bluuebunny/crossref_metadata_2025 huggingface dataset:
Decreased Enteral Stimulation Alters Mucosal Immune Chemokines
Authors: Hermsen Joshua L. , Gomez F. Enrique , Maeshima Yoshinori , Sano Yoshifumi , Kang Woodae , Kudsk Kenneth A.
Published: May 2008

Background: Migration of lymphocytes into and through the mucosal immune system depends upon adhesion molecules to attract circulating cells and chemokines to stimulate diapedesis into tissues. Decreased enteral stimulation significantly reduces mucosal addressin cellular adhesion molecule‐1 (MAdCAM‐1) levels, an adhesion molecule critical for homing of T and B cells to Peyer's patches (PP), which reduces PP and intestinal T and B cells. We studied the effect of type and route of nutrition on tissue specific chemokines in PP (CXCL‐12, ‐13 and CCL‐19, ‐20 and ‐21), small intestine (SI; CCL‐20, ‐25 and ‐28) and lung (CXCL‐12, CCL‐28). Methods: Intravenously cannulated male Institute of Cancer Research (ICR) mice were randomized to chow or parenteral nutrition (PN) for 5 days. PP, SI, and lung chemokine mRNA levels were measured using real‐time qRT–polymerase chain reaction, and analyzed semiquantitatively by the ΔΔCt method. Protein levels were quantified using enzyme‐linked immunosorbent assay (ELISA) techniques, and groups compared using Student's t‐test. Results: PP CXCL13 protein significantly decreased, whereas CCL21 protein increased significantly in the parenterally fed group. Parenteral feeding significantly decreased SI CCL20 and CCL 25 protein levels. CCL28 decreased significantly in the SI and lung of intravenously fed animals. mRNA levels changed in the opposite direction (compared with protein) for all chemokines except CCL28. Conclusions: Decreased enteral stimulation significantly alters key mucosal immune chemokine protein levels at multiple sites. In general, PN (and concomitant lack of enteral stimulation) results in decreased levels of chemokines that control lymphocyte migration within the mucosal immune system.
Gastric Motility Function in Critically Ill Patients Tolerant vs Intolerant to Gastric Nutrition
Authors: Landzinski James , Kiser Tyree H. , Fish Douglas N. , Wischmeyer Paul E. , MacLaren Robert
Published: May 2008

Background: Administration of gastric enteral nutrition (EN) in the intensive care unit (ICU) is commonly impeded by high gastric residual volumes (GRV). This study evaluated gastric emptying in patients with limited GRV (tolerant group) vs volumes ≥150 mL (intolerant group) and whether prokinetic therapy improves gastric motility in intolerant patients. Methods: To assess gastric motility, mechanically ventilated patients received acetaminophen 975 mg, and peak plasma concentration (Cmax), concentration at 60 minutes (C60), time to Cmax (Tmax), and area under the concentration‐time curve from 0 to 60 minutes (AUC0‐60) were determined. This evaluation was repeated in intolerant patients after 24 hours of either erythromycin 250 mg or metoclopramide 10 mg therapy, both administered intravenously every 6 hours. Results: Ten tolerant and 20 intolerant patients were studied. Tolerant patients had significantly greater Cmax (14.12 ± 7.25 vs 9.28 ± 5.22 mg/L; p < .05), C60 (9.62 ± 4.65 vs 6.08± 4.00 mg/L; p < .001), and AUC0‐60 (10.01± 5.97 vs 3.93 ± 2.84 mg/h/L; p < .01) and shortened Tmax (0.81 ± 0.61 vs 1.98 ± 1.26 hours; p < .001) compared with intolerant patients. After prokinetic therapy, Cmax (15.26 ± 8.85 mg/L), C60 (11.96 ± 5.99 mg/L), and AUC0‐60 (10.90 ± 6.57 mg/h/L) increased and Tmax (1.07 ± 1.01 hours) decreased in the intolerant group to values similar to the tolerant group. Conclusions: ICU patients with elevated GRV during gastric EN have delayed gastric motility. Initiating prokinetic therapy accelerates gastric emptying to resemble that of ICU patients tolerating EN.
An Evaluation of the “Cut and Push” Method of Percutaneous Endoscopic Gastrostomy (PEG) Removal
Authors: Merrick Susan , Harnden Sarah , Shetty Shishir , Chopra Preeti , Clamp Philip , Kapadia Suneil
Published: May 2008

Background: This study aimed to establish whether 15‐Fr gauge percutaneous endoscopic gastrostomy (PEG) tubes can be safely removed by“ cut and push.” Methods: Patients were prospectively recruited who were found to be without significant intestinal dysfunction requiring removal of Freka (Fresenius Kabi) 15‐Fr gauge PEG tubes. The PEG tube was cut close to the stoma and the remnant pushed into the gastric lumen with a 14‐Fr nasogastric tube. Patients were asked to observe their stool for the remnant. Patients were contacted at day 7 and an abdominal x‐ray was arranged for those who had not seen the remnant in the stool. If the remnant was still present as seen on plain x‐ray, the patient was contacted on day 14. A second x‐ray was ordered if the patient reported that they had still not seen the remnant. Outcome measures were PEG remnant observed in stool or not seen on plain abdominal x‐ray, and adverse events. Results: Forty‐two patients were recruited over 29 months: 38 head and neck patients and 4 others (stroke, head injury, cystic fibrosis [CF], and lung cancer). Of these, 41 had passed the remnant by day 8 and all by day 14. No adverse events occurred. Conclusions: We have concluded that cut and push is a safe method of removal for Freka 15‐Fr PEG tubes in ambulant patients without significant gastrointestinal history.
Necrotizing Candida Infection After Percutaneous Endoscopic Gastrostomy: A Fatal and Rare Complication
Authors: Wirth Rainer , Bauer Jürgen , Sieber Cornel
Published: May 2008

Gastrostomy site infections following percutaneous endoscopic gastrostomy (PEG) are the most common complication after PEG placement. Recent meta‐analyses were able to show that PEG site infections can be reduced significantly with a systemic antimicrobial prophylaxis. This mostly cephalosporin‐ or penicillin‐based prophylaxis does not cover fungal infections. Although Candida skin infections after PEG placement are rarely described, a mucosal colonization or infection of the upper GI tract with Candida species is very common, especially in severely ill patients such as those requiring artificial nutrition. The authors report a rare and lethal case of a necrotizing PEG site infection with Candida albicans in a patient with diabetes with multiple comorbidities, presenting like gas gangrene. In patients with probable immunodeficiency or visible candidiasis of the skin, oropharynx, or esophagus, a Candida infection should be considered in case of a gastrostomy site infection.
Patient Compliance with a Home Parenteral Nutrition Program
Authors: Hughes Bernadette A. , FLEMING C. RICHARD , Berkner Sharon , Gaffron Robert
Published: May 2008

A systematic study of patient compliance to home parenteral nutrition (HPN) was done by an independent nurse who visited 10 patients and families at varying periods after HPN had been started. A compliance scale was based on assessment of aseptic technique, sequènce of steps followed, safety precautions, proper use of equipment, and knowledge of complications. Compliance percentiles ranged from 73 to 97, with a median of 95. Seven of the 10 patients scored 90% or more in overall compliance. The only category that clearly showed a deficiency was patient knowledge of potential complications of HPN. Factors that correlated positively with a high compliance score were male sex, absence of children in the home, and wives who were enthusiastic about HPN and who offered the most moral support. This study shows that patients with chronic disabling diseases of the small bowel and severe malnutrition can be managed safely at home with HPN if they are properly trained and supervised.
Use of a Peptide Rather Than Free Amino Acid Nitrogen Source in Chemically Defined “Elemental” Diets
Authors: Silk David B. A. , Fairclough Peter D. , Clark Michael L. , Hegarty John E. , Addison Jill M. , Burston David , Clegg Katherine Mary , Matthews David M.
Published: May 2008

Previous studies have shown that amino acid (AA) residues are absorbed more rapidly from di‐ and tripeptides than from free AA. In the present study, an intestinal perfusion technique has been used in normal human subjects to compare absorption of AA residues and total α‐amino nitrogen (N) from 4 partial enzymic hydrolysates of protein (50–80% of the N contents present as small peptides) and their respective equimolar free AA mixtures. α‐Amino N absorption was greater from 2 casein hydrolytes and a lactalbumin hydrolysate than from the respective free AA mixtures but similar to that from a fish protein hydrolysate and its AA mixture. The considerable variation in absorption of individual AA residues from the AA mixtures was much reduced when the protein hydrolysates were perfused, as a number of AA which were poorly absorbed from the AA mixtures were absorbed to a greater extent from the protein hydrolysates. The casein and lactalbumin hydrolysates had a stimulatory effect on jejunal absorption of water and electrolytes. In contrast, the fish protein hydrolysate appeared to cause a mean net secretion of fluid and electrolytes. The findings indicate that when absorption is limited by diminished luminal hydrolysis or absorptive capacity, serious consideration might be given to using partial enzymic hydrolysates of whole protein rather than free AA mixtures as the N source in “elemental” diets. Care should be taken, however, in ensuring that the preparation of choice does not promote a net secretion of fluid and electrolytes for such a property could have a deleterious effect in the clinical setting.
Mg Deficiency in Chronic Inflammatory Bowel Disease and Requirements During Intravenous Nutrition
Authors: Main Alistair N.H. , Morgan Roger J. , Russell Robin I. , Hall Michael J. , Mackenzie John F. , Shenkin Alan , Fell Gordon S.
Published: May 2008

Assessment of magnesium (Mg) status by serum and 24‐hr urine estimations has been used to study a group of 17 patients with severe Crohn's disease, 10 of whom have required intravenous (IV) nutrition. Mg depletion was present in 15 (88%) and severe enough to cause symptoms in two. Urine levels were low in most patients and would appear to be a more sensitive indication of Mg depletion than serum levels alone. Serum Mg levels were significantly lower in the Crohn's group than in a group of hospital controls; 5–10 mmol of IV Mg were required daily to prevent Mg depletion during IV nutrition and some patients required higher intakes. Three patients with particularly severe malabsorption required oral Mg supplements in the long‐term. The rationale for using our method of assessing Mg status, and the importance of recognizing and treating chronic Mg deficiency are presented.
Malnutrition and Hyperglycemia Associated with TPN Do Not Alter Polymorphonuclear Leukocyte Adherence to Nylon
Authors: Phair John , Holland Elizabeth , Craig Robert , Vazquez Richard
Published: May 2008

Polymorphonuclear leukocyte (PMN) adherence to nylon was assayed in blood obtained from 10 malnourished patients before and during therapy with total parenteral nutrition (TPN). All patients demonstrated minimal to moderate loss of visceral and somatic protein. Adherence of PMN was unaltered by malnutrition or during the 4 wk of TPN in spite of hyperglycemia, which required insulin therapy in 4 patients. There was no correlation of blood sugar levels and PMN adherence.
Instant Nutritional Assessment in the Intensive Care Unit
Authors: Seltzer Murray H. , Fletcher H. Stephen , Slocum Bernadette A. , Engler Peter E.
Published: May 2008

Instant nutritional assessment of the critically ill patient using serum albumin level and total lymphocyte count is reported. When an intensive care unit population is compared to the general hospital population a 6‐fold increase in albumin level depressions, a 2‐fold increase in lymphocyte count depression, and an 11‐fold increase in depression of both parameters was noted in the intensive care unit population. Surgical intensive care unit (SICU) patients with depressed albumin levels and total lymphocyte counts had twice the complication rate and 4.5 times the death rate of those SICU patients with normal albumin levels and lymphocyte counts. It is concluded that serum albumin levels and total lymphocyte count determinations are valuable tools for instant nutritional assessment of the critically ill patient.
Quality of Life in Patients on Permanent Home Parenteral Nutrition
Authors: Ladefoged Karin
Published: May 2008

A psychosocial survey of patients on permanent home parenteral nutrition (HPN) has been made to assess the quality of life in these patients. All patients on permanent HPN in the period August 1978 to August 1979, including 7 women and 6 men, age range 24–62 yr (median 53) were interviewed, as well as partners of 11 patients who were married or cohabiting. The duration of HPN ranged from 2–43 mon (median 24 mon). They were asked specific questions about physical symptoms, social and leisure activities, interpersonal relationships, sexuality, psychological problems, and feelings about HPN. None had an outside job, but 6 (46%) did most of the housekeeping. Some physical distress was recorded in almost all patients, but 9 (69%) considered themselves healthy or fairly healthy, whereas 4 (31%) felt diseased. Social and leisure activities were normal or only slightly impaired in most. Sexual activity had ceased completely in 5 above 55 yr, in association with onset of the disease; younger patients displayed normal and unchanged sexual activity. Psychological symptoms were recorded in 6 (46%), major symptoms in 4 (31%). Seven partners considered HPN to be a moderate or severe burden, mainly psychological changes in the patient that caused marital tension in 3 cases. Criteria for quality of life were: 1) no major physical distress, 2) no major psychological symptoms, 3) no substantial restriction of social and leisure activities, 4) ability to accept HPN, 5) overall satisfaction with conditions of life. Nine patients who fulfilled at least 3 of these criteria were considered to have a fair quality of life, 4 who complied with <3 of the criteria a poor quality of life. The interviews were repeated at intervals of 6–10 mon in 9 patients, and revealed no systematic improvement or deterioration of quality of life during HPN.
Elemental Diet Composition and the Structure and Function of Rat Small Intestine: Comparison of the Effects of Two Diets on Morphology and in Vivo Absorption of Water
Authors: Nelson Lesley M. , Russell R.I. , Lee F.D.
Published: May 2008

The effects of feeding elemental diets on small bowel structure and function in normal rats has been investigated, and two commercial diets Vivonex (#1) and Flexical (#2) compared. Rats were fed Diet #1 (n = 12) or Diet #2 (n = 12) for 1 month and jejunal and ileal histology compared with that of an equal number of rats fed on a normal pelleted diet. Diets #1 and #2 significantly increased villus height and decreased crypt height to villus height ratio in both jejunum and ileum (p < 0.02 in all cases). Crypt height was also significantly reduced in the ileum but not jejunum by both elemental diets (p < 0.05 in both cases). Segments of jejunum or ileum were perfused by an in vivo technique and water absorption measured to assess small bowel function. No significant difference in absorption was found between the rats fed Diet #1 and controls but absorption of water was depressed in both jejunum and ileum of those fed Diet #2. Small intestinal absorptive function is thus influenced by the composition of the elemental diet.
Plasma Fatty Acid Patterns of Bone Marrow Transplant Patients Primarily Supported by Fat‐Free Parenteral Nutrition
Authors: Clemans Gordon W. , Yamanaka William , Flournoy Nancy , Aker Saundra N. , Thomas E. Donnall , Hutchinson Martha L. , Cheney Carrie
Published: May 2008

Oral food tolerance is compromised by drug and radiation therapy administered to patients undergoing bone marrow transplantation for hematological malignancy or aplastic anemia. Resultant decreases in oral fat intake coincident with fat‐free parenteral nutrition may predispose patients to essential fatty acid (EFA) deficiency. Determinations were made of the fatty acid composition of plasma total lipid from 20 bone marrow transplant patients on admission, at the time of bone marrow transplant, and on days 7, 14, 30, and 60 post‐bone marrow transplant. Patients ate ad libitum but with little appetite and received fat‐free parenteral nutrition interrupted for numerous blood product and drug infusions. Abnormal EFA status was manifest (20:3ω9/20:4 ratio>0.2) in 12 of 20 patients during the course of treatment. Plasma EFA status was consistently correlated with oral fat intake but not with sex, age, percentage of ideal body weight, or amount of plasma infused. This suggests that dietary fat was absorbed limiting the severity of EFA deficiency. Interruptions of glucose infusion averaging only about 2 hours/day, also may have helped moderate the deficiency.
Net Protein Utilization During Total Parenteral Nutrition of Injured Critically III Patients: An Original Approach
Authors: Iapichino Gaetano , Solca Maurizio , Radrizzani Danilo , Zucchetti Marco , Damia Giorgio
Published: May 2008

Traumatized critically ill patients with either a moderate or severe catabolic response were studied. Patients were randomly allocated to receive an intravenous solution which was either protein‐free or contained protein and hypertonic glucose. The overall energy intake in both groups was equivalent to each patient's daily requirement. In both the moderately catabolic and severely catabolic patients the urinary nitrogen loss with the protein‐free solution was negatively correlated to the energy intake/energy need ratio (p < 0.01, moderate catabolism; p < 0.001, severe catabolism). The ratio of energy intake/energy need was correlated with the nitrogen loss. From the resultant straight line, the obligatory nitrogen loss was determined for those patients receiving the protein containing solution (test diet). The net protein utilization was subsequently calculated using this value of the obligatory nitrogen loss. The net protein utilization was inversely correlated with the severity of trauma. It was significantly (p < 0.005) greater in the patients with a moderate catabolic response. In the acute postinjury phase, the net protein utilization of infused amino acids was similar to that for protein fed orally to normal healthy subjects.
An Evaluation of the Diurnal Rhythm of Urea Excretion in Healthy Young Adults
Authors: Steffee William P. , Anderson Carl F. , Young Vernon R.
Published: May 2008

A diurnal variation in urine urea excretion has been documented to exist in healthy young adults. Its persistence when dietary nitrogen intake approaches zero suggests that influences other than diet may in part generate the rhythm. These may include variations in the efficiency of rates of endogenous protein turnover or perhaps changes in renal tubular handling of urea especially in states of dietary nitrogen inadequacy. Recognition of these effects in the normal state are important before ascribing importance to changes in the disease state, particularly as we gain the ability to intervene nutritionally in the hospital setting.
Total Parenteral Nutrition with Vamin and Intralipid
Authors: Shizgal Harry M. , Forse R. Armour
Published: May 2008

The present study was undertaken to evaluate the efficacy of total parenteral nutrition (TPN) with a solution containing 10% fructose and 7% crystalline amino acid (Vamin), administered with equal volumes of a 10% soybean oil emulsion (Intralipid). The two solutions are available in separate sterile containers and therefore solution preparation is not required. Because the 10% Intralipid emulsion is isotonic, a central venous catheter is not required. Patients referred for TPN were randomly allocated to receive either the Vamin and Intralipid combination or a solution containing 2.5% L‐amino acids (Travasol) and 25% dextrose. The efficacy of each solution was assessed by determining body composition by multiple isotope dilution, at the onset, at 2‐week intervals during, and at the completion of, TPN. In 49 patients receiving Vamin and Intralipid, 109 body composition studies were performed to evaluate 61 periods of TPN of 14.6 ± 0.5 days duration. One hundred and sixty‐seven studies were performed in 73 patients receiving TPN with hypertonic dextrose to evaluate 92 periods of TPN of 15.3 ± 0.5 days. In the absence of preexisting malnutrition, both solutions maintained body composition. In the presence of preexisting malnutrition, TPN with the Vamin and Intralipid combination maintained, but did not improve, body composition. However, TPN with the hypertonic dextrose solution resulted in a significant improvement in the nutritional state with an increase in the body cell mass, accompanied by a contraction of the extracellular mass. Conventional TPN with 2.5% crystalline amino acids and hypertonic dextrose was superior to TPN with Vamin and Intralipid.
Employment of a Mobile Infusion System for Continuous Ambulatory Tube Feeding
Authors: Kien Craig L.
Published: May 2008

A mobile infusion system originally designed for home parenteral nutrition has been applied to the outpatient care of a patient with radiation enteritis requiring continuous jejunostomy feeding. This treatment allowed for normal ambulation and may be useful for other patients requiring tube feeding at home.
Effects of Essential Fatty Acid Deficiency on the Induction of Liver Microsomal Membranes by Phenobarbital: An Ultrastructural and Biochemical Investigation
Authors: Friedman Harold Ira , Caldwell Michael D. , Lollini Lance , Shearer Jeffrey , Nemeth Thomas J.
Published: May 2008

The essential fatty acids, particularly arachidonic, are important components of intracellular membrane systems. Their absence during dietary manipulation has been postulated to cause alterations in both composition and function of membranes and associated enzyme systems. In the current investigation, the effect of essential fatty acid deficiency on the induction of hepatic microsomal membranes by phenobarbital was studied. Control rats were fed a standard chow diet and either injected daily for 4 days with phenobarbital or with a placebo. Experimental animals were given an essential fatty acid‐deficient (EFAD) diet and similarly injected with either phenobarbital or placebo. Following the above regimens, liver tissue was obtained for electron microscopy and biochemical membrane analysis. Control animals given phenobarbital displayed a marked proliferation of smooth endoplasmic reticulum in comparison to placebo controls. In contrast, EFAD rats did not exhibit an endoplasmic reticulum response to phenobarbital injection and appeared to recover from the drug administration more slowly than control animals. The alterations in fatty acid composition characteristic of an EFAD diet were observed in the microsomal membranes of the deficient animals. The concentrations of palmitic, palmitoleic, oleic, and 5,8,11‐eicosatrienoic acids were significantly increased above that found in control animals. Concentrations of linoleic and arachidonic acids were reduced. Phenobarbital administration significantly increased the concentrations of palmitic, linoleic, and arachidonic acids in microsomal fractions of chow‐fed animals but not in EFAD animals. Conversely, eicosatrienoic acid concentrations increased in phenobarbital‐treated EFAD animals but not in chow‐fed, drug‐injected rats. The triene/tetraene ratio reflected these alterations.

Essential fatty acid deficiency causes biochemical alterations of the hepatic microsomal membranes which are exaggerated by the administration of phenobarbital. These compositional changes appear to alter the functional ability of the membranes to proliferate in response to phenobarbital and, thereby, inhibit the efficaceous metabolism of this drug.
A Primate Model for Enteral Nutrition by Tube
Authors: Barot Lenora R. , Rombeau John L. , Stein T. Peter , Chernoff Ronni , Settle R.G. , Mullen James L.
Published: May 2008

To establish an animal model for the controlled study of enteral nutrition by tube, five adult chair‐adapted primates (Macaca fasicularis) had gastrostomy and jejunostomy tubes placed for the delivery of a modified protein isolate diet. Following 7 days of postoperative depletion with a hypo‐caloric infusion of dextrose (20 kcal, 0 g N/kg/day), the animals were repleted for 10 days with tube feedings (124 kcal, 0.73 g N/kg/day). There was no operative mortality or morbidity and each animal demonstrated conversion to anabolism by significant weight gain, positive nitrogen balance, and net protein synthesis as determined by [15N]glycine protein turnover rates. Significant correlation was found between caloric intake and nitrogen balance at the level of nitrogen provided in this diet (r = 0.88, p < 0.05). This model was found to be well suited for the surgical and nutritional techniques required for the long‐term study of enteral nutrition by tube.
An Evaluation of a Microcomputer in Reducing the Preparation Time of Parenteral Nutrition Solutions
Authors: Rich Darryl S. , Karnack Charles M. , Jeffrey Louis P.
Published: May 2008

A microcomputer was evaluated in reducing the activities of pharmacists and pharmacy technicians in processing orders for parenteral nutrition (PN) solutions. A program in BASIC was developed for a Radio Shack TRS‐80 microcomputer. The program maintains a patient profile, prints a label, generates a worksheet for the preparation of solutions, and provides statistical data for the Pharmacy Nutritional Support Service. A direct time study by intensive samplings was performed on 24 patients utilizing 51 units of PN solution. The computerized method was compared to the current manual method for processing PN orders. The computerized method significantly reduced the processing time (p < 0.001), saving an average of 2.61 minutes/order. This represented 41.3% of the manual processing time. The time savings was greater when two or more units per patient were ordered (3.37 minutes/ order) when compared to patients who received only one unit of PN (0.76 minutes/order). At Rhode Island Hospital, this would result in a savings in time of 300 to 400 hours annually. The authors concluded that a microcomputer is a valuable addition to a nutritional support service. In addition, it should provide the pharmacist with substantially more time to engage in activities related to the care of patients receiving PN solutions.
Vitamin Regimens in Parenteral Nutrition: A Dilemma
Authors: Robinson Lawrence A. , Mabry Charles D. , Wright Brenda T.
Published: May 2008

Recently, a parenteral vitamin product which matches the recommended dietary allowance for parenteral vitamins set forth by the Nutrition Advisory Group (NAG) of the American Medical Association has been marketed. The release of this product calls attention once again to the NAG recommendations and their applicability. The authors point out that the NAG guidelines do not address the needs of the traumatized or hypermetabolic patient. Further, the cost of the new vitamin product is questioned in regard to the additional expense incurred in attempting to administer vitamins as per the NAG recommendations. The authors offer cost and therapeutic comparisons of existing products on the market to the new vitamin product, and explain a therapeutic regimen utilizing multiple products administered on a regular basis compared to the daily administration of the new product. The weekly cost of the plan proposed by the authors is $7.56 compared to $16.70 per week for the new vitamin product.
Hyperammonemia During Total Parenteral Nutrition in Children
Authors: Seashore John H. , Seashore Margretta R. , Riely Caroline
Published: May 2008

Serial blood ammonia (NH3) determinations in 19 low birth weight (LBW) infants, 14 term neonates and 12 children receiving total parenteral nutrition (TPN) have shown that 73% of patients had one or more elevated NH3 values (>150 μg/dl). The mean blood NH3 was 220 ± 13 μg/dl in LBW infants, 180 ± 9 ug/dl in 10 infants, and 140 ± 7 μg/dl in children. All of these values are significantly higher than normal (p < 0.001). There was no difference in incidence or mean blood ammonia concentration between patients receiving casein hydrolysate and those receiving a crystalline amino acid solution. Only four patients were symptomatic and several infants remained fully alert despite blood NH3 concentration in excess of 400 μg/dl. One infant who had sustained hyperammonemia was given another amino acid source (Travasol) containing 1.2 mmol/dl of arginine; blood NH3 promptly fell to the normal range. However, six of seven additional infants had hyperammonemia while receiving Travasol (mean = 184 μg/dl). Hyperammonemia is common during TPN in children, often is not recognized clinically, and occurs with equal frequency in infants and older children. The high levels observed in LBW infants may be due to hepatic immaturity. Blood NH3 concentration should be monitored frequently during TPN. Persistent hyperammonemia should be treated by decreasing protein content of the infusate. The role of supplemental arginine is unclear.
Nutritional Assessment and Surgical Infections in Patients with Gastric Cancer or Peptic Ulcer
Authors: Dionigi Paolo , Nazari Stefano , Bonoldi Alberto Pietro , Cividini Flavio , Olezza Silvana , Dionigi Renzo
Published: May 2008

Recent reports provide evidence that cancer is frequently associated with malnutrition and infection. This is particularly evident when the gastrointestinal tract is involved. The purpose of this study is to investigate the difference between the nutritional status of patients with gastric cancer and with peptic ulcer, and to determine which of the nutritional indicators may be of value in identifying patients with high risk of postoperative infections.

A complete nutritional assessment was performed at admission and the following parameters were determined: hemoglobin, total serum protein, albumin, ceruloplasmin, retinol binding protein, transferrin; Fe; urine creatinine, creatinine/height index, arm muscle circumference; ideal body weight, usual body weight, arm circumference, triceps skinfold; lymphocytes, white blood cells, C3c, skin tests to recall and primary antigens.

In the cancer patient group, hemoglobin, total protein, albumin, Fe, percentage usual body weight, and delayed hypersensitivity response to skin antigens were significantly more impaired than in controls. Preoperative delayed hypersensitivity response was the only test in correlation with the tumor stage. It was also significantly different in the gastric cancer patients who developed postoperative infections.
Clinical Use of Pulse Rates to Determine Daily Energy Expenditures in Trauma and Surgical Patients
Authors: Dennis Robert S. , Long Calvin L. , Hall Timothy , Blakemore William S.
Published: May 2008

This study was conducted to establish practical application by using pulse rates to determine resting energy expenditures in trauma and surgical patients. A continuous flow gas analyzer measured energy expenditures and a cardiotachometer/recorder determined pulse rates simultaneously. The study consisted of 18 normal subjects as controls, seven surgical patients (totaling 36 samples), a combination of the seven surgical and three trauma patients (totaling 23 samples). The group of seven surgical patients had a correlation coefficient of 0.531 when comparing pulse rate/min with kcal/m2/hr, and this was the best correlation among the group population studied. An attempt to establish a single regression line from individual patients showed no significant correlation, with the exception of two surgical patients. Of the total number of patient samples, we found no significant correlation between pulse rate and energy expenditures. Independently, Andrews (Am J Clin Nutr 24:1139–1147, 1971) and Payne (Am J Clin Nutr 24:1164–1170, 1971) suggested that there are multiple variables such as stroke volume, state of physical training, etc., that affect the outcome of such data. In this study, our variables were more extensive with respect to the severity of injuries and varying degrees of surgical procedures. The study concluded that there is no practical clinical use of pulse rates in determining daily resting energy expenditures of surgical or trauma patients.
Teaching Home Parenteral Nutrition to Patients with Limited Compliance Skills
Authors: Lansky David , Doerr Hans O. , Ivey Marianne
Published: May 2008

Information gathered from psychological and behavioral assessment procedures was used to select a teaching approach for two home parenteral nutrition patients with limited abilities to learn—and therefore to comply with—their regimens. A “behavior shaping” procedure, involving the simplification of complex home parenteral nutrition tasks, resulted in significantly improved performance by both patients. Results suggest that these procedures may be applied to other home parenteral nutrition patients, including those without apparent skill deficits.
Bacterial Safety of Reconstituted Continuous Drip Tube Feeding
Authors: Hostetler Cheryl , Lipman Timothy O. , Geraghty Maureen , Parker Richard H.
Published: May 2008

Chemically defined diets require reconstitution and transfer to a delivery system. When reconstituted High Vivonex was noted in our Medical Center to be bacteriologically contaminated, we instituted a series of control procedures. We then reevaluated bacterial growth in reconstituted High Nitrogen Vivonex and diluted Isocal under ward conditions. The mixtures were prepared with sterile water versus tap water, using a hand washed blender versus a machine washed blender. We also investigated the bacteriological effect of blast freezing reconstituted High Nitrogen Vivonex. All preparations of the nonfrozen High Nitrogen Vivonex showed occasional low level contamination, although quantitative cultures did not show logarithmic growth over eight hours of observation. No growth occurred in the blast frozen High Nitrogen Vivonex or in the Isocal. We conclude that reconstituted High Nitrogen Vivonex and diluted Isocal may be prepared and hung safely for eight hours, and that blast freezing of High Nitrogen Vivonex is bacteriologically safe. As a result of our initial findings of bacteriologic contamination, we believe a program for bacterial monitoring of the tube feeding is desirable.
Malnutrition and Hospital Prognosis in the Alcoholic Patient
Authors: Bienia Richard , Ratcliff Sandra , Barbour Galen L. , Kummer Mary
Published: May 2008

The nutritional status of 65 alcoholic patients admitted to the Medical Service of a Veterans Administration Hospital was evaluated and compared to that of 87 nonalcoholic patients admitted during the same period of time. There was no statistical difference in the prevalence of malnutrition in the alcoholic population (36.9%) when compared to the nonalcoholic population (43.7%).

The death rate and incidence of infection were similar in both populations as was the prevalence of anemia, depressed total lymphocyte count, and skin test anergy. Malnutrition, however, correlated with an increased death rate and incidence of infection, regardless of whether the patient was an alcoholic or not.
Combined or Individual Administration of Branched‐Chain Amino Acids Following Total Hepatectomy in the Rat: Effects on Amino Acids and Indoleamines in Brain
Authors: Herlin Per M. , James J. Howard , Gimmon Zvi , Fischer Josef E.
Published: May 2008

The effects of infusing leucine, isoleucine, and valine, either singly or together into rats after total hepatectomy were compared. Hepatectomized rats receiving only glucose had high concentrations in plasma of most amino acids, except the branched‐chain amino acids; in brain, the concentrations of glutamine, most large neutral amino acids and 5‐hydroxyindoleacetic acid were greatly elevated. When all three branched‐chain amino acids were infused, the rise in plasma concentration of essential amino acids and tyrosine was significantly reduced. Infusion of isoleucine did not significantly reduce the concentrations of any essential amino acid in plasma while valine reduced lysine, methionine and tryptophan and leucine reduced only methionine. In contrast, all infusions of branched‐chain amino acids, either singly or in combination, reduced brain levels of other large neutral amino acids. Infusion of branched‐chain amino acids greatly elevated the plasma concentrations of glutamine and alanine and prevented the decrease in brain concentrations of glutamic acid, a neurotransmitter.
Effects of Hypocaloric Dextrose and Amino Acids on Body Composition and Nitrogen Balance in Rats
Authors: Scott Rhonda L. , Albina Jorge E. , Caldwell Michael D.
Published: May 2008

Studies were conducted to compare the effects of isocaloric intake of glucose, amino acids, and combinations of these nutrients on nitrogen balance, body composition, and selected metabolic parameters of adult rats. Diets were administered either orally or intravenously at 20% (semi‐starvation) of the daily caloric requirement. Although nitrogen balance was improved when all calories were supplied as amino acids when compared to glucose alone, one‐half the amino acids could be replaced with glucose without sacrificing nitrogen balance. Animals from the semi‐starvation treatment showed similar weight and body composition changes, there was no apparent difference whether the diets were administered orally or intravenously. These results indicate that replacement of at least one‐half the calories of an all amino acid hypocaloric diet with glucose does not adversely affect body composition weight change or nitrogen balance, but may reduce blood urea nitrogen, ketosis, and cost of nutritional support.
Total Parenteral Nutrition With Fat Emulsions During Pregnancy— Nutritional Requirements: A Case Report
Authors: Di Costanzo Jacques , Martin Jacques , Cano Noel , Mas Jean‐Claude , Noirclerc Michel
Published: May 2008

After a corrosive burn of the upper gastrointestinal tract leading to a severe dysphagia and to a weight loss of 15 kilograms, a 21‐year‐old female was treated by total parenteral nutrition (TPN) during the last 7 weeks of pregnancy. TPN by complete nutritive mixtures comprised daily crystalline amino acid solutions and as energy sources glucose plus lipids, the latter representing 43% of the nonprotein calories. A term normal 2800 gram female was delivered by cesarian section. This case report demonstrates the absence of any side effects on pregnancy related to fat emulsions used in usual proportions. Among the nutritional parameters studied here, the variations of weight and creatinine height index seem to be the best indicators of the maternal nutritional status in these cases. Approximately 50 kilocalories and 220 milligrams of nitrogen per kilograms body weight daily seem to be sufficient to restore and to maintain the maternal nutritional conditions and fetal growth.
Comparative Study of Clearance of 10% and 20% Fat Emulsion
Authors: Kaminski Mitchell V. , Abrahamian Vasken , Chrysomilides Sonia A. , Nasr Norma J. , Armstrong Michael K. , Lynch Don M.
Published: May 2008

The rate of fat emulsion clearance from the blood of 10 healthy adult male volunteers administered 0.1 gram of fat per kilogram body weight as 10% or 20% safflower oil emulsion (Liposyn) was studied. The subjects were hospitalized for 2 days and each was given the predetermined amount of one of the two fat emulsions (10% or 20%) by rapid injection into a peripheral vein and the rate of clearance of the emulsion determined over a 60‐minute period, beginning when half of the emulsion had been injected. There was no significant difference in the clearance rate between the two emulsions. It is concluded that 20% fat emulsion is as safe as 10% fat emulsion for use in intravenous nutritional support.
Rupture of Indwelling Venous Catheters
Authors: Gulley R.M. , Hawk Nancy
Published: May 2008

Recently a design change in certain Broviac and Hickman catheters has created a serious problem. The paper described the defect and a means of reinforcing the catheter both before it is inserted and after it is in place.
Microbial Contamination of Enteral Feeding Solutions in a Community Hospital
Authors: Schroeder Patricia , Fisher Debra , Volz Marilyn , Paloucek James
Published: May 2008

Seven related studies were done to estimate the type and amount of contamination that occurred in nutrient feeding solution when administered according to procedure in a community hospital. The initial study was done in a simulated nonclinical setting with select technicians monitoring for gavage systems delivering a commercially prepared nutrient feeding solution. The solution remained sterile over 48 hr. In the second study, various nurses maintained the enteral feeding simulations unaware of the objective of study. Significant contamination was found, but a decrease occurred when the study was duplicated and the nurses were made aware that contamination was the issue being studied. The subsequent study had all gavage equipment in clinical use in the hospital on a given day cultured for microbial contamination. Significant contamination was present and did not decrease when the study was duplicated following inservice training. Suggestions for standards of care are made. (Journal of Parenteral and Enteral Nutrition 7:364–368, 1983)
Studies in the Use of the Intraperitoneal Route for Parenteral Nutrition in the Rat
Authors: Leleiko N.S. , Bronstein A.D. , Murphy J. , Fox J. , Lieberman K.
Published: May 2008

The effects of intraperitoneal administration of normal saline, dextrose, and amino acids were studied in a rat model for intraperitoneal alimentation. No adverse effects from the use or placement of an intraperitoneal catheter were found. Animals who received amino acids demonstrated a specific metabolic advantage over animals who received isocaloric amounts of carbohydrate. They lost less weight and maintained a higher serum albumin. The intraperitoneal route may provide a relatively simple and efficient method of studying parenteral nutrition in laboratory animals. Conceivably, it may also be of value for humans who are on chronic ambulatory peritoneal dialysis, or even as an alternative for central venous alimentation. (Journal of Parenteral and Enteral Nutrition 7:381–384, 1983)
Red Cell and Plasma Amino Acid Concentrations in Renal Failure
Authors: Flügel‐Link Reinhild M. , Jones Michael R. , Kopple Joel D.
Published: May 2008

Red cell and plasma amino acid concentrations were measured in nine healthy subjects, nine patients with advanced chronic renal failure, and before and after dialysis in eight patients undergoing maintenance hemodialysis. Blood was obtained after an overnight fast except for postdialysis specimens. In red cells from the chronically uremic patients and in predialysis specimens, there was increased histidine, cystine, glutamic acid, glycine, ornithine, citrulline, taurine, and N'‐methylhistidine, and an increased glycine to serine ratio. Red cell valine, tyrosine, and the ratios of tyrosine to phenylalanine and valine to glycine were decreased in the two groups. Many amino acid levels that were abnormal in red cells were also abnormal in plasma. However, several amino acids were altered in only one of these compartments. Some red cell or plasma amino acid concentrations were abnormal in the uremic or hemodialysis patients but not in both. During hemodialysis, red cell amino acids did not decrease as markedly as did the plasma concentrations. These findings indicate that in chronically uremic and hemodialysis patients there is an abnormal amino acid pattern in both red cells and plasma. Although the altered amino acid patterns in these two compartments have similarities, they are not identical. (Journal of Enteral and Parenteral Nutrition 7:450–456, 1983)
Efficacy of Guar Gum in Preventing the Dumping Syndrome
Authors: Harju E. , Larmi T.K.I.
Published: May 2008

The occurrence of dumping symptoms during 1 wk of use of 5 g of guar gum or placebo in meals was examined in a double‐blind study in 11 patients, who had undergone gastric resection and were suffering from the dumping syndrome. The results show that guar gum prevented the dumping syndrome and increased tolerance to foods not previously tolerated in nine of the 11 patients. (Journal of Parenteral and Enteral Nutrition 7:470–472, 1983)
The Effect of Increasing Total Parenteral Nutrition on Protein Metabolism
Authors: Ang S.D. , Leskiw M.J. , Stein T.P.
Published: May 2008

We asked the question, if the amount of nutrients given parenterally is progressively increased, does the rate of whole body protein synthesis rate increase correspondingly and how does the protein breakdown rate change? Eight malnourished patients requiring total parenteral nutrition (TPN) were studied. We measured their whole body protein synthesis and breakdown rate four times at intervals of 3 days using 15N glycine as the tracer. The first study was done pre‐TPN. The 2nd, 3rd, and 4th studies were done at increasing TPN rates. The rates were TPN 1, 1440 kcal/day and 7.9 g/N/ day; TPN 2, 2160 kcal/day and 11.9 g/N/day; TPN 3, 2880 kcal/day and 15.8 g/N/day. The protein synthesis rate initially increased as the amount of TPN was increased, but increasing the rate from TPN‐2 to TPN‐3 did not result in further increase. Increasing the rate of TPN above a certain level does not lead to a concomitant increase in the protein synthesis rate. (Journal of Parenteral and Enteral Nutrition 7:525–529, 1983)
Fat‐Based (Intralipid 20%) Versus Carbohydrate‐Based Total Parenteral Nutrition: Effects on Hepatic Structure and Function in Rats
Authors: Boelhouwer Roelof U. , King Walter W.‐K. , Kingsnorth Andrew N. , Weening Jan J. , Young Vernon R. , Malt Ronald A.
Published: May 2008

The role of fat‐based total parenteral nutrition (TPN) in preventing or ameliorating hepatic dysfunction during TPN was investigated. Adult ACI‐N rats were given fat‐free carbohydrate‐based TPN or isocaloric, isonitrogenous fat‐based TPN (50% cal from 20% Intralipid, 50% cal from carbohydrate) for 7 days with Purina Chow‐fed and fasting rats as controls. After fat‐based TPN as compared with Chow or carbohydrate‐based TPN, serum alkaline phosphatase activity and cholesterol levels doubled. Fatty infiltration and periportal inflammation in the liver were more marked. Both the TPN regimens were equally effective in maintaining body weight, positive nitrogen balance, muscle and hepatic protein content. Hepatic dysfunction in rats during TPN was not prevented by using a fat emulsion to provide 50% of the caloric requirement; the optimal proportion of fat as energy substrate in this system is less than 50%. (Journal of Parenteral and Enteral Nutrition 7:530–533, 1983)
E‐Rosette Formation, Total T‐Cells, and Lymphocyte Transformation in Infants Receiving Intravenous Safflower Oil Emulsion
Authors: Helms Richard A. , Herrod Henry G. , Burckart Gilbert J. , Christensen Michael L.
Published: May 2008

There has been much concern about impaired immune function in children receiving infused lipid emulsions. Immunologic studies were carried out on 15 infants maintained on parenteral nutrition with intravenous safflower oil emulsion as part of the infusate. Significant increases in percentage rosette formation, total circulating T‐cells, and mitogenesis to phytohemagglutinin and pokeweed mitogen were demonstrated after only 1 wk of lipid infusion. Additional parenteral nutrition did not further increase any immunologic parameter. These results suggest that infused safflower oil emulsion does not adversely alter cellular immune function. (Journal of Parenteral and Enteral Nutrition 7:541–545, 1983)