Isolated Superior Mesenteric Artery Dissection Mimicking Impending Rupture of Abdominal Aortic Aneurysm.

BACKGROUND Isolated superior mesenteric artery dissection (SMAD) is a rare vascular disease that is difficult to diagnose. We report a case of SMAD in a patient with an abdominal aortic aneurysm (AAA) that mimicked an impending rupture of the AAA. In addition, we describe several clinical biases that contributed to the delayed diagnosis. CASE REPORT A 66-year-old man presented with a 3-day history of abdominal pain, without a history of trauma, that worsened gradually and caused him to visit our hospital. The patient's medical history included an AAA under observation. The patient was well oriented and initially remained hemodynamically stable, and the abdomen was soft and non-tender on palpation. An emergency contrast-enhanced computed tomography (CT) scan confirmed a 44-mm AAA without any leakage, but with an isolated SMAD. His previous physician confirmed there was no change in the AAA size since 3 months prior to hospital admission. Thus, the symptoms were caused by the isolated SMAD. The patient showed improvement with pain-relieving and antihypertensive management, without anticoagulation therapy or revascularization, and was discharged on day 25 of admission without any complications. CONCLUSIONS The misdiagnosis in this case was attributable to several clinical biases, including search satisfaction, Sutton's slip, and anchoring bias. Physicians should guard against presumptive diagnoses based on patient symptoms or initial plausible findings and instead pursue a thorough workup to reach a definitive diagnosis.

Metastatic spinal cord compression by gastric cancer: a case report.

Metastatic spinal cord compression (MSCC) is one of the serious complications of malignancy. Most cases of MSCC occur from breast or prostate cancer primaries; MSCC secondary to gastric cancer is rare. We herein report a case of a patient with gastric cancer with weakness of the lower limbs and urinary retention on initial presentation. This case demonstrates that although rare, bone metastases and MSCC may occur from gastric primaries. It also highlights the importance of prompt diagnosis and early treatment of MSCC.

Effects of 5'-uridylic acid feeding on postprandial plasma concentrations of metabolites and metabolic hormones in pre-weaning goats.

5'-Uridylic acid (UMP), which is present at high concentrations in cow's colostrum, has been shown to cause a reduction in increased plasma levels of insulin and glucose after ingestion of milk replacer in pre-weaning calves. However, the precise mechanisms of UMP action have not been investigated, and its action has not been investigated in other pre-weaning ruminants. In order to demonstrate whether UMP causes changes in postprandial metabolic and hormonal parameters in pre-weaning goats, 11 Saanen kids were given milk replacer (twice a day) without (n = 5) or with (n = 6) UMP (1 g for each meal, 2 g/day for each head) for 14 days. Analysis of blood samples taken in the morning of day 14 demonstrated that the feeding of milk replacer with UMP abolished the significant changes in postprandial plasma glucose, NEFA, GH and insulin concentrations induced by feeding of milk replacer alone, and demonstrated a tendency to increase IGF-I levels. However, there was no significant difference between the two groups at any sampling time. We conclude that UMP feeding with milk replacer showed a tendency to blunt the postprandial changes in levels of some plasma metabolites and hormones that are induced by replacer alone in pre-weaning goats.