Cases reported "Stomach Neoplasms"

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1/387. Clinical value of protein-bound fucose in patients with carcinoma and other diseases.

    Protein-bound fucose content in sera from normal persons and patients with various malignant and non-malignant diseases was measured and statistically analyzed. Normal serum gave a mean value of 6.84 /- 0.13 mg/100 ml, and rarely exceeded 9 mg/100 ml. Although no significant difference was found between sexes, there was a tendency of fucose content to decrease in older persons. It was noted that more than 90% of cancer-bearing patients have significantly higher level than critical value (9 mg/100 ml), while only 8.7% of patients with benign tumor showed positive result. These results were not limited to special organs but in common to all cases studied. The elevation of serum fucose content in malignant tumor was well correlated with its stages of progression, though the levels were less significant in early and in rather locally restricted breast and thyroid cancer. Serial postoperative follow-up study showed that the levels in serum fucose content was a useful parameter for judging the effectiveness of therapy and the prognosis of the patient. The fucose content in malignant tumor tissue and metastasized lymph node appeared to be significantly elevated than that in normal tissue. The practical usage and limitation of the fucose value in various diseases, together with a possible source of serum fucose were discussed.
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2/387. Synchronous and metachronous gastric adenocarcinoma: case report and literature review.

    Whilst synchronous adenocarcinoma of the stomach is well documented, metachronous primary disease is exceedingly rare. We report a man with a family history of colonic and gastric cancer, who underwent a resection of a Duke's C adenocarcinoma of the rectum, aged 56 years, and a proximal partial gastrectomy for synchronous stage 1 gastric adenocarcinomas of the lesser curve, aged 61 years. Nine years later, a metachronous gastric primary was discovered in the gastric remnant, necessitating total gastrectomy. Total gastrectomy is the operation of choice for synchronous gastric primaries as it ensures clearance and prevents metachronous growth. However, it may not be appropriate for all gastric cancer as operative morbidity and mortality are increased, and because synchronicity and metachronicity of gastric cancer are uncommon. Moreover, there are no consistent data to demonstrate a survival advantage for total compared with partial gastrectomy for operable gastric cancer. If, after partial gastrectomy, synchronous disease is detected in the resected specimen (as in this reported case), endoscopic surveillance for metachronous disease is advised, since this may be amenable to surgical cure.
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3/387. Gastric leiomyoblastoma: report of three cases.

    Leiomyoblastoma is a rare smooth muscle tumor characterized by epithelioid cells with clear cytoplasms and an unknown biological behaviour. Since pre-operative diagnosis is difficult, the optimum strategy during the operation could be determined only by having a thorough knowledge about it beforehand. Leiomyoblastoma can be exogastric, intramural or endogastric. In the mostly benign exogastric leiomyoblastomas, total excision with resection of full thickness of gastric wall around the tumor is appropriate. Partial or total gastrectomy should be performed for intramural or endogastric tumors. We report one exogastric and two intramural gastric leiomyoblastoma cases treated in our hospital.
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4/387. A case of bleeding gastric lipoma: US, CT and MR findings.

    We report a case of gastric lipoma which manifested with an episode of acute gastrointestinal hemorrhage. Preoperative diagnosis was based on the US, CT, and MRI findings, as the results of gastrointestinal endoscopy were inconclusive. The role of current imaging methods, and particularly of MRI, is discussed.
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5/387. Simultaneous MALT-type lymphoma and early adenocarcinoma of the stomach associated with helicobacter pylori gastritis.

    We report about two cases of combined gastric lymphoma and gastric carcinoma with one of them representing a case of early gastric high grade B-cell lymphoma of mucosa-associated lymphoid tissue (MALT) with co-existing early gastric adenocarcinoma. In contrast to most previously reported similar cases, in both of our cases the definitive diagnosis of gastric lymphoma and carcinoma was obtained preoperatively. This, however, seems to be in future times an essential prerequisite for employing minimal invasive methods such as eradication therapy in the case of diagnosed early lymphoma and endoscopic treatment for early gastric carcinomas. These methods have been proven to be an effective and beneficial alternative treatment especially with regard to the life quality of the patients.
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6/387. Laparoscopic ultrasound guidance for laparoscopic resection of benign gastric tumors.

    Laparoscopic excision of gastric leiomyoma is technically feasible and safe, but it may fail to localize the exact placement of the lesion because of the lack of tactile sensitivity. The authors present two cases of small gastric leiomyomas that were resected by a totally laparoscopic approach, assisted with intraoperative laparoscopic ultrasonography because the lesions could not be palpated. A gastric wedge resection with tumor-free margins was performed with an endostapler device. Use of a harmonic scalpel to divide the gastroepiploic vessels facilitated the laparoscopic procedure.
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7/387. An unusual cause of haemorrhagic ascites following blunt abdominal trauma.

    Slow intraperitoneal haemorrhage following blunt abdominal trauma may present as haemorrhagic ascites. Such haemorrhage is usually due to rupture of spleen, liver or damage to small bowel mesenteric vasculature. We encountered a patient with bleeding from ruptured exogastric leiomyoblastoma. Two cases of traumatic rupture of gastric leiomyosarcomas have been reported previously. The operative treatment is usually delayed and the diagnosis established only at laparotomy. We suggest a high level of suspicion and early laparotomy.
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8/387. Possible development of idiopathic sclerosing encapsulating peritonitis.

    We report a rare case of idiopathic sclerosing encapsulating peritonitis (SEP). During a laparotomy before undergoing a distal gastrectomy with Billroth II reconstruction for early gastric cancer, the patient was found to have a membranous encapsulation wrapping each small bowel loop, unlike peritoneal encapsulation or typical SEP. He had complained of persistent heartburn, distension and diarrhea for 2 months in the post-operative course. The second laparotomy, which was performed to improve prolonged transit, revealed typical SEP with a thick and fibrotic membrane that encased the small bowel entirely. Stripping of the sclerosing encasing membrane, separation of the adherent loops of the proximal small bowel, and Braun's anastomosis were performed. The patient complained of epigastric fullness and diarrhea after he was relieved from the complete bowel obstruction for 45 days post-operatively. trimebutine maleate was administrated 5 months after the second operation and this markedly improved his symptoms. This case might reflect the developmental process of idiopathic SEP. In addition, the use of a motility regulator may improve symptoms related to the abnormal intestinal motility by this disease.
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9/387. Gastroduodenal intussusception secondary to a gastric carcinoma.

    A case of gastroduodenal intussusception secondary to transpyloric prolapse of a primary gastric carcinoma is reported. Both the condition itself and the leading tumor, gastric carcinoma, are extremely exceptional. A diagnosis of this rare entity was established pre-operatively by endoscopy that demonstrated spontaneous reduction of the intussusception. This may be the first documentation of spontaneous reduction of the gastroduodenal intussusception during endoscopy.
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10/387. Completely laparoscopic resection of a rare pyloric tumor with laparoscopically sutured gastroduodenostomy.

    We report the case of a 31-year-old woman who presented with epigastric pain and weight loss. Esophagogastroduodenoscopy revealed a submucosal mass in the distal antrum and pylorus. Endoscopic biopsy of the mass was nondiagnostic. A CT scan confirmed a 3.0-cm mass in the posterior wall of the distal antrum. She underwent laparoscopic resection of the distal antrum and pylorus with end-to-end gastroduodenostomy. Pathologic examination showed an adenomyoma of the antrum and pylorus. Her postoperative course was uncomplicated, and she continues to do well 38 months postoperatively. Gastric adenomyoma is a rare, benign intramural tumor of the antrum and pylorus. Fewer than 40 cases have been described in the literature. The lesions are generally within 4 cm of the pylorus. Histologically, they are characterized by ductal structures lined by cuboidal to columnar epithelium surrounded by smooth muscle bundles and, occasionally, Brunner's-type glands and heterotopic pancreas. Treatment is by resection, and recurrence has not been reported. Laparoscopic resection of portions of the stomach has been reported. Side-to-side gastrojejunostomies (Billroth II) performed laparoscopically have been reported. This is the first report in the English-language literature of a completely laparoscopically performed sutured gastroduodenostomy. Technical details of the procedure and adenomyomas are discussed.
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