Neurofibromatosis (NF) is a genetic neurological disorder which can lead to abnormal tumour suppression. Neurofibromatosis associated neurological tumour is usually benign in nature, only occasionally can become malignant. Gastrointestinal involvement is reported to be infrequent with only up to 25% of patients with neurofibromatosis showing involvement. Solitary gastrointestinal neurofibroma is very rare, with most cases involving the stomach or small bowel. We report here a case of solitary small intestinal neurofibroma with no other associated systemic signs, causing intussusception and intestinal obstruction.
Positron Emission Tomography-Computed Tomography (PET-CT) was introduced over four decades ago as an imaging tool to evaluate functional and anatomical aspects of disease such as malignancy. Besides pathological uptake, PET-CT also shows physiological uptake, especially in the gastrointestinal system, thus impacting diagnostic accuracy in these cases. There are many conditions that can attribute to increasing physiological uptake in PET-CT including microbial activity and drugs. Therefore, certain anti-spasmodic agents have been introduced to help reduce physiological uptake during scanning such as Hyoscine-n-butylbromide (Buscopan). This study aims to establish its effectiveness in reducing physiological bowel uptake on 18F-FDG PET-CT scan. Methods: 133 subjects were recruited in random for this study and divided into hyoscine (68 subjects) and control groups (65 subjects), respectively. Subjects in control group not given any anti-spasmodic medications and both groups received intravenous 18F-FDG according to body weight. PET-CT scan and images were interpreted by experienced nuclear medicine physician who scored the images according to the degree of bowel uptake and difficulty of image interpretation. Results: There were no statistical difference in bowel uptake based on SUV mean of the bowel and bowel-to-liver ratio between hyoscine and control groups. Conclusion: There was no significant effect of Hyoscine-n-butylbromide in reducing physiological bowel uptake in PET-CT scan.
Mitragyna speciosa (Korth.) or kratom is a native medicinal plant of Southeast Asia. Commonly used by hard labours in harsh working environment, the ingestion of brewed kratom decoction is reported to produce dose-dependent stimulant and opioid-like effects. Kratom is also regularly consumed as a pain killer and as traditional cure for common maladies such as fever and cough. However, it remains unknown whether regular consumption of kratom decoction is associated with brain abnormalities in regular users in traditional settings. Methods: A total of 14 subjects (7 regular kratom users and 7 non-kratom users) voluntarily participated in this cross-sectional study. Face-to-face interviews were conducted with kratom users to determine history of kratom use and later these respondents underwent brain magnetic resonance imaging (MRI). Results: There were no significant differences (p>0.05) in the intracranial volume (ICV), cortical volumes (frontal, parietal, temporal, occipital, or cingulate lobe), or subcortical volumes (striatum, hippocampus, or amygdala), as well as in the diffusion tensor imaging (DTI) metrics, fractional anisotropy (FA) and mean diffusivity (MD) between kratom users and the controls. Conclusion: This preliminary study showed long-term consumption of kratom decoction is not significantly associated with altered brain structures in regular kratom users in traditional settings. However, further study is needed to establish more data for kratom use and its effects.