Refeeding and metabolic syndromes: two sides of the same coin.

Refeeding syndrome describes the metabolic and clinical changes attributed to aggressive rehabilitation of malnourished subjects. The metabolic changes of refeeding are related to hypophosphatemia, hypokalemia, hypomagnesemia, sodium retention and hyperglycemia, and these are believed to be mainly the result of increased insulin secretion following high carbohydrate intake. In the past few decades, increased consumption of processed food (refined cereals, oils, sugar and sweeteners, and so on) lowered the intake of several macrominerals (mainly phosphorus, potassium and magnesium). This seems to have compromised the postprandial status of these macrominerals, in a manner that mimics low grade refeeding syndrome status. At the pathophysiological level, this condition favored the development of the different components of the metabolic syndrome. Thus, it is reasonable to postulate that metabolic syndrome is the result of long term exposure to a mild refeeding syndrome.

Eating disorders and schizophrenia in male patients: a review.

OBJECTIVE: To understand the comorbidity of schizophrenia and eating disorders (ED) in male patients. METHOD: A review of the published literature was made via Med- Line using the following terms: "schizophrenia" or "psychosis" in association with "eating disorders", "anorexia nervosa", "binge eating" or "bulimia nervosa", in association with the terms "comorbidity" or "comorbidities" and finally in association with the term "male", "man" or "men". RESULTS: Groups of male patients known to suffer from schizophrenia and screened for ED suffer essentially from anorexia nervosa (0.81%). Groups of male patients screened for anorexia nervosa and then for schizophrenia demonstrate high comorbidity prevalence (36%). In general, ED symptoms diminish with psychotic episodes and recur when the psychotic episode remits. A man with an ED has a 3.6 times more risk than a woman with an ED to have comorbid schizophrenia. In men, ED present atypical features so that ED not otherwise specified (EDNOS) is relatively frequent. DISCUSSION AND CONCLUSION: Male patients described in the literature as suffering from schizophrenia and ED fall under one of four categories: a) acute psychotic episode related to organic causes due to malnutrition; b) male patients presenting with an ED who later develops schizophrenia; c) male patients known to suffer from schizophrenia and who develops distorted eating cognitions and disordered behaviors; d) male patients suffering from schizophrenia and developing a medication-induced ED.

[Spontaneous rupture of the esophagus (Boerhaave syndrome) in a patient with scleroderma treated by continuous ambulatory peritoneal dialysis]. / Rupture spontanée de l'oesophage (syndrome de Boerhaave) chez une patiente sclérodermique traitée par dialyse péritonéale continue ambulatoire.

Esophageal involvement is a common situation found in 50 to 80% of patients with scleroderma, but Boerhaave's syndrome is rare in this context. The authors report the first case of spontaneous esophageal rupture occurring in a chronic renal failure patient treated by continuous ambulatory peritoneal dialysis. In this observation, sclerodermal esophageal dyskinesia, chronic renal failure which is a classical cause of vomiting and the peritoneal dialysis which play an increasing role in the intraabdominal pressure are potential contributing factors to Boerhave's syndrome. In such patients presenting risk factors, even if they are asymptomatic, it seems reasonable to propose esophageal explorations with manometry or/and endoscopy looking for dyskinesia or other complications of gastro-esophageal reflux.