1/31. Small intestinal ulceration secondary to carcinoid tumour arising in a Meckel's diverticulum.A solitary small intestinal ulcer associated with a carcinoid tumour in a nearby Meckel's diverticulum was found in a 77 year old man presenting with massive rectal bleeding. Angiography and a radioisotope study localised the bleeding to the ileum. At operation, the Meckel's diverticulum was identified, with bleeding from an ulcer just distal to it. Pathological examination revealed a small carcinoid tumour confined to the Meckel's diverticulum. Close to the opening of the diverticulum, within the ileum, a well demarcated ulcer was present. histology showed a non-specific ulcer which eroded a large blood vessel. This is the first documented occurrence of solitary small intestinal ulceration in association with a carcinoid tumour. Carcinoid tumour should be added to the list of possible causes of small intestinal ulceration. The ulceration may be secondary to release of cytokines by the tumour.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
2/31. Dieulafoy-like lesions of colon and rectum in patients with chronic renal failure on long-term hemodialysis.Two rare cases with Dieulafoy-like ulcer bleeding of the colon and rectum are reported. The patients have been suffering from chronic renal failure (CRF) on long-term hemodialysis (HD), and they were brought to Saiseikai Yahata General Hospital with anal bleeding. In both patients, colonoscopy was performed, showing arterial bleeding from a protuberant vessel on the mucosa of the rectum in Case 1 and gradual arterial bleeding from the protuberant vessel on the ascending colon in Case 2. For both cases, endoscopic clipping treatment was done for hemostasis and was successful.- - - - - - - - - - ranking = 2keywords = vessel (Clic here for more details about this article) |
3/31. Surgical treatment of the radiation injured bowel.Over the last 10 years, 9 patients treated by surgical procedure for radiation injuries of the bowel were studied with the following conclusions: The damage to the small intestine caused by external irradiation leads to adhesion of the bowel, perforation and postoperative anastomotic dehiscence if the irradiated bowel is used in the anastomosis. Surgical treatment for the small intestine is resection of the damaged loop. In order to determine the extent of the resection it is important that during the operation fibrosis and obstruction of vessels in the submucosa and subserosa is examined by biopsy. On the other hand, rectal ulcer and/or rectovaginal fistula is chiefly caused by intracavitary application plus external irradiation. For these lesion Hartmann operation or colostomy is performed, and the postoperative course is uneventful.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
4/31. Blood supply of hemipelvectomy flaps: the anterior flap hemipelvectomy.In posterior flap hemipelvectomy, preservation of the gluteus maximus with the flap guarantees its viability regardless of the level of ligation of the iliac vessels. In anterior flap hemipelvectomy with the quadriceps femoris attached to the flap, the dominant blood supply is through the lateral femoral circumflex branches of the profunda vessels, which is sufficient to maintain the flap.- - - - - - - - - - ranking = 2keywords = vessel (Clic here for more details about this article) |
5/31. Delayed relapse of churg-strauss syndrome manifesting as colon ulcers with mucosal granulomas: 3 cases.churg-strauss syndrome (CSS) is characterized by small vessel vasculitis and extravascular granulomas. The American College of rheumatology classification criteria for CSS include asthma, eosinophili, and clinical manifestation of vasculitis. Gastrointestinal (GI) manifestations occur in 30% of patients, but are inaugural in only 16%. They denote vasculitis of the stomach and small bowel wall, and consist in protean, nonspecific pain. GI involvement is of adverse prognostic significance in CSS. ulcer formation in the GI tract mucosa is a rarer manifestation, usually discovered upon laparotomy or autopsy. We describe 3 new cases of colonic ulcers in CSS. Unusual features were diagnosis of the ulcers during a delayed relapse and presence of eosinophilic granulomas within the mucosa.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
6/31. The radiographic appearances of non-specific small intestinal ulceration.AIM: To determine the imaging characteristics of non-specific ulceration of the small intestine. MATERIALS AND methods: The radiographic investigations undertaken in three patients originally referred for visceral angiography in whom a histological diagnosis of non-specific ulceration of the small bowel was subsequently made were retrospectively reviewed. Two men and one woman aged from 17 to 24 years all presented with anaemia requiring blood transfusion. Visceral angiography was available for review in all three patients, abdominal computed tomography in two, and a small bowel enema and white cell scintigraphy in one. RESULTS: In all three patients an angiographic abnormality was present within the ileum consisting of irregularity of the vasa recta, an area of subtle increased vascularity and early venous return. A long, non-branching vessel interpreted as a persistent vitello-intestinal artery was seen in two of these patients. A CT abnormality was present in two individuals consisting of a focal area of thickened small bowel. The single small bowel enema demonstrated a focal stricture and the white cell scan showed localized accumulation of radioactivity within the pelvis. CONCLUSION: Non-specific small intestinal ulceration may produce abnormalities that are discernible on barium studies, computed tomography, radiolabelled white cell scanning and visceral angiography. Recognition of these findings may allow a pre-operative diagnosis of this condition.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
7/31. Surgery for coronary artery disease with penetrating atherosclerotic ulcer of the ascending aorta.Penetrating atherosclerotic ulcer (PAU) is most often found in the descending aorta but rarely in the ascending aorta. In such a rare case, a 63-year-old man with ischemic change at precordial leads in electrocardiography was found in coronary angiography to have the left main trunk stenosis and in aortography (aortic phase of left ventriculography) to have PAU in the ascending aorta. We conducted 3-vessel coronary artery bypass grafting and replaced the ascending aorta. Preoperative evaluation of the ascending aorta is thus important in cardiac surgery as in this case.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
8/31. Jejunal perforation associated with cytomegalovirus infection in a patient with adult T-cell leukemia-lymphoma.A patient with adult T-cell leukemia-lymphoma suffered a jejunal perforation, which we believe was directly attributable to cytomegalovirus (CMV) infection. In the areas of ulceration and perforation in the small bowel, blood vessels penetrating the muscularis propria showed extensive lining of cytomegalic endothelial cells with CMV inclusions, accompanied by occasional disruption of the walls, partial occlusion of the lumina, fibrin thrombi, and hemorrhage. The CMV-induced vascular damage seemed to be closely related to the occurrence of ulcers and perforation. The recognition of CMV as a cause of lethal gastrointestinal lesions in immunocompromised hosts has become more important with the advent of anti-CMV therapy.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
9/31. Endovascular repair of a penetrating thoracic aortic ulcer by way of the carotid artery.INTRODUCTION: Endovascular repair of thoracic aortic lesions offers an attractive alternative to traditional open repair. Access to the thoracic aorta can occasionally be challenging because of large device size and vessel tortuosity. Traditional access by way of the femoroiliac vessels might not be possible in the setting of synchronous iliac occlusive disease. MATERIALS AND methods: A 63-year-old woman presented with a 7.1-cm symptomatic, penetrating ulcer of the descending thoracic aorta. The patient's severe pulmonary disease prohibited an open repair. A Talent endoprosthesis was placed under compassionate use with approval of the institutional review board. The graft was placed by way of the left common carotid artery because of severe iliac occlusive disease. RESULTS: The thoracic endograft was successfully placed with exclusion of the pseudoaneurysm. The patient's chest pain resolved immediately. She developed mild left-sided weakness from a postoperative right anterior cerebral artery stroke that quickly resolved. The patient was discharged on postoperative day 5. No aortic endoleak was noted on follow-up computerized tomography scan at 1 month. CONCLUSIONS: Endovascular repair should be considered in patients with thoracic aortic aneurysms, particularly those with severe medical comorbidities. Placement by way of the common carotid artery is technically feasible in the setting of synchronous aortoiliac disease.- - - - - - - - - - ranking = 2keywords = vessel (Clic here for more details about this article) |
10/31. Reactive angioendotheliomatosis of the intestine.We present a case of reactive angioendotheliomatosis (RAE) of the colon, featuring intravascular proliferation of endothelial cells with histologic resemblance to glomeruloid hemangioma. A 19-year-old Japanese male with an anal fistula was diagnosed endoscopically with Crohn's disease. Six months later, he was hospitalized for fever and abdominal pain. Emergency resection of ileocecum and splenic flexure of the colon was undertaken to control massive intestinal hemorrhage, and in all parts of the resected colon, foci of many small vessels with intravascular proliferation of endothelial cells were noted throughout the layers. Moreover, solid proliferation of endothelial cells was seen in the submucosa at the base of open ulcers. Two small granulomas, compatible with Crohn's disease, were also evident in the muscle layer of the terminal ileum. No other hemangiomas or hemangioma-like structures were observed with CT scans, and the vascular lesions were histologically diagnosed as RAE. The pathogenesis of this disorder is unknown, and most cases occur in skin with systemic disease. The present case might thus be a first case of RAE of the intestine without cutaneous involvement. Whether there is a relation with coexistent enteritis suggestive of Crohn's disease needs to be clarified.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
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