摘要:

Administration of an elemental diet to rats given methotrexate (MTX), 20 mg/kg intraperitoneally (ip), results in 100% mortality from severe enterocolitis. Previous studies indicate that glutamine (GLN), which is not present in elemental diets, is the preferred oxidative substrate for the gut' and may facilitate intestinal recovery after injury.2This study investigated the effects of a glutamine‐supplemented elemental diet (GLN‐ED) on nutritional status, intestinal morphometry, bacterial translocation and survival in this lethal model of intestinal injury. Three experiments were performed. In the first experiment, rats received an intragastric elemental diet supplemented with either 2% GLN or an equivalent amount of glycine (Control). After 4 days animals received either MTX, 20 mg/kg ip, or saline ip and were killed 3 days later. The GLN‐ED resulted in significantly decreased weight loss, improved nitrogen retention, and increased mucosal weight, protein, and DNA content of the jejunum and colon.In the second experiment rats were assigned to diet as in the first experiment, but all animals received MTX. Control diet animals died within 120 hrs of MTX administration. The GLN‐ED group had significantly longer survival time and decreased mortality.In the third experiment animals were assigned to diet and MTX as in the first experiment. Ninety‐six hrs later aortic blood cultures revealed enteric bacteremia in animals administered MTX. GLN‐ED resulted in a significant reduction in the incidence of bacteremia.These experiments showed that a GLN‐ED significantly improved nutritional status, decreased intestinal injury, decreased bacterial translocation, and resulted in improved survival in a lethal model of enterocolitis.(Journal of Parenteral and Enteral Nutrition12:325–331, 1988)

ISSN:0148-6071    

DOI:10.1177/0148607188012004325

出版商:SAGE Publications    

年代:1988

数据来源: WILEY

摘要:

A prospective, randomized, controlled trial of nutritional effects of branched‐chain‐enriched amino acid (BCAA) solution was undertaken in 173 surgical patients with gastric cancer. Eighty‐six and 87 patients underwent subtotal and total gastrectomy, respectively. The effects were evaluated in total parenteral nutrition (TPN) in an isocaloric/isonitrogenous setting where the major difference between the group was the amount of BCAA received. Each 80 patients in the control and the BCAA groups completed the trial. The group receiving BCAA‐enriched amino acid solution demonstrated a statistically significant improvement on days 2 and 3 in nitrogen balance in patients with total gastrectomy. Three‐methylhistidine excretion gradually decreased after day 1, and the values on day 7 were significantly lower than those on day 1 in the BCAA group in both those receiving subtotal and total gastrectomy. There were no significant differences of serum albumin and rapid turnover proteins between the control and BCAA groups in both those receiving subtotal and total gastrectomy. Plasma BCAA level and BCAA to aromatic amino acid (AAA) ratio were significantly higher, and AAA level was significantly lower in the BCAA group than in the control group. There were no serious complications encountered during the observation period in both groups. These results indicated that a BCAA‐enriched amino acid solution can improve metabolism and maintains good nitrogen retention without increasing side effects as compared with a conventional amino acid solution for nutritional support of patients who have received subtotal or total gastrectomy.(Journal of Parenteral and Enteral Nutrition12:332–337, 1988)

ISSN:0148-6071    

DOI:10.1177/0148607188012004332

出版商:SAGE Publications    

年代:1988

数据来源: WILEY

摘要:

The hypermetabolic state observed in thermally injured patients warrants aggressive nutritional management. Enteral support is the preferred route of nutrient delivery, however diarrhea is reported to be a persistent complication of continuous nasogastric or nasoduodenal hyperalimentation. Diarrhea adds to problems in patient care, disturbs fluid and electrolyte balance, and worsens nutritional status. There has been the impression that tube feeding hyperosmolality, antibiotics, and low serum albumin induce diarrhea. However, in view of the sparsity of published work, a prospective study was undertaken to determine the incidence of diarrhea and to define factors associated with its cause. Of the 50 patients studied, 16 (32%) developed diarrhea. Stool cultures were negative for pathogenic organisms. Although the risk of diarrhea was associated with antibiotics (p<0.005), several nutrients also had an impact. Results demonstrated a significant relationship between dietary lipid content (p<0.05) or vitamin A intake(p<0.001) and diarrhea. Implementation of tube feeding within 48 hrs postburn was also associated with a decreased incidence of diarrhea (p<0.001). This paper describes a modular tube feeding program in which diarrheal frequency is lessened (p<0.0001). Surprisingly, tube feeding osmolality, drugs used to prevent stress ulcers, or hypoalbuminemia did not have an adverse effect on intestinal absorption. The cause of diarrhea in burn patients is obviously multifactorial. It is concluded that a low fat (10,000 IU/day), early enteral support program maximizes conditions which promote tube feeding tolerance while minimizing nutrient malabsorption during the nutritional rehabilitation of thermal injury.(Journal of Parenteral and Enteral Nutrition12:338–345, 1988)

ISSN:0148-6071    

DOI:10.1177/0148607188012004338

出版商:SAGE Publications    

年代:1988

数据来源: WILEY

摘要:

Effects of postoperative infusion of a 3% amino acid solution on natural killer (NK) cell activity were studied in 10 patients undergoing major abdominal surgery. Eight additional patients formed the control group. Preoperative NK cell activity against K562 target cells determined in a short‐term51Cr release assay was similar in patients of both groups. After the operation, in general the patients of both groups showed a decrease in NK cell activity (p<0.01) but without differences between the groups. There were no changes in the percentages of Leu‐7 positive cells (NK cells) between or within the two groups. However, the number of Leu‐7 positive cells in blood was lower in the amino acid than in the control group patients during the postoperative days 3–7(p<0.05 and 0.01).In vitro,the amino acid solution proved to be nontoxic both for effector and target cells and no depression of NK cell activity was observed. A 16‐hr preincubation of mononuclear cells with the amino acid solution did not affect NK cell activity.The results suggest that postoperative infusion of an isotonic amino acid solution does not routinely offer any advantages over glucose containing electrolyte solution as to its effects on NK cell activity.(Journal of Parenteral and Enteral Nutrition12:346–350, 1988)

ISSN:0148-6071    

DOI:10.1177/0148607188012004346

出版商:SAGE Publications    

年代:1988

数据来源: WILEY

摘要:

The purpose of this study was to explore the fate of a single dose of labeled selenium as determined by its route of administration. Thus, the appearance of a stable isotope of selenium, administered as74‐Se‐selenite, was measured in plasma, urine, and feces, with neutron activation analysis, following a 81.7 μg dose of74Se‐selenite given either intravenously or orally in two groups (n = 4) of healthy, young adult men, who were otherwise maintained on a diet providing a constant and adequate selenium intake. From these isotopic data, measurable parameters of urine excretion, total body retention and selenite‐exchangeable metabolic pool (Se‐EMP) were defined to provide a quantitative assessment of selenium metabolism in these subjects. The initial 24‐hr urine excretion of the label was higher for the intravenously administered label (18.2 ± 2.1% of dose) compared to the oral dose (11.7 ± 2.6% absorbed dose). Thereafter, the excretion of isotope was the same for both groups. For equivalent entry of Se into the body, measured total body retention and Se‐EMP were the same for both groups. These initial kinetic data suggest that the overall utilization of selenium from a single administration of selenite is comparable for the two routes of intake and that the host's selenium requirement can probably be met adequately via the intravenous administration of selenite.(Journal of Parenteral and Enteral Nutrition12:351–355, 1988)

ISSN:0148-6071    

DOI:10.1177/0148607188012004351

出版商:SAGE Publications    

年代:1988

数据来源: WILEY

摘要:

Fat emulsions (FE) support microbial growth when inoculatedin vitro;dextrose/amino acid solutions (D/ AA) do not. Can FE be safely added to D/AA when delivered over 24 hrs? We attempted to answer this question by culturing both conventional (C) total parenteral nutrition (TPN), in which the FE and D/AA are given separately, and the 3‐in‐1 admixture TPN, in which all components are delivered in one bag. Two‐hundred TPN fluid cultures were obtained serially by collecting 1 ml of fluid from the distal‐most connection when the TPN was changed every 24 hrs. Quantitative and qualitative cultures were obtained. One hundred sixty‐six (83%) were negative. Of the 34 (17%) positive cultures, 15 (17% of 88) were from the conventional system whereas 19 (17% of 112) were from the 3‐in‐1 system. Six clinically septic patients furnished 11 TPN fluid specimens which grew>400 colonies/ ml. Seven (8% of 88) of these were from the conventional system whereas four (3.6% of 112) were from the 3‐in‐1 system. All had distant sites of sepsis. The 23 remaining positive TPN fluid cultures grew less than 25 colonies/ml, with 20 growingStaphylococcus epidermidis.All of these patients were clinically well and there was no significant difference in the distribution of positive cultures between the conventional system (9%) and the 3‐in‐1 system (13%). We therefore conclude: (1) the 3‐in‐1 admixture system does not have an increased risk of contamination compared to the conventional system; and (2) positive fluid cultures in clinically well patients may have been due to sampling technique with catheter hub rather than fluid contamination being the source of the positive culture.(Journal of Parenteral and Enteral Nutrition12:356–359, 1988)

ISSN:0148-6071    

DOI:10.1177/0148607188012004356

出版商:SAGE Publications    

年代:1988

数据来源: WILEY

摘要:

Although cyclic nocturnal total parenteral nutrition is a widely used technique, its metabolic consequences have not been fully investigated. During two successive 7‐day periods, 12 patients received randomly either standard continuous (infusion 24 hr/day) or cyclic (infusion between 5 pm and 9 am) total parenteral nutrition (TPN). Calorie and nitrogen intakes were identical during both periods. Energy expenditure was investigated by indirect calorimetry and showed practically no difference between continuous standard (1383 ± 41 kcal/ day−1) and cyclic total parenteral nutrition (1428 ± 46 kcal/ day−1). However, in the cyclic regimen, when compared with continuous infusion, energy expenditure was higher between 5 pm and 9 am and lower between 9 am and 5 pm. At the end of the noninfusion period, the 24‐hr profile of the nonprotein respiratory quotient showed a slight decrease in patients receiving the cyclic infusion, in contrast with the stability of the quotient in the standard regimen. However, the nitrogen balance and variations in nutritional status did not differ significantly. In conclusion cyclic TPN is efficient for achieving a positive energy and nitrogen balance and in addition it induces a metabolic profile closer to physiological conditions.(Journal of Parenteral and Enteral Nutrition12:360–364, 1988)

ISSN:0148-6071    

DOI:10.1177/0148607188012004360

出版商:SAGE Publications    

年代:1988

数据来源: WILEY

摘要:

A prospective controlled study of the safety of various catheter dressing protocols was carried out in 168 patients receiving parenteral nutrition via an infraclavicular central venous catheter. Four protocols were compared: 36 patients received gauze dressings changed three times per week; 31 received OpSite dressings changed every 7th day (OpS‐7), 32 received OpSite changed every 10th day (OpS‐10), and 69 received OpSite changed twice weekly (OpS‐ICU). Mean duration of parenteral nutrition was approximately 2 weeks and all groups were well matched except that OpS‐ICU patients suffered more frequently from an acute illness. Catheter‐related sepsis was identified by clinical signs of systemic sepsis, positive peripheral venous blood and catheter‐tip cultures and/or defervescence of fever after catheter removal. Catheter‐related sepsis rates were low in all groups: 1/36 for Gauze, 0/31 for OpS‐7, 1/ 32 for OpS‐10, and 2/69 for OpS‐ICU. Septicemia attributable to causes apart from catheter sepsis occurred in two, two, three, and four patients, respectively. Bacterial colonization of skin beneath OpSite was no more common in the OpS‐10 than in the other groups. Signs of inflammation at catheter insertion sites were common in all groups but did not relate closely to skin colonization. OpSite can be safely applied to central venous catheters inserted under strict aseptic conditions, even in patients with open septic drainage. Dressings can be left in place for 7 days with a margin of safety lasting to 10 days, thus saving on cost of materials and nursing time.(Journal of Parenteral and Enteral Nutrition12:365–370, 1988)

ISSN:0148-6071    

DOI:10.1177/0148607188012004365

出版商:SAGE Publications    

年代:1988

数据来源: WILEY

摘要:

A retrospective review of 771 patients' charts in two acute care hospitals was performed to determine likelihood of malnutrition (LOM) at admission and to assess the effect of LOM on costs and charges. Using accepted criteria, LOM was present in 59 and 48% of medical and surgical patients, respectively. Patients with LOM were 2.6 or 3.4 times as likely to have a predefined minor or major complication, respectively; and 3.8 times as likely to die as patients without LOM (allp<0.001). In every diagnosis‐related group, the mean length of stay was longer for LOM patients (range 1.1–12.8 excess days).Accountants converted charges to direct variable costs using departmental cost‐to‐charge ratios. LOM status increased excess costs and charges per patient by $1738 and $3557, respectively (p<0.0001). When complications occurred, LOM patients incurred $2996 or $6157 excess costs and charges per patient (p<0.01). Serum albumin was the strongest clinical predictor of cost.The hospitals' cost of providing enteral or parenteral nutrition support was $18 or $102 per day, respectively. Too few patients received early nutrition support to assess efficacy. Nonetheless, the costs associated with malnutrition warrant early detection and aggressive treatment.(Journal of Parenteral and External Nutrition12:371–376, 1988)

ISSN:0148-6071    

DOI:10.1177/0148607188012004371

出版商:SAGE Publications    

年代:1988

数据来源: WILEY

摘要:

The effect of fat infusion with medium chain triglycerides (MCT) and long chain triglycerides (LCT) on serum lipoproteins before and after passage through the skeletal muscle was investigated with the forearm technic in eight patients after abdominal operation.All lipoprotein fractions were enriched with triglycerides and phospholipids from infused artificial fat particles with the consequence of significantly increased ratios of TG/PL and TG/apo B in VLDL, of TG/apo B in LDL and TG/apo A‐I in HDL.Uptake and release of lipoprotein components by skeletal muscle are given by arterial‐deepvenous differences considering the blood flow rates. The positive arterial‐deepvenous difference of VLDL triglycerides after 4‐hr infusion is interpreted as cleavage and uptake of infused MCT by the muscle. The release of LDL is more pronounced after the fat infusion than before, suggesting a degradation and enhanced catabolism of artificial fat particles. HDL release may be also a consequence of catabolism of artificial TG/PL‐particles. These results indicate an uptake of MCT/LCT emulsion by the skeletal muscle.(Journal of Parenteral and Enteral Nutrition12:377–381, 1988)

ISSN:0148-6071    

DOI:10.1177/0148607188012004377

出版商:SAGE Publications    

年代:1988

数据来源: WILEY