Hemangioma cavernoso como causa de hemorragia digestiva oculta manifiesta: reporte de caso / A Case Report of Cavernous Hemangioma as a Cause of Occult Gastrointestinal Bleeding

Resumen Se realizó un estudio descriptivo tipo reporte de caso de un paciente valorado por el servicio de gastroenterología en la Clínica Nuestra en la ciudad de Cali, por sospecha de sangrado digestivo oculto cuyos estudios previos no habían mostrado causa de sangrado. Se realizó videocápsula endoscópica (MiroCam®) con un hallazgo positivo de lesión en el intestino delgado. Se llevó a enteroscopia en Clínica Farallones de la Ciudad de Cali con enteroscopio Olympus 180 Q que confirmó el hallazgo. Ulteriormente, se llevó a cirugía, en la que se confirmó el diagnóstico. Los datos y las fotografías se obtuvieron en bases de datos de los servicios de endoscopia y las fotos de patología se obtuvieron del registro del médico patólogo. Finalmente, se realizó una búsqueda en PubMed sobre literatura existente de historia clínica y reportes de casos similares.

Abstract This is a descriptive study based on the case report of a patient suspected of occult gastrointestinal bleeding who was evaluated by the gastroenterology service in Clínica Nuestra in Cali. Previous studies had not shown cause of bleeding. Video endoscopy (Mirocam) found a lesion in the small intestine. Enteroscopy at performed at Clínica Farallones in Cali with an Olympus 180 Q enteroscope confirmed the finding. Surgery further confirmed the diagnosis. Data and photographs were obtained from the database of endoscopy services and the pathology photos were obtained from the pathologist's registry. A literature review based on a Pubmed search of the existing literature on clinical histories and reports of similar cases is included.

Ga-67 uptake by metastatic carcinoma of the penis.

Six patients with metastatic carcinoma of the penis underwent Ga-67 citrate scanning. Intense radioactive uptake was noted in the metastatic inguinal lymph nodes that was not influenced by the presence or absence of infection. There was a correlation between clinical improvement and decrease in abnormal groin uptake. The results reported here suggest the possibility of using Ga-67 citrate scanning in the staging, management, and follow-up of this relatively rare condition, although further experience is needed to establish its precise role.

Pitfalls of a 99mTc-RBC bleeding study due to gallbladder and ileal-loop visualization.

A series of 99mTc-labeled red blood cell (RBC) scintigrams in a patient with a past history of radiation proctitis demonstrated incidental findings of gallbladder activity, probably related to multiple blood transfusions and renal failure. Variable activity in an ileal-loop urinary diversion simulating bowel pooling was also noted. Thus, difficulties encountered in scan interpretation are presented.

Effect of a mouthrinse containing triclosan and a copolymer on plaque formation in the absence of oral hygiene.

Twenty male and female adult subjects were entered into a 7-week, double-blind clinical study to determine the effect on plaque formation of a mouthrinse containing 0.03% [corrected] triclosan and 0.25% of a copolymer of methoxyethylene and maleic acid, as compared to 1) a water placebo mouthrinse, 2) a matching alcohol placebo mouthrinse, and 3) Plax antiplaque pre-brushing dental rinse. The subjects were stratified according to their initial plaque scores and assigned in a type of randomized block design (repeated Latin square), so that each subject received each of the four mouthrinses only once for 1 week during the study. The subjects did not use any other oral hygiene procedure (including use of a toothbrush and dentifrice) during the 1-week period of time when they rinsed with their assigned mouthrinse product. The results indicated that use of the triclosan/copolymer mouthrinse provided a 49.8% reduction in supragingival plaque formation compared to the water placebo mouthrinse. The difference was statistically significant at the 99% level of confidence (P less than .01). Similarly, the use of the triclosan/copolymer mouthrinse provided a 47.6% reduction in supragingival plaque formation compared to Plax antiplaque pre-brushing dental rinse. The difference was statistically significant at the 99% level of confidence (P less than .01). The results further indicated that use of the triclosan/copolymer provided a 31.2% reduction in supragingival plaque formation compared to the alcohol placebo mouthrinse. The difference was statistically significant at the 99% level of confidence (P less than .01).

Malignant cardiac fibrous histiocytomas and angiosarcomas: MR features.

Primary tumors of the heart are rare, and one-third of them are malignant. The magnetic resonance (MR) features, their specificity, and significance in two patients with malignant fibrous histiocytoma and three patients with angiosarcoma are presented and the literature briefly reviewed. Malignant fibrous histiocytoma occurred in the left atrium and demonstrated slightly heterogeneous intermediate signal intensity on T1-weighted images and high signal intensity on T2-weighted images. The angiosarcomas involving primarily the right heart were more varied in MR appearance with heterogeneous signals. The extensive angiosarcomas almost circumferentially involving the epicardium and pericardium showed the "cauliflower" appearance with focal areas of increased signal intensity probably related to thrombosis or hemorrhage. Magnetic resonance provided detailed anatomic information and characterization of malignant cardiac tumors.

Magnetic resonance imaging of malignant fibrous histiocytoma.

The magnetic resonance imaging (MRI) changes in 39 patients with malignant fibrous histiocytoma (MFH) were reviewed retrospectively. Twenty-one sarcomas were in the lower extremity, five each in the upper extremity and trunk, two each in the neck and heart, and one each in the maxillary sinus, sella turcica, tongue, and spermatic cord. The examinations were performed with spin-echo sequences on a 1.5 Tesla Signa Scanner (GE, Milwaukee WI). Twenty-two tumors exhibited intermediate signal intensity on T1-weighted images and 23 were of high signal intensity on T2-weighted images. There was no significant differences in signal intensity of 12 preoperative and 13 recurrent neoplasms. Twelve of 13 patients were correctly diagnosed as having postoperative changes. The MR sensitivity and specificity for detecting a neoplasm were 96% and 83% respectively, but the signal changes were nonspecific for MFH. When compared to CT in 14 patients, MR better defined the extent of the MFH, its relationship to surrounding tissues and vessels, and best differentiated residual or recurrent disease from postoperative changes when examined at least 3 months after surgery.

Costochondral involvement in systemic candidiasis in heroin addicts: clinical, scintigraphic, and histologic features in 26 patients.

We studied the clinical, scintigraphic, and histopathologic characteristics of 26 intravenous drug abusers with costochondral involvement secondary to systemic infection with Candida albicans. The clinical findings were of a mass appearing in the anterior region of the thorax. In general, signs of inflammation were absent. Histopathologic study of this costochondral mass in 12 patients showed perichondritis in 100% and myositis in 87%, with secondary involvement of cartilage in 43% and of bone in 75%. Results of bone scintigrams using 99mTc-methylene diphosphonate were positive in only 7 of 15 patients (47%), with a correlation between positive uptake and osteitis. Gallium scintigraphy findings were positive in 9 of 10 patients (90%). The greater sensitivity of 67Ga was probably because the invariably present pericartilaginous inflammatory mass was not always accompanied by secondary cartilage and bone involvement.

MRI and CT of ankylosing spondylitis with vertebral scalloping.

Three cases of cauda equina syndrome in long-standing ankylosing spondylitis are reported. In all, vertebral scalloping and dural ectasia were confirmed by magnetic resonance imaging and computed tomography. MRI showed widening of the dural sac with signal intensity corresponding to cerebrospinal fluid. CT demonstrated asymmetrical lesions of the posterior elements of the lumbar spine. Myelography was not felt necessary to confirm the findings.

False-positive early indium-111 leukocyte scan.

An In-111 leukocyte scan was performed in a cirrhotic patient with ascitic fluid infection to rule out an abdominal abscess. Scintigraphy showed localized uptake in the area between the liver and right lung 30 minutes after reinjection of the labeled cells. The 24-hour study was negative. No purulent collection was demonstrated in any location.

Nasal mucociliary transport in laryngectomees.

A study has been carried out to assess the mucociliary function of nasal mucosa in 30 patients: 16 had undergone surgery due to larynx malignancy and the remaining 14 were divided in two groups. The first group was composed of seven patients suffering from larynx cancer but not operated, and the second group of seven had pathology not related to the airways (control group). The method used a 99mtechnetium sulphur colloid drop deposited on the nasal mucosa of one nostril. To calculate the rate of transport, a new method of quantification has been introduced, based on the formation of a parametric image. The mean velocity in laryngectomees was 3.6 mm/min (range 1.1-6.4). It was compared with the group of 14 patients without tracheostomy (mean 5.3, range 3.3-8.2). An impaired Student's-t-test gave a significant difference between both groups (P less than 0.005). The comparison between patients with nonoperated larynx cancer and normals gave a nonsignificant difference. The 16 operated patients were arbitrarily divided into two groups as per the time elapsed from laryngectomy; seven were studied within the first 3 years of operation and seven other patients after this term. The comparison between them was not significant.

Unusual metastatic chondrosarcoma detected with bone scintigraphy.

A case is presented of a scapular chondrosarcoma which showed intense uptake of Tc99m MDP in the primary tumour and in pleural and osseous metastases. Additionally, there was intense visualization of the malignant pleural effusion. The bone scintigraphy correctly diagnosed the extent of the involvement. This finding is unusual because chondrosarcomas in such a disseminated state are relatively rare.

Enterogastric reflux detection with technetium-99m IDA.

A Tc-99m IDA scan was performed in a patient with severe alkaline esophagitis subsequent to a Billroth I gastroenterostomy. The scan showed enterogastric reflux simultaneously with gastroesophageal reflux of bile. The study was recorded in a computer and the reflux quantitated.