Crohn disease-associated pancreatitis: is there a new extra-intestinal manifestation of the disease?

We report the case of a 23-year old woman suffering from Crohn's ileocolitis for 14 years who died of a prolonged shock followed by hyperglycaemia. The post-mortem examination showed an acute pancreatitis. There was no hint for Crohn's disease of the duodenum or primary sclerosing cholangitis (PSC). Unexplained Pancreatitis coincident with Crohn's disease might be a possible extraintestinal manifestation of the disease. However such association remains speculative at the moment. Further studies based on morphological, functional, immunological and epidemiological data are required. Review of the literature and our own data show the necessity to look attentive for other causes of acute pancreatitis associated with Crohn's disease (PSC, pancreas divisum, drug induced-pancreatitis).     

Early supradiaphragmatic Hodgkin's disease. High-dose gallium scanning obviates the need for staging laparotomy

Experience with 16 sequential patients with Stage IA/IIA supradiaphragmatic Hodgkin's disease who had no evidence of intra-abdominal disease using high-dose gallium and computerized tomography scanning is reported. Subsequent staging laparotomy also was negative in all these patients and did not alter management decisions. It is suggested that high-dose, whole-body gallium scanning and other noninvasive staging procedures give reliable data for therapeutic decisions.     

Muscle-nerve pedicle laryngeal reinnervation

A muscle-nerve pedicle implantation to the lateral cricoarytenoid muscle as described by Tucker is an alternative to Teflon injection for treating dysphonia due to vocal cord palsy. Improvement in voice was noted in 19 of the 20 (95%) selected patients who were treated by muscle-nerve pedicle reinnervation. These patients have been followed for 6 months to 10 years. Changes in the voice were documented through assessment of high-quality audio tape recordings by three speech pathologists, results of a patient questionnaire, and evaluation by the surgeon. The improvement in voice quality was attributed to reestablishment and maintenance of vocal cord tone and mass, without the vocal cord stiffness usually associated with Teflon injection. The improvements in quality of voice with pedicle implantation are natural and lasting. This technique is proposed as an alternative to Teflon injection in selected cases.     

Bone mineral density in well-differentiated thyroid cancer patients treated with suppressive thyroxine: a systematic overview of the literature.

BACKGROUND: The effects of subclinical hyperthyroidism on bone mineral density (BMD) induced by suppressive thyroxine therapy in patients with well-differentiated thyroid cancer (WDTC) remains unclear. An overview of the current literature was undertaken to evaluate studies to date. METHODS: A systematic medline search yielded a total of 11 studies appropriate for review which included premenopausal women, postmenopausal women, and men on suppressive thyroxine post thyroidectomy for WDTC. Main outcome measures were bone mineral density and bone turnover markers. CONCLUSIONS: Although studies were limited by small numbers and varying degrees of control for confounding variables, results suggested no significant change in bone mineral density for premenopausal women or men. Findings for postmenopausal women remain unclear with two of the best controlled studies reporting opposing results. Further studies for this population are recommended to help guide clinical practice.