bluuebunny/crossref_metadata_2025 huggingface dataset:
Anabolic steroids support postoperative gut/liver amino acid metabolism
Authors: Souba WW , Goldwater DL , Techtmeyer H , Mossberg K , Copeland EM
Published: May 2008

The effects of an anabolic steroid (nandrolone decanoate, 5 mg/kg) on postoperative splanchnic fuel metabolism were studied in order to gain further understanding of the regulation of the altered gut/liver amino acid metabolism that occurs following catabolic illness. In addition to studying glutamine and alanine, which together transport 60% of whole blood amino acid nitrogen, we determined the fluxes of glutamate and glucose across the gastrointestinal tract and liver in 12 postoperative dogs. Substrate exchange (flux) was calculated by multiplying bloodflow by the arterial‐venous concentration difference for each substrate. Arterial glutamine, glutamate, and alanine were significantly increased in dogs receiving the anabolic steroid (AS) compared to control animals (p less than 0.05). Intestinal bloodflow was unchanged, but gut glutamine uptake doubled in dogs receiving steroids (1.4 +/‐ 0.3 mumol/kg/min in controls vs 2.8 +/‐ 0.7 in AS, p less than 0.05). Simultaneously, gut alanine release was augmented by 100% in dogs receiving steroids (p less than 0.05). Control dogs demonstrated net glutamate release by the gut, while dogs treated with the anabolic steroid demonstrated glutamate balance (p less than 0.05). Liver bloodflow remained unchanged in AS dogs, but hepatic alanine uptake nearly tripled (p less than 0.01) and hepatic glucose production increased by 60% (p less than 0.05). Anabolic steroids appear to support postoperative splanchnic fuel metabolism by increasing blood amino acid levels, enhancing gut/liver amino acid uptake and processing, and augmenting hepatic gluconeogenesis.
Total parenteral nutrition in germfree colostrum‐deprived neonatal miniature piglets: a unique model to study the ontogeny of the immune system
Authors: Mehrazar K , Kim YB
Published: May 2008

In order to investigate the regulatory role of the immune system on gastrointestinal macromolecular permeability in neonates, and ontogeny of the neonatal immune system, we have developed a total parenteral nutrition (TPN) program capable of maintaining immunologically “virgin” germfree (GF) neonatal piglets. GF colostrum‐deprived piglets obtained by aseptic hysterectomy 3–5 days prior to term were denied any oral feeding and maintained on central venous hyperalimentation in the GF isolators. GF piglets were anesthetized and 20‐gauge silicone tubing was inserted into the external jugular vein and advanced to the level of right auricle of the heart. The distal end of the cannula was subcutaneously tunneled out between the shoulders and attached to a light jacket, tether, and swivel assembly that allowed the piglet to move freely inside the cage in a germfree unit. The TPN formula provided 60 Cal/kg/day for the first day and gradually increased up to 165 Cal/kg/day for day‐7 and older piglets. The GF piglets were maintained on the TPN formula for 21 days and weight gain of the GF‐TPN piglets averaged 23 g/day. The hematologic and serum biochemical parameters of GF‐TPN piglets were within the normal range of gnotobiotic animals of their age group. The serum levels of total protein and albumin in the GF‐TPN piglets were significantly less than those of colostrum‐fed piglets, who absorbed a large quantity of the colostral macromolecules through their gastrointestinal tract into the blood stream.(ABSTRACT TRUNCATED AT 250 WORDS)
Splanchnic glucose balance and insulin resistance in the early postoperative phase of cardiac surgery
Authors: Nilsson F , Ekroth R , Milocco I , Nilsson NJ , Svensson S , Berglin E , William‐Olsson G
Published: May 2008

The splanchnic balance of glucose was studied in the basal state and at three levels of “clamped” hyperinsulinemia (260 +/‐ 23, 510 +/‐ 59, 3875 +/‐ 367 mU/liter) in 24 patients (43–70 years of age), who had undergone coronary surgery about 1 hr previously. The splanchnic balance of glucose in the basal state was negative in all patients (‐1.6 +/‐ 0.3 mg/kg/min) and was changed into a zero‐balance within 30 min when 0.15 or 0.3 U/kg/hr of insulin was infused. At an insulin infusion rate of 1.0 U/kg/hr the net splanchnic glucose balance was turned into a significant positive balance of an average 0.9 +/‐ 0.3 mg/kg/min.
Improvement of nutritional measures during preoperative parenteral nutrition in patients selected by the prognostic nutritional index: a randomized controlled trial
Authors: Smith RC , Hartemink R
Published: May 2008

Patients undergoing major gastrointestinal surgery who had a prognostic nutritional index (PNI) score of greater than 30% were randomized to receive a preoperative course of 10 days of intravenous nutrition or to undergo surgery at the next convenient operation list. Two groups of 17 patients were well matched for age, sex, and nutritional status. Although they underwent diverse operations, the extent of these was similar: 12 +/‐ 3 days of parenteral nutrition resulted in weight gain, 3.2 +/‐ 2.3 kg p less than 0.01; increased triceps skinfold, 0.6 +/‐ 1.2 mm p less than 0.05; improved immunological state, p less than 0.02; and improved PNI, 5.5 +/‐ 10.1% p less than 0.05. The changes in serum albumin and transferrin were not significant. There were only three major complications with one death in the treatment group but this was not significantly different from the control group which had six major complications and three deaths. This study suggests that patients with demonstrable nutritional depletion who require major gastrointestinal surgery will benefit from a preoperative course of parenteral nutrition, but to conclusively prove this a large and probably multicentre study will be required.
Hyperbilirubinemia in neonates associated with total parenteral nutrition
Authors: Kubota A , Okada A , Nezu R , Kamata S , Imura K , Takagi Y
Published: May 2008

To identify the factors responsible for total parenteral nutrition (TPN) associated jaundice in the neonate, 77 newborns who had been started on TPN during the past 12 years had their charts reviewed. Forty‐four (57%) of these infants developed jaundice during the 1st month of life. The incidence of jaundice was significantly higher in the presence of those diseases which were associated with impaired intestinal passage such as congenital duodenal atresia, jejunal atresia, etc, and those with an abnormal rotation of the gut such as diaphragmatic hernia, gastroschisis, etc. Thirty‐two (42%) of these 77 infants had accompanying infectious signs, and 28 (88%) of those 32 infants with infectious signs developed jaundice. This incidence was significantly higher than that (36%) among those who had no infectious signs. Of the possible etiologic factors other than infection, neither the length of intrauterine life nor birth weight showed significant correlation with the incidence of jaundice. The incidence of jaundice tended to be higher in infants started on TPN at a younger age. There was no significant correlation between the incidence of jaundice and the duration of TPN or fasting period. Infants receiving 110 cal/kg/day or more during TPN developed jaundice significantly more frequently than those receiving fewer calories. No definite correlation was obtained between the incidence of jaundice and the amount of amino acids administered.
Catheter tip position in central vein thrombosis
Authors: Pithie A , Soutar JS , Pennington CR
Published: May 2008

Clinical central venous thrombosis (CVT) was found to be associated with a catheter tip position in the superior vena cava (SVC), but not in the right atrium (RA), in patients receiving a standard parenteral nutrition regime in which dextrose was the sole energy source. CVT was rare with standard lipid containing three in one mixes, even when the catheter tip lay in the SVC. The reasons for this are discussed and the complications associated with catheter tip position are reviewed.
Two cannula method for parenteral infusion and serial blood sampling in the freely moving rat
Authors: Moslen MT , Kanz MF , Bhatia J , Catarau EM
Published: May 2008

Materials and techniques are described for positioning and exteriorizing two chronic venous cannulas in the rat. A cannula for fluid infusion is placed in the inferior vena cava via the femoral vein and exteriorized on the tail, whereas a cannula for blood withdrawal is placed in the superior vena cava and exteriorized in the scapular region. Grooming behavior and range of motion are not impeded since the cannula used for chronic infusion is shielded by a light‐weight tail cover instead of a torso harness. Application of this method can minimize numbers of rats used in total parenteral nutrition (TPN) studies as demonstrated by our feasibility study in which serum parameters of liver function were serially monitored in toxin‐treated rats infused with nutrient mixtures.
Relationship of Jejunostomy and Urine Polyamine Content to Refeeding and Intestinal Structure and Function
Authors: Thompson Jon S. , Laughlin K.
Published: May 2008

The polyamine content of the intestinal mucosa is increased with mucosal proliferation. Our purpose was to determine if urine and jejunostomy polyamine content increases after refeeding and correlates with intestinal length and carbohydrate absorption after intestinal resection. Five patients with intestinal remnant lengths ranging from 1.5 to 8 feet after intestinal resection and jejunostomy formation were studied after refeeding of an elemental diet. Mean putrescine and spermidine levels in the jejunostomy effluent but not in the urine increased significantly after refeeding (p < 0.05). These changes correlated with intestinal remnant length and carbohydrate absorption. Carbohydrate absorption correlated with polyamine levels in a single patient studied longitudinally. The polyamine content of intestinal fluid may serve as a marker of the status of the intestinal mucosa and may prove useful in the dietary management of individuals with the short bowel syndrome. (Journal of Parenteral and Enteral Nutrition 13:13— 17; 1989)
Energy Expenditure during Severe Acute Pancreatitis
Authors: Bouffard Yves H. , Delafosse Bertrand X. , Annat Guy J. , Viale Jean P. , Bertrand Olivier M. , Motin Jean P.
Published: May 2008

Energy expenditure (EE) was measured, during 3 consecutive days, in six patients suffering from acute pancreatitis. Measurements were achieved postoperatively, under mechanical ventilation, using a mass spectrometer system. EE represented 1.49 times (range: 1.08–1.78) the predicted resting energy expenditure (PREE) according to the reevaluated Harris‐Benedict equation. There was a weak positive correlation between EE and core temperature and a negative correlation between EE and nitrogen balance. EE/PREE was not different between septic and nonseptic patients (1.58 ± 0.06 vs. 1.39 ± 0.07). The calculations of nutrient oxidation rate indicated a high protein catabolic rate, a neoglucogenesis, and a lipolysis. (Journal of Parenteral and Enteral Nutrition 13:26–29, 1989)
Hand Grip Dynamometry as a Predictor of Postoperative Complications Reappraisal Using Age Standardized Grip Strengths
Authors: Webb Andrew R. , Newman Lindsey A. , Taylor Martine , Keogh Jennifer B.
Published: May 2008

A mechanical hand grip dynamometer was used to derive age‐ and sex‐related standard grip strengths from 247 healthy volunteers between 16 and 95 yr old. Preoperative grip strength was measured in 90 patients and related to postoperative complication rates. A grip strength of 85% standard for age and sex was found to be the most effective cut‐off for prediction of postoperative complications in terms of sensitivity and specificity, predicting 74% of the complications (p < 0.05). Specificity is improved over previously published standards related to sex alone especially when assessing the elderly patient (50% vs 21%). A grip strength below the recommended cut‐off for age and sex suggests that the patient is in a high‐risk group and demands further investigation of nutritional status. Studies of pre‐operative nutritional support for the at risk group need to be undertaken. (Journal of Parenteral and Enteral Nutrition 13:30–33, 1989)
Comparison of Forearm Muscle Dynamometry with Nutritional Prognostic Index, as a Preoperative Indicator in Cancer Patients
Authors: Kalfarentzos F. , Spiliotis J. , Velimezis G. , Dougenis D. , Androulakis J.
Published: May 2008

We studied 95 patients with cancer of the gastrointestinal tract in various sites. The aim of the study was to compare the forearm dynamometry vs the prognostic nutritional index which was reported by Busby et al, 1890. We used these methods as preoperative prognostic indicators for postoperative mortality and morbidity. The forearm muscle dynamometry has greater positive predictive value (58.33 vs 32.4%), higher sensitivity (77.78 vs 66.6%), and specificity (86.11 vs 65.28%) than the prognostic nutritional index. The forearm muscle dynamometry predicted the patients mortality with a high rate of sensitivity (100%). The results suggest that dynamometry is a useful, rapid, and inexpensive test. It is more accurate than the nutritional index, and can indentify cancer patients at a high risk of developing major postoperative complications, and predict the postoperative morbidity and mortality. (Journal of Parenteral and Enteral Nutrition 13:34–36, 1989)
Imbalance between Jejunum and Ileum in the Response of Brush Border Hydrolases to Oral Feeding after Intravenous Alimentation in Rats
Authors: Galluser Michel , Doffoel Michel , Lacombe Guy , Raul Francis
Published: May 2008

The effect of oral refeeding after total parenteral nutrition (TPN) on brush border hydrolases was measured in the proximal jejunum and ileum of adult rats. The animals received intravenously for 4 days a mixture of Intralipid 10% and Vamine‐Glucose. At the end of TPN, oral feeding was reinstituted and the rats were fed with an isocaloric standard diet (60% carbohydrate, 17% protein, 3% lipid). Sucrase, isomaltase, lactase, and aminopeptidase N activities were measured at the end of TPN and at 1, 3, and 5 days after TPN. Sham‐operated rats nourished orally with the standard diet were used as controls. In both intestinal segments, lactase activity showed no significant changes at the end of TPN or during oral realimentation. Isomaltase, and especially sucrase activities, exhibited an important drop at the end of TPN. After TPN, a complete restoration of isomaltase and sucrase activities was obtained in the jejunum only. During oral refeeding a 40% deficit in sucrase activity persisted in the ileum throughout the experimental period, whereas normal isomaltase activity was restored in this segment. Aminopeptidase N activity was lowered by TPN and recovered normal values within a few hours after oral realimentation. Thus, reinstitution of oral feeding after TPN should take into account that the intestine is capable of digesting normal amounts of dietary protein but has a reduced tolerance for carbohydrates. (Journal of Parenteral and Enteral Nutrition 13:37–40, 1989)
Stability and Delivery of Vancomycin Hydrochloride When Admixed in a Total Parenteral Nutrition Solution
Authors: Schilling Craig G. , Watson David M. , McCoy Harry G. , Uden Donald L.
Published: May 2008

Vancomycin hydrochloride, 400 mg/liter was mixed in six standard pediatric parenteral nutrition solutions with and without heparin added. The solutions were stored over a period of 8 days (192 hr) under refrigeration and at room temperature. Aliquots from all six solutions were assayed in duplicate for vancomycin at time 0, 24, 96, and 192 hr. All samples were run through an Ivex 0.22‐micron filter, observed for physical incompatibilities, and frozen at —70°C until assay.

Our results indicate that vancomycin was stable and was delivered with loss in concentration of less than 5% with and without storage under refrigeration.

This study suggests an alternative method for delivering vancomycin when treating a catheter‐related infection. If vancomycin is delivered in this fashion, less manipulations of the line would be required. In addition, there may be a theoretical advantage of constantly bathing the catheter with vancomycin when the catheter is suspected of harboring the infecting organism. (Journal of Parenteral and Enteral Nutrition 13:63–64, 1989)
Isotonic Tube Feeding Formula Induces Liquid Stool in Normal Subjects: Reversal by Pectina
Authors: Zimmaro Donna M. , Rolandelli Rolando H. , Koruda Mark J. , Settle R. Gregg , Stein T. Peter , Rombeau John L.
Published: May 2008

Diarrhea is one of the most common complications in patients who receive tube‐feeding formulas. Since the colon is the final site of water and electrolyte absorption and ultimately determines fecal composition, diarrhea during tube feeding may result from altered colonic function. The lack of dietary fiber, such as pectin, in tube‐feeding formulas may be one of the means by which colonic function is affected. The purpose of this study was to determine the effect of a standard, liquid, commercially available, isotonic tube‐feeding formula (ITFF) and the effects of supplementing the ITFF with pectin on colonic function as measured by stool consistency and colonic fluid composition in 13 normal adults. Data were obtained when subjects consumed their regular diet, ITFF, and ITFF supplemented with pectin using the technique of in vivo dialysis of colonic fluid. Ingestion of the ITFF resulted in a significant increase in the percentage of liquid stools compared to a regular diet [median (interquartile range) = 0% (0), 60% (64);p < 0.01]. Ingestion of the ITFF also resulted in significant decreases in the concentrations of sodium, potassium, and short‐chain fatty acids, and increases in pH and osmotic gap in colonic fluid compared to the subjects' regular diet. Supplementing the ITFF with pectin significantly reduced the incidence of liquid stools [0% (0)] and promoted a normalization of colonic fluid composition. The results suggest that the addition of pectin may enhance tolerance to ITFFs. (Journal of Parenteral and Enteral Nutrition (13:117–123, 1989)
Resting Energy Expenditure in Patients with Alcoholic Hepatitis
Authors: John William J. , Phillips Renee , Ott Linda , Adams Linas J. , Mcclain Craig J.
Published: May 2008

Patients with alcoholic hepatitis are typically malnourished. A hypermetabolic state would explain, at least in part, the muscle wasting observed in these patients. However, data on hypermetabolism in liver disease are limited and conflicting. In this study, we evaluated measured energy expenditure (MEE) vs predicted energy expenditure (PEE), and MEE in relation to urinary creatinine excretion in 20 patients with moderate and severe alcoholic hepatitis, and 20 controls. Patients with alcoholic hepatitis had depressed creatinine height index (moderate 66%, severe 78%) demonstrating muscle depletion. Patients with alcoholic hepatitis also had depressed mean serum albumin concentrations, the moderate group 2.6 g/dl and the severe group 2.0 g/dl. The mean values for measured energy expenditure in moderate alcoholic hepatitis patients, severe alcoholic hepatitis patients, and the control group were: 1556 kcal, 1878 kcal, and 1943 kcal, respectively. The mean measured energy expenditures per g of creatinine for the same groups were: 1520 kcal, 1813 kcal, and 1043 kcal, respectively. The mean measured energy expenditure/predicted energy expenditure ratio was not increased in alcoholic hepatitis patients compared to controls. However, when related to urinary creatinine excretion, the alcoholic hepatitis patients had a mean measured energy expenditure that was 55% higher than controls. In conclusion, whereas the measured energy expenditure to predicted energy expenditure ratio was not elevated in alcoholic hepatitis patients compared to controls, the measured energy expenditure per gram of creatinine was significantly increased in alcoholic hepatitis patients, supporting the concept of alcoholic hepatitis as a hypermetabolic state. (Journal of Parenteral and Enteral Nutrition 13:124–127, 1989)
D‐Lactate and Metabolic Bone Disease in Patients Receiving Long‐Term Parenteral Nutrition
Authors: Karton Mitchell A. , Rettmer Rebecca , Lipkin Edward W. , Ott Susan M. , Chait Alan
Published: May 2008

D‐lactate accumulates in some patients with malabsorption who continue oral intake of carbohydrate leading to a clinical syndrome of acidosis and encephalopathy. To assess the possibility that D‐lactate contributes to acidosis and/ or metabolic bone disease in patients with malabsorption receiving long‐term parenteral nutrition yet maintaining oral intake, D‐lactate levels in serum and urine were measured in 14 long‐term parenteral nutrition subjects (average duration of support 74 months) and 27 control subjects. Significant elevations in both serum and urine D‐lactate were found in only two parenteral nutrition subjects. Both subjects with elevated D‐lactate levels had bone pain, x‐ray evidence of fractures, and biopsy evidence of osteomalacia. These studies suggest that D‐lactate accumulation may be a heretofore unappreciated metabolic abnormality associated with metabolic bone disease and acidosis in patients with malabsorption who are supported by long‐term parenteral nutrition. (Journal of Parenteral and Enteral Nutrition 13:132–135, 1989)
Impact of Fat and Glucose Administration on Metabolic and Respiratory Interactions in Sepsis
Authors: Giovannini Ivo , Chiarla Carlo , Boldrini Giuseppe , Castagneto Marco
Published: May 2008

Metabolic and respiratory interactions were analyzed in a large group of septic patients (S) and in a reference group of nonseptics (NS) during the iv administration of glucose and fat. In spite of a moderate increase in CO2 production (VCO2) observed during the administration of fat in S, a VCO2‐sparing effect of fat, with respect to equicaloric amounts of glucose, was reconfirmed. The relevance of the therapeutic modulation of CO2 production during parenteral nutrition, and the relative impact on the abnormal septic respiratory patterns, were emphasized by analyzing the physiological relationships and mechanisms responsible for the increase in respiratory work in sepsis. (Journal of Parenteral and Enteral Nutrition 13:141–146, 1989)
Nutritional Repletion in Malnourished Patients with Emphysema
Authors: Otte K.E. , Ahlburg P. , D'Amore F. , Stellfeld M.
Published: May 2008

We examined the effect of nutritional supplementation for 13 wk on anthropometric, pulmonary function, and immunological status in malnourished ambulant patients with pulmonary emphysema (EP). The study was placebo controlled, randomized and double blind. Twenty‐eight patients were included. Thirteen patients in the fed group were provided with a nutritional formula providing 20% protein, 30% fat, and 50% carbohydrate, 1 Kcal/ml, 400 ml/day. The control group was provided with a reference product of the same consistency and taste containing 0.1 Kcal/ml, 400 ml/day for 13 wk. The fed group had a mean weight gain of 1.5 kg during the study period, the control group increased concomitantly 0.16 kg, the difference being significant (p < 0.01). Sum of four skinfolds increased 2.7 mm in the fed group, and decreased 0.9 mm in the control group the difference being significant (p < 0.01). No difference were observed regarding pulmonary function or immunological status. We also found a high habitual energy intake in our study group (204% Basal Energy Expenditure). We conclude that nutritional supplementation produce weight gain in malnourished patients with EP, but it does not change other indices of well‐being. (Journal of Parenteral and Enteral Nutrition 13:152–156, 1989)
Review: Amino Acid Metabolism in Thermal Burns
Authors: Cynober Luc
Published: May 2008

Burn injury induces time‐dependent variations in plasma amino acids, ie, an initial hyperaminoacidemia reflecting proteolysis in the wound areas, a decrease in gluconeogenic amino acids a consequence of excessive utilization in the liver, and a progressive return to normal. There is also a durable hyperphenylalaninemia, reflecting increased protein turnover and specific alterations of sulfur amino acids. In burned rats, the same general pattern is observed, except that glycine rather than alanine and glutamine exhibits the largest variations. Improvements in nutritional support with regard to the amino acid composition of diets are envisaged. (Journal of Parenteral and Enteral Nutrition 13:196–205, 1989)
Pulmonary Deposition of Calcium Phosphate Crystals as a Complication of Home Total Parenteral Nutrition
Authors: Knowles Jarol B. , Cusson Gil , Smith Marilyn , Sitrin Michael D.
Published: May 2008

A patient on home total parenteral nutrition (TPN) developed a diffuse granulomatous interstitial pneumonitis secondary to calcium phosphate deposition. Calcium and phosphorus concentrations in the TPN formula were not unusually high, indicating that other factors contributed to calcium phosphate crystallization. The effects of duration of storage of the TPN formulation, solution temperature, pH, and magnesium concentration on calcium phosphate precipitation are discussed. (Journal of Parenteral and Enteral Nutrition 13:209–213, 1989)
Relative Importance of Amino Acid Infusion as a Means of Sparing Protein in Surgical Patients
Authors: Humberstone David A. , Koea Johnathan , Shaw James H.F.
Published: May 2008

We performed isotopic infusions in 51 surgical patients to investigate the effectiveness of different substrates to conserve protein. All patients were initially studied in the basal state and then the effects of glucose infusion (GL, N = 13), lipid infusion (LIP, N = 11), or amino acid infusion (AA, N = 17) were determined. Ten patients receiving total parenteral nutrition (TPN) were also studied. The basal value for net protein catabolism (NPC) in GL patients was 1.53 ± 0.4 (SEM) g/kg/day decreasing to 1.39 ± 0.4 g/kg/day during glucose infusion (p < 0.01). The basal NPC in the LIP group was 2.04 ± 0.4 g/kg/day decreasing to 1.72 ± 0.3 g/kg/day during lipid infusion (p < 0.01). In the TPN patients the NPC was 0.79 ± 0.46 g/kg/day whereas in the AA patients the basal value for NPC was 1.37 ± 0.14 g/kg/day decreasing to ‐0.77 ± 0.11 g/kg/day during amino acid infusion (p < 0.0005). From our study we conclude that: (1) All substrates commonly used in intravenous feeding have the capacity to spare protein. (2) Protein sparing was more pronounced when a balanced amino acid infusion was used than with either glucose or lipid infusion alone. (3) This effect is not solely due to insulin secretion as larger insulin responses were seen with both GL and TPN patients. (4) These results may have implications for peripheral vein feeding with amino acid solutions where there is a contraindication for full TPN or the lack of resources for administering it. (Journal of Parenteral and Enteral Nutrition 13: 223–227, 1989)
In Vivo Biliary Function in the Adult Rat: The Effect of Parenteral Glucose and Amino Acids
Authors: Rivera Audelio , Bhatia Jatinder , Rassin David K. , Gourley William K. , Catarau Elena
Published: May 2008

Parenteral glucose and glucose‐amino acid mixtures are used in the nutritional support of infants, children, and adults when enteral feedings are precluded for any reason. During the first week of such nutritional support, the total energy intakes are generally low and glucose and electrolytes are the only nutrients provided. To assess the effects of such “hypocaloric” regimens, we determined the hepatic responses to parenteral infusions of either glucose or glucose‐amino acid mixtures in rats. Further, to illustrate the magnitude of these changes in comparison to normally fed animals, we included a group of sham‐operated, chow‐fed rats. Bile flow, biliary bile acid output, bile osmolarity, serum bile acids, and plasma amino acids were measured in adult rats following 5 days of the respective dietary regimens. Liver histology was also assessed. Bile acid output, but not bile flow, was significantly decreased by the infusion of glucose compared to glucose‐amino acid mixtures. However, in comparison to the chow‐fed rats, bile acid output was significantly reduced in both groups of parenterally fed animals, whereas bile flow was significantly reduced only in the glucose‐infused animals. Plasma amino acids were markedly different between the groups; concentrations of essential amino acids were greater in the glucose‐amino acid infused animals than in the glucose infused animals. Nonessential gluconeogenic amino acids were significantly higher in the glucose‐infused animals compared to the other groups; plasma valine was significantly lower in the glucose‐infused animals reflecting the lack of protein intake. Liver histology was markedly abnormal in all of the glucose‐infused animals, whereas only half the glucose‐amino acid infused animals had abnormal pathology. Our data indicate that adverse effects on hepatic function are induced by the infusion of glucose alone in the rat; further, the addition of amino acids to the infusion of glucose appears to decrease some of these adverse effects. Data in sham‐operated, chow‐fed animals indicate the magnitude of change in hepatic function due to the parenteral infusions. We hypothesize that the use of glucose and electrolytes alone for extended periods of time prior to the introduction of amino acids may increase the possibility of hepatic dysfunction in response to parenteral nutrition. (Journal of Parenteral and Enteral Nutrition 13:240–245, 1989)
Vitamin Prescriptions on a Hospital General Medical Ward: Results of a Drug Utilization Review
Authors: Alto Benzel Renee , Lipman Timothy O.
Published: May 2008

Records of 103 consecutive admissions to a general medical ward over 4 months in a Veterans Administration Medical Center were reviewed. Assessment was made of nutritional status and potential need for supplemental vitamin therapy based upon predetermined criteria. Thirty‐five of the 103 patients received one or more vitamin supplements. No patient received unnecessary vitamins as defined by our criteria. However, 48 patients had indications for vitamin supplementation, but did not receive any. Analysis of data by indication for vitamin therapy revealed 125 indications for vitamin therapy in 83 patients. Of the 125 indications 54 were treated appropriately, but there were no vitamin prescriptions in 71 indicated instances. We conclude that indicated vitamin supplementation may be underutilized in hospitalized general medical patients. (Journal of Parenteral and Enteral Nutrition 13:262–264, 1989)
Reduction of 24‐Hour Gastric Acidity by Different Dietary Regimens: A Randomized Controlled Study in Healthy Volunteers
Authors: Hopert Rüdiger , Liehr Ralph‐Marco , Emde Carsten , Riecken Ernst‐Otto
Published: May 2008

Evidence from animal experiments suggests that intraduodenal infusion of nutrients leads to an inhibition of gastric acid secretion via an enterogastric feedback mechanism. Detailed data are lacking, however, on the difference in circadian gastric acidity between gastric and intraduodenal alimentation in man. We conducted a randomized study in 10 healthy volunteers (5 men, 5 women, age 22–30 yr). From 8:00 am of the first study day until 4:00 pm of the next day, either a standardized normal meal or a liquid polymer diet (Fresubin) was given orally at 8:00 am, noon, and 6:00 pm. In a third experiment, a liquid hydrolysed diet (Survimed OPD) was continuously applied to the duodenum using a portable pump. Daily caloric intake and main nutrient components were comparable in all three diets. From 2:00 pm of the first day until 4:00 pm of the next day, an intragastric pH‐metry was performed with a combined glass pH‐electrode in the gastric corpus. Median pH‐values from predefined time periods (whole day, prandial, interdigestive, nocturnal) were compared between the three groups.

The orally applied liquid polymer diet led to a significantly stronger increase in 24‐hr and prandial gastric pH than the normal diet. Twenty‐four‐hr, interdigestive, and nocturnal pHmedian values were significantly higher during continuous intraduodenal application of the liquid hydrolysed diet than during the normal diet. (Journal of Parenteral and Enteral Nutrition 13:292–295, 1989)
Enteral Feeding Contamination: Comparison of Diluents and Feeding Bag Usage
Authors: Perez Susan Kimura , Brandt Karen
Published: May 2008

This quasi‐experimental study compared bacterial growth in enteral feeding solution in six Kangaroo feeding bags filled with enteral formula diluted with sterile water vs six of the same diluted with tap water. Feeding bags, which were on continuous pumps in patient‐occupied rooms, were rinsed and refilled every 8 hours, and formula cultures were obtained at 0, 24, and 48 hr. Acceptability of cultures was based on published recommended standards.

Low levels of nonpathogenic staphylococci were found in sterile water bags; high levels of bacilli and Gram negative rods were found in tap water bags. No significant differences were found in the relationship between type of formula diluent and outcomes. Type of water diluent and acceptability were not related. There was a systematic relationship between length of use and outcome; with both diluents, bags used over 24 hr became unacceptably contaminated. Further study with a larger sample is needed to determine the effects of using tap water rather than sterile water as diluent. (Journal of Parenteral and Enteral Nutrition 13:306–308, 1989)
Perforation by Central Venous Catheters: A New Testament to an Old Test
Authors: Malenka David J. , Ross Jonathan M.
Published: May 2008

Perforation by central venous catheters into the extravascular space is a rare complication of central venous lines that may explain new onset shortness of breath in hospitalized patients. We found that lowering bottles containing infusate and looking for return of venous blood is a highly specific test for this problem. Using Bayes' Theorem we calculated that for prior probabilities of catheter perforation of 0.01 and 0.05, corresponding posterior probabilities ranged from 0.1 to 0.15 and 0.35 to 0.49 respectively. This test should be used in all patients with new shortness of breath who have central venous catheters. (Journal of Parenteral and Enteral Nutrition 13:309–311, 1989)
Respiratory Insufficiency in Acid Maltase Deficiency: The Effect of High Protein Diet
Authors: Demey H.E. , Van Meerbeeck J.P. , Vandewoude M.F.J. , Prové A.M. , Martin J.J. , Bossaert L.L.
Published: May 2008

A 27‐yr‐old woman with the myopathic form of acid maltase deficiency (AMD) developed severe respiratory insufficiency after a crash diet resulting in a 6‐kg weight loss. While being maintained on home ventilation, an hypercaloric high‐protein, low‐carbohydrate diet (1800–2000 cal; 28% carbohydrates, 55% fat, 17% protein with 1.7 g protein/kg body weight) was instituted. This ameliorated her condition up to a level where useful life was possible and ventilation could be diminished. (Journal of Parenteral and Enteral Nutrition 13:321–323, 1989)
Functional Duodenal Obstruction (Superior Mesenteric Artery or Cast Syndrome) in Cerebral Palsy
Authors: Vaisman Nachum , Stringer David A. , Pencharz Paul
Published: May 2008

An 8‐yr‐old girl with cerebral palsy who was chronically malnourished presented with functional duodenal obstruction (superior mesenteric artery or cast syndrome) proven by barium meal. Six months of feeding through a fluoroscopically positioned gastrojejunal tube generated sufficient weight gain and increase in body bulk to cure the functional obstruction. (Journal of Parenteral and Enteral Nutrition 13:326–328, 1989)
Pentobarbital Improves Nitrogen Retention in Sepsis
Authors: Dickerson Roland N. , Fried Robert C. , Daniel Melba Gibson , Stein T. Peter , Mullen James L. , Buzby Gordon P.
Published: May 2008

Pentobarbital therapy has been associated with decreased urinary nitrogen excretion and resting energy expenditure in stressed patients. The metabolic effects of pentobarbital in sepsis were investigated in 29 well‐nourished rats who underwent superior vena caval cannulation, cecal ligation, and puncture. Animals were randomly assigned to receive either a continuous infusion of 20 mg/kg/day of pentobarbital combined with parenteral nutrition (n = 13) or parenteral nutrition alone (n = 16). Both groups received isocaloric, isonitrogenous parenteral nutrition postoperatively for 24 hr. Mean nitrogen balance (±SEM) was better in the pentobarbital group (+169 ± 76 mg/kg/day us ‐190 ± 66 mg/kg/day, p < 0.01). No significant differences between the pentobarbital and control groups were noted for urinary 3‐methylhistidine excretion (9 ± 0.7 μg/kg/day us 11 ± 0.6 μg/kg/day, respectively) or 24 hr survival (77% vs 69%, respectively). Pentobarbital improves nitrogen retention without decreasing urinary 3‐methylhistidine excretion in septic rats. (Journal of Parenteral and Enteral Nutrition 13: 359–361, 1989)
Changes in Liver Function Tests in Patients with Inflammatory Bowel Disease on Enteral Nutrition
Authors: Dolz Carles , Xiol Xavier , Abad Agueda , Cabré Eduard , González‐Huix Ferrán , Giné Josep J. , Gassull Miquel A.
Published: May 2008

Morphologic and functional hepatic changes occur in inflammatory bowel disease (IBD). Patients with this disease often require the administration of artificial nutritional support. Liver function tests (LFT) derangement is a widely recognized side‐effect of total parenteral nutrition (TPN). Therefore, the use of this modality of nutritional support may be an additional factor to cause hepatic damage in IBD patients. However whether or not the same occurs in patients receiving total enteral nutrition (TEN) is not well‐established. The aim of the present study was to evaluate the effect of TEN upon LFT in patients with moderate to severe acute attacks of IBD, by means of a prospective, controlled, and nonrandomized design. Forty‐nine patients were included; 29 (11 patients with ulcerative colitis and 18 with Crohn's disease) received TEN, and 20 (11 with ulcerative colitis and 9 with Crohn's disease) did not. Both groups were homogeneous regarding age, sex, disease activity index, nutritional status, and length of the study (24.8 ± 1.3 vs 23.9 ± 16.8 days). In all cases, weekly measurements of serum alkaline phosphatase, GOT, and GPT were performed. There were no significant differences in LFT at the beginning of the study between groups. The percentage of patients showing derangement of some LFT during the study did not differ between both groups: six of 29 (20.6%) in TEN group vs three of 20 (15%) in control group. Six out of the nine patients (in both groups) who developed LFT derangement had one or more causes, other than TEN for explaining hepatic dysfunction. Only in three patients (one in the control group and two in the TEN group) could no other cause, apart from TEN and/or IBD itself, be found to explain the impairment in LFT. Nevertheless, this was mild and did not require either the performance of liver biopsy or the suppression of TEN. These results suggest that, in contrast to TPN, TEN does not imply an additional risk for liver damage in IBD patients. Therefore, TEN can only be blamed for producing LFT derangement when other causes linked to IBD, its complications, and its treatment have been carefully ruled‐out. (Journal of Parenteral and Enteral Nutrition 13:401–405, 1989)
Osteomyelitis of the Clavicle Secondary to Infected Hickman Catheter
Authors: Kravitz Alan B.
Published: May 2008

A patient receiving home parenteral nutrition developed osteomyelitis of the clavicle associated with a Hickman catheter which had been functioning for 14 months. The infection was treated with bone curettage, parenteral antibiotics, and catheter removal. Although this has been a reported complication of subclavian vein catheters, this is the first reported case associated with a Hickman catheter. (Journal of Parenteral and Enteral Nutrition 13:426–427, 1989)
A Simple Method of Repositioning the Wayward Central Venous Catheter
Authors: Kayal Thomas J. , Salloum Leslie J. , Snyder Averel B. , Barone James E.
Published: May 2008

Malposition of a central venous catheter occurs despite improvements in catheter design and regardless of the skill of the physician. A simple method of repositioning a central venous catheter has been successful in 25 of 25 attempts. Documentation of the rationale for the use of this technique is provided using x‐rays. (Journal of Parenteral and Enteral Nutrition 13:438–439, 1989)
Gallstone Disease in Patients with Severe Short Bowel Syndrome Dependent on Parenteral Nutrition
Authors: Manji Nasrullah , Bistrian Bruce R. , Mascioli Edward A. , Benotti Peter A. , Blackburn George L.
Published: May 2008

An increased incidence of gallbladder disease is seen in patients receiving long‐term parenteral nutrition (PN). Stasis is thought to play a key role in the development of gallbladder sludge and gallstone formation. The highest incidence of gallbladder disease, by previous reports, is seen in patients with terminal ileal disease or resection. Since PNdependent patients with severe short bowel syndrome secondary to mesenteric vascular accident have both gallbladder stasis and massive small bowel resection, a retrospective study was undertaken to evaluate the incidence of symptomatic gallbladder disease in this group. Of 11 patients followed over 9 years, five met the inclusion criteria of less than 60 cm of bowel remaining, receiving PN for longer than 6 months and the initial presence of a gallbladder. All five patients developed symptomatic gallbladder disease manifested by cholecystitis or pancreatitis. Factors contributing to gallbladder stasis included poor oral intake and use of anticholinergic and analgesic drugs. Gastric hypersecretion indirectly contributed to decreased oral intake as a means to minimize stool output. As these patients often require several laparotomies during the initial hospitalization, consideration should be given to performing prophylactic cholecystectomy, especially when the potential mortality and morbidity of emergent cholecystectomy done for symptomatic gallbladder disease is taken into account. (Journal of Parenteral and Enteral Nutrition 13:461–464, 1989)
Comparison of Isomolar vs Hyperosmolar Enteral Diets in Experimental Ileus
Authors: Brolin Robert E. , Reddell Michael T. , Cody Ronald P.
Published: May 2008

The diarrhea observed after infusing hypertonic enteral alimentation solutions may be due to the high osmolality. We compared Vivonex HN (810 mOsm) to Osmolite (300 mOsm) in two canine ileus models. After having bipolar electrodes inplanted in the stomach, duodenum, jejunum, and colon, four dogs sequentially underwent operations to produce intestinal obstruction (SBO) or perforation/peritonitis (PER). The SBO was released and the perforation closed 24 hr later. GI myoelectric activity (MEA) was monitored during the first 4 postoperative days and again on the 10th day to determine steady‐state MEA. Fasting MEA was recorded for 1 hr, followed by 1‐hr recordings after intragastric cannula infusion of either Vivonex HN or Osmolite. There was no significant difference in MEA produced by Osmolite us Vivonex at any recording site. The 24‐hr postop gastric and small bowel MEA was significantly decreased (p < 0.05) us postoperative days 2 to 4 and 10 under both fasting and fed conditions. The ileus operations had no effect on colonic MEA. These data show that SBO and PER cause significant decreases in gastrointestinal MEA for 24 hr. There was no difference in MEA response of Osmolite us Vivonex HN. These results suggest that infusion of hypertonic enteral alimentation solutions does not produce increases in GI myoelectric responsiveness us isotonic solutions. (Journal of Parenteral and Enteral Nutrition 13:465–470,1989)
Immediate Stimulation of Protein Metabolism in Burned Rats by Total Parenteral Nutrition Enriched in Branched‐Chain Amino Acids
Authors: Mori Eigo , Hasebe Masaharu , Kobayashi Kunio , Suzuki Hiromasa
Published: May 2008

The effects of two kinds of total parenteral nutrition (TPN) on energy and protein metabolism were examined in rats subjected to 15% full‐thickness scald burns in the absence of septic complications. One type of TPN was enriched in branched‐chain amino acids (BCAAs), especially leucine (45% BCAA content), and the other was conventional TPN (21% BCAA content). Burned rats received isocaloric and isonitrogeneous TPN solutions for 48 hr after resuscitation by saline infusion for 24 hr. Liver and rectus abdominis muscle were removed from the rats at 7, 24, 48, and 72 hr. The concentrations of adenine nucleotides, RNA, protein, glucose‐6‐phosphate, hepatic glycogen, muscle phosphocreatine, and 3‐methylhistidine were determined. Metabolic alterations occurred during the period of saline resuscitation (0–24 hr). At 48 hr the RNA and protein levels were significantly more improved in the BCAA‐TPN group than in the conventional TPN group. At 72 hr, however, the results for the two groups were similar in most metabolite levels. Thus, BCAA‐TPN enriched in leucine rapidly stimulated protein synthesis in the liver and muscle. This rapid effect may make it useful during the initial nutritional management of severe trauma patients. (Journal of Parenteral and Enteral Nutrition 13:484–489,1989)
Decrease of Polyunsaturated Fatty Acids and Elevation of the Oleic/Stearic Acid Ratio in Plasma and Red Blood Cell Lipids of Malnourished Cancer Patients
Authors: Mosconi Cristina , Agradi Elisabetta , Gambetta Achille , Bozzetti Federico , Galli Claudio
Published: May 2008

The fatty acids profiles of plasma and red blood cell lipids have been evaluated in 12 malnourished cancer patients in comparison with samples from eight healthy controls. In such patients, significantly lower levels of linoleic acid (LA) as percentage of total fatty acids were observed in plasma phospholipids (PL) and cholesterol esters (CE), and in red blood cells PL. The levels of arachidonic acid (AA) and the unsaturation index of the two lipid classes were also reduced in plasma CE but not in PL. In spite of the marked reduction of LA and, more generally, of total polyunsaturated fatty acids (PUFA), no elevation of eicosatrienoic acid (20:3 n‐9) was observed, such acid being considered a typical index of essential fatty deficiency. Moreover, no modification of the parameters indicating impairment of the fatty acid desaturation activity was shown. In addition, the levels of palmitic and oleic acids were significantly higher in both plasma PL and CE and in red blood cells PL.

The reported elevation of the oleic to stearic acid ratio in lipids of red blood cells from malnourished cancer patients, already observed by other authors, was confirmed in our study. This ratio was even more markedly elevated in plasma lipids of the patients. A very good correlation was found between the reduction of linoleic acid levels, especially in plasma CE, and weight loss, suggesting enhanced utilization of this fatty acid in association with extensive depletion of lipid stores, in this pathological state. (Journal of Parenteral and Enteral Nutrition 13:501–504, 1989)