1/39. anorexia nervosa with severe liver dysfunction and subsequent critical complications.A twenty-year-old woman with anorexia nervosa (body mass index=11) suffered from severe liver dysfunction (aspartate aminotransferase 5,000 IU/l, alanine aminotransferase 3,980 IU/l, prothrombin time 32%), hypoglycemia (serum glucose 27 mg/dl), and pancreatic dysfunction (amylase 820 IU/l, lipase 558 IU/l). She fell into a depressive state with irritability, which was not improved by intravenous glucose. Despite treatment with plasmapheresis for the liver dysfunction, she subsequently developed pulmonary edema, acute renal failure, gastrointestinal bleeding, and disseminated intravascular coagulation. Hemodialysis, mechanical ventilation and drug therapy including prednisolone, prostaglandin E1, and branched-chain amino acid, improved her critical condition. In this case, malnutrition may have been the cause for the liver dysfunction and subsequent complications.- - - - - - - - - - ranking = 1keywords = gland (Clic here for more details about this article) |
2/39. Hemorrhage from the gastroesophageal junction. A cryptic angiographic diagnosis.The angiographic localization of gastroesophageal-junction hemorrage emanating from the left inferior phrenic artery (which originated from the abdominal aorta) is described. The diagnosis was established after conventional selective celiac and left gastric arteriography failed to demonstrate extravasation. The arteriographic evaluation of upper gastrointestinal hemorrhage requires consideration of the variable arterial distribution to the gastroesophageal junction and an awareness of the variable causes of dense opacification (including superimposed adrenal glands) that may mimic extravasation.- - - - - - - - - - ranking = 1keywords = gland (Clic here for more details about this article) |
3/39. Cyclooxygenase-2 inhibitor celecoxib: a possible cause of gastropathy and hypoprothrombinemia.Gastrointestinal side effects from nonsteroidal anti-inflammatory drugs (NSAIDs) result mainly from inhibition of the enzyme cyclooxygenase (COX)-1; it is responsible for the synthesis of prostaglandin E2, which leads to increased mucosal blood flow, increased bicarbonate secretion, and mucus production, thus protecting the gastrointestinal mucosa. In inflammation, COX-2 is induced, causing synthesis of the prostaglandins in conditions such as osteoarthritis and rheumatoid arthritis. Two NSAIDs (celecoxib and rofecoxib) with very high specificity for COX-2 and virtually no activity against COX-1 at therapeutic doses have been approved for clinical use. In trials of celecoxib and rofecoxib, only 0.02% of patients had clinically significant gastrointestinal bleeding, compared to a 1% to 2% yearly incidence of severe gastrointestinal side effects with NSAIDs. Our patient had arthritis of the hips and chronic atrial fibrillation and was on warfarin therapy for stroke prevention; less than a week after starting celecoxib therapy, gastrointestinal bleeding and hypoprothrombinemia occurred.- - - - - - - - - - ranking = 2keywords = gland (Clic here for more details about this article) |
4/39. Nonsteroidal antiinflammatory drugs: benefits, risks, and COX-2 selectivity.Nonsteroidal antiinflammatory drugs (NSAIDs) are the most frequently prescribed class of medication for arthritis and other musculoskeletal disorders. NSAIDs block prostaglandin production, thereby reducing pain and inflammation, but may also cause significant side effects, particularly ulcers in stomach and duodenum. Some risk factors include age, previous history of ulcer, and high dose of NSAID. Synthetic prostaglandins, H2 blockers, and proton pump inhibitors have been employed to reduce risks with varying degrees of success. New NSAIDs that block only prostaglandins at sites of inflammation (COX-2 selective NSAIDs) may be significantly safer than traditional NSAIDs.- - - - - - - - - - ranking = 3keywords = gland (Clic here for more details about this article) |
5/39. A giant Brunner's gland adenoma presenting as gastrointestinal hemorrhage.Brunner's gland adenomas are rare tumors of the duodenum that are usually small in size. Only a few cases of tumors more than 4 to 5 cm in size are reported in the literature. Although the majority of patients are asymptomatic, hemorrhage and obstruction are the most clinically significant manifestations. We report a case of Brunner's gland adenoma in which the patient presented with major gastrointestinal bleeding. Endoscopic, radiologic, and endosonographic appearances are illustrated.- - - - - - - - - - ranking = 6keywords = gland (Clic here for more details about this article) |
6/39. A case of parotid mucoepidermoid carcinoma complicated by fatal gastrointestinal bleeding.Mucoepidermoid carcinoma is one of the most common of the salivary gland neoplasms. Histologically, it is classified as either a low-, intermediate-, or high-grade tumor, and there are significant differences in prognosis among the different grades. patients with low-grade disease have an excellent chance of survival. High-grade tumors behave aggressively, and they frequently manifest as local recurrences and distant metastases. We describe a case of a high-grade mucoepidermoid carcinoma of the parotid gland that had metastasized to the skin, stomach, and liver. The disease culminated in a rapidly fatal bleeding from the stomach metastasis. Such a complication is unusual and to our knowledge has not been previously reported. We briefly discuss the clinical features, biologic behavior, and treatment of this tumor.- - - - - - - - - - ranking = 2keywords = gland (Clic here for more details about this article) |
7/39. Esophageal intramural pseudodiverticulosis: review of symptoms including upper gastrointestinal bleeding.BACKGROUND: Esophageal intramural pseudodiverticulosis (EIP) is a rare condition manifested by multiple, flask-shaped outpouchings in the wall of the esophagus, which represent dilated excretory ducts of esophageal mucous glands. STUDY: Five patients with EIP were evaluated with regard to symptoms and concomitant diseases, as well as endoscopic, radiologic, and manometric findings. RESULTS: Primary clinical symptoms reported by the five patients (three men and two women; age range, 59-72 years) were increasing dysphagia ( n = 3), upper gastrointestinal bleeding ( n = 1), and no symptoms ( n = 1). Concomitant diseases were chronic alcoholism ( n = 3), diabetes mellitus ( n = 1), and reflux esophagitis ( n = 1). Primary diagnosis was made endoscopically in all cases. Endoscopic findings other than pseudodiverticula were esophageal webs ( n = 2) and proximal esophageal stenoses ( n = 4). The typical radiologic findings were detectable in two patients, pathologic manometric findings were seen in only one patient. The authors treated the concomitant diseases and performed endoscopic dilatations of esophageal stenoses. One case with initial bleeding from an associated web is described in detail. According to our knowledge, this is the first publication of a case of EIP-associated bleeding. CONCLUSION: Esophageal intramural pseudodiverticulosis is a differential diagnosis in cases of dysphagia and/or esophageal strictures if no other causes are found. The authors think that endoscopy is the method of choice for establishing the diagnosis.- - - - - - - - - - ranking = 1keywords = gland (Clic here for more details about this article) |
8/39. Brunner's gland hamartoma: a rare cause of gastrointestinal bleeding -- case report and review of the literature.An unusual cause of upper gastrointestinal bleeding is described in a previously healthy 45-year-old man who was admitted to hospital with weakness and fatigue, and had experienced an episode of melena two days before admission. His medical and surgical history was unremarkable. Upon admission to hospital, he showed evidence of iron-deficiency anemia, with a hemoglobin concentration of 61 g/L (normal range 135 to 175 g/L), a mean corpuscular volume of 73 fL (normal range 85.0 to 95.0 fL) and a ferritin concentration of 1.0 microg/L (normal range in males 15 to 400 microg/L). Upper gastrointestinal endoscopy revealed a 3.5 cm ulcerated submucosal mass in the third portion of the duodenum, for which mucosal biopsies were nondiagnostic. A subsequent endoscopic ultrasound revealed a 2.7 x 4.0 cm hyperechoic, cystic, submucosal tumour in the third portion of the duodenum. endoscopic ultrasound-guided fine needle aspiration revealed no malignant cells. The patient eventually underwent a resection of the third portion of his duodenum. Surgical pathology revealed that this tumour was a Brunner's gland hamartoma, 4.5 cm in its greatest dimension.- - - - - - - - - - ranking = 5keywords = gland (Clic here for more details about this article) |
9/39. Duodenal polypectomy of Brunner's gland hyperplasia using a novel laparoscopic technique. A case report.Brunner's gland hyperplasia rarely is associated with clinical problems, and it accounts for only about 10% of benign tumors of duodenum. Therapeutic intervention is indicated when Brunner's gland hyperplasia evokes symptoms such as indigestion, bleeding, or obstruction. Endoscopic intervention (esophagogastroduodenoscopy) often can be used effectively, and in some cases may be preferable because of its minimal invasivencss. However, when the lesion is too large to pass through the endoscopic snare, endoscopic treatment is not possible. In these cases, a laparoscopic procedure may provide a novel approach to resection of the polyp, while still serving as a minimally invasive approach. We report the case of a 28-year-old woman with a large duodenal polyp treated by laparoscopic polypectomy.- - - - - - - - - - ranking = 6keywords = gland (Clic here for more details about this article) |
10/39. Severe intestinal bleeding caused by intestinal metastases of a primary angiosarcome of the thyroid gland.A 75 year old male presented with gastrointestinal bleeding after resection of both upper lobes of the lungs because of metastases. One year ago an angiosarcoma was the reason for a complete removal of the thyroid gland. In esophago-gastro-duodenoscopy we found multiple hemorrhagically stained polyploids lesions in the postbulbar duodenum and jejunum. colonoscopy showed isolated polyploid lesions of the right flexura. Because of persistent gastrointestinal bleeding a diagnostic laparotomy was done. Intraoperative intestinoscopy demonstrated multiple bleeding metastasis. To remove many of the bleeding lesions two longer intestinal segments of the jejunum and ileum were resected. The histology of the metastases showed arrangements of polygonal cells with prominent nucleoli and atypical mitosis. immunohistochemistry identified CD 31, vimentin and factor viii associated antigen. There was an erosion of the superficial intestinal mucosal cells with resulting hemorrhage; same histology had been found in the thyroid gland and the right upper lobe of lung. Eight days after surgery the patient died because of respiratory and circulatory insufficiency.- - - - - - - - - - ranking = 6keywords = gland (Clic here for more details about this article) |
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