1/9. pregnancy outcome in a patient with chronic malnutrition: case report.This case report describes the management of a chronically malnourished woman during her first and second pregnancies. The emphasis of the management is on the investigation of her dysphagia and subsequent bypassing of her colonic interposition by the formation of a percutaneous gastrostomy. The case highlights spontaneous conception with a body mass index of 14 and the safety of enteral feeding during pregnancy.- - - - - - - - - - ranking = 1keywords = malnutrition (Clic here for more details about this article) |
2/9. Necrotizing stomatitis in the developed world.We present a case of a malnourished 68-year old man with occult hypothyroidism who presented with malaise, pyrexia, tongue swelling, oral ulceration and dysphagia after a 6-month period of increasing lethargy and failing self-care. Severe necrotic oral ulcerative lesions were accompanied by cutaneous purpura, blood-filled blisters and bedsores. It was concluded that the patient's clinical condition reflected necrotizing stomatitis on a background of malnutrition with scorbutic skin lesions and hypothyroidism. The patient made a good recovery with scrupulous oral hygiene, debridement, intravenous metronidazole and nutritional support. Healing occurred with marked fibrosis and trismus, which has slowly improved with mouth-opening exercises. Necrotizing stomatitis is more commonly encountered in malnourished children in developing countries, and may subsequently result in devastating facial defects and death. patients in the developed world with poor oral hygiene, malnourishment and immunosuppression are also at risk, but early diagnosis and treatment is life-saving and reduces subsequent disability.- - - - - - - - - - ranking = 0.25keywords = malnutrition (Clic here for more details about this article) |
3/9. Palliative surgery in patients with bulbar amyotrophic lateral sclerosis.patients with amyotrophic lateral sclerosis (ALS), a progressive neurodegenerative disorder, commonly develop bulbar symptoms including dysphagia, dysarthria, and defective airway protection. Otolaryngologists/head and neck surgeons are frequently asked to assist in the management of these problems. We reviewed our experience of 13 surgical procedures in 7 patients with advanced bulbar ALS. In spite of technically good surgery, 3 patients died within 1 week of hospitalization. Four patients appeared to benefit from the surgery. patients with bulbar ALS are a high risk group because of chronic malnutrition and dehydration, covert aspiration and pneumonitis, and diminished ventilation. A team approach to these problems is stressed. Perioperative morbidity can be reduced with careful preoperative preparation and patient selection.- - - - - - - - - - ranking = 0.25keywords = malnutrition (Clic here for more details about this article) |
4/9. Perioperative considerations in esophageal replacement for epidermolysis bullosa: report of two cases successfully treated by colon interposition.Esophageal stricture commonly occurs in patients with epidermolysis bullosa dystrophica recessive (EBDR), but esophageal replacement is considered a high risk procedure because of limited exposure of the airway, malnutrition, and postoperative skin bullae to secondary infection. Recent innovations in care, including preoperative parenteral nutrition, topical care for bullae and skin ulceration, fiberoptic tracheal intubation, electrocardiogram monitoring with metallic pacer leads, and an overall concern to protect the fragile intact skin, have improved the results of esophageal replacement. Utilizing these adjunctive measures, ileocolonic substernal interposition has been successfully performed in a 26-yr-old male and a 19-yr-old female at our institution. Despite cervical anastomotic stricture requiring resection in one, and an obstructive cervical esophageal bullous developing acutely 5 yr after operation in the second, both patients now gum or chew a solid diet. The first patient also benefited from total esophagectomy for squamous dysplasia detected at the time of esophageal replacement. Multidisciplinary management by the surgeon, gastroenterologist, anesthesiologist, and dermatologist makes esophageal replacement available for younger patients with epidermolysis bullosa dystrophica recessive and esophageal strictures.- - - - - - - - - - ranking = 0.25keywords = malnutrition (Clic here for more details about this article) |
5/9. Oculopharyngeal muscular dystrophy as a cause of dysphagia in the elderly.A case of oculopharyngeal muscular dystrophy in an elderly woman of French-Canadian background presenting with dysphagia is discussed. Typical features of the clinical presentation include bilateral ptosis and dysphagia with significant potential for morbid outcomes of aspiration pneumonia and malnutrition. Although relatively uncommon, this diagnosis should be considered in an elderly person with dysphagia, a history of ptosis, and the proper family background. Surgical treatment appears to improve the signs and symptoms of this disease.- - - - - - - - - - ranking = 0.25keywords = malnutrition (Clic here for more details about this article) |
6/9. Giant posterior inferior cerebellar artery aneurysm with dysphagia.Presented is a case of giant aneurysm of the posterior inferior cerebellar artery with the unusual clinical presentation of dysphagia to the point of inability to swallow even oral secretions, resulting in severe malnutrition. A computed tomography scan with contrast-medium enhancement appeared normal. The correct diagnosis was suspected from the results of metrizamide myelocisternography and was confirmed at angiography. The patient underwent ligation of the feeding right vertebral artery with subsequent improvement in her dysphagia and resolution of her other neurological deficits. Discussion of the incidence, diagnosis, and treatment of this uncommon lesion is presented.- - - - - - - - - - ranking = 0.25keywords = malnutrition (Clic here for more details about this article) |
7/9. Early identification and treatment necessary to prevent malnutrition in children and adolescents with severe disabilities.Children with severe developmental disabilities frequently have nutrition and growth problems that range from moderate to severe. Because of notable continuing medical concerns and lowered growth expectations, parents and physicians may fail to recognize gradual deterioration in nutritional status before severe medical complications occur. The two cases reported in this article illustrate the need for early identification and treatment to prevent the development of notable morbidity secondary to malnutrition. Children and adolescents who have growth parameters consistently below age norms require assessment and monitoring by a registered dietitian to detect feeding problems and intake changes and to provide early intervention to help prevent negative consequences (eg, dehydration, protein-energy malnutrition, decubitus ulcers, increased rate and duration of infections, and altered bowel motility). An initial assessment should consist of measurement of length or height, weight, triceps, and subcapsular skinfolds; dietary and feeding history and a review of medical history; and biochemical testing as indicated by the medical and dietary histories. Monitoring frequency, which is determined by age, severity of condition, and response to treatment, may vary from weekly to bimonthly.- - - - - - - - - - ranking = 1.5keywords = malnutrition (Clic here for more details about this article) |
8/9. Palliation of esophageal cancer with a self-expanding, silicone-covered stent and a technique for stent retrieval.Most patients with carcinoma of the esophagus present with progressive, unrelenting dysphagia, malnutrition, and weight loss. Palliation is the primary treatment, since these patients are not candidates for curative surgical resection. Surgery, radiotherapy, and endoscopic modalities have been used for palliation. Recently, self-expanding, metallic stents have been used with considerable success. This type of stent can dislodge into the stomach during or after deployment. We report an approach to retrieve an expandable, silicone-coated stent using a double-channel endoscope, an esophageal dilating balloon, and a polypectomy snare.- - - - - - - - - - ranking = 0.25keywords = malnutrition (Clic here for more details about this article) |
9/9. Nutritional management of patients with feeding-induced pain: acute pancreatitis.A 36-year-old women with severe acute pancreatitis induced by familial hyperlipidemia is presented. Ranson's score, apache-II score, assessment of organ function, and a computed tomography scan are used to diagnose the severity of pancreatitis. Withholding oral alimentation, parenteral analgesia, fluid resuscitation, and antibiotics all serve important roles in management of this disease. Protein-calorie malnutrition can easily develop as a result of no oral intake and hypercatabolism. Tube feeding into the jejunum using a partially hydrolyzed formula has been reported in modest to severe pancreatitis. If tube feeding is not tolerated or a feeding tube cannot be properly positioned, parenteral nutrition may be necessary to maintain bowel rest. parenteral nutrition administered to patients with pancreatitis is associated with catheter-related infection, hyperglycemia, and hypertriglyceridemia. These complications can be managed through careful design of parenteral solutions and close monitoring.- - - - - - - - - - ranking = 0.25keywords = malnutrition (Clic here for more details about this article) |