Gene/Protein Disease Symptom Drug Enzyme Compound
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This study was undertaken because circulatory distrubances had been advanced as a possible cause of death during initial renourishing of protein-calorie deprived children. Body weight, plasma albumin concentration, intravascular volumes (radiochromium), cardiac index (dye dilution technique), intravascular pressures (flow-guided catheterization), and related hemodynamic parameters were determined at rest in 43 infection-free African children with a form of protein-calorie malnutrition known as marasmic kwashiokor, and were compared with values observed in 24 convalescent children. The malnourished children showed a prolonged circulation time with a tendency to bradycardia and hypotension; cardiac index, stroke index, and heart work were significantly reduced, as were the intravascular volumes. Hemodynamic data correlated with either body weight or plasma albumin and cardiac index bore a direct relation to red cell volume. In the most severely malnourished subjects, ventricle filling pressures were low and vascular resistances were high. It is inferred that most patients were in an adaptive hypocirculatory state comparable to hypothroidism, while the most severely malnourished children showed frank peripheral circulatory failure comparable to hypovolemic shock. Circulatory failure on admission was associated with high death rate during treatment but the relation between cause and effect could not be clearly demonstrated.
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PMID:Hemodynamic findings in servere protein-calorie malnutrition. 40 6

While conduction disturbances and arrhythmias are seen frequently in alcoholic cardiomyopathy, the specific relationship of these changes to ethyl alcohol has been unclear. To investigate the long-term effects of ethanol upon cardiac conduction, alcoholism was induced in 11 male mongrel dogs for 7 to 33 (mean 14.4) months by feeding up to 36 per cent of total daily calories as ethanol while adequate nutrition was maintained. His and left bundle branch electrograms in the intact anesthetized animals were recorded along with high-speed, high-frequency ECG's. While resting left ventricular pressures, volumes, and stroke outputs were normal, H-Q time was prolonged in the alcoholic animals drinking for longer than one year (35 +/- 3 msec., normals 26 +/- 1 msec.-P less than 0.001). QRS widening (to 80 +/- 4 msec.) was also evident after one year as compared with normals (62 +/- 2 msec.-P less than 0.001), and both H-Q and QRS alterations correlated with duration of intake. These changes were less after shorter ingestion periods, could not be reproduced in normals by acute ethanol infusion, and were not associated with ventricular hypertrophy, inflammation, or necrosis. No abnormalities of atrial conduction were noted. Morphologic correlates of the conduction abnormalities included accumulation of Alcian Blue-positive interstitial material as well as dilatation and localized swelling of the nonspecialized region of the intercalated discs in ventricular muscle and Purkinje fibers. Thus, prolonged ethanol intake in the absence of evident malnutrition resulted in demonstrable intraventricular conduction abnormalities and morphologic alterations which were related to duration of ingestion, consistent with a cumulative toxic effect of ethanol.
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PMID:Cardiac conduction abnormalities produced by chronic alcoholism. 94 75

The function of ANP in the cardiovascular regulation is very similar with the TCM theory of "the Heart governs blood circulation". Using the method of cardiac impedance to check cardiac output and the method of radioimmunoassay (RIA) to check plasma ANP, the result showed that in the status of Blood Deficiency Syndrome, cardiac function was impaired, there were reduced kinemia and stroke volume, as well as markedly raised plasma ANP and peripheral resistance. The above-mentioned indexes were significantly different from those of normal group (P < 0.01). Using multivariate regression analysis, cardiac output was negatively correlated with the plasma ANP (P < 0.05). 23 cases with Blood Deficiency Syndrome showed normal hemoglobin, but an evidently changed cardiac output and plasma ANP were closely related with the level of the Blood Deficiency. Both parameters might serve as the objective basis to reflect the level of Blood Deficiency to facilitate the clinical diagnosis of the patient.
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PMID:[Correlation analysis between plasma atrial natriuretic peptide and cardiac function in blood deficiency syndrome]. 139 89

Some elderly patients with chronic illness such as stroke, or Parkinsonism cannot take food orally because of dysphagia. In such cases, tube feeding can be used as a supplement to oral intake when malnutrition is present. This route allows for easier nursing care and decreases the frequency of aspiration pneumonia. Complications of tube feeding include nutrient deficiency states, pulmonary aspiration, gastrointestinal and metabolic disorders. We report two cases with complications of acute gastric ulcer which was thought to be induced with long-term tube feeding. Case 1 was a 61-year-old male patient with Parkinson's disease for ten years. L-DOPA had been administered with good control of his condition. However, his ability to swallow has deteriorated gradually. As he often suffered from aspiration pneumonia, nasogastric tube feeding was performed. After three years of tube feeding, he suddenly vomited much bloody material. He died from massive bleeding with acute gastric dilatation. Autopsy showed giant acute gastric ulcer covered with coagulated blood. UL3, 50 mm in maximum diameter, was observed in the middle portion of the greater curvature, where the top of tube probably came in contact with the gastric wall. Case 2 was an 83-year-old female patient with stroke and chronic heart failure. She had been hospitalized for about one year because of the intermittent deterioration of her cardiac condition. Furthermore, her inability to swallow increased during her hospitalization. She also suffered from aspiration pneumonia. Nasogastric tube feeding was performed to prevent aspiration pneumonia and malnutrition. She died of acute heart failure after twelve months. Autopsy revealed heart dilatation, old myocardial infarction and stroke. In addition, two acute gastric ulcers (UL3.10 and 30 mm in diameter) were recognized; one was in the upper portion of the greater curvature, the other in the lower portion of the greater curvature. The location of these gastric ulcers was unusual. Moreover, they coincided with location of top of the nasogastric tube. From these two cases, we conclude that in long-term tube feeding the tip of the tube often comes in contact with the gastric wall, and gastric ulcer could be produced by repeated mechanical stimulus of the wall. Reports of acute gastric ulcer induced by tube feeding have not been published previously. Therefore, we should pay much attention to this complication in the care of the elderly people with long-term tube feeding.
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PMID:[Long-term nasogastric feeding and complications of acute gastric ulcer in two elderly patients]. 143 62

The elderly patient may present to the critical care unit with neurologic deficits such as acute confusion, loss of consciousness, or signs of a cerebrovascular accident. Recognizing the normal age-related changes that occur in the nervous system enables the critical care nurse to evaluate the patient's response to neurologic disorders. The normal neurologic changes associated with aging provide implications for assessment, response to the critical care environment, and the time needed for education and rehabilitation. Other changes, especially decreased immunity, malnutrition, and pulmonary and cardiac pathology, significantly increase the risk for morbidity and mortality after an acute neurologic event. Changes in pharmacokinetics and the likelihood of polypharmacy in the older patient greatly increase the risk for complications and side effects of the commonly used treatments. Important elements of nursing management for the elderly neuroscience patient include performing an accurate neurologic assessment, including noting changes in cognition, observing for adverse drug reactions, optimizing ventilation, and maximizing mobility and nutritional status. This article focuses on these aspects of nursing care for the elderly neuroscience patient.
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PMID:The elderly neuroscience patient: implications for the critical care nurse. 155 77

We studied 25 children, aged 1-5 years (mean 2.65 +/- 0.8 years) with severe protein energy malnutrition, and compared their left ventricular mass and function to those of 26 healthy, age- and sex-matched normal children. The mean left ventricular mass in the patients was lower than that in the controls (25.75 +/- 8.09 g vs. 32.44 +/- 11.64 g; P less than 0.05, C.I. 2.08 to 11.30). However, left ventricular mass (g)/kg body weight was significantly increased in the patients (4.44 +/- 1.45 vs. 2.42 +/- 0.87; P less than 0.001, C.I. 1.28 to 2.76) suggesting relative cardiac "sparing". The systolic function indices like ejection fraction, percentage fractional shortening, and velocity of circumferential fiber shortening were not significantly different in the patients and in the normal children. The left ventricular end-diastolic volume, stroke volume and cardiac output were reduced in proportion to decrease in body size in the patients, so that the cardiac index was not reduced but slightly increased in the patients. (5.95 +/- 1.9 l/min/m2 in patients, 4.97 +/- 1.4 l/min/m2 in controls; P less than 0.05, C.I. 0.04 to 1.92). There was no significant difference in any of these parameters of left ventricular function or mass in patients with marasmus, as compared to those of patients with marasmic kwashiorkor. Amongst the 25 patients, however, 5 patients (20%) had an ejection fraction of less than 50%. Compared to the other 20 patients, these 5 patients had lower left ventricular mass (18.4 +/- 4.3 g vs. 27.5 +/- 7.8 g, P less than 0.05 C.I. 1.63 to 16.75), lower left ventricular mass (g)/kg body weight and a worse prognosis.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Left ventricular mass and function in children with severe protein energy malnutrition. 156 75

Four hundred consecutive hip fractures were studied prospectively. Two hundred forty-seven patients were classified as unhealthy (poor cardiac status, pneumonia, cancer history, bowel obstruction history, malnutrition, dehydration, stroke history, renal failure history, cirrhosis). Twenty-two percent of this unhealthy group died, while only 6% of the remaining healthy group died. Death rates varied with admission activity level and mental status but not when patient health status was factored out. After factoring out health status, age was associated with higher death rates only in patients older than age 85. Confusion, a change of mental status in the hospital, occurred in 25% of patients. Confusion was associated with a medical complication in 94% of cases, was the presenting symptom of a medical complication in 79% of cases, and was associated with a 39% death rate. Major medical complications occurred in 9% of the healthy group (29% of them died) and 21% of the unhealthy group (64% of them died). Major medical complications in unhealthy, shut-in patients were associated with an 80% death rate. Vigorous urinary tract monitoring and early treatment of bacteriuria decreased death rate. Postfracture malnutrition was associated with higher complication rates. Hip surgery performed within 72 hours on patients with acute medical illnesses in addition to their fracture was associated with a higher death rate. Whether a patient walked postfracture seemed not to be correlated with the death rate. Patients who were not walking prefracture but treated by internal fixation had a 34% failure rate.
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PMID:Hip fracture mortality. A prospective, multifactorial study to predict and minimize death risk. 161 47

The varying roles of a widely diverse group of noncardiac disorders on the heart, particularly their ability to induce heart failure, are explored. A general overview of the cardiac effects of volume and pressure overloading is followed by specific discussions of the roles of vascular, endocrine and metabolic, renal, gastrointestinal, central nervous system, hematologic, and other miscellaneous disorders (heat stroke, sepsis, immune-mediated disease, obesity, malnutrition, and pregnancy) in producing cardiac dysfunction and failure in companion animals. Pathogenetic and pathophysiologic mechanisms are emphasized.
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PMID:The role of noncardiac disease in the development and precipitation of heart failure. 183 10

Metabolic events combined with neurological deficits place some stroke patients at risk for malnutrition. Nutritional support in the poststroke patient is an important part of recovery. Basic knowledge of nutritional assessment and interventions for altered nutritional status can help the nurse plan appropriate care.
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PMID:Potential for altered nutritional status in the stroke patient. 239 61

A case-controlled epidemiologic study on the risk factors leading to prematurity and IUGR was carried out in 7 rural areas in Shunyi County, Beijing. 88 prematures, 83 IUGR and 509 normal controls were included in this study and 142 factors have been taken into consideration. The result revealed that strong or abrupt physical and psychic stroke to the gravidae were the main risk factors for prematurity while maternal poor health and malnutrition played a leading role in IUGR. Deficient in-take of various diet constituents might also play a part in both prematurity and IUGR Preventive measures, based on this study are postulated.
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PMID:[An epidemiologic study of the risk factors leading to prematurity and intrauterine growth retardation]. 262 May 77


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