Cases reported "Cachexia"

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1/5. Treatment of cachexia with recombinant growth hormone in a patient before lung transplantation: a case report.

    OBJECTIVES: To describe the effects of recombinant human growth hormone (rhGH) in a severely malnourished patient before lung transplantation. DESIGN: Case study. SETTING: intensive care unit. patients: A 38-yr-old severely malnourished (body mass index, 15.1 kg/m2) woman (receiving prednisone) with bronchiolitis obliterans evolving during 10 yrs presented with end-stage lung disease and required continuous noninvasive mechanical ventilation. INTERVENTIONS: Two courses of 35 days of 16 IU/day (0.42 IU/kg/day) rhGH administered subcutaneously, with an interruption of 5 wks between the two courses of rhGH. MEASUREMENTS AND MAIN RESULTS: weight gain of 14.7% and 12.8% fat-free mass, as measured by 50-kHz bioelectrical impedance analysis, during treatment during a 3.5-month period. nitrogen excretion decreased from 23.7 g/day before treatment to 8.0 g/day while receiving rhGH. Improvement of pulmonary function was also noted and allowed discharge of the patient from the hospital after the second course of rhGH. She underwent successful lung transplantation 2 months later and reached 48.8 kg of body weight 6 months later. CONCLUSIONS: rhGH treatment is a possible strategy that could be used with malnourished patients who are awaiting lung transplantation to improve the nutritional status and respiratory muscle function to prevent recurring respiratory infection and postoperative complications favored by malnutrition and possibly to decrease the length of hospital stay.
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keywords = nutritional status, status
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2/5. Growth hormone for optimization of refractory heart failure treatment.

    It has been reported that growth hormone may benefit selected patients with congestive heart failure. A 63-year-old man with refractory congestive heart failure waiting for heart transplantation, depending on intravenous drugs (dobutamine) and presenting with progressive worsening of the clinical status and cachexia, despite standard treatment, received growth hormone replacement (8 units per day) for optimization of congestive heart failure management. Increase in both serum growth hormone levels (from 0.3 to 0.8 microg/l) and serum IGF-1 levels (from 130 to 300ng/ml) was noted, in association with clinical status improvement, better optimization of heart failure treatment and discontinuation of dobutamine infusion. Left ventricular ejection fraction (by MUGA) increased from 13 % to 18 % and to 28 % later, in association with reduction of pulmonary pressures and increase in exercise capacity (rise in peak VO2 to 13.4 and to 16.2ml/kg/min later). The patient was "de-listed" for heart transplantation. Growth hormone may benefit selected patients with refractory heart failure.
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ranking = 0.00012528706745458
keywords = status
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3/5. Superior mesenteric artery (Wilkie's) syndrome as a result of cardiac cachexia.

    Superior mesenteric artery (SMA) syndrome is a rare acquired disorder in which acute angulation of SMA causes compression of the third part of the duodenum between the SMA and the aorta, leading to obstruction. Loss of fatty tissue as a result of a variety of debilitating conditions is believed to be the etiologic factor causing the acute angulation. We report a case of an 86-year-old man with prolonged congestive heart failure and aortic stenosis in which SMA syndrome developed as a result of cardiac cachexia. Because of poor functional status and comorbidities, he was not a suitable candidate for decompressive surgery. Conservative treatment using a gastrostomy tube with jejunal extension led to improvement in nutritional status and resolution of symptoms.
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ranking = 1.0000626435337
keywords = nutritional status, status
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4/5. Gelatinous transformation of bone marrow in systemic lupus erythematosus.

    Gelatinous transformation of marrow is a rare disease entity described in cachexia and various other disorders. Its association with systemic lupus erythematosus (SLE) has never been reported. We found gelatinous transformation in 3 of 30 patients with SLE with pancytopenia. Two of these patients were cachetic, one of whom also had active tuberculosis. We propose that gelatinous transformation can be associated with SLE, and its detection calls for an evaluation of nutritional status, and a search for chronic debilitating infections such as tuberculosis.
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keywords = nutritional status, status
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5/5. death resulting from overzealous total parenteral nutrition: the refeeding syndrome revisited.

    Although cachectic patients are relatively well adapted to their calorically deprived state, they are prone to acute metabolic imbalances when infused with hypertonic solutions of dextrose and amino acids. Of particular concern is hypophosphatemia and its associated disorders of cardiac, pulmonary, hematological, and neuromuscular functions. This report describes two chronically malnourished but stable patients who were given aggressive total parenteral nutrition support, which was rapidly followed by acute cardiopulmonary decompensation associated with severe hypophosphatemia and other metabolic abnormalities. Despite attempts at correction, progressive multiple systems failure led to death. In light of the high prevalence of hospital malnutrition and the ready availability of total parenteral nutrition, attention is brought to these examples of how overzealous nutrition repletion can paradoxically precipitate deterioration in clinical status.
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ranking = 6.2643533727291E-5
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