Conventional colonoscopy and barium enema are the main examinations for colonic lesions, but each of them has different limitations according to the condition of the patient. It has been reported that preparations for these examinations also caused complications, such as colonic perforation leading to fatality. To avoid these complications, colonic enema with water-soluble contrast medium (Gatrografin®) has been performed as a screening method for those suspected to have obstructive colonic diseases, or those in whom it was difficult to be form colonoscopy and barium enema because of their poor condition. There are few reports about water-soluble contrast enema (WSCE). We retrospectively examined 121 cases of WSCE performed from January 2004 to December 2005 and assessed the acceptability of examination and its ability to detect colonic lesions. We divided our patients into five groups according to the reason for parforming WSCE. In all cases, we were able to perform WSCE without complications and assess colonic lesions. In 58 cases, we compared the results of WSCE with those of barium enema or colonoscopy, or both In 8 cases we missed small colonic polyps and erosions, but we missed only one large polyp 3cm in diameter, which we detected retrospectively. In conclusion, WSCE is safe and useful for the diagnosis of colonic disease, and may be one of the choices of colonic examination especially for those who are suspected to have obstructive colonic diseases or hemorrhagic lesions as well as for those in whom it is difficult to parform barium enema or colonoscopy.
This study was undertaken to clarify the importance of nutritional status in patients with acute cholecystitis, and also evaluate whether they benefited from enteral nutrition supplementation, including medium-chain triglycerides (MCT), during the convalescent stage. Patients with acute cholecystitis admitted to our hospital between April 1994 and March 2002 were classified into a poor nutrition group (n=40; total serum protein<5.0g/dl) or a fair nutrition group (n=71; >5.0g/dl). Patients with poor nutrition were significantly more elderly than those with fair nutrition, and had significantly higher serum C-reactive protein (CRP) concentrations. The two groups did not differ significantly with respect to other laboratory data, gender distribution, or medical treatment. We supplemented ordinary meals with enteral nutrition including MCT in 16 patients during the convalescent stage (MCT group). We compared their length of hospital stay and days required to recovery to pre-admission functional status for activities of daily living (ADL) with the same intervals in 16 patients without supplementation (non-MCT group) selected to match for age, gender, and fair or poor nutritional status from among 111 patients. Hospitalizations were significantly longer in the poor nutrition group (43.0±2.2 days) than in the fair nutrition group (27.0±8.2 days). Significantly more days were required to recover ADL status in the poor nutrition group (12.0±7.2 days) than in the fair group (9.4±5.2 days). Hospitalizations were significantly shorter in the MCT group (20.1±15 days) than in the non-MCT group (35.4±12.8 days). Significantly fewer days were required to recover ADL status in the MCT group (10.9±7 days) than in the non-MCT group (13.1±6.8 days). Administration of enteral nutrition including MCT during convalescence from acute cholecystitis thus appears to promote functional recovery shorten hospital stay.
We report a case of gastric cancer that was detected due to chylothorax. A 64-year-old man visited our hospital with chief complaints of anterior chest pain and right lower leg swelling. Chest X-ray showed bilateral pleural effusion. Biochemical tests of the pleural fluid detected chyle and cytological examination of the left pleural revealed poorly differentiated adenocarcinoma cells. An upper gastrointestinal examination revealed a type 4 gastric cancer that was diagnosed as the primary lesion. The appearance of the pleural effusion changed from chylaus to light yellow in the cancer progressad. Gastric cancer combined with chylothorax is quite rare and we discussed in this report how this change of the appearance of the pleural effusion occurred in comparison with the mechanism of chylothorax.
Amyotrophic lateral sclerosis (ALS) is a degenerative disease involving both upper and lower motor neurons and the pathogenesis of this disorder is still unknown. To date, few reports have suggested that motor neuron diseases may have a paraneoplastic origin. However, it is still under discussion whether ALS occurring in cancer patients is paraneoplastic. A 60-year-old man with rectal cancer (Stage IV) having multiple lung, liver and para-aortic lymph node metastases underwent anterior resection of the rectum as palliative surgery. He was referred to our hospital for adjuvant chemotherapy. Lung and lymph node metastases decreased after 2 courses of chemotherapy using CPT-11 and 5-FU/LV but liver metastases were enlarged, following up increase in CEA. Thereafter, he suffered from muscle weakness in hands, arms, and legs and results of neurophysiologic studies were compatible with primary lateral sclerosis (ALS). For second line chemotherapy, he was treated with low-dose CDDP/5-FU over 6 courses. As a result, the size the of metastatic lesions markedly reduced and CEA was decreased to the normal level. Although significant tumor reduction was observed, his neurological symptoms rapidly progressed. He died of aspiration pneumonia 8 months after onset of the disease. Autopsy revealed that his neuropathological findings were compatible with ALS, and it was thought to be the primary cause of death in the because of absence of cancer progression. In this case the neurological syndrome was not affected by cancer therapy. Thus our case does not support the hypothesis that ALS in associated with cancer and the relationship between both disorders remains uncertain.
A 17-year-old girl who had right lower abdominal pain with multiple swelling of lymph nodes in the ileocecal region and she was admitted to a neighboring hospital. Since there was no improvement of condition with antibiotic resistance, we were consulted. Lymph node biopsy under laparoscopy demonstrated nonspecific findings. She then developed erythema nodosum, suggesting the presence of autoimmune etiology. Treatment with systemic corticosteroid resulted in symptomatic improvement. Mesenteric lymphadenitis like this case is rare.
A 33-year-old man with epigastralgia was admitted. Upper gastrointestinal endoscopy revealed gastric fold hypertrophy, mucosal hemorrhage, and widespread erosion in the stomach and aphthoid erosion in the duodenum. The presence of intranuclear inclusion bodies positively stained with anti-cytomegalovirus antibody from the biopsy specimens indicated that the gastroduodenitis was related to cytomegalovirus(CMV)infection. He recovered within 2 weeks without antiviral therapy. Duodenal involvement of CMV infection is fairly rare in immunocompetent hosts.
A 85-year-old Japanese woman was urgently admitted to our hospital complaining of vomiting 20 months after the initial diagnosis of Merkel cell carcinoma on the right eyelid. The patient died of a huge intra-abdominal mass with complete obstruction of the distal duodenum two months later. On autopsy, the mass measuring 18×12×5cm in size was histologically diagnosed as metastatic Merkel cell carcinoma and directly invaded the stomach, pancreas, and distal duodenum.