BACKGROUND Superior mesenteric artery(SMA)syndrome is a rare cause of duodenal obstruction by extrinsic compression between the SMA and the aorta(SMA-Ao).Although the left lateral recumbent position is considered effe...BACKGROUND Superior mesenteric artery(SMA)syndrome is a rare cause of duodenal obstruction by extrinsic compression between the SMA and the aorta(SMA-Ao).Although the left lateral recumbent position is considered effective in the treatment of SMA syndrome,individual variations in the optimal patient position have been noted.In this report,we present two elderly cases of SMA syndrome that exhibited rapid recovery due to ultrasonographic dynamic evaluation of the optimal position for each patient.CASE SUMMARY Case 1:A 90-year-old man with nausea and vomiting.Following diagnosis of SMA syndrome by computed tomography(CT),ultrasonography(US)revealed the SMA-Ao distance in the supine position(4 mm),which slightly improved in the lateral position(5.7–7.0 mm)without the passage of duodenal contents.However,in the sitting position,the SMA-Ao distance was increased to 15 mm accompanied by improved content passage.Additionally,US indicated enhanced passage upon abdominal massage on the right side.By day 2,the patient could eat comfortably with the optimal position and massage.Case 2:An 87-year-old woman with vomiting.After the diagnosis of SMA syndrome and aspiration pneumonia by CT,dynamic US confirmed the optimal position(SMA-Ao distance was improved to 7 mm in forward-bent position,whereas it remained at 5 mm in the supine position).By day 7 when her pneumonia recovered,she could eat with the optimal position.CONCLUSION The optimal position for SMA syndrome varies among individuals.Dynamic US appears to be a valuable tool in improving patient outcomes.展开更多
Superior mesenteric artery(SMA)syndrome(also known as Wilkie's syndrome,cast syndrome,or aorto-mesenteric compass syndrome)is an obstruction of the duodenum caused by extrinsic compression between the SMA and the ...Superior mesenteric artery(SMA)syndrome(also known as Wilkie's syndrome,cast syndrome,or aorto-mesenteric compass syndrome)is an obstruction of the duodenum caused by extrinsic compression between the SMA and the aorta.The median age of patients is 23 years old(range 0-91 years old)and predominant in females over males with a ratio of 3:2.The symptoms are variable,consisting of postprandial abdominal pain,nausea and vomiting,early satiety,anorexia,and weight loss and can mimic anorexia nervosa or functional dyspepsia.Because recurrent vomiting leads to aspiration pneumonia or respiratory depression via metabolic alkalosis,early diagnosis is required.The useful diagnostic modalities are computed tomography as a standard tool and ultrasonography,which has advantages in safety and capability of real-time assessments of SMA mobility and duodenum passage.The initial treatment is usually conservative,including postural change,gastroduodenal decompression,and nutrient management(success rates:70%-80%).If conservative therapy fails,surgical treatment(i.e.,laparoscopic duodenojejunostomy)is recommended(success rates:80%-100%).展开更多
Introduction: With the arrival of the 21st century, drastic worldwide changes to natural, economic and social events have occurred. These include the Great East Japan Earthquake, and the global financial crisis. Furth...Introduction: With the arrival of the 21st century, drastic worldwide changes to natural, economic and social events have occurred. These include the Great East Japan Earthquake, and the global financial crisis. Furthermore, Japan experienced the introduction of a specific education system. In this study, we traced and compared the psychological characters of university freshmen for 16 years (years 2000-2016) using Big-Five personalities inventory (Japanese version). Methods: A total of 1189 physically and mentally healthy university freshmen participated in this study. They were divided into four groups according to the year they entered university. They completed a self-filled questionnaire, Big-Five personalities inventory, which consists of Extraversion, Agreeableness, Neuroticism, Conscientiousness and Openness. Result and Discussion: Compared with the year 2008, Extraversion nominally increased in 2012, however, it statistically significantly decreased in 2016. Agreeableness notably decreased from 2000 to 2008, then showed an increase in 2012. Compared to 2000, Neuroticism was statistically significantly lower in 2008 and 2016. Such statistically significant differences were not observed in the other two personalities. The personalities of university freshmen have changed in the last 16 years, which may be been caused by drastic changes. However, further research (e.g., larger-scale studies or studies including other university students) is required to support the current findings.展开更多
文摘BACKGROUND Superior mesenteric artery(SMA)syndrome is a rare cause of duodenal obstruction by extrinsic compression between the SMA and the aorta(SMA-Ao).Although the left lateral recumbent position is considered effective in the treatment of SMA syndrome,individual variations in the optimal patient position have been noted.In this report,we present two elderly cases of SMA syndrome that exhibited rapid recovery due to ultrasonographic dynamic evaluation of the optimal position for each patient.CASE SUMMARY Case 1:A 90-year-old man with nausea and vomiting.Following diagnosis of SMA syndrome by computed tomography(CT),ultrasonography(US)revealed the SMA-Ao distance in the supine position(4 mm),which slightly improved in the lateral position(5.7–7.0 mm)without the passage of duodenal contents.However,in the sitting position,the SMA-Ao distance was increased to 15 mm accompanied by improved content passage.Additionally,US indicated enhanced passage upon abdominal massage on the right side.By day 2,the patient could eat comfortably with the optimal position and massage.Case 2:An 87-year-old woman with vomiting.After the diagnosis of SMA syndrome and aspiration pneumonia by CT,dynamic US confirmed the optimal position(SMA-Ao distance was improved to 7 mm in forward-bent position,whereas it remained at 5 mm in the supine position).By day 7 when her pneumonia recovered,she could eat with the optimal position.CONCLUSION The optimal position for SMA syndrome varies among individuals.Dynamic US appears to be a valuable tool in improving patient outcomes.
文摘Superior mesenteric artery(SMA)syndrome(also known as Wilkie's syndrome,cast syndrome,or aorto-mesenteric compass syndrome)is an obstruction of the duodenum caused by extrinsic compression between the SMA and the aorta.The median age of patients is 23 years old(range 0-91 years old)and predominant in females over males with a ratio of 3:2.The symptoms are variable,consisting of postprandial abdominal pain,nausea and vomiting,early satiety,anorexia,and weight loss and can mimic anorexia nervosa or functional dyspepsia.Because recurrent vomiting leads to aspiration pneumonia or respiratory depression via metabolic alkalosis,early diagnosis is required.The useful diagnostic modalities are computed tomography as a standard tool and ultrasonography,which has advantages in safety and capability of real-time assessments of SMA mobility and duodenum passage.The initial treatment is usually conservative,including postural change,gastroduodenal decompression,and nutrient management(success rates:70%-80%).If conservative therapy fails,surgical treatment(i.e.,laparoscopic duodenojejunostomy)is recommended(success rates:80%-100%).
文摘Introduction: With the arrival of the 21st century, drastic worldwide changes to natural, economic and social events have occurred. These include the Great East Japan Earthquake, and the global financial crisis. Furthermore, Japan experienced the introduction of a specific education system. In this study, we traced and compared the psychological characters of university freshmen for 16 years (years 2000-2016) using Big-Five personalities inventory (Japanese version). Methods: A total of 1189 physically and mentally healthy university freshmen participated in this study. They were divided into four groups according to the year they entered university. They completed a self-filled questionnaire, Big-Five personalities inventory, which consists of Extraversion, Agreeableness, Neuroticism, Conscientiousness and Openness. Result and Discussion: Compared with the year 2008, Extraversion nominally increased in 2012, however, it statistically significantly decreased in 2016. Agreeableness notably decreased from 2000 to 2008, then showed an increase in 2012. Compared to 2000, Neuroticism was statistically significantly lower in 2008 and 2016. Such statistically significant differences were not observed in the other two personalities. The personalities of university freshmen have changed in the last 16 years, which may be been caused by drastic changes. However, further research (e.g., larger-scale studies or studies including other university students) is required to support the current findings.
