BACKGROUND Superior mesenteric artery syndrome is a disease with a complex diagnosis,and it is associated with complications that make it even harder to identify.Currently,a frequent association with psychiatric disor...BACKGROUND Superior mesenteric artery syndrome is a disease with a complex diagnosis,and it is associated with complications that make it even harder to identify.Currently,a frequent association with psychiatric disorders has been noted.Despite numerous case reports and case series,the variability of the disease has not allowed the development of protocols regarding diagnosis and management.CASE SUMMARY A 33-year-old woman presented with abdominal pain,nausea,and bile vomiting over the last 15 mo,associated with a 15-kg weight loss over the last three months.After the onset of the symptoms,the patient was diagnosed with anxietydepressive disorder and treated appropriately.Standard examinations excluded an organic cause,and the cause of the symptoms was considered psychogenic.The persistence of symptoms,even under treatment,prompted a computer tomography angiography examination of the abdomen and pelvis.The examination identified emergence at a sharp angle of 13.7°of the superior mesenteric artery,with a reduced distance between the artery and the anterior wall of the aorta up to a maximum of 8 mm.A diagnosis of aortomesenteric clamp was established.Surgical treatment by laparoscopic duodenojejunostomy was performed.Postoperative evolution was marked by a patent anastomosis at 1 mo,with a 10-kg weight gain and improvement of the associated anxiety.CONCLUSION This case report underlines two major aspects.One aspect refers to the predisposition of patients with superior mesenteric artery syndrome to develop psychiatric disorders,with an excellent outcome when proper treatment is administered.The second aspect underlines the key role of a multidisciplinary approach and follow-up.展开更多
Hepatitis C virus （HCV） is a global health problem affecting 3% of the world＇s population （about 180 million） and a cause of both hepatic and extrahepatic diseases. B-cell lymphoproUferative disorders, whose prot...Hepatitis C virus （HCV） is a global health problem affecting 3% of the world＇s population （about 180 million） and a cause of both hepatic and extrahepatic diseases. B-cell lymphoproUferative disorders, whose prototype is mixed cryoglobulinemia, represent the most closely related as well as the most investigated HCV- related extrahepatic disorder. The association between extrahepatic （lymphoma） as well as hepatic malignancies （hepatocellular carcinoma） has justified the inclusion of HCV among human cancer viruses. HCV-associated manifestations also include porphyria cutanea tarda, lichen planus, nephropathies, thyreopathies, sicca syndrome, idiopathic pulmonary fibrosis, diabetes, chronic polyarthritis, sexual dysfunctions, cardiopathy/ atherosclerosis, and psychopathological disorders. A pathogenetic link between HCV virus and some lymphoproliferative disorders was confirmed by their responsiveness to antiviral therapy, which is now considered the first choice treatment. The aim of the present paper is to provide an overview of extrahepatic manifestations of HCV infection with particular attention to B-cell lymphoproliferative disorders. Available pathogenetic hypotheses and suggestions about the most appropriate, currently available, therapeutic approaches will also be discussed.展开更多
AIMTo investigate the prevalence and the risk of temporomandibular disorders (TMDs) in patients with irritable bowel syndrome (IBS) (including each subtype: constipation, diarrhoea, and mixed) compared to the general ...AIMTo investigate the prevalence and the risk of temporomandibular disorders (TMDs) in patients with irritable bowel syndrome (IBS) (including each subtype: constipation, diarrhoea, and mixed) compared to the general population.METHODSBetween January 2014 and December 2015 we enrolled consecutively adult patients diagnosed with IBS at the outpatient clinic of the University of Salerno and healthy controls (HC) without IBS. At enrollment, we analyzed all patients for the presence of TMDs according to the Research Diagnostic Criteria for TMD.RESULTSWe enrolled 91 IBS patients (23 IBS-D, 30 IBS-C and 38 IBS-M) and 57 HC in the study. We found a higher risk of having TMD (OR = 3.41, 95%CI: 1.66-7.01) compared to the HC. The risk of having TMD was independent of IBS-subtype. Multiple regression analysis showed that facial pain was positively related to abdominal pain and higher level of depression.CONCLUSIONIBS patients had a more than three times greater risk of TMD compared to HC. The risk of having TMD was similar in different IBS subtypes. IBS patients that also fulfilled criteria for TMD seem to share along with chronic facial and abdominal pain a significant co-occurrence with psychiatric disorders and female preponderance.展开更多
文摘BACKGROUND Superior mesenteric artery syndrome is a disease with a complex diagnosis,and it is associated with complications that make it even harder to identify.Currently,a frequent association with psychiatric disorders has been noted.Despite numerous case reports and case series,the variability of the disease has not allowed the development of protocols regarding diagnosis and management.CASE SUMMARY A 33-year-old woman presented with abdominal pain,nausea,and bile vomiting over the last 15 mo,associated with a 15-kg weight loss over the last three months.After the onset of the symptoms,the patient was diagnosed with anxietydepressive disorder and treated appropriately.Standard examinations excluded an organic cause,and the cause of the symptoms was considered psychogenic.The persistence of symptoms,even under treatment,prompted a computer tomography angiography examination of the abdomen and pelvis.The examination identified emergence at a sharp angle of 13.7°of the superior mesenteric artery,with a reduced distance between the artery and the anterior wall of the aorta up to a maximum of 8 mm.A diagnosis of aortomesenteric clamp was established.Surgical treatment by laparoscopic duodenojejunostomy was performed.Postoperative evolution was marked by a patent anastomosis at 1 mo,with a 10-kg weight gain and improvement of the associated anxiety.CONCLUSION This case report underlines two major aspects.One aspect refers to the predisposition of patients with superior mesenteric artery syndrome to develop psychiatric disorders,with an excellent outcome when proper treatment is administered.The second aspect underlines the key role of a multidisciplinary approach and follow-up.
文摘Hepatitis C virus （HCV） is a global health problem affecting 3% of the world＇s population （about 180 million） and a cause of both hepatic and extrahepatic diseases. B-cell lymphoproUferative disorders, whose prototype is mixed cryoglobulinemia, represent the most closely related as well as the most investigated HCV- related extrahepatic disorder. The association between extrahepatic （lymphoma） as well as hepatic malignancies （hepatocellular carcinoma） has justified the inclusion of HCV among human cancer viruses. HCV-associated manifestations also include porphyria cutanea tarda, lichen planus, nephropathies, thyreopathies, sicca syndrome, idiopathic pulmonary fibrosis, diabetes, chronic polyarthritis, sexual dysfunctions, cardiopathy/ atherosclerosis, and psychopathological disorders. A pathogenetic link between HCV virus and some lymphoproliferative disorders was confirmed by their responsiveness to antiviral therapy, which is now considered the first choice treatment. The aim of the present paper is to provide an overview of extrahepatic manifestations of HCV infection with particular attention to B-cell lymphoproliferative disorders. Available pathogenetic hypotheses and suggestions about the most appropriate, currently available, therapeutic approaches will also be discussed.
文摘AIMTo investigate the prevalence and the risk of temporomandibular disorders (TMDs) in patients with irritable bowel syndrome (IBS) (including each subtype: constipation, diarrhoea, and mixed) compared to the general population.METHODSBetween January 2014 and December 2015 we enrolled consecutively adult patients diagnosed with IBS at the outpatient clinic of the University of Salerno and healthy controls (HC) without IBS. At enrollment, we analyzed all patients for the presence of TMDs according to the Research Diagnostic Criteria for TMD.RESULTSWe enrolled 91 IBS patients (23 IBS-D, 30 IBS-C and 38 IBS-M) and 57 HC in the study. We found a higher risk of having TMD (OR = 3.41, 95%CI: 1.66-7.01) compared to the HC. The risk of having TMD was independent of IBS-subtype. Multiple regression analysis showed that facial pain was positively related to abdominal pain and higher level of depression.CONCLUSIONIBS patients had a more than three times greater risk of TMD compared to HC. The risk of having TMD was similar in different IBS subtypes. IBS patients that also fulfilled criteria for TMD seem to share along with chronic facial and abdominal pain a significant co-occurrence with psychiatric disorders and female preponderance.
