1/32. The role of surgery in occult gastrointestinal bleeding.The surgeon is frequently involved in the management of patients with occult gastrointestinal bleeding. It is important to have a systematic approach to these patients to avoid the "looking for a needle in a haystack" approach to this problem. These are a group of patients who have undergone extensive standard gastroendoscopic evaluation and continue to bleed. Five percent of gastrointestinal bleeding occurs between the ligament of Treitz and the ileocecal valve. Therapeutic management may be guided by the age of the patient. patients aged younger than 50 years will usually bleed from readily identifiable palpable lesions, such as leiomyoma, Meckel's diverticulum, or other small-bowel tumors, whereas the patients aged older than 50 years most commonly bleed from angiodysplasias or arteriovenous malformations that are not palpable, frequently multiple, and may be evanescent.- - - - - - - - - - ranking = 1keywords = ligament (Clic here for more details about this article) |
2/32. Heavy transfusions and presence of an anti-protein 4.2 antibody in 4. 2(-) hereditary spherocytosis (949delG).BACKGROUND AND OBJECTIVE: A patient with hereditary spherocytosis (HS) was found not to have red cell membrane protein 4.2. This rare form of HS, or 4.2 (-) HS, stems from mutations within the ELB42 or the EPB3 genes. The patient had long suffered from a gastric ulcer and impaired liver function. He had had several dramatic episodes of gastrointestinal tract bleeding and had received numerous transfusions. An antibody against a high frequency, undefined antigen was found, creating a transfusional deadlock. We elucidated the responsible mutation and searched for an anti-protein 4.2 antibody. DESIGN AND methods: Red cell membranes were analyzed by SDS-PAGE and by Western blotting. Nucleotide sequencing was performed after reverse transcriptase-polymerase chain reaction (RT-PCR) and nested PCR. RESULTS: The not previously described mutation was a single base deletion: 949delG (CGCAECC, exon 7, codon 317) in the homozygous state. It was called protein 4.2 Nancy. The deletion placed a non-sense codon shortly downstream so that no viable polypeptide could be synthesized. The patient carried a strong antibody against protein 4.2 as shown by Western blotting. INTERPRETATION AND CONCLUSIONS: The manifestations resulting from the mutation described were compared with the picture of HS stemming from other ELB42 gene mutations. We discuss the mechanism through which the anti-protein 4.2 antibody developed. There was no way to establish or to rule out whether the antibody participated in the transfusional deadlock found in our patient.- - - - - - - - - - ranking = 0.03035450099858keywords = membrane (Clic here for more details about this article) |
3/32. Severe and relapsing upper gastrointestinal bleeding in a patient with Glanzmann's thrombasthenia.Glanzmann's thrombasthenia (GT) is a rare familial thrombocytic disease inherited as an autosomal recessive disorder that can induce hemorrhages due to a defect of platelet aggregation, resulting from the absence or reduced concentration of the membrane glycoproteic receptor binding the fibrinogen (integrin alpha(IIb)beta3). The gastrointestinal tract is the site of bleeding in only about 10% of cases but the related mortality is high (12.8%). Among the deaths due to hemorrhage, digestive bleeding causes 57.1%. According to reported data, the source of bleeding may be from preexisting gastroduodenal chronic and acute lesions. We report a case of severe and relapsing upper digestive bleeding in a woman with GT and coexisting thrombocytopenia (from HCV-related liver cirrhosis) and H. pylori-positive duodenal ulcer.- - - - - - - - - - ranking = 0.01517725049929keywords = membrane (Clic here for more details about this article) |
4/32. Anorectal melanoma: report of two cases.We have described the clinicopathologic findings in two cases of anorectal melanoma, and extracted the salient features from the medical literature. The disease is rare. melanoma arises from the anal squamous membrane and very often spreads upward through submucosal planes, producing secondary satelites in the rectum. Trauma from defecation, vast lymphatic and venous systems in the anorectal region, and high invasiveness of the tumor cells eviden;ly account for early distant metastases. Histologically, the neoplastic cells often mimic other cancers. Treatment is surgical, with dismal end results.- - - - - - - - - - ranking = 0.01517725049929keywords = membrane (Clic here for more details about this article) |
5/32. The radiology corner: metastasis to the colon.This case serves to illustrate the multiple routes which may occur in the dissemination of carcinoma of the stomach of the large bowel. Spread along the gastrocolic ligament involves the superior aspect of the transverse colon with limitation laterally by the phrenicocolic ligament. Once ascites has developed there is spread along the superior border of the sigmoid and lateral margin of the right side of the colon.- - - - - - - - - - ranking = 2keywords = ligament (Clic here for more details about this article) |
6/32. Massive bleeding from multiple jejunal diverticula associated with an angiodysplasia: report of a case.We report herein the case of a 70-year-old woman who presented with massive bleeding from multiple jejunal diverticula. She was initially admitted to our hospital with massive melena. An upper gastrointestinal endoscopic examination revealed no bleeding site. colonoscopy revealed clotted and red blood throughout the colon, and a small diverticulum in the ascending colon which was thought to be the source of bleeding. Following admission, she was treated conservatively at first, but melena continued and the anemia did not improve despite blood transfusions. A laparotomy was performed and multiple jejunal diverticula, distributed from 10 to 40 cm distal to the ligament of Treitz, were found. A segment of the jejunum containing all diverticula was resected. The most distal diverticulum contained a clot of blood, but no ulceration was observed. A histological examination revealed many dilated blood vessels in the mucosa and submucosa of this diverticulum, which were compatible with the findings of angiodysplasia. Based on these findings, we believe that angiodysplasia was the cause of bleeding from the jejunal diverticula in this case.- - - - - - - - - - ranking = 1keywords = ligament (Clic here for more details about this article) |
7/32. Massive gastrointestinal bleeding caused by ectopic pancreas mimicking jejunal tumor.BACKGROUND: Ectopic pancreas is usually an incidental finding at surgery or autopsy and rarely produces clinical symptoms. But it is capable of producing symptoms, depending on its location, size and involvement of the overlying mucosa. CASE REPORT: We report a case with massive gastrointestinal bleeding from ectopic pancreas mimicking jejunal tumor, confirmed by emergency operation. A 40-year-old male was admitted to Chonnam National University Hospital with a 2-day history of melena. A technetium-99m-labeled RBC scan showed massive radioactivity in loops of small bowel due to active bleeding. Superior mesenteric angiography revealed a hypervascular stained mass supplied by proximal jejunal branch. A computed tomographic scan of abdomen revealed an enhancing mass in the proximal jejunum. At emergency operation, bleeding from the center of the mass was found situated approximately 30 cm from the Treitz ligament. Segmental resection of the involved jejunum and end-to-end anastomosis were performed. Histologic examination of resected specimen revealed an ectopic pancreas. CONCLUSION: So far, there have been no case reports of massive gastrointestinal bleeding from ectopic pancreas mimicking jejunal tumor as described in our case. In every patient in whom ectopic pancreas can definitely be seen to cause clinical symptoms including gastrointestinal bleeding, the lesion should be excised.- - - - - - - - - - ranking = 1keywords = ligament (Clic here for more details about this article) |
8/32. Successful surgery using recombinant factor viia for recurrent, idiopathic nonulcer duodenal bleeding in a patient with Glanzmann's thrombasthenia.A 68-year-old man with Glanzmann's thrombasthenia suffered from recurrent cryptogenic bleeding originating in the upper duodenal flexure. Extensive endoscopic procedures and medical treatments were unsuccessful and proximal duodenectomy was proposed. In preceding years platelet transfusions had often had a suboptimal result and were complicated by allergic reactions. Surgery was carried out while he was being treated with recombinant factor viia. Neither major blood loss nor other complications occurred. Histological examination of the bleeding site failed to show abnormalities and the nature of this patient's bleeding problem remained unexplained. Glanzmann's thrombasthenia is a rare autosomal recessive disorder of platelet aggregation characterized by a lifelong bleeding tendency due to abnormalities of the glycoprotein IIb-IIIa membrane complex. Common clinical manifestations include purpuric type bleeding, epistaxis, menorrhagia and gingival bleeding. Spontaneous bleeding is uncommon but posttraumatic and postoperative hemorrhage may be particularly serious. There is no specific treatment. Prophylactic and therapeutic platelet transfusions are the cornerstone of supportive treatment. In many patients the efficacy of this approach is diminished by allo-anti-platelet antibodies. We report on a patient with Glanzmann's disease with recurrent nonulcer duodenal bleeding refractory to conservative medical treatment. Despite documented suboptimal effectiveness of platelet transfusions, he underwent successful surgery with administration of recombinant factor viia (rFVIIa).- - - - - - - - - - ranking = 0.01517725049929keywords = membrane (Clic here for more details about this article) |
9/32. Pseudomembranous gastritis: a complication from aspergillus infection.Pseudomembranes in the gastrointestinal tract are usually associated with the use of antibiotics, steroids, and severe immunosuppression. Reported cases of this condition have usually been confined to the large and small bowel. We discuss a 41-year-old woman who was transferred to The University of mississippi Medical Center for severe upper gastrointestinal bleeding after admission to an outside facility following a motor vehicle collision. Upper endoscopy revealed an antral ulcer with fungal hyphae found in the biopsy specimen. Because of her exsanguinating hemorrhage from her gastric pathology a total gastrectomy was performed. Pathological inspection of the stomach revealed a green/brown pseudomembranous gastritis throughout the entire stomach. aspergillus cultures confirmed the etiologic agent. The patient later fell into multiorgan system failure and died. autopsy results showed no aspergillus in other organ systems. The current literature suggests that this is the first reported case of isolated pseudomembranous gastric aspergillosis.- - - - - - - - - - ranking = 0.01517725049929keywords = membrane (Clic here for more details about this article) |
10/32. Atypical pancreatic pseudocysts.The authors present three cases of atypical pancreatic pseudocysts, occurring in the course of chronic pancreatitis: intrasplenic pseudocyst, pseudocyst in the hilus of spleen and bleeding into the pseudocyst of the tail of pancreas. Such cysts are extremely difficult, or even impossible to be recognized by conventional clinical and radiological methods. Located in the parenchyma or in the hilus of spleen, they are formed by means of fistulization along the lienorenal ligament. In every case when the chronic pancreatitis coexists with the splenic cyst, the intrasplenic localization of the pancreatic speudocyst should be taken into consideration. The cyst in the hilus of spleen may imitate intraperitoneal mass and its relation with the pancreas may be recorded angiographically only. angiography is also the basic diagnostic method in the haemorrhage into the pseudocyst. Bleeding into the pseudocyst has a form of vascular blush appearing during arteriography. The blush increases its intensity and persists after an examination. early diagnosis in atypical pseudocyst is vital for the patient's fate.- - - - - - - - - - ranking = 1keywords = ligament (Clic here for more details about this article) |
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