1/2. Coil compaction after embolization of the superior mesenteric artery pseudoaneurysm.A 58-year-old man with an abscess of the psoas muscle was returned to our hospital with hematemesis. Two years earlier, he had undergone coil embolization for a superior mesenteric artery (SMA) pseudoaneurysm secondary to pancreatitis. Based on the physical examination, serum amylase level, and abdominal radiographs, a diagnosis of acute exacerbation of pancreatitis and coil compaction of the SMA pseudoaneurysm was made. The patient underwent re-embolization for the coil compaction using interlocking detachable coils. His condition improved gradually, and he was discharged 3 weeks later. To our knowledge, this is the first report of coil compaction of SMA pseudoaneurysm.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
2/2. Multiple gastrointestinal stromal tumors and synchronous ileal carcinoids.BACKGROUND: A 74-year-old African-American male presented with a 3-day history of hematemesis and melena. The patient reported no abdominal pain, constitutional symptoms, bright red blood per rectum, constipation, or diarrhea. His physical examination and medical history were unremarkable except for benign prostatic hypertrophy. An esophagogastroduodenoscopy showed a 3 x 2 x 2 cm smooth round mass in the cardia, 2 cm distal to the gastroesophageal junction. biopsy of the mass revealed an ulcerated tumor composed of spindle cells. immunohistochemistry showed positive staining for a number of biochemical markers, including KIT, Ki-67 and smooth muscle actin, but was negative for the markers S100 and desmin. A gastric-wedge resection revealed an ulcerated 4.5 cm mass in the stomach, and exploration of the abdomen revealed two ileal carcinoid tumors, jejunal diverticula and reactive mesenteric lymphadenopathy. INVESTIGATIONS: Esophagogastroduodenoscopy, biopsy, CT scan, immunohistochemistry, dna microarray analysis and quantitative reverse transcriptase-PCR. diagnosis: Multiple gastrointestinal stromal tumors occurring concomitantly with ileal carcinoids. MANAGEMENT: Gastric-wedge resection and segmental resection.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |