An uncommon cause of visceral arterial embolism in patients presenting with acute abdominal pain: a report of 2 cases.

We report on 2 cases of visceral arterial embolism presenting with acute abdominal pain. In neither patient a cause could be established on initial clinical, laboratory, echographic or radiological investigation. Both patients were subsequently found to have a mural thrombus in the thoracic aorta, with visceral arterial embolism. Each underwent a successful operative thrombectomy. Both patients had a normal underlying aortic intima at inspection. The first patient was a young male with no known diseases. He regularly used cannabis and tested positive on admission, an association not yet reported with aortic mural thrombus. He was found to have a slightly reduced protein C. The second patient was a middle aged man with non-insulin dependent diabetes, hyperlipidaemia, arterial hypertension and hyperthyroidism. He was found to have an underlying adenocarcinoma of the lung and received chemotherapy. He died due to his cancer, 4 months after first presentation.

Safety of alternative medicines reconsidered: lead-induced anaemia caused by an indian ayurvedic formulation.

We report two cases of Belgian women diagnose with a lead poisoning. Both patients presented with abdominal pain and a normochromic normocytic anaemia. The diagnosis was based on the clinical symptoms, the anaemia, the basophilic stippling of erythrocytes and the elevated blood lead level Upon further questioning, both patients reported the use of Ayurvedic medications. Toxicological analysis of the different pills revealed that, in both, the same orange-red pills contained a remarkably high amount of lead. Cases of lead poisoning associated with the use ofAyurvedic formulations are emerging around the world. However, to our knowledge, these are the first reported cases in Belgium.

Treatment of Zenker's diverticulum through a flexible endoscope with a transparent oblique-end hood attached to the tip and a monopolar forceps.

BACKGROUND AND STUDY AIMS: Zenker's diverticulum was commonly treated by means of external transcervical diverticulectomy, myotomy or diverticulopexy, or by means of an endoscopic myotomy through a rigid endoscope. Gastroenterologists first described flexible endoscopic therapy for Zenker's diverticulum in 1995. In our single-center study we report the safety and feasibility of endoscopic myotomy through a flexible endoscope, performed at a secondary referral centre. PATIENTS AND METHODS: A series of 21 patients with Zenker's diverticulum were treated using a flexible endoscope with a transparent oblique-end hood attached to the tip and a monopolar coagulation forceps. Relief of the dysphagia was the main outcome measure with evaluation of safety and complications. Dysphagia was graded on a scale of 0 to 4 before and after treatment. General anesthesia was not used. RESULTS: Access to the esophagus was attained without problems in all patients. Oral feeding was resumed the following day. Complete relief of dysphagia was reported by all patients after 1 month. Dysphagia recurred in two patients (9.5%) after the first session. These patients were successfully treated again in the same way. Adverse events were limited to transient cervical emphysema in a single patient. CONCLUSIONS: This endoscopic technique is an efficient, safe and minimally invasive method for the treatment of Zenker's diverticulum. General anesthesia is not necessary and oral feeding can be resumed the next day. In view of the excellent results and minimal complications, it can be considered a safe alternative for the treatment of Zenker's diverticulum.

Dental age estimation in Belgian children: Demirjian's technique revisited.

AIM: The purpose of this study was to evaluate the accuracy of Demirjian's dental age estimation in children in a Belgian Caucasian population and to adapt the scoring system in case of a significant overestimation as frequently reported. We selected 2523 orthopantomograms of 1265 boys and 1258 girls, of which 2116 (1029 boys and 1087 girls) were used for estimating the dental age with the Demirjian's technique. The 407 other orthopantomograms were beyond the original age limit. A second sample of 355 orthopantomograms was used to evaluate the accuracy of the original method and the adapted method. A signed-rank test was performed to search for significant age differences between the obtained dental age and the chronological age. A weighted ANOVA was performed in order to adapt the scoring system for this Belgian population. The overestimation of the chronological age was confirmed. The adapted scoring system resulted in new age scores expressed in years and in a higher accuracy compared to the original method in Belgian Caucasians.

Hypodontia and tooth formation in groups of children with cleft, siblings without cleft, and nonrelated controls.

OBJECTIVE: To compare the occurrence of hypodontia, dental age, and asymmetric dental development in children with cleft with their siblings and a nonsibling control group. SUBJECTS: The sample consisted of 54 children with cleft (aged 4.2 to 13.1 years), who had at least one sibling available for an orthopantomogram, 63 siblings without cleft (aged 4 to 14.9 years) and 250 controls without cleft (aged between 4 and 14.9 years). METHOD: Hypodontia, dental age, and asymmetric dental development were assessed on panoramic radiographs of the children with cleft, the siblings without cleft, and the control children without cleft. RESULTS: Both the cleft (p <.001) and the sibling group (p <.05) showed a significantly higher frequency of hypodontia and a significantly higher occurrence (cleft p <.01 and sibling group p <.001) of asymmetric dental development, compared with the control group. Only a small, but insignificant, delay in dental development could be found in the cleft and the sibling group. CONCLUSIONS; The cleft subjects with siblings showed a significantly higher occurrence of hypodontia and asymmetric dental development than the noncleft control group. This may suggest a genetic component for the occurrence of hypodontia and asymmetric dental development.

Pouch-sacral fistula three years after restorative proctocolectomy for ulcerative colitis.

Fistula formation after restorative proctocolectomy poses a challenge to the surgeon and sometimes can lead to the excision of the pouch. A 21-year-old female patient developed an ileal J-pouch-sacral fistula with abscess and osteomyelitis of the sacrum, more than three years after the pouch construction for ulcerative colitis. Two months prior to this event, the patient had a single and transient episode of pouchitis. The role of pouchitis in the aetiopathogenesis of the fistula is unclear. To our knowledge, the late development of such a fistula has not been reported previously.