Intravenous Hyperalimentation Research Articles

Supportive care for patients with small cell lung cancer

Weight loss is frequently seen in patients with small cell carcinoma of the lung even when the tumour is small and there is no mechanical interference with the gastrointestinal tract [ 11. The use of increasingly aggressive chemotherapy drug regimens and combined modality programs increase the probability of weight loss and debility. These intensive programs can also produce severe and sometimes protracted myelosuppression with risk of intercurrent infections. This review will focus on these two aspects of supportive care: nutritional support and prophylaxis against infection. The etiology of cancer-related weight loss is likely multifactorial. Increased energy requirements, anorexia secondary to tumour-induced changes in taste, insulin resistance and other metabolic abnormalities and anorexia induced by psychological reactions to the disease likely all play a role in patients with small cell lung cancer. The frequency of weight loss in lung cancer (approximately 40-501 of patients) and its known negative impact on survival, led to several studies of intravenous nutritional support These studies, which administered the intravenous nutrients at the beginning of antineoplastic therapy, were given in the hope that they might increase response to therapy, improve survival and ameliorate toxicity [2,3]. As a result of encouraging preliminary observations, the Division of Cancer Treatment, National Cancer Institute organized a number of randomized controlled clinical trials in tumour types known to be responsive to chemotherapy, including small cell lung cancer. In the study of patients with SCLC mported by Clamon [4], 119 evaluable patients were randomized to receive either 28 days of intravenous hyperalimentation (IVH) or an ad lib oral diet. The IVH consisted of an amino acid mixture, hypertonic glucose and a lipid emulsion and the amount of calories and protein delivered was calculated to maximize nutritional repletion. The median survival time for patients with limited disease treated on the study was 18 months and for those with extensive disease, it was 11 months. However, there were no differences in the response rate or survival between the nutritionally supported group and the control group. In particular, IVH did not sig

An Esophagobronchopleural Fistula Successfully Treated by a Surgical Procedure Combined with Conservative Therapy after Resection for Lung Cancer

The patient was a 43-year-old woman, who had undergone a right middle and lower lobectomy for adenocarcinoma of the lung. An esophagobronchopleural fistula developed two months after the operation. It was treated by a combined procedure consisting of pedicle flap closure of the fistula and thoracoplasty. The esophagobronchopleural fistula recurred two days later, however, and another pedicle flap closure with fenestration of the chest wall were performed in a third operation. A bronchopleural fistula then recurred, after which it was treated by conservative therapy including intravenous hyperalimentation, frequent dressing changes and systemic administration of appropriate antibiotics. It closed spontaneously 23 days after surgery, in spite of this being a very rare but serious complication very difficult to treat and cure. From our experience with this particular case, we recommend, for treating esophagobronchopleural fistulas, proper drainage, antibiotic therapy, intravenous hyperalimentation and packing of the empyema space, together with closure of the fistula using a muscle or pleural flap.

An Analysis of Factors Contributing to the Development of Total Parenteral Nutrition‐Induced Cholestasis

The risk of developmental of total parenteral nutrition (TPN)-associated cholestatic jaundice in neonates receiving intravenous hyperalimentation is high. Numerous factors have been cited as contributing to TPN cholestasis; however, the exact etiology remains obscure. This retrospective study was undertaken in order to identify any factors which might contribute to this syndrome. The hospital records of 172 neonates requiring TPN for a minimum of 1 week were reviewed. In addition, a subgroup of 32 infants requiring TPN for a minimum of 7 weeks was also examined. Cholestasis was defined as a direct serum bilirubin greater than 2.0 mg/dl during the course of TPN therapy. Significant factors for the development of cholestasis in both groups (n = 172, n = 32) included: number of operations (2.56 vs. 1.08, p = 0.0000), the number of days the patients received antibiotics (40.3 vs 12.9, p = 0.0000), and delayed start of enteral feedings (33.8 vs 14.1, p = 0.0000). Fifteen of the 32 patients who received TPN for at least 7 weeks did not develop cholestasis. In this subgroup (n = 32), there were no differences in birth weight, gestational age, days from birth to the start of TPN, or respiratory distress between those who developed cholestasis and those who remained anicteric. In contrast, there were significant differences between the cholestasis and noncholestasis groups in number of operations (13 vs 6, p = 0.0407), and days until enteral feedings were started (33.1 vs 18.9, p = 0.0289). This study suggests that the factor(s) contributing to the development of TPN-associated cholestasis are likely multifactorial. There appears to be a direct correlation between increasing severity of cholestatic jaundice and duration of TPN. This review does add a new parameter to the various causative factors suggested, namely the number of operative procedures. This new variable could be related to the stress of surgery itself or to the repeated administration of anesthetic agents.

Experimental studies on an artificial esophagus for the purpose of neoesophageal epithelization using a collagen-coated silicone tube.

An artificial esophagus was fabricated from a collagen-coated silicone tube 5 cm long, with an inner diameter of 2.5 cm and a wall thickness of 1 mm. The outer surface was coated with dry collagen to 5 mm thickness. The bilayered prosthesis was anastomosed to the cervical esophagus of adult mongrel dogs that were fed only by intravenous hyperalimentation (IVH) with 80 cal/kg/day and 60 ml water/kg/day for 3 weeks after the operation. Once the dogs began to consume food orally, the artificial esophagus dropped spontaneously into the stomach and formation of the neoesophagus was complete. Macroscopically, the neoesophagus showed no evidence of leakage or inflammation and had a smooth internal surface, but it developed slight segmental narrowing. Microscopically, layers of stratified squamous epithelium covered the neoesophagus within 3 to 4 weeks. The most characteristic feature of the artificial esophagus was that the replacement prosthesis did not remain in the esophagus after healing. Esophageal epithelization extended into the collagen layer coating the silicone tube and a new esophageal lumen was regenerated, thereby decreasing the chance of infection and leakage. However, neoesophageal stenosis was observed when the silicone tube was removed.

Nutritional status in hepatocellular carcinoma associated with liver cirrhosis: Effect of intravenous administration of branched-chain amino acid-enriched solution.

Patients with hepatocellular carcinoma (HCC) frequently also suffer from chronic hepatitis or liver cirrhosis (LC). Preoperative nutritional assessment was made of HCC patients with or without LC and of patients with esophageal varices or cholelithiasis as controls. The patients with HCC and esophageal varices associated with LC were malnourished and were especially lacking in protein and other nutrients. The blood molar ratio of branched-chain amino acids (BCAA) to aromatic amino acids was low in LC patients. The effects of post-operative parenteral nutrition with a BCAA-enriched amino acid solution on the plasma amino acid profile and on protein renewal were evaluated in HCC patients with LC. Although the ratio was unchanged after intravenous hyperalimentation with a 21% BCAA-enriched solution, it rose in the group receiving a 31% BCAA-enriched solution. This group showed a rise in BCAA and a fall in aromatic amino acids in the plasma. Moreover, following hepatectomy, the serum level of prealbumin, a rapid turnover protein, improved significantly after intravenous hyperalimentation with the 31% BCAA-enriched solution. These results suggest that nutritional support with BCAA is a useful measure for the post-operative management of HCC patients with LC.

TWO CASES OF SPONTANEOUS ESOPHAGEAL PERFORATION

Spontaneous perforation or rupture of the esophagus is a relatively rare but lethal disease, requiring rapid diagnosis and appropriate treatment. We reported two cases of spontaneous esophagea1 perforation. A 50-year-old male was hospitalised with a complaint of severe chest pain 24 hours after the sudden onset. He immediately underwent surgery, i.e., primary suturing of ruptured segment of the esophagus and drainage of the mediastinum and left pleural cavity. However, major leakage from the lesion occurred 14 days postoperatively, and the patient was treated by local irrigation of IsodinR in saline solution through the drains and managed with nutritional supports using intravenous hyperalimentation and elementary diets. He recovered and discharged 122 days after operation. Another 50-year-old male was transferred to our clinic under a suspicion of ruptured aortic aneurys approximately 24 hours after the start of pain attack. The diagnosis was first corrected to esophageal tear by thoracotomy, then a drainage of the mediastinum was done. He was expired forrwoing delayed mediastinitis and septicemia 64 days after operation.

Current management of mediastinal infection following open heart surgery

Postoperative mediastinal wound complications occur in 0.5 to 5 per cent of patients undergoing cardiac operations requiring median sternotomy. Superficial infections can be effectively managed by debridement and repeated dressing changes. Deeper infections of short duration and of limited extent may respond to aggressive debridement and continuous closed catheter irrigation with antimicrobial solutions. The patients with greater involvement and delayed infections are best managed by extensive debridement of the sternum and costal cartilages and coverage of the exposed mediastinal wound with either an omental flap or muscle flaps constructed from pectoralis major and/or rectus abdominis. Systemic administration of adequate dosages of appropriate antibiotics and maintainance of positive nitrogen balance by enteral or intravenous hyperalimentation are also necessary to control infection and promote healing.

Status of Sterilization Treatment of Intravenous Hyperalimentation

Status of Sterilization Treatment of Intravenous Hyperalimentation

GASTRECTOMY OF PYLORIC STENOSIS FOLLOWING CORROSIVE ESOPHAGOGASTRITIS

Ingestion of strong acid often causes maximum damage to the wall of the stomach. Alkali burns, however, usually injuries the esophagus and the oropharynx and spares the stomach. The absence of severe symptoms is observed in most patients soon after ingestion of acids. Symptoms may be delayed for weeks. Two cases of strong acid ingestion for suicidal means were reported here. After gastric lavage, early esophago-gastric endoscopy was carried out in each case. They had gastric involvement but esophagus and duodenum were spared. Intravenous hyperalimentation for nutritional support was used. In both cases pyloric stenosis as late complication developed following an asymptomatic interval for thirty days, and upper GI series revealed a gastric outlet obstruciton that suggested a necessity of follow-up evaluation after injury. They were required distal gastrectomy with good result but in one patient esophageal stenosis occurred and esophageal dilatation was applied. Fibrosis derived from the maximum involvement of the stomach was histoloigcally found along the lesser curvature and in the region of the antrum. The initial treatment as well as the surgical management are discussed.

急性期脳卒中と高カロリー輸液法 リハビリテーション病棟における間欠的中心静脈高カロリー輸液治療

急性期脳卒中と高カロリー輸液法 リハビリテーション病棟における間欠的中心静脈高カロリー輸液治療

Studies on Preparation of Intravenous Hyperalimentation based on Order-made Prescription

Studies on Preparation of Intravenous Hyperalimentation based on Order-made Prescription

Clinical study of intravenous hyperalimentation in oral and maxillofacial surgery

Clinical study of intravenous hyperalimentation in oral and maxillofacial surgery

Chylothorax and Chylous Ascites in a Patient with Uterine Cancer

A 63-year-old woman, who had undergone radical hysterectomy and radiation therapy for cervical cancer of the uterus three years previously, was found to have pleural effusion and ascites. A diagnosis of chylothorax and chylous ascites was made on the basis of these fluids' characteristics. She received medium-chain triglyceride (MCT) in her diet and intra-venous hyperalimentation to decrease the leakages of chyle into the pleural and peritoneal cavities, but she died of respiratory and renal failures after six months. At autopsy, metastases from the cervical cancer of the uterus to the lymph nodes in the mediastinum and around the abdominal aorta were proved histologically. Lymph node swelling due to metastasis had caused a rupture of the thoracic duct, leading to chylothorax and chylous ascites. The diagnosis, evaluation and therapeutic modalities of the condition are outlined and the literature reviewed.

Submaximal Exercise During Intravenous Hyperalimentation of Depleted Subjects

The peripheral nitrogen wasting and loss of functional capacity caused by the malnutrition of disease and the immobilization of hospitalization may not be readily reversed by refeeding alone. In order to examine submaximal exercise as an adjunctive anabolic stimulus to intravenous refeeding (IVF) in depleted subjects, 14 volunteers were studied in the postabsorptive (PA) state, after 10 days of total starvation, and again after 10 days of nutritional repletion with I.V. feedings. The subjects were randomized to one group that received IVF alone and one group that performed 1 hour of submaximal (51% of VO2max) stationary bicycle exercise daily during IVF. The exercised group was not significantly different from the nonexercised group in urinary nitrogen balance, resting energy expenditure, extremity amino acid flux, or maximal oxygen consumption. Acute exercise did not induce significant derangements in electrolytes or counter-regulatory hormone concentrations. Ten days of submaximal exercise does not appear to be detrimental in this population recovering from moderate hospitalized malnutrition, but additional anabolic stimulae may be needed for improvements in protein accrual or functional capacity.

Ｍ．Ｖ．Ｉ．（Ｍｕｌｔｉ‐Ｖｉｔａｍｉｎ Ｉｎｆｕｓｉｏｎ）配合時の輸液中における抗生物質の力価変化およびビタミンの安定性 （第２報）

The change of antibacterial activity of antibiotics and the stability of vitamins in intravenous hyperalimentation (I. V. H.) transfusions mixed with cephem-antibiotics and multi-vitamin infusion (M. V. I.) were investigated. No change in appearance and pH was observed 24 hr after the combination of antibiotics and M. V. I. in the I. V. H. transfusions.The antibacterial activities of antibiotics in the I. V. H. transfusions were not changed in the mixture of M. V. I., latamoxef, cefoperazone, ceftizoxime and cefotaxime after 24 hr. The stability of antibiotics used was studied by not only the antibacterial test method but also by the high performance liquid chromatography method. From our present results, we did not recognize the remarkable difference by these two methods.Vitamin A in Hicaliq-1, Hicaliq-2 was decomposed by light, but was almost stable by shielding a light. Vitamin B1 in Paremental A, Paremental B and Paremental B+Proteamin 12 X was decomposed.It seems to be induced by NaHSO3 “preservative” containing in these solutions. Vitamin C in Hicaliq-1, Hicaliq-2 and Hicaliq-2+Proteamin 12X was decomposed by keeping at room temperature, and was also stable under the cold condition.All other vitamins (B2, B6, D2, E, nicotinamide and panthenol) were stable in the I. V. H. transfusions containing antibiotics and M. V. I.

Chylothorax with chylous ascites, successfully controlled by pleuro-peritoneal and peritoneo-venous shunts

A 29-year-old male patient was referred to our hospital because of bilateral chylothorax. He was first treated with bilateral closed pleural drainage and intravenous hyperalimentation. He lost 2000-2500 cc of chyle every day. One month later, when the right pleural effusion had decreased in volume, a left pleuroperitoneal shunt was placed, which controlled the effusion on the left thereafter. As serous effusion accumulated in the right pleural space again, transthoracic supradiaphragmatic thoracic duct ligation was performed, but the chylous leak continued undiminished. Two months later, the right pleural effusion decreased spontaneously, and ascites appeared. A peritoneo-venous shunt was interposed to control the ascites without loss of fluid. It was appropriate to use a double-valved shunt tube to prevent occlusion. Chyle was returned to the vein, and the normal physiological route was restored. His nutritional state returned to normal. He was discharged on a low fat diet and is doing well.

Role of gastrin/pentagastrin in regulation of intestinal cytochrome P-450

1. 1. In the absence of intraluminal inducers, low “basal” levels of cytochrome P-450 and its dependent MFO activities are detected in the rat intestinal mucosa, and may be regulated by endogenous hormones. 2. 2. Rats were nutritionally maintained by either short term (48 hr) intravenous glucose infusion or chronic (8 days) intravenous hyperalimentation, and were treated with various doses of pentagastrin in the infusate. 3. 3. Regardless of the dose (6–90 μg/kg/hr) or duration of infusion (2–8 days), pentagastrin had no effect on small intestinal cytochrome P-450, its dependent MFO activity, or the activity of δ-aminolevulinic acid synthetase. 4. 4. The intestinal trophic peptide hormone, gastrin, apparently does not regulate the cytochrome P-450-dependent MFO system of the small intestine.

Serum alpha-tocopherol concentrations in preterm infants receiving less than 25 mg/kg/day alpha-tocopherol acetate supplements.

Alpha-tocopherol (aT) concentrations were determined in 52 preterm infants receiving less than 25 mg/kg/day alpha-tocopherol acetate (aTA) supplements through intravenous hyperalimentation solutions, lipid, and oral aTA. One fourth of the study infants had aT concentrations greater than 3.5 mg/dl at least once, and an association between concentrations greater than 3.5 mg/dl and necrotizing enterocolitis was demonstrated. In contrast, another one fourth of the infants' concentrations remained less than 0.5 mg/dl through the first postnatal week. The highly variable serum tocopherol concentrations correlated with total serum lipid content but not with plasma aTA hydrolysis activity.

NON-SURGICAL REMOVAL OF INTRAVASCULAR FOREIGN BODIES

We successfully treated two cases of intra-atrial foreign bodies using the basket catheter technique without invasive operations. In both cases, an intravenous hyperalimentation catheter was accidentally broken during insertion or exchange. Through the femoral vein, an FG-17k basket catheter (Olympus Co., Ldt.) was inserted into the right atrium and the fragment was picked up in a few minutes without any complications.This method is a treatment of choice for intravascular foreign bodies.

無菌製剤処理化高カロリー輸液剤でのビタミンの長期安定性に関する薬剤学的研究

For the purpose of supply of intravenous hyperalimentation solutions (IVH) for home care, we examined long-term stability, especially vitamins B1, B2, C and A for two weeks to monitor changes in hospital coded prescription, IVH 1-5.Decrease of vitamin B1 was observed in IVH 1-4 with time.It was decreased by 27.0-40.5 % on the 14th day, while in IVH 5 the concentration decreased to at 83.7%.Vitamine C showed the next largest decrease to 65.1% being retained two weeks in IVH 5.In IVH 1-4, on the other hand, it remained at 83.6-94.4%.Other two vitamins B2 and A remained stable at the comparatively high level of 80.9-101.4% in each preparation.From the results, it is seemed that if the constituents of IVH are given sufficient consideration, it would be possible to guarantee the long-term stability of IVH with vitamins in the index of vitamins B1 and C.