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Query: UMLS:C0020505 (hyperphagia)
 6,116 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

In a 12-year period, 37 of 3,536 burn patients developed acute obstruction of the duodenum by the superior mesenteric artery. Nasogastric decompression and intravenous fluids were required initially in all 37 patients. Twelve patients received no further therapy, with resolution of the obstruction in six and death of the other six from burn wound sepsis or pneumonia. Ten patients underwent operative treatment consisting of either duodenojejunostomy (eight) or vagotomy and gastroenterostomy (two), with resolution in seven and three postoperative deaths. Fifteen patients were treated with intravenous hyperalimentation and gastric decompression, with resolution in 12 patients, one required operative intervention, and two died of complications. A high degree of suspicion followed by prompt diagnosis and treatment of the SMA syndrome are required in all critically ill patients with unexplained bilious vomiting. Gastric decompression coupled with aggressive use of intravenous hyperalimentation recently has reduced the need for operative treatment (42% versus 11%).
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PMID:Superior mesenteric artery syndrome in thermally injured patients. 46 69

Candida albicans arthritis is uncommon. Although occasional instances of meningitis, osteomyelitis, endocarditis, pneumonia, and extensive visceral involvement due to Candida species have been reported, only 7 documented cases of arthritis caused by Candida albicans are found in the literature. The present case was an infant with a gastroschisis defect of the abdominal wall, who required multiple surgical procedures, prolonged antibiotic therapy, and parental intravenous hyperalimentation. Following a blood stream infection with Candida albicans, septic arthritis of the left knee developed. Treatment with intravenous Amphotericin-B over a 6-week period was successful in eridicating the infection. The child is completely well 9 months after discharge from the hospital. Factors which may predispose patients to infection by Candida albicans include prolonged antibiotic therapy. corticosteroids, generalized debilitation, malnutrition, parental hyperalimentation, and immunosuppressive therapy. Amphotericin-B therapy may be associated with considerable toxicity including azotemia, hepatic dysfunction, and hematologic abnormalities. The therapeutic regimen of Amphotericin-B is effective but a 6-week course of antifungal therapy may be necessary to eradicate septic arthritis of Candida albicans. Surgical drainage is probably indicated only for recent infections.
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PMID:Candida arthritis. A case report and review of the literature. 80 14

Forty patients with a mean age of 56 yrs, all of whom required hemodialysis therapy, for mean of 32 days, were treated with a minimum of 2000 kilocalories of I.V. glucose, potassium orthophosphate with mulit-vitamins and 25 Gm of I.V. albumin. Patients were initially dialyzed daily and then every other day or 3 times/wk. Complications including pneumonia, GI bleeding, gram negative septicemia, shock, the need for tracheostomy and ventialtory assist were high. Overall survival rate was 33%. This survival rate we beleive to be high considering the complicated type of illness these patients had as well as our clinical experience prior to the use of total parenteral nutrition in the manner described in this report. Essential L-amino acids were not used based on our experience in 3 patients with hepatic and renal failure who developed worsening neurological findings with the use of this substance. We believe further that I.V. glucose and albumin may be preferred mode of hyperalimentation.
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PMID:Total parenteral nutrition in acute renal failure. 82 19

A prospective study of patients hospitalized in a large Veterans Administration Hospital between November 1963 and November 1973 revealed 123 patients with deep mycotic infections. The incidence of these infections almost doubled during the last 5 years. Candida (55 patients) and Aspergillus (26 patients) were the major causative agents. Nine other fungal caused infection in the remaining patients. Candidemia was rare prior to the introduction of commerical percutaneously-inserted venous catheters in 1965. The incidence increased further following the introduction of parenteral hyperalimentation in 1969, and Torulopsis fungemia (5 patients) appeared for the first time. Invasive pneumonia caused by spore-forming Aspergillus decreased when patients were moved from an old, naturally-ventilated hospital to a new, mechanically-ventilated one. The air in both hospitals was sampled on one occasion for the presence of fungal spores, and spores of Aspergillus fumigatus were detected only in the old hospital. Our experience suggests that hospital-acquired Aspergillus infection of the lung might be eliminated if all incoming hospital air is filtered, properly vented, and not recirculated. Efforts to decrease hospital-acquired fungal infections include vigorous infection control procedures for intravenous therapy, judicious use of any therapy that predisposes to infection, and further evaluation of improved mechanical control of hospital ventilation.
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PMID:Deep mycotic infection in the hospitalized adult: a study of 123 patients. 118 93

RhGM-CSF is a hematopoietic growth factor which stimulates the proliferation, differentiation and functional activity of neutrophils, monocytes and macrophages. It also stimulates proliferation of endothelial cells and induces the production of other cytokines, such as interleukin (IL-1), tumor necrosis factor (TNF), interferon, prostaglandin E2, and plasminogen activating factor which affects both hematopoietic and non-hematopoietic cell activities. Initial clinical studies in 1987 generally excluded experimental therapy with rhGM-CSF in pediatric patients (age < or = 17 years) unless life threatening illness related to neutropenia and infection developed (i.e., patients with graft failure). Serious complications of patients undergoing autologous bone marrow transplantation (BMT) related to pancytopenia include infection and hemorrhage. Other regimen related complications include venooclusive disease, pneumonitis and mucositis. As a result of these complications, patients require intensive medical support including antibiotics and hyperalimentation. Initial hospital duration following marrow reinfusion is generally 4 to 5 weeks. Hematopoietic growth factors have been administered to patients undergoing autologous BMT as an attempt to reduce regimen related toxicity.
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PMID:RhGM-CSF in bone marrow transplantation: experience in pediatric patients. 130 85

Candidemias were reviewed in 22 elderly patients hospitalized in Yokufukai Geriatric Hospital. Their ages ranged from 62 to 101 years, with a mean age of 81 years. Sixteen patients had either old cerebrovascular disease or senile dementia. In seven patients, synchronous or metachronous bacteremia in the blood culture was associated with the candidemia. Eighty-six percent of total candidemias were related to intravenous hyperalimentation (IVH). The mean duration from the start of IVH to candidemia was 46 days. Eleven patients (50%) developed candidemia within one month after the beginning of IVH. Fourteen patients had the IVH catheters changed one or more times before the time of positive candida in the blood culture. The mean duration from the start of IVH to candidemia was 59 days. Eight patients, on the other hand, had the catheters unchanged and the mean duration was 23 days. Ninety-six percent were receiving broad-spectrum antibiotic therapy at the time of the positive candida in blood culture. Eight patients developed DIC. The overall mortality was 91% (twenty patients) and thirteen (65%) of them died within one month after the onset of candidemia. There was no difference in mortality when all candidemic patients received no anti-mycotic therapy were compared with the patients given any amount of miconazole or 5-FC. The causes of death for candidemic patients included fungemic shock (6 patients), hemorrhagic shock (4 patients), and shock associated with DIC (3 patients). From the results of this study, candidemia in the elderly was produced by various underlying diseases such as central nervous system diseases or pneumonia.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[A clinicopathological study of candidemia in the elderly]. 211 55

In summary, the association between malnutrition and infections, including respiratory infections, seems clear from consistent experience in developing nations. Young children are at the greatest risk, both of severe malnutrition and complicating infections. The cell-mediated immune system is the most affected by protein-calorie malnutrition, but antibody responses are also affected and complement levels are low. Infections with organisms handled by cell-mediated immunity would be the most predictable, but the immunoglobulin responses that are important for opsonization of invading microorganisms may also be impaired. The experience in developing nations has been extrapolated to patients in US hospitals, because hospitalized patients often have one or more abnormal nutritional parameters. However, severe malnutrition of the sort found in children in developing nations is uncommon in hospitalized patients, and the effects of malnutrition on host defenses in adults are likely to be less severe than in children. Whether the degrees of malnutrition that have been described in hospitalized patients produce clinically significant effects on antibacterial defenses in the lungs of adults remains uncertain. Despite the intuitive importance of nutritional support, and the repeated observation that nutritional parameters improve with nutritional support, a number of controlled trials have failed to show a clear improvement in patient outcome with aggressive nutritional therapy, including parenteral hyperalimentation. The results of these studies, together with the risks involved in parenteral alimentation have led some to suggest that "the emperor has no clothes," and that aggressive nutritional support is not worthwhile for most patients. The major problem in interpreting the data is the lack of clear clinical endpoints, and this may obscure potentially important responses to nutritional therapy. Nutritional status is only one of many interacting variables that may affect clinical outcome, particularly in patients in critical care units. Survival usually depends on many factors, particularly the status of major organ systems independent of nutrition, so that survival as an endpoint for nutritional studies is likely to be too insensitive. Prospective studies of the incidence and significance of infections, particularly pneumonia, in malnourished patients and the effects of nutritional therapy are lacking. At present, the prudent approach is to treat infections aggressively in malnourished patients, with antibiotics and drainage if necessary, and to provide nutritional supplementation in all patients via the gut as long as possible.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:The relationship between malnutrition and lung infections. 311 82

Infection, particularly that involving the respiratory tract, is commonly seen in the patient with ARDS. It can be either an etiologic factor leading to the syndrome or a complicating factor leading to a high likelihood of mortality. Pneumonia develops in up to 70% of individuals with ARDS, and when present, converts the syndrome to its most severe and mortal form. In addition, when systemic injury coexists with any type of infection, ARDS will develop with an increased frequency. Nosocomial pneumonia results when upper and lower respiratory tract defenses fail and these sites are overwhelmed by bacteria. Colonization of the oropharynx and tracheobronchial tree, both of which are common in critically ill patients, precedes the development of pneumonia. In the patient with ARDS, all levels of host antibacterial defenses may be impaired, thus accounting for the high incidence of both colonization and pneumonia. These impairments result from the acute lung injury itself, coexisting systemic illnesses, therapeutic interventions, and acquired malnutrition. Once pneumonia develops in the course of acute lung injury, diagnosis is exceedingly difficult and potentially inaccurate. With proper application of the protected specimen brush, inserted bronchoscopically, diagnostic accuracy may improve. Therapy must be undertaken early and with agents directed at likely pathogens, particularly P. aeruginosa and other gram-negative bacilli. In the future, preventive efforts against pneumonia may be effective for the ARDS patient. Strategies that may be effective include hyperalimentation, judicious use of all pharmacotherapy, active and passive antibacterial vaccines, airway microenvironment manipulation, and the use of aerosolized antibiotics.
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PMID:The interaction of infection and the adult respiratory distress syndrome. 333 58

Bulimia is an eating disorder characterized by episodic, uncontrollable overeating and frequently by purging after binges. It appears to afflict approximately 5 percent of female college students in the United States. Most sufferers are high-achieving but passive and unassertive young women from similarly high-achieving but disorganized families. Confusion over social roles for women is common in bulimic patients. Bulimia shows a strong association with affective disorders; depression is common in both bulimic patients and their close family members. Bulimic patients seem to have a pronounced affective vulnerability to rejection, loss, and failure. Bulimia presents a special diagnostic challenge to the primary care physician because of the paucity of clues provided by a typical review of systems and a physical examination, even a very thorough one. Making the diagnosis requires persistent and thorough history-gathering and is best accomplished through special attention to the psychosocial history (particularly history of depression and substance abuse, family dynamics, and recent stressors) as well as pointed questioning regarding eating behavior. Because of the severe, potentially lethal complications that may attend bulimia (including fluid and electrolyte imbalance, cardiac conduction abnormalities, gastric rupture, pneumonia), diagnosis and appropriate referral by the primary care physician may have a critical impact on the patient's life and health.
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PMID:Bulimia: diagnosis and management in the primary care setting. 354

A 64-year-old man presented with mediastinal and bilateral hilar adenopathy, and a biopsy of a scalene node revealed non-Hodgkin's lymphoma. One week after a cycle of combination chemotherapy, he developed an esophagobronchial fistula. Following a resolution of pneumonia by antibiotics, a cervical esophagostomy was made and, after the improvement of his general condition with parenteral hyperalimentation, he was given one course of combination chemotherapy which was continued until the mediastinal lymph node shadow completely disappeared. A subcutaneous bypass operation was performed on the stomach. After receiving one more cycle of intensification chemotherapy, he was discharged. Three months later, a bronchoscopy showed healing of the fistula. Nine months postoperatively, there is no evidence of the lymphoma or the esophagobronchial fistula recurring. Esophageal involvement is rare in malignant lymphoma and this is only the sixth reported case of esophageal fistula of the respiratory tract in association with lymphoma, and just the second to be treated successfully.
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PMID:Mediastinal malignant lymphoma complicated with esophagobronchial fistula: successfully treated case. 369 29


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