Eosinophilic gastroenteritis

Eosinophilic gastroenteritis represents a very rare inflammatory disease of the stomach and bowel. Aetiologically an allergic diathesis must be assumed, but it is only very seldom that a particular allergen can be identified as being responsible for any case. Characterized by peripheral blood eosinophilia and eosinophilic infiltration of various parts of the gastro-intestinal tract, together with disturbed gastro-intestinal function, complications can arise in this disease requiring surgical intervention. In general, however, conservative therapy is adequate. The clinical features are discussed on the basis of an own case report.     

Eosinophilic gastroenteritis presenting as relapsing severe abdominal pain and enteropathy with protein loss

Eosinophilic gastroenteritis (EG) is an uncommon gastrointestinal tract disease, and diagnosis can be difficult. A combination of acute or recurrent abdominal pain with peripheral hypereosinophilia suggests the diagnosis. Surgery in patients with these features might therefore be avoided. Physicians must maintain a high index of suspicion and a working knowledge of the natural history of EG in order to establish the proper diagnosis. We present the case of a young man with EG who presented with relapsing severe abdominal pain and enteropathy with protein loss.     

Role of ultrasonography in the diagnosis and follow-up of pediatric eosinophilic gastroenteritis: a case report and review of the literature

Eosinophilic gastroenteritis (EG) is a rare disease characterized by the infiltration of one or more layers of the digestive tract by eosinophilic leukocytes. The diagnosis is confirmed by histological examination of a characteristic biopsy, but radiological features are useful for diagnostic suspicion. We report the case of an adolescent boy with recurrent epigastric pain, nausea and vomiting, in whom sonographic features and eosinophilia of the peripheral blood suggested the diagnosis of EG. Moreover, we reviewed the radiological features of EG with particular regard to the role of sonography in the diagnosis and follow-up of EG, especially in children. We emphasize the utility of sonography in pediatric patients presenting with gastrointestinal symptoms, since it may provide useful information in a quick, inexpensive and noninvasive way. Ultrasonographic detection of features such as bowel wall thickness, ascites and peritoneal nodules may be largely suggestive of EG and may prevent other invasive exams and abdominal surgery. Ultrasonography can also be easily used in the follow-up of these patients, and may obviate the frequent and potentially dangerous exposure to radiation.     

MEFV gene mutations in a patient with eosinophilic gastroenteritis

Eosinophilic gastroenteritis (EG) is an uncommon gastrointestinal disease affecting both children and adults. The underlying molecular mechanism predisposing to the clinical manifestation of eosinophilic gastroenteritis is unknown. A 39-year-old man who was followed up with the diagnosis of familial Mediterranean fever (FMF) was admitted to our clinic with diarrhea, abdominal pain, and weight loss. After endoscopic and colonoscopic examinations EG was diagnosed by histopathological examination. Symptoms were resolved with the treatment of budesonide. To our knowledge, this is the first reported case of EG with the MEFV gene mutations in the literature.     

嗜酸粒细胞性胃肠炎内镜特征及诊治分析（附21例报道）

目的探讨嗜酸粒细胞性胃肠炎(EGE)的临床表现,观察其多样性,减少误诊漏诊,提高临床诊治率。方法回顾性分析该院2008年-2016年消化内科住院诊治的EGE患者临床资料,对其临床表现、诊断经过及方法、确诊依据及治疗进行分析、总结。结果最终确诊21例患者临床表现无特异性,分别以腹痛、腹泻,腹胀、伴恶心和呕吐等就诊入院;多数有哮喘病史、皮肤或药物食物过敏史。临床分型以黏膜型为主16例,浆膜型3例,混合型2例。外周血中性粒细胞百分比及嗜酸性粒细胞比例增高;部分骨髓增生活跃,嗜酸性粒细胞比例增高;腹水化验嗜酸性粒细胞比例增高;胃肠镜见黏膜充血、糜烂和溃疡等表现;腹部CT亦可见肠壁增厚、可见腹水;19例患者激素治疗有效治愈。结论 EGE是可以治愈的疾病,因其临床表现多样性,需得到更多临床医生及病理科医师的认识及关注,以尽早诊断及治疗,避免误诊及漏诊。     

嗜酸性粒细胞性胃肠炎9例临床病理分析

目的探讨嗜酸性粒细胞性胃肠炎临床、病理学特点及鉴别诊断要点。方法对9例嗜酸性粒细胞性胃肠炎进行临床及病理分析。结果所有嗜酸性粒细胞性胃肠炎患者都有消化道症状，伴有外周血嗜酸性粒细胞增多，其中黏膜病变8例，分布在胃、小肠和结肠；肌层病变1例。8例黏膜性病变患者对类固醇治疗有效。结论嗜酸性粒细胞性胃肠炎是以嗜酸性粒细胞浸润消化道为特征的少见疾病。     

Eosinophilic gastroenteritis with abdominal pain and ascites: A case report

BACKGROUNDEosinophilic gastroenteritis (EGE) is a rare disease that presents many unspecific gastroenterological symptoms. The disease includes three types depending on the depth of eosinophil infiltration in the gastrointestinal tract. The serosal type is the most rare, presenting as ascites. CASE SUMMARYA 34-year-old man presented with abdominal pain, diarrhea without bloody stool, or nausea. Laboratory test results revealed a peripheral blood eosinophil count (4.85 × 10⁹/L), which was remarkedly elevated. Computed tomography scan demonstrated extensive intestinal wall edema thickening in the duodenum, jejunum, ascending colon and transverse colon; multiple exudative effusion surrounding the intestinal tract, and ascites in the abdominal cavity. A series of examinations excluded eosinophil elevation in secondary diseases. Endoscopic multipoint biopsy detected eosinophilic infiltration in the mucous layer of the transverse colon, with ≥ 50 eosinophils/high power field. All symptoms vanished after a few days of steroid therapy and ascites disappeared within 2 wk.CONCLUSIONEGE should be considered in patients with abdominal pain, ascites, and eosinophilia. Multiple point biopsies are essential for diagnosis.     

Ultrasonographic images of the hand in a case with early eosinophilic fasciitis

Eosinophilic fasciitis (EF), a rare rheumatic disease, usually affects the limbs symmetrically and generally spares the hands and feet. Cases of unilateral hand involvement are rarely reported. Here, we report such a rare case. Ultrasonography demonstrated thickening of the overlying skin and subcutaneous tissue, peripheral deep fascia, myositis of lumbrical muscles and adductor pollicis muscle, and edema surrounding flexor digitorum tendons. It reminds us that EF should be considered in the differential diagnosis of unilateral painful hand swelling despite being uncommon. Ultrasonography can be used to aid the diagnosis and monitor therapeutic response in patients with EF.     

Uterine leiomyosarcoma: diagnosis, treatment, and nursing management

Uterine leiomyosarcoma is a rare form of sarcoma with limited treatment options and a high potential for distant recurrence. At the time of diagnosis, swift action should be taken to initiate treatment. Options for treatment include surgical debulking and disease staging, radiation therapy, and/or chemotherapy. The purpose of this article is to review the disease epidemiology, presentation at diagnosis, surgical staging, and prognosis. Treatment options and the role of targeted therapies are discussed in addition to the various nursing implications associated with management of the disease.     

Active pulmonary tuberculosis with vertebra and rib involvement: case report

Multifocal skeletal tuberculosis is defined as osteoarticular lesions that occur simultaneously at two or more locations and is generally associated with disseminated disease. Although involvement of bones accounts for 1 to 5% of all tuberculosis cases, multifocal involvement of the skeleton is extremely rare. We present a case of active pulmonary tuberculosis (TB) with vertebral and rib involvement and multiple hypodense lytic lesions accompanied by a paravertebral mass lesion. In the differential diagnosis, metastases, lymphoma, multiple myeloma, chordoma sarcoidosis and rare spinal infections such as brucellosis and fungal disease were considered. The diagnosis was established by surgical biopsy, taken by video-assisted thoracoscopic surgery. Especially for patients from TB-endemic areas, tuberculosis must be considered in the differential diagnosis and treatment should be started without delay.     

Extensive inflammatory eosinophilic bladder tumors in children: experience with three cases

Eosinophilic cystitis, an uncommon lesion, is rare in children; < 25 cases have been reported. The intense inflammatory changes in the bladder wall associated with this lesion may produce heaped-up excrescences, which resemble vesical rhabdomyosarcoma. Our experience with 3 patients shows that the initial diagnosis of eosinophilic cystitis may not be easily made, and that the lesions produced may mask other disease processes. We alsoreport the fifth case of eosinophilic infiltration of the bladder occurring in association with chronic granulomatous disease.     

Diagnosis and treatment of eosinophilic fasciitis: Report of two cases

BACKGROUNDEosinophilic fasciitis (EF) is a rare disease characterized by inflammation of the fascia with immune system involvement. Failure to promptly diagnose and treat this disease can seriously affect the quality of life of patients. However, no clear and uniform criteria for diagnosis and treatment exist.CASE SUMMARYIn this paper, we report two cases of EF, both of which showed symmetrical limb swelling and rigidity, increased eosinophils in the peripheral blood and bone marrow, increased red blood cell sedimentation rate, increased antinuclear antibody titer, and pathological changes in the tissues such as eosinophil and lymphocyte infiltration. Both patients were treated with hormones and cyclosporine, and showed significant improvements in their conditions.CONCLUSIONEF is an autoimmune disease causing swelling and sclerosis of the fascia and eosinophilia. It is diagnosable by magnetic resonance imaging, positron emission tomography-computed tomography, blood routine tests, and bone marrow puncture. Glucocorticoids and immunosuppressants are effective treatments.     

Eosinophilic enteritis presenting as acute abdomen: US features of two cases

Eosinophilic enteritis is a rare disease which may mimic acute abdominal emergency. Two sonographically documented cases are presented, which were subsequently proven at operation. Although the sonographic features of severe echolucent bowel wall thickening were not specific, combination with clinical and laboratory data may suggest the correct diagnosis.     

Allergic reaction to gemfibrozil manifesting as eosinophilic gastroenteritis

Eosinophilic gastroenteritis (EGE) is a rare condition of unknown etiology characterized by eosinophilic infiltration of the gastrointestinal (GI) tract. Previous associations with a drug or food allergy, allergic rhinitis, atopic dermatitis, and elevated IgE levels suggest an atopic predisposition in the pathogenesis of this disorder. Diagnostic criteria are GI symptoms, eosinophilic infiltration proven by biopsy of the GI tract, and absence of parasitic infection. We describe a case of EGE manifested as an allergy to gemfibrozil.     

儿童重症克罗恩病2例并文献复习

目的:探讨儿童克罗恩病(Crohn′s,CD)的临床特点及诊断和治疗,以提高儿童CD的诊断、治疗水平,减少急重型病例的误漏诊。方法:回顾我院2007年经内镜、手术和病理证实的2例儿童重症CD,并结合近期文献进行分析。结果:2例儿童重症CD均并发肠道多发穿孔,行外科病变肠段切除。并经儿内科治疗后缓解出院,目前仍在随访。结论:儿童CD早期诊断极为困难,易误漏诊。内镜加组织学是诊断CD的金标准,胃肠道直接显影对于明确儿童肠道炎症的部位、范围和类型极为重要。除皮质类固醇、氨基水杨酸类药物治疗外,可选用免疫调节制剂治疗。肠穿孔是炎症性肠病最主要的并发症和儿童CD主要的死亡原因。     

Eosinophilic gastroenteritis, ascites, and pancreatitis: a case report and review of the literature

Eosinophilic gastroenteritis is an inflammatory disorder of the gastrointestinal tract in which eosinophilic infiltration occurs in the gut layers. A case of subserosal eosinophilic gastroenteritis was diagnosed in a patient with abdominal pain, eosinophilic ascites, and pancreatitis. To our knowledge, this is the first case report of eosinophilic gastroenteritis associated with concurrent eosinophilic ascites and pancreatitis.     

Changing aspects in the evaluation and treatment of patients with benign prostatic hyperplasia

Lower urinary tract symptoms are a common clinical symptom among men and a frequent reason for referring to a urologist. The most important information comes from the patient history because evaluation of symptoms is fundamental in the diagnosis and treatment planning for LUTS. Other aspects of the initial evaluation, such as the physical examination and initial laboratory values, can provide valuable additional information about the severity of the disease and the need for treatment. If treatment is warranted based on this information, additional diagnostic tests may be appropriate to set a pretreatment baseline, rule out other conditions, and plan treatment approach. Fortunately, a variety of effective medical and surgical treatments are available to treat this common disease.     

Diagnosis and treatment of pleomorphic rhabdomyosarcoma of the uterus: a rare case report and review of the literature

Pleomorphic rhabdomyosarcomas of the uterus (PRMSu) is a rare malignant tumor of the female genital tract. Accurate diagnosis and effective treatment of PRMSu are important. We report an 81-year-old woman who was diagnosed with PRMSu. She had an extremely unusual presentation of secondary dyspnea because of an extremely large uterus (26.0 cm). Pelvic magnetic resonance imaging showed rare severe enlargement and intrauterine filling with tumor tissue, and she was initially diagnosed with uterine leiomyosarcoma. The patient underwent hysterectomy, as well as bilateral salpingo-oophorectomy and omentectomy, and was finally confirmed as having PRMSu by histopathology combined with immunohistochemistry. We performed a systematic review of the literature between 1982 and 2020 and focused on different treatment strategies and prognosis of PRMSu. A retrospective review of 28 cases was conducted and survival analysis was estimated by using the Kaplan–Meier method. We found that the accuracy of diagnosis of PRMSu completely depends on histopathology and immunohistochemistry because of no special clinical symptoms, no sensitive tumor markers, and no special imaging findings. Although there is no standardized approach for treating this rare disease, the treatment strategy of a surgical operation combined with adjuvant chemotherapy appears to be the best choice.     

脐尿管癌临床病理学特点及手术效果分析

目的 探讨脐尿管癌的临床病理学特点和手术方式,提高其诊治水平.方法 回顾性分析9例脐尿管癌的临床特点、病理特征、诊断、手术方式及手术效果.结果 9例中病理诊断结果为脐黏液腺癌7例,未特殊分类腺癌、小细胞型内分泌癌各1例.Sheldon分期ⅢA期8例,ⅢC期1例.行扩大性膀胱部分切除术8例,膀胱部分切除术1例.术后3个月死于骨转移1例,术后11个月因膀胱前壁局部复发行二次手术1例,分别于术后15个月和24个月出现膀胱颈部及尿道复发行肿瘤电切术1例,余6例随访6～42个月,均无肿瘤复发.结论 脐尿管癌临床少见,预后较差.熟悉本病的临床病理学特点对于提高诊断水平非常重要.早期行扩大性膀胱部分切除术可达到长期无瘤生存的效果.     

Acute abdominal pain in children

Acute abdominal pain in children presents a diagnostic dilemma. Although many cases of acute abdominal pain are benign, some require rapid diagnosis and treatment to minimize morbidity. Numerous disorders can cause abdominal pain. The most common medical cause is gastroenteritis, and the most common surgical cause is appendicitis. In most instances, abdominal pain can be diagnosed through the history and physical examination. Age is a key factor in evaluating the cause; the incidence and symptoms of different conditions vary greatly over the pediatric age spectrum. In the acute surgical abdomen, pain generally precedes vomiting, while the reverse is true in medical conditions. Diarrhea often is associated with gastroenteritis or food poisoning. Appendicitis should be suspected in any child with pain in the right lower quadrant. Signs that suggest an acute surgical abdomen include involuntary guarding or rigidity, marked abdominal distention, marked abdominal tenderness, and rebound abdominal tenderness. If the diagnosis is not clear after the initial evaluation, repeated physical examination by the same physician often is useful. Selected imaging studies also might be helpful. Surgical consultation is necessary if a surgical cause is suspected or the cause is not obvious after a thorough evaluation.