ABSTRACT
Primary intestinal lymphangiectasia is a rare clinical condition of unknown etiology. The common age of presentation is during the first 3 years of life, but cases in adults have also been reported. It has a variable symptomatology, but the main clinical manifestation is edema, also diarrhea and weight loss can occur. The loss of lymph fluid into the gastrointestinal tract also leads to hypoproteinemia and lymphopenia. Diagnosis is based on clinical manifestations, laboratory and endoscopic findings, and is confirmed on histopathological examination of biopsy. The main treatment is a protein rich, low in fat and medium chain triglyceride diet. We present the case of a 1-year-old male patient who presents with generalized edema, predominantly in lower limbs, and diarrhea. Laboratory findings show the presence of marked hypoproteinemia. Then an endoscopy and a duodenal biopsy are performed, and the histopathological study confirms the diagnosis of primary intestinal lymphangiectasia. The patient is treated and after a satisfactory evolution, is discharged.
Subject(s)
Lymphangiectasis, Intestinal/diagnosis , Adrenal Cortex Hormones/therapeutic use , Combined Modality Therapy , Diarrhea/etiology , Dietary Fats/therapeutic use , Dietary Proteins/therapeutic use , Diuretics/therapeutic use , Edema/etiology , Hemodynamics , Humans , Hypoproteinemia/diet therapy , Hypoproteinemia/etiology , Infant , Lymphangiectasis, Intestinal/complications , Lymphangiectasis, Intestinal/epidemiology , Lymphangiectasis, Intestinal/therapy , Male , Peru/epidemiology , Venezuela/ethnologyABSTRACT
La linfangiectasia intestinal primaria es una entidad clínica poco común de etiología desconocida. La edad típica de presentación de esta enfermedad es durante los 3 primeros años de vida, pero también se han reportado casos en adultos. Posee sintomatología variable, pero la manifestación clínica principal es el edema, puede presentarse también diarrea y pérdida de peso. La pérdida de fluido linfático en el tracto gastointestinal conlleva también a hipoproteinemia y linfopenia. El diagnóstico se establece en base a la clínica, a los estudios de laboratorio, al estudio endoscópico y se confirma con la evaluación histológica de la biopsia realizada. El manejo se da mediante una dieta rica en proteínas, baja en grasas y triglicéridos de cadena media. A continuación, se presenta el caso de un paciente varón de 1 año de edad que presenta edema generalizado, con predominio de miembros inferiores, y diarrea. Los exámenes de laboratorio muestran la presencia de hipoproteinemia marcada. Posteriormente, se realiza una endoscopía digestiva alta y una biopsia duodenal. El estudio histológico confirma el diagnóstico de linfangiectasia intestinal primaria. El paciente recibe el tratamiento establecido para esta enfermedad y, finalmente es dado de alta.
Primary intestinal lymphangiectasia is a rare clinical condition of unknown etiology. The common age of presentation is during the first 3 years of life, but cases in adults have also been reported. It has a variable symptomatology, but the main clinical manifestation is edema, also diarrhea and weight loss can occur. The loss of lymph fluid into the gastrointestinal tract also leads to hypoproteinemia and lymphopenia. Diagnosis is based on clinical manifestations, laboratory and endoscopic findings, and is confirmed on histopathological examination of biopsy. The main treatment is a protein rich, low in fat and medium chain triglyceride diet. We present the case of a 1-year-old male patient who presents with generalized edema, predominantly in lower limbs, and diarrhea. Laboratory findings show the presence of marked hypoproteinemia. Then an endoscopy and a duodenal biopsy are performed, and the histopathological study confirms the diagnosis of primary intestinal lymphangiectasia. The patient is treated and after a satisfactory evolution, is discharged.
Subject(s)
Humans , Infant , Male , Lymphangiectasis, Intestinal/diagnosis , Peru/epidemiology , Venezuela/ethnology , Dietary Fats/therapeutic use , Dietary Proteins/therapeutic use , Adrenal Cortex Hormones/therapeutic use , Combined Modality Therapy , Diarrhea/etiology , Diuretics/therapeutic use , Edema/etiology , Hemodynamics , Hypoproteinemia/diet therapy , Hypoproteinemia/etiology , Lymphangiectasis, Intestinal/complications , Lymphangiectasis, Intestinal/therapy , Lymphangiectasis, Intestinal/epidemiologyABSTRACT
BACKGROUND: As more patients undergo bariatric surgery to assist with weight loss, the demand for post-bariatric body contouring surgery, to address both functional and aesthetic concerns, is increasing. However, high wound healing complication rates remain a significant problem for these patients. One theory is that chronic malnourishment and hypoproteinemia may contribute significantly to these wound healing complications. OBJECTIVE: The purpose of this study was to determine the effect of pretreatment protein nutritional supplementation on wound healing in post-bariatric surgery massive weight loss patients undergoing abdominoplasty. Our hypothesis was that protein supplementation would decrease wound healing complications. METHODS: A retrospective review was performed of 23 post-bariatric surgery patients undergoing abdominoplasty who received pretreatment protein nutritional supplementation. This group was compared with a historical control group of 23 post-bariatric surgery patients who underwent abdominoplasty in the period immediately before the implementation of the protein supplementation protocol. Patient demographics and procedural characteristics were similar for the two groups. RESULTS: Forty-six patients were identified who had undergone abdominoplasty, half of whom were prescribed the protein supplementation protocol. Overall wound healing complication rates were significantly lower in the protein-supplemented group (0.0% vs. 21.8%, p = 0.04). There was no significant difference between the protein supplementation and historical control groups in regards to total complication rate. CONCLUSIONS: Pretreatment protein supplementation is a simple intervention that can significantly decrease wound healing complications in post-bariatric surgery massive weight loss patients undergoing abdominoplasty. LEVEL OF EVIDENCE 4: Therapeutic.
Subject(s)
Abdominoplasty , Bariatric Surgery , Dietary Proteins/administration & dosage , Dietary Supplements , Hypoproteinemia/diet therapy , Malnutrition/diet therapy , Obesity/surgery , Weight Loss , Abdominoplasty/adverse effects , Adult , Bariatric Surgery/adverse effects , Chronic Disease , Female , Humans , Hypoproteinemia/diagnosis , Hypoproteinemia/etiology , Male , Malnutrition/diagnosis , Malnutrition/etiology , Middle Aged , Nutrition Assessment , Nutritional Status , Postoperative Complications/etiology , Postoperative Complications/prevention & control , Retrospective Studies , Risk Factors , Time Factors , Treatment Outcome , Wound HealingABSTRACT
BACKGROUND AND AIMS: Stroke is the number one cause of death in China. Although the effective management has reduced the mortality and lengthened survival, little attention has been paid to nutritional issues in patients with stroke in China. This study aimed to assess the premorbid nutrition status in dying patients with acute cerebral infarction. METHODS: In this study, a total of 185 acute ischemic stroke patients dying within 30 days were recruited from medical records. Characteristics of dying patients were assessed on admission, and serum biochemical parameters including serum total protein, serum albumin, and serum prealbumin were measured within 24 hours after stroke onset and every week routinely. RESULTS: Among 185 ischemic stroke patients, 86 dying patients experienced their first-ever acute cerebral infarction, while 99 dying patients were experiencing a recurrent cerebral infarction. The prevalence of dysphagia, post-stroke pneumonia, and gastrointestinal hemorrhage in recurrent stroke groups were higher than those in the first-ever stroke group (P<0.01). There were gradually declines in serum total protein, serum albumin, and serum prealbumin in dying patients from admission to death, especially in the recurrent ischemic stroke group, as compared to their normal range. The sensitive sequence of serum nutritional index for dying patients with ischemic infarction was: serum prealbumin>serum albumin>serum total protein. CONCLUSIONS: This study showed that hypoproteinemia and undernutrition were serious in dying patients with acute ischemic stroke, especially in patients with recurrent ischemic stroke. This study also confirmed that serum prealbumin is more sensitive than serum albumin to assess nutritional status. The strategies to improve malnutrition in stroke patients are urgently needed in China.
Subject(s)
Cerebral Infarction/mortality , Hypoproteinemia/mortality , Malnutrition/mortality , Acute Disease , Aged , Aged, 80 and over , Brain Ischemia/diet therapy , Brain Ischemia/mortality , Cerebral Infarction/diet therapy , China/epidemiology , Comorbidity , Female , Humans , Hypoproteinemia/blood , Hypoproteinemia/diet therapy , Male , Malnutrition/blood , Malnutrition/diet therapy , Middle Aged , Pilot Projects , Terminally IllABSTRACT
The investigation involved 307 patients operated on for gastric adenocarcinoma. Nutritional support was given enterally (50), parenterally (98) and by standard methods (159). Enteral nutrition should be recommended because it was followed by relatively higher total protein and serum albumin levels.
Subject(s)
Adenocarcinoma/diet therapy , Nutritional Support , Stomach Neoplasms/diet therapy , Adenocarcinoma/blood , Adenocarcinoma/surgery , Adult , Aged , Aged, 80 and over , Enteral Nutrition , Female , Humans , Hypoproteinemia/diet therapy , Hypoproteinemia/etiology , Male , Middle Aged , Nutritional Support/methods , Parenteral Nutrition , Protein-Energy Malnutrition/diet therapy , Protein-Energy Malnutrition/etiology , Retrospective Studies , Serum Albumin/metabolism , Stomach Neoplasms/blood , Stomach Neoplasms/surgery , Time Factors , Treatment OutcomeABSTRACT
BACKGROUND: Congenital intestinal lymphangiectasia is a rare disease in childhood, which may already cause protein-losing enteropathy in newborns. PATIENT, METHODS AND RESULTS: This is a case report of an infant with generalized edema and protein-losing enteropathy, in whom intestinal lymphangiectasia was diagnosed at the age of two months. Following repetitive intravenous albumin und gamma globulin infusions, the elimination of long-chain fats from the diet and the substitution with medium-chain triglycerides (MCT) led to an improvement of the protein-losing enteropathy. CONCLUSION: In newborns with low level of serum protein and edema protein-losing enteropathy caused by congenital lymphangiectasia might be considered as a differential diagnosis.
Subject(s)
Hypoproteinemia/congenital , Lymphangiectasis, Intestinal/congenital , Protein-Losing Enteropathies/congenital , Biopsy , Consanguinity , Diagnosis, Differential , Dietary Fats/administration & dosage , Dietary Fats/adverse effects , Duodenum/pathology , Edema/etiology , Edema/pathology , Endothelium, Lymphatic/pathology , Humans , Hypoproteinemia/diagnosis , Hypoproteinemia/diet therapy , Hypoproteinemia/pathology , Infant , Intestinal Mucosa/pathology , Lymphangiectasis, Intestinal/diagnosis , Lymphangiectasis, Intestinal/diet therapy , Lymphangiectasis, Intestinal/pathology , Milk Proteins/administration & dosage , Protein-Losing Enteropathies/diagnosis , Protein-Losing Enteropathies/diet therapy , Protein-Losing Enteropathies/pathologySubject(s)
Dermatitis, Atopic/etiology , Hypoproteinemia/etiology , Dermatitis, Atopic/diet therapy , Female , Humans , Hypoproteinemia/diet therapy , Infant Food , Infant, Newborn , Infant, Newborn, Diseases/diet therapy , Infant, Newborn, Diseases/etiology , Milk Proteins/therapeutic use , Severity of Illness IndexABSTRACT
We report on a patient with protein-losing enteropathy due to primitive intestinal lymphangiectasia with an early reversal of clinical and biochemical signs and a stable late reversal of pathologic signs after treatment with a hypolipidic diet enriched with medium-chain triacylglycerols.
