1/15. Prescription of proton pump inhibitors before endoscopy. A potential cause of missed diagnosis of early gastric cancers.BACKGROUND: Early gastric cancer is frequently seen with nonspecific dyspeptic symptoms and subtle endoscopic features. Treatment at this stage of the disease produces a high chance of cure. If the diagnosis is missed at this early stage, then the prognosis may be much poorer depending on the subsequent delay in reaching a diagnosis. OBJECTIVES: To report the healing effect of proton pump inhibitors on early gastric cancer. methods: This article reports a case series of 7 patients with ulcerated early gastric cancers indistinguishable as malignant gastric ulcers at endoscopy who were inadvertently prescribed a short course of a proton pump inhibitor prior to a second confirmatory endoscopy. The cases studied were patients with dyspeptic symptoms referred from primary care physicians for upper gastrointestinal endoscopy. RESULTS: In each case the patient became asymptomatic, the endoscopic signs seen at the first endoscopy had resolved, and the lesions could not be recognized even by an experienced endoscopist. If the proton pump inhibitors had been prescribed by the referring physician before the first endoscopy, the diagnosis probably would have been missed. These cases demonstrate the potentially serious masking effect of prescribing a short course of these drugs before making an endoscopic diagnosis. Even though the patient has been referred for endoscopy, the endoscopist may fail to identify the lesion and thus miss the diagnosis. CONCLUSIONS: Primary care physicians must resist the pressures to prescribe proton pump inhibitors before endoscopy, particularly in patients older than 45 years, if the diagnostic yield of gastric cancer in the early curable stages is to be maximized.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/15. Options for investigative postsurgical therapy for gastric cancer, and case report of using the option for combined immunotherapy and chemotherapy.The investigative therapy for a senior patient after radical subtotal gastroesophagectomy for regional lymph node and proximal esophagus metastasized adenocarcinoma (stage IIIA, T3, N 1 M0) of the cardioesophageal junction is reported. The case has several unusual features: (1) the patient is the author and is not a physician; (2) in the absence of codified postsurgical treatment, he used his academic biomedical background, commercial associations, and international contacts to find and prioritize six clinically tested options for investigative postsurgical therapy; (3) after unsuccessful efforts to append ongoing clinical trials of new immunotherapies for breast adenocarcinoma (the first two therapy options), an innovative protocol was designed and gained allowance by the U.S. food and Drug Administration for his use of combined nonspecific immunotherapy and chemotherapy based on extensive trials in South korea that showed the synergistic effect of the two postsurgical therapies used together. A potent, new, nonspecific immunostimulant (DetoxPC) was injected subcutaneously in 10 diminishing doses during 105 weeks. Two standard chemotherapeutic drugs (5-fluorouracil and mitomycin-C) were injected intravenously in six equal doses during three weeks. Five years after the surgery, the patient enjoys good health without signs or symptoms of recurrence or metastasis. He discusses his perspectives on future clinical trials and on a patient actively pursuing investigative postsurgical therapy for a malignancy when otherwise poor survival is indicated.- - - - - - - - - - ranking = 0.33333333333333keywords = physician (Clic here for more details about this article) |
3/15. Complexities in prognostication in advanced cancer: "to help them live their lives the way they want to".Predicting survival and disclosing the prediction to patients with advanced disease, particularly cancer, is among the most difficult tasks that physicians face. With the de-emphasis of prognosis in favor of diagnosis and therapeutics in the medical literature, physicians may have difficulty finding the survival information they need to make appropriate estimates of survival for patients who develop cancer. Quite separate from the challenge of estimating survival accurately, physicians may also find the process of disclosing the prognosis to their patients difficult. Using the vignette of a real patient with advanced cancer who far outlived her physician's prognostic estimate, we discuss clinical issues related to the science of prognosis in advanced cancer and the art of its disclosure.- - - - - - - - - - ranking = 1.3333333333333keywords = physician (Clic here for more details about this article) |
4/15. An unusual case of gastric heterotopic pancreas.CONTEXT: Submucosal lesions of the gastrointestinal tract represent a diagnostic challenge for the physician. Endoscopic ultrasonography may provide useful information before deciding on therapeutic strategy. CASE REPORT: We report on a case of a young female presenting with a large gastric submucosal mass, 32 mm in size. Endoscopic ultrasonography identified a non-homogeneous lesion, with three cystic spaces suggesting a degenerated gastrointestinal stromal tumor. An exploratory laparoscopy was performed. Surprisingly, the final diagnosis was gastric heterotopic pancreas. CONCLUSION: Heterotopic pancreas should always be kept in mind when facing extramucosal gastric masses, especially in young people. A perioperative biopsy is recommended to prevent unnecessary extensive surgery.- - - - - - - - - - ranking = 0.33333333333333keywords = physician (Clic here for more details about this article) |
5/15. Pancreatic and gastric metastases of leiomyosarcoma arising in the left leg.Pancreatic or gastric metastases from other primary malignancies are rare, especially from leiomyosarcoma. We report a case of leiomyosarcoma in the left lower leg with metastases to the pancreas and stomach. A 61-year-old man had liver cirrhosis caused by hepatitis c virus infection and was followed up by his primary physician. Two years before presentation at our hospital, he had undergone surgical resection of leiomyosarcoma in the left lower leg and systemic chemotherapy for multiple metastatic tumors in the lung. On admission, endoscopic examination and computed tomography were performed for a routine checkup to exclude esophageal varices and liver tumor. Although the patient had no specific symptoms, multiple gastric and pancreatic metastases were identified by endoscopy and computed tomography, respectively. In general, metastases to the pancreas and stomach are rare. We discuss the clinical and diagnostic findings of pancreatic and gastric metastases by reviewing previously reported cases.- - - - - - - - - - ranking = 0.33333333333333keywords = physician (Clic here for more details about this article) |
6/15. aphonia and dysphagia after gastrectomy.A 67-year-old male was referred to our otolaryngological clinic because of aphonia and dysphagia. His voice was breathy and he could not even swallow saliva following a total gastrectomy for gastric carcinoma performed 2 weeks previously. Laryngeal fiberscopy revealed major glottal incompetence when he tried to phonate. However, both vocal folds abducted over the full range during inhalation. The patient could not swallow saliva because of a huge glottal chink, even during phonation. Based on these findings, he was diagnosed as having bilateral incomplete cricoarytenoid dislocation after intubation. The patient underwent speech therapy; within 1 min his vocal fold movement recovered dramatically and he was able to phonate and swallow. There have been few case reports of bilateral cricoarytenoid dislocation, and no effective rehabilitation has been reported. We believe that our method of vocal rehabilitation serves as a useful reference for physicians and surgeons worldwide.- - - - - - - - - - ranking = 0.33333333333333keywords = physician (Clic here for more details about this article) |
7/15. Cancer in the excluded stomach 4 years after gastric bypass.gastric bypass is the preferred operation for treatment of morbid obesity on many services. The evaluation of the excluded stomach is always difficult and a matter of concern for the attending physician. There are only four reported cases of gastric cancer in the distal stomach after gastric bypass. We report a 57-year-old man who had intestinal metaplasia at the time of the Roux-en-Y gastric bypass 4 years ago and now developed an aggressive carcinoma in the bypassed stomach.- - - - - - - - - - ranking = 0.33333333333333keywords = physician (Clic here for more details about this article) |
8/15. Metastatic ossified gastric carcinoid with hypergastrinemia associated with gastric and thyroid autoantibodies.A 42-year-old white woman was seen by her physician because of somatic complaints of the neck and right arm discomfort, difficulty in swallowing, and "heartburn." Findings of the workup led to the diagnosis of metastatic ossified gastric carcinoid. review of the literature suggests that this is the third report of ossified gastric carcinoid. However, this is the only case in which such a tumor was associated with hypergastrinemia, gastric (antiparietal cell), and thyroid (antimicrosomal) autoantibodies.- - - - - - - - - - ranking = 0.33333333333333keywords = physician (Clic here for more details about this article) |
9/15. An unusual case of gastric carcinoma initially presenting bone metastasis and later transverse myelopathy.A 44-year-old man with Borrmann type III gastric carcinoma initially presenting bone metastasis and later transverse myelopathy is reported. Chest and skull roentgenograms showed multiple punched-out lesions. A bone scintigram showed multiple abnormal uptake. Histological examinations of biopsy and autopsy materials revealed signet-ring cell carcinoma of the stomach. Disseminated carcinomatosis of the bone marrow was ruled out histologically and neither microangiopathic hemolytic anemia nor disseminated intravascular coagulopathy was observed. Because this patient with bone metastasis did not have metastasis to the liver and lungs we propose that a nonportal route through the vertebral venous plexus might be an alternative to the portal route of bone metastasis from gastric carcinoma. During the last 20 years, only 10 such cases including this one have been reported in japan. Their prognosis was quite poor and in most of them the malignancy was either undifferentiated adenocarcinoma or signet-ring cell carcinoma. If a bone metastasis is found as the initial sign, physicians should keep in mind that the primary lesion might be in the stomach, or in the thyroid, kidney, lung or prostate as another point of search.- - - - - - - - - - ranking = 0.33333333333333keywords = physician (Clic here for more details about this article) |
10/15. Sarcomas arising after radiotherapy for peptic ulcer disease.Therapeutic gastric irradiation has been used to reduce peptic juice secretion in patients with peptic ulcer disease. Between 1937 and 1968 a total of 2049 patients received such therapy at the University of chicago. Three of these patients are known to have developed sarcomas in the field of radiation. Two gastric leiomyosarcomas of the stomach were diagnosed 26 and 14 years after treatment and a malignant fibrous histiocytoma of the anterior chest wall was removed six years after gastric irradiation. Of 743 peptic ulcer patients treated without irradiation and constituted as a control group for the study of therapeutic gastric radiation, none is known to have developed sarcoma. As the incidence of sarcoma in these patient groups is known only from the tumor registry of the University of chicago, other cases of sarcoma may exist in the groups. While an increased incidence of sarcoma has not been proven to occur in patients who received therapeutic gastric irradiation for peptic ulcer disease, the possibility of such a risk should be borne in mind by physicians caring for such patients.- - - - - - - - - - ranking = 0.33333333333333keywords = physician (Clic here for more details about this article) |
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