Clinical presentation of Bartter syndrome is similar to surrepitious vomiting or use of diuretics. Therefore, precise differential diagnosis of Bartter syndrome is crucial. We report a case of medullary nephrocalcinosis (MNC) induced by furosemide mimicking Bartter syndrome. A 55-year-old female patient visited our hospital with renal dysfunction on basis of hypokalemia and metabolic alkalosis. She had no history of hypertension or drug use except allopurinol and atorvastatin. She did not complain of nausea or vomiting on presentation and the serum magnesium level was normal. We performed ultrasonography, that showed MNC. For these reasons, we suspected Bartter syndrome and corrected the electrolyte imbalance. During outpatient follow up, we found that the patient had been taking 400 mg of furosemide daily for 30 years. We could diagnose furosemide induced MNC, and recommended to her to reduce the amount of furosemide.
Alkalosis ; Allopurinol ; Bartter Syndrome* ; Diagnosis, Differential ; Diuretics ; Female ; Follow-Up Studies ; Furosemide* ; Humans ; Hypertension ; Hypokalemia ; Magnesium ; Middle Aged ; Nausea ; Nephrocalcinosis* ; Outpatients ; Ultrasonography ; Vomiting ; Atorvastatin Calcium

A 56-year-old woman with emphysematous pyelonephritis underwent an emergent left nephrectomy due to her religious creed. Postoperative hemoglobin level was decreased to 4.4 g/dL from preoperative value of 13.9 g/dL. The patient completely recovered without transfusion and was discharged on the 40th postoperative day without complication.
Anemia* ; Female ; Humans ; Middle Aged ; Nephrectomy* ; Pyelonephritis

Neurofibromatosis type 1 (NF-1) is an autosomal dominant disorder with a prevalence of approximately 1 in 3,500 live births. NF-1 predisposes to various benign and malignant neoplasms. Neurological malignancies are most frequent, but the risks of non-nervous system tumors, such as of the esophagus, stomach, colon, liver, biliary tract, pancreas, lung, melanoma, thyroid gland, female breast and ovaries, are also increased. Malignant tumors are the most common cause of death in patients with NF-1. Cases with double primary tumors have been reported, but cases involving three or more primary cancers are rarely reported. Therefore, we present the case of a NF-1 patient diagnosed with gastrointestinal stromal tumor, breast cancer and ampulla of Vater cancer.
Ampulla of Vater* ; Biliary Tract ; Breast Neoplasms ; Breast* ; Cause of Death ; Colon ; Esophagus ; Female ; Gastrointestinal Stromal Tumors* ; Humans ; Live Birth ; Liver ; Lung ; Melanoma ; Neurofibromatoses* ; Neurofibromatosis 1* ; Ovary ; Pancreas ; Prevalence ; Stomach ; Thyroid Gland

We report two cases of endoscopic submucosal dissection (ESD) for recurrent or residual esophageal squamous cell carcinoma (ESCC) lesions after chemoradiotherapy for advanced esophageal cancer. Case 1 involved a 64-year-old man who had previously undergone chemoradiotherapy for advanced ESCC and achieved a complete response (CR) for 22 months, until metachronous recurrent superficial ESCC was detected on follow-up esophagogastroduodenoscopy (EGD). We performed ESD and found no evidence of recurrence for 24 months. Case 2 involved a 59-year-old man who had previously undergone chemoradiotherapy for advanced ESCC. He responded favorably to treatment, and most of the tumor had disappeared on follow-up EGD 4 months later. However, there were two residual superficial esophageal lugol-voiding lesions. We performed ESD, and he had a CR for 32 months thereafter. ESD can be considered a viable treatment option for recurrent or residual superficial ESCC after chemoradiotherapy for advanced esophageal cancer.
Carcinoma, Squamous Cell ; Chemoradiotherapy* ; Endoscopy, Digestive System ; Esophageal Neoplasms* ; Follow-Up Studies ; Humans ; Middle Aged ; Recurrence

The rare cause of lower gastrointestinal bleeding is angiodysplasia. Angiolysplasia is most common in the right colon, but it can be found throughout the whole gastrointestinal tract. The main lesion of angiodysplasia is located at the submucosal layer. So, it is sometimes very difficult to search for the focus of bleeding via laparotomy or colonoscopy. We recently experienced a case of rectal arteriovenous malformation that was misdiagnosed as intussusception. A 57-year-old man visited the emergency room because of abrupt anal bleeding and low abdominal pain, and this was the third episode he'd experienced during the past 20 years. Sigmoidoscopy and abdominal CT revealed that his rectum was obstructed with a dark black colotuberant mass, which was suggestive of ischemic intussusception. We performed emergency laparotomy and we found an extremely swollen rectum with surrounding hematoma instead of intussusception. We performed low anterior resection and colo-anal anastomosis with ileostomy. The final pathologic diagnosis showed that the protuberant mass was a hematoma in the submucosal layer, and this developed by bleeding from an arteriovenous malformation in the rectum.
Abdominal Pain ; Angiodysplasia ; Arteriovenous Malformations ; Colon ; Colonoscopy ; Emergencies ; Gastrointestinal Tract ; Hematoma ; Hemorrhage ; Humans ; Ileostomy ; Intussusception ; Laparotomy ; Middle Aged ; Rectum ; Sigmoidoscopy

Chronic neutrophilic leukemia (CNL) is a rare myeloproliferative neoplasm characterized by sustained neutrophilia, splenomegaly, and hypercellular bone marrow without Philadelphia chromosome. Diagnosis of CNL requires exclusion of identifiable causes of reactive neutrophilia, such as infection and tumors. Our patient presented with general weakness and weight loss. Computed tomography (CT) showed a mass in the distal rectum, which was confirmed to be an adenocarcinoma by colonoscopic biopsy. Positron emission tomography-CT showed multiple liver, bone, and lymph node metastases. Liver and lymph node biopsies revealed neutrophilic infiltration with no evidence of adenocarcinoma. The pathological findings of the bone marrow were compatible with CNL. Cytogenetic analysis revealed a normal karyotype, and molecular analysis was negative for BCR/ABL. Here, we present a 73 year-old man diagnosed with concurrent CNL and rectal cancer.
Adenocarcinoma ; Biopsy ; Bone Marrow ; Cytogenetic Analysis ; Diagnosis ; Electrons ; Humans ; Karyotype ; Leukemia ; Leukemia, Neutrophilic, Chronic* ; Leukemoid Reaction ; Leukocytosis ; Liver ; Lymph Nodes ; Neoplasm Metastasis ; Neutrophils ; Philadelphia Chromosome ; Rectal Neoplasms* ; Rectum ; Splenomegaly ; Weight Loss