A rare cause of upper gastrointestinal system obstruction: Superior mesenteric artery syndrome (Wilkie's syndrome); two different case reports.

Superior mesenteric artery syndrome is defined as a collection of clinical symptoms and findings that result from compression of the third part of the duodenum between the aorta and the superior mesenteric artery. Here, we describe two patients who were diagnosed with superior mesenteric artery syndrome. Two patients, 18 and 38 years old, respectively, presented to our clinic with complaints of nausea, vomiting, and weight loss. Computed tomography scans of both patients supported diagnoses of superior mesenteric artery syndrome. The 18-year-old patient recovered with conservative treatment. However, our 38-year-old patient did not recover with conservative treatment and required two surgeries. In the first operation, duodenal release with Treitz's ligament dissection and pyloroplasty were performed because of concomitant hypertrophic pyloric stenosis. Because the patient exhibited gastroparesis and gastric ptosis after the first operation, subtotal gastrectomy and Roux-n-Y gastrojejunostomy were performed in the second operation. No complications were observed during follow-up after the second operation. Superior mesenteric artery syndrome should be considered in the differential diagnosis of patients with nausea, vomiting, and weight loss of unknown cause. During treatment, weight-gaining conservative approaches should be attempted initially, but surgical treatment should not be excessively delayed in patients who do not respond to medical treatment.

Correlation of Block Success with Perfusion Index Measurement in Cases of Pediatric Surgery Under Caudal Epidural Block Anesthesia.

PURPOSE: One of the regional anesthetic procedures, caudal epidural block, is important for lower extremities surgeries in the pediatric patient population. The perfusion index (PI) value, which reflects vasomotor tone, can be used to indicate block success. The aim was to compare the role of perfusion index, heart rate, and mean arterial pressure in detecting the success of caudal epidural block and to investigate whether perfusion index was an earlier indicator in determining the success of the block in pediatric surgery cases. DESIGN: A randomized controlled trial. METHODS: The study included 58 patients, American Society of Anesthesiologists'classification 1, between the ages 1 and 6 years. In the left lateral decubitus posture, caudal epidural block was performed using a 23 or 25-gauge caudal needle and a dosage of 0.25% bupivacaine (1 mL/kg). At the 0, 1, 5, 7, 10, 15, and 20th minutes, peripheral oxygen saturation, heart rate, mean arterial pressure, and PI values were obtained using a probe attached to the first toe of the left foot. A successful caudal epidural block indication was defined as an increase of at least 100% in the PI value over the baseline value and a 15% decrease in mean arterial pressure and heart rate FINDINGS: PI represents the ratio of the photoplethysmography signal to pulsatile over nonpulsatile light absorbance. An increase in the PI value indicates that the block is effective. In the 20-minute follow-up period after caudal epidural block, there was at least a 100% increase in PI value in all of the patients at the seventh minute. An expected 15% reduction in mean arterial pressure was observed in 14.5% of the patients and an expected 15% reduction in heart rate was observed in 45.6% of the patients. CONCLUSIONS: The results obtained from our study show that the increase in PI values is associated with caudal epidural block success. The PI value is more rapid, sensitive and objective than those produced by other parameters. Benefits include an earlier change in anesthesia management due to block failure and faster initiation to surgery, which reduces exposure to anesthetic chemicals.

Acute kidney injury in the elderly hospitalized patients.

OBJECTIVE: We aimed to evaluate acute kidney injury (AKI), occurrence of recovery and risk factors associated with permanent kidney injury and mortality in the elderly individuals. DESIGN: Evidence for this study was obtained from retrospective cohort study from our center. PATIENTS: A total of 193 patients (>65 years, mean age: 79.99 ± 6.93) with acute kidney injury were enrolled in this study between 2011 and 2012. PATIENTS with kidney failure or renal replacement therapy (RRT) history at admission were excluded. INTERVENTION: Main outcome measurements: serum creatinine (SCr), estimated GFR (with CKD-Epi) and complete blood counts were evaluated at baseline and daily basis thereafter. The AKI was defined based on Kidney Disease Improving Global Outcomes (KDIGO) classification. RESULTS: Among 193 patients, 43 (22%) patients required RRT. Mortality rate was 18% (n = 36) SCr levels were restored within 9.9 ± 6.7days on average (8-39 days). Sixteen patients (12.7%) required RRT after discharge. The mean hospital stay was 10.1 ± 8.6 days (7-41 days). Mortality rate of patients who have no renal recovery was higher (44.8% vs. 4.8%) than renal recovery group (p < 0.01). CONCLUSION: The AKI represents a frequent complication in the elderly patients with longer hospital stay and increased mortality and morbidity. Our results show that dialytic support requirement is an independent predictor of permeant kidney injury in the elderly AKI patients. Older age, low diastolic blood pressure, high CRP and low hemoglobin levels were independent risk factors for mortality.