Endoscopic features for early decision to evaluate superior mesenteric artery syndrome in children

Background Diagnostic delay of superior mesenteric artery syndrome (SMAS) is common due to its rarity and lack of index of clinical suspicion. Early diagnosis under suspicion is pivotal for adequate treatment. Present study aims to explore the endoscopic features for early decision to evaluate SMAS in children. Methods In case controlled observation study, the recruitment was limited to patients who had endoscopic finding I or finding 1 plus more as follows: a pulsating vertical or oblique band or slit like luminal narrowing of the third part of the duodenum without no expansion over one third during air insufflation for at least 15 s (finding I), a marked dilation of the duodenal first and second part during air insufflation at the third part of the duodenum (finding II), a bile mixed fluid collection (bile lake) in the stomach (finding III). SMAS was confirmed with UGI series or hypotonic duodenography in enrolled patients. We analyzed positive endoscopic findings related with SMAS. Results The enrolled 29 patients consisted of 18 (62.1%) with SMAS and 11 (37.9%) without SMAS. The three most common presenting symptoms were abdominal pain, postprandial discomfort, and early satiety. The clinical impressions based on history and physical examination before endoscopy were functional dyspepsia (34.6%), gastritis or gastric ulcer (31.0%), and SMAS (17.3%). The constellation of three endoscopic findings (finding I + II + III, feature D) observed in 13 (72.2%) patients of SMAS group and 3 (27.3%) patients of non SMAS group (P = 0.027). Of 16 patients with features D, SMAS was diagnosed in 13 patients (81.2%) and not detected in 3 patients (18.8%) on UGI series or hypotonic duodenography. Conclusions Endoscopic examination to the third part of the duodenum can provide a clue making a decision to evaluate SMAS, which consists of features of three endoscopic findings as follows: a pulsating vertical or oblique band or slit like luminal narrowing of the third part of the duodenum without no expansion over one third during air insufflation for at least 15 s, a marked dilation of the first and second part of the duodenum, and a bile lake in the stomach.

Endoscopic features for early detection of superior mesenteric artery syndrome in children

Background Superior mesenteric artery syndrome (SMA) syndrome is a rare cause of duodenal obstruction. Diagnostic delay of SMA syndrome is common due to its rarity and lack of index of clinical suspicion. Present study aims to explore the endoscopic features for early decision to evaluate SMA syndrome in children. Methods In case controlled observation study, we identified three endoscopic findings in enrolled cases like as, finding I: a pulsating band like luminal narrowing of the third part of the duodenum without no expansion over one third during air insufflation for at least 15 seconds, finding II: marked dilatation of the duodenal second part during air insufflation at the duodenal third part, and finding III: bile lake in the stomach. SMA syndrome was confirmed with upper GI series in patients with endoscopic finding I or I plus more. We analyzed positive endoscopic findings related with SMA syndrome. Results Twenty-nine patients consisted of 18 (62.1%) cases with SMA syndrome and 11 (37.9%) cases without SMA syndrome. The 3 most common presenting symptoms were postprandial discomfort, abdominal pain, and early satiety. The initial impressions before endoscopy were functional dyspepsia (37.9%), gastritis or gastric ulcer (31.0%), and SMA syndrome (24.1%). Sixteen patients (55.2%) had the constellation of three endoscopic findings (finding I + II + III). Of them, 72.2% confirmed with SMA syndrome, and 27.3% had no SMA syndrome in upper GI series (P = 0.027). Conclusions Endoscopic examination down to the third part of duodenum can provide a clue making a decision to evaluate SMA syndrome, which includes a feature composed of three findings like as a pulsating band like luminal narrowing of duodenal third part, a marked expansion of duodenal second part, and a bile lake in the stomach.

Microalgae of Protected Lakes of Northwestern Ukraine

The paper reports the first comprehensive study of microalgal species composition in four lakes of Volhynian Polissya (northwestern Ukraine), in which 271 species (279 intraspecific taxa) of 11 microalgal phyla were identified. Four dominant phytoplankton assemblages were determined for each lake. Bacillariophyta and Charophyta formed more than half (59.2%) of the taxonomic list, accounting for 94 and 66 species respectively. Desmidiaceae was the most diverse family, with 44 species (47 intraspecific taxa) of microalgae. The four lakes are highly dissimilar in species richness and composition, having only 8 (2.9%) species in common. Lake Cheremske had the highest number of algal species – 137 (144). Lake Bile, Lake Somyne and Lake Redychi were much less diverse, with 105, 79 (80) and 75 (78) species respectively. Morphological descriptions, original micrographies and figures are presented for a number of species, including some not previously documented in Ukraine: Chromulina cf. verrucosa G. A. Klebs, Eunotia myrmica Lange-Bert. and E. tetraodon Ehrenb. The lakes, which are almost pristine or are recovering, maintain diverse and valuable algal floras, making them important sites in the Pan-European ecological network.