Crohn disease: perirectal and perianal findings at CT

The computed tomographic scans of 200 consecutive patients with Crohn disease were studied to determine the frequency and patterns of perirectal and perianal involvement. In 163 patients (82%) abnormalities in the perirectal-perianal region were demonstrated; findings included inflammation of fat planes (73%), bowel wall thickening (30%), fistulas or sinus tracts (22%), and abscesses (14%). Fistulas or sinus tracts occurred with equal frequency above or below the level of the anterior symphysis pubis. Abscesses, rectal thickening, and inflammatory infiltration of fat occurred more than twice as often above the symphysis pubis. However, 37% of patients had manifestations of Crohn disease below the symphysis pubis, emphasizing the importance of extending scanning sequences to the perineum.     

Cryptosporidiosis of the gastric antrum: detection using CT

We describe a patient who had cryptosporidiosis and cytomegalovirus infection of the gastric antrum that was initially detected on computed tomography (CT) scans. CT may be useful in the evaluation of immunocompromised patients with diarrheal illness, as well as in the assessment of the gastrointestinal tract.     

Congenitally corrected transposition in the adult: detection by radionuclide angiocardiography

Congenitally corrected transposition (CCT) of the great vessels is an uncommon anomaly usually detected in children because of associated severe cardiac malformations. When these are absent, patients may be hemodynamically normal, but associated cardiac abnormalities are usually present in CCT, leading to symptoms in adulthood. When CCT is suggested in an adult, diagnosis by means of ultrasound may be difficult. Radionuclide angiocardiography (RA) is a simple, noninvasive method by which to diagnose CCT. We found consistent morphologic scintigraphic results in 13 patients with proved CCT, leading to establishment of reliable diagnostic criteria. In all instances of situs solitus the aorta ascends and descends on the left with vertical orientation. In the case of situs inversus, the aorta ascends and descends on the right with vertical orientation. Our criteria are independent of the situs and cardiac position, unlike earlier reports by others. We believe images obtained in the anterior projection are sufficient for the study. The practical application of RA study in patient diagnosis is demonstrated, giving special attention to patients referred because of situs solitus and dextrocardia, in which CCT is known to be present in 50% of cases.     

MR angiography with two-dimensional acquisition and three-dimensional display. Work in progress

Magnetic resonance arteriograms of healthy volunteers and selected patients were produced with a new spoiled gradient-echo pulse sequence based on time-of-flight phenomena. The procedure involves sequential acquisition of many contiguous, thin (1.5-mm) axial two-dimensional sections. These volume data are then submitted to a raytracing projection program, which retrospectively yields multiple arbitrary projection angles rotating through any plane. Venous structures are suppressed with a presaturation slab superior to the current section. The slab location is advanced in concert with advancement of each new section location. The acquisition time varies from 6 to 13 minutes, depending on the number of sections acquired for three-dimensional display. This method obviates the subtraction of image data sets to suppress signals from stationary spins, is more sensitive to slow blood flow than three-dimensional methods of acquisition, and shows special promise for the study of extracranial vascular disease.     

Bacterial renal infection: role of CT

The imaging studies done on 62 patients hospitalized for acute renal infections were retrospectively reviewed. Thirty-six (58%) had one or more abscesses, 17 (27%) had focal or diffuse acute bacterial nephritis, five (8%) had pyonephrosis, and four (6%) had pyelonephritis. All had prolonged fever (greater than or equal to 72 hours) and leukocytosis. Among 25 patients examined with both ultrasound (US) and computed tomography (CT), US failed to depict three of five (60%) cases of acute bacterial nephritis and seven of 15 (47%) intrarenal and extrarenal abscesses. One renal abscess was misdiagnosed as a tumor at CT. US is not an adequate screening test for detecting lesions that may require invasive therapy. CT is more sensitive for the detection of acute renal inflammatory disease and for defining the extent of disease for planning of radiologic or surgical intervention.     

How can the health community foster and promote the health of Aboriginal children and youth?

Aboriginal people have poor health status, but there is also evidence that they access the health care system less effectively and find it more intimidating than other Canadians. The present paper reviews the evidence for this, details some of the history that has led to the continued disenfranchisement of Aboriginal people and makes some modest suggestions for ways that the health system can work toward better health and health care for Aboriginal people. Efforts should focus on making the entire system more patient-centred, improving cultural competence, increasing Aboriginal presence in the health workforce, and improving access through cultural and language interpreter services and outreach.     

PLASMA AND RED BLOOD CELL FOLATE IN BREASTFED INFANTS

Abstract. We have studied growth, red blood cell status and folate concentrations in plasma and red cells in a group of 35 breastfed infants during the first year of life. Folic acid supplementation was not given to the mothers during pregnancy or lactation, and none of them developed megaloblastic anaemia. The growth and red blood cell status of the infants were both normal. At birth, and throughout the period of observation, the folate concentrations in plasma and red cells were significantly higher than in the adult reference material. A positive correlation between plasma and red cell folate was demonstrated. During the latter part of pregnancy and lactation the foetuses and infants seem to be protected against folate deficiency. We regard the folate status of normal breastfed infants as optimal. The optimal supply of the vitamin in artificial nutrition should be the amount of folate necessary to maintain plasma and red cell folate concentrations similar to those found in breastfed infants.     

Selective presence of the chemokine growth-regulated oncogene alpha (GROalpha) in the human follicle and secretion from cultured granulosa- lutein cells at ovulation

Ovulation is an inflammation-like reaction in which leukocytes are postulated to have a central role. The abundance of leukocytes in the ovary varies with the stage of the cycle and a marked influx of neutrophils and monocytes into the interior of the follicle during ovulation has been observed. The intraovarian signals causing this preovulatory influx are not known. In the present study we have investigated the presence in the ovary of two chemotactic cytokines, GROalpha (growth-regulated oncogene alpha) and RANTES (regulated upon activation, normal T-cell expressed and secreted), which have specific chemotactic activity towards neutrophils/basophils/T-cells and monocytes/T-cells/eosinophils respectively. The concentrations of these cytokines were first measured in follicular fluid and peripheral blood from a group of patients undergoing in-vitro fertilization (IVF) procedures. GROalpha was found in approximately 10-fold higher concentrations in follicular fluid than in blood plasma from the same patients (P < 0.001). The concentrations in peripheral blood of GROalpha were similar and without significant variations in women during the time of gonadotrophin stimulation for IVF and throughout the normal menstrual cycle. There was no correlation between follicular fluid concentrations of GROalpha and follicular fluid concentrations of progesterone or oestradiol. Cultured granulosa-lutein cells secreted detectable amounts of GROalpha. The concentrations of GROalpha in the medium were markedly increased by the presence of the proinflammatory cytokine interleukin (IL)-1beta, with approximately 10-fold higher concentrations in the medium, compared with the controls (P < 0.001). GROalpha was localized by immunohistochemistry predominantly in the theca layer but also in the granulosa layer of the dominant follicle during the late follicular phase. The concentrations of RANTES in follicular fluid were only 1/50 of those in blood plasma (P< 0.001). RANTES protein was not detectable in the culture medium of granulosa- lutein cells neither during basal nor IL-1beta stimulated conditions. In conclusion, these results suggest that the chemokine GROalpha is one of the chemotactic signals which cause recruitment and activation of specific leukocytes within the ovulating follicle.