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Biomedical subjects

M V Kaminski

Publications and source records attributed to M V Kaminski.

At least 19 recordsLinked to original sources
PubMed1993

Metabolic and nutritional support of the intensive care patient. Ascending the learning curve.

The learning curve of nutritional support in the critically ill began with the amelioration of the effects of starvation in patients with a disabled intestine. Next, there was an appreciation that feeding formulas could be tailored to support patients with specific organ insufficiencies. Then it was realized that feeding enterally has distinct advantages over feeding parenterally. In addition to a decrease in catheter-related sepsis, there was noted a distinct decrease in "remote site" sepsis. In fact, good scientific reasons have been identified to explain why this occurs, such as maintaining the competency of the intestine against a translocation of endotoxin and bacteria and "turn-on" of the stress response. Further, we now know that specific nutrients can produce desirable pharmacologic effects. In the future, feeding formulae will be devised that continue to modify the patient's response to illness favorably. Another important consideration is to begin nutritional support as soon as possible--i.e., on the day of admission, if appropriate. The critical care specialist should be expert in these techniques, with the goal of eliminating malnutrition as a confounding variable in the clinical course of the intensive care unit patient.

Critical Care↗
PubMed1990

Review of the rapid normalization of serum albumin with modified total parenteral nutrition solutions.

The theoretical basis for the rapid normalization of hypoalbuminemia is contingent on recognition of those clinical circumstances requiring rapid and prolonged repair of colloid oncotic pressure. Standard total parenteral nutrition (TPN) solutions repair serum protein only after prolonged periods of therapy. Nutritionists have empirically observed that adding albumin to TPN solutions can quickly normalize hypoalbuminemia for sustained periods. Infusion of similar quantities of albumin without TPN results in no prolonged normalization. The mechanism of the rapid normalization of serum albumin with albumin-modified TPN solutions has yet to be determined, as has its relationships to prevention of hypoalbuminemia-associated morbidity and mortality.

Digestive System↗
PubMed1987

Incidence of protein calorie malnutrition in the nursing home population.

That nutritional parameters change with age is a well-known phenomenon. Physical activity, lean body mass, and metabolic rate all decline with increasing age. There has been little work regarding the nutritional assessment of geriatric nursing home patients to determine their nutritional status and to focus attention on their nutritional needs. The purpose of this study was to assess the nutritional status of the residents of two urban nursing homes. The nutritional status of 227 nursing home residents (mean age 72.2 years) was evaluated using biochemical and anthropometric measurements. Midarm muscle circumference, triceps skinfold thickness, weight, height, serum albumin, serum pre-albumin, serum retinol binding protein, and a complete blood count with differential were obtained. The evaluation of this data indicated that there was a 52% incidence of malnutrition. This can be broken down to: 24% hypoalbuminemic malnutrition, 19% Kwashiokor-Marasmus mix, and 9% Marasmus. Twenty-eight percent of all patients were anergic, and 76% of the patients were anemic. In conclusion, there appears to be far more documentable malnutrition than anticipated or previously reported in this population.

Aged↗
PubMed1987

Efficacy of enteral diets in the prevention of stress-induced gastric erosions in rats.

This study compares the prophylactic effects of two different diets and routes of feeding on restraint stress-induced gastric erosions in the rat. Thirty male Sprague-Dawley rats were food-deprived and immobilized for 24 hours using a steel wire mesh. A small silicone tube was placed into either the proximal jejunum or the stomach via a laparotomy. There were three groups of ten rats (five jejunum-fed, five stomach-fed), receiving infusions (50 ml/24 h) of: (A) normal saline; (B) free amino acids (Vivonex HN, Norwich Eaton Pharmaceuticals) (60 cal and 0.318 G nitrogen); or (C) a peptide diet, with the nitrogen source as lactalbumin hydrolysate, otherwise identical to B. Gastric acidity was measured every 4 hours. At 24 hours, blood was collected and serum gastrin levels determined. The animals were then sacrificed and the stomachs examined. The results were analyzed using one-way analysis of variance. Fewer gastric erosions and lower serum gastrin levels and gastric acidity were found in animals fed diets B and C, versus animals fed normal saline (p less than 0.05). There was no difference between groups B and C. Our results also show that enteral diets using the jejunal route are better than those using the gastric route in reducing the incidence of stress-induced gastric erosions in rats.

Amino Acids↗
PubMed1986

Effect of peptide chain length on amino acid and nitrogen absorption from two lactalbumin hydrolysates in the normal human jejunum.

A double lumen jejunal perfusion technique has been used in man to study the effect of peptide chain length on absorption of amino acid nitrogen from two partial enzymic hydrolysates of lactalbumin. Copper-chelation chromatography showed that one lactalbumin hydrolysate (LH2) contained 98% peptides with a chain length greater than 4, whilst the other (LH1) contained a more even spread of chain lengths with 55% less than 4. Absorption of total nitrogen and of 14 amino acid residues occurred to a significantly greater extent from the low molecular weight LH1 than from the higher molecular weight LH2. The results suggest that the pattern of nitrogen and amino acid absorption from partial enzymic hydrolysates of whole protein is markedly influenced by peptide chain length and that brush border peptide hydrolysis has an important rate limiting effect on absorption rates.

Absorption↗
PubMed1986

Correlation of pressure sores and nutritional status.

As life expectancy increases, so do the problems of the elderly population. One major problem is that of protein calorie malnutrition; another is the susceptibility of this population to pressure sores. The purpose of this study was to determine if a correlation exists between deteriorating nutritional status and the development of pressure sores. The nutritional status of 232 nursing home patients (mean age 72.9 +/- 12 years) was determined using biochemical and anthropometric measurements. Overall, the incidence of some degree of malnutrition was 59%. Seventeen of the patients were found to have pressure sores and were all malnourished. When classified as mild, moderate, or severe malnutrition, the patients with pressure sores were in the severe group. There was a significant difference (P less than .001) between the nutritional status of pressure sore patients and the malnourished patients. It appears that the development of pressure sores correlates with nutritional deficiencies. The authors' findings suggest a need for more aggressive nutritional support in the elderly, especially those with pressure sores.

Aged↗
PubMed1986

Cholesterol: an antidiarrheal agent in rats with short-bowel syndrome fed elemental diets.

Studies show that bile acids and long-chain fatty acids are responsible for diarrhea in certain malabsorption syndromes. Recent reports indicate that substances such as dietary cholesterol, when moderately consumed, can reduce bile-induced excessive mucosal fluid and electrolyte output. This study explores the antidiarrheal effect and dosage of dietary cholesterol in rats following massive bowel resection, co-fed elemental diet. Thirty-five male Sprague-Dawley rats weighing 248-253 g underwent 75% resection of the small bowel and were fed ad libitum for 21 days with 1 of 5 diets (n = 7) of Vivonex HN, supplemented by 0, 2.5, 5, 10 or 15 mM cholesterol/1,000 g of the powdered elemental diet. Parameters measured included daily food and water consumption, daily changes in weight, volume of excrement and stool consistency graded by the same individual (water, semiformed or formed). It was found that 5 mM dietary cholesterol in 1,000 g of the elemental diet produced the most formed stool and significantly improved weight gain in rats with short-bowel syndrome.

Animals↗
PubMed1985

Increasing malnutrition during hospitalization: documentation by a nutritional screening program.

Nutritional status can change during hospitalization. To evaluate the degree of change, a nutrition screening program (NSP) that included admission and 3-week reassessment was implemented. NSP parameters were weight for height, percentage of weight loss, arm muscle circumference, triceps skinfold, serum albumin, and total lymphocyte count. Nutritional risk factors (NRF) were also recorded: cancer, nothing by mouth (NPO) for 3 or more days, loss of appetite, difficulty chewing or swallowing, persistent fever, and cancer chemotherapy or radiation therapy. Of 15,876 patients admitted during the period of March 1982 through December 1982, 583 (3.67%) were found to be suffering from malnutrition or to have NRFs. Of the 583 patients, 182 received nutritional support and were excluded from the study. The remaining patients were reassessed after 3 weeks and had significant decreases in nutritional parameters; 622 patients with deficits in one parameter (visceral or somatic) on admission had a significant decrease in all parameters (p less than .001) on 3-week assessment. There was a deterioration in nutritional status in those patients entering the hospital with NRFs only or with one low parameter.

Body Weight↗
PubMed1984

Suppression of appetite by parenteral nutrition in humans.

The effects of parenteral nutrition on appetite during and after therapy are unclear. Previous studies done in animals, as well as in humans, are inconclusive. The purpose of this study was to investigate the effects of parenteral nutrition on voluntary oral intake of food. The study was done on ten stable patients receiving parenteral nutrition for transient dysfunction of their gastrointestinal tract. For each patient, a calorie count of the ingested food was obtained for 3 consecutive days. Parenteral calories were then decreased without the patient's knowledge. A calorie count for 3 more days was obtained following the day of change. The mean daily oral intake was 823 kcal when the mean daily parenteral nutrition intake was 2,902, providing a total of 3,723 kcal. When parenteral nutrition calories were decreased to a mean of 1,550, the mean daily oral intake increased to 1,396. This difference in oral and parenteral calorie intake was statistically significant (P less than .001). It can be concluded from this data that parenteral nutrition decreases voluntary oral intake of food. It is therefore suggested that if the gastrointestinal tract is functionally satisfactory, parenteral nutrition can be rapidly weaned off, provided oral consumption is monitored to assure adequacy.

Adult↗
PubMed1984

A new method for long-term intravenous alimentation in unrestrained rats.

A new technique for continuous long term intravenous alimentation in unrestrained rats has been developed. The model involves the use of the intravenous tubing set which was constructed from the barrel of a 1 ml syringe-cylinder with flanges sutured to the rat's skin. After inserting the silicone catheter into the jugular vein the free end was exited at the intraauricular area and passed through the intravenous tubing set. The tubing was then connected with a silk suture to the top of the cage. This prohibits twisting of the system and allows unrestrained movement of the rat in the cage with a rotation of 6-8 turns in either direction. The metabolic cage was constructed from an inverted 4-liter glass jug with the base removed. A floor and root were fashioned from coarse wire screen. Urine and feces were easily separated and collected through the neck of the jug. This new "proxy" set was tested and compared with the standard swivel assembly parameters in rats infused by either method. However, the cost of the new set (excluding pump) was almost 90 times less than its commercially available counterpart. This self constructed approach should bring small animal research within the economic means of the most investigators.

Animals↗
PubMed1983

Nutritional support of the hospitalized patient.

Malnutrition is being recognized more frequently in hospitalized patients. Clinically significant malnutrition is defined as nutritional deficits that have serious adverse effects on the treatment and outcome of illness. The anergic metabolic profile is a simple method of assessing nutritional status. New techniques of enteral and parenteral nutritional support can stop or reverse the progression of malnutrition.

Adipose Tissue↗