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52,094 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The clinical and pathologic features of 43 primary adenacarcinomas of the small intestine (32 jejunal and 11 ileal) are reported. Seventy-four percent of the patients presented with partial or complete small bowel obstruction, 56% complained of abdominal pain, 37% had symptoms of anemia (weakness, easy fatigability), and 35% had lost weight. Anemic hemoglobin levels occurred in 69%, and a palpable abdominal mass in 25%. Treatment consisted of a "curative" or "palliative" resection, or a bypass procedure. Seventy-nine percent of the tumors showed an annular, constricting pattern, while the remaining 21% had a predominantly fungating or polypoid appearance. Three individuals currently free of clinical recurrence have been followed less than 5 years. Of the remaining 40 patients, a 5-year cure was achieved in 11 (28%), including 6 (15%) who at present have no recurrence and 5 (13%) who subsequently died of other causes. Within 5 years, 28 of these 40 patients (70%) were known or presumed dead tumor, and 1 had succumbed to other causes (2%). Various pathologic features were correlated with the clinical course. Documented lymph node metastasis proved to be the most valuable prognostic finding, 88% of these individuals dying of tumor, as contrasted to 45% of those with tumor-free nodes. A few cases of superficially invasive carcinoma found in an otherwise benign adenomatous lesion had a good prognosis when symptoms were produced mainly by the adenoma, the carcinoma being a relatively minor component.
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PMID:Primary adenocarcinoma of the jejunum and ileum. A clinicopathologic study. 5 95

Small bowel leiomyosarcomas are uncommon but potentially curable tumors often diagnosed at an advanced stage. Twenty such lesions were studied, and 19 of these produced symptoms and signs. Clinical findings included abdominal pain in 17 (85%), rectal bleeding in 8 (40%), anemia in 7 (35%), intraperitoneal perforation in 6 (30%), and abdominal mass in 4 (20%). Various abdominal x-ray examinations revealed nonspecific abnormalities (ileus, bowel obstruction, abdominal mass) in about half the cases in which they were obtained, but in only one instance was the correct diagnosis of small bowel tumor made preoperatively. Five of 12 patients undergoing resection in hope of cure survived five years. These tumors tend to metastasize by hematogenous dissemination, peritoneal implantation, local invasion, and, uncommonly, lymphogenous spread. Wide small bowel resection with adjacent mesentery is suggested for most lesions. Five year survival following resection approximates 50% in reported series.
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PMID:Leiomyosarcomas of the small intestine. 45 59

A retrospective study of 174 patients with small intestine cutaneous fistulas was carried out. Cause, location of fistula, amount of output, presence of inflammation, intestinal obstruction, presence of malnutrition and anemia are associated wih an increased mortality. The results of various modes of treatment indicate that intestinal resection with primary anastomosis, carried out six weeks or later after the onset of the fistula, was associated with the lowest mortality and the highest success rate.
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PMID:Small intestine cutaneous fistulas. 47 91

Forty patients with colorectal schistosomiasis who failed to respond to medical therapy were studied. They had dysentery with bloody mucus and anemia, polyps, pericolic masses, and schistosomal ulcers. Two patients had cecal masses which appeared to be intussusception and appendicitis. Three patients had chronic intestinal obstruction. Diverting transverse colostomy, followed by other surgical procedures, is the safest method of management.
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PMID:Colorectal schistosomiasis: clinicopathologic study and management. 49 94

Malignant tumors of the small bowel are rare but carry a grave prognosis. Thirty-seven cases from the Tumor Registries of Brooke Army Medical Center. Fort Sam Houston, Texas, and Fitzsimons Army Medical Center, Denver, Colorado, were retrospectively studied. Twenty-nine males and eight females ranging from five to 86 years were included in the combined series. Thirteen carcinoid tumors, eight adenocarcinomas, seven lymphosarcomas, five leiomyosarcomas, two reticulum cell sarcomas, one liposarcoma, and one mesenchymal cell sarcoma were found. Symptoms included intermittent crampy abdominal pain, intestinal obstruction, intestinal bleeding with anemia, and weight loss. The diagnosis was made on the basis of the clinical picture in addition to physical findings and pertinent x-ray contrast studies. The overall survival rate was 25%. The treatment of choice is surgical extirpation of the tumor whenever possible followed by appropriate adjunctive modalities.
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PMID:Malignant tumors of the intestine: a review of 37 cases. 57 64

Gastrointestinal metastases secondary to bronchogenic carcinoma are relatively uncommon and most are found incidentally at autopsy examination in patients with advanced or widely disseminated lung cancer. Occasionally gastrointestinal metastases occurr relatively early in the course of the disease and give rise to a variety of clinical symptoms and radiological abnormalities. Recognition of these abnormalities is important in order that appropriate palliative therapy may be undertaken. The clinical. radiological and pathological findings in 12 patients with symptomatic gastrointestinal metastases secondary to bronchogenic carcinoma were reviewed. Clinical symptoms varied according to the site of metastatic involvement and included dysphagia, epigastric pain, nausea, vomiting, gastrointestinal bleeding, anaemia and signs of intestinal obstruction or perforation. The sites of metastatic involvement were: oesphagogastric junction (2 cases); stomach (2 cases); duodenum (1 case): jejunum (3 cases); ileum (2 cases), colon (2 cases). The radiological findings are discussed and illustrated.
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PMID:Symptomatic gastrointestinal metastases secondary to bronchogenic carcinoma. 63 63

Twenty-seven patients with peritonitis to whom a drain was applied were given sulbenicillin (SBPC), a broad-spectrum antibiotic, which has so little hepatic and renal toxicity that massive doses may be feasible, and examination was made as to its therapeutic effects and concentrations of the antibiotic in the ascites. Daily dosage of SBPC was 10g in two divided doses in most cases given by the intravenous infusion. Medication was continued for 3 approximately 15 days. The highest daily dosage was 20g and the largest total dosage reached 190g, but there was no adverse reaction except for one case of a slight anemia. Peritonitis complicated appendicitis, adnexitis, duodenal ulcer perforation, intestinal obstruction or trauma as its primary disease. No difference in the therapeutic effect existed among the primary diseases. The response to SBPC treatment was excellent in 8 of the 27 patients and good in 17. Two patients failed to respond to the therapy. When SBPC was given just before operation, the SBPC concentration in ascites obtained at operation was 112 microgram/ml in 2 cases. The SBPC concentrations in ascites were examined following intravenous infusion of 5g over an hour, and a peak concentration of 94.7 microgram/ml was obtained at the completion of infusion (an hour after the start of infusion), which gradually decreased thereafter. In the ascites excreted from the drain after operation, a high concentration of 12.7 approximately 90.2 microgram/ml (mean: 51.7 +/- 7.7 microgram/ml) was obtained on the day after the operation day, but the concentration was lower thereafter. The SBPC concentrations in ascites were compared as regards the sites of drainage (Winslow's foramen, ileocecum and Douglas' fold), but no particular difference was observed. The SBPC concentrations in ascites after operation were in inverse proportion to the alleviation of peritonitis. They were higher when the inflammation was severer.
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PMID:[Chemotherapy of peritonitis with particular reference to concentrations of sulbenicillin in human ascites (author's transl)]. 65 Aug 86

Infantile transmural ulcerative enteritis is a disorder of early infancy characterized by feeding difficulties, intermittent and progressive diarrhea, cachexia, anemia, abdominal distention, and small-bowel dilation which may progress to intestinal obstruction. The pathologic process, of unknown etiology, involves a transmural enteritis with deep undermining mucosal ulceration, not unlike that seen in Crohn's disease, except that granulomas are usually not present. The early stages of the diseases may be reversible if the bowel is simply placed at rest by use of intravenous nutrition. In the later stages of the illness, there is progressive mechanical and functional intestinal obstruction due to inflammatory constriction of the distal small bowel and lack of effective peristalsis through the inflammed segments. The terminal stages are characterized by marked abdominal distention, complete obstruction, septicemia, and death. It is during the period of abdominal distention due to progressive intestinal obstruction that surgical intervention is of benefit. A cutaneous enterostomy proximal to the involved segments of small intestine serves to decompress the bowel, to minimize bacteremia, and to allow the distal inflamed intestine to heal. Total intravenous nutrition is mandatory for a period of several weeks until there is healing of the distal small bowel and closure of the enterostomy. In all surviving infants, bowel function has returned to normal and there have been no long-term sequelae or recurrences.
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PMID:Surgical management of infantile ulcerative enteritis. 80 75

Two cases of symptomatic inflammatory fibroid polyps (IFP) of the small intestine are presented, and the 17 adequately described symptomatic IFP previously reported are reviewed. IFP of the small bowel are rare. Most patients present with intestinal obstruction and a few with chronic anemia. IFP have characteristic histologic features and are easily recognized if they are considered in differential diagnosis.
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PMID:Symptomatic inflammatory fibroid polyp of the small bowel: report of two cases with review of literature. 84 84

Soil-transmitted helminth infections when light-to-moderate usually are well tolerated, but heavy-to massive infections invariably cause disease. A massive infection with Ascaris lumbricoides may cause intestinal obstruction, liver abscess, or some other condition requiring surgical treatment; more regularly, however, ascaris disease is a form of malnutrition. Trichuris trichiura causes diarrhea and dysentery and, at times, rectal prolapse. The hookworms, Necator americanus and Ancylostoma duodenale, cause blood-loss from the intestine resulting in anemia. Necator infection is acquired percutaneously, and is more frequently massive than is that of Ancylostoma which may be acquired percutaneously or orally. Estimates of egg output in the feces, based on egg-counts by dilution, direct smear, or thick-film techniques, provide a reliable index of light, medium, or heavy infection. Acquisition of heavy infection with Ascaris and Trichuris depends on favorable qualities of the soil, and on the sorting action of rain which transports and concentrates the eggs of helminths in locations where survival and transmission are favored. The high frequency of heavy hookworm infection in southeastern United States and probably elsewhere may depend largely on the presence of feces-burying dung beetles. Human infection with soil-transmitted helminths of dogs and cats has become a serious public health problem attributable to the persistence of rural mores in the urban setting.
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PMID:Biology of soil-transmitted helminths: the massive infection. 105 7


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