RESUMEN

BACKGROUND: To evaluate the radiologic features of recurrent Crohn's disease after extensive enteric resection and jejunocolostomy. METHODS: We reviewed the small bowel studies of 25 patients with recurrent enteritis and less than 125 cm of jejunum following enteric resection and jejunocolostomy and the studies of 27 patients with jejunitis in an intact jejunum. RESULTS: Twenty-three patients with recurrences had neoterminal jejunitis, six under 10 cm, 10 over 10 cm and continuous, and seven with skip lesions (six jejunal, one duodenal). Two had isolated jejunitis or duodenitis. Three with continuous disease had lengthy recurrences. Enteritis showed only one or two abnormalities in 12 of 25 patients with recurrences and in two of 27 with disease in the intact jejunum. Recurrent jejunitis and jejunitis in the intact jejunum showed similar frequencies of mucosal thickening, strictures, ulceration and its complications, skip lesions, sacculation, obstructive dilatation, featureless mucosa, and polyps, and significantly different frequencies only of mesenteric masses. Recurrent jejunitis and terminal ileitis showed significantly different frequencies of mucosal thickening, strictures, ulceration and its complications, skip lesions, sacculation, obstructive dilatation, and mesenteric masses, and similar frequencies only of a featureless mucosa. CONCLUSIONS: The neoterminal jejunum is the most common site of recurrence and the only site in almost 25%. Jejunitis remote from the fecal stream is also frequent, but duodenitis is not. Recurrences are seldom extensive and often show only one or two radiographic findings. The frequencies of most lesions in recurrent jejunitis do not differ significantly from those in jejunitis in the intact jejunum but do differ from those in terminal ileitis.

Asunto(s)

RESUMEN

PURPOSE: To identify the clinical and radiologic findings in patients with diaphragm-like strictures in the small bowel. PATIENTS AND METHODS: We reviewed the histories, radiologic findings, and pathologic findings in two men and two women, all in their sixties, with a history of long-term nonsteroidal antiinflammatory drug (NSAID) or aspirin (ASA) usage and one or more radiologically demonstrated diaphragm-like strictures in the small bowel. RESULTS: Two patients had long histories of NSAID usage, and two of ASA usage. One NSAID user had a long segment of jejunal involvement, and the other three had short segments of duodenal involvement. The ASA users presented with symptoms of esophageal disease, the small bowel lesions were unexpected, and ASA usage was not initially elicited. In one NSAID user and one ASA user, broader strictures with humps rather than diaphragms were also seen producing a lifesaver-like or bagel-like configuration. CONCLUSIONS: Multiple diaphragm-like strictures can occur in NSAID injury and are pathognomonic except in the rare patient with ulcerative enteritis complicating celiac disease. Single or few diaphragm-like strictures can occur in NSAID injury and peptic ulceration. ASA should be considered an NSAID with regard to small-bowel toxicity. A careful medication history is required when an unexplained small bowel abnormality is seen radiologically, and a dedicated small bowel examination is required when NSAID injury is suspected.

Asunto(s)

RESUMEN

BACKGROUND: Kayexalate (sodium polystyrene sulphonate) in sorbitol is commonly used to treat hyperkalemia in patients with renal insufficiency. Isolated case reports and one recent large series have documented intestinal necrosis following administration of kayexalate in sorbitol. METHODS: Two patients with luminal kayexalate crystals associated with intestinal pathology were first identified in the pathology department, and clinicopathological correlation was carried out. RESULTS: Both patients were seriously ill, had prior cardiac surgery and were in renal failure (uremic). Examination of autopsy and colonic resection showed luminal kayexalate crystals associated with underlying mucosal necrosis, submucosal edema and transmural inflammation. CONCLUSION: Although occurring in complex clinical settings, the pathological findings provide additional evidence that kayexalate in sorbitol may be associated with intestinal necrosis and inflammation in uremic patients and that this may be a clinically and pathologically under-recognized iatrogenic bowel injury.

Asunto(s)

RESUMEN

This study examined the histological changes following irradiation on nonexpanded and tissue-expanded pigskin. Six Yorkshire pigs received 4860 cGy radiation to one flank with the opposite side serving as the control. A histopathological comparison of tissue expansion in irradiated tissue to nonradiated tissue showed a reduction in the thickness of the dermal and subcutaneous layers, with less prominent rete ridges and a thicker stratum spinosum (p < 0.05). Nonexpanded irradiated tissue showed a reduction of thickness in the dermis and subcutaneous layer, less prominent rete ridges, and a thicker stratum spinosum layer (p < 0.05) when compared with nonradiated tissue. Tissue-expanded irradiated tissue showed no significant differences (p > 0.05) in any of these parameters when compared with nonexpanded irradiated tissue. This study demonstrates that radiation produced a significant change in porcine skin, but tissue expansion did not further alter the histological changes associated with irradiation.

Asunto(s)

Asunto(s)

RESUMEN

The authors describe an occult metastatic deposit in the kidney of a 22-year-old woman; such lesions are not usually detected until autopsy. They postulate that after the development of acute subcapsular hematoma, a "renal compartmental syndrome" occurred, leading to renal artery thrombosis. Primary vascular involvement by the metastatic osteosarcoma, which was remote from the renal hilus, was not identified pathologically.

Asunto(s)

RESUMEN

A 32-year-old white man presented with worsening acne and noticeable increase in muscle bulk. On examination, a firmer area with a granular consistency was noted in the right testis. A right radical orchiectomy was performed and the histologic findings were those of a typical seminoma associated with marked Leydig cell hyperplasia. A solitary right iliac lymph node metastasis, but not the primary seminoma, contained human chorionic gonadotrophin- (HCG) producing syncytiotrophoblast, which was regarded as the hormonal stimulus for Leydig cell hyperplasia and elevated serum testosterone. This seems to be the first report of testicular seminoma presenting with symptoms of androgen excess.

Asunto(s)

Asunto(s)

RESUMEN

An adenocarcinoma of the papilla of Vater showing hepatoid differentiation similar to that described for hepatoid adenocarcinoma of the stomach is reported. The tumor was a poorly differentiated adenocarcinoma with clear cells containing occasional hyaline droplets and exhibiting bile secretion. Alpha-fetoprotein (AFP), alpha 1-antitrypsin (alpha 1-AT) and carcino-embryonic antigen (CEA) were demonstrated by immunoperoxidase staining. This appears to be the first report of a hepatoid adenocarcinoma at this location.

Asunto(s)

RESUMEN

We report a rare case of a patient with blastomycosis who presented with splenic abscess and peritoneal involvement. This case is unique in that no historical or radiographic evidence of antecedent pulmonary infection was apparent and therapy with orally administered ketoconazole was effective. We reviewed the English-language literature on blastomycotic splenic abscess and compared findings from other cases with findings from the current case.

Asunto(s)

RESUMEN

Radiologic and routine histologic examinations, transmission electron microscopy and scanning electron microscopy were carried out on membranes retrieved from the following hip implant prostheses: loose cemented metal-on-polyethylene, resorptive cysts around fixed cemented metal-on-polyethylene, cemented without polyethylene (Thompson), noncemented without polyethylene (Moore), loose ceramic-on-ceramic and loose noncemented metal-on-polyethylene. From histologic analysis the most common factor in the membranes reviewed, in terms of production of multinucleated giant cells, is the presence of polyethylene wear debris. Neither loosening of the implant nor the presence or absence of bone cement produces such cells within the membrane.

Asunto(s)

RESUMEN

We describe three patients with Crohn's disease of the small intestine with a polypoid configuration. In two patients, the polypoid masses were the only radiologic abnormalities and were suggestive of jejunoileal lymphoma and terminal ileal adenomas. The diagnosis of Crohn's disease was established only at laparotomy. In the third patient, a polypoid mass simulating a sessile adenoma was seen along with other typical features of ileitis and was recognized preoperatively as a manifestation of the ileitis. The resected ileal segments of all three patients showed mural thickening, luminal narrowing and distortion, and mucosal ulceration and fissuring. The asymmetry of the mural thickening and the resultant luminal narrowing simulated sessile polyps to which mucosal ulceration and fissuring gave a lobulated appearance.

Asunto(s)

RESUMEN

We present a unique case of diffuse linitis plastica involving the gastrointestinal tract and the scrotal skin of a 63-year-old man. The radiologic and pathologic features of this entity are discussed together with a review of the pertinent literature.

Asunto(s)

RESUMEN

Posterior rhinometric measurements of nasal resistance were conducted on two groups of patients with perennial rhinitis: those whose symptom of nasal stuffiness responded to a topical steroid spray and those in whom it did not. The anterior ends of the inferior turbinates in 48 patients were treated with either cryosurgery or cautery, and in half of the subjects the erectile tissue of the septum was also thermally ablated. Measurements were made before and 10-16 weeks after therapy. It is concluded from statistical comparison that there is no benefit to treating the septum, and that cryosurgery is more effective in those whose symptoms respond to topical steroids, while cautery works better in those who do not. Histology showed no change in the capacitance vessels (sinusoids) after either modality, and xylometazoline caused a marked decrease in nasal resistance, suggesting that vascular smooth muscle function was intact. Irrespective of the change in airway resistance, most subjects felt that there had been an improvement. The mechanism is discussed.

Asunto(s)

RESUMEN

A duodenal somatostatinoma was found incidentally in a 60-year-old woman undergoing cholecystectomy. Microscopically, the tumor had a glandular architecture with abundant psammoma bodies. Electron microscopy revealed tumor cells resembling D-cells of the pancreatic islets. Immunohistochemically, there was staining for neuron-specific enolase, chromogranin, and diffuse cytoplasmic positivity for somatostatin only. By immunoelectron microscopy, somatostatin was identified predominantly in lucent membrane-bound secretory granules. X-ray-dispersive microanalysis showed the psammoma bodies contained calcium apatite crystals. This case is compared with other reported cases with a description of cellular localization of somatostatin and development of psammomatous calcification.

Asunto(s)

RESUMEN

Obstruction of renal collecting tubules by protein cats inciting a giant cell reaction is usually characteristic of myeloma cast nephropathy. Rarely other causes of proteinuria may result in a similar morphology. We report a rare case of 'myeloma-like' tubular casts in the kidney of a patient who was subsequently found at autopsy to have acinar cell carcinoma of the pancreas with peritoneal carcinomatosis. Only two similar reports could be found in the English literature.

Asunto(s)

RESUMEN

The results of a five-year experience with fine-needle thyroid aspiration cytology are reported to assess the value, accuracy and limitations of this biopsy procedure. The cytologic diagnoses on 1,465 thyroid aspirates are listed, and correlation of cytology with histology on 207 cases undergoing surgery is reported. The incidence of malignancy among the atypical and malignant cytology aspirates with histologic confirmed diagnosis was 65% (28/43) while a false negative rate of 11.5% (15/131) was found. Fine-needle aspiration biopsy is a safe and useful procedure with an acceptable accuracy rate that complements other investigations in the screening of patients for thyroid surgery.

Asunto(s)

RESUMEN

An atypical carcinoid tumor of the small bowel in a patient with celiac disease is described. Although an increased incidence of malignancy has been observed in celiac disease, this seems to be the first report of a carcinoid tumor of the small intestine associated with this condition. Although the significance of this association is unclear, the implications with regard to gastrointestinal endocrine cell proliferation and tumor histogenesis are discussed.

Asunto(s)

Asunto(s)