Thoracolumbar Junction Syndrome Accompanying Renal Artery Stenosis: A Case Report

Flank pain is a common reason for visits to the emergency room. The most common reason warranting hospital visits are urology-related problems. However, there are many other causes, such as musculoskeletal lesions, that difficult to achieve a correct diagnosis. Here, we describe a rare case of flank pain caused by thoracolumbar junction syndrome, accompanying renal artery stenosis. A 54-year-old male with hypertension presented with severe left flank pain for 1 week. Initially, he was diagnosed with left renal artery stenosis by computed tomography and decreased renal function on renal scan (Tc-99m DTPA). Although a stent was inserted into the left renal artery, flank pain persisted with only minor improvement. Through detailed physical examination, he was finally diagnosed with thoracolumbar junction syndrome. After three injections in the left deep paravertebral muscles at the T10–T12 levels, flank pain completely ceased. Clinicians must consider thoracolumbar junction syndrome, when treating patients with flank pain.

Subacute combined degeneration associated with vitamin E deficiency due to small bowel obstruction: A case report

RATIONALE

There have been a few reported cases of subacute combined degeneration (SCD) associated with vitamin E deficiency, but the period of intestinal malabsorption was more than several years. We present a rare case of acute onset SCD that occurred in a relatively short period of several weeks with vitamin E deficiency related to small bowel obstruction.

PATIENT CONCERNS

A 50-year-old woman had abdominal pain. A small bowel obstruction was suspected and conservative treatment was performed. She underwent bowel surgery after 2 weeks without any improvement. Following the operation, she was in a state of reduced consciousness. She was treated in an intensive care unit. Her consciousness level gradually recovered to alert in a week, but other symptoms such as ataxia, weakness on limbs, severe dysarthria, and dysphagia occurred. Since then, she had spent nearly 6 weeks in a bed-ridden state without improving.

DIAGNOSIS

SCD associated with vitamin E deficiency was confirmed by laboratory investigations, electrophysiologic test, and whole spine magnetic resonance imaging scans.

INTERVENTIONS

For vitamin E supplementation, she was administered a dose of 1200 mg/d. Physical therapy was focused on strengthening exercise, balance, and walker gait training. Occupational therapy was focused on activities of daily living training and dysphagia rehabilitation.

OUTCOMES

After 6 weeks, her muscle strengths and functional level were substantially improved. The vitamin E level was recovered to normal range.

LESSONS

This case suggests that if neurological symptoms occur in patients with intestinal obstruction, clinicians need to consider a deficiency of micronutrients such as vitamin E and vitamin B12. Patients with short clinical courses suffer less neurological damage and achieve faster recovery.

Effects of x-irradiation on survival and extracellular matrix gene expression of cultured keloid fibroblasts

Survival and extracellular matrix gene expression were studied by viable cell count assay and Northern transfer analysis to compare the sensitivity of normal skin and keloid fibroblasts towards x-irradiation. As the dosage of radiation increased, the numbers of viable cells in irradiated groups were remarkably decreased exponentially, with no significant difference between normal and keloid cell lines. By Northern blot analysis, there was no change in size of the mRNAs for pro alpha 1(I) collagen, fibronectin and beta-actin. By slot-blot hybridization, pro alpha 1(I) collagen mRNA levels in x-irradiated fibroblasts were markedly decreased compared with non-irradiated controls. The amounts of fibronectin and beta-actin mRNAs were also decreased. This study suggests that both normal skin and keloid fibroblasts are sensitive to x-irradiation, and that extracellular matrix gene expression is also affected by such exposure.