Tendon rupture of the flexor digitorum profundus of the little finger secondary to hamate non-union.

Several cases of hamate fracture and non-union have been reported. The hook of the hamate acts as a pulley for the flexor tendons for the little and ring fingers. Hamate non-union is frequently associated with irritation of the adjacent soft tissues. We report the case of hamate non-union that was only detected because of a flexor digitorum profundus tendon rupture in the little finger, associated with tendinopathy of both flexor tendons of the ring finger.

Effects of branched amino acids supplementation in malnourished elderly with catabolic status.

BACKGROUND: Among various nutrients branched amino acids (BCAAS) have been shown to be the most responsible for the stimulation of protein synthesis in various situations including catabolic states. OBJECTIVES: We evaluated the effect of a small amount of proteins enriched with BCAAs (0.4 g/kg/day and 0.2 g/kg/day BCAAs) on body weight and composition; nitrogen balance, energy intake and inflammation after 2 weeks of supplementation in acute elderly with catabolic status. DESIGN: Two weeks randomized controlled trial. SETTING: Geriatric department of teaching hospital. SUBJECTS: Thirty patients with malnutrition and inflammatory process (MNA < 24, albumin < 30 g/l and CRP > or = 20 mg/l) who agreed to participate in the study were consecutively included. METHODS: Body composition was determined by labelled water dilution method; resting energy expenditure (REE) was determined by indirect calorimetry; energy intake was calculated for a 3 days period at D1 and D12. Nutritional and inflammatory proteins and cytokines (IL-6 and TNF) were measured at day 1 and 14. RESULTS: No difference was observed at day 14 between supplemented (S) and control (C) group for weight (S: 58.0 +/- 11.8 kg and C: 60.0 +/- 15.9 kg); fat free mass (S: 40.7 +/- 8.3 kg and C: 40 +/- 8.2 kg); nitrogen balance (S: 1.34 +/- 2.21 g/day and C: 0.59 +/- 4.47 g/day); and energy intake (S: 20 +/- 3.6 kcal/day and C: 20.5 +/- 8.6 kcal/day). Energy intake was at similar level than REE and clearly less than energy requirement in C and S. A significant decrease was observed for orosomucoid and Prognostic Inflammatory and Nutritional Index (PINI) in S. CONCLUSION: Our results do not confirm improvement of nutritional status with enriched BCAAs supplementation as suggested in the literature. Persistence of inflammatory condition may be an explanation despite an improvement of inflammatory status was observed in the supplemented group. Those results show clearly that energy requirements are not covered in acute hospitalized elderly people. The fact that not only energy intake but also REE are decreased brings a new insight on catabolic situations.

[Death caused by anorexia nervosa (author's transl)]. / La mort des anorexiques mentales.

The authors examine the clinical history of two women whose first symptoms of anorexia nervosa appeared at the ages of 20 and 30 years respectively. Their illness remained stationary for many years then suddenly became fatal after a series of severe metabolic disturbances. These occurred after a period of 26 years in the first case, and 11 years in the second. This illustrates the concept that the prognosis of anorexia nervosa is not as good when the first symptoms appear at an advanced age, and also that a vital prognosis can be established in certain cases according to percentages that are variable but no negligible. A survey of what has been written to date seems to confirm this.