ABSTRACT
BACKGROUND: children affected by refractory epilepsy could be at risk of malnutrition because of feeding difficulties (anorexia, chewing, swallowing difficulties or vomiting) and chronic use of anticonvulsants, which may affect food intake and energy metabolism. Moreover, their energy requirement may be changed as their disabilities would impede normal daily activities. The aim of the present study was to evaluate nutritional status, energy metabolism and food intake in children with refractory epilepsy. METHODS: 17 children with refractory epilepsy (13 boys and 4 girls; mean age 9 +/- 3,2 years; Body Mass Index 15,7 +/- 3,6) underwent an anthropometric assessment, body composition evaluation by dual-energy X-ray absorptiometry, detailed dietetic survey and measurement of resting energy expenditure by indirect calorimetry. Weight-for-age, height-for-age (stunting) and weight-for-height (wasting) were estimated compared to those of a reference population of the same age. RESULTS: 40% of children were malnourished and 24% were wasted. The nutritional status was worse in the more disabled children. Dietary intake resulted unbalanced (18%, 39%, 43% of total daily energy intake derived respectively from protein, lipid and carbohydrate). Adequacy index [nutrient daily intake/recommended allowance (RDA) x 100] was < 60% for calcium iron and zinc. CONCLUSION: many children with refractory epilepsy would benefit from individual nutritional assessment and management as part of their overall care.
Subject(s)
Epilepsy/physiopathology , Nutritional Status , Absorptiometry, Photon , Adipose Tissue , Anthropometry , Body Composition , Body Height , Body Mass Index , Body Weight , Bone Density , Calorimetry, Indirect , Child , Diet Records , Drug Resistance , Eating , Energy Intake , Energy Metabolism , Epilepsy/complications , Epilepsy/drug therapy , Female , Humans , Intellectual Disability/complications , Male , Malnutrition/complications , Malnutrition/epidemiology , Minerals/administration & dosage , Nutrition Assessment , Nutritional Requirements , Rest , Skinfold Thickness , Wasting Syndrome/complicationsABSTRACT
A 4-year old girl affected by intractable seizures was treated with ketogenic diet. The diet was calculated to provide appropriate protein intake for growth (1.4 g/kg body weight) and adequate calories (1600 kcal) derived from 4 parts fat and 1 part protein + carbohydrates. The child remained on the diet for 8 months and had a decrease in seizure frequency of 90%. No serious side effects were reported and it was possible to discontinue or decrease antiepileptic drugs. Our results confirm the efficacy of ketogenic diet in the treatment of epilepsy. Since it is known that 20 to 30% of all patients with epilepsy do not have their seizures completely controlled with established antiepileptic drugs, it would be useful to increase the application of this dietetic treatment in selected patients in Italy as it already happens in other countries.
Subject(s)
Anticonvulsants/therapeutic use , Dietary Fats/therapeutic use , Epilepsy/diet therapy , Epilepsy/drug therapy , Ketone Bodies/biosynthesis , Child, Preschool , Dietary Carbohydrates/administration & dosage , Dietary Fats/administration & dosage , Dietary Proteins/administration & dosage , Energy Intake , Female , Humans , Seizures/diet therapy , Seizures/drug therapy , Time FactorsABSTRACT
We performed bio-electrical impedance analysis (BIA) on 38 healthy adults with an initial body mass index (+/- s.d.) of 30 kg/m2 (+/- 5) before and after a low calorie diet. Five weeks later a mean weight loss of 4.2 +/- 2.3 kg was observed. According to BIA, fat-free mass (FFM) decreased in 28 subjects and increased in ten. In four cases the reduction was greater than the weight loss. At the end of the ten week diet regimen all 27 subjects followed up demonstrated a further weight reduction. According to BIA, FFM decreased in 22 subjects, increased in four and did not change in one case. In one case the reduction was greater than the weight loss. Although mean FFM values assessed by skinfolds and BIA were not significantly different before and after the weight loss period, no correlations were found among the individual changes in FFM evaluated by the two methods. Our results suggest that single frequency (50 KHz) impedance must be used with care in clinical conditions.
Subject(s)
Body Composition , Electric Impedance , Adult , Evaluation Studies as Topic , Female , Humans , Male , Middle Aged , Skinfold Thickness , Weight LossSubject(s)
Hip Prosthesis , Polyethylenes , Evaluation Studies as Topic , Humans , Stress, MechanicalSubject(s)
Hip Joint/surgery , Hip Prosthesis , Adult , Age Factors , Aged , Clinical Trials as Topic , Female , Femur Head/surgery , Humans , Italy , Male , Methods , Middle Aged , Surgical InstrumentsSubject(s)
Acetabulum , Bone Cysts/pathology , Adult , Bone Cysts/diagnostic imaging , Bone Cysts/surgery , Female , Hip Joint/physiopathology , Humans , Male , Middle Aged , Movement , Pain/etiology , RadiographySubject(s)
Neurilemmoma/diagnosis , Tibial Nerve , Female , Humans , Middle Aged , Neurilemmoma/pathology , Neurilemmoma/surgerySubject(s)
Hip Prosthesis/instrumentation , Ceramics , Female , Follow-Up Studies , Humans , Male , Middle Aged , TitaniumSubject(s)
Hip Prosthesis , Adult , Aged , Female , Follow-Up Studies , Hip Joint/diagnostic imaging , Hip Prosthesis/adverse effects , Humans , Italy , Male , Methods , Middle Aged , RadiographyABSTRACT
A method of surface replacement arthroplasty of the hip joint is described for use in selected patients, often in the younger age group. One hundred and forty patients were reviewed after a mean interval of four years. Seventy-two per cent were graded 5 or 6 on the Charnley scale, the remainder had symptoms due to femoral neck fracture or loosening of the prosthetic components. In the main the bad results were attributed to incorrect patient selection or technical imperfections with the operative technique. The advantages of the operation are no alteration in the relationship of the femoral head, neck and acetabulum and minimal interference with the surrounding muscle and soft tissues. The amount of implanted material is reduced and no entry is made into the femoral medullary canal, which facilitates any further revision surgery that may be necessary.
Subject(s)
Hip Prosthesis/instrumentation , Adult , Aged , Female , Hip Joint/diagnostic imaging , Hip Prosthesis/adverse effects , Hip Prosthesis/methods , Humans , Locomotion , Male , Middle Aged , Pain , Postoperative Complications , RadiographySubject(s)
Joint Diseases/surgery , Knee Joint/surgery , Ligaments, Articular/surgery , Muscular Diseases/surgery , Adult , Female , Humans , MaleSubject(s)
Joint Diseases/surgery , Knee Joint/surgery , Ligaments, Articular/surgery , Muscular Diseases/surgery , Adolescent , Adult , HumansSubject(s)
Hip Prosthesis , Adult , Aged , Follow-Up Studies , Hip Joint , Humans , Joint Diseases/surgery , Middle Aged , Postoperative ComplicationsABSTRACT
The Paltrinieri-Trentani type of resurfacing the hip has been under clinical investigation for over 6 years. The prostheses consist of a metal cap, which is fitted to the head of the femur (no amputation of the neck and the head being required) and an acetabular cup made of high density polyethylene. Matched cups and caps are available in different sizes. The biomechanical preconditions upon which this hip resurfacing is based must be understood to successfully perform the operation. The series of patients reported here were aged between 32 and 70 years. The results after 6 years are 76% successful, and typical cases rate between 5 and 6 on the Charnley Scale; 12% rated between 3 and 4; 12% were failures owing either the fracture of the neck of the femur or to loosening of the femoral prosthesis. Further analysis of the cases demonstrated that: prostheses applied with the correct surgical technique gave satisfactory results; failures were attributable to errors of technique and indication.
Subject(s)
Arthroplasty/methods , Hip Joint/surgery , Joint Prosthesis , Biomechanical Phenomena , Evaluation Studies as Topic , Humans , Postoperative Complications , Prosthesis DesignABSTRACT
Laboratory tests carried out by means of body environment simulators have proved to be very important for the evaluation of endoprostheses potentially useful for implantation. The present paper examines the problems connected with the design of such a simulator. The results obtained with an initial, very primitive simulator concerning the outlines of the phenomena of wear, corrosion, and friction and some wear properties of commercially available hip endoprostheses are presented. From these results, the motivation that led to the design of a more advanced simulator is presented. This latter simulator is also described.
Subject(s)
Hip Joint , Joint Prosthesis/standards , Corrosion , Evaluation Studies as Topic , Models, Structural , Polyesters , Polyethylenes , Stainless Steel , Titanium , VitalliumABSTRACT
A new total hip endoprosthesis for implantation without bone cement is reported. This prosthesis consists of a ceramic socket and a titanium femoral component which is covered with a ceramic layer (Al2O3). The proximal end of the femoral component is shaped to a conus on which a ceramic ball for articulation with the socket is placed. Beside the construction principles the implantation technique and first clinical experiences are described.
