RESUMO
We present four cases of gastrointestinal granular cell tumors (GCT) with a literature review. Gastrointestinal granular cell tumors, a benign neural tumor thought to arise from Schwann cells, can occur in several areas, including the gastrointestinal tract. Studies suggest that endoscopic ultrasound and endoscopic removal is the treatment of choice for esophageal GCTs if they are small in size (< 2 cm) and do not involve the muscularis propria. GCTs are malignant less than 2% of the time. Although most GCTs are benign and can be followed endoscopically without resection, the malignant potential warrants evaluation with endoscopic ultrasound for possible endoscopic or surgical resection.
Assuntos
Neoplasias do Colo/diagnóstico , Neoplasias Esofágicas/diagnóstico , Tumor de Células Granulares/diagnóstico , Neoplasias Gástricas/diagnóstico , Colonoscopia , Endoscopia do Sistema Digestório , Endossonografia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
A 66-year-old white male presented with jaundice, pruritus, and a 30-pound weight loss over two months. Physical examination revealed scleral icterus. Laboratory evaluation revealed ALT 161 U/L, AST 290 U/L, alkaline phosphatase 2004 U/L, GGT 2,552 U/L, total bilirubin 10.2 mg/dL, and a carbohydrate antigen 19-9 (CA 19-9) level of 4,374 U/mL. Initial endoscopic retrograde cholangiopancreatography (ERCP) was unsuccessful due to ulceration in the duodenum healed with esomeprazole therapy. Subsequent ERCP showed a possible filling defect in the common bile duct treated with sphincterotomy and balloon sweeping of the common bile duct. Symptoms and jaundice resolved five months after initial presentation with normal labs and studies. While elevated CA 19-9 levels occur in most patients with carcinoma of the pancreas, it can also be elevated in patients with extrapancreatic malignancies and acute cholangitis. This case illustrates the fact that a markedly elevated CA 19-9 can be secondary to causes other than carcinoma.
Assuntos
Antígeno CA-19-9/sangue , Colangite/sangue , Icterícia/sangue , Neoplasias Pancreáticas/diagnóstico , Idoso , Biomarcadores/sangue , Colangiopancreatografia Retrógrada Endoscópica , Colangiopancreatografia por Ressonância Magnética , Colangite/complicações , Colangite/diagnóstico , Diagnóstico Diferencial , Humanos , Icterícia/diagnóstico , Icterícia/etiologia , Masculino , Tomografia Computadorizada por Raios XAssuntos
Infecções Oportunistas Relacionadas com a AIDS/parasitologia , Colite/parasitologia , Toxoplasma/isolamento & purificação , Toxoplasmose/parasitologia , Infecções Oportunistas Relacionadas com a AIDS/complicações , Infecções Oportunistas Relacionadas com a AIDS/diagnóstico , Animais , Colite/complicações , Colite/diagnóstico , Colonoscopia , Diagnóstico Diferencial , HIV , Humanos , Masculino , Pessoa de Meia-Idade , Toxoplasmose/complicações , Toxoplasmose/diagnósticoRESUMO
The early institution of enteral nutrition is now accepted as the preferred route of feeding in critically ill patients with a functioning gastrointestinal tract. It is particularly important to establish early enteral nutrition in mechanically ventilated patients because of the metabolic demands associated with mechanical ventilation. The options for enteral access in mechanically ventilated patients are reviewed, with an emphasis on those techniques that may be performed at the bedside. The advantages, disadvantages, and complications of the different techniques will be considered.
