bluuebunny/crossref_metadata_2025 huggingface dataset:
Photosensitized Oxidation of Tryptophan and Hepatic Dysfunction in Neonatal Gerbils
Authors: Bhatia Jatinder , Rassin David K.
Published: May 2008

Hepatic dysfunction is a common metabolic complication of parenteral nutrition. Studies in animals have suggested that several amino acids, especially tryptophan, may play a role in the development of hepatic dysfunction. Further, photoirradiation of amino acids in the presence of photosensitizers, such as riboflavin, causes photooxidative changes in several amino acids. The present study was undertaken to determine the effect of tryptophan, after photoirradiation in the presence of riboflavin, on hepatic function in neonatal gerbils. Two‐week‐old suckling gerbils received approximately 4 mmol/kg/day of light‐exposed or nonlight‐exposed tryptophan or received saline intraperitoneally for 4 days. An increase in the activity of serum γ‐glutamyl transpeptidase was found in gerbils receiving both light‐exposed and nonlight‐exposed tryptophan compared to control. Concentrations of tryptophan were significantly higher in animals receiving saline than in the other two groups. There were no significant differences in the major tissue amino acids among the three groups of animals. Our data suggest the role of photosensitized oxidation of tryptophan in the pathogenesis of hepatic dysfunction in neonatal gerbils. It is possible that similar photooxidation occurring during infusion of parenteral amino acid solutions containing vitamins exposed to constant illumination in the newborn nursery is responsible for the observed hepatic dysfunction in parenterally fed neonates. (Journal of Parenteral and Enteral Nutrition 9:491–495, 1985)
Metronidazole Prevention of Serum Liver Enzyme Abnormalities during Total Parenteral Nutrition
Authors: Lambert John R. , Thomas Susan M.
Published: May 2008

Abnormal serum liver enzymes are common in adults receiving total parenteral nutrition (TPN). The mechanism(s) responsible for these changes is unclear. One hypothesis is that there is overgrowth of intestinal anaerobic bacteria with subsequent toxic effects on the liver from endotoxins and/ or bile acids. A retrospective survey of patients receiving TPN was undertaken. The patients were divided into two matched groups. One group had received metronidazole, a drug that suppresses anaerobic bacteria, while the other group had not. The administration of metronidazole during TPN was associated with prevention of the expected rise of serum alkaline phosphatase, γ glutamyl transpeptidase, and aspartate aminotransferase. This study supports the concept that anerobic intestinal bacteria may be involved in the pathogenesis of liver changes commonly observed during TPN. (Journal of Parenteral and Enteral Nutrition 9:501–503, 1985)
The Effect of Choline Supplementation on Hepatic Steatosis in the Parenterally Fed Rat
Authors: Hall Richard I. , Ross Laurence H. , Bozovic Mladjan G. , Grant John P.
Published: May 2008

Information regarding hepatic function during total parenteral nutrition in rats is often extrapolated to the clinical situation, but the steatosis observed in that species may simply reflect choline deficiency and be irrelevant to man. The effect of choline supplementation on hepatic lipid content and triglyceride secretion was examined in parenterally fed rats. Eighty to 90‐day‐old rats were randomized into three groups; group I received oral Purina Chow ad libitum, groups II and III received identical total parenteral nutrition regimens with the exception that group III received supplemental choline. After 7 days, peripheral triglyceride uptake was inhibited with Triton WR1339, the rate of secretion of 14C‐labeled triglyceride measured after a bolus injection of 1‐14C‐palmitic acid, and total hepatic lipid content was measured. Total hepatic lipid content was elevated in group II (86.3 mg/g) and group III (83.3 mg/g), and both differed significantly from the control group I (35.2 mg/g, p < 0.01), but the choline supplementation appeared to make no difference. Hepatic secretion of 14C‐palmitic acid as 14C‐triglyceride was reduced in group II (0.73%/ml plasma), and group III (0.72%/ml plasma) compared to group I (1.06%/ ml plasma, p < 0.05), and was unaffected by choline. The hepatic steatosis produced in the parenterally fed rat did not appear to be due to choline deficiency but to some other factors which may be important in man. (Journal of Parenteral and Enteral Nutrition 9:597–599, 1985)
Total Parenteral Nutrition in the Mouse: Body Composition and Plasma Chemistries
Authors: Sitren Harry S. , Heller Patricia A. , Bailey Lynn B. , Baumgartner Thomas G. , Cerda James J.
Published: May 2008

Mice that were maintained in energy and nitrogen (N) balance by total parenteral nutrition (TPN) for 12 days were analyzed for changes in organ weight, carcass and liver N and fat, and plasma glucose, urea N, and total protein. The results are compared with two other groups: (1) PO, which consisted of mice that were given the TPN solution per os in amounts equivalent to the TPN group, and (2) AL, which consisted of mice allowed to consume a stock diet ad libitum. In comparison with group AL, the TPN‐fed mice had normal liver, kidney, and lung weights but heavier spleens and hearts. Group PO had an increase in liver weight only. Hepatic lipid content declined in group TPN but increased markedly in POfed mice. The latter group also demonstrated a 35% increase in carcass fat whereas it was unchanged in the TPN group. No differences were found in plasma urea N and total protein among the groups but plasma glucose increased 2‐fold in group PO. It appears that our technique of parenteral feeding in mice maintains fairly normal body composition and plasma chemistries. However, mice drinking the TPN solution (group PO) exhibited the greatest number of alterations. These results are discussed in relation to differences in route of feeding, diet composition, feeding pattern, and the possible influence of circadian rhythms. The dilemma of choosing appropriate control groups in TPN studies is also discussed. (Journal of Parenteral and Enteral Nutrition 9:600–604, 1985)
The Use of Cyclic Home Hyperalimentation for Malabsorption in Patients with Scleroderma Involving the Small Intestines
Authors: Levien David H. , Fiallos Federico , Barone Richard , Taffet Sanford
Published: May 2008

When scleroderma involves the small intestines, malnutrition with resulting immune incompetence and sepsis can occur. Two cases are presented in which patients with scleroderma involving the gastrointestinal tract were treated with cyclic home hyperalimentation, restoring their nutritional status and improving their quality of life. (Journal of Parenteral and Enteral Nutrition 9:623–625, 1985)
High Protein Enteral Feedings: A Means of Achieving Positive Nitrogen Balance in Head Injured Patients
Authors: Twyman Diana , Young A. Byron , Ott Linda , Norton Jane A. , Bivins Brack A.
Published: May 2008

In an attempt to improve early enteral nitrogen replacement, nitrogen status was compared in two groups of head injured patients receiving enteral regimens of 38 to 51 kcal/kg/day with different protein concentrations. Eleven control patients received 1.5 g protein/kg/day and 10 study patients received 2.2 g protein/kg/day. Daily nitrogen excretion, corrected nitrogen balance, blood urea nitrogen changes, and enteral formula tolerance were compared between groups over a 10‐day period. Those receiving 2.2 g protein/kg/day had significantly higher daily and cumulative nitrogen balances despite their higher nitrogen excretion levels. Over 10 days, the study group retained 9.2 g nitrogen. By comparison, the control group sustained a cumulative loss of 31.2 g nitrogen over 10 days, despite a mean intake of 109 g protein/day. In both groups, full strength, full rate feedings were not possible until day 10 postinjury. These data indicate that once enteral formulas are tolerated high nitrogen regimens are required to achieve positive nitrogen balance in acute severe head injury patients. (Journal of Parenteral and Enteral Nutrition 9:679–684, 1985)
Accuracy of Recumbent Height Measurement
Authors: Gray David S. , Crider John B. , Kelley Connie , Dickinson Linda C.
Published: May 2008

Since many patients requiring specialized nutritional support are bedridden, measurement of height for purposes of nutritional assessment or prescription must often be done with the patient in bed. This study examined the accuracy of measuring body height in bed in the supine position. Two measurements were performed on 108 ambulatory inpatients : (1) standing height using a standard height‐weight scale, and (2) bed height using a flexible tape. Patients were divided into four groups based on which of two researchers performed each of the two measurements. Each patient was also weighed and self‐reported height, weight, sex, and age were recorded. Bed height was significantly longer than standing height by 3.68 cm, but the two measurements were equally precise. It was believed, however, that this 2% difference was probably not clinically significant in most circumstances. Bed height correlated highly with standing height (r = 0.95), and the regression equation was standing height = 13.82 ± 0.09 bed height. Patients overestimated their heights. Heights recorded by nurses were more accurate when patients were measured than when asked about their heights, but the patients were more often asked than measured. (Journal of Parenteral and Enteral Nutrition 9:712–715, 1985)
The Effects of Oral Soybean Phospholipid on Serum Total Cholesterol, Plasma Triglyceride, and Serum High‐Density Lipoprotein Cholesterol Concentrations in Hyperlipidemia
Authors: Ovesen L. , Ebbesen K. , Olesen E.S.
Published: May 2008

In a randomized, double‐blind, cross‐over trial soybean phospholipid and placebo, 18 g daily for 6 wk, were given orally to 20 patients on long‐term treatment with standard lipid lowering diets. The effect of this treatment on serum total cholesterol and high‐density lipoprotein cholesterol and plasma triglyceride was studied. After 6 wk mean (±SE) cholesterol concentration was decreased by 0.54 (±0.19) mmol/ liter in phospholipid‐treated as compared to placebo‐treated patients (p < 0.02). The decrease in serum cholesterol was significant (p < 0.02) only in patients assigned to receive phospholipid before placebo. A highly significant increase (p < 0.001) followed the withdrawal of phospholipid. No effect on triglyceride and high‐density lipoprotein cholesterol concentrations was demonstrated. (Journal of Parenteral and Enteral Nutrition 9:716–719, 1985)
Hickman Catheter Separation
Authors: Rubenstein Richard B. , Alberty Roger E. , Michels Lee G. , Pederson Robert W. , Rosenthal David
Published: May 2008

Seven patients with Hickman/Broviac catheters implanted via the percutaneous subclavian route are reported to have had catheter separation and embolization; one catheter implanted via cephalic vein cutdown also separated. The method of percutaneous subclavian catheter insertion is briefly described, and the mechanism of catheter separation is discussed. Percutaneous insertion routes the silicone catheter between the clavicle and first rib, producing compressive/shearing force which can cause the catheter to break—usually after several months. Embolized catheter fragments can be retrieved with a percutaneous transfemoral venous snare. The described complication represents a 1% incidence. Recommendations to minimize this problem include: (1) placement of subclavian puncture at or lateral to midclavicular line; (2) chest x‐rays at 2‐ to 3‐month intervals to identify catheter indentation at the thoracic inlet; (3) early removal of catheters for patients with radiologic evidence of significant catheter compression. (Journal of Parenteral and Enteral Nutrition 9:754–757, 1985)
Intraperitoneal Infusion as a Complication of Needle Catheter Feeding Jejunostomy
Authors: Blebea John , King Terry A.
Published: May 2008

The needle catheter feeding jejunostomy is being increasingly utilized for postoperative nutritional support. We report a case of catheter dislodgement with intraperitoneal infusion of an elemental diet with subsequent peritonitis and death. A review of the literature reveals this complication to occur in 1.5% of patients, even when the serosa of the small bowel has been attached to the anterior abdominal wall. Recommendations are made regarding the prevention and management of such complications. (Journal of Parenteral and Enteral Nutrition 9:758–759, 1985)
DRGs and Specialized Nutrition Support. Prospective Payment and Nutritional Support: The Need for Reform
Authors: Anderson G.F. , Steinberg E.P.
Published: May 2008

The Medicare Prospective Payment System does not recognize the use of parenteral and enteral nutrition services as an explicit factor to be used in determination of DRG payment rates. When the DRGs were originally created, the use of parenteral and enteral nutrition services (PENS) was not coded in discharge data sets. As a result, it was impossible to determine whether patients who received PENS were more expensive to treat. Data we have collected indicate that patients who receive PENS tend to have high hospital costs—costs that often exceed the DRG payments established by the Health Care Financing Administration (HCFA). The potential for a hospital to incur a financial loss as a result of treating patients who require PENS could make such patients less attractive to hospitals and thus could adversely affect patients requiring these services. In order to minimize this possibility, we suggest several alternative modifications to the DRG payment system. The modifications would provide higher payments for patients who require PENS, thereby reducing the possibility of discrimination against these patients. By readjusting the DRG prices for patients who do not require PENS, the entire payment modification can be made budget‐neutral. (Journal of Parenteral and Enteral Nutrition 10:3–8, 1986)
Is it Possible to Evaluate the Efficacy of Amino Acid Solutions after Major Surgical Procedures or Accidental Injuries? Evaluation in a Randomized and Prospective Study
Authors: Lundholm Kent , Bennegard Klas , Wickström Ingemar , Lindmark Lars
Published: May 2008

Two unbalanced amino acid solutions (essential amino acids, branched‐chain amino acids) were compared to a complete and balanced amino acid solution with regard to efficacy of nitrogen balance. Patients were randomized to receive the amino acid solutions over 3 days for each regimen. The patients were examined postoperatively or directly after accidental trauma. Nonprotein calories were given as 40 kcal/ kg/day consisting of 50% fat and 50% glucose. Nitrogen was given at the amount of 0.15 g N/kg/day. Unbalanced amino acid solutions gave a 2‐fold more negative nitrogen balance than a balanced and complete amino acid solution. However, this difference disappeared and nitrogen balance approached equilibrium irrespective of the amino acid composition of the infused solutions when nitrogen in blood products was accounted for. All patients received a considerable amount of blood products in a comparable but unpredictable way. Blood products corresponded to around 40% of the daily nitrogen intake. Our study demonstrates that it is not possible to test the efficacy of amino acids for nitrogen retention in patients who are in the need of blood‐product transfusions. It is likely that amino acids in blood proteins serve as a significant amino acid source that is utilized for resynthesis of body proteins especially in flow‐phase patients with high protein breakdown. This fact has not been sufficiently accounted for in the previous literature. (Journal of Parenteral and Enteral Nutrition 10:29–33, 1986)
A Cost‐Utility Analysis of the Home Parenteral Nutrition Program at Toronto General Hospital: 1970–1982
Authors: Detsky Allan S. , Mclaughlin John R. , Abrams Howard B. , Whittaker J. Scott , Whitwell Jocelyn , L'Abbé Kristan , Jeejeebhoy Khursheed N.
Published: May 2008

We performed an economic evaluation of a home parenteral nutrition (HPN) program by measuring the incremental costs and health outcomes for a cohort of 73 patients treated at our institution from November 1970 to July 1982.

Over a 12‐year time frame, we estimate that HPN resulted in a net savings in health care costs of $19,232 per patient and an increase in survival, adjusted for quality of life, of 3.3 years, compared with the alternative of treating these patients in hospital with intermittent nutritional support when needed. This result was sensitive to assumptions made about the cost of the alternative treatment strategy. When these assumptions were most unfavorable to the HPN program, we estimated that HPN resulted in incremental costs of $48,180 over 12 years, $14,600 per quality‐adjusted life‐year gained.

We conclude that the cost‐utility of HPN compares favorably with other health care programs, when HPN is used to treat patients with gut failure secondary to conditions such as Crohn's disease or acute volvulus. Since only one patient with active malignancy was enrolled in our HPN program, these results should not be extrapolated to patients with active malignancy. (Journal of Parenteral and Enteral Nutrition 10:49–57, 1986)
Hickman Catheter Complications in Marrow Transplant Recipients
Authors: Petersen Finn Bo , Clift Reginald A. , Hickman Robert O. , Sanders Jean E. , Meyers Joel D. , Kelleher Joleen , Buckner C. Dean
Published: May 2008

The complications associated with the insertion and use of 95 single lumen and 312 double lumen Hickman right atrial catheters in 357 marrow transplant recipients were retrospectively analyzed. Three‐hundred (84%) first inserted catheters were in place for a median of 93 days (range, 16–209) without complications and were removed electively. Thirty‐nine (9.6%) of all catheters were removed for infections and 24 (5.9%) for mechanical complications. Ninety‐five patients (26.6%) had 111 episodes of septicemia involving 128 separate organisms and 25 patients had 25 episodes of localized catheter infection with 26 separate organisms. The most frequently isolated organism was coagulase‐negative staphylococcus. Twelve of 24 removals due to mechanical complications were caused by accidental pulling of the catheter by the patient. (Journal of Parenteral and Enteral Nutrition 10:58–62, 1986)
Serum Vitamin E Levels in Very Low‐Birth Weight Infants Receiving Vitamin E in Parenteral Nutrition Solutions
Authors: Devito Victoria , Reynolds John W. , Benda Gerda I. , Carlson Christina
Published: May 2008

Serum vitamin E levels were measured in 17 very low‐birth weight infants in the first 2 wk of life, before and after the institution of intravenous vitamin E supplementation in a dosage of 4.5 mg/day, as a component of MVI Pediatric multivitamin preparation. Serum vitamin E levels were 0.22 ± 0.16 (SD) mg/dl before supplementation, and rose to 2.55 ± 0.65 (SD) mg/dl in nine infants more than 899 g birth weight, and rose to 3.68 ± 0.70 (SD) mg/dl in six infants less than 900 g at birth. These postsupplementation serum vitamin E levels are in the range in which a reduction of incidence or severity of retinopathy of prematurity and intraventricular cerebral hemorrhage has been reported by others. No toxic effects of the preparation or of the increased vitamin E levels were found. (Journal of Parenteral and Enteral Nutrition 10:63–65, 1986)
The Increase of Body Iron Stores Estimated by the Increase of Serum Ferritin Concentration during Ferrous Sulphate Treatment after Gastrointestinal Surgery
Authors: Harju E. , Lindberg H.
Published: May 2008

A 6‐wk period of iron therapy with ferrous sulphate (80 mg Fe++ three times daily) was given to 16 males and 16 females on whom previously various common gastrointestinal surgery had been performed and who had empty iron stores estimated from low serum ferritin concentration. The results were compared with a control group corresponding to the study group in respect to sex, number of patients, primary disease, previous operation, and the empty iron stores. The iron therapy replenished the empty body iron stores, because the serum ferritin concentrations increased from 11 ± 7 to 35 ± 13 μg/liter (p < 0.001) in the males and from 9 ± 6 to 30 ± 10 μg/liter (p < 0.001) in the females, whereas the corresponding changes in the control group were from 10 ± 9 to 11 ± 8 μg/liter and from 11 ± 8 to 13 ± 11 μg/liter in the males and females, respectively. Also the blood hemoglobin concentration increased in the group receiving iron from 136 ± 11 to 152 ± 11 g/liter (p < 0.01) and from 130 ± 12 to 142 ± 11 g/liter (p < 0.01) and the serum iron from 14 ± 6 to 18 ± 5 mmol/liter (p < 0.01) and from 13 ± 6 to 17 ± 6 mmol/liter (p < 0.01) in males and females, respectively, whereas corresponding changes in the control group for hemoglobin were from 135 ± 10 to 137 ± 11 g/liter and from 129 ± 11 to 131 ± 10 g/liter and for serum iron from 14 ± 6 to 14 ± 5 mmol/liter and from 14 ± 6 to 14 ± 5 mmol/liter, in the males and females, respectively. The response to iron treatment varied considerably between different patients, because in some few patients serum ferritin decreased during the study and in some the increase was several‐fold the initial value. The study shows that ferrous sulphate treatment is an effective and practical way to replenish the empty iron stores, estimated from serum ferritin concentrations, in patients after various gastrointestinal surgery and that concomitantly the blood hemoglobin and serum iron concentrations will increase. (Journal of Parenteral and Enteral Nutrition 10: 66–69, 1986)
Inexpensive, Safe and Simple Nasoenteral Intubation—An Alternative for the Cost Conscious
Authors: Ramos Sylvia M. , Lindine Paula
Published: May 2008

The efficacy and safety of nasoenteral feedings via small bore, flexible tubes have been extensively studied and reported. Most of the tubes currently used have similar characteristics including a high price ($7.00‐$17.30 per tube). Our study using inexpensive (.55 each), polyvinyl pediatric feeding tubes and reusable guide wires in 21 patients shows that a weighted tip is not necessary for the passage of tubes into the duodenum (19/27 tubes passed) and that with proper nursing care and patient cooperation, the tubes can remain in place and patent for periods up to 71 days. The cost savings using the ubiquitous pediatric feeding tube and a reusable guide wire are significant (between $6.25 and $16.55 per tube used) and make this a more cost conscious alternative. (Journal of Parenteral and Enteral Nutrition 10:78–81, 1986)
Lack of Modulation of Postoperative Immunosuppression by Isotonic Amino Acid Infusion
Authors: Neuvonen P. , Salo M. , Perttilä J. , Havia T.
Published: May 2008

Effects of an isotonic amino acid solution on the immune defence systems of surgical patients were studied. Twenty‐two patients admitted for major abdominal operations were randomly allocated into two groups. Eleven of them received 1 liter of 3% amino acid solution daily for 5 days postoperatively, while 11 control patients received balanced 5% glucose‐containing electrolyte solutions. Immune variables were studied preoperatively and at 1, 3 to 4, and 6 to 7 days postoperatively. These studies included leukocyte and differential counts, T (OKT3+), B (sIg+), T helper/inducer (OKT4+) and suppressor/cytotoxic (OKT8+) cell determinations, measurement of in vitro lymphocytic responses to phytohemagglutinin (PHA), pokeweed mitogen (PWM) and Staphylococcus aureus Cowan I (StaCw) in cultures of separated lymphocytes, and to PHA, concanavalin A (Con A), and PWM in whole blood cultures. B lymphocyte functions were studied by measuring synthesis of immunoglobulins IgG, IgM, and IgA in the cell culture medium when lymphocytes were stimulated with PWM alone and in the presence of Con A or hydrocortisone.

Postoperative amino acid infusion slightly improved the capacity of lymphocytes to synthetize and secrete IgG and IgM. By contrast, no improvement was seen in cell counts or lymphocyte transformation patterns. (Journal of Parenteral and Enteral Nutrition 10: 160–165, 1986)
Cost Containment Using Cysteine HCl Acidification to Increase Calcium/ Phosphate Solubility in Hyperalimentation Solutions
Authors: Schmidt Gerald L. , Baumgartner Thomas G. , Fischlschweiger Werner , Sitren Harry S. , Thakker Kamlesh M. , Cerda James J.
Published: May 2008

The purpose of this study was to determine if (1) the calcium/phosphate insoluble product was inversely related to pH [when cysteine HCl (CH) was added as neonatal supplementation at 0.5 mM/kg/day to hyperalimentation (HAL) solutions] and (2) the potential cost savings to the hospital. The pH of the HAL solutions was adjusted by adding various amounts of CH to the HAL solution. HAL solutions containing 27 mEq of calcium/liter and 30 mEq (15 mM) of phosphate/liter were compounded. Ten‐milliliter aliquots were analyzed at 0, 12, 24, and 48 hr. All samples (n = 56) were filtered (0.22 μ), viewed with 7–10,000 x magnification scanning electron microscopy, and qualitatively analyzed with a Philips Energy Dispersive X‐Ray Analysis System equipped with a SW9100 Microprocessor. Calcium/phosphate insoluble product was present in the 0‐, 12‐, 24‐, and 48‐hr samples from the CHfree solutions. The solutions containing 759 mg (4.17 mM)/ liter of CH however, remained free of precipitant. This investigation demonstrated that addition of CH to HAL can foster significant cost containment (projected $82,000/yr tangible hospital savings) by the elimination of current calcium/phosphate separation procedures for neonates on parenteral nutrition. (Journal of Parenteral and Enteral Nutrition 10:203–207, 1986)
Dressing Changes by Specialized Personnel Reduce Infection Rates in Patients Receiving Central Venous Parenteral Nutrition
Authors: Nelson David B. , Kien Craig L. , Mohr Barbara , Frank Sharon , Davis Starkey D.
Published: May 2008

In 60 pediatric patients, 75 central venous catheters representing 1866 patient days were placed to provide parenteral nutrition. During the 21‐month study period, surgical residents were responsible for dressing changes during the first 16 months and a specially trained nurse was responsible during the final 5 months. Twenty percent of the lines became infected. The infection rate was significantly higher in the lines cared for by residents, 28.8% compared to 3.3% in the lines cared for by the nurse. This occurred in spite of the lines being in place significantly longer in the nurse group (31.7 us 20.3 patient days/line).

These data indicate that a specially trained person using aseptic techniques can reduce infection rates in patients receiving central venous parenteral nutrition. (Journal of Parenteral and Enteral Nutrition 10:220–222, 1986)
Endocrine Mediators of Metabolism Associated with Injury and Sepsis
Authors: Dahn Michael S. , Jacobs Lloyd A. , Lange M. Patricia , Smith Stuart , Mitchell Robert A.
Published: May 2008

We have studied the endocrine characteristics of 13 seriously ill patients with the use of a provocative intravenous glucose bolus. Notable in this stressed patient population was that no major interpatient differences in response to glucose were found for insulin, glucagon, cortisol, or epinephrine. However, following glucose challenge half of this group (7/13) exhibited a prominent “paradoxical” mean human growth hormone (hGH) elevation (26.4 ± 9.3 μU/ml) whereas the others (6/13) exhibited only a minor increase (7.8 ± 2.9 μU/ml). In addition, norepinephrine levels were significantly higher in the latter group suggesting that the adrenergic nervous system plays a major role in regulating hGH in stress. (Journal of Parenteral and Enteral Nutrition 10:253–257,1986)
Metabolic Derangements in Children Requiring Parenteral Nutrition
Authors: Baker Susan S. , Dwyer Ellen , Queen Patt
Published: May 2008

Intravenous alimentation is routinely used in many hospitalized pediatric patients, however, there are few reports of the nature and frequency of metabolic complications. In order to assess the frequency and nature of metabolic complications all children receiving parenteral nutrition from Janury 1, 1982 to December 31, 1982 were prospectively enrolled in the study. Data collection began with the institution of parenteral nutrition. Serum electrolytes, minerals, liver function tests, and renal function tests were followed weekly. A total of 201 patients received parenteral nutrition for 5378 days. Nutrition was delivered to 146 patients (4980 patient days) via a central line and 55 patients via a peripheral line (398 patient days). The sepsis rate was 3.7% in central lines used only for parenteral and 4.8% in multipurpose central lines.

In general, complications were fewer in the patients supported peripherally. In patients supported centrally, hypoalbuminemia was the most commonly found abnormality followed by hypocalcemia, hypophosphatemia and hypomagnesemia, reflecting a malnourished state. One‐third of the patients had abnormal liver function tests, and in half of those factors causing liver dysfunction other than parenteral nutrition were present. Abnormal renal function tests occurred in 10% of the patients.

Thus, a high incidence of metabolic complications occurred in association with parenteral nutrition. Most were present during the initiation of parenteral nutrition, suggesting an abnormal metabolic state was present prior to the institution of parenteral nutrition. The frequency of low serum albumin and minerals is consistent with previous publications of the prevalence of malnutrition in hospitalized patients. (Journal of Parenteral and Enteral Nutrition 10:279–281, 1986)
Phenobarbital Does Not Prevent Total Parenteral Nutrition‐Associated Cholestasis in Noninfected Neonates
Authors: Gleghorn Elizabeth E. , Merritt Russell J. , Subramanian Niru , Ramos Angela
Published: May 2008

Cholestasis associated with total parenteral nutrition (TPN) is a serious complication of this therapy for which there is no known treatment other than beginning enteral feeds. Phenobarbital is commonly used in other cholestatic disease states, but its benefit in this syndrome has not been demonstrated. We conducted a retrospective review of phenobarbital use in neonates receiving concurrent TPN. Thirty‐one noninfected neonates were studied. They were without evidence of intrinsic liver disease at the institution of exclusive TPN therapy. For the purposes of this study, TPN‐associated cholestasis was defined as a serum bilirubin in excess of 3 mg/dl at postnatal age of 3 weeks or more. Fourteen of the study infants received phenobarbital therapy for neurologic indications. Sixty percent of the phenobarbital‐treated infants developed TPN‐associated cholestasis, as compared to 33% of the untreated patients. Phenobarbital therapy was not effective in preventing TPN‐associated cholestasis. (Journal of Parenteral and Enteral Nutrition 10:282–283, 1986)
Hematologic Disorders following Prolonged Use of Intravenous Fat Emulsions in Children
Authors: Goulet O. , Girot R. , Maier‐Redelsperger M. , Bougle D. , Virelizier J.L. , Ricour C.
Published: May 2008

Abnormalities in hematologic parameters, associated with prolonged utilization of intravenous fat emulsion (IVFE), were observed in seven children on long‐term cyclic total parenteral nutrition (TPN). All patients were receiving IVFE (Intralipid 20%) 1 to 2 g/kg/24 hr as part of TPN, during 3 to 18 months. Recurrent thrombocytopenia occurred in all seven patients. Platelet lifespan, as measured with 111 Indium was reduced. Sea‐blue histiocytes containing granulations and hemophagocytosis were seen on bone marrow smears. Scans taken after injection of autologous erythrocytes labeled with technetium‐99 showed bone marrow sequestration of these cells. Taken together, this constellation of hematologic abnormalities suggests that long‐term IVFE administration induces hyperactivation of the monocyte‐macrophage system. (Journal of Parenteral and Enteral Nutrition 10:284–288, 1986)
Experience with the Hickman Catheter: Unusual Complications and Suggestions for Their Prevention
Authors: Wagman Lawrence D. , Neifeld James P.
Published: May 2008

With the expanding clinical use of the Hickman catheter, new complications have emerged. This report describes two such complications: one in an adult with postplacement malposition and a second in a child with a ballooning double‐lumen catheter. The risk of postplacement malposition can be reduced by placing the catheter's tunnel as medial as possible; the risk of material malfunction can be reduced by careful quality control and careful surgical technique. (Journal of Parenteral and Enteral Nutrition 10:311–315, 1986)
Regulation of Glucose Metabolism by Altered Pyruvate Dehydrogenase Activity. I. Potential Site of Insulin Resistance in Sepsis
Authors: Vary Thomas C. , Siegel John H. , Nakatani Toshio , Sato Toshihide , Aoyama Hidehisa
Published: May 2008

Regulation of the pyruvate dehydrogenase (PDH) complex has been demonstrated to be a key mechanism in the control of carbohydrate oxidation and conservation of glucose carbon. The effect of sterile inflammation and chronic sepsis (small and large abscess) on the activity of the PDH complex was examined in liver and skeletal muscle. Sepsis altered the proportion of PDH in the active, dephosphorylated form. In hepatic tissue, sterile inflammation leads to a 2.5‐fold increase in the proportion of active PDH complex compared to fed control. The same increase in the proportion of active PDH complex was observed in rats with a small septic abscess. However, when the severity of septic episode was increased, the proportion of active PDH complex decreased relative to sterile inflammation or small septic abscess animals. A different pattern in the response to sterile inflammation and sepsis on the proportion of active PDH complex was observed in skeletal muscle compared to liver. In contrast to liver, sterile inflammation did not alter the proportion of active PDH in skeletal muscle. In addition, sepsis (either small or large septic abscess) resulted in a 3‐fold decrease in the proportion of active PDH relative to fed control or sterile inflammatory animals. The decrease in the proportion of active PDH complex in sepsis was associated with a corresponding increase in the skeletal muscle acetyl‐CoA/CoA ratio. The mechanism responsible for lowered PDH complex activity may have been due to increased PDH kinase activity, secondary to increased skeletal muscle acetyl‐CoA/CoA ratios. (Journal of Parenteral and Enteral Nutrition 10:351–355, 1986)
Total Parenteral Nutrition‐Related Cholestasis in Infants
Authors: Bell R.L. , Ferry G.D. , Smith E.O. , Shulman R.J. , Christensen B.L. , Labarthe D.R. , Wills C.A.
Published: May 2008

An epidemiological study was conducted to estimate the proportion of infants on total parenteral nutrition (TPN) who developed cholestasis and to identify risk factors associated with the development of this disease. Data were abstracted from medical records of 624 infants ≤ 30 days of age who were treated with TPN. A case of TPN‐related cholestasis was defined as an infant whose serum level of direct bilirubin was ≥1.5 mg/dl subsequent to initiation of TPN. Risk factors were assessed using multiple logistic regression analysis. Forty‐six of 624 infants in the cohort (7.4%) were classified as having TPN‐related cholestasis. The multivariable analysis indicated that cholestasis was associated with intracranial hemorrhage, patent ductus arteriosus, sepsis and gastrointestinal conditions that require surgery. Two distinct processes appear to have occurred: (1) in infants who experienced patent ductus arteriosus or intracranial hemorrhage (conditions associated with hypoxia) where TPN may be the necessary trigger for the development of cholestasis, and (2) in infants with gastrointestinal conditions requiring surgery or sepsis, where cholestasis may develop with or without parenteral infusions. (Journal of Parenteral and Enteral Nutrition 10:356–359, 1986)
Urea Nitrogen Excretion in Chair‐Adapted Primates
Authors: Dempsey Daniel T. , Lusk Edward , Crosby Lon O. , Melnik George , Mullen James L.
Published: May 2008

To evaluate the temporal pattern of urea excretion in chair‐adapted primates (Macaque fascicularis) on continuous total parenteral nutrition (TPN), two groups of five animals were studied. Group I received continuous TPN (75 glucose kcal; 0.56 g nitrogen; and 100 ml fluid per kg per day) while Group II received a single morning isonitrogenous oral meal along with a continuous isovolemic intravenous infusion of 0.45% saline. Urine was collected hourly in group I for 2 days and every 4 hr in group II for 5 days and analyzed for urea content. Time series analysis revealed no periodicity of urea excretion in either group. Six animals were then studied for a total of 46 TPN days to define the relationship between the urea content of a single 3‐hr morning urine aliquot and its respective content in a 24‐hr collection. A significant linear relationship was found (r = +0.76, p < 0.01). However, using this relationship, a reasonable estimate (±20%) of measured 24‐hr urea output was achieved only 50% of the time using a single 3‐hr urea output. Chair‐adapted primates maintained on continuous TPN or a single oral meal with continuous saline infusion do not exhibit a periodic pattern of urea excretion. The variability in 3‐hr urinary urea output in the chaired primate on continuous TPN does not consistently permit accurate estimation of the coincident 24‐hr urinary urea output. (Journal of Parenteral and Enteral Nutrition 10:369–374, 1986)
Decrease of Available Vitamin A in Parenteral Nutrition Solutions
Authors: Riggle Martha A. , Brandt Richard B.
Published: May 2008

The efficiency of vitamin A delivery in total parenteral nutrition solutions was determined using spectrofluorometric and radioisotope assays. Experiments incubating total parenteral nutrition solutions in intravenous tubing demonstrated that an 88% decrease in vitamin A content from solution occurred over a 5‐hr period. This decrease was independent of the method of assay and was not due to photodecomposition. Recovery of vitamin A from hexane rinses of the intravenous tubing demonstrated that the vitamin decrease was due to uptake by the tubing. Experiments simulating clinical practice situations showed saturation of these binding sites, with mean decrease of 26 to 67% of the vitamin, which were partially dependent on flow‐rate. Clinical samples analyzed for comparison showed a greater loss of vitamin (77–98%) from the intravenous solutions. A decrease of vitamin A from solution should be a consideration when using parenteral nutrition. (Journal of Parenteral and Enteral Nutrition 10: 388–392, 1986)
A Review of the Current National Status of Home Parenteral and Enteral Nutrition from the Provider and Consumer Perspective
Authors: Howard Lyn , Heaphey Lenore L. , Timchalk Maryann
Published: May 2008

Home parenteral and enteral nutrition (HPEN) has grown rapidly in the past decade. By examining data from physician reports, patient surveys, and the infusion industry, this review attempts to delineate the diagnostic indications, age range, mortality, medical complications and rehabilitation potential of HPEN patients.

A clear trend exists towards greater use of this expensive therapy in bowel obstructed cancer patients and in pediatric and geriatric age groups. Complications in parenterally fed patients appear to result in a readmission to the hospital, on average, once every 2 yr. Life expectancy depends heavily on the underlying diagnosis: whereas 50% of the patients with a malignancy survive only 6 months, 50% without a malignancy survive beyond 3 yr. Fifty to 60% of HPEN patients are able to work full time or part time, 15 to 20% are retired or of preschool age, and 20 to 30% are unable to work.

The home care service options considered most important by patients are the pharmacy premixing of intravenous solutions, home delivery of supplies by the home service carrier, reimbursement management by the home care service and the availability of a nurse for an initial home visit and 24‐hr emergency backup.

In regard to fiscal concerns one of the difficult issues that should be addressed is the separation of medical coverage from disability status; another is that enteral feedings can sometimes be a less expensive alternative to parenteral feedings but little information exists about the complications and outcome with this modality and its fiscal reimbursement is much less assured. (Journal of Parenteral and Enteral Nutrient 10:416–424, 1986)
Phosphate Balance and Distribution during Total Parenteral Nutrition: Effect of Calcium and Phosphate Additives
Authors: Al‐Jurf Adel S. , Chapmann‐Furr Frances
Published: May 2008

Hypophosphatemia is occasionally observed during total parenteral nutrition (TPN). The phenomenon was recognized since the introduction of TPN and was attributed to preexisting phosphate deficits and inadequate phosphate supplements. Because of the close relationship between phosphate and calcium metabolisms, we speculated that calcium additives may also influence phosphate balance and distribution during TPN. We tested this hypothesis in previously fasted animals receiving TPN with variable amounts of calcium and maintenance or no phosphate. Fasting resulted in considerable losses of phosphate in the urine. Refeeding (with TPN) after fasting produced hypophosphatemia but only in animals receiving calcium additives and no maintenance phosphate in the solution. Addition of moderate or large amounts of calcium decreased phosphate in the muscle in groups not receiving maintenance phosphate. There were no significant changes in bone phosphate. Increasing calcium intake was accompanied by significant and progressive reductions in urine phosphate in animals receiving maintenance phosphate, thus increasing net phosphate retention in those groups. In other respects, refeeding with TPN after fasting displayed features compatible with those of the phosphate depletion syndrome, including hypophosphatemia, hypophosphaturia, hypercalcemia, and hypercalciuria. The magnitude of change in these parameters seemed to be dependent upon the amount of calcium added and the availability of phosphate in the solution. (Journal of Parenteral and Enteral Nutrition 10:508–512, 1986)
Estimation of Nitrogen Balance Based on a Six‐Hour Urine Collection in Infants
Authors: Lopez Ana Mari , Wolfsdorf Jack , Raszynski Andre , Contijoch‐Serrano Virginia
Published: May 2008

The accuracy of a 6‐hr vs a 24‐hr urine collection for the determination of urinary urea nitrogen was studied in 15 infants. Patient's age ranged from 2 weeks to 3 yr, encompassing a wide variety of diagnoses. All patients had normal renal function at the time of the study.

Participants had indwelling foley catheters throughout the study. Urine specimens were collected over a continuous 24‐hr period. Aliquots obtained from urine collected over 0 to 6 hr and the total urine collection were analyzed utilizing the urease enzymatic method in the Astra.

Statistical analysis was performed comparing the actual 24‐hr determination to the estimation based on the 6‐hr collection, utilizing linear regression. The analysis of data produced a highly significant correlation (r = 0.904, p < 0.0001).

When a 24‐hr urine collection is not possible, a 6‐hr collection is a useful alternative for the calculation of nitrogen balance in infants. (Journal of Parenteral and Enteral Nutrition 10:517–518, 1986)
Nutritional Management of Thoracic Duct Fistulas. A Comparative Study of Parenteral Versus Enteral Nutrition
Authors: Ramos Wilmer , Faintuch Joel
Published: May 2008

Thoracic duct fistulas represent one of the serious technical complications of head and neck surgery, and reoperation for control of the leakage involves considerable morbidity and mortality. In an attempt to define the possibilities of both enteral and parenteral nutrition in the treatment of this problem, two comparable groups of patients were given, respectively, one or the other of these modalities. Significant advantages for parenteral nutrition could be demonstrated regarding duration of therapy (p < 0.05), closure rate (p < 0.05), and nutritional response (p < 0.05). These results strongly recommend the utilization of parenteral nutrition in the primary therapy of thoracic duct fistulas. (Journal of Parenteral and Enteral Nutrition 10:519–521, 1986)
The Effect of Protein Malnutrition and Nutritional Support on the Mechanical Properties of Fracture Healing in the Injured Rat
Authors: Pollak D. , Floman Y. , Simkin A. , Avinezer A. , Freund H.R.
Published: May 2008

We investigated the effect of different nutritional regimens on fracture healing in the injured rat model. Four groups, each consisting of 12 male rats (307 ± 16 g), were subjected to anesthesia, laparotomy (injury), and tibial osteotomy with internal fixation. Group I received 23% protein, group II received 23% protein and high caloric feed, group III received 5% protein, and group IV received 38% protein. After 8 weeks, calluses were x‐rayed and the tibia was removed, fixed in a special block of methyl‐metacrylate, and tested at tension up to failure in a mechanical testing apparatus. The distraction force at failure was measured, and callus stiffness and energy absorbed to failure were calculated.

The low protein diet resulted in significantly lower tensile strength and stiffness of calluses compared to the other three dietary regimens, this despite adequate caloric intake. In addition, the low protein diet resulted in a callus with “rubbery” mechanical properties compared to the “rigid” calluses of the other three groups.

The high protein diet did not result in any significant improvement in fracture healing.

These results gain clinical significance in the face of a high incidence of protein calorie malnutrition in injured orthopedic surgery patients. (Journal of Parenteral and Enteral Nutrition 10:564–567, 1986)
Postoperative Parenteral Nutrition with High Supply of Branched‐Chain Amino Acids: Effects on Nitrogen Balance and Liver Protein Synthesis
Authors: Kirvelä Olli , Takala Jukka
Published: May 2008

Branched‐chain amino acids (BCAA) stimulate muscle and liver protein synthesis in vitro. The significance of this action in catabolic conditions in vivo remains controversial. The effects of a high supply of BCAA in total parenteral nutrition (TPN) on nitrogen balance and liver protein synthesis were studied in a postoperative rat model. After standard operative trauma TPN was commenced with one of two isocaloric programs (I: 20.1% BCAA and II: 50% BCAA) and continued for 48 hr. The relative rate of liver protein synthesis, measured after TPN in vitro by perfusion with 14C‐leucine, was similar in both groups (I: 53.4 ± 17.3 and II: 49.0 ± 27.3 arbitrary units of synthesis rate, mean ± SD). The cumulative nitrogen balance was positive with both regimens and was not improved by the high supply of BCAA (I: 2.02 ± 0.81 and II: 1.87 ± 0.63 gN/kg/48 hr mean ± SD). We conclude that after moderate surgical trauma TPN with a high supply of BCAA offers no advantage over conventional TPN. (Journal of Parenteral and Enteral Nutrition 10:574–577, 1986)