bluuebunny/crossref_metadata_2025 huggingface dataset:
Malposition of a Total Parenteral Nutrition Catheter in the Accessory Hemiazygos Vein
Authors: Smith Douglas C. , Pop Peter M.
Published: May 2008

A total parenteral nutrition catheter was surgically introduced into the left cephalic vein of a 31‐yr‐old man with regional enteritis. After placement, a frontal radiograph indicated malplacement of the catheter. Its left vertical para‐median position indicated a left internal thoracic vein, a persistent left superior cava, or a left superior intercostal‐accessory hemiazygos vein position. The left internal thoracic vein is very anterior within the thorax, a persistent left superior vena cava is centrally located, and the left superior intercostal‐accessory hemiazygos vein is quite posterior. A lateral radiograph revealed a markedly posterior catheter course, with its tip at the level of the vertebral bodies. A venogram confirmed its location within the left superior intercostal‐hemiazygos vein. The catheter was removed and replaced. After placement of all total parenteral nutrition catheters, a chest radiograph should be obtained. A single frontal film is usually adequate; if not, a supplemental lateral view may be taken. If uncertainty still exists, a venogram through the catheter may be obtained for precise localization.
Reversal of Biochemical and Functional Abnormalities in Erythrocytes Secondary to Selenium Deficiency
Authors: Baker Susan S. , King Walter W.K. , Michel Luc , Wood William C. , Malt Ronald A. , Cohen Harvey J.
Published: May 2008

A patient with multiple enterocutaneous fistulae on total parenteral nutrition for 14 months developed low erythrocyte selenium and low erythrocyte glutathione peroxidase. Erythrocyte hexose monophosphate shunt activity stimulated with an H2O2 generating system was approximately one‐fourth that of control. Hexose monophosphate shunt activity stimulated with methylene blue showed little difference between patient and control. With selenium supplementation erythrocyte selenium, glutathione peroxidase, and hexose monophosphate shunt activity became normal. Thus, the biochemical and functional consequences of selenium deficiency can be corrected with selenium supplementation.
An Improved Fine Needle Catheter Introducing Set for Safer Central Vein Cannulation
Authors: Cope Constantin
Published: May 2008

The serious clinical complications of central venous catheterization are mostly due to laceration of vital thoracocervical structures by large caliber introducing needles. A new percutaneous sheath catheter introducing kit requiring only a 21‐gauge needle for its introduction has been devised for the purpose of significantly reducing the incidence of life‐threatening pneumothoraces and arterial injuries.
Enteral Nutrition in Malnourished Patients with Hepatic Cirrhosis and Acute Encephalopathy
Authors: Keohane P.P. , Attrill Helen , Grimble G. , Spiller R. , Frost P. , Silk D.B.A.
Published: May 2008

Ten patients with histologically proven cirrhosis, admitted in grade I to III acute hepatic coma, received in addition to a standard dietary protein free “anticoma” regime, a continuous nasogastric infusion of a branched‐chain amino acid enriched chemically defined enteral diet (Hepaticaid) containing an equivalent of 70 g protein/day for a mean of 7.3 days (range 3–23). No complications of therapy were observed and, specifically, the use of fine bore tubes did not provoke variceal hemorrhage. Overall positive nitrogen balance (4.3 ± 1.7 g N/ day) was observed in patients fed 7 or more days. Improvement to coma grade 0 was seen in all patients save one, who died from hepatorenal failure. While serum ammonia levels remained elevated during the study period, there was a significant increase in the branched‐chain/aromatic ratio (p < 0.01) as plasma branched‐chain amino acids rose (p < 0.05) and tryosine levels fell (p < 0.05). (Journal of Parenteral and Enteral Nutrition 7:346–350, 1983)
Plasma Amino Acid Concentrations in Newborn Infants during Parenteral Nutrition
Authors: Andersen Gunnar E. , Bucher Ditlef , Frs‐Hansen Bent , Nexø Ebba , Olesen Henrik
Published: May 2008

Amino acid substance concentrations in plasma have been measured during total and partial parenteral nutrition with Vamin in 12 seriously ill newborn infants. When plasma amino acid concentrations were compared to the levels in reference infants, 11 of 21 were low, among the 11 were seven essential amino acids (Arg, Cys, Ile, Leu, Lys, Thr, Tyr), while concentrations above the reference median and range occurred for seven amino acids. For three (Asp, Glu, Phe) levels were exceptionally high. From these findings, from studies by others on amino acid levels during parenteral nutrition with Vamin, and from amino acid needs judged from venous‐arterial differences in newborns, an amino acid preparation for parenteral administration to newborn infants is suggested. (Journal of Parenteral and Enteral Nutrition (7:369–373, 1983)
Feeding Stoma Surgery on a Nutritional Support Service
Authors: Peters Thomas G. , Jackson Anthony W. , Luther R. Wayne
Published: May 2008

Thirty patients undergoing feeding stoma operation over a 2½ yr period were managed by the nutritional support service. The policy of preoperative nutritional support of these generally ill and malnourished patients contributed to operative survival and discharge from the hospital for 23 patients; only one death 21 days postoperatively was directly attributable to the feeding stoma procedure. Nonfatal complications of the surgery occurred in nine cases, and required reoperation in three instances. Early stoma use was the rule, and there were 10 documented cases of long‐term stoma use averaging 14 months. Three‐month survival of 19 patients (63%), and six‐month survival of 13 patients (43%) along with early discharge from the hospital for most patients attest to efficacy and ease of stoma use. An essential feature contributing to diminished postoperative problems was prestoma surgery nutritional support. Continuity of feeding stoma planning and patient care may be best achieved when a nutritional support service is involved through the entire course of management. (Journal of Parenteral and Enteral Nutrition 7: 374–377, 1983)
Parenteral Nutrition and Nutritional Support in Veterans Administration Medical Centers
Authors: Lipman Timothy O. , Munyer Thomas O. , Hall Charles
Published: May 2008

Two surveys eliciting information regarding parenteral nutrition and nutritional support in Veterans Administration Medical Centers were performed in 1981. Of 133 answering Veterans Administration Medical Centers, 45% had nutritional support teams. Two‐thirds of these nutritional support groups were reported to be active. If an attempt to assess the quality of these programs is made by establishing performance criteria, then 23 medical centers have active and well‐functioning nutritional support programs. (Journal of Parenteral and Enteral Nutrition 7:385–386, 1983)
Gastrointestinal Disorders Caused by Medication and Electrolyte Solution Osmolality during Enteral Nutrition
Authors: Niemiec Paul W. , Vanderveen Timothy W. , Morrison John I. , Hohenwarter Mark W.
Published: May 2008

Enteral feeding tubes represent convenient avenues for medication administration and electrolyte replacement. The frequent association of medication therapy with gastrointestinal disorders during enteral nutrition prompted this evaluation of medication and electrolyte solution osmolality. It is concluded that the hypertonicity of electrolyte replacement solutions and various medications may cause gastrointestinal intolerance in patients. Electrolyte supplementation by parenteral means or by appropriate dilution and mixture with an enteral formula is preferable to bolus administration of undiluted solutions via the feeding tube. Routine admixture of medications such as antibiotic suspensions to enteral formulas cannot be recommended at this time pending specific study of drug compatibility and availability from enteral tube feeding systems. (Journal of Parenteral and Enteral Nutrition 7:387–389, 1983)
Home Parenteral Nutrition Via Arteriovenous Fistulae
Authors: Engels L.G.J. , Skotnicki S.H. , Buskens F.G.M. , Van Tongeren J.H.M.
Published: May 2008

Vascular access for home parenteral nutrition was achieved with arteriovenous fistulae during an average 14.3 months in seven patients. Two Cimino fistulae and six bovine grafts were used. The only complication was bovine graft thrombosis which occurred in six instances despite anticoagulant therapy. Thrombectomy could successfully be performed in three graft thrombosis. Considering complication rates arteriovenous fistulae are valuable alternatives for central venous catheters in long‐term parenteral nutrition at home. (Journal of Parenteral and Enteral Nutrition 7:412–414, 1983)
Stability of the B Vitamins in Mixed Parenteral Nutrition Solution
Authors: Chen Marianne F. , Worth Boyce H. , Triplett Linda
Published: May 2008

The effects of various light conditions such as fluorescent light, and indirect and direct sunlight on the stability of the water‐soluble B vitamins in parenteral mixtures were studied. The levels of the B vitamins were determined by microbiologic assays and spectrophotometrically. Most of the B vitamins were found to be stable. However, indirect and direct sunlight destroyed 47 and 100%, respectively, of riboflavin‐5‐phosphate in eight hours. Direct sunlight destroyed 86% of pyridoxine HCl. There was no loss of folic acid in parenteral nutrition mixtures after storage for 7 wk. The microbiologic assays were found to be reliable to measure the levels of the B vitamins in parenteral nutrition solution. (Journal of Parenteral and Enteral Nutrition 7:462–464, 1983)
Jejeunal Variceal Hemorrhage: An Unusual Complication of Needle Catheter Jejeunostomy
Authors: Edington Howard , Zajko Albert , Reilly James J.
Published: May 2008

Needle catheter jejeunostomy is a useful method for providing fluid and nutritional support in selected patients after laparotomy. The technique is widely used, and complications are infrequent. We report herein a new complication of this procedure. A cirrhotic patient with portal hypertension underwent needle catheter jejeunostomy subsequent to esophageal transection for esophageal hemorrhage. The catheter functioned satisfactorily in the postoperative period and was removed before discharge. Approximately 1 yr later, gastrointestinal hemorrhage recurred which was localized to the site of the previous needle catheter jejeunostomy. Portasystemic collaterals between the small bowel and the abdominal wall at the jejeunostomy were the source of bleeding. Take‐down of the jejeunostomy site and resection of the involved bowel successfully controlled hemorrhage. Needle catheter jejeunostomy may be contraindicated in patients with portal hypertension. (Journal of Parenteral and Enteral Nutrition 7:489–491, 1983)
Monitoring Parenteral Nutrition Intraoperatively with the Dextrometer
Authors: Thompson Jon S. , Chapin James W. , Brown Gregory L.
Published: May 2008

Patients receiving parenteral nutrition support frequently undergo operative procedures. Proper selection of patients and close monitoring of glucose levels are crucial if parenteral nutrition is to be maintained intraoperatively. The Dextrometer was used in 10 patients receiving parenteral nutrition intraoperatively. The difference between the Dextrometer readings and the serum glucose level obtained by laboratory analysis was less than 10% in 83% of cases and readings were most accurate in the 200 to 400 mg/dl range. The Dextrometer provides a simple, inexpensive, and reasonably accurate method of monitoring glucose intraoperatively as part of the optimal management of these patients. (Journal of Parenteral and Enteral Nutrition 7:492–494, 1983)
Does Modified Amino Acid Total Parenteral Nutrition Alter Immune‐Response in High Level Surgical Stress
Authors: Nuwer Nancy , Cerra Frank B. , Shronts Eva P. , Lysne Jolynn , Teasley Kathy M. , Konstantinides Frank N.
Published: May 2008

A randomized prospective double‐blinded study was conducted in patients in moderate to high level surgical stress to ascertain the effect of high dose branched‐chain (BcAA) hyperalimentation on skin test reactivity and lymphocyte count. Isocaloric, isonitrogenous balanced total parenteral nutrition solutions were administered to two treatment groups. The study group received the high dose (45% BcAA) solution while the control group received a standard amino acid solution (24.2% BcAA). All patients received 1 to 1.5 g/kg/day of amino acids and 30 nonprotein cal/kg/day, with 30% of them as fat. Immune function was assessed by absolute lymphocyte count and delayed cutaneous hypersensitivity on days 0 and 7 of therapy. Absolute lymphocyte count showed a marked improvement in patients receiving high dose aBcAA (p < 0.03). All patients were anergic at baseline; a much greater percentage of skin test reactivitry was observed in the BcAA group on day 7 (p < 0.03). They were also in positive nitrogen balance. The data suggest that improved nitrogen retention and immune‐competence is possible with branched‐chain‐enriched hyperalimentation in high level surgical stress. (Journal of Parenteral and Enteral Nutrition 7:521–524, 1983)
Effect of Guar Gum on Gastric Emptying after Gastric Resection
Authors: Harju E. , Heikkilä J. , Larmi T.K.I.
Published: May 2008

Gastric emptying after a conventional semisolid meal containing 5 g of guar gum granules or placebo was measured in a double‐blind, controlled trial, using a radioisotopic (technetium Tc‐99m DTPA) technique, in 11 patients who had undergone gastric resection, and who were experiencing the dumping syndrome. Guar gum clearly slowed gastric emptying in five of the 11 patients, and the results suggest that the addition of guar gum to normal meals, especially those rich in monosaccharides or disaccharides, may be helpful to post‐gastrectomy patients suffering from the dumping syndrome. (Journal of Parenteral and Enteral Nutrition 8:18–20, 1983)
Effects of Amino Acid Additives during Hemodialysis of Children
Authors: Abitbol Carolyn L. , Ozinska Krystyna , Mandel Susan , Mcvicar Melinda , Wapnir Raul A.
Published: May 2008

The intradialytic losses into the dialysate of free amino acids (AA) and α‐amino nitrogen were determined during the dialysis of three children. Variations in plasma AA were determined pre‐ and postdialysis. The effect of these losses with the addition of an Abbott General Amino Acid Mixture to the dialysate in concentrations of 8.5, 17, and 34 mg/100 ml was studied. The major determinant of AA losses was the plasma concentration of the AA before beginning the dialysis treatment. Dialysance of individual AA varied inversely with their molecular weights. A zero flux of α‐amino nitrogen occurred at a derived concentration of 22 mg/100 ml of the AA additive in the dialysate. Plasma concentrations of nonessential amino acids were little affected by the dialysate additive. In contrast, total essential amino acid nitrogen which fell during baseline dialyses showed significant improvement when the AA solution was added to the dialysate. This study suggests that the addition of AA to the dialysate bath may be effective in decreasing AA nitrogen losses during dialysis. (Journal of Parenteral and Enteral Nutrition 8:25–29, 1983)
Parenteral Nutrition in a Premature Infant with Phenylketonuria
Authors: Cole David E.C. , Landry Daniel A.
Published: May 2008

Parenteral nutrition (PN) is now an important facet of the management of the extremely premature infant. However, its effects on those with inherited metabolic disease have not been well documented. We report an infant with classical phenylketonuria (PKU) who had unusually high serum phenylalanine at 12 days of life (5200 μmol; >3.2 SD above our mean for PKU at 10–15 days of age) while on parenteral nutrition, despite a relatively high tolerance for phenylalanine on oral feeds at 3–4 months of life (97–128 mg/ kg/day; normal for PKU: <90 mg/kg/day). Identification of PKU was somewhat delayed in this child because of failure to recognize that parenteral nutrition provides a phenylalanine load equivalent to or greater than the routine oral formula feeding. Despite the high levels of phenylalanine in the first 2 wk of life, mental and motor development are normal at 16 months of age. This case, the first such reported, suggests the parenteral nutrition in the premature PKU infant is relatively safe, but draws attention to the possible need for phenylalanine‐free amino acid infusates for those who require long‐term treatment. (Journal of Parenteral and Enteral Nutrition 8:42–44, 1984)
Consultative Total Parenteral Nutrition Teams: The Effect on the Incidence of Total Parenteral Nutrition‐Related Complications
Authors: Dalton Michael J. , Schepers Greg , Gee Joseph P. , Alberts Cary C. , Eckhauser Frederick E. , Kirking Duane M.
Published: May 2008

A two part, prospective study was undertaken to establish the existing frequency of total parenteral nutrition‐(TPN) related mechanical, metabolic, and septic complications in an institution with a consultative TPN team (group A) and to determine if increasing the involvement of the TPN team in patient monitoring and verifying adherence to TPN infection control guidelines would reduce the incidence of these complications (group B). The initial 28 consecutive patients were managed entirely by their primary physicians with the role of the TPN team limited to consultative activities while the next 29 patients receiving TPN were managed jointly by their primary physicians and the TPN team. Analysis of the results show group B to have a significant reduction in metabolic complications, decreased incidence of mechanical abnormalities, and approximately equal incidences of documented sepsis. However, when compared to the results of an institution in which the TPN team has complete control of TPN therapy, even the group B patients had a relatively excessive number of TPN‐related complications especially in the categories of mechanical and metabolic abnormalities. Thus, consultative TPN teams do not necessarily ensure optimum TPN therapy and institutions using this approach to provide nutrition parenterally must be prepared to establish the incidence of TPN‐related complications and to expand the involvement of the TPN team as required to control the frequency of these anomalies. (Journal of Parenteral and Enteral Nutrition 8:146–152, 1984)
Evaluating the Accuracy of Nutritional Assessment Techniques Applied To Hospitalized Patients: Methodology and Comparisons
Authors: Detsky Allan S. , Baker Jeffrey P. , Mendelson Rena A. , Wolman Stephen L. , Wesson David E. , Jeejeebhoy Kursheed N.
Published: May 2008

Herein we describe a methodology which can be used to evaluate the predictive accuracy of nutritional assessment techniques. We use this methodology to compare seven techniques of nutritional assessment in terms of their ability to predict one nutrition associated hospital complication (infection) by dividing a sample of 59 surgical patients into high risk and low risk groups. One technique was subjective global assessment (SGA) of the patient's nutritional status on admission to hospital. Five techniques were single objective measurements (albumin, transferrin, delayed cutaneous hypersensitivity, anthropometry, and creatinine‐height index). The 7th technique was the prognostic nutritional index. The best combination of sensitivity (0.82) and specificity (0.72) was found with SGA. The second best combination (0.88 and 0.45) was found by using either the prognostic nutritional index or creatinine‐height index. We also found that combining the five objective measurements with SGA into a single index did not increase the discriminatory (or predictive) power over that of SGA alone in a clinically significant way. We conclude that a larger study comparing these approaches should be undertaken to confirm these findings and to develop methods which improve the predictive properties of SGA. (Journal of Parenteral and Enteral Nutrition 8:153–159, 1984)
The Effects on Beagles of Long‐Term Administration of 20% Travamulsion Fat Emulsion
Authors: Izzo Rodger S. , Larcker Sally , Remis William , Mennear John , Woods Eugene , Leissing Nancy
Published: May 2008

The tolerance of 20% Travamulsion intravenous fat emulsion (Travenol Laboratories, Inc., Deerfield, IL) was studied using male beagle dogs. Physiologic (0.9%) saline, USP, was used as the control, and 10% Travamulsion Intravenous fat emulsion (Travenol Laboratories) as the reference article. The 20 and 10% emulsions were administered intravenously to each of eight animals for 91 days at 20 and 40 ml/ kg/day, respectively. These dosages were administered over 4 hr and they correspond to approximately 4 g of lipid as soybean oil per kilogram of body weight. The saline was administered to eight animals at 40 ml/kg/day. On day 92, one‐half of the animals in each group were necropsied. The remaining dogs were observed and necropsied on day 122. Toxicity was assessed on animal survival; changes in body weight, urinalysis, and hematologic, and serum biochemical analyses; ophthalmologic examination; gross pathology; and histopathology. The results obtained for the 20% Travamulsion fat emulsion correlated well with those for the 10% Travamulsion fat emulsion. The emulsions were well tolerated and all animals survived and gained weight. The 20% Travamulsion fat emulsion administered provided about 45% of the total caloric requirement of the dog, which is equal to an often used clinical dose. However, caloric administration in the form of lipid emulsion in relation to total energy required was performed at three to six times the indicated clinical rate. In addition to demonstrating that it is safe for prolonged administration, the 20% Travamulsion fat emulsion offers an advantage over the 10% Travamulsion fat emulsion in providing the same amount of calories because it produces lower serum levels of phospholipid, cholesterol, and triglyceride, and the volume of emulsion required is reduced. (Journal of Parenteral and Enteral Nutrition 8:160–168, 1984)
Alterations in the Metabolism of Exogenous Lipid Associated with Sepsis
Authors: Dahn Michael S. , Kirkpatrick John R. , Blasier Ralph
Published: May 2008

The responses to an exogenous lipid challenge of nonhypermetabolic surgical patients requiring parenteral nutrition and seriously ill septic patients were compared. All patients received a 500‐ml intravenous infusion of a 10% lipid emulsion over a 4‐hr period. An early elevation of glycerol and triglyceride was noted during the infusion suggesting chylomicron fractionation. Peak triglyceride levels were higher in the septic group but the rate of lipid clearance appeared essentially identical in both septic and nonseptic patients. Lipoprotein lipase levels remained constant and were equal for both groups. Significant late ketone body production was statistically identical in both groups despite depressed albumin levels in the septic group suggesting adequate hepatic ketogenic capacity in septic as well as nonseptic patients. (Journal of Parenteral and Enteral Nutrition 8:169—173, 1984)
In Vitro Leukocyte Endogenous Mediator Production Is Not Impaired following Surgical Stress in Moderately Malnourished Patients
Authors: Duncan John L. , Moldawer Lyle L. , Bistrian Bruce R. , Blackburn George L.
Published: May 2008

Leukocyte endogenous mediator (LEM), a protein produced by phagocytizing cells, plays a critical role in the metabolic response to injury and infection. There is an important interaction between protein‐calorie malnutrition and the capacity of cells to produce LEM, since severely malnourished or severely stressed individuals, have a reduced capacity to produce LEM. The leukocytes of 10 mildly to moderately malnourished patients undergoing elective major surgery, a moderate stress, had an intact ability to produce LEM on preoperative assessment. This ability was not affected by a 5‐day postoperative period of hypocaloric nutrient intake despite a significant loss of body protein in one‐half of the patients and a significant fall in serum protein concentrations. These results suggest a high biologic priority for LEM production during the metabolic response to injury and for infection. (Journal of Parenteral and Enteral Nutrition 8:174–177, 1984)
Relationships between Serum Total Iron‐Binding Capacity and Transferrin
Authors: Crosby Lon O. , Giandomenico Albert , Forster Jameson , Mullen James L.
Published: May 2008

The relationship between serum transferrin (TFN) and serum total iron‐binding capacity (TIBC) in a clinical setting was evaluated in two related studies. The initial study evaluated 101 blood samples representing a cross‐section of hospitalized adults. The samples were double assayed for TIBC using clinical and research methodologies. TFN was assayed by a commercial radial immunodiffusion method. Clinical laboratory TIBC correlated well with research laboratory TIBC (r = 0.87, slope = 0.97, p < 0.001, n = 50) and the relationship of TIBC to TFN yielded the following equation: TFN = 0.83 TIBC — 5.6 (r = 0.82, p < 0.001, n = 101) where TFN = mg/100 ml and TIBC = μ g/100 ml. The second study evaluated a new TIBC assay and its effect on the TIBC/TFN relationship. Additionally, the TFN‐TIBC relationship was evaluated at low normal and abnormal TIBC levels. In this second study, TFN = 1.0 TIBC ‐ 18.8 (r = 0.88, p < 0.01, n = 126). Subsample analysis for specimens with TIBC between 105 and 160 showed a TIBC‐TFN regression line that was not significantly different than the entire sample. Inclusion of ancillary patient data such as hemoglobin and hematocrit did not improve the relationship between TFN and TIBC in either study. The relationship was unaffected by age, sex, race, disease, treatment, fever, surgery, degree of nutritional support, blood transfusion, or blood chemistry parameters in either study. Laboratories deriving TFN from measured TIBC as a nutritional status indicator must determine the relationship for the specific procedures being used in their laboratories. (Journal of Parenteral and Enteral Nutrition 8:274–278, 1983)
Lipid Infusion in Premature Infants Suffering from Sepsis
Authors: Park Wilhelm , Paust Helmut , Schroder Heinz
Published: May 2008

In as much as possible side effects attributing to insufficient fat clearance with hyperlipemia, parenteral lipid administration to septic premature infants is controversial. In this study serum triglyceride and free fatty acid concentrations of nine low birth weight infants with septicemia and 21 low birth weight infants without septicemia were measured. Acidosis, hypoxia, hyperglycemia, and cardiovascular insufficiency were treated before parenteral lipid infusion was started. There was no occurrence of septic shock. In the course of fat infusion with 3 g/kg body weight per day in low birth weight infants without systemic infection we only found triglyceride concentrations of 1.15 mmol/liter and free fatty acid levels of 1.05 mmol/liter. Premature infants with septicemia showed, under fat application of 2 g/kg body weight per day, mean triglyceride levels of 1.67 mmol/liter and free fatty acid values of 1.94 mmol/liter. The highest concentrations occurred at 3 g fat/kg body weight per day with triglycerides of 2.02 mmol/liter and free fatty acids of 2.06 mmol/liter. They indicate a reduced clearance and support earlier findings of reduced utilization of infused fat in premature infants with septicemia. Triglyceride concentrations more than 1.7 mmol/liter probably induce an increase of phagocytosis of the fat particles with the effect of a partial block of the reticuloendothelial system and an impairment of pulmonary diffusion capacity. Therefore, we suggest dosages no higher than 2 g fat/kg body weight per day to low birth weight infants and we advise to check the triglycerides daily. Hypertriglyceridemia implicates an immediate reduction or total interruption of the lipid infusion until normal triglyceride values are regained. (Journal of Parenteral and Enteral Nutrition 8:290–292, 1984)
Biotin Deficiency in a Patient with Short Bowel Syndrome during Home Parenteral Nutrition
Authors: Khalidi Nabil , Wesley John R. , Thoene Jess G. , Whitehouse Walter M. , Baker Wendy L.
Published: May 2008

A 54‐year‐old woman with short bowel syndrome was supported with home parenteral nutrition. Six months after receiving 2200 kcal/day of balanced home parenteral nutrition without biotin, she developed biotin deficiency with complete hair loss, eczematous dermatitis, waxy pallor, lethargy, and hypersthesias. Blood and urine samples were collected prior to treatment. Serum zinc was 64 μg/dl (nl 50–150 μg/dl), and the triene/tetraene ratio was 0.068 (nl 0.4), thereby ruling out zinc and essential fatty acid deficiencies. Serum biotin was 332 pg/ml (nl 520 ± 220 pg/ml), and urine biotin was 5.22 ng/mg of creatinine (nl 4.3–95 with a mean of 30.2 ng/mg creatinine). The same parenteral nutrition regimen was contained and oral biotin was administered (10 mg/day). After 3 wk, serum and urine biotin levels were 650 pg/ml and 35.6 ng/mg creatinine, respectively. New hair growth was evident and all of her other symptoms resolved. Intravenous biotin was then provided (5 mg/day) for a month after which serum and urine biotin levels were 1316 pg/ml and 178 ng/mg creatinine, respectively. The patient has been subsequently maintained on an intravenous multivitamin product containing 60 μg biotin per daily dose and remains free of signs and symptoms of biotin deficiency. (Journal of Parenteral and Enteral Nutrition 8:311–314, 1984)
Hypocaloric Lipid Emulsions and Amino Acid Metabolism in Injured Rats
Authors: Yamazaki Kazuma , Maiz Alberto , Sobrado Javier , Babayan Vigen , Moldawer Lyle L. , Bistrian Bruce R. , Blackburn George L.
Published: May 2008

The present study was designed to determine the degree and mechanism by which administration of medium‐chain triglyceride emulsions spare body protein after injury. Forty male rats underwent venous catheterization and received nonsterile bilateral femur fractures. All rats received 2.5 g/day amino acids and either no additional calories (group I) or 20 kcal/day of either glucose (group II), a long‐chain triglyceride emulsion (group III), a medium‐chain triglyceride emulsion (group IV), or a structured lipid emulsion composed of 40% sunflower oil and 60% medium‐chain triglycerides (group V). The diets were administered for 3 days, and rates of plasma leucine flux, oxidation, and incorporation into protein as well as tissue protein synthetic rates in liver and muscle were measured using the constant infusion of L‐[1‐14C]leucine. Results demonstrated that the administration of glucose or various lipid emulsions improved cumulative nitrogen balance significantly when compared to a diet containing amino acids alone. In addition, the administration of glucose or lipid emulsions significantly stimulated protein synthesis in liver and muscle. Moreover, a structured lipid emulsion of medium‐ and long‐chain fatty acids produced significant increases in liver protein synthesis greater than that observed with either glucose or long‐chain triglyceride emulsions. We conclude that added energy as fat or glucose reduces net protein catabolism and improves tissue protein synthesis in these injured rats and that lipid emulsions are as effective as dextrose. A structured triglyceride emulsion synthesized from medium‐ and long‐chain fatty acids appears to better support hepatic protein synthesis. (Journal of Parenteral and Enteral Nutrition 8:361–366, 1984)
Parenteral Nutrition Complications in a Voluntary Hospital
Authors: Jones Kenneth W. , Seltzer Murray H. , Slocum Bernadette A. , Cataldi‐Betcher Emma L. , Goldberger David J. , Wright Florine R.
Published: May 2008

A prospective study analyzing the complications in 307 patients who had specialized nutrition support administered by their private practitioners was performed and compared to other series in which a nutrition support service exclusively provided such care to patients. The mechanical complication rate of 4.6%, septic complication rate of 2.9%, and metabolic complication rate of 4.2% compared favorably with the reported literature. A new category of complications, the judgmental complication, is described and was 12.7% in the reported series. The Saint Barnabas Medical Center experience suggests that individual practitioners can satisfactorily administer intravenous specialized nutrition support if in fact an involved nutrition support service functions administratively and supportively in the background. (Journal of Parenteral and Enteral Nutrition 8:385–390, 1983)
Microbial Growth Comparisons of Five Commercial Parenteral Lipid Emulsions
Authors: Crocker Kathleen S. , Noga Richard , Filibeck Donald J. , Krey Susanna H. , Markovic Mario , Steffee William P.
Published: May 2008

The ability of parenteral lipid emulsions to support microbial growth was compared using commercially available brands of lipid emulsion. Both 10 and 20% concentrations of soybean and safflower oil emulsions were used. Washed cultures of six gram‐negative, three gram‐positive, and one yeast, in concentrations of 1 × 104 to 2 × 104 colony‐forming units/ml, were inoculated into lipid emulsion aliquots and stored at room temperature. These were then subcultured at 0, 6, 12, 24 and 48 hr. After 48 hr at 37°C, growth was recorded as colony‐forming units/ml. Normalized growth curves were expressed as x ± SEM. ANOVA demonstrated no difference in growth patterns due to the nature of the oil or its concentration. Gram‐negative organisms multiplied faster when compared to gram‐positive (p < 0.05 at 12 hr, p < 0.01 at 24 hr, and p < 0.005 at 48 hr). Yeast grew as well as bacteria. The Center for Disease Control's recommendation of a 12‐hr hang time for parenteral lipid emulsions should be observed until correlation of laboratory microbial growth patterns and clinical use are studied further. (Journal of Parenteral and Enteral Nutrition 8:391–395, 1984)
Blood Culture as a Guide for the Diagnosis of Central Venous Catheter Sepsis
Authors: Bozzetti Federico , Terno Giovanni , Bonfanti Giuliano , Gallus Giuseppe
Published: May 2008

The purpose of this study was to evaluate the predictability of peripheral (PBC) and central blood cultures (CBC) in the diagnosis of central venous catheter (CVC) sepsis (growth of the same microorganism in the peripheral blood and on the catheter tip). The contamination and sepsis rate of 256 CVCs and the relationship with PBC and CBC was evaluated in a series of cancer patients included in a prospective protocol on CVC infections at the Istituto Nazionale Tumori of Milan. Overall CVC contamination was 10.5% and sepsis rate was 3.1%. The positive predictive value for CVC sepsis was 46.7% for positive PBC + CBC, 38.1% for positive PBC and 16.6% for positive CBC. The small gain in the predictive positive value obtained with the use of PBC and CBC and the slight increase in the specificity does not justify, in our opinion, the use of both these parameters for the diagnosis of CVC sepsis. (Journal of Parenteral and Enteral Nutrition 8:396–398, 1984)
Stability of Folic Acid in 25% Dextrose, 3.5% Amino Acids, and Multivitamin Solution
Authors: Louie Nancy , Stennett Douglass J.
Published: May 2008

The chemical stability of folic acid in 25% dextrose, 3.5% amino acids, and multivitamin solution was investigated. Solutions of 0.25, 0.5, 0.75, and 1.0 mg/liter of folic acid admixed in the study solution were prepared. Solutions were stored in light‐room temperature, light‐refrigeration, dark‐room temperature, or dark‐refrigeration. Samples were drawn to determine initial folic acid concentration and again at 4, 8, 12, 18, 24, 36, and 48 hr after admixture. Folic acid concentration was determined by competitive binding radioassay, and results are expressed as percent of initial folic acid concentration. Folic acid was stable for 48 hr with each tested concentration and stability was found to be independent of temperature or light storage effects. Folic acid admixed in the study solution is chemically stable for up to 48 hr after initial admixture under normal total parenteral nutrition storage conditions. (Journal of Parenteral and Enteral Nutrition 8:421–426, 1984)
Relationship between Serum Albumin and Parenteral Nutrition‐Associated Cholestasis
Authors: Nanji Amin A. , Anderson Frank H.
Published: May 2008

In a prospective study of 59 patients receiving total parenteral nutrition we found that patients with low serum albumin were more likely to develop cholestasis than patients with normal serum albumin. Only 25% of patients with a normal serum albumin developed cholestasis. Seventy‐nine percent of patients with low serum albumin (< 3.5 g/dl) developed cholestasis (p < 0.01). In those patients who developed cholestasis, there was a significant correlation (r = 0.63, p < 0.01) between the serum albumin and the number of days after onset of total parenteral nutrition when cholestasis appeared. The role of hypoalbuminemia in the development of total parenteral nutrition‐associated cholestasis deserves further study. (Journal Parenteral and Enteral Nutrition 8:438— 439, 1984)
Fatal Cardiac Tamponade in a Patient Receiving Total Parenteral Nutrition Via a Silastic Central Venous Catheter
Authors: Harford Francis J. , Kleinsasser Jan
Published: May 2008

This is the first reported case of cardiac tamponade secondary to ventricular perforation involving a silastic catheter. The catheter had advanced into the right ventricle and become enmeshed in the trabeculae carnae. At autopsy there was an area of necrosis which we presumed was caused by the continuous direct contact of a small area of endocardium and subadjacent myocardium with the hypertonic infusate used for parenteral nutrition. (Journal of Parenteral and Enteral Nutrition 8:443–446, 1983)
Inadvertent Intravenous Administration of Enteral Diet
Authors: Stellato Thomas A. , Danziger Larry H. , Nearman Howard S. , Creger Richard J.
Published: May 2008

Needle catheter jejunostomy feedings were instituted in a 64‐yr‐old man on postoperative day 1 following subtotal gastrectomy for carcinoma of the antrum. Several days later, the enteral tube catheter was inadvertently connected to the patient's peripheral intravenous cannula which resulted in the intravenous administration of the enteral formula solution. The administration was stopped immediately when recognized, but 4 hr later the patient became febrile, hypotensive, and tachycardic. Cultures from the enteral solution demonstrated Streptococcal viridans and yeast; the patient's blood cultures similarly demonstrated S. viridans. Broad spectrum antibiotics, hemodynamic monitoring, and intravascular support with crystalloid solutions resulted in a favorable outcome. Prevention of the complication could be assured by adopting luer connectors for enteral feeding sets which cannot be connected to intravenous cannulas. Until these are available, the addition of methylene blue to the tube feeding formula or utilization of color coded distal connecting tubing may prevent accidental intravenous administration of tube feeding formulas. The potential for this complication must be recognized by those dealing with enteral feedings. (Journal of Parenteral and Enteral Nutrition 8:453–455, 1984)
Energy and Mineral Utilization from a Peptide‐Based Elemental Diet and a Polymeric Enteral Diet Given to Ileostomists in the Early Postoperative Course
Authors: Andersson H. , Hultén L. , Magnusson O. , Sandström B.
Published: May 2008

Small intestinal absorption was studied in 12 patients receiving enteral nutrition in the immediate postoperative period after colorectal surgery including construction of an ileostomy. Seven patients were given a peptide‐based, low osmolality elementary diet and five patients were given a polymeric diet. Comparisons between the intake and ileal excretion showed on both diets a high utilization of energy, fat, and nitrogen as well as of calcium, phosphorus, magnesium, zinc, and iron. From a nutritional point of view a polymeric diet could thus replace an elementary diet in the immediate postoperative course. (Journal of Parenteral and Enteral Nutrition 8:497–500, 1984).
A Prospective Randomized Trial of Central Venous Catheter Removal Versus Intravenous Amphotericin B in Febrile Neutropenic Patients
Authors: Lazarus Hillard M. , Lowder James N. , Anderson James M. , Herzig Roger H.
Published: May 2008

Empiric amphotericin B therapy was compared to central venous catheter withdrawal in a prospective randomized trial. Of 32 febrile, neutropenic patients with indwelling Broviac catheters and without documented infection, 14 had persistent fever while receiving broad spectrum antibacterial drugs. Six patients were randomized to catheter removal and eight patients received amphotericin B empirically. None of six patients responded to catheter removal and six of eight defervesced after receiving antifungal therapy (p <0.01). Of the six patients in whom catheters were removed, two later became afebrile while on subsequent therapy with amphotericin B. Culture and histologic evaluation of the removed catheters failed to implicate the prosthesis as an infectious source. Central venous catheters in a persistently febrile neutropenic host need not be removed, unless local difficulties or bacteremia with skin commensal organisms occur. Amphotericin B can be infused through a central venous catheter in febrile, neutropenic patients unresponsive to empiric antibacterial drugs, with many patients becoming afebrile as a result of this therapy. (Journal of Parenteral and Enteral Nutrition 8:501–505, 1984)
An Evaluation of Peripheral Essential Amino Acid Infusion following Major Surgery
Authors: Hogbin B.M. , Smith A.M. , Craven A.H.
Published: May 2008

To assess postoperative progress 43 patients undergoing major abdominal procedures were randomized to be given normal postoperative electrolyte solutions alone or with the addition of 400 ml of essential amino acids. Postoperative measurements confirmed a nitrogen retention significant at 0.1%. Decreased breakdown of muscle was also shown by measuring the upper arm muscle circumference and by following the grip strength. Those treated had no significant muscle loss postoperatively but there was significant loss in those not receiving amino acids. The intravenous cannulae survived equally well in both groups. There was no demonstrable difference in the overall clinical progress. (Journal of Parenteral and Enteral Nutrition 8 :511–514, 1984)
Reference Values for Arm Muscle Area, Arm Fat Area, Subscapular Skinfold Thickness, and Sum of Skinfold Thicknesses for American Adults
Authors: Bishop Charles W.
Published: May 2008

Reference values for the mid‐upper arm muscle area, mid‐upper arm fat area, subscapular skinfold thickness, and sum of triceps and subscapular skinfold thicknesses of American adults were developed from data collected by the National Center for Health Statistics during the first National Health and Nutrition Examination Survey, 1971 to 1974. The reference values were compared to other reference values derived from a similarly conducted cross‐sectional survey of the American population, the Health Examination Survey of 1960 to 1962. These comparisons revealed that (1) arm muscle area and subscapular skinfold thickness of men and arm muscle area of women continuously increase with aging from 18 to 74 yr; (2) arm fat area and sum of skinfold thicknesses of men increase with aging from 18 to 34 yr but stabilize or decrease with further aging; and (3) arm fat area, subscapular skinfold thickness, and sum of skinfold thicknesses of women increase with aging from 18 to 64 yr but decrease thereafter. As these parameters frequently change more than 20% over the period of a single decade, it is important that age be considered in nutritional evaluations based on anthropometric measurements. Changes in these four parameters with successive generations are also frequently large. Consequently, it is imperative that the reference values used in nutritional assessment protocols be updated at regular intervals. (Journal of Parenteral and Enteral Nutrition 8:515–522, 1984)
Transferrin—A Poor Measure of Nutritional Status
Authors: Roza Allan M. , Tuitt Deborah , Shizgal Harry M.
Published: May 2008

The present study evaluated the sensitivity and specificity of the serum transferrin concentration as a measure of the nutritional state. Serum transferrin was derived from total iron‐binding capacity measurements in 74 patients on 114 occasions and correlated with body composition as measured by multiple isotope dilution. Highly significant correlations (p < 0.001) existed between serum transferrin and both the body cell mass and the nutritional state as measured by the Nae/Ke ratio. However, the 95% confidence limits about both regressions were wide. The false‐positive rate was 60% while the false‐negative rate was 31%. Body composition and transferrin were measured before and after 2 wk of total parenteral nutrition in 34 malnourished patients. Eighteen patients restored body cell mass toward normal after 2 wk of total parenteral nutrition while in 16 patients the body cell mass continued to decrease in size, despite 2 wk of total parenteral nutrition. The changes in serum transferrin were not significant over this period of time in either group, despite significant changes in the nutritional state in both groups. The presence of a statistically significant relationship between the serum transferrin concentration and the nutritional state indicates that the serum transferrin concentration accurately reflects a population's nutritional status, and is therefore useful in epidemiologic surveys. However, because of the large variance of the data, as demonstrated by the wide 95% confidence limits, and because of the poor sensitivity and specificity, in an individual patient it is of little value as a measure of the nutritional status. (Journal of Parenteral and Enteral Nutrition 8:523–528, 1984)
Serum Amino Acid Concentrations in Patients Receiving Total Parenteral Nutrition with an Amino Acid Plus Dextrose Mixture
Authors: Philcox Jeffrey C. , Hartley Thomas F. , Worthley Lindsay I.G. , Thomas David W.
Published: May 2008

The results of monitoring the serum amino acid concentrations during three infusion regimens using a 5:4 mixture of 70% glucose and the synthetic L‐amino acid solution, Synthamin 17 (Travasol) are reported. Twelve stabilized patients received continuous total parenteral nutrition (TPN), eight of whom were subsequently placed on a second regimen of cyclical feeding. A separate group of five patients was infused with amino acids, both with and without simultaneous glucose. The serum amino acid concentrations indicated that the supply of valine, leucine, isoleucine, lysine, and histidine, and the synthesis of taurine from the infused methionine was suboptimal, particularly if the period of TPN was prolonged. The synthesis of tyrosine from phenylalanine appeared to be inversely proportional to the infusion rate of the TPN mixture, in particular the glucose component, resulting in depressed tyrosine and increased phenylalanine concentrations in serum during continuous iv nutrition. Cyclical infusions, on the other hand, permitted the tyrosine and phenylalanine concentrations to return to normal during the noninfusion stage of the cycle. Amino acid measurements enabled us to design an amino acids additive mixture which normalized the serum concentrations in three long‐term home parenteral nutrition patients. As a result of these investigations serum amino acid measurements are used routinely to monitor the efficacy of TPN and accommodate any specific amino acid requirements of individual patients. (Journal of Parenteral and Enteral Nutrition 8: 535–541, 1984)