Cases reported "Gastrointestinal Diseases"

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11/18. Hydrostatic balloon catheters. A new dimension of therapeutic endoscopy.

    Disorders secondary to strictures of various segments of the gastrointestinal tract, e.g. esophagus, stomach, bile ducts, pancreas and colon often produce symptoms requiring continuing medical management or aggressive intervention. Until now, surgery has been required for failures of medical treatment. Endoscopically placed balloon catheters offer an alternative method for effectively treating a variety of gastrointestinal strictures. In this report we present examples of applications of balloon catheters in clinical gastroenterology.
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12/18. Endoscopic biopsy for improved accuracy in upper gastrointestinal tract diagnosis.

    Esophagogastroduodenoscopy has become the most accurate diagnostic method for identifying lesions of the upper gastrointestinal (GI) tract. It permits thorough inspection and a direct biopsy yielding a tissue diagnosis of surface lesions from the upper part of the esophagus to the second portion of the duodenum. The surgeon responsible for patients with upper GI tract disease should perform the endoscopic examination to gain first-hand information on the nature, extent, and location of the patient's problem. The surgeon-endoscopist gains an extra advantage, since the size and proximity of a lesion to the cardia, pylorus, or ampulla will determine surgical options available for the patient's problem. In patients with upper GI tract hemorrhage, the surgeon can determine immediately whether the bleeding is due to esophageal varices, Mallory-Weiss tear, gastric erosions, or an ulcer or tumor of the esophagus, stomach, or duodenum.
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13/18. A familial visceral myopathy.

    A kindred contained at least 18 members with visceral myopathy. Sixteen had symptoms of chronic obstruction of the gastrointestinal or urinary tracts. Of six patients with megaduodenum on contrast roentgenograms, two were asymptomatic. Four patients had redundant colon on barium enema, and four had megacystis. Specimens from duodenum, jejunum, ileum, colon, or urinary bladder from five patients showed thinning and extensive collagen replacement of the longitudinal muscle layer; ganglion cells were normal by light and electron microscopy. Esophageal manometry in three patients showed decreased gastroesophageal sphincter pressures and no contractions in the smooth muscle segment of the esophagus; duodenal manometry showed a low frequency and amplitude of contractions. Three patients developed fever and signs of peritonitis after operations to bypass dilated segments. This seems to be a generalized smooth muscle disease with variable clinical manifestations and with an autosomal dominant or sex-linked dominant mode of inheritance.
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14/18. Gastrointestinal involvement in tuberous sclerosis. Two case reports.

    Two patients with tuberous sclerosis had multiple semispherical polyps in the large intestine, predominantly in the rectosigmoid colon. These were hamartomas with an excess of smooth muscle fibers in the stroma. In addition, the 21-year-old man had multiple tiny protrusions in the esophagus and oral fibroepithelial polyps. In the 31-year-old woman, who had pulmonary lymphangiomyomatosis with positive estrogen and progesterone receptors, hamartomatous gastric polyps, colonic leiomyoma, and adenomatous rectal polyps were also identified. Our findings suggest that gastrointestinal polyposis may be one of the phenotypes of tuberous sclerosis complex, possibly linking this disease with other hereditary polyposis syndromes.
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15/18. Gastrointestinal manifestations of Cowden's disease. Report of four cases.

    Four patients with an established diagnosis of Cowden's disease underwent barium meal study, upper gastrointestinal endoscopy, barium enema examination, and colonoscopy. In three, the esophagus was affected by small protrusions, which were diagnosed as glycogenic acanthosis. Numerous hyperplastic polyps were found in the stomach in three patients, and in one an inflammatory fibroid polyp was also detected. Either lymphangiectasia or lymphoid polyps were found in the duodenum in two patients. In all patients, the colon showed polyps that varied in histology and included adenoma, hamartomatous polyp, and ganglioneurofibroma. In addition, jejunal lymphangiomas were found in one of the three patients in whom the small intestine could be precisely evaluated. These findings suggest that the gastrointestinal involvement in Cowden's disease is characterized by various benign lesions, especially esophageal glycogenic acanthosis, numerous gastric hyperplastic polyps, and multiple hamartomatous polyps in the rectosigmoid colon. Detection of these gastrointestinal manifestations may lead to early diagnosis of this potentially malignant disease.
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16/18. Gastrointestinal tract aspergilloma: possible cause of malabsorption.

    A 62 year old man with chronic lymphocytic leukaemia presented with malabsorption, the cause of which could not be found during life. Necropsy examination showed aspergillosis, limited to the stomach, where tumour-like masses were seen, the oesophagus, and lungs. This case illustrates the problems of diagnosing fungal infections in life and the importance of clinicopathological correlation at necropsy.
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17/18. Heterotopic bone formation in the gastrointestinal tract.

    Heterotopic bone is found rarely in the gastrointestinal tract. Here we report four cases, one of which occurred in Barrett's esophagus in an area of metaplasia of specialized cell type without evidence of neoplasia. In the remaining cases, bone was associated with mucin-producing tumors of the appendix, transverse colon, and rectum. The clinical and pathologic findings are discussed in detail. Heterotopic bone formation in the digestive tract usually occurs in the colorectum in association with benign or malignant epithelial tumors, and most often with those that produce abundant mucin. The pathogenesis of the osseous metaplasia in the gastrointestinal tract is not understood, although mucin extravasation is an almost constant feature. Fragments of metaplastic bone in a biopsy of a mucinous neoplasm of the digestive tract should not be misinterpreted as osseous invasion.
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18/18. Beta 2 microglobulin haemodialysis related amyloidosis: distinctive gross features of gastrointestinal involvement.

    Two cases of beta 2 microglobulin amyloidosis following long term haemodialysis found during necropsy are reported. The patients were 59 and 65 year old Japanese men, respectively. In both cases, systemic distribution of beta 2 microglobulin amyloid deposits was observed. The gastrointestinal tract including the stomach, small intestine, and colon showed the distinctive gross feature of rippled appearance, which was characterised by serosal wrinkles along the muscle layer arrangement. These areas were confirmed to contain deposits of beta 2 microglobulin in the muscularis propria. Although the outline of the muscle layers was preserved, most muscle fibres, encircled by the amyloid deposits, were atrophic or had disappeared microscopically. In neither case could a definite diagnosis of amyloidosis be made while the patient was alive. Interestingly, the oesophagus presented less involvement compared to the remainder of the gastrointestinal tract. In comparison with the AA or AL type of amyloidosis, beta 2 microglobulin haemodialysis related amyloidosis showed a rippled appearance of the serosal rather than mucosal changes, which may explain the difficulty in diagnosing amyloid deposits using biopsies of the gastrointestinal tract.
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