New preparations of the elemental diet and the clinical application

In 1978, we designed a new elemental diet, ED-AC, which modified after Vivonex-HN with the co-operation of Ajinomoto Co., Japan and Morton-Norwich Co., U.S.A.. ED-AC is now being used widely in Japan for enteral hyper-alimentation, even in case of pediatric surgery. We have new prepared another elemental diet, this time for infants, ED-P (pediatric). The ratio of amino acids in both ED was determined according the proposal of Professor Goro Inoue, Department of Nutrition, Tokushima University. The application of ED, particularly for surgical patients, has been most effective. the use of this diet for enteral hyperalimentation should find a wide application in surgical and medical practice.     

Efficient Decompression and Immediate Enteral Hyperalimentation via Gastrostomy as an Adjunct to Gastroplasty

A triple-lumen Moss^R gastrostomy tube was advanced into the proximal duodenum as an adjunct to the postoperative management of patients who underwent vertical banded gastroplasty (VBG) for the treatment of morbid obesity. The tube efficiently aspirated the proximal duodenum and stomach to prevent postoperative ileus and allow maximum immediate postoperative absorption of an elemental diet fed simultaneously into the distal duodenum. Decompression and feeding were started as soon as the patient arrived in the recovery room. Both were continued for at least the first 48 h after surgery. Patients seemed to improve better clinically on this postoperative regimen than with only the traditional i.v. infusion of fluids, carbohydrates, and electrolytes. The length of stay also was shorter than that allowed in the Diagnosis Related Group (DRG) for the surgical management of morbid obesity: with the average of 3.0 days (range 2-6 days) versus the general mean length of stay of 7.4 days. Immediate enteral decompression and hyperalimentation through a gastroduodenostomy tube is a useful adjunct to the post-VBG treatment of morbidly obese patients.     

静脉治疗电子信息管理系统的建立及应用

目的 提高静脉治疗的效率和信息记录的完整性.方法 将142例静脉治疗患者按时间段及等同原则分为观察组70例和对照组72例;两组操作方法相同,对照组采用传统手工记录法,观察组采用静脉治疗电子信息管理系统记录.结果 观察组信息记录完整性显著优于对照组,记录时间显著短于对照组(均P＜0.01).结论 静脉治疗电子信息管理系统的应用可提高静脉治疗的效率和信息记录的完整性.     

The effects of administering hyperalimentation solutions into the atrium and pulmonary artery

Pulmonary hypertension, edema, and congestion have been found in three infants who died after infusion of chronic TPN solutions through catheters placed into the right atrium (RA) or pulmonary artery (PA). In 24 anesthetized dogs receiving varying concentrations of dextrose and water through catheters placed into the RA, the endothelium of the RA evidenced injury only when concentrations of 20% DW or greater were infused. Both the main PA and distal PA endothelium showed evidence of injury only when concentrations higher than 40% DW were infused. When solutions were infused directly into the main PA, the main PA endothelium revealed injury if more than 15% DW was infused, and the distal PA showed moderate endothelial injury when 10% DW or greater was infused. The distal PA evidenced more severe endothelial injury after concentrated dextrose solution infusion than either the RA or main PA. Pulmonary congestion, edema, and hypertension became increasingly prominent when 24-hour infusions of 10% DW or more were placed into the main PA, or concentrations higher than 40% were infused into the RA. Distal PA endothelial injury appears to correlate directly with the severity of pulmonary congestion, suggesting endothelial cell emboli.     

补益肝肾药膳联合轻断食疗法对围绝经期肥胖的改善效果

目的 探讨补益肝肾药膳联合轻断食疗法对围绝经期肥胖的改善效果.方法 将72例围绝经期肥胖患者随机分为对照组和干预组各36例.对照组采取线上、线下相结合模式对患者进行营养与饮食健康教育;干预组在对照组基础上实施补益肝肾药膳联合轻断食疗法,连续干预8周.结果 干预后干预组体质量、腰围测量值显著低于对照组(均P＜0.05);...     

Intravenous injection of elemental mercury: A report of two cases

Two cases of intravenous injection of elemental mercury are described in this report. One patient succumbed and the other remains asymptomatic two years after the surgical removal of all the injected mercury. Management of intravenous injection of elemental mercury (intended to be an aphrodisiac in these two cases) is discussed here and the need for surgical removal of all accessible mercury has been emphasized.     

腰椎滑脱短节段固定器的初步有限元分析

目的：探讨有限元方法对腰椎滑脱复位固定器进行力学分析的可行性。方法：应用有限元方法建立腰椎滑脱复位固定器（HOIST）有限元模型，并对其在复位和负重两种载荷下的生物力学进行分析。结果：该器械在复位和负重时的不同应力分布图显示连接杆后方等处所受拉应力较大，但未超出器械设计强度。结论：利用有限元模型可对滑脱复位固定器械的受力进行分析，是一种对此类脊柱器械进行评价和预测的新方法。     

肠外营养预混配方与全合一配液配方的临床应用调查

目的 了解国内住院患者全合一肠外营养液与预混肠外营养液的配方特点。方法 收集国内6家不同地区医院的配制中心因不同疾病住院患者的肠外营养处方,统计营养素供给量、总液体量、非蛋白质热卡、总氮量、热氮比、糖脂比等指标,并与预混营养液相比较。结果 全合一营养液处方中营养素的供给量能够满足患者基本营养需要,不同能最级别的预混营养液基本能够满足大多数住院患者的营养需要。全合一营养液处方中总氮量基本能够满足患者营养需要,但热氮比[(180～250):1]、糖脂比(0.56 ～1.26)与推荐值[(100 ～ 150):1,1.0]差距较大,而3种不同能量级别的预混营养液中的热氮比(167)、糖脂比(0.8)更为理想。结论 全合一营养液和预混营养液各有优缺点,能满足多数住院患者疾病治疗的需要。全合一营养液处方应多考虑营养素分配比例的问题。     

The effect of intravenous hyperalimentation on cell mediated immunity

The effect of intravenous hyperalimentation (IVH) on cell mediated immunity was examined in 22 patients. Each patient received PHA and PPD skin tests before and after the performance of IVH. In this study both PHA and PPD skin reactivity showed significant increase after IVH, and serum albumin levels had positive correlation with the PPD skin reaction changes. Absence of the established delayed hypersensitivity in the surgical patient, especially those with malignant diseases, is probably secondary to generalized malnutrition, and established cell mediated immunity can be restored by proper nutritional repletion.     

Inducible nitric oxide synthase knockout mice are resistant to diet-induced loss of gut barrier function and intestinal injury

Loss of gut barrier function has been documented to occur in animals receiving total parenteral nutrition (TPN) and certain liquid diets. However, the mechanisms responsible for diet-induced gut barrier dysfunction remain to be fully determined. Thus we tested the hypothesis that increased intestinal nitric oxide production contributes to this phenomenon. To test this hypothesis, iNO S-deficient (iNOS -/-) mice and their wild-type littermates (iNOS +/+) were fed either chow or TPN solution for 14 days. Subsequently they were killed and gut barrier function was assessed by measuring bacterial translocation to the mesenteric lymph node (MLN) complex. Additionally, intestinal bacterial population levels, gut morphology, plasma and intestinal nitric oxide levels, as well as intestinal levels of the nitric oxide synthase (NOS) enzymes cNOS and iNOS, were measured. Bacterial translocation occurred in the iNOS +/+ but not the iNOS -/- mice receiving oral TPN solution. Oral TPN-induced bacterial translocation was associated with increased intestinal bacterial population levels as well as morphologic evidence of intestinal injury. Plasma and intestinal levels of the nitric oxide products, nitrite/nitrate, were increased in the iNOS +/+ mice fed the TPN solution but not in the chow-fed groups or the iNOS -/- mice receiving TPN solution. Last, intestinal iNOS, but not cNOS, activity was increased in the iNOS +/+ oral TPN-fed mice. These results implicate a role for increased intestinal nitric oxide production, through iNOS, in the pathogenesis of oral TPN-induced gut barrier dysfunction and injury.     

Perioperative management of a paediatric patient on the ketogenic diet

The ketogenic diet has become commonplace for the treatment of paediatric patients with refractory epilepsy. I describe the perioperative management of a patient on the ketogenic diet. The basis, complications and anaesthetic implications of the diet are discussed.     

Effect of elemental diet on albumin and urea synthesis: Comparison with partially hydrolyzed protein diet

Enhanced nitrogen utilization occurs when adults with gastrointestinal disease are fed partially hydrolyzed proteins instead of isonitrogenous, isocaloric crystalline amino acids. A controlled trial was conducted to determine if this difference was also seen in malnourished stressed cancer patients and to gain an understanding of the underlying mechanism. Sixteen malnourished patients with head and neck cancer were prospectively randomized to either crystalline amino acid-glucose (CAA-G) or partially hydrolyzed protein-glucose (PHP-G) diets. Patients were fed via an enteral tube for 10 days starting on the second postoperative day. Blood SMA-6 and amino acid levels were measured on Days 1 and 10. Daily calorie counts and fluid balance were obtained. Daily 24-hr urine and stools were analyzed for total N during the last 5 days of the study period. The daiy positive N balance with both diets was the same (CAA-G = +7.8 ± 0.8 vs PHP-G = +8.2 ± 1.0 g; mean ± SE) and 3-methylhistidine:creatinine ratio did not differ. Patients on PHP-G diet gained significantly more weight (+0.5 vs ?1.5 kg; P < 0.01) and had significantly higher serum albumin (3.2 ± 0.2 vs 2.8 ± 0.1 g/dl; P = 0.5) by the end of the 10th study day. Weight changes were not due to fluid retention: serum Na⁺, K⁺, creatinine and mean fluid intake for the two groups remained the same during the study period. A significantly greater rise in BUN occurred on the CAA-G diet (from 9.2 ± 1.7 to 15.4 ± 1.4 mg/dl; P < 0.05) while BUN remained unchanged on the PHP-G diet. The urea cycle intermediary amino acids, ornithine and citrulline, were significantly (P < 0.05) elevated in patients ingesting the CAA-G diet as compared with the PHP-G. Results show that the PHP-G diet promoted weight gain, and albumin synthesis, while CAA-G failed to do so, suggesting use of CAA-G for gluconeogenesis and ureagenesis.     

静脉全麻复合硬膜外麻醉用于腹腔镜胆囊切除术的临床观察

目的:探讨静脉全麻复合硬膜外麻醉用于腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)的麻醉效果,并与单纯静脉全麻比较。方法:随机将LC60例患者分为对照组(静脉全麻)与观察组(静脉全麻复合硬膜外麻醉),每组30例。记录麻醉前、麻醉后(气管插管后或硬膜外平面固定后期气腹前)、气腹后5min及术毕时的SBP、DBP、HR、呼之睁眼时间、拔管时间、术后恶心呕吐(PONV)发生例数及8h内的平均VAS评分、两组异丙酚的用量。结果:两组患者术中血流动力学变化无显著性差异;观察组患者苏醒质量、PONV、8h平均VAS评分及异丙酚量与对照组有显著性差异。结论:LC全麻复合硬膜外麻醉对循环和呼吸的干扰小,清醒质量高且经济安全。     

Experimental study of the effect of an elemental diet on liver regeneration

The influence of branched chain amino acids and lipid on liver regeneration was examined after two-thirds hepatectomy in rats. Elemental diet (ED) as components of enteral nutrition was given through the gastrostomy tube. The rats were divided into four groups according to the amounts of branched chain amino acids (BCAA) and lipid in the diet as follows: ED-I; BCAA 27%, Cal/N ratio: 74, ED-II; BCAA 37%, Cal/N ratio: 95, ED-III; BCAA 37% + lipid emulsion, Cal/N ratio: 99, ED-AC; commercially available elemental diet. The degree of liver regeneration of these groups of rats were compared with that of the control rats which were fed per os ad libitum. The liver regeneration rate of each group was as follows: ED-I; 59%, ED-II; 88%, ED-III; 92%, ED-AC; 79%, the control group; 89%. Remarkable fatty deposits were microscopically observed in each liver of ED-I, II and AC groups. Fatty change in the liver of ED-III group was minimum. The observation indicates that administration of branched chain amino acid enriched elemental diet and lipid emulsion is effective for regeneration of the liver after partial hepatectomy.     

Diet and colorectal cancer: implications for the obese and devotees of the Atkins diet

Colorectal cancer (CRC) is the second most common cause of cancer-related death in the Western world and its prevalence is increasing. Potential causes of this increase are changes in diet and the increases in obesity seen. This paper looks at the literature surrounding diet and obesity and the links to this increase in CRC. Heralded as a weight loss miracle we investigate whether the literature suggests the Atkins diet may actually do more harm than good by acting to increase an individual's risk of CRC. Obesity has been demonstrated to be a major factor in the increase in CRC although links to changes in diet are more tenuous. Published studies on diet suggest the Atkins diet may help reduce rather than increase the risk of CRC.     

Calcium content of common food items in Chinese diet

Summary It has been shown that the amount of calcium consumed in childhood and adolescence has a role in determining the bone mass in later life. We recently showed that the daily calcium intake among Hong Kong Chinese is only 300–500 mg, which decreases with age. An investigation was thus made into the calcium content and other constituents of common food consumed by the local population. Test items included vegetables, rice, cooked food, and seasoning paste. The samples were first digested to remove organic constituent, and the mineral content was then analyzed using atomic absorption spectrophotometry. The results show that egg, beancurd, and sesame paste contain a high calcium content and, if consumed in sufficient amount, would provide a good source of calcium. In view of the high incidence of lactase deficiency and thus the difficulty in increasing intake of milk and milk products, increased consumption of other types of food with high calcium would be useful in improving the daily calcium intake.