Ultrasonographic findings in Crohn’s disease

In recent years transabdominal bowel sonography has become a first-line modality both in the diagnosis and in the follow-up of inflammatory bowel diseases, especially Crohn’s disease, reaching values of sensitivity ranging from 84 to 93 %. In particular, its role is very useful in the early diagnosis of complications such as stenosis, phlegmons, abscesses and fistulae. According to the available literature the ability of US to provide information about disease activity is still under debate and further studies are necessary. In this regard, of fundamental importance is the use of additional techniques such as color- and power-Doppler and contrast-enhanced ultrasound. The purpose of this paper is to report the main sonographic intestinal and extraintestinal findings detectable in Crohn’s disease.     

Pediatric Burkitt’s lymphoma: CT findings

Purpose To review and analyze all CT scans of the cases of Burkitt’s lymphoma (BL) in children diagnosed in our institution. Materials and methods A retrospective analysis of 33 children with BL between the years 2003 and 2005 seen in our institution was undertaken. Twenty-nine male and four female patients from age 3 to 16 years (with a mean age 5.9 years) were reviewed. Results The gastrointestinal tract was involved in 19 patients (57.5%), kidneys in 9 (27.2%), peritoneum in 8 (24.2%), liver in 4 (12.1%), spleen in 3 (9%), adrenals in 3 (9%), and pancreas in 1 patient (3%). Extra-nodal head and neck involvement was seen in eight patients (24.2%). Bone involvement in four (12.1%), lung in three (9%), heart in two (6%), skin in two (6%), and testis in one (3%) of these patients. Abdominal lymph nodes were enlarged in 21 children (63.6%), while cervical lymph nodes were enlarged in 8 (24.2%). Conclusion CT proved to be an invaluable tool in the characterization of the disease processes in these children. In addition, it provided us with useful information about the anatomical distribution, patterns of involvement, as well as complications of BL.     

Unique CT imaging findings of liver in Wilson��s disease

Purpose  

To present unique CT imaging findings of the liver in Wilson’s disease.     

CT enterography and fistulizing Crohn’s disease: clinical benefit and radiographic findings

Background  To estimate the clinical benefit of CT enterography (CTE) in patients with fistulizing Crohn’s disease and describe the appearance of fistulas at CTE. Methods  Crohn’s patients who had undergone CTE, which diagnosed an abscess or fistula, were identified. A gastroenterologist reviewed clinical notes prior to and following CTE to assess the pre-CTE clinical suspicion for fistula/abscess, and post-CTE alteration in patient management. A radiologist reassessed all fistula-positive cases, which were confirmed by a non-CT reference standard, to describe their radiologic appearance. Results  Fifty-six patients had CT exams identifying 19 abscesses and 56 fistulas. There was no or remote suspicion of fistula or abscess at pre-imaging clinical assessment in 50% of patients. Thirty-four patients (61%) required a change in or initiation of medical therapy and another 10 (18%) underwent an interventional procedure based on CT enterography findings. Among 37 fistulas with reference standard confirmation, 30 (81%) were extraenteric tracts, and 32 (86%) were hyperenhancing compared to adjacent bowel loops. Most fistulas (68%) contained no internal air or fluid. Conclusion  CTE detects clinically occult fistulas and abscesses, resulting in changes in medical management and radiologic or surgical intervention. Most fistulas appear as hyperenhancing, extraenteric tracts, usually without internal air or fluid.     

CT of Uhl’s Anomaly in an Adult

Uhl’s anomaly is an extremely rare condition of unknown cause characterized by complete or partial absence of the right ventricular myocardial layer, which is replaced by nonfunctional fibroelastic tissue. The disease causes progressive right-sided heart failure, increased right-sided cardiac pressure, massive peripheral edema, and ascites. Patients usually present in infancy and rarely survive to adulthood. The disease appears to be congenital in origin. Diagnosis was previously made at autopsy, but advances in imaging now permit diagnosis by echocardiography or cross-sectional imaging (computed tomography or magnetic resonance). We present a case of a 51-year-old patient with Uhl’s anomaly who underwent placement of a ventricular assist device as a bridge to cardiac transplantation, and discuss CT findings.     

CT enterography of Crohn’s disease

CT enterography (CTE) is a technique using neutral oral contrast, intravenous contrast and thin cut, multiplanar CT acquisitions to optimize small bowel imaging. One of the primary indications for CTE is the detection and evaluation of Crohn’s disease. This article summarizes the advantages/disadvantages, scanning technique, imaging findings, performance and pitfalls of CTE for the evaluation of Crohn’s disease.     

Sonographic findings of Sister Mary Joseph’s nodule from ovarian cancer

Sister Mary Joseph’s nodule (SMJN), which is known as a malignant tumor metastasized to the umbilicus, is a rare condition. We report ultrasonic findings of SMJN secondary to ovarian cancer in a 66-year-old woman. The umbilical tumor was observed as a hypoechoic mass with punctate hyperechoic foci. A pathological specimen obtained by needle biopsy confirmed adenocarcinoma with psammoma bodies. A comparison of the ultrasonographic findings with the pathological findings of the resected specimen suggested that the hyperechoic foci corresponded to psammoma bodies. When hyperechoic foci are observed inside SMJN by ultrasonography, adenocarcinoma from ovarian cancer should be included in the differential diagnosis.     

Perforated Meckel’s diverticulitis on the mesenteric side: MDCT findings

Meckel’s diverticulum (MD) is the most common congenital anomaly of the gastro-intestinal tract (approximately 2% of population), and arises from improper closure and absorption of the omphalomesenteric duct. Very few cases of Meckel’s diverticulitis on the mesenteric side have been reported in the surgical literature, and no reported cases have been documented on preoperative imaging. We report a 65-year-old woman presenting symptoms and signs of acute abdomen with an initial suspicion of acute appendicitis. MDCT imaging revealed a mesenteric abscess in the right lower quadrant at the level of the distal ileum as a complication of Meckel’s diverticulitis on the mesenteric side. The patient recovered after a diverticulectomy without the need for a small bowel resection. This case demonstrates that MDCT is a fast imaging technique that may be helpful in the emergency setting for the preoperative diagnosis of an unusual complicated MD on the mesenteric side.     

Depression in women’s magazines

BackgroundMass communication research suggests that the media influence both what a population thinks about and how it thinks about an event or situation by controlling what is covered and how topics are framed. One medium, popular women’s magazines, has published depression-related articles for decades. However, little is known about the content and frame of these articles.ObjectiveThe research sought to determine what women’s magazines published about depression between 1980 and 2000.DesignArticles published on depression in the top eight circulating women’s magazines, between 1980 to 1985 and 1995 to 2000 were retrieved and analyzed using qualitative media analysis methodology.ResultsBetween the two periods, the magazines increased the number of published articles on depression and increasingly framed it as a treatable but stigmatized illness.ConclusionWomen’s magazines, which regularly publish information on depression, have high circulation rates, resulting in millions of exposures to their messages. Psychiatric nurse-authors have an opportunity to influence these messages.     

Petersen��s hernia as a complication of bariatric surgery: CT findings

Referrals for bariatric surgery have currently increased due to the need for more effective interventions in the management of severely obese patients. The Roux-en-Y gastric bypass is currently one of the preferred procedures, and internal hernias are the main causes of late postoperative complication. Petersen’s hernia is a less common finding in most published papers compared to transmesocolic hernia, however, it seems to be increasing in incidence (in our service, eight cases which have been tomographic diagnosed in 2 years, were confirmed by laparoscopic surgery). The clinical findings are not specific, usually with abdominal pain, associated or not with abdominal distention and vomiting. In this context, imaging exams have an important role in the early diagnosis and surgery of this condition, with multislice computed tomography being the most accurate method. The aim of this pictorial essay is to the demonstrate the main CT findings associated with Petersen’s hernia in patients who underwent Roux-en-Y gastric bypass.     

CT诊断Paget’s病1例

病例 男，79岁，因言语不清、表达困难来院就诊，临床检查：意识清，读写、表达困难，无肢体活动障碍．无抽接，无大小便失禁．查体：BP160，90mmHg，神清，示齿左偏．伸舌右偏。双侧痛觉对称．四肢肌力．肌张力正常，病理征未引出，临床诊断：缺血性脑血管病．脑梗死，高血压。     

Australia’s first Transition to Professional Practice in Primary Care Program: Qualitative findings from a mixed-method evaluation

Background

In Australia, there is an increasing demand for registered nurses in primary health care. Registered nurses graduating from university typically enter the workforce via supported transition to professional practice programs in acute-care hospital settings. A prospective strategy to create a sustainable primary health care workforce is to develop comparable transition programs in primary health care settings, such as general practice. We developed, implemented, and evaluated Australia’s first transition to professional practice in primary care program.