Necrotizing myopathy in critically-ill patients

Article Abstract:

Necrotizing myopathy (muscle wasting) of skeletal muscles frequently occurs in patients who have sustained severe injury and in patients with multiple organ failure. The degeneration of the muscles is thought to be caused by a number of mechanisms, including degeneration of the muscle fibers and disorders of the nerves associated with the muscles. Patients who were critically ill were examined for necrotizing myopathy. Fifteen of 31 patients (48 percent) had necrotizing myopathy. Many of the patients with necrotizing myopathy had degeneration of isolated muscles, but 42 percent had necrosis affecting up to 95 percent of the muscle fibers examined. Causes of the necrotizing myopathy were thought to include lack of blood supply to the muscles and, in some of the patients, generalized infection. Necrosis was seen in muscles of the legs and arms and occurred within one week of becoming critically ill. The amount of necrosis increased with time, but was reversible when the patient's condition improved. The amount of muscle necrosis was related to the severity of the illness. The protein myoglobin, which is involved in the contraction of muscle fibers, was increased in the urine of patients with myopathy. This may lead to renal failure. These findings indicate that wasting of skeletal muscle occurs in critically ill patients and may contribute to weakness and complicate their clinical conditions. (Consumer Summary produced by Reliance Medical Information, Inc.)

Muscles, Striated muscle, Critically ill, Necrosis, Myonecrosis

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Catabolic effects of high-dose corticosteroids persist despite therapeutic benefit in rheumatoid arthritis

Article Abstract:

Rheumatoid arthritis (RA) is one of the more common forms of chronic, inflammatory arthritis. Corticosteroids (CS) are often used during RA treatment to provide symptomatic relief and reduce synovitis and stiffness. Although CS have appetite-stimulating effects, they also cause nitrogen wasting. Therefore, nitrogen balance was measured in nine patients with RA before, during and after three days of therapy with methylprednisolone, a corticosteroid. Seven of the nine patients showed signs of protein and fat depletion (cachexia) prior to the study. During CS therapy joint inflammation was reduced. Unfortunately, nitrogen wasting occurred during all phases, despite an increase in energy and nitrogen intakes by the patients. This result suggests that CS treatment may accelerate loss of body mass, which is already occurring in patients with chronic inflammatory disease. (Consumer Summary produced by Reliance Medical Information, Inc.)

Drug therapy, Corticosteroids, Adrenocortical hormones, Rheumatoid arthritis, Methylprednisolone

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Comparison of the metabolic effects of continuous postoperative enteral feeding and feeding at night only

Article Abstract:

A study was performed to assess the effectiveness of two different feeding patterns on nitrogen balance, blood biochemistry, oxygen consumption and urinary catecholamine excretion. Two groups of nine patients each were fed for five days by continuous 24-hour infusion with an enteral (intestinal) feeding pump or only during the night. In the 24-hour feeding group, oxygen consumption and catecholamine excretion were higher, and nitrogen balance was better than in the group fed only at night. Continuous feeding for 24 hours induced a higher metabolic rate in the patients, while nighttime feeding was associated with a negative nitrogen balance. Although intermittent feeding at night may be more energy efficient, it is associated with poor nitrogen balance, which is undesirable. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Oxygen consumption, Oxygen consumption (Metabolism), Enteral feeding, Enteral nutrition

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