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11/30. Familial multiple upper gastrointestinal leiomyoma.

    This report describes three adult members of a family who developed leiomyomas in the muscularis propria of their upper gastrointestinal tract. When in their thirties, numerous leiomyomas were present in ileum and jejunum. In their sixties, multiple and confluent esophageal leiomyomas formed the clinical picture of esophageal leiomyomatosis. Presenting symptoms were esophageal obstruction and hemorrhage. This is the first case in the published literature describing an association of familial multiple upper gastrointestinal leiomyomas with esophageal leiomyomatosis. ( info)

12/30. role of computed tomography and endoscopy in the management of alimentary tract lipomas.

    Four cases of alimentary tract lipomas are described. While conventional radiology is unable to differentiate these tumours from the much commoner carcinomas, computed tomography and endoscopic examination may allow a definitive diagnosis thus sparing the patient major surgery. In selected cases endoscopic polypectomy is feasible and safe. ( info)

13/30. Endoprosthetic insertion for malignant obstructive jaundice: a retrospective review.

    We reviewed 13 cases of biliary endoprosthetic insertion for malignant obstructive jaundice from August 1983 to May 1987, and recorded (1) location and etiology of the obstruction, (2) length of time the endoprosthesis remained functional, and (3) complications related to the endoprosthesis, its insertion, or its long-term function. Of the 13 patients, 3 had pancreatic carcinoma, 3 had cholangiocarcinoma, and 3 had metastatic disease to the porta hepatis. The underlying malignancy was not histologically proved in four patients despite evidence of neoplasm by percutaneous cholangiography and computerized tomography. These four patients were not considered good surgical risks and were referred for percutaneous therapy. The longest endoprosthetic patency was 3.5 years. Three patients experienced obstruction of the endoprosthesis at 3, 4, and 9 months after insertion, respectively. Two of the endoprostheses were subsequently removed endoscopically, while the third was extracted through a new percutaneous tract with use of a balloon angioplasty catheter. Complications related to endoprosthetic insertion included bilous hydro pneumothorax (1 patient), subcutaneous and subcapsular liver abscess (1 patient), postinsertion cholangitis (4 patients), and reflex ileus (1 patient). ( info)

14/30. UCHL1-positive extranodal lymphoma resembling multiple lymphomatous polyposis of the gastrointestinal tract.

    Histopathologic and immunohistochemical studies were done on paraffin sections from a patient with alimentary tract lymphoma resembling multiple lymphomatous polyposis of the gastrointestinal tract (MLP). Diffuse, but not follicular, proliferation of medium-sized lymphoid cells was noted in the polypoid lesions of the alimentary tract, peripancreatic lymph nodes, spleen, liver, and bone marrow. These cells possessed a T-cell-related antigen (UCHL1), but were negative for the B-cell-related and myeloid cell-related antigens examined. Because neoplastic cells in MLP are usually of B-cell origin, the current case will provide important information on the relation between phenotypes and morphologic patterns of proliferation. ( info)

15/30. Perioperative use of long-acting somatostatin analog (SMS 201-995) in patients with endocrine tumors of the gastroenteropancreatic axis.

    The clinical manifestations of hormone excess caused by functioning neuroendocrine tumors of the gastroenteropancreatic (GEP) axis can be life threatening and frequently prove refractory to conventional antisecretory drugs. Administration of a long-acting somatostatin analog (SMS 201-995) proved effective in three patients with complex management problems related to GEP tumors. A patient with an insulinoma was maintained euglycemic intraoperatively with a single 100 micrograms dose of SMS given before surgery. Gastric suction in two patients with gastrinomas caused hypochlorhydric alkalosis that was preventable with preoperative SMS. Iatrogenic pancreatic fistula occurring after resection of a benign insulinoma healed within 4 days of SMS administration. This drug may be a useful adjunct in the perioperative management of patients with GEP endocrine tumors. Caution is advised regarding potential hazards related to malabsorption and gastric dysmotility. ( info)

16/30. diagnosis of submucosal tumors by injecting a water soluble contrast medium: diagnosis of extra-gastric tumors and gastric varices.

    Extra-gastric compression caused tumescent lesions that are difficult to differentiate from gastric submucosal tumors, and gastric varices similar in appearance to circumscribed tumors were sometimes experienced clinically. Up to now, the differential diagnosis of these lesions has been done by the palpation through x-ray examination or the tactile test under endoscopic examination. Even by the recent use of the CT scan, the differential diagnosis still remains unsatisfactory except in a few specific cases. Under these present circumstances, submucosography is recommended for routine screening test for outpatients. Our method is simple, safe and time-saving. Recently, it has become easy to diagnose hemangiomas as well as varices in the stomach by application of submucosography. Accordingly, in the cases of vascular tumors or tumescent lesions caused by extra-gastric compression, the risk of incidental major bleeding or perforation can be prevented by using the submucosography. ( info)

17/30. Absence of correlation between liver metastases and unexplained fever episodes.

    An accepted, although debatable explanation for fever of unexplained origin (FUO) in cancer patients is the presence of liver metastases. This controlled study was aimed to determine whether FUO is more common in patients with liver metastases (Group A) as compared to those without evidence of spread to the liver (Group B). One hundred forty-five patients were studied in each group. fever of unknown origin was experienced by 45 patients of Group A (31%) and 39 of Group B (26.9%). The duration and the fever characteristics were comparable in both groups. There was no relationship between the extent of the liver metastases and the incidence of FUO. That FUO was not caused by the presence of liver metastases per se, is deduced also from the remission of fever in 18 preoperative episodes after the resection of the primary tumor only, in spite of the persistence of the liver metastases. The type of fever and its duration was similar in patients with or without liver metastases. Thirteen severe infectious conditions were missed by the premature adoption of the convenient diagnosis of "fever due to liver metastases." indomethacin, administered to normalize the fever incorrectly attributed to the liver metastases, obscured four of the above infectious conditions, with a fatal outcome. The authors conclude that the existence of "fever due to liver metastases" as an entity is not supported by the current study, and that the premature adoption of this diagnosis further compromised the outcome of patients with liver metastases and unexplained fever. ( info)

18/30. Peutz-Jeghers polyposis associated with carcinoma of the digestive organs. Report of three cases and review of the literature.

    Three cases of Peutz-Jeghers polyposis with carcinoma of the digestive organs are studied. Although mucocutaneous pigmentation was not present in two of the three patients, the features of intestinal polyposis are consistent with those of peutz-jeghers syndrome. One patient had a carcinoma of the pancreas and the other two had carcinomas with colonic Peutz-Jeghers polyps. Previous reports on carcinomas associated with peutz-jeghers syndrome are reviewed. An unusual location in the gastrointestinal tract, together with occurrence at an early age, characterize the carcinoma in peutz-jeghers syndrome. In Japanese patients, the large bowel is the site of the greatest number of carcinomas. On the other hand, Western patients showed a relatively even distribution. A possible surveillance protocol for early detection of gastrointestinal carcinoma in patients with peutz-jeghers syndrome is discussed. ( info)

19/30. intermittent claudication associated with cancer--case studies.

    Cancer was diagnosed in 15 patients among 300 consecutive patients with intermittent claudication. The cancer-associated claudication is characterized by a more accelerated course of claudication, more often requires vascular surgery, and moreover, the lasting relief of claudication depends upon the efficiency of cancer therapy. It is the authors' impression that cancer-associated claudication is predetermined by atherosclerosis and aggravated by cancer through the chronic hypercoagulability state secondary to neoplasm. The clinical picture is characterized by rapid progression, with the frequent necessity of vascular surgery for limb salvage and a higher incidence of graft occlusion. awareness of this possibility of hidden malignancy may be related to the clinical picture of hemodynamic deterioration of the underlying arterial insufficiency. A high index of suspicion leads to earlier diagnosis of neoplasm. Effective oncologic therapy will often bring the symptomatic relief of ischemic symptoms in the lower extremities. This report indicates that associated neoplasm has a more vicious course of the underlying arterial insufficiency and intermittent claudication. ( info)

20/30. Condylomatous lesions of the upper aerodigestive tract.

    Condyloma acuminatum is one of four types of common human verrucous lesions that are of viral etiology. Also known as "moist wart," condyloma acuminatum is most often seen on the mucosal surfaces of the anogenital area. However, occurrences in the mucosal lined areas of the head and neck region are quite rare. Since 1901, 30 cases of condylomatous lesions have been reported in the upper aerodigestive tract, occurring mainly in the various regions of the oral cavity. Eighteen of the cases were confirmed by histopathologic documentation, while the remainder were anecdotal. We have recently encountered six new cases of condyloma acuminatum, verified by histologic examination. One occurred on the tongue, another in the tonsillar fossa, one in the hypopharynx and three on the vocal cords. We present these cases and review the previously reported cases. In addition, we will discuss the differential diagnosis of these lesions, and their importance to the practicing otolaryngologist. ( info)
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