#Wilkies syndrome
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*me noticing I have a high heart rate not knowing why
Me: why this time body? I’m sitting down? 🤨
Body: You dared to have dinner
Me: Oh for f***s sake…
#life of being chronically ill#POTS#postural orthostatic tachycardia syndrome#SMAS#superior mesenteric artery syndrome#Wilkies syndrome#chronically ill#chronic illness#me/cfs#eds#ehlers danlos syndrome#median arcuate ligament syndrome#MALS
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A mystery illness and one womans decade-long fight against misdiagnosis
A mystery illness and one woman’s decade-long fight against misdiagnosis
https://theheartysoul.com/wilkies-syndrome/
Mystery illnesses plague many people and oftentimes, the victims of them suffer in silence. Other times, symptoms are dismissed or even ignored. For Eser Toprak, it’s taken years to discover what her mystery illness actually is — and she wants to raise awareness for others. At the young age of 17-years-old, Toprak moved from Turkey […]
The post A mystery illness and one woman’s decade-long fight against misdiagnosis appeared first on The Hearty Soul.
via The Hearty Soul https://theheartysoul.com/
February 13, 2024 at 09:11AM
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Holidays 7.16
Holidays
Artificial Intelligence Appreciation Day
Assata Shakur Day
Atomic Bomb Day
Catcher in the Rye Day
Closet Space Appreciation Day
DC Day
Elderly Women Day (Kiribati)
Engineer’s Day (Honduras)
Festival of Convivial Tools
Fiesta de La Tirana (Tarapacá Region, Chile)
Guinea Pig Appreciation Day
Harela (Uttarakhand, India)
Holocaust Memorial Day (France)
International Disability Awareness Day
International Drag Day
International Juggling Day
Islamic Calendar Day
Lady of Carmen Day (Chile)
La Paz Day (Bolivia)
Manu’s Cession Day, Day 2 (American Samoa)
National Atomic Veterans Day
National Change Your Font Day
National D.R.E.S.S. Syndrome Day
National Emily Day
National Geordie Day (UK)
National Jerry Day
National Peace Day (Dia de la Paz; Bolivia)
National Stick Shift Day
National Wedding Invitation Day
No Kissing Day
Order of the Arrow Day (BSA)
Parking Meter Day
Parks Day (Canada)
Reading Together Day (UK)
Rural Transit Day
716 Day
Talk to a Telemarketer Day
Tare Day (French Republic)
Trinity Test Day
Urs Shah-I-Hamdan Sahib (Kashmir, India)
World PR Day
World Snake Day
World Wizkid Day (Nigeria)
Food & Drink Celebrations
Darwin Beer Can Regatta 2023 (Australia) [Date Varies]
Fresh Spinach Day
Hot Coal Chicken Day (Peru)
Hot Dog Night
Ice Cream Cone Day
National Cherry Day (UK)
National Corn Fritter Day
National Funnel Cake Day
National Personal Chef Day [also 2.26]
3rd Sunday in July
Anne Hutchinson Memorial Day (Rhode Island) [Sunday closest to 20th]
Bosphorus Cross-Continental Swim (Istanbul, Turkey) [3rd Sunday]
Children’s Day (Cuba) [3rd Sunday]
Galla Bayramy (Turkmenistan celebration of the wheat harvest) [3rd Sunday]
Ginibiimanaan (a.k.a. Lake Superior Day) [3rd Sunday]
Lake Superior Day [3rd Sunday]
Luxembourg Beer Festival [3rd Sunday]
Metallurgist’s Day (Russia) [3rd Sunday]
National Ice Cream & Beer Day (mix some vanilla ice cream with your favorite Porter or Stout) [3rd Sunday]
National Ice Cream Day [3rd Sunday]
National Ice Cream Soda Day [3rd Sunday]
Sundae Sunday [3rd Sunday]
Independence Days
Custosia (Declared; 2017) [unrecognized]
Feast Days
Andrea del Sarto (Artology)
Asalha Puja Day (Buddhist Lent begins)
Bobby Henderson Day (Pastafarian; Saint)
Charles Sheeler (Artology)
Dr. Doom Day (Church of the SubGenius; Saint)
Display of the Embarrassing Swimsuits (Church of the SubGenius)
Eustathius (Christian; Saint)
First Sermon of Lord Buddha (Bhutan)
Gondulphus of Tongeren (Christian; Saint)
Helier (a.k.a. Elier; Christian; Saint)
Our Lady of Mount Carmel (Christian; Saint)
Phoebe Cates Day (Humanism)
Reineldis (Christian; Saint)
Rotary Doozer (Muppetism)
Skip This Day Day (Pastafarian)
Solstitium XI (Pagan)
The Troubadours (Positivist; Saint)
Vardavar (Pagan Prank Day; Armenia) [14 Weeks after Easter]
Zoot (Muppetism)
Lucky & Unlucky Days
Prime Number Day: 197 [45 of 72]
Sakimake (先負 Japan) [Bad luck in the morning, good luck in the afternoon.]
Premieres
Ain’t No Mountain High Enough, by Diana Ross (Song; 1970)
Alice’s Restaurant Massacree, by Arlo Guthrie (Song; 1976)
Akira (Anime Film; 1988)
Ant-Man (Film; 2015)
The Blair Witch Project (Film; 1999)
The Catcher in the Rye, by J.D. Salenger (Novel; 1951)
Die Entführung aus dem Serail, by Wolfgang Amadeus Mozart (Opera; 1782)
Dragon Around (Disney Cartoon; 1954)
Drop Dead Gorgeous (Film; 1999)
Eyes Wide Shut (Film; 1999)
False Hare (WB LT Cartoon; 1964)
Free Willy (Film; 1993)
From Up on Poppy Hill (Studio Ghibli Animated Film; 2011)
George of the Jungle (Film; 1997)
The Half-Blood Prince, by J.K. Rowling (Novel; 2005) [Harry Potter #6]
Hocus Pocus (Film; 1993)
Inception (Film; 2010)
The Moonstone, by Wilkie Collins (Novel; 1868)
Mouse and Garden (WB LT Cartoon; 1960)
Once A Day, by Connie Smith (Song; 1964)
Poison Ivy, recorded by The Coasters (Song; 1959)
Pom Poko (Studio Ghibli Animated Film; 1994)
Schmigadoon! (TV Series; 2021)
Sex & Drugs & Rock & Roll (TV Series; 2015)
Space Jam: A New Legacy (Animated Film; 2021)
Space Race (Video Game; 1973)
Stargate: Atlantis (TV Series; 2004)
Topper (Film; 1937)
Today’s Name Days
Carmen, Irmgard, Maria (Austria)
Yulian, Yuliana, Yuliya (Bulgaria)
Elvira, Karmela (Croatia)
Luboš (Czech Republic)
Tychos (Denmark)
Rein, Reinhold, Reino, Reinu, Reinut, Rinaldo, Ronald (Estonia)
Reino, Rene (Finland)
Elvire (France)
Carmen, Irmgard (Germany)
Valter (Hungary)
Maria, Vitaliano (Italy)
Hermīne, Rasulite (Latvia)
Danguolė, Faustas, Vaigaudas (Lithuania)
Sanna, Susanne (Norway)
Andrzej, Benedykt, Dziersław, Dzierżysław, Eustachiusz, Eustachy, Faust, Maria Magdalena, Marika, Ostap, Ruta, Stefan (Poland)
Drahomíra (Slovakia)
Carmen (Spain)
Reine, Reinhold (Sweden)
Ruth, Valentina, Valia (Ukraine)
Carmel, Carmela, Carmelo, Carmen, Shelby, Sherman, Sherwood (USA)
Carma, Carmel, Carmela, Carmelita, Carmella, Camelo, Carmélo, Carmen, Carmencita, Carmi, Carmie, Carmina, Carmine, Karmen, Phoebe (Universal)
Today is Also…
Day of Year: Day 197 of 2024; 168 days remaining in the year
ISO: Day 7 of week 28 of 2023
Celtic Tree Calendar: Tinne (Holly) [Day 7 of 28]
Chinese: Month 5 (Wu-Wu), Day 29 (Yi-Hai)
Chinese Year of the: Rabbit 4721 (until February 10, 2024)
Hebrew: 27 Tammuz 5783
Islamic: 27 Dhu al-Hijjah 1444
J Cal: 17 Lux; Theesday [17 of 30]
Julian: 3 July 2023
Moon: 1%: Waning Crescent
Positivist: 1 Dante (8th Month) [The Troubadours]
Runic Half Month: Ur (Primal Strength) [Day 3 of 15]
Season: Summer (Day 26 of 94)
Zodiac: Cancer (Day 26 of 31)
Calendar Changes
Dante (Modern Epic Poetry) [Month 8 of 13; Positivist]
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Holidays 7.16
Holidays
Artificial Intelligence Appreciation Day
Assata Shakur Day
Atomic Bomb Day
Catcher in the Rye Day
Closet Space Appreciation Day
DC Day
Elderly Women Day (Kiribati)
Engineer’s Day (Honduras)
Festival of Convivial Tools
Fiesta de La Tirana (Tarapacá Region, Chile)
Guinea Pig Appreciation Day
Harela (Uttarakhand, India)
Holocaust Memorial Day (France)
International Disability Awareness Day
International Drag Day
International Juggling Day
Islamic Calendar Day
Lady of Carmen Day (Chile)
La Paz Day (Bolivia)
Manu’s Cession Day, Day 2 (American Samoa)
National Atomic Veterans Day
National Change Your Font Day
National D.R.E.S.S. Syndrome Day
National Emily Day
National Geordie Day (UK)
National Jerry Day
National Peace Day (Dia de la Paz; Bolivia)
National Stick Shift Day
National Wedding Invitation Day
No Kissing Day
Order of the Arrow Day (BSA)
Parking Meter Day
Parks Day (Canada)
Reading Together Day (UK)
Rural Transit Day
716 Day
Talk to a Telemarketer Day
Tare Day (French Republic)
Trinity Test Day
Urs Shah-I-Hamdan Sahib (Kashmir, India)
World PR Day
World Snake Day
World Wizkid Day (Nigeria)
Food & Drink Celebrations
Darwin Beer Can Regatta 2023 (Australia) [Date Varies]
Fresh Spinach Day
Hot Coal Chicken Day (Peru)
Hot Dog Night
Ice Cream Cone Day
National Cherry Day (UK)
National Corn Fritter Day
National Funnel Cake Day
National Personal Chef Day [also 2.26]
3rd Sunday in July
Anne Hutchinson Memorial Day (Rhode Island) [Sunday closest to 20th]
Bosphorus Cross-Continental Swim (Istanbul, Turkey) [3rd Sunday]
Children’s Day (Cuba) [3rd Sunday]
Galla Bayramy (Turkmenistan celebration of the wheat harvest) [3rd Sunday]
Ginibiimanaan (a.k.a. Lake Superior Day) [3rd Sunday]
Lake Superior Day [3rd Sunday]
Luxembourg Beer Festival [3rd Sunday]
Metallurgist’s Day (Russia) [3rd Sunday]
National Ice Cream & Beer Day (mix some vanilla ice cream with your favorite Porter or Stout) [3rd Sunday]
National Ice Cream Day [3rd Sunday]
National Ice Cream Soda Day [3rd Sunday]
Sundae Sunday [3rd Sunday]
Independence Days
Custosia (Declared; 2017) [unrecognized]
Feast Days
Andrea del Sarto (Artology)
Asalha Puja Day (Buddhist Lent begins)
Bobby Henderson Day (Pastafarian; Saint)
Charles Sheeler (Artology)
Dr. Doom Day (Church of the SubGenius; Saint)
Display of the Embarrassing Swimsuits (Church of the SubGenius)
Eustathius (Christian; Saint)
First Sermon of Lord Buddha (Bhutan)
Gondulphus of Tongeren (Christian; Saint)
Helier (a.k.a. Elier; Christian; Saint)
Our Lady of Mount Carmel (Christian; Saint)
Phoebe Cates Day (Humanism)
Reineldis (Christian; Saint)
Rotary Doozer (Muppetism)
Skip This Day Day (Pastafarian)
Solstitium XI (Pagan)
The Troubadours (Positivist; Saint)
Vardavar (Pagan Prank Day; Armenia) [14 Weeks after Easter]
Zoot (Muppetism)
Lucky & Unlucky Days
Prime Number Day: 197 [45 of 72]
Sakimake (先負 Japan) [Bad luck in the morning, good luck in the afternoon.]
Premieres
Ain’t No Mountain High Enough, by Diana Ross (Song; 1970)
Alice’s Restaurant Massacree, by Arlo Guthrie (Song; 1976)
Akira (Anime Film; 1988)
Ant-Man (Film; 2015)
The Blair Witch Project (Film; 1999)
The Catcher in the Rye, by J.D. Salenger (Novel; 1951)
Die Entführung aus dem Serail, by Wolfgang Amadeus Mozart (Opera; 1782)
Dragon Around (Disney Cartoon; 1954)
Drop Dead Gorgeous (Film; 1999)
Eyes Wide Shut (Film; 1999)
False Hare (WB LT Cartoon; 1964)
Free Willy (Film; 1993)
From Up on Poppy Hill (Studio Ghibli Animated Film; 2011)
George of the Jungle (Film; 1997)
The Half-Blood Prince, by J.K. Rowling (Novel; 2005) [Harry Potter #6]
Hocus Pocus (Film; 1993)
Inception (Film; 2010)
The Moonstone, by Wilkie Collins (Novel; 1868)
Mouse and Garden (WB LT Cartoon; 1960)
Once A Day, by Connie Smith (Song; 1964)
Poison Ivy, recorded by The Coasters (Song; 1959)
Pom Poko (Studio Ghibli Animated Film; 1994)
Schmigadoon! (TV Series; 2021)
Sex & Drugs & Rock & Roll (TV Series; 2015)
Space Jam: A New Legacy (Animated Film; 2021)
Space Race (Video Game; 1973)
Stargate: Atlantis (TV Series; 2004)
Topper (Film; 1937)
Today’s Name Days
Carmen, Irmgard, Maria (Austria)
Yulian, Yuliana, Yuliya (Bulgaria)
Elvira, Karmela (Croatia)
Luboš (Czech Republic)
Tychos (Denmark)
Rein, Reinhold, Reino, Reinu, Reinut, Rinaldo, Ronald (Estonia)
Reino, Rene (Finland)
Elvire (France)
Carmen, Irmgard (Germany)
Valter (Hungary)
Maria, Vitaliano (Italy)
Hermīne, Rasulite (Latvia)
Danguolė, Faustas, Vaigaudas (Lithuania)
Sanna, Susanne (Norway)
Andrzej, Benedykt, Dziersław, Dzierżysław, Eustachiusz, Eustachy, Faust, Maria Magdalena, Marika, Ostap, Ruta, Stefan (Poland)
Drahomíra (Slovakia)
Carmen (Spain)
Reine, Reinhold (Sweden)
Ruth, Valentina, Valia (Ukraine)
Carmel, Carmela, Carmelo, Carmen, Shelby, Sherman, Sherwood (USA)
Carma, Carmel, Carmela, Carmelita, Carmella, Camelo, Carmélo, Carmen, Carmencita, Carmi, Carmie, Carmina, Carmine, Karmen, Phoebe (Universal)
Today is Also…
Day of Year: Day 197 of 2024; 168 days remaining in the year
ISO: Day 7 of week 28 of 2023
Celtic Tree Calendar: Tinne (Holly) [Day 7 of 28]
Chinese: Month 5 (Wu-Wu), Day 29 (Yi-Hai)
Chinese Year of the: Rabbit 4721 (until February 10, 2024)
Hebrew: 27 Tammuz 5783
Islamic: 27 Dhu al-Hijjah 1444
J Cal: 17 Lux; Theesday [17 of 30]
Julian: 3 July 2023
Moon: 1%: Waning Crescent
Positivist: 1 Dante (8th Month) [The Troubadours]
Runic Half Month: Ur (Primal Strength) [Day 3 of 15]
Season: Summer (Day 26 of 94)
Zodiac: Cancer (Day 26 of 31)
Calendar Changes
Dante (Modern Epic Poetry) [Month 8 of 13; Positivist]
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omori characters as hit pl bands/musicians
Sunny - Nagrobki, Noże, Siekiera
Kel - Maanam, Ich Troje, Oki
Hero - Róże Europy, Maryla Rodowicz, Czerwone Gitary
Aubrey - Gówno!, The Analogs, Dezerter
Basil - Myslowitz, Syndrom Paryski, Happysad
Mari - Super Girl & Romantic Boys, Wanda i Banda, Wilki
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Treści Kształcenia: Turystyka Jako Zjawisko Społeczne
Klami Ataman, koń forumowej krak, miał podobny wypadek. Klami czyli już jakaś poprawa,będzie dobrze! Klami Jak naprawdę Cię czytam to zaczynam kupować w jedne gusła :swirek: Po prostu pech niemożliwy. Niestety doskonale mogę sobie wyobrazić, kiedy się czujesz w niniejszej spraw. Ucieszony Marcin był sobie , zamyślony . Ci.. ale sprobuj zaczac sie hartowac od dzisiaj, bo łatwo Ci niewątpliwie z Nia nie bedzie, i na glowe nie mozesz pozwolic sobie wejsc, bo konsekwencje tego bywaja niewesole.. Jak i tak mamrocze, żebym sobie na rzecz konkretnego odłożyła czy coś a ja decyduje na co je robi. Alabamka a za pracę? coś wykombinujesz, na pewno. Alabamka oraz czy twój rodzic nie potrafiłby docenić, że zamiast kupienia dwóch bluz z np około 300zl wolisz kasę stracić na pasję? Nie kojarzę kompletnie. wypracowanie a czy twój ojciec nie potrafiłby docenić, że zamiast kupienia dwóch bluz z np około 300zl wolisz kasę wydać na pasję?
1. Działamy z młodym podręcznikiem - strona 141. Przygotujcie do zeszytu zadanie 4 i 5 ze strony 141. Pamiętajcie, że danie nierozwinięte zbiera się ale z dwóch wyrazów albo z jednego. Zadanie: Znasz już, jakie zadanie przed Tobą - masz przeprowadzić wywiad z którąkolwiek z sytuacje „Dziadów cz. Wyniki badań publikowane są w czasopismach naukowych o zasięgu wewnętrznym oraz zewnętrznym, a plus są prezentowane podczas zewnętrznych i polskich konferencji naukowych. Wnioski z tej matury były mocno niż satysfakcjonujące :cool: (ang podstawowy - 100%, ang rozszerzony -86%, polski podstawowy - 90%, rozszerzony - 83%, wos - 78%, matma - 62% i luz, bo na nic mi nie była przydatna). Ja, jak ta stara a dużo stara jestem dostępna za to, żeby wszystko grało, polecenia były na chwila, niczego nie zabrakło itd. W takiej okoliczności jestem przymuszona do spoglądania na ręce bratu, bo gdyby nikt go nie pilnował panował by absolutny chaos. Dwoma głównymi centrami muzycznej Europy istniały w początkowej połowie stulecia Wiedeń i Paryż.
Postanowił przerwać te połączenia, podając się wszelkimi możliwymi formami nacisku. Jako, że cała rodzina była kolejnego dnia zaproszona do teściowej na obiad, zięć postanowił "mamusi" zrobić zabawa i dać jeden z nich. Mordeczka to swoisty syn, ktory stał w domu, więc syndrom syneczka mamusi jak ciężko się załączył. Gdy tylko wiedział, jak bardzo odległa i indywidualna się czuję, na pewno byś przyjechał. Miliony bezrobotnych otrzymały funkcję oraz wspaniałe warunki socjalne, nawet gdyby istniała zatem tylko praca przy pracach publicznych, budowie dróg, linii kolejowych, obiektów przemysłowych i fizycznych, osuszaniu bagien itp. Sposób był wsparty na centralnym mieniu i precyzyjnej kontroli państwa oraz z obecnego czynnika pod względem ekonomicznym nosił wszelkie cechy ustroju lewicowego. Podręczniki pod względem zamkniętego w nich tematu zawierają treści zarówno dostosowane do tych trochę zaawansowanych uczniów. Przygotowanie uczniów do przyjęcia odpowiedniej decyzji odnośnie wyboru dalszej szkoły. W ćw.4/str.113 czytacie wypowiedzi z ćw.3 jeszcze raz i odpowiadacie pisemnie na pytania.
Wypowiedzi pisane wymagają być pełniejsze treściowo od mówionych (brak kontekstu sytuacyjnego). Jeszcze mnie na oczy nie widziałą, i teraz mnie zjechała jak szmaciarz konia. Z kolejnej części takie zwierzęta jak wilki, czaple, czy żurawie padają ofiarą przesądów kłusowników. No i spróbowało się od wtopy, skoro nie słyszała jak mawiała dzień dobry to walnęła focha, że się nie przywitałam. Współczuję, byłam wtedy w całej sytuacji, potem przyszło kilka nowych rzeczy oraz na dzień dzisiejszy - nie mam znajomej dodatkowo w wyniku nie mogę się dogadać z osobniczkami własnej płci. I uśmiech na twarz - jednak i w wszystkiej sytuacji, gdy ona focha to ty uśmiech. Jak uczyć ortografię? Poradnik dla uczniaAleksandra Mikulska. Bardzo lepiej, niczym nie zależy się od teściów, nie żyje z nimi. Tyle, że ona działa totalnie powalone wjazdy na osobę własnemu synowi, przez co podejmuje się między nami z serii niewesoła sytuacja :/ i gdy się dowiedziała, że jestem suchsza od niego wtedy kraj świata.
Na wynik w kolekcji nie dała mi się pożegnać z Mordką skoro go ciągle poganiała, weszła do ich samochodu a ja wsiadłam do znanego i pojechałam. Zgoda - a ale dzięki uporowi pogan dodatkowo w całości bezsilności chrześcijan, jacy nie stanowili w stanie pilnować każdego poganina na każdym etapu. rozprawka wypływała jednak z uczucia głębokiej dziejowej niesprawiedliwości i upokorzenia, jakiemu zależni byli Ukraińcy na obszarze kolonializowanym najpierw przez Polaków, potem przez Rosjan (co wprawdzie nie przeszkadzało, żeby Puszkin i Mickiewicz byli ważnymi inspiracjami poezji Szewczenki). Proponujemy jednak zacząc z muzyki. wypracowanie gdy sie porusza to juz nie podskakuje na trzech a jednak niesmialo probuje obciazac ta noge. Gdy zaprezentuję się ale w ciągu dalszego ciągu, iż jego dumy nie gwarantują jego zdolnością, może spotkać ogólne zawyżanie poziomu aspiracji, lec i w związku z mówiącymi się porażkami poziom aspiracji ulegnie takiemu obniżeniu, że dziecko przestaje w siebie wierzyć. Gdy dowiadujemy się o sukcesach znęcania się nad zwierzętami - o tych wynikających ludzi już nawet nie wspominam - wiążemy je z nienormalnością sprawców, ich każdego rodzaju ”ułomnością” (najdelikatniej mówiąc).
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Wilkie's Syndrome Symptoms, Causes, Surgery, Life expectancy
Wilkie’s Syndrome Symptoms, Causes, Surgery, Life expectancy
Wilkie’s syndrome or superior mesenteric artery syndrome (SMA) is a kind of gastro-vascular disorder. It is an acquired disorder in which acute angulation of the superior mesenteric artery occurs. This gastrointestinal disorder is rare; it is present in approximately 0.013–0.3% of the general population. The condition is characterized; by vascular compression.
During this medical condition, the…
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"Wilkie’s syndrome, also known as superior mesenteric artery syndrome, is a disease often confused with anorexia due to the similarity of the symptoms. Most patients, especially women, often have weight loss, body image distortion, nausea, and vomiting.
Because of the similarity in symptoms, many patients end up being misdiagnosed with anorexia nervosa, when, in fact, they have a condition that does not merit psychopharmacological treatment or psychiatric care, but only surgery."
https://itoldyouiwassick.com/2019/09/09/wilkies-syndrome-not-anorexia-misdiagnosis/
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Juniper Publishers- Open Access Journal of Case Studies
Superior Mesenteric Artery Syndrome: A Case Report with Emphasis on Radiological Findings
Authored by Rola Mahmood
Abstract
Superior mesenteric artery syndrome, AKA Wilkie’s, or Cast syndrome, is a rare cause of proximal intestinal obstruction. It occurs as a result to the compression of the third portion of the duodenum by the superior mesenteric artery and the aorta. In this paper we are presenting a case of SMA of a 27 years old male who presented with abdominal pain and vomiting.
Keywords: Superior mesenteric artery syndrome; Wilkie’s syndrome; Cast syndrome; Arteriomesentric duodenal compression
Introduction
Superior mesenteric artery syndrome is a rare condition first described by Rokitansky in 1861 [1-6] resulting from a reduced angle between the artery at its origin from the abdominal aorta and the transverse third part of the duodenum causing duodenal obstruction [3,4,6]. Symptoms are nonspecific and hence the diagnosis of the syndrome depends on high index of suspicion, supported by the radiological features of the syndrome. Treatment can either be conservative or operative, depending on the severity and cause of the condition[1,3,4-6].
Case Report
Superior mesenteric artery syndrome is a rare condition first described by Rokitansky in 1861 [1-6] resulting from a reduced angle between the artery at its origin from the abdominal aorta and the transverse third part of the duodenum causing duodenal obstruction [3,4,6]. Symptoms are nonspecific and hence the diagnosis of the syndrome depends on high index of suspicion, supported by the radiological features of the syndrome. Treatment can either be conservative or operative, depending on the severity and cause of the condition[1,3,4-6].
A 27 years old gentleman not known case of any medical illness presented with history of peri-umbilical pain, for 6 days, associated with vomiting and constipation. No history of fever or diarrhea. Unremarkable medical, allergy and surgical history. Never smoker or drinker with negative family history. On physical examination abdomen was soft and lax, no significant abnormalities were noted. Labs were unremarkable (WBC 5.78, Platelets 316, Hb 11.4) (Figure 1).
Patient was admitted in the surgical ward as he was dehydrated and ill-looking. Due to the persistent vomiting NG was passed to decompress the stomach. CT abdomen with oral and IV contrast was done as the vomiting was persistent which revealed dilatation of the stomach and proximal part of the duodenum followed by an abrupt duodenal constriction proximal to the overlying SMA (Figure 2-7) where the aortomesenteric angle is 12 ° (normally measure 25-60 60°) and the aortomesenteric distance is 7.5mm (normally 10-28mm) (Figure 8), CT feature consistent with superior mesenteric artery syndrome. Barium meal follow through was performed after which showed a slow flow of the contrast from the stomach through the duodenum when the patient was in supine position. Hold up within the stomach was noted (Figure 9).
When the patient was in a prone position the contrast was flowing freely to the duodenum to reach the terminal ileum (s 10-12), a consistent finding with superior mesenteric artery syndrome. During his hospital stay patient was afebrile and vitally stable, no acute events took a place. Patient was treated conservatively with NG tube and IV fluids. Patient was discharged after one week.
Discussion
Superior mesenteric artery syndrome (SMAS), also known as Wilkie’s or Cast syndrome, was first described in 1861 by Rokitansky, followed by Wilkie that provided a more detailed anatomical, clinical and patho-physiologic description, naming it chronic duodenal ileus [1,3,4,6]. The incidence of this condition varies form 0.013-0.3%. Only 400 cases have been reported so far [1,7,8].
The superior mesenteric artery arises from the anterior aspect of the aorta at the level of the L1 vertebral body. It is enveloped in fatty and lymphatic tissue and extends in a caudal direction at an acute angle into the mesentery. In the majority of patients, the aorto-mesenteric angle and aorto-mesenteric distance is 25°-60° and 10 to 28mm respectively, in which the angle correlates with body mass index [3-5]. Both parameters are reduced in SMAS, with values of 6° to 15° and 2 to 8mm respectively, which in turn cause compression of the third portion of the duodenum [4,5,7].
The most common cause of SMA syndrome is severe weight loss including trauma, burns, anorexia nervosa and/or after prolonged bed rest, other causes include an abnormal high, fixed position of ligament of Treitz, unusually low origin of the SMA, a congenitally short ligament of Treitz and in rare cases following surgical correction of scoliosis, cast application abdominal aortic aneurysm and pancreatitis [3,4,7].
It mostly affects young females (10 to 39 years). The symptoms are usually chronic, comprising mostly of weight loss, bloating sensation, epigastric pain, abdominal distension, nausea and vomiting, depending merely on the cause and degree of duodenal compression. Acute presentation is uncommon [1,7,8].
Diagnostic modalities include abdominal ultrasound with Doppler or contrast enhanced abdominal CT to measure the AO angle and AO distance [1,5,6]. Upper GI studies are extremely helpful in these cases, revealing the characteristic dilatation of the first and second parts of the duodenum, with an abrupt vertical or linear cutoff in the third part with normal mucosal folds. Very little barium is seen to pass into jejunum during the early part of the examination. Other finding includes delay of 4-6 hours in gastroduodenojejunal transit [4,7,8].
In literature generally, symptoms may be relieved, by lying prone, on the left lateral decubitus or knee-chest position [1,4,5]. Conservative initial treatment is tried at least over a period of 4 to 6 weeks and consists of correction of the electrolytes imbalance, decompression of the obstruction via a nasogastric tube and nutritional support via a nasojejunal tube placed beyond the third portion of the duodenum. However, surgical treatment (either laparoscopic or open) remains the only accepted way of managing SMAS, as conservative treatment is rarely successful [1,5]. The main goal is to bypass the obstruction through either a duodenojejunostomy, gastrojejunostomy or a duodenal derotation procedure ( Strong procedure). This is a popular procedure in paediatric patients, in which the third and fourth parts of the duodenum are moved into the right of the superior mesenteric artery [4,5].
Conclusion
Superior mesenteric artery syndrome is a rare condition, causing intestinal obstruction. Radiological modalities play a major role in its diagnosis and surgical methods remain the gold standard in its management.
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Wilkie's syndrome: a case report of favourable minimally invasive <b>surgery</b>
Abstract. Wilkie's syndrome, or superior mesenteric artery syndrome (SMAS), is a rare clinical entity caused by compression of the third portion of the duodenu.
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premature e
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Holidays 7.16
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Day of Year: Day 197 of 2022; 168 days remaining in the year
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Holidays 7.16
Holidays
Artificial Intelligence Appreciation Day
Atomic Bomb Day
Catcher in the Rye Day
Closet Space Appreciation Day
DC Day
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Festival of Convivial Tools
Fiesta de La Tirana (Tarapacá Region, Chile)
Guinea Pig Appreciation Day
Harela (Uttarakhand, India)
Holocaust Memorial Day (France)
International Juggling Day
Islamic Calendar Day
Lady of Carmen Day (Chile)
Manu’s Cession Day, Day 2 (American Samoa)
National Atomic Veterans Day
National D.R.E.S.S. Syndrome Day
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Urs Shah-I-Hamdan Sahib (Kashmir, India)
World Snake Day
Food & Drink Celebrations
Fresh Spinach Day
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National Personal Chef Day [also 2.26]
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Celebration of the Horse begins (Texas) [3rd Saturday]
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Railroad Day [3rd Saturday]
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Woman’s Dive Day [3rd Saturday]
Woodie Wagon Day [3rd Saturday]
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Eid al-Adha, Day 7 [Muslim Feast of Sacrifice] (a.k.a. ...
Eid al Adha (Kuwait, Qatar)
Eustathius (Christian; Saint)
First Sermon of Lord Buddha (Bhutan)
Gondulphus of Tongeren (Christian; Saint)
Helier (a.k.a. Elier; Christian; Saint)
Our Lady of Mount Carmel (Christian; Saint)
Phoebe Cates Day (Humanism)
Reineldis (Christian; Saint)
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Thulsa Doom Day (Church of the SubGenius; Saint)
The Troubadours (Positivist; Saint)
Zoot (Muppetism)
Lucky & Unlucky Days
Prime Number Day: 197 [45 of 72]
Taian (大安 Japan) [Lucky all day.]
Premieres
Ain’t No Mountain High Enough, by Diana Ross (Song; 1970)
Akira (Anime Film; 1988)
Ant-Man (Film; 2015)
The Catcher in the Rye, by J.D. Salenger (Novel; 1951)
Free Willy (Film; 1993)
George of the Jungle (Film; 1987)
The Half-Blood Prince, by J.K. Rowling (Novel; 2005) [Harry Potter #6]
Hocus Pocus (Film; 1993)
The Moonstone, by Wilkie Collins (Novel; 1868)
Poison Ivy, by The Coasters recorded (Song; 1959)
Schmigadoon! (TV Series; 2021)
Stargate: Atlantis (TV Series; 2004)
Today’s Name Days
Carmen, Maria (Austria)
Yulian, Yuliana, Yuliya (Bulgaria)
Elvira, Karmela (Croatia)
Luboš (Czech Republic)
Tychos (Denmark)
Rein, Reinhold, Reino, Reinu, Reinut, Rinaldo, Ronald (Estonia)
Reino, Rene (Finland)
Elvire (France)
Carmen, Irmgard (Germany)
Valter (Hungary)
Maria, Vitaliano (Italy)
Hermīne, Rasulite (Latvia)
Danguolė, Faustas, Vaigaudas (Lithuania)
Sanna, Susanne (Norway)
Andrzej, Benedykt, Dziersław, Dzierżysław, Eustachiusz, Eustachy, Faust, Maria Magdalena, Marika, Ostap, Ruta, Stefan (Poland)
Drahomíra (Slovakia)
Carmen (Spain)
Reine, Reinhold (Sweden)
Ruth, Valentina, Valia (Ukraine)
Carmel, Carmela, Carmelo, Carmen, Shelby, Sherman, Sherwood (USA)
Carma, Carmel, Carmela, Carmelita, Carmella, Camelo, Carmélo, Carmen, Carmencita, Carmi, Carmie, Carmina, Carmine, Karmen, (Universal)
Today is Also…
Day of Year: Day 197 of 2022; 168 days remaining in the year
ISO: Day 6 of week 28 of 2022
Celtic Tree Calendar: Tinne (Holly) [Day 9 of 28]
Chinese: Month 6 (Héyuè), Day 18 (Geng-Wu)
Chinese Year of the: Tiger (until January 22, 2023)
Hebrew: 17 Tammuz 5782
Islamic: 16 Ḏū al-Ḥijjah 1443
J Cal: 17 Lux; Twosday [17 of 30]
Julian: 3 July 2022
Moon: 88% Waning Gibbous
Positivist: 1 Dante (8th Month) [The Troubadours]
Runic Half Month: Ur (Primal Strength [Day 5 of 15]
Season: Summer (Day 26 of 90)
Zodiac: Cancer (Day 26 of 30)
Calendar Changes
Dante (Modern Epic Poetry) [Month 8 of 13; Positivist]
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Superior mesenteric artery syndrome (SMAS) also known as Wilkie syndrome is a rare condition which results from an acute angulation of the superior mesenteric artery, with consequent compression of the third duodenal segment (D3), leading to chronic, intermittent or acute, complete or partial obstruction. (1,2) Approximately 15 causes of SMAS have been described, however in scoliosis repair surgery, the onset and presentation of intestinal obstruction can be acute. (3) Conservative initial treatment is recommended in all patients and is usually successful. (2)
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A “view” from the courtroom: “OK, boomer”
Sometime on Thursday, Chief Justice John Roberts will cross the street from the Supreme Court building to the Capitol to begin presiding over the Senate impeachment trial of President Donald Trump. This week’s activities will be somewhat ceremonial—the chief justice taking an oath himself, then swearing in senators for their special role as jurors (or as a “court,” as Chief Justice William Rehnquist ruled in President Bill Clinton’s 1999 impeachment trial).
The real action is set to start next week, after the Martin Luther King Jr. Day holiday. Throughout the court’s current term, the chief justice has received daily reminders of his potential role as the impeachment process inched along. Perhaps he was warming up for the role when, back on November 13 (the day impeachment hearings began before a House committee), Roberts was officiating the court’s annual charity dodgeball game.
Chief Justice Roberts in Babb v. Wiklie (Art Lien)
The court’s newsletter, “Oyez! Oyez!,” reports that the law-clerk team, Balls & Strikes, playing for Toys for Tots, defeated a court-staff team, Torts Illustrated, playing for Veterans Support Foundation. (Happily, both charities received contributions through the court’s participation in the Combined Federal Campaign.)
The Balls & Strikes team name, of course, evokes Roberts’ statement at his confirmation about judges as umpires merely applying the rules.
We all can recall his famous line, “Nobody ever went to a charity dodgeball game, or an impeachment trial, to see the chief justice presiding.”
Meanwhile, Roberts has been tending to his day job, without betraying any hint of distraction by the impeachment trial that is soon to begin. That was evident in court Wednesday as the justices took up a potentially dull case of statutory interpretation involving the Age Discrimination in Employment Act that resulted in a lively argument in which Roberts had the best line.
In Babb v. Wilkie, the question is whether the federal-sector provision of the ADEA, which says that job actions for those 40 or older “shall be made free from any discrimination based on age,” requires plaintiffs to prove that their age was the “but-for” cause of the challenged action.
The “free from any discrimination” language does not apply to private-sector or state and local employers, who already have the employer-friendly “but-for” causation standard thanks to several Supreme Court rulings.
The case involves Noris Babb, a pharmacist for the Department of Veterans Affairs who was around age 50 when she alleges that age discrimination was a factor that denied her promotions.
Roman Martinez, representing Babb, engages with several justices about how much of a role age must play in an employment decision before the federal-sector provision would be violated.
Roberts wonders whether Martinez really believes that age must be a “significant factor” before invoking a phrase that has only recently entered the lexicon.
“Let’s say in the course of the, you know, weeks-long process, you know, [there is] one comment about age,” the chief justice says. “The hiring person is younger, [and] says, you know, ‘OK, boomer’ … once to the applicant.”
The courtroom erupts in laughter. A dozen or so high school students in the second and third rows of the public gallery perk up and nudge each other over this au courant phrase. Some internet sources say the riposte has been around for several years, but it clearly gained traction with a 2019 TikTok video responding to a baby boomer who had complained online about millennials and Gen Z having “Peter Pan syndrome.” The retort has also been lobbed in the chambers of the New Zealand Parliament.
Roberts, whose 1955 birth places him squarely in the 1945-1964 baby boom generation, continues, essentially asking Martinez whether that kind of one-time ageist reference in the employment process would be actionable.
“I think we would say that it does have to play a role in the decision-making process,” says Martinez, adding that a “stray comment” such as the one suggested by Roberts wouldn’t be enough.
The chief justice presses him a little further. “So calling somebody a ‘boomer’ and considering them for a position would be actionable?” Roberts says.
“I think if the decisionmakers are sitting around the table and they say, we’ve got Candidate A who’s 35 and we’ve got Candidate B who’s 55 and is a boomer and is probably tired and — and, you know, doesn’t have a lot of computer skills, I think that absolutely would be actionable,” Martinez says.
The argument continues with questions about not hiring an 82-year-old (from Justice Stephen Breyer, 81) and an extended hypothetical from U.S. Solicitor General Noel Francisco, in support of the but-for causation standard for the federal sector, involving cakes without eggs.
The court has two cases set for argument on Tuesday morning and one on Wednesday morning next week, then a short courtroom session on January 27 for orders, bar admissions and possibly opinions. That is followed by the usual four-week recess before the February sitting.
So, the chief justice will soon be able to direct much more of his attention to officiating the game of impeachment dodgeball in the Senate.
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HCSM News ~ A mystery illness and one woman's decade-long fight against misdiagnosis
Eser Toprak has had a rare, life-threatening disorder since she was a teenager. But for a decade it went undiagnosed and she felt "invisible" in Nova Scotia's health system. Her journey for answers took her to the other side of the Atlantic.
Read more from CBC https://www.cbc.ca/news/canada/nova-scotia/mystery-illness-nova-scotia-misdiagnosis-wilkie-s-syndrome-1.5222471?cmp=rss
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