1/9. Managing the obese patient after bariatric surgery: a case report of severe malnutrition and review of the literature.Surgery is now considered to be the most effective treatment for reducing weight and maintaining weight loss in patients with clinically severe obesity. Although the jejuno-ileal bypass has been abandoned, the vertical banded gastroplasty (VBG) and Roux-en-Y gastric bypass (RYGB) operations are now commonly performed. A third operation, the bilio-pancreatic diversion (BPD), is performed less frequently. The RYGB and BPD procedures cause predictable selective micronutrient deficiencies that can be avoided by early supplementation. Surgical complications from all of these procedures may result in more severe forms of malnutrition. This article is intended to familiarize the nutrition support specialist with the anatomic and physiologic changes produced by these procedures, the resulting nutritional deficiencies and recommended supplementation, and the manifestations of severe malnutrition caused by complications. A case of severe malnutrition after RYGB surgery is reported for illustration.- - - - - - - - - - ranking = 1keywords = malnutrition (Clic here for more details about this article) |
2/9. jaundice in non-cirrhotic primary biliary cirrhosis: the premature ductopenic variant.The clinical and pathological findings of four females with primary biliary cirrhosis (PBC) with an unusual and hitherto not well recognised course are reported. patients suffered severe pruritus and weight loss with progressive icteric cholestasis which did not respond to such treatments as ursodeoxycholic acid and immunosuppressives. In all cases liver histology revealed marked bile duct loss without however significant fibrosis or cirrhosis. Further diagnostic studies and repeat biopsies confirmed the absence of liver cirrhosis as well as other potential causes of hyperbilirubinaemia. Comparison of the fibrosis-ductopenia relationship for our cases with that for a group of 101 non-cirrhotic PBC patients indicated that in the former the severity of bile duct loss relative to the amount of fibrosis was significantly higher. The proportion of portal triads containing an interlobular bile duct was 3%, 4%, 6%, and 10% compared with 45% (median; range 8.3--100%) for controls (p<0.001). Three patients received a liver transplant 6--7 years after the first manifestation of PBC because of progressive cholestasis, refractory pruritus, and weight loss, while the fourth patient is considering this option. In one case cirrhosis had developed at the time of transplantation while the others still had non-cirrhotic disease. These cases suggest that cholestatic jaundice in non-cirrhotic PBC may be secondary to extensive "premature" or accelerated intrahepatic bile duct loss. Although the extent of fibrosis may be limited initially, progression to cirrhosis appears to be inevitable in the long run. Despite intact protein synthesis and absence of cirrhotic complications, liver transplantation in the pre-cirrhotic stage for preventing malnutrition and to improve quality of life should be considered for these patients.- - - - - - - - - - ranking = 0.14285714285714keywords = malnutrition (Clic here for more details about this article) |
3/9. Treatment of devastating postgastrectomy symptoms: the potential role of jejunal pouch reconstruction.After gastrectomy a few patients develop severe symptoms and malnutrition. There are probably several reasons for this, such as insufficient gastric reservoir function, malassimilation, diarrhea and dumping. The patient presented here developed severe malnutrition after partial gastrectomy and his weight gradually decreased from 95 to 40 kg during the first 6 postoperative years. His major complaint was postprandial vomiting and early satiety. During the course of his illness, he was repeatedly investigated with computerized tomography scans, repeated endoscopies with biopsies, barium examinations, etc. Finally the only positive finding was bacterial intestinal overgrowth, but antibiotic treatment did not improve his condition. After repeated periods of parenteral nutrition or enteral tube feeding, an S-shaped jejunal pouch was attached to the gastric remnant. Dual-energy X-ray absorptiometry was used to examine the body composition and bone density in the immediate postoperative period and 1 year after the operation. During the first postoperative year he gained 11 kg weight and reported an essentially normal food intake. Both laboratory and clinical parameters improved and a gain in lean body mass was recorded. patients with severe postgastrectomy symptoms, with no other plausible explanation than nonexistent or insufficient gastric reservoir function, may benefit from re-reconstruction with a jejunal pouch.- - - - - - - - - - ranking = 0.28571428571429keywords = malnutrition (Clic here for more details about this article) |
4/9. radiation arteritis following treatment for Wilms' tumor: an unusual case of weight loss.Wilms' tumor is the most common pediatric primary renal cancer and is highly responsive to surgery and chemotherapy. The role of radiotherapy has evolved in the last three decades from the use of stepwise incremental doses in all patients to the current concept of added radiotherapy in advanced cases or in those with unfavorable pathology. To the authors' knowledge, this is the first case of a young woman with prior history of Wilms' tumor and significant weight loss due to radiation arteritis involving the abdominal vasculature. A 31-year-old woman presented with a history of weight loss and severe malnutrition. An angiogram revealed that the aorta was occluded below the renal artery. The celiac artery and the superior mesenteric artery were occluded at the origin, and large intercostal collaterals reconstituted the pelvic circulation. She was initially treated with total parenteral nutrition (TPN) and underwent an infrarenal aortic bypass surgery. Histopathology of the aorta revealed intimal fibrocalcific thickening and changes consistent with radiation-induced arteritis. Later, she was readmitted with progressive hepatic insufficiency. Despite intensive medical therapy, she died of multi-organ failure.- - - - - - - - - - ranking = 0.14285714285714keywords = malnutrition (Clic here for more details about this article) |
5/9. A 47-year-old alcoholic man with progressive abnormal gait.Central pontine myelinolysis should be considered in the differential diagnosis of a patient with a history of alcoholism and malnutrition presenting with ataxia, regardless of serum sodium values. T2-weighted images are the most sensitive imaging technique, but changes may not be evident for weeks after the insult, and in addition, the insult may not be known. Supportive care is important to prevent complications, but no treatment has been found to be effective in treating the illness. Patient outcomes vary considerably and are difficult to predict.- - - - - - - - - - ranking = 0.14285714285714keywords = malnutrition (Clic here for more details about this article) |
6/9. esophageal perforation during pneumatic dilatation for achalasia: a possible association with malnutrition.Pneumatic balloon dilatation of the lower esophageal sphincter is commonly utilized as primary therapy for achalasia. Perforation related to pneumatic dilatation is uncommon (2-6%) but may result in severe morbidity. Factors associated with risk of perforation are not well defined. We noted perforation in three patients undergoing forceful balloon dilatation. All these patients had clinical evidence of significant malnutrition (recent marked weight loss and severe hypoalbuminemia). malnutrition may be a causal factor for perforation in patients with achalasia undergoing dilatation.- - - - - - - - - - ranking = 0.71428571428571keywords = malnutrition (Clic here for more details about this article) |
7/9. Reversible anorexia and rapid weight loss associated with neuroleptic administration in Alzheimer's disease.weight loss and malnutrition despite adequate dietary intake has been reported to be part of the clinical course in advanced dementia of the Alzheimer type. We present a case of reversible weight loss associated with neuroleptic use in a patient with Alzheimer's disease and discuss a possible pathophysiological basis for the weight loss.- - - - - - - - - - ranking = 0.14285714285714keywords = malnutrition (Clic here for more details about this article) |
8/9. Catastrophic weight loss after vertical banded gastroplasty: malnutrition and neurologic alterations.The case of a patient with severe vomiting and very rapid weight loss following vertical banded gastroplasty (VBG) (almost 50% of original weight in 11 months) and who suffered severe neurological and nutritional disorders is reported. All abnormal findings with the exception of nystagmus, disappeared during enteral nutritional support with a complete diet and vitamin supplementation. The alterations found in this case may have been related to the very rapid weight loss, which resulted in protein calorie malnutrition and, probably, in one or more vitamin deficiencies. This complication may be preventable by early nutritional intervention in subjects undergoing gastric reduction surgery and who exhibit very rapid weight loss and intractable vomiting.- - - - - - - - - - ranking = 0.71428571428571keywords = malnutrition (Clic here for more details about this article) |
9/9. Functional, social, and psychological disability as causes of loss of weight and independence in older community-living people.This article reviews functional, social, and psychological disabilities that relate to weight loss and independence in older community residents and suggests possible ways in which these factors may be alleviated. Although these disabilities clearly interact with one another as causes of failure to thrive, this article is organized into three major sections: functional disability, psychological and social factors, and malnutrition. In-depth geriatric assessment provides directions to reverse or halt failure to thrive. Using case materials, possible interventions are presented; these include dietary changes, a carefully planned program of physical exercise, treatment for depression, and a combination of social and environmental "prescriptions" designed to reduce social and emotional isolation. Appropriate social supports are also necessary, as is careful attention to how caregiver stress may be reduced through suitable interventions.- - - - - - - - - - ranking = 0.14285714285714keywords = malnutrition (Clic here for more details about this article) |