1
|
Kawasaki Y, Ejiri S, Hakozaki M, Konno S. Impaired Extension of the Digits due to Bilateral Idiopathic Intrinsic Contracture: A Case Report. J Hand Surg Asian Pac Vol 2019; 24:383-385. [PMID: 31438786 DOI: 10.1142/s2424835519720160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Idiopathic intrinsic contracture (IIC) with no history of trauma, ischemia, or spasticity is extremely rare. We report herein a case of impaired extension of the digits due to bilateral IICs occurred in a 30-year-old woman with a past medical history of eating disorder and amenorrhea. Although no previous case has been reported in the literature, eight similar cases of IIC have been presented at Japanese domestic conferences. In these eight cases and the present case, resection of the thenar muscle cords and unilateral resection of the lateral band were effective. Since IIC in patients with an eating disorder is a rare condition, it would be treated conservatively at first as tendon sheath inflammation or locking. However, this condition may be resistant to conservative treatment, and surgical treatment should be considered in such cases.
Collapse
Affiliation(s)
- Yuki Kawasaki
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Fukushima, Japan.,Department of Regional Medical Support for Orthopaedic Surgery, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Soichi Ejiri
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Fukushima, Japan.,Department of Regional Medical Support for Orthopaedic Surgery, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Michiyuki Hakozaki
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Shinichi Konno
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Fukushima, Japan
| |
Collapse
|
2
|
Kawai K, Yamashita S, Yamanaka T, Gondo M, Morita C, Nozaki T, Takakura S, Hata T, Yamada Y, Matsubayashi S, Takii M, Kubo C, Sudo N. The longitudinal BMI pattern and body composition of patients with anorexia nervosa who require urgent hospitalization: A case control study. Biopsychosoc Med 2011; 5:14. [PMID: 22142436 PMCID: PMC3275451 DOI: 10.1186/1751-0759-5-14] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2011] [Accepted: 12/05/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The prevention of serious physical complications in anorexia nervosa (AN) patients is important. The purpose of this study is to clarify which physical and social factors are related to the necessity for urgent hospitalization of anorexia nervosa (AN) patients in a long-term starvation state. We hypothesized that the change of longitudinal BMI, body composition and social background would be useful as an index of the necessity for urgent hospitalization. METHODS AN patients were classified into; urgent hospitalization, due to disturbance of consciousness or difficulty walking(n = 17); planned admission (n = 96); and outpatient treatment only groups (n = 136). The longitudinal BMI pattern and the clinical features of these groups were examined. In the hospitalization groups, comparison was done of body composition variation and the social background, including the educational level and advice from family members. RESULTS After adjusting for age and duration of illness, the BMI of the urgent hospitalization group was lower than that of the other groups at one year before hospitalization (P < 0.01) and decreased more rapidly (P < 0.01). Urgent hospitalization was associated with the fat free mass (FFM) (P < 0.01). Between the groups, no considerable difference in social factors was found. CONCLUSIONS The longitudinal pattern of BMI and FFM may be useful for understanding the severity in AN from the viewpoint of failure of the homeostasis system.
Collapse
Affiliation(s)
- Keisuke Kawai
- Department of Psychosomatic Medicine, Graduate School of Medical Science, Kyushu University, Fukuoka, Japan, 3-1-1 Higashi-ku, Fukuoka, Japan 812-8582.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
3
|
Baş M, Karabudak E, Kiziltan G. Vegetarianism and eating disorders: association between eating attitudes and other psychological factors among Turkish adolescents. Appetite 2005; 44:309-15. [PMID: 15927731 DOI: 10.1016/j.appet.2005.02.002] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2004] [Revised: 10/30/2004] [Accepted: 02/18/2005] [Indexed: 11/26/2022]
Abstract
The purpose of this study was to determine whether differences exist in eating attitudes, self-esteem, social trait anxiety and social physique anxiety of self-reported vegetarian and nonvegetarian Turkish adolescents. The sample for the Turkish University' students is designed to provide the estimates of vegetarian indicators and prevalence. The participants were 608 females and 597 males, in total 1205 adolescents aged between 17 and 21 years. Disturbed eating behaviors (EAT-26> or =20) was found in 45.2% (14 of vegetarian) of the total vegetarian sample; which included two of the male vegetarians and 12 of the female vegetarians. The mean BMI was 19.78+/-1.49 kg/m(2) for female vegetarians and 20.78+/-2.46 kg/m(2) for female nonvegetarians (p<0.05). Male vegetarians had significantly higher score than male nonvegetarians on EAT-26 (17.25+/-11.18 for male vegetarians and 9.38+/-6.60 for male nonvegetarians), dieting (6.50+/-7.65 for male vegetarians and 2.55+/-3.87 for male nonvegetarians) and oral control (6.13+/-4.67 for male vegetarians and 3.20+/-3.19 for male nonvegetarians) scores (p<0.05). Besides, female vegetarians had significantly higher score than female nonvegetarians on EAT-26 (22.04+/-13.62 for female vegetarians and 11.38+/-8.28 for female nonvegetarians), dieting (10.35+/-9.58 for female vegetarians and 4.41+/-5.30 for female nonvegetarians), oral control (7.78+/-5.13 for female vegetarians and 3.33+/-3.51 for female nonvegetarians) and STAI (51.39+/-7.28 for female vegetarians and 47.29+/-5.13 for female nonvegetarians) scores (p<0.05). As a conclusion, the present study indicated abnormal eating attitudes, low self-esteem, high social physique anxiety, and high trait anxiety in Turkish vegetarian adolescents. The vegetarian adolescents may be more likely to display disordered eating attitudes and behaviors than nonvegetarians.
Collapse
Affiliation(s)
- Murat Baş
- Department of Nutrition and Dietetics, Health Sciences Faculty, Baskent University, Bağlica Kampusu, Eskişehir Yolu 20.km, 06530 Ankara, Turkey.
| | | | | |
Collapse
|
4
|
Franssen FME, Wouters EFM, Schols AMWJ. The contribution of starvation, deconditioning and ageing to the observed alterations in peripheral skeletal muscle in chronic organ diseases. Clin Nutr 2002; 21:1-14. [PMID: 11884007 DOI: 10.1054/clnu.2001.0485] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Muscle weakness and early fatigue are common symptoms of chronic organ diseases, like chronic obstructive pulmonary disease (COPD), chronic heart failure (CHF) and chronic renal failure (CRF). It is becoming more and more clear that symptom intensities and exercise intolerance are related to muscle wasting and intrinsic alterations in peripheral skeletal muscle in these patient populations, while correlations with parameters of organ functioning are poor. Also, changes in muscle structure and function in COPD, CHF and CRF show much resemblance. Semi-starvation, reduced physical activity and ageing are external factors possibly confounding a direct relationship between the primary organ impairments and alterations in peripheral skeletal muscle and exercise capacity. Reducing the catabolic effects of the various contributing factors might improve muscle function and health status in chronic disease. In this review, we present a systematic overview of human studies on alterations in skeletal muscle function, morphology and energy metabolism in COPD, CHF, CRF and we compare the results with comparable studies in anorexia nervosa, disuse or inactivity and ageing. Unravelling the relative contributions of these external factors to the observed alterations in the various diseases may contribute to targeted intervention strategies to improve muscle function in selected groups of patients.
Collapse
Affiliation(s)
- F M E Franssen
- Department of Pulmonology, University Hospital Maastricht, The Netherlands
| | | | | |
Collapse
|
5
|
Abstract
Eating disorders are serious illnesses affecting 1-2% of young women. Patients may present to any doctor, sometimes atypically (e.g. unexplained weight loss, food allergy, infertility, diarrhoea), delaying diagnosis and leading to needless investigation. The cardinal signs are weight loss, amenorrhoea, bingeing with vomiting and other compensatory behaviours, and disturbances in body image with an exaggeration of the importance of slimness. When other causes have been excluded, useful investigations are serum potassium, bone mineral density scanning and pelvic ultrasound. In emaciated patients multiple systems may fail with pancytopaenia, neuromyopathy and heart failure. Clinical assessment of muscle power is used to monitor physical risk. Treatment may involve individual, group or family sessions, using cognitive-behavioural, psychodynamic and family approaches. More severe or intractable illness is treated with day care, with in-patient care in a medical or specialist psychiatric unit reserved for the most severely ill patients. Antidepressants have a place in the treatment of bulimia nervosa unresponsive to psychological approaches, and when severe depressive symptoms develop. The children of people with eating disorders may have an increased risk of difficulties. Support for the patient and family, and effective liaison between professionals, are essential in the treatment of severe eating disorders.
Collapse
Affiliation(s)
- P H Robinson
- Department of Psychiatry, Royal Free Hospital, London, UK.
| |
Collapse
|
6
|
|
7
|
McLoughlin DM, Wassif WS, Morton J, Spargo E, Peters TJ, Russell GF. Metabolic abnormalities associated with skeletal myopathy in severe anorexia nervosa. Nutrition 2000; 16:192-6. [PMID: 10705074 DOI: 10.1016/s0899-9007(99)00286-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The aim of this study was to characterize the metabolic disturbance associated with the skeletal myopathy resulting from extreme weight loss in anorexia nervosa. Muscle function was examined in eight female patients with severe (40%) weight loss due to anorexia nervosa and histologically confirmed myopathy. A wide range of biochemical and hematologic investigations were carried out, including serum enzymes and the response of plasma lactate to ischemic exercise of forearm muscles. All patients showed proximal muscular weakness. A diminished lactate response to ischemic exercise was a consistent finding, and a reduction of serum carnosinase activity was also found. There were no other consistent biochemical or hematologic abnormalities apart from lymphopenia of no clinical consequence. These findings contribute to our understanding of severe protein-energy malnutrition on the musculoskeletal system. The resulting disorder is a metabolic myopathy from which the patients recover rapidly as their nutrition improves. Although the patients admitted to a variety of abnormal eating behaviors, no correlation was found between a specific type of abnormal eating behavior and subsequent biochemical abnormalities. Reinstating appropriate eating behavior will treat the myopathy.
Collapse
Affiliation(s)
- D M McLoughlin
- Department of Psychiatry, Institute of Psychiatry, London, UK
| | | | | | | | | | | |
Collapse
|
8
|
Morton J, McLoughlin DM, Whiting S, Russell GF. Carnitine levels in patients with skeletal myopathy due to anorexia nervosa before and after refeeding. Int J Eat Disord 1999; 26:341-4. [PMID: 10441250 DOI: 10.1002/(sici)1098-108x(199911)26:3<341::aid-eat12>3.0.co;2-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To assess the role of carnitine in the skeletal myopathy present in anorexia nervosa. METHOD Serum levels of free and total carnitine were measured in a group of severely underweight women with anorexia nervosa and skeletal myopathy before and after an inpatient refeeding program. RESULTS Carnitine levels were within the reference range before refeeding and remained unchanged despite significant weight gain in all the subjects. CONCLUSION These findings suggest that carnitine plays no part in the muscle weakness seen in severe anorexia nervosa.
Collapse
Affiliation(s)
- J Morton
- Department of Clinical Pathology, The Maudsley Hospital, London, United Kingdom
| | | | | | | |
Collapse
|
9
|
Snape MD, Sawyer SM, Nash MC. Weight loss and purpura. Lancet 1999; 354:1352. [PMID: 10533865 DOI: 10.1016/s0140-6736(99)08095-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- M D Snape
- Royal Children's Hospital, Victoria, Australia
| | | | | |
Collapse
|
10
|
Abstract
Eating disorders lead to numerous physical complaints with signs and symptoms affecting nearly every organ system of the body. We review the presentation of a patient with eating disorder to the primary care giver or general psychiatrist, focusing on the physical manifestations of the underlying illness. Specific complications related to laboratory findings, the gastrointestinal tract, and the endocrine system are reviewed. Algorithms for medical evaluation of these patients are also presented.
Collapse
Affiliation(s)
- C P Carney
- Department of Internal Medicine, University of Iowa College of Medicine, Iowa City, USA
| | | |
Collapse
|
11
|
Abstract
A 19-year-old female patient with anorexia nervosa developed profound weight loss over 1 year associated with vegetarianism and excessive exercise. There was severe wasting and proximal muscle weakness in the legs and bilateral weakness of eye closure. A purpuric rash developed due to vitamin C deficiency. This case demonstrates a new neurological sign in anorexia nervosa indicating a weakness of the orbicularis oculi muscles as part of a more general myopathy. The myopathic and scorbutic features may have a common pathogenesis.
Collapse
Affiliation(s)
- P W Woodruff
- Institute of Psychiatry, De Crespigny Park, Denmark Hill, London, United Kingdom
| | | | | |
Collapse
|
12
|
Abstract
The physical complications of anorexia nervosa are common and can be life threatening, but psychiatrists and the increasing number of non-medical therapists involved in treatment programmes often overlook these complications. Cardiovascular complications are the most common, and the most likely to result in fatalities, particularly in those patients who vomit, purge or abuse diuretics, because of the electrolyte abnormalities induced. Osteoporosis is an early and perhaps irreversible consequence of severe weight loss. Further, there are dangers in rapid intravenous hyperalimentation.
Collapse
Affiliation(s)
- C W Sharp
- Department of Psychiatry, Royal Edinburgh Hospital, University of Edinburgh
| | | |
Collapse
|
13
|
Abstract
A 41 year old woman with severe emaciation due to longstanding anorexia nervosa presented with recurrent hypoglycaemia. During an episode of hypoglycaemia, serum insulin and C peptide were undetectable and plasma beta hydroxybutyrate, free fatty acids and lactate were inappropriately low. Response to intravenous glucagon was poor. Muscle enzymes were grossly elevated until she gained weight. Hypoglycaemia was abolished by weight gain.
Collapse
|
14
|
Abstract
Seventeen patients with anorexia nervosa were examined by computed tomography (CT) and psychometry and compared with ten normal control subjects. The patients were found to have enlarged external cerebrospinal fluid spaces compared to controls. No differences were found in ventricular size and X-ray absorption density measurements between patients and controls. The patients performed abnormally on the symbol digit test, the scores of which displayed a significant negative correlation with the CT scan changes.
Collapse
Affiliation(s)
- E Palazidou
- Department of Psychiatry, King's College Hospital, London
| | | | | |
Collapse
|