Condition In Young Adults Research Articles

Small Intestinal Diverticulosis (SID)

Small intestinal diverticulosis (SID) refers to the clinical entity characterized by the presence of multiple saclike mucosal herniations through weak points in the intestinal wall. Small intestinal diverticula are far less common than colonic diverticula. The cause of this condition is not known. It is believed to develop as the result of abnormalities in peristalsis, intestinal dyskinesis, and high segmental intraluminal pressures. CASE REPORT A 82-year-old women presented with a history of chronic abdominal discomfort and dyspepsia. She was diagnosed as having malabsorption syndrome and was treated with broadspectrum enteral antibiotics. She had a symptom free period. Contrast examination was carried out (Figures 1 and 2). Figure 1 Figure 1: Barium meal follow through shows out pouching of the bowel wall – diverticuli in the jejunal loops (supine film). Figure 2 Figure 2: Another film from the series (erect film) clearly demonstrates the diverticuli. QUESTIONS What is this examination and how is it done? 1. What is the diagnosis? 2. What are the complications? 3. How do you treat this condition? 4. ANSWERS This is a barium meal follow through examination 1. where diluted barium contrast is given to the patient to drink (300 ml) and as it passess through the stomach and duodenum in to the small bowel Small Intestinal Diverticulosis (SID) 2 of 3 (jejunum and Ileum) series of films are taken. This examination is mainly intended for the visualisation of small bowel. The diagnosis is jejunal diverticulosis. 2. Complications – see below in discussion. 3. Treatment – see below in discussion. 4. DISCUSSION The incidence of small bowel diverticulosis is difficult to ascertain for several reasons. It is likely that many clinicians do not document the presence of these lesions simply because little clinical significance has been attributed to them. Their importance is based on the fact that they carry the risk of serious complications such as infection, hemorrhage or intestinal obstruction The predominance of small bowel diverticula in the jejunum is attributed to the greater diameter of the penetrating jejunal arteries [8]. The jejunal diverticula emerge on the mesenteric border, i.e., sites where mesenteric vessels penetrate the small bowel. Diverticula are classified as true and false. True diverticula are composed of all layers of the intestinal wall, whereas false diverticula are formed from the herniation of the mucosal and submucosal layers. Meckel’s diverticulum is a true diverticulum. Diverticula can also be classified as intraluminal or extraluminal. Intraluminal diverticula and Meckel’s diverticulum are congenital. Extraluminal diverticula may be found in various anatomic locations and are referred to as duodenal, jejunal, ileal, or jejunoileal diverticula. With the exception of Meckel diverticulum, small bowel diverticula are generally benign, seldom creating serious complications. Major complications include diverticulitis, GI hemorrhage, intestinal obstruction, acute perforation, and pancreatic and/or biliary disease in duodenal diverticula. Mortality is influenced by patients' age, nature of complications, and timeliness of intervention. No racial predilection exists. A slight male preponderance exists in jejunoileal diverticula. Jejunoileal diverticula are commonly observed in patients aged 60-70 years. Reports of this condition in young adults exist as well. Their importance is based on the fact that they carry the risk of serious complications. Complications occur in 15% of SBD cases. The specific diagnosis of SID is possible by radiologic contrast studies using various forms of barium. The radiologic technique of enteroclysis is specific for the jejunum and the ileum. Lesions bleeding at the time of investigation can be identified either by a 99m Tc-bleeding scan, or by arteriography if blood loss is greater than 1±2 l/minute. TREATMENT Asymptomatic no treatment Small bowel diverticula do not require surgical treatment unless refractory symptoms or complications occur. Surgical management is recommended for complications of SBD. When complications of jejunal diverticula occur, partial enterectomy and primary anastomosis should be performed . It is reasonable to conclude that asymptomatic diverticula incidentally discovered on routine contrast studies or at laparotomy do not need resection.

Hyperhomocysteinemia and other inherited prothrombotic conditions in young adults with a history of ischemic stroke.

The mechanisms of ischemic stroke in young adults are poorly understood. During the last years, several studies suggested a role for genetic factors predisposing to thrombophilia and for moderate hyperhomocysteinemia in this setting. We evaluated in 132 consecutive patients (66 males, 66 females; mean+/-SD age, 38.4+/-11.7 years; mean+/-SD age at first event, 34.8+/-10.9 years; range, 6 months to 50 years) referred to our center between January 1997 and December 1999 for a history of young adult ischemic stroke (age at first event, <51 years) the prevalence of factor V (FV) Leiden, prothrombin (FII) G20210A, and C677T and 5,10-methylenetetrahydrofolate reductase (MTHFR) gene mutations and fasting serum total homocysteine levels. Two hundred sixty-two apparently healthy subjects (117 males, 145 females; mean+/-SD age, 36+/-13.2 years) served as controls. Total homocysteine levels differed significantly (P=0.004, t test) between patients and controls: 13.03+/-18.61 versus 10.75+/-6.24 micromol/L (mean+/-SD), respectively. In contrast, homozygosity for the TT mutation of the MTHFR gene was 30 of 132 (22.7%) in patients and 45 of 262 (17.2%) in controls; this difference was not statistically significant (P>0.05, chi(2) test). However, when we stratified the whole population according to genotype, fasting serum homocysteine levels were significantly higher in TT patients than in TT controls (25.3+/-36.8 versus 15+/-11.6 micromol/L; P=0.02, t test). Mutations of FV Leiden and of FII G20210A gene are currently reported to be associated with a tendency toward ischemic stroke. Their frequencies were not statistically significantly different between patients and controls in this setting: 7 of 132 (5.3%) versus 17 of 262 (6.5%) for FV Leiden and 10 of 132 (7.6%) versus 16 of 262 (6.1%) for FII G20210A, respectively (all P>0.05, chi(2) test). In the present cohort of patients, moderate hyperhomocysteinemia is the only variable that helps to identify young adults with a history of ischemic stroke.

Chronic orthostatic intolerance: a disorder with discordant cardiac and vascular sympathetic control.

Chronic orthostatic intolerance (COI) is a debilitating autonomic condition in young adults. Its neurohumoral and hemodynamic profiles suggest possible alterations of postural sympathetic function and of baroreflex control of heart rate (HR). In 16 COI patients and 16 healthy volunteers, intra-arterial blood pressure (BP), ECG, central venous pressure (CVP), and muscle sympathetic nerve activity (MSNA) were recorded at rest and during 75 degrees tilt. Spectral analysis of RR interval and systolic arterial pressure (SAP) variabilities provided indices of sympathovagal modulation of the sinoatrial node (ratio of low-frequency to high-frequency components, LF/HF) and of sympathetic vasomotor control (LFSAP). Baroreflex mechanisms were assessed (1) by the slope of the regression line obtained from changes of RR interval and MSNA evoked by pharmacologically induced alterations in BP and (2) by the index alpha, obtained from cross-spectral analysis of RR and SAP variabilities. At rest, HR, MSNA, LF/HF, and LFSAP were higher in COI patients, whereas BP and CVP were similar in the two groups. During tilt, BP did not change and CVP fell by the same extent in the 2 groups; the increase of HR and LF/HF was more pronounced in COI patients. Conversely, the increase of MSNA was lower in COI than in control subjects. Baroreflex sensitivity was similar in COI and control subjects at rest; tilt reduced alpha similarly in both groups. COI is characterized by an overall enhancement of noradrenergic tone at rest and by a blunted postganglionic sympathetic response to standing, with a compensatory cardiac sympathetic overactivity. Baroreflex mechanisms maintain their functional responsiveness. These data suggest that in COI, the functional distribution of central sympathetic tone to the heart and vasculature is abnormal.

Dissecting thoracic aortic aneurysm in a 22-year-old man

A 22-year-old man presented with a 12-hour history of acute epigastric pain associated with hematochezia. Emergency echocardiography and aortography were diagnostic of a bicuspid aortic valve and dissection of the thoracic aortic aneurysm. Surgical intervention included repair of the aneurysm, partial small bowel resection, and revascularizations of the superior mesenteric artery. An eventful hospital course ended in the patient's death on the eighth postoperative day. Dissecting aortic aneurysm is a rare condition in young adults. Prompt diagnosis with aggressive medical management and urgent surgical consultation affords the best outcome.

A study of the possible correlation of high salivary calcium levels with periodontal and dental conditions in young adults

The periodontal bone level and the number of erupted and intact teeth were assessed from the X-rays of 46 dental students (mean age 24.2 yr). Paraffin-stimulated whole saliva was collected in a standarized way and the salivary flow-rate was measured. The salivary concentration of calcium was analysed by atomic absorption spectrophotometry. The subjects were divided into 2 groups according to the salivary Ca level. Subjects with salivary Ca levels over the mean value (51.03 μg/ml) were included in the ‘high salivary Ca group’ ( n = 20). Age- and sex-matched pairs showing Ca levels below the mean formed the ‘low salivary Ca group’ ( n = 26). The results show that subjects in the high salivary Ca-group had significantly more intact teeth than their pairs in the low salivary Ca group ( p < 0.025). There was no difference in the total number of teeth present nor in the salivary flow rate. No periodontal breakdown could be detected in any of the X-rays. It seems that in young adults high salivary Ca content can be correlated with good dental health but not with periodontal bone destruction.

Long-term follow-up of young adults following permanent pacemaker placement for complete heart block

Young adults with nonsurgically induced complete heart block (CHB) do not necessarily have a banign prognosis and pacemaker (PM) implantation may be necessary. No one has reported long-term PM follow-up in young adults with CHB. We studied 13 patients aged 15 to 37 years (mean 24 years) at PM implantation. There were nine female and four male patients. All were functional class II or III (NYHA) before PM implantation. Syncope, dizziness, fatigue, shortness of breath, and dyspnea on exertion were the most common symptoms. Cardiac catheterization findings (11 of 13 patients) were normal in five, and additional cardiac anomalies were present in six. His bundle studies (9 of 13 patients) showed absent AH intervals in all patients, with HV intervals not identified in two, 20 to 30 msec in one, and 30 to 50 msec in six patients. Holter monitor recordings (8 of 13 patients) demonstrated CHB in all eight with intermittent second- to third-degree block in two of these patients. Two patients had occasional premature ventricular contractions. Stress exercise tests (9 of 13 patients) demonstrated increased ventricular rate response (although subnormal in some patients); symptoms developed in seven. One patient had ventricular ectopy. All 13 patients were contacted 3 months to 7 years (mean 4 years) after PM implantation. Two patients had died, but the deaths were not related to PM dysfunction. All patients who are currently alive had marked improvement in functional symptomatology and all are currently functional class I. CHB is not a benign condition in young adults and may require PM implantation, which improves symptoms and allows the patient to lead a normal life.

ACUTE INFECTIOUS LYMPHOCYTOSIS

THE RECOGNITION of acute infectious lymphocytosis as an entity separate from infectious mononucleosis dates from Smith's¹report in 1941. Since that time the number of reported cases of this condition has increased, until at this writing 38 have been published. The series of Reyersbach and Lenert²undoubtedly must be of this nature, and Smith, in his recognition of the entity, made reference to the report of these investigators. Smith designated infectious lymphocytosis as being acute or chronic and established definite criteria for the diagnosis as differentiated from lymphatic leukemia and infectious mononucleosis. The disease is termed infectious because it has occurred in small epidemics.³Recently, Lorenz, Hardy and Alt⁴reported the disease in 2 brothers. Most reports have been of young children under the age of 6 years, although Duncan⁵and Yuskis⁶recorded cases of the condition in young adults. The symptoms are remarkably