Superior mesenteric artery syndrome in a child with acute gastric dilatation with refractory Guillain-Barré syndrome.

Superior Mesenteric Artery Syndrome (SMAS) resulting from proximal partial small bowel obstruction is one of possible causes of acute gastric dilatation (AGD). A child with refractory demyelinating Guillain-Barré syndrome which received 5 times IVIG and consequently 5 times plasmapheresis intubated until 59th day of admission. Because of complicated treatment and cardiopulmonary resuscitation (CPR) nutrition was completely neglected which lead to severe SMAS because of weight loss. Gradual advancements of continuous enteral and parenteral nutrition improved patient's symptoms significantly. Hypophosphatemia complicated the weaning from ventilator which after nutrition therapy resolved and patient extubated. Present case is the first report of pediatric demyelinating GBS suspected to SMAS.

[Electroacupuncture at "Zusanli"(ST 36) can inhibit frequencies of transient lower esophageal sphincter relaxation induced by gastric distention in cats].

OBJECTIVE: To observe the influence of electroacupuncture (EA) of "Zusanli" (ST 36) and ST 36 + "Neiguan" (PC 6) on gastric distention induced transient lower esophageal sphincter relaxation (TLESR) in cats. METHODS: Forty cats were randomly divided into model (gastric distension) group, EA-ST 36 group, EA-PC 6 group, EA-ST 36 + PC 6 group, EA-non-acupoint group, EA-ST 36 + saline (2 mL i.v.) group, EA-ST 36 + L-arginine (precusor of nitric oxide, 200 mg/kg i.v.) group, and EA-ST 36+Tacrine (cholinesterase inhibitor, 5.6 mg/kg i. p.) group, with 5 cats being in each group. TLESR model was established by extending the stomach with an air balloon. EA (2 Hz/100 Hz, 3-4 mA) was applied to bilateral ST 36, PC 6 and ST 36 + PC 6 and non-acupoint (exterior-superior site of the hip) while gastric distension. L-Arginine was given 10 min before EA, and Tacrine was given 30 min before EA. The frequency of TLESR and lower esophageal sphincter pressure (LESP) were recorded by using a perfused sleeve assembly. RESULTS: Compared with the model group, the frequency of TLESR in 60 min as well as the percentage of common cavity during TLESR were significantly decreased in the EA-ST 36, EA-PC 6, EA-ST 36 + PC 6, EA-ST 36 + saline groups (P < 0.05). Compared with the EA-ST 36 + saline group, the frequency of TLESR in 60 min was up-regulated significantly in the EA-ST 36 + Tacrine group (P < 0.01) rather than in the EA-ST 36 + L-Arginine group, suggesting a reduction of the efficacy of EA-ST 36 by cholinergic suppression (not by nitric oxide). No significant differences were found among the EA-ST 36, EA-PC 6 and EA-ST 36 + PC 6 groups in the frequency of TLESR and the percentage of common cavity (P > 0.05). In comparison with the baseline level, LESP was increased significantly only in the EA-ST 36 group (P < 0.05). CONCLUSION: EA at ST 36 can reduce both the frequency of TLESR and the percentage of common cavity during TLESR in gastric distension cats, which may be mediated by cholinergic pathway.