A 49-year-old man visited our hospital because he was positive for immunological fecal occult blood. Barium enema revealed pedunculated polyps in the sigmoid and transverse colon, so he underwent ...colonoscopy and two tubular adenomas were resected, which show severe and moderate atypia. Two months later, on the second colonoscopic examination, a submucosal tumor like elevated lesion with smooth and reddish surface was detected in the descending colon, about 12mm in size. This polyp was resected by snare polypectomy, and pathological findings revealed dilated, congested vessels in the submucosa, which was compatible with arterio-venous malformaion. In the Japanese literature, only four cases of AVM which show submucosal tumor-like appearance were reported. We should be careful in treating with such polyps to avoid hemorrhage due to polypectomy.
Aortic insufficiency was found in 9 of 44 cases of aortitis syndrome seen during 8 years, representing a high incidence (20%), unreported previously. They consisted of 2 men and 7 women, ranging in ...age from 21 to 68. Two cases which developed congestive heart failure died. Blood pressure in the diseased extremity lacked the characteristic peripheral signs of aortic insufficiency. X-ray films of the chest showed cardiac enlargement, dilatation of the ascending aorta and calcification of the aortic wall. Electrocardiogram showed left ventricular hypertrophy and phonocardiogram showed diastolic decreascendo murmur in the Erb's area. Retrograde aortography showed dilatation of the ascending aorta. Distribution of the aortitis included at least an involvement of aortic arch. Etiological classification of 205 cases of aortic insufficiency revealed unexpectedly high incidence of aortitis syndrome, which occupied the fourth place following rheumatic (112), syphilitic (32) and hypertensive (25) nature. Thirty-one similar cases were collected from the previous and the present reports and were reviewed. Pathology of the disease revealed dilatation of the ascending aorta, and destruction of the medial elastic fibers. Mechanism of producing aortic insufficiency in the aortitis syndrome was discussed. High incidence of aortic insufficiency among the cases of aortitis syndrome, frequent occurrence of aortic insufficiency in other types of aortitis and finally the pathological findings strongly indicated that dilatation of the aortic ring due to aortitis involving the ascending aorta is the primary cause of aortic insufficiency.
Pathological changes in the aorta and its major branches, which were similar, at least in part, to those seen in patients with aortitis syndrome, could be produced in rabbits by long-term ...administration of the isologous aortic extracts or the patients' sera containing anti-aorta antibodies of a high titer. The occurrence of vascular changes was preceded by a rise in the titer of the circulating complement fixing antibodies against the isologous aorta, suggesting that the vascular lesions are the product of a specific antigen-antibody reaction. The results of the present study may support the authors' opinion that a certain immune mechanism participates in the development of arterial lesions in patients with aortitis syndrome.
We report two patients with recto-vaginal fistrula diagnosed by colonoscopy. A 63-year-old female with a ring pessary for prolapse uteri visited the hospital with a chief complaint of defecation from ...vagina. Colonoscopic findings showed the whitish mucosa at the rectum and the ring pessary. Histological findings of the whitish mucosa was squamous cell epithelium, then we diagnosed recto-vaginal fistura. Fistulectomy, colonostomy and ligamentopexy were performed. A 66-year-old female visited the hospital with a complaint of positive fecal blood test. Colonoscopic findings showed hemipheral elevation at the rectum that was seemed vaginal mucosa. Then we inserted the Neraton's catheter from vagina, we could detected it by colonoscopy. The histological findings of the hemipheral elevation showed squamous cell epithelium. So we diagnosed recto-vaginal fistula. However no treatment was performed because of no symptom. We reviewed the literatures briefly.
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