Atrophic beriberi. A complication of jejunoileal bypass surgery for morbid obesity

Nitroglycerin

Angina

Nitrate esters

Congestive heart failure

1976.

conduction Ventricular

Transvenous pacemaker

Cardiac output

Hemodynamics pacing

Atrophic beriberi Dietary deficiency

Thiamine deficiency Peripheral neuropathy

Jejunoileal bypass surgery

Cutaneous hepatic porphyria

Genetic porphyria

The diagnosis of porphyria variegata is based on both clinical and chemical findings. People with manifest cases present typically with cutaneous, neurologic and/or abdominal symptoms complicated by paralysis, or even respiratory failure in unsuspected cases if the patients are given porphyrogenic chemicals or drugs. Latent cases may only be detected by stool quantitation of porphyrins. Difficulty might arise when the value of fecal porphyrins is borderline, making the designation probable latent or, in some cases, even questionable. Study of a large kindred with porphyria variegata in the United States, consisting of 91 members, revealed the complexity of classification in the younger generation. The incidence of porphyria variegata in our country may be greater than recognized, especially when an enzyme assay specific for porphyria variegata is available.

Fromke VL, Bossenmaier I. Cardinal R, Watson CJ: Porphyria variegata. Study of a large kindred in the United States. Am J Med 65: 80-68, 1978.

Porphyria Variegata

A 37 year old black woman, four months after jejunoileal bypass surgery for morbid obesity and who ate a grossly inadequate diet, was hospitalized with severe peripheral neuropathy thought to result from electrolyte imbalance. She was fed a high-protein diet as tolerated and given intravenous electrolyte therapy, but despite this her neuropathy progressed. Serum vitamin studies showed zero levels of thiamine with normal levels of other vitamins tested and the diagnosis of atrophic beriberi was made. Replacement of thiamine and subsequent feeding of a complete elemental diet via jejunostomy tube has resulted in gradual clinical improvement. Atrophic beriberi should be suspected when peripheral neuropathy develops after jejunoileal bypass surgery for morbid obesity.

Glad BW, Hodges RE, Michas CA, Moussavian SN, Righi SP: Atrophic beriberi. A complication of jejunoileal bypass surgery for morbid obesity. Am J Med 68: 69-74, 1978.

Short bowel syndrome

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Ventriculoatrial conduction complicating ventricular pacing in a patient with ischemic heart disease led to severe clinical disability and hemodynamic compromise. Data obtained at cardiac catheterization documented that ventriculoatrial conduction of the patient’s paced beats led to inadequate left ventricular filling pressures, pulmonary congestion and depressed cardiac output. This complication of ventricular pacing can be suspected at bedside examination and emphasizes the importance of considering the possible hemodynamic effects of ventricular pacing when long-term pacemaker therapy is contemplated.

Johnson AD, Laiken SL, Engler RL: Hemodynamic compromise associated with ventriculoatrial conduction following transvenous pacemaker placement. Am J Med 65: 75-79, 1978.

Pulmonary congestion

Ventriculoatrial

The expanding applications of nitroglycerin and nitrate esters-in congestive heart failure, in the reduction of infarct size in myocardial infarction and in the long-term prophylaxis of angina-have enhanced the clinical importance of these drugs. This article reviews some of tbe significant recent investigations of the nitrates and makes specific recommendations regarding clinical use.

Warren SE, Francis GS: Nitroglycerin and nitrate esters. Am J Med 65: 53-62,

Myocardial infarction