Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0038187 (starvation)
 24,951 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Frequently, MPD patients present themselves to the clinician with a variety of psychophysiological symptoms. Eating-disorder symptoms may be one of these, and may include the following: binge eating, self-induced vomiting, laxative abuse, excessive exercising, body image distortion, self-starvation, fluctuations in body weight, and nausea. Following are five cases in whom the pathological eating behavior was a manifestation of an underlying multiple personality disorder. The pathological eating behavior was so severe that some patients matched DSM-III-R diagnostic criteria for an eating disorder. Clinicians dealing with eating disorders should be aware that some patients may represent a subgroup in whom the underlying cause for the eating disorder may be MPD. These patients seldom respond to conventional treatment modalities used in eating-disorders programs, and only when the underlying multiplicity is identified and treated by a trained clinician, will the patient's eating-disorder symptoms improve.
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PMID:Covert multiple personality underlying eating disorders. 222 Dec 8

"Inpitan" is the first Soviet full-value balanced food mixture for tube feeding, produced under industrial conditions. It was used for enteral nutrition of 50 patients with different diseases of the upper gastro-intestinal tract. The mixture contains protein (12%), fat (30%), carbohydrates (58%), all the necessary mineral substances, and water- and fat-soluble vitamins. Depending on the clinical situation the patients received 2000-3200 ml of the mixture/day. The use of "Inpitan" with the energy density of 1 kcal/ml as the only source of nutrition during 7-75 days has demonstrated its high nutritious effectiveness. When the mixture was introduced directly into the small intestine according to the authors' schedule, no dyspeptic symptoms (eructation, nausea, vomiting, abdominal pain, meteorism, diarrhea) were recorded, dipsosis and the sense of starvation disappeared, the body weight increased, biochemical parameters returned to normal, the time of the preoperational preparation was significantly reduced, the post-operational complications were better managed.
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PMID:[Enteral feeding of patients with surgical diseases of the digestive tract using the Soviet balanced food mixture Inpitan]. 311 53

Thirteen patients met our criteria for severe acetaminophen hepatotoxicity over a 5-year study period. Six patients had therapeutic misadventures (not attempting suicide), and seven were attempting suicide. Five of six patients in the therapeutic misadventure group were chronic alcoholics, and three were taking other drugs reported to cause hepatic microsomal enzyme induction. In the suicide group, two of seven patients were alcoholics, and one patient was taking another inducing drug. All six patients in the therapeutic misadventure group had nausea, vomiting, or starvation, whereas two of seven patients in the suicide group had similar characteristics. Starvation could deplete the protective factor glutathione, thus augmenting hepatotoxicity. In the therapeutic misadventure group, four of six patients developed acute tubular necrosis, as compared to two of seven in the suicide group. One patient died in each group. Clinicians should be aware of these features as part of the spectrum of acetaminophen toxicity.
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PMID:Clinical features of acetaminophen toxicity. 335 89

The metabolic response to human growth hormone (HGH) was studied in five obese subjects in the fed state and during prolonged (5-6 wk) starvation. In the fed state (three subjects), HGH induced an elevation in basal serum insulin concentration, a minimal increase in blood and urine ketone levels, and a marked reduction in urinary nitrogen and potassium excretion resulting in positive nitrogen and potassium balance. In prolonged fasting (four subjects), HGH administration resulted in a 2- to 3-fold increase in serum insulin which preceded a 50% elevation in blood glucose. Persistence of the lipolytic effects of HGH was indicated by a rise in free fatty acids and glycerol. The response differed markedly from the fed state in that blood beta-hydroxybutyrate and acetoacetate levels rose by 20-40%, resulting in total blood ketone acid concentrations of 10-12 mmoles/liter, ketonuria of 150-320 mmoles/day, and increased urinary potassium loss. The subjects complained of nausea, vomiting, weakness, and myalgias. Despite a 50% reduction in urea excretion during HGH administration, total nitrogen loss remained unchanged as urinary ammonia excretion rose by 50% and correlated directly with the degree of ketonuria. It is concluded that in prolonged starvation (a) HGH may have a direct insulinotropic effect on the beta cell independent of alterations in blood glucose concentration, (b) persistence of the lipolytic action of HGH results in severe exaggeration of starvation ketosis and interferes with its anticatabolic action by necessitating increased urinary ammonia loss, and (c) failure of HGH to reduce net protein catabolism in starvation suggests that this hormone does not have a prime regulatory role in conserving body protein stores during prolonged fasting.
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PMID:Metabolic response to human growth hormone during prolonged starvation. 554 Jan 76

Mild tail pinch (TP) in rats resulted in 72% of animals displaying ingestive behavior with 20% demonstrating gnawing behavior without food ingestion and 8% demonstrating licking behavior only. The animals ate steadily over 5 min with a maximum rate occurring at 1 min (0.5 +/- 0.2 g). There was a circadian rhythm of TP-induced behavior with the peak food ingestion occurring at 24 h. A mild increase in blood glucose occurred 120 s after commencement of TP (115 +/- 4 mg/dl). Common satiety signals such as stomach distension and glucose decreased food ingestion. Parenteral administration of glucagon, cholecystokinin-octapeptide, bombesin, and thyrotropin-releasing hormone resulted in suppression of TP-induced food ingestion. Chronic TP (12 5-min TP periods/day) resulted in a fall in spontaneous food intake with the total intake remaining similar to food intake prior to the chronic TP period. We suggest that TP serves as an excellent model for eating behavior because 1) it correlates well with starvation-induced eating; 2) it precludes the necessary deprivation of food and water to adrenalectomized animals; and 3) animals subjected to TP continue chewing in the face of decreased food intake allowing one to exclude the possibility that the effects of an anorectic are secondary to nausea.
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PMID:Stress-induced eating in rats. 719 55

Many factors can modify nutritional status in cancer patients, including cachexia, nausea and vomiting, decreased caloric intake or oncologic treatments capable of determining malabsorption. Cachexia is a complex disease characterized not only by a poor intake of nutrients or starvation, but also by metabolic derangement. Nausea and vomiting may limit the nutrient intake and are most often the consequences of oncologic treatments or opioid chronic therapy. Decreased caloric intake is considered to be one of the major causes of malnutrition, although the causes of anorexia remain unclear. Malabsorption is generally attributed to the consequences of oncologic treatments reducing the gastrointestinal absorption. Biochemical measurements and immunological tests may be not reliable indicators of nutritional status in cancer patients. Therefore, medical history, physical examination, estimates of daily oral intake, weight changes and an appropriate consideration of the nutritional requirements according to the stage of disease must still be assessed. The therapeutic approaches should be individualized and realistic. Whenever possible, oral nutrition is the method of choice, with due consideration for specific dietary needs. Nausea and anorexia can be reduced by different kinds of drugs. A careful decision based on good clinical judgement is necessary before deciding to start either enteral or parenteral nutrition, to avoid a useless, costly and difficult treatment. In choosing the route for administration of nutrients, availability of and access to a functioning gastrointestinal tract, compliance and comfort of the patient, gastrointestinal toxicity due to chemotherapy or radiotherapy fields, different costs, duration and place of treatment should be considered rather than the different capacity of parenteral versus enteral nutrition. However, postoperative periods after massive intestinal resection often require prolonged parenteral nutrition. The benefits of parenteral nutrition are not often demonstrable in patients with bowel obstruction. Different ethical aspects are presented. Flexibility in attempting to meet the nutrition needs of each patient is probably the most useful guide.
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PMID:Nutrition in cancer patients. 877 Dec 86

The cachexia-anorexia syndrome occurs in chronic pathophysiologic processes including cancer, infection with human immunodeficiency virus, bacterial and parasitic diseases, inflammatory bowel disease, liver disease, obstructive pulmonary disease, cardiovascular disease, and rheumatoid arthritis. Cachexia makes an organism susceptible to secondary pathologies and can result in death. Cachexia-anorexia may result from pain, depression or anxiety, hypogeusia and hyposmia, taste and food aversions, chronic nausea, vomiting, early satiety, malfunction of the gastrointestinal system (delayed digestion, malabsorption, gastric stasis and associated delayed emptying, and/or atrophic changes of the mucosa), metabolic shifts, cytokine action, production of substances by tumor cells, and/or iatrogenic causes such as chemotherapy and radiotherapy. The cachexia-anorexia syndrome also involves metabolic and immune changes (mediated by either the pathophysiologic process, i.e., tumor, or host-derived chemical factors, e.g., peptides, neurotransmitters, cytokines, and lipid-mobilizing factors) and is associated with hypertriacylglycerolemia, lipolysis, and acceleration of protein turnover. These changes result in the loss of fat mass and body protein. Increased resting energy expenditure in weight-losing cachectic patients can occur despite the reduced dietary intake, indicating a systemic dysregulation of host metabolism. During cachexia, the organism is maintained in a constant negative energy balance. This can rarely be explained by the actual energy and substrate demands by tumors in patients with cancer. Overall, the cachectic profile is significantly different than that observed during starvation. Cachexia may result not only from anorexia and a decreased caloric intake but also from malabsorption and losses from the body (ulcers, hemorrhage, effusions). In any case, the major deficit of a cachectic organism is a negative energy balance. Cytokines are proposed to participate in the development and/or progression of cachexia-anorexia; interleukin-1, interleukin-6 (and its subfamily members such as ciliary neurotrophic factor and leukemia inhibitory factor), interferon-gamma, tumor necrosis factor-alpha, and brain-derived neurotrophic factor have been associated with various cachectic conditions. Controversy has focused on the requirement of increased cytokine concentrations in the circulation or other body fluids (e.g., cerebrospinal fluid) to demonstrate cytokine involvement in cachexia-anorexia. Cytokines, however, also act in paracrine, autocrine, and intracrine manners, activities that cannot be detected in the circulation. In fact, paracrine interactions represent a predominant cytokine mode of action within organs, including the brain. Data show that cytokines may be involved in cachectic-anorectic processes by being produced and by acting locally in specific brain regions. Brain synthesis of cytokines has been shown in peripheral models of cancer, peripheral inflammation, and during peripheral cytokine administration; these data support a role for brain cytokines as mediators of neurologic and neuropsychiatric manifestations of disease and in the brain-to-peripheral communication (e.g., through the autonomic nervous system). Brain mechanisms that merit significant attention in the cachexia-anorexia syndrome are those that result from interactions among cytokines, peptides/neuropeptides, and neurotransmitters. These interactions could result in additive, synergistic, or antagonistic activities and can involve modifications of transducing molecules and intracellular mediators. Thus, the data show that the cachexia-anorexia syndrome is multifactorial, and understanding the interactions between peripheral and brain mechanisms is pivotal to characterizing the underlying integrative pathophysiology of this disorder.
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PMID:Central nervous system mechanisms contributing to the cachexia-anorexia syndrome. 1105 8

The paper highlights a series of questions that doctors need to consider when faced with end-stage cancer patients with bowel obstruction: Is the patient fit for surgery? Is there a place for stenting? Is it necessary to use a venting nasogastric tube (NGT) in inoperable patients? What drugs are indicated for symptom control, what is the proper route for their administration and which can be administered in association? When should a venting gastrostomy be considered? What is the role of total parenteral nutrition (TPN) and parenteral hydration (PH)? A working group was established to review issues relating to bowel obstruction in end-stage cancer and to make recommendations for management. A steering group was established by the (multidisciplinary) Board of Directors of the European Association for Palliative Care (EAPC) to select members of the expert panel, who were required to have specific clinical and research interests relating to the topic and to have published significant papers on advanced cancer patients in the last 5 years, or to have particular clinical expertise that is recognised internationally. The final constitution of this group was approved by the Board of the EAPC. This Working Group was made up of English, French and Italian physicians involved in the field of palliative care for advanced and terminal cancer patients; and of English, American and Italian surgeons who also specialized in artificial nutrition (Dr. Bozzetti) and a professor of health economics. We applied a systematic review methodology that showed the relative lack of RCTs in this area and the importance of retrospective and clinical reports from different authors in different countries. The brief was to review published data but also to provide clinical opinion where data were lacking. The recommendations reflect specialist clinical practice in the countries represented. Each member of the group was allocated a specific question and briefed to review the literature and produce a position paper on the indications, advantages and disadvantages of each symptomatic treatment. The position papers were circulated and then debated at a meeting held in Athens and attended by all panel members. The group reviewed all the available data, discussed the evidence and discussed what practical recommendations could be derived from it. An initial outline of the results of the review and recommendations was produced. Where there were gaps in the evidence, consensus was achieved by debate. Only unanimous conclusions have been incorporated. Subsequently the recommendations were drawn together by Carla Ripamonti (Chairperson) and Robert Twycross (Co-Chair) and refined with input from all panel members. The recommendations have been endorsed by the Board of Directors of the EAPC. It was concluded that surgery should not be undertaken routinely in patients with poor prognostic criteria, such as intra-abdominal carcinomatosis, poor performance status and massive ascites. A nasogastric tube should be used only as a temporary measure. Medical measures such as analgesics, anti-secretory drugs and anti-emetics should be used alone or in combination to relieve symptoms. A venting gastrostomy should be considered if drugs fail to reduce vomiting to an acceptable level. TPN should be considered only for patients who may die of starvation rather than from tumour spread. PH is sometimes indicated to correct nausea, whereas regular mouth care is the treatment of choice for dry mouth. A collaborative approach involving both surgeons and physicians can offer patients an individualized and appropriate symptom management plan.
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PMID:Clinical-practice recommendations for the management of bowel obstruction in patients with end-stage cancer. 1143 Apr 17

Nutrient insults in early pregnancy, such as nutrient deprivation during famines, are often associated with an unfavourable outcome. Suboptimal nutrition in the early stage of gestation has been linked to a number of adverse effects on fetal growth and development. Historically, nausea and vomiting in pregnancy (NVP) was an important contributor to pregnancy-related mortality; indeed, Charlotte Bronte died from starvation and dehydration after suffering very severe NVP 4 months into her first pregnancy (Gaskell, 1858). Although NVP seldom now progresses to be life-threatening, it affects the majority of pregnant women, and potentially presents a challenge to nutrient intake in the most vulnerable period of development. Symptoms range from mild (nausea only) to severe (a level of vomiting that restricts nutrient intake and ultimately threatens metabolic and electrolyte balance). Although NVP has been documented for thousands of years, its cause has not yet been satisfactorily elucidated, but seems to be related to endocrinological changes. Pregnant women also frequently report dietary cravings and aversions during pregnancy which can be linked to both the incidence and severity of NVP. Paradoxically, NVP appears to be positively associated with a favourable outcome of pregnancy, including increased birth weight and gestational age. The mechanisms by which NVP favours the outcome of pregnancy are not known. They may be related to women increasing their nutrient intake to alleviate symptoms, improving the quality of their diet or reducing energy expenditure. Alternatively, adaptation to a reduced nutrient intake might stimulate the expression of growth factors and affect placentation or metabolism, thus favouring fetal growth when NVP resolves.
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PMID:Nutrient insult in early pregnancy. 1200 95

Conscious intravenous sedation is a safe alternative method to general anaesthesia. We have used a technique of continuously titrated, as opposed to incremental boluses of, intravenous or intramuscular midazolam for conscious sedation, with tumescent adrenaline-lignocaine solution for local anaesthesia, routinely in 421 plastic surgical procedures between 1997 and 2000. All patients were American Society of Anesthesiologists (ASA) class I or II. Conscious sedation was administered through our protocol of continuously titrated doses of midazolam in dextrose saline. The operative field was injected subcutaneously with varying volumes of diluted lignocaine and adrenaline, depending on the anatomical region. Preoperative sedation was administered 1 h before the procedure in the form of an intramuscular injection of pethidine and promethazine (Phenergan). Intraoperatively, a subset of patients received up to four divided diluted doses of pethidine. A preoperative 4 h starvation period pronounced the effect of the sedative. No intraoperative conversions to general anaesthesia were needed, and no sedation complications occurred. No unplanned re-admissions secondary to nausea, prolonged drowsiness or pain were required. All patients who were treated using this technique had an uneventful postoperative course. Hospital stay was substantially shorter than following general anaesthesia, which provided a significant reduction in medical-care expenses and a faster return to work. In conclusion, conscious sedation administered by titrated intravenous midazolam is a well-tolerated, safe, consistent, predictable and effective anaesthetic choice for a variety of plastic surgical procedures, many of which would commonly be performed under general anaesthesia.
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PMID:Continuous intravenous versus bolus parenteral midazolam: a safe technique for conscious sedation in plastic surgery. 1285 24


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