What happens to blindly placed nasoenteral tubes?
Explore the source record for details and available documents.
Equipment Failure↗
Biomedical subjects
S Mobarhan
Publications and source records attributed to S Mobarhan.
High levels of reactive oxygen metabolites in colon cancer tissue: analysis by chemiluminescence probe.
Reactive oxygen metabolites (ROM) have been postulated to contribute to the development of various carcinomas, including colon cancer. Indeed, the effects of ROM scavengers are being tested for chemoprevention of adenocarcinoma of the colon. However, there has been no evidence to indicate that high levels of ROM are indeed present in cancerous tissue. In this study, we used a chemiluminescence probe to estimate ROM levels in cancerous and neighboring noncancerous colonic tissues from seven patients with colon cancer. Cancerous tissues contained significantly (p less than 0.05) more luminol-enhanced chemiluminescence (4,808 +/- 2,282 counts/min/mg protein) than neighboring noncancerous tissues (2,175 +/- 1,111). The addition of an ROM scavenger, catalase (2, 4, and 8 micrograms/ml), to the tissue suspension inhibited chemiluminescence produced by both noncancerous (-74%, -85%, and -71%) and cancerous (-11%, -61%, and -53%) tissues. This study shows that colonic cancerous tissue contains high levels of ROM, which may play an important role in the pathogenesis of colon cancer.
Adenocarcinoma↗
Prolonged tube feeding in long-term care: nutritional status and clinical outcomes.
This study examines nutritional status and clinical outcomes, including pressure ulcers and death in 40 chronically tube-fed long-term care patients. Anthropometric, biochemical, clinical and dietary data were collected over a 3-month period, with follow-up of mortality at 1 year. Subjects' functional and cognitive status was generally poor. Adequate calories and protein were provided, with sample means exceeding standard means for energy, protein and micronutrients. Still, subjects showed weight loss and severe depletion of lean and fat body mass. Mean serum protein and micronutrient status measures were in the low normal range. Hemoglobin, hematocrit, and serum zinc and carotenoid levels were below normal in a sizable proportion of patients. Pressure ulcers were present in 65% of patients. Weight loss was associated with longer time on tube feeding and more pressure ulcers. Negative correlations with ulcer number were observed for cholesterol, albumin, zinc, retinol, alpha-tocopherol and iron. This study shows that despite administration of apparently adequate formula, micronutrient deficiencies and marasmic malnutrition exist in chronically ill patients. Causes may include the combined effects of chronic disease, sepsis, immobility, and severe neurologic deficits. Clinical outcomes may be expressions of an organism-wide diminution of protein synthesis, the cause of which is unknown. For clinical management, serial measures of weight, albumin, cholesterol, hemoglobin and hematocrit are recommended. Future research must address the many subsets of the population of chronically tube-fed patients.
Adult↗
Oral diet does not alter pulmonary pentane or ethane excretion in healthy subjects.
Ethane and pentane are alkanes that are excreted through the lungs to a small degree in healthy subjects. These gasses are produced from the peroxidation of unsaturated fats which are found both in body tissues and in foods. These gasses are excreted in larger amounts by patients with increased production of reactive oxygen metabolites, including those with inflammation or ischemia. Thus, detection of these gasses in excessive quantities is considered evidence for lipid peroxidation. However, the effects of dietary factors on these measurements have not been defined. To define the effects of eating on the pulmonary excretion of these alkanes, 29 healthy subjects were fed a standardized liquid diet (1060 kcal, 12.9 g linoleic acid and 385 mg linolenic acid) after an overnight fast. Breath alkanes were measured at 0, 1, 3, and 6 hours. All subjects had normal vitamin E (1.11 + 0.26 mg/dl), retinol (64 +/- 14 micrograms/dl), beta carotene (27 +/- 21 micrograms/dl), lycopene (23 +/- 12 micrograms/dl) and zinc (81.9 +/- 13.5 micrograms/dl) levels. No statistically significant changes in either alkane were noted relative to the fasting level. We conclude that oral diet does not alter pulmonary ethane or pentane excretion in healthy subjects.
Adult↗
Nutrition in acute pulmonary disease.
Acutely stressed patients with chronic pulmonary disease have a particular need for accurate nutritional assessment and appropriate nutritional therapy. Loss of skeletal muscle, often extensive, can be paralleled by dramatic alterations in cellular function; inadvertent provision of excessive calories or of individual substrates may produce more harm than benefit. In the absence of a single "gold standard" for nutritional assessment and monitoring, no single value should take precedence over the entire clinical picture, which should be thoughtfully assessed and reassessed, with both the patient's nutritional needs and the consequences of their provision kept in mind. In the future, assessments of the impact of nutritional intervention will probably rely more heavily on functional tests of specific organs and of the immune system. Intervention will be based not only on provision of calories, individual substrates, vitamins, and minerals, but also on control of the inflammatory response in order that the nutrients may be properly utilized.
Acute Disease↗
Gastrostomy tube deterioration and fungal colonization.
Explore the source record for details and available documents.
Aged↗
Zinc deficiency reduces hepatic cellular retinol-binding protein in rats.
Hepatic cellular retinol-binding protein (cRBP) levels were measured from the livers of four groups of Sprague-Dawley rats after three weeks of dietary treatment. The experimental group (n = 8) received a zinc-deficient (2.3 mg/kg dry powder) liquid diet ad libitum. A pair-fed control group (n = 8) received the same amount of liquid diet with supplemental zinc (60 mg/kg dry powder). Another control group (n = 8) received liquid diet ad libitum with supplemental zinc (60 mg/kg powder). A third control group (n = 7) received a pellet diet which also contained the same amount of zinc as the other control groups (60 mg/kg). Hepatic cRBP was reduced by more than 50% in the experimental group as compared to each of three control groups. It appears that zinc may be an essential element for the intra-cellular transport of vitamin A, in addition to its well-established role in the intercellular transport of vitamin A.
Animals↗
Protein and carbohydrate absorptive efficiency of chronically malnourished and well-nourished patients during enteral feeding initiation.
To investigate the efficiency of protein and carbohydrate absorption, we studied malnourished and well-nourished subjects during the first 72 hours of tube feeding. We furthermore investigated whether differences in absorptive efficiency existed between malnourished patients with and without nongastrointestinal malignancy. Twenty-one subjects starting tube feeding without edema or major organ failure and not on antibiotics (well-nourished controls = 7; malnourished = 7; malnourished with nongastrointestinal malignancy = 7) received 50 kcal/hr Osmolite continuously for 72 hours. Twelve of these subjects completed an additional 48 hours of study where they received 125 kcal/hr continuously. We performed hydrogen breath tests to assess carbohydrate absorption and determined stool nitrogen content to assess protein absorption. We also measured frequency of defecation, stool weight, and stool moisture content. The results of these tests failed to reveal statistically significant differences between the three groups in terms of protein and carbohydrate absorption, as well as failed to demonstrate the presence of diarrhea. We conclude that patients receiving an isoosmolar diet who are malnourished, or malnourished with nongastrointestinal malignancy, absorb carbohydrate and protein as well as well-nourished patients during enteral hyperalimentation.
Adult↗
Enteral alimentation: administration and complications.
Tube feeding is commonly used for providing essential calories and nutrients to the patient otherwise unable to eat. In the last two decades there has been significant expansion in the number and quality of enteral formulas. In this review, we evaluate the indications for each major class of formula, and survey complications associated with formulas and devices that deliver formula. Recommendations for future research are listed.
Deficiency Diseases↗
Serum time curve characteristics of a fixed dose of beta-carotene in young and old men.
The present study was designed to evaluate age-related differences in serum beta-carotene time curve response characteristics when a beta-carotene dose was given in conjunction with 1500 kcal over the course of a day. On two consecutive days, seven old (73 +/- 4 years) and six young (24 +/- 1 years) men were each fed three 500-kcal meals of an isotonic liquid formula diet containing only trace amounts of beta-carotene. On the first day of testing, no supplemental beta-carotene was given (baseline day). A 15 mg dose of beta-carotene was fed with the morning meal on the second day (test dose day). Fasting blood and hourly blood samples were obtained for 8 consecutive hours on both days. Additional blood was drawn 24 and 48 hours after the test beta-carotene dose. There were no statistical differences in baseline beta-carotene concentrations between the two age groups tested, but, because of high individual variability, serum time curve characteristics were adjusted for fasting beta-carotene levels. After adjustment, the postdose serum beta-carotene response was two to three times greater (p less than or equal to 0.04) in young subjects, as evaluated by peak concentration, area under the curve, or ascending slope of the serum response curve. Examination of factors besides age group that may have accounted for these results suggests that the serum response of the elderly may be more a function of body composition and/or serum lipid patterns than of age per se. However, in the present US population, it may not be valid to control for these factors, which are both closely related to aging.
Adult↗
Age-related effects of chronic ethanol intake on vitamin A status in Fisher 344 rats.
The present study was designed to investigate the interaction of age and ethanol on vitamin A status in rats. Rats aged 2 and 19 mo were fed a liquid diet containing 36% of total energy as ethanol or pair-fed a diet containing isoenergetic carbohydrate in place of ethanol. After 3 wk older rats had lower serum retinol (P = 0.04) and higher vitamin A concentrations in liver (P = 0.0001), esophagus (P = 0.0001) and the proximal (P = 0.03) and distal (P = 0.0001) colon than younger animals. Hepatic microsomal cytochrome P-450, retinyl ester hydrolase (REH) and cellular retinol-binding protein (cRBP) were significantly reduced; acyl coenzyme A: retinol acyltransferase (ARAT) was increased; and alcohol (retinol) dehydrogenase (ADH) activity was unchanged with age. Ethanol ingestion increased serum retinol as well as esophageal and colonic vitamin A levels in both age groups. Hepatic cRBP decreased further in the older rats with ethanol feeding, but no change was noted in the percentage of hepatic vitamin A as retinol or retinyl esters. Ethanol ingestion decreased REH (P = 0.0001) and ARAT activities (P = 0.02) and increased cytochrome P-450 (P = 0.04) but had no effect on the activity of ADH in either age group. These data indicate that, regardless of age, chronic ethanol ingestion significantly alters the tissue distribution of vitamin A; however, ethanol reduced cRBP levels only in older rats.
Acyltransferases↗
Diarrhea associated with tube feeding: the importance of using objective criteria.
Since the published incidence of tube feeding-associated diarrhea varies widely between 2.3 and 68%, and because commonly used definitions of diarrhea are subjective and imprecise, we determined the actual fecal output of malnourished patients during the first 6 days of tube feeding. Nine patients on the same isoosmolar formula were evaluated for diarrhea. Patients were interviewed daily as to whether they thought diarrhea was present or absent. Frequency of defecation was recorded, and stool was collected daily for weight. When assessed subjectively, the incidence of diarrhea rose from 11% on day 1, to 25% on day 4, and to 43% by day 6. The group (n = 4) complaining of diarrhea averaged 3.0 bowel movements per day, whereas those denying diarrhea (n = 5) averaged fewer than 0.2 bowel movements per day (p less than 0.01). Stool weight, however, plateaued for all patients by day 6 at 52.7 +/- 35.7 g of stool per day. No patient produced in excess of 250 g of stool per day. We suggest that traditional subjective measures for assessing diarrhea may be flawed and should not be relied upon when evaluating and treating tube feeding-associated diarrhea.
Adult↗
The hazards of hypercaloric nutritional support in respiratory disease.
This case illustrates the dangers of hypercaloric feeding in a patient with limited respiratory reserve, in this instance secondary to heart-lung transplantation. The patient's postoperative course was complicated by repeated bouts of infection and/or rejection that resulted in intubation and ventilatory support. The excessive caloric and protein load given to the patient resulted in increased CO2 generation with subsequent inability to wean the patient off the ventilator. Recognition of the problem and appropriate decreases in substrate intake permitted extubation.
Adult↗
Enteral tube feeding: a clinical perspective on recent advances.
Explore the source record for details and available documents.
Enteral Nutrition↗
In vitro formation of retinoic acid from retinal in rat liver.
Enzymatic conversion of retinal to retinoic acid in rat liver cytosol was detected using a rapid and sensitive assay based on high pressure liquid chromatography (HPLC). This retinal oxidase assay system did not require extraction steps or any other manipulation of the sample mixture once the sample vial was sealed for incubation. The product (retinoic acid) and the reactant (retinal) were separated by HPLC in 14.0 min with a sensitivity of 15 and 40 pmol per injection for retinoic acid and retinal, respectively. Enzymatic activity was observed to be linear with protein concentration (0-2.4 mg/mL) and time (0-30 min) and displayed a broad pH maximum of 7.7-9.7. The enzyme exhibited Michaelis-Menten single-substrate kinetics with an apparent Km of 0.25 mM. The average specific activity in nine normal rats was 35.6 +/- 3.3 nmol retinoic acid formed/h per mg protein. Incubation of the enzyme with zinc did not affect the rate of retinoic acid synthesis. Dithiothreitol inhibited the reaction. Both NAD and NADH stimulated retinoic acid formation. Formation of retinol was also observed when these pyridine nucleotides were added to the reaction mixture, indicating the presence of retinal reductase activity. The results of kinetic studies suggest that NADH may act indirectly to stimulate retinoic acid formation.
Aldehyde Oxidoreductases↗
Nutritional problems of the elderly.
Malnutrition is common in elderly persons living in institutions and in the community. In many cases, the problem arises from a highly individual constellation of interacting physiologic, economic, and psychosocial causes that have the common effect of reducing nutrient intake. Protein-calorie and micronutrient undernutrition added to the normal effects of aging can undermine functional independence and diminish the quality of life of the elderly. The spectrum of the elderly is extremely broad, and, consequently, nutritional assessment and support must be highly individualized to be effective. A multidisciplinary approach focusing on prompt identification and treatment of correctable causes of undernutrition is most effective. There is a wide range of support modalities, from simple supplemental foods to total parenteral nutrition, any of which may be used successfully in an elderly patient, provided that the necessary care is taken to define the goals of therapy and to provide patient assessment and monitoring.
Aged↗
Effects of beta-carotene repletion on beta-carotene absorption, lipid peroxidation, and neutrophil superoxide formation in young men.
The chemopreventive effects of beta-carotene are usually attributed to its antioxidant properties. To determine the effects of beta-carotene supplementation on different parameters of oxidative metabolism, 15 normal young male subjects (18-30 yrs) were placed on a carotenoid-free liquid diet for two weeks prior to entry into the study. Blood was then measured for five carotenoids, retinol, retinyl palmitate, retinol-binding protein, alpha-tocopherol, vitamin C, zinc, lipid peroxides, and neutrophil superoxide production. Absorption tests were performed with 15 mg of beta-carotene to determine absorption curves for each subject. Subjects were then divided into two groups and given either 15 (n = 7) or 120 (n = 8) mg of beta-carotene daily for four weeks along with the same carotenoid-free liquid diet. The absorption test and the blood measurements were repeated. After repletion with beta-carotene, serum lipid peroxide levels decreased in both groups (p less than 0.05), but no other changes were noted in either the neutrophil superoxide production or in the levels of any of the vitamins measured. In contrast to vitamin E, the superoxide scavenging ability of beta-carotene apparently does not contribute to its effects in lowering serum lipid peroxide levels.
Absorption↗