Cases reported "Malnutrition"

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1/37. Percutaneous endoscopic gastrostomy tube in a patient with a left ventricular assist device.

    We report a successful PEG tube insertion in a patient with an LVAD. Adequate prolonged nutritional support was provided. PEG placement in patients with an implantable or paracorporeal LVAD may be possible but present additional concerns. We believe that PEG placement should be cpnsidered in patients with an LVAD with swallowing difficulties or who are debilitated are not meeting their caloric requirements. ( info)

2/37. The advantages of intravenous renal anaemia treatment in an undernourished patient with chronic kidney disease.

    The subcutaneous (SC) treatment of renal anaemia in undernourished patients has potential limitations. In this case report we demonstrate the value of intravenous (IV) darbepoetin alfa in such a patient who experienced difficulty tolerating SC recombinant human erythropoietin (rHuEPO) therapy due to severe malnutrition. Intravenous treatment of renal anaemia in a malnourished patient is preferred because the absence of SC fat makes SC administration difficult. In such patients, darbepoetin alfa is the treatment of choice as it is administered less frequently than other erythropoietic therapies and is more effective at maintaining target haemoglobin (Hb) concentrations. In contrast to rHuEPO, darbepoetin alfa also has the additional advantage of bioequivalent IV and SC dose requirements. ( info)

3/37. noma-like gangrenous cheilitis in a child with cyclic neutropenia associated with myeloperoxidase deficiency.

    An unusual case of cyclic neutropenia and hereditary myeloperoxidase deficiency complicated by noma-like gangrenous cheilitis is described. klebsiella pneumoniae and candida albicans were cultured from the involved area. We present this case to increase physician awareness of the possible association of both quantitative and qualitative defects of neutrophils and to stress the importance of the early and effective management of skin infections that can rapidly progress to severe sequelae when associated with profound neutropenia. ( info)

4/37. A case study utilizing an enteral refeeding technique in a premature infant with short bowel syndrome.

    Premature and full-term infants may be born with congenital abnormalities or develop acquired lesions of the gastrointestinal tract that require the placement of an enterostomy. Enterostomies can result in significant segments of excluded small bowel, creating a functional short bowel syndrome. Infants with enterostomies can develop dehydration, electrolyte imbalance, and failure to thrive. An illustrative case report of a premature infant with short bowel syndrome treated with enteral refeedings via a mucous fistula is presented. This report highlights the lessons learned from the interdisciplinary team's collective 10-year experience with enteral refeeding in infants with enterostomies. The physiologic basis for this approach is reviewed and literature reports are outlined. The specific nursing care and step-by-step techniques to deliver enteral refeeding through the mucous fistula are provided along with implications for clinical practice, education, and research. ( info)

5/37. refeeding syndrome: implications for the inpatient rehabilitation unit.

    patients admitted to inpatient rehabilitation units commonly have underlying medical disorders and are at risk for poor oral intake and malnutrition, which may be compounded by dysphagia and anorexia. The refeeding syndrome is an underappreciated but clinically important entity characterized by acute electrolyte abnormalities, fluid retention, and dysfunction of various organ systems, which can result in significant morbidity and, occasionally, death. Reinstitution of nutrition by any route in a undernourished patient may lead to acute electrolyte shifts and fluid retention, which are hallmarks of the refeeding syndrome. As such, this article briefly summarizes the clinical manifestations and treatment of refeeding syndrome as it relates to patients admitted to the inpatient rehabilitation unit. ( info)

6/37. Prolonged neuromuscular blockade as a result of malnutrition-induced pseudocholinesterase deficiency.

    Mivacurium is a short-acting neuromuscular blocking drug, ideal for short surgical procedures. The brief duration of action depends on rapid hydrolysis by plasma cholinesterase. An inherited or acquired deficiency of plasma cholinesterase can prolong the effect of mivacurium. We present an unusual case of unanticipated postoperative apnea following mivacurium administration, as a result of acquired plasma cholinesterase deficiency, in a patient with previous uneventful exposure to both mivacurium and suxamethonium (succinylcholine). ( info)

7/37. Providing nutritional information to people with lung disease.

    Studies have shown that about 30 per cent of people who have chronic obstructive pulmonary disease (COPD) lose weight. weight loss has been shown to be associated with a reduction in lung function (Poole, 1993). Conversely, patients who are overweight have an increased respiratory workload due to their extra weight. Excess weight also increases the risk of hypertension, diabetes, heart disease and osteoarthritis (Collins, 2003). Many patients are unaware of changes in their nutritional status. The case study in Box 1 provides an illustration of this. ( info)

8/37. A fatal case of sclerosing mesenteritis.

    A 22-year-old patient was admitted because of abdominal pain and vomiting. Computed tomography diagnosed small intestinal malignancy. Ileal resection was performed, and the histological findings were consistent with sclerosing mesenteritis. The patient was treated with enteral nutrition, corticosteroids, azathioprine and methotrexate, but died 2 years later. ( info)

9/37. Benefits of home parenteral nutrition before lung transplantation: report of a case.

    A 54-year-old woman, who was severely malnourished and awaiting lung transplantation for chronic respiratory failure, was given nutritional support by home parenteral nutrition (HPN). The patient's emaciated state was further compromised by the fact that she had undergone a distal gastrectomy 4 years earlier. We decided that HPN was indicated because her oral intake was so poor and drinking enteral formula reduced her appetite. After 1 year of HPN, her body weight increased and her nutritional, anthropometric, and biochemical values were well maintained by the time of transplantation. Moreover, her progress after lung transplantation was remarkably good, indicating the effectiveness of nutritional support by HPN during the protracted waiting period. ( info)

10/37. malnutrition, steatorrhoea and pancreatic head tumour.

    A 61-year-old female patient is described who presented with weight loss, steatorrhoea and enlargement of the pancreatic head. Surgical exploration for suspected pancreatic cancer revealed multiple peritoneal white spots, initially suggestive for peritoneal metastases or tuberculosis but finally identified as peritoneal sarcoidosis. Pancreatic insufficiency could not be proven in further studies. We found pancreas divisum as an additional cause for the pancreatic head mass, and steatorrhoea was due to late-onset oligosymptomatic coeliac disease. This case demonstrates diagnostic pitfalls when several rare disorders are manifest in a single patient. Coeliac disease and sarcoidosis might be sequels of similar immune responses to certain antigens. ( info)
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