1/14. Cutaneous bleeding related to zinc deficiency in two cases of advanced cancer.BACKGROUND: One patient with metastatic squamous cell carcinoma of the larynx and one with advanced non-Hodgkin lymphoma, both with poor nutritional status, developed ecchymoses and demonstrated prolonged bleeding time and abnormal aggregation of platelets. methods: On the basis of previous studies, the author measured the level of zinc in the serum and urine of these patients and the effect of zinc supplementation on the clinical symptoms and laboratory findings. Also studied were serum and urine zinc levels in 15 newly diagnosed, untreated cancer patients with no evidence of bleeding. RESULTS: The two patients were found to have very low serum and urine zinc levels, which were 6 and 9 microgram/dL and 28 and 22 microgram/24 hours, respectively, compared with normal average values of 70-150 microgram/dL and 150-1200 microgram/24 hours. The mean values of zinc in the serum and urine of the 15 patients newly diagnosed with cancer were 109.18 microgram/dL and 433.8 microgram/24 hours, respectively. Oral administration of zinc without any additional therapy was rapidly followed by control of bleeding, normalization of bleeding time, and platelet aggregation. Discontinuation of zinc caused the return of bleeding and abnormal laboratory findings, which again were corrected with zinc supplementation. CONCLUSIONS: Severe depletion of zinc in two patients with advanced cancer and malnutrition was accompanied by cutaneous bleeding and laboratory findings of platelet dysfunction, both of which were corrected by oral supplementation of zinc and reoccurred on discontinuing therapy. Zinc deficiency should be suspected in patients with advanced cancer demonstrating bleeding when a prolonged bleeding time is the only hemostatic abnormality.- - - - - - - - - - ranking = 1keywords = nutrition (Clic here for more details about this article) |
2/14. Zinc deficiency in total parenteral nutrition.A patient with multiple enterocutaneous fistulae who developed the skin manifestations of acrodermatitis enteropathica while on total parenteral nutrition is described. The value of monitoring the serum alkaline phosphatase to demonstrate zinc deficiency is shown. The skin manifestations responded rapidly to the re-introduction of zinc to the diet.- - - - - - - - - - ranking = 2.5keywords = nutrition (Clic here for more details about this article) |
3/14. Dermopathic changes in hypozincemia.In seven patients with chronic debilitating gastrointestinal disease who were being given total parenteral nutrition using L-amino acids and concentrated dextrose solution, severe hypozincemia (less than 60 micrograms/dL) developed with characteristic skin lesions and alopecia. The lesions were similar to seborrheic dermatitis, and they occurred in areas of high sebaceous gland concentration. Hyperkeratotic lesions were also seen on the extensor surfaces of large joints. The skin lesions and alopecia disappeared when serum zinc values were raised to levels above 60 micrograms/dL, with appropriate zinc sulfate replacement. A hypothesis on the etiology and clinical manifestations is presented.- - - - - - - - - - ranking = 0.5keywords = nutrition (Clic here for more details about this article) |
4/14. selenium deficiency in a patient with Crohn's disease receiving long-term total parenteral nutrition.We report a case of selenium deficiency in a patient with Crohn's disease on long-term total parenteral nutrition (TPN). She manifested lassitude of the legs, discoloration of the nail beds, and macrocytosis. Since her plasma selenium level was found to be below the measurable level, we diagnosed this case as selenium deficiency. After intravenous administration of sodium selenite, her symptoms were reversed. Careful attention should be paid to selenium deficiency when a patient receives long-term TPN; supplementary administration of selenium via TPN may be required because selenium is often not routinely added to TPN formulations.- - - - - - - - - - ranking = 2.5keywords = nutrition (Clic here for more details about this article) |
5/14. selenium deficiency in long-term total parenteral nutrition.Although selenium is an essential trace element, it is often not routinely added to total parenteral nutrition (TPN) formulations. When selenium is not added, patients are at risk for selenium deficiency. This report describes such a patient. He had several operations for colon cancer, including a massive resection of the small bowel that resulted in a short bowel and a fistula. TPN was started after his last operation. After he was discharged, he had a normal, active lifestyle, except that he limited oral intake to water and an occasional soft drink. After 3 years of almost exclusive nourishment by TPN, he developed whitened nail beds. Investigation for possible trace element deficiency resulted in a finding that he had very low levels of selenium in his blood. He did not have any of the cardiac or skeletal muscle abnormalities that have been associated with selenium deficiency. After supplementation with selenium, his blood levels of selenium rose and the nail bed changes were reversed.- - - - - - - - - - ranking = 2.5keywords = nutrition (Clic here for more details about this article) |
6/14. Essential fatty acid deficiency in infants receiving parenteral nutrition.The clinical and biochemical features of essential fatty acid deficiency are described in an infant with gastroschisis who required long-term (6 mo) parenteral nutrition. The deficiency responded to therapy with Intralipid, topical sunflower oil, and breast milk. In a prospective study of three infants with gastroschisis, biochemical essential fatty acid deficiency developed in each during the first week of lipid-free parenteral nutrition; clinical signs of the deficiency were absent. The biochemical features were progressive in the one patient followed for 19 days, and were associated with a decrease in weight gain. Both the deficiency and weight gain were corrected by Intralipid. Biochemical essential fatty acid deficiency did not develop in three other gastroschisis infants who were given prophylactic Intralipid (two patients) or topical sunflower oil (one patient). We conclude that all infants on parenteral nutrition should receive a source of linoleic acid to prevent essential fatty acid deficiency.- - - - - - - - - - ranking = 3.5keywords = nutrition (Clic here for more details about this article) |
7/14. Acquired copper deficiency following prolonged jejunostomy feeds.A 19-year-old man who developed extensive oesophageal lye (Alkali) stricture and received long-term enteral nutrition (eight months) with a jejunostomy tube developed macrocytic anaemia (Hb: 41 g/L) with leucopenia (white blood cell [WBC]: 3.0 x 10(9)/L). The patient's serum vitamin B12, folate, iron and liver function tests were normal. bone marrow examination revealed gross erythroid hyperplasia and cytoplasmic vacuolization of erythroid and myeloid elements. Further investigations revealed low serum copper (0.3 micromol/L) and ceruloplasmin concentrations (<30 mg/L) with marginally low normal serum concentration of red cell peroxidase (13 U/gHb), establishing the diagnosis of copper deficiency anaemia. The anaemia and leucopenia responded intermittently to intravenous copper therapy, but the serum copper concentration dropped when intravenous copper therapy was withdrawn. Enteral jejunostomy copper supplementation failed to maintain adequate serum copper concentrations. After stabilizing the general condition of the patient, a pharyngo-gastric anastamosis was performed and normal oral diet commenced, which restored normal serum copper concentration. This case report suggests that copper supplements in the form of copper sulphate are not adequately absorbed when administered through a jejunostomy tube.- - - - - - - - - - ranking = 0.5keywords = nutrition (Clic here for more details about this article) |
8/14. Correction of copper deficiency improves erythropoietin unresponsiveness in hemodialysis patients with anemia.We have encountered five hemodialysis patients who had received enteral nutrition and recovered from erythropoietin-resistant anemia with neutropenia after the correction of copper deficiency. We reduced the required doses of recombinant human erythropoietin (rHuEPO) to maintain the target hematocrit levels and three patients were finally weaned from the rHuEPO therapy. Thus, copper deficiency is involved in erythropoietin-resistant anemia in hemodialysis patients.- - - - - - - - - - ranking = 0.5keywords = nutrition (Clic here for more details about this article) |
9/14. Effect of zinc supplementation in a Turkish woman with two previous anencephalic infants.The authors report a case of nutritional zinc deficiency in a young (18-year-old) Turkish woman, who previously delivered 2 anencephalic stillborn infants. The patient was supplemented with 22.5 mg oral zinc sulfate (100 mg ZnSO4.7H2O) for 5 months after her second delivery prior to her third pregnancy. Her blood (plasma and red blood cell) and hair zinc levels returned to normal following zinc supplementation. Good response to Zn supplementation was another criterion of Zn deficiency in this particular case. After an uneventful gestational period, she delivered an apparently normal full-term male child who has grown normally during the first 12 months.- - - - - - - - - - ranking = 0.5keywords = nutrition (Clic here for more details about this article) |
10/14. Multiple nutritional deficiencies and metabolic complications 20 years after jejunoileal bypass surgery.We have reported a patient with multiple nutritional and metabolic abnormalities following JI bypass. Most of her biochemical abnormalities were corrected with cautious but vigorous supplementation, and her nutritional status improved, as documented by several positive nitrogen balances and normalization of most of her vitamin and trace element serum concentrations. This case clearly demonstrates many of the metabolic complications that can result from the JI bypass procedure and the meticulous followup that is needed during nutritional rehabilitation.- - - - - - - - - - ranking = 3.5keywords = nutrition (Clic here for more details about this article) |
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