Abdollahi A, Bagheri R, Maddah Gh, Rajabi Mashhadi Mt,
Volume 66, Issue 6 (9-2008)
Abstract
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Background: Stromal tumors of the gastrointestinal tract (GISTs) are uncommon and
the cell of origin is actually mesenchymal. Stemming from smooth muscle, 90% of GISTs, or
leiomyomas, are found in the lower two thirds of the esophagus. Typically
solitary, multiple tumors (leiomyomatosis) are occasionally reported. Remaining
intramural during their growth, most of their bulk protrudes toward the
esophageal outer wall, with a freely-movable, normal-looking overlying mucosa. In
this study, we report a rare case of esophageal leiomyomatosis treated by
esophagectomy.
Case
Report: A 70-year-old man presented with discomfort upon
swallowing, dysphagia, nausea, belching and weight loss. After a barium
swallow, only dilatation of the esophagus from the retained food and saliva was
seen. CT
scan revealed a 10-cm
dilatation of the thoracic esophagus. An endoscopy and upper GI series was performed,
but no pathology was found. Esophageal manometry and pH monitoring for
gastroesophageal reflux were normal. Upon endoscopic ultrasonography, a thickening
of the esophageal wall was identified 20-30 cm from the dental arch. The patient was diagnosed with
a GIST,
referred to surgeon and a transhiatal esophagectomy was performed. The patient was
discharged from the hospital in good condition and has had no problem during
the one-year period of follow up.
Ali Ghafouri, Zhamak Khorgami, Saadat Moulanaei,
Volume 67, Issue 12 (3-2010)
Abstract
Background: Intraabdominal schwannomas are rare tumors mostly occur in patients with neurofibromatosis. Tumors arisen from vagus nerve are rarer especially in sporadic cases.
Case: A 34-year-old man admitted in surgery ward Milad Hospital, in Tehran, Iran with long-lasting vomiting, dysphagia, and cachexia for four years. Multiple previous paraclinical assessments were normal, he had been treated as anorexia nervosa for three years without improvement. Our evaluations showed a mass in diaphragmatic hiatus. Explorative laparotomy revealed a mass parallel to distal esophagus, which was resected completely. Immunohistochemical examinations revealed a benign schwannoma. After surgery, the patient&aposs symptoms recovered and he returned to normal life.
Conclusions: Vagus nerve schwannoma can present with dysphagia and cachexia with normal endoscopic evaluations. It is important to rule out physical causes in patients with cachexia who are treated with psychiatric diagnoses.
Reza Pourrashidi, Shervin Sharifkashani , Hashem Sharifian, Habib Mazaher , Peyman Salamati , Batool Ghorbani Yekta ,
Volume 71, Issue 4 (7-2013)
Abstract
Background: Detection of retained foreign bodies remains a significant problem in the emergency department. Foreign bodies can go undetected causing infectious complications ultrasonography is too inaccessible and expensive. The purpose of this study is comparison of ultrasonography with radiography for the detection of cervical esophageal foreign bodies
Methods: This cross-sectional study evaluated 58 patients referred with suspected upper esophageal foreign body in the Emergency Department, Amir Alam. Patients were evaluated with ultrasonography and x-ray. After surgical exploration, different type of foreign bodies were recorded. The SPSS statistical software was used for analysis. For applicable efficacy outcome measures, a Spearman correlation was used. Differences were significant when P<0.05. All values were expressed as the frequency and present.
Results: Fifty eight patients were studied. 25 patients (43.4%) were male and 31 patients (56.9%) were female, in 28 (48.2%) patients foreign bodies were detected in radiography. 30 patients (51.8%) were not recorded in techniqe. It was found in patients 22 (78.6%) organic body, and six cases (21.4%) non-organic body. radiographic outcomes in patients with foreign bodies were positive in 26 patients (92.9%) and in two patients (7.1%) were negative. Ultrasound results were positive in 27 patients (96.4%) and in one patient (3.6%) were negative. Association of ultrasound and radiography results were significant in patients with foreign body (Spearman correlation=0.896, P=0.001 Kappa=0.890).
Conclusion: These reports suggest that result of ultrasound with radiography for the detection foreign bodies in cervical esophagus have good agreement. The use of ultrasonography in the emergency department to detect and eventually remove foreign bodies by emergency physicians is an important issue because there is not always an ultrasound technologist or radiologist available.
Alireza Sharifi, Shahab Dolatshahi , Atefeh Rezaeifar , Tayeb Ramim ,
Volume 72, Issue 6 (9-2014)
Abstract
Background: Lack of precise diagnostic criteria and sufficient findings in support of biopsy sampling during upper gastrointestinal endoscopy is one of the special challenge in endoscopy assessment in Barrett's esophagus. The aim of this study was to evaluate the mucosa in the distal esophagus tissues through a biopsy during upper gastrointesti- nal endoscopy in gastroesophogeal reflux disease patients whose symptoms don't im- prove or only partially resolve with treatment.
Methods: A cross-sectional study was done in patients with gastroesophogeal reflux disease medically resistant to treatment. The patients were assessed by gastroenterology department in Sina Hospital, Tehran, Iran, since September 2012 to September 2013. Patients with coagulopathy, esophageal varicose, esophageal cancer, earlier detection of developing Barrett's esophagus, history of irritable bowel syndrome, psychological dis- orders and using of nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin, were excluded. Esophageal squamous epithelium and cylindrical tissue of stomach was carefully checked by endoscope. Then 2 to 4 biopsy of the Z-line above the gastroe- sophageal mucosa were obtained.
Results: One hundred and fifty three patients included 78 men (51%) and 75 females (49%) with a mean age of 47.92±17.57 years participated in the study. The mean of body mass index of patients was 25.05±4.17 kg/m2 and body mass index in 45.8 % of the patients more than 230 kg/m2. Biopsy specimens were taken in 31 cases were not enough for histological examination. In other patients, 25 cases (20.5%) were normal and 97 cases (79.5%) had the following pathological diagnosis: mild esophagitis (49 cases 40.2%), moderate esophagitis (24 cases 19.7%), severe esophagitis (14 cases
11.5%), Barrett's esophagus (8 cases, 6.5%), fungal esophagitis (1 cases, 0.8%), and eosinophilic esophagitis (1 cases 0.8%). 117 patients (76.5%) had H. pylori infection. Sensitivity and specifity of endoscopy for detection of Barrett's esophagus during upper gastrointestinal endoscopy were 100% and 84.13% (CI 95%:78.53-89.09%), respec- tively.
Conclusion: Our data showed that doing of accurate and adequate biopsy samples from lesions in upper GI endoscopy can be helpful in the diagnosis of Barrett's esophagus
