Cronkhite Canada syndrome complicated by pulmonary embolism—A case report
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Abstract:
Cronkhite Canada Syndrome (CCS) is a rare syndrome, described in 1955 by Americans, Leonard Wolsey Cronkhite and Wilma Jeanne Canada in the New England Journal of Medicine [1]. About 450 cases have been reported. Complications, like malignant transformation, unprovoked thromboembolism is known. Since there is wide variability in medical presentation, no definitive diagnostic and treatment protocol s have been set. The mortality remains at 55%.We report a case of a 50 year old male patient presenting with diarrhea, weight loss, abdominal pain, ectodermal features. His upper (UGI) and lower Gastrointestinal (LGI) endoscopy showed multiple polypoidal and carpet like lesions in fundus, body and antrum of stomach. Videocolonoscopy showed multiple sessile and pedunculated polyps. Multiple biopsies were taken, proving malignancy. Because of poor nutrition, total parenteral nutrition was given for four weeks. After nutritional optimization, he underwent laparoscopic assisted subtotal colectomy. His post-operative course was complicated by the occurrence of pulmonary embolism and anastomotic leak.CCS is an ailment of unknown pathophysiology. Considering what is known so far, patients suffering from CCS are at highest risk of thromboembolic episodes. This seems to be irrespective of surgical intervention. Patients of CCS should have thromboembolic prophylaxis started as soon as a diagnosis is made. They should have thrombophilia profile, fibrinogen level and Factor 8 tested before any intervention is planned.If CCS presents with a surgical indication, namely malignancy, the patient should be categorized as highest risk for thromboembolic complications and both mechanical and pharmacological prophylaxis be instituted.Keywords:
Gastrointestinal bleeding
Patients with a known primary malignancy and one or more suspicious skeletal lesions are often assumed to have skeletal involvement by the known malignancy. We set out to determine how often one would be correct in making this assumption.All CT-guided bone biopsies performed at our institution between January 2006 and January 2009 in patients with a history of a single biopsy-proven malignancy were retrospectively reviewed. Pathology results were assigned to one of three outcomes: skeletal involvement by known malignancy, newly diagnosed malignancy, or no malignancy identified. Patients categorized as no malignancy identified required repeat biopsy or stability on follow-up imaging for confirmation.Of 104 patients with a known primary malignancy, 11 were excluded. Of the 93 included patients, there was skeletal involvement by the known malignancy in 82 (88%), a newly diagnosed malignancy in seven (8%), and no malignancy identified in four (4%).Biopsy of a suspicious skeletal lesion in a patient with a solitary known malignancy reveals a newly diagnosed malignancy or no evidence of malignancy in 12% of patients, emphasizing the importance of biopsy.
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Aim : Henoch‐Schönlein purpura is an IgA‐mediated autoimmune vasculitis of children. It often presents with symptoms including purpuric rash, abdominal pain, renal involvement or arthritis. Abdominal pain is a frequent symptom in children with HSP and raises the suspicion of intussusception or perforation. We sought to evaluate abdominal pain via stool occult blood and image studies. Methods : A retrospective study of 261 patients diagnosed with Henoch‐Schönlein purpura from December 1991 to December 2001 was conducted. Image studies, including abdominal echo, abdominal CT and panendoscopy, were performed for patients who suffered from abdominal pain. Results : Of the 261 patients, 151 (58%) had abdominal pain, and 46 (17.6%) suffered either overt gastrointestinal bleeding or had positive stool occult blood. Seven patients had gross bloody stools. One acute intussusception and one bowel perforation were noted. One patient suffered from hypovolemic shock due to massive gastrointestinal bleeding. When stool occult blood was 3+ or 4+, the incidence of a positive image finding was high. Conclusion : We found that stool occult blood and image studies may be necessary regarding severe gastrointestinal involvement. Ultrasonography is an important tool when intussusception or bowel perforation is suspected. Monitoring the vital signs is important, especially in patients with massive gastrointestinal bleeding.
Purpura (gastropod)
Gastrointestinal bleeding
Occult
Perforation
Palpable purpura
Abdominal ultrasonography
Gastrointestinal perforation
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Pulmonary angiography
Computed Tomography Angiography
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Abstract Background : Cryptococcal meningitis (CM) was found to be coexist with malignancy in non-human immunodeficiency virus (HIV) infected patients. The purpose of this study was to evaluate the clinical characteristics and therapeutic outcomes of CM in non-HIV infected patients with malignancy. Methods : A total of 320 CM patients were enrolled for analysis from January 2013-May 2019. One hundred and four patients underwent positron emission computed tomography (PET-CT) examination. The demographics, clinical characteristics, microbiological, radiological, therapeutic outcomes were analyzed in CM patients with and without malignancy. Results : Twelve patients with malignancy were found, of which 7 malignancy before CM (MBC), 5 malignancy after CM (MAC). CM patients with malignancy were older than non-malignancy ones. The prognosis of MBC patients was comparable to that of non-malignancy patients, but was extremely poor in MAC patients. Four out of 5 CM patients, who was suggested diagnosis as malignancy by PET-CT, were finally confirmed. Conclusions : This study found an increase rate of solid malignancies in CM patients. Screening malignancy in older CM patients was very important because it is closely related to prognosis and might affect treatment strategy. PET-CT might be a useful tool for early malignancy screening in CM.
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To the Editor.
—Several misconceptions may result from the recent report of pulmonary embolism in women and men in the Prospective Investigation of Pulmonary Embolism Diagnosis (PIOPED) study.1In this study, risk factors were compared for men and women suspected of having pulmonary embolism. It is valid to compare the presence of risk factors in men and women who have the disease (eg, positive angiogram). However, when one compares these risk factors for those suspected of a disease, the results are biased by the physician's threshold for suspicion of disease, which includes the risk factors under study. The comparison of the frequency of a risk factor in men and women with definite pulmonary embolism with those suspected of pulmonary embolism but with a negative angiogram is invalid owing to selection bias. The authors acknowledge the problem of a biased denominator and concede that suspicion of pulmonary embolism and, hence,Cite
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Objective To explore the value of MSCT features in predicting the malignancy degree of gastrointestinal stromal tumor(GIST).Methods CT Data of 44 patients with pathologically proved GIST were reviewed.The differences of CT features among different malignancy degrees of GIST were analyzed.Results Pathology confirmed very low malignancy GIST in 5 patients,low malignancy in 9,moderate malignancy in 7 and high malignancy in 23.The tumor size,location,growth pattern,enhancement pattern,contour,mesenteric fat infiltration,cystic-necrosis,tumor vascularization and direct organ invasion had statistical differences among different malignancy degrees(all P0.05).Conclusion Tumor size,location,growth pattern,enhancement pattern,border,mesenteric fat infiltration,cystic-necrosis,tumor vascularization and direct organ invasion might be predictive indexes for malignancy of GIST.
Stromal tumor
Infiltration (HVAC)
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Aim: Henoch-Schönlein purpura is an IgA-mediated autoimmune vasculitis of children. It often presents with symptoms including purpuric rash, abdominal pain, renal involvement or arthritis. Abdominal pain is a frequent symptom in children with HSP and raises the suspicion of intussusception or perforation. We sought to evaluate abdominal pain via stool occult blood and image studies. Methods: A retrospective study of 261 patients diagnosed with Henoch-Schönlein purpura from December 1991 to December 2001 was conducted. Image studies, including abdominal echo, abdominal CT and panendoscopy, were performed for patients who suffered from abdominal pain. Results: Of the 261 patients, 151 (58%) had abdominal pain, and 46 (17.6%) suffered either overt gastrointestinal bleeding or had positive stool occult blood. Seven patients had gross bloody stools. One acute intussusception and one bowel perforation were noted. One patient suffered from hypovolemic shock due to massive gastrointestinal bleeding. When stool occult blood was 3+ or 4+, the incidence of a positive image finding was high. Conclusion: We found that stool occult blood and image studies may be necessary regarding severe gastrointestinal involvement. Ultrasonography is an important tool when intussusception or bowel perforation is suspected. Monitoring the vital signs is important, especially in patients with massive gastrointestinal bleeding.
Purpura (gastropod)
Gastrointestinal bleeding
Occult
Perforation
Palpable purpura
Abdominal ultrasonography
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Abstract Background : Cryptococcal meningitis (CM) was found to be coexist with malignancy in non-human immunodeficiency virus (HIV) infected patients. The purpose of this study was to evaluate the clinical characteristics and therapeutic outcomes of CM in non-HIV infected patients with malignancy. Methods : A total of 320 CM patients were enrolled for analysis from January 2013-May 2019. One hundred and four patients underwent positron emission computed tomography (PET-CT) examination. The demographics, clinical characteristics, microbiological, radiological, therapeutic outcomes were analyzed in CM patients with and without malignancy. Results : Twelve patients with malignancy were found, of which 7 malignancy before CM (MBC), 5 malignancy after CM (MAC). CM patients with malignancy were older than non-malignancy ones. The prognosis of MBC patients was comparable to that of non-malignancy patients, but was extremely poor in MAC patients. Four out of 5 CM patients, who was suggested diagnosis as malignancy by PET-CT, were finally confirmed. Conclusions : This study found an increase rate of solid malignancies in CM patients. Screening malignancy in older CM patients was very important because it is closely related to prognosis and might affect treatment strategy. PET-CT might be a useful tool for early malignancy screening in CM.
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Most pathologic nipple discharge (PND) is benign, but duct excision has been advised to exclude malignancy. To identify factors associated with malignancy, we reviewed 280 patients with PND at our institution from 2004 to 2014. In 49 cases, malignancy was found. These patients more often had palpable masses (39% vs 11%, P < .001) and abnormal imaging (94% vs 75%, P = .004). On multivariable analysis, age, palpable mass, and abnormal imaging were independently associated with malignancy. Among 48 patients with PND but no other clinical/imaging abnormalities, only 1 malignancy, a small ductal carcinoma in situ, was identified. Observation may be reasonable for these select patients.
Nipple discharge
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