1/12. Confluent ecchymoses on the lower extremities of a malnourished patient. Nutritional deficiencies result in many distinctive cutaneous manifestations. Vitamin C deficiency, or scurvy, produces follicular hyperkeratosis, perifollicular hemorrhages, gingival hypertrophy, and bleeding (1). We report here a case of malnutrition who suddenly developed extensive eccymoses on the lower extremities sharing morphological similarities with purpura fulminans. Although the patient did not have the characteristic dermatological features of scurvy, serum levels of vitamins C, K, B12, and E were decreased. ( info) |
| Intestinal bypass was a popular surgical procedure for morbid obesity resulting, on average, in a 50 kg weight loss. We describe a 66-year-old woman who underwent the procedure 12 years earlier and subsequently presented with recurrent episodes of erythema nodosum-like lesions. Further investigations revealed hyperoxaluria, renal failure, deficiency of fat-soluble vitamins (causing night blindness, osteomalacia and easy bruising) and anaemia. Antibiotics led to only temporary remission and, as with 24-30% of similar cases, she underwent surgical reversal to prevent the complications from worsening. ( info) |
| BACKGROUND: abetalipoproteinemia (ABL) is a metabolic disorder resulting in poor absorption of fat-soluble vitamins. CASE: Two pregnancies in a woman with ABL are reported, contrasting outcomes with subtherapeutic and normal vitamin levels. CONCLUSION: Fat-soluble vitamin levels in pregnancy are critical for many aspects of fetal development. This report details a congenital ophthalmologic finding that may be associated with vitamin a deficiency. ( info) |
4/12. Laboratory measurements of nutritional status as correlates of atrophic glossitis. OBJECTIVE: To perform a comprehensive laboratory assessment of nutritional status in two elderly patients selected for the presence of atrophic glossitis, a classic physical sign of malnutrition. DESIGN: Case report. SETTING: Inpatient internal medicine ward at the William S. Middleton Memorial veterans Medical Center, Madison, wisconsin. MEASUREMENTS AND MAIN RESULTS: blood specimens were analyzed by the Nutrition Evaluation Laboratory at the USDA Human Nutrition research Center on aging at Tufts University. Both subjects had biochemical evidence of protein-calorie malnutrition and were deficient or marginally deficient in several vitamins and trace minerals. CONCLUSIONS: Much work needs to be done to determine the sensitivity and positive predictive value of the classic physical signs of malnutrition as predictors of low biochemical levels and adverse clinical outcomes. The presence of atrophic glossitis should prompt the clinician to consider a basic nutritional assessment. ( info) |
5/12. Vitamin deficiency in the elderly. The oral manifestations of vitamin deficiencies are often the first indications of malnutrition. This is especially true among the elderly, whose more frequent physical and/or psychological disorders may prevent them from eating a balanced diet. The following is a guide to the dentist, who is often the first health professional to recognize nutritional deficiencies in this age group. ( info) |
6/12. Essential fatty acid sufficiency does not preclude fat-soluble-vitamin deficiency in short-bowel syndrome. patients with extensive small-bowel resection may experience malabsorption and nutrient deficiencies. We evaluated the ability to absorb fat and fat-soluble vitamins in a short-gut patient. For 18 wk after stopping intravenous lipid, while consuming a low-lactose, low-fat diet, he exhibited no clinical manifestations of essential fatty acid deficiency (EFAD). serum 20:4n-6 (20:4 omega-6) and 18:2n-6 fatty acid concentrations were normal, whereas the concentration of 20:3n-9 remained less than or equal to 0.1% of total serum fatty acids. Although serum vitamin A was normal, beta-carotene was undetectable despite oral supplementation. prothrombin time was elevated until parenteral vitamin k was given. This patient has fat absorption adequate to prevent EFAD but inadequate absorption of fat-soluble vitamins. In patients with short bowel, the requirements for parenteral lipids and fat-soluble vitamins should be determined independently. ( info) |
7/12. koro syndrome associated with alcohol-induced systemic disease in a Zulu. A case report is presented of the genital retraction syndrome, koro, associated with alcoholic hepatitis, avitaminosis and urinary tract infection, occurring in a Zulu male. Treatment of the physical conditions resulted in resolution of the koro symptomatology. The nosological status of koro is discussed and it is proposed that the condition be regarded as a symptom-complex reaction to a variety of psychological or physical stressors rather than as a purely culture-bound syndrome. ( info) |
8/12. Mental confusion in the elderly. Etiologies of confusion are discussed, including vascular, infectious, toxic-metabolic, tumorous, convulsive, and vitaminologic. Other diverse conditions are reviewed, including normal-pressure hydrocephalus. ( info) |
9/12. Micro-nutrient deficiency in a case of jejunoileal bypass. This report describes various clinical and micro-nutrient abnormalities that existed in a 47-year-old woman who underwent a jejunoileal bypass operation. She exhibited extensive electrolyte, mineral, amino acid, and vitamin deficiencies. Amino acid absorption tests indicated an inability to absorb essential amino acids, especially the branched-chain and aromatic varieties. Vitamin absorption tests indicated an inability to notably absorb folic acid, niacin, vitamins B6, A, and E; the fat-soluble beta-carotene (provitamin A) was not absorbed from the diet. A liver biopsy revealed that 80% of the tissue was filled with fatty cysts. The ensuing liver disease compounded with biochemical abnormalities due to the bypass, contributed to the patient's death. ( info) |
10/12. Current status of nutritional deficiencies in Canadian aboriginal people. Since the Nutrition canada Survey (1973) there has been clear evidence that Aboriginal people have low intakes of many nutrients such as iron, vitamin d, calcium, folate, vitamin A, and fluoride. Recent surveys suggest that the situation has not changed. Children are most likely to be affected clinically. More than half of Aboriginal children in some subpopulations in manitoba suffer a period of iron deficiency, which may affect development. Nutritional rickets is still a common problem in manitoba. We have seen cases of megaloblastic anemia due to folate deficiency. The relationship of the well-described low folate intake in pregnancy and birth defects has received no attention for the Aboriginal population. In a recent survey of Inuit children, dental caries of the primary teeth were present in over 70% of children, with a mean DMF (decayed, missing, and filled) index of 1.8 teeth in children under 2 and 9.5 in children 6 to 8 years. Although clinical vitamin a deficiency is not seen, there is now good evidence that subclinical deficiency increases susceptibility to infections. Although not all Aboriginal populations suffer all of these deficiencies, the problems are sufficiently widespread to suggest this is an urgent problem. It will not be solved simply by education. There must be a political will and a coordinated effort to make a balanced diet available to all at an affordable cost. ( info) |