An Incidental Asymptomatic Dieulafoy's Lesion in the Colon: A Case Report

A Dieulafoy's lesion is an uncommon, but important, cause of gastrointestinal bleeding. It is associated with massive, life-threatening hemorrhage and is typically difficult to diagnose. Although originally described in the stomach and rarely found below the proximal stomach, identical lesions have been reported in other gastrointestinal organs, including the duodenum, jejunum, colon, and rectum. Most cases occur with bleeding in the gastrointestinal tract. However, we present an incidental asymptomatic Dieulafoy's lesion in the colon, which was treated successfully by using an endoscopic hemoclipping technique.

Clinical features of gastritis cystica profunda in patients without history of gastric surgery (Gastric Cancer Patients vs. Non-cancerous Patients) / 대한내과학회지

BACKGROUND: The relationship between gastric cancer and gastritis cystica profunda (GCP) has been frequently reported on, but there have been no systemic studies on whether or not GCP is a precancerous lesion. The aim of this study is to retrospectively analyze the groups in which some of the patients were accompanied by carcinoma and the other patients were non-cancerous (35 GCP cases were without previous surgery). METHODS: From February 2000 through July 2005, 35 cases of GCP without antecedent gastric surgery were diagnosed histologically. We reviewed the medical records, the endoscopic findings and the histologic findings of the patients. RESULTS: In these cases, the age ranged from 33 and 82 years (mean: 63+/-10.1 years). The endoscopic findings of GCP were various: there were 6 erosions and 9 ulcers in the cancer group and 12 polyps in the non-cancer group (p=0.000). The mean size of the lesions was 21.4+/-17.8 mm in the cancer group and 14.6+/-9.3 mm in the non-cancer group (p=0.337). Hypertension was associated with 15 cases (42.9%) in the cancer group and with 2 cases (5.7%) in the non-cancer group (p=0.000). There were 13 smokers (37.1%) in the cancer group and 6 smokers (17.1%) in the non-cancer group (p=0.028). For the histologic findings, 6 GCP patients were associated with dysplasia of adenomas, 4 GCP patients with intestinal metaplasias and 28 GCP patients (80%) with precancerous lesions and carcinomas. CONCLUSIONS: In this study, 18 GCP patients (51.4%) were associated with carcinoma and 10 GCP patients (29%) were associated with precancerous lesions. These results suggest that GCP is a precancerous or paracancerous lesion and it may be one step in the development of carcinoma. The underlying mechanisms of gastric carcinogenesis might be confirmed if we investigate the gene mutations and environmental differences of documented GCP cases that are without previous surgery.

High Ligation with Sclerotherapy for Lesser Saphenous Varicose Veins

PURPOSE: The purpose of this study was to determine the validity of high ligation of saphenopopliteal junction with sclerotherapy under local anesthesia in the management of lesser saphenous vein varicosity. METHOD: Between September, 1998 and June, 2000, we managed 37 patients of lesser saphenous vein varicosity and the clinical records were reviewed retrospectively. The patients were divided into two groups: one was 27 patients treated by high ligation of saphenopopliteal junction with sclerotherapy group under local anesthesia, and the other was 10 patients by stripping of lesser saphenous vein with stab avulsion group under general anesthesia. We compared the two groups on the basis of number of sclerotherapy after operation, recurrence, total cost and measure of health outcome with Aberdeen Varicose Veins Questionnaire. Of 37 patients, 20 patients in the high ligation group and 8 patients in the stripping group were available to follow-up with telephone. The differences between groups were tested with Mann-Whitney test. RESULT: The mean age was 42.4+/-8.1 year for the high ligation group and 47.1+/-12.2 year for the stripping group and the male to female ratio was 1:5.5 and 1:2.3 respectively. The mean number of sclerotherapy after first treatment was significantly more in high ligation group than stripping group (1.4 vs 0.3; P<0.001). The mean total cost was significantly higher in the stripping group than high ligation group (646,102 won vs 323,184 won; P=0.001). There was only one case of recurrence in the high ligation group. No statistical differences could be found between the two group concerning mean score of Aberdeen Varicose Veins Questionnaire (11.10 vs 10.13; P=0.953). CONCLUSION: We conclude that the high ligation of saphenopopliteal junction with sclerotherapy under local anesthesia is very effective and sufficient treatment modality in the management of lesser saphenous vein varicosity.