1/9. endosonography in the diagnosis of "blue rubber bleb nevus syndrome": an uncommon cause of gastrointestinal tract bleeding.Blue rubber bleb nevus syndrome is a rare condition characterized by the presence of multiple angiomatic lesions of the skin. These are associated with similar lesions in other organs, namely in the gastrointestinal tract, causing anemia through chronic bleeding. We describe the case of a 72-year-old woman with microcytic anemia. A barium study revealed irregular lacunae in the distal esophagus. A subsequent endoscopy showed blue nodular lesions similar to angiomas of the esophagus and stomach fundus. endosonography confirmed its angiomatic nature. Exploration of other organs, using magnetic resonance and cranial computed tomography, did not reveal the presence of this type of lesion. In physical examination, two angiomatic lesions were observed on the face and lips, respectively. These were blue in color and compressible, leaving an empty wrinkled sac that rapidly refilled, typical of angiomas.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
2/9. Transesophageal echocardiography detection of an esophageal sarcoma mimicking aortic dissection.This report shows that transesophageal echocardiography can detect thoracic pathology, in this case esophageal sarcoma, as well as cardiac and aortic abnormalities. Transesophageal echocardiography can help differentiate cardiac from aortic or other intrathoracic pathology when the patient's history and physical examination do not provide enough information.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
3/9. Endoscopic comparison of two cases: distal resection of reconstructed gastric tube.Recently, with the improvement of the prognosis of esophageal cancer, subsequent gastric cancer has increased. However, the standard surgical treatment for such patients has not been established as of yet. Since the patient's physical condition is relatively poor after Ivor-Lewis esophagectomy, it is important that surgical strategies must be decided according to both physical and cancerous conditions. Hence, various surgical procedures have been reported to date. The authors experienced two cases with cancer occurring in the reconstructed gastric tube after Ivor-Lewis esophagectomy. One was subsequent primary gastric cancer, and the other was metastatic gastric cancer. Distal resection of the gastric tube including the dissection of the right gastroepiploic vessels was carried out in both cases. Vascular reconstruction by utilizing microsurgery technique was attempted for each case, but failed in one case. After surgery, four sessions of endoscopic examinations were carried out. In the early period, we could identify mucosal ischemic change in the remnant gastric tube in the case without successful vascular reconstruction. On the contrary, no ischemic change was revealed in the other with successful vascular reconstruction. Hence, we came to the conclusion that vascular reconstruction must be added to the cases, which undergo distal resection of the reconstructed gastric tube with regional vascular dissection.- - - - - - - - - - ranking = 0.17702939083621keywords = physical (Clic here for more details about this article) |
4/9. A case of primary low grade mucosa associated lymphoid tissue (MALT) lymphoma of the oesophagus.We report a very rare case of primary low grade mucosa associated lymphoid tissue (MALT) lymphoma of the oesophagus. An 83 year old woman was referred to our hospital in June 1999 for further examination and treatment of oesophageal tumour. Although a physical examination and laboratory data showed no significant abnormalities, endoscopic observation revealed two slightly elevated submucosal tumour-like lesions of the oesophagus. Tissue specimens were obtained by endoscopic mucosal resection of the oesophagus using a cap fitted panendoscope. The lesions were composed of diffuse small atypical lymphoid cells--that is, centrocyte-like cells--which were stained with CD20, L26, BCL-2, and kappa, but not with CD3, CD5, CD10, or cyclin d1. Monoclonality was detected by polymerase chain reaction analysis using the primer for CDR-3 of immunoglobulin H and diagnosed as low grade MALT lymphoma of the oesophagus. The tumours were considered to be completely resected and therefore additional treatment was not administered. The patient is alive and well 22 months after treatment and diagnosis.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
5/9. ASA score as prognostic criterion for incidence of postoperative complications after transhiatal esophagectomy.The aim of this study is to point out the importance of the American Society of Anesthesiologists risk score (ASA score) as a very cheap and simple prognostic criterion for the incidence and severity of postoperative complications of transhiatal esophagectomy (THE). During the past ten years, twenty-nine patients were operated for cancer of the esophagus using the THE method at the University Hospital Center "Rijeka". patients' preoperative physical status was estimated using the 19 parameters of ASA score and they were classified into ASA risk groups. The incidence and severity of the two most common and potentially fatal postoperative complications of THE--aspiration pneumonia and anastomotic leak--were compared with the patients ASA score as well as with the duration of postoperative hospital stay and operative mortality. postoperative complications after THE, even with lethal outcome occurred only in patients with high ASA score (ASA risk group IV and V). Our conclusion is that ASA score has proven to be a reliable and useful prognostic criterion for the development of postoperative complications after THE and for the incidence of operative mortality.- - - - - - - - - - ranking = 0.088514695418103keywords = physical (Clic here for more details about this article) |
6/9. A possible case of werner syndrome presenting with multiple cancers.The treatment of a man with six metachronous primary cancers is described. The primary lesions were in the soft palate, both edges of the tongue, the hard palate, the esophagus, and the right ureter. Pathologically, all of the first five tumors in the head and neck and esophagus were proven to be squamous cell carcinoma with various grades of differentiation, and the last one was transitional cell carcinoma. The cancers were found in the early clinical stage, and were completely controlled one by one except for the ureteral tumor under treatment. His characteristic medical history and physical findings, i.e. bilateral cataracts, short stature, baldness, diabetes mellitus, high-pitched voice, and multiple malignancies, met the clinical criteria for possible werner syndrome, a genetic premature aging disorder, though the possibility of phenocopy of this syndrome has not been ruled out. We have followed him carefully because he might be vulnerable to malignant tumor formation.- - - - - - - - - - ranking = 0.088514695418103keywords = physical (Clic here for more details about this article) |
7/9. Haemodynamic instability during transhiatal resection of oesophagus results in postoperative metabolic acidosis and hypoxia: is there a need for assisted ventilation?Oesophagectomy for oesophageal carcinoma is a stressful physical and metabolic challenge for an individual. The metabolic acidosis and hypoxia resulting postoperatively in a 34-year-old male, suffering from oesophageal carcinoma, after transhiatal oesophagectomy was managed without assisted ventilation contrary to the usual teaching. Relevant literature has been reviewed.- - - - - - - - - - ranking = 0.088514695418103keywords = physical (Clic here for more details about this article) |
8/9. portal vein gas after concurrent chemoradiotherapy for advanced oesophageal carcinoma.portal vein gas is a rare but potentially lethal condition commonly caused by mucosal damage, bowel distention and sepsis. However, the association between portal vein gas and concurrent chemoradiotherapy has not been documented. We present the case of a 56-year old woman with portal vein gas revealed on computed tomography (CT) after concurrent chemoradiotherapy for advanced oesophageal carcinoma. The portal vein gas totally disappeared 10 days later without any specific treatment. This case demonstrates that the option of close observation for portal vein gas after concurrent chemoradiotherapy is appropriate for consideration. If physical examination, CT findings and laboratory data are unremarkable, it is essential that the patient undergoes close observation and repeated follow-up CT.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
9/9. Malignant tracheoesophageal fistula in two siblings. A coincidence?The incidence of carcinoma of the esophagus is 1:10,000 for males. Esophageal carcinoma occurs less frequently in females. tracheoesophageal fistula may occur as a complication of esophageal cancer. In this report, a brother and sister are presented who, although six years different in age, developed malignant tracheoesophageal fistulas within one month of each other. The probability of this occurring coincidentally is less than one in five hundred million. Each sibling had a different form of palliation with markedly different results. The first patient was treated with a Celestin tube which never provided good palliation. He suffered a rapid and miserable decline and death. The second patient was treated with substernal esophageal bypass using the stomach and exclusion of the thoracic esophagus. She has since undergone irradiation to the area of the fistula. She remains alive and well, physically active and eating a regular diet 23 months after surgery.- - - - - - - - - - ranking = 0.088514695418103keywords = physical (Clic here for more details about this article) |