1/188. Primary gastric T-cell lymphomas: report of two cases and a review of the literature.To understand more fully the clinicopathological features of primary gastric T-cell lymphomas (PGTL), we report two cases of PGTL and review the literature. The present cases were not associated with human T-cell leukemia virus type 1 (HTLV-1) and were at clinical stage IIE. In both cases, T-cell origin of the lymphoma cells was diagnosed immunohistochemically. The clinical courses of these two cases were different: one followed a very aggressive clinical course and the patient died 6 months after the diagnosis, whereas the other patient survived more than 2 years without adjuvant chemotherapy. Clinicopathological features of 23 patients with PGTL are summarized with regard to their differences from primary small intestinal T-cell lymphomas (PSITL) and by association with HTLV-1. The median age at onset of PGTL was 58 years. The gender ratio was male-dominant (M:F = 2.3:1). About two-thirds (10 of 17) of PGTL cases had evidence of HTLV-1 infection. The most common presenting symptom for PGTL was upper abdominal discomfort and/or pain (76%), whereas that in PSITL was weight loss (61%) and diarrhea (42%). Typical lesions for PGTL were large ulcerations at the corpus to antrum. Neoplastic cells had no typical morphological characteristics for PGTL including HTLV-1-associated cases. CD3 4 8- was the most frequently observed surface phenotype of PGTL cells. Laboratory findings at diagnosis were not informative. Most patients were treated by gastrectomy with or without chemotherapy. PGTL, excluding that with HTLV-1, showed better prognosis than PSITL, although PGTL with HTLV-1 had a poorer prognosis.- - - - - - - - - - ranking = 1keywords = pain, upper (Clic here for more details about this article) |
2/188. clostridium difficile infection of a prosthetic joint presenting 12 months after antibiotic-associated diarrhoea.clostridium difficile is a common cause of antibiotic-associated diarrhoea, but it rarely causes extra-colonic disease. An 83-year-old woman who developed culture-positive C. difficile-associated diarrhoea following pneumonia and a total hip replacement was treated successfully with oral metronidazole therapy. She was readmitted 12 months later for revision of the hip prosthesis because of increasing pain. At surgery an abscess associated with the prosthesis was discovered. culture of the pus grew C. difficile. When the surgical isolate and the cryopreserved faecal isolates were compared using Pulsed Field Gel electrophoresis (PFGE), an identical banding pattern was observed. This case extends the clinical spectrum of C. difficile infection by documenting a prolonged interval between the initial infection, and diagnosis of the prosthetic joint infection. The importance of molecular typing to show strain relatedness is demonstrated.- - - - - - - - - - ranking = 0.9855789213341keywords = pain (Clic here for more details about this article) |
3/188. clostridium difficile diarrhea and colitis: a clinical overview.infection with toxin-producing strains of clostridium difficile is common and potentially life-threatening. It occurs mostly in patients in the hospital or nursing home who are taking or have recently taken antibiotics. Two toxins, A and B, damage the colonic mucosa, resulting in symptoms ranging from mild diarrhea to bloody diarrhea with fever and abdominal pain, colitis, or even pseudomembranous colitis. Severe cases may involve dehydration, toxic megacolon, or colonic perforation. This article reviews the microbiology, epidemiology, clinical manifestations, diagnosis, treatment, and prevention of this disease.- - - - - - - - - - ranking = 20.084818542004keywords = abdominal pain, pain (Clic here for more details about this article) |
4/188. 5-fluorouracil-induced small bowel toxicity in patients with colorectal carcinoma.BACKGROUND: diarrhea and oral mucositis are the most frequently reported gastrointestinal side effects caused by 5-fluorouracil (5-FU). diarrhea may be severe in 10-30% of patients and is schedule-dependent. 5-FU-induced gastrointestinal toxicity predominantly affects the upper and the lower gastrointestinal tract. The current study describes 5-FU-induced small bowel toxicity as an entity that to the authors' knowledge has not been reported previously in patients with colon carcinoma receiving 5-FU-based therapy. methods: The authors report a series of six patients with colorectal carcinoma who developed acute small bowel toxicity after treatment with 5-FU and leucovorin. RESULTS: Six patients developed a clinical picture of acute abdominal pain and diarrhea. Small bowel damage was documented by laparotomy in two patients, by colonoscopy in one patient, and by abdominal computed tomography scan in three patients. The course was complicated by recurrence of symptoms in one patient who was rechallenged with 5-FU and leucovorin, but the remaining four patients were rechallenged safely with lower doses of 5-FU and leucovorin after the acute toxicity episode. A possible explanation for this toxicity is 5-FU-induced vasospasm and/or decrease in fibrinolytic activity that results in decreased mucosal blood flow. CONCLUSIONS: 5-FU-induced small bowel toxicity is a potentially severe toxicity that may occur in patients with colon carcinoma or other malignancies who are receiving 5-FU-based therapy. [See editorial on pages 1099-100, this issue.] copyright 1999 american cancer society.- - - - - - - - - - ranking = 20.09923962067keywords = abdominal pain, pain, upper (Clic here for more details about this article) |
5/188. Intestinal capillariasis acquired in egypt.A 34-year-old Egyptian man presented with a 4-month history of profound weight loss, diarrhoea and abdominal pain. Extensive investigations in egypt had failed to provide a diagnosis but subsequent stool examinations revealed ova of capillaria philippinensis. The patient made a slow but complete recovery after treatment with albendazole. The literature on intestinal capillariasis is reviewed.- - - - - - - - - - ranking = 20.084818542004keywords = abdominal pain, pain (Clic here for more details about this article) |
6/188. Colonic spasm and pseudo-obstruction in an elongated colon secondary to physical exertion: diagnosis by stress barium enema.Anatomic and functional abnormalities of the colon are known to cause a variety of abdominal complaints, including constipation, diarrhea, and pain. We describe a patient with dolichocolon (elongated colon) with transient spasm (pseudo-obstruction) associated with exertion. The diagnosis in this case rested with a novel approach and less invasive evaluation of the colon.- - - - - - - - - - ranking = 0.9855789213341keywords = pain (Clic here for more details about this article) |
7/188. capillaria philippinensis: an emerging parasite causing severe diarrhoea in egypt.Four cases with capillaria philippinensis have been reported from egypt during 1989-1992. The authors report here four other cases of severe diarrhoea caused by this parasite. A male and three female patients aged 12-45 years presented with severe diarrhoea of 1-7 months duration associated with vomiting and central abdominal colics. Stools were yellowish or greenish and voluminous. anorexia was profound with loss of weight. Bilateral painless ankle oedema developed early in the course of the disease and two cases had ascites and bilateral pleural effusion at presentation. There was hyponatraemia, hypocalcaemia and marked hypokalaemia and hypoalbulinaemia. Small bowel series showed a rapid transit time in 3 cases and malabsorption pattern in one. Duodenal biopsies showed non-specific chronic inflammation while jejunal biopsies from one case revealed grade II villous atrophy with moderate cellular infiltration of lamina propria. The infection was diagnosed by finding the eggs, larvae and adult worms of C. philippinensis in stool. patients were treated with mebendazole 400 mg/day in two divided doses for 28 days in addition to high protein diet and correction of electrolyte disturbance. vomiting stopped on the second day of treatment, appetite improved and diarrhoea regressed by the fourth day. Unfortunately, one case died two days after admission due to marked hypokalaemia. Clinico-pathological and epidemiological aspects of this infection in egypt are discussed.- - - - - - - - - - ranking = 0.9855789213341keywords = pain (Clic here for more details about this article) |
8/188. Thymic carcinoid and parathyroid hyperplasia detection with 99mTc-MIBI men type 1.We report a case of a 35-year-old male, with a history of diarrhea, renal lithiasis with frequent expulsions of calculus and hypercalcemia during the last 2 years. The patient was studied and diagnosed with a multiple endocrine neoplasia type I (MEN I), familiar (mother with MEN I). A scintigraphic study with 99mTc-MIBI was performed in order to localize hyperfunctioning parathyroid glands because of biochemical diagnosis of primary hyperparathyroidism. Double phase 99mTc-MIBI scan detected one hyperfunctioning parathyroid gland and a large anterior mediastinal mass. Subsequent, plain radiograph and CT of the chest showed a soft-tissue mass in that localization. Punch biopsy of the lesion guided by CT revealed malignant cells of neuroendocrine tumor. The tumor was removed and histologically confirmed as a carcinoid within a thymus in a MEN type I syndrome. MEN I patients can benefit from the examination with this agent which can potentially localize not only parathyroid endocrine pathology but also unknown associated tumors.- - - - - - - - - - ranking = 0.0038980548402627keywords = chest (Clic here for more details about this article) |
9/188. Fibrosing colonopathy in an adult owing to over use of pancreatic enzyme supplements.A woman, then in her late 20s, underwent a cholecystectomy in 1962 for gallstone disease and subsequent common bile duct stones were managed endoscopically. However, because of unrelenting pain, a pylorus preserving pancreaticoduodenectomy was done in 1990 and in the following years the patient took large amounts of pancreatic enzyme supplements. She developed large bowel obstruction in 1997 and a right hemicolectomy was undertaken. histology confirmed fibrosing colonopathy of the ascending colon and caecum. Her pancreatic enzyme dose was reduced and her subsequent course has been uncomplicated.- - - - - - - - - - ranking = 0.9855789213341keywords = pain (Clic here for more details about this article) |
10/188. Pitfall: a pseudo tumor within the left liver lobe presenting with abdominal pain, jaundice and severe weight loss.A 51 year old male patient with a history of chronic alcohol consumption and recurrent pancreatitis was referred to our hospital with jaundice, epigastric pain, severe diarrhoea and weight loss of 28 kg within the last 12 months. A CT scan of the abdomen 4 months before admission had shown a pancreatitis with free fluid around the corpus and tail of the pancreas as well as dilated intrahepatic bile ducts and a cavernous transformation of the portal vein. Moreover, a tumor (3.5 x 3.0 x 3.6 cm) with irregular contrast enhancement was seen within the left liver lobe. The patient was referred to us for further evaluation and treatment. The initial B-Mode sonogram revealed a bull's eye like well defined lesion (8.1 x 7.5 x 7.0 cm) within the left liver lobe, consistent with a tumour or abscess. Prior to a diagnostic needle biopsy a PTCD was performed in this case presenting with dilated intrahepatic bile ducts and having a history of Billroth II operation. An additional colour coded Duplex Doppler ultrasonography demonstrated a visceral artery aneurysm and prevented us from performing the diagnostic puncture. The aneurysm was assumed to originate from a variant or a branch of the left hepatic artery. angiography revealed a pseudoaneurysm of the pancreaticoduodenal artery and coil embolization was performed because of the increasing size and the risk of a bleeding complication. Postinterventional colour duplex ultrasound measurement showed no blood flow within the aneurysm. Retrospectively, the pseudoaneurysm must have led to a compression of the common bile duct, since the patient did not develop cholestasis after embolization and removal of the PTCD. Thus, a pseudoaneurysm of the pancreaticoduodenal artery must be included in the differential diagnosis of liver tumours in patients with chronic pancreatitis, despite its unusual localization near the liver. Therefore, we suggest that colour coded ultrasonography should be applied to any unclear, bull's eye like lesion, even though this method alone cannot exactly determine the origin of the pseudoaneurysm. Interventional angiography remains the gold standard for the diagnosis and therapy of visceral artery aneurysm.- - - - - - - - - - ranking = 81.324853089349keywords = abdominal pain, pain (Clic here for more details about this article) |
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