Melaena: an unusual presentation of a pseudoaneurysm of the internal carotid artery.
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Pseudoaneurysm of the internal carotid artery is a rare but potentially fatal condition, and its clinical manifestations are often varied. Knowledge of this condition is essential to making the diagnosis. We describe a case of a 38-year-old man who presented with melaena. He also reported blood-stained sputum in the morning for several days. The only significant physical finding was a left peritonsillar mass. Initially worked up for a gastrointestinal bleed, computed tomography of the neck showed a large pseudoaneurysm of the internal carotid artery. A bypass from the proximal external carotid artery to the distal middle cerebral artery had to be created prior to angiographic embolisation of the pseudoaneurysm due to an inadequate supply from the contralateral cerebral hemisphere. The patient made an uneventful recovery with no neurological deficits. (+info)
The management of multi-site, bleeding, visceral artery pseudoaneurysms, secondary to necrotising pancreatitis.
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High versus low dosing of oral colchicine for early acute gout flare: Twenty-four-hour outcome of the first multicenter, randomized, double-blind, placebo-controlled, parallel-group, dose-comparison colchicine study.
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Dietary interventions for fecal occult blood test screening: systematic review of the literature.
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OBJECTIVE: To determine whether dietary restrictions enhance the specificity of guaiac-based fecal occult blood tests (FOBTs) when screening for colorectal cancer. DATA SOURCES: PubMed-MEDLINE, the Cumulative Index to Nursing and Allied Health Literature, and Cochrane databases were searched. STUDY SELECTION: English-language case series, cohort studies, randomized controlled trials (RCTs), and meta-analyses were selected. Studies that did not include dietary manipulation or the use of guaiac-based FOBTs available in North America were excluded. SYNTHESIS: Ten case series, 5 cohort studies, 4 RCTs, and 1 meta-analysis were critically appraised. All studies used Hemoccult, Hemoccult II, or Hemoccult SENSA tests. Data from case series involving challenge diets showed no increase in positive FOBT results from high-peroxidase vegetables, but results varied with red-meat challenges depending on the amount of meat consumed and the test used. Case series, cohort studies, and RCTs comparing FOBT results during restricted versus unrestricted diets consistently showed no differences in positive FOBT results. CONCLUSION: Most of the evidence evaluating the effect of dietary restrictions on FOBT results is dated and of suboptimal quality. However, 4 RCTs and a meta-analysis of these data do not support dietary restrictions when screening for colorectal cancer. Because patient adherence can be an issue with FOBTs, and dietary restrictions can affect adherence in some populations, it is reasonable to abandon these recommendations without fear of substantially affecting specificity. (+info)
Hemangioma of the ileum in a dog.
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An 11-year-old, castrated male beagle dog was presented with a sudden onset of clinical signs of depression, abdominal discomfort, anorexia and melena. Radiography and ultrasonography revealed a well-circumscribed mass lesion with a size of 5 cm in diameter at the hypogastrium. A complete blood count and blood chemistry revealed severe anemia, hypoproteinemia and hypoalbuminemia. Through celiotomy, a large tumor mass involving the ileum was resected. The inside of the mass was irregular and sponge-like structure with multiple cavitated structures. On histology, the lesion was diagnosed to be hemangioma of the ileal wall. To the best of our knowledge, this unusual case is the first clinical report on the ileal hemangioma in non-human animal species. (+info)
Exploring the interplay of barrier function and leukocyte recruitment in intestinal inflammation by targeting fucosyltransferase VII and trefoil factor 3.
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Early colon cancer within a diverticulum treated by magnifying chromoendoscopy and laparoscopy.
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We report a unique case of intramucosal carcinoma in a tubulovillous adenoma arising from a single diverticulum. Endoscopic mucosal resection (EMR) was carried out successfully and completely with the assistance of laparoscopy. A 71-year-old man was admitted to our hospital because of melena and anemia. Emergent colonoscopy showed diverticulosis in the right-sided colon. However, endoscopy could not exactly detect the bleeding site. A flat elevated polyp was found within a single diverticulum located in the descending colon and diagnosed as an intramucosal carcinoma, as magnifying chromoendoscopy revealed a type IV pit pattern. As his diverticular bleeding repeated, a right-sided hemicolectomy was decided for treatment, the polyp within the diverticulum was also completely removed by EMR with the assistance of laparoscopy. Although a colonic perforation was detected immediately after EMR, the perforation was closed with endoclips intraluminally and also repaired laparoscopically from the serosal side. Histologically, the resected lesion was an intramucosal well-differentiated adenocarcinoma and the surgical margin was free of tumor. (+info)
Gastric adenomyoma presenting as melena: a case report and literature review.
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Gastric adenomyoma (AM) is a rare benign tumor characterized by gland-like structures embedded within a smooth muscle stroma. We report a case of a 68-year-old man with gastric AM admitted to our hospital for melana. Endoscopic examination revealed a gastric mass of about 4 cm in diameter, located in the antrum. Histologic examination of the excised specimen showed irregularly arranged glands and interlacing smooth muscle bundles surrounding the glandular elements. Although gastric AM is rare, it should be considered in differential diagnosis of extramucosal gastric tumor. (+info)