ISSN:0148-6071    

DOI:10.1177/0148607187011005433

出版商:SAGE Publications    

年代:1987

数据来源: WILEY

ISSN:0148-6071    

DOI:10.1177/0148607187011005435

出版商:SAGE Publications    

年代:1987

数据来源: WILEY

摘要:

We studied 202 patients admitted to two major teaching hospitals for planned gastrointestinal surgery to assess the ability of several techniques of nutritional assessment to predict major postoperative complications (infection and/or wound problems). Subjective global assessment (SGA) and albumin were both of predictive value, and combinations of these variables were useful in differentiating low‐risk from high‐risk patients. Transferrin, creatinine‐height index, percent ideal weight, percent body fat, and total lymphocyte count were not useful in predicting complications.We conclude that SGA and albumin are useful “nutritional assessment techniques” for patients undergoing major gastrointestinal surgery if the purpose of such an assessment is to predict postoperative “nutrition‐associated complications.” The second major finding of this study was the unexpectedly low rate of complications (10%) which was found in both hospitals. We suggest that these low complication rates may be more generalizable to patient populations derived from a wide community base, rather than those described in other studies in which veterans or patients of lower socioeconomic status comprised the sample. (Journal of Parenteral and Enteral Nutrition11:440–446,1987)

ISSN:0148-6071    

DOI:10.1177/0148607187011005440

出版商:SAGE Publications    

年代:1987

数据来源: WILEY

摘要:

The effects of branched chain amino acid (BCAA)‐enriched diets (fed for 7 days) on encephalopathy, plasma amino acid concentrations, aromatic amino acid turnover, and protein synthesis rates were determined in eight patients with alcoholic liver failure. Four patients were given the diet intravenously (iv group) (total amino acids, 60–80 g/day, BCAA content 51%, energy 2000 kcal/day) and four patients (NG group) were given a semi‐elemental formulation via constant nasogastric (NG) infusion (amino acids 58 g, BCAA 43%, oligopeptides 19.5 g, energy 2000 kcal/day). The enteral diet was given at one‐half strength for the first 3 days. A 10‐hr constant infusion of [U‐14C]phenylalanine tracer was used in four patients to measure aromatic amino acid (AA) turnover and rates of incorporation into various body proteins. Seven of the eight patients made a good clinical recovery, with reversal of encephalopathy within 3 days of dietary intervention. One became septicemic and deteriorated. While plasma bilirubin concentrations dropped, liver enzymes remained elevated. Mean nitrogen balance was negative at the beginning and positive at the end of the study, in both groups. Initial amino acid profiles demonstrated low plasma BCAA content and BCAA:AA ratios. Significant improvements occurred in the iv group by day 2 and in both groups by day 7. Isotope studies showed that, whereas aromatic amino acid oxidation remained unchanged, greater quantities were incorporated in whole body protein, albumin, transferrin, fibrinogen, and immunoglobulins. (Journal of Parenteral and Enteral Nutrition11:447–453, 1987)

ISSN:0148-6071    

DOI:10.1177/0148607187011005447

出版商:SAGE Publications    

年代:1987

数据来源: WILEY

摘要:

This study was conducted to resolve discrepancies in the literature with regard to changes in protein metabolism following surgical stress. Twelve patients who had undergone abdominal surgery and six who were controls were studied. Whole body protein turnover was measured on the third and 10th postoperative day, during isonitrogenous and isocaloric total parenteral nutrition (TPN), by the method of constant infusion of [15N]glycine. Six patients who underwent abdominal surgery without any complications showed positive nitrogen balance on the 10th postoperative day (group I). However, nitrogen balance was still negative on the 10th postoperative day in another six patients who showed some critical complications after abdominal surgery (group II). A significant increase in whole body protein breakdown was seen in groups I and II on the third postoperative day (p>0.02,p>0.01, respectively), compared with control. Breakdown was greater in group II (p>0.05) than in group I. Protein synthesis tended to increase in group II, whereas in group I, it was at the same level as control. It was concluded that protein synthesis was unchanged in moderate stress, concomitant with increment of breakdown, but it tended to increase with a greater increase of breakdown in severe stress. (Journal of Parenteral and Enteral Nutrition11:454–457,1987)

ISSN:0148-6071    

DOI:10.1177/0148607187011005454

出版商:SAGE Publications    

年代:1987

数据来源: WILEY

摘要:

Plasma and erythrocyte amino acid concentrations in seven female patients in the acute stage of anorexia nervosa were compared with values in the same subjects after refeeding, and with normal controls. We also compared these values with literature values from patients with protein‐calorie malnutrition and prolonged starvation in an attempt to identify a biological indicator of severity and prognosis. Our data indicate: (1) Routine laboratory analyses that reflect protein status do not differentiate normal subjects from patients with anorexia nervosa. (2) The plasma aminogram in the acute stage of anorexia nervosa differs from normal, and differs from values reported for both protein malnutrition and prolonged starvation. (3) The Whitehead ratio clearly separates the acutely ill anorectic state from the treated state and from normal controls. (4) Both erythrocyte and plasma amino acid concentrations differ from normal in anorexia nervosa, but changes in erythrocyte concentrations are more obvious. (5) Erythrocyte glycine concentrations are unique, in that values were persistently elevated at all stages of illness in anorexia nervosa. (6) Erythrocyte‐to‐plasma amino acid ratios do not provide a biological index of severity and prognosis for patients with anorexia nervosa, in contrast to data reported for individuals with protein malnutrition. (Journal of Parenteral and Enteral Nutrition11:458–464,1987)

ISSN:0148-6071    

DOI:10.1177/0148607187011005458

出版商:SAGE Publications    

年代:1987

数据来源: WILEY

摘要:

Thirty‐seven patients with external gastrointestinal fistulas were treated with a combination of total parenteral nutrition (TPN) and somatostatin (ST). There was a significant fall in fistula output within the first day of treatment (p>0.001). On the first day of combined therapy, the reduction of fistula output was 70%, and in 68% of the cases, the fistula output fell to less than 50% of the initial level. Spontaneous closure was observed in 82% of the cases, and the time taken to close the fistula ranged between 1 and 14 days of starting therapy [5.4 ± 0.7 days (mean ± SEM)]. The response to TPN‐ST treatment occurred irrespective of age and sex of patients, duration and daily output of the fistulas before ST use, and their location in the gastrointestinal tract. Infection of fistula output was a factor of adverse prognosis. In all cases, and in the absence of mechanical obstacles, treatment that combines TPN and ST could be tried and continued up to 14 days in cases in which the fistula output falls more than 50% on the first day of treatment. (Journal of Parenteral and Enteral Nutrition11:465–470,1987)

ISSN:0148-6071    

DOI:10.1177/0148607187011005465

出版商:SAGE Publications    

年代:1987

数据来源: WILEY

摘要:

In “Relationship of Antioxidant Enzymes to Trace Metals in Premature Infants” by Robert K. Huston, Thomas R. Shearer, Barbara J. Jelen, P. Danielle Whall, and John W. Reynolds in the March–April 1987 issue of JPEN, Volume 11, Number 2, page 163, the following change should be noted: on page 164, Table I, the value for EGA (weeks) underParameter for Group Iis listed as 25.9 ± 1.2; it should read 29.5 ± 1.2.

ISSN:0148-6071    

DOI:10.1177/0148607187011005411

出版商:SAGE Publications    

年代:1987

数据来源: WILEY

摘要:

Patients maintained in our home total parenteral nutrition (HTPN) program receive very small amounts of cholesterol in their solutions. Because of the severe intestinal insufficiency which is characteristic of this group, they do not absorb significant amounts of cholesterol or bile salts from their intestines. We investigated the serum lipoproteins in nine patients maintained on HTPN for 36 ± 4 (mean ± SEM) months. Fat emulsions were given twice a week as a source of essential fatty acids. Mean serum cholesterol 110 ± 6.5 mg/dl, LDL‐cholesterol 75 ± 6 mg/dl, and HDL‐cholesterol 29 ± 1 mg/dl, were at or below the 5th percentile compared with age‐and sex‐matched Lipid Research Clinic controls. HDL‐cholesterol to serum cholesterol ratio was in the normal range (0.25 ± 0.30). The mean serum cholesterol did not rise, but the mean serum triglyceride rose significantly from 72 ± 4 to 104 ± 16 mg/dl (p>0.05) immediately after completion of TPN infusions with fat emulsions. There was a negative correlation between the length of HTPN therapy and the total serum cholesterol (r= 0.43,p>0.05). Thus, HTPN patients have markedly depressed concentrations of total serum cholesterol, LDL‐cholesterol, and HDL‐cholesterol, but the ratio of HDL cholesterol to total serum cholesterol is in the normal range. (Journal of Parenteral and Enteral Nutrition11:471–474,1987)

ISSN:0148-6071    

DOI:10.1177/0148607187011005471

出版商:SAGE Publications    

年代:1987

数据来源: WILEY

摘要:

Ambulatory total parenteral nutrition (TPN) at home was used in 85 patients within a 6‐yr period Indications include severe malabsorption, fistulas, anorexia nervosa, and malignancies. The median duration of home TPN (HPN) was 67 days (range: 30–4,155 days). HPN duration for patients with benign diseases was longer [357.12 days (range: 30–4,155 days)] than for cancer patients [93.54 days (range: 30–421 days)]. Under HPN, patients gained a good nutritional status with an increase of total protein (p>0.001) and serum albumin levels (p>0.001). Weight gain was also significant (p>0.001). The rehospitalization rate was low (7.8%), but it was higher when HPN lasted for more than 3 months (10.87% ± 1.58%) compared with short‐term HPN (5.69% ± 1.25%). Metabolic complications were unusual, and rehospitalization was related to the oncological treatment and/or infectious complications. Therefore, ambulatory HPN is a nutritional support that can significantly improve the life of patients with alimentary failure. Moreover, HPN allows significant cost savings compared to the alternative of prolonged hospitalization. (Journal of Parenteral and Enteral Nutrition11:475–479,1987)

ISSN:0148-6071    

DOI:10.1177/0148607187011005475

出版商:SAGE Publications    

年代:1987

数据来源: WILEY