Volume 80 - 2017 - Fasc.2 - Letters
Esophageal ectopic sebaceous glands
The authors report the case of a 75 years old female, with history of porphyria cutanea tarda, who was sent to the emergency department after a recent abdominal waist increase that after etiologic study revealed to be secondary to paraneoplastic ascites due to an ovarian adenocarcinoma. During hospitalization the patient underwent an upper endoscopy. In the lower half of the esophagus, the mucosa showed not detachable whitish plaques (Fig. 1), suggestive of candidiasis, and whose biopsies revealed to ectopic sebaceous glands (Fig. 2). At the same time, in the greater curvature of the gastric antrum, there was a sub-epithelial lesion with a central orifice, compatible with ectopic pancreas.
Effectivity of hemodialysis in acute gastrointestinal bleeding associated with dabigatran overdose
Novel oral anticoagulants (NOACs) have become available as alternatives for warfarin in patients with nonvalvular atrial fibrillation (AF). NOACs directly inhibit either factor IIa (dabigatran) or activated coagulation factor X. Limitations to the use of the NOACs include the lack of a reversal agent ; an inability to use the therapies in specific patient populations and a lack of available coagulation tests to quantify their effects. There are no published clinical trials or other high-quality evidence addressing the management of gastrointestinal (GI) bleeding on NOACs ; thus, most current recommendations are based on experts' opinions (1).
Pancreatic resection for isolated metastasis from melanoma of unknown primary
A 55-year-old female patient presented with a three- week history of upper abdominal pain and itching. She had no past medical history. Examination revealed fever and jaundice. Laboratory tests showed cholestasis. Tumor markers including CEA and CA 19.9 were normal. Computed tomography (CT) and magnetic resonance imaging (MRI) showed a 6x5 cm mass located in the head of the pancreas with peripheral enhancement, leading to intra and extrahepatic biliary tract dilatation (Fig. 1). The patient underwent surgery and a pancreaticoduodenectomy was performed. She had an uneventful postoperative course and was discharged 10 days later. The macroscopic examination of the pancreatectomy found a pigmented mass measuring 5,5×4 cm in the head of the pancreas (Figure 1). Histological examination confirmed melanoma with epithelioid and polygonal cells (Fig. 2). All resection margins were free and there was no lymph node involvement.
A Petrifying Bowel Movement: a non-operative assistance to nature's resolution of colonic gallstone obstruction?
Gallstones are a rare cause of intestinal obstruction (1-4%) (1) with 2-8% involving the colon (2). A stone is usually over 2cm, 4cm if no stricture or other mass is present (2). Commoner diseases such as malignancy should be considered first. We present a case report of non-operative resolution.
A 71 year old male with five days of abdominal pain, emesis and loose stools presents to the ER. The remainder of his history is unremarkable. On exam, he was vitally normal, distended and without peritonitis. Rectal exam demonstrated an enlarged prostate.
Amelanotic metastatic melanoma of the stomach presenting with iron deficiency anemia
Melanoma is an extremely aggressive cancer affecting people in young age. About 18% of patients with cutaneous melanoma will show clinical metastases. The gastrointestinal tract has a frequency of involvement by metastatic melanoma of about 26-48%.(1) Clinical diagnosis of enteric metastasis is made in less than 5% of patients affected by melanoma. Instead, at autopsy of 216 subjects with disseminated melanoma, Patel et al described a share of spread to intestinal site of about 60%.
Invasive liver abscess syndrome in North America
Most community-acquired Klebsiella pneumonia infections cause pneumonia or urinary tract infections. Invasive liver abscess syndrome is very rare in Western countries. Clinicians should be aware about invasive Klebsiella pneumonia liver abscess especially in patients with Asian background presented with liver abscess failed the treatment with antibiotics. Over the past decade, few patients were diagnosed as having a liver abscess caused by Klebsiella pneumoniae in two case series in the Unites States of America (1). This is a 25 years old male from Philippine with no past medical history presented with fever, rigors, fatigue and night sweats for three days. Patient travelled to Philippines five months ago where he stayed for one month. Upon presentation, patient was febrile with Temp 104F, heart rate 139 beats/minute, and Blood pressure 113/76 mm Hg. He appeared to be diaphoretic and tachypneic on physical exam. Abdomen was soft and non-tender.
An uncommon variation of the coeliac trunk in an adult patient with a splenic infarct : computed tomography angiography findings
In several clinical situations, such as living-donor liver transplantations and surgical treatment of hepatic tumors, the knowledge of the arterial hepatic vasculature is crucial (1-3). The complicated nature of the variable anatomy of the celiac trunk and hepatic arteries may complicate surgical resection. Therefore, accurate knowledge of the vascular anatomy before surgical therapy is required (3). In the present case, the splenic infarct may have been secondary to or favored by the observed arterial arrangement. Computed tomography (CT) angiography offers excellent three-dimensional reformatted images and is a useful noninvasive method for demonstrating the details of vascular structures (4).
