bluuebunny/crossref_metadata_2025_split huggingface dataset:
Lack of Modulation of Postoperative Immunosuppression by Isotonic Amino Acid Infusion
Authors: Neuvonen P. , Salo M. , Perttilä J. , Havia T. 
Published: May 2008

Effects of an isotonic amino acid solution on the immune defence systems of surgical patients were studied. Twenty‐two patients admitted for major abdominal operations were randomly allocated into two groups. Eleven of them received 1 liter of 3% amino acid solution daily for 5 days postoperatively, while 11 control patients received balanced 5% glucose‐containing electrolyte solutions. Immune variables were studied preoperatively and at 1, 3 to 4, and 6 to 7 days postoperatively. These studies included leukocyte and differential counts, T (OKT3+), B (sIg+), T helper/inducer (OKT4+) and suppressor/cytotoxic (OKT8+) cell determinations, measurement of in vitro lymphocytic responses to phytohemagglutinin (PHA), pokeweed mitogen (PWM) and Staphylococcus aureus Cowan I (StaCw) in cultures of separated lymphocytes, and to PHA, concanavalin A (Con A), and PWM in whole blood cultures. B lymphocyte functions were studied by measuring synthesis of immunoglobulins IgG, IgM, and IgA in the cell culture medium when lymphocytes were stimulated with PWM alone and in the presence of Con A or hydrocortisone.Postoperative amino acid infusion slightly improved the capacity of lymphocytes to synthetize and secrete IgG and IgM. By contrast, no improvement was seen in cell counts or lymphocyte transformation patterns. (Journal of Parenteral and Enteral Nutrition 10: 160–165, 1986)
Dressing Changes by Specialized Personnel Reduce Infection Rates in Patients Receiving Central Venous Parenteral Nutrition
Authors: Nelson David B. , Kien Craig L. , Mohr Barbara , Frank Sharon , Davis Starkey D. 
Published: May 2008

In 60 pediatric patients, 75 central venous catheters representing 1866 patient days were placed to provide parenteral nutrition. During the 21‐month study period, surgical residents were responsible for dressing changes during the first 16 months and a specially trained nurse was responsible during the final 5 months. Twenty percent of the lines became infected. The infection rate was significantly higher in the lines cared for by residents, 28.8% compared to 3.3% in the lines cared for by the nurse. This occurred in spite of the lines being in place significantly longer in the nurse group (31.7 us 20.3 patient days/line).These data indicate that a specially trained person using aseptic techniques can reduce infection rates in patients receiving central venous parenteral nutrition. (Journal of Parenteral and Enteral Nutrition 10:220–222, 1986)
Metabolic Derangements in Children Requiring Parenteral Nutrition
Authors: Baker Susan S. , Dwyer Ellen , Queen Patt 
Published: May 2008

Intravenous alimentation is routinely used in many hospitalized pediatric patients, however, there are few reports of the nature and frequency of metabolic complications. In order to assess the frequency and nature of metabolic complications all children receiving parenteral nutrition from Janury 1, 1982 to December 31, 1982 were prospectively enrolled in the study. Data collection began with the institution of parenteral nutrition. Serum electrolytes, minerals, liver function tests, and renal function tests were followed weekly. A total of 201 patients received parenteral nutrition for 5378 days. Nutrition was delivered to 146 patients (4980 patient days) via a central line and 55 patients via a peripheral line (398 patient days). The sepsis rate was 3.7% in central lines used only for parenteral and 4.8% in multipurpose central lines.In general, complications were fewer in the patients supported peripherally. In patients supported centrally, hypoalbuminemia was the most commonly found abnormality followed by hypocalcemia, hypophosphatemia and hypomagnesemia, reflecting a malnourished state. One‐third of the patients had abnormal liver function tests, and in half of those factors causing liver dysfunction other than parenteral nutrition were present. Abnormal renal function tests occurred in 10% of the patients.Thus, a high incidence of metabolic complications occurred in association with parenteral nutrition. Most were present during the initiation of parenteral nutrition, suggesting an abnormal metabolic state was present prior to the institution of parenteral nutrition. The frequency of low serum albumin and minerals is consistent with previous publications of the prevalence of malnutrition in hospitalized patients. (Journal of Parenteral and Enteral Nutrition 10:279–281, 1986)
A Review of the Current National Status of Home Parenteral and Enteral Nutrition from the Provider and Consumer Perspective
Authors: Howard Lyn , Heaphey Lenore L. , Timchalk Maryann 
Published: May 2008

Home parenteral and enteral nutrition (HPEN) has grown rapidly in the past decade. By examining data from physician reports, patient surveys, and the infusion industry, this review attempts to delineate the diagnostic indications, age range, mortality, medical complications and rehabilitation potential of HPEN patients.A clear trend exists towards greater use of this expensive therapy in bowel obstructed cancer patients and in pediatric and geriatric age groups. Complications in parenterally fed patients appear to result in a readmission to the hospital, on average, once every 2 yr. Life expectancy depends heavily on the underlying diagnosis: whereas 50% of the patients with a malignancy survive only 6 months, 50% without a malignancy survive beyond 3 yr. Fifty to 60% of HPEN patients are able to work full time or part time, 15 to 20% are retired or of preschool age, and 20 to 30% are unable to work.The home care service options considered most important by patients are the pharmacy premixing of intravenous solutions, home delivery of supplies by the home service carrier, reimbursement management by the home care service and the availability of a nurse for an initial home visit and 24‐hr emergency backup.In regard to fiscal concerns one of the difficult issues that should be addressed is the separation of medical coverage from disability status; another is that enteral feedings can sometimes be a less expensive alternative to parenteral feedings but little information exists about the complications and outcome with this modality and its fiscal reimbursement is much less assured. (Journal of Parenteral and Enteral Nutrient 10:416–424, 1986)
Estimation of Nitrogen Balance Based on a Six‐Hour Urine Collection in Infants
Authors: Lopez Ana Mari , Wolfsdorf Jack , Raszynski Andre , Contijoch‐Serrano Virginia 
Published: May 2008

The accuracy of a 6‐hr vs a 24‐hr urine collection for the determination of urinary urea nitrogen was studied in 15 infants. Patient's age ranged from 2 weeks to 3 yr, encompassing a wide variety of diagnoses. All patients had normal renal function at the time of the study.Participants had indwelling foley catheters throughout the study. Urine specimens were collected over a continuous 24‐hr period. Aliquots obtained from urine collected over 0 to 6 hr and the total urine collection were analyzed utilizing the urease enzymatic method in the Astra.Statistical analysis was performed comparing the actual 24‐hr determination to the estimation based on the 6‐hr collection, utilizing linear regression. The analysis of data produced a highly significant correlation (r = 0.904, p < 0.0001).When a 24‐hr urine collection is not possible, a 6‐hr collection is a useful alternative for the calculation of nitrogen balance in infants. (Journal of Parenteral and Enteral Nutrition 10:517–518, 1986)
The Effect of Protein Malnutrition and Nutritional Support on the Mechanical Properties of Fracture Healing in the Injured Rat
Authors: Pollak D. , Floman Y. , Simkin A. , Avinezer A. , Freund H.R. 
Published: May 2008

We investigated the effect of different nutritional regimens on fracture healing in the injured rat model. Four groups, each consisting of 12 male rats (307 ± 16 g), were subjected to anesthesia, laparotomy (injury), and tibial osteotomy with internal fixation. Group I received 23% protein, group II received 23% protein and high caloric feed, group III received 5% protein, and group IV received 38% protein. After 8 weeks, calluses were x‐rayed and the tibia was removed, fixed in a special block of methyl‐metacrylate, and tested at tension up to failure in a mechanical testing apparatus. The distraction force at failure was measured, and callus stiffness and energy absorbed to failure were calculated.The low protein diet resulted in significantly lower tensile strength and stiffness of calluses compared to the other three dietary regimens, this despite adequate caloric intake. In addition, the low protein diet resulted in a callus with “rubbery” mechanical properties compared to the “rigid” calluses of the other three groups.The high protein diet did not result in any significant improvement in fracture healing.These results gain clinical significance in the face of a high incidence of protein calorie malnutrition in injured orthopedic surgery patients. (Journal of Parenteral and Enteral Nutrition 10:564–567, 1986)
Skeletal Muscle Function and Metabolism in Obese Women
Authors: Lennmarken C. , Sandstedt S. , Von Schenck H. , Larsson J. 
Published: May 2008

A possible mechanism to regulate body weight during a high calorie intake may be an increased metabolic rate in skeletal muscle. To approach this hypothesis the energy metabolites, ATP, phosphocreatine, creatine, glycogen and lactate were measured in biopsies from the quadriceps femoris muscle. Concomitantly the function of the adductor pollicis muscle was studied as assessed after electrical stimulation of the ulnar nerve. The muscle function variables were, force of contraction at 5, 10, 20, and 50 Hz of stimulation, relaxation rate, and endurance. Eight obese women were studied before gastroplastic surgery and 6 months postoperatively and a weight loss of 19.4 ± 3.4% (mean ± SEM). Preoperatively ATP, phosphocreatine, glycogen, and lactate were significantly decreased and the same pattern was found postoperatively. These findings can be related to a low production of energy‐rich phosphates or a high energy utilization. Both pre‐ and postoperatively there was, a decreased force of contraction at 10 Hz of stimulation(p< 0.001), a faster relaxation rate(p< 0.01) and a normal endurance. These functional results indicate a high metabolic rate. At admission a decreased serum insulin level indicated a moderate insulin resistance which was normalized after the weight loss.The triiodothyronine concentration was normal before and after operation.In conclusion our findings of changed muscle energy metabolite concentrations and altered muscle function indicate a high metabolic rate in skeletal muscle in obese women. This may be an adaptation in skeletal muscle energy metabolism to a high body weight.(Journal of Parenteral and Enteral Nutrition10:583–587, 1986)
Alteration of Lipoprotein Profile during Total Parenteral Nutrition with Intralipid 10%
Authors: Tashiro Tsuguhiko , Mashima Yoshiya , Yamamori Hideo , Okui Katsuji 
Published: May 2008

Eight patients were studied for lipoprotein profiles over a period of 3–7 weeks. Four patients received total parenteral nutrition (TPN), including 1000 ml/day of Intralipid 10%. Three patients received fat‐free TPN, and one patient was tube fed 1000 ml/day of Intralipid 10% enterally.Fat‐free TPN lowered plasma lipid, especially low density lipoprotein (LDL) and high density lipoproteins (HDL). On the other hand, intravenous administration of Intralipid 10% caused a marked increase of LDL, together with increases of phospholipid and cholesterol, especially free cholesterol. Triglyceride, VLDL, and HDL remained within the normal range in this group. Enteral administration of the same amount of Intralipid 10% did not cause a rise of LDL. Lipid composition of the increased LDL approximated that of lipoprotein X with the intravenous Intralipid 10%.From these findings, we suggest that phospholipids in Intralipid 10% formed abnormal LDL as the result of mobilization of cholesterol from extravascular tissues, when administered intravenously. (Journal of Parenteral and Enteral Nutrition 10:622–626, 1986)
Prospective Evaluation of Single and Triple Lumen Catheters in Total Parenteral Nutrition
Authors: Mccarthy M.C. , Shives J.K. , Robison R.J. , Broadie T.A. 
Published: May 2008

The recent introduction of triple lumen catheters has facilitated the care of seriously ill patients by providing multipurpose central venous access through a single percutaneous 7 French catheter. This prospective study was performed to examine the complications associated with the use of these catheters in patients receiving long‐term total parenteral nutrition (TPN).Seventy‐five patients undergoing catheterization were randomly separated into two groups: 36 patients underwent placement of a single lumen catheter (SLC), and 39 patients, a triple lumen catheter (TLC). The two groups were comparable with respect to concomitant infections, treatment with antibiotics, and need for intensive care. Patients in the SLC group received TPN for a mean of 9.7 days and in the TLC group, for a mean of 8.5 days (p = 0.427). However, after 5 days of catheterization, there was a marked increase in the number of TLC removed because of skin entry site infections. SLC were more likely to be used for the full duration of TPN administration (p = 0.025). Catheter tips were cultured by semiquantitative techniques. A higher incidence of catheter sepsis was seen with TLC, 12.8% vs 0% with SLC (p = 0.055).TLC used for TPN are associated with higher rates of catheter entry site infections and systemic sepsis. SLC should be used for TPN administration. (Journal of Parenteral and Enteral Nutrition 11: 259–262, 1987)
Central Venous Catheter Guidewire Replacement According to the Seldinger Technique: Usefulness in the Management of Patients on Total Parenteral Nutrition
Authors: Bonadimani Bruno , Sperti Cosimo , Stevanin Anna , Cappellazzo Francesco , Militello Carmelo , Petrin Pietro , Pedrazzoli Sergio 
Published: May 2008

While on total parenteral nutrition (TPN), 37 patients underwent replacement of a central venous catheter (CVC), during which a wire introducer was used, according to the Seldinger technique. In 25 patients, the CVC was placed in the superior cava via the subclavian, and, in 12, via the jugular vein.Overall, 82 CVC changes were performed.: 74 for assumed CVC sepsis, 6 as preventive treatment, and 2 for partial catheter displacement. Catheter tip culture proved to be positive in 25 of 119 CVC examined.The catheters were defined as sterile when the tip culture was negative; contaminated, when the tip culture was positive and peripheral blood culture was either negative or positive for different bacteria; septic when both tip and blood were positive for the same bacteria.The results indicated that 10 catheters were contaminated and 17 were septic. Eight previously sterile CVC were found positive after the exchange: 3 were removed at the end of TPN in asymptomatic patients, and 5 were successfully resterilized by means of one more change.Guidewire replacement allowed CVC sterilization of 22 of 24 catheters (91.6%). No complications due to the catheter‐changing method were seen. (Journal of Parenteral and Enteral Nutrition 11:267–270, 1987)
Effects of Different Rinsing Regimen on Totally Implantable Vascular Access after 70 Days Infusion of Total Parenteral Nutrition in Vitro
Authors: Klem Wendy , Bentdal Eystein H. , Flaatten Hans , With Karin 
Published: May 2008

Totally implantable vascular access catheters with injection ports (IP) have been used for total parenteral nutrition (TPN). It is well known that thrombosis may cause occlusion of catheters. Recently we have experienced occlusion of the vascular access chambers in TPN‐patients because of precipitation from the solutions.Three different IPs were tested in vitro: Port‐A‐Cath (PAC), Vascular‐Access‐Port (VAP), and Implantofix (IMP). Each received a daily infusion of a 2.5‐liter solution consisting of fat emulsion, amino acids, glucose, and additives from a “3‐liter bag.” After infusions, the IPs were washed with three different rinsing methods, one including 45% v/v alcohol. After 70 days the ports were opened and examined for precipitation. Ports washed with alcohol showed no signs of precipitation, while four of six ports which were washed with conventional rinsing methods had precipitates. (Journal of Parenteral and Enteral Nutrition 11:566–568, 1987)
A Seldinger Technique for the Insertion of Tunneled Fixed‐Hub Total Parenteral Nutrition Catheters
Authors: Farquhar Iain 
Published: May 2008

Total parenteral nutrition lines are commonly tunneled subcutaneously to decrease rates of sepsis. The history of line tunneling is discussed briefly, noting that to date a surgical approach, a detachable hub catheter or more recently a tunneling rod and ‘peel away’ introducer have been necessary for this form of central venous access. These systems have problems associated with cost, catheter type and insertion technique.A simple technique for insertion of tunneled total parenteral nutrition catheters is described. The device used consists of a polyurethane catheter with a fixed‐hub. The applications of this approach are discussed. (Journal of Parenteral and Enteral Nutrition 11:590–593, 1987)
Prognostic Significance of Serum Cholesterol in Nursing Home Men
Authors: Rudman Daniel , Mattson Dale E. , Nagraj Hoskote S. , Feller Axel G. , Jackson Daniel L. , Caindec Norma , Rudman Inge W. 
Published: May 2008

Serum cholesterol was measured in 129 men (average age 70.6; range 41–96) of a Veterans Administration Nursing Home, and was correlated with other items in an extensive clinical data base.Serum cholesterol was less than 150 mg/dl in 13% of the subjects, and was less than 160 mg/dl in 18%. Cholesterol greater than 280 mg/dl occurred in 8%. Serum cholesterol varied directly (p < 0.02) with: body weight, serum albumin, serum total protein, serum sodium, ability to walk, and ability to feed oneself; and indirectly (p < 0.02) with death rate, degree of functional dependence, and serum SGOT and LDH. Nursing home men with cholesterol less than 150 mg/dl had a death rate of 63% during the 14 months after the cholesterol analysis, compared to a death rate of 9% in men with cholesterol greater than 150 mg/dl (p < 0.05). Death rate during the year after the analysis was 52% if cholesterol was below 160 mg/dl, compared to 7% if it was above this threshold (p < 0.05). (Journal of Parenteral and Enteral Nutrition 12:155–158; 1988)
Review: Neurological Complications of Central Venous Cannulation
Authors: Defalque Ray J. , Fletcher Mark V. 
Published: May 2008

The reports of neurological damage after central venous cannulation over the past 20 yrs have been gathered, summarized, and analyzed. We found 59 cases of nerve lesions: 32 serious or even fatal, and 27 light or transient ones. They included: Lesions of the cervical sympathetic chain: needle trauma, compression by hematoma, anesthetic blockade; brachial plexopathies: needle trauma or compression by hematoma; phrenic or recurrent nerve palsies: anesthetic blockade, needle trauma, or compression by hematoma; cerebral damage following venous air embolism, carotid artery embolism or obstruction (thrombosis, compression), or internal jugular vein obstruction (thrombosis or catheter tip); lesions of the IX, X, XI, and XII cranial nerves by hematoma compression or spilling of histotoxic solutions; and, massive lesions of the anterior rami of the cervical nerves by spillage of histotoxic solutions.We believe that the following simple and well‐known measures can substantially reduce the incidence of those serious complications.1. Avoiding the subclavian or jugular central routes in patients with marked anatomical changes, coagulopathies, and carotid artery or lung diseases.2. Using only small amounts of dilute concentrations of short‐acting local anesthetics before the puncture.3. Using a small gauge “seeking” needle and placing a finger on the carotid artery during a jugular venipuncture to avoid accidental arterial puncture.4. Using radiopaque catheters long enough to have their tip in midsuperior vena cava. The position of the catheter must be checked radiographically immediately after insertion and even at later periods. The catheter must be meticulously fixed to the skin to avoid its movement.5. An experienced physician, familiar with the technique and its dangers and with the anatomy of the region will avoid the multiple, blind punctures in all directions which produce those complications.(Journal of Parenteral and Enteral Nutrition12:406–409, 1988)
Hormonal and Metabolic Changes following Severe Head Injury or Noncranial Injury
Authors: Chioléro R. , Schutz Y. , Lemarchand TH , Felber J.‐P. , De Tribolet N. , Freeman J. , Jéquier E. 
Published: May 2008

In order to evaluate the effect of head injury in severely traumatized patients on the response of plasma cortisol, glucagon, insulin, glucose, and FFA as well as urinary N and catecholamines excretions, 36 patients were prospectively studied over 5 consecutive days following injury. They were divided into three groups: group I, severe isolated head injury (n = 14); group II, multiple injury combined with severe head injury (n = 12); group III multiple injury without head injury (n = 10).The results demonstrate similar hormonal and metabolic changes between these three groups of patients, characterized by elevated urinary adrenaline, noradrenaline excretion, increased cortisol, glucagon, insulin plasma levels throughout the study and elevated N urinary excretion with strongly negative N balances during the first 5 days postinjury. A significant correlation was observed between N intake and 5 day cumulated N balance (r = 0.63, p < 0.001). In addition, N balance was negatively correlated with urinary excretion of adrenaline (r = —0.47, p < 0.01) and noradrenaline (r = ‐0.44, p < 0.05) as well as plasma levels of glucagon (r = —0.44, p < 0.05). Isolated severe head injury seems to induce a full response in the secretion of the catabolic counterregulatory hormones comparable to that encountered in patients with multiple injury and associated with a marked increase in protein catabolism; additional noncranial major injury does not seem to enhance these responses. (Journal of Parenteral and Enteral Nutrition 13:5–12, 1989)
Microbial Contamination of Continuous Drip Feedings
Authors: Freedland Curtis P. , Roller Robert D. , Wolfe Bruce M. , Flynn Neil M. 
Published: May 2008

We evaluated the extent and effects of bacterial contamination of an open continuous enteral feeding system. Eighty‐two quantitative enteral feeding cultures and clinical data were obtained during 8 days of observation on each of 33 patients. Cultures of appropriate sites were obtained on febrile patients and compared to the enteral feeding culture.Gram negative bacilli (GNB) in the enteral feeding correlated with abdominal distension in the patients (10 of 12 patients with GNB compared to 5 of 21 without GNB; p < 0.01). Nine of the 10 patients with GNB and distension were receiving systemic antimicrobics to which the organism was resistant. Contamination of feeding with Serratia marcescens correlated with cultures for the same organism in patients' other body sites (p < 0.01). The feeding contaminant may have been the source of sepsis in one patient who expired from septic shock. No relationship was demonstrated between contamination and liquid stools or fever.Undiluted, canned feedings were significantly less contaminated at 24 hr (15%) than those requiring mixing of powder (94%) (p < 0.0001). The canned feedings grew primarily enteric organisms, whereas the powder feedings grew flora typically resident on the skin.Mixing or diluting feedings appears to represent an increased risk of contamination. Growth of GNB may produce adverse effects. Further investigation into methods to limit contamination and growth is warranted. (Journal of Parenteral and Enteral Nutrition 13:18–22, 1989)