[Superior mesenteric vein syndrome: a case of duodenal stenosis caused by atypical malposition of the superior mesenteric vein]. / Vena-mesenterica-superior-Syndrom--eine Duodenalstenose, bedingt durch eine atypisch verlaufende V. mesenterica superior.

Cases in which mesenteric vessels lead to stenosis of the duodenum are very rare. Several cases have been reported of patients suffering from stenosis of the last third of the duodenum due to a malpositioning of the superior mesenteric artery or the left renal vein. We report a 78-year-old patient who was suffering from dyspepsia, pain in the upper abdominal region, nausea, and vomiting. The medical history revealed that the patient had undergone a subtotal gastrectomy according to Billroth II at the age of 19 because of similar complaints. In the last 20 years the patient had to be laparotomized several times for ileus of the small intestine. Now the patient presented abdominal complaints with nausea and pressure in the upper abdominal region. Assuming an efferent-loop syndrome and adhesions, the patient was laparotomized. We discovered malpositioning of the superior mesenteric vein, leading to stenosis of the superior part of the duodenum. In fact, 60 years ago surgeons performed a duodenojejunostomy, circumvening the stenosis of the duodenum. With a "delay of 60 years", we then performed a subtotal gastrectomy according to Billroth II. The postoperative course was uneventful; the patient had no complaints and increased in body weight. To our knowledge, this is the first time that a stenosis of the duodenum due to malpositioning of the superior mesenteric vein has been observed.

Biochemical and morphological effects of polyamine biosynthesis inhibitors on Trichophyton and Microsporum.

The minimum inhibitory concentrations (MICs) of three known irreversible inhibitors of polyamine synthesis, alpha-difluoromethylornithine (DFMO) and monofluoromethyldehydroornithine methylester (MFMOme), inhibitors of ornithine decarboxylase (ODC) and alpha-difluoromethylarginine (DFMA), an inhibitor of arginine decarboxylase (ADC), were determined for 10 species of dermatophytic fungi. Trichophyton species were generally more sensitive to these inhibitors than Microsporum species. Both genera produced arginase, and treatment of members of either genus with DFMO or DFMA resulted in an inhibition of ODC activity and a depletion of cellular polyamines. However, conversion of labelled DFMA to DFMO, either in vivo or in vitro, could not be demonstrated in spite of both genera producing arginase. The ultrastructure of cells cultured in the presence of either DFMO or DFMA was similar, and revealed disruption of calcium metabolism, an increase in mitochondrial number and alterations to membrane systems. DFMA and DFMO also inhibited sporulation in Microsporum gypseum. Our findings indicate that DFMO limits the growth of dermatophytes by direct inhibition of ODC and lowering of cellular polyamine levels; in contrast, DFMA inhibits polyamine synthesis in an unspecified manner as ADC activity was undetected.