Objectives: Upper gastrointestinal (UGI) bleeding is one of the most frequent complications among patients who need long-term care in a chronic ward. In this retrospective study, we therefore investigated the characteristics of UGI bleeding among patients hospitalized on a chronic ward. Methods: A total of 173 patients admitted to the chronic ward of the Ren-Ai Branch, Taipei City Hospital, were retrospectively enrolled. These individuals consisted of 109 patients with UGI bleeding and 64 patients without UGI bleeding. The demographic data and clinical courses of these patients were compared. Results: There were 135 (78.0%) patients who needed long-term naso-gastric (NG) tube feeding. Patients with UGI bleeding had a significantly higher rate of NG tube placement than those without UGI bleeding (89.9% vs. 57.8%, p＜0.001). All 12 patients with uremia suffered from UGI bleeding. In addition, the presence of a NG tube (odds ratio, 6.19; 95% CI, 2.69-14.21, p＜0.001) and the presence of diabetes mellitus as a comorbidity (odds ratio, 2.63; 95% CI, 1.16-5.96, p=0.021) were independent risk factors associated with UGI bleeding. A total of 75 UGI bleeding associated lesions were observed among 53 patients who underwent upper gastrointestinal endoscopy. Esophagitis or an esophageal ulcer was the most frequent causes of UGI bleeding (36%). The overall mortality rate was 50.3%. However, only 3.5% of the patients died from uncontrolled bleeding. Conclusions: UGI bleeding occurs frequently in patients with chronic illness. The presence of a NG tube, uremia as a comorbidity and diabetes mellitus as a comorbidity were found to be risk factors associated with UGI bleeding. The most common source of UGI bleeding in patients who were undergoing NG tube feeding was esophagitis and/or esophageal ulcer.
Background We aimed to improve the sensitivity of immunochemical fecal occult blood test (I-FOBT) to screen colorectal neoplasm among average-risk adults. Methods This is a diagnostic cohort study. All health examination participants receiving a single qualitative I-FOBT and a screening colonoscopy from January 2010 to June 2011 were included. Stool specimens were collected for I-FOBT before colonoscopy. Using pathology as gold standard, significant colorectal neoplasm was defined as advanced adenoma or malignancy. Results A total of 1 007 health examinees were identified. Fifty-five (5.5%) had borderline positive (+/-) I-FOBT, while 38 (3.8%) had positive I-FOBT. Twenty-four (2.4%) had advanced adenoma, and five (0.5%) had carcinoma. Using borderline positive I-FOBT as cutoff value, the sensitivity and specificity for significant colorectal neoplasm were 34.5% (95% confidence interval ( CI ) 19.9%-52.7%) and 91.5% (95% CI 89.6%-93.1%), respectively. If combined with advanced age, high blood pressure (BP), and abdominal obesity, a fulfillment of either two criteria further increased the sensitivity to 72.4% (95% CI 54.3%-85.3%) with a specificity of 68.8% (95% CI 65.8%-71.6%). Conclusion The sensitivity of a single qualitative I-FOBT for the detection of significant colorectal neoplasm can be increased by coupling with age, BP, and abdominal obesity.
In a review of 1,268 appendectomies from January 1984 to April 1989, ten cases were diagnosed as ”mucocele” by pathology. All these cases presented with a right lower quadrant (RLQ) mass or pain of variable duration except one whose mucocele was found incidentally during an operation for gastric cancer. One case revealed curvilinear and mottled calcification outlining a large mucocele on plain film of the abdomen. Abdominal ultrasonography in 7 patients showed negative finding in one case, a hypoechoic or anechoic tubular lesion with good transmission in two, an ovoid cystic lesion with variable internal echoes in dependent portion in two, intussusception in one and a periappendiceal abscess in one. Barium enema of 4 patients showed nonvisualization of the appendix but either filling defects with round smooth shape or external compression to the cecum were found. Fibercolonoscopy was performed in 4 cases, all were disclosed intrusions of mucocele from the appendiceal orifice. In one of them, the mucocele invaginated deeply and caused chronic appendico-cecal intussusception. Computed tomography was performed in one case, the mucocele showed a near-water-density tubular lesion with good enhancement of the wall after contrast injection. Though appendiceal mucocele is a rare clinical entity, it should be in the list of differential diagnosis of RLQ pain. With the disease in mind and advanced imaging modalities available, preoperative diagnosis is probable.
Due to the fact that epithelial neoplastic polyps in the colon and rectum are reported as having malignant potential elsewhere in the world, it intrigued our group and impelled us to conduct this retrospective analysis.
One hundred and forty-six patients reviewed and 213 adenomas in total found by colonoscopy in about 2,000 times of in-and outpatients examined and subsequently removed by the procedure of colonoscopic polypectomy. All the specimens were subjected to histopathological study.
The observation of adenoma tends to appear most commonly in aging colon. The interval for the development of atypia is estimated about 10 years. Polyps smaller than 0.5 cm in diameter rarely show malignancy, whereas polyps between 2-2.9 cm in diameter, the frequency of malignancy of tubular and villous adenomas is 10% and 33.3% respectively. If the size over 3 cm in villous adenoma, 71.4% resulted in malignant propensity. Villous adenomas have a marked malignant predilection up to 55.6% of villous lesions showing evidence of carcinoma. Thus, size and histological feature are two parameters involved in determining the malignant potential of an adenoma.
Furthermore, while tubular adenomas are distributed throughout the large intestine, villous adenomas occur predominantly in the rectum and sigmoid. The anatomic distribution of the adenomas bears a relationship to potential for adenomas in the distal descending, sigmoid and rectum have a greater frequency of malignancy than those elsewhere in the colon. This correlates well with the predominant distribution of colorectal cancer. Contrary to the expectation, the risk of cancer is greater in those patients with single adenoma than those with multiple adenomas.
In clinical setting, proctosigmoidoscopy is a very important single procedure to detect the polyps. In our series, more than half of the tubular adenomas and all villous adenomas are disclosed by this procedure alone. It is simple, safe and not cumbersome. In order to ensure that no secondary lesions existed, a detailed examination of the entire colon by colonoscope may be required. A vigorous surveillance programme including colonoscopic examination for both screening and follow-up in patients with colonic polyp is recommended. Therapeutic endoscopic polypectomy is worthwhile, since it may reduce the incidence of colorectal cancer because of adenomacarcinoma sequence.
Lipomas, uncommon in the GI tract, occur most often in the colon. The commonest site for symptomatic lipomas is the ascending colon. 90% of lipomas originate in the submucosa. Histologically, it is a well-differentiated tumor arising from deposites of adipose connective tissue in the bowel wall. Most colonic lipomas cause no symptoms at all. They are usually detected during the investigation of a symptom apparently derived from the large bowel. The most common manifestations are abdominal pain, change in bowel habit, obstruction, diarrhea, intussusception, or rarely a palpable mass. In this report, we describe a 63 year-old female patient with a colonic lipoma that induced intussusception. The patient had one episode of bloody diarrhea and a three-day history of severe intermittent cramping abdominal pain. Barium enema examination demonstrated an intraluminal tumor mass located in the transverse colon with colo-colonic intussusception. Abdominal CT showed colo-colonic intussusception and a suspicious colonic lipoma at leading point of the intussusception. A right hemicolectomy was performed. Microscopic examination showed a submucosal lipoma consisting of mature fit cells. After surgical treatment, the patient was discharged in stable condition.
Gastric carcinoids are epithelial tumors with potential malignancy. Generally they are small yellow or gray submucosal nodules. When tumors become enlarged, they are grossly indistinguishable from carcinomas. Some big gastric carcinoid tumors simulate Borrmann type II or III, rarely Borrmann type I gastric carcinomas macroscopically. We herein report a 76-year-old man with a giant polypoid carcinoid of the stomach, locating at the antrum, which is a rare morphological picture of gastric carcinoid in the literature.
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