bluuebunny/crossref_metadata_2025_split huggingface dataset:
Extraction of Diethylhexylphthalate from Total Nutrient Solution‐Containing Polyvinyl Chloride Bags
Authors: Mazur Helen I. , Stennett Douglass J. , Egging Paulette K. 
Published: May 2008

Total nutrient solution (TNS) is a new method for delivering total parenteral nutrition (TPN) by admixing dextrose, amino acids, and lipids in a single container. Recommendations are to use nonpolyvinyl chloride (PVC) containers for admixture of these solutions. PVC is a hard, brittle, and inflexible substance, and plasticizers, predominantly diethylhexylphthalate (DEHP), are added to impart flexibility. DEHP is a lipid soluble suspected carcinogen, hepatotoxin, and teratogen which has been shown to leach from PVC products containing lipophilic admixtures. The purpose of this study was to quantitate the amount of DEHP which leaches from PVC bags containing TNS.Six study groups, which contained three formulas stored at 25°C ± 2°C and 4°C ± 1°C, were assayed for DEHP at time 0, 12, 24, 48 and 72 hr, 1 wk, and 3 wk using high‐performance liquid chromatography. The control group contained an amino acid source, a carbohydrate source, and standard electrolytes, and the other groups contained a 10% lipid source or a 20% lipid source in addition to the constituents of the control group.Lipid‐containing groups demonstrated detectable levels of DEHP at 48 hr, and DEHP content increased in these groups throughout the 21‐day study. DEHP concentrations were lower in lipid‐containing groups stored at 4°C than comparable groups stored at 25°C. (Journal of Parenteral and Enteral Nutrition 13:59–62, 1989)
Influence of Energy Source upon Body Composition in Patients Receiving Intravenous Nutrition
Authors: Almond D.J. , King R.F.G.J. , Burkinshaw L. , Laughland A. , Mcmahon M.J. 
Published: May 2008

The influence of energy substrate upon body composition was investigated by measuring changes in the body composition of 24 patients who received intravenous nutrition for 2 weeks. The patients were randomly allocated to two groups. Twelve patients (the “glucose group”) received all ‘nonprotein’ calories as glucose, the remaining 12 (the “fat‐glucose group”) received 60% of ‘nonprotein’ calories as fat emulsion (Intralipid). Amino acids (FreAmine II) were supplied to give a calorie/nitrogen ratio of 150:1. Total calories were supplied at a rate of 1.4 times the measured resting energy expenditure of each patient. Body composition was measured using routine anthropometric techniques and in vivo neutron activation analysis. Significant increases in body fat and total body potassium (TBK) were recorded in the glucose group, but there was no significant change in total body water (TBW) or total body nitrogen (TBN) in either group. The initial value of the ratio of TBK:TBW had a significant negative correlation with the change of TBK in both groups, and with the change of TBN in the glucose group.The study demonstrates the importance of considering nutritional status when analyzing the effects of intravenous nutrition. Glucose as the sole source of calories induced an increase in body potassium independent of protein synthesis; this effect was not observed in patients who received 60% of their energy supply as lipid emulsion. (Journal of Parenteral and Enteral Nutrition 13:471–477, 1989)
Lipid Tolerance in the Very Low Birth Weight Infant on Intravenous and Enteral Feedings
Authors: Wells David H. , Ferlauto Jerry J. , Forbes Debbie J. , Graham Tony R. , Newell Robert W. , Wareham John A. , Wilson Catherine A. 
Published: May 2008

Nutrition is of critical importance to very low birth weight (VLBW) survival. Intravenous (iv) lipid tolerance has been studied using a soybean or safflower‐based lipid emulsion. We studied lipid levels in a group of VLBW infants on both intravenous lipids (soybean‐safflower emulsion) and on enteral feedings (24 cal/oz premature formula). Levels were obtained on 1, 2, and 3 g/kg/day of iv lipid and after 3 and 10 days of feeding.Triglyceride (TG) and free fatty acid (FFA) proved the most sensitive indicator of both iv and enteral tolerance. The higher the lipid dose, the more likely there would be elevated lipid levels, especially FFA. Mean lipid levels for the group of enteral‐fed infants were normal. Comparison of lipid levels on iv to those on enteral feedings showed significant differences in trough iv levels of TG compared to preprandial TG. FFAs tended to be significantly higher on iv feedings. Monitoring lipid levels on iv and enteral feedings is appropriate to document tolerance. (Journal of Parenteral and Enteral Nutrition 13:623–627, 1989)
Availability of Insulin from Total Parenteral Nutrition Solutions
Authors: Marcuard Stefan P. , Dunham Bruce , Hobbs Alton , Caro José F. 
Published: May 2008

Insulin is frequently required in total parenteral nutrition (TPN) solutions to control hyperglycemia. The purpose of this study was to evaluate the recovery of human insulin from standard TPN solutions with and without lipids and from TPN solutions with specialized amino acid formulations and to compare it to the insulin recovery from normal saline.All solutions were mixed in currently utilized PVC‐free bags (ethylene vinyl acetate) and drained through PVC‐containing tubing. Human insulin (Humulin‐R) was spiked with 125I‐labeled insulin and then added in concentrations of 10, 25, and 50 units to 1‐liter bags containing 39‐g amino acids (10% Freamine‐III; or 6.9% Freamine HBC; or 8% Hepatamine), 257‐g dextrose, electrolytes (Hyperlyte‐R), 1000 units of heparin, MVI‐12, and MTE‐5 Concentrate. Alternate sets of bags contained 125 ml of 20% Intralipid and an appropriate amount of sterile water to keep the final volume at 1 liter. Actual clinical conditions of preparation, storage, and administration were simulated in this in vitro experiment. Multiple samples were collected during the 8‐hr infusion period directly in gamma counter vials. All experiments and assays were done in triplicate.Our findings indicate that human insulin availability in TPN solutions is much higher (90%‐95%) than the 50% suggested in the literature. Insulin recovery was not appreciably altered by adding lipids or by using Freamine HBC. Insulin recovery from TPN solutions was significantly reduced if they contained Hepatamine (87% and 88%, p<0.05) as compared to Freamine (90% and 94%). In comparison, insulin recovery from normal saline was 65% (p<0.001) and, accordingly, insulin binding to the infusion materials was significantly greater than with TPN solutions. (Journal of Parenteral and Enteral Nutrition 14:262–264, 1990)
Effects of Gas Leak Around Endotracheal Tubes on Indirect Calorimetry Measurement
Authors: Dietrich Kenneth A. , Romero Michael D. , Conrad Steven A. 
Published: May 2008

The use of uncuffed endotracheal tubes (ETT) in pediatric patients raises concern over the accuracy of indirect calorimetry measurement in the presence of a gas leak around an ETT. We examined the effects of ETT gas leak on respiratory gas measurements in a dog model.Mongrel dogs (n=12) were sedated, paralyzed, intubated, and placed on mechanical ventilation. Leak was achieved by adjusting cuff volume. Oxygen consumption (VO2), CO2 production (VCO2), respiratory exchange ratio (RER), and resting energy expenditure (REE) were measured at each leak pressure (Pleak). Peak inspiratory pressure (PIP), Pleak, inspiratory and expiratory tidal volume (VTinsp, VTexp), VE, end tidal CO2 (ETCO2), and blood gases were recorded at each leak pressure.VO2, VCO2, and REE decreased significantly with increasing gas leak. There was a linear relationship between VO2, VCO2, and REE with both TVratio (VTexp/VTinsp) and Pdiff (PIP‐Pleak). Multiple regression equations based on TVratio and Pdiff were obtained which allowed correction of the measurement error in VO2, VCO2, and REE, with correlation coefficients (R 2) of 0.71, 0.75, and 0.73, respectively.ETT gas leak affects measurements of VO2, VCO2, and REE, but not RER. Measurements made with TVratio > 0.80 required no correction. Measurements made with TVratio > 0.45 could be corrected to actual values in our model with regression equations based on TVratio and Pdiff. We conclude that indirect calorimetry measurements can be useful in the presence of tracheal gas leak around an ETT. (Journal of Parenteral and Enteral Nutrition 14:408–413, 1990)
Urinary Urea Nitrogen: Too Insensitive for Calculating Nitrogen Balance Studies in Surgical Clinical Nutrition
Authors: Konstantinides Frank N. , Konstantinides Nancy N. , Li John C. , Myaya Mary E. , Cerra Frank B. 
Published: May 2008

Urinary urea nitrogen (UUN) has been used as an estimate of total urinary nitrogen (TUN) when calculating nitrogen output for nitrogen balance (NB) studies. UUN is assumed to constitute 80 to 90% of the total nitrogen output; when estimating TUN from UUN, UUN values are multiplied by 1.25 to correct for non‐urea nitrogen components. In order to evaluate the validity of estimating total urinary nitrogen output from measured UUN in a clinical setting, 491 UUN:TUN paired studies were performed on 24‐hour urine collections in general surgical/trauma patients who had measured TUN outputs ranging from 0.04 to 54.0 g/d.Assessment of 315 NB studies was done to compare NB values of those calculated by using UUN as an estimate of TUN with those calculated from measured TUN. Patients in both studies were subdivided into four stress categories, using TUN/day as the index: < 5 g, 5–10 g, 10–15 g, and > 15 g.On average, 80 to 90% of TUN is represented by the UUN. However, in our patient population the variability ranged from 12 to 112%. If these UUN values are used as estimates for TUN in calculating NB, variations of up to 12 g/d would result. Application of the correction factor of 1.25 is not consistent in correcting for nonurea nitrogen components in this clinical setting. The use of actual rather than estimated TUN may be a more accurate and appropriate method than UUN when calculating NB. (Journal of Parenteral and Enteral Nutrition 15:189–193, 1991)
Successful High‐Dose Calcium Treatment of Aluminum‐Induced Metabolic Bone Disease in Long‐Term Home Parenteral Nutrition
Authors: Lidor Cobi , Schwartz Ivan , Freund Uri , Gazit Dan 
Published: May 2008

A patient who developed severe metabolic bone disease is presented. He had received long‐term home parenteral nutrition (HPN) following extensive small bowel resection after mesenteric vein thrombosis. Bone disease caused by aluminum intoxication had components of osteomalacia and low‐turnover osteoporosis. Aluminum was detected at the surface of mineralized bone and was elevated in the serum, resulting in a positive deferoxamine infusion test.One year of treatment with high doses of calcium (up to 24 mEq per day) significantly diminished the patient's bone pain, increased the serum levels of calcium, abolished aluminum deposits in the mineralized trabecula, improved bone formation, and increased trabecular bone volume as assessed by repeated histomorphometric analysis. (Journal of Parenteral and Enteral Nutrition 15:202–206, 1991)
Infusion of Enteral vs Parenteral Nutrients Using High‐Concentration Branch‐Chain Amino Acids: Effect on Wound Healing in the Postoperative Rat
Authors: Delany Harry M. , Teh Eutiquio , Dwarka Brian , Levenson Stanley M. 
Published: May 2008

Starting total parenteral nutrition (TPN) the day after acute surgical stress has beneficial effects on body weight, nitrogen balance, and colonic anastomosis bursting pressure in normally nourished rats. In view of the reported favorable utilization of high‐concentration branch‐chain amino acids (BCAA) following severe stress, we compared enteral (TEN) to parenteral (TPN) nutrient infusions containing increased BCAA starting the day of operation. Twenty‐four male Sprague‐Dawley rats, in two groups paired by weight under IP pentobarbital anesthesia underwent jugular vein catheter (CVP) insertion, laparotomy, gastrostomy, colon anastomosis, dorsal skin incision and SC polyvinyl alcohol sponge insertion. The rats were maintained for 6 days with continuous IV infusion in the TPN group (gastrostomy plugged) and continuous gastric infusion for the TEN group (CVP plugged). Urine and feces were collected daily. The infusions contained 1000 to 1002 Kcal, 847 to 845 nonprotein Kcal, 38 to 39 g of amino acids, 206 to 209 g of carbohydrates, and 2.8 to 2.9 g of rat per liter in the TEN and TPN, respectively, with indentical ratios of dietary essential amino acids to nonessential amino acids (52/ 48), and 28.34% BCAA in the TPN and 33.10% BCAA in the TEN. There were 491 mg/100 mL of glutamine in the TEN and 170 mg of glutamic acid in the TPN. Amino acids were infused at 8.59 g/kg per day for TEN and 8.34 g/kg per day for TPN. The vitamins, minerals, and trace minerals were essentially the same in the TEN and TPN except for the absence of iron, iodine, selenium, and molybdenum in the TPN. There were no statistically significant differences between the two groups in body weight change, daily and cumulative nitrogen intake, urinary and fecal nitrogen excretion, and nitrogen balance, colonic bursting strength, (215.8 ± 7.0 mm Hg for TEN, 203.3 ± 4.6 for TPN), colon anastamosis hydroxyproline (2.15 ± 0.20 μg/mg for TEN, 1.94 ± 0.13 μg/mg for TPN) skin incision breaking strength (Fresh, 100 ± 6.1 g for TEN, 105 ± 5.7 g for TPN) and after formalin fixation 379 ± 27 g for TEN, 370 ± 23 g for TPN and hydroxyproline content of reparative tissue in the SC sponges (1259 ± 92 μg/100 mg sponge for TEN, 1312 ± 86 μg/100 mg sponge for TPN).In conclusion, the overall utilization of high BCAA concentration nutrients of very similar composition infused enterally (TEN) or intravenously (TPN) are equivalent and the route of their administration does not influence cutaneous, subcutaneous, and colonic wound healing, weight change, or daily and cumulative nitrogen balance following acute surgical stress. (Journal of Parenteral and Enteral Nutrition 15: 464–468,1991)
Feeding Jejunostomy for Post Operative Nutritional Support M. CARMON, D. SEROR, R. UDASSIN, ET AL. Clinical Nutrition 10:298–301, 1991
Authors: Bell Stacey J. , Borlase Bradley C. 
Published: May 2008

The authors describe their experience using jejunostomy tubes placed during a primary surgical procedure in 19 adult patients during a 2‐year period. All but one patient underwent a laparotomy (the one exception had a thoracotomy) for gastrointestinal cancer, peptic ulcer disease, or trauma. Large‐bore (16 or 18 French) red rubber catheters were used for feeding jejunostomies. Patients were fed according to a standard protocol that included (1) use of commercially available formulas, (2) infusion pumps, (3) liberal use of antidiarrheal agents, and (4) initiation of feeding on the second postoperative day. Patients were fed by tube for a mean of 22 days and received a mean of 1850 calories with 62 g of protein per day. Feeding tubes remained in place (insertion to removal) for an average of 59 days. Seven of the 19 patients had the tubes removed during hospitalization; for the remaining patients, tubes were removed after discharge. After removal of the tube, the tract closed spontaneously and uneventfully in all patients.No mortality was associated with feeding tube insertion. One patient developed intestinal obstruction believed to be due to angulation of the bowel caused by the jejunostomy tube; the obstruction resolved after removal of the tube. Another patient exhibited paralytic ileus that necessitated discontinuation of the formula; upon resolution of the ileus, administration of the formula resumed. Five patients (26%) developed diarrhea, and two patients had clogged feeding tubes (one had the tube removed and a new tube was inserted under fluoroscopy). Four patients (21%) had inadvertent removal of their tubes, and all tubes were immediately reinserted. Three patients required home enteral support; one experienced a minor skin irritation at the catheter site that resolved by replacement with a larger feeding tube.In conclusion, the authors have successfully employed enteral feeding in the hospital setting with low morbidity. They selected jejunostomy feeding tubes rather than gastrostomy tubes for patients requiring prolonged enteral nutrition support because of the reduced risk of aspiration of gastric contents.
Lecithin Increases Plasma Free Choline and Decreases Hepatic Steatosis in Long‐Term Total Parenteral Nutrition Patients A. L. BUCHMAN, M. DUBIN, D. JENDEN, ET AL Gastroenterology 102:1363–1370, 1992
Authors: Demetriou Achilles A. 
Published: May 2008

Several investigators, including the authors, have demonstrated that patients receiving long‐term total parenteral nutrition (TPN) have low plasma choline levels.1–3 In the present study, 15 patients who were receiving home TPN were randomly chosen from a group of long‐term TPN patients found to have low levels of plasma free choline on initial screening.3The patients received TPN for 7.0 ± 1.1 years (range, 1.5 to 12.5 years). Their TPN consisted of 2 to 3 liters of 15% to 25% dextrose solution with 3.5% to 4.25% amino acids, electrolytes, trace elements, and vitamins. Patients received 20.1 ± 2.2 kcal/kg per day actual body weight. Parenteral lipid supplied was 22 ± 5% of daily intravenous caloric intake (Intralipid 20%, Kabi‐Vitrum, Alameda, CA).Patients received either lecithin supplementation (20 g/12 hours in 2.5 tablespoons of soybean oil‐based liquid) or placebo (2.5 tablespoons of oil) for 6 weeks in a double‐blind fashion. Patients were evaluated at baseline and at 2 and 6 weeks. Laboratory measurements included plasma and red blood cell free choline, plasma and red blood cell phospholipid‐bound choline, transaminases, alkaline phosphatase, bilirubin, cholesterol, high and low density lipoproteins, carnitine (total and free), and methionine. Free and phospholipid‐bound choline levels were measured in bottles of Intralipid. Liver imaging was carried out by computed tomography (CT) scanning. Limited noncontrast CT scans of the liver and spleen were performed at 120 kV, 120 mA with a 3.0‐second scan time. Multiple representative sections were examined and a mean CT number in Hounsfield units was determined by two methods, determination of the mean absolute liver CT number and the liver spleen differential, obtained by subtracting the average spleen CT number from the average liver CT number to correct for interscan variability. Data were analyzed statistically by comparing percent changes in blood tests at 2 and 6 weeks and absolute changes in Hounsfield units.The full 6‐week study was completed in 10 of the 15 patients. Eight of 15 subjects had fatty livers at baseline. Lecithin supplementation led to an increase in plasma free choline of 53.4% ± 15.4% at 2 weeks (p <.04), whereas the placebo group had no change at 2 weeks. A significant (p <.02) decrease in liver fat, indicated by the change in Hounsfield units was seen at 2 weeks in the lecithin‐supplemented group (7.5 ± 1.7 units). No significant changes were seen in the placebo group.The authors concluded that hepatic steatosis in many patients receiving long‐term TPN is caused by plasma free choline deficiency and may be reversed with lecithin supplementation.
Defining and Reporting Diarrhea in Tube‐Fed Patients—What a Mess! D. Z. BLISS, P. A. GUENTER, R. G. SETTLE American Journal of Clinical Nutrition 55:753–759, 1992
Authors: Heimburger Douglas C. 
Published: May 2008

The purpose of this study is to document the effect that various definitions of diarrhea have on its reported incidence in tube‐fed patients. Following a group of 29 patients who were tube‐fed for at least 5 days (median duration of feeding, 13 days), the investigators prospectively monitored the occurrence of diarrhea according to each of eight definitions: ≥1, ≥2, ≥3, ≥4 liquid stools/ day; ≥3 stools/day; ≥4 stools/day; ≥4 stools/day for 2 days; and ≥5 stools/day. None of the definitions incorporated measurements of either stool weights or volumes. Because treatment with antibiotics and the presence of hypoalbuminemia have been associated with diarrhea in some reports, the investigators took those into account. Sixty‐six percent of the patients (19 patients) were treated with antibiotics and only 7% (2 patients) had serum albumin levels <26 g/L; the mean serum albumin level of the remaining 27 patients was 34 g/L. Only 10% (3 patients) were in critical care units. Because duration of monitoring would be expected to correlate positively with incidence, and is often not reported in studies of tube‐feeding‐associated diarrhea, the authors reported both the incidence of diarrhea and the percent of days with diarrhea. It is also noteworthy that 31% (9 patients) of the patients received kaolin‐pectin for treatment of diarrhea, which probably affected the percent of days with diarrhea.The more lenient definitions of diarrhea resulted in higher incidence rates and higher percentages of days with diarrhea. The most lenient definition (≥1 liquid stool/day) was associated with an incidence rate of 72%, and 26% of days with diarrhea, whereas the most rigorous definitions (≥4 liquid stools/day and ≥5 stools/day) resulted in 21% incidence and 1.7% of days with diarrhea. The number of days patients were monitored correlated positively with the incidence of diarrhea, but very weakly with the percent of days with diarrhea. Thus, the use of percent of days with diarrhea as the method of reporting reduced the effect of varying durations of monitoring. Antibiotic treatment correlated positively with percent of days with diarrhea, but not with incidence. Serum albumin levels did not correlate with diarrhea, but this may have been caused by the largely normal albumin levels in this population.