Situs solitus refers to the normal arrangement of body organs. Situs inversus totalis is a complete mirror image or reverse isomeric form of the thoracic and abdominal viscera. Any arrangement of organs between these two extremes is designated by heterotaxia. Several patterns of vascular and visceral abnormalities are associated with heterotaxia, and two loosely defined syndromes of splenic anomalies (asplenia and polysplenia) are most common. We present the case of a 71-year-old woman with situs inversus totalis and polysplenia syndrome who developed synchronous double cancer originating from the stomach and rectum. Abdominal manifestations were situs inversus totalis combined with multiple lobulated spleen, azygous continuation of the interrupted inferior vena cava, direct drainage of hepatic vein to left atrium, preduodenal portal vein, short pancreas, incomplete rotation of the colon, and malrotation of the intestine. Histologically, gastric cancer was diagnosed as papillary adenocarcinoma and rectal cancer, as moderately differentiated adenocarcinoma. The patient was successfully treated with total gastrectomy for gastric cancer and low-anterior resection of the rectum for rectal cancer.
A 47 year-old male was admitted to Miyazaki Medical college Hospital for further evaluation of an abdominal mass in the left upper quadrant. Abdominal ultrasound (US) and abdominal computed tomography (CT) showed two cystic masses in the mesenterium, which were suspected to be hematomas, but were not related to the pancreas, kidney or spleen. Superior mesenteric artery angiography and gallium (GA)-scintigraphy showed no definite findings. The patient underwent laparotomy on a suspicion of mesenteric hematoma. Two 4 x 3 x 3 cm soft tumors were found in the small intestinal mesenterium. These masses were histopathologically hematomas and surrounded by thick collagenous granulation tissue. The patient had no recent history of abdominal trauma, taking drugs capable of producing bleeding tendency, and/or vascular disease. The case was diagnosed as spontaneous mesenteric hematoma.
A case of extramedullary plasmacytoma (EMP) of the jejunum, an uncommonneoplasia, is reported. A 56-year-old Japanese womanwhoexperienced intermittent upper abdominal pain and weight loss had a large movablemassin the upper abdomen.The mass washypervascular in an (Internal Medicine 35: 422-426, 1996)
A case of systemic amyloidosis involving the gastrointestinal tract is presented. The initial manifestation of this case was mechanical obstruction. On laparotomy, a submucosal hematoma of the sigmoid colon which completely obliterated the lumen, was found. With intense medical treatment, the obstructed lumen became patent, but segmental ischemic colitis ensued. The terminal course of this case was complicated by chronic renal failure, upper gastrointestinal bleeding and coagulopathy. Pathological examination of the stomal specimen revealed massive amyloid deposits in the wall of the large intestine as well as other vital organs.
Gastrin releasing peptide(GRP)-like immunoreactivity in human plasma was measured using radioimmunoassay of neuromedin C (NMC) in 83 healthy and 58 diseased subjects. In the healthy group, the mean value of fasting GRP-like immunoreactivity was 2.1 +/- 1.4 (mean +/- SD) pmol/L. There was a slight positive correlation between the GRP-like immunoreactivity values and aging. Postprandial serial measurements demonstrated that GRP-like immunoreactivity showed no response to a significant elevation of serum gastrin concentration. The group with chronic renal failure on hemodialysis gave the highest value, 7.1 +/- 2.1 pmol/L (p less than 0.01). There were no statistical differences between the healthy controls and groups with peptic ulcer, liver cirrhosis, diabetes mellitus or carcinomas, although some cancer patients had a marked increase in GRP-like immunoreactivity value.
A patient with short bowel syndrome manifesting psychiatric deterioration was demonstrated. Four years after extensive small bowel resection the patient developed various psychological manifestations. Laboratory data did not indicate the specific causes but showed extensive hyponutritional state. After 2 weeks therapy by total parenteral nutrition (TPN), laboratory data returned to normal, but her psychiatric condition remained almost unchanged. When trace elements (copper, cobalt, manganese and zinc) were added to TPN, her psychiatric impairment rapidly improved. Although the mechanism involved in this situation may be multifactorial, the trace elements were primarily responsible for recovering from abnormal psychiatric condition.
Two cases with roentgenologic findings of extravasation of contrast medium into the stomach and colon following lymphangiography are presented. One is clinically diagnosed as primary intestinal lymphangiectasia; the other as retroperitoneal spread from uterine cancer. The significance of lymphangiography in gastrointestinal or retroperitoneal disorders is discussed.
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