bluuebunny/crossref_metadata_2025 huggingface dataset:
Effects of Amino Acid Infusions on Liver Regeneration after Partial Hepatectomy in the Rat
Authors: Rigotti Paolo , Peters John C. , Tranberg Karl‐Goran , Fischer Josef E.
Published: May 2008

Administration of solutions high in branched‐chain amino acids (BCAA) has been advocated in patients with severe liver failure; however, the effect of this treatment on the process of liver regeneration is still unclear. In the present study using rats we investigated the influence on liver regeneration of infusing solutions differing in amino acid content. After 75% hepatectomy, rats were infused via jugular vein with one of the following solutions: Sol A) 10% dextrose, Sol B) 10% dextrose + 3% amino acids (22% BCAA), Sol C) 10% dextrose + 3% amino acids (35% BCAA). Liver regeneration was estimated by measuring the incorporation of 3H‐thymidine into DNA at five different time points after the operation. Peak regeneration occurred earlier in rats infused with the BCAA‐enriched solution compared to animals infused with the standard amino acid solution or with dextrose alone. The increased incorporation of 3H‐thymidine into DNA at 24 hr in rats infused with the BCAA‐enriched solution was associated with elevated plasma levels of BCAA and decreased concentrations of tyrosine, phenylalanine, and methionine in comparison with the other two treatment groups. These results suggest that liver regeneration in rats can be accelerated by administering a parenteral nutrition solution tailored to normalize the deranged pattern of plasma amino acids associated with compromised liver function. (Journal of Parenteral and Enteral Nutrition 10:17–20, 1986)
Normalization of Abnormal Electroencephalograms in Beagles with Portacaval Anastomosis by Infusion of Solutions Rich in Branched‐Chain Amino Acids
Authors: Okamoto Hiroh , Fujimura Takao
Published: May 2008

The effects of intravenous infusions of amino acid solutions on the electroencephalograms (EEG) and biochemical indices of 12 beagle dogs with a portacaval anastomosis (PCA) were studied in unanesthetized and unrestrained conditions. EEGs were recorded everyday from 2 days after the operation. When the EEGs showed predominant delta and theta frequency bands (slow‐wave), solutions of amino acids were infused intravenously at 5 ml/kg/hr for an hour. Blood was withdrawn immediately before and after the infusion to determine plasma amino acids and ammonia.

Infusion of amino acid solutions enriched in branched‐chain amino acids (BCAA) with restricted aromatic amino acids (AAA) normalized the predominantly slow‐wave EEGs. These solutions reduced the increased plasma AAA and ammonia concentrations and increased the lowered plasma BCAA concentrations. The abnormal EEGs were not improved by infusion with a balanced and AAA‐enriched amino acid solution for nutritional support of surgical patients and became worse on infusion of AAA solution. Significant correlations were found between percent changes in the incidence of slow‐waves and plasma AAA concentrations. These results suggest that infusion of solution with low AAA and high BCAA concentrations may be suitable for treatment of cirrhotic patients with abnormal EEG or with hepatic encephalopathy. (Journal of Parenteral and Enteral Nutrition 10:34–39, 1986)
Efficacy of Two Elemental Diets: A Pair Feeding Study
Authors: Muggia‐Sullam Michael , Matarese Laura E. , Edwards Laura L. , Fischer Josef E.
Published: May 2008

The efficacy and side effects of two elemental diets were studied. Twenty young Sprague‐Dawley rats were fed one of three different diets. Group I (n=7) was fed Vivonex‐HN (VIV) ad lib; group II (n = 7) was given Criticare‐HN (CRI), pair‐fed to group I (the two elemental diets were given in glass bottles); group III was fed regular rat chow and served as control (CON). Body weight (WT), food intake, and nitrogen balance (NB) were measured daily. After 21 days, change in body weight was similar in the three groups (VIV = 64.9 ± 3.2 %; CRI = 59.6 ± 3.3 %; CON = 63.9 ± 4.8 %). Cumulative nitrogen balance was also similar in the two groups fed elemental diets (VIV = 4788 ± 277 mg N; CRI = 4690 ± 118 mg N), but in both these groups it was less than the control group fed chow (8060 ± 85 mg N). Blood urea nitrogen (BUN) on the last day was higher in the VIV group (12.9 ± 1.22 mg/dl) than in the CRI group (9.43 ± 0.43 mg/dl), but in both study groups it was lower than in the CON group (17.2 ± 1.08 mg/dl), although nitrogen intake was higher in the control (ad lib) group. SGPT was similar in the two elemental diets but higher than in CON. Liver weights were higher in the CRI group, probably abnormally so and likely due to increased fat content. Both diets had similar efficacy in nutritional support. (Journal of Parenteral and Enteral Nutrition 10:45–48, 1986)
Parenteral Nourishment of Patients Undergoing Surgical or Traumatic Stress
Authors: Gilder Helena
Published: May 2008

Severe surgical or other traumatic stress initiates an integrated central nervous system and metabolic response characterized by catabolism which selectively preserves vital organs, drawing on peripheral tissue proteins for required amino acids. When oral intake is prohibited adequate intravenous nutritional support hastens convalescence and may be life‐saving. Intravenous nutrients routinely consist of amino acids for replacement of lost protein, a nonprotein calorie source—usually glucose, and vitamins and minerals. Lipid, infrequently used in routine surgery as part of the calorie source, supplies essential fatty acids and prevents side effects resulting with large amounts of intravenous glucose. Lipid has other benefits. Stress‐induced hormones stimulate lipid catabolism. When lipid is used for part of the calorie requirement in intravenous feedings, the plasma insulin level is reduced and peripheral amino acids become available for synthesis of critically needed visceral proteins. Recent work has shown that the branched chain amino acids carnitine and some species of lipid added to intravenous nutrient formulations postoperatively affect the nitrogen retention and may hasten convalescence. Further work should be directed at understanding the unique biochemical changes occurring after injury, devising objective assay procedures to measure the severity of the response and improving intravenous formulations for the acutely ill surgical patient. (Journal of Parenteral and Enteral Nutrition 10:88–99, 1986)
Parenteral Nutrition, Biochemistry and Respiratory Gas Exchange
Authors: Silberman Howard , Silberman Allan W.
Published: May 2008

Lipid‐based total parenteral nutrition (TPN) may have an advantage over glucose‐based TPN in certain patients because less carbon dioxide is produced. This conclusion, however, does not properly derive from respiratory quotient (RQ) data. Stoichiometric analysis of glucose and lipid metabolism leads to conclusions similar clinically but at variance conceptually with those based on RQ. Thus, changing from glucose to lipid oxidation is associated with an 11% increase in oxygen consumption, a 23% decrease in carbon dioxide production, and a fall in RQ. In contrast, the diversion of glucose metabolism to synthesis of palmitylstearyloleyl triglyceride results in an 8‐fold increase in RQ, but contrary to widely published concepts, the rate of carbon dioxide production falls by 68%. However, even this reduced carbon dioxide production associated with lipogenesis is undesirable because it is not associated with significant ATP production. (Journal of Parenteral and Enteral Nutrition 10:151–154, 1986)
Percutaneous Endoscopic Gastrostomies: A Prospective Evaluation and Review of the Literature
Authors: Kirby Donald F. , Craig Robert M. , Tsang Tat‐Kin , Plotnick Bennett H.
Published: May 2008

The results of the first 55 consecutive percutaneous endoscopic gastrostomies (PEGs) that were performed over an 18‐month period in a tertiary care center are presented. We followed these cases prospectively to assess the morbidity, mortality, staff acceptance, short‐ and long‐term complications, and cost effectiveness of the technique. Fifty‐one (93%) were successful with no mortality. Long‐term morbidity included 6/ 55 (11%) tube extrusions; 5/55 (9%) cellulitis around the catheter site; 5/55 (9%) aspiration pneumonias; and 2/55 (3.6%) clogged tubes requiring replacement. Morbidity was considered minor and easily dealt with in all but five instances (9%) where more prolonged treatment was required. A review of the literature including other techniques used for percutaneous gastrostomy is also presented. It is concluded that percutaneous gastrostomies are relatively safe, cost‐effective, and should be given first consideration for long‐term enteral therapy in appropriate patients. (Journal of Parenteral and Enteral Nutrition 10:155–159, 1986)
Plasma and Erythrocyte Essential Fatty Acids during Total Parenteral Nutrition in Infants: Effects of a Cutaneous Supply
Authors: Bougle D. , Pepin D. , Delhaye M. , Chambaz J. , Ricour C.
Published: May 2008

In order to prevent essential fatty acid (EFA) deficiency induced by fat‐free total parenteral nutrition (TPN), 10 infants on TPN were rubbed three times daily for 20 days using oenethera oil (80% EFA). Total EFA amount provided cutaneously was 1900 mg/kg/d. Plasma and red blood cells phospholipids were determined on days 1 and 20 in these 10 treated and six untreated infants on TPN and compared with those of normal control infants. On day 1, plasma nonessential FA including 20:3 n‐9(p < 0.01) were increased in both TPN groups while 18:2 n‐6 and and 18:3 n‐3 (p < 0.001 and p < 0.01) were decreased. On the 20th day, EFA deficiency had worsened with a decrease in plasma level of 20:4 n‐6 (p < 0.02) and a higher than normal triene/tetraene ratio : 3.4±1.1 and 2.3±0.6 us 0.1±0.1 (p < 0.02). As for red blood cells phospholipids, 16:0 was increased and 18:2 n‐6 and 20:3 n‐6 were decreased (p < 0.05) on day 1. On day 20, these FA were more abnormal while 20:3 n‐9 became significantly increased (p < 0.05). No difference was observed between the TPN groups at any time. These results show that cutaneous application of large amounts of EFA‐rich oil is unable to prevent or cure TPN induced EFA deficiency. (Journal of Parenteral and Enteral Nutrition 10:216–219, 1986)
Zinc Deficiency and Lymphocyte Subpopulations. A Study by Flow Cytometry
Authors: Couvreur Yves , Quarre Jean‐Paul , Bailly Andre , Cornut Patricia
Published: May 2008

Zinc deficiency is well known to alter immunity. We report the case of a 18‐yr‐old female with relapsing Crohn's disease who experienced acrodermatitis enteropathica due to zinc deficiency during total parenteral nutrition (TPN). Blood lymphocytes have been studied by flow cytometry: before zinc treatment an important decrease of T‐helper lymphocytes with high level of OKM‐5 + lymphocytes had been observed. Zinc‐supplemented diet induced within a few days, a rise of T‐helper lymphocytes and a proportional reduction of OKM5 + cells. Increased values of high metabolism surface marker (OKT‐9) were also observed, as well as cytoplasmic modifications. The authors suggest that lymphocyte surface markers could be useful to monitor TPN in patients at high risk for zinc deficiency. (Journal of Parenteral and Enteral Nutrition 10:239–241, 1986)
An Evaluation of Total Parenteral Nutrition in the Management of Steroid‐dependent and Steroid‐resistant Patients with Crohn's Disease
Authors: Lerebours E. , Messing B. , Chevalier B. , Bories C. , Colin R. , Bernier J.J.
Published: May 2008

This study is an evaluation of short‐ and long‐term benefits of total parenteral nutrition (TPN) in 20 patients with active Crohn's disease but without fistulae. TPN was done during 42 (14–80) days (median‐range) after failure of medical therapy including patients with steroid‐resistant (11 SR) or steroid‐dependent (9 SD) active Crohn's disease. Efficacy of short‐term TPN was demonstrated by nutritional repair and achievement of clinical remission in all but one patients. Follow‐up was 28 (8–78) months in the 19 patients (10 SR, 9 SD) discharged improved after the end of TPN. At 1 yr, the cumulative recurrence rate was 26% (5/19). During the follow‐up, three patients (2 SR, 1 SD) remained symptom‐free, 13 (6 SR, 7 SD) had a partial remission defined as relapse controlled by medication, and only three patients (2 SR, 1 SD) had a relapse uncontrolled by medical therapy leading to surgery. Therefore in our selected population without fistula or abscess, after failure of medical therapy TPN was obviously an effective therapy which avoided surgery. Furthermore follow‐up indicated that SD and SR were only transient events in the course of Crohn's disease patients. (Journal of Parenteral and Enteral Nutrition 10:274–278, 1986)
Supplemental Parenteral Nutrition in Cystic Fibrosis
Authors: Lester Lucille A. , Rothberg Richard M. , Dawson Glyn , Lopez Angelita L. , Corpuz Zenaida
Published: May 2008

The efficacy and safety of short‐term supplemental peripheral hyperalimentation (PH) was evaluated in 15 hospitalized cystic fibrosis (CF) patients who exhibited varying degrees of pulmonary disease severity and nutritional impairment. An average of 1000 supplemental calories/day were administered intravenously for a 2‐ to 3‐week period to patients being treated with parenteral antibiotics for exacerbation of their pulmonary disease. Eleven of 15 patients responded with a weight gain of > 2.0 kg and showed continued weight gain and stabilized pulmonary status for the 6‐ to 12‐month follow‐up period; two patients showed dramatic reversal of poor weight gain and growth following PH. Total calorie intake (oral + PH) equaled 141 ± 40% of the recommended dietary allowances (RDA) in responders, with 45 ± 12% RDA contributed by PH, in contrast to 68 ± 20% of the RDA for total calories with 31 ± 13% supplied using PH achieved in the nonresponders. Linoleic acid deficiency was documented in these patients (linoleic acid level as a percent of total fatty acid = 21.9% ± 1.41 SEM vs 31.8% ± 1.16 SEM in normal controls), and all seven patients achieved normalization of linoleic acid level after PH. Prior assessment of nutritional status (anthropometric measurements) or of severity of pulmonary disease (NIH clinical score) did not allow prediction of response to PH. No complications resulted from administration of PH to these hospitalized CF patients. (Journal of Parenteral and Enteral Nutrition 10:289–295, 1986)
Effects of pH, Temperature, Concentration, and Time on Particle Counts in Lipid‐Containing Total Parenteral Nutrition Admixtures
Authors: Soges Bettner Francoise , Stennett Douglass J.
Published: May 2008

It has been standard practice in the United States to separate lipid emulsion from the other components of total parenteral nutrition (TPN) due to the reported instability of admixed intravenous lipid emulsions. Some clinicians, however, have combined all TPN components into one container and administered these admixtures to patients without apparent difficulties. Infusion of all nutrients from one container has many advantages. In this study standard and concentrated admixtures were aseptically prepared using generally accepted guidelines of the nutritional requirements for a 70‐kg patient. Treatments of standard and concentrated admixtures consisted of: (1) storing at 4°C without adjusting the pH; (2) increasing the pH to 6.6 and storing at 4°C; (3) increasing the pH to 6.6 and storing at room temperature. Samples were monitored for 3 weeks by means of Coulter Counter analysis, pH determinations, and visual observations.

The pH of the admixtures did not change over 3 weeks. Mean counts of particles with sizes between 1.6 and 25.4 μ increased over time for each treatment group. Within treatments, concentrated admixtures had significantly greater particle counts than the corresponding standard admixtures. Within the standard and within the concentrated admixtures, the particle counts were significantly greater for group one than for group three. Particle counts in group two tended to lie between the values of group one and three. Visual signs of emulsion deterioration were greatest in those admixtures in which the pH was not adjusted and occurred earlier in concentrated admixtures. (Journal of Parenteral and Enteral Nutrition 10:375–380, 1986)
Influence of the Intake and Composition of Elemental Diets on Bile Acid Metabolism and Hepatic Lipids in the Rat
Authors: Nelson Lesley M. , Russell R.I.
Published: May 2008

The effects of the elemental diets Vivonex (V) and Flexical (F) on bile acid metabolism and hepatic lipids in the rat has been investigated both with ad libitum feeding and when calorie intake was limited to that of control rats (C) fed a standard diet (Oxoid 41B). Ad libitum feeding of V and F for 9 weeks resulted in a weight gain in excess of that for the control diet. After 9 weeks of isocaloric feeding the V‐fed rats were significantly lighter than those fed F and C. Fecal bile acid excretion (FBA) and the fractional turnover rates for cholic acid (CA) and chenodeoxycholic acid (CDC) were measured. The elemental diets significantly reduced FBA when fed both ad libitum and isocalorically compared with the control diet, the reduction with V being significantly greater than for F. In the isocaloric feeding study both elemental diets significantly increased the half life of CA and CDC. The increase for CA was significantly greater for V than F but for CDC the effect of the two diets was the same. Thus the percentage of CDCderived 6 substituted bile acids was greater with V than F feeding. There was a strong negative correlation between bile acid half‐life and fecal excretion of metabolites for the three dietary groups indicating that bile acid pool size was unchanged by the elemental diets. A gross increase in liver lipid both histologically and chemically was found for the ad libitum fed V rats with a marked but lesser increase for F. Isocaloric feeding resulted in a statistically significant but much less striking increase in liver lipid for V and F vs the controls, and no difference was observed between the rats fed V and F. (Journal of Parenteral and Enteral Nutrition 10:399–404, 1986)
In Vitro Contamination of “Piggyback/Heparin Lock” Assemblies: Prevention of Contamination with a Closed, Positive Locking Device (Click‐Lock)
Authors: Gibilisco Paul A. , Lopez George A. , Appleman Maria D. , Millburg W. Joseph , Kushell Deborah L. , Elowitz Linda , Johnson Philip A. , Zenowich Dorothy
Published: May 2008

Direct contact and airborne transmission are established modes of microbial contamination of standard intravenous (iv) assemblies such as piggyback and heparin lock.1–17 In this study, 60% of the standard iv assemblies inoculated with Staphylococcus aureus (S. aureus) at the barrel of their exposed needle grew these organisms when cultured in a Soy Casein Digest Broth (SCDB). Also, 40 closed, positive locking iv assemblies (Click‐Lock) were inoculated at possible contamination sites, and none of these assemblies grew S. aureus in a SCDB. These in vitro studies suggest that a closed, positive locking iv assembly such as the Click‐Lock device may substantially reduce, and potentially prevent contamination of iv systems. (Journal of Parenteral and Enteral Nutrition 10: 431–434, 1986)
Amino Acids and Indoleamines in the Brain after Infusion of Branched‐Chain Amino Acids to Rats with Liver Ischemia
Authors: Bugge M. , Bengtsson F. , Nobin A. , Holmin T. , Jeppsson B. , Hultberg B. , Falck B. , Herlin P.
Published: May 2008

Rats with a portacaval anastomosis and ligation of the hepatic artery 2 days later were infused for 6 hr with a 10% glucose solution (group I) or the same solution combined with 0.24 M/liter branched‐chain amino acids (BCAA, group II). Control animals with portacaval anastomosis and sham‐operation (group III) or two sham‐operations (group IV) were infused with a 10% glucose solution. The rats were killed by decapitation and indoleamines and amino acids were determined in the brain. Rats with liver ischemia were stuporous at the end of the experiment irrespective of treatment.

The concentrations in the cortex of lysine, methionine, phenylalanine, threonine, alanine, glutamine, glycine, histidine, and tyrosine were significantly increased in group I compared to group IV. Infusion of BCAA to rats with liver‐ischemia (group II) resulted in significantly lower concentrations of lysine, methionine, phenylalanine, threonine, histidine and tyrosine and increased concentrations of isoleucine, leucine, valine, and arginine compared to group I.

The content of serotonin in the cortex and brain stem was significantly increased in group I compared with the BCAAtreated animals (group II) and the control groups III and IV. The concentrations of 5‐hydroxyindoleacetic acid (5‐HIAA) in the cortex and brain stem were higher in group I than in group IV. Infusion of BCAA to rats with liver ischemia normalized the concentrations of 5‐HIAA in the cortex and brain stem. (Journal of Parenteral and Enteral Nutrition 10:474–478,1986)
Microbial Growth Patterns in a Total Parenteral Nutrition Formulation Containing Lipid Emulsion
Authors: Gilbert Michael , Gallagher S. Cathy , Eads Michael , Elmore Michael F.
Published: May 2008

Microbial growth of Staphylococcus aureus, Escherichia coli, Pseudomonas aeruginosa and Candida albicans was evaluated in a standard amino acid‐dextrose‐based total parenteral nutrition (TPN) solution, 10% lipid emulsion, and a combined TPN formulation containing amino acids, dextrose, and lipid emulsion. At an initial inoculum of 104 CFU/ml, all three bacterial organisms grew well in 10% lipid emulsion, died in the standard solution and grew only minimally or died in the combined formulation. C. albicans grew in all three formulations at an initial inoculum of 104 CFU/ml; however, at an initial inoculum of 102 CFU/ml, which approximates touch contamination, growth of Candida in the standard and combined formulations was <1 log at 24 hr in contrast to the 10% lipid emulsion which showed significant growth >2 log at 24 hr.

It is concluded that a 24‐hr infusion time is safe for the combined TPN formulation used in this study. This should result in significant cost savings compared to the previously recommended 12‐hr infusion time. (Journal of Parenteral and Enteral Nutrition 10:494–497, 1986)
Neutropenia Due to Copper Deficiency in Total Parenteral Nutrition
Authors: Sriram Krishnan , O'Gara Judith A. , Strunk John R. , Peterson Julie K.
Published: May 2008

Copper (Cu) deficiency has been reported both in pediatric and adult patients on total parenteral nutrition (TPN). Manifestations of Cu deficiency are usually hematologic in the adult. A 56‐yr‐old patient with a history of subtotal gastrectomy underwent massive small bowel resection and partial colectomy in 1977. TPN was initiated. Intravenous (iv) trace mineral supplements were not available in 1977 at our institution. By June 1978, the patient manifested neutropenia with a white blood cell (WBC) count of 2000/mm3 and 39% neutrophils or a total neutrophil count (TNC) of 780/mm3. The serum Cu level at that time was 5 μg/dl (normal, 70–140), and the serum zinc (Zn) level was low, although within normal limits. Oral supplementation with Cu and Zn tablets proved ineffective. Twice weekly infusions of fresh frozen plasma were begun in April 1979, and intravenous chromium supplementation started in September 1979, but neither the WBC count nor the TNC improved. Intravenous Cu and Zn were approved in October 1979, and were added to the TPN formula. Within 2 weeks, the WBC count rose to 6300/mm3, and the neutrophils increased to 83% with a TNC of 5229. After 12 weeks, the serum Cu level rose to 80 μg/dl The increase in WBC count and percentage of neutrophils can be attributed to the addition of Cu to the TPN infusate. (Journal of Parenteral and Enteral Nutrition 10: 530–532, 1986)
Pediatric Parenteral Nutrition Management Using a Comprehensive User‐Friendly Computer Program Designed for Personal Computers
Authors: Yamamoto Loren G. , Gainsley Gloria J. , Witek J. Edward
Published: May 2008

The use of parenteral nutrition is becoming more widespread. The need for individualized parenteral nutrition solutions in pediatric patients makes the ordering and preparation of these solutions more complex and error‐prone. A computer program is described which performs comprehensive management of parenteral nutrition by assisting in accurately ordering and preparing parenteral nutrition solutions. It also performs extensive error‐checking and provides additional nutritional information. Data base management is also a feature which permits future large scale analysis of parenteral nutrition data for research purposes. This program, designed to run on a personal computer, is very comprehensive, yet flexible and user‐friendly. (Journal of Parenteral and Enteral Nutrition 10:535–539, 1986)
Biochemical and Histopathological Findings after a Long‐Term Intraperitoneal Fat Infusion. An Experimental Study in Rats
Authors: Moran J.M. , Limon M. , Mahedero G. , Garcia V. , Climent V. , Molina M. , Noguerales F. , Vinagre L.M.
Published: May 2008

The object of this work was to see the possible side effects that a long‐term intraperitoneal (IP) fat infusion would have. We used 56 female Wistar rats weighing 250 g, divided into a control group (CG) of eight and three groups of 16 in each one. These three groups were administered a 20% Intralipid infusion in a daily amount of 4 g/kg over 5, 10, and 15 days, respectively (groups I, II, and III) intraperitoneally. Twenty‐four hr after the last infusion the animals were anesthetized and after having drawn 3 ml of blood, 5% glutaraldehyde (GTH) was instilled in situ and optical and electron microscopic specimens were taken of the lung, liver, right diaphragm, and parietal peritoneum. The results show a decrease in triglyceride (TG) rate 24 hr after the last infusion in each group, but blood glucose, cholesterol, bilirubin, glucose oxidase test (GOT), glutamic pyruvic transaminase (GPT), nor other serum parameters varied. No alterations were noticed in the lung or liver under optical or electron microscopes in the groups than had under gone treatment, except for an increase in circulating macrophages with fat in the lung. In the diaphragm we observed hyperplasia in the serous layer of the peritoneum and an increase in fat in the lymphatic channels of the right diaphragm. The possibility of using IP infusions in order to study parenteral nutrition solutions was put forward as well as their possible clinical use in alternative nutrition techniques on both a short‐term and long‐term basis. (Journal *of Parenteral and Enteral Nutrition 10:609–613, 1986)
Influence of Parenteral Nutrition on Phospholipid Metabolism in Posttraumatic Rat Lungs
Authors: Bahrami Soheyl , Gasser Harald , Redl Heinz , Strohmaier Wolfgang , Schlag Guenther
Published: May 2008

In the current investigation, we studied two groups of rats—one group supplied exogenous phospholipid precursors (carbohydrate plus fat emulsion group) and the other given only calories (carbohydrate group)—to evaluate the effects on surfactant composition by normocaloric alimentation, using a hypovolemic‐traumatic shock model. The total phospholipid (PHL) contents of lung tissue were similar in both groups. However, we found differences in the dipalmitoylphosphatidylcholine fraction (DPPC—the most important component of surfactant material) in both lung tissue and lavage fluid. With lipid emulsion, there was an increased fraction of saturated lecithins (mainly DPPC) both in lung tissue and lavage fluid, similar to former studies with hypocaloric alimentation. In this model, those findings suggest that the PHL pattern does not depend on the quantity of caloric supply, but, rather, on the infusion composition. The enhanced DPPC content is further reflected in improved surfactant status: lipid in parenteral nutrition (PN) may exert a direct salutary effect on lung mechanics. (Journal of Parenteral and Enteral Nutrition 10:617–621, 1986)
Successful Pregnancy Outcome using Total Parenteral Nutrition from the First Trimester of Pregnancy
Authors: Lipkin Edward W. , Benedetti Thomas J. , Chait Alan
Published: May 2008

A 27‐yr‐old gravida 3, para 2 was supported from the 8th week of pregnancy by intermittent daily total parenteral nutrition (TPN) following the loss of her small bowel. Nutrient intake was adjusted by monitoring nitrogen balance and the rate of increase in fetal cranial enlargement. Maternal calcium balance proved difficult to maintain, since massive urinary Ca+2 losses occurred during infusion of nutrients (576 ± 2 mg/12 hr on TPN compared to 47 ± 12 mg/12 hr off). This increase in urine Ca+2 was due to depressed Ca+2 reabsorption by the kidney (87.1 ±.7 us 98.1 ±.3%) and increased filtered load (4623 ± 241 mg/12 hr us 2591 ± 329). Initially calcium balance was ‐180 mg/day. Nitrogen balance assessed by total stool and urine nitrogen was 1.1 g/24 hr, which was judged to be suboptimal. Deficits were corrected by increasing nitrogen intake, lengthening the duration of infusion and the oral administration of elemental calcium during periods off infusion. A normal fetus was delivered vaginally without complications at 35½ weeks. This patient demonstrates that normal fetal growth and development as well as appropriate maternal weight gain and nitrogen balance can be maintained throughout pregnancy, including the first trimester, by intermittent daily TPN. (Journal of Parenteral and Enteral Nutrition 10: 665–669; 1986)
Parenteral infusion with an admixture of amino acids, dextrose, and fat emulsion solution: compatibility and clinical safety
Authors: Ang SD , Canham JE , Daly JM
Published: May 2008

Fat emulsions are increasingly utilized as intravenous calorie sources in patients requiring total parenteral nutrition. In the United States, they are traditionally administered separate from the dextrose/amino acid solution because of concern regarding physical stability and clinical safety when fat emulsions are administered, having been mixed with the dextrose solution. The separate infusion entails multiple manipulations of the infusion system with increased risk of contamination and sepsis and increased cost in maintaining two infusion lines. This prospective sequential two‐phase clinical study evaluated solution compatibility and clinical safety of an admixture of fat emulsion (Intralipid 20%), dextrose, amino acids (Veinamine 8%), electrolytes, vitamins, and trace minerals. Continuous infusion of this solution in 25 adult patients from 2 to 35 days did not result in any adverse clinical reactions or abnormal laboratory parameters. Gross, visual examination and in vitro analysis of the admixture solutions revealed no physical instability or changes in fatty acid composition in admixture solutions stored at 4 degrees C for up to 6 weeks.
The influence of intravenous medium‐ and long‐chain triglycerides and carnitine on the excretion of dicarboxylic acids
Authors: Bohles H , Akcetin Z , Lehnert W
Published: May 2008

Four groups of male Wistar rats were alimented parenterally for 3 days. Groups 1 and 2 received medium‐chain triglycerides (MCT) and groups 3 and 4 long‐chain triglycerides (LCT). Groups 2 and 4 were supplemented with 100 mg L‐carnitine/kg/day. The MCT‐alimented rats presented with a distinct excretion of the dicarboxylic acids: adipic acid (C6), suberic acid (C8), and sebacic acid (C10). The acids excreted corresponded to the infused pattern of monocarboxylic acids: caproic acid (C6), caprylic acid (C8), and capric acid (C10). Dicarboxylic acid excretion after MCT administration may reflect an insufficient capacity of beta‐oxidation on one hand or a preferential omega‐oxidation of medium‐chain fatty acids on the other. Carnitine supplementation lead to a further increase of the dicarboxylic acids in the MCT‐group. beta‐OH‐butyric acid excretion decreased after carnitine in the MCT as well as in the LCT group. An increased transport of fatty acid‐carnitine compounds out of the mitochondria is discussed as an important effect of carnitine supplementation. Hereby medium‐chain fatty acids may be more accessible for omega‐oxidation.
Elimination kinetics of Lipofundin MCT: bolus injection and infusion compared
Authors: Leonhardt W , Julius U
Published: May 2008

Fifteen healthy young probands (nine males, six females) underwent an intravenous fat tolerance test (IVFTT) and, on the following day, a fat infusion lasting 6 hr. The emulsion tested was Lipofundin MCT 10%. One half of its triglyceride mass contains medium chain fatty acids. The IVFTT was started by injection of 0.1 g lipid per kg body weight into the fasting proband. Lipid elimination was estimated by measurement of light‐scattering intensity of serum samples collected during a 60‐min period. Individual fraction elimination rate constants covered a considerable range (K2 = 8.84 +/‐ 3.45%/min). The infusion test was performed at a rate of 0.1 g lipid per kg body weight and hr and lasted 6 hr. Serum triglyceride concentrations were determined enzymatically. They increased from 0.941 +/‐ 0.285 mmol/liter at the fasting state to a plateau level of 1.753 +/‐ 0.306 mmol/liter during infusion, and returned to initial levels 1 to 2 hr after the infusion was terminated. Individual triglyceride increments during infusion were significantly correlated with half‐life periods of lipid elimination during IVFTT (r = 0.792, p less than 0.001). This relationship was derived using a model of the stationary state during infusion. We conclude that elimination kinetics of exogenous fat given either as bolus or infusion are ruled by the same fractional elimination rate constant K2. The IVFTT provides an estimate of the stationary triglyceride increment during a lipid infusion lasting several hr.
Fat kinetics and recommended dietary intake in burns
Authors: Gottschlich MM , Alexander JW
Published: May 2008

In recent years, there has been an increased interest in the nutritional consequences of injury. This review paper attempts to collate available knowledge concerning the impact of burn injury on fat metabolism, and the effect of manipulated dietary fat intake on burn outcome. Although the interaction is only partially understood at present, several conclusions are evident. Burn patients exhibit alterations in triglyceride, cholesterol, carnitine, fatty acid, lipoprotein and prostaglandin metabolism. Glucose appears to be more effective than fat as an energy source in the nutritional support of seriously burned patients. Conservative administration of fat, particularly linoleic acid, is recommended in view of its immunosuppressive and hyperlipidemic tendencies. Dietary enrichment with eicosapentaenoic acid may likewise prove to be of merit in the diet therapy of burns.
Use of separate insulin infusions with total parenteral nutrition
Authors: Sajbel TA , Dutro MP , Radway PR
Published: May 2008

The efficacy, safety, and cost effectiveness of treating total parenteral nutrition (TPN)‐induced hyperglycemia with a continuous insulin infusion, separate from the actual TPN bottle, was evaluated. A patient was included in the study if his serum glucose was greater than 200 mg/dl at a TPN infusion rate of less than 75% of the calculated caloric goal. The insulin infusion was run into the central line with the TPN via a Y‐connector. At the patient's caloric goal, the infusion was stopped and the insulin was added to the TPN bottle, after the glucose was in the 100–200 mg/dl range for 24 hr. Sixteen patients including five known diabetics were studied, with data gathered retrospectively through chart review. It was estimated that 7.3 liters of TPN per patient were saved, compared to the amount used when insulin was added to newly prepared bottles of TPN each time a dosage change was required. In our institution, this amounts to a savings of $395.00 per patient (including charges for materials and an infusion pump for the insulin infusion). We conclude that separate insulin infusion is a reasonable and cost‐effective alternative when treating glucose intolerance in patients receiving TPN.
The Effect of Nutritional Status on Morbidity after Elective Surgery for Benign Gastrointestinal Disease
Authors: Muntzer Mughal M. , Meguid Michael M.
Published: May 2008

The effect of nutritional status on the morbidity and mortality of major gastrointestinal surgery for benign disease was studied in 32 patients. Malnutrition was defined as a serum albumin <3.5 g/dl and a recent weight loss >10%, in addition to any two of the following: weight for height, mid‐arm circumference or triceps skin‐fold thickness <10th percentile. The morbidity and mortality in the 17 malnourished patients was 59% and 29%, respectively, compared with 20% and 7% in 15 well‐nourished patients matched for age and operative procedure (p < 0.05). After operation, the mean duration of inadequate oral nutritional intake period (IONIP, defined as a caloric intake >60% requirement) was 11.9 days ± 2.9 (SEM) in well‐nourished patients compared with 30.5 days ± 3.7 in the malnourished group. The longer IONIP in malnourished patients was a consequence of the higher morbidity in this group, thus warranting the consideration of supportive (postoperative) parenteral nutrition in malnourished patients who undergo major gastrointestinal surgery for benign disease. (Journal of Parenteral and Enteral Nutrition 11: 140–143, 1987)
Parenteral Nutrition‐Associated Cholestasis: Recovery Following Phenobarbitone
Authors: South Michael , King Ashley
Published: May 2008

A case is presented of a very preterm neonate who developed severe cholestatic jaundice in association with prolonged parenteral nutrition. The effects of a therapeutic trial of phenobarbitone on bilirubin and liver enzymes are shown. This case suggests that phenobarbitone may have a role to play in the treatment of this condition, which is contrary to indications in a few other case reports in the literature. (Journal of Parenteral and Enteral Nutrition 11:208–209, 1987)
Determining an Individual's Ideal Body Weight from Skeletal Measurements: A New Method
Authors: Nguyen DE , Reilly David A. , Reilly James J.
Published: May 2008

Determining an individual's “ideal” body weight is fundamental in nutritional therapy. A simulation of the human body to a cylindrical volumetric model permits the calculation of the ideal body weight from the measured height, interacromioclavicular distance, and humeral length. A group of 189 healthy normal volunteers were assessed. The calculated “Pitt” ideal body weight correlated closely (r = 0.88 for males, r = 0.72 for women) with values obtained from the Metropolitan tables. The technique provides an estimate of ideal body weight based upon reproducible, easily obtained measurements of fixed bony landmarks. (Journal of Parenteral and Enteral Nutrition 11:255–258,1987)
Fate of Right Atrial Catheters Inserted Prior to Arrival at a Transplant Center
Authors: Petersen Finn Bo , Holo Mary , Hickman Robert O. , Clift Reginald A. , Sanders Jean E. , Meyers Joel D. , Buckner C. Dean
Published: May 2008

An analysis of catheter‐related complications in a study group consisting of 83 patients, each of whom arrived at a major marrow transplant center after having had a large bore right atrial catheter (RAC) inserted by the referring institution, was compared to a similar analysis of catheter‐related complications in 357 patients who had their RAC inserted at the transplant center just before the transplant procedure was begun (control group). Fourteen (17%) patients in the study group had their original catheter removed for complications (five for septicemia and nine for mechanical complications) compared to 57 (16%) of the patients in the control group. Thirteen (16%) of the 83 catheters in the study group were double lumen and only two of these (15%) were replaced due to complications. Sixteen of 59 patients (27%), 13 years old or older, who arrived with a single lumen RAC already inserted, required an additional catheter during the transplant procedure because of an increased need for intravenous access. From this study, we concluded that patients who arrived for marrow transplantation with a RAC already inserted did not routinely need the catheter replaced. However, it is recommended that double lumen catheters be inserted in adult patients if marrow transplantation is anticipated. (Journal of Parenteral and Enteral Nutrition 11 :263–266, 1987)
Liver Composition and Histology in Growing Infant Miniature Pigs Given Different Total Parenteral Nutrition Fuel Mixes
Authors: Shulman Robert J. , Fiorotto Marta L. , Sheng Hwai‐Ping , Finegold Milton J. , Garza Cutberto
Published: May 2008

Although young infants are at greater risk for total parenteral nutrition (TPN)‐related liver disease than adults, previous studies on the effect of the TPN energy source on the development of hepatic steatosis have been carried out in adult rats and adult humans. We studied the effect of a glucose and a glucose/fat TPN energy regimen on hepatic chemical composition and the development of steatosis in newborn miniature pigs. Twenty miniature pigs were randomized at 10 days of age to receive a TPN regimen which utilized either glucose (group A) or glucose/fat (group B) as the non‐nitrogen energy source. After 8 days, blood was drawn for insulin, glucagon, SGPT, albumin, and bilirubin determinations. Samples of liver were obtained at 9 days. Plasma insulin levels were significantly higher and glucagon levels lower in group A piglets than in those in group B. Normal values were obtained for SGPT, albumin, and bilirubin, and no differences were found between groups. Chemical analysis of the livers revealed no differences between groups in the concentrations of glycogen, fat, protein, DNA, and RNA. Group A animals had significantly higher concentrations of water than group B (group A: 0.75 ± 0.01 liter/kg; group B: 0.74 ± 0.01; p < 0.03). A significant correlation was found in group B between the plasma insulin/glucagon ratio and the hepatic glycogen concentration (r = 0.73, p < 0.05). Group A animals had fat vacuoles in centrilobular hepatocytes, in contrast with group B animals who had visible fat only in Kupffer cells. Thus, in the newborn miniature pig, the different TPN energy sources affected the chemical composition of the livers similarly, except for water. Similar chemical composition did not preclude the histologic development of steatosis. (Journal of Parenteral and Enteral Nutrition 11:275–279, 1987)
Trace Element Status of PKU Children Ingesting an Elemental Diet
Authors: Acosta Phyllis B. , Stepnick‐Gropper Sareen , Clarke‐Sheehan. Noreen , Wenz Elizabeth , Cheng Mary , Anderson Kathryn , Koch Richard
Published: May 2008

We assessed the trace metal status of 10 children (3.5 to 13.3 yr) with phenylketonuria (PKU) who were successively treated for at least 6 months with a semi‐synthetic formula restricted in phenylalanine, then for 6 months with a reformulated formula. The reformulated product contained higher concentrations of magnesium (Mg), potassium (K), phosphorus (P), selenium (Se), and zinc (Zn) and lower concentrations of calcium (Ca), sodium (Na), and unsaturated fats. Diet records, blood samples, and urine specimens were collected from each subject. Mean intakes of Mg, K, and Zn increased significantly when subjects were switched to the reformulated product. The subject's mean intakes of Se (for all age groups) and Zn (children 11 to 14 yr old) were below 67% of recommended intakes while they were ingesting the original formula. The mean trace metal concentrations of urine, blood, and serum did not differ significantly during the two periods. Mean serum Zn, Se, and Cu concentrations of the subjects were less than those reported for normal children. Significant negative correlations were obtained between serum Zn concentrations and the molar ratio of dietary (Ca + P):Zn, and the molar ratio of dietary Fe:Zn. No significant differences in mean urinary Cu and Zn excretion (mg/g creatinine) were observed in subjects after they were changed to the reformulated product. Individuals whose primary source of energy and protein is derived from semi‐synthetic elemental diets are especially at risk for multiple trace element deficiencies. (Journal of Parenteral and Enteral Nutrition 11:287–292, 1987)
Nutritional Parameters at Hospital Admission as Predictors of Pressure Ulcer Development in Elective Surgery
Authors: Stotts Nancy A.
Published: May 2008

Nutritional parameters obtained at hospital admission were studied to determine whether they would predict which surgical patients would develop pressure ulcers during a period of up to three weeks of hospitalization. Nutrition parameters were serum albumin, total protein, lymphocyte count, mid‐arm muscle circumference, triceps skin fold, and weight change. Lymphocyte count was significant (p = 0.007, adjusted r2 = 0.019) in predicting the development of a pressure ulcer during hospitalization. Because lymphocyte count accounted for less than 2% of the variance, it is not a clinically significant predictor. When nonnutritional pressure ulcer risk factors were controlled for in the regression, no nutritional factors were predictive of ulcer development. (Journal of Parenteral and Enteral Nutrition 11:298–301, 1987)
Problems of Trace Elements and Vitamins during Long‐Term Total Parenteral Nutrition: A Case Report of Idiopathic Intestinal Pseudo‐obstruction
Authors: Kadowaki Hiroko , Ouchi Minami , Kaga Makiko , Motegi Tomiko , Yanagawa Yukishige , Hayakawa Hiroshi , Hashimoto Gotaro , Furuya Kiyokazu
Published: May 2008

An 8‐year‐old girl with chronic idiopathic intestinal pseudo‐obstruction (CIIP), who is the first case of CIIP in Japan, has been receiving total parenteral nutrition (TPN) for more than 6 years. During this time, she experienced deficiencies of copper, zinc, vitamin A, vitamin B12, folic acid, and biotin, and an excess of vitamin A; she exhibited a series of signs and symptoms due to these deficiencies and vitamin A overdosage. Nevertheless, careful monitoring of serum levels of trace elements and vitamins and appropriate therapy have almost solved these problems. She has achieved normal physical and mental development and goes to school, while receiving home parenteral nutrition with an ambulatory infusion system. (Journal of Parenteral and Enteral Nutrition 11:322–325,1987)
The Chest Tube: A Simple Device for the Tunneling of Central Venous Catheters
Authors: Hoelzer Dennis J. , Tuggle David W. , Judd A. Tommye , Smith E. Ide
Published: May 2008

The chest tube is presented as a device for the tunneling of central venous catheters. It offers several advantages over currently recommended tunneling devices. It is readily available in multiple sizes to accommodate different diameter catheters, produces lengthy atraumatic tunnels, and can be bent into various shapes to facilitate passage through the subcutaneous tissues. (Journal of Parenteral and Enteral Nutrition 11:326–327, 1987)