bluuebunny/crossref_metadata_2025 huggingface dataset:
Plasma Carotenoid Profiles in Normals and Patients with Cancer
Authors: Meguid Michael M. , Landel Aurora M. , Oey Lily , Mclaren Donald S.
Published: May 2008

Most human cancers arise in epithelial tissues, which are critically dependent on vitamin A for normal differentiation and proliferation. Dietary carotenoids consist of individual retinoids—pro‐vitamin A precursors and non‐pro‐vitamin A precursors—displaying different biological activity. Although epidemiological data suggest that low serum vitamin A levels were associated with an increased risk of cancer, it is not known whether one specific or all vitamin A carotenoids are involved.

To assess whether the plasma carotenoids are related to the nutritional or cancer‐bearing state, a study was conducted to measure total and individual carotenoids in four groups: cancer‐bearing, malnourished; cancer‐bearing, well‐nourished; non‐cancer, malnourished; and well‐nourished volunteers of comparable age and sex.

There was no difference in total carotenoids and pro‐vitamin A precursors between the well—nourished—both normal volunteers and cancer patients. Malnourished cancer and non‐cancer patients had significantly (p < 0.05) lower value of both. Most of the circulating carotenoids in all groups were the non‐pro‐vitamin A precursors. Both malnourished cancer and non‐cancer patients had lower values than well‐nourished (p < 0.05). Differences were related to nutritional state, rather than presence of cancer. (Journal of Parenteral and Enteral Nutrition 12:147–151, 1988)
Neonatal Metabolic Acidosis: Effect of Chloride from Normal Saline Flushes
Authors: Groh‐Wargo S. , Ciaccia A. , Moore J.
Published: May 2008

Metabolic Acidosis is a reported complication of total parenteral nutrition (TPN). A large number of infants receiving TPN in an NICU were noted to have metabolic acidosis. We evaluated the effect of lowering the chloride intake on the incidence of metabolic acidosis in low birth weight (LBW) infants on TPN. Standard TPN solutions were adjusted to provide about 2–3 mEq/kg/day chloride instead of 5–7 mEq/ kg/day provided previously. Most infants on TPN received approximately another 1–3 mEq/kg/day from intravenous and arterial line flushes with normal saline. Ten infants who had been on the original TPN solutions were compared to 10 infants who were on the revised TPN solutions. Serum pH, bicarbonate, and base deficit were used to measure acidosis. Medical records were reviewed for the number of days the infants had abnormal values. Serum chloride levels were also recorded. While similar in gestational age, birth weight, age during study period, days on TPN, and days on orally supplemented parenteral nutrition, the group with higher chloride intake had significantly more days of metabolic acidosis. They also had significantly higher serum chlorides. It is concluded that a total chloride load in excess of 6 mEq/kg/day in LBW infants receiving TPN is associated with more metabolic acidosis. Also, if saline is used for clearing of intravenous and arterial lines, standard TPN solutions should be formulated with consideration of the total chloride load. (Journal of Parenteral and Enteral Nutrition 12:159–161, 1988)
Efficacy and Safety of Low‐Dose Intravenous Versus Intramuscular Vitamin K in Parenteral Nutrition Patients
Authors: Schepers Gregory P. , Dimitry Anne R. , Eckhauser Frederic E. , Kirking Duane M.
Published: May 2008

Efficacy and safety of intravenous and intramuscular vitamin K were compared prospectively in patients receiving total parenteral nutrition. Sixty patients randomly received either a 1‐mg daily iv injection (iv group) or a 10‐mg weekly injection group (im group). Efficacy was determined by the prolongation of twice‐weekly prothrombin (PT) and activated partial thromboplastin (APTT) times. The prolongation of both was not significantly different between the im and iv groups. The percent of PTs outside the normal range was not different for the two groups, although the iv group had more APTT values outside the range than did the im group (p = 0.002). The number of adverse reactions reported in the iv (5) and im (4) groups was also similar. Reactions were minor, not reproducible, and all patients recovered without sequelae. PT results from the iv and im groups were combined and compared to values from 28 patients in an earlier study who did not receive vitamin K. PTs in the no‐vitamin K group were significantly prolonged over the vitamin K group (p = 0.0004). The results confirm that regular addition of vitamin K to TPN regimens decreases the incidence of elevated PTs. When administered appropriately, iv and im administration of vitamin K appear to be equally safe and effective in maintaining normal PTs and APTTs. (Journal of Parenteral and Enteral Nutrition 12:174–177, 1988)
A Safe Technique for the Insertion of Hickman Catheter into the Internal Jugular Vein
Authors: Fan S.T.
Published: May 2008

A modified technique of inserting a Hickman catheter into the internal jugular vein is described. Instead of using a purse string suture, this technique involves the complete isolation of a short segment of the internal jugular vein and the application of bulldog vascular clamps above and below the site of venotomy. By such modification, the risk of intraoperative bleeding and air embolism is reduced, unilateral advancement of the catheter into the superior vena cava is ensured and the caliber of the vein is not narrowed. (Journal of Parenteral and Enteral Nutrition 12:223–224, 1988)
Effect of total parenteral nutrition on whole body protein kinetics in cachectic patients with benign or malignant disease
Authors: Jeevanandam M , Legaspi A , Lowry SF , Horowitz GD , Brennan MF
Published: May 2008

The metabolic effects of total parenteral nutrition on malnourished cancer and noncancer patients were investigated by determining whole‐body protein metabolism before and during intravenous nutritional support. The results were compared to similar studies reported in normal subjects. Primed‐continuous infusion of 15N glycine was used and the isotopic enrichments in urinary urea and ammonia were measured. The end product average values were used in the calculation of whole body protein turnover. After 10 days of nutritional support in cancer and noncancer patients whole body protein breakdown decreased by 50% (p = 0.01), and 59% (p = 0.001), whereas protein synthesis decreased by 21% (p = 0.005) and 33% (p = 0.025), respectively. Protein turnover did not change in noncancer patients but increased by 15% (p = 0.005) in cancer patients. The efficiency of utilization of the endogenous supply of amino acids from the breakdown of body proteins for synthetic purposes was 77% in this group of subjects. The utilization efficiency of the intravenously infused amino acids for synthesis of body protein was 39% in cancer and noncancer patients but 51% (p less than 0.05) in normals. The data suggest that depleted patients synthesize proteins from intravenous amino acids less well than normals.
Infusion of a branched‐chain amino acid‐enriched solution and alpha‐ketoisocaproic acid in septic rats: effects on nitrogen balance and skeletal muscle protein turnover
Authors: Hasselgren PO , LaFrance R , Pedersen P , James JH , Fischer JE
Published: May 2008

Sepsis was induced by cecal ligation and puncture in male Sprague‐Dawley rats weighing approximately 70 g and the animals were intravenously infused with one of four isocaloric solutions: group I (N = 16), 8.5% dextrose solution; group II (N = 16), alpha‐ketoisocaproic acid (KIA, 5.1 mg/ml) in 8.5% dextrose; group III (N = 16), FreAmine HBC (containing 45% branched‐chain amino acids) in 2.5% dextrose; and group IV (N = 17), FreAmine HBC in 2.5% dextrose + KIA (5.1 mg/ml). Eighteen hr after induction of sepsis, extensor digitorum longus (EDL) and soleus (SOL) muscles were dissected with intact tendons and incubated for the study of protein synthesis and degradation, which were measured as incorporation of 14C‐phenylalanine into protein and release of tyrosine into incubation medium, respectively. Urine was collected for determination of nitrogen balance. Nitrogen balance, which was equally negative in groups I and II, was significantly improved in groups III and IV and became equally positive in these groups. Protein synthesis and degradation rates in incubated EDL and SOL muscles were similar to those which we have reported previously in septic rats. Except for a higher synthetic rate in SOL in group II, no other differences in protein synthesis or degradation rates between the four experimental groups were found. Thus, the present study showed that infusion of a branched‐chain amino acid‐enriched solution improved nitrogen balance in septic rats. KIA alone or administered with the amino acid solution did not affect nitrogen balance.(ABSTRACT TRUNCATED AT 250 WORDS)
Lipid‐associated total parenteral nutrition in patients with severe acute pancreatitis
Authors: Van Gossum A , Lemoyne M , Greig PD , Jeejeebhoy KN
Published: May 2008

Biochemical data were studied in 18 patients with severe acute pancreatitis receiving lipid associated with total parenteral nutrition. The mean nonprotein energy intake was 30 kcal/kg/day, with 34–70% of the nonprotein calories as lipid. These parameters were no different between patients who survived and those who died. The mean sum of Ranson criteria was significantly higher in patients who died as compared with those who survived. Plasma triglycerides, glucose, albumin, and the amount of insulin supplementation were related to the severity of the disease and to the outcome. Persistent hypertriglyceridemia, hyperglycemia, hypoalbuminemia, and higher insulin requirements were observed in patients who died in comparison with those who survived and this appeared to be an index of fatal outcome. These abnormalities reflect in part an inability to utilize nonprotein energy, because the measured energy expenditure in relation to intake was lower in the patients who died, despite comparable intakes and expected energy expenditures.
Fiber supplementation of enteral formulas: effects on the bioavailability of major nutrients and gastrointestinal tolerance
Authors: Heymsfield SB , Roongspisuthipong C , Evert M , Casper K , Heller P , Akrabawi SS
Published: May 2008

Two fiber‐supplemented enteral formulas were recently introduced for patient application, Susta II and Enrich (12.4‐g and 38.5‐g soy polysaccharide/2000 kcal, respectively). This investigation had a 3‐fold purpose: to determine if and to what extent fiber‐supplementation changes the chemical composition of stool relative to a fiber‐free formula (Ensure); to establish the clinical tolerance of the two new formulas; and to quantify the effects of soy polysaccharide on nutrient bioavailability. The study was conducted in two consecutive phases: A (n = 6 subjects; random assignment to either Ensure or Susta II for 1–2 weeks followed by isocaloric cross‐over to the alternate formula for an equal period of time) and B (n = 8 subjects evaluated as in phase A except Enrich replaced Ensure). Each balance week consisted of clinical/subjective monitoring, evaluation of stool composition (H2O and dry weight), apparent nutrient absorption (energy, fat, N, P, K, Ca, Mg, Zn, Na, and Cl), and metabolic balance (N, P, K, Ca, Mg, Na, and Cl). Relative to the fiber‐free formula the two fiber‐supplemented solutions produced increases in fecal N, fat, H2O, and minerals of variable magnitude; there were corresponding reductions in net absorption of organic compounds and minerals. The additional minerals added to the fiber‐supplemented formulas and the minimal effects on N absorption preserved balance; the retention of N, P, K, Ca, Mg, Na, and Cl were similar for all three formulas. No adverse clinical effects of the fiber‐supplemented formulas were noted.(ABSTRACT TRUNCATED AT 250 WORDS)
Empty iron stores as a significant risk factor in abdominal surgery
Authors: Harju E
Published: May 2008

The mortality and morbidity in abdominal surgery were investigated in two groups of patients, one with empty (N = 228) and the other with normal (N = 220) iron stores before operation. The estimation of body iron stores by measurements of serum ferritin concentration assumes that the only reason for a low ferritin value is an empty iron store. The results showed that the period of hospital treatment was shorter and the number of complications, especially infections, fewer, in patients with normal as compared to empty iron stores before the operation (p less than 0.001). These differences were especially striking in patients subjected to gastric or large bowel surgery. The results were not explained by differences in sex, age, serum albumin, or clinical anemia. The complications were not predictable from preoperative serum albumin, alkaline phosphatase, or alanine amino transferase levels. Among patients with postoperative complications those with preoperative empty iron stores also had a lower preoperative blood hemoglobin concentration (127 +/‐ 10 g/liter) than those with normal preoperative iron stores (136 +/‐ 9 g/liter). Thus it is speculated that the mechanisms behind postoperative complications due to preoperative empty iron stores might be a decrease in tissue oxygenation, resulting in an increased fatigue while working, decreased contractile capacity of the respiratory muscles, and a decrease in immune function. Thus a measurement of serum ferritin concentration and correction of empty iron stores is recommended before abdominal surgery.
Effect of a Glutamine‐Supplemented Enteral Diet on Methotrexate‐Induced Enterocolitis
Authors: Fox Andrew D. , Kripke Scott A. , De Paula Juan , Berman Jeffery M. , Settle R. Gregg , Rombeau John L.
Published: May 2008

Administration of an elemental diet to rats given methotrexate (MTX), 20 mg/kg intraperitoneally (ip), results in 100% mortality from severe enterocolitis. Previous studies indicate that glutamine (GLN), which is not present in elemental diets, is the preferred oxidative substrate for the gut' and may facilitate intestinal recovery after injury.2 This study investigated the effects of a glutamine‐supplemented elemental diet (GLN‐ED) on nutritional status, intestinal morphometry, bacterial translocation and survival in this lethal model of intestinal injury. Three experiments were performed. In the first experiment, rats received an intragastric elemental diet supplemented with either 2% GLN or an equivalent amount of glycine (Control). After 4 days animals received either MTX, 20 mg/kg ip, or saline ip and were killed 3 days later. The GLN‐ED resulted in significantly decreased weight loss, improved nitrogen retention, and increased mucosal weight, protein, and DNA content of the jejunum and colon.

In the second experiment rats were assigned to diet as in the first experiment, but all animals received MTX. Control diet animals died within 120 hrs of MTX administration. The GLN‐ED group had significantly longer survival time and decreased mortality.

In the third experiment animals were assigned to diet and MTX as in the first experiment. Ninety‐six hrs later aortic blood cultures revealed enteric bacteremia in animals administered MTX. GLN‐ED resulted in a significant reduction in the incidence of bacteremia.

These experiments showed that a GLN‐ED significantly improved nutritional status, decreased intestinal injury, decreased bacterial translocation, and resulted in improved survival in a lethal model of enterocolitis. (Journal of Parenteral and Enteral Nutrition 12:325–331, 1988)
Kinetics of a Single Administration of 74Se‐Selenite by Oral and Intravenous Routes in Adult Humans
Authors: Martin Ramon F. , Janghorbani Morteza , Young Vernon R.
Published: May 2008

The purpose of this study was to explore the fate of a single dose of labeled selenium as determined by its route of administration. Thus, the appearance of a stable isotope of selenium, administered as 74‐Se‐selenite, was measured in plasma, urine, and feces, with neutron activation analysis, following a 81.7 μg dose of 74Se‐selenite given either intravenously or orally in two groups (n = 4) of healthy, young adult men, who were otherwise maintained on a diet providing a constant and adequate selenium intake. From these isotopic data, measurable parameters of urine excretion, total body retention and selenite‐exchangeable metabolic pool (Se‐EMP) were defined to provide a quantitative assessment of selenium metabolism in these subjects. The initial 24‐hr urine excretion of the label was higher for the intravenously administered label (18.2 ± 2.1% of dose) compared to the oral dose (11.7 ± 2.6% absorbed dose). Thereafter, the excretion of isotope was the same for both groups. For equivalent entry of Se into the body, measured total body retention and Se‐EMP were the same for both groups. These initial kinetic data suggest that the overall utilization of selenium from a single administration of selenite is comparable for the two routes of intake and that the host's selenium requirement can probably be met adequately via the intravenous administration of selenite. (Journal of Parenteral and Enteral Nutrition 12:351–355, 1988)
Answering the Fat Emulsion Contamination Question: Three in One Admixture vs Conventional Total Parenteral Nutrition in a Clinical Setting
Authors: Vasilakis Alexander , Apelgren Keith N.
Published: May 2008

Fat emulsions (FE) support microbial growth when inoculated in vitro; dextrose/amino acid solutions (D/ AA) do not. Can FE be safely added to D/AA when delivered over 24 hrs? We attempted to answer this question by culturing both conventional (C) total parenteral nutrition (TPN), in which the FE and D/AA are given separately, and the 3‐in‐1 admixture TPN, in which all components are delivered in one bag. Two‐hundred TPN fluid cultures were obtained serially by collecting 1 ml of fluid from the distal‐most connection when the TPN was changed every 24 hrs. Quantitative and qualitative cultures were obtained. One hundred sixty‐six (83%) were negative. Of the 34 (17%) positive cultures, 15 (17% of 88) were from the conventional system whereas 19 (17% of 112) were from the 3‐in‐1 system. Six clinically septic patients furnished 11 TPN fluid specimens which grew >400 colonies/ ml. Seven (8% of 88) of these were from the conventional system whereas four (3.6% of 112) were from the 3‐in‐1 system. All had distant sites of sepsis. The 23 remaining positive TPN fluid cultures grew less than 25 colonies/ml, with 20 growing Staphylococcus epidermidis. All of these patients were clinically well and there was no significant difference in the distribution of positive cultures between the conventional system (9%) and the 3‐in‐1 system (13%). We therefore conclude: (1) the 3‐in‐1 admixture system does not have an increased risk of contamination compared to the conventional system; and (2) positive fluid cultures in clinically well patients may have been due to sampling technique with catheter hub rather than fluid contamination being the source of the positive culture. (Journal of Parenteral and Enteral Nutrition 12:356–359, 1988)
Arterial Deepvenous Difference of Lipoproteins in Skeletal Muscle of Patients in Postoperative State: Effects of Medium Chain Triglyceride Emulsion
Authors: Hailer S. , Jauch K.‐W. , Günther B. , Wolfram G. , Zöllner N. , Heberer G.
Published: May 2008

The effect of fat infusion with medium chain triglycerides (MCT) and long chain triglycerides (LCT) on serum lipoproteins before and after passage through the skeletal muscle was investigated with the forearm technic in eight patients after abdominal operation.

All lipoprotein fractions were enriched with triglycerides and phospholipids from infused artificial fat particles with the consequence of significantly increased ratios of TG/PL and TG/apo B in VLDL, of TG/apo B in LDL and TG/apo A‐I in HDL.

Uptake and release of lipoprotein components by skeletal muscle are given by arterial‐deepvenous differences considering the blood flow rates. The positive arterial‐deepvenous difference of VLDL triglycerides after 4‐hr infusion is interpreted as cleavage and uptake of infused MCT by the muscle. The release of LDL is more pronounced after the fat infusion than before, suggesting a degradation and enhanced catabolism of artificial fat particles. HDL release may be also a consequence of catabolism of artificial TG/PL‐particles. These results indicate an uptake of MCT/LCT emulsion by the skeletal muscle. (Journal of Parenteral and Enteral Nutrition 12:377–381, 1988)
Muscle Protein Metabolism of Rats in Surgical Trauma
Authors: Lee Virginia M. , Hansen Robert J. , Wolfe Bruce M. , Clifford Andrew J.
Published: May 2008

The effects of decreased food intake and degree of surgical trauma on total, myofibrillar and sarcoplasmic muscle protein synthesis and degradation were assessed in two experiments (A and B). Trauma consisted of an abdominal incision with or without hysterectomy. The degree of trauma in experiment B was increased relative to that in experiment A by extending the length of the incision, operative manipulation and time required to perform the surgery. To account for postoperative diminutions in food intake on protein turnover, a group of nonoperated rats were pair‐fed to the level of food consumed by hysterectomized rats. Traumatized rats in experiment B lost more weight, ate less, and had a lower muscle total protein concentration than corresponding rats in experiment A, confirming a more severe trauma in experiment B. In both experiments, trauma depressed total protein content of muscle. Synthesis was measured by the incorporation of L‐[U‐14C] tyrosine from a single meal into total, sarcoplasmic and myofibrillar proteins of gastrocnemius muscle. Degradation was calculated as the difference between the growth rate and the synthetic rate. Synthetic rate (ks) of total protein was depressed by surgical trauma; the more severe the trauma, the greater the depression. In mild trauma, the depression in ks was due only to a decrease in sarcoplasmic protein synthesis (ke), whereas with more severe trauma, synthetic rates of both sarcoplasmic (kes) and myofibrillar (kem) proteins were decreased. Protein degradation (kd,) was increased on day 2 in experiments A and B, had returned to control values on day 4 in experiment A and had decreased below control values in experiment B. Postoperative food restriction did not alter muscle protein turnover rates although growth rate was reduced. (Journal of Parenteral and Enteral Nutrition 12:445–451, 1988)
High Lipid Parenteral Nutrition Improves Portasystemic Encephalopathy
Authors: Glynn Michael J. , Powell‐Tuck Jeremy , Reaveley David A. , Murray‐Lyon Iain M.
Published: May 2008

We have conducted a randomized double crossover study over 4 days in six parenterally fed patients with portasystemic encephalopathy (PSE) in which the nonprotein energy source of otherwise identical feeds was alternately all glucose or predominantly fat. Concentrations of plasma branched chain amino acids (BCAA), plasma insulin, and blood glucose were measured after an initial fast and subsequently after each of the four 24‐hr periods of isonitrogenous feeding. The grade of PSE was assessed clinically and by the number connection test, BCAA concentrations were significantly lower during the glucose infusion than during fasting or the lipid infusion. PSE was significantly less with the lipid than with the glucose infusion. Trials testing the effect of infused BCAA must take account of the opposing effect on BCAA concentrations of simultaneous glucose infusion. A high lipid feed may have advantages in the short‐term treatment of PSE. (Journal of Parenteral and Enteral Nutrition 12:457–461, 1988)
Effect of a Fecal Bulking Agent on Diarrhea during Enteral Feeding in the Critically Ill
Authors: Hart Graeme K. , Dobb Geoffrey J.
Published: May 2008

Diarrhea is a common complication of enteral feeding in critically ill patients. This placebo‐controlled clinical trial assessed the effect of adding fiber in the form of ‘Fybogel’ (Ispaghula husk), one sachet twice daily, on the occurrence of diarrhea during enteral feeding. Sixty‐eight patients without prospectively defined exclusion criteria were enterally fed with ‘Osmolite’ in the Intensive Care Unit during the study period, 35 receiving ‘Fybogel’, and 33 placebo. Nineteen patients in each group had diarrhea on at least 1 day during enteral feeding, with 66 (23%) feeding days complicated by diarrhea in the ‘Fybogel’ group, and 68 (23%) in the placebo group. Narcotic infusions, thiopentone infusions, ’Mylanta', H2‐antagonists, and nystatin suspension did not significantly affect the incidence of diarrhea. Weak correlations were found between diarrhea and the number of antibiotics each patient received (r = 0.2, p < 0.05) and also the number of positive nonenteral bacterial cultures (r = 0.2, p < 0.05). The addition of fiber in the form of ‘Fybogel’ to enteral feeds did not affect the occurrence of diarrhea. (Journal of Parenteral and Enteral Nutrition 12:465–468, 1988)
Diagnosis‐Related Group Impact of Nutrition Support in Cardiac Surgery Patients
Authors: Flancbaum Louis , Brolin Robert E. , Kirzecky Maria , Mast Bruce A. , Smith Ciel E. , Kenler Hallis A. , Wallis Ellen M. , Mackenzie James W.
Published: May 2008

We studied the diagnosis‐related groups (DRG) impact of nutrition support on 80 consecutive cardiac surgery patients operated upon during a 6‐month period. Six of 80 patients were nutritionally depleted preoperatively. Seven received postoperative supplemental nutrition, all of whom had major postoperative complications. Patients were arbitrarily placed into three outcome groups: group I consisted of seven patients who received postoperative nutrition support; group II included 38 patients who received no nutrition support and did not develop complications; Group III consisted of 35 patients who received no nutrition support but developed postoperative complications. All group I patients were length of stay (LOS) outliers. Group I patients were significantly older than groups II and III (p < 0.0003) and had a significantly longer average length of stay (ALOS) (p < 0.001), ALOS in SICU (p < 0.0001) and greater incidence of both septic complications (p < 0.02) and mortality (p < 0.02). Nutrition support in cardiac surgery patients warrants special DRG consideration in light of the significantly increased hospitalization and resource utilization as compared with all other patients in cardiac surgery. (Journal of Parenteral and Enteral Nutrition 12:473–477, 1988)
Use of Hydrochloric Acid to Clear Obstructed Central Venous Catheters
Authors: Shulman Robert J. , Reed Theresa , Pitre Douglas , Laine Laura
Published: May 2008

Central venous catheters are being used with increasing frequency to administer drugs, and as a result, catheter obstruction caused by precipitation of poorly soluble fluid components has become a common problem. We report our first experience using 0.1 N hydrochloric acid to restore patency to central venous catheters obstructed from insolubility‐induced precipitation. Precipitation was caused by drug as well as calcium and phosphorus incompatibilities. The initial use of urokinase in two cases was unsuccessful in restoring catheter patency. In all four cases, the instillation of 0.2–1.0 ml of HCl cleared the catheters. Catheter patency usually was gained immediately. No side effects were noted. Our experience supports preliminary data (JPEN 9 (suppl):255, 1985) which suggest that 0.1 N HCl is effective in clearing insolubility‐induced precipitation in central venous catheters. (Journal of Parenteral and Enteral Nutrition 12:509–510, 1988)
Maintenance of visceral protein levels in serum during postoperative parenteral nutrition
Authors: Tulikoura I
Published: May 2008

Nitrogen metabolism and plasma insulin level were studied postoperatively in 14 patients (six males and eight females) with a disease of the upper gastrointestinal tract and therefore operated on electively. The patients received one of the two isocaloric parenteral nutrition regimens postoperatively: one, on the average, with 1.2 g of amino acids/kg/day and the other with 3.1 g of amino acids/kg/day. During postoperative intravenous alimentation rich in amino acids the cumulative nitrogen balance over 3 days was +13.1 (interval from ‐1.3 to +21.4) gN but ‐10.1 (interval from ‐12.1 to ‐2.4) gN during parenteral nutrition with a smaller amount of amino acids. The difference was significant (p less than 0.001). During parenteral nutrition rich in amino acids the changes of the serum albumin level, ie, ‐0.4 (SEM 1.1) g/liter, and of the serum transferrin level, ie; ‐0.16 (SEM 0.22) g/liter, were statistically insignificant (p greater than 0.05). During intravenous alimentation poor in amino acids serum albumin decreased by 3.8 (SEM 1.2) g/liter (p less than 0.01) and serum transferrin by 0.44 (SEM 0.05) g/liter (p less than 0.001). The differences of the changes between the groups were significant (p less than 0.01 and p less than 0.01, respectively). These various effects of the two parenteral nutrition regimens were not dependent on the different fluid balances during intravenous alimentation or on the different plasma insulin levels. It is concluded that a rich supply of amino acids‐‐more than 1.2 g/kg/day‐‐in postoperative parenteral nutrition better maintains the visceral protein levels in the serum, which possibly depends on the greater protein production in the liver.
Serum cobalamins and cobalamin‐binding proteins during total parenteral nutrition
Authors: van Spreeuwel JP , Verwimp JJ , de Vos N , Rouflart M , Flendrig JA
Published: May 2008

Levels of serum cobalamin and both saturated and unsaturated serum cobalamin‐binding proteins (transcobalamin II and R‐binders) were determined prospectively in 43 patients before and after 2 weeks of total parenteral nutrition (TPN). Nine patients showed subnormal serum levels of cobalamin but none of them had clinical signs of cobalamin deficiency. Serum cobalamin levels significantly declined after 2 weeks of TPN as did both saturated and unsaturated R‐binder levels whereas transcobalamin II levels remained constant. Since cobalamin in serum is entirely bound to proteins, of which R‐binders comprise 80–90%, the changes in R‐binder levels will markedly influence serum cobalamin levels, in fact they adequately explain the short time fluctuations of serum cobalamin levels observed. It is argued that the changes in serum cobalamin levels may reflect a changed distribution of cobalamins over the various body compartments rather than decreased or increased body stores. Moreover, only cobalamin bound to transcobalamin II is delivered to the tissues. Therefore, serum cobalamin levels alone may inadequately reflect cobalamin availability in patients receiving TPN.
Catastrophic weight loss after vertical banded gastroplasty: malnutrition and neurologic alterations
Authors: Albina JE , Stone WM , Bates M , Felder ME
Published: May 2008

The case of a patient with severe vomiting and very rapid weight loss following vertical banded gastroplasty (VBG) (almost 50% of original weight in 11 months) and who suffered severe neurological and nutritional disorders is reported. All abnormal findings with the exception of nystagmus, disappeared during enteral nutritional support with a complete diet and vitamin supplementation. The alterations found in this case may have been related to the very rapid weight loss, which resulted in protein calorie malnutrition and, probably, in one or more vitamin deficiencies. This complication may be preventable by early nutritional intervention in subjects undergoing gastric reduction surgery and who exhibit very rapid weight loss and intractable vomiting.
Wernicke's encephalopathy during total parenteral nutrition: observation in one case
Authors: Mattioli S , Miglioli M , Montagna P , Lerro MF , Pilotti V , Gozzetti G
Published: May 2008

A patient operated for toxic megacolon secondary to ulcerative colitis developed a Wernicke syndrome (thiamine deficiency) during the postoperative period despite the administration of the usually recommended doses of vitamin B1 during total parenteral nutrition (TPN) treatment. Vitamin B1 deficiency should be checked in order to evaluate the patients' nutritional condition before starting TPN, especially those suffering from severe chronic malnutrition. Routine administration of vitamin B1 in repletion doses may be reasonably proposed in order to avoid the development of a Wernicke syndrome which is potentially lethal in a short time if not recognized and corrected in time.
Alteration of Erythrocyte Lipid Composition following Total Parenteral Nutrition in the Rat
Authors: Innis Sheila M.
Published: May 2008

Rats were infused continuously for 7 days with a complete total parenteral nutrition (TPN) solution in which 27.5% total calories were given as a parenteral lipid emulsion containing soybean oil (Liposyn) or safflower oil (Intralipid) emulsified with egg phospholipid (PL). Compared to sham‐operated rats fed chow, the erythrocyte membranes from rats given TPN with lipid emulsion had increased cholesterol and PL but normal molar cholesterol:PL ratios. The fatty acid changes in sphingomyelin and phosphatidylcholine, in particular, suggested replacement of endogenous PL with the exogenous egg PL infused with the emulsion. The changes in membrane lipid composition were accompanied by greater resistance of the cells from rats given TPN to osmotic lysis in vitro. (Journal of Parenteral and Enteral Nutrition 13:47–50, 1989)
Review: Overview of Gastrointestinal Disorders Due to Diabetes Mellitus: Emphasis on Nutritional Support
Authors: Nompleggi Dominic , Bell Stacey J. , Blackburn George L. , Bistrian Bruce R.
Published: May 2008

Gastrointestinal disorders associated with diabetes mellitus have a prevalence rate of 30 to 75%. The most prominent disorders are gastroparesis, diarrhea, and constipation. Severity of symptoms range from mild to severe with the most affected patients being at risk for the development of protein calorie malnutrition. An historical review of the major studies which defined the diagnosis, pathophysiology, and prevalence of these disorders is presented. Guidelines for accurate nutritional assessment, which is essential to the decision to initiate nutritional therapy in this difficult to assess population, are also included. Current methods devised for treatment of diabetic gastroparesis and related disorders are presented. Emphasis is placed on recent developments in nutritional support techniques which make it possible to meet the energy requirements of all such patients. Practical outlines for glucose control in patients receiving TPN or enteral feeding and guidelines for transitioning from parenteral feeding to an oral diet are also presented. (Journal of Parenteral and Enteral Nutrition 13:84–91, 1989)
Treatment of an Infected Silicone Right Atrial Catheter with Combined Fibrinolytic and Antibiotic Therapy: Case Report and Review of the Literature
Authors: Lewis John A. , Lafrance Richard , Bower Robert H.
Published: May 2008

Tunnelled silicone rubber right atrial catheters are commonly used to administer long‐term total parenteral nutrition (TPN), cancer chemotherapeutic agents, and antimicrobial agents. The indwelling devices potentiate platelet‐fibrin thrombi formation, providing a nidus for infection. Although many episodes of sepsis associated with thrombotic tunnelled catheters respond to antimicrobial therapy alone, a significant number require catheter removal. Evidence from case studies and small clinical trials suggests that fibrinolytic agents may increase the response rate and prevent removal of the device when combined with antimicrobial therapy. We present the first case reported of bacterial sepsis secondary to a thrombotic indwelling Hickman catheter for long‐term TPN successfully treated with a combination of streptokinase and antibiotic therapies. (Journal of Parenteral and Enteral Nutrition 13:92–98, 1989)
Effects of Enterectomy on Postoperative Visceral Organ Glucose Exchange
Authors: Souba Wiley W. , Roughneen Patrick T. , Goldwater Diane L. , Reed R. Lawrence , Rowlands Brian J.
Published: May 2008

The effects of a 60% small‐bowel resection on postoperative visceral organ glucose exchange was studied in order to gain further understanding of the role of the intestinal tract as a supplier of gluconeogenic substrate to the liver following operative stress. We determined the flux of glucose across the gastrointestinal tract, liver, and kidneys in 20 postoperative dogs. With enterectomy portal bloodflow and total hepatic bloodflow were diminished by 33% and 25%, respectively. Arterial glucose was slightly lower in the enterectomized group 6 hr following the operation. Intestinal glucose uptake was diminished by more than 50% in the enterectomized dogs (p < 0.01). Net hepatic glucose release fell from 22 μmole/kg/ min to 8 μmole/kg/min (p < 0.01). In control animals the kidney was an organ of slight glucose uptake while in the enterectomized group, the kidney released glucose at the rate of 4.1 μmole/kg/min (p < 0.05). The data suggest that the gut is an important supplier of gluconeogenic precursors to the liver which are used to support gluconeogenesis in the postoperative period. The ability of the kidney to accelerate glucose production in this setting suggests that metabolic adaptation and cooperation between organs occurs during organ absence or dysfunction which helps preserve glucose homeostasis. (Journal of Parenteral and Enteral Nutrition 13:128–131, 1989)
Nutritional Support in Patients with Systemic Scleroderma
Authors: Grabowski G. , Grant J.P.
Published: May 2008

Systemic scleroderma often involves the gastrointestinal tract and can lead to significant malnutrition. Specialized home nutritional support was provided to five patients (one enteral and four parenteral) with restoration of adequate nutritional status, improved quality of life, and few metabolic or technical complications over a period of 12 to 86 months. Three patients eventually died of their disease, one was converted to an oral diet, and one patient remains dependent on total parenteral nutrition. This experience would recommend consideration of home nutritional support in patients with systemic scleroderma when the disease is relatively stable and no major organ failure is present. (Journal of Parenteral and Enteral Nutrition 13:147–151, 1989)
Iron Nutrition in Childhood Malignancy
Authors: Garcia Maria E. , Van Eys Jan , Wang Y.‐M.
Published: May 2008

Status of iron nutrition along with demographic, anthropometric, dietary, and biochemical parameters were recorded in 98 pediatric cancer patients at the time of referral. Dietary intake in each patient was analyzed for calories, protein, and iron. Blood specimens were analyzed for hemoglobin (Hgb), hematocrit (Hct), iron, total iron‐binding capacity (TIBC), transferrin, and ferritin. Dietary intake measures were assessed according to each subject's Recommended Dietary Allowance (RDA). The results were compared among three diagnostic groups, namely, benign, solid tumor, and hematopoietic. The nutrient lowest in intake was iron. The overall mean RDA for iron was 79.3 ± 55.9. Analysis of laboratory measures revealed significant differences between the benign and hematopoietic groups in all parameters except TIBC and transferrin. A correlation coefficient of 0.55 (p < 10−5 between transferrin and TIBC was generated in our patients. Significant differences were noted for ferritin in the acute lymphocytic leukemia (p = 0.0001) and lymphoma (p = 0.0007) groups when compared with the benign group. A correlation coefficient of 0.55 (p < 10–5) was generated in our patients. A 3‐month follow‐up assessment was conducted in order to document the effects of therapy. Tumor response and progression was compared to changes in ferritin levels from baseline to follow‐up. Our results support the literature, that ferritin is a sensitive tumor marker in various malignancies. (Journal of Parenteral and Enteral Nutrition 13:162–167, 1989)
Plasma Manganese Concentrations in Infants and Children Receiving Parenteral Nutrition
Authors: Hambidge K. Michael , Sokol Ron J. , Fidanza Sara J. , Goodall Marge A.
Published: May 2008

Manganese is excreted primarily via the bile. The objective of this study was to determine if plasma Mn concentrations were elevated in infants and children fed intravenously who developed cholestatic liver disease. An additional aim was to determine the Mn content of intravenous solutions. The study included nine subjects with normal liver function (group A) and five subjects who developed cholestatic liver disease while fed intravenously (group B). Serum total bilirubin in group B had been elevated for 1 wk to 5 months prior to entry into this study. Mean plasma Mn for group A was 0.79 ± 0.18 ng/ml, which was similar to that for adult controls. The mean for group B was 3.06 ± 2.07 ng Mn/ml which was significantly higher (p < 0.005). Plasma Mn was correlated positively with serum total bilirubin (r = 0.874, p < 0.001). In four group B subjects studied longitudinally, plasma Mn declined. This decline was associated with a decline in serum total bilirubin in one subject and both a decline in serum total bilirubin and a reduction in, or a cessation of, supplemental intravenous Mn in two subjects. In the fourth subject, hepatic dysfunction remained severe, but plasma Mn declined to a near normal value after discontinuing supplemental intravenous Mn. The mean Mn contamination in the final intravenous infusate was 5.1 ± 2.1 μg Mn/1. In conclusion, it is recommended that plasma Mn concentrations be monitored in patients fed intravenously who have evidence of cholestatic liver disease. If monitoring is not feasible, Mn supplements should be withheld. (Journal of Parenteral and Enteral Nutrition 13:168–171, 1989)
Blood Levels of Water‐Soluble Vitamins in Pediatric Patients on Total Parenteral Nutrition Using a Multiple Vitamin Preparation
Authors: Marinier E. , Gorski A.M. , Potier De Courcy G. , Criqui C. , Bunodiere M. , Christides J.P. , Bourgeay Causse M. , Brion F. , Ricour C. , Navarro J.
Published: May 2008

Although guidelines for the parenteral use of vitamin preparations in pediatric patients have been published, there are very limited data on the efficiency of these preparations and on the exact needs of infants and children on total parenteral nutrition (TPN). We report here an open, prospective, study of the blood levels of water‐soluble vitamins in infants and children on TPN before and during supplementation with a new water‐soluble multivitamin formula containing per vial unit: B1, 3 mg; B2, 3.6 mg; B6, 4 mg; niacin, 40 mg; pantothenate, 15 mg; ascorbate, 100 mg; biotin, 60 μg; folic acid, 400 μg; B12, 5 μg. Thirteen children, 9 months to 15 yr old, on home TPN for 1.5 months to 7 yr, and 17 hospitalized infants and children, 1 week to 15 yr old, receiving TPN were studied for 2 weeks to 4 months. Daily doses were given according to age: ½ vial if <18 months; 1 vial if > 18 months and < 10 years; 1.5 vials if >10 years. Assays for B1, B2, biotin, niacin, plasma and red blood cell (RBC) folates were performed by microbiologic methods, B12 was measured by radioimmunoassay. During the study, B1 levels were consistently above the upper limit of the normal range, B2 and B12 remained in the normal range although there was a slight decrease in B12 values. Almost half of the patients had initially low levels of biotin, niacin, and folates. Biotin, after a significant sharp rise during the first month of supplementation returned to normal range. Niacin levels were initially low in infants and rose toward normal values during treatment. In contrast, teenage patients had niacin levels consistently above normal range before and during the study. Plasma and RBC folate levels had a 3‐fold increase during the supplementation. Although the prevalence of abnormal vitamin levels in the hospitalized patients was high, the multivitamin formula appeared adequate to restore normal levels of the surveyed vitamins. However, several elevated values suggest that more studies are needed to define a more precise range of vitamin supplementation in the pediatric population. (Journal of Parenteral and Enteral Nutrition 13:176–184, 1989)
Warfarin Resistance and Enteral Feedings
Authors: Martin Jill E. , Lutomski Dave M.
Published: May 2008

Nutritional support via enteral feeding tubes may interfere with the response to medications by a number of mechanisms. A 31‐year‐old, white man was admitted after sustaining a gunshot wound to the chest and mandible. Subsequently, the patient developed pulmonary emboli documented by angiography. Attempts at anticoagulation with oral warfarin were unsuccessful while the patient was receiving 50–100 ml/ hr of Osmolite through an Entriflex feeding tube and intermittent oral Ensure Plus supplements. Discontinuation of the Osmolite resulted in a prompt prolongation of the prothrombin time. The Ensure Plus was continued and adequate prothrombin times were achieved on 7.5 to 10 mg of warfarin daily. The total amount of vitamin K received from the enteral feedings ranged from 50 to 115 μg/day, which is less than the normal daily intake of 300 to 500 μg. Previous reports of warfarin resistance implicated older enteral feeding products with a much higher vitamin K content. Difficulty with anticoagulation may still be experienced with the newer formulations. It is unknown whether the vitamin K content or malabsorption of warfarin is the mechanism of resistance. (Journal of Parenteral and Enteral Nutrition 13:206–208, 1989)
An Alternative Method of Securing Broviac Catheters in Children and Infants
Authors: Goolishian Wade , Konefal Stanley
Published: May 2008

A method of securing broviac catheters in children is described. Instead of passing sutures through a Dacron cuff we use polypropylene mesh to transfix the catheter to the skin. This method offers an easy and effective method of preventing accidental dislodgment. It also offers several advantages over previous methods as there are no additional incisions made and less risk to the catheter. (Journal of Parenteral and Enteral Nutrition 13 :218–219, 1989)
Contaminated Enteral Nutrition Solutions as a Cause of Nosocomial Bloodstream Infection: A Study Using Plasmid Fingerprinting
Authors: Levy Jack , Van Laethem Yves , Verhaegen Godelieve , Perpête Chantal , Butzler Jean‐Paul , Wenzel Richard P.
Published: May 2008

In July 1984, two patients fed enteral nutrition solutions contaminated with Enterobacter cloacae developed nosocomial bacteremia. Despite careful review of the preparation procedures as well as repeated microbiological surveys, 83 (27%) of the 309 formula bottles tested over a 1‐yr period were contaminated and the source of contamination remained unknown. E. cloacae was the most frequent organism isolated (34%). The plasmid profiles of E. cloacae recovered from enteral nutrition solutions remained identical for several months. Blood culture isolates from 10 of the 40 patients who had developed E. cloacae nosocomial sepsis over a 7‐yr period (1979–1985) had plasmid profiles linking them to contaminated enteral nutrition solutions. Epidemiological data from a case control study revealed that these 10 patients were indeed more likely to be exposed to enteral nutrition than the 30 others: 9/ 10 vs 10/30 (odds ratio 18, p = 0.002). Similarly, two of seven nosocomial Klebsiella pneumoniae bacteremias over a 6‐month period in 1986 could be ascribed to administration of contaminated enteral liquid feeds prompting a general policy for using sterile commercially prepared solutions. Our results suggest that contaminated enteral nutrition solutions represent a significant cause of nosocomial sepsis. (Journal of Parenteral and Enteral Nutrition 13:228–234, 1989)