1/28. Treatment of radiation-induced proctitis with sucralfate enemas.OBJECTIVE: To report a case of radiation-induced proctitis treated with sucralfate enemas. CASE SUMMARY: A 77-year-old white woman was transferred from an acute care institution to our inpatient rehabilitation unit with impaired mobility and reduced activities of daily living. Her condition was secondary to myopathy and peripheral neuropathy associated with postradiation chemotherapy and metastatic ovarian carcinoma. During her stay, she developed hematochezia and pain secondary to a diagnosis of radiation-induced proctitis. Her hemoglobin had reached a nadir of 7.3 g/dL. The patient received blood transfusions and was started on 10% w/v sucralfate retention enemas 2 g/20 mL daily for 12 consecutive days. She was symptom-free at discharge, with a stable hemoglobin of approximately 10 g/dL. DISCUSSION: proctitis is a common adverse effect of radiotherapy to the lower abdomen and pelvic area. sucralfate is an aluminum complex that acts as a local cytoprotective agent against ulceration of the gastrointestinal mucosal lining. Rectal administration of sucralfate, as described in our patient and reported in published case studies, may provide an alternative therapy for patients with radiation-induced proctitis. CONCLUSIONS: sucralfate suspension enemas provide a viable treatment option in patients who are intolerant of, refractory to, or not candidates for standard therapy for radiation-induced proctitis.- - - - - - - - - - ranking = 1keywords = radiation-induced (Clic here for more details about this article) |
2/28. Surgical treatment of recalcitrant radiation-induced gastric erosions.BACKGROUND: Uncontrolled bleeding as a result of radiation gastritis in patients who have pharyngo-laryngo-esophagectomy and gastric pull-up is seldom reported. Surgical resection in the management of this condition has rarely been described. METHOD: A 66-year-old man with hypopharyngeal cancer was treated by pharyngo-laryngo-esophagectomy and gastric transposition. He received postoperative radiotherapy and had recurrent hemorrhagic gastritis, necessitating surgical resection. The manubrium was resected to access the mediastinal part of the gastric conduit. The diseased part of the gastric conduit was removed and a free jejunal graft was interposed to replace the resected stomach. RESULTS: Manubrial resection offered adequate access to the stomach transposed in the mediastinum, and the life-threatening bleeding gastritis was successfully controlled by surgical resection. CONCLUSION: Surgical resection of the radiation-damaged transposed stomach through a manubrial resection approach can safely be performed. Free jejunal graft is the choice of reconstruction of the circumferential defect.- - - - - - - - - - ranking = 0.5keywords = radiation-induced (Clic here for more details about this article) |
3/28. T-cell prolymphocytic leukemia with hemorrhagic gastrointestinal involvement and a new chromosomal abnormality.We report a case of T-cell prolymphocytic leukemia in a 56-year-old woman who exhibited hemorrhaging with gastric involvement as the first manifestation. This patient's condition was diagnosed as T-cell prolymphocytic leukemia based on the findings of lymphocytosis, abnormal immunophenotype, hepatosplenomegaly, lymphadenopathy, and cutaneous involvement. Endoscopic examination of the upper gastrointestinal tract revealed hemorrhage from a gastric lesion with histological involvement. cytogenetic analysis revealed chromosomal abnormalities, 46,XX,der(1), add(1)(p36), that have not previously been described in T-cell prolymphocytic leukemia. In spite of a transient response to chemotherapy, the patient died 15 months after onset of the disease.- - - - - - - - - - ranking = 0.016381835912128keywords = leukemia (Clic here for more details about this article) |
4/28. radiation-induced aortoesophageal fistula: an unusual case of massive upper gastrointestinal bleeding.Aortoesophageal fistula (AEF) is an unusual cause of massive upper gastrointestinal bleeding. Thoracic aortic aneurysm is the most common etiology of primary AEF followed by, respectively, foreign body ingestion, esophageal malignancy, and postsurgical fistulization. radiation-induced damage to the great vessels is well recognized and some authors in the past have suggested that AEF may be caused by radiotherapy. However, previous case reports of radiation-induced AEF involved patients who received radiotherapy for esophageal carcinoma, and precise histopathologic differentiation between AEF secondary to esophageal malignancy and that induced by radiation was difficult. We present here the unique case of a patient with a non-esophageal carcinoma who received radiotherapy before the development of an AEF, thus providing further evidence for the role of radiation injury in the development of this condition. As well, we discuss current opinion regarding etiology, clinical presentation, diagnosis, and management of this entity.- - - - - - - - - - ranking = 0.125keywords = radiation-induced (Clic here for more details about this article) |
5/28. octreotide treatment of massive hemorrhage due to cytomegalovirus colitis.cytomegalovirus (CMV)-associated colitis can result in abdominal pain, diarrhea, significant blood loss and perforation. The standard therapy for CMV colitis includes supportive measures and antiviral medications. Severe hemorrhage due to CMV colitis often necessitates surgical resection. We present a case of a patient who was undergoing chemotherapy for acute B-cell lymphoblastic leukemia and developed significant abdominal pain and diarrhea followed by massive hematochezia. colonoscopy showed numerous actively bleeding deep ulcers in the cecum. A provisional diagnosis of CMV colitis was made and she was started on ganciclovir. Histological assessment confirmed the diagnosis of CMV colitis. She continued to bleed profusely per rectum over the following five days, passing up to 1 L to 1.5 L of blood per day. She required 10 units of packed red blood cells over this time period. The patient refused surgical intervention and after discussion of possible options, octreotide was instituted. Her blood loss stopped almost immediately and she required no further transfusions. She tolerated the medication well and was discharged home at a later date in stable condition. This is the first reported case of the use of octreotide in the treatment of massive hematochezia from CMV colitis.- - - - - - - - - - ranking = 0.0023402622731611keywords = leukemia (Clic here for more details about this article) |
6/28. Chronic lymphocytic leukemia with portal hypertension and without liver involvement: a case report underlining the roles of increased spleno-portal blood flow and "protective" sinusoidal vasoconstriction.We report the case of a 72-year-old woman with well-controlled chronic lymphocytic leukemia (CLL) and splenomegaly who developed portal hypertension with bleeding oesophageal varices in the absence of liver fibrosis or regenerative nodular hyperplasia at surgical wedge liver biopsy. The hepatic venous pressure gradient (HVPG) was elevated and splenectomy resulted in both its normalisation and the regression of oesophageal varices. This case shows the potential for an increased spleno-poral flow to generate severe portal hypertension likely through a "protective" sinusoidal vasoconstriction.- - - - - - - - - - ranking = 0.011701311365806keywords = leukemia (Clic here for more details about this article) |
7/28. Successful treatment of massive gastrointestinal hemorrhage in acute biphenotypic leukemia with recombinant factor viia (NovoSeven).Acute biphenotypic leukemia is a very rare malignancy of childhood. Hemorrhage is a frequent complication of these patients. An 18-year-old-male with acute biphenotypic leukemia developed massive gastrointestinal bleeding that was thought to be due to thrombocytopenia during chemotherapy-induced pancytopenia and did not respond to conventional therapy. Although the prothrombin time and the partial thromboplastin time were within normal limits, inspired by the success in thrombocytopenia and platelet function disorders we decided to use recombinant activated factor VII (rFVIIa) as a last resort. After using a single dose (65 microg/kg) of rFVIIa on the fifth day of bleeding, the bleeding ceased immediately. rFVIIa may be a novel therapeutic alternative in leukemia or chemotherapy-associated massive bleeding.- - - - - - - - - - ranking = 0.016381835912128keywords = leukemia (Clic here for more details about this article) |
8/28. Granulocytic sarcoma of the colon and leukemic infiltration of the liver in a patient presenting with hematochezia and jaundice.Granulocytic sarcoma (GS) is an extramedullary tumor composed of immature cells of the granulocytic series known to occur in patients with myelodysplastic syndrome, chronic myelogenous leukemia, or acute myelogenous leukemia (AML). Involvement of the gastrointestinal tract is relatively rare in GS. We present an extremely rare case of GS of the colon and liver infiltration in a 60-year-old male patient with AML presenting with jaundice and hematochezia and review the literature. It should be kept in mind that hematochezia may be due to colonic involvement of GS besides thrombocytopenia which is usually encountered in patients with AML.- - - - - - - - - - ranking = 0.0046805245463222keywords = leukemia (Clic here for more details about this article) |
9/28. Recombinant activated factor VII for severe gastrointestinal bleeding after chemotherapy in an infant with acute megakaryoblastic leukemia.Recombinant activated factor VII (rFVIIa) is a major alternative for management of hemophiliac patients with inhibitors. Additionally, it has been used off-label for the treatment of massive life-threatening hemorrhage associated with various bleeding situations. Herein, we describe a 16-month-old boy with acute megakaryoblastic leukemia and severe intractable gastrointestinal bleeding controlled by rFVIIa. rFVIIa should be considered as a novel treatment alternative in severe bleeding conditions including leukemias that may have hemostatic defects and platelet dysfunction.- - - - - - - - - - ranking = 0.014041573638967keywords = leukemia (Clic here for more details about this article) |
10/28. Hyperbaric oxygen treatment of hemorrhagic radiation-induced gastritis after esophagectomy.My colleagues and I present 2 cases of hemorrhagic postesophagectomy gastritis after chemoradiotherapy for esophageal cancer. On the basis of the location of the gastritis (lesser curve and midstomach) and the classic radiation injury appearance, radiation damage was believed to be the cause. In both patients, hyperbaric oxygen therapy rapidly arrested bleeding. This is the first description in which hyperbaric oxygen therapy was used to treat hemorrhagic postesophagectomy gastritis.- - - - - - - - - - ranking = 0.5keywords = radiation-induced (Clic here for more details about this article) |
| | Next -> |