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[Complications in primary tumors of the small intestine].

Of 112 000 patients undergoing surgery between 1952 and 1973, 67 had a primary tumor of the small intestine. 22 patients had a benign tumor, 8 a carcinoid, 21 carcinoma and 15 sarcoma. Benign tumors were more frequent in the duodenum and ileum, carcinoids in the terminal ileum and carcinomas in the duodenum and jejunum. Sarcomas were found equally in all parts of the small intestine. The most common symptom for all types of the tumor was variable pain in the abdomen. Loss of weight occurred only in patients with carcinomas and sarcomas; heavy intestinal blood loss was most common in patients with benign tumors. Benign tumors often show invagination, while sarcomas cause occlusive ileus or perforation. All duodenal tumors show heavy intestinal bleeding but hematemesis is rare. Emergency surgery was necessary in 42% of patients with benign tumors or sarcoma and in 30% of patients with carcinoma. Five-year survival in patients with benign tumors is excellent (100%). Compared to this, five-year survival in patients with carcinoma, sarcoma or carcinoids is only 15%.

Adenoma, Islet Cell↗

Prograde and retrograde intussusception: A rarity in Peutz-Jeghers syndrome.

A 30-year-old woman presented with subacute intestinal obstruction. Clinical evaluation and radiological studies pointed toward an enteroenteric intussusception with intestinal polyps. Exploratory laparotomy revealed a retrograde intussusception mass acting as a lead point for a second prograde jejuno-jejunal intussusception. Resection and anastomosis of the involved segment was done. Histopathology revealed the presence of hamartomas. The patient was diagnosed with Peutz-Jeghers syndrome. The rarity of such a case is highlighted, and the diagnostic challenge it poses is discussed.

Adult↗

[Isolated tricuspid endocarditis. Apropos of a case caused by Streptococcus D bovis and faecalis occurring after coloscopy].

A 59-year-old chronic alcoholic male, with no cardiac past history, was hospitalised with septicemia 5 months after the endoscopic removal of 2 benign intestinal polyps. The diagnosis of tricuspid endocarditis was possible only 2 months later on the basis of echocardiography requested because of the onset of a tricuspid systolic murmur. Blood cultures revealed the presence in succession of streptococcus D fecalis then bovis. Antibiotics, changed several times because of the onset of complications (allergy, agranulocytosis), failed to deal with the problem of infection as shown by the development of several septic pulmonary emboli which finally resulted in total tricuspidectomy with neither immediate nor secondary valve replacement. The authors use this clinical case to review the characteristics of tricuspid endocarditis, the incidence of which is on the increase in certain etiological contexts (staphylococcal endocarditis in drug addicts or secondary to central vascular lines). They stress that the clinical picture is often confusing since the murmur of tricuspid incompetence is absent in 2/3 of cases. Echocardiography must therefore be requested routinely in all septicemias, thus enabling earlier diagnosis and assessment of the risk of pulmonary embolism (risk if vegetation greater than 10 mm). The nature of the organism responsible may be suggestive of certain etiologies. Thus malignant disease of the colon should be sought if the bacterium is a streptococcus D bovis. Apart from antibiotics, treatment must include effective anticoagulation to decrease the risk of embolic recurrence.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

[Peutz-Jeghers syndrome (mucocutaneous melanosis associated with gastrointestinal polyposis). Presentation of 5 cases presenting in the same family].

Five brothers suffering from Peutz-Jeghers syndrome with freckles in the skin of the face and mucous membrane of the oral cavity, and intestinal polyps are reported. These patients have not been traditionally considered of being at risk. The current opinion is that patients with this disorder can develop malignancies in the gastrointestinal tract, and tumors in other organs.

Adolescent↗

Gardner's syndrome: a case report.

Gardner's syndrome, with characteristic dental abnormalities and osteomas involving the jaws, is described in an adolescent male. The sinister aspect of the syndrome relates to the malignant potential of intestinal polyps and therefore the need for early diagnosis and prophylactic colectomy. The dentist may be the first health professional to have an opportunity to make an early diagnosis and referral of a patient with Gardner's syndrome, and should therefore be aware of the features of the syndrome that affect the teeth and jaws.

Adolescent↗

[Hypothesis on the existence of an adenoma-carcinoma sequence in the small intestine].

An analysis of a literature survey of 104 adenomas of the ampulla of Vater, 94 of the duodenum and 20 of the jejunum and ileum, as well as 735 carcinomas of Vater's ampulla, 180 carcinomas of the duodenum and 72 carcinomas of the jejunum and ileum, demonstrated, in spite of small case collectives, that there is probably a similar close relationship between adenomas and carcinomas in the small intestine, as in the large intestine. In adenomas of the small intestine signs of malignancy sometimes can be seen, as well as in some case of carcinoma of the small intestine rests of adenomas have been described. The age and sex distribution of the epithelial neoplasms of the small intestine permits an adenoma-carcinoma-sequence. The relative distribution of the adenomas over the different parts of the small intestine corresponds with that of the carcinomas. The adenomas and carcinomas of the small intestine in patients with adenomatosis coli have the same relationship to the neoplasms of the small intestine in patients without adenomatosis coli, as it is valid in the large intestine. The hypothesis of an adenoma-carcinoma-sequence in the small bowel with a great significance, which explains the results best, is therefore proposed. As the distribution of adenomas and carcinomas of the small bowel in patients with and without familial polyposis is equal, the theory is suggested, that the principle of the adenomatosis intestine disease is a general increase of the overall liability to adenomas in the large and small intestine.

Adenomatous Polyposis Coli↗

[Methods and possibilities of surgical endoscopy].

In a number of diseases, operative or therapeutic endoscopy permits an effective therapy without the necessity to open up the abdominal wall and the digestive organs themselves. Included here are the removal of foreign bodies, haemostasis, papillotomy with concrement dislodgement, polypectomy and the obliteration of the excretory pancreas. The evaluation of the achieved results and the examination of operative endoscopy in respect of its clinical value cooperation with the pathologisz should not be neglected. The refined endoscopic methods and the highly developed technology can only be applied successfully, when it is possible to get enough skillful endoscopists and to prevent an everyman's endoscopy by which the new methods could be brought into discredit.

Cholelithiasis↗

Genetics of gastrointestinal polyposis.

This review deals with the types of gastrointestinal polyposis in which genetic factors play an essential part, namely, the hamartomatous lesions of Peutz-Jeghers syndrome and multiple juvenile polyposis and the neoplastic tumors of familial polyposis coli and multiple adenomas. The mode of inheritance, associated lesions, malignancy potential, and possible interrelationships between the various types of polyposis are discussed. The knowledge that the lesions are inherited should enable other family members to be investigated and treated at an early stage, a matter of considerable importance in the prevention of cancer when there is an associated risk of gastrointestinal carcinoma.

Adenoma↗