ISSN:0148-6071    

DOI:10.1177/0148607187011003217

出版商:SAGE Publications    

年代:1987

数据来源: WILEY

摘要:

We used a sensitive whole body counter which measures potassium‐40 (40K) to determine total body potassium and to estimate body cell mass (BCM) in 104 previously untreated patients with upper gastrointestinal malignancies, 233 normal volunteers, and 18 patients with anorexia nervosa. BCM was greater in normal males than in females. In both normal males and females, the BCM tended to decrease with age, both as an absolute measure and as a percentage of body weight. Anorexia nervosa patients experienced marked weight loss (30.5%), and had significant depletion of absolute BCM, but exhibited relative sparing of BCM as indicated by a rise in BCM as a percentage of body weight. This may reflect a normal adaptation and predominant fat utilization in chronic malnutrition. The cancer patients, on the other hand, had significant weight loss (12.7% for females, 13.9% for males) and demonstrated a proportional decline in BCM, with no change in BCM as a percentage of body weight. These findings support the contention that, in the cancer‐bearing patient, weight loss consists of a significant depletion of both fat and BCM. The challenge to the clinicians caring for cancer patients is repletion of this supremely functional body compartment.(Journal of Parenteral and Enteral Nutrition11:219–222, 1987)

ISSN:0148-6071    

DOI:10.1177/0148607187011003219

出版商:SAGE Publications    

年代:1987

数据来源: WILEY

摘要:

Knowledge of the amino acid requirements of a neoplasm is valuable in determining optimal nutritional support and antineoplastic therapy for the tumor‐bearing host. The standard human tumor stem cell assay (HTSCA) was modified by reducing an individual amino acid below the normal plasma concentration of the Fischer 344 rat. All other amino acids were maintained at levels sufficient for normal HTSCA tumor colony growth. Twenty‐two amino acids were tested at a mean concentration of 12% (range 3% to 35%) of their normal plasma level. Results indicated that all amino acids except L‐glutamine and L‐asparagine were present in sufficient quantity for normal tumor growth. Dose‐response curves have shown more than 70% inhibition of tumor growth with a glutamine concentration of 50% and an asparagine concentration of 25%. Glutamine and asparagine levels of 4% and 1%, respectively, resulted in 100% inhibition. The data indicate that rat sarcoma stem cells are sensitive to decreased glutamine and asparagine concentrations.(Journal of Parenteral and Enteral Nutrition11:223–228, 1987)

ISSN:0148-6071    

DOI:10.1177/0148607187011003223

出版商:SAGE Publications    

年代:1987

数据来源: WILEY

摘要:

To determine the prevalence of abnormal vitamin levels in an adult hospitalized population requiring total parenteral nutrition (TPN) and to assess the effect of routine parenteral vitamin therapy on vitamin levels, we studied 35 general surgical patients. Assays for 12 vitamins were performed both before and after a standard 10‐day course of TPN. Patients were given nothing by mouth. The first 25 patients received a daily parenteral vitamin mixture tailored to the recommendations of the Nutrition Advisory Group of The American Medical Association (maintenance dose). The final 10 patients were given a parenteral multivitamin dose providing substantially greater amounts of most vitamins (repletion dose). Only 58% (190/324) of pre‐TPN vitamin levels were normal, 25% were low, and 17% were high. No patient had fewer than two abnormal baseline levels. Vitamin levels did not correlate with serum albumin, body weight, or nitrogen balance. After 10 days of treatment, only 39% of low pre‐TPN vitamin levels improved; most (45/62) of the low posttreatment levels were low at baseline. The higher repletion dose resulted in a significantly (p<0.01) greater percent increase in vitamin A, C, and pyridoxine levels.The prevalence of abnormal vitamin levels in this population is high (42%). Standard parenteral vitamin therapy leads to marginal improvement in abnormally low pre‐TPN vitamin levels.(Journal of Parenteral and EnteralNutrition11:229–237, 1987)

ISSN:0148-6071    

DOI:10.1177/0148607187011003229

出版商:SAGE Publications    

年代:1987

数据来源: WILEY

摘要:

Complete nutritive mixtures (CNM) of all intravenous nutrients including fat emulsions are being used increasingly because of their convenience. However, this may lead to chemical interactions and reduce the amount of active vitamins and trace elements made available to the patient. We have studied the effects on micronutrient status of provision of all nutrients in one 3‐liter bag (CNM: amino acids, dextrose, Intralipid 20%, a nine‐element trace metal mixture, and complete fat‐ and water‐soluble vitamin mixtures) in 10 postoperative surgical patients [median intravenous nutrition (IVN) 14.5 days, range 7–38]. A similar group received the fat emulsion plus water‐ and fat‐soluble vitamins as a separate infusion (SI) from a 3‐liter bag (median IVN 14.0 days, range 8–28). Serum and urine magnesium, zinc, copper, manganese, chromium, and selenium, serum vitamins A, E, C, folate, and B12, RBC B1, B2B6, and folate and leukocyte vitamin C were measured at weekly intervals. All patients in both groups maintained or improved their status for all the micronutrients analyzed. No significant differences between the CNM and SI groups were found in blood concentrations of any of the elements or vitamins. Only for urine copper did the CNM lead to increased excretion (1.51 ± 0.59μmol/24 hr; copper input 20μmol/day), compared to SI (1.00 ± 0.70μmol/day,p<0.001 Mann‐Whitney test) suggesting possible interaction. It is concluded that micronutrient status was maintained during short‐term IVN with the CNM and that it did not lead to a significantly greater loss of vitamins or essential trace elements than the SI system.(Journal of Parenteral and Enteral Nutrition11: 238–242, 1987)

ISSN:0148-6071    

DOI:10.1177/0148607187011003238

出版商:SAGE Publications    

年代:1987

数据来源: WILEY

摘要:

Forty‐three patients with mild weight loss were studied prospectively to determine whether the parenteral water‐soluble vitamin doses in a commercially available preparation (MVI concentrate; USV Laboratories, Tarrytown, NY) maintained serum, red blood cell (RBC), and urinary concentrations of water‐soluble vitamins in stressed cancer patients receiving total parenteral nutrition (TPN). Patients were divided into three groups: (1) oral diet, no intravenous vitamins given; (2) TPN plus 5 ml MVI; and (3) TPN plus 10 ml MVI. Vitamins C, B1, B2, B3, B6, and niacin were measured initially and weekly during a 6‐week study period. Caloric and nitrogen balances were quantified. Most of the patients in all three groups had normal blood or urine levels of all water‐soluble vitamins. No clinical evidence of vitamin deficiency or MVI toxicitv was detected. The recommended parenteral dosages of vitamin C (100 mg/day) and B3(15 mg/day) provided measurably adequate levels in all patients. Levels of vitamins B1, B2, B6, and niacin that were less than the normal range were noted in 4–40% of patients receiving the recommended daily dosages of 3 mg, 3.6 mg, 4 mg, and 40 mg, respectively. These deficiencies appeared to improve in group III patients who received twice the recommended parenteral vitamin dosages, although they did not completely disappear. Niacin deficiency appeared to be the most prevalent, occurring in 40% of patients studied. Since intravenous doses of B1, B2, B6, and niacin are safe and well tolerated, it appears that increased daily amounts of these vitamins should be given to cancer patients on parenteral nutrition.(Journal of Parenteral and Enteral Nutrition11:243–249, 1987)

ISSN:0148-6071    

DOI:10.1177/0148607187011003243

出版商:SAGE Publications    

年代:1987

数据来源: WILEY

摘要:

The metabolism of the hydrogenated disaccharide maltitol was compared to that of sucrose in a group of eight normal subjects. On two separate days, with an interval of at least one week each subject ingested a load of 30 g of either substance. The evolution of the levels of plasma glucose, insulin, and free fatty acids was followed during the 6 hr following the oral load. Carbohydrate and lipid oxidation rates were assessed simultaneously by continuous indirect calorimetry during the 6 hr following the oral load. Plasma glucose and insulin peaks occurred 30 min after ingestion of the load for both sugars. The peak of the delta glucose concentration was significantly smaller after maltitol than after sucrose (21 ± 4us38 ± 4 mg/100 ml,p<0.02), as was the peak of the delta insulin concentration (9.3 ± 2.7μU/ml after maltitolvs25.5 ± 5.0 μU/ml after sucrose,p<0.001). The peak of the stimulation of glucose oxidation occurred 60 min after the load of sucrose and 90 min after the load of maltitol. The delta glucose oxidation was significantly lower with maltitol than with sucrose during the first 90 min after the ingestion of the load. It was slightly higher (although not significantly) with maltitol than with sucrose starting from the 210th min. Maltitol resulted in a cumulated suprabasal glucose oxidation which amounted to 40% that obtained with sucrose after 180 min.(Journal of Parenteral and Enteral Nutrition11:250–254, 1987)

ISSN:0148-6071    

DOI:10.1177/0148607187011003250

出版商:SAGE Publications    

年代:1987

数据来源: WILEY

摘要:

Determining an individual's “ideal” body weight is fundamental in nutritional therapy. A simulation of the human body to a cylindrical volumetric model permits the calculation of the ideal body weight from the measured height, interacromioclavicular distance, and humeral length. A group of 189 healthy normal volunteers were assessed. The calculated “Pitt” ideal body weight correlated closely(r= 0.88 for males,r= 0.72 for women) with values obtained from the Metropolitan tables. The technique provides an estimate of ideal body weight based upon reproducible, easily obtained measurements of fixed bony landmarks.(Journal of Parenteral and Enteral Nutrition11:255–258,1987)

ISSN:0148-6071    

DOI:10.1177/0148607187011003255

出版商:SAGE Publications    

年代:1987

数据来源: WILEY

摘要:

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%vs0% 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 Nutrition11:259–262, 1987)

ISSN:0148-6071    

DOI:10.1177/0148607187011003259

出版商:SAGE Publications    

年代:1987

数据来源: WILEY

摘要:

An analysis of catheter‐related complications in a study group consisting of 83 patients, each of whom arrived at a major marrow transplant center after having had a large bore right atrial catheter (RAC) inserted by the referring institution, was compared to a similar analysis of catheter‐related complications in 357 patients who had their RAC inserted at the transplant center just before the transplant procedure was begun (control group). Fourteen (17%) patients in the study group had their original catheter removed for complications (five for septicemia and nine for mechanical complications) compared to 57 (16%) of the patients in the control group. Thirteen (16%) of the 83 catheters in the study group were double lumen and only two of these (15%) were replaced due to complications. Sixteen of 59 patients (27%), 13 years old or older, who arrived with a single lumen RAC already inserted, required an additional catheter during the transplant procedure because of an increased need for intravenous access. From this study, we concluded that patients who arrived for marrow transplantation with a RAC already inserted did not routinely need the catheter replaced. However, it is recommended that double lumen catheters be inserted in adult patients if marrow transplantation is anticipated.(Journal of Parenteral and Enteral Nutrition11:263–266, 1987)

ISSN:0148-6071    

DOI:10.1177/0148607187011003263

出版商:SAGE Publications    

年代:1987

数据来源: WILEY