ABSTRACT
OBJECTIVE: Patients with Von Recklinghausen's disease (neurofibromatosis type 1) are at increased risk of developing various tumours. However, the coexistence of neurofibromatosis with small-bowel adenocarcinoma is exceedingly rare. We present an uncommon case of neurofibromatosis type 1, involving the small bowel in a 73-year-old man, who was admitted to our department with signs of acute abdomen. At laparotomy, multiple mesenteric and intramural nodules were seen in the distal ileum. These nodules obstructed ileal lumen, while the intestine wall was perforated in one point. A wide resection of the affected ileum together with all visible nodules in the adjacent mesentery was performed. Histology revealed neurofibromatosis type 1 with malignant transformation to small-bowel adenocarcinoma. The patient had no additional therapy. In a follow-up of 2 years, the patient is very well and there was no recurrence of the disease. We suggest that adenocarcinoma of small bowel should be considered in the evaluation of acute abdominal pain in neurofibromatosis patients.
Subject(s)
Adenocarcinoma/pathology , Ileal Neoplasms/pathology , Intestine, Small/pathology , Neoplasms, Multiple Primary/pathology , Neurofibromatosis 1/pathology , Abdomen, Acute/etiology , Aged , Follow-Up Studies , Humans , Intestinal Obstruction/etiology , Intestinal Obstruction/pathology , Male , Tomography, X-Ray ComputedABSTRACT
BACKGROUND: Quality of life is poor in morbidly obese patients, because of impaired physical and psychosocial functioning. Surgical treatment offers long-term weight reduction and amelioration of most associated comorbidities. Studies of the effect of weight loss on patients' mental well-being are required, because discrimination and psychopathologic consequences represent a heavy burden. PATIENTS AND METHODS: 53 patients were interviewed 48 hours before vertical banded gastroplasty (VBG) by the psychiatric team and completed the self-administered SCL-90-R questionnaire. Correlations of patients' age, educational level, employment, duration of obesity and family conditions were investigated and compared with the degree of obesity 10-12 months postoperatively. 35 patients returned to psychiatric follow-up and completed the same questionnaire, and the various psychopathologic characteristics were compared to the preoperative ones. RESULTS: Females had statistically significant higher scores in all psychopathologic parameters studied; more obvious differences were seen in depression (P < 0.001), paranoid ideation (P < 0.001) and interpersonal sensitivity (P < 0.001). Correlations of several demographic characteristics with the patients' preoperative BMI were negative. 10-12 months following VBG, statistically significant improvement in the parameters of phobic anxiety, obsessions-compulsions, paranoid ideation and interpersonal sensitivity (P < 0.05) were found. CONCLUSION: Pre-existing psychopathology was more obvious among females, and improved significantly following successful weight loss 1 year postoperatively.
Subject(s)
Gastroplasty/psychology , Obesity, Morbid/psychology , Surveys and Questionnaires , Adult , Female , Follow-Up Studies , Humans , Male , Middle Aged , Obesity, Morbid/surgery , Postoperative Care/psychology , Preoperative Care/psychology , Prospective Studies , Quality of Life , Treatment Outcome , Weight LossABSTRACT
The authors present a very rare case of ulcerative colitis and acute stroke appearing as complications after Mason's vertical banded gastroplasty for treatment of morbid obesity in a 46-year-old man. On the basis of recent studies, the authors attempt to find the correlation of these three diseases and the possible effect of each disease on the appearance of the others. The dilemmas in the treatment of this patient are also described.
