Malrotation of the midgut associated with horseshoe kidney presenting as gastric outlet obstruction in a 15-year-old boy.

Malrotation occurs in approximately 1 in 500 live births. However, the true incidence of malrotation is unknown since many asymptomatic patients fail to present. Approximately 90% of patients with malrotation are diagnosed within the 1st year of life. Eighty per cent of them are diagnosed within the 1st month of life. Nevertheless, there are recent reports of manifestations later in life both as emergency conditions and more chronic gastrointestinal symptoms. The relationship between malrotation and horseshoe kidney has not been fully understood, but few case reports have highlighted their occurrence in the same patient. The mode of presentation of this case and its association with a horseshoe kidney is the reason for this report. This was a case of malrotation associated with horseshoe kidney. He had exploratory laparotomy and Ladd's procedure. Malrotation is associated with horseshoe kidney which presented as gastric outlet obstruction. He responded well to treatment after Ladd's procedure.

The potential role of sphingolipid-mediated cell signaling in the interaction between hyperglycemia, acute myocardial infarction and heart failure.

INTRODUCTION: Patients with acute myocardial infarction or heart failure frequently have abnormalities of glucose metabolism and insulin resistance, both of which are associated with a poor outcome. Sphingolipids are a class of lipids, which play important roles in cellular biological processes including insulin resistance and myocardial ischemia. AREAS COVERED: This review examines the available evidence linking abnormalities in sphingolipids, glucose tolerance and insulin resistance to acute myocardial infarction and heart failure. EXPERT OPINION: Pharmacological and genetic activation of enzymes controlling key sphingolipids synthesis, such as sphingosine-1-phosphate, increases insulin sensitivity in rodents and increases myocardial tolerance to ischemia. Major projects are being realized to develop clinical strategies to manipulate sphingolipid metabolism in this clinical settings, with the ultimate goal of increasing insulin sensitivity and augmenting myocardial tolerance to ischemia. Thus, a clear understanding of the sphingolipid-mediated signaling in ischemic heart disease is required to devise strategies to develop novel agents and technologies that directly target this signaling pathway.