Anorexia Nervosa

Prevalence of malnutrition in medical and surgical wards of a university hospital

2009-07-02T15:30:00.000-07:00

Malnutrition is frequently found in hospitals, where is related to poor outcomes. There are contradictory data about if prevalence of malnutrition is greater in surgical or medical patients. The aim of this study is to know the prevalence of malnutrition in both groups of patients.

METHODS:
The nutritional status of 189 patients from medical and surgical wards was assessed with Subjective Global Assessment, and data about sex, age, length of hospital stay, mortality, diseases, and wards of admission were collected. Qualitative variables were compared with chi-square test, and independent quantitative variables with Student's t test. P < 0.05 was accepted as significative.

RESULTS:
The prevalence of malnutrition was 40.2%. Malnourished patients have lost 7.3% of their weight, 67.1% referred a diminished oral intake, and 53.9% anorexia. Malnutrition was significatively associated to male sex, greater length of stay, and cancer.

Prevalence and severity of malnutrition were similar in medical and surgical wards, and malnourished patients just differed in diseases (chronic diseases in medical; surgical procedures and cancer in surgery).

CONCLUSIONS:
Malnutrition is equally prevalent in medical and surgical wards, probably due to different but highly frequent risk factors, and is related to a longer hospital stay.

"Prevalence of malnutrition in medical and surgical wards of a university hospital"
Vidal A, Iglesias MJ, Pertega S, Ayúcar A, Vidal O
Nutr Hosp. 2008 May-Jun ; 23(3): 263-7 (Hubmed.org)

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Treatment of Anorexia And Bulimia | Symptoms of Anorexia And Bulimia |Causes of Anorexia And Bulimia

Self-schemas as predictors of disordered eating behaviors

2009-07-02T05:26:00.000-07:00

There is broad consensus that the eating disorders of anorexia nervosa and bulimia nervosa stem from fundamental disturbances in identity development, but theoretically based empirical support is lacking.

OBJECTIVE:
To extend work on the identity impairment model by investigating the relationship between organizational properties of the self-concept and change in disordered eating behaviors (DEB) in an at-risk sample of college women transitioning between freshman and sophomore years.

METHODS:
The number, valence, and organization of self-schemas; availability of a fat body weight self-schema; and DEB were measured at baseline in the freshman year and 6 and 12 months later in a community-based sample of college women engaged in subthreshold DEB (n = 77; control: n = 41). Repeated-measures analyses of variances were used to examine group differences, and hierarchical regression analyses were used to predict disordered eating behaviors.

RESULTS:
Women in the DEB group had more negative self-schemas at baseline and showed information-processing evidence of a fat self-schema compared with the controls. The groups did not differ in the number of positive self-schemas or interrelatedness.

The number of negative self-schemas predicted increases in the level of DEB at 6- and 12-month follow-up, and these effects were mediated through the fat self-schema. The number of positive self-schemas predicted the fat self-schema score but was not predictive of increases in DEB. Interrelatedness of the self-concept was not a significant predictor in this model.

DISCUSSION:
Impairments in overall collection of identities are predictive of the availability in memory of a fat self-schema, which in turn is predictive of increases in DEB during the transition to college in a sample of women at risk for an eating disorder. Therefore, organizational properties of the self-concept may be an important focus for effective primary and secondary prevention.

"The identity impairment model: a longitudinal study of self-schemas as predictors of disordered eating behaviors"
Stein KF, Corte C
Nurs Res. 2008 May-Jun ; 57(3): 182-90 (Hubmed.org)

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The Treatment of Anorexia | Causes of Anerexia

Eating disorders and headache: coincidence or consequence ?

2009-07-02T01:20:00.000-07:00

The eating disorders anorexia nervosa and bulimia nervosa are important psychiatric and somatic conditions occurring mainly in young women. The aetiology is unknown, but there are social, biological and psychological factors that play a relevant role in the pathogenesis, along with multiple endocrine abnormalities.

Hypothalamic monoamines (especially serotonin), neuropeptides (especially neuropeptide Y and cholecystokinin) and leptin are involved in the regulation of the human appetite. eating disorders share with migraine the same metabolic profile and aspect of psychiatric and psychological conditions.

In support of this hypothesis in one study, it has been shown that the incidence of migraine is high in these patients; and it has been shown that the incidence in a female group that suffers from migraine was greater than in the normal population.

In order to understand the possible relationship between migraine and eating disorders, we have investigated the incidence of primary headache in a group of anorexia nervosa and bulimia nervosa patients. The result of this study shows that the prevalence of migraine in women affected by anorexia nervosa and bulimia nervosa is very high (75%) in comparison to the general population (12.5% headache incidence in normal population).

In most patients the onset of migraine attacks began before or at the same time as the symptoms of anorexia nervosa and bulimia nervosa. We suggest that migraine is a predisposing condition for the occurence of AD in young women.

"Eating disorders and headache: coincidence or consequence ?"
Ostuzzi R, D'Andrea G, Francesconi F, Musco F
Neurol Sci. 2008 May ; 29 Suppl 1: S83-7 (Hubmed.org)

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Successful Treatment of Anorexia Nervosa | Physical Symptoms of Anorexia | Causes And Effects of Anorexia, Causes of Anerexia

Phase I trial of nanoparticle albumin-bound paclitaxel in combination with gemcitabine in patients with thoracic malignancies

2009-07-01T20:49:00.000-07:00

Nab-paclitaxel has a different toxicity profile than solvent-based paclitaxel including a lower rate of severe neutropenia. This trial was designed to determine the maximum tolerated dose and dose limiting toxicities (DLT) of nab-paclitaxel in combination with gemcitabine.

METHODS:
Patients were required to have a performance status of 0 to 1, < or = three prior cytotoxic chemotherapy regimens, and preserved renal, hepatic, and bone marrow function. Patients received gemcitabine 1000 mg/m on days 1, 8 in all cohorts, and nab-paclitaxel at doses of 260, 300, 340 mg/m every 21 days depending on the treatment cohort (1 cycle = 21 days).

DLT were assessed after the first cycle, and doses were escalated in cohorts of 3 to 6 patients.

RESULTS:
Eighteen patients were consented and 15 patients are evaluable [median age 62 years (range, 35-75); median number of prior treatments 3 (range, 1-4); tumor types: non-small cell lung cancer (NSCLC) (n = 8), small cell lung cancer (SCLC) (n = 6), and esophageal cancer (n = 1)].

At a nab-paclitaxel dose of 300 mg/m, 1 of 6 pts experienced a DLT (omission of day 8 gemcitabine due to absolute neutrophil count < 500), and at an nab-paclitaxel dose of 340 mg/m 2 of 3 patients experienced a DLT (1 pt grade 3 rash and pruritus; 1 pt grade 3 fatigue and anorexia). Responses were observed in NSCLC and SCLC.

CONCLUSIONS: The maximum tolerated dose of nab-paclitaxel is 300 mg/m in combination with gemcitabine 1000 mg/m on days 1, 8 every 21 days. This combination demonstrated activity in previously treated NSCLC and SCLC patients.

"Phase I trial of nanoparticle albumin-bound paclitaxel in combination with gemcitabine in patients with thoracic malignancies"
Stinchcombe TE, Socinski MA, Lee CB, Hayes DN, Moore DT, Goldberg RM, Dees EC
J Thorac Oncol. 2008 May ; 3(5): 521-6 (Hubmed.org)

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The Treatment of Anorexia Nervosa | Early Symptoms of Anorexia | Biological Causes of Anorexia Nervosa

Illness intrusiveness in anorexia nervosa

2009-07-01T15:44:00.000-07:00

"Illness intrusiveness" refers to illness-induced lifestyle disruptions. The primary aim of the current study was to compare the level of illness intrusiveness in anorexia nervosa (AN) to that reported in a variety of other chronic medical and psychiatric conditions.

A secondary aim was to compare the two subtypes of anorexia nervosa (binge/purge vs. restricting) in terms of the nature and extent of illness intrusiveness. A final goal was to examine changes in the level of illness intrusiveness in AN following successful completion of specialized inpatient treatment.

METHODS:
The participants were a consecutive series of 121 female inpatients with anorexia nervosa who were admitted to a specialized inpatient unit for treatment of the eating disorder. Assessments took place before and after inpatient treatment and at 3-month follow-up.

RESULTS:
At baseline, illness intrusiveness scores for anorexia nervosa patients were significantly higher than those reported by women in the medical and psychiatric comparison groups. Overall, illness intrusiveness scores decreased (i.e., improved) significantly following successful completion of inpatient treatment.

Among patients with the restricting subtype, scores continued to improve during follow-up, whereas this was not the case among patients with the binge-purge subtype of anorexia nervosa, whose scores did not change significantly during follow-up.

CONCLUSION:
Despite being notoriously ambivalent about change, these findings suggest that anorexia nervosa patients perceive their illness to be highly disruptive to a variety of life domains, even more so than patients with other chronic medical and psychiatric conditions.

"Illness intrusiveness in anorexia nervosa"
Carter JC, Bewell C, Devins GM
J Psychosom Res. 2008 May ; 64(5): 519-26 (Hubmed.org)

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Most Successful Treatment of Anorexia | Signs And Symptoms of Anorexia Nervosa | Biological Causes of Anorexia Nervosa

Partial laparoscopic splenectomy for splenic abscess

2009-07-01T01:37:00.000-07:00

Splenic abscess as a presentation of a Salmonella infection is described in children and adults. A combination of antibiotics and splenectomy is the standard treatment. We report a 12-year-old girl admitted to the hospital with fever, abdominal pain, and anorexia.

White blood cell count was 17,900/microL and C-reactive protein level was 230 mg/L; abdominal ultrasound and abdominal computed tomographic (CT) scan showed a splenic abscess of 11.3 x 12.9 x 13.8 cm in the upper part of the spleen.

She was treated with percutaneous drainage and antibiotics for 8 days. A week later, she represented with a recurrent abscess and identical symptoms. She was treated with percutaneous drainage and intravenous (i.v.) antibiotics for 21 days followed by oral therapy for another 2 weeks.

Abscess culture grew Salmonella type B. Because of a persistent abscess on CT scan, she underwent a partial laparoscopic splenectomy with radiofrequency ablation to preserve functional splenic tissue.

The operative and postoperative course was uneventful. Pathologic finding showed an inflammatory cystic reaction without epithelial cell lining. Splenic abscess in children is a rare condition. Long-term antibiotic therapy is needed. Percutaneous drainage can be a temporary solution, but (partial) splenectomy is the final treatment in most cases.

"Partial laparoscopic splenectomy for splenic abscess because of Salmonella infection: a case report"
De Greef E, Hoffman I, Topal B, Broers C, Miserez M
J Pediatr Surg. 2008 May ; 43(5): E35-8 (Hubmed.org)

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Treatments of Anorexia | Signs And Symptoms of Anorexia | Biological Causes of Anorexia

Central versus peripheral antagonism of cannabinoid CB1 receptor in obesity

2009-06-30T15:33:00.000-07:00

The endogenous cannabinoid system plays an important modulatory role in feeding behaviour and metabolism, acting at both central and peripheral levels.

Chronic administration of cannabinoid CB(1) receptor antagonists has been found to be effective in experimental obesity. However, clinically available cannabinoid receptor antagonists are inverse agonists that can target CB(1) receptors located in both central circuits regulating appetite and motivation and in peripheral organs regulating metabolism and energy expenditure.

This profile complicates understanding of cannabinoid CB(1) receptor blockade as a therapeutic strategy in obesity and metabolic disorders. This review aims to explore the relevance of both inverse agonism and peripheral cannabinoid receptor blockade on the beneficial actions of chronic cannabinoid receptor blockade, by comparing the actions of the reference antagonist/inverse agonist rimonabant and the newly designed drug LH-21. LH-21 is a triazol derivative and a neutral cannabinoid receptor antagonist; it has a poor penetration rate into the central nervous system.

When given acutely it decreases food intake and enhances the anorectic actions of oleoylethanolamide, a feeding suppressant lipid that acts on peripheral sensory terminals in a similar way as rimonabant.

Unlike rimonabant, chronic administration of LH-21 (3 mg/kg) reduces feeding but does not improve hypertriglyceridaemia or hypercholesterolaemia; nor does it reduce liver fat deposits in Zucker rats. These results suggest that the inverse agonism and/or the antagonism of central cannabinoid CB(1) receptors are necessary for the metabolic benefits of cannabinoid CB(1) receptor blockade, but not for the appetite reduction.

"Central versus peripheral antagonism of cannabinoid CB1 receptor in obesity: effects of LH-21, a peripherally acting neutral cannabinoid receptor antagonist, in Zucker rats"
Pavón FJ, Serrano A, Pérez-Valero V, Jagerovic N, Hernández-Folgado L, Bermúdez-Silva FJ, Macías M, Goya P, de Fonseca FR
J Neuroendocrinol. 2008 May ; 20 Suppl 1: 116-23 (Hubmed.org)

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Treatment of Anorexia Nervosa | Symptoms of Anorexia Nervosa | Causes of Anorexia Nervosa

An assessment of daily food intake in participants with anorexia nervosa in the natural environment

2009-06-30T04:33:00.000-07:00

To examine the caloric intake in women with anorexia nervosa (AN) and how it varies by day as a function of the presence or absence of binge eating and/or purging behaviors.

METHOD:
Female participants with AN (n = 84, mean age = 24.4, range 18-51) were recruited from three different sites. Data on food intake were obtained through the use of 24-h dietary recall using the Nutritional Data Systems for Research, and data on binge eating and purging behaviors were collected on palmtop computers using an ecological momentary assessment paradigm.

Daily macronutrient intake was compared on days during which binge eating and/or purging behaviors did or did not occur.

RESULTS:
On days during which binge eating and purging behaviors both occurred, participants reported significantly greater kilocalorie intake when compared with days when neither behavior occurred, or when only binge eating or purging occurred. Binge eating episodes were only modest in size on days when purging did not occur. Energy intake overall was higher than expected.

DISCUSSION:
Intake on days where binge eating occurred varied dramatically based on whether or not purging occurred. Whether markedly increased binge eating intake was causally related to purging is unclear. Nonetheless eating episodes were at times quite large and equivalent to those reported by participants with bulimia nervosa in other research.

"An assessment of daily food intake in participants with anorexia nervosa in the natural environment"
Burd C, Mitchell JE, Crosby RD, Engel SG, Wonderlich SA, Lystad C, Le Grange D, Peterson CB, Crow S
Int J Eat Disord. 2009 May ; 42(4): 371-4 (Hubmed.org)

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Treatments of Anorexia | Signs And Symptoms of Anorexia | Causes And Effects of Anorexia

An examination of decision making in bulimia nervosa.

2009-06-30T01:35:00.000-07:00

Patients with eating disorders favor immediate gratification and ignore long-term negative consequences. This study investigated decision making in bulimia nervosa using the Iowa Gambling Task (IGT) and skin conductance responses (SCR).

METHOD:
A total of 26 bulimia nervosa patients and 51 healthy controls took part in this study; 29 patients with anorexia nervosa were included for comparison.

RESULTS:
Bulimia nervosa patients performed poorly in the IGT, but showed no decrease in anticipatory SCR, whereas a markedly diminished anticipatory SCR was seen in the anorexia nervosa group.

CONCLUSIONS:
This finding does not support the somatic marker hypothesis. Impaired decision making was associated with obsessive-compulsive traits.

"An examination of decision making in bulimia nervosa"
Liao PC, Uher R, Lawrence N, Treasure J, Schmidt U, Campbell IC, Collier DA, Tchanturia K
J Clin Exp Neuropsychol. 2009 May ; 31(4): 455-61 (Hubmed.org)

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Treatment of Anorexia Nervosa | Symptoms of Anorexia Nervosa | Biological Causes of Anorexia

Protein modulates superoxide dismutase and neuropeptide Y-mediated feeding behavior

2009-06-26T01:13:00.000-07:00

The appetite-suppressing effect of phenylpropanolamine (PPA) has been attributed to its inhibitory action on neuropeptide Y (NPY), an appetite stimulant. However, molecular mechanisms underlying this effect are not clear.

This study aimed to investigate if cAMP response element binding protein (CREB) signaling was involved. Moreover, possible role of superoxide dismutase-2 (SOD-2) during PPA treatment was also examined.

Rats were daily treated with PPA for 4 days. Changes in hypothalamic NPY, protein kinase A, CREB, and SOD-2 mRNA contents were measured and compared. Results showed that protein kinase A, CREB, and SOD-2 mRNA levels increased during PPA treatment, which is concomitant with decreases in NPY and feeding.

Moreover, CREB DNA binding activity detected by electromobility shift assay increased during PPA treatment, revealing an involvement of CREB-dependent gene transcription. Furthermore, infusions of CREB antisense oligonucleotide (or missense control) into cerebroventricle were performed at 1 h before daily PPA treatment in free-moving rats, and results showed that CREB knockdown could block PPA-induced anorexia and modify NPY and SOD-2 mRNA content toward normal.

It is suggested that CREB signaling may participate in the central regulation of PPA-mediated appetite suppression via the modulation of NPY gene expression and that an increase of SOD-2 may favor this modulation

"Transcriptional interruption of cAMP response element binding protein modulates superoxide dismutase and neuropeptide Y-mediated feeding behavior in freely moving rats"
Hsieh YS, Yang SF, Chu SC, Ho YJ, Kuo CS, Kuo DY
J Neurochem. 2008 May ; 105(4): 1438-49 (Hubmed.org)

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Treatment Of Anorexia, Treatment of Anorexia Nervosa, Treatments of Anorexia, Most Successful Treatment of Anorexia, Successful Treatment of Anorexia Nervosa, The Treatment of Anorexia, The Treatment of Anorexia Nervosa, Treatment of Anorexia And Bulimia | Symptoms Of Anorexia, Symptoms of Anorexia Nervosa, Signs And Symptoms of Anorexia, Signs And Symptoms of Anorexia Nervosa, Early Symptoms of Anorexia, Early Symptoms of Anorexia Nervosa, Physical Symptoms of Anorexia, Symptoms of Anorexia And Bulimia, Symptons of Anorexia, Symtoms of Anorexia, The Symptoms of Anorexia, The Symptoms of Anorexia Nervosa | Causes of Anorexia, Causes of Anorexia Nervosa, Biological Causes of Anorexia, Biological Causes of Anorexia Nervosa, Causes And Effects of Anorexia, Causes of Anerexia, Causes of Anorexia And Bulimia, Psychological Causes of Anorexia, Social Causes of Anorexia, The Causes of Anorexia, The Causes of Anorexia Nervosa

Temporal occurrence and environmental risk factors

2009-06-25T01:03:00.000-07:00

Cytauxzoon felis is a tick-transmitted protozoan parasite of domestic and wild felids in the south-central and southeastern United States. Infection of domestic cats (Felis domesticus) with C. felis is typically acute and characterized by fever, anorexia, listlessness, anemia, icterus and usually death within 19-21 days.

To determine the temporal occurrence and environmental risk factors associated with infection of C. felis in domestic cats from Oklahoma, information in the electronic medical records from the Oklahoma Animal Disease Diagnostic Laboratory (OADDL) and Boren Veterinary Medical Teaching Hospital (BVMTH) was retrospectively searched.

A total of 232 cytauxzoonosis cases from 1995 to 2006 from OADDL (n=180) and 1998 to 2006 from BVMTH (n=52) were combined and analyzed. The number of cytauxzoonosis cases remained relatively consistent from year to year.

Diagnosis of C. felis infection in domestic cats followed a bimodal pattern with a peak in the number of cases in April, May, and June followed by a second smaller peak in August and September.

The majority (n=72; 31.0%) of cytauxzoonosis cases were diagnosed in May. No cases of C. felis infection were diagnosed in December and only a few (n=10; 4.3%) cases were observed from November through March during the 12-year period.

In cases for which the client's address was available, geographic coordinates were assigned and landscape characteristics were quantified within a 100-m radius of each cytauxzoonosis case location.

Of cytauxzoonosis cases (n=41) with a known client address, a majority (n=28; 68.3%) occurred in low density residential areas and more cases (n=8; 19.5%) were found in urban edge habitat than expected at random. Locations of diagnosed cytauxzoonosis cases were significantly associated with more wooded (31.8+/-4.03%) cover and closer (55.5+/-18.45m) proximity to natural or unmanaged areas than randomly selected control sites.

Practicing and diagnostic veterinarians can expect to see a distinct temporal pattern in cases of cytauxzoonosis and more cases can be expected in domestic cats living in close proximity to environments that support tick vectors and bobcats.

"Temporal occurrence and environmental risk factors associated with cytauxzoonosis in domestic cats"
Reichard MV, Baum KA, Cadenhead SC, Snider TA
Vet Parasitol. 2008 Apr 15; 152(3-4): 314-20 (Hubmed.org)

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The Treatment of Anorexia | Early Symptoms of Anorexia Nervosa | The Causes of Anorexia Nervosa

Loss of appetite in elderly people

2009-06-24T01:45:00.000-07:00

The reasons of anorexia of ageing are multiple and not well-known. One of them is loss of appetite. We aimed to know the prevalence of self-reported appetite-loss in the elderly and its relationship with nutritional status, muscle strength and functional capacity.

SUBJECTS AND METHOD:
A population based cross-sectional study in which 236 non-institutionalized subjects over 70 years were randomly selected. Hand grip, functional capacity and nutritional status were assessed and a specific questionnaire was administered to assess appetite. Anorexia or loss of appetite was considered when subjects declared none or low usual appetite both in breakfast and lunch time.

RESULTS:
A 30.0% global prevalence of anorexia was observed (37.1% in females and 17.9% in males; p = 0.001). Loss of appetite was related to higher risk of malnutrition (41% in anorexic vs 27% in non-anorexic; p = 0.039), lower muscular strength and poorer functional capacity.

CONCLUSIONS:
Loss of appetite in the elderly has a high prevalence and must alert about frailty.

"Loss of appetite in elderly people in the community and its relationship with functional capacity"
Serra Prat M, Fernández X, Ribó L, Palomera E, Papiol M, Serra P
Med Clin (Barc). 2008 Apr 19; 130(14): 531-3 (Hubmed.org)

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Treatment of Anorexia Nervosa | Signs And Symptoms of Anorexia | Biological Causes of Anorexia

Plasma intact fibroblast growth in women with anorexia nervosa

2009-06-23T01:49:00.000-07:00

Fibroblast growth factor (FGF)23 is a novel phosphaturic factor associated with inorganic phosphate homeostasis. Previous human studies have shown that serum FGF23 levels increase in response to a high phosphate diet.

For anorexia nervosa (AN) patients, inorganic phosphate homeostasis is important in the clinical course, such as in refeeding syndrome. The purpose of this study was to determine plasma levels of intact FGF23 (iFGF23) in restricting-type anorexia nervosa (AN-R) patients, binge-eating/purging-type anorexia nervosa (AN-BP) patients, and healthy controls.

METHODS:
The subjects consisted of 6 female AN-R patients, 6 female AN-BP patients, and 11 healthy female controls; both inpatients and outpatients were included. Plasma iFGF23, 1,25-dihydroxyvitamin D (1,25-(OH)2D), and 25-hydroxyvitamin D (25-OHD) levels were measured. Data are presented as the median and the range. A two-tailed Mann-Whitney U-test with Bonferroni correction was used to assess differences among the three groups, and a value of p < p =" 0.001)," p =" 0.015)."

"Plasma intact fibroblast growth factor 23 levels in women with anorexia nervos"
Otani M, Takimoto Y, Moriya J, Yoshiuchi K, Akabayashi A
Biopsychosoc Med. 2008; 2: 10 (Hubmed.org)

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Most Successful Treatment of Anorexia | Signs And Symptoms of Anorexia Nervosa | Causes And Effects of Anorexia

MGCD0103 oral dose in patients with advanced solid tumors

2009-06-22T07:39:00.000-07:00

MGCD0103 is a novel isotype-selective inhibitor of human histone deaceylases (HDACs) with the potential to regulate aberrant gene expression and restore normal growth control in malignancies.

PATIENTS AND METHODS:
A phase I trial of MGCD0103, given as a three-times-per-week oral dose for 2 of every 3 weeks, was performed in patients with advanced solid tumors. Primary end points were safety, tolerability, pharmacokinetics (PK), pharmacodynamic (PD) assessments of HDAC activity, and histone acetylation status in peripheral WBCs.

RESULTS:
Six dose levels ranging from 12.5 to 56 mg/m(2)/d were evaluated in 38 patients over 99 cycles (median, 2; range, 1 to 11). The recommended phase II dose was 45 mg/m(2)/d. Dose-limiting toxicities consisting of fatigue, nausea, vomiting, anorexia, and dehydration were observed in three (27%) of 11 and two (67%) of three patients treated at the 45 and 56 mg/m(2)/d dose levels, respectively.

Disease stabilization for four or more cycles was observed in five (16%) of 32 patients assessable for efficacy. PK analyses demonstrated interpatient variability which was improved by coadministration with low pH beverages.

Elimination half-life ranged from 6.7 to 12.2 hours, and no accumulation was observed with repeated dosing. PD evaluations confirmed inhibition of HDAC activity and induction of acetylation of H3 histones in peripheral WBCs from patients by MGCD0103.

CONCLUSION:
At doses evaluated, MGCD0103 appears tolerable and exhibits favorable PK and PD profiles with evidence of target inhibition in surrogate tissues.

"Phase I study of MGCD0103 given as a three-times-per-week oral dose in patients with advanced solid tumors"
Siu LL, Pili R, Duran I, Messersmith WA, Chen EX, Sullivan R, MacLean M, King S, Brown S, Reid GK, Li Z, Kalita AM, Laille EJ, Besterman JM, Martell RE, Carducci MA
J Clin Oncol. 2008 Apr 20; 26(12): 1940-7
(Hubmed.org)

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Treatment of Anorexia And Bulimia | Symptoms Of Anorexia | Causes of Anorexia Nervosa

Development and validation of an Eating Disorders Symptom Impact Scale

2009-06-21T17:56:00.000-07:00

Family members of relatives with eating disorders experience high levels of distress due to the difficulties in their care giving role. However no measures have been developed to measure the specific impact that an individual with an eating disorder has on family life.

The aim of this study was to develop a measure to assess the specific caregiving burden of both anorexia nervosa and bulimia nervosa. A secondary aim was to examine whether this measure was sensitive to change.

METHODS:
A new scale, the Eating Disorders Symptom Impact Scale (EDSIS), was generated by a panel of clinicians and researchers based upon quantitative and qualitative work with carers and reviewed by a panel of "expert carers".

A cross-sectional study was conducted among carers of relatives with an eating disorder to examine the properties of the new scale. In addition, participants from an ongoing pre-and-post design study completed several self-report questionnaires to assess the sensitivity of the EDSIS to change.

RESULTS:
A sample of 196 carers of relatives with an eating disorder aged 25-68 compted the scale. A 24-item EDSIS scale was derived with four factors: nutrition, guilt, dysregulated behaviour and social isolation.

These explained 58.4% of the variance in carer distress. Reliability was acceptable (Cronbach's alpha ranged from 0.84 to 0.90). The convergent validity of the EDSIS subscales was moderately supported by correlations with a general caregiving measure (Experience of Caregiving Inventory (ECI), r = 0.42 to 0.60), psychological distress (General Health Questionnaire (GHQ-12), r = 0.33) and perceived functioning of the relative (Children Global Assessment Scale (CGAS), r = -30).

A sample of 57 primary caregivers completed pre-post intervention assessments and the overall scale (t = 2.3, p < 0.05) and guilt subscale (t = 3.4, p < 0.01) were sensitive to change following a skills training workshop.

CONCLUSION:
The EDSIS instrument has good psychometric properties and may be of value to assess the impact of eating disorder symptoms on family members. It may be of value to highlight carers' needs and to monitor the effectiveness of family based interventions.

"Development and validation of an Eating Disorders Symptom Impact Scale (EDSIS) for carers of people with eating disorders"
Sepulveda AR, Whitney J, Hankins M, Treasure J
Health Qual Life Outcomes. 2008; 6: 28 (Hubmed.org)

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Most Successful Treatment of Anorexia | Signs And Symptoms of Anorexia | Biological Causes of Anorexia

Treatment of anorexia nervosa: insights and obstacles

2009-06-21T07:52:00.000-07:00

Anorexia nervosa is a behavioral disorder characterized by ego-syntonic self-starvation, denial of illness and ambivalence towards treatment. Treatment refusal and drop-out rates are high and relapse is common.

Treatment is best viewed as comprised of two phases, weight restoration and normalization of eating behavior followed by relapse prevention. Most patients verbalize a desire to change, however they seek treatment on their own terms, ideally with minimal or no weight gain.

Successful treatment must therefore convince patients to overcome their drive to diet. Evidence-based data on treatment interventions for anorexia nervosa are scarce and methodological problems afflict the few published, controlled trials.

Taken together, clinical expertise and data from correlational and controlled trials suggest that chronicity and adult status are associated with a worse prognosis. Outpatient family therapy is effective in weight-restoring the majority of adolescent patients whereas older patients, or those with severe medical or psychiatric comorbidity, often require intensive treatment on an inpatient eating disorders behavioral specialty unit.

Correlational data suggest that weight-restored patients are less likely to relapse. Despite limitations of the current knowledge-base, several new areas of research hold promise in elucidating risk factors, in identifying the pathophysiology that sustains anorectic behavior, and in developing more targeted and effective treatments.

"Treatment of anorexia nervosa: insights and obstacles"
Guarda AS
Physiol Behav. 2008 Apr 22; 94(1): 113-20 (Hubmed.org)

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Treatments of Anorexia | Symptoms of Anorexia Nervosa | Biological Causes of Anorexia

Neurobiology of anorexia and bulimia nervosa

2009-06-21T04:47:00.000-07:00

Anorexia nervosa (AN) and bulimia nervosa (BN) are related disorders of unknown etiology that most commonly begin during adolescence in women. Anorexia nervosa and bulimia nervosa have unique and puzzling symptoms, such as restricted eating or binge-purge behaviors, body image distortions, denial of emaciation, and resistance to treatment.

These are often chronic and relapsing disorders, and Anorexia nervosa has the highest death rate of any psychiatric disorder. The lack of understanding of the pathogenesis of this illness has hindered the development of effective interventions, particularly for Anorexia nervosa.

Individuals with Anorexia nervosa and bulimia nervosa are consistently characterized by perfectionism, obsessive-compulsiveness, and dysphoric mood. Individuals with Anorexia nervosa tend to have high constraint, constriction of affect and emotional expressiveness, ahendonia and asceticism, whereas individuals with bulimia nervosa tend to be more impulsive and sensation seeking.

Such symptoms often begin in childhood, before the onset of an eating disorder, and persist after recovery, suggesting they are traits that create a vulnerability for developing an ED. There is growing acknowledgement that neurobiological vulnerabilities make a substantial contribution to the pathogenesis of Anorexia nervosa and bulimia nervosa.

Considerable evidence suggests that altered brain serotonin (5-HT) function contributes to dysregulation of appetite, mood, and impulse control in Anorexia nervosa and bulimia nervosa. Brain imaging studies, using 5-HT specific ligands, show that disturbances of 5-HT function occur when people are ill, and persist after recovery from Anorexia nervosa and bulimia nervosa.

It is possible that a trait-related disturbance of 5-HT neuronal modulation predates the onset of Anorexia nervosa and contributes to premorbid symptoms of anxiety, obsessionality, and inhibition.

This dysphoric temperament may involve an inherent dysregulation of emotional and reward pathways which also mediate the hedonic aspects of feeding, thus making these individuals vulnerable to disturbed appetitive behaviors. Restricting food intake may become powerfully reinforcing because it provides a temporary respite from dysphoric mood.

Several factors may act on these vulnerabilities to cause Anorexia nervosa to start in adolescence. First, puberty-related female gonadal steroids or age-related changes may exacerbate 5-HT dysregulation. Second, stress and/or cultural and societal pressures may contribute by increasing anxious and obsessional temperament.

Individuals with AN may discover that reduced dietary intake, by reducing plasma tryptophan availability, is a means by which they can modulate brain 5-HT functional activity and anxious mood. People with Anorexia nervosa enter a vicious cycle which accounts for the chronicity of this disorder because caloric restriction results in a brief respite from dysphoric mood.

However, malnutrition and weight loss, in turn, produce alterations in many neuropeptides and monoamine function, perhaps in the service of conserving energy, but which also exaggerates dysphoric mood. In summary, this article reviews findings in brain chemistry and neuroimaging that shed new light on understanding the psychopathology of these difficult and frustrating disorders.

"Neurobiology of anorexia and bulimia nervosa.
Kaye W
Physiol Behav. 2008 Apr 22; 94(1): 121-35 (Hubmed.org)

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Treatment of Anorexia And Bulimia | Symptoms of Anorexia And Bulimia | Causes And Effects of Anorexia

High ambient temperature reverses hypothalamic MC4 receptor overexpression in an animal model of anorexia nervosa

2009-06-21T02:20:00.000-07:00

The potential involvement of the melanocortin system in the beneficial effects of heat application in rats submitted to activity-based anorexia (ABA), an analogous model of anorexia nervosa (AN), was studied.

Once ABA rats had lost 20% of body weight, half of the animals were exposed to a high ambient temperature (HAT) of 32 degrees C, whereas the rest were maintained at 21 degrees C. Control sedentary rats yoked to ABA animals received the same treatment.

ABA rats (21 degrees C) showed increased Melanocortin 4 (MC4) receptor and Agouti gene Related Peptide (AgRP) expression, and decreased pro-opiomelanocortin (POMC) mRNA levels (Real Time PCR), with respect to controls. Heat application increased weight gain and food intake, and reduced running rate in ABA rats, when compared with ABA rats at 21 degrees C.

However, no changes in body weight and food intake were observed in sedentary rats exposed to heat. Moreover, heat application reduced MC4 receptor, AgRP and POMC expression in ABA rats, but no changes were observed in control rats.

These results indicate that hypothalamic MC4 receptor overexpression could occur on the basis of the characteristic hyperactivity, weight loss, and self-starvation of ABA rats, and suggest the involvement of hypothalamic melanocortin neural circuits in behavioural changes shown by anorexia nervosa patients.

Changes in AgRP and POMC expression could represent an adaptative response to equilibrate energy balance. Moreover, the fact that HAT reversed hypothalamic MC4 receptor overexpression in ABA rats indicates the involvement of brain melanocortin system in the reported beneficial effects of heat application in anorexia nervosa.

A combination of MC4 receptor antagonists and heat application could improve the clinical management of AN.

"High ambient temperature reverses hypothalamic MC4 receptor overexpression in an animal model of anorexia nervosa"
Gutiérrez E, Churruca I, Zárate J, Carrera O, Portillo MP, Cerrato M, Vázquez R, Echevarría E
Psychoneuroendocrinology. 2009 Apr ; 34(3): 420-9 (Hubmed.org)

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Treatment of Anorexia And Bulimia | The Symptoms of Anorexia Nervosa | Psychological Causes of Anorexia

Tonic and phasic effects of corticosterone on food restriction

2009-06-20T11:18:00.000-07:00

In the experimental rat model of anorexia nervosa the interactions between the hyperactivity of the hypothalamo-pituitary-adrenal (HPA) axis and increased physical activity associated with food restriction remain unidentified.

In addition to their role in energy homeostasis, glucocorticoids have complex effects in the central nervous system, increasing the salience of activities such as wheel running. The objective of the present study was to analyze the role of corticosterone (cort) on wheel activity in food-restricted rats.

Lewis rats were adrenalectomized and replaced with pellets containing increasing amounts of cort that caused different steady-state plasma concentrations from low to high HPA activity.

They were given free access to a running wheel and were fed ad libitum or food-restricted. We also investigated the acute effect of cort injection mimicking the prefeeding cort peak on prefeeding wheel activity.

Wheel running induced by food restriction was nearly non-existent in adrenalectomized food-restricted rats and increased in a dose-related manner with cort replacement. An acute stimulation of activity was also expressed during the preprandial peak of cort, suppressed by adrenalectomy and experimentally restored by acute cort injection. No such effects of cort were found in ad libitum fed rats.

Our data demonstrate that food restriction-induced hyperactivity is critically and quantitatively dependent upon cort, not only on the mean basal levels of the hormone but also on the secretory peak that accompanies the burst of preprandial activity. The present results have special relevance for the pathophysiology of anorexia nervosa and other compulsive behaviors.

"Tonic and phasic effects of corticosterone on food restriction-induced hyperactivity in rats"
Duclos M, Gatti C, Bessière B, Mormède P
Psychoneuroendocrinology. 2009 Apr ; 34(3): 436-45 (Hubmed.org)

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The Treatment of Anorexia | Symptons of Anorexia | Causes of Anorexia And Bulimia

Mechanisms of cancer cachexia

2009-06-20T09:13:00.000-07:00

Up to 50% of cancer patients suffer from a progressive atrophy of adipose tissue and skeletal muscle, called cachexia, resulting in weight loss, a reduced quality of life, and a shortened survival time.

Anorexia often accompanies cachexia, but appears not to be responsible for the tissue loss, particularly lean body mass. An increased resting energy expenditure is seen, possibly arising from an increased thermogenesis in skeletal muscle due to an increased expression of uncoupling protein, and increased operation of the Cori cycle.

Loss of adipose tissue is due to an increased lipolysis by tumor or host products. Loss of skeletal muscle in cachexia results from a depression in protein synthesis combined with an increase in protein degradation.

The increase in protein degradation may include both increased activity of the ubiquitin-proteasome pathway and lysosomes. The decrease in protein synthesis is due to a reduced level of the initiation factor 4F, decreased elongation, and decreased binding of methionyl-tRNA to the 40S ribosomal subunit through increased phosphorylation of eIF2 on the alpha-subunit by activation of the dsRNA-dependent protein kinase, which also increases expression of the ubiquitin-proteasome pathway through activation of NFkappaB.

Tumor factors such as proteolysis-inducing factor and host factors such as tumor necrosis factor-alpha, angiotensin II, and glucocorticoids can all induce muscle atrophy. Knowledge of the mechanisms of tissue destruction in cachexia should improve methods of treatment.

"Mechanisms of cancer cachexia"
Tisdale MJ
Physiol Rev. 2009 Apr ; 89(2): 381-410 (Hubmed.org)

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Successful Treatment of Anorexia Nervosa | Early Symptoms of Anorexia | Causes And Effects of Anorexia

Systematic review and meta-analysis of the baseline concentrations and physiologic responses of gut hormones to food in eating disorders

2009-06-20T04:06:00.000-07:00

Disturbances in gastrointestinal hormones have been widely identified in persons with eating disorders (EDs) and have been implicated in their clinical pathologies.

OBJECTIVE:
The objective was to identify, critically examine, and summarize studies investigating the short-term response of gastrointestinal hormones to food in persons with an ED, including the subtypes anorexia nervosa and bulimia nervosa.

DESIGN:
A priori inclusion and exclusion criteria were set and included a procedure in which a test meal or glucose load was given and blood hormone concentrations measured. All studies included a healthy control group for comparison.

The outcome variable was defined as the mean difference between fasting plasma hormone concentrations and the maximum postprandial peak or nadir. The difference in baseline values between groups was also examined. Pooled standardized mean differences were calculated and analyzed where possible.

RESULTS:
A total of 28 studies were identified, including sufficient studies to perform a meta-analysis for ghrelin, peptide YY, cholecystokinin, insulin, and pancreatic polypeptide. Persons with an ED had higher baseline concentrations of ghrelin (large effect), peptide YY (medium effect), and cholecystokinin (medium effect for ED, large effect for anorexia nervosa).

The response of insulin to food was decreased in persons with an ED (medium effect). No further differences were found in the release of gut peptides to a standardized test meal.

CONCLUSIONS:
All of the studies had low power for the different subtypes of EDs. High heterogeneity among the studies was observed, and limitations are discussed. The findings suggest that the physiologic changes observed in patients with EDs are highly variable and subject to multiple confounding factors.

"Systematic review and meta-analysis of the baseline concentrations and physiologic responses of gut hormones to food in eating disorders"
Prince AC, Brooks SJ, Stahl D, Treasure J
Am J Clin Nutr. 2009 Mar ; 89(3): 755-65 (Hubmed.org)

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The Treatment of Anorexia Nervosa | Signs And Symptoms of Anorexia | Causes of Anerexia

Leptin in humans: lessons from translational research

2009-06-20T02:12:00.000-07:00

Leptin has emerged over the past decade as a key hormone in not only the regulation of food intake and energy expenditure but also in the regulation of neuroendocrine and immune function as well as the modulation of glucose and fat metabolism as shown by numerous observational and interventional studies in humans with (complete) congenital or relative leptin deficiency.

These results have led to proof-of-concept studies that have investigated the effect of leptin administration in subjects with complete (congenital) leptin deficiency caused by mutations in the leptin gene as well as in humans with relative leptin deficiency, including states of lipoatrophy or negative energy balance and neuroendocrine dysfunction, as for instance seen with hypothalamic amenorrhea in states of exercise-induced weight loss.

In those conditions, most neuroendocrine, metabolic, or immune disturbances can be restored by leptin administration. Leptin replacement therapy is thus a promising approach in several disease states, including congenital complete leptin deficiency, states of energy deprivation, including anorexia nervosa or milder forms of hypothalamic amenorrhea, as well as syndromes of insulin resistance seen in conditions such as congenital or acquired lipodystrophy.

In contrast, states of energy excess such as garden-variety obesity are associated with hyperleptinemia that reflects either leptin tolerance or leptin resistance. For those conditions, development of leptin sensitizers is currently a focus of pharmaceutical research.

This article summarizes our current understanding of leptin's role in human physiology and its potential role as a novel therapeutic option in human disease states associated with a new hormone deficiency, ie, leptin deficiency.

"Leptin in humans: lessons from translational research"
Blüher S, Mantzoros CS
Am J Clin Nutr. 2009 Mar ; 89(3): 991S-997S (Hubmed.org)

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The Treatment of Anorexia | Early Symptoms of Anorexia | Biological Causes of Anorexia

AdipoR1 mediates the anorexigenic and insulin/leptin-like actions of adiponectin in the hypothalamus

2009-06-19T14:21:00.000-07:00

Adiponectin exerts an insulin-sensitizing effect, improving insulin action in peripheral tissues and restraining insulin resistance. Here, we explore the hypothesis that adiponectin can reproduce some of the actions of insulin/leptin in the hypothalamus.

The presence of AdipoR1 and AdipoR2 was mapped to the arcuate and lateral hypothalamic nuclei. Icv adiponectin reduced food intake, which was accompanied by activation/engagement of IRS1/2, ERK, Akt, FOXO1, JAK2 and STAT3.

All these actions were dependent on AdipoR1, since inhibition of this receptor, and not of AdipoR2, completely reversed the effects described above. Thus, adiponectin acts in the hypothalamus, activating elements of the canonical insulin and leptin signaling pathways and promoting reduction of food intake.

"AdipoR1 mediates the anorexigenic and insulin/leptin-like actions of adiponectin in the hypothalamus.
Coope A, Milanski M, Araújo EP, Tambascia M, Saad MJ, Geloneze B, Velloso LA
FEBS Lett. 2008 Apr 30; 582(10): 1471-6 (Hubmed.org)

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Treatment Of Anorexia | Symptoms Of Anorexia | Causes of Anorexia

Clinical features of 107 autoimmune hepatitis patients and 30 of them with AIH-primary biliary cirrhosis overlap syndrome

2009-06-19T11:17:00.000-07:00

In order to provide a reliable basis for the diagnosis and treatment of autoimmune hepatitis (AIH) and its overlap syndrome, we investigated the clinical, immunological characteristics of and the therapeutic methods for AIH and AIH-primary biliary cirrhosis (PBC) overlap syndrome.

METHODS:
One hundred seven patients (77 with AIH and 30 with AIH-PBC overlap syndrome) were enrolled in the study. Their clinical manifestations, serum liver function tests (LFTs) findings, serum immunoglobulins, liver histopathological changes and their responsiveness to the therapies were investigated.

RESULTS:
The age distribution of AIH patients showed a single peak during their fifties and their main clinical manifestations were malaise, abdominal distension, anorexia and jaundice. Serum gamma globulin and IgG were significantly higher than their normal levels.

74% of the patients were positive for anti-nuclear antibody (ANA), 32% of the patients were positive for anti-smooth muscle antibody (AMA), and over 50% of the patients suffered from concurrent extrahepatic autoimmune diseases.

The main histological changes in the liver biopsies were interface hepatitis (65%), lobular hepatitis and rosette formation of liver cells. Bridging necrosis was observed in severe AIH cases.

In the AIH-PBC overlap syndrome patients, the levels of serum ALT, AST, GGT, ALP and incidences of ANA and AMA/AMA-M2 were all significantly higher than those of the AIH group. After treating AIH patients with prednisolone and azathioprine (Aza), complete response was seen in 42 cases (70%), sustained response was seen in 26 cases (43%).

Sixteen cases had relapses after the withdrawal of the treatment or prednisolone dosage was reduced lower than 10 mg/d. The cases having normal serum ALT, AST, gamma-globulin and IgG levels after treatment were still responding to the reduced prednisolone dosage of 5-10 mg/d without azathioprine added.

After combination with ursodeoxycholic acid (UDCA) treatment, the liver function tests (AST, ALT, TBil) of AIH-PBC overlap syndrome patients also significantly improved compared to those before the treatment (P<0.01).

CONCLUSION:
AIH and AIH-PBC overlap syndrome are not rare in our clinics. Their diagnoses should be based on the clinical presentations, biochemical and immunological indices and liver histological changes.

In AIH cases, once their AST, ALT, gamma-globuline and IgG levels return to normal, the prednisolone dosage can be maintained at 5-10 mg/d and Aza can even be withdrawn. Good improvement for patients with AIH-PBC overlap syndrome can be obtained with UDCA and immunosuppression treatment.

"Clinical features of 107 autoimmune hepatitis patients and 30 of them with AIH-primary biliary cirrhosis overlap syndrome
Qiu DK, Li XM, Wei J, Ye LJ, Peng YS, Ma X
Zhonghua Gan Zang Bing Za Zhi. 2008 May ; 16(5): 367-71 (Hubmed.org)

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Treatment Of Anorexia | Symptoms Of Anorexia | Causes of Anorexia

Mental disorders among relatives of patients with anorexia nervosa and bulimia nervosa

2009-06-19T05:13:00.000-07:00

Family studies of anorexia (AN) and bulimia (BN) nervosa in relatives of patients with eating disorders compared to control subjects are rare in German-speaking countries.

METHODS:
A German multicenter study compared first-, second- and third-degree relatives of 65 adolescent anorexia nervosa subjects (n = 746), 21 adolescent bulimia nervosa subjects (n = 265) and relatives of 11 adolescent depressive control subjects (n = 157), as well as those of 37 adolescent healthy control subjects (n = 480).

Assessments included the Diagnostic Interview for Genetic Studies (DIGS), the short form of the Family Interview of Genetic Studies (FIGS), and the Eating Disorder Family History Interview.

RESULTS:
Rates of anorexia nervosa and major depressive disorder (trend) were significantly (p < .01) higher among the first- and second-degree relatives of anorexic and bulimic subjects than among the relatives of healthy controls.

Most results were more prominent among relatives of bulimic index patients. Nevertheless, the frequencies were lower in this sample than in comparable US-American samples.

CONCLUSIONS:
The data confirm the hypothesis of familial vulnerability to anorexia and bulimia nervosa. The observed differences in comorbidity patterns among eating-disordered relatives may be due to an age effect of the index patients.

"Mental disorders among relatives of patients with anorexia nervosa and bulimia nervosa"
Wagner A, Wöckel L, Bölte S, Radeloff D, Lehmkuhl G, Schmidt MH, Poustka F
Z Kinder Jugendpsychiatr Psychother. 2008 May ; 36(3): 177-84 (Hubmed.org)

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Treatment Of Anorexia | Symptoms Of Anorexia | Causes of Anorexia

Prophylactic use of acetaminophen in children vaccinated with diphtheria-tetanus-pertussis

2009-06-19T01:10:00.000-07:00

The present randomized non-blind trial was conducted to clarify the effect of analgesics on febrile responses of booster diphtheria-tetanus-whole cell pertussis (DTP) vaccine in 15-20 months old infants.

METHODS:
A total of 270 healthy infants were randomized to receive acetaminophen (10 mg/kg) along with DTP vaccine (group 1), 2 hours after vaccination (group 2), and after the appearance of febrile reactions or irritability following vaccination (group 3, control).

In addition to study medication, if the axillary temperature was higher than 38 degrees C or if the infant seemed to be irritable, the parents were told to give acetaminophen (10 mg/kg) and record on a diary card. Vaccinees were monitored for local and systemic reactions.

RESULTS:
The incidences of local swelling, pain and erythema were not significantly different among the 3 groups. No difference was observed in the incidence of systemic reactions including febrile responses, irritability, anorexia, and vomiting among the 3 groups during the 7 days after vaccination.

Of the infants, 45.1%, 46.7% and 51.9% manifested fever (axillary temperature > or =38 degrees C) within 24 hours after the vaccination in groups 1, 2 and 3, respectively (P>0.05). The second dose of acetaminophen was less in the control group than in the prophylactic groups (P=0.009).

CONCLUSIONS:
Administration of acetaminophen along with DTP vaccine or 2 hours after vaccination does not affect the occurrence of febrile responses following booster vaccination. Unnecessary use of analgesics should be prevented.

"Prophylactic use of acetaminophen in children vaccinated with diphtheria-tetanus-pertussis.
Yalçin SS, Gümüş A, Yurdakök K
World J Pediatr. 2008 May ; 4(2): 127-9 (Hubmed.org)

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Treatment Of Anorexia | Symptoms Of Anorexia | Causes of Anorexia

An outbreak of fatal herpesvirus infection

2009-06-18T16:08:00.000-07:00

A herpesvirus infection affecting mini Rex and crossbred meat rabbits was identified in a rabbitry in Alaska. Illness affected over half of the 55 rabbits on the premises, and 16 rabbits died or were euthanatized because of illness.

Disease affected all ages from adults to nursing young and occurred over an approximately 2-month period. Clinical signs included conjunctivitis and periocular swelling, ulcerative dermatitis, progressive weakness, anorexia, respiratory distress, and abortion. Hemorrhagic dermatitis and panniculitis were associated with epidermal microvesicular degeneration, dermal and subcutaneous vascular necrosis, and thrombosis.

Eosinophilic intranuclear inclusions consistent with herpesvirus were found within the epidermis and superficial follicular epithelium and within mesenchymal cells within the dermis and subcutis. Syncytial cells containing viral inclusions occurred within the epidermal and superficial follicular epithelium.

Other findings were hemorrhagic necrosis of the myocardium with rare intranuclear inclusions within stromal cells, multifocal pulmonary hemorrhage, hemorrhage with sinus erythrophagocytosis in lymph nodes, and massive necrosis and fibrin deposition within red pulp of the spleen.

A virus isolated from the skin produced syncytia, intranuclear inclusions, and cell lysis typical of herpesvirus in rabbit kidney cells in vitro. The viral isolate was characterized ultrastructurally as an enveloped virus with icosahedral nucleocapsids 100 nm diameter, consistent with a herpesvirus.

"An outbreak of fatal herpesvirus infection in domestic rabbits in Alaska"
Jin L, Valentine BA, Baker RJ, Löhr CV, Gerlach RF, Bildfell RJ, Moerdyk-Schauwecker M
Vet Pathol. 2008 May ; 45(3): 369-74 (Hubmed.org)

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Treatment Of Anorexia | Symptoms Of Anorexia | Causes of Anorexia

Tumor necrosis factor alpha-308 gene polymorphism in patients with anorexia nervosa

2009-06-18T14:04:00.000-07:00

Tumor necrosis factor alpha (TNF-alpha) is a principal cytokine that may induce weight loss. TNF-alpha -308 G to A polymorphism increases transcription of TNF-alpha in vitro.

The aim of this study was to investigate whether TNF-alpha gene promoter polymorphism at position -308 (G to A substitution) is one of the factors playing a role in the development of anorexia nervosa (AN).

Sixteen patients with anorexia nervosa, aged 11-20 years, were included in this study, and 5/16 (31%) patients had TNF-alpha -308 G/A genotype. In the control group, 12/174 (7%) had -308 G/A genotype.

There was a significant statistical difference between the patient and control groups (p=0.007). The minimum body mass index (BMI) values ever recorded for each patient during the course of the disease were significantly higher in the five patients with TNF-alpha -308 G to A polymorphism (p= 0.003).

TNF-alpha gene promoter polymorphism at position -308 might be associated with a predisposition to AN and initiate the disease. The protective mechanisms that affect clinical manifestation of the disease may be related with other anti-inflammatory cytokines or immunologic mechanisms.

"Tumor necrosis factor alpha-308 gene polymorphism in patients with anorexia nervosa"
Kanbur N, Mesci L, Derman O, Turul T, Cuhadaroğlu F, Kutluk T, Tezcan I
Turk J Pediatr. 2008 May-Jun ; 50(3): 219-22 (Hubmed.org)

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Treatment Of Anorexia | Symptoms Of Anorexia | Causes of Anorexia

Avoidance of physical activity is a sensitive indicator of illness

2009-06-18T06:09:00.000-07:00

Although fever and sickness behavior are common responses to infection, it has been proposed that the sickness behaviors associated with infection, in particular lethargy and fatigue, may be more valuable clinical markers of illness and recovery in patients, than is body temperature alone.

Measuring abdominal temperature, food intake and wheel running we therefore determined the dose thresholds and sensitivities of these responses to lipopolysaccharide (LPS). Male Sprague-Dawley rats were randomly assigned to receive one of three LPS doses (10, 50, 250 microg/kg), or saline, subcutaneously.

Administration of LPS induced a dose-dependent increase in abdominal temperature and decrease in wheel running, food intake and body mass. Regression analysis revealed that decreased running was the most-sensitive of the sickness responses to LPS administration, with a regression slope of -41%/log microg, compared to the slopes for food intake (-30%/log microg, F(1,2)=244, P=0.004) and body mass (-2.2%/log microg, F(1,5)=7491, P<0.0001). anorexia induced by LPS administration would present differently depending on whether rats had been exercising or sedentary.

Six weeks of wheel running had no effect on the magnitude of fever and anorexia induced by LPS administration. Avoidance of physical activity therefore appears to be a more-sensitive indicator of a host's reaction to LPS than is anorexia and fever.

"Avoidance of physical activity is a sensitive indicator of illness"
Skinner GW, Mitchell D, Harden LM
Physiol Behav. 2009 Mar 2; 96(3): 421-7 (Hubmed.org)

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Treatment Of Anorexia | Symptoms Of Anorexia | Causes of Anorexia

Single and combined supplementation of glutamin

2009-06-18T01:06:00.000-07:00

Prior reports suggest that during irinotecan (7-ethyl-10-[4-(1-piperidino)-1-piperidino]carbonyloxy-camptothecin; CPT-11) chemotherapy in laboratory rats, the anti-tumour efficacy and diarrhoea toxicity could be modulated by n-3 PUFA and glutamine, respectively.

We further examined how these two dietary elements, when provided individually and in combination, would affect the efficacy of a cyclical regimen of CPT-11/5-fluorouracil (5-FU), an accepted combination regimen for colorectal cancer.

Prior to initiating chemotherapy, diets enriched either with glutamine (2 %, w/w total diet) or n-3 PUFA (0.88 %, w/w total diet) alone, inhibited Ward colon tumour growth (P < 0.05). These diets also completely or partially normalized the changes in peripheral leucocyte counts associated with the tumour-bearing state (e.g. neutrophil proportion/concentration and lymphocyte proportion).

During chemotherapy, either glutamine- or n-3 PUFA-enriched diet enhanced tumour chemo-sensitivity, and reduced body weight loss, anorexia and muscle wasting (v. animals fed control diet, P < 0.05).

Surprisingly, providing both glutamine and n-3 PUFA together did not confer a greater benefit on tumour inhibition either in the presence or absence of chemotherapy; individual benefits associated with single treatments, particularly in respect to host nutritional status (i.e. body weight, food intake and muscle weight) and immune (peripheral leucocyte counts) features were instead partially or completely lost when these two nutrients were combined.

These results draw into question the common assumption that there are additive or synergistic benefits of combinations of nutrients, which are beneficial on an individual basis, and suggest that co-supplementation with glutamine and n-3 PUFA is not indicated during chemotherapy with CPT-11 and 5-FU.

"Single and combined supplementation of glutamine and n-3 polyunsaturated fatty acids on host tolerance and tumour response to 7-ethyl-10-[4-(1-piperidino)-1-piperidino]carbonyloxy-camptothecin (CPT-11)/5-fluorouracil chemotherapy in rats bearing Ward colon tumour"
Xue H, Le Roy S, Sawyer MB, Field CJ, Dieleman LA, Baracos VE
Br J Nutr. 2009 Mar 2; 1-9 (Hubmed.org)

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Treatment Of Anorexia | Symptoms Of Anorexia | Causes of Anorexia

A case of primary hyperparathyroidism with severe bone and renal changes

2009-06-17T13:03:00.000-07:00

We report a 79-year-old Japanese woman who had primary hyperparathyroidism (HPT) with end-stage renal disease and severe bone changes.

In 2004, she began to experience pain in her shoulders and knees, as well as muscle weakness and anorexia. She already had renal failure with a serum Cr of 4.7 mg/dl, while serum calcium was 9.6 mg/dl, PTH was 2,710 pg/ml, and serum alkaline phosphatase was 923 mU/ml.

Multiple fractures of the pelvic bones and lumbar spine, osteoporosis, and subperiosteal bone resorption were detected. Although hemodialysis (HD) was started in February 2005, her symptoms became more severe.

Total parathyroidectomy (PTX) and right iliac crest bone biopsy were performed. Histomorphometric analysis of the cancellous bone indicated a diagnosis of osteitis fibrosa, but a reduction of cortical bone and near absence of cancellous bone were also apparent.

This showed that bone resorption by osteoclasts was predominant over bone formation by osteoblasts. Soon after PTX, her pain subsided completely. We conclude that primary HPT should be detected and treated early enough to avoid renal damage, since renal dysfunction markedly accelerates bone changes in patients with primary HPT.

"A case of primary hyperparathyroidism with severe bone and renal changes"
Jimbo-Saito R, Ubara Y, Kadoguchi H, Suwabe T, Nakanishi S, Higa Y, Hoshino J, Sawa N, Katori H, Takemoto F, Nishimura H, Nakamura M, Tomikawa S, Ohashi K, Takaichi K
J Bone Miner Metab. 2009 Mar 3; (Hubmed.org)

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Treatment Of Anorexia | Symptoms Of Anorexia | Causes of Anorexia

Substance use disorders in women with anorexia nervosa

2009-06-17T10:00:00.000-07:00

We examined prevalence of substance use disorders (SUD) in women with: (1) anorexia nervosa (AN) restricting type (RAN); (2) anorexia nervosa (AN) with purging only (PAN); (3) anorexia nervosa (AN) with binge eating only (BAN); and (4) lifetime AN and bulimia nervosa (ANBN). Secondary analyses examined SUD related to lifetime purging behavior and lifetime binge eating.

METHOD::
Participants (N = 731) were drawn from the International Price Foundation Genetic Studies.

RESULTS::
The prevalence of SUD differed across anorexia nervosa (AN) subtypes, with more in the ANBN group reporting SUD than those in the RAN and PAN groups. Individuals who purged were more likely to report substance use than those who did not purge. Prevalence of SUD differed across lifetime binge eating status.

DISCUSSION::
SUD are common in anorexia nervosa (AN) and are associated with bulimic symptomatology. Results underscore the heterogeneity in AN, highlighting the importance of screening for SUD across AN subtypes. (c) 2009 by Wiley Periodicals, Inc. Int J Eat Disord 2009.

"Substance use disorders in women with anorexia nervosa"
Root TL, Pinheiro AP, Thornton L, Strober M, Fernandez-Aranda F, Brandt H, Crawford S, Fichter MM, Halmi KA, Johnson C, Kaplan AS, Klump KL, La Via M, Mitchell J, Woodside DB, Rotondo A, Berrettini WH, Kaye WH, Bulik CM
Int J Eat Disord. 2009 Mar 3; (Hubmed.org)

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Treatment Of Anorexia | Symptoms Of Anorexia | Causes of Anorexia

Estradiol increases Pet-1 and serotonin transporter mRNA in the midbrain raphe nuclei of ovariectomized rats

2009-06-17T03:57:00.000-07:00

Previous research has shown that estradiol increases the anorexia associated with serotonin (5-HT) neurotransmission.

To examine further the putative relationship between estradiol and 5-HT, we investigated whether estradiol increases the expression of Pet-1 and the 5-HT transporter (5-HTT), two genes implicated in the development and regulation of the 5-HT system.

Ovariectomized (OVX) rats (n=5-6/group) were treated with 0, 2, or 10 microg estradiol benzoate (EB) in sesame oil on 2 consecutive days. Food intake and body weight were recorded 2 days later when EB-treated rats typically display signs of behavioral estrus (e.g., reduced feeding).

Following the collection of behavioral data, rats were perfused, brains were removed, and coronal sections were cut through the midbrain raphe nuclei. Pet-1 and 5-HTT mRNA levels were quantified throughout the dorsal and median raphe nuclei (DRN and MRN) by conducting in situ hybridization on free-floating tissue sections using (35)S-labeled cDNA probes.

As expected, EB treatment decreased food intake and body weight on the day that modeled estrus. At this same time, EB treatment increased Pet-1 and 5-HTT mRNA levels within the DRN and MRN. We conclude that a physiologically relevant regimen of estradiol treatment in OVX rats increases Pet-1 and 5-HTT mRNA levels in the midbrain raphe nuclei at a time when the anorexigenic effect of estradiol is apparent.

Further studies are required to determine whether the increased expression of Pet-1 and 5-HTT mRNA plays a causal role in the anorexigenic effect of estradiol.

"Estradiol increases Pet-1 and serotonin transporter mRNA in the midbrain raphe nuclei of ovariectomized rats"
Rivera HM, Oberbeck DR, Kwon B, Houpt TA, Eckel LA
Brain Res. 2009 Mar 9; 1259: 51-8 (Hubmed.org)

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Attention-deficit hyperactivity symptoms and disorder in eating disorder inpatients

2009-06-17T01:31:00.000-07:00

The objective of this study was to determine the prevalence of attention-deficit hyperactivity disorder (ADHD) symptoms and a DSM-IV ADHD diagnosis in women admitted for treatment of an eating disorder.

METHOD:
One hundred eighty-nine inpatient women with an eating disorder were interviewed using the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) and ADHD interview from the Multi-international Psychiatric Interview (MINI).

RESULTS:
Twenty-one percent of the sample reported at least six current ADHD symptoms, but the estimated prevalence rate for a diagnosis of ADHD in this population was only 5.8% (95% CI: 2.6%-9.5%). Most current ADHD inattentive symptoms appeared after childhood suggesting late-onset non-ADHD origins.

Current inattention symptoms in those without a diagnosis of ADHD correlated with higher BMI (p < .0001), symptoms of bulimia nervosa and current level of depression symptoms (p = .025). DISCUSSION: Although current ADHD symptoms were commonly endorsed in this population, clinicians should carefully examine for childhood symptom-onset of ADHD.

"Attention-deficit hyperactivity symptoms and disorder in eating disorder inpatients"
Yates WR, Lund BC, Johnson C, Mitchell J, McKee P
Int J Eat Disord. 2009 May ; 42(4): 375-8
(Hubmed.org)

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Elevated cannabinoid 1 receptor mRNA is linked to eating disorder related behavior and attitudes in females with eating disorders.

2009-06-16T13:40:00.000-07:00

The endocannabinoid system is involved in the regulation of appetite, food intake and energy balance.

METHODS:
To study possible differences in CB(1) and CB(2) mRNA expression in eating disorders, 20 patients with anorexia nervosa (AN), 23 with bulimia nervosa (BN) and 26 healthy women were enrolled into the trial (Homocysteine and Eating Disorders, HEaD).

RESULTS:
We found significantly higher levels of CB(1) receptor mRNA in the blood of patients with AN (DeltaCT: -3.9 (1.0); KW: 11.31; P=0.003) and BN (DeltaCT: -3.7 (1.7)) when compared to controls (DeltaCT: -4.6 (0.6); Dunn's test AN vs. Controls: P<0.05; style="font-style: italic;">

"Elevated cannabinoid 1 receptor mRNA is linked to eating disorder related behavior and attitudes in females with eating disorders"
Frieling H, Albrecht H, Jedtberg S, Gozner A, Lenz B, Wilhelm J, Hillemacher T, de Zwaan M, Kornhuber J, Bleich S
Psychoneuroendocrinology. 2009 May ; 34(4): 620-4 (Hubmed.org)

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The relationship between eating disorder not otherwise specified (EDNOS) and officially recognized eating disorders: meta-analysis and implications fo

2009-06-16T13:36:00.000-07:00

Eating disorder not otherwise specified (EDNOS) is the most prevalent eating disorder (ED) diagnosis. In this meta-analysis, the authors aimed to inform Diagnostic and Statistical Manual of Mental Disorders revisions by comparing the psychopathology of EDNOS with that of the officially recognized EDs: anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED).

A comprehensive literature search identified 125 eligible studies (published and unpublished) appearing in the literature from 1987 to 2007. Random effects analyses indicated that whereas EDNOS did not differ significantly from anorexia nervosa (AN) and binge eating disorder (BED) on eating pathology or general psychopathology, BN exhibited greater eating and general psychopathology than EDNOS.

Moderator analyses indicated that EDNOS groups who met all diagnostic criteria for anorexia nervosa (AN) except for amenorrhea did not differ significantly from full syndrome cases. Similarly, EDNOS groups who met all criteria for BN or binge eating disorder (BED) except for binge frequency did not differ significantly from full syndrome cases.

Results suggest that EDNOS represents a set of disorders associated with substantial psychological and physiological morbidity. Although certain EDNOS subtypes could be incorporated into existing Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994) categories, others-such as purging disorder and non-fat-phobic anorexia nervosa (AN)-may be best conceptualized as distinct syndromes. (PsycINFO Database Record (c) 2009 APA, all rights reserved).

"The relationship between eating disorder not otherwise specified (EDNOS) and officially recognized eating disorders: meta-analysis and implications for DSM"
Thomas JJ, Vartanian LR, Brownell KD
Psychol Bull. 2009 May ; 135(3): 407-33 (Hubmed.org)

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Urocortins: Emerging Metabolic And Energy Homeostasis Perspectives

2009-06-16T13:03:00.000-07:00

The effects of stress on energy balance and the involvement of the neuropeptide corticotropin releasing factor in modulating the anorexia of stress and sympathetic nervous system tone are well recognized.

Currently, studies centered on the roles of the more recently described members of this family of ligands, the urocortins, and their preferred receptor, the corticotropin releasing factor type 2 receptor, suggest that they are important modulators of centrally controlled metabolic functions.

In addition, urocortins also regulate fuel utilization in the periphery by acting locally within key metabolic tissues through autocrine and/or paracrine mechanisms. Recent findings have demonstrated that urocortin 2 and urocortin 3, by acting through their specific receptor in peripheral tissues, are novel modulators of glucose homeostasis and metabolic functions.

"Urocortins: emerging metabolic and energy homeostasis perspectives"
Kuperman Y, Chen A
Trends Endocrinol Metab. 2008 May-Jun ; 19(4): 122-9 (Hubmed.org)

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Incidence And Outcomes of Bulimia Nervosa

2009-06-16T05:38:00.000-07:00

Little is known about the epidemiology of bulimia nervosa outside clinical settings. We report the incidence, prevalence and outcomes of bulimia nervosa using for the first time a nationwide study design.

METHOD:
To assess the incidence and natural course and outcomes of DSM-IV bulimia nervosa among women from the general population, women (n=2881) from the 1975-79 birth cohorts of Finnish twins were screened for lifetime eating disorders using a two-stage procedure consisting of a questionnaire screen and the Structured Clinical Interview for DSM-IV (SCID).

Clinical recovery was defined as 1-year abstinence from bingeing and purging combined with a body mass index (BMI) 19 kg/m2.

RESULTS:
The lifetime prevalence of DSM-IV bulimia nervosa was 2.3%; 76% of the women suffered from its purging subtype and 24% from the non-purging subtype. The incidence rate of bulimia nervosa was 300/100000 person-years at the peak age of incidence, 16-20 years, and 150/100000 at 10-24 years.

The 5-year clinical recovery rate was 55.0%. Less than a third of the cases had been detected by health-care professionals; detection did not influence outcome. After clinical recovery from bulimia nervosa, the mean levels of residual psychological symptoms gradually decreased over time but many women continued to experience significantly more body image problems and psychosomatic symptoms than never-ill women.

CONCLUSIONS:
Few women with bulimia nervosa are recognized in health-care settings. Symptoms of bulimia are relatively long-standing, and recovery is gradual. Many clinically recovered women experience residual psychological symptoms after attaining abstinence from bingeing and purging.

"Incidence and outcomes of bulimia nervosa: a nationwide population-based study"
Keski-Rahkonen A, Hoek HW, Linna MS, Raevuori A, Sihvola E, Bulik CM, Rissanen A, Kaprio J
Psychol Med. 2009 May ; 39(5): 823-31 (Hubmed.org)

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Nutritional support in multimodal therapy for cancer cachexia

2009-06-15T13:48:00.000-07:00

Malnutrition has since long been known to be associated with adverse outcomes in cancer patients.

The wasting in cancer cachexia involves loss of muscle and fat and reflects a catabolic metabolism induced by an abnormal host response to tumour presence and/or tumour factors. Patients with cancer cachexia frequently develop a chronic negative energy and protein balance driven by a combination of reduced food intake and metabolic change.

Thus, alterations in both energy intake and components of energy expenditure may contribute to progressive weight loss. Increased resting energy expenditure related to the systemic inflammatory response is common and a sustained hypermetabolism over a long period of disease progression can make a large contribution to negative energy balance and wasting if not compensated for by an increase in energy intake.

Hypermetabolism and diminished energy intake due to anorexia may thus constitute a vicious circle in the development of cancer cachexia.

DISCUSSION:
Though nutritional support alone can improve energy intake to a variable extent and for a variable period of time, it will not address the underlying catabolic metabolism and is thus likely to be of limited efficacy if attempts to attenuate the tumour-induced catabolic response are not carried out at the same time.

Concomitant drug treatments for cancer cachexia may slow down the wasting process by reducing anorexia, attenuating the systemic inflammation, the skeletal muscle catabolism or stimulating the muscle protein anabolism.

Thus, improved management of cancer cachexia may require a multimodal approach by a multi-disciplinary team and is best commenced earlier rather than later. Early start of therapy also facilitates the use of oral nutritional supplementation, which is preferable to parenteral nutrition in the majority of cases. Once a patient is severely wasted it may be neither practical nor ethical to intervene with anything else than supportive care.

CONCLUSION:
An improvement in the condition of all patients with cachexia may not be possible, however, the goal must be to stabilise cachexia and prevent or delay further decline. There is currently no single or combined treatment strategy which is successful in all patients.

However, strategies to counteract both hypermetabolism and reduced dietary intake have been demonstrated to be of importance for the survival, function and quality of life of cancer patients and should be further explored in interventional studies.

"Nutritional support in multimodal therapy for cancer cachexia"
Bosaeus I
Support Care Cancer. 2008 May ; 16(5): 447-51 (Hubmed.org)

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Frequency and assessment of symptoms in hospitalized patient with advanced chronic diseases

2009-06-15T08:45:00.000-07:00

Physicians tend to over or underestimate symptoms reported by patients. Therefore standardized symptom scoring systems have been proposed to overcome this drawback. AIM: To estimate the prevalence and the diagnostic accuracy of physical and psychological symptoms and delirium in patients admitted to an internal medicine service at a university hospital.

MATERIAL AND METHODS:
We studied 58 patients, 45 with metastasic cancer and 13 with other advanced chronic diseases. The following scales were used: the Confusion Assessment Method for the diagnosis of delirium; the Edmonton Symptom Assessment Scale (ESAS) for pain and other physical symptoms; the Hospital Anxiety and Depression Scale to assess anxiety and depression.

The ESAS was simultaneously applied to patients without delirium and their doctors to assess the level of diagnostic concordance.

RESULTS:
Twenty two percent of patients had delirium. Among the 45 patients without delirium, 11 (25%) had at least eight symptoms and 39 (88.6%) had four symptoms. The prevalence of symptoms was very high, ranging from 22 to 78%.

Pain, restlessness, anorexia and sleep disorders were the most common. The concordance between symptoms reported by patients and those recorded by doctor was very low, with a Kappa index between 0.001 and 0.334.

CONCLUSIONS:
In our sample of chronic patients, there is a very high frequency of psychological and physical symptoms that are insufficiently recorded by the medical team.

"Frequency and assessment of symptoms in hospitalized patient with advanced chronic diseases: is there concordance among patients and doctors?
Palma A, Del Río I, Bonati P, Tupper L, Villarroel L, Olivares P, Nervi F
Rev Med Chil. 2008 May ; 136(5): 561-9 (Hubmed.org)

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Excessive Exercise In Eating Disorder Patients And In Healthy Women

2009-06-15T06:25:00.000-07:00

In order to elucidate the nature of excessive exercise among individuals with eating disorders, exercise behaviours were compared between eating disorder patients receiving specialist treatment and healthy women, and between subgroups of patients.

METHODS:
Self-report measures of obligatory exercise, motivation for exercise and frequency of hard exercise for weight or shape reasons were completed by eating disorder patients (n=102) and healthy women (n=184).

RESULTS:
The experience of intense guilt when exercise is missed and exercising solely or primarily for reasons of weight, shape or physical attractiveness, were the exercise behaviours that most clearly differentiated between women with eating disorders and healthy women.

Patients with the purging form of anorexia nervosa (n=13) and those with bulimia nervosa (n=41) tended to have higher scores on measures of these behaviours than those with the restricting form of anorexia nervosa (n=15).

CONCLUSIONS:
Research addressing the prevalence and correlates of excessive exercise in eating disorder patients would benefit from a broader assessment of exercise behaviour than has typically been used in previous studies. In addition, the findings may indicate specific targets for the clinical management of excessive exercise as well as for community-based health promotion initiatives.

"Excessive exercise in eating disorder patients and in healthy women"
Mond JM, Calogero RM
Aust N Z J Psychiatry. 2009 Mar ; 43(3): 227-34 (Hubmed.org)

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Laboratory Assessment Of Lhe Food Intake of Children And Adolescents With Loss of Control Eating

2009-06-15T01:22:00.000-07:00

Loss of control (LOC) eating in youth predicts excessive weight gain. However, few studies have measured the actual energy intake of children reporting LOC eating.

OBJECTIVE:
The objective was to characterize the energy intake and macronutrient composition of "normal" and "binge" laboratory meals in nonoverweight and overweight boys and girls with LOC eating.

DESIGN:
Children aged 8-17 y (n = 177) consumed 2 lunchtime meals ad libitum from a multi-item food array after being instructed to either binge eat (binge meal) or to eat normally (normal meal). Prior LOC eating was determined with a semistructured clinical interview.

RESULTS:
Participants consumed more energy at the binge meal than at the normal meal (P = 0.001). Compared with youth with no LOC episodes (n = 127), those reporting LOC (n = 50) did not consume more energy at either meal.

However, at both meals, youth with LOC consumed a greater percentage of calories from carbohydrates and a smaller percentage from protein than did those without LOC (P < 0.05). Children with LOC ate more snack and dessert-type foods and less meats and dairy (P < 0.05). LOC participants also reported greater increases in postmeal negative affect at both meals than did those without LOC (P < or = 0.05).

Secondary analyses restricted to overweight and obese girls found that those with LOC consumed more energy at the binge meal (P = 0.025).

CONCLUSIONS:
When presented with an array of foods, youth with LOC consumed more high-calorie snack and dessert-type foods than did those without LOC. Further research is required to determine whether habitual consumption of such foods may promote overweight. This trial was registered at clinicaltrials.gov as NCT00320177.

"Laboratory assessment of the food intake of children and adolescents with loss of control eating"
Tanofsky-Kraff M, McDuffie JR, Yanovski SZ, Kozlosky M, Schvey NA, Shomaker LB, Salaita C, Yanovski JA
Am J Clin Nutr. 2009 Mar ; 89(3): 738-45 (Hubmed.org)

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Systematic Review And Meta-Analysis Of Baseline Concentrations And Physiologic Responses of Gut Hormones to Food in Eating Disorders

2009-06-14T13:10:00.000-07:00

Disturbances in gastrointestinal hormones have been widely identified in persons with eating disorders (EDs) and have been implicated in their clinical pathologies.

OBJECTIVE:
The objective was to identify, critically examine, and summarize studies investigating the short-term response of gastrointestinal hormones to food in persons with an ED, including the subtypes anorexia nervosa and bulimia nervosa.

DESIGN:
A priori inclusion and exclusion criteria were set and included a procedure in which a test meal or glucose load was given and blood hormone concentrations measured. All studies included a healthy control group for comparison.

The outcome variable was defined as the mean difference between fasting plasma hormone concentrations and the maximum postprandial peak or nadir. The difference in baseline values between groups was also examined. Pooled standardized mean differences were calculated and analyzed where possible.

RESULTS:
A total of 28 studies were identified, including sufficient studies to perform a meta-analysis for ghrelin, peptide YY, cholecystokinin, insulin, and pancreatic polypeptide. Persons with an ED had higher baseline concentrations of ghrelin (large effect), peptide YY (medium effect), and cholecystokinin (medium effect for ED, large effect for anorexia nervosa).

The response of insulin to food was decreased in persons with an ED (medium effect). No further differences were found in the release of gut peptides to a standardized test meal.

CONCLUSIONS:
All of the studies had low power for the different subtypes of EDs. High heterogeneity among the studies was observed, and limitations are discussed. The findings suggest that the physiologic changes observed in patients with EDs are highly variable and subject to multiple confounding factors.

"Systematic review and meta-analysis of the baseline concentrations and physiologic responses of gut hormones to food in eating disorders"
Prince AC, Brooks SJ, Stahl D, Treasure J
Am J Clin Nutr. 2009 Mar ; 89(3): 755-65 (Hubmed.org)

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Sexual Functioning In Women With Eating Disorders

2009-06-14T09:17:00.000-07:00

To describe sexual functioning in women with eating disorders.

METHOD::
We assessed physical intimacy, libido, sexual anxiety, partner status, and sexual relationships in 242 women from the International Price Foundation Genetic Studies relative to normative data.

RESULTS::
Intercourse (55.3%), having a partner (52.7%), decreased sexual desire (66.9%), and increased sexual anxiety (59.2%) were common. Women with restricting and purging anorexia nervosa had a higher prevalence of loss of libido than women with bulimia nervosa and eating disorder not otherwise specified (75%, 74.6%, 39%, and 45.4%, respectively).

Absence of sexual relationships was associated with lower minimum lifetime body mass index (BMI) and earlier age of onset; loss of libido with lower lifetime BMI, higher interoceptive awareness and trait anxiety; and sexual anxiety with lower lifetime BMI, higher harm avoidance and ineffectiveness. Sexual dysfunction in eating disorders was higher than in the normative sample.

DISCUSSION::
Sexual dysfunction is common across eating disorders subtypes. Low BMI is associated with loss of libido, sexual anxiety, and avoidance of sexual relationships. (c) 2009 by Wiley Periodicals, Inc. Int J Eat Disord 2009.

"Sexual functioning in women with eating disorders"
Pinheiro AP, Raney TJ, Thornton LM, Fichter MM, Berrettini WH, Goldman D, Halmi KA, Kaplan AS, Strober M, Treasure J, Woodside DB, Kaye WH, Bulik CM
Int J Eat Disord. 2009 Mar 3; (Hubmed.org)

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Substance Use Disorders In Women With Anorexia nervosa

2009-06-14T04:13:00.000-07:00

We examined prevalence of substance use disorders (SUD) in women with: (1) anorexia nervosa (AN) restricting type (RAN); (2) AN with purging only (PAN); (3) AN with binge eating only (BAN); and (4) lifetime AN and bulimia nervosa (ANBN). Secondary analyses examined SUD related to lifetime purging behavior and lifetime binge eating.

METHOD::
Participants (N = 731) were drawn from the International Price Foundation Genetic Studies.

RESULTS::
The prevalence of SUD differed across AN subtypes, with more in the ANBN group reporting SUD than those in the RAN and PAN groups. Individuals who purged were more likely to report substance use than those who did not purge. Prevalence of SUD differed across lifetime binge eating status.

DISCUSSION::
SUD are common in AN and are associated with bulimic symptomatology. Results underscore the heterogeneity in AN, highlighting the importance of screening for SUD across AN subtypes. (c) 2009 by Wiley Periodicals, Inc. Int J Eat Disord 2009.

"Substance use disorders in women with anorexia nervosa"
Root TL, Pinheiro AP, Thornton L, Strober M, Fernandez-Aranda F, Brandt H, Crawford S, Fichter MM, Halmi KA, Johnson C, Kaplan AS, Klump KL, La Via M, Mitchell J, Woodside DB, Rotondo A, Berrettini WH, Kaye WH, Bulik CM
Int J Eat Disord. 2009 Mar 3; (Hubmed.org)

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Low Serum BDNF And Food Intake Regulation : A Possible New Explanation of Pathophysiology of Eating Disorders

2009-06-14T01:09:00.000-07:00

Several lines of evidence suggest that brain-derived neurotrophic factor (BDNF) plays an important role in weight regulation and eating behavior, and poorly balanced diets lead to a decrease in blood BDNF levels.

However, studies regarding BDNF blood levels in eating disorders (ED) have yielded inconsistent results. We measured serum concentrations of BDNF and assessed behavior and cognition related to eating in ED patients and control subjects.

METHODS:
Forty female drug-free patients [19 with anorexia nervosa (AN), 21 with bulimia nervosa (BN)], who did not meet the diagnostic criteria for depressive disorder, and 24 age-matched normal control subjects were enrolled in the current study.

We evaluated eating-related psychopathology and depressive symptoms using the Eating Disorder Inventory-2 (EDI-2), Eating Attitude Test-26 (EAT-26) and the Hamilton Depression Rating Scale (HDRS), and measured serum BDNF levels by an enzyme-linked immunosorbent assay.

RESULTS:
Compared to normal controls, serum levels of BDNF were significantly reduced in AN, but not in BN. There was a significant positive correlation between serum BDNF levels and BMI in both AN patients (r=.649, p=.003) and BN patients (r=.626, p=.002).

However, no correlation between serum BDNF levels and BMI was detected in the controls. Furthermore, there was a significant negative correlation between serum BDNF levels and the oral control subscale scores of EAT in both AN patients (r=-.506, p=.027) and BN patients (r=-.511, p=.018); whereas, no correlation was detected in normal controls.

CONCLUSION:
Our study demonstrated that individuals showing more extreme food intake regulation were those with lower serum BDNF levels. This finding is contrary to that in mice where mice with reduced BDNF levels showed aberrant eating behavior. This result suggests that BDNF is no longer functioning appropriately in ED patients, which could be an important factor in the pathophysiological of ED

"Low serum BDNF and food intake regulation: a possible new explanation of the pathophysiology of eating disorders"
Saito S, Watanabe K, Hashimoto E, Saito T
Prog Neuropsychopharmacol Biol Psychiatry. 2009 Mar 17; 33(2): 312-6 (Hubmed.org)

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Psychometric Properties Of The Spanish Version of The Eating Behaviours And Body Image Test for Preadolescent Girls

2009-06-13T13:36:00.000-07:00

The purpose of the current study was to explore the psychometric properties of the Spanish adaptation of the Eating Behaviours and Body Image Test for Preadolescent Girls (EBBIT), as well as its factor structure and internal consistency.

A further objective was to determinate the convergent validity between measures of body mass index (BMI) and scores on the Body Dissatisfaction (BD) subscale, taking into account a wider questionnaire, known as the Eating Disorders Inventory (EDI-2).

Once the original scale was translated, 525 girls (age range 7-12 years) were assessed by the EBBIT, and the BD subscale. Students were weighed and measured, using calibrated electronic instruments to calculate BMI scores.

Factor analysis suggested two primary factors which represent body image dissatisfaction/ restrictive eating (BIDRE) and binge eating behaviours (BEB). The internal consistency of the EBBIT was 0.904. A multiple regression analysis was performed using BMI, age and BD subscale data (independent variables).

Results suggest that scores on the EBBIT factors are related to body size satisfaction. Higher BMI and higher BD scores were associated with higher scores on the BIDRE, and BD scores were associated with higher scores on the BEB factor.

"Psychometric properties of the Spanish version of the Eating Behaviours and Body Image Test for Preadolescent Girls (EBBIT"
Jáuregui I, Perez-Lancho C, Gomez-Capitan MJ, Duran E, Garrido O
Eat Weight Disord. 2009 Mar ; 14(1): e22-8 (Hubmed.org)

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Managing Anxiety In Eating Disorders With Knitting

2009-06-13T11:38:00.000-07:00

Recovery from anorexia nervosa (AN) is often confounded by intrusive, anxious preoccupations with control of eating, weight and shape. These are distressing and represent a potential barrier to psychological change.

Theoretical and empirical evidence suggests that performing a concurrent visuospatial task reduces the emotional intensity of distressing images. We assessed whether the visuospatial task of knitting influences the anxious preoccupation experienced by inpatients with AN.

METHOD:
Prospective interventional cohort.

SUBJECTS:
Thirty-eight women with AN admitted to a specialized eating disorder unit.

INTERVENTION:
All subjects were given knitting lessons and free access to supplies. MEASURE: Subjects were asked to report the qualitative effects of knitting on their psychological state using a self-report questionnaire.

RESULTS:
Patients reported a subjective reduction in anxious preoccupation when knitting. In particular, 28/38 (74%) reported it lessened the intensity of their fears and thoughts and cleared their minds of eating disorder preoccupations, 28/38 (74%) reported it had a calming and therapeutic effect and 20/38 (53%) reported it provided satisfaction, pride and a sense of accomplishment.

DISCUSSION:
This preliminary data suggests that knitting may benefit inpatients with eating disorders by reducing their anxious preoccupations about eating, weight and shape control. The specificity of this effect is yet to be determined.

This preliminary outcome requires further controlled study in AN subjects. From a clinical perspective, knitting is inexpensive, easily learned, can continue during social interaction, and can provide a sense of accomplishment.

The theoretical and empirical rationale for this observation, and implications for deriving alternative strategies to augment treatment in AN, are discussed.

"Managing anxiety in eating disorders with knitting"
Clave-Brule M, Mazloum A, Park RJ, Harbottle EJ, Birmingham CL
Eat Weight Disord. 2009 Mar ; 14(1): e1-5 (Hubmed.org)

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An Outbreak Of Hepatitis In Recently Vaccinated Students From Ice Snacks Made From Contaminated Well Water

2009-06-13T06:40:00.000-07:00

On 30 May 2006, township S in Sichuan Province, China, reported an outbreak of hepatitis A (HA) in students who had recently received HA vaccine.

The concern was raised that the vaccine had caused the outbreak. We attempted to identify the source of infection and mode of transmission. A HA case was defined as onset of jaundice or anorexia since 1 April 2006 with a twofold elevation of alanine aminotransferase (ALT) and anti-HA virus-IgM in a resident of or visitor to the township.

Exposures to vaccine and snacks of 90 case-students to those of 107 control-students were compared. Thirty-four per cent of cases ate ice slush compared to 4.7% of controls (OR 4.1), and 51% of cases ate snow cones compared to 17% of controls (OR 8.3). The ice snacks were made with well water.

HA virus RNA was detected by reverse transcription-polymerase chain reaction from patients' blood and well water. Untreated well water poses important dangers to the public in areas where piped, potable water is available.

"An outbreak of hepatitis A in recently vaccinated students from ice snacks made from contaminated well water"
Zhang LJ, Wang XJ, Bai JM, Fang G, Liu LG, Zhang Y, Fontaine RE
Epidemiol Infect. 2009 Mar ; 137(3): 428-33 (Hubmed.org)

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Bruch Revisited And Revised

2009-06-13T01:42:00.000-07:00

The aim of this text is to remind the clinical and scientific field of eating disorders of the seminal figure Hilde Bruch. Her work is highly original, but is it sinking into the mists of oblivion?

The contemporary overemphasis on cognitive behavioural therapy may indicate that. Hilde Bruch's contribution was a descriptive and theoretical model defining anorexia nervosa and severe eating disorders as self-disorders, with emphasis on developmental deficits in the organisation of the psychological self.

A limited focus on cognitions may undermine both the awareness of central aspects of the psychopathology of eating disorders, as well as the relevance of sensitively regulating the psychotherapeutic stance.

"Bruch revisited and revised"
Skårderud F
Eur Eat Disord Rev. 2009 Mar ; 17(2): 83-8 (Hubmed.org)

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A Phase I And Pharmacokinetic Study Of Daily Oral Cediranib

2009-06-12T11:44:00.000-07:00

Cediranib, a potent vascular endothelial growth factor inhibitor, demonstrated broad pre-clinical anti-tumour activity. This study evaluated escalating cediranib doses with combination chemotherapy in advanced non-small cell lung cancer patients.

METHODS:
Patients received cisplatin 80 mg/m(2) on day 1 and gemcitabine 1250 mg/m(2) on days 1 and 8 of a 3-week cycle, and daily oral cediranib at either 30 mg or 45 mg. Pharmacokinetics of all drugs were analysed, and response was assessed by RECIST.

RESULTS:
Fifteen patients were enrolled. No dose-limiting toxicities were observed during cycle 1. Fatigue, nausea, diarrhoea, anorexia and granulocytopaenia were common; hypertension was manageable.

No grade 3/4 bleeding occurred. At 45 mg/d, fatigue, diarrhoea and thrombocytopaenia were increased; and headache, hoarseness and grade 2 hand-foot syndrome were observed. Cediranib had no effect on cisplatin elimination, but clearance of gemcitabine is significantly reduced in the presence of cediranib (p>0.02). Central review confirmed responses in four of 15 enrolled patients (26.7%, 95% CI 7.8-55%) and four of 12 evaluable patients (33.3%, 95% CI 9.9-65%).

CONCLUSION:
Cediranib at 30 mg daily can be combined with standard doses of cisplatin/gemcitabine with encouraging anti-tumour activity, and is the recommended phase III dose. Toxicity is increased, but is predictable and manageable.

"A phase I and pharmacokinetic study of daily oral cediranib, an inhibitor of vascular endothelial growth factor tyrosine kinases, in combination with cisplatin and gemcitabine in patients with advanced non-small cell lung cancer: a study of the National Cancer Institute of Canada Clinical Trials Group"
Goss G, Shepherd FA, Laurie S, Gauthier I, Leighl N, Chen E, Feld R, Powers J, Seymour L
Eur J Cancer. 2009 Mar ; 45(5): 782-8 (Hubmed.org)

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A Case Of Cocaine-Induced Panhypopituitarism With Human Neutrophil Elastase-Specific Anti-Neutrophil Cytoplasmic Antibodies

2009-06-12T09:46:00.000-07:00

To describe a patient with cocaine-induced panhypopituitarism associated with human neutrophil elastase-anti-neutrophil cytoplasmic antibodies (HNE-ANCA).

CASE:
A 41-year-old man presented with extreme fatigue, cold intolerance and anorexia with 20 kg weight loss in the last 6 months. His medical history was unremarkable. He snorted cocaine twice a week during the last 6 years.

On examination, we saw a pale and skinny man, with a normal blood pressure. Because of the severity of symptoms central hypothyroidism was suspected and very low values of TSH, free thyroxine and free triiodothyronine were measured. His FSH, LH, ACTH, cortisol, prolactin and testosterone levels were also low.

Magnetic resonance imaging and computed tomography scan showed a normal-sized pituitary gland entirely embedded in a dense, oedematous, contrast-enhancing mass, and a total destruction of the nasal septum with the absence of conchae and severely impaired sinus walls.

A transnasal biopsy showed an acute necrotising, non-specific and non-granulomatous inflammation. Although cocaine-induced panhypopituitarism was suspected, Wegener's granulomatosis could not be excluded. Serology on ANCA showed a strongly positive C-ANCA titre (320 U/l) with specificity for HNE.

A cocaine-induced HNE-ANCA-associated panhypopituitarism was diagnosed. Our patient was advised to quit using cocaine immediately and was initially treated with glucocorticoids and testosterone, followed by thyroxine.

This led to a dramatic clinical response with an increase of appetite, weight gain and regained energy. After 2 years, the patient is well and his ANCA titre is no longer positive.

CONCLUSION:
We describe the first documented case of cocaine-induced panhypopituitarism associated with HNE-specific ANCA.

"A case of cocaine-induced panhypopituitarism with human neutrophil elastase-specific anti-neutrophil cytoplasmic antibodies"
de Lange TE, Simsek S, Kramer MH, Nanayakkara PW
Eur J Endocrinol. 2009 Mar ; 160(3): 499-502 (Hubmed.org)

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Treatment Of Anorexia | Symptoms Of Anorexia | Causes of Anorexia

Pssible New Explanation Of The Pathophysiology Of Eating Disorders

2009-06-12T04:22:00.000-07:00

Several lines of evidence suggest that brain-derived neurotrophic factor (BDNF) plays an important role in weight regulation and eating behavior, and poorly balanced diets lead to a decrease in blood BDNF levels.

However, studies regarding BDNF blood levels in eating disorders (ED) have yielded inconsistent results. We measured serum concentrations of BDNF and assessed behavior and cognition related to eating in ED patients and control subjects.

METHODS:
Forty female drug-free patients [19 with anorexia nervosa (AN), 21 with bulimia nervosa (BN)], who did not meet the diagnostic criteria for depressive disorder, and 24 age-matched normal control subjects were enrolled in the current study.

We evaluated eating-related psychopathology and depressive symptoms using the Eating Disorder Inventory-2 (EDI-2), Eating Attitude Test-26 (EAT-26) and the Hamilton Depression Rating Scale (HDRS), and measured serum BDNF levels by an enzyme-linked immunosorbent assay.

RESULTS:
Compared to normal controls, serum levels of BDNF were significantly reduced in AN, but not in BN. There was a significant positive correlation between serum BDNF levels and BMI in both AN patients (r=.649, p=.003) and BN patients (r=.626, p=.002).

However, no correlation between serum BDNF levels and BMI was detected in the controls. Furthermore, there was a significant negative correlation between serum BDNF levels and the oral control subscale scores of EAT in both AN patients (r=-.506, p=.027) and BN patients (r=-.511, p=.018); whereas, no correlation was detected in normal controls.

CONCLUSION:
Our study demonstrated that individuals showing more extreme food intake regulation were those with lower serum BDNF levels. This finding is contrary to that in mice where mice with reduced BDNF levels showed aberrant eating behavior. This result suggests that BDNF is no longer functioning appropriately in ED patients, which could be an important factor in the pathophysiological of ED.

"Low serum BDNF and food intake regulation: a possible new explanation of the pathophysiology of eating disorders"
Saito S, Watanabe K, Hashimoto E, Saito T
Prog Neuropsychopharmacol Biol Psychiatry. 2009 Mar 17; 33(2): 312-6 (Hubmed.org)

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Treatment Of Anorexia | Symptoms Of Anorexia | Causes of Anorexia

Comparison Of Anorexia, Lethargy, And Fever Induced By Bacterial And Viral Mimetics

2009-06-12T01:34:00.000-07:00

Although it has been established that some acute phase responses present differently depending on whether a virus or bacteria activates the innate immune system, it has not yet been established whether fever and sickness behaviors, such as anorexia and lethargy, present differently.

We therefore investigated the effects of administering lipopolysaccharide (LPS) and polyinosinic : polycytidylic acid (poly I:C) on body temperature, food intake, body mass, and activity (cage activity and wheel running).

Male Sprague-Dawley rats were randomly assigned to receive an intraperitoneal injection of one of LPS (75 microg/kg or 250 microg/kg), poly I:C (3000 microg/kg or 4000 microg/kg), or saline. Administration of LPS or poly I:C induced fever, anorexia, and lethargy.

Although voluntary wheel running and cage activity were both significantly reduced after administration of LPS or poly I:C, they were not affected equally. Indeed voluntary wheel running was decreased on average by approximately 30% more than cage activity regardless of the dose or type of mimetic administered.

Our results indicate that poly I:C is less effective at inducing anorexia, lethargy, and fever in rats than is LPS, and that avoidance of exercise in animals and humans during infection is likely to be a more prominent feature of illness than is avoidance of routine daily activity.

"Comparison of anorexia, lethargy, and fever induced by bacterial and viral mimetics in rats"
Hopwood N, Maswanganyi T, Harden LM
Can J Physiol Pharmacol. 2009 Mar ; 87(3): 211-20 (Hubmed.org)

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Treatment Of Anorexia | Symptoms Of Anorexia | Causes of Anorexia

Thalidomide-Dexamethasone Versus Interferon-Alpha-Dexamethasone As Maintenance Treatment After ThaDD Induction For Multiple Ryeloma

2009-06-11T13:31:00.000-07:00

Maintenance therapy was explored in multiple myeloma (MM) patients after conventional thalidomide, dexamethasone and pegylated liposomal doxorubicin (ThaDD). Patients with newly or relapsed MM obtaining at least minor response after 6 ThaDD courses, were randomised to receive alpha-interferon (IFN) 3 MU 3 times a week or thalidomide 100 mg daily until relapse. Both groups also received pulsed dexamethasone 20 mg 4 d a month.

Fifty-one patients were randomized in the IFN-dexamethasone (ID) arm and 52 in the thalidomide-dexamethasone (TD) arm. The characteristics of two groups were similar. A significantly better 2-years progression-free survival (PFS; 63% vs. 32%; P = 0.024) and overall survival (84% vs. 68%; P = 0.030) was observed in the thalidomide arm.

In high-risk patients and in those achieving less than very good partial response after induction, TD fared better in term of PFS. Main side effects were peripheral neuropathy and constipation in TD group, fatigue, anorexia and haematological toxicity in ID arm.

There was a 21% probability of discontinuation at 3 years in the thalidomide arm and 44% in the IFN arm (P = 0.014). Low-dose thalidomide plus pulsed low-dose dexamethasone after conventional thalidomide combination-based therapy was also feasible in the long term, enabling significantly better residual disease control if compared with a standard maintenance therapy.

"Thalidomide-dexamethasone versus interferon-alpha-dexamethasone as maintenance treatment after ThaDD induction for multiple myeloma: a prospective, multicentre, randomised study"
Offidani M, Corvatta L, Polloni C, Piersantelli MN, Gentili S, Galieni P, Visani G, Alesiani F, Catarini M, Brunori M, Samori A, Burattini M, Centurioni R, Ferranti M, Giuliodori L, Candela M, Mele A, Marconi M, Leoni P
Br J Haematol. 2009 Mar ; 144(5): 653-9 (Hubmed.org)

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Treatment Of Anorexia | Symptoms Of Anorexia | Causes of Anorexia

Excessive Exercise In Eating Disorder Patients And In Healthy Women

2009-06-11T09:27:00.000-07:00

Motivational Change In An Inpatient Anorexia Nervosa Population And Implications For Treatment

2009-06-11T06:21:00.000-07:00

The relationship between motivation and recovery in anorexia nervosa has received increased attention in the research literature although few controlled investigations of increasing motivation in this population exist.

Three questions were therefore examined in an inpatient anorexia nervosa population: (i) does baseline motivation predict change in eating pathology; (ii) does change in motivation predict change in eating pathology; and (iii) can we increase motivation to recover in this group?

METHOD:
Inpatients (n=47) in a specialist weight disorder unit with a mean age of 21.85 years (SD=5.37) were randomly allocated to receive four sessions of motivational interviewing with a novice therapist in addition to treatment as usual (n=22) or treatment as usual alone (n=25).

Assessment of eating pathology and motivation to recover was conducted on three occasions: at admission (baseline), and at 2- and 6 week follow up. Eating pathology was assessed using the Eating Disorder Examination and self-reported motivation was assessed using the Anorexia Nervosa Stages of Change Questionnaire and six Likert scales.

RESULTS:
Higher baseline motivation across five of the seven measures predicted significant decreases in eating pathology, and increased Anorexia Nervosa Stages of Change Questionnaire scores between baseline and 2 week follow up predicted significant improvement in eating pathology between baseline and 6 week follow up.

Significantly more patients were lost to follow up from the treatment as usual compared to the motivational interviewing group. More patients in the motivational interviewing condition moved from low readiness to change at baseline to high readiness to change at 2 and 6 week follow up.

CONCLUSIONS:
Motivation is an important predictor of change in anorexia nervosa and preliminary evidence is provided that motivation can be improved in this population. Further investigations, however, of ways of improving motivation in this population need to be conducted, along with the impact of motivational changes on treatment outcome.

"Motivational change in an inpatient anorexia nervosa population and implications for treatment"
Wade TD, Frayne A, Edwards SA, Robertson T, Gilchrist P
Aust N Z J Psychiatry. 2009 Mar ; 43(3): 235-43 (Hubmed.org)

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Treatment Of Anorexia | Symptoms Of Anorexia | Causes of Anorexia

An Open-Label Study Of Vandetanib With Pemetrexed In Patients With Previously Treated Non-Small-Cell Lung Cancer

2009-06-11T01:17:00.000-07:00

Vandetanib (ZACTIMA; ZD6474) is a once-daily, oral inhibitor of vascular endothelial growth factor receptor and epidermal growth factor receptor signaling. The safety and tolerability of vandetanib plus pemetrexed was assessed in patients with advanced non-small-cell lung cancer (NSCLC).

PATIENTS AND METHODS:
Patients with previously treated NSCLC (stage IIIB/IV) received once-daily oral vandetanib (100 or 300 mg) with pemetrexed (500 mg/m(2) i.v. infusion every 21 days).

RESULTS:
Patients received vandetanib 100 mg + pemetrexed (n=10) or vandetanib 300 mg + pemetrexed (n=11). The protocol definition of a tolerable dose [vandetanib-related dose-limiting toxicity (DLT) in less than 2 patients] was met in both dose cohorts, with one DLT reported in each: asymptomatic QTc prolongation (>100 ms increase from baseline, but absolute QTc<500 rash, anorexia, fatigue and diarrhea (all n=10).

CONCLUSION:
Vandetanib and pemetrexed in combination were generally well tolerated in patients with advanced NSCLC.

"An open-label study of vandetanib with pemetrexed in patients with previously treated non-small-cell lung cancer"
de Boer R, Humblet Y, Wolf J, Nogová L, Ruffert K, Milenkova T, Smith R, Godwood A, Vansteenkiste J
Ann Oncol. 2009 Mar ; 20(3): 486-91 (Hubmed.org)

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Treatment Of Anorexia | Symptoms Of Anorexia | Causes of Anorexia

Combination Therapy With S-1 And Irinotecan In Patients With Advanced Colorectal Cancer

2009-06-10T13:08:00.000-07:00

The aim of this study was to determine the maximum tolerated dose, recommended dose and dose-limiting toxicities of irinotecan (CPT-11) plus S-1 in advanced colorectal cancer.

METHODS:
S-1 was administered orally at 80 mg/m(2) per day for 14 consecutive days followed by a 2-week rest. CPT-11 was given intravenously on days 1 and 15 of each course, at an initial dose of 80 mg/m(2) per day, stepping up to 100, 120 or 150 mg/m(2) per day. Courses were repeated every 4 weeks, unless disease progression or severe toxicities were observed.

RESULTS:
A total of 21 patients were entered in this study. The maximum tolerated dose of CPT-11 was considered to be 150 mg/m(2), because 2 of 3 patients developed dose-limiting toxicities such as leukopenia, neutropenia, diarrhea and anorexia.

The recommend dose of CPT-11 was set at 120 mg/m(2). Tumor response rate was 42.8% and median progression-free survival time was 10 months (95% confidential interval, 6.0-14.0 months).

CONCLUSION:
A combination of S-1 and CPT-11 showed a good safety profile and can be recommended for further phase II studies in patients with colorectal cancer.

"A phase I study of combination therapy with S-1 and irinotecan (CPT-11) in patients with advanced colorectal cancer"
Shiozawa M, Sugano N, Tsuchida K, Morinaga S, Akaike M, Sugimasa Y
J Cancer Res Clin Oncol. 2009 Mar ; 135(3): 365-70 (Hubmed.org)

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Treatment Of Anorexia | Symptoms Of Anorexia | Causes of Anorexia

Determining Calcium And Aitamin D Intake By Adolescent Girls With Anorexia Nervosa

2009-06-10T06:05:00.000-07:00

Assessing calcium and vitamin D intake becomes important in conditions associated with low bone density such as anorexia nervosa. Food records that assess intake over a representative time period are used in research and sometimes clinical settings. However, compliance in adolescents can be suboptimal.

This study was undertaken to determine the validity of a food frequency questionnaire (FFQ) for assessing calcium and vitamin D intake in adolescent girls with anorexia nervosa and healthy girls compared to validated food records assessing intake during a 4-day period, the hypothesis being that intake would be adequately predicted by the FFQ.

Thirty-six girls with anorexia nervosa and 39 healthy girls aged 12 to 18 years completed both the food record and the FFQ. An additional 31 subjects (20 with anorexia nervosa, 11 controls) completed the FFQ, but not the food record, and one girl with anorexia nervosa completed the food record, but not the FFQ.

Subjects demonstrated greater compliance with the FFQ (99%) than the food record (71%). Daily calcium and vitamin D intake calculated using the food record and FFQ did not differ, although the FFQ tended to under-report vitamin D intake corrected for energy intake.

Using quartile analysis, no gross misclassification was noted of calcium or vitamin D intake calculated using the food record or FFQ in girls with anorexia nervosa. Strong correlations were observed for daily vitamin D intake derived from the FFQ vs the food record, particularly in girls with anorexia nervosa (r=0.78, P<0.0001). r="0.65," style="font-style: italic;">

"Validation of a food frequency questionnaire for determining calcium and vitamin D intake by adolescent girls with anorexia nervosa"
Taylor C, Lamparello B, Kruczek K, Anderson EJ, Hubbard J, Misra M
J Am Diet Assoc. 2009 Mar ; 109(3): 479-85, 485.e1-3 (Hubmed.org)

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Treatment Of Anorexia | Symptoms Of Anorexia | Causes of Anorexia

Metastatic Uterine Adenocarcinoma And Hepatic Lipomatosis In llama

2009-06-10T04:21:00.000-07:00

A 6-year-old, female llama (Lama glama) presented with progressive anorexia and ascites. Postmortem examination revealed an infiltrative uterine adenocarcinoma with widespread metastases.

The neoplasm completely replaced and infiltrated the myometrium of the uterine body and cervix and metastasized largely to the serosal surfaces of the peritoneal cavity.

Histopathology identified a highly invasive growth of neoplastic cells in solid packets or tubular arrangements and marked fibroplasia. No bovine or llama papillomavirus DNA was detected intralesionally by polymerase chain reaction.

"Metastatic uterine adenocarcinoma and hepatic lipomatosis in a llama (Lama glama"
Klopfleisch R, van der Grinten E, Gruber AD
J Vet Diagn Invest. 2009 Mar ; 21(2): 280-2 (Hubmed.org)

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Treatment Of Anorexia | Symptoms Of Anorexia | Causes of Anorexia

Endoscopically Assisted Minimally Invasive Surgery For Gallstones

2009-06-10T01:01:00.000-07:00

We present a case report of Bouveret syndrome followed by a review of the recent literature regarding the management of this condition.

Bouveret syndrome is a form of gastric outlet obstruction secondary to a gallstone which has eroded through the gallbladder into the duodenum. It is an uncommon variant of gallstone ileus. Endoscopic methods have been described to extract the stone from the duodenum.

METHODS:
This is a case of an 85-year-old female patient who presented with a 1-week history of nausea, intermittent bilious vomiting and anorexia. Imaging confirmed the diagnosis of Bouveret syndrome caused by two large gallstones.

Conventional endoscopic methods successfully extracted the impacted stones from the duodenum into the stomach but were unable to extract the stones from the stomach. A mini-transverse laparotomy and gastrotomy were performed to finally extract the stones

"Endoscopically assisted minimally invasive surgery for gallstones"
Thompson RJ, Gidwani A, Caddy G, McKenna E, McCallion K
Ir J Med Sci. 2009 Mar ; 178(1): 85-7 (Hubmed.org)

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Treatment Of Anorexia | Symptoms Of Anorexia | Causes of Anorexia

Roles of Protein Kinase Calpha Isozyme In The Regulation Of Oxidative Stress

2009-06-09T17:11:00.000-07:00

Hypothalamic neuropeptide Y (NPY) is an appetite stimulant in the brain. Although regulation of NPY expression has been reported to contribute to the appetite-suppressing effect of phenylpropanolamine (PPA), it is still unknown if protein kinase C (PKC) is involved in this effect. Rats were daily treated with PPA for 4 days.

Changes in food intake, hypothalamic NPY, PKC, and proopiomelanocortin (POMC) mRNA levels were assessed and compared. Results showed that the NPY gene was down-regulated following PPA treatment, which was parallel with the decrease of feeding.

Moreover, several isotypes of PKC mRNA level (alpha, betaI, betaII, gamma, delta, eta, lambda, epsilon, and zeta) were changed. Among these, alpha, delta, and lambda PKC were up-regulated along with POMC gene expression which coincided with down-regulation of the NPY gene.

To further determine if PKCalpha was involved, infusions of antisense oligonucleotide into the cerebroventricle were performed at 1 h before daily PPA treatment in free-moving rats. Results showed that PKCalpha knock-down could modify both anorexia induced by PPA and the NPY mRNA levels.

Moreover, PKCalpha knock-down could also modify superoxide dismutase (SOD) gene expression. It is suggested that PKCalpha participates in the regulation of PPA-mediated appetite suppression via the modulation of NPY and SOD gene expression.

"Roles of protein kinase Calpha isozyme in the regulation of oxidative stress and neuropeptide Y gene expression in phenylpropanolamine-mediated appetite suppression.
Kuo DY, Yang SF, Chu SC, Chen CH, Hsieh YS
J Neurochem. 2009 Mar ; 108(6): 1495-506 (Hubmed.org)

The Causes of Anorexia Nervosa

2009-06-09T11:22:00.000-07:00

Although there are many socio-cultural factors that can causes of anorexia, it is likely that some people have a natural predisposition to suffer this disorder, regardless of which can exert pressure environment.

Thus there are general factors that are associated with causes of anorexia or some biological vulnerability, which is what precipitated the development of the disease.

The origin that causes of anorexia is, in short, a combination of biological (physical), psychological and social. In this way we can distinguish two types of factors: general and triggers.

In short, among the factors that causes of anorexia are:

The very obese patient.
Maternal Obesity.
Death or illness of a loved one.
Separation from parents.
Removal from the home.
School failure.
Accidents.
Traumatic events.

The most important factors that predispose and facilitate the emergence of the causes of anorexia :

Low self-esteem and anorexia
Personality characteristics: low self-esteem, dependent personality, lack of autonomy, high need for approval from others, difficulty in interpersonal relationships, difficulty in perceiving their environment objectively, problems in accepting the difficulties of life, feeling inadequacy, feeling of failure and lack of control, low tolerance to frustration, causing much discomfort accompanied by symptoms of anxiety or depression;

Family circumstances and anorexia
There is a typical family that causes the disease of anorexia or bulimia but on the contrary, asserts that there is great variability among families.

The great social pressure on thinness and anorexia
The great social pressure on thinness has been experienced in recent years with the media, advertising and fashion, to raise the fee and the importance of beauty in our society the cult of body worship and the slender body proposing goals for weight loss.

Tags:
causes of anorexia nervosa, social causes of anorexia, biological causes of anorexia nervosa, main causes of anorexia

The Symptoms Of Anorexia Nervosa

2009-06-09T03:19:00.000-07:00

The following are the most common physical symptoms of anorexia , which are often the result of hunger and malnutrition. However, each child may experience symptoms in a different way. Symptoms of anorexia may include:

Refusal to maintain body weight or above the minimum weight stopping age and height.
Intense fear of gaining weight, even having a low weight for the physical parameters themselves.
Distortion of the perceived weight and body image itself.
For women, in advanced cases of anorexia, absence of at least three consecutive menstrual cycles.
Dry skin that when pinched and released does not recover its normal shape.
Dehydration.
Abdominal pain.
Constipation.
Lethargy.
Fatigue.
Intolerance to cold.
Demacracion.
Development of lanugo (fine body hair and white).
Yellowish skin.

People who have anorexia can become socially introverted, irritable, and a variable, or depressed. Symptoms of anorexia nervosa may resemble those of other medical problems or psychiatric conditions. Always consult your child's doctor for diagnosis.

So if you warn or express in the following loved ones:
Warning!

abnormally low body weight.
discussions that insufficient weight through diet, exercise, abuse of laxatives or diuretics, or any combination of these factors.
symptoms of starvation

Tag:
physical symptoms of anorexia, list of symptoms of anorexia nervosa, specific symptoms of anorexia nervosa, anorexia nervosa symptoms

The Treatment Of Anorexia Nervosa

2009-06-09T01:14:00.000-07:00

Treatment of anorexia is long and should involve the physician, a nutritionist and a psychologist in addition to the family in order to achieve improvement

There are various treatment of anorexia, the alternatives are: psychotherapy, behavioral therapy, drug therapy, family, etc.. The treatment of anorexia objectives is to stabilize the food in the individual and the family try to solve their shortcomings and the role of the family is essential for recovery.

It is recommended for the parents concerned to try to find her son missing values, encourage initiative, independence and self-esteem.

Treatment of anorexia nervosa

The specific treatment of anorexia nervosa will be determined by your child's physician based on:

age, general health and medical history.
The extent of symptoms.
Tolerance to certain drugs, procedures or therapies.
Expectations for the trajectory of the condition.
Your opinion or preference.

Anorexia is usually treated with a combination of individual therapy, family therapy, behavior modification and nutritional rehabilitation. Treatment of anorexia should always be based on a thorough assessment of the adolescent and family.

Individual therapy usually includes cognitive and behavioral techniques. Medications (usually antidepressants) may help if the adolescent has anorexia is also depressed.

The existence of frequent medical complications and the possibility of death during the acute treatment and rehabilitation require that your child's doctor and a nutritionist to be active participants of the treatment of anorexia team. Parents play a vital supportive role in any treatment of anorexia process.

Treatment of anorexia is difficult because people who suffer think that they do not have this problem. For successful treatment of anorexia, patients must want to change and should be supported by family and friends to help.

Tags:
acute treatment of anorexia nervosa, nutrition treatment of anorexia nervosa, outpatient treatment anorexia

Self-monitoring In Anorexia Nervosa

2009-06-08T14:59:00.000-07:00

A possible connection between Mark Snyder's concept of self-monitoring and anorexia nervosa (AN) has not previously been examined.

AIMS: We hypothesized that AN symptomatology correlates positively with the Other-Directedness aspect of Snyder's self-monitoring construct and negatively with its Extraversion aspect.

METHOD: 194 women with a history of AN were classified as currently ill (n = 17), partially recovered (n = 106) and recovered (n = 71).These women and 100 female controls with no history of an eating disorder completed Snyder's Self-Monitoring Scale (SMS) and the Eating Attitudes Test-26 (EAT-26). ;Other-Directedness' and ;Acting and Extraversion'subscales were derived from an exploratory factor analysis of the Hebrew version of the SMS.

Mean total and subscale scores were compared across groups, and correlations were calculated between EAT-26 scores and SMS total and subscale scores.

RESULTS:
Both subscales of the SMS correlated significantly with total scores but not with one another. As expected, AN symptomatology and EAT-26 scores were associated positively with Other-Directedness yet negatively with Acting and Extraversion, rendering the correlation with total SMS scores insignificant.

CONCLUSION:
Different aspects of Snyder's self-monitoring construct correlate in opposite directions with eating pathology and AN symptomatology. AN appears to be associated with high Other-Directedness but low Acting and Extroversion.

"Self-monitoring in anorexia nervosa"
Bachner-Melman R, Zohar AH, Kremer I, Komer M, Blank S, Golan M, Ebstein RP
Int J Soc Psychiatry. 2009 Mar ; 55(2): 170-9 (Hubmed.org)

Aromatic Amino Acids In Weight-Recovered Females With Anorexia Nervosa

2009-06-08T11:54:00.000-07:00

Most previous studies investigating amino acid levels in anorexia nervosa (AN) have focused on acutely underweight patients.

The present study assessed the availability of aromatic amino acids in the plasma of weight-recovered outpatients with AN (recAN) in comparison to acutely underweight AN patients (acAN) and healthy control woman (HCW).

METHOD:
Plasma tryptophan (TRP), tyrosine (TYR), and phenylalanine (PHEN) as well as leptin concentration were determined in 32 recAN, 32 acAN, and 32 HCW.

RESULTS:
Both recAN and acAN patients showed significantly lower levels of TRP and PHEN when compared to HCW. TYR was reduced in acAN patients only.

DISCUSSION:
Normal weight and normal leptin levels but lower availability of TRP and PHEN in recAN patients might indicate that outside a tightly controlled setting these patients still engage in abnormal eating patterns.

Reduced peripheral availability of these precursor amino acids could impact on 5-HT and catecholamine functioning in the brain.

"Aromatic amino acids in weight-recovered females with anorexia nervosa"
Ehrlich S, Franke L, Schneider N, Salbach-Andrae H, Schott R, Craciun EM, Pfeiffer E, Uebelhack R, Lehmkuhl U
Int J Eat Disord. 2009 Mar ; 42(2): 166-72 (Hubmed.org)

"Ice" Use And Eating Disorders

2009-06-08T06:20:00.000-07:00

To describe the use of crystal methamphetamine hydrochloride "ice," a powerful, synthetic stimulant drug associated with rapid weight loss.

METHOD:
We report the first three cases of young women "ice" users requiring admission to a specialized eating disorders unit.

RESULTS:
Case one had no prior history of an eating disorder and became emaciated following regular use of "ice"; she regarded weight gain positively. Case 2 had polysubstance abuse since early adolescence and commenced binge eating and vomiting in response to weight gain when not using "ice"; she learned to maintain her weight without weight losing behaviors.

Case 3 developed anorexia nervosa in early adolescence, required numerous inpatient admissions and commenced using stimulant drugs for weight loss in her late teens; she discharged prematurely. All patients had features of personality disorder on interview and drug abuse had impaired their work and social adjustment.

DISCUSSION:
"Ice" use may be associated with the onset of disordered eating or used as an efficient weight losing behavior in an established eating disorder.

""Ice" use and eating disorders: a report of three cases"
Neale A, Abraham S, Russell J
Int J Eat Disord. 2009 Mar ; 42(2): 188-91 (Hubmed.org)

Eating-Disorder Symptoms And Syndromes In A Sample Of Urban-Dwelling Canadian Women

2009-06-08T02:18:00.000-07:00

We estimated the prevalence of eating disorders and maladaptive eating behaviors in a population-based sample and examined the association of maladaptive eating with self-rated physical and mental health.

METHOD:
A sample of 1,501 women (mean age = 31.2 years, SD = 6.2) were recruited using random-digit dialing to participate in a 20-min telephone interview about eating behaviors.

RESULTS:
Weighted frequency analysis showed the prevalence of frequent binge-eating to be 4.1%, that of regular purging to be 1.1%, and that of frequent compensation to be 8.7%.

Although we found none of the women to meet full criteria for anorexia nervosa, 0.6% met criteria for bulimia nervosa, 3.8% provisional criteria for binge eating disorder, and 0.6% criteria for a newly proposed entity, purging disorder.

As many as 14.9% fell into a residual category representing subthreshold, but potentially problematic variants of eating disturbances. Logistic regression analyses showed that clinical-level maladaptive eating attitudes and behaviors predicted self-rated physical- and mental-health problems after sociodemographic factors were controlled.

DISCUSSION:
This population-based survey provides prevalence estimates of BN, BED, and purging disorder that are compatible with those of recent epidemiological studies and shows that maladaptive eating attitudes and behaviors represent a substantial population burden

"Eating-disorder symptoms and syndromes in a sample of urban-dwelling Canadian women: contributions toward a population health perspective"
Gauvin L, Steiger H, Brodeur JM
Int J Eat Disord. 2009 Mar ; 42(2): 158-65 (Hubmed.org)

A Study Of Anorexia Nervosa Patients

2009-06-07T14:17:00.000-07:00

Individuals with alexithymia are typically unable to identify, understand, or describe their own emotions. Patients with anorexia nervosa (AN) have been shown to have high levels of alexithymia, and the latter trait may play an important role over the course of AN.

However, relatively little is known about the underlying neurobiological relationships between alexithymia and AN. The aim of this study was to investigate the relationship between alexithymia level and brain activation in patients with AN. Thirty female patients participated in this study.

Alexithymia was measured using the 20-item Toronto Alexithymia Scale. Functional magnetic resonance imaging was used to identify the brain regions that display abnormal hemodynamic activity while patients with AN were engaged in an emotional decision-making task.

There was significant activation in the amygdala during the task, but not in the posterior and anterior cingulate cortices (PCC, ACC). However, PCC and ACC activation did vary as a function of alexithymia level. These results suggest that alexithymia in AN patients is associated with a deficit in the cognitive evaluation of negative emotions concerning body image.

Alexithymia might play a crucial role in the emotional processing impairments that are often observed in AN patients, and this trait might ultimately help to better account for the psychopathological mechanism that underlies AN.

"Neural correlates of alexithymia in response to emotional stimuli: a study of anorexia nervosa patients"
Miyake Y, Okamoto Y, Onoda K, Shirao N, Mantani T, Yamawaki S
Hiroshima J Med Sci. 2009 Mar ; 58(1): 1-8 (Hubmed.org)

Phase II Evaluation Of Neoadjuvant Chemotherapy And Debulking

2009-06-07T11:14:00.000-07:00

Intraperitoneal (IP) chemotherapy prolongs survival in optimally reduced ovarian cancer patients. For patients in whom optimal debulking cannot be achieved, one could incorporate IP therapy post-operatively if the cancer was optimally debulked following neoadjuvant chemotherapy. We sought to evaluate overall survival (OS), progression-free survival (PFS), percent of patients optimally debulked and toxicity in patients treated with this strategy.

METHODS:
Women with adenocarcinoma by biopsy or cytology with stage III/IV (pleural effusions only) epithelial ovarian, fallopian tube or primary peritoneal carcinoma that presented with bulky disease were treated with neoadjuvant intravenous (IV) paclitaxel 175 mg/m2 and carboplatin AUC 6 q 21 daysx3 cycles followed by surgery (if >/=50% decrease in CA125). If optimally debulked they received IV paclitaxel 175 mg/m2 and IP carboplatin AUC 5 (day 1) and IP paclitaxel 60 mg/m2 (day 8) q 28 daysx6 cycles.

RESULTS:
Sixty-two patients were registered. Four were ineligible. Fifty-six were evaluated for neoadjuvant chemotherapy toxicities. One patient died of pneumonia. Five patients had grade 4 toxicity, including neutropenia (3), anemia, leukopenia, anorexia, fatigue, muscle weakness, respiratory infection, and cardiac ischemia.

Thirty-six patients had debulking surgery. Two had grade 4 hemorrhage. Twenty-six patients received post-cytoreduction chemotherapy. Four had grade 4 neutropenia. At a median follow-up of 21 months, median PFS is 21 months and median OS is 32 months for all 58 patients. PFS and OS for the 26 patients who received IV/IP chemotherapy is 29 and 34 months respectively.

CONCLUSIONS:
These results compare favorably with other studies of sub-optimally debulked patients.

"Phase II evaluation of neoadjuvant chemotherapy and debulking followed by intraperitoneal chemotherapy in women with stage III and IV epithelial ovarian, fallopian tube or primary peritoneal cancer: Southwest Oncology Group Study S0009."
Tiersten AD, Liu PY, Smith HO, Wilczynski SP, Robinson WR, Markman M, Alberts DS
Gynecol Oncol. 2009 Mar ; 112(3): 444-9 (Hubmed.org)

[A Case Of Bone Marrow Carcinosis From Gastric Cancer

2009-06-07T02:11:00.000-07:00

The case was a 64-year-old man. He was diagnosed as gastric cancer, lymph node metastases, brain metastases, bone marrow carcinomas, and disseminated intravascular coagulation(DIC).

He was started on methotrexate(MTX)/5- fluorouracil(5-FU)sequential therapy(weekly administration of MTX(100 mg/m(2), iv bolus)followed by 5-FU(600 mg/m(2), iv bolus)with a 3 h interval).

DIC was resolved, and the tumor marker decreased remarkably. Four weeks later, he received zoledronic acid 4 mg to prevent skeletal complication. Next day, fatigue and anorexia onset. Six days later, laboratory data showed severe hypocalcemia.

He was started on calcium gluconate 3.4 g/day. The calcium level was normalized in twelve days, and the symptoms were improved. MTX /5-FU therapy was resumed, and his condition remained stable. However, after the ninth dosage, he developed fatigue and low back pain, and the DIC relapsed.

We started paclitaxel therapy. But it was not effective and he died ten days later. It was considered that careful attention to hypocalcemia is necessary when we use zoledronic acid for the bone marrow carcinomas treated with chemotherapy.

"A case of bone marrow carcinosis from gastric cancer that presented hypocalcemia caused by zoledronic acid during the treatment of methotrete/5-fluorouracil sequential therapy"
Tsukasa K, Fujimoto C, Ariyama H, Esaki T, Murakawa M, Syoji T, Baba E, Hiranuma S
Gan To Kagaku Ryoho. 2009 Mar ; 36(3): 489-92 (Hubmed.org)

A Case Of An Older Adult Patient With Recurrent Gastric Cancer

2009-06-07T01:43:00.000-07:00

An 88-year-old woman, who had undergone distal gastrectomy for Stage IIIA gastric cancer, was diagnosed with recurrent abdominal lymph node metastasis 11 months after surgery.

Creatinine clearance of this patient calculated by Cockcroft-Gault method was 44 mL/min and renal function was impaired, so we reduced the administration dosage to 50 mg/day. S-1 was administered for two weeks followed by one week rest.

This schedule induced grade 2 anorexia and fatigue after one week administration, so it was converted to one week administration followed by one week rest. By this dosage and administration schedule, a partial response(PR)was continued for about four years without any adverse reaction.

This successful case might indicate that it was important for older adult patients with gastric cancer to consider not only appropriate reduction of the dosage but also shortening of S-1 administration.

"A case of an older adult patient with recurrent gastric cancer successfully treated by low-dose S-1 for a long time"
Kimura Y, Yano H, Iwazawa T, Miyazaki S, Danno K, Kano T, Ohnishi T, Tono T, Nakano Y, Monden T, Imaoka S
Gan To Kagaku Ryoho. 2009 Mar ; 36(3): 493-5 (Hubmed.org)

A Case Of Peritoneal Serous Papillary Adenocarcinoma

2009-06-06T14:41:00.000-07:00

A78-year-old female was admitted to our hospital with anorexia due to ascites. We were not able to diagnose by cytological diagnosis.

For a definite diagnosis she underwent an open biopsy. Histological findings revealed observable papillary adenocarcinoma with psammoma body, carcinoma cells were positive for Ber-EP4 on immunostaining, and ovaries were normal.

Thus, we made a diagnosis of peritoneal serous papillary adenocarcinoma. She was treated by intraperitoneal administration of CDDP(20 mg/day: day 1, every four weeks). Ascites vanished and CA125 was within the normal range.

There was no recurrence after 3 years, but Virchow's lymph node metastasis occurred. The patient is still alive 12 months after metastasis with CDDP intraperitoneal administration

"A case of peritoneal serous papillary adenocarcinoma"
Shinji A, Hara E, Mukawa K, Mochizuki T, Ohta H, Yamamura N, Oguchi H, Yazawa K, Kajikawa S, Nakamura T
Gan To Kagaku Ryoho. 2009 Mar ; 36(3): 497-500 (Hubmed.org)

Prostaglandin Mdiates Endotoxaemia-Induced Hypophagia

2009-06-06T11:39:00.000-07:00

Corticotrophin-releasing factor (CRF) and alpha-melanocyte-stimulating hormone (alpha-MSH), both of which are synthesized by hypothalamic neurons, play an essential role in the control of energy homeostasis.

Neuroendocrine and behavioural responses induced by lipopolyssacharide (LPS) have been shown to involve prostaglandin-mediated pathways. This study investigated the effects of prostaglandin on CRF and alpha-MSH neuronal activities in LPS-induced anorexia.

Male Wistar rats were pretreated with indomethacin (10 mg kg(-1); i.p.) or vehicle; 15 min later they received LPS (500 microg kg(-1); i.p.) or saline injection. Food intake, hormone responses and Fos-CRF and Fos-alpha-MSH immunoreactivity in the paraventricular and arcuate nuclei, respectively, were evaluated.

In comparison with saline treatment, LPS administration induced lower food intake and increased plasma ACTH and corticosterone levels, as well as an increase in Fos-CRF and Fos-alpha-MSH double-labelled neurons in vehicle-pretreated rats.

In contrast, indomethacin treatment partly reversed the hypophagic effect, blunted the hormonal increase and blocked the Fos-CRF and Fos-alpha-MSH hypothalamic double labelling increase in response to the LPS stimulus.

These data demonstrate that the activation of pro-opiomelanocortin and CRF hypothalamic neurons following LPS administration is at least partly mediated by the prostaglandin pathway and is likely to be involved in the modulation of feeding behaviour during endotoxaemia.

"Prostaglandin mediates endotoxaemia-induced hypophagia by activation of pro-opiomelanocortin and corticotrophin-releasing factor neurons in rats"
Rorato R, Menezes AM, Giusti-Paiva A, de Castro M, Antunes-Rodrigues J, Elias LL
Exp Physiol. 2009 Mar ; 94(3): 371-9 (Hubmed.org)

Anorectic Behavior In An Animal Model For Anorexia Nervosa

2009-06-06T05:36:00.000-07:00

Excessive physical activity is commonly described as symptom of Anorexia Nervosa (AN). Activity-based anorexia (ABA) is considered an animal model for AN.

The ABA model mimics severe body weight loss and increased physical activity. Suppression of hyperactivity by olanzapine in anorectic patients as well as in ABA rats suggested a role of dopamine and/or serotonin in this trait.

Here, we investigated the effect of a non-selective dopamine antagonist in the ABA model. A dose-response curve of chronic treatment with the non-selective dopaminergic antagonist cis-flupenthixol was determined in the ABA model.

Treatment reduced activity levels in both ad libitum fed and food-restricted rats. Treated ABA rats reduced body weight loss and increased food intake. These data support a role for dopamine in anorexia associated hyperactivity. Interestingly, in contrast to leptin treatment, food-anticipatory activity still persists in treated ABA rats.

"Dopamine antagonism inhibits anorectic behavior in an animal model for anorexia nervosa"
Verhagen LA, Luijendijk MC, Hillebrand JJ, Adan RA
Eur Neuropsychopharmacol. 2009 Mar ; 19(3): 153-60 (Hubmed.org)

Screening The Nutritional Status In Oncology

2009-06-06T01:31:00.000-07:00

This study presents the preliminary data of a prospective multi-centre investigation on the screening of the nutritional status of cancer outpatients with the purpose to define: (1) prevalence and rate of weight loss and nutritional risk in this patient population, and (2) to assess the association among some patient-dependent, tumour-dependent and therapy-dependent variables with the nutritional status and the nutritional risk.

MATERIALS AND METHODS:
Seventeen centres were involved to collect demographic data (age and sex), oncologic data (site of primary tumour, stage, Eastern Cooperative Oncology Group Performance State, oncologic therapy) and presence and severity of systemic and digestive/nutritional symptoms (fatigue, anorexia, nausea/vomiting, early satiety, dysgeusia/dysosmia, dysphagia/odynophagia, diarrhoea/constipation).

Furthermore, the percentage of the weight loss on the usual body weight and the body mass index were computed. The nutritional risk was assessed according to the Nutrition Risk Screening 2002 questionnaire which scores the risk from 0 to 7.

MAIN RESULTS:
On the first 1,000 screened patients, a significant weight loss (>/=10%) and a nutritional risk score >/=3 were observed in 39.7% and 33.8% of patients, respectively. Weight loss was higher in upper gastrointestinal tumours, in advanced stages of disease and in patients with a poor performance status. Similarly, the nutritional risk was higher in esophageal and pancreatic cancer and in those with a worse performance status.

There was a good correlation between the severity of anorexia and the rate of the weight loss The majority of patients with no weight loss or a weight loss <10% were not anorectic; on the contrary, the majority of those with more severe weight loss had some degree of anorexia.

CONCLUSIONS:
Weight loss and nutritional risk are frequent in an unselected series of cancer outpatients. Site of primary tumour, stage and performance state appear to be associated, at a preliminary analysis, with significant weight loss and nutritional risk. Anorexia and weight loss are closely related, and this supports the concept that nutritional depletion can play a major role in the onset of malnutrition-cachexia.

"Screening the nutritional status in oncology: a preliminary report on 1,000 outpatients"
Bozzetti F, on behalf of the SCRINIO Working Group
Support Care Cancer. 2009 Mar ; 17(3): 279-284 (Hubmed.org)

Assessing The Heritability Of Anorexia Nervosa Symptoms

2009-06-05T14:07:00.000-07:00

Assessment of eating disorders at the symptom level can facilitate the refinement of phenotypes. We examined genetic and environmental contributions to liability to anorexia nervosa (AN) symptoms in a population-based twin sample using a genetic common pathway model.

METHOD:
Participants were from the Norwegian Institute of Public Health Twin Panel (NIPHTP) and included all female monozygotic (MZ; 448 complete pairs and four singletons) and dizygotic (DZ; 263 complete pairs and four singletons) twins who completed the Composite International Diagnostic Interview (CIDI) assessing DSM-IV Axis I and ICD-10 criteria.

Responses to items assessing AN symptoms were included in a model fitted using the marginal maximum likelihood (MML) approach.

RESULTS:
Heritability of the overall AN diagnosis was moderate [a2=0.22, 95% confidence interval (CI) 0.0-0.50] whereas heritabilities of the specific items varied. Heritability estimates for weight loss items were moderate (a2=0.31-0.34) and items assessing weight concern when at a low weight were smaller (0.18-0.29).

Additive genetic factors contributed little to the variance of amenorrhea, which was most strongly influenced by unshared environment (a2=0.16, e2=0.71).

CONCLUSIONS: AN symptoms are differentially heritable. Specific criteria such as those related to body weight and weight loss history represent more biologically driven potential endophenotypes or liability indices.

The results regarding weight concern differ somewhat from those of previous studies, highlighting the importance of assessing genetic and environmental influences on variance of traits within specific subgroups of interest.

"Assessing the heritability of anorexia nervosa symptoms using a marginal maximal likelihood approach"
Mazzeo SE, Mitchell KS, Bulik CM, Reichborn-Kjennerud T, Kendler KS, Neale MC
Psychol Med. 2009 Mar ; 39(3): 463-73 (Hubmed.org)

Anorexia Nervosa Trios

2009-06-05T11:05:00.000-07:00

Anorexia nervosa (AN) is associated with behavioral traits that predate the onset of AN and persist after recovery. We identified patterns of behavioral traits in AN trios (proband plus two biological parents).

METHOD:
A total of 433 complete trios were collected in the Price Foundation Genetic Study of AN using standardized instruments for eating disorder (ED) symptoms, anxiety, perfectionism, and temperament. We used latent profile analysis and ANOVA to identify and validate patterns of behavioral traits.

RESULTS:
We distinguished three classes with medium to large effect sizes by mothers' and probands' drive for thinness, body dissatisfaction, perfectionism, neuroticism, trait anxiety, and harm avoidance. Fathers did not differ significantly across classes.

Classes were distinguished by degree of symptomatology rather than qualitative differences. Class 1 (approximately 33%) comprised low symptom probands and mothers with scores in the healthy range.

Class 2 ( approximately 43%) included probands with marked elevations in drive for thinness, body dissatisfaction, neuroticism, trait anxiety, and harm avoidance and mothers with mild anxious/perfectionistic traits. Class 3 (approximately 24%) included probands and mothers with elevations on ED and anxious/perfectionistic traits. Mother-daughter symptom severity was related in classes 1 and 3 only. Trio profiles did not differ significantly by proband clinical status or subtype.

CONCLUSIONS:
A key finding is the importance of mother and daughter traits in the identification of temperament and personality patterns in families affected by AN. Mother-daughter pairs with severe ED and anxious/perfectionistic traits may represent a more homogeneous and familial variant of AN that could be of value in genetic studies.

"Anorexia nervosa trios: behavioral profiles of individuals with anorexia nervosa and their parents"
Jacobs MJ, Roesch S, Wonderlich SA, Crosby R, Thornton L, Wilfley DE, Berrettini WH, Brandt H, Crawford S, Fichter MM, Halmi KA, Johnson C, Kaplan AS, Lavia M, Mitchell JE, Rotondo A, Strober M, Woodside DB, Kaye WH, Bulik CM
Psychol Med. 2009 Mar ; 39(3): 451-61 (Hubmed.org)

Usher Syndrome And Psychiatric Symptoms: A Challenge In Psychiatric Management

2009-06-05T06:02:00.000-07:00

Usher syndrome, the most common case of deaf - blindness, may be associated with various psychiatric disorders.

Inability of communication through spoken language in association with progressive visual impairment affects diagnostics and management in case of co-morbidity with mental disorder.

A patient with Usher syndrome and psychiatric symptoms is described and the difficulties in psychiatric assessment in her case are discussed. A 28 years old woman with hearing impairment diagnosed at the age of 3 months and progressive pigmentary retinopathy diagnosed at the age of 19 years, has been treated for ADHD in childhood, eating disorder in adolescence and psychosis-like disorder in adult life.

Direct observation of patient behavior and the effects of pharmacotherapy were the main diagnostic procedures, since the use of sign language and handwriting was very limited. The limitations of management are discussed.

"Usher syndrome and psychiatric symptoms: a challenge in psychiatric management"
Rijavec N, Grubic VN
Psychiatr Danub. 2009 Mar ; 21(1): 68-71 (hubmed.org)

Olanzapine Treatment In Anorexia Nervosa: Case Report

2009-06-05T01:56:00.000-07:00

A 15 year old patient suffering from psychiatric disturbances looked for psychiatric help but refused hospital admission. Following an ambulatory treatment, the patient was diagnosed with Anorexia nervosa.

The patient, a girl, was 175 centimeters tall, weighting only 39 kilos. Within the clinical picture, there were few dominant disorders present; anxiety, depression, low self-esteem, fear of feminization, with recurrent psychotic episodes.

By the implementation of an intensive psychotherapeutic treatment, without the use of psychopharmacs, the weight was kept stable. In accordance with the girl's mother, a psychopharmacotherapy was commenced, a combination of olanzapine and paroxetine (the choice of psychopharmacs was lead by the side effects known).

At the end of a 24-month period of a psychological treatment which was combined with psychopharmacotherapy, the patient exhibited no symptomatology and a stable clinical remission of the illness was achieved.

"Olanzapine treatment in anorexia nervosa: case report."
Dadić-Hero E, Ruzić K, Pernar M, Kabalin M, Medved P
Psychiatr Danub. 2009 Mar ; 21(1): 122-5 (Hubmed.org)

Phase II Study Of Docetaxel And Carboplatin In Elderly Patients

2009-06-04T22:21:00.000-07:00

Mainly single-agent chemotherapy has been considered as standard treatment for elderly patients with non-small cell lung cancer (NSCLC). Docetaxel monotherapy is regarded as a standard treatment for elderly patients with advanced NSCLC, and recent subset analyses have suggested that platinum-based chemotherapy can be safely used in the elderly.

This phase II study was conducted to evaluate the efficacy and safety of docetaxel and carboplatin in elderly patients with advanced NSCLC.

METHODS:
Patients enrolled in this study had stage IIIB or IV NSCLC with measurable disease, no prior chemotherapy, Eastern Cooperative Oncology Group performance status of 0-2, and were 70 years or older. Treatment consisted of docetaxel at a dose of 60 mg/m(2) and carboplatin at area under the curve of 5 mg/ml/min on day 1 every 3 weeks.

RESULTS:
From October 2003 to April 2006, 30 patients were enrolled. One complete response and 13 partial responses were observed, for an overall response rate of 46.7% (95% confidence interval: 28.8-64.6%).

Median progression-free survival and overall survival periods were 4.4 months and 9.9 months, respectively. One-year survival rate was 43.3%. Major grade 3 and 4 hematological toxicities included neutropenia (86.7%), leucopenia (80.0%) and febrile neutropenia (16.7%).

Major grade 3 nonhematological toxicities were anorexia (30.0%) and diarrhea (13.3%). There were no grade 4 nonhematological toxicities or treatment-related deaths.

CONCLUSIONS:
Docetaxel combined with carboplatin was an active treatment with manageable toxicity for the treatment of elderly patients with chemotherapy-naive NSCLC.

"Phase II study of docetaxel and carboplatin in elderly patients with advanced non-small cell lung cancer"
Yoshimura N, Kudoh S, Kimura T, Mitsuoka S, Kyoh S, Tochino Y, Asai K, Kodama T, Ichimaru Y, Yana T, Hirata K
J Thorac Oncol. 2009 Mar ; 4(3): 371-5 (Hubmed.org)

Safety And Efficacy Of Mid-Term Pregnancy Termination

2009-06-04T22:19:00.000-07:00

To investigate effects and side effects of aglepristone in terminating pregnancy in bitches. METHODS: Twenty-two bitches were treated in mid-pregnancy with subcutaneous injections of aglepristone at a total dose of 20 mg/kg.

Short-term follow-up (one to two weeks after treatment) included clinical examination and abdominal ultrasonography in 18 of the dogs. Long-term telephone follow-up was recorded for all 22 dogs.

RESULTS:
Pregnancy was terminated in 21 bitches (95 per cent). Signs of abortion occurred one to eight days after treatment. Vaginal discharge was evident in 17 (77 per cent) dogs. Obvious signs of parturition were seen in nine (41 per cent) dogs.

Eight dogs (36 per cent) developed anorexia, and in two (9 per cent) of the dogs a local reaction at the injection site was evident. Two dogs developed pyometra two and four years after treatment, respectively.

CLINICAL SIGNIFICANCE: Aglepristone, when administered in mid-gestation, is effective in terminating pregnancy. Side effects are few and transient.

"Safety and efficacy of mid-term pregnancy termination using aglepristone in dogs"
Pettersson CH, Tidholm A
J Small Anim Pract. 2009 Mar ; 50(3): 120-3 (Hubmed.org)

Levels of N-acylethanolamines in O,O,S-trimethylphosphorothioate

2009-06-04T17:53:00.000-07:00

O,O,S-Trimethylphosphorothioate (OOS-TMP) has been shown to induce hypophagia and hypopraxia. Recent studies suggest that OOS-TMP-induced anorexia is partly mediated by its effect on the central nervous system.

In this study, we examined the profiles of N-acylethanolamines (NEAs), including five amide-linked compounds, in the gastrointestinal system in C57BL/6J (B6) mice.

The present results shown an orexigenic profile of the levels of NEAs with downregulation of the anorectic lipid, N-stearoylethanolamine (SEA), upregulation of the orexigenic lipid, 2-arachidonoyl glycerol (2-AG), at 2 h and upregulation of 2-AG at 24 h albeit with significant anorexia. However, the data indicated that the high level of 2-AG may be responsible for the hypopraxia.

We next explored whether OOS-TMP may affect two models of hyperphagia and hyperglycemia, ins2(+/Akita) B6 (Akita) and B6-lepr(db)/lepr(db) mice (db/db). We identified potential anorexigenic effects in B6, Akita and db/db mice. Moreover, OOS-TMP was found to reduce blood glucose in Akita mice but not in db/db mice.

Collectively, these findings suggest that N-acylethanolamines are not involved in the hypophagia but rather hypopraxia, and may play multiple physiological roles in this process. OOS-TMP might be a promising candidate for anti-obesity and anti-diabetic drug development.

"Levels of N-acylethanolamines in O,O,S-trimethylphosphorothioate (OOS-TMP)-treated C57BL/6J mice and potential anti-obesity, anti-diabetic effects of OOS-TMP in hyperphagia and hyperglycemia mouse models"
Huang L, Toyoshima M, Asakawa A, Inoue K, Harada K, Kinoshita T, Chen S, Koizumi A
Pharmacol Biochem Behav. 2009 Mar ; 92(1): 1-5 (hubmed.org)

Trichomegaly in A 3-Year-Old Girl With Alopecia Areata

2009-06-04T13:42:00.000-07:00

We report here a case of bilateral trichomegaly associated with alopecia areata in a 3-year-old girl, healthy except for mild atopic dermatitis.

Trichomegaly is a rare condition and, in many cases, is a side effect of medication such as ophthalmic solution prostaglandin analogs and epidermal growth factor receptor inhibitors.

Trichomegaly has also been associated with acquired medical conditions such as HIV, systemic lupus erythematosus, anorexia nervosa, porphyria cutanea tarda, hypothyroidism, and dermatomyositis.

In very rare circumstances, trichomegaly has been described as part of congenital conditions such as Oliver-McFarlane syndrome. We believe that the development of bilateral trichomegaly in conjunction with alopecia areata in this patient represents a novel finding as it occurred in the absence of any significant health problems, congenital abnormalities, or medications.

"Trichomegaly in a 3-year-old girl with alopecia areata"
Nazareth MR, Bunimovich O, Rothman IL
Pediatr Dermatol. 2009 Mar-Apr ; 26(2): 188-93 (Hubmed.org)

Understanding Women's Experiences Of Developing An Eating Disorder

2009-06-04T05:40:00.000-07:00

Qualitative inquiry into eating disorders is burgeoning, offering valuable and innovative insights into various aspects of the condition. This study used life-history interviews with 20 women who had recovered from anorexia nervosa, bulimia nervosa or both and who had remained healthy.

The interviews focused on the women's narratives and experience rather than a diagnostic therapeutic model. Three themes of control, connectedness and conflict emerged as significant in the development, experience of, and recovery from an eating disorder.

The development of the condition was attributed to a lack of control, a sense of non-connectedness to family and peers and extreme conflict with significant others. Recovery occurred when the women re-engaged with life, developed skills necessary for conflict resolution and rediscovered their sense of self.

Rather than viewing the development of, and recovery from an eating disorder as separate and discrete events, the data from the life-history interviews suggest they are better viewed as one entity - that is, the journey of an individual attempting to discover and develop their sense of self.

This perspective challenges some current constructs of eating disorders; it is not a condition in and of itself but a symptom of deeper issues that if addressed, when the individual is 'ready' to make that choice, will lead to recovery.

"Understanding women's experiences of developing an eating disorder and recovering: a life-history approach"
Patching J, Lawler J
Nurs Inq. 2009 Mar ; 16(1): 10-21 (Hubmed.org)

Analysis Of Treatment Efficacy In Girls With Anorexia Nervosa

2009-06-04T01:37:00.000-07:00

So far, no unequivocal answer has been provided to the question of how to treat girls with anorexia nervosa (AN). The goal of the study was evaluation of treatment results and search for prognostic factors, regarding the outcome of administered therapy in girls with AN.

PATIENTS AND METHODS:
The analysis comprised eighty-seven (87) patients with diagnosis of AN. In the course of treatment, the patients received only a balanced and highly energetic diet.

The effects of dietetic procedure were evaluated, comparing clinical data and routine laboratory test results (full blood cell count, serum concentrations of sodium, potassium, glucose, cholesterol, triglycerides, total calcium, phosphates, total protein and the urea) at the onset and on the last day of hospitalisation and also an analysis of clinical data in patients with regained menstrual cycles was performed.

Also, on admission to hospital, serum concentrations of TSH, FT4, FT3, E2, T and cortisol were measured (the last hormone - three times - at 8:00, 17:00 and 24:00). Moreover, a stimulation test with GnRH was performed to assess LH and FSH release.

A comparison was made between the clinical data, the results of routine laboratory tests and hormone concentrations, obtained at the beginning of the therapy in the group of cured girls (the girls with regained menses) and the group, in which the therapy did not bring complete elimination of the disease.

RESULTS:
After hospitalisation, 75.9% of the patients with AN continued outpatient treatment. In all the patients, who adhered to proposed therapy, menstruation cycles returned within 1 to 12 months. It was found that in the group with positive treatment outcome, the patients were older, demonstrated higher BMI values at the beginning of the therapy, as well as shorter disease duration than those in the group of patients who refused further treatment.

In the group of cured patients, estradiol concentrations were significantly higher and cortisol concentrations (at 17:00 and 24:00) were significantly lower, in comparison to the uncured group.

CONCLUSIONS:
The findings suggest that body weight increase by proper diet application is the most important element of therapy in AN. Patient's age, disease duration, the degree of body weight loss and serum concentrations of estradiol and cortisol at 17:00 and 24:00 are the prognostic factors for the outcome of therapy in anorexia nervosa.

"Analysis of treatment efficacy in girls with anorexia nervosa (III)"
Nogal P, Pniewska-Siark B, Lewiński A
Neuro Endocrinol Lett. 2009 Mar ; 30(1): 32-8 (Hubmed.org)

Health Benefits Of Probiotics And Prebiotics in Women

2009-06-03T11:34:00.000-07:00

Among the numerous positive effects of probiotic microorganisms and prebiotic carbohydrates observed in clinical studies--the majority of which, however, does not fulfil the criteria of pharmaceutical verification--some are of specific relevance to female health.

The present review addresses--besides some notes concerning the potential microbiota-hormone interactions--the first line with preventive and/or therapeutic applications of probiotic bacteria in order to maintain a balanced intestinal and urogenital flora, as well as in the case of irritable bowel syndrome, constipation (idiopathic slow-transit) and urogenital tract infections.

Further aspects are the promotion of bone health and osteoporosis prevention brought about by inulin, oligofructose and galactooligosaccharides.

Some further conditions, namely anorexia nervosa, the premenstrual syndrome as well as prevention or alleviation of climacteric and menopausal disorders, for which the use of probiotics is rather hypothetical or is largely studied by alternative medicine practising physicians, are addressed briefly.

"Health benefits of probiotics and prebiotics in women"
de Vrese M
Menopause Int. 2009 Mar ; 15(1): 35-40 (Hubmed.org)

Evaluation of The Safety And Compliance Of 3-Week Cycles Of Vinorelbine

2009-06-03T05:05:00.000-07:00

With regard to adjuvant chemotherapy for non-small-cell lung cancer, the usefulness of combined chemotherapy with cisplatin (CDDP) and vinorelbine (VNR) has been reported. However, poor compliance has been reported with VNR administered weekly by the conventional method for 16 consecutive weeks, and there is no report on the safety and compliance of adjuvant chemotherapy with CDDP and VNR in Japanese patients.

METHODS:
The subjects were 25 non-small-cell lung cancer patients who received CDDP and VNR as adjuvant chemotherapy at the Shizuoka Cancer Center between April 2005 and April 2008.

The treatment schedule included combined treatment, with CDDP at 80 mg/m(2) administered on Day 1 and VNR at 25 mg/m(2) administered on Days 1 and 8. The treatment was repeated every 3 weeks, and each 3-week treatment schedule was designated as one cycle. A total of four cycles were administered.

RESULTS:
The main adverse events were Grade 3 or more severe neutropenia (76%), anemia (12%), anorexia (12%) and nausea (12%). Thus, the adverse events were mostly mild. There were no treatment-related deaths.

The rate of completion of the four cycles was 92%. The mean dose of CDDP and VNR was 312 and 195 mg/m(2), respectively. The mean dose administered of either drug was 97.5% of the scheduled dose.

CONCLUSION:
This study was retrospective and had some limitations, for example, non-hematological toxicity would be evaluated milder. However, it was considered that adjuvant chemotherapy with CDDP administered on Day 1 and VNR administered on Days 1 and 8 every 3 weeks was safe, and that the rate of completion of the four cycles was also satisfactory in Japanese patients.

"Evaluation of the safety and compliance of 3-week cycles of vinorelbine on days 1 and 8 and cisplatin on day 1 as adjuvant chemotherapy in Japanese patients with completely resected pathological stage IB to IIIA non-small cell lung cancer: a retrospective study.
Shukuya T, Takahashi T, Tamiya A, Ono A, Igawa S, Tsuya A, Nakamura Y, Murakami H, Naito T, Kaira K, Endo M, Yamamoto N
Jpn J Clin Oncol. 2009 Mar ; 39(3): 158-62 (Hubmed.org)

Pyometra in Captive Large Felids

2009-06-03T01:01:00.000-07:00

Eleven cases of pyometra were diagnosed in a captive exotic felid collection over 3 yr in seven African lions (Panthera leo), two tigers (P. tigris), one liger (lion-tiger crossbreed), and one leopard (P. pardus).

Clinical signs included anorexia, lethargy, vulvar discharge, and vomiting. Diagnosis was based on clinical signs, complete blood cell counts, plasma biochemistry and electrolyte values, radiographs, and abdominal ultrasonography.

The most common findings on complete blood count and biochemistry profiles were leukocytosis (>15,000/microL) and hyperproteinemia (>8.2 g/dL) due to increased globulins. Abdominal radiographic findings were largely nonspecific, but ultrasonography routinely showed a distended, fluid-filled uterus.

Each case was treated with ovariohysterectomy and systemic antibiotic therapy. Lions were shown to be at an increased risk for developing pyometra compared with other species. Pyometra should be considered as a differential diagnosis in anorexic or lethargic intact female large felids, and ovariohysterectomy may be warranted in nonbreeding female lions.

"Pyometra in captive large felids: a review of eleven cases"
McCain S, Ramsay E, Allender MC, Souza C, Schumacher J
J Zoo Wildl Med. 2009 Mar ; 40(1): 147-51 (hubmed.org)

Colonic Obstruction In Three Captive Reticulated Giraffe

2009-06-02T21:21:00.001-07:00

Fatal colonic obstructions were diagnosed in three captive, adult, reticulated giraffe (Giraffa camelopardalis reticulata). Clinical presentations varied, but all cases displayed decreased activity, anorexia, and considerably decreased fecal production, consistent with intestinal obstruction.

Case 1 was diagnosed at necropsy with a phytobezoar obstructing the spiral colon. Case 2 was diagnosed at necropsy with a fecal impaction of the colon. Case 3 was diagnosed during surgery with colonic ileus.

Cases 2 and 3 underwent surgical intervention but were markedly compromised by the time of surgery and died during surgery or 24 hr postoperatively.

Gastrointestinal obstruction, requiring aggressive supportive care and early surgical intervention, should be considered in giraffe in which anorexia and substantially decreased fecal production are observed.

Abdominal exploratory surgery will likely be necessary for diagnosis and treatment. Based on a small number of cases, gastrointestinal obstruction has a poor prognosis in giraffe.

"Colonic obstruction in three captive reticulated giraffe (Giraffa camelopardalis reticulata)"
Davis MR, Langan JN, Mylniczenko ND, Benson K, Lamberski N, Ramer J
J Zoo Wildl Med. 2009 Mar ; 40(1): 181-8 (Hubmed.org)

Compressive Myelopathy Of The Cervical Spine In Komodo Dragons

2009-06-02T21:19:00.000-07:00

Cervical subluxation and compressive myelopathy appears to be a cause of morbidity and mortality in captive Komodo dragons (Varanus komodoensis).

Four cases of cervical subluxation resulting in nerve root compression or spinal cord compression were identified. Three were presumptively induced by trauma, and one had an unknown inciting cause. Two dragons exhibited signs of chronic instability.

Cervical vertebrae affected included C1-C4. Clinical signs on presentation included ataxia, ambulatory paraparesis or tetraparesis to tetraplegia, depression to stupor, cervical scoliosis, and anorexia.

Antemortem diagnosis of compression was only confirmed with magnetic resonance imaging or computed tomography. Treatment ranged from supportive care to attempted surgical decompression. All dragons died or were euthanatized, at 4 days to 12 mo postpresentation.

Studies to define normal vertebral anatomy in the species are necessary to determine whether the pathology is linked to cervical malformation, resulting in ligament laxity, subsequent instability, and subluxation.

"Compressive myelopathy of the cervical spine in Komodo dragons (Varanus komodoensis)"
Zimmerman DM, Douglass M, Sutherland-Smith M, Aguilar R, Schaftenaar W, Shores A
J Zoo Wildl Med. 2009 Mar ; 40(1): 207-10 (Hubmed.org)

A Suspected Case of Lyme Borreliosis In A Hunting Dog In Korea

2009-06-02T21:17:00.000-07:00

A two-year-old male Pointer had been presented with anorexia, cachexia, and weight loss of 10-day duration. Upon physical examination, fever, lethargy, superficial lymph node enlargement, and tick infestation were noted.

The only abnormality in CBC and serum chemistry analyses was mild hyperglobulinemia. Spleen was enlarged by radiography, and the lymph nodes showed neutrophilic lymphadenitis by cytological examination.

A polymerase chain reaction test for babesiosis and commercial ELISA tests for Ehrlichia canis, heartworm, and Lyme disease was negative except for Lyme disease, which was verified by both an IFA-IgG test and a quantitative C(6) assay. Doxycycline was administered for 2 weeks and the recovery was uneventful. Post-treatment C(6) titer decreased to within normal limits.

"A suspected case of Lyme borreliosis in a hunting dog in Korea"
Choi US, Kim HW, You SE, Youn HJ
J Vet Sci. 2009 Mar ; 10(1): 89-91

Baccharis Pteronioides Toxicity In Livestock And Hamsters

2009-06-02T21:07:00.000-07:00

Baccharis pteronioides DC has been intermittently associated with livestock poisoning in the southwestern United States. In 2004, nearly 100 cows were reported poisoned by B. pteronioides in southern New Mexico.

Initial field studies and postmortem examinations found drought conditions, evidence of B. pteronioides consumption, and a reported mortality of nearly 40%. Because postmortem materials were unsuitable for further examination, plant samples were collected for feeding trials and chemical evaluation.

Forty-eight Syrian hamsters (8 weeks old) were randomly divided into 4 groups and dosed with 0, 50, 100, and 200 mg of B. pteronioides for 10 days. After dosing, the hamsters were necropsied; sera were analyzed biochemically; and tissues were collected and evaluated histologically.

The hamsters treated with 200 mg and several of the 100-mg animals developed anorexia and diarrhea. These animals developed multiple hemorrhagic infarcts in the liver and kidney, with severe hemorrhagic enteritis. Histologically, the higher-dosed animals had severe necrotizing vasculitis with vascular thrombosis of hepatic and renal vessels. Many glomerular capillaries contained fibrin thrombi.

The superficial intestinal and colonic mucosa was necrotic, with extensive hemorrhage and proliferation of luminal bacteria. Lower-dosed animals had mild hepatocellular swelling, with proliferation of intestinal and gastric bacteria and yeast.

The findings indicate that at high doses, B. pteronioides is toxic to hamsters and produces lesions that are very similar to bacterial endotoxin-produced vasculitis and infarction. Research to purify and identify the toxin, the toxic dose, and mechanism of toxicity are ongoing.

"Baccharis pteronioides toxicity in livestock and hamsters"
Stegelmeier BL, Sani Y, Pfister JA
J Vet Diagn Invest. 2009 Mar ; 21(2): 208-13