Cases reported "Weight Loss"

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1/9. Is weight loss possible in patients treated with thiazolidinediones? Experience with a low-calorie diet.

    BACKGROUND: weight gain is a frequent side-effect of thiazolidinediones, possibly related to fluid retention and stimulation of pre-adipocyte differentiation. methods: We report our experience with a low-calorie diet (800 cal, sodium content 1500 mmol/day) combined with behavior modification on eight patients treated with thiazolidinediones (six pioglitazone and two rosiglitazone). RESULTS: All patients had reported previous weight gain following treatment with thiazolidinediones. All patients lost weight over 12 weeks in the program with their mean /- SD body weight falling from 270 /- 54 lbs (123 /- 25 kg) to 244 /- 61 lbs (111 /- 28 kg) (p < 0.01). The weight loss observed was no different from that observed in 16 age- and gender-matched patients with type 2 diabetes not treated with thiazolidinediones (from 263 /- 54 lbs (120 /- 25 kg) to 239 /- 52 lbs (109 /- 24 kg); p < 0.01). Glycemic control improved while reducing insulin treatment. blood pressure control also improved and antihypertensive medications were decreased. The degree and time course of weight loss is no different from that in patients treated with other diabetic therapies and is associated with improved glycemic and blood pressure control. CONCLUSIONS: We conclude that a program of caloric restriction and behavior modification is effective in leading to weight loss in patients treated with thiazolidinediones. This effect is reassuring, since thiazolidinediones stimulate adipogenesis.
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2/9. Estimate of daily calorie needs for a neuromuscular disease patient receiving noninvasive ventilation.

    The purpose of this report is to estimate the daily caloric intake needed by a person with substantial muscle wasting due to neuromuscular disease and who also uses a ventilator for substantial amounts of time. Although this study was done for a particular individual, its methodology is generalized to any nonambulatory neuromuscular disease patient. The author, the person chosen for this analysis, is a male, limb girdle muscular dystrophy patient, who uses noninvasive ventilation approximately 20 hrs/day. An experimental technique gave a range of energy requirements for the study individual of total energy expenditure (TEE) of 788 kcal/day < or = TEE (experimental) < or = 876 kcal/day, or an average of 832 kcal/day, and the model developed here gave a range of 801 kcal/day < or = TEE (model) < or = 871 kcal/day, or an average of 836 kcal/day. This article examines and then generalizes these results to develop a simple equation that clinicians and nutritionists may use to estimate daily energy needs for ventilated neuromuscular disease patients. Because severe muscle wasting--which we define for the purposes of this article to be <30% of normal--is assumed, this analysis represents a near minimum daily energy need.
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3/9. weight loss in obese children carrying the proopiomelanocortin R236G variant.

    To acquire more information relative to the course of obesity in conditions of food restriction in subjects carrying mutations in the melanocortin signaling pathway, 710 obese children (mean age: 9.5 /-2.1 yr; mean z-score body mass index: 3.63 /-1.6) were genotyped for the proopiomelanocortin (POMC) R236G substitution, a variant which has been associated to early onset obesity, by restriction fragment length polymorphism (RFLP) analysis. Three children were heterozygotes for the R236G variant (0.4%). One of them had the metabolic syndrome. This variant was not found in 400 controls. The 3 probands followed a hypocaloric balanced diet and, after about 12 months, normalized their weight as well as fat mass and insulin resistance. The patient with the metabolic syndrome reversed this condition. These results show that a) the R236G substitution of POMC gene, although not a major cause of obesity among Italian obese children and adolescents, is associated with early onset obesity, and that b) inherited alterations of the melanocortin signaling pathway, independently of the degree of obesity, do not preclude the possibility to lose weight in mutated individuals following a hypocaloric diet.
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4/9. Euthyroid goitre and sleep apnea.

    A number of predisposing factors (obesity, nasal obstruction, adenoidal hypertrophy, macroglossia, etc) have been related to obstructive sleep apnea syndrome (OSAS). In addition hypothyroidism and large goitres have been reported to be associated to OSAS, but this association has not been adequately studied. We describe an obese patient with euthyroid goitre associated with OSAS. The patient showed a body mass index (BMI) of 47 and a large neck with a circumference of 60 cm. The flow-volume curve demonstrated an expiratory plateau suggesting an intrathoracic upper airway obstruction. Arterial blood gas analysis results were: pH 7.39; PCO2 54.2 mmHg; P O2 47 mmHg. Nocturnal polisomnography showed an apnea/hypopnea index (AHI) of 31 episodes/hour. Upper airway collapse was overcome by a nasal continuous positive airway pressure (nCPAP) of 14 cmH2O. weight loss obtained by a hypocaloric diet was not accompanied by any OSAS improvement. After thyroidectomy, a nCPAP of 4 cmH2O was sufficient to prevent upper airway closure. Discontinuation of nCPAP treatment for 4 consecutive nights did not determine worsening of sleep apnea symptoms, nor a worsening of overnight oxymetry. A new polysomnography carried out after 4 nights off nCPAP showed an AHI of 33 episodes/hour. OSAS should be suspected in patients with large goitres. Decisions regarding discontinuation of nCPAP treatment after thyroidectomy should be based on polisomnographic results.
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5/9. An unexpected finding in an eight-year-old child with cerebral palsy and weight loss.

    Poor weight gain is frequently seen in children with cerebral palsy. This is most commonly due to poor oral-motor coordination, resulting in inadequate caloric intake. We present the case of an eight-year-old girl with aicardi syndrome who had been an exclusively oral feeder and who was noted to have had a 10-lb weight loss over the previous months when she was admitted to the hospital with seizures. Due to ongoing diminished oral intake, a barium swallow was performed, which revealed a filling defect. The mass that was removed at surgery proved to be a lactobezoar, a very uncommon finding in a child of this age.
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6/9. Respiratory failure due to morbid obesity in a patient with prader-willi syndrome: an experience of long-term mechanical ventilation.

    prader-willi syndrome (PWS) is characterized by obesity, mild mental retardation or learning disability, and behavior problems, especially in association with food and eating. A 19 year-old man, 150 cm, 140 kg (body mass index [BMI], 62.2 kg.m(-2)), whose condition had been diagnosed as PWS, received 41-day mechanical ventilation because of respiratory failure, chiefly due to morbid obesity. Because the patient frequently developed bronchoconstriction, metered-dose inhalers of a corticosteroid (beclomethasone dipropionate) and a beta2 agonist (salbutamol) were needed. To achieve adequate sedation, which was also crucial to control the bronchoconstriction, the concurrent use of midazolam, fentanyl, ketamine, and propofol was required. Pressure-control ventilation was useful to avoid high airway pressure due to low respiratory system compliance associated with the morbid obesity. Because it appeared that the basic problem leading to respiratory failure in this patient was morbid obesity, body weight reduction was considered to be mandatory. Thus, caloric intake was limited to 1000 kcal.day(-1), resulting in body weight reduction by 50 kg during the patient's stay in the intensive care unit (ICU). The patient was successfully extubated on ICU day 35.
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7/9. A head-injured patient: caloric needs, clinical progress and nursing care priorities.

    This case study explored literature on nursing care of the head-injured patient and identified outcomes of a head-injured patient in regard to nutritional status, skin breakdown and infection. literature review revealed head-injured patients experience a hypermetabolism requiring increased nutritional support. Patient outcomes included mild skin breakdown, infection and a 12% loss in body weight. Inadequate nutrition was the patient's most significant outcome. The patient maintained an average daily intake of 915 calories and averaged a total energy expenditure of 2337 calories, thus, demonstrating an average daily deficit of 1422 calories. Top nursing care priorities noted in the patient's chart were: alteration in cerebral tissue perfusion, potential for injury and alteration in skin integrity. Results indicated more accurate assessment of the patient's needs and inclusion of more applicable nursing diagnoses were required to ensure greater continuity in care.
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keywords = caloric
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8/9. Cure of sleep apnea syndrome after long-term nasal continuous positive airway pressure therapy and weight loss.

    Two male patients [aged 53 and 54 years; body mass index (BMI) of 36.8 and 34.4 kg/m2] presented with severely symptomatic sleep apnea syndrome. Polysomnographic recording showed sleep fragmentation, diminution of stages III and IV and continuous sleep-related disordered breathing with mixed and obstructive apneas and hypopneas, and snoring. apnea index (number of apneas per sleep-hour) was 73 and 30, respectively. These abnormalities were reversed by nasal continuous positive airway pressure (nCPAP). Home treatment with nCPAP associated with hypocaloric diet was started. Six months later, all symptoms had disappeared and BMI was 29 and 29.2 kg/m2, respectively. Polygraphic recordings without nCPAP showed regular breathing in all sleep stages, which were stable and normally abundant. Therapy has been discontinued and clinical and polygraphic data have remained normal for up to 6 and 11 months, respectively.
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9/9. hyperphagia and weight loss during fluoxetine treatment.

    OBJECTIVE: To report the unusual coincidence of weight loss with increased appetite and food intake in a patient treated for depression on two separate occasions with fluoxetine. CASE SUMMARY: A 27-year-old woman experienced a modest weight loss during treatment for depression with fluoxetine. The weight loss was associated with a reported increase in daily caloric intake and consumption of a greater proportion of dietary fat than usual for the patient. The same patient was treated again with fluoxetine more than a year later and again experienced weight loss associated with an increase in appetite, caloric intake, and dietary fat consumption. DISCUSSION: fluoxetine is a selective serotonin reuptake inhibitor that often is associated with a modest weight loss when used for the treatment of depression, although it also has been reported to have the opposite effects of weight gain and hyperphagia in some patients. The effects on weight usually are assumed to be the result of primary effects on appetite, but the discrepancy between the appetite and weight changes in this case challenges the applicability of that assumption in all cases. CONCLUSIONS: The effects of fluoxetine on appetite and weight may be mediated by partially distinct mechanisms and might conceivably involve a direct metabolic effect in some patients.
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keywords = caloric
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