Superior Mesenteric Artery Syndrome in Traumatic Brain Injury: A case report

Superior mesenteric artery syndrome (SMAS) is a rare cause of proximal duodenal obstruction resulting from compression of the duodenum by the SMA against the aorta. Risk factors associated with SMAS are prolonged supine position, weight loss and decreased abdominal wall muscle tone; all of which are frequently accompanied with traumatic brain injury (TBI). The following case report describes a patient who developed SMAS in the setting of TBI. This report presents a 16 year old male with TBI who had postprandial epigastric pain, vomiting and weight loss. Computed tomography and upper gastrointestinal series demonstrated the existence of SMAS. The patient was managed conservatively with total parenteral nutrition to obtain a positive nitrogen balance. Physician should consider SMAS in the differential diagnosis of patients presenting with abdominal pain and vomiting.

The Utility of Non-invasive Positive Pressure Ventilation Support during the Procedure of Percutaneous Gastrostomyin Amyotrophic Lateral Sclerosis

OBJECTIVE: To consider the utility of non-invasive positive pressure ventilation (NIPPV) support during percutaneous gastrostomy procedure in amyotrophic lateral sclerosis (ALS) patients with severe respiratory insufficiency and weight loss. METHOD: Percutaneous gastrostomy was performed in 25 ALS patients with forced vital capacity (FVC) below 50% of predicted normal value. NIPPV was applied to all these patients during the procedure. To estimate the utility of NIPPV application during gasrtostomy tube placement, safety and procedure related complications were investigated. RESULTS: Percutaneous endoscopic gastrostomy (PEG) was performed successfully in 21/25 patients (84%). Percutaneous radiologic gastrostomy (PRG) was performed to the rest. FVCP (predicted value of FVC) in seated position were 1,239.1 ml (32.1%) in PEG-successful group and 1,065.0 ml (26.8%) in PEG-failed group, respectively. All the patients tolerated the use of NIPPV successfully and there were no respiratory complications with the procedure. There were no major complications and procedure-related mortality in all the patients. CONCLUSION: NIPPV support during percutaneous gastrostomy tube placement could make the procedure possible in ALS patients with very low vital capacities.

Cystic Solitary Fibrous Tumor Arising From the Left Occipital Meninges: A Case Report

Solitary fibrous tumor (SFT) is a benign mesenchymal neoplasm of a spindle-cell origin, and it usually involves the pleura. It's occurrence in various organs of the body has recently been described. Meningeal SFT is very rare. Radiologically, it is a strongly enhancing solid mass and is undistinguishable from fibrous meningioma and hemangiopericytoma. Yet we report here on a case of SFT with massive cystic degeneration that arose from the meninges of the left occipital region.

The Expression of nNOS in Hirschsprung's Disease

Abnormal distribution of enteric nerves such as adrenergic, cholinergic and non-adrenergic non-cholinergic nerves (NANC) may cause the failure of relaxation at the involved bowel segment in Hirschsprung's disease (HD). Nitric oxide (NO) is a major inhibitory NANC neurotransmitter in the gastrointestinal tract. NO is synthesized by activation of nNOS (neuronal nitric oxide synthase) in the intramural ganglion cells and regulates bowel movement. To assess the distribution of nNOS in HD, immunohistochemical staining to nNOS was utilized on paraffin embedded specimens. Ten control colon specimens were tested for feasibility of staining. Immunohistochemisrty was done on ganglionic colon as well as aganglionic segment of 15 patients with HD. nNOS immunoreactivity was observed in the neuronal cells, small cells and nerve fibers in the muscle layer and submucosal neuronal cells of control specimens. This finding was also observed in the ganglionic segments of HD. But, there was no nNOS immunoreactivity in aganglionic segments of HD. In conclusion nNOS immunohistochemical staining of paraffin embedded specimen is feasible and reliable. And the results suggest that the relaxation failure of the aganglionic bowel in HD is related to the absence of nNOS containing cells and nerve fibers.

The Investigation of Spinal Deformity in Korean Elementary School Students

OBJECTIVE: The aim of this study was to investigate the prevalence of spinal deformities such as scoliosis, thoracic kyphosis and lumbar lordosis in Korean elementary school students. METHOD: Five hundred forty Korean elementary school students were preliminary screened for spinal deformities by physical examinations and the three dimensional skeletal analysis system. The study time and pain regions were investigated in sitting on chairs that commonly used in Korean elementary school. RESULTS: The prevalence of scoliosis, thoracic kyphosis and lumbar lordosis were 9.8%, 18.7% and 23.1%. There was a significant difference in study time between spinal deformity group and control group (p<0.01). In spinal deformity group, pain regions were low back (45%), posterior neck (23%), buttock (21%) and shoulder and elbow joints (11%). CONCLUSION: The spinal deformities showed high prevalence in elementary school students assessed by the three dimensional skeletal system analyser. The long term follow-up evaluation and confirmative radiographic study will be necessary to assess curve progression in spinal deformity group.

Relation of Radiographic Parameters and Psychosocial Condition in Idiopathic Adolescent Scoliosis

OBJECTIVE: To determine the relation of Radiographic Scoring System and Scoliosis Research Society-22 (SRS-22), a revised form of health-related quality-of-life (HRQL) questionnaire in idiopathic adolescent scoliosis patients. METHOD: A patient group was made up of 41 adolescents who were diagnosed as idiopathic scoliosis. A control group of 17 persons with Cobb's angle <10degrees was established. To evaluate psychosocial condition, SRS-22 was used to collect the data on both patient and control group. Roentgenographic study was conducted to obtain the Radiographic Deformity Score and evaluate the curve pattern. RESULTS: Pain, self image/appearance, mental health and total score of SRS domains were found to be significantly different between patient and control group (p<0.05). Radiog raphic Deformity Score was positively correlated with pain and self image of SRS domains (p<0.05). However, the pattern of curve was found to be not correlated with SRS score. CONCLUSION: We could evaluate a psychologic condition of idiopathic adolescent scoliosis using Scoliosis Research Society-22 (SRS-22) health-related quality-of-life (HRQL) questionnaire. The more severe spinal deformity, it had the more negative influence on psychologic conditions in idiopathic adolescent scoliosis patients. Therefore, the clinician who is managing idiopathic adolescent scoliosis patients should consider their psychosocial conditions.

Correlation of beta-catenin and p53 Protein Expression with Clinico-pathologic Characteristics of Colorectal Cancer

PURPOSE: Both the beta-catenin and p53 play a crucial role in the process of colon carcinogenesis. The expression of beta-catenin and/or p53 has been reported to be associated with pathologic features of tumor and prognosis of patients. In addition, several recent studies have suggested a close biological association between p53 expression and nuclear beta-catenin level. We analyzed the pathologic variables and p53 expression according to the intra-nuclear beta-catenin expression in colon cancer to make such assumptions more clear since they are still controversial issues. METHODS: The expressions of beta-catenin, p53 and Ki-67 protein in colon cancer were determined by immunohistochemical staining. The relationship between these protein expressions and tumor characteristics was statistically analyzed. RESULTS: The intra-nuclear beta-catenin accumulation was not associated with any of the pathological variables including lymph node metastasis and tumor differentiation, but it was correlated with higher level of Ki-67 proliferation index (P=0.006) and negative staining of p53 (P=0.015). Positive p53 staining was significantly associated with lymph node metastasis (P=0.006), lymphatic invasion (P=0.03) and venous invasion (P=0.02). CONCLUSION: These results support the suggestion that intra-nuclear accumulation of beta-catenin may regulate the p53 activity in colorectal cancer. In addition, positive staining of p53 may be used as a valuable prognostic indicator since it was strongly associated with lymph node metastasis, lymphatic and venous invasion.