ISSN:0148-6071    

DOI:10.1177/014860719401800401

出版商:SAGE Publications    

年代:1994

数据来源: WILEY

ISSN:0148-6071    

DOI:10.1177/014860719401800402

出版商:SAGE Publications    

年代:1994

数据来源: WILEY

摘要:

The inpatient and outpatient records were reviewed for 527 patients, including 138 children, who were discharged on home total parenteral nutrition and followed by the University of California, Los Angeles, home total parenteral nutrition service for a minimum of 1 week between April 1973 and October 1991. The total follow‐up time was 1154 patient years; the median follow‐up time was 206 days (range 7 to 6344 days). Thirty‐six patients were followed for more than 10 years (median 12.7 years). Three hundred fifteen adults (but only four children) were never infected. A total of 427 catheter‐related infections occurred, giving an overall infection rate of 0.37 per patient year (0.51 per patient year in children and 0.28 per patient year in patients followed for more than 10 years). Seventy percent of the infections overall were sepsis (0.26 per patient year); of those, 17% were exit site (0.06 per patient year), and 2% were tunnel (0.01 per patient year) infections. In children, 67% of the infections were sepsis (0.37 per patient year) and 24% were exit site (0.13 per patient year). Fifty‐four different organisms were responsible, and 12% of the infections were polymicrobial in origin. Sixty percent of sepsis in all patients was caused by Gram‐negative organisms (44% of the catheters were removed). Forty‐three percent of sepsis in children was caused by Gram‐negative organisms. Twenty‐six percent of sepsis in all patients was caused by Gram‐positive organisms (40% of the catheters were removed). Thirty‐six percent of sepsis in children was caused by Gram‐positive organisms. Fourteen percent of sepsis was fungal in origin in both adults and children (92% of the catheters were removed). Seventy‐four percent of the exit‐site infections were caused byStaphylococcus aureus. (38% of the catheters were removed). Fifty‐seven percent of the tunnel infections were caused by Saureus. (100% of the catheters were removed), x2analysis demonstrated that the presence of fever, leukocytosis, bandemia, left shift, organism, Gram status, polymicrobial infections, or organism species (except for fungi and mycobacteria) could not reliably predict the need for catheter removal in any type of catheter‐related infection. Catheter infection is uncommon in home total parenteral nutrition patients, although it is more common in children than in their adult counterparts. This, as well as the overall incidence of catheter infection in home total parenteral nutrition patients, may relate to the protocol and technique of catheter care. (Journal of Parenteral and Enteral Nutrition. 18:297–302, 1994)

ISSN:0148-6071    

DOI:10.1177/014860719401800403

出版商:SAGE Publications    

年代:1994

数据来源: WILEY

摘要:

In addition to its role in absorbing nutrients, the intestinal mucosa provides an important barrier against toxins and bacteria in the bowel lumen. This study evaluated changes in rat jejunal permeability and histology after total parenteral nutrition (TPN) or TPN supplemented with glutamine. Lactulose and mannitol were used to measure jejunal permeability, and fixed stained histologic specimens were used to measure mucosal dimensions. After the insertion of central venous catheters, 18 male rats were randomly divided into three groups: CHOW, saline infusion with a standard laboratory rat dietad libitum; TPN; and GLN, 2% L‐glutamine‐supplemented TPN. The TPN and GLN groups received isocaloric, isovolumic, and isonitrogenous feedings. After 7 days of infusion, a laparotomy was performed, and lactulose and mannitol were instilled into the lumen of a 25‐cm ligated segment of jejunum. Urine was collected for 5 hours and assayed for lactulose, mannitol, and creatinine. The jejunum was harvested, and wet weight, villus height, mucosal thickness, and villus width were measured. Intestinal permeability to lactulose and the lactulose to mannitol ratio significantly increased after TPN compared with CHOW, and these effects were prevented with the addition of glutamine to the TPN solution. Jejunal villus height and mucosal thickness significantly decreased following TPN but were not significantly different from CHOW when glutamine was added to the TPN solution. These data suggest that TPN was associated with increased jejunal permeability and that glutamine, when added to the TPN solution, prevented this effect. In addition, glutamine reduced TPN‐associated atrophy of the jejunum. (Journal of Parenteral and Enteral Nutrition 18:303–307, 1994)

ISSN:0148-6071    

DOI:10.1177/014860719401800404

出版商:SAGE Publications    

年代:1994

数据来源: WILEY

摘要:

Drug stability and compatibility studies should be performed for all medications added to total nutrient admixtures (TNAs) before administration to patients. The stability of TNA components will vary depending on product selection and final concentrations. This variability prohibits generalizing published study results generically to TNAs containing untested products or combinations. Histamine receptor antagonists (H2RAS) are commonly administered by continuous infusion via nutrient solutions. When the delivery vehicle is a TNA, comparative stability and compatibility studies performed under similar test conditions are lacking. The stability of marketed parenteral H2RAs and of the investigational H2RA, nizatidine was analyzed in TNA solutions containing either Liposyn II or Intralipid at differing concentrations. All H2RAS remained at more than 90% of initial concentration at 24 hours. After 48 hours, only ranitidine concentrations fell to less than 90% in all study solutions. Each TNA containing an H2RA was within pH stability ranges for lipid products, and no change in particle size was detected during the 48‐hour period. This is the first report determining H2RA compatibility and stability in TNA solutions with both 3% and 5% Intralipid and Liposyn II and using similar methodology for all standard H2RA concentrations. Results suggest that these drugs are stable for 24 hours in TNAs containing either lipid product. Beyond this time, administration of ranitidine may be unreliable because of poor stability under the conditions tested. (Journal of Parenteral and Enteral Nutrition18:308–312, 1994)

ISSN:0148-6071    

DOI:10.1177/014860719401800405

出版商:SAGE Publications    

年代:1994

数据来源: WILEY

摘要:

The objective of this study was to determine whether supplemental glutamine (alanylglutamine dipeptide) is effective in preventing small intestinal mucosal atrophy associated with total parenteral nutrition and whether it affects the growth of other organs in neonatal pigs. We compared organ growth, intestinal enzyme activity, and plasma nitrogen metabolites in 4‐day‐old pigs randomly selected to receive total parenteral nutrition supplemented with 0 g, 2.0 g, or 4.5 g of glutamine per deciliter for a total amino acid intake of either 11 or 25 g‐kg−1d−1for 7 days. Glutamine supplementation increased (60% to 100%) plasma concentrations of glutamine, urea nitrogen, ammonia, and both jejunal villus height and surface area, but it did not significantly affect jejunal mucosal protein and DNA masses or the relative growth of liver, kidneys, and brain. No histologic evidence of tissue toxicity was found. Supplementing large amounts of glutamine (alanylglutamine dipeptide) did not completely prevent total parenteral nutrition‐associated intestinal mucosal atrophy but did improve villus morphology without affecting vital organ growth or histology. (Journal of Parenteral and Enteral Nutrition18:313–319, 1994)

ISSN:0148-6071    

DOI:10.1177/014860719401800406

出版商:SAGE Publications    

年代:1994

数据来源: WILEY

摘要:

In order to evaluate the long‐term effect of total parenteral nutrition supplemented with glutamine after surgery, patients (n = 17) undergoing elective abdominal surgery were randomized into two groups and studied for 30 days after surgery. During the 3 days immediately after surgery, one group (n = 8) was given total parenteral nutrition including a conventional amino acid solution (control group). The other group (n = 9) was given isocaloric and isonitrogenous total parenteral nutrition including the same amino acid solution supplemented with the dipeptide, glycyl‐glutamine (GLN group). Oral food intake started on the third postoperative day and was gradually increased at will. The concentration of free amino acids in percutaneous muscle biopsy specimens was determined preoperatively and on days 3, 10, 20, and 30 after the operation. Free glutamine decreased in skeletal muscle in the control group on days 3 and 10 by 32.2 ± 5.4% (p<.01) and 20.1 ± 6.9% (p<.05), respectively. In the glycyl‐glutamine group, the decrease in glutamine was delayed until day 10 when it was 22.1 ± 8.1% (p<.05). The glutamine levels were restored on days 20 and 30 in both groups. Total parenteral nutrition supplemented with glutamine maintained the free glutamine levels in skeletal muscle after surgery, but when treatment was discontinued, the glutamine concentration in muscle dropped, despite a normal enteral dietary intake.(Journal of Parenteral and Enteral Nutrition18:320–325, 1994)

ISSN:0148-6071    

DOI:10.1177/014860719401800407

出版商:SAGE Publications    

年代:1994

数据来源: WILEY

摘要:

The relationship among parenteral nutrition, hepatic energy charge, and mitotic activity was investigated in partially hepatectomized rats fed diets based on glucose, ketone bodies, and saline (starvation). Male Sprague‐Dawley rats underwent 70% hepatectomy and jugular vein catheterization for parenteral feeding. All rats were infused with saline for 6 hours, then randomly assigned to one of three parenteral infusions. Rats received either 0.9% saline only (group A rats), 25% glucose + 4% amino acid (group B rats), or 18% monoacetoacetin + 7% glucose + 4% amino acid (group C rats). Three rats receiving saline infusion were killed at 2, 4, and 6 hours after surgery, and three rats from each diet group were killed at 2‐ to 4‐hour intervals from 10 through 32 hours. Hepatic energy charge and mitotic index were measured at each time point. Energy charge was similar for each treatment until 18 hours but was depressed from 6 through 16 hours and began to increase between 16 and 18 hours. Energy charge at 22 hours for group B rats was significantly higher than energy charge for group A and C rats. This difference was maintained through 32 hours. Mitosis started between 24 and 26 hours for all treatments, and group A and C rats exhibited a much higher mitotic index than did group B rats. Adenosine triphosphate was the main driving force for changes in energy charge. The data showed that energy charge and mitotic index were inversely related. It is speculated that high energy charge may negatively influence activity of enzymes inasmuch as activity of these enzymes is altered by phosphorylation‐dephosphorylation.(Journal of Parenteral and Enteral Nutrition18:326–330, 1994)

ISSN:0148-6071    

DOI:10.1177/014860719401800408

出版商:SAGE Publications    

年代:1994

数据来源: WILEY

摘要:

The present study was designed to assess the cholesterol‐lowering effect of enteral nutrition when administered either as discontinuous or as continuous infusion. Twelve neurologic patients were randomly assigned to receive exclusive continuous (n = 6) or discontinuous (n = 6) enteral feeding for 7 days. Serum lipids, apoproteins, and 24‐hour urinary C‐peptide concentrations were determined on days 0 and 7. The fall during continuous nutrition was significantly greater than that during discontinuous nutrition for serum cholesterol (14%vs2.4%;p<.05), low‐density lipoprotein cholesterol (17.4%vs3.9%;p=.02), and apoprotein B (19%vs0.2%;p<.05) concentrations. Mean 24‐hour urinary C‐peptide excretion increase was significantly greater (p<.05) during discontinuous (78%) than during continuous enteral nutrition (15.6%). These results suggest that the cholesterol‐lowering effect of enteral nutrition was induced mainly by the continuous delivery of the nutrients and was related to changes in insulin secretion.(Journal of Parenteral and Enteral Nutrition18:331–334, 1994)

ISSN:0148-6071    

DOI:10.1177/014860719401800409

出版商:SAGE Publications    

年代:1994

数据来源: WILEY

摘要:

Pancreatic protein and fluid secretion in response to intraduodenal infusion of polymeric and elemental liquid defined‐formula diets were studied in conscious rats. Rats were prepared with chronic pancreatic, biliary, and duodenal cannulas and had their pancreatic secretions collected and continuously returned to the intestine during intraduodenal infusion with commercial liquid defined‐formula diets. Ensure HN, a polymeric defined‐formula diet containing intact protein, and two elemental diets, in which the protein component consisted of enzymatically hydrolyzed protein and free amino acids, were tested. Ensure HN strongly stimulated pancreatic protein and fluid secretion, causing a maximal 10‐fold increase in protein secretion. In contrast, the elemental diets stimulated only 30% to 47% of the protein secretion caused by Ensure HN. Separate infusion of the fat, protein, and carbohydrate components of one elemental diet, RTF Elemental, showed that fat was the major stimulant, but the responses to the separate components were not significantly different from each other and none caused more than 50% of the response to the complete diet. The results demonstrate that defined‐formula elemental diets are much less stimulatory for pancreatic enzyme secretion than defined‐formula polymeric diets in rats. The probable explanation for this difference is the replacement of intact protein by hydrolyzed protein and amino acids in the elemental diets.(Journal of Parenteral and Enteral Nutrition18:335–339, 1994)

ISSN:0148-6071    

DOI:10.1177/014860719401800410

出版商:SAGE Publications    

年代:1994

数据来源: WILEY