MR enterocolonography in patients with Crohn's disease and healthy volunteers - Do we achieve diagnostic bowel distension?

PURPOSE

The aim of our prospective randomized study was to assess diagnostic quality and stability of bowel distension in patients with Crohn's disease (CD) and healthy volunteers subjected to synchronous magnetic resonance enterography and colonography (MREC), as well as to test the role of water enema and intravenous spasmolytics. The influence of gastric content, age, gender, and body mass on bowel distension was also evaluated.

METHOD

Study groups included 164 CD patients and 53 healthy volunteers. After bowel preparation, randomized subgroups started ingestion ≥1000 mL of hyperosmolar solution within 30, 45, 60, 75, and 90 min before admission to MRI, respectively. Patients were examined in prone position and water enema was applied. Spasmolytics were administered prior to I.V. gadolinium. Distension of five bowel segments was independently assessed by two experienced radiologists.

RESULTS

MREC yields diagnostic distension of the jejunum in 81.1 % and 79.2 % patients in the CD group and controls, respectively. For the terminal ileum it was >94 % in both groups. Good and excellent distension was achieved in other bowel segments. Distension was maintained up to 75 min from the start of oral ingestion. Water enema and spasmolytics significantly and independently improved distension of the small bowel. Distension of the cecum after spasmolytics was decreased. Gastric content, age, gender and body mass had no significant influence of bowel distension.

CONCLUSIONS

MREC enables diagnostic distension of the colon and ileum (including terminal segment) in CD patients and healthy volunteers and diagnostically acceptable distension of the jejunum.

Scleral Thinning Documented by Ultrasound Biomicroscopy after Plaque Therapy for Anterior Ciliary Melanoma

PURPOSE

To evaluate, by ultrasound biomicroscopy (UBM), changes in scleral thickness after ruthenium-106 CCB and CCC plaque (Eckert & Ziegler BE-BIG GmbH, Berlin, Germany) therapy for anterior ciliary melanoma.

METHODS

Eleven patients with anterior ciliary melanoma underwent ruthenium-106 CCB and CCC plaque radiation with a radiation dose at the tumor apex of 80-100 Gy. UBM measurements performed prior to and after treatment were as follows: the largest prominence of the tumor perpendicular to the sclera and scleral thickness at scleral spur, 1.0 mm, and 2.0 mm posteriorly.

RESULTS

The article presents one year follow-up results for each of the 11 patients. The mean regression of the tumor of 24.3±9.31% was observed. The thinning of the sclera was statistically significant at the scleral spur (t=1.80, p ≤ 0.05) and at maximal tumor thickness (t=1.35, P=0.05).

CONCLUSION

UBM documented significant thinning of the sclera at the scleral spur and overlying the maximal tumor thickness after Ru-106 CCB and CCC plaque radiation. Taking into consideration the shortcomings of the study-small sample size, insufficient probe resolution, and subjectively determined anatomic landmarks-observed minimal thickness change of the sclera does not necessarily mean its necrosis. However, thinning of the sclera documented at one year follow-up associated with very slow regression of the tumor indicates the need for the introduction of the CIA plaque treatment in our patients with anterior ciliary melanoma.

The relationship between gray matter changes in schizophrenia patients and the number of psychotic episodes

Introduction

A significant amount of evidence from structural brain imaging studies provide new insights into the neuroanatomical basis of schizophrenia.

Objectives

To investigate whole brain gray matter (GM) differences between schizophrenia patients grouped according to the number of psychotic episodes and normal controls (NC).

Aim

To determine regions of GM differences in schizophrenia patients grouped according to the number of psychotic episodes.

Methods

A group of 53 schizophrenia patients (23 with up to 3 psychotic episodes, 15 with 4 to 6 and 15 with 7 or more psychotic episodes) and 35 age and gender matched NC were included. Voxel-based morphometry (VBM) is an adaptation of the statistical parametric mapping technique that allows investigators to quantitatively examine brain structural changes. VBM data of schizophrenia patients divided into 3 groups: up to 3, 4 to 6 and 7 or more episodes were compared with NC.

Results

Patients with up to 3 episodes had reduced gray matter volume (GMV) in the right claustrum, right Brodmann areas 6 and 13 and left Brodmann area 10, patients with 4 to 6 episodes in left Brodmann areas 25, 35 and 37 and in right Brodmann area 13, and those with 7 or more episodes showed decreased GMV in left substantia nigra and left Brodmann area 10 compared with NC.

Conclusion

GMV reduction in schizophrenia varies depending on the number of psychotic episodes. The affection of different brain areas indicates separated neurobiological mechanisms underlying the stage and the progression of illness.

Mediastinal necrosis in acute pancreatitis - case report

Ascites, pseudocyst, necrosis of the retroperitoneal fat tissue and pancreatopleural fistula with left sided pleural effusion may complicate pancreatitis. However, steatonecrosis of the mediastinum and right side pleural effusion are rather rare complications of pancreatitis. We present a case of a patient with alcohol induced pancreatitis. Chest x-ray showed right sided pleural effusion. Although high levels of amylase in pleural fluid made the diagnosis of pancreatopleural fistula most likely, necrosis of the mediastinal fat tissue with right side pleural effusion was found postmortem.

Effect of 6-month athletic training on motor abilities in seven-year-old schoolgirls

The effects of six-month athletic training on improving motor abilities in 7-year-old schoolgirls were assessed. Analysis of the results of 12 motor tests showed significant improvement in the study group (n = 38) in comparison with control group (n = 140) subjected to conventional physical education classes only. The improvement referred to the variables of aerobic endurance (3-min run), flexibility (forward bow), explosive strength (ball throwing and 20-m run), keeping balance (bench standing), static strength (bent arm hang), and repetitive strength (sit-ups). These are probably adaptive changes brought up by discriminant functions. The varimax factor and discriminative function correlations indicated that all four factors of changes contributed significantly to the explanation of discriminative function. An almost equally high correlation of varimax factors and discriminative function was obtained on the basis of differences in the third factor responsible for changes in the frequency of movements and in the explosive strength of the jump type; in the second factor responsible for changes in coordination with changes in the repetitive strength of the body; and in the fourth factor responsible for changes in the explosive strength of the throw and sprint types with changes and endurance.

Ultrasonography in the evaluation of hemoperitoneum in war casualties

The aim of this study was to evaluate the sensitivity, specificity, accuracy, and positive and negative predictive values of emergent ultrasound examination in the detection of hemoperitoneum among war casualties, and to compare the results of this method in a specific war situation and civil conditions. Ninety-four wounded individuals with suspected blunt or penetrating abdominal trauma were treated at a level I war hospital (group W), and 242 civilians with multiple injuries with suspected blunt abdominal trauma were evaluated at the emergency center of a university hospital (group C). All examinations were performed in less than 5 minutes with a portable ultrasonographic scanner, and typical points were scanned (Morison's pouch, Douglas and perisplenic spaces, paracolic gutter). In group W, hemoperitoneum was identified correctly in 19 patients, with three false-negative and no false-positive findings, whereas group C presented 98 true-positive results, 13 false-negative results, and again no false-positive results. We observed that ultrasonography in specific war conditions showed sensitivity of 86%, specificity of 100%, accuracy as high as 97%, positive predictive value of 100%, and negative predictive value of 96%, whereas in civil conditions the corresponding values were 88%, 100%, 95%, 100%, and 91%, respectively. The sensitivity, specificity, accuracy, and positive and negative predictive values of emergent ultrasound examination in the diagnosis of hemoperitoneum are approximately equal in war and civil conditions.

Kidney length in postoperative acute renal failure

PURPOSE

The aim of this study was to evaluate kidney length in patients with postoperative acute renal failure (PARF).

METHODS

The effect of PARF on renal size was prospectively studied in 76 patients with PARF and 40 healthy volunteers. Sonographic measurements of kidney length and the level of serum creatinine were obtained each day patients stayed in our surgical intensive care unit. These measurements were done once in volunteers. All study subjects were divided into groups on the basis of age, those younger than 65 years and those 65 years or older. Statistical analyses on the relation of renal size, age, and degree of PARF used the kidney length:body height ratio (KBR) and the peak serum creatinine level. Follow-up kidney length and creatinine measurements were done in 24 patients 1-5 years after they recovered from PARF.

RESULTS

Regardless of age, mean KBRs were significantly greater in patients than in healthy volunteers (< 65 years, p < 0.001; > or = 65 years, p = 0.008), with a negative correlation between KBR and patient age (r = -0.664; p < 0.001). A positive correlation was found between the KBR and the peak serum creatinine level in patients younger than 65 years (r = 0.543; p < 0.001); an insignificant negative correlation was found between these factors in patients 65 years or older (r = -0.264; p = 0.1). Follow-up on recovered patients showed that their KBRs were significantly lower than the values when patients had PARF (< 65 years, p < 0.001; > or = 65 years, p = 0.027).

CONCLUSIONS

PARF produces a sonographically measurable increase in renal size.

Sonographic measurement of absolute and relative renal length in adults

PURPOSE

The aim of this study was to evaluate sonographically measured absolute and relative lengths of normal kidneys according to subject height, sex, and age.

METHODS

Real-time sonography was performed on 202 subjects. Measurements of longitudinal renal diameter represented absolute renal length. Relative renal length was calculated using the kidney length: body height ratio (KBR).

RESULTS

Statistical analyses were done on findings in 175 subjects without renal impairment (104 men and 71 women) whose ages ranged from 17 to 85 years (mean +/- SD, 46.3 +/- 17.1). The mean heights of the subjects were 176 +/- 7 cm for men and 167 +/- 6 cm for women. The left kidney was absolutely (mean +/-SD, 112 +/- 9 mm) and relatively (mean KBR +/- SD, 0.655 +/- 0.042) longer than the right kidney (absolute length, 110 +/- 8 mm; KBR, 0.641 +/- 0.038), regardless of sex (p < 0.01). The absolute renal length was significantly greater in men than in women for both kidneys (p < 0.01), but there was no significant difference between KBRs (p > 0.05). Renal length decreased with age, and the rate of decrease seemed to accelerate at 60 years and older. When height and age were included in the multivariate regression analysis, sex was not a significant predictor of kidney length.

CONCLUSIONS

Relative renal length better represents kidney size than absolute renal length because it eliminates sex and height differences.

Resistance and pulsatility indices in acute renal obstruction

PURPOSE

The aim of this study was to evaluate the reliability of Doppler waveform alterations in diagnosing acute unilateral renal obstruction.

METHODS

From December 1993 to January 1996, 54 patients with unilateral renal obstruction were prospectively examined by conventional and duplex Doppler sonography. Seventy-eight patients with nonrenal abdominal problems comprised the control group. Doppler signals were obtained from interlobar arteries and arcuate arteries at the corticomedullary junction. From the waveform analysis, we calculated resistance (RI) and pulsatility (PI) indices. We also used the differences in RI and PI between the 2 kidneys in the same examinee (delta RI and delta PI) for further statistical analysis.

RESULTS

The mean RI and PI (+/- standard deviation) in the patients without renal impairment were 0.64 +/- 0.04 and 1.14 +/- 0.14, respectively. The mean delta RI and delta PI were 0.02 +/- 0.01 and 0.07 +/- 0.05, respectively. Both the RI and PI were significantly correlated with age (r = 0.74 and 0.69, respectively; p < 0.01). Acute renal obstruction significantly (p < 0.01) elevated the mean RI (0.72 +/- 0.04), delta RI (0.09 +/- 0.04), PI (1.42 +/- 0.17), and delta PI (0.33 +/- 0.18). Significant decreases in RI and delta RI were noted after relief of the obstruction. The best accuracy in diagnosing acute unilateral renal obstruction was achieved with the combination of delta RI > or = 0.06 and/or delta PI > or = 0.20, which had a sensitivity of 94% and specificity of 99%.

CONCLUSIONS

Renal Doppler indices are reliable parameters in the sonographic diagnosis of acute unilateral obstructive uropathy.

[Anastomosis of the rectum]

The anastomosis between rectal remnant and anal canal with other parts of digestive system, remains a big challenge for surgeons till nowadays. In the years period 173 anastomoses has been done with 21 case (12%) of clinical leaks. According to our experience the technique of continuous extramucosal one layer anastomosis is a good one for high colorectal and ileorectal anastomosis. For low colorectal anastomosis the technique of extramucosal interrupted sutures for posterior and Lembert's suture for anterior wall as single layer have had the lowest incidence of clinical leaks. Low and ultra low anastomoses could be best done with double staptechnique acc. to Knight-Griffen. Our figure of 12% of clinical leaks is rather comparable with published data of others.