Diagnosis and Differential Diagnosis of Crohn’s Disease of the Ileal Pouch

Approximately 20%-30% of patients with ulcerative colitis will eventually require colectomy despite recent advances in medical therapy. Ileal pouch-anal anastomosis has become the surgical treatment of choice. A subset of patients with ileal pouches can develop Crohn's disease or a Crohn's-disease-like condition of the ileal pouch after surgery. Diagnosis, differential diagnosis, and management of Crohn's disease of the ileal pouch have been challenging. A combined assessment of clinical history, endoscopy, histology, abdominal/pelvic imaging, and examination under anesthesia is often necessary for accurate diagnosis, disease classification, management, and prognosis. A multidisciplinary approach with gastroenterologists, colorectal surgeons, gastrointestinal pathologists, and radiologists is advocated.     

Differential Diagnosis of Crohn’s Disease Versus Ileal Tuberculosis

Both intestinal tuberculosis and Crohn’s disease are chronic granulomatous inflammatory diseases of the bowel having overlap of clinical, endoscopic, radiological, and histological features. Differentiating between the two disorders is relevant not only in Asian countries but also in the West. In spite of diagnostic criteria for both diseases being available, still the dilemma of segregating the two diseases remains. Nearly one third of the patients with Crohn’s disease may receive anti-tuberculosis treatment also. Diagnosis should be based on the combination of all disease-specific and corroborative evidences.     

Cervical Osteophytes Increase the Risk for Foreign Body Impaction: A 171-Patient Case–Control Study

The aim of this study is to define the relationship between anatomical and pathological cervical structures and the impaction of ingested foreign bodies (FBs). The effects of such structures on deglutition have been previously discussed, however their contribution to FB impaction has not yet been examined. This was a retrospective case–control study of 171 patients who underwent computed tomography (CT) scans over the period 2008–2014: 57 patients with an esophageal or hypopharyngeal FB; the other 114 comprised the control group, selected using the ‘neighbor control’ method. CT scans were reviewed for measurements of cervical structures. The mean age was 63 ± 13 years and 55 ± 17 years in the case and control groups, respectively (p-value = 0.003). Age was the only demographic or clinical characteristic which demonstrated a significant difference. Overall, 24 patients had cervical osteophytes: 28 %(16) with an impacted FB, compared with 7 %(8) from the control group (p-value < 0.001). Of the patients with osteophytes and impacted FBs, 62.5 % had the FB lodged at a vertebral level corresponding to their osteophytes, while another 18.75 % had the FB within three vertebral levels above the osteophytes. Stepwise logistic regression revealed that osteophytes were a significant factor, independent of older age (p-value = 0.004). Adjusted odds ratio for FB impaction in the presence of osteophytes was 4.04. Ventral cervical osteophytes increase the risk for FB impaction in the upper digestive tract. This risk is independent of older age. These findings can be of value in preventive medicine, and emphasize the importance of looking for spinal changes in patients with recurrent FB impaction.     

Merits of FDG PET/CT and Functional Molecular Imaging Over Anatomic Imaging With Echocardiography and CT Angiography for the Diagnosis of Cardiac Device Infections

The diagnosis of cardiac device infections, particularly device-related endocarditis, is challenging. Fluorine-18-fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) is based on in vivo FDG targeting of the pre-existing inflammatory cells at an infectious site. Hence, it is able to identify cardiac device infection early, before the development of morphological damages from the infectious process. Transesophageal echocardiography (TEE) and electrocardiographically gated computed tomographic angiography (CTA) are currently the first-line imaging studies for device-related endocarditis, but their application to evaluate the extracardiac components or sources of primary infection and/or emboli is limited. Functional FDG PET/CT may have unique advantages over the anatomically based TEE and CT or CTA in the following settings: 1) diagnosing infection earlier than TEE and CTA, before morphological damage ensues; 2) identifying prosthetic endocarditis when findings on TEE and CTA are inconclusive; 3) evaluating infection in the extracardiac components of devices; 4) detecting unexpected source of the primary infection; and 5) discovering embolic consequences of endocarditis in the body. All of these findings may ultimately affect patient management. Although the nonspecific nature of FDG is a concern in differentiating infection from inflammation, accurate diagnosis of infection can be reasonably achieved on the basis of FDG distribution pattern and clinical history or by adding radiolabeled white blood cell scan to improve specificity. Recent publications support the judicious use of FDG PET/CT, particularly in patients with inconclusive or negative results on initial echocardiography and CT.     

Do Cervical Degenerative Diseases Associate with Foreign Body Sensation of the Pharynx?

Foreign body sensation of the pharynx is a common complaint in otolaryngologic practice. The definite cause of this symptom is seldom precisely diagnosed, leading to chronic pharyngitis. The purpose of the present study was to evaluate the relationship between lump in throat and cervical degenerative disease by their clinical symptoms and the associated image characteristics. All patients with or without the complaint of lump in throat who attended the otolaryngologic clinics of Chang Gung Memorial Hospital—Kaohsiung Medical Center from January 2009 to May 2010 were prospectively eligible for this study. A total of 225 patients who met the inclusion criteria were assigned to either the study group (150 patients with symptoms of lump in the throat) or the control group (75 individuals without symptoms). All patients received plain views of the cervical lateral neck. The study group underwent further diagnostic examinations, including esophagography to exclude other diseases. Symptom scores (range, 0–3) and imaging characteristics such as the number (total spurs) and location (C level) of cervical osteophytes, interspace narrowing, spondylolisthesis, and retrolisthesis were compared between the two groups. It was found that the study group had a significantly greater number of total spurs (P < 0.001), and C45, C56, and C67 were the predominant sites, with significant odds ratios of more than 2 at all these levels. Only C67 revealed a difference in interspace narrowing, and only C45 showed a difference in spondylolisthesis between groups. Hence, a high correlation was found between the lump-in-throat sensation and total number of spurs, especially at the levels of C45, C56, and C67. This result implied that cervical osteophytes might be associated with foreign body sensations of the pharynx.     

A Local Equation for Differential Diagnosis of β-Thalassemia Trait and Iron Deficiency Anemia by Logistic Regression Analysis in Southeast Iran

The most common differential diagnosis of β-thalassemia (β-thal) trait is iron deficiency anemia. Several red blood cell equations were introduced during different studies for differential diagnosis between β-thal trait and iron deficiency anemia. Due to genetic variations in different regions, these equations cannot be useful in all population. The aim of this study was to determine a native equation with high accuracy for differential diagnosis of β-thal trait and iron deficiency anemia for the Sistan and Baluchestan population by logistic regression analysis. We selected 77 iron deficiency anemia and 100 β-thal trait cases. We used binary logistic regression analysis and determined best equations for probability prediction of β-thal trait against iron deficiency anemia in our population. We compared diagnostic values and receiver operative characteristic (ROC) curve related to this equation and another 10 published equations in discriminating β-thal trait and iron deficiency anemia. The binary logistic regression analysis determined the best equation for best probability prediction of β-thal trait against iron deficiency anemia with area under curve (AUC) 0.998. Based on ROC curves and AUC, Green & King, England & Frazer, and then Sirdah indices, respectively, had the most accuracy after our equation. We suggest that to get the best equation and cut-off in each region, one needs to evaluate specific information of each region, specifically in areas where populations are homogeneous, to provide a specific formula for differentiating between β-thal trait and iron deficiency anemia.     

Single Versus Standard Multiview Assessment of Global Longitudinal Strain for the Diagnosis of Cardiotoxicity During Cancer Therapy

Objectives

The goal of this study was to compare echocardiographic measurements of global longitudinal strain (GLS) (using 3 apical views) with single-view longitudinal strain (LS, 4- or 2-chamber [4CV_LS and 2CV_LS, respectively]) for detection of cancer-therapy related cardiotoxicity.

Body mass and reflux oesophagitis: an oestrogen-dependent association?

BACKGROUND: There is widespread belief that obesity is associated with gastro-oesophageal reflux disease, but the scientific evidence is weak and contradictory. Our aim is to evaluate the relation between body mass and reflux oesophagitis. METHODS: A population-based case-control study of endoscopically verified case subjects with reflux oesophagitis, and of randomly selected, control subjects matched for age, sex and area of residence. Subjects were classified within three body mass index (BMI) categories: BMI <25 (normal in the WHO classification), BMI 25-30 (overweight) and BMI >30 (obese). Odds ratios (OR) with 95% confidence intervals (CI) were the measures of association. RESULTS: Of 179 matched case-control pairs included in the study, 71 pairs were female. In males, no association between overweight and/or obesity and the risk of reflux oesophagitis was found. In females, there was a strong association between increasing BMI and the risk of reflux oesophagitis, with an OR of 2.9 (95% CI: 1.1-7.6) in the BMI 25-30 group and 14.6 (95% CI: 2.6-80.9) in the BMI >30 group (P value for trend = 0.0007). The association between obesity and oesophagitis was further strengthened by the use of oestrogen replacement medication. CONCLUSIONS: The study discloses a strong and dose-dependent association between body mass and reflux oesophagitis in women as opposed to no association among men. This association might be caused by increased oestrogen activity in overweight and obese females.     

Surgery for perforated colorectal malignancy in an Asian population: an institution’s experience over 5 years

Introduction  

Perforated colorectal malignancy is associated with numerous peri-operative complications and dismal long-term survival. The study aimed to review the outcome and factors predicting peri-operative complications and long-term survival of patients who underwent surgery for perforated colorectal malignancy.