Elevated transaminases as a predictor of coma in a patient with anorexia nervosa: a case report and review of the literature

<p>Abstract</p> <p>Introduction</p> <p>Liver injury is a frequent complication associated with anorexia nervosa, and steatosis of the liver is thought to be the major underlying pathology. However, acute hepatic failure with transaminase levels over 1000 IU/mL and deep coma are very rare complications and the mechanism of pathogenesis is largely unknown.</p> <p>Case presentation</p> <p>A 37-year-old Japanese woman showed features of acute liver failure and hepatic coma which were not associated with hypoglycemia or hyper-ammonemia. Our patient's consciousness was significantly improved with the recovery of liver function and normalization of transaminase levels after administration of nutritional support.</p> <p>Conclusions</p> <p>Our case report demonstrates that transaminase levels had an inverse relationship with the consciousness of our patient, although the pathogenesis of coma remains largely unknown. This indicates that transaminase levels can be one of the key predictors of impending coma in patients with anorexia nervosa. Therefore, frequent monitoring of transaminase levels combined with rigorous treatment of the underlying nutritional deficiency and psychiatric disorder are necessary to prevent this severe complication.</p

Evaluation of the effects of sensory denervation on osteoblasts by 3 H-proline autoradiography

The inferior alveolar nerve was unilaterally resected in 30-day-old mice; other animals were unilaterally sham-operated. At 15, 30, 60, 90, or 150 days after surgery, the mice were injected with 2μCi of 3 H-proline (sp. act. 1.0 Ci/mM) per g of body weight and killed 15, 30, or 60 min later. Autoradiographs were prepared from 5μm decalcified sagittal sections of mandibles and grain counts made over periosteal osteoblasts mesial to the first molar. In denervated mandibles, osteoblasts incorporated less isotope compared to controls with differences being maximal at the early intervals. These differences became attenuated with time, possibly due to an intrinsic compensatory mechanism, secondary to neurotrophic regulation.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/47675/1/441_2004_Article_BF00219365.pd

Absence of large-diameter sensory fibres in a nerve to the cat humerus

A fine branch of the median nerve innervates the periosteum and medullary cavity of the cat humerus. After branching to innervate the periosteum on the medial surface of the humerus, the nerve enters and supplies the medullary cavity via a nutrient foramen, accompanied by a small artery and vein. The composition of the fibres in the nerve was examined using electron microscopy. Myelinated fibres with diameters of 0.8–6.6 µm and unmyelinated fibres with diameters of 0.1–1.4 µm were observed. These diameters indicate that afferent fibres of this nerve are confined within the Group III and IV categories, and may therefore be nociceptive or mechanoreceptive in function. In addition, autonomic efferent fibres may also be present in these fibre groups. As no fibre diameters greater than 7 µm were noted, it appears that Group I and II fibres are absent in this nerve. The fibre distribution suggests that the principal role of this nerve is to relay bone-related nociceptive or mechanoreceptive information to the central nervous system and to provide autonomic regulatory influences on the bone