The effect of metoclopramide on gastric emptying in traumatic brain injury.

OBJECTIVE: Gastric paresis in traumatic brain injury (TBI) hinders the effectiveness of enteral support in this patient group. In this study we have investigated the effect of metoclopramide on gastric emptying in TBI patients. METHOD: In this prospective, randomized, controlled, double-blind study, 19 TBI patients with Glasgow Coma Scale scores of 3-11 were included. In all patients, enteral nutrition was commenced with a nasogastric feeding tube within 48 hours of trauma. Patients were randomized into two groups. In the metoclopramide (M) group, 10 mg metoclopramide was delivered intravenously three times daily for 5 days. In the control (C) group, an equal volume of saline was administered. Besides demographics, gastric emptying according to a paracetamol absorption test at days 0 and 5, time to reach target nutritional requirements, gastric residues, intolerance to feeding, nutritional complications, and clinical outcomes were recorded for each patient. RESULTS: The gastric residue rates were 2.7+/-7.4 mL and 8.1+/-17.7 mL per 100 patient days for groups C and M respectively (p=0.408). Similarly, feeding intolerance and complication rates did not significantly differ between groups C and M, (respectively p=0.543 and 0.930). Gastric emptying parameters also were similar between the study groups. CONCLUSION: We were unable to document any advantage to using metoclopramide in TBI patients. Simple intragastric enteral feeding with close monitoring of the possible complications seems to be sufficient with acceptable morbidity rates.     

Schwannoma of the lateral ventricle: eight-year follow-up and literature review.

Intracerebral and intramedullary schwannomas are uncommon; but, in general, spinal intramedullary schwannomas are more frequent than intracerebral schwanomas. We present a case of right lateral ventricle schwannoma in a 21-year-old man and review the associated literature. The 21-year-old right-handed man presented with loss of the left-eye vision approximately 8 months before referral to an ophthalmologist. The patient was immediately subjected to computed tomography (CT) scan, which showed an enhanced lesion with cystic component in the right occipital horn of the lateral ventricle. And consecutively, he was admitted to our department. The tumor was evacuated via craniotomy with marked improvement in his clinical state. The postoperative course was uneventful and postoperative CT control showed no residue. On MRI control no recurrence was noted after a follow-up period of 8 years. Intracerebral schwannoma is a rare, benign neoplasm. It is usually located superficially or adjacent to a ventricle. Characteristic imaging features include cyst formation, calcification, and evidence of peritumoral edema or gliosis. The recognition of this benign and potentially curable neoplasm and its differentiation from other neoplasms, some of which have less favourable outcomes, is of obvious importance.     

Effect of age, breast size, menopausal and hormonal status on mammographic skin thickness

Background/purpose: The localized or generalized skin thickness detected on mammography may reflect an underlying pathology of breast or a systemic disease involving the skin. The aim of this report is to describe the range of normal breast skin thickness in women using a film-screen mammographic technique.
Methods: Measurement of the mammographic skin thickness over different parts of the breast was performed in 144 women who had normal findings in a combined mammographic and ultrasonographic examination. Patients were grouped as premenopause, postmenopause and surgical menopause who were under continuous oestrogen treatment. The skin thickness in four regions (superior, inferior, medial, lateral) of both breasts was compared, and their relations with age, breast size, menopausal and hormonal status were investigated. The interobserver reliability was tested in a small subgroup of patients.
Results: Interobserver agreement was good for all measurements. The range of normal breast skin thickness was between 0.50 and 3.10 mm. There were no differences in skin thickness between the corresponding regions of the breasts, with significant differences between the regions in the same breast. While breast size increased with age, skin thickness decreased in all regions.
Conclusion: The breast size, age, regional variations and hormonal status of the patients should be considered when defining the normal range of skin thickness in mammographic examinations. We assume that upper limit of mammographic skin thickness should be set as 3.0 mm, regardless of the focal spot size and film-focus distance.     

The rupture through posterior vaginal fornix of the posterior lower uterine segment.

Uterine rupture during labor, when it is in the immediate vicinity of the cervix, frequently extends transversely or obliquely. Usually the tear is longitudinal when it occurs in the portion of the uterus adjacent to the broad ligament. We report an unusual case of uterine rupture through posterior vaginal fornix of the posterior lower uterine segment.     

Sneddon's syndrome: clinical and laboratory analysis of 10 cases

Sneddon's syndrome is characterized by livedo reticularis and cerebrovascular lesions. We report the cases of women (mean age, 36.2 +/- 8.1 years) diagnosed with Sneddon's syndrome based on the presence of livedo reticularis and characteristic cerebrovascular findings. Seven of these patients had cerebral infarcts on cranial computed tomography scan. Antiphospholipid antibodies were positive in 6 of these cases. Three cases had abnormal levels of antithrombin III. Analyses of chromosome 6 revealed no abnormalities. In 3 of the cases, investigation of the pedigrees revealed autosomal dominant traits. Two cases had epilepsy, and 3 had migraine. One case with migraine also had myasthenia gravis. In addition, we detected inferior altudinal hemianopia in 2 cases, cognitive functional disorder in 3 and depression in 2. Based on these findings, the entire vascular, haematologic, neurologic, and dermatologic systems should be evaluated in patients diagnosed with Sneddon's syndrome.     

Hereditary pancreatitis: Report of a family from Turkey

Chronic pancreatitis is a rare disease in children and is usually secondary to underlying diseases such as hereditary pancreatitis, cystic fibrosis, hyperlipidemia, prolonged malnutrition, gallstones or anomalies of the biliary-pancreatic duct system. Hereditary pancreatitis is a common cause of chronic pancreatitis in children but is often unrecognized until months or years later. We report here a family with hereditary pancreatitis in which four members are affected.