretion would be a poor method for measuring muscle protein catabolism in this species.
Arginine Stimulates Thymic Immune Function and Ameliorates the Obesity and the Hyperglycemia of Genetically Obese Mice
Authors: Barbul Adrian , Sisto Donato A. , Wasserkrug Hannah L. , Levenson Stanley M. , Efron Gershon , Seifter Eli
Published: May 2008

The effect of 6‐day dietary arginine supplementation on the weight gain, blood glucose, thymus weight, thymic lymphocyte content, and in vitro thymic lymphocyte immune‐reactivity was studied in obese (C57BL/6J‐OB/OB) and heterozygous lean mice. Control mice were fed a commercial laboratory chow (1.8% arginine content) and drank tap water, while supplemented mice were given 0.5% arginine in the chow and 0.5% arginine solution for drinking. All mice ate and drank ad libitum. Supplemental arginine significantly decreased the weight gain (1.2 g vs. 2.2 g, p < 0.01) and blood glucose levels (303 mg% vs 236 mg%, p < 0.02) of the OB/OB mice; no such effects were noted in the lean heterozygotes, all of which had normal blood glucose levels. OB/OB mice had thymus glands which weighed less and contained significantly fewer lymphocytes than their lean littermates. In vitro mitogen‐stimulated thymic lymphocyte protein synthetic rates were equal in chow‐fed lean and OB/OB mice. In both groups, supplemental arginine significantly increased thymus weight, the number of thymic lymphocytes per gland, and thymic lymphocyte immunereactivity in vitro. The hormonal secretagogue activity of arginine on the pituitary may explain its beneficial effects on the rate of weight gain, hyperglycemia, and depressed thymic immune function of OB/OB mice.
Effect of Diverting Bile and Pancreatic Secretions into the Ileum on Small Bowel Mucosa in Rats Fed a Liquid Formula Diet
Authors: Weser Elliot , Drummond Alonzo , Tawil Tippy
Published: May 2008

The long‐term effects of diverting bile and pancreatic secretions directly into the ileum on small bowel mucosa was determined in rats fed a hydrolyzed liquid formula diet. Male Sprague‐Dawley rats were divided into four experimental groups: duodenal papilla transplant‐sham operation, transplantation of the duodenal papilla into the ileum, bile duct sham operation, and transplantation of the bile duct into the ileum. After 28 days, animals were killed, the small bowel removed, rinsed with cold isotonic saline, and divided into six segments (two jejunal segments and four ileal segments). The mucosa of each segment was weighed and assayed for DNA and protein concentration, and specific activity of sucrase and maltase. Bile and particularly pancreatic secretions diverted into the ileum stimulated local mucosal growth compared with their respective controls. The absence of pancreatic secretions from the jejunum also was associated with an increase in jejunal mucosal mass. Diverting pancreatic secretions into the ileum decreased ileal sucrase and maltase specific activity while the absence of both bile and pancreatic secretions from the jejunum increased jejunal sucrase specific activity. The results suggest that bile and pancreatic secretions entering the ileum are important factors in stimulating ileal mucosal hyperplasia while the absence of these secretions from the proximal intestine is associated with greater jejunal mucosal growth. The mechanisms regulating jejunal mucosal growth appear to be different than those influencing the ileum.
Changes in Lipoprotein Cholesterol Distribution in Weight‐Stable Postjejuno‐Ileal Bypass Patients
Authors: Pagnotta Inez , Daudiss Krista , Ovesen Lars , Howard Lyn
Published: May 2008

The influence of the jejuno‐ileal bypass procedure upon serum lipoproteins was investigated. Lipoprotein cholesterol distribution was measured in 12 jejuno‐ileal bypass subjects. The results were compared to 12 obese controls and 12 normal weight controls. In the bypass group, total cholesterol and low density lipoprotein cholesterol concentration was significantly reduced compared to both control groups. The high density lipoprotein cholesterol concentration in the bypass group was not significantly different when compared to the obese control group and in fact both obese groups had high density lipoprotein cholesterol levels significantly less than the normal weight controls. In the bypass group, the high density lipoprotein/low density lipoprotein cholesterol ratio was significantly increased compared to both control groups. These findings suggest a decreased atherogenic potential in jejunoileal bypass patients.
Changes in Red Cell Membrane Fatty Acids in Patients Receiving Total Parenteral Nutrition Supplemented with a Safflower Oil Emulsion
Authors: Bryant Patrick J. , Clawson Kim D. , Bivins Brack A. , Rapp Robert P.
Published: May 2008

Previous studies in patients suffering from essential fatty acid deficiency (EFAD) have shown erythrocyte membrane fatty acids to change in parallel with those seen in plasma. A study was conducted to determine if this same relationship existed in patients that were not diagnosed as having EFAD. Three subjects maintained on parenteral nutrition were given 500 milliliters of a safflower oil emulsion twice weekly for 14 days. Plasma and red blood cell membrane fatty acids were determined before and after the study period. The red blood cell membrane fatty acids did not appear to follow the changes seen in the plasma. Changes that did occur in the erythrocyte membrane fatty acid composition were inconsistent between patients. The incorporation of plasma fatty acids into erythrocyte membranes may occur at a different rate for patients with EFAD compared to those without EFAD due to an increased red blood cell turnover associated with EFAD.
Studies on the Efficacy of a New 20% Fat Emulsion in Pediatric Parenteral Nutrition
Authors: Coran Arnold G. , Drongowski Robert , Sarahan Teresa M. , Wesley John R.
Published: May 2008

A new 20% safflower oil emulsion was studied in a small series of pediatric patients. Eight infants and children were evaluated over a 2‐week period. The 20% fat emulsion supplied a major portion of daily caloric requirements. No serious side effects or toxicity were noted. No major changes in blood chemistries were observed; however, a statistically significant increase in serum albumin was noted. In addition, 63% of the patients gained weight during the study. This investigation supports the contention that 20% Liposyn is a safe and effective component of a parenteral nutrition program for children.
A Safe Technique of Central Venous Catheterization
Authors: Sriram Krishnan , Kaminski Mitchell V. , Berger Rodney
Published: May 2008

A modified techniquue of internal jugular catheterization is described, especially suitable for patients in whom subclavian vein catheterization may be dangerous. After introduction into the internal jugular vein, the catheter is tunneled to exit on the chest wall, using the same needle used for venipuncture. A catheter exit site on the chest wall is comfortable for the patient and makes nursing care easy. This factor, in combination with the safety of internal jugular vein cannulation, makes this an ideal method of central vein catheterization for both nutritional support and monitoring.
Nutritional Responses of Tumor‐bearing Rats to Oral or Intravenous Feeding
Authors: Kishi Tetsuya , Iwasawa Yasuo , Itoh Hiroshi , Chibata Ichiro
Published: May 2008

Two experiments were conducted with male rats weighing 170 to 190 grams. In experiment 1, some nutritional parameters were determined in tumor‐bearing (TB) (Walker 256 carcinosarcoma) rats fed a 23.6% casein diet for 4 weeks after the tumor inoculation. Cumulative weight gain and food intake were less in TB rats than in nontumor‐bearing (NTB) rats. At 3 and 4 weeks after the tumor inoculation, plasma histidine, alanine, and glycine levels were higher in TB rats than in NTB animals. The arginine level was lower in the plasma of TB rats at 4 weeks after the inoculation. The significance of decrease in plasma arginine with regard to tumor growth is discussed. In experiment 2, the effects of total parenteral nutrition (TPN) on TB rats were evaluated as compared with those of 5% glucose (Glc) solution. Body weights of TPN rats were maintained and their nitrogen (N) balances were positive during a 7‐day experimental period. while 5% Glc animals showed severe body weight loss and apparent negative N balance. After the end of infusion, the plasma urea level of the TPN group was within normal range, whereas that of 5% Glc group showed a markedly high value. The plasma albumin level was higher in the TPN group. Liver and spleen weights were increased in TPN rats. Absolute tumor weight was somewhat greater in TPN rats than in 5% Glc rats, but the difference in tumor weight:body weight ratios became more slight. These results indicate that TPN was effective for maintaining the nutritional status of TB host without significant acceleration in tumor growth.
Simultaneous Bilateral Central Catheters: A Safe Technique
Authors: Jakobowski Diane , Moon Millie , Arbeter Alan , August Charles , Pereira Gilberto , Roth Karl , Cooper Arthur , Ziegler Moritz M.
Published: May 2008

Optimal central catheter care includes restriction on usage for blood sampling and blood product administration to enhance continued sterility, but our experience with 25 children receiving bone marrow transplants after cytoreduction challenges this concept. Prior to transplantation, bilateral percutaneous subclavian vein silastic catheters were inserted without incident, one utilized for continuous nutritional support in caloric quantity to assure body weight maintenance, and the contralateral catheter utilized for daily venous sampling plus administration of medications including blood products. Patients subsequently entered a protective environment and biweekly surveillance cultures were monitored.

Nutritional therapy was given for 876 days through 53 catheters. One patient developed culture‐proven sepsis, an organism first cultured from the skin. The patient complication rate of 4% and the per diem rate of 0.11% in this immunocompromised population compares favorably to the 10.5 and 0.32% incidence we previously reported for 200 children with unilateral catheters. These data demonstrate that bilateral central catheters can be safely utilized in children for nutrition and sampling.
Growth Failure Due to Uremia and Congenital Nephrosis: Growth Enhancement by Aggressive Nutritional Therapy
Authors: Takala Jukka
Published: May 2008

The metabolic and nutritional effects of long‐term parenteral and enteral nutrition were studied in two infants and one child with severe growth failure due to chronic renal failure (two patients) and congenital nephrosis (one patient). Six periods of treatment were analyzed. Both the parenteral nutrition and continuous enteral nutrition were found efficient in enhancing growth and correcting the metabolic abnormalities of uremia. The beneficial effects of this intensive nutrition were smaller in congenital nephrosis, although growth accelerated. Nitrogen balance studies confirmed effective nutrient utilization. The serum levels of calcium and phosphate were normalized as anabolism was achieved in the uremia. In fact, the rapid development of severe hypophosphatemia in one of the patients proved that the “fatal hyperalimentation syndrome” appears to be a specific threat in parenteral nutrition applied in uremia.
Relationship of Serum Transferrin to Total Iron Binding Capacity for Nutritional Assessment
Authors: Stromberg Brent V. , Davis Robert J. , Danziger Larry H.
Published: May 2008

To evaluate the relationship of serum transferrin, serum albumin, and total iron binding capacity, 100 patients were selected and simultaneous measurements of each parameter were made. In contrast to some studies, the relationship of serum transferrin to total iron binding capacity was found to be linear. The relationship was: Serum transferrin = (total iron binding capacity X 0.76) + 18. Serum transferrin was also seen to correlate with transferrin and total iron binding capacity. The measurement of total iron binding capacity, because of its relationship to transferrin, may be used to aid in the determination of the nutritional assessment of hospitalized patients.
Weight Loss in Patients Receiving Radical Radiation Therapy for Head and Neck Cancer: A Prospective Study
Authors: Johnston Catherine A. , Keane Thomas J. , Prudo Susan M.
Published: May 2008

Thirty‐one patients receiving radiation therapy for localized cancer of the head and neck areas were systematically assessed before, during, and after treatment. The pathogenesis of weight loss and its association with treatment morbidity and other determinants were sought. The serial data collected consisted of a food frequency questionnaire based on Canada's Food Guide, anthropometric measurements, 10 Linear Analogue Self Assessment questions on morbidity, and biochemical and hematological indices. Twenty of 31 patients (68%) lost over 5% of their presenting weight within one month after completing treatment. The mean weight loss was 10% and the range of weight loss in this group was 5.4 to 18.9%. Pretreatment dietary habits, serum albumin, absolute lymphocyte count, serum creatinine, creatinine height index, and anthropometric measurements did not predict for weight loss. However, weight loss can be predicted on the basis of field size and site irradiated. Treatment‐related morbidity involving dysguesia, xerostomia, dysphagia of solids, and mouth pain was greater and of longer duration in patients with weight loss. The sequence of development of these symptoms during treatment and their duration provide a rational basis for the timing and methods of nutritional intervention in this patient population.
Differences in Vitamin A Content of Enteral Feeding Solutions Following Exposure to a Polyvinyl Chloride Enteral Feeding System
Authors: Bryant Carol A. , Neufeld Norma J.
Published: May 2008

This research was conducted to determine if there were significant differences in the vitamin A content of two enteral feeding solutions following timed exposure to a polyvinyl chloride (PVC) enteral tube feeding system. This study took place in the laboratory setting with procedures designed to simulate clinical conditions with respect to rate of flow and time of exposure. Feeding solutions (Ensure Osmolite and Vivonex High Nitrogen) were sampled, placed in PVC feeding system pouches (Vivonex Delivery System, Norwich‐Eaton Pharmaceuticals, Norwich, NY) and permitted to drip from the pouches at a constant rate. Solution remaining in the pouches was sampled at intervals for a period of six hours, and all samples were analyzed for Vitamin A content using spectrophotometric methods. Statistical analysis of the data indicated no significant difference in Vitamin A content of either feeding solution following six hours of exposure to a PVC enteral tube feeding system.
Effects of Intravenous Administration of Travenol 10% Lipid Emulsion to Miniature Swine for 28 Consecutive Days
Authors: Izzo Rodger S. , Mieszala James , Woods Eugene , Larcker Sally , Remis William , Leissing Nancy
Published: May 2008

The potential toxicity of Travenol 10% lipid emulsion was studied using miniature swine. Physiological (0.9%) saline, USP, was used as the control, and Intralipid 10% fat emulsion as the reference article. The emulsions were administered intravenously at dosages of 40 milliliters (approximately 4 grams of lipid) and 60 milliliters (approximately 6 grams of lipid) per kilogram of body weight per day to eight animals (four males and four females) in each treatment group on each of 28 consecutive days. The saline was administered to eight animals at 60 milliliters per kilogram per day. On day 29, one half of the male and female animals in each group were necropsied. The remaining pigs were observed and necropsied on either day 56 or 57. Toxicity was assessed on the basis of animal survival; changes in body weight, urinalyses, and hematological, and serum biochemical analyses; ophthalmological examination; gross pathology; and histopathology.

The results obtained for the Travenol emulsion correlated well with those for the Intralipid emulsion. The emulsions were well tolerated, and they did not produce any major clinical signs of toxicity. All Travenol emulsion‐treated animals survived. In addition to demonstrating the similarity of Travenol and Intralipid emulsions, the results of this study indicate that the Travenol emulsion demonstrated an adequate margin of safety for prolonged administration. Travenol emulsion was well tolerated by miniature swine infused at about one and one‐half (40 milliliters per kilogram per day) and two (60 milliliters per kilogram per day) times the proposed clinical dose, and at three and two times the anticipated clinical rate, respectively.
Effect of Serum Zinc Level on Amount of Collagen‐Hydroxyproline in the Healing Gut during Total Parenteral Nutrition: An Experimental Study
Authors: Iriyama Keiji , Mori Takao , Takenaka Takumi , Teranishi Tadashi , Mori Hiroshi
Published: May 2008

Changes of serum zinc level in dogs receiving either a zinc‐free solution or a zinc‐supplement solution during total parenteral nutrition (TPN) and the influence of variety of serum‐zinc level on serum albumin and collagen‐hydroxyproline (C‐Hyp) in the incised intestine were investigated. The serum zinc level of zinc‐free dogs that was 126.0 ± 34.3 micrograms per deciliter at the initiation of TPN decreased significantly to 80.0 ± 15.0 micrograms per deciliter during the one week of TPN, whereas that of zinc‐supplement dogs did not decrease during the same period of TPN. Lowering of the serum albumin value was more evident in zinc‐free dogs than in zinc‐supplement dogs. The amount of C‐Hyp in the incised area of the intestine of zinc‐free dogs was 2.63 ± 0.66 micrograms per milligram and that of zinc‐supplement dogs was 4.26 ± 1.04 micrograms per milligram and this difference was significant. It was found that serum zinc level during TPN sharply reflects a supplement of zinc, and C‐Hyp in the incised gut and serum albumin of zinc‐free dogs are lower than those of zinc‐supplement dogs.
Central Venous Alimentation: A Prospective Study of the Frequency of Metabolic Abnormalities Among Medical and Surgical Patients
Authors: Weinsier Roland L. , Bacon Jane , Butterworth C.E.
Published: May 2008

Many studies have described the frequency of septic and technical complications of central venous alimentation (CVA), but metabolic complications of CVA have received scant attention.

Among 100 consecutive medical and surgical patients receiving CVA under routine hospital conditions, at least one severe biochemical defect (above the 99th percentile ranking) was observed in 63 cases (63%). Uncontrolled hyperglycemia (defined as blood glucose >300 milligrams per deciliter after more than 48 hours of CVA) was present in 47 individuals. Hypophosphatemia (serum phosphorus <2.0 milligrams per deciliter) occurred in 30 and was life‐threatening (<1.0 milligrams per deciliter) in 6. Although liver function tests (LFT) remained stable or improved in 26% of the 34 evaluable subjects, 74% showed deterioration in one or more tests, and 35% showed deterioration in two or more tests. Deterioration was defined as an abnormal result that was 50% or more above baseline in patients having weekly LFT and CVA for a minimum of 10 days.

The study involved 1378 patient‐days of CVA, a mean of 14 days per patient with a range of 2 to 70 days, and an average of 2.2 catheter insertions per patient. Technical complications occurred in 3% and septic complications occurred in 4% of 220 catheter insertions. There was no significant difference in the type or frequencies of metabolic, septic, and technical complications occurring between medical and surgical patients. The findings suggest that many reports concerning septic and technical complications of CVA have promoted awareness of the problem and served to minimize these risks. However, this study demonstrates that serious metabolic complications of CVA occur at an unexpectedly high rate and that greater attention should be directed at their prevention.
Pronounced Dyslipoproteinemia in Intensive Care Patients
Authors: Lindholm Marianne , Eklund Jan , Rössner Stephan
Published: May 2008

Concentrations of triglycerides (TG) and cholesterol in serum and in lipoproteins were determined in two groups of intensive care patients. Group I included 17 moderately ill, postelective surgery patients, and group II, 23 critically ill patients. All were studied in an intensive care situation. The lipoprotein lipid concentrations were compared with those from a group of healthy men and women. In group I, both TG and cholesterol concentrations in serum were decreased, whereas in group II, only cholesterol concentration was lowered and the TG concentration was close to control values. In the lipoproteins, marked abnormalities were found. The most striking was an increase in low density lipoprotein (LDL)‐TG and a decrease in high density lipoprotein (HDL)‐cholesterol concentrations. In group II, 5/18 males had a LDL‐TG concentration above any control value and 21/23 had a HDL‐cholesterol concentration below any value in the control group. In addition, the α‐lipoprotein (HDL) band on electrophoresis was often grossly abnormal with a broad or double‐peaked band. There was a highly significant negative correlation between LDL‐TG and HDL‐cholesterol concentrations. Patients who received conventional treatment with insulin or heparin had similar lipid concentrations as those not given these drugs. The time effect on lipoprotein changes was analyzed in 11 patients, from whom samples were drawn repeatedly during the intensive care period. A tendency was found for LDL‐TG to increase and HDL‐cholesterol to decrease with time. The mechanisms causing the lipoprotein changes are not presently known; however, possible explanations include liver function impairment, gastrointestinal tract paralysis, physical inactivity, the catabolic state as such, and combinations.
Thyroid Function on Short‐term Total Parenteral Nutrition Without Iodine Supplements
Authors: Gough David C.S. , Laing Ian , Astley Peter
Published: May 2008

Short‐term total parenteral nutrition in the neonate who weighs more than 1.5 kg is not associated with biochemical signs of iodine deficiency if iodine supplements are not provided.
Hyperammonemia in Neonates Receiving Intravenous Nutrition
Authors: Thomas Daniel W. , Sinatra Frank R. , Hack Shirley L. , Smith Thomas M. , Platzker Arnold C.G. , Merritt Russell J.
Published: May 2008

Inadequate arginine intake has been suggested as an etiology for hyperammonemia in neonates on parenteral nutrition. We randomized 26 nonasphyxiated neonates to receive amino acid solutions containing either 3.6 or 10.4% of total nitrogen as arginine when intravenous nutrition (IVN) therapy was initiated. Neonates in both amino acid solution study groups were observed to have significantly elevated blood ammonia (BA) concentrations during IVN (p < 0.01) as compared to pre‐IVN levels. Blood ammonia concentrations tended to be higher in infants receiving the 3.6% arginine amino acid solution. Septic infants were at particular risk for hyperammonemia as compared to nonseptic patients (p < 0.025). Other clinical parameters including birth weight, gestational age, oxygen requirements, enteral nutritional intake, congenital anomalies, and heart disease did not appear to be related to BA concentration.
Design Considerations for Multidisciplinary Continuing Nutrition Education Programs
Authors: Hain Wanda F. , Howell Barbara B. , Crosby Lon O. , Mullen James L.
Published: May 2008

A multidisciplinary group of nutritional care providers was surveyed to assess degree of agreement on the relative importance of various areas of nutrition knowledge. A 35‐item nutrition content area survey was mailed to a stratified, random sample (n = 400) of the American Society for Parenteral and Enteral Nutrition (ASPEN) membership representing dietitians, nurses, pharmacists, and physicians. Through the use of modified Delphi survey, respondents rated each content area as ‘essential,’ ‘useful,’ or ‘nonessential’ for inclusion in a proposed test to assess nutrition knowledge. Respondents from all disciplines agreed that they should be knowledgeable in 22 of the 35 content areas. Chi square tests were used to assess significant response differences among disciplines. Systematic differences were primarily between dietitians and pharmacists. The study results provide direction to multidisciplinary continuing nutrition education program planners regarding appropriate content for combined discipline programs as well as for those more discipline‐specific.