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A Journal on Physical Medicine and Rehabilitation after Pathological Events

Official Journal of the Italian Society of Physical and Rehabilitation Medicine (SIMFER), European Society of Physical and Rehabilitation Medicine (ESPRM), European Union of Medical Specialists - Physical and Rehabilitation Medicine Section (UEMS-PRM), Mediterranean Forum of Physical and Rehabilitation Medicine (MFPRM), Hellenic Society of Physical and Rehabilitation Medicine (EEFIAP)
In association with International Society of Physical and Rehabilitation Medicine (ISPRM)
Indexed/Abstracted in: CINAHL, Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
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Europa Medicophysica 1998 September;34(3):125-9

language: English

The per­sis­tence of hyper­cat­a­bol­ic ­state in reha­bil­i­ta­tion ­patients ­with com­pli­cat­ed ­head inju­ry

Fugazza G. 1, Aquilani R. 2, Iadarola P. 4, Dossena M. 3, Catapano M. 3, Boschi F. 3, Cobianchi A. 5, Pastoris O. 3

1 Department of Rehabilitation, “S. Maugeri” Foundation, IRCCS, Pavia, Italy;
2 Service of Nutritional Physiopathology, “S. Maugeri” Foundation, ­IRCCS Rehabilitation Center of Montescano (Pavia), Italy;
3 Institute of Pharmacology, University of Pavia, Pavia, Italy;
4 Institute of Biochemistry, University of Pavia, Pavia, Italy;
5 Centro Grandi Strumenti, University of Pavia, Pavia, Italy


BACKGROUND: The aim of the ­present ­study was to inves­ti­gate wheth­er ­patients ­with ­severe ­head inju­ry ­(SHI) have a hyper­cat­a­bol­ic ­state dur­ing ­their reha­bil­i­ta­tion peri­od.
METHODS: Eleven ­patients ­with SHI under­went the fol­low­ing eval­u­a­tions: a) nutri­tion­al stat­us (anthro­pom­e­try, ser­um albu­min lev­els, 24-hr crea­ti­nine uri­nary excre­tion); b) rest­ing ener­gy expen­di­ture (REE: indi­rect cal­o­rim­e­try); c) 24-hr nitro­gen uri­nary excre­tion; d) deter­mi­na­tion of plas­ma lev­els of lac­tate, pyru­vate, glyce­rol, ace­toac­e­tate, β hydrox­y­bu­ti­rate, ­total car­ni­tine. All ­patients ­were fed enter­al­ly via a nas­o­gas­tric ­tube. Eight ­healthy sub­jects, ­matched for sex and age, ­served as con­trols.
RESULTS: The ­patients ­with SHI ­showed an impor­tant reduc­tion of ­body ­weight and skel­e­tal mus­cles. Their REE was 91.2%±17.3% of pre­dict­ed val­ues. An ade­quate ener­gy ­intake was ­found in ­only 5/11 ­patients. As a ­group, the ­patients had a neg­a­tive nitro­gen bal­ance. Plasma con­cen­tra­tions in sub­strates ­were sim­i­lar between the two groups. Esterified/free carnitine ratio and total carnitine were higher in patients than in controls (p<0.05 and p<0.01 respectively).
CONCLUSIONS: Catabolic non hyper­met­a­bol­ic pro­cess­es may per­sist in reha­bil­i­ta­tion ­patients ­with SHI, delay­ing and reduc­ing func­tion­al recov­ery.

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