Inflammatory fibroid polyp of the stomach. Report of a case

Inflammatory fibroid polyp (IFP) is a rare lesion of the gastroenteric tract more frequently occurring at the level of the stomach. The etiopathogenesis of IFP as well as the nature of the cells constituting these lesions remain unknown. Abdominal pain and anaemia due to chronic blood loss are the most common presenting features but neither radiology and CT scanning nor endoscopy are capable to achieve any conclusive diagnostic information. Histologic examination of the specimen obtained by endoscopic or surgical excision is considered to be the only way for the definitive exclusion of a neoplastic nature. A case of IFP treated by means of total gastrectomy is presented.     

Rectal mucosal stripping: a technique for preservation of the rectum after total colectomy for chronic ulcerative colitis

Rectal mucosal stripping is a technique for removal of diseased tissue secondary to chronic ulcerative colitis. It is a technique for the preservation of a functional rectum following a total colectomy. Subsequent mucosal regeneration can allow ileorectal anastomosis without fear of recurrent disease and with maintenance of general health and acceptable gastrointestinal tract function.     

Pouchitis after ileo-anal anastomosis with a reservoir in hemorrhagic rectocolitis]

DEFINITION AND FREQUENCY: An ileoanal anastomosis with creation of an ideal pouch is proposed as the treatment for familial adenomatous polyposis and ulcerative hemorrhagic rectocolitis. The ideal pouch may become inflammatory in 10 to 30% of the cases. The diagnosis of pouchitis is based on a clinical, endoscopid and histological criteria. PATHOGENIC HYPOTHESES: Pouchitis is a late complication, mainly after ileoanal anastomosis for ulcerative rectocolitis. The pathogenic mechanism is a subject of debate. Fecal stasis, bacterial pollution, mucine secretion and the underlying inflammatory disease could be involved. TREATMENT: Antibiotics active against anaerobic bacteria, such as metronidazole, are generally given. In case of failure, common antiinflammatory agents used in inflammatory bowel disease are indicated.     

Rectal cancer after sulindac therapy for a sporadic adenomatous colonic polyp

Correlation of the clinical manifestations of a patient with fibroblastic rheumatism with sequential skin biopsy findings revealed an early inflammatory stage with cutaneous nodules, patchy erythematous skin lesions, polyarthritis, dermal lymphomonocytic infiltrates, and fibroblastic and myofibroblastic proliferation, followed by a chronic stage with sclerodactyly, joint ankylosis, deformities and dense dermal fibrosis. Treatment of this rare disorder in its early active stages may prevent the development of incapacitating joint sequelae.     

Total colectomy with rectal mucosectomy and ileoanal anastomosis for chronic ulcerative colitis in children and young adults

Total colectomy with rectal mucosectomy and ileoanal anastomosis has been utilized as a sphincter-saving operation in young people with chronic ulcerative colitis. From 1977 to 1979, our section of pediatric surgery performed this procedure on 12 children and young adults with chronic ulcerative colitis, with encouraging results. All patients are alive and well, and all have had excellent rectal continence. Follow-up ranges from 7 to 27 months. Eight patients describe an excellent result, two have had a fair result, and two have required a temporary ileostomy. Numerous loose stools have been observed early, but stools become formed by diet and medical management, and early return to school and work has been possible. The number of stools continues to decrease for at least 1 year.     

Development of invasive adenocarcinoma in a long-standing Kock continent ileostomy: report of a case

The first case of adenocarcinoma developing in a continent ileostomy is reported. A healthy, 39-year-old man with a continent ileostomy for 17 years developed subacute obstructive symptoms and was found on endoscopy to have a large adenocarcinoma involving the intussusception valve. At operation, he was found to have a large tumor originating in the valve, extending through the reservoir, and involving the afferent ileal limb. A number of metastatic lymph nodes were identified in the mesentery of the small bowel. He underwent excision of the pouch and formation of an end ileostomy. He is currently undergoing adjuvant chemotherapy. Biochemical and morphologic changes in the ileal pouch, both in the pelvis and the continent ileostomy, are discussed. The implications of this apparent de novo cancer arising in an ileal pouch are discussed.     

Peritoneal pseudomyxoma in a child with a gallbladder Peutz-Jeghers-like hamartomatous polyp: a case report

A 2-year, 6-month-old boy with peritoneal pseudomyxoma had a hamartomatous Peutz-Jeghers-like polyp in the gallbladder. The morphological pattern of the polyp was very characteristic of what is usually considered an hamartomatous polyp. The patient presently reported has no clinical characteristics of Peutz-Jeghers syndrome. The peritoneal pseudomyxoma creates differential diagnostic problems with well-differentiated mucinous adenocarcinoma.     

Antrochonal polyp: a case report of treatment with intranasal steroids

The aetiology of antrochonal polyps is unknown. We report one case where treatment with topical intranasal cortico-steroids was successful. We are not aware of any previous reports of medical treatment.     

Motility in the Hunt-Lawrence pouch after total gastrectomy

PURPOSE: The aim of this study was to evaluate motility patterns of the Hunt-Lawrence pouch and the jejunal limb of patients reconstructed with a pouch after total gastrectomy, and to compare the findings in symptomatic patients to those without symptoms after the operation. PATIENTS AND METHODS: Thirty-three patients who had undergone post-gastrectomy pouch reconstruction were studied using a water-perfused motility system. In 21, the pouch was connected by a Roux-en-Y, and, in 12, by a jejunal interposition. Twenty-eight patients were asymptomatic, including 17 connected by a Roux-en-Y and 11 by a jejunal interposition. Five patients were by a jejunal interposition. Five patients were symptomatic, including 4 connected by Roux-en-Y Y and 1 by jejunal interposition. A control group consisted of 5 healthy volunteers who had not undergone operation. RESULTS: The motility phases in the pouch and jejunal limb of asymptomatic patients were of shorter duration than those of controls, and they followed a random sequence instead of a normal progression from phase I to II to III. Motility features were similar in the pouch and the jejunal limb. Orthograde propagation of phase III-like activity was reduced and may contribute to the pouch storage function. Four of the 5 symptomatic patients showed highly abnormal motility with hypomotile or obstructive patterns. The technique of connecting the pouch--jejunal interposition of Roux-en-Y--did not affect the motility findings. CONCLUSIONS: The altered motility occurs after a Hunt-Lawrence pouch reconstruction in asymptomatic patients. Symptoms after gastrectomy are associated with further disturbed motility that can be differentiated from the motility changes in asymptomatic patients.     

Quality of life after proctocolectomy for ulcerative colitis

Nowadays, restorative proctocolectomy is considered the "gold standard" in the surgical therapy of ulcerative colitis. Alternative procedures such as Brooke ileostomy or Kock pouch are limited to special indications. Preservation of function is the decisive advantage of the ileoanal pouch, but preservation of function is not equal to quality of life. Quality of life is a multidimensional concept that is difficult to define and measure. Quality of life can only be assessed by standardized and validated quality-of-life questionnaires. Preoperatively, patients with ulcerative colitis have a restricted quality of life, depending on the intensity of their disease. Proctocolectomy is the curative therapy and improves quality of life. When evaluating quality of life it is not essential if patients are treated by Brooke ileostomy or restorative proctocolectomy. The advantage of restorative proctocolectomy is the improvement in some aspects such as sexuality and physical activity. The "Total Quality-of-Life Index" is not improved. Preoperatively, patients should be informed that preservation of function by restorative proctocolectomy is accompanied by an increased postoperative morbidity in comparison to other procedures. Decreased quality-of-life results when complications occur postoperatively that cannot be controlled over a long period of time. In some cases excision of the ileoanal pouch may be the most sensible way of solving the problems. On the other hand, patients without complications and good function after ileoanal pouch procedure may achieve a quality of life comparable to that of healthy controls. Preoperatively, patients should be aware of this risk-benefit relationship and should share the responsibility of the decision for or against restorative proctocolectomy.     

Inflammatory pseudotumor of the abdomen: report of a case

BACKGROUND: Cosmetic denervation of hyperfunctional facial lines using botulinum toxin (Botox, Allergan, Inc., Irvine, CA) has gained growing popularity over recent years. Understanding the clinical use and effects of botulinum toxin requires a thorough understanding of the muscular anatomy of the treatment areas. OBJECTIVE: The purpose of this article is to review the anatomy of the frown, forehead, and periocular regions. Function of individual muscles is discussed to understand proper injection technique. CONCLUSIONS: The anatomy of the frown, forehead, and periocular regions is complex. Individual muscles are tightly intertwined and treatment of one anatomic region may affect many different muscles. A complete understanding of the anatomy of the upper face is essential to ensure proper injection technique, safe and predictable results as well as anticipating complications.     

Adenocarcinoma arising in "J" pouch after total proctocolectomy for familial polyposis coli

Cigarette smoking has a major impact both on oral health and general systemic health. Because up to 70 percent of smokers see their dentists each year, the dentist is in a very powerful position to intervene with the smokers to help them stop smoking. I have suggested a four-step program for assisting patients to quit, based on the National Cancer Institute's suggested protocol for the dental office, which uses techniques shown in clinical trials to be effective for helping smokers quit. The core of the NCI program involves identifying smokers, advising them to quit, providing assistance to patients trying to quit, and following-up on patients as a means of enhancing success rates. Dentists who implement an effective smoking cessation program in their practices can expect to achieve quit rates up to 10 to 15 percent each year among their patients who smoke. Such a rate of success, if established nationwide and continued over a period of years, would markedly reduce the prevalence of smoking in the United States.     

Inflammatory pseudotumour of the trachea: report of a case in an eight-year-old child

A polypoid inflammatory pseudotumour was diagnosed in the trachea of an eight-year-old child who presented with asthmatic symptoms. The tumour showed 80 per cent blockage of the lower trachea and consisted of proliferating spindly fibroblastic cells admixed with a variable number of inflammatory cells. The literature on childhood inflammatory pseudotumours is reviewed together with the differential diagnosis of other polypoid mesenchymal tumours of the trachea.     

Comparative analysis of histology, DNA content, p53 and Ki-ras mutations in colectomy specimens with long-standing ulcerative colitis

CYP2C19 (S-mephenytoin hydroxylase) is a polymorphically expressed enzyme. Currently, two defective alleles are known--CYP2C19*2 and CYP2C19*3. The authors have developed an oligonucleotide ligation assay to detect these two alleles. This assay combines the hybridization of one common, biotinylated capture probe and two allele-specific probes to the target DNA, with the ability of a DNA ligase to distinguish mismatched nucleotides. The probes are only ligated if they are base paired correctly to the target strand. The biotin is bound to streptavidin, and all DNA not covalently bound to the biotin-labeled capture probe, is removed in a washing procedure. The allele-specific probes are labeled with either europium or samarium, and their emission can be measured simultaneously. The ratio between the emission separates the genotypes. This method was applied on DNA from 19 whites and 21 Vietnamese living in Denmark. All genotypes determined by the assay were consistent with the results from restriction enzyme cleavage. There were 12 poor metabolizers; 10 homozygous CYP2C19*2/CYP2C19*2, one heterozygous CYP2C19*2/CYP2C19*3, and one heterozygous CYP2C19*1/CYP2C19*2. The authors conclude that this assay is well-suited for a high throughput of samples in a routine laboratory. The finding of an apparently heterozygous CYP2C19*1/CYP2C19*2 poor metabolizer, confirms that there are still unknown mutations in CYP2C19.