摘要:

Rats were infused continuously for 7 days with a complete total parenteral nutrition (TPN) solution in which 27.5% total calories were given as a parenteral lipid emulsion containing soybean oil (Liposyn) or safflower oil (Intralipid) emulsified with egg phospholipid (PL). Compared to sham‐operated rats fed chow, the erythrocyte membranes from rats given TPN with lipid emulsion had increased cholesterol and PL but normal molar cholesterol:PL ratios. The fatty acid changes in sphingomyelin and phosphatidylcholine, in particular, suggested replacement of endogenous PL with the exogenous egg PL infused with the emulsion. The changes in membrane lipid composition were accompanied by greater resistance of the cells from rats given TPN to osmotic lysis invitro. (Journal of Parenteral and Enteral Nutrition13:47–50, 1989)

ISSN:0148-6071    

DOI:10.1177/014860718901300147

出版商:SAGE Publications    

年代:1989

数据来源: WILEY

摘要:

Studies were made on the effects of inosine, guanosine 5′‐monophosphate (GMP), cytidine, uridine, thymidine, and their mixture (4:4:4:3:1, OG‐VI) on DNA and RNA syntheses in primary monolayer cultures of normal hepatocytes and cultures of hepatoma cells, AH130, to use these compounds for total parenteral nutrition. Addition of an appropriate amount of inosine, GMP, uridine, or thymidine to primary cultures of hepatocytes enhanced both DNA and RNA syntheses by the salvage and de novo pathways. Cytidine appeared to have lower optimal concentration for enhancing these pathways. The OG‐VI mixture also enhanced the syntheses of DNA and RNA, but the composition of the mixture was not optimal. Additions of inosine, GMP, uridine, and thymidine to cultured hepatoma cells also enhanced their DNA and RNA syntheses, but the cells consumed more of the added nucleic acid compounds than hepatocytes did. Addition of cytidine had no effect on proliferation of the cells. The OG‐VI mixture at relatively higher concentration inhibited the syntheses of DNA and RNA by hepatoma cells. Addition of high concentrations of nucleic acid compounds was found to suppress the proliferation of both hepatocytes and hepatoma cells. These results suggest that addition of optimal amounts of nucleic acid compounds such as nucleosides and nucleotides would enhance growth of hepatocytes, particularly during liver regeneration, but that they may also enhance proliferation of tumor cells in the liver.(Journal of Parenteral and Enteral Nutrition13:51–58, 1989)

ISSN:0148-6071    

DOI:10.1177/014860718901300151

出版商:SAGE Publications    

年代:1989

数据来源: WILEY

摘要:

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 Nutrition13:59–62, 1989)

ISSN:0148-6071    

DOI:10.1177/014860718901300159

出版商:SAGE Publications    

年代:1989

数据来源: WILEY

摘要:

Vancomycin hydrochloride, 400 mg/liter was mixed in six standard pediatric parenteral nutrition solutions with and without heparin added. The solutions were stored over a period of 8 days (192 hr) under refrigeration and at room temperature. Aliquots from all six solutions were assayed in duplicate for vancomycin at time 0, 24, 96, and 192 hr. All samples were run through an Ivex 0.22‐micron filter, observed for physical incompatibilities, and frozen at —70°C until assay.Our results indicate that vancomycin was stable and was delivered with loss in concentration of less than 5% with and without storage under refrigeration.This study suggests an alternative method for delivering vancomycin when treating a catheter‐related infection. If vancomycin is delivered in this fashion, less manipulations of the line would be required. In addition, there may be a theoretical advantage of constantly bathing the catheter with vancomycin when the catheter is suspected of harboring the infecting organism.(Journal of Parenteral and Enteral Nutrition13:63–64, 1989)

ISSN:0148-6071    

DOI:10.1177/014860718901300163

出版商:SAGE Publications    

年代:1989

数据来源: WILEY

摘要:

Increased brain concentrations of tryptophan, and presumably thereby increased brain serotonin metabolism, have been observed following liver impairment and implicated in the etiology of portal‐systemic encephalopathy (PSE). Increased plasma‐free tryptophan (ie, not albumin‐bound) concentrations can be expected after exogenous fat administration. This might further increase the brain serotonin metabolism in liver failure and negatively influence the PSE.We treated rats 2 weeks after end‐to‐side portacaval shunt (PCS) with continous intravenous infusion of fat emulsion (Intralipid 20%) for 24 and 72 hr, respectively. The regional serotonin turnover was determined in different regions of the central nervous system (CNS) by measuring 5‐hydroxyindole concentrations after NSD 1015 decarboxylase inhibition. The results revealed no further increase of the CNS serotonin turnover after fat infusion to PCS rats, compared with PCS rats given equal amounts of glucose. Thus, continuous infusion of a fat emulsion caused no major alteration of the CNS serotonin metabolism in PCS rats.(Journal of Parenteral and Enteral Nutrition13:65–70, 1989)

ISSN:0148-6071    

DOI:10.1177/014860718901300165

出版商:SAGE Publications    

年代:1989

数据来源: WILEY

摘要:

The financial data of all patients (535) admitted to the Nutritional Support Service (NSS) during 1985, including charges, true care costs, and actual reimbursement including pass‐through payments (which are Medicare funds given directly to hospitals for education and capital equipment, and vary significantly from hospital to hospital), were analyzed. The NSS Medicare patients fell into 98 diagnostic related groups (DRGs). All 3,939 Medicare patients admitted in 1985 with the same DRGs as the NSS patients were also identified and their financial data analyzed. The NSS patients lost $999,643 because the 266 medicare reimbursed NSS patients sustained high losses which overwhelmed the modest profits of the 269 non‐Medicare patients. When data from all Medicare patients (which includes both NSS and non‐NSS patients) with the same DRGs are analyzed, large profits are realized. These profits are totally due to pass‐through payments received. Without pass throughs the loss for all 3,939 Medicare patients in these 98 DRGs would have been $1,641,273. The impact of eliminating pass throughs in the next few years needs to be determined. NSS patients represent a group that generates high financial losses under the federal prospective reimbursement system. However, present Medicare reimbursement of other less seriously ill patients with similar DRGs more than compensate these losses if pass throughs are used in determining reimbursements.(Journal of Parenteral and Enteral Nutrition13:71–76, 1989)

ISSN:0148-6071    

DOI:10.1177/014860718901300171

出版商:SAGE Publications    

年代:1989

数据来源: WILEY

摘要:

The effect of short‐term infusion of intravenous fat on serum lipids was assessed in 23 patients who had elective cancer operations and were given 20% Intralipid for 5 days postoperatively as part of a standard total parenteral nutrition regimen. Serum lipids were measured prior to, during and after the 5‐day infusion period. The percentage of cholesterol as high‐density lipoproteins (HDL) fell from a mean preinfusion value of 34.7 ± 2.8 to 27.9 ± 2.5 (p<0.05), while the percentage of cholesterol as low‐density lipoproteins (LDL) increased from 40.7 ± 2.2 to 46.8 ± 3.4 (p<0.05). Serum triglycerides fell significantly (p<0.01) from 106.2 ± 13.7 mg/dl to 64.6 ± 8.8 mg/dl at 3 days, being 85.3 ± 3.7 mg/dl at 5 days. No significant change in percent cholesterol as very low‐density lipoproteins (VLDL), or levels of serum total cholesterol or phospholipids occurred. Lipoprotein X was detectable in six patients after 5 days. To study triglyceride clearance 1.7 g/kg of fat emulsion was infused over 8 hr and serial blood samples obtained. Within 3 hr of stopping the fat infusion, triglyceride levels had fallen to preinfusion values.(Journal of Parenteral and Enteral Nutrition13:77–80, 1989)

ISSN:0148-6071    

DOI:10.1177/014860718901300177

出版商:SAGE Publications    

年代:1989

数据来源: WILEY

摘要:

This is a report of an in vitro study evaluating the ability of six solutions to dissolve clotted enteral feeding, which can cause feeding tube occlusion. The following clotted enteral feeding products were tested: Ensure Plus, Ensure Plus with added protein (Promod 20 g/liter), Osmolite, Enrich, and Pulmocare. Clot dissolution was then tested by adding Adolf's Meat Tenderizer, Viokase, Sprite, Pepsi, Coke, or Mountain Dew. Distilled water served as control. Dissolution score for each mixture was assessed blindly. Best dissolution was observed with Viokase in pH 7.9 solution(p<0.01). Similar results were obtained when feeding tube patency was restored in eight in vitro occluded feeding tubes (Dobbhoff, French size 8) by using first Pepsi (two/eight successful) and then Viokase in pH 7.9 (six/six successful).We also report our experience in the first 10 patients with occluded feeding tubes using this Viokase solution injected through a Drum catheter into the feeding tube. In seven patients, this method proved to be successful, and the reasons for failure in three patients include a knotted tube, impacted tablet powder, and a formula clot of 24 hr duration and 45 cm in length.(Journal of Parenteral and Enteral Nutrition13:81–83, 1989)

ISSN:0148-6071    

DOI:10.1177/014860718901300181

出版商:SAGE Publications    

年代:1989

数据来源: WILEY

摘要:

Gastrointestinal disorders associated with diabetes mellitus have a prevalence rate of 30 to 75%. The most prominent disorders are gastroparesis, diarrhea, and constipation. Severity of symptoms range from mild to severe with the most affected patients being at risk for the development of protein calorie malnutrition. An historical review of the major studies which defined the diagnosis, pathophysiology, and prevalence of these disorders is presented. Guidelines for accurate nutritional assessment, which is essential to the decision to initiate nutritional therapy in this difficult to assess population, are also included. Current methods devised for treatment of diabetic gastroparesis and related disorders are presented. Emphasis is placed on recent developments in nutritional support techniques which make it possible to meet the energy requirements of all such patients. Practical outlines for glucose control in patients receiving TPN or enteral feeding and guidelines for transitioning from parenteral feeding to an oral diet are also presented.(Journal of Parenteral and Enteral Nutrition13:84–91, 1989)

ISSN:0148-6071    

DOI:10.1177/014860718901300184

出版商:SAGE Publications    

年代:1989

数据来源: WILEY

摘要:

Tunnelled silicone rubber right atrial catheters are commonly used to administer long‐term total parenteral nutrition (TPN), cancer chemotherapeutic agents, and antimicrobial agents. The indwelling devices potentiate platelet‐fibrin thrombi formation, providing a nidus for infection. Although many episodes of sepsis associated with thrombotic tunnelled catheters respond to antimicrobial therapy alone, a significant number require catheter removal. Evidence from case studies and small clinical trials suggests that fibrinolytic agents may increase the response rate and prevent removal of the device when combined with antimicrobial therapy. We present the first case reported of bacterial sepsis secondary to a thrombotic indwelling Hickman catheter for long‐term TPN successfully treated with a combination of streptokinase and antibiotic therapies.(Journal of Parenteral and Enteral Nutrition13:92–98, 1989)

ISSN:0148-6071    

DOI:10.1177/014860718901300192

出版商:SAGE Publications    

年代:1989

数据来源: WILEY