ABSTRACT
A rare case of ganglioneuromatous polyposis of the colon found in association with mucinous adenocarcinoma and primary hyperparathyroidism caused by a parathyroid adenoma in a 77-year-old woman is described. We discuss the clinical implications of this finding and review the literature.
Subject(s)
Adenocarcinoma, Mucinous/pathology , Adenoma/pathology , Colonic Polyps/pathology , Ganglioneuroma/pathology , Hyperparathyroidism/etiology , Neoplasms, Multiple Primary/pathology , Parathyroid Neoplasms/pathology , Adenoma/complications , Aged , Female , Humans , Parathyroid Neoplasms/complicationsABSTRACT
Although manometry is used with increasing frequency to evaluate the effectiveness of different treatments for achalasia, the criteria for a successful manometric response have not been well defined. Manometric responses were collected before and after 43 treatments in 35 patients with achalasia in order to determine manometric changes after different clinical outcomes: 15 unsuccessful outcomes and 28 successful outcomes were reported. In the latter, resting pressure of the lower esophageal sphincter decreased to 12.8 mm Hg, whereas in unsuccessful outcomes this was significantly higher (28.2 mm Hg). A decrease of lower esophageal sphincter pressure below 17 mm Hg or more than 40% of the pretreatment level was associated with successful outcomes. Our data suggest that manometry is a good indicator of therapeutic effectiveness and we propose that it be used systematically for objective evaluation of achalasia treatment.
Subject(s)
Esophageal Achalasia/diagnosis , Esophageal Achalasia/therapy , Catheterization , Esophagogastric Junction/physiopathology , Female , Humans , Male , Manometry , Middle Aged , Nifedipine/therapeutic use , Treatment OutcomeABSTRACT
BACKGROUND AND STUDY AIMS: Oral endoscopic examination of the small bowel is of vital importance when studying various clinical conditions. In this study we evaluate the diagnostic yield of push-type enteroscopy in patients with undiagnosed suspected clinical Crohn's disease using lower and upper endoscopy and double contrast X-ray in order to establish the diagnostic value of this instrument in the jejunum. PATIENTS AND METHODS: Eight patients displaying symptoms of Crohn's disease, five adults with chronic diarrhea and abdominal pain and three children with retarded growth and weight loss associated with diarrhea underwent ambulatory enteroscopy using a Pentax videoenteroscope. RESULTS: The average depth of insertion beyond the ligament of Treitz was 125 cm. Four patients (50%) were found to have macroscopic and/or microscopic lesions of Crohn's disease in the small intestine, which went unrecognized by other standard endoscopic and radiologic methods. Tolerance was good and there were no complications related to the procedure. CONCLUSION: Oral videoenteroscopy with biopsy is a safe and useful procedure for diagnosis of Crohn's disease in selected patients with suggestive symptoms and can be of great diagnostic value after failure of conventional endoscopic X-ray methods.
Subject(s)
Crohn Disease/diagnosis , Endoscopy, Gastrointestinal , Jejunum/pathology , Adult , Child , Child, Preschool , Crohn Disease/pathology , Endoscopes, Gastrointestinal , Follow-Up Studies , Humans , Videotape RecordingABSTRACT
A case of chronic hepatitis in a 20-year-old patient in whom hepatitis C virus infection markers and type 1 liver and kidney antimicrosome antibodies (anti-LKM 1) were detected, thereby allowing diagnosis of autoimmune type 2b hepatitis, is reported. The different types of autoimmune hepatitis (AIH) and the type 2a and 2b AIH are discussed as are the rejection of this terminology by some authors followed by their proposals and the therapeutic strategy to be used in these patients.
