A Rare Case of Intestinal Obstruction in an Elderly Woman.

Among intestinal obstruction, intussusception is one of the rare mechanical causes in the adult period. When it is met it present with abdominal pain, vomiting and other symptoms compatible with intestinal obstruction varying on the segments being involved. Compared to pediatric invagination which it is mostly idiopathic the adult form has an organic etiology causing a blurred symptomatology and needing advanced imaging diagnosis like computerized tomography. We present the case of a 70 year old woman with multiple Emergency Department presentations with abdominal pain and vomiting which received a clear diagnosis only the third time she came to hospital. Ultrasonography and plain abdominal x-ray were no specific and only the CT scan revealed the real cause of obstruction. Also conservative measures were useless the definitive treatment being surgery, the lesion necessitating enteral resection and end to end anastomosis. The pathology report revealed a benign tumor of proximal jejunum. In conclusion, adult intestinal invagination, although it is a rare condition, can present with symptomatology varying with segment of bowel involved into the intussusception. Unlike pediatric invagination, the adult one needs standard surgical revision unless there are certain contraindications.

Autonomic impairment in patients with migraine.

OBJECTIVE: Heart rate variability analysis of electrocardiogram is becoming an increasingly common method to non-invasively evaluate autonomic nervous function. The aim of the study was to investigate cardiac autonomic function in subjects with and without migraine by using 24-hour ambulatory electrocardiographic recordings. PATIENTS AND METHODS: We investigated 27 subjects with migraine (10 with migraine with aura and 17 without aura) during headache free periods and 10 age-matched healthy control subjects. The migraine was diagnosed using the International Classification of Headache Disorders 2nd Edition criteria. Beck Depression and Beck Anxiety Inventory forms were completed by all subjects. Time and frequency-domain of HRV was analyzed for two periods: diurnal and nocturnal. RESULTS: We found an increased frequency of anxiety and depressive symptoms in migraine patients, especially in migraine with aura group. The heart rate variability parameters SDNN, RMSSD, high frequency were decreased and low frequency was increased in migraine patients during night period compared with normal subjects, most affected were migraine with aura patients. During day period we found modification for SDNN, RMSSD and high frequency parameters only in migraine with aura group. CONCLUSIONS: Reduced parasympathetic activity with sympathetic predominance was found in migraine patients during the night period, most affected being migraine with aura patients.

Autonomic dysfunction in type 2 diabetes mellitus with and without vascular dementia.

INTRODUCTION: Autonomic dysfunction has been implicated in sudden cardiac death and cognitive impairment in diabetes. OBJECTIVES: Objectives of the study were to examine the associations between vascular, metabolic risk factors, autonomic and cognitive function in patients with diabetes mellitus. METHOD: We investigate autonomic function in 45 participants with type 2 diabetes and in 23 age related normal subjects, using Ewing's tests and power spectral analysis of heart rate variability. Mini Mental State Examination and Hachinski's ischemic scale were used to identify vascular dementia. Only 11 patients were diagnosed with vascular dementia. RESULTS: The glycosylated haemoglobin, triglycerides, and systolic blood pressure had much larger values in vascular dementia patients compared to the controls. The averages of results obtained in heart rate deep-breathing, Valsalva ratio and lying-to-standing tests for vascular dementia patients are statistically lower than the averages for controls. Vascular dementia patients had a greater fall in blood pressure on standing (p<0.001) and reduced blood pressure responses to isometric exercise (p<0.001) in comparison with controls. Also they had an increase in the mean heart rate at rest (p<0.05), a decrease in time domain parameters of heart rate variability (p<0.001), and an increase in the low/high frequency component ratio (p<0.001) indicating a vagal-sympathetic dysfunction. CONCLUSIONS: Using standard cardiovascular reflex tests and analysis of heart rate variability we demonstrated an impairment of the autonomic nervous system in vascular dementia patients with marked parasympathetic dysfunction and sympathetic predominance.