Wereport two identical male twins whosuffered from superior mesenteric artery (SMA) syndrome. A 28-yearold manwas admitted for investigation of postprandial nausea and vomiting. Upper gastrointestinal examination revealed a dilated proximal duodenumwith an abrupt vertical cutoff of barium flow in the third portion of the duodenum, establishing the diagnosis of SMAsyndrome. One year later, his twin brother also presented similar symptomsand was radiologically diagnosed as SMAsyndrome. The twin brothers did not respond adequately to conservative therapy and underwent duodenojejunostomy. This is the first report of SMAsyndrome in identical twins. (Internal Medicine 40: 713-715, 2001)
The Wallstent is effective for long-term palliation in patients with obstruction caused by pancreatic cancer invading the middle to lower part of the common bile duct. The covered Wallstent can prevent tumor ingrowth, a problem with the uncovered Wallstent. However, it may be necessary to take measures to prevent the migration or clogging of covered Wallstents.
Abstract.A 77-year-old man was diagnosed as having hypothyroidism. An electrocardiogram obtained at the time of the first examination revealed Brugada electrocardiographic waveforms in leads V1 to V3. When pilsicainide hydrochloride loading changed the waveforms of the electrocardiographic ST segment, this result suggested an abnormality of the cardiac muscle sodium channels. The Brugada electrocardiographic waveforms disappeared with the normalization of thyroid function. This case is the first report ever of hypothyroidism that presented Brugada electrocardiographic waveforms. The results obtained in this case suggested that thyroid functions changed the waveforms of the electrocardiogram because of its effect on myocardial ion channels. WE experienced a case of hypothyroidism with Brugada electrocardiographic waveforms (Brugada-ECG) that normalized with the improvement of thyroid function. No case report of hypothyroidism with Brugada-ECG has been published so far. We report this case showing the effect of thyroid functions on Brugada-ECG in this paper.
Case presentationA 77-year-old man visited his local doctor because of diabetes mellitus, diabetic neuropathy, and hyperlipidemia. He had been taking 40 mg of gliclazide, 1.5 mg of mecobalamin, and 5 mg of atorvastatin calcium hydrate each day. He was referred to our clinic for examinations concerning liver dysfunction in August 2005. He underwent total gastrectomy in 1999, and had no history of syncopal attack. His family had no history of diabetes mellitus, thyroid disorder, or arrhythmia. His grandmother suddenly died at 80 years of age, but the reasons were not clear.Physical findings at the first examination were height of 160 cm and body weight of 54 kg, with a body mass index of 21.1 kg/m 2 . Blood pressure was 138/61 mmHg, and pulse rate was 61 per min. with regular rhythm. His skin was not icteric, and the thyroid gland was not goitrous. His voice was deep. Edema was observed in both legs. No thoracicoabdominal or neurological abnormality was observed.Laboratory findings are shown in Table 1. Serum aspartate aminotransferase, alanine aminotransferase, lactate dehydrogenase, and creatine kinase (CK) levels were high. We considered thyroid dysfunction because of his deep voice and edema. Serum thyrotropin and free thyroxine were markedly high and low, respectively.
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