bluuebunny/crossref_metadata_2025 huggingface dataset:
Investigation of Protein Metabolism with Respect to Amino Acid Administration
Authors: Tempel G. , Jelen S. , Jekat F.
Published: May 2008

A comparative study of the protein metabolism of two groups of patients having suffered major trauma (group I, n = 26, and group II, n = 16) and of two groups having undergone major surgery (group III, n = 10, and group IV, n = 9) was performed from the 2nd to the 11th day of treatment. All of the patients received approximately 35 kcal/kg body weight/day. In addition the patients in groups I and III received a 10% amino acid solution containing 0.24 g N/kg body weight/ day whereas groups II and IV were administered a 5% solution containing only essential and semiessential amino acids amounting to 0,12 g N/kg body weight/day. The 24‐hr nitrogen output in urine, the serum free amino acid concentration as well as the serum protein fractions of transferrin and the C3c and C4 complements were contrasted. Significant differences between traumatised patients and those having had major surgery with respect to nitrogen balance and serum free amino acid concentrations were observed regardless of the pattern of nutrition. However, only slight differences in the concentrations of serum protein fractions of the two groups of patients were noted. Following amino acid solution the polytraumatised patients exhibited an average N balance of —11.9 g N/day, which is indicative of a severely catabolic metabolism. The average nitrogen loss observed in the postsurgical patients amounted to only half this amount. Following administration of the semiessential amino acid solution an appreciable difference in the nitrogen balance between comparable groups was not observed. However, the blood urea nitrogen was lower. In both the postoperative as well as the traumatized patients glycine, alanine, and proline levels were reduced to below normal. Thus, in the treatment of the catabolic patient with adequate renal function, a routine parenteral nutrition consisting of essential and semiessential amino acids exclusively can not be considered advantageous. (Journal of Parenteral and Enteral Nutrition 9:725–731, 1985)
Survey: Use of Clear and Full Liquid Diets with or without Commercially Produced Formulas
Authors: Murray Don P. , Welsh Jack D. , Rankin Robert A. , Warner Roberta
Published: May 2008

A survey of hospital dietitians was taken to determine the usage of clear and full liquid diets in the United States. All of the 299 who responded had these diets in their hospital manuals. Clear liquid diets in 82.3% of the hospitals provided less than 1000 kcal/day, while 27% of full liquid diets contained less than 1500 kcal/day. Both diets were usually taken for 3 or less days. Nearly 75% of those responding rarely used commercially prepared formulas with clear liquid diets whereas commercial formulas were often given with full liquid diets. Higher kilocalories per day are provided when these liquid diets are supplemented with commercial formulas. Prescribing foods only because they are liquid or liquify at room temperature regardless of their osmolarity or kilocalories has little rationale. The addition and/or substitution of newer commercially prepared formulas is suggested. (Journal of Parenteral and Enteral Nutrition 9:732–734, 1985)
Biotin Deficiency during Total Parenteral Nutrition: Its Clinical Manifestation and Plasma Nonesterified Fatty Acid Level
Authors: Matsusue Satoru , Kashihara Sadao , Takeda Hiroshi , Koizumi Shunzo
Published: May 2008

We report a case of biotin deficiency developed in a 25‐yr‐old man with Crohn's disease who had been on total parenteral nutrition for more than 9 months. His cutaneous, ophthalmic, and neurologic manifestations were characteristic of this disease entity described in literature. In particular, the appearance of his face deserves to be called “biotin deficiency facies.” After administration of biotin the low plasma nonesterified fatty acid level promptly returned to normal. This phenomenon may prove to serve as a convenient means for the purpose of detecting biotin deficiency. (Journal of Parenteral and Enteral Nutrition 9:760–763, 1985)
Shoshin Beriberi: An Unusual Complication of Prolonged Parenteral Nutrition
Authors: La Selve P. , Demolin P. , Holzapfel L. , Blanc P.L. , Teyssier G. , Robert D.
Published: May 2008

After 4 weeks of total parenteral nutrition (TPN), a 12‐yr‐old girl exhibited an acute heart failure with high cardiac output, anuria, and severe lactic acidosis. The clinical, hemodynamic, and biological data suggested the diagnosis of shoshin beriberi which was proved by the low erythrocyte transketolase activity with elevated “TPP effect” and by the dramatic improvement of the patient after thiamin administration. Thiamin deficiency and severe neurological disorders have been described during long‐term parenteral nutrition. To our knowledge, this is the first report of the cardiovascular complication of this vitamin deprivation in long‐term TPN. (Journal of Parenteral and Enteral Nutrition 10:102–103,1986)
Prediction of Whole Blood Selenium Levels in Patients on Long‐Term Parenteral Nutrition
Authors: Lipkin Edward , Schumann Louise , Young Jeffry H. , Ivey Marianne
Published: May 2008

In an attempt to define clinical variables which might predict the whole blood selenium level prior to supplementation, whole blood selenium levels were determined in 21 home parenteral nutrition patients who were not receiving selenium supplementation. These levels were examined for possible correlations by single and multivariant analysis with the following clinical parameters: age at initiation of home parenteral nutrition, months of home parenteral nutrition received, hematocrit, albumin, estimated length of remaining small bowel, kilocalories per kilogram actual body weight infused per day, grams protein per kilogram actual body weight infused per day, and multiple of ideal body weight. Of all the combinations of variables examined, the best correlation obtained was between whole blood selenium levels and the total kilocalories per kilogram body weight per day delivered intravenously (r = ‐0.89, p < 0.001). A statistically significant correlation (r = ‐0.67, p < 0.01) was also observed between selenium levels and the grams protein per kilogram actual body weight infused per day. However, inclusion of this or additional variables did not increase the predictive value of the equation describing whole blood selenium levels as a function of the calories delivered. The implication of this study is that patients requiring more intensive nutritional support develop lower selenium levels during the course of treatment. Despite these correlations, no single clinical parameter or combination of parameters, however, was of sufficient predictive value to preclude laboratory determination of whole blood selenium values in deciding which patients might benefit from selenium supplementation. (Journal of Parenteral and Enteral Nutrition 10: 40–44, 1986)
Intact Protein Versus Free Amino Acids in the Nutritional Support of Thermally Injured Animals
Authors: Trocki Orrawin , Mochizuki Hidetaka , Dominioni Lorenzo , Alexander J. Wesley
Published: May 2008

This study compared the nutritional effects of intact protein with that of constituent amino acids as the sole source of nitrogen in a burn guinea pig model. Forty‐five guinea pigs bearing a gastrostomy feeding tube were given 30% total body surface area, full thickness flame burn and were randomized into four groups. Group I (n = 12) and group III (n = 15) received a diet containing whey protein, while group II (n = 9) and group IV (n = 9) received an otherwise identical diet containing free amino acids in a whey protein pattern. Full strength continuous intragastric feeding was initiated immediately postburn in groups I and II, but a 72‐hr adaptive period was provided in groups III and IV. Resting metabolic expenditure was measured by indirect calorimetry on postburn days 2, 6, 9, and 13. After 14 days of enteral feeding, the animals were killed. Immediate enteral feeding of intact protein or free amino acids reduced postburn hypermetabolic response (p < 0.01). However, the intact protein was found to maintain body weight and provide nitrogen retention better than the amino acid mixture (p < 0.05). The animals on the intact protein diet also showed statistically significant benefits in carcass, liver, and gastrocnemius muscle weights and in serum albumin, transferrin and C3 levels. It is concluded that intact protein is superior to free amino acids for nutritional support following burn injury. (Journal of Parenteral and Enteral Nutrition 10:139–145, 1986)
Improvements in Host Immunity by Partially Purified Interleukin 1 in Rats with Portacaval Anastomosis and Splenectomy
Authors: Hamawy Karim J. , Yamazaki Kazuma , Georgieff Michael , Dinarello Charles A. , Moldawer Lyle L. , Blackburn George L. , Bistrian Bruce R.
Published: May 2008

Despite the high incidence and severity of bacterial infections in individuals with chronic liver disease, the relative role of host immunity and the effects of immune stimulants have not been fully investigated. To study the role of the liver and spleen in reticuloendothelial system (RES) function and the host response to infection following portacaval anastomosis, 107 Sprague Dawley CD rats received a portacaval anastomosis either with or without an additional splenectomy, or a sham procedure. Animals that had undergone portacaval anastomosis and splenectomy were also administered a nonspecific host immune stimulant, interleukin 1, or saline and the effect on blood bacterial clearance and organ uptake examined. Three to four weeks following surgery, animals that received a portacaval anastomosis had a decreased ability to clear 59Felabeled Pseudomonas aeruginosa from the blood and an increased uptake of bacteria in the spleen (p < 0.01) when compared to sham‐treated animals. Rats that received a portacaval anastomosis and splenectomy showed further decreases in blood clearance and increased sequestration of bacteria in the liver (p < 0.01). Rats with a portacaval anastomosis and splenectomy that received interleukin 1 treatment prior to Pseudomonas bacteremia showed significantly improved blood bacteria clearance (p < 0.05) and a reduced bacterial sequestration in the liver (p < 0.001) when compared to similar animals receiving saline. These findings suggest that portacaval anastomosis and splenectomy result in impaired immune function as reflected by blood bacteria clearance and changes in organ sequestration of bacteria. Secondly, pretreatment of those immunocompromised animals with interleukin 1 improves immune function. (Journal of Parenteral and Enteral Nutrition 10:146–150, 1986)
Effect of Dietary Nucleotides on Response to Bacterial Infections
Authors: Kulkarni Anil D. , Fanslow William C. , Rudolph Frederick B. , Van Buren Charles T.
Published: May 2008

A nucleotide‐free diet (NFD) suppresses cellular immunity including suppression of both murine allograft rejection and murine graft‐ vs‐host disease in H2 mismatched marrow recipients. To explore the effect of this diet upon response to a bacterial challenge, BALB/c mice were placed upon one of four diets: NFD, NFD supplemented with 0.25% RNA (NFR) and NFD reconstituted with either 0.06% adenine (NFA) or 0.06% uracil (NFU). After 8 weeks on the diets, which supported normal growth in all groups, each dietary group of 10 mice was challenged with an intravenous injection of 1 X 107 live Staphylococcus aureus (Strain ATCC 25923). By 120 hr postinoculation all mice in the NFD group had died; mortality was only 56% in the NFR group (p < 0.05). Addition of uracil resulted in mortality similar to that of the NFR group. Addition of adenine resulted in mortality close to that of the NFD group. Thus, dietary nucleotide restriction increases the mortality from staphylococcal sepsis. Addition of certain dietary nucleotides appears to decrease this susceptibility to bacterial challenge. (Journal of Parenteral and Enteral Nutrition 10:169–171, 1986)
Protective Effect of Vitamin E in Rats with Acute Liver Injury
Authors: Sclafani Lisa , Shimm Peter , Edelman Jeffrey , Seifter Eli , Levenson Stanley M. , Demetriou Achilles A.
Published: May 2008

We have previously shown that supplemental vitamin E has a cytoprotective effect in the liver of rats with chronic CCL4‐induced liver cirrhosis. In this study, we hypothesized that vitamin E would have a protective effect in acute liver injury induced by D‐galactosamine. D‐Galactosamine‐induced injury has been thought to be due to a synergistic direct toxic effect and presence of intestinal bacteria and/or endotoxins. D‐Galactosamine was used to induce acute “hepatitis” (1.5–2.0 g/Kg body weight, ip). Rats were placed on either standard chow or the same chow supplemented with vitamin E (300 mg DL‐alpha‐tocopherol/Kg diet) and 6 days later were given D‐galactosamine. There was significantly improved early (5‐day) survival and late (14‐day) survival in the vitamin E‐supplemented group. The vitamin E beneficial effect was manifested also by decreased liver fat and collagen content and decreased SGPT level. Because bacterial endotoxins have been implicated as playing a role in the pathogenesis of D‐galactosamine hepatitis, the same experiment was carried out using germ‐free and conventional rats. There was significantly improved survival in both the germ‐free and conventional vitamin E‐supplemented groups both at 5 and 14 days. There was no significant difference between conventional and germ‐free rats with or without vitamin E supplementation. In summary (a) vitamin E improves the early fat and collagen accumulation in the liver, decreases SGPT level, and improves survival in the D‐galactosamine experimental model of acute liver injury in both conventional and germ‐free rats; and (b) D‐galactosamine toxicity is probably not mediated through intestinal bacteria and/or endotoxins. (Journal of Parenteral and Enteral Nutrition 10:184–187,1986)
Reduction of Total Parenteral Nutrition‐Induced Urinary Calcium Loss by Increasing the Phosphorus in the Total Parenteral Nutrition Prescription
Authors: Wood Richard J. , Sitrin Michael D. , Cusson Gilbert J. , Rosenberg Irwin H.
Published: May 2008

Hypercalciuria and negative calcium balance are potential complications of total parenteral nutrition (TPN). Dietary phosphorus has been observed to have an hypocalciuretic effect. The present study evaluates the effects of administration of increasing intravenous phosphorus (P) loads on urinary calcium excretion in TPN patients. Urinary calcium exceeded daily calcium intake by 50 mg/d when 700 mg/d P was administered, was equal to intake at 1000 mg/d P, and was 30 mg/d less than calcium intake when 1300 mg/d P was given. These findings suggest that TPN‐induced hypercalciuria can be attenuated in the short‐term by intravenous phosphate. Reevaluation of the phosphorus requirement in patients receiving long‐term TPN should be considered. (Journal of Parenteral and Enteral Nutrition 10:188–190, 1986)
Effect of Enteral Feeding Bag Composition and Freezing and Thawing upon Vitamin Stability in an Enteral Feeding Solution
Authors: Davis Alan T. , Fagerman Kenneth E. , Downer Faye D. , Dean Richard E.
Published: May 2008

The effect of enteral feeding bag composition and freezing and thawing upon the stability of riboflavin and vitamins A and E in an enteral feeding solution was tested. Feeding bags composed of either polyvinyl chloride or polyethylene were filled with an enteral feeding solution. The samples were frozen for 3 months, thawed in warm water, and allowed to stand in room temperature for 12 hr. Samples for vitamin analysis were obtained prior to freezing, upon thawing, and at 12 hr after thawing. No significant differences in vitamin stability due to bag composition or time were seen. These results support the viability of the concept of mixing large batches of enteral feeding solution, and freezing aliquots in individual feeding bags for later use. (Journal of Parenteral and Enteral Nutrition 10:245–246; 1986)
Bone and Mineral Status of Patients Beginning Total Parenteral Nutrition
Authors: Epstein Sol , Traberg Hans , Levine Gary , Mcclintock Ron
Published: May 2008

Total parenteral nutrition (TPN) is commonly used to provide nutrition in the seriously ill. Osteomalacia has been described with long‐term TPN and the administered solutions and/or vitamin D metabolites have been blamed for the occurrence of osteomalacia. These studies however were performed on patients on long‐term TPN programs. We in contrast measured the serum calcium (Ca), ionized calcium (Ca2+), phosphate (Pi), bone GLA protein (BGP), alkaline phosphatase (ALK‐P), 25(OH)D, 1,25(OH)2D, the iPTH (carboxyl terminal) in 25 malnourished patients just beginning TPN therapy. The patients ranged from 25 to 80 yr of age and suffered from a variety of diseases. No patient had symptoms, recent fractures, or radiographic evidence of osteomalacia. The results of our study revealed significantly lower 25(OH)D (p < 0.001), Pi (p < 0.01), and Ca (p < 0.01), but higher iPTH (p < 0.002) values when compared to normals. BGP, 1,25(OH)2D and Ca2+ and ALK‐P were not significantly different.

We conclude that patients requiring TPN have low serum 25(OH)D values reflecting their nutritional status with a compensatory increase in PTH secretion to maintain their serum Ca2+ levels. The normal BGP levels may indicate depressed bone formation and skeletal resistance to PTH in the very ill patient. The cause of osteomalacia in these patients may therefore be multifactorial and not only related to the TPN infusions. (Journal of Parenteral and Enteral Nutrition 10:263–264, 1986)
Time Course for the Changes of Serum Lipoproteins and Apolipoprotein T Concentrations after Major Surgical Trauma in Man
Authors: Lindh Annika , Lindholm Marianne , Holmquist Leif , Carlson Lars A.
Published: May 2008

Trauma induces changes in the serum lipoprotein pattern in man. A characteristic apolipoprotein, named apolipoprotein T existing in its isoforms T‐I to T‐IV, in the high density lipoprotein (HDL) fraction of serum, also appears in response to trauma. In this report eight patients operated on for abdominal aortic aneurysms were studied concerning the time dependency in changes of serum lipoproteins and the appearance of apolipoprotein T. Blood samples for lipoprotein analysis were taken preoperatively, postoperatively on days 1, 2, 4, 6 and thereafter twice a week until discharge from the hospital. The serum lipoprotein concentrations were compared with those from a group of healthy men. The most striking abnormalities were found in serum VLDL where both concentrations of triglycerides and cholesterol decreased during the first 2 days by more than 50%, compared to the initial level, and remained low for about 1 week. Also the concentration of LDL cholesterol in serum decreased about 40% from the preoperative value during the first days. Serum HDL cholesterol either increased during the first 2 days in those patients with a low preoperative concentration or stayed on a subnormal level during the first 4 days. After day 4 the serum HDL cholesterol decreased and reached the minimum level on days 10 to 13. Already on day 1 after trauma apolipoprotein T had reached a high level in order to stay high for several weeks. The apolipoprotein T isoforms had different appearance with time and varied independently of serum cholesterol in HDL. (Journal of Parenteral and Enteral Nutrition 10:265–273, 1986)
Massive Azoturia and Failure to Achieve Positive Nitrogen Balance in a Botulism Patient
Authors: Cashman Michael D. , Wightkin William T. , Madden Janet E. , Phillips Ramona S.
Published: May 2008

Observations of a patient with botulism requiring mechanical ventilatory support for 59 days and hospitalization for approximately 3 months are reported. During the time of greatest muscular paralysis, urinary urea nitrogen excretion exceeded 20 g per day. This degree of azoturia was thought to be due to obligate loss of lean body tissue secondary to paralysis and not to stress or starvation related demands. A contributing factor to the magnitude of azoturia was the presence of a large premorbid body frame and muscle mass. The nutritional goal was not to achieve nitrogen balance but to maintain visceral protein stores. As the patient improved neurologically, the azoturia decreased allowing a positive nitrogen balance with a rebuilding of skeletal muscle. (Journal of Parenteral and Enteral Nutrition 10:316–318, 1986)
Knotting and Entanglement of Multiple Central Venous Catheters
Authors: Graff Jonathen , Gong Richard , Byron Rachel , Hassett James M.
Published: May 2008

A 53‐yr‐old black male was admitted with peripheral vascular disease and septic shock. Appropriate cardiopulmonary resuscitation and operative intervention required the placement of mutiple central venous lines. These included two subclavicular central venous pressure (CVP) catheters and one Swan‐Ganz catheter (SGC). During manipulation of the SGC, it formed a knot with the two CVP catheters entangled in it. After consideration of the variety of strategies that could be employed, the CVP catheters were manually disengaged from the knot and the knot was surgically removed. The increasing frequency and multiple central angioaccess catheters will result in a finite increase in the nature and complexity of the clinical challenges. The insistence on the use of multiple single‐channel catheters for separate therapeutic functions and the duration of stay of pulmonary catheters should be reconsidered. (Journal of Parenteral and Enteral Nutrition 10:319–321, 1986)
Interaction of Oral Phenytoin with Enteral Feedings
Authors: Saklad Judith J. , Graves Richard H. , Sharp William P.
Published: May 2008

A 48‐yr‐old man with squamous cell carcinoma of the lung, hypercalcemia, and brain metastases with seizures was treated with phenytoin. Constant nasogastric infusion with Osmolyte was begun for hydration and nutritional status, necessitating an increase in his phenytoin dosage. Adequate seizure control and phenytoin levels were obtained on this adjusted regimen. However, on the 16th hospital day, the patient pulled out his nasogastric tube and received two doses of phenytoin without Osmolyte. The patient became lethargic, and his phenytoin level was 53 μg/ml. The patient was placed on bolus nasogastric feedings and a lower dose of phenytoin administered between feedings. Adequate seizure control and appropriate phenytoin levels were obtained with no further problems. The recommended management of the phenytoin‐enteral feeding interaction is to flush and clamp the nasogastric tube for 2 hr before and 2 hr after the phenytoin dose. (Journal of Parenteral and Enteral Nutrition 10: 322–323, 1986)
Indirect Calorimetry in Chair‐Adapted Primates
Authors: Dempsey Daniel T. , Crosby Lon O. , Mullen James L.
Published: May 2008

This paper describes the construction of an indirect calorimeter for measurement of respiratory gas exchange in the chaired primate. Preliminary determinations of energy expenditure and respiratory quotient in five animals under a variety of dietary conditions suggest that this system will prove useful in the laboratory study of primate nutrition, energy metabolism, and cardiorespiratory physiology. Other possible uses and limitations are discussed. (Journal of Parenteral and Enteral Nutrition 10: 324–327, 1986)
The Effect of a Pectin‐Supplemented Elemental Diet on Intestinal Adaptation to Massive Small Bowel Resection
Authors: Koruda Mark J. , Rolandelli Rolando H. , Settle R. Gregg , Saul Scott H. , Rombeau John L.
Published: May 2008

The effect of a pectin‐supplemented elemental diet on intestinal adaptation to massive small bowel resection in the rat was investigated in this study. Sixty adult Sprague‐Dawley rats underwent placement of a feeding gastrostomy and swivel apparatus. Control animals (N = 16) were then returned to their cages while the remaining animals underwent an 80% small bowel resection and anastomosis (resected, N = 44). Postoperatively, animals were randomly assigned to receive either a fat‐ and fiber‐free elemental diet (no pectin) or the same diet supplemented with 2% pectin (pectin). After 8 days of full strength diet, samples of jejunum, ileum, and colon were obtained for analysis. The weights per unit length of the ileum and colon were significantly greater in the resected pectin group than either the resected no pectin or pectin control groups. Mucosal parameters (unit weight, DNA, RNA, and protein content) were significantly increased in the jejunum and ileum of both the resected pectin and resected no pectin groups relative to their respective control groups. However, jejunal and ileal mucosal parameters were significantly greater (1.3‐ to 2‐fold) for the resected pectin group than for the resected no pectin group. All the mucosal parameters of the colons were significantly greater for the pectin resected group than for the pectin control group, while only colonic mucosal RNA was significantly greater for the no pectin resected group than for the no pectin control group. These data indicate that the addition of pectin to an elemental diet significantly enhanced intestinal adaptation to massive small bowel resection in the rat. (Journal of Parenteral and Enteral Nutrition 10: 343–350, 1986)
Body Composition in Quadriplegic Patients
Authors: Shizgal H.M. , Roza A. , Leduc B. , Drouin G. , Villemure Jean‐Guy , Yaffe C.
Published: May 2008

The nutritional state of 12 patients with quadriplegia, secondary to spinal cord injury, was assessed by determining body composition with a multiple isotope dilution technique. For comparative purposes, similar measurements were obtained in 25 normal volunteers. The mean duration of quadriplegia was 14.8 ± 8.5 months. All the patients were hospitalized, receiving a regular hospital diet and all were on a similar rehabilitation program. Because skeletal muscle atrophy is extensive in quadriplegics, we had expected a reduced body size, which was otherwise normal in composition, with a comparable decrease in both the body cell mass (BCM) and the extracellular mass (ECM). Instead, a body composition characteristic of malnutrition was observed in an unexpectedly large percentage (58%) of patients. In the normally nourished individual, the BCM and ECM are approximately equal in size. However, in seven of the 12 quadriplegic patients, the body composition was characteristic of malnutrition, with a BCM (13.5 ± 1.6 kg) which was reduced relative to the ECM (28.7 ± 1.9 kg). Their body composition was significantly (p<0.05) different from the body composition of both the healthy volunteers and the other five quadriplegic patients, whose body composition was normal (BCM = 22.9 ± 1.5 kg, ECM = 28.5 ± 1.6 kg). The nutritional state of the quadriplegic patients correlated significantly with the level of spinal cord injury and not with the duration of quadriplegia. (Journal of Parenteral and Enteral Nutrition 10: 364–368, 1986)
Total Parenteral Nutrition by a Nutrition Support Team: Improved Quality of Care
Authors: Traeger Sheldon M. , Williams Gary B. , Milliren Ginny , Young Dawn S. , Fisher Marianne , Haug Marcus T.
Published: May 2008

Most of the studies that have examined the effect of nutrition support teams (NST) on the quality of total parenteral nutrition (TPN) have found reductions in the frequency of metabolic and central venous catheter related complications. Previous studies have not examined the patterns of nutrient delivery (eg, calories and protein) when TPN is provided either by a primary physician or by a NST. We compared the quality of TPN care provided by our NST or by primary physicians utilizing nonspecialized hospital personnel and resources. As expected, catheter complications were significantly less frequent in NST patients. Assessment of nutritional status and nutrient requirements as well as nitrogen balance were performed and documented significantly more often in NST patients. In addition, nutritional goals for calories and protein were achieved and positive nitrogen balance documented more often in NST patients.

The need to consult the NST physician to utilize the NST was not well received by primary attending and resident physicians and resulted in nonuse of the team. In the future, modification of NST policies will be explored to encourage greater utilization of the NST without compromising the high standard of nutrition care delivered by the NST. (Journal of Parenteral and Enteral Nutrition 10: 408–412, 1986)
Effects of Total Parenteral Nutrition on the Development of Intestinal Endotoxemia in Rats: A Comparison between Glucose and Lipid
Authors: Iriyama Keiji , Nishiwaki Hiroshi , Asami Hisao , Kihata Masafumi , Hioki Tonan , Asakawa Toyomatsu
Published: May 2008

The effects of parenteral nutrition (PN) and of the difference in the PN regimens between glucose and lipid emulsion on the development of endogenous endotoxemia were studied in 40 Wister rats. Endotoxemia was induced by occluding the superior mesenteric vein (SMV) for 30 min. The plasma endotoxin in the portal blood at the time of the release of the SMV occlusion and that in the arterial blood 10 min after the release were quantified. Twenty of the 40 rats had received PN for 48 hr prior to the SMV occlusion. Ten of these 20 rats received the total nonprotein calorie (TNPC) solely with glucose, and the other 10 rats received 25% of the TNPC with lipid emulsion. Ten rats had been allowed free access to lab food until the SMV occlusion. The remaining 10 rats underwent neither the SMV occlusion nor PN, and served as the control group. Both the portal and the arterial endotoxin increased after the release of the SMV occlusion, however the portal endotoxin was higher than that of the arterial one. Both the portal and the arterial endotoxin of the rats supported by PN were significantly lower than those of the rats nourished by lab food, while they were higher than the control values. The difference in the PN regimens did not cause any alteration in the endotoxin levels.

These results indicate that the development of intestinal endotoxemia was not influenced by the difference in the PN regimens, but it was rather influenced by a presence of intestinal content. (Journal of Parenteral and Enteral Nutrition 10:413–415, 1986)
Net Protein Catabolic Rate after Kidney Transplantation: Impact of Corticosteroid Immunosuppression
Authors: Seagraves Annette , Moore Ernest E. , Moore Frederick A. , Weil Richard
Published: May 2008

Protein catabolic rate (PCR) was measured during the first 3 to 7 weeks after kidney transplantation in nine nondiabetic patients (16–52 yr old) who were receiving azathioprine and corticosteroid immunosuppression. Five of the patients received additional amounts of corticosteroids to treat rejection episodes. The PCR paralleled the amounts of corticosteroids administered initially as prophylactic immunosuppression and later as treatment for rejection episodes. In spite of a diet containing 1.2 g of protein per kg ideal body weight, net urea generation reflected severe lean body mass breakdown, roughly equivalent in magnitude to a 50% body surface area full‐thickness burn. This catabolism was accompanied by a fall in serum albumin without significant weight loss. Hypercatabolism in the early posttransplant period is severe. After transplantation diet should be modified to try to satisfy these nitrogen demands. (Journal of Parenteral and Enteral Nutrition 10:453–455, 1986)
Cardiac Function during Protein Malnutrition and Refeeding in the Isolated Rat Heart
Authors: Freund Herbert R. , Holroyde Jane
Published: May 2008

In an attempt to elucidate the effect of protein restriction and subsequent refeeding on cardiac muscle function, 133 rat hearts were studied on a Langendorff perfusion apparatus: 19 normal controls, 55 rats during 6 weeks of protein restriction, and 59 rats during 6 weeks of refeeding following starvation.

During starvation animals lost 14.3% of body weight and 12.8% in heart weight, both to be gained upon refeeding.

Both developed force and force velocity tended to decrease in starving rats compared to control or refeeding rats. This trend was present at time 0, but more so after 60 min of perfusion. Furthermore, these differences became even more obvious and significantly different at the higher heart rates of 300 and 400 beats/min, and less so at 100 or 200 beats/min.

These protein malnutrition‐associated cardiac function derangements reversed almost completely to normal upon refeeding. (Journal of Parenteral and Enteral Nutrition 10:470–473, 1986)
Improved Nutritional Management Reduces Length of Hospitalization in Intractable Diarrhea
Authors: Smith Alice E. , Powers Catherine A. , Cooper‐Meyer Roberta A. , Lloyd‐Still John D.
Published: May 2008

Sixteen patients were managed by one of two specific refeeding protocols to compare the efficacy of two enteral formulas in the nutrition restoration of infants with intractable diarrhea (IDI). The protocols outlined specific nutritional therapy including transition from parenteral to enteral nutrition; concentration, volume, and steps of advancement of formulas. Patient progress was monitored daily. Average length of stay, number of days on parenteral nutrition support, and number of formula changes for the IDI protocol groups were compared with a retrospective chart audit group of 29 IDI patients. The protocol groups had substantially fewer days of parenteral nutrition support, significantly fewer formula changes (p < 0.01), and fewer days of hospitalization. The differences resulted in $14,750 of charges saved per protocol patient. (Journal of Parenteral and Enteral Nutrition 10:479–481,1986)
Utilization of Intralipid in Septic Rats: Effects of Sepsis on the Clearance of Exogenous Fat Emulsion from Various Organs
Authors: Wei Jao Chen
Published: May 2008

The rats were used for the study of the effects of sepsis on the utilization of exogenous fat emulsion. The studies were carried out by measuring the rate and the pattern of clearance of intravenously‐administered 14C‐Intralipid from the plasma, liver, spleen, kidney, and muscle of control and septic rats. Plasma clearance of the exogenous fat measured for 14C at 30, 60, 90, 120, 360 min (n = 5) after intravenous injection revealed that the clearance was retarded by sepsis. In the liver, the initial 14C uptake was much greater in the septic rats than those in the control group (34.8 ± 3.6% us 14.4 ± 1.6%, p < 0.01). Six hr after injection, as high as 19.6 ± 2.4% of the injected dose was detected in the liver of the septic rats, but the control rats had only 4.4 ± 0.8%. In spleen, kidney, and muscle, however, both the 14C uptake and the rate of its clearance were greater for the control rats than those of the septic group. The increase in the amount of liver uptake of the exogenous fat by the septic rat and the retained large amount of the fat may account for the decreased plasma clearance and the decrease in its subsequent utilization by other organs and tissues. Significant increase in liver contents of total lipid and triglyceride with a decrease in nonesterified fatty acid (NEFA) at the end of a 6‐hr period in septic rats suggest that accumulation of fat in the liver may be a result of impaired triglyceride hydrolysis, possibly due to suppressed lipoprotein lipase activity. (Journal of Parenteral and Enteral Nutrition 10:482–486, 1986)
Taste Preferences for Nutritional Supplements: Comparison of Cancer Patients and Healthy Controls Using a Wine‐Tasting Scale
Authors: Brown Rex O. , Schlegel Kaye , Hall Nancy H. , Bernard Stephen , Heizer William D.
Published: May 2008

Thirty‐nine cancer patients (Ca) and 37 age‐and sex‐matched healthy controls (Co) evaluated 11 commercially available enteral supplements using a modified wine‐tasting scale. The cancer patients were 19 males with lung cancer and 20 females with breast cancer, and their controls consisted of 17 males and 20 females, respectively.

Mean evaluation scores for the individual supplements revealed no significant differences (NS) between lung cancer patients and controls. Ensure Plus (strawberry) received the highest score from both groups (Ca 16.0 ± 3.0 us Co 17.1 ± 2.6, N.S.) while Vital received the lowest (Ca 6.3 ± 4.8 us Co 4.9 ± 4.2. NS). Similar results were obtained for breast cancer Datients and their controls except that chocolate Sustacal was rated significantly higher by breast cancer patients than by controls (16.6 ± 2.6 νs 13.3 ± 4.3, p < 0.01). Again, Ensure Plus (strawberry) received the highest score from both groups (Ca 17.0 ± 3.5 us Co 17.8 ± 2.3, NS), while Vital was rated lowest by both groups (Ca 5.6 ± 4.7 us Co 4.3 ± 5.0, NS).

The modified wine‐tasting scale provides a method for quantitating taste preference for various dietary supplements. We report here the numerical rating of 11 supplements by patients with lung cancer and patients with breast cancer as well as their age‐ and sex‐matched controls. (Journal of Parenteral and Enteral Nutrition 10:490–493, 1986)
Bacterial Contamination of Enteral Nutrient Solutions: Intestinal Colonization and Sepsis in Mice after Ingestion
Authors: Van Enk Richard A. , Furtado Dolores
Published: May 2008

Contaminated enteral nutrient solution (ENS) was used to assess the risks of intestinal colonization and invasive sepsis using normal mice. Dilute Osmolite containing 106 Group B Streptococci/ml given for 2 to 10 consecutive days resulted in the detection of organisms by rectal washing sampling and in the recovery of 103 to 104 organisms from the cecum, large intestine, and rectum. Only 101 organisms survived in the small intestine. Colonization, or the persistence of organisms for 10 days after exposure, was produced after 2 days of ingestion in 44% of animals and in 100% after exposure for 5 days. There were 39 septic deaths. During the 7‐day ingestion interval 15 died and 24 died within 10 days after exposure. The risk of sepsis was highest for young mice. Ways to minimize bacterial contamination of ENS intended for administration to patients are discussed. (Journal of Parenteral and Enteral Nutrition 10: 503–507, 1986)
Effects of Alternate and Simultaneous Administrations of Calcium and Phosphorus on Calcium Metabolism in Children Receiving Total Parenteral Nutrition
Authors: Kimura Saburo , Nose Osamu , Seino Yoshiki , Harada Tokuzo , Kanaya Shinobu , Yabuuchi Hyakuji , Itakura Takeo , Takagi Yoji , Okada Akira
Published: May 2008

The effects of alternate and simultaneous administrations of calcium (Ca) and phosphorus (P) on Ca metabolism in children receiving total parenteral nutrition (TPN) were examined. Eight children, aged 2 to 36 months, were studied. The following three solutions were administered: solution 1 contains Ca (533 mg/liter); solution 2 contains P (413 mg/liter); and solution 3 contains Ca (267 mg/liter) and P (207 mg/liter). Solutions 1 and 2 were administered alternately for 24‐hr periods. (Results) I. During administration of solution 1, significant hypophosphatemia (4.39 ± 0.26 mg/dl) and hypercalcemia (9.96 ± 0.15 mg/dl) were observed and, conversly, during administration of solution 2, significant hypocalcemia (8.36 ± 0.18 mg/dl) and hyperphosphatemia (6.16 ± 0.27 mg/ dl) were observed. During administration of solution 3, the serum levels of both minerals were maintained within the normal ranges (Ca 9.46 ± 0.12 mg/dl, P 5.65 ± 0.21 mg/dl). II. The urinary excretion of cyclic AMP was significantly lower during administration of solution 1 (6.67 ± 0.45 nmol/mg creatinine (Cr)) as compared with solution 3 (7.50 ± 0.61 nmol/ mg of Cr). On the other hand, the excretion was significantly higher during administration of solution 2 (11.55 ± 1.58 nmol/ mg of Cr) as compared with solution 3, indicating the existence of secondary hyperparathyroidism. III. The Ca and Pretention rates were significantly higher with solution 3 (Ca 79.0 ± 5.5%, P 73.2 ± 7.2% of the intake) than with solutions 1 and 2 alternately (Ca 62.7 ± 4.5%, P 49.2 ± 9.3%). (Conclusions) Simultaneous administrations of Ca and P are preferable to their alternate administrations for Ca metabolism in children receiving TPN. (Journal of Parenteral and Enteral Nutrition 10: 513–516,1986)
Effects of Resistive Exercise on Skeletal Muscle in Marrow Transplant Recipients Receiving Total Parenteral Nutrition
Authors: Cunningham Beth Ann , Morris Gene , Cheney Carrie L. , Buergel Nancy , Aker Saundra N. , Lenssen Polly
Published: May 2008

Skeletal muscle protein loss occurs during marrow transplantation despite total parenteral nutrition. To determine if muscle atrophy could be minimized with exercise therapy, 30 patients undergoing marrow transplantation for acute leukemia completed a prospective randomized trial to receive: (1) no therapy (controls), (2) physical therapy thrice weekly (PT3), or (3) physical therapy five times weekly (PT5). Patients were studied through 35 days posttransplant. Muscle protein status and turnover was assessed by weekly nitrogen balance, and creatinine and 3‐methylhistidine excretion. Results favored a muscle protein‐sparing effect of exercise, as a significant decrease in creatinine excretion in controls only suggested muscle protein loss associated with inactivity. Changes in arm muscle area correlated with energy, but not protein intake. Large individual variation, inadequate nutritional support and differences in admission arm muscle area may have clouded these results. (Journal of Parenteral and Enteral Nutrition 10:558–563, 1986)
Aluminum in Parenteral Nutrition Solution—Sources and Possible Alternatives
Authors: Koo Winston W.K. , Kaplan Lawrence A. , Horn Jack , Tsang Reginald C. , Steichen Jean J.
Published: May 2008

The extent of aluminum (Al) contamination in parenteral nutrition (PN) solutions for infants is not known. Aluminum was measured in 136 samples from various commercially available components that are used with PN. Results showed Al content varied widely among different components. The same chemical may have a different Al content depending on the manufacturer. However, Al contents were similar among lots from the same manufacturer for the same chemical. Aluminum contamination was arbitrarily classified as high (> 500 μg Al/liter), intermediate (51–500 μg Al/liter) or low (≤ 50 μg Al/liter). The high group included most calcium and phosphorus containing salts, 1 multivitamin preparation, folic acid, ascorbic acid and concentrated (25%) albumin. The intermediate group included sodium lactate, potassium phosphates, zinc and chromium chloride, multitrace metal preparation, and 5% plasma protein. The low group included amino acids, sterile water and dextrose water, chloride salts of sodium, potassium, calcium, copper and chromium, sodium phosphates, magnesium sulphate, zinc sulphate, vitamin B12, vitamin K1, 1 multivitamin preparation, soybean oil emulsion and heparinized (2 U/ml) saline. PN solutions made from high Al components may contain up to 300 μg Al/liter. Calcium gluconate contributed> 80% of the total Al load from PN. Lowering of Al content in calcium gluconate in addition to use of specific low Al components offers the opportunity to significantly lower the Al concentration of the final PN solution and theoretically may achieve an Al content as low as 12 μg/l. We speculate that Al contamination may occur because Al is present naturally in the chemical substance or added during the manufacturing process. (Journal of Parenteral and Enteral Nutrition 10: 591–595, 1986)
Influences of an Infusion of Lipid Emulsion on Phagocytotic Activity of Cultured Kupffer's Cells in Septic Rats
Authors: Nishiwaki Hiroshi , Iriyama Keiji , Asami Hisao , Kihata Masafumi , Hioki Tonan , Asakawa Toyomatsu , Suzuki Hiroshi
Published: May 2008

An experimental study was undertaken to study the influences of an infusion of lipid emulsion on phagocytosis of Kupffer's cells in septic rats. Sepsis was induced in 13 rats by ligating the cecum. Five of them received glucose as the sole nonprotein calorie (septic‐glucose group), four of the rats received 25% of the nonprotein calorie with lipid emulsion, Intralipid (septic‐lipid group), and the remaining four rats did not receive any intravenous solution and were allowed access to water (septic‐fasted group). Another four rats which received neither intravenous solution nor ligation of the cecum served as the control group. The intravenous infusion was carried out for 72 hr. The phagocytotic activity of Kupffer's cells was determined by the ability to engulf latex particles with a size of 1.09 μm, in vitro. The phagocytotic activity was enhanced by the presence of sepsis but it was inhibited by starvation. The difference in the phagocytotic activity between the septic‐glucose group and the septic‐lipid group was not significant. These results suggest that, insofar as an in vitro study is concerned, a 72‐hr infusion of lipid emulsion at a rate of 25% of the total nonprotein calorie does not influence the phagocytotic activity of cultured Kupffer's cell obtained from septic rats. (Journal of Enteral and Parenteral Nutrition 10:614–616, 1986)
Impaired Fat Utilization in Parenterally Fed Low‐Birth‐Weight Infants Suffering from Sepsis
Authors: Park W. , Paust H. , Brösicke H. , Knoblach G. , Helge H.
Published: May 2008

Lipid infusion in low‐birth‐weight infants suffering from sepsis is still controversial. Consequently, we investigated the fat tolerance in six low‐birth‐weight infants with sepsis and 15 low‐birth‐weight infants without sepsis. (1) For measurement of fat clearance, we assayed the serum concentrations of triglycerides enzymatically, and of the free fatty acids by colorimetric micromethod. (2) The fatty acid oxidation was analyzed with the [13C]triolein breath test by means of ratio‐mass spectrometry. The infants were maintained on continuous parenteral nutrition with various amounts of soybean oil emulsion (1 g, 2 g, and 3 g fat/kg body weight per day). Comparing the lipid infusion of 1 and 2 g fat/kg body weight per day between the two groups, we found triglyceride and free fatty acid values in both groups to be in the normal range. At a dose of 3 g of fat/kg body weight per day. septic low‐birth‐weight infants showed a significantly higher concentration of triglycerides (2.02 ± 0.46 mmol/liter) and of free fatty acids (2.06 ± 0.45 mmol/liter) than the nonseptic low‐birth‐weight infants (triglycerides: 1.09 ± 0.43 mmol/liter; free fatty acids: 1.05 ± 0.41 mmol/liter). The low‐birth‐weight infants with sepsis showed a reduced fat oxidation rate of 16.0 ± 1.5% in contrast to that of the low‐birth‐weight infants without sepsis, whose rate was 38.4 ± 1.8%. Accordingly, we apply dosages not exceeding 2 g of fat/kg body weight per day to septic low‐birth‐weight infants. (Journal of Parenteral and Enteral Nutrition 10:627–630, 1986)