共查询到20条相似文献,搜索用时 15 毫秒
1.
Zanon P Pattis P Pittscheider W Roscia G De Giorgi G Sacco G Vötter K Stockner I De Giorgi F Wiedermann CJ 《麻醉学,监护医学,急救医学,疼痛治疗》2006,41(3):156-159
Botulism is a rare but potentially fatal disease caused by toxins produced by Clostridium botulinum. We report botulism in two adult females, one of them just tasting from "bad" asparagus and the other eating the full portion. Both patients survived after intermittent mechanical ventilation and trivalent antitoxin administration. The diagnosis was confirmed by detection of botulinum toxin. Acute onset of bilateral cranial neuropathies associated with symmetric descending weakness as well as some key features of the botulism syndrome including absence of fever, symmetric neurologic deficits, the patients remaining responsive and no sensory deficits, with the exception of blurred vision, led to the clinical diagnosis in the first presenting case which was then easily made in the second. Despite the fact that amount of toxin ingested, time-to-symptom development, and time-to-recovery markedly differed in the two patients, their maximal disease severity was similar. 相似文献
2.
A case of severe adult botulism with paralysis, respiratory failure and cranial nerve palsies is presented. The pathophysiology, clinical manifestations, diagnosis and treatment options for botulism are discussed. 相似文献
3.
A case of botulism is reported in a heroin-abusing parturient who initially presented with lethargy and slurred speech. The diagnostic difficulty, complications, intensive care and anaesthetic management of this case are discussed, with particular reference to the pregnancy and the effects of both botulism and its empirical treatment on the fetus. A short review is provided of a condition that has seen a marked increase in its incidence since 2000. 相似文献
4.
Fandiño JN Benchimol AK Fandiño LN Barroso FL Coutinho WF Appolinário JC 《Obesity surgery》2005,15(8):1207-1210
Wernicke-Korsakoff syndrome (WKS) and disordered eating behavior have been reported separately after bariatric surgery. We report a patient who following
a bariatric operation developed WKS associated with a disturbed eating behavior without vomiting. This morbidly obese man
developed an intense fear of gaining weight in the postoperative period and engaged in an extreme form of "food avoidance
behavior". 2 months postoperatively after severe weight loss, he was hospitalized with disorientation and an amnesic syndrome.
He was discharged 2 months later with stable weight and regular eating habits. Despite this, at the last follow-up visit 2
years postoperatively, he still had a residual partial amnesic syndrome. The surgical team must be aware of peculiar forms
of pathological eating that may appear after bariatric surgery; the emergence of an eating avoidance disorder may be associated
with the development of WKS. 相似文献
5.
Timothy D Anderson Udayan K Shah Mark S Schreiner Ian N Jacobs 《Otolaryngology--head and neck surgery》2002,126(3):234-239
OBJECTIVE: The study goal was to understand the incidence, etiology, and management of airway complications in infant botulism. METHODS: We conducted a retrospective review of the period from January 1, 1987, to December 31, 1997. SETTING: Urban tertiary care children's hospital. RESULTS: Of 60 children with infant botulism, 37 (61.7%) required endotracheal intubation for a mean of 21 days. No patient required a tracheostomy. Airway complications (stridor, subglottic stenosis, granuloma formation) occurred in 5 (13.5%) of 37 patients, with 3 requiring surgical bronchoscopy. Of the 37 children, 14 (37.8%), including 4 with airway complications, had endotracheal tube leak pressures recorded. In 3 (50%) of 6 patients with measured leak pressures of greater than 40 cm H2O, airway complications developed. Complications did not develop in patients with leak pressures of less than 20 cm H2O. No correlation between length of intubation and complications could be established. CONCLUSION: Airway complications in infant botulism may be accompanied by high leak pressures and can be managed with endoscopic techniques. The study data suggest that leak pressures should be measured on a regular basis and maintained at less than 20 to 25 cm H2O. A prospective trial to study this issue is warranted. Tracheotomy is not routinely necessary. A high index of suspicion, early diagnosis, and prompt intervention are required for the optimal management of airway complications in infant botulism. 相似文献
6.
Clostridium novyi has recently been identified as the causative organism responsible for the deaths of 35 heroin addicts who had injected themselves intramuscularly. We present two heroin addicts who developed C. botulinum infection following intramuscular or subcutaneous injection of heroin. Like C. novyi, this grows under anaerobic conditions and clinical presentation may be similar; however, descending motor or autonomic signs are invariably present in botulism. The prognosis is good if the diagnosis is made early and appropriate treatment commenced. 相似文献
7.
Binge Eating and its Relationship to Outcome after Laparoscopic Adjustable Gastric Banding 总被引:1,自引:1,他引:0
Larsen JK van Ramshorst B Geenen R Brand N Stroebe W van Doornen LJ 《Obesity surgery》2004,14(8):1111-1117
Background: The aim of this cross-sectional study was to examine short and long-term eating behavior after laparoscopic adjustable
gastric banding (LAGB) and the relationship of binge eating with weight and quality of life outcome. Methods: 250 patients
(221 female, 29 male, mean age 39.6 years, age range 22-61) filled out questionnaires to evaluate quality of life and eating
behavior: 93 patients before LAGB, 48 with a follow-up duration of 8 through 24 months, and 109 patients 25 through 68 months
after LAGB. Results: Compared with patients before surgery, patients after surgery, in both follow-up groups, reported less
binge eating, fat intake, external eating, and more restrained eating and eating self-efficacy. After surgery, about one-third
of the patients showed binge eating problems, which were associated with a worse postoperative outcome. Conclusion: Our results
suggest that eating behavior improves both short- and long-term after surgery for severe obesity. Although LAGB could be a
long-term solution to part of preoperatively eating disordered patients, the identification and treatment of postoperative
binge eating appear critical to promote successful outcome after bariatric surgery. 相似文献
8.
Martina de Zwaan Anja Hilbert Lorraine Swan-Kremeier Heather Simonich Kathy Lancaster L. Michael Howell Tim Monson Ross D. Crosby James E. Mitchell 《Surgery for obesity and related diseases》2010,6(1):79-85
BackgroundWeight loss surgery induces a marked change in eating behavior. However, not much work has been done characterizing the eating behavior after weight loss surgery. We conducted a detailed analysis of patients' eating behavior 18–35 months after Roux-en-Y gastric bypass surgery, determined whether preoperative eating disorders might be associated with non-normative postoperative eating, and examined the association of such eating behaviors with weight loss and psychopathology.MethodsA sample of 59 patients who had undergone Roux-en-Y gastric bypass was interviewed in person after surgery about a range of eating behaviors, including binge eating, chewing and spitting out food, picking at and nibbling food, and nocturnal eating and compensatory behaviors such as vomiting and laxative and diuretic misuse. An established semistructured interview was used. The prevalence of preoperative eating disorders was assessed retrospectively. The eating-related and general psychopathology and quality of life were assessed using self-report questionnaires before and after surgery.ResultsSubjective bulimic episodes were reported by 25% and vomiting for weight and shape reasons by 12% of the participants, on average, 2 years after surgery. Subjective bulimic episodes were significantly associated with a preoperative binge eating disorder, with more eating-related and general psychopathology after surgery, and with less weight loss.ConclusionA substantial subgroup of patients with a preoperative eating disorder will develop binge eating after surgery that might be associated with less weight loss. A subsample will start vomiting for weight and shape reasons after bariatric surgery. Clinicians must probe carefully for these behaviors postoperatively to identify patients in need of treatment of pathological eating behaviors. 相似文献
9.
Rademaker AW Vonesh EF Logemann JA Pauloski BR Liu D Lazarus CL Newman LA May AH MacCracken E Gaziano J Stachowiak L 《Head & neck》2003,25(12):1034-1041
BACKGROUND: Head and neck cancer patients treated with chemoradiation have difficulty eating a normal diet. This study was designed to characterize eating ability over 12 months after chemoradiation treatment. Analyses take patient dropout into account. METHODS: Two hundred fifty-five patients with head and neck cancer treated with chemoradiation were followed for 12 months. Eating ability was analyzed using generalized linear model methods that accounted for non-ignorable dropout. RESULTS: Eating ability was compromised immediately after treatment and improved over 12 months to near pretreatment levels. Ability to eat at most 50% of the diet orally did not return to baseline levels (p <.05). However, the percent of patients eating a normal diet did return to baseline levels. Accounting for dropout modified the results, but the pattern of significance was similar. CONCLUSIONS: Treatment of head and neck cancer with chemoradiation has a significant effect on eating ability, which improves after 12 months after treatment. 相似文献
10.
Boyadjiev I Leone M Garnier F Thomachot L Martin C 《Annales fran?aises d'anesthèsie et de rèanimation》2005,24(11-12):1397-1399
The neurotoxin produced by Clostridium botulinum, is responsible for botulism. The clinical signs are digestive disorders, pupillar alterations, and peripheral muscular weakness. The failure of thoracic muscles is responsible for the severity of botulism. We describe a case of a 74 year old woman who presented a severe form of botulism, requiring a prolonged intensive care unit stay. 相似文献
11.
Background: The effectiveness of topiramate was evaluated in the treatment of recurrent binge eating and weight gain in patients
with binge eating disorder (BED) and obesity who had undergone initially successful bariatric surgery. Methods: The records
of 3 consecutive patients with BED and obesity who presented to our clinic with recurrent binge eating and weight gain after
undergoing initially successful bariatric surgery were reviewed. They were treated with topiramate for an average of 10 months.
Results: All three patients reported complete amelioration of their binge eating symptoms and displayed weight loss (31.7
kg in 17 months, 14.5 kg in 9 months, 2 kg in 4 months, respectively) in response to topiramate (mean dose 541 mg). Conclusion:
Although anecdotal, these observations suggest that topiramate may be an effective treatment for patients with BED and obesity
who experience recurrent binge eating and weight gain after initially successful bariatric surgery. 相似文献
12.
Kathleen Ashton Michelle Drerup Amy Windover Leslie Heinberg 《Surgery for obesity and related diseases》2009,5(2):257-262
BackgroundThe objective of this study was to evaluate the effectiveness of a brief, 4-session cognitive behavioral, group psychotherapy for binge eating among bariatric surgery candidates at an academic medical center. Binge eating behaviors have been linked to poorer outcomes among bariatric surgery patients, and binge eating disorder have be considered a contraindication in surgery programs, some of which have mandated preoperative binge eating treatment. However, no previous studies have examined whether a preoperative binge eating intervention could successfully reduce binge eating behaviors among severely obese bariatric surgery candidates.MethodsA total of 243 bariatric surgery candidates completed a brief cognitive behavioral group treatment for binge eating behaviors and were administered the Binge Eating Scale and reported the number of weekly binge eating episodes at the initial psychological evaluation and again after the group sessions. The study used a pre–post intervention design.ResultsThe results suggested significant reductions in both binge eating behaviors and cognitions and binge eating episodes after the group intervention. The intervention's effectiveness did not differ according to gender or ethnicity (black versus white).ConclusionA brief cognitive behavioral intervention can reduce binge eating behaviors among bariatric surgery candidates. Given the potential influence of binge eating on outcomes, bariatric surgery programs could benefit by treating binge eating before surgery. 相似文献
13.
This article reviews the diagnosis and treatment of achalasia, a rare esophageal motility disorder characterized by absent peristalsis and failure of the lower esophageal sphincter (LES) to relax. Various treatment options including management with sublingual nitrates or calcium channel blockers, injection of the LES with botulism toxin, pneumatic dilation of the LES, and pneumatic dilation are discussed. Laparoscopic Heller myotomy is minimally invasive with incumbent low morbidity and mortality rates, and combined with a partial fundoplication is a durable, safe, and effective treatment option for patients with achalasia. 相似文献
14.
Background: Binge eating and other patterns of disordered eating in obese patients need further investigation. In a previous
study by this author, one-third of patients presenting for bariatric surgery met strict criteria for Binge Eating Disorder.
It is important to clarify the role of such eating behaviors on outcome of surgery to determine whether treatments targeted
specifically at these behaviors and associated psychological issues can improve surgical outcome. The aim of this paper is
to raise awareness of the range of disordered eating patterns in bariatric patients, describe an approach used, and discuss
issues reported by patients after surgery. Methods: Patients completed questionnaires before surgery (QWEP, BES, BDI) and
were seen for a pre-surgery mental health evaluation. High risk patients were identified and invited to attend a postsurgery
group (CBT approach) as a preventive measure to help them deal with eating patterns as well as emotional adjustment. Results:
Disordered eating patterns can persist after surgery. While surgery may decrease actual physical hunger and reduce physical
capacity for food, it is still possible to eat compulsively,although the patterns may change somewhat due to the surgical
procedure. Conclusion: Since long-term weight maintenance depends on post-operative changes in eating behaviors, it is important
to identify patients at risk for a range of disordered eating patterns so that a comprehensive treatment plan that targets
the eating disturbances and associated psychological components can be implemented. 相似文献
15.
Delbos V Abgueguen P Fanello S Brenet O Alquier P Granry JC Pichard E 《Presse medicale (Paris, France : 1983)》2005,34(6):455-459
With a mean of 30 cases reported per year, following Italy, France ranks second in the European countries in terms of incidence of botulism. Food stuff of commercial origin, of artisanal or industrial manufacture fabrication, is increasingly implicated in the genesis of outbreaks of botulism. Moreover, the modern methods of conserving food (vacuum packed food, frozen food...) allow the development of Clostridium bacteria. The diversification of the risks related to the type of products incriminated and to the new conservation methods, associated with the extension of commercial exchanges, result in the risk of widespread internationally outbreaks of botulism. 相似文献
16.
We report a case of infant botulism presenting as primary colonic ileus—mimicking Hirschprung's megacolon. Infant botulism should be considered in any infant with constipation and neurologic abnormalities. 相似文献
17.
Margot van den Heuvel Rogier Hörchner Anneke Wijtsma Noufissa Bourhim Dascha Willemsen Elisabeth M. H. Mathus-Vliegen 《Obesity surgery》2011,21(6):714-721
Background
Previous studies have suggested that patients who are defined as so-called sweet eaters have more difficulties to lose weight and to maintain weight loss after both conservative treatment and restrictive bariatric surgery, such as gastric banding. There is, however, no agreement on the definition of sweet eating. Also, a questionnaire to measure sweet eating is not available. Therefore, the aim of our study was to agree on a definition of sweet eating and to construct a valid and reliable questionnaire that might be of help to assess the influence of sweet eating on weight loss after bariatric surgery. 相似文献18.
19.
Saunders R 《Obesity surgery》2004,14(8):1128-1131
Background: The prevalence of both compulsive eating patterns (bingeing and "grazing") and psychosocial distress and/or psychiatric
co-morbidity in patients seeking bariatric surgery has been documented. While surgery is often seen as the solution, research
has shown that these problems can persist postoperatively and may adversely affect outcome. This paper will describe a postoperative
psychotherapy group process designed specifically for gastric bypass patients. Methods: A semi-structured cognitive-behavioral
group therapy program adapted from a treatment program for compulsive eaters was designed for patients who had been identified
(by questionnaire and clinical interview) as having compulsive eating problems before surgery. Therapy addresses eating patterns
as well as the emotional adjustments following surgery. Results: 16 12-week therapy groups have been conducted to date. The
groups are small and designed to help patients understand the stages of postoperative adjustment and the tasks, both eating-related
and psychological, associated with each stage. Feedback from participants has been very positive with patients reporting the
need for a therapy group in addition to the traditional support group. Conclusion: Since both disturbed eating patterns and
psychological difficulties are seen following surgery, it is imperative that treatment programs be developed to address these
issues. The group process is a highly effective intervention but must be designed for the special needs of these patients.
Measures of success need to take psycho-social factors into account as well as eating behaviors and weight loss. Outcome studies
are needed to compare those receiving treatment vs those who do not. 相似文献
20.
Sarwer DB Moore RH Spitzer JC Wadden TA Raper SE Williams NN 《Surgery for obesity and related diseases》2012,8(5):561-568
BackgroundBariatric surgery is a powerful treatment of severe obesity. During the past several years, a greater appreciation for the need for multidisciplinary care to optimize outcomes has developed, and a number of studies have been started to examine the role of postoperative interventions used in combination with surgery. The purpose of the present study was to investigate the hypothesis that the provision of postoperative dietary counseling, delivered by a registered dietitian, would lead to greater weight loss and more positive improvements in dietary intake and eating behavior compared with standard postoperative care. The study was performed at an academic medical center.MethodsEighty-four individuals who underwent bariatric surgery were randomly assigned to receive either dietary counseling or standard postoperative care for the first 4 months after surgery. The participants completed measures of macronutrient intake and eating behavior at baseline and 2, 4, 6, 12, 18, and 24 months after surgery.ResultsThe patients who received dietary counseling achieved greater weight loss than those who received standard postoperative care that did not involve this counseling, although this difference did not reach statistical significance. Patients in the dietary counseling arm did report significant changes in several eating behaviors believed to be important to successful long-term weight maintenance.ConclusionThe results of our pilot study provide some support for the efficacy of early postoperative dietary counseling to improve outcomes after bariatric surgery. 相似文献