Wilkie's syndrome: review of eight cases.

BACKGROUND: The superior mesenteric artery (SMA) syndrome is a rare entity presenting with upper gastrointestinal tract obstruction and abrupt weight loss. Usually seen in tall individual with low bod mass index (BMI), the weight loss may be primary or secondary to a systemic disease or to the syndrome itself Compression of the duodenum between the abdominal aorta and the superior mesenteric artery due to loss of the duodenal pad of fat causes the obstruction. Early recognition prevent complications. Imaging and endoscopy is diagnostic. Aorto-mesenteric angle and SMA aorta distance is lower than 22 degree and eight millimeter respectively. If nutritional support fails, surgery is required (e.g. guodeno-jejunostomy). Studies to determine the optimal methods of diagnosis and treatment, especially in a suburban hospitals with limited expertise are essential. CASE REPORT: We retrospectively evaluated 8 cases presented over three years. Six (75%) patients were males, age ranged from 19 to 70 years and weight from 40 to 55 kg. The mean BMI was 18.7 kg/ m2 (range 16.42 to 25.11 kg/m2). Mean weight loss before diagnosis was 9.88 kg (range 6 to 12 kg). Symptoms developed between 8 to 180 days (median 12 days). Commonest presentation was epigastric pain, vomiting and nausea. Four patients had pre-morbid conditions and the syndrome was idiopathic in the other 4. Median aorto-mesentric angle was 16.5 degree and SMA-aorta distance was 5.15 mm. Four patients required operation. The rest improved on conservative treatment. CONCLUSION: Early recognition, institution of the appropriate conservative measures and timely selection of a definite surgical method are critical to prevent severe complications and death.

Ghosal hematodiaphyseal dysplasia with myelofibrosis.

Diaphyseal dysplasia with refractory anemia requiring blood transfusion is a relatively new entity having possible autosomal recessive inheritance. Prednisolone therapy alleviates the need for repeated transfusion. One such case is being reported here.

Wilkie’s syndrome: review of eight cases / Wilkie’s syndrome: review of eight cases.

BACKGROUND: The superior mesenteric artery (SMA) syndrome is a rare entity presenting with upper gastrointestinal tract obstruction and abrupt weight loss. Usually seen in tall individual with low bod mass index (BMI), the weight loss may be primary or secondary to a systemic disease or to the syndrome itself Compression of the duodenum between the abdominal aorta and the superior mesenteric artery due to loss of the duodenal pad of fat causes the obstruction. Early recognition prevent complications. Imaging and endoscopy is diagnostic. Aorto-mesenteric angle and SMA aorta distance is lower than 22 degree and eight millimeter respectively. If nutritional support fails, surgery is required (e.g. guodeno-jejunostomy). Studies to determine the optimal methods of diagnosis and treatment, especially in a suburban hospitals with limited expertise are essential. CASE REPORT: We retrospectively evaluated 8 cases presented over three years. Six (75

) patients were males, age ranged from 19 to 70 years and weight from 40 to 55 kg. The mean BMI was 18.7 kg/ m2 (range 16.42 to 25.11 kg/m2). Mean weight loss before diagnosis was 9.88 kg (range 6 to 12 kg). Symptoms developed between 8 to 180 days (median 12 days). Commonest presentation was epigastric pain, vomiting and nausea. Four patients had pre-morbid conditions and the syndrome was idiopathic in the other 4. Median aorto-mesentric angle was 16.5 degree and SMA-aorta distance was 5.15 mm. Four patients required operation. The rest improved on conservative treatment. CONCLUSION: Early recognition, institution of the appropriate conservative measures and timely selection of a definite surgical method are critical to prevent severe complications and death.

Wilkies syndrome: review of eight cases. / Wilkies syndrome: review of eight cases.

BACKGROUND: The superior mesenteric artery (SMA) syndrome is a rare entity presenting with upper gastrointestinal tract obstruction and abrupt weight loss. Usually seen in tall individual with low bod mass index (BMI), the weight loss may be primary or secondary to a systemic disease or to the syndrome itself Compression of the duodenum between the abdominal aorta and the superior mesenteric artery due to loss of the duodenal pad of fat causes the obstruction. Early recognition prevent complications. Imaging and endoscopy is diagnostic. Aorto-mesenteric angle and SMA aorta distance is lower than 22 degree and eight millimeter respectively. If nutritional support fails, surgery is required (e.g. guodeno-jejunostomy). Studies to determine the optimal methods of diagnosis and treatment, especially in a suburban hospitals with limited expertise are essential. CASE REPORT: We retrospectively evaluated 8 cases presented over three years. Six (75

) patients were males, age ranged from 19 to 70 years and weight from 40 to 55 kg. The mean BMI was 18.7 kg/ m2 (range 16.42 to 25.11 kg/m2). Mean weight loss before diagnosis was 9.88 kg (range 6 to 12 kg). Symptoms developed between 8 to 180 days (median 12 days). Commonest presentation was epigastric pain, vomiting and nausea. Four patients had pre-morbid conditions and the syndrome was idiopathic in the other 4. Median aorto-mesentric angle was 16.5 degree and SMA-aorta distance was 5.15 mm. Four patients required operation. The rest improved on conservative treatment. CONCLUSION: Early recognition, institution of the appropriate conservative measures and timely selection of a definite surgical method are critical to prevent severe complications and death.

Randomized controlled study comparing effect of magnesium sulfate with placebo on fetal umbilical artery and middle cerebral artery blood flow in mild preeclampsia at ≥ 34 weeks gestational age.

AIMS: The aim of this study was to evaluate whether prophylactic magnesium sulfate given in women with mild preeclampsia or gestational hypertension brings any significant change in umbilical artery and fetal middle cerebral artery pulsatility index. MATERIAL AND METHODS: Forty-eight women with gestational age greater than 34 weeks with mild preeclampsia or gestational hypertension were randomly assigned to receive either magnesium sulfate or placebo. Pre- and post-magnesium sulfate pulsatility index of umbilical and fetal middle cerebral artery were compared by Mann-Whitney U-test between the groups. Within-group comparison was conducted using Wilcoxon's signed rank test. RESULTS: There was a significant reduction in the post-magnesium sulfate umbilical artery pulsatility index in the intervention group (median 0.88 [0.82-1.03]) when compared to the placebo group (median 1.00 [0.89-1.10]). Post-magnesium sulfate fetal middle cerebral artery pulsatility index in the intervention group (median 1.78 [1.63-1.98]) did not show a significant change compared to the placebo group (median 1.65 [1.42-1.91]). Within-group comparison showed change in both variables after treatment in the intervention group. CONCLUSION: Magnesium sulfate produces a significant decrease in fetal umbilical artery and middle cerebral artery pulsatility index.

Status of carotid intima-media thickness and associated risk factors in diabetic, prediabetic and non-diabetic acute stroke.

OBJECTIVE: Measure carotid intima-medial thickness (CIMT), its variability, risk factors, their correlation, in type 2 diabetic (DM), pre-diabetic (PDM) and non-diabetic (NDM) acute strokes. METHODS: Twenty four DM and a matched population of 14 patients each of PDM and NDM strokes were studied. Each group was compared as whole and by gender and stroke segregation. Study parameters were right and left CIMTs (CIMTR, CIMTL), insulin resistance (IR), age, BMI and lipids, correlations between CIMTs and CIMTs with risk markers. RESULTS: CIMTR was higher in DM and PDM compared to NDM, but CIMTLs did not differ. CIMTs were similar in genders and stroke types of each group. The IR was significantly high only in DM. Age and BMI correlations were predominantly positive and lipids variable except in PDM. Age and IR had better impacts on CIMTs in DM while BMI was poor. Females and infarcts had a more congruous CIMT increment in DM and PDM but male and haemorrhage in NDM. CONCLUSION: With similar levels of risk markers, their impacts on the CIMTs are highly variable at various levels of glycaemia. CIMTs were similar in the genders and stroke types of each group, irrespective of the glycemic status. The pre-diabetes group had distinct features.