Cricopharygeal dysfunction (CPD) may lead to a range of symptoms including dysphagia and aspiration. Treatments for CPD have included mechanical dilation, myotomy and botulinum injection. Recently, the use of botulinum toxin injection has been reported to be safe and effective for the treatment of CPD. Ultrasonography guided technique, however, is not well established. A 55-year-old woman visited the hospital with a left cerebellar, lateral medullary, and pons infarct 4 years ago. A three-year conventional dysphagia therapy had not improved the patient's condition. Nutrition had been provided via a percutaneous endoscopic gastrostomy (PEG) tube. Videofluoroscopic swallowing study (VFSS) showed CPD. Ultrasonography and elelctromyography-guided injection of 20 units of botulinum (Meditoxin®) in left cricopharyngeal muscle. One month after injection, the VFSS showed improvement in relaxation of the upper esophageal sphincter. The patient could eat semisolid food and a soft diet at 1,200 kcal/day orally; the treatment was a success.
Botulinum Toxins ; Deglutition ; Deglutition Disorders ; Diet ; Electromyography* ; Esophageal Sphincter, Upper ; Female ; Gastrostomy ; Humans ; Middle Aged ; Pons ; Relaxation ; Ultrasonography*

Gastrointestinal stromal tumors (GIST) are the most common mesenchymal neoplasm of the gastrointestinal tract. They are preferentially located in the stomach and small intestine. However, the duodenum is an unusual location for GIST. Here we present a case of a 67-year-old woman with a GIST of the 3rd portion of duodenum mimicking vascular neoplasm as an obscure acute gastrointestinal bleeding. The upper gastrointestinal endoscopy and colonoscopy failed to find the lesion. Finally, a large protruded lesion with ulcer was found at the 3rd portion of duodenum using a colonoscope through the oral approach. A spurting bleeding was developed during hypertonic saline epinephrine injection for treatment of oozing bleeding at the margin of the ulcer. Abdominal 3D CT-angiography showed a round and hypervascular structure at the posterior wall of duodenum. A wedge resection of the third portion of the duodenum was performed. Microscopic findings revealed GIST.
Aged ; Colonoscopes ; Colonoscopy ; Duodenum ; Endoscopy, Gastrointestinal ; Epinephrine ; Female ; Gastrointestinal Stromal Tumors ; Gastrointestinal Tract ; Hemorrhage ; Humans ; Intestine, Small ; Stomach ; Ulcer ; Vascular Neoplasms

Isolated middle cerebral artery (MCA) dissection with atherosclerosis is a rare entity, and its clinical progression is not well known. We recently came across a case of isolated MCA dissection with atherosclerosis. A 62-year-old man presented to the emergency department with right-sided weakness and mild aphasia. Diffusion-weighted imaging (DWI) showed a multifocal infarction in the left MCA region, and perfusion Magnetic resonance imaging (MRI) detected a moderate time delay in the left MCA region. High-resolution MRI and transfemoral cerebral angiography revealed that the atherosclerotic plaque was accompanied by the dissecting intimal flap. Despite 40 days of antiplatelet therapy, the ischemic stroke recurred and the dissection did not heal. After stenting, the MCA and intracranial circulation revealed a widened lumen and improved flow across the dissection, and no embolic sequelae in the distal intracranial circulation. This case suggest that in MCA dissection with atherosclerosis, early stage intracranial stenting may be a better therapeutic strategy than medical treatment, to prevent recurrent cerebral infarction