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Rivista di Medicina Fisica e Riabilitativa dopo Eventi Patologici

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

lingua: Inglese

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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