摘要:

The effect of chemically defined liquid diets on the intestinal microflora and bacterial translocation from the gut was studied in the rat. Seventy‐five female Fischer rats were randomized to five groups of 15 animals each. Group I was fed rat chow and water, group II was fed Vivonex TEN, group III was fed Ensure, group IV was fed Enrich, and group V was fed Ensure plus ground corn cobs, a crude fiber source. Animals were fed their respective diets ad libitum for 1 week and then killed. Quantitative culture of the mesenteric lymph nodes (MLN) and cecum was performed to determine bacterial translocation from the gut. A 66% translocation rate (10/15) of bacteria to MLN was observed in the animals fed Ensure and Enrich compared to 21% in the Vivonex TEN group (3/14) and 20% in the animals fed Ensure plus ground corn cobs (3/15). None of the animals in the control group eating their normal diets of rat chow and water developed positive MLN. Statistical significance (p less than 0.001) was achieved between the Ensure and Enrich groups when compared to controls but not between the Vivonex TEN and Ensure plus corn cobs. Cecal culture revealed a statistically significant rise in cecal bacteria in all groups when compared to the control group (group I). These results indicate that chemically defined liquid diets result in altered intestinal microflora and bacterial translocation from the gut.

ISSN:0148-6071    

DOI:10.1177/014860719001400101

出版商:SAGE Publications    

年代:1990

数据来源: WILEY

摘要:

Although weight loss is a common problem in chronic obstructive pulmonary disease (COPD), the precise cause of malnutrition in COPD patients is not known. The purpose of this study was to measure and compare resting energy expenditure (REE) in stable undernourished and adequately nourished COPD. REE was measured in normal, adequately nourished, and undernourished COPD patients by indirect calorimetry and then compared to predicted basal metabolic rate (BMR) calculated from the Harris‐Benedict equation. We found that measured REE, compared to predicted, was significantly higher in the undernourished group, (1.15 +/‐ 0.02) and compared to the adequately nourished COPD (0.99 +/‐ 0.03) and normal groups (0.93 +/‐ 0.02) (p less than 0.0001). We conclude that there is a hypermetabolic state in stable malnourished COPD patients which may be a factor in weight loss. This elevated REE also needs to be taken into account when determining caloric requirements for COPD patients.

ISSN:0148-6071    

DOI:10.1177/014860719001400107

出版商:SAGE Publications    

年代:1990

数据来源: WILEY

摘要:

Most immunological functions are accomplished by means of interactions between mediator molecules (cytokines or lymphokines) and their specific receptors on the lymphocyte surface. One particular lymphokine, Interleukin‐2 (IL‐2) is central to the generation of most immune responses including those with antitumor activity. Prompted by two clinical trials which have suggested distinct but apparently opposite effects of lipid emulsions on the production of and lymphocyte responses to IL‐2 we have examined the effects of pharmacological concentrations of three lipid emulsions currently in clinical use on IL‐2 related interactions in vitro. Mitogen‐stimulated and IL‐2 activated human lymphocyte proliferation were both inhibited in a dose‐dependent manner in the presence of all three lipid emulsions although the effects were less marked with the solution in which 50% of the calories are present as medium‐chain triglycerides (MCT) rather than long‐chain triglycerides (LCT). Similarly the LCT, but less so the MCT‐containing solutions inhibited the generation of cytotoxic lymphokine‐activated killer cells. These solutions did not inhibit the proliferation of cell lines which are not growth‐factor dependent but did inhibit the growth of an IL‐2‐dependent cell line. We conclude that lipid emulsions can upset IL‐2‐dependent lymphocyte responses. These observations may lead to parenteral feeding regimens which are less immunocompromising for the tumor‐bearing patient.

ISSN:0148-6071    

DOI:10.1177/014860719001400112

出版商:SAGE Publications    

年代:1990

数据来源: WILEY

摘要:

Weanling mice fed chow or chow plus water supplemented with 3.5 mg of nucleotides per 100 ml of water for 6 weeks exhibited increased natural killer cell (NK) activity and lower macrophage activation compared to mice fed chow plus nonsupplemented water. In a dose‐response study, NK activity, macrophage activation and spleen weight (as a percentage of body weight) were higher in mice fed up to 0.035% w/w nucleotides, however macrophage activation was decreased by feeding over 0.35% w/w compared to those receiving basal purified diet (BPD). Nucleotides in human milk may affect the immune response in breast‐fed infants.

ISSN:0148-6071    

DOI:10.1177/014860719001400118

出版商:SAGE Publications    

年代:1990

数据来源: WILEY

摘要:

This study evaluated the growth of 51 children with cerebral palsy after the initiation of enteral tube feedings. The children were divided into three groups according to how soon after their central nervous system (CNS) insult they were started on enteral feedings. Group 1 consisted of 14 children who were within a year of their CNS insult; they were underweight for age, but had normal length as well as weight for length. Within 6 months of initiating enteral tube feedings, most children in this group had normalized their weights. Group 2 consisted of 27 children who were within 8 years of their CNS insult; they were stunted and were underweight for both their age and their length. Within 6 months of initiating enteral feeds, the group increased both weight and weight for length to near normal, but their gains in length reached a plateau at 90% of ideal for age. Group 3 consisted of 10 children who were more than 8 years after their CNS insult. This group was severely malnourished but had some improvement in their weight for age and for length but, length for age showed no significant change. We conclude that the earlier adequate nutritional management of children with severe cerebral palsy is initiated, the more readily the nutritional deficits will reverse.

ISSN:0148-6071    

DOI:10.1177/014860719001400123

出版商:SAGE Publications    

年代:1990

数据来源: WILEY

摘要:

One hundred forty‐three large bore right‐atrial catheters (RACs) in 111 bone marrow transplant recipients were prospectively analyzed for the incidence of complications interfering with catheter function. Of the 143 RACs, 108 (76%) were patent on departure from Seattle or death. Infectious complications occurred in 63 (44%) of the catheters, resulting in 18 (13%) removals. Noninfectious complications occurred with 54 (38%) of the catheters, resulting in 17 (12%) removals. Successful interventions included catheter repair, dissolving precipitates with ammonium chloride solution, and declotting catheter lumens with heparin and/or urokinase. We conclude that RACs continue to be reliable and safe devices to use in marrow transplant patients. Complications interfering with catheter function are frequent; however, most can be resolved without the need to remove the catheter.

ISSN:0148-6071    

DOI:10.1177/014860719001400127

出版商:SAGE Publications    

年代:1990

数据来源: WILEY

摘要:

Total parenteral nutrition (TPN) today is a fundamental procedure in the treatment of critically ill patients, especially if they have serious gastrointestinal diseases. However, use of the central venous catheter is connected with a very important morbidity. At the “Istituto di Patologia Chirurgica” and at the “Intensive Care Unit” of the University of Ferrara, we analyzed 59 cases of deaths from different diseases, on whom a postmortem examination had been performed. Twenty‐seven patients had had no central venous catheter: none of them presented thrombosis of the central veins. Thirty‐two patients had had a central venous catheter for TPN: five of them presented thrombosis of the central veins at the post‐mortem examination. Except for one case who had thrombosis connected with a carcinoma of the right main bronchus, four cases (12.9%) presented thrombosis due to the central venous catheter. The subclavian vein seems to be more commonly connected with thrombosis than the jugular vein.

ISSN:0148-6071    

DOI:10.1177/014860719001400131

出版商:SAGE Publications    

年代:1990

数据来源: WILEY

摘要:

Significant compositional differences in protein and lipid content are present in currently available enteral nutrition preparations. Since variations in dietary protein and/or lipid have previously been shown to produce alterations in liver and gut drug metabolism, effects of five commonly used enteral nutrition regimens on several drug metabolic parameters were assessed in rats. Study formulations included: 1) Vivonex: low protein ‐no lipid; 2) High Protein Vivonex: normal protein ‐no lipid; 3) Vital: normal protein ‐normal lipid; 4) Sustacal: high protein ‐high lipid; 5) Isocal: normal protein ‐high lipid. Hepatic and intestinal microsomes were prepared after a continuous 7‐day intragastric infusion of one of the formulations, and measurements of cytochrome P‐450 content and assays of drug metabolizing activity were performed. No differences in intestinal microsomal cytochrome P‐450 content or meperidine demethylase activity were seen among the various alimentation groups. However, significantly decreased amounts of cytochrome P‐450 and reduced meperidine demethylase and pentobarbital hydroxylase activity were present in hepatic microsomes of animals receiving the lipid‐poor Vivonex and High Nitrogen Vivonex preparations compared to the other alimentation groups. These data suggest that the composition of enteral nutrition formulations may significantly impact on hepatic function and specifically that the presence of lipid in such preparations may be important for maintaining normal levels of hepatic drug metabolism.

ISSN:0148-6071    

DOI:10.1177/014860719001400134

出版商:SAGE Publications    

年代:1990

数据来源: WILEY

ISSN:0148-6071    

DOI:10.1177/014860719001400401

出版商:SAGE Publications    

年代:1990

数据来源: WILEY

摘要:

The amino acid glutamine has important and unique metabolic functions. It is the most abundant free amino acid in the circulation and in intracellular pools and a precursor for the synthesis of amino acids, proteins, nucleotides, and many other biologically important molecules. It is the most important precursor for ammoniagenesis in the kidney, the major end product of ammonia‐trapping pathways in the liver, a substrate for gluconeogenesis, and an oxidative fuel in rapidly proliferating cells and tissues. Glutamine also may have a number of important regulatory roles, increasing protein synthesis and decreasing protein degradation in skeletal muscle and stimulating glycogen synthesis in the liver. The demonstration that glutamine concentrations decrease and tissue glutamine metabolism increases markedly in many catabolic, stressful disease states has led to a reconsideration of the classification of glutamine as a nonessential amino acid and to the alternative hypothesis that glutamine may be a conditionally essential nutrient. This hypothesis has been supported by recent studies that have shown trophic effects of glutamine‐supplemented diets on the growth of specific tissues and on total body nitrogen balance. These observations form the basis for current efforts to define the clinical usefulness of glutamine‐supplemented nutrition. (Journal of Parenteral and Enteral Nutrition14:40S‐44S, 1990)

ISSN:0148-6071    

DOI:10.1177/014860719001400402

出版商:SAGE Publications    

年代:1990

数据来源: WILEY