ISSN:0148-6071    

DOI:10.1177/014860718901300101

出版商:SAGE Publications    

年代:1989

数据来源: WILEY

摘要:

In order to evaluate the effect of head injury in severely traumatized patients on the response of plasma cortisol, glucagon, insulin, glucose, and FFA as well as urinary N and catecholamines excretions, 36 patients were prospectively studied over 5 consecutive days following injury. They were divided into three groups: group I, severe isolated head injury (n = 14); group II, multiple injury combined with severe head injury (n = 12); group III multiple injury without head injury (n = 10).The results demonstrate similar hormonal and metabolic changes between these three groups of patients, characterized by elevated urinary adrenaline, noradrenaline excretion, increased cortisol, glucagon, insulin plasma levels throughout the study and elevated N urinary excretion with strongly negative N balances during the first 5 days postinjury. A significant correlation was observed between N intake and 5 day cumulated N balance(r= 0.63, p<0.001). In addition, N balance was negatively correlated with urinary excretion of adrenaline (r= —0.47,p<0.01) and noradrenaline (r= ‐0.44,p<0.05) as well as plasma levels of glucagon (r= —0.44,p<0.05). Isolated severe head injury seems to induce a full response in the secretion of the catabolic counterregulatory hormones comparable to that encountered in patients with multiple injury and associated with a marked increase in protein catabolism; additional noncranial major injury does not seem to enhance these responses.(Journal of Parenteral and Enteral Nutrition13:5–12, 1989)

ISSN:0148-6071    

DOI:10.1177/014860718901300105

出版商:SAGE Publications    

年代:1989

数据来源: WILEY

摘要:

The polyamine content of the intestinal mucosa is increased with mucosal proliferation. Our purpose was to determine if urine and jejunostomy polyamine content increases after refeeding and correlates with intestinal length and carbohydrate absorption after intestinal resection. Five patients with intestinal remnant lengths ranging from 1.5 to 8 feet after intestinal resection and jejunostomy formation were studied after refeeding of an elemental diet. Mean putrescine and spermidine levels in the jejunostomy effluent but not in the urine increased significantly after refeeding (p<0.05). These changes correlated with intestinal remnant length and carbohydrate absorption. Carbohydrate absorption correlated with polyamine levels in a single patient studied longitudinally. The polyamine content of intestinal fluid may serve as a marker of the status of the intestinal mucosa and may prove useful in the dietary management of individuals with the short bowel syndrome.(Journal of Parenteral and Enteral Nutrition13:13— 17; 1989)

ISSN:0148-6071    

DOI:10.1177/014860718901300113

出版商:SAGE Publications    

年代:1989

数据来源: WILEY

摘要:

We evaluated the extent and effects of bacterial contamination of an open continuous enteral feeding system. Eighty‐two quantitative enteral feeding cultures and clinical data were obtained during 8 days of observation on each of 33 patients. Cultures of appropriate sites were obtained on febrile patients and compared to the enteral feeding culture.Gram negative bacilli (GNB) in the enteral feeding correlated with abdominal distension in the patients (10 of 12 patients with GNB compared to 5 of 21 without GNB;p<0.01). Nine of the 10 patients with GNB and distension were receiving systemic antimicrobics to which the organism was resistant. Contamination of feeding withSerratia marcescenscorrelated with cultures for the same organism in patients' other body sites (p<0.01). The feeding contaminant may have been the source of sepsis in one patient who expired from septic shock. No relationship was demonstrated between contamination and liquid stools or fever.Undiluted, canned feedings were significantly less contaminated at 24 hr (15%) than those requiring mixing of powder (94%) (p<0.0001). The canned feedings grew primarily enteric organisms, whereas the powder feedings grew flora typically resident on the skin.Mixing or diluting feedings appears to represent an increased risk of contamination. Growth of GNB may produce adverse effects. Further investigation into methods to limit contamination and growth is warranted.(Journal of Parenteral and Enteral Nutrition13:18–22, 1989)

ISSN:0148-6071    

DOI:10.1177/014860718901300118

出版商:SAGE Publications    

年代:1989

数据来源: WILEY

摘要:

Two related studies were done to determine the incidence of bacterial contamination in enteral delivery systems that were used for 15 and 7.5 hr, rinsed after each use, and reused dailyin vitrofor 7 and 5 days, respectively. In the first study, systems infusing either a premixed formula (Ensure) or a hand‐mixed formula (Vivonex) did not show bacterial growth until the 4th day, 1.0–2.0 × 10 colony‐forming units per milliliter (CFU/ml) ofStaphylococcus epidermidis.Thereafter there was sporadic growth of different organisms but never increasing growth during the 7 days of infusion. In the second study, systems with Ensure were initially contaminated withStaphylococcus aureus and Escherichia coliand reused for 5 days.S. aureuswas eliminated by rinsing, butE. colipersisted in the delivery system at concentrations of 103‐106CFU/ml. We conclude that clean enteral nutrition systems can be rinsed after short‐infusion periods and reused up to 7 daysin vitrowithout significant contamination; however, once a bag has become heavily contaminated some bacteria cannot be eradicated from the system by rinsing.(Journal of Parenteral and Enteral Nutrition13:23–25, 1989)

ISSN:0148-6071    

DOI:10.1177/014860718901300123

出版商:SAGE Publications    

年代:1989

数据来源: WILEY

摘要:

Energy expenditure (EE) was measured, during 3 consecutive days, in six patients suffering from acute pancreatitis. Measurements were achieved postoperatively, under mechanical ventilation, using a mass spectrometer system. EE represented 1.49 times (range: 1.08–1.78) the predicted resting energy expenditure (PREE) according to the reevaluated Harris‐Benedict equation. There was a weak positive correlation between EE and core temperature and a negative correlation between EE and nitrogen balance. EE/PREE was not different between septic and nonseptic patients (1.58 ± 0.06vs.1.39 ± 0.07). The calculations of nutrient oxidation rate indicated a high protein catabolic rate, a neoglucogenesis, and a lipolysis.(Journal of Parenteral and Enteral Nutrition13:26–29, 1989)

ISSN:0148-6071    

DOI:10.1177/014860718901300126

出版商:SAGE Publications    

年代:1989

数据来源: WILEY

摘要:

A mechanical hand grip dynamometer was used to derive age‐ and sex‐related standard grip strengths from 247 healthy volunteers between 16 and 95 yr old. Preoperative grip strength was measured in 90 patients and related to postoperative complication rates. A grip strength of 85% standard for age and sex was found to be the most effective cut‐off for prediction of postoperative complications in terms of sensitivity and specificity, predicting 74% of the complications (p<0.05). Specificity is improved over previously published standards related to sex alone especially when assessing the elderly patient (50%vs21%). A grip strength below the recommended cut‐off for age and sex suggests that the patient is in a high‐risk group and demands further investigation of nutritional status. Studies of pre‐operative nutritional support for the at risk group need to be undertaken.(Journal of Parenteral and Enteral Nutrition13:30–33, 1989)

ISSN:0148-6071    

DOI:10.1177/014860718901300130

出版商:SAGE Publications    

年代:1989

数据来源: WILEY

摘要:

We studied 95 patients with cancer of the gastrointestinal tract in various sites. The aim of the study was to compare the forearm dynamometry vs the prognostic nutritional index which was reported by Busby et al, 1890. We used these methods as preoperative prognostic indicators for postoperative mortality and morbidity. The forearm muscle dynamometry has greater positive predictive value (58.33vs32.4%), higher sensitivity (77.78vs66.6%), and specificity (86.11vs65.28%) than the prognostic nutritional index. The forearm muscle dynamometry predicted the patients mortality with a high rate of sensitivity (100%). The results suggest that dynamometry is a useful, rapid, and inexpensive test. It is more accurate than the nutritional index, and can indentify cancer patients at a high risk of developing major postoperative complications, and predict the postoperative morbidity and mortality.(Journal of Parenteral and Enteral Nutrition13:34–36, 1989)

ISSN:0148-6071    

DOI:10.1177/014860718901300134

出版商:SAGE Publications    

年代:1989

数据来源: WILEY

摘要:

The effect of oral refeeding after total parenteral nutrition (TPN) on brush border hydrolases was measured in the proximal jejunum and ileum of adult rats. The animals received intravenously for 4 days a mixture of Intralipid 10% and Vamine‐Glucose. At the end of TPN, oral feeding was reinstituted and the rats were fed with an isocaloric standard diet (60% carbohydrate, 17% protein, 3% lipid). Sucrase, isomaltase, lactase, and aminopeptidase N activities were measured at the end of TPN and at 1, 3, and 5 days after TPN. Sham‐operated rats nourished orally with the standard diet were used as controls. In both intestinal segments, lactase activity showed no significant changes at the end of TPN or during oral realimentation. Isomaltase, and especially sucrase activities, exhibited an important drop at the end of TPN. After TPN, a complete restoration of isomaltase and sucrase activities was obtained in the jejunum only. During oral refeeding a 40% deficit in sucrase activity persisted in the ileum throughout the experimental period, whereas normal isomaltase activity was restored in this segment. Aminopeptidase N activity was lowered by TPN and recovered normal values within a few hours after oral realimentation. Thus, reinstitution of oral feeding after TPN should take into account that the intestine is capable of digesting normal amounts of dietary protein but has a reduced tolerance for carbohydrates.(Journal of Parenteral and Enteral Nutrition13:37–40, 1989)

ISSN:0148-6071    

DOI:10.1177/014860718901300137

出版商:SAGE Publications    

年代:1989

数据来源: WILEY

摘要:

The effects of two parenteral nutrition (PN) amino acid solutions (FreAmine II and F080) on the serum amino acid levels of 51 children, 27 affected by multiple trauma and 24 by bacterial sepsis, and aged from 1 month to 12 years, were studied. Serum amino acids were determined on day 1 immediately before administrating PN, and on day 5 during PN. Trauma patients on F080 exhibited higher levels of alanine, aspartate, asparagine, leucine, isoleucine, valine, total branched‐chain amino acids (BCAA) and total essential amino acids than those on FreAmine II; in contrast septic children showed similar levels of serum amino acids on both PN solutions. BCAA were lower in septics than in trauma patients, probably as a consequence of an increased utilization of these amino acids in sepsis because of the higher organ protein synthesis typical of this situation. The phenylalanine/tyrosine ratio was found elevated both in septic and trauma children, but it decreased after PN in the latter when using an enriched BCAA solution. Utilization of this solution, partly corrects the metabolic disturbances induced by stress, but the metabolical responses induced either by sepsis or trauma are partially different which may have important implications for patient care. (Journal of Parenteral and Enteral Nutrition13:41–46, 1989)

ISSN:0148-6071    

DOI:10.1177/014860718901300141

出版商:SAGE Publications    

年代:1989

数据来源: WILEY