1/295. Surgical management of necrotizing candida esophagitis. Invasive esophageal candidiasis produced transmural necrosis leading to perforation in 2 patients aged 10 and 27 years. Both patients survived after esophageal resection and complete diversion. One patient with acute leukemia and neutropenia experienced systemic candidiasis, which resolved after esophagectomy. esophagectomy and diversion for yeast-induced necrosis may lead to complete recovery and resolution of disseminated candidiasis when combined with systemic antifungal therapy. ( info) |
2/295. esophagitis dissecans superficialis associated with pemphigus vulgaris. The extension of bullous lesions in pemphigus to the esophagus is relatively uncommon, especially in patients who appear to be in clinical remission. Very rarely, pemphigus vulgaris may affect the entire esophagus, resulting in complete sloughing of the mucous membrane. A 20-year-old man with pemphigus vulgaris presented to the emergency room with acute onset of dysphagia, odynophagia, and hemoptysis. There were no cutaneous or oral findings of pemphigus on presentation, since he was being maintained on corticosteroids and azathioprine with excellent results. During initial evaluation in the emergency room, the patient was observed to vomit a cast of the mucosal lining of the esophagus. The morphologic description of such an esophageal cast is termed esophagitis dissecans superficialis. This is the third case of esophagitis dissecans superficialis in pemphigus vulgaris recorded in the medical literature. ( info) |
3/295. Differential diagnosis of chest pain: a case report. chest pain in a common presenting complaint in many healthcare settings, including Gl settings. It may be caused by a variety of cardiac and noncardiac abnormalities. nurses can play a critical role in the differential diagnosis of chest pain by obtaining a thorough history and conducting a directed physical examination. This article describes the differential diagnosis of chest pain through a case presentation. ( info) |
| The esophagus is one of the most common sites of gastrointestinal involvement in human immunodeficiency virus (HIV)-infected patients, with at least 30% of the patients having esophageal symptoms at some point during the course of HIV infection. Esophageal ulcers are commonly caused by infections such as cytomegalovirus (CMV) or may be idiopathic. The clinical presentation of the various causes of esophageal ulcers are similar; therefore, a thorough endoscopic and histological workup is imperative to make a diagnosis and, consequently, to provide appropriate therapy. The widespread use of more effective antiretroviral therapy appears to have led to a decline in gastrointestinal opportunistic disorders in patients with acquired immunodeficiency syndrome (AIDS), including those involving the esophagus. Unfortunately, there are several reports of resistance of hiv-1 to multiple antiretroviral agents, and thus it is possible we will observe an increase in various opportunistic disorders again. The aim of this article is to provide a practical approach to the clinical, endoscopic, and histopathologic evaluation of esophageal ulcers in patients with AIDS. ( info) |
| Roentgenographic changes in a case of tuberculosis involving the esophagus were ulceration and narrowing of the esophagus, and sinus tracts to the mediastinum. Disseminated tuberculosis was discovered only at autopsy. The diagnosis of tuberculous esophagitis in a patient with no other demonstrable tuberculous lesions is difficult, as clinical and roentgenographic findings are not specific. ( info) |
| A 25-year-old woman with diabetic ketoacidosis and esophagitis was given total parenteral nutrition to improve her nutritional status. A central venous catheter inserted in the right subclavian vein was well tolerated for three weeks, when infection developed. The line was replaced by a left subclavian line. Within an hour the patient complained of back pain. A chest x-ray film showed that the tip of the catheter was to the left of the mediastinum and that left pleural effusion was present. The line was removed and 1,500 cc of fluid was removed from the left pleural space. The pleural fluid cleared gradually over several days and the patient became asymptomatic. ( info) |
7/295. Gastroesophageal involvement in herpes simplex. herpes simplex in the gastric mucosa has not been previously described. The case presented here describes gastritis and esophagitis resulting from herpes simplex in a patient being treated with immunosuppressive agents. These changes were confirmed endoscopically and radiographically. biopsy specimens of the gastric and esophageal mucosa showed eosinophilic intranuclear inclusion bodies typical of herpes simplex. The pathogenesis and pathological appearance of herpetic gastritis and esophagitis are presented. ( info) |
8/295. esophagitis induced by combined radiation and adriamycin. With the increasing use of combined chemotherapy and radiotherapy in the treatment of certain types of malignancy, a clinically distinct type of esophagitis has been recognized as an undesirable side effect. It occurs with low doses (less than 2,000 rad) of mediastinal radiation in patients who simultaneously or sequentially receive either adriamycin or actinomycin D. Characteristic of this entity is "recall": recurrent episodes of esophagitis with each course of chemotherapy. The radiographic findings are nonspecific, ranging from subtle alterations in motility to severe damage with irreversible stricture formation. The primary differential diagnostic considerations are infectious processes. The radiographic spectrum, clinical aspects, and differential diagnoses in five patients are discussed. ( info) |
9/295. Laryngeal cleft and eosinophilic gastroenteritis: report of 2 cases. Although laryngotracheoesophageal clefts are often found in association with other well-described anomalies, we know of no previous reported association with eosinophilic gastroenteritis, a disorder of unknown etiology characterized by eosinophilic infiltration of the gastrointestinal tract. We treated 2 children who had laryngeal clefts and eosinophilic gastroenteritis. Since the esophageal inflammatory changes found in eosinophilic gastroenteritis may persist despite aggressive therapy, management of the laryngotracheoesophageal clefts is more complicated. The diagnosis of eosinophilic gastroenteritis should not be overlooked in patients with laryngotracheoesophageal clefts and warrants prompt referral to a pediatric gastroenterologist. ( info) |
| A 28-year-old white male with AIDS-C3 staging, presented with an extensive hemorrhagic dark mass localized in the left orbit. No other ophthalmic findings were disclosed. ultrasonography and computed axial tomographic scans showed orbital involvement. Orbital Kaposi's sarcoma is a rare finding and only a few cases have been reported. Systemic examination revealed other lesions suggestive of disseminated mucocutaneous Kaposi's sarcoma, oral candidiasis, membranous esophagitis and granulomatous hepatitis. Eyelid incisional biopsy disclosed Kaposi's sarcoma. Despite intensive chemotherapy progression was aggressive with a fatal outcome. ( info) |