摘要:

A randomized prospective double‐blinded study was conducted in patients in moderate to high level surgical stress to ascertain the effect of high dose branched‐chain (BcAA) hyperalimentation on skin test reactivity and lymphocyte count. Isocaloric, isonitrogenous balanced total parenteral nutrition solutions were administered to two treatment groups. The study group received the high dose (45% BcAA) solution while the control group received a standard amino acid solution (24.2% BcAA). All patients received 1 to 1.5 g/kg/day of amino acids and 30 nonprotein cal/kg/day, with 30% of them as fat. Immune function was assessed by absolute lymphocyte count and delayed cutaneous hypersensitivity on days 0 and 7 of therapy. Absolute lymphocyte count showed a marked improvement in patients receiving high dose aBcAA (p<0.03). All patients were anergic at baseline; a much greater percentage of skin test reactivitry was observed in the BcAA group on day 7 (p<0.03). They were also in positive nitrogen balance. The data suggest that improved nitrogen retention and immune‐competence is possible with branched‐chain‐enriched hyperalimentation in high level surgical stress. (Journal of Parenteral and Enteral Nutrition7:521–524, 1983)

ISSN:0148-6071    

DOI:10.1177/0148607183007006521

出版商:SAGE Publications    

年代:1983

数据来源: WILEY

摘要:

We asked the question, if the amount of nutrients given parenterally is progressively increased, does the rate of whole body protein synthesis rate increase correspondingly and how does the protein breakdown rate change? Eight malnourished patients requiring total parenteral nutrition (TPN) were studied. We measured their whole body protein synthesis and breakdown rate four times at intervals of 3 days using15N glycine as the tracer. The first study was done pre‐TPN. The 2nd, 3rd, and 4th studies were done at increasing TPN rates. The rates were TPN 1, 1440 kcal/day and 7.9 g/N/ day; TPN 2, 2160 kcal/day and 11.9 g/N/day; TPN 3, 2880 kcal/day and 15.8 g/N/day. The protein synthesis rate initially increased as the amount of TPN was increased, but increasing the rate from TPN‐2 to TPN‐3 did not result in further increase. Increasing the rate of TPN above a certain level does not lead to a concomitant increase in the protein synthesis rate. (Journal of Parenteral and Enteral Nutrition7:525–529, 1983)

ISSN:0148-6071    

DOI:10.1177/0148607183007006525

出版商:SAGE Publications    

年代:1983

数据来源: WILEY

ISSN:0148-6071    

DOI:10.1177/014860718300700603

出版商:SAGE Publications    

年代:1983

数据来源: WILEY

摘要:

The role of fat‐based total parenteral nutrition (TPN) in preventing or ameliorating hepatic dysfunction during TPN was investigated. Adult ACI‐N rats were given fat‐free carbohydrate‐based TPN or isocaloric, isonitrogenous fat‐based TPN (50% cal from 20% Intralipid, 50% cal from carbohydrate) for 7 days with Purina Chow‐fed and fasting rats as controls. After fat‐based TPN as compared with Chow or carbohydrate‐based TPN, serum alkaline phosphatase activity and cholesterol levels doubled. Fatty infiltration and periportal inflammation in the liver were more marked. Both the TPN regimens were equally effective in maintaining body weight, positive nitrogen balance, muscle and hepatic protein content. Hepatic dysfunction in rats during TPN was not prevented by using a fat emulsion to provide 50% of the caloric requirement; the optimal proportion of fat as energy substrate in this system is less than 50%. (Journal of Parenteral and Enteral Nutrition7:530–533, 1983)

ISSN:0148-6071    

DOI:10.1177/0148607183007006530

出版商:SAGE Publications    

年代:1983

数据来源: WILEY

摘要:

Because of its high caloric density, intravenous fat emulsions have been suggested as useful sources of calories and essential fatty acids in patients with serious heart disease in whom fluid restriction must be closely monitored. Previous studies in the experimental animal have suggested a myocardial depressant effect of intravenous fat emulsions at high infusion rates. In the present study, 19 adult patients, following uncomplicated isolated coronary artery bypass surgery, were divided into two groups. A constant infusion of 2 ml/min of soy oil emulsion (20% Intralipid) was administered to the first group. The second group received 20% Intralipid at 1 ml/min followed by a 2 ml/min infusion. In the group receiving the 2 ml/min infusion (averaging 5.25 mg/kg/min), significant decreases in cardiac output and increases in pulmonary capillary wedge pressure occurred. One patient suffered an adverse side effect which may have been related to myocardial ischemia. The second group of patients received an initial infusion of 1 ml/ min (averaging 2.35 mg/kg/min) following which the rate was doubled. No significant hemodynamic changes or adverse side effects occurred in the second group. It is concluded that 20% soy oil emulsion can be administered safely to the recently postoperative cardiac surgical patient recovering from coronary bypass grafting, but the rate should not exceed the maximum clearance rate of 1 ml/min (2.67 mg/kg/min). (Journal of Parenteral and Enteral Nutrition7:534–540, 1983)

ISSN:0148-6071    

DOI:10.1177/0148607183007006534

出版商:SAGE Publications    

年代:1983

数据来源: WILEY

摘要:

There has been much concern about impaired immune function in children receiving infused lipid emulsions. Immunologic studies were carried out on 15 infants maintained on parenteral nutrition with intravenous safflower oil emulsion as part of the infusate. Significant increases in percentage rosette formation, total circulating T‐cells, and mitogenesis to phytohemagglutinin and pokeweed mitogen were demonstrated after only 1 wk of lipid infusion. Additional parenteral nutrition did not further increase any immunologic parameter. These results suggest that infused safflower oil emulsion does not adversely alter cellular immune function. (Journal of Parenteral and Enteral Nutrition7:541–545, 1983)

ISSN:0148-6071    

DOI:10.1177/0148607183007006541

出版商:SAGE Publications    

年代:1983

数据来源: WILEY

摘要:

A review of 253 patients treated with enteral nutrition support via tube feedings is presented for the purpose of evaluating the incidence of complications. Thirty patients, (11.7%) experienced either gastrointestinal, (6.2%) mechanical (3.5%), or metabolic (2.0%) complications. The recognition and treatment of such complications are discussed and it is concluded that tube feedings are safely tolerated by most patients; however, constant attention must be exerted to either avoid or recognize such complications. (Journal of Parenteral and Enteral Nutrition7:546–552, 1983)

ISSN:0148-6071    

DOI:10.1177/0148607183007006546

出版商:SAGE Publications    

年代:1983

数据来源: WILEY

摘要:

Parenteral nutrition (PN) is commonly used in the management of inflammatory bowel disease. Previously we reported about the serum protein levels in Crohn's disease before and after treatment with PN; in that study we found an increase of some indicators of nutritional status and a decrease of some acute phase reactants after treatment. We have now completed the trial determining the concentration of 19 serum proteins in 25 patients with Crohn's disease before and after treatment with PN and 8 wk thereafter. The concentration of albumin, retinol‐binding protein, prealbumin, and transferrin were found to rise in parallel with the body weight during PN, whereas 8 wk after treatment only albumin and transferrin showed a further significant rise. α‐1‐Glycoprotein, α‐2‐chymotrypsin, α‐1‐antitrypsin, CRP, and haptoglobin decreased during and 8 wk after PN, α‐1‐glycoprotein, α‐2‐chymotrypsin, and α‐1‐antitrypsin showed a positive correlation to the Crohn's Disease Activity Index. The serum IgM‐levels were found to be significantly increased during and after PN with a negative correlation to the Crohn's Disease Activity Index. Our data indicate that PN not only improves nutritional status in the active phase of Crohn's disease during therapy but reduces the grade of inflammatory activity during and even after treatment with PN. (Journal of Parenteral and Enteral Nutrition7:553–556, 1983)

ISSN:0148-6071    

DOI:10.1177/0148607183007006553

出版商:SAGE Publications    

年代:1983

数据来源: WILEY

摘要:

Eighteen low birth weight infants (27–34 wk gestation) were given supplementary parenteral nutrition via peripheral veins of a maximal dose of 8.5 g glucose, 2.5 g amino acids (Aminovenös päd 10%) and 2 g soybean oil egglecithin emulsion (Intralipid 10%)/kg body weight/24 hr. The fat emulsion was infused continuously at a rate of 0.084 g/kg body weight/hr. The elimination of Intralipid from the blood stream was controlled by enzymatic determination of serum triglyceride concentrations, and the fatty acid pattern of the serum lipids was determined by gas chromatography. The serum triglyceride concentrations were 0.60 ± 0.16 mmol/liter on the 1st day, increased to 0.96 ± 0.29 mmol/liter up to the 5th day, and approached a level around 0.90 mmol/liter in the further course. No hypertriglyceridemia was noted. The fatty acid pattern of the serum lipids showed a linoleic acid fraction of 8.1 ± 4.0% in the beginning, which was followed by a continuous increase up to 27.8 ± 4.8% on the 7th day. No significant changes were noticed thereafter. The levels were within the normal limits as found in 2‐wk‐old enterally fed preterm infants of comparative maturity (25.6 ± 3.4%). We conclude that the preterm infants can eliminate Intralipid from the blood stream if maximal dosage and infusion rate, as described above, are applied. (Journal of Parenteral and Enteral Nutrition7:557–559, 1983)

ISSN:0148-6071    

DOI:10.1177/0148607183007006557

出版商:SAGE Publications    

年代:1983

数据来源: WILEY

摘要:

Clinical occurrence of subclavian venous thrombosis due to indwelling catheters is rare, but there is some evidence that subclinical thrombosis frequently occurs. It is purpose of this study to report the results of a prospective investigation in patients with subclavian vein catheters. Fifty‐two patients admitted to the Istituto Nazionale Tumori of Milan and candidate to infraclavicular percutaneous catheterization of the subclavian vein were evaluated. There were 26 polyvinyl chloride and 26 rubber silicone catheters, which were correctly positioned in the superior vena cava‐atrium. Average duration of the intravenous stay was 12.8 days. Asymptomatic thrombosis was venographically demonstrated in 46.1% of the polyvinyl chloride catheters and in 11.5% of the silicone ones (p= 0.005). The average age of catheters with or without thrombosis was 10.8 and 13.8 days, respectively. Addition of heparin to the infusate (1 U/ml) did not reduce the thrombosis rate in polyvinyl chloride or in silicone catheters, but risk of thrombosis was significantly higher (p= 0.03) in polyvinyl chloride catheters without heparin in comparison to the silicone ones. Osmolarity of the infusional fluid, manipulation during the cannulation, colonization of the catheter tip, and duration of the intravenous stay of the catheter apparently did not influence the rate of thrombosis. Since the natural history of the thrombotic subclavian veins is not known, some caution must be paid to repeat the percutaneous cannulation of the same vein and the change the catheter over a guidewire. (Journal of Parenteral and Enteral Nutrition7:560–562, 1983)

ISSN:0148-6071    

DOI:10.1177/0148607183007006560

出版商:SAGE Publications    

年代:1983

数据来源: WILEY