Subject(s)
Abdomen, Acute/etiology , Ileal Diseases/diagnosis , Intussusception/diagnosis , Jejunal Neoplasms/diagnosis , Peutz-Jeghers Syndrome/diagnosis , Adult , Female , Humans , Ileal Diseases/etiology , Ileal Diseases/surgery , Intestine, Small/blood supply , Intussusception/etiology , Intussusception/surgery , Ischemia/diagnosis , Ischemia/surgery , Jejunal Neoplasms/surgery , Middle Aged , Peutz-Jeghers Syndrome/surgery , Tissue Adhesions/complications , Tissue Adhesions/surgery , Tomography, X-Ray ComputedABSTRACT
'Pyloric gland-type adenoma' is a recently described and very rare entity. We report a case of a pedunculated polyp of the duodenal bulb showing the features of pyloric gland-type adenoma. Heterotopic gastric mucosa was found adjacent to the tumour. Immunohistochemically, the tumour cells at the surface of the polyp showed foveolar-type mucin (M1) while most other tumour cells showed deep gastric mucin (M2), displaying a pattern of differentiation similar to the normal gastric mucosa. The polyp also showed villous or papillary structures with disorganization of gastric differentiation and marked increase of proliferating in foci cells. This is the first case of pyloric gland-type adenoma found to arise in heterotopic gastric mucosa of the duodenum, showing dysplastic progression of the gastric type.
Subject(s)
Adenoma/pathology , Duodenal Neoplasms/pathology , Gastric Mucosa/pathology , Adenoma/chemistry , Adenoma/diagnosis , Aged , Choristoma/metabolism , Choristoma/pathology , Duodenal Neoplasms/chemistry , Duodenal Neoplasms/diagnosis , Female , Gastric Mucosa/chemistry , Humans , Immunohistochemistry , Mucins/analysisABSTRACT
Eleven patients with severe Raynaud's syndrome were treated with intravenous infusion of prostacyclin (Prostaglandin I2). Raynaud's syndrome was caused by inflammatory diseases such as progressive systemic sclerosis (N = 9) or thromboangiitis obliterans (N = 2). Five patients had acral ulcerations. Treatment with prostacyclin lead to immediate cessation of acral pain in all patients if doses of 5-6 ng/kg/min were tolerated. In 7 out of 11 patients there was a long-term analgesic effect with clinical improvement of Raynaud's syndrome. In three of five patients we achieved healing of the ulcerations within a few weeks. Plasmaconcentrations of prostaglandin F1-alpha, the main metabolite of prostacyclin, were about 10 times above normal during infusion and returned to normal levels within 30 min after the end of the infusion, in spite of the prolonged clinical effect. Therefore, prostacyclin alone cannot be responsible for the long-term clinical benefit. (Parts of this publication were published as an abstract and presented at the 23rd Congress of the Deutsche Gesellschaft für Rheumatologie (15).
