A 30-yr-old man was referred for suspicious rectal cancer because of ulcerated lesions in the rectum and a palpable mass in left inguinal area. Sigmoidoscopy showed two indurated masses and histologic evaluation of biopsy revealed obliterative endarteritis with heavy plasma cell infiltration. Both venereal disease research laboratories (VDRL) and fluorescent treponemal antibody absorption (FTA-ABS) tests were positive. After injection of penicillin G benzathine for 3 weeks, the rectal chancre and the palpable mass disappeared.
Adult ; Diagnosis, Differential ; Humans ; Male ; Rectal Diseases/*complications/drug therapy/*pathology ; Rectal Neoplasms/pathology ; Syphilis/*complications/drug therapy/*pathology

Solitary rectal ulcer syndrome (SRUS) is a rare, benign disorder in children that usually presents with rectal bleeding, constipation, mucous discharge, prolonged straining, tenesmus, lower abdominal pain, and localized pain in the perineal area. The underlying etiology is not well understood, but it is secondary to ischemic changes and trauma in the rectum associated with paradoxical contraction of the pelvic floor and the external anal sphincter muscles; rectal prolapse has also been implicated in the pathogenesis. This syndrome is diagnosed based on clinical symptoms and endoscopic and histological findings, but SRUS often goes unrecognized or is easily confused with other diseases such as inflammatory bowel disease, amoebiasis, malignancy, and other causes of rectal bleeding such as a juvenile polyps. SRUS should be suspected in patients experiencing rectal discharge of blood and mucus in addition to previous disorders of evacuation. We herein report six pediatric cases with SRUS.
Adolescent ; Anti-Inflammatory Agents, Non-Steroidal/therapeutic use ; Anti-Ulcer Agents/therapeutic use ; Child ; Colonoscopy ; Female ; Gastrointestinal Hemorrhage/*diagnosis ; Humans ; Male ; Mesalamine/therapeutic use ; Rectal Diseases/*diagnosis/drug therapy ; Steroids/therapeutic use ; Sucralfate/therapeutic use ; Syndrome ; Ulcer/*diagnosis/drug therapy

No abstract available.
Adult ; Antineoplastic Agents/*adverse effects ; Antitubercular Agents/therapeutic use ; Biopsy ; Female ; Gastrointestinal Stromal Tumors/*drug therapy/pathology/surgery ; Humans ; Imatinib Mesylate/*adverse effects ; Lung Diseases, Interstitial/*chemically induced/diagnosis ; Mycobacterium tuberculosis/*isolation & purification ; Protein Kinase Inhibitors/*adverse effects ; Rectal Neoplasms/*drug therapy/pathology/surgery ; Tomography, X-Ray Computed ; Tuberculosis, Pulmonary/diagnosis/drug therapy/*microbiology

A Dieulafoy lesion in the rectum is a very rare and it can cause massive lower gastrointestinal bleeding. An 83-year-old man visited our hospital. He had chronic constipation and had taken aspirin for about 10 years because of a previous brain infarction. He was admitted because of a recent brain stroke. On the third hospital day, he had massive hematochezia and suddenly developed hypovolemic shock. Abdominal computed tomography showed active arterial bleeding on the left side of the mid-rectum. Emergency sigmoidoscopy showed an exposed vessel with blood spurting from the rectal wall. The active bleeding was controlled successfully by an injection of epinephrine and two hemoclippings. On the fourth day after the procedure, he had massive recurrent hematochezia, and his vital signs were unstable. Doppler-guided hemorrhoidal artery band ligation was performed urgently at two sites. However, he rebled on the third postoperative day. Selective inferior mesenteric angiography revealed an arterial pseudoaneurysm in a branch of the superior rectal artery, as the cause of rectal bleeding, and this was embolized successfully. We report a rare case of life-threatening rectal bleeding caused by a Dieulafoy lesion combined with pseudoaneurysm of the superior rectal artery which was treated successfully with embolization.
Aged, 80 and over ; Aneurysm/radiography ; Angiography ; Aspirin/therapeutic use ; Brain Infarction/drug therapy/prevention & control ; Embolization, Therapeutic ; Gastrointestinal Hemorrhage/*diagnosis/etiology/therapy ; Hemorrhoids/*complications ; Humans ; Male ; Mesenteric Artery, Inferior/radiography ; Platelet Aggregation Inhibitors/therapeutic use ; Rectal Diseases/complications/diagnosis/therapy ; Rectum/blood supply ; Sigmoidoscopy ; Tomography, X-Ray Computed

A Dieulafoy lesion in the rectum is a very rare and it can cause massive lower gastrointestinal bleeding. An 83-year-old man visited our hospital. He had chronic constipation and had taken aspirin for about 10 years because of a previous brain infarction. He was admitted because of a recent brain stroke. On the third hospital day, he had massive hematochezia and suddenly developed hypovolemic shock. Abdominal computed tomography showed active arterial bleeding on the left side of the mid-rectum. Emergency sigmoidoscopy showed an exposed vessel with blood spurting from the rectal wall. The active bleeding was controlled successfully by an injection of epinephrine and two hemoclippings. On the fourth day after the procedure, he had massive recurrent hematochezia, and his vital signs were unstable. Doppler-guided hemorrhoidal artery band ligation was performed urgently at two sites. However, he rebled on the third postoperative day. Selective inferior mesenteric angiography revealed an arterial pseudoaneurysm in a branch of the superior rectal artery, as the cause of rectal bleeding, and this was embolized successfully. We report a rare case of life-threatening rectal bleeding caused by a Dieulafoy lesion combined with pseudoaneurysm of the superior rectal artery which was treated successfully with embolization.
Aged, 80 and over ; Aneurysm/radiography ; Angiography ; Aspirin/therapeutic use ; Brain Infarction/drug therapy/prevention & control ; Embolization, Therapeutic ; Gastrointestinal Hemorrhage/*diagnosis/etiology/therapy ; Hemorrhoids/*complications ; Humans ; Male ; Mesenteric Artery, Inferior/radiography ; Platelet Aggregation Inhibitors/therapeutic use ; Rectal Diseases/complications/diagnosis/therapy ; Rectum/blood supply ; Sigmoidoscopy ; Tomography, X-Ray Computed

Intracerebral metastases are among the most feared complication of systemic malignant disease and most occur late in the course of the systemic cancer so often are viewed as a terminal maifestation for which diagnosis and treatment are neigher required nor desirable. However, this situation is changing. Improved survival rates with many kinds of cancer have led increasingly to instances where the neurologic complications themselves limit the quality of life, forcing physicians to assume a more active attitude toward the diagnosis and treatment of the neurologic disorder. The authors analysed 125 cases of intracerebral metastatic tumors which are diagnosed with the brain CT scan at Yonsei University, Severance Hospital from January, 1979 to December, 1984 and following results were obtained. 1. Intracerebral metastatic tumors are found in 125 cases(31.2%) of all intracranial neoplasm. 2. The most common primary tumor is lung ca. (50.4%) followed by chorioca. (8%), breast ca. (8%) and GI tract ca. (6.4%) in the order while 16 casese (12.8%) were of unknown primary tumor. 3. Chorioca. (14.9%), melanoma(5.6%), lung ca.(4.2%), kidney ca.(3.3%) and breast ca.(2.3%) exhibit relatively high rate of intracerebral metastasis in the order whereas stomach ca.(0.2%), hepatoma (0.3%) and cervix ca (0.1%), which constitute most common primary maliqnancies in Korea, revealed very low rate of intracerebral metastasis. 4. The youngest patient was 11 years old and the oldest 80. Most intracerebral metastatic tumors, 97%, occur above 30 years of age and peak in the 6th decade (32%). In age below 40, chorioca. Is the most common pimary tumor and the age above 40, lung ca. 5. There is no sexual difference between male and female. In male most conmon primary site is lung (64.6%) followed by GI tract(7.7%)and in female, lung (35%), chorioca. (16.7%) in the order. 6. The most common presenting symptom and sign is headache (58.4%) followed by motor deficit (48.0%), mental deterioration (43.2%) and nausea or vomiting (32.8%). 7. In most of intracerebral metastases the onset is gradual with duration of less than 3 months in 84% whereas in a few patients, 8 cases (6.4%), the onset is apoplectic and the primary sites that revealed apoplectic onset are lun. (3 cases), chorioca. (3 cases), liver (3 cases), unknown (1 cases). 8. Intracerebral metastases are detected simultaneously (50.5%), precociously (3.7%) or after (45.9%) diagnosis of the primary tumor. 9. Average interval between the diagnosis of primary tumor and development of intracerebral metastasis is 9.1 months in total and short in lung, stomach, kidney and liver cancer whereas and long in breast, rectum cancer and sarcoma. 10. In 96 cases who can be reevaluated with brain CT, the findings are as follows; 1) Metastatic lesions are multiple in 67.7% and single in 32.3%. 2) Most intracerebral metastases are located supratentorially (77.%), in 4.2%; infratentorially and in 18.8%; both. 3) Density of lesions are variable from hypodense to hyperdense and intracerebral metastases from chorioca., breast, kidney and nasopharynx ca. Are likely to iso to hyper than hypodense. Calcifications are rare and observed only in 2 cases (2%). 4) Most cases (98.5%) reveal perifocal edema of variable degree while a few patients (11.5%) reveal no edema. 5) Most metastatic lesions demonstrate variable contrast enhancement with nodular type (52.1%), rign type (25.0%), combined (15.6%) and a few patients (7.3%) fail to enhance. 6) Hemorrhages are found in 11 cases (11.5%) and chorioca. (4 cases), hepatoma 3 cases) and lung ca, (3 cases) are the most frequent offenders. 11. Radiation, surgery and chemotherapy seems to improve the prognosis.
Brain ; Brain Neoplasms ; Breast ; Carcinoma, Hepatocellular ; Cervix Uteri ; Child ; Criminals ; Diagnosis ; Drug Therapy ; Edema ; Female ; Gastrointestinal Tract ; Headache ; Hemorrhage ; Humans ; Kidney ; Korea ; Liver ; Liver Neoplasms ; Lung ; Male ; Nasopharynx ; Nausea ; Neoplasm Metastasis ; Neoplasms, Unknown Primary ; Nervous System Diseases ; Prognosis ; Quality of Life ; Rectal Neoplasms ; Sarcoma ; Stomach ; Survival Rate ; Tomography, X-Ray Computed ; Vomiting