1/14. Successful intradialytic parenteral nutrition after abdominal "Catastrophes" in chronically hemodialysed patients.OBJECTIVE: To assess the therapeutic contribution of intradialytic parenteral nutrition (IDPN) in four acutely ill, hypercatabolic, hemodialysed patients. All underwent major surgery, complicated by infection and malnutrition. DESIGN: A retrospective clinical study. SETTING: An in-center hemodialysis unit, at a tertiary referral hospital. patients: Patient 1: a young woman, with a good renal transplant. Developed gastric lymphoma, which required gastrectomy. After cessation of immunosuppression, "lost" her kidney and returned to hemodialysis. Received IDPN for 4 months and recovered well from severe malnourishment. Patient 2: an elderly, malnourished man, on continuous ambulatory peritoneal dialysis (CAPD). Developed biliary peritonitis and bacteremia. In a 3-month period, the patient had four operations. Maintained on IDPN for 4 months. Patient 3: a young and obese man, who suffered from life-threatening staphylococcal aureus peritonitis, resulting in widespread bowel adhesions. Underwent repeated aspirations of purulent ascites, laparoscopy, and explorative laparotomy. IDPN was administered for 4 months and stopped on the patient's request. Patient 4: a young man, who after cadaveric renal transplantation remained hospitalized for 6 months because of acute rejection and peritoneal and retroperitoneal abscesses. Had major surgery performed seven times. Received IDPN for 6 months, and is now well. RESULTS: All four patients benefited from 4 to 6 months of IDPN, as an integral part of intensive supportive and nutritional treatment. weight loss was halted, as patient appetite returned and oral nutrition became adequate. Estimated daily protein intake reached 1.2 g/kg, while caloric intake rose to nearly 30 kcal/kg/d (Table 3). Mean serum albumin levels increased from 25.5 g/L /- 0.9 g/L to 38.0 g/L /- 1.5 g/L. No adverse side effects were seen from IDPN. CONCLUSION: IDPN is a worthwhile part of treatments used in the catabolic, postoperative hemodialysed patient. It is safe and efficient when used over a 6-month period in trying to attenuate existing, or worsening malnutrition in these patients. It should be commenced at an early stage in these patients, after attempts at oral nutritional support have been deemed inadequate.- - - - - - - - - - ranking = 1keywords = malnutrition (Clic here for more details about this article) |
2/14. Severe gastrointestinal involvement in systemic sclerosis: report of five cases and review of the literature.OBJECTIVE: To review current literature on the gastrointestinal tract (GIT) manifestations of systemic sclerosis (SSc) and to report on 5 patients with severe gastrointestinal SSc. MATERIALS AND methods: The clinical course and histopathology of 5 patients are described. A review of the medical literature registered in medline and PreMedLine databases from 1996 through mid-2004 was performed using the keywords systemic sclerosis and scleroderma and combining them with text words such as gastric, gastrointestinal, anorectal, colonic, and hepatic. RESULTS: All 5 patients had severe GIT involvement: 4 with diffuse cutaneous SSc (dcSSc) and 1 with limited cutaneous SSc (lcSSc). autopsy results of 2 patients who died from severe malnutrition and aspiration pneumonia are presented. literature review includes involvement from oral cavity to anus with varying degrees of severity. Most GIT manifestations result from dysmotility secondary to infiltration of the gastrointestinal wall with fibrous tissue and can cause life-threatening malabsorption and malnutrition. Diagnostic tests, pathology, and treatments of GIT SSc are reviewed. CONCLUSIONS: GIT involvement in SSc can be severely debilitating and even life-threatening. Although morbidity is inevitable, appropriate supportive treatment can prolong survival. RELEVANCE: GI complications of SSc cause significant morbidity and mortality.- - - - - - - - - - ranking = 1keywords = malnutrition (Clic here for more details about this article) |
3/14. nutritional support in patients with systemic scleroderma.Systemic scleroderma often involves the gastrointestinal tract and can lead to significant malnutrition. Specialized home nutritional support was provided to five patients (one enteral and four parenteral) with restoration of adequate nutritional status, improved quality of life, and few metabolic or technical complications over a period of 12 to 86 months. Three patients eventually died of their disease, one was converted to an oral diet, and one patient remains dependent on total parenteral nutrition. This experience would recommend consideration of home nutritional support in patients with systemic scleroderma when the disease is relatively stable and no major organ failure is present.- - - - - - - - - - ranking = 0.5keywords = malnutrition (Clic here for more details about this article) |
4/14. Bronchial and gastrointestinal cryptosporidiosis in AIDS.cryptosporidiosis is a coccidial protozoan initially reported in domestic animals. It is primarily a gastrointestinal organism that does not invade mucosa. It was first described in 1976 in developing countries as an etiology of infantile diarrhea with inanition and malnutrition. Gastrointestinal involvement in patients with AIDS has been increasingly reported. We report a case of combined gastrointestinal and bronchial cryptosporidiosis. cryptosporidium is an acid-fast organism which was successfully treated with erythromycin.- - - - - - - - - - ranking = 0.5keywords = malnutrition (Clic here for more details about this article) |
5/14. Myo-, neuro-, gastrointestinal encephalopathy (MNGIE syndrome) due to partial deficiency of cytochrome-c-oxidase. A new mitochondrial multisystem disorder.A 42-year-old woman had a 10-year history of external ophthalmoplegia, malabsorption resulting in chronic malnutrition, muscle atrophy and polyneuropathy. Computer tomography revealed hypodensity of her cerebral white matter. A metabolic disturbance consisted of lactic acidosis after moderate glucose loads with increased excretion of hydroxybutyric and fumaric acids. Post-mortem studies revealed gastrointestinal scleroderma as the morphological manifestation of her malabsorption syndrome, ocular and skeletal myopathy with ragged red fibers, peripheral neuropathy, vascular abnormalities of meningeal and peripheral nerve vessels. Biochemical examination of the liver and muscle tissues revealed a partial defect of cytochrome-c-oxidase (complex IV of the respiratory chain). This mitochondrial multisystem disorder may represent a separate entity to be classified between the spectrum of myoencephalopathies and oculo-gastrointestinal muscular dystrophy.- - - - - - - - - - ranking = 0.5keywords = malnutrition (Clic here for more details about this article) |
6/14. Gastrointestinal malacoplakia in children.Four children, whose ages ranged from 1 to 13 years, with malacoplakia of the gastrointestinal tract were treated at King Faisal Specialist Hospital between 1979 and 1983. All patients had either a preceding or a coexisting chronic illness. In one patient, malacoplakia was an incidental finding, while the remaining three patients presented with bloody diarrhea, abdominal pain, recurrent fever, and severe malnutrition. colonoscopy in two patients revealed markedly inflamed and friable mucosa with focal ulceration alternating with patches of normal mucosa and pseudopolyposis. They were treated with antibiotics and cholinergic agonists. Three patients responded favorably, while one patient continued to have extensive active disease. Although the response to therapy is unpredictable, patients may respond if the treatment is continued on a long-term basis.- - - - - - - - - - ranking = 0.5keywords = malnutrition (Clic here for more details about this article) |
7/14. Total parenteral nutrition during pregnancy.Parenteral hyperalimentation or total parenteral nutrition has become an established therapy for patients with a wide variety of conditions that preclude oral feeding. Because pregnancy is an infrequent event in poorly nourished women with acute or chronic illness, total parenteral nutrition has not been widely used for pregnant patients. Some obstetricians believe that total parenteral nutrition entails risks in excess of its potential benefit to pregnancy and demands skills and knowledge that are either not available or are in limited supply. Sufficient favorable clinical experience has accumulated over the past 15 years so that total parenteral nutrition can be recommended in the management of malnutrition during pregnancy. The purpose of this report is to review the authors' experience and the literature about total parenteral nutrition during pregnancy.- - - - - - - - - - ranking = 0.5keywords = malnutrition (Clic here for more details about this article) |
8/14. Severe gastrointestinal involvement in children with the acquired immunodeficiency syndrome.Five children with the acquired immunodeficiency syndrome (AIDS) and unusual gastrointestinal disease are described. Two children presented with malnutrition, abdominal distention, and diarrhea. One was found to have moderately severe villus atrophy on jejunal biopsy and was initially thought to have celiac disease. Jejunal biopsy from the second child revealed infiltration of the mucosa with acid-fast bacilli-laden macrophages. A third child suffered recurrent abdominal pain, progressive weight loss, diarrhea, and severe gastrointestinal hemorrhage secondary to infection with cytomegalovirus. Pseudomembranous necrotizing jejunitis associated with overgrowth of klebsiella pneumoniae in the duodenal fluid occurred in one patient. The fifth child presented in the newborn period with serratia marcescens cholecystitis. Gastrointestinal disease in children with AIDS may be due to idiopathic villus atrophy and bacterial or opportunistic infection.- - - - - - - - - - ranking = 0.5keywords = malnutrition (Clic here for more details about this article) |
9/14. A familial visceral myopathy with dilatation of the entire gastrointestinal tract.We are reporting a new kindred in which familial visceral myopathy was identified in four siblings. There was no other symptomatic case identified in this 75-member, four-generation family, suggesting an autosomal recessive inheritance. All patients had recurrent symptoms of intestinal obstruction, and 3 died from malnutrition. Gastrointestinal lesions showed marked dilatation of the entire digestive tract from the esophagus to the rectum, which is different from other types of familial visceral myopathies. Microscopic examination of the gastrointestinal smooth muscle showed degeneration and increased fibrosis indistinguishable from other types of familial visceral myopathy.- - - - - - - - - - ranking = 0.5keywords = malnutrition (Clic here for more details about this article) |
10/14. parenteral nutrition in surgical and medical gastroenterology. Clinical review.A number of medical and surgical conditions in gastro-enterology are important indications for modern parenteral nutrition. In such conditions only parenteral nutrition can provide adequate nourishment and prevent malnutrition. It is important in these cases to provide complete intravenous nutrition, comprising amino acids, carbohydrates, fat, electrolytes and vitamins. Furthermore, a special infusion technique must be used in order to reduce such complications as catheter sepsis to a minimum.- - - - - - - - - - ranking = 0.5keywords = malnutrition (Clic here for more details about this article) |
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