1/11. Evidence for an anabolic action of essential amino acid analogues in uremia and starvation.nitrogen-free analogues of essential amino acids, when administered with those essential amino acids for which analogues are ineffective or unavailable, exert three actions that may be beneficial in protein-deficient or protein-intolerant subjects. First, they bring about an increase in the concentrations of essential amino acids in the blood at the expense of the concentrations of certain non-essential amino acids, notably alanine and glutamine. This effect is most readily demonstrated in children with congenital defects of the urea cycle enzymes, but can also be seen during daily therapy of adults with portal-systemic encephalopathy. Second, these compounds promote nitrogen balance through their suppressive effect on urea synthesis (an effect not attributable to re-utilization of ammonia derived from urease action in the gut). This action is demonstrable in obese subjects who are already conserving nitrogen maximally at the end of a prolonged fast and can also be shown in the first week of fasting when the branched-chain keto acids alone are administered. In both situations, improved nitrogen conservation persists long after the analogues are metabolized, suggesting enzyme adaptations. In chronic uremics, nitrogen balance can be maintained in some (but not all) patients on very low nitrogen intakes. Third, these mixtures may delay or reverse the progressive decline in glomerular filtration rate characteristic of chronic renal failure in some cases: thus, for example, 5 of 6 patients taken off chronic dialysis have maintained lower serum urea concentrations without evidence of protein malnutrition for periods of 2-24 months.- - - - - - - - - - ranking = 1keywords = malnutrition (Clic here for more details about this article) |
2/11. Clinical nutrition in primary health care.Nutritional diagnosis and management are important aspects of general practice. This information, which is presented in two parts, offers the general practitioner a practical framework and an approach to nutritional advice. Part 1 outlines the clinical conditions and principles involved in nutritional diagnosis with a management approach to macrovascular disease and obesity. Part 2 covers protein malnutrition, eating disorders, osteoporosis, nutrient toxicity, cancer, inherited metabolic disorders, nutrient deficiency and diabetes mellitus. This material is based on a seminar organised by Kellogg (australia) Pty Ltd in Melbourne in 1989 and the material is reproduced with the kind permission of Kellogg (australia) Pty Ltd.- - - - - - - - - - ranking = 1keywords = malnutrition (Clic here for more details about this article) |
3/11. Errant and unrecognized antiperistaltic Roux limb construction during Roux-en-Y gastric bypass for clinically significant obesity.BACKGROUND: Proper isoperistaltic orientation of the Roux limb is important. We report on 5 patients with errant anatomic construction of the Roux limb during Roux-en-Y gastric bypass for clinically significant obesity. methods: We performed a retrospective review of the medical records of these 5 patients. Of the 5 patients, 3 had undergone open and 2 laparoscopic Roux-en-Y gastric bypass. RESULTS: These 5 patients developed persistent and predominantly bilious vomiting in the immediate postoperative period, with subsequent protein-calorie malnutrition. At least 18 operations were undertaken in these 5 patients at different times to correct the abnormally dilated Roux limb to no avail. The diagnosis of an antiperistaltic anatomy was unsuspected, and these operations failed to address the errant anatomy of the Roux limb or resolve the symptoms. Definitive treatment involved repositioning of the Roux limb in an isoperistaltic direction, which resulted in immediate resolution of the symptoms and reversal of the protein-calorie malnutrition. CONCLUSION: Antiperistaltic Roux anatomy is deleterious, and repositioning of the Roux limb in an isoperistaltic direction will resolve the symptoms and associated protein-calorie malnutrition.- - - - - - - - - - ranking = 3keywords = malnutrition (Clic here for more details about this article) |
4/11. Wernicke's encephalopathy in association with complicated acute pancreatitis and morbid obesity.A young obese female with acute pancreatitis complicated by pseudocyst formation and intermittent gastric outlet obstruction, who had been maintained on high-calorie enteral feeds, developed a sudden onset of confusion and ophthalmoplegia associated with papilloedema and retinal haemorrhages. A possible diagnosis of Wernicke's encephalopathy (WE) was made, and the patient was treated with parenteral thiamine. Clinical resolution was complete. Any patient with suspicious or unusual neurological symptoms and signs associated with possible malnutrition, hyperemesis or malabsorption should be given intravenous thiamine without delay to avoid the potential morbidity and mortality associated with undiagnosed WE.- - - - - - - - - - ranking = 1keywords = malnutrition (Clic here for more details about this article) |
5/11. Morbid obesity, gastric plication and a severe neurological deficit.A 39-year-old man had protracted vomiting after gastric plication for morbid obesity. Within three months he lost 53 kg in weight and developed neuromuscular weakness, especially in the lower extremities. Clinical and laboratory studies suggested both radicular and peripheral neuropathy. One year later the condition was only marginally improved: he took only few steps unsupported. The apparent etiology is malnutrition but the primary cause remained unknown.- - - - - - - - - - ranking = 1keywords = malnutrition (Clic here for more details about this article) |
6/11. halothane hepatitis after jejunoileal bypass.A case of halothane hepatitis occurring 14 months after jejunoileal bypass for morbid obesity in a 49-year-old woman is described. Hepatic dysfunction after bypass procedures is especially seen in the weight losing phase, and has been ascribed to protein malnutrition. halothane is considered immunogenic and it is possible that the hepatitis was provoked by repeated halothane administrations due to the patient's altered immunological competence.- - - - - - - - - - ranking = 1keywords = malnutrition (Clic here for more details about this article) |
7/11. liver injury with alcoholiclike hyalin after gastroplasty for morbid obesity.Hepatic damage resembling alcoholic hepatitis has been described after jejunoileal bypass surgery for morbid obesity, but has not been previously reported as a complication of gastric partitioning operations (gastric bypass and gastroplasty). A patient who developed an alcoholic hepatitislike clinical picture 8 mo after gastroplasty is described, suggesting that malnutrition superimposed on obesity may be responsible for the injury in both settings. Reversal of the gastroplasty was associated with clinical and biochemical improvement.- - - - - - - - - - ranking = 1keywords = malnutrition (Clic here for more details about this article) |
8/11. Cutaneous anergy and marrow suppression as complications of gastroplasty for morbid obesity.Although serious morbidity from gastric restriction for morbid obesity is rare, outflow tract dilation after gastroplasty has become a well-recognized complication, and reoperation to decrease outflow tract size has become increasingly common. We report the case of a patient who developed outflow tract obstruction with subsequent malnutrition, recurrent infections, and marrow suppression. Extensive immunologic evaluation revealed impaired cutaneous reactivity to a battery of recall antigens. Other in vitro T cell functions, B cell functions, neutrophil respiration, and quantification of complements were within normal limits. The patient's immunodeficiency was attributed to protein-calorie malnutrition and was corrected with total parenteral nutrition. Recovery of immune function with renutriture was demonstrated, and coincident resolution of infection and marrow suppression also occurred. Because of the reversibility of the immunologic abnormality with appropriate nutritional therapy, it is important to consider and treat malnourishment in connection with any operation in which oral intake is severely limited.- - - - - - - - - - ranking = 2keywords = malnutrition (Clic here for more details about this article) |
9/11. tuberculosis after intestinal bypass for morbid obesity.tuberculosis of organs other than the lung may occur after an intestinal bypass operation for morbid obesity, with an incidence varying from 1% to 4%, a value rather higher than that of the general population. As its clinical symptoms (fever and chills, abundant sweating and an increase or return of weight loss) appear during the period of greatest weight loss, it is probably caused by malnutrition and malabsorption. In most cases lymphadenopathy (usually cervical) also appears. tuberculosis occurring after bypass operation should be treated with the classic antitubercular therapy; this always results in recovery if the disease is diagnosed in time.- - - - - - - - - - ranking = 1keywords = malnutrition (Clic here for more details about this article) |
10/11. tuberculosis after jejuno-ileal bypass for morbid obesity.A patient contracted tuberculosis after 2 operations for morbid obesity. The difficulty in diagnosis and treatment is described. Jejuno-ileal bypass is a non-physiological operation, with many reported complications and side effects. Following this short experience the author and his colleagues have now abandoned this operation. patients suffering from malnutrition as a result of slimming operations should be carefully monitored for tuberculosis.- - - - - - - - - - ranking = 1keywords = malnutrition (Clic here for more details about this article) |
| | Next -> |