Magnetic Resonance enteroclysis imaging in Crohn's disease

PURPOSE: To assess the role of magnetic resonance enteroclysis (MRE) in patients with Crohn's disease, in order to identify involved segments, define the extension and evaluate transmural alterations. MATERIALS AND METHODS: Eighteen patients with known Crohn's disease were studied with MR (1.5 T), with breath-hold T2-weighted TSE, T2-weighted TSE SPIR and 3D T1-weighted sequences before and after gadolinium injection (0.2 mmol/kg) in the coronal and axial planes. The small bowel was distended by the administration of 2 l of methylcellulose through a nasojejunal tube and drug induced hypotony. Typical patterns of Crohn's disease, such as mucosal abnormalities, parietal thickening and narrowing of the bowel, prestenotic dilation, fibrofatty proliferation and enlarged lymph nodes were analysed on radiological and MRE images. MRE was performed within 30 days from conventional radiological studies (conventional enteroclysis and small bowel follow-through). RESULTS: Good distension of the bowel wall was obtained in all cases. MRE assessed the presence of parietal thickening and narrowing of the bowel wall (14/18 cases) and the presence of prestenotic dilatation (12/18 cases). Vascular enhancement (14/18 cases), transmural abnormalities (8/18 cases), fibrofatty proliferation (3/18 cases), abscess formation (2/18 cases) and enlarged mesenteric lymph nodes (6/18 cases) were also observed. MRE missed small fistulas which were visible in radiological studies in two patients. CONCLUSIONS: MRE appears to be a promising technique in patients with Crohn's disease. Due to limited spatial resolution MRE could be a useful adjunct to radiological studies and in following up selected groups of patients with prior known disease.     

Detection of carbamyl phosphate synthetase 1 deficiency using duodenal biopsy samples

The activity of urea cycle enzymes was assayed in duodenal biopsy specimens obtained from a female infant who presented with neonatal hyperammonaemia. All enzyme levels were normal except N-acetyl glutamate-dependent carbamyl phosphate synthetase 1 (CPS1) which was half the mean activity in normal control specimens. A similar deficiency of CPS1 was also shown in duodenal specimens from the patient's mother who became slightly symptomatic after relatively high protein meals and during pregnancy, and had spontaneously modified her diet to one with protein restriction. The patient is growing normally on a dietary regimen similar to that spontaneously adopted by her mother. Urea cycle enzyme activity in the duodenal biopsy material from the controls was similar to that found in the normal human liver and appears to have distinct advantages as a means of assaying for urea cycle defects in patients with hyperammonaemia and their relatives.     

Controlled trial of continuous inflating pressure for hyaline membrane disease

A controlled trial of elective intervention with continuous inflating pressure (CIP) was performed in infants with severe hyaline membrane disease who weighed more than 1000 g at birth. Infants entered the trial if their arterial oxygen tension (PaO2) fell below 60 mmHg while breathing a fractional inspired oxygen concentration (F1O2) greater than 0-95. 11 out of 12 infants in the CIP-treated group and 10 out of 12 in the control group survived. 7 treated and 6 control infants required mechanical ventilation. When CIP was started the Pao2 of the treated infants increased, and they breathed high concentrations of oxygen for a significantly shorter period than the control infants. During the 31-month duration of the trial 107 other infants with severe hyaline membrane disease were admitted who did not meet the criteria for entry to the trial. 37 survived after breathing high concentrations of oxygen (F1O2 greater than 0-60) spontaneously without any ventilatory assistance, and the remaining 70 infants were already being ventilated on their arrival in the unit, usually because they had required mechanical ventilation during transfer from other hospitals. The neonatal survival rate for those infants born in this hospital during the study period was 88% (50 out of 57 infants) and for those referred from other hospitals it was 69% (51 out of 74 infants). The maximum further increase in overall survival rate that might have been achieved in our population of infants if CIP had been initiated very early in the course of the illness was 5%--i.e. from 77% (101/131) to 82% (107/131).     

Endoscopic retrograde cholangiopancreatography in children

Gastroduodenoscopy and retrograde cholangiopancreatography has been performed on 25 occasions in 20 children aged between 7 and 16. Radiographs of the clinically relevant duct or ducts were achieved in 96% of attempts, with no complications. The diagnostic information proved useful clinically; in particular it provided a precise map if biliary or pancreatic surgery was being contemplated. Several unexpected congenital duct anomalies were found. This and other recent reports, particularly from Germany, indicate that endoscopic retrograde cholangiopancreatography deserves greater application in children, and can also be used in babies.     

Effectiveness of hygienic-dietary recommendations as enhancers of antidepressant treatment in patients with Depression: Study protocol of a randomized controlled trial

Background  

In recent years some studies have been published supporting the efficacy of light exposure, physical activity, sleep control and a Mediterranean diet pattern on the improvement or prevention of Depression. However, to our knowledge, there have been no studies using all these measures together as an adjuvant antidepressant strategy.     

Essential skills for purchasing — The views of directors of public health andhealth authority chief executives

Since the NHS reforms, health authorities have been purchasing health care and have been advised that publichealth considerations must inform all NHS activities, and that the Director of Public Health must be supported by a team of qualified support staff. This survey of directors of public health and health authority chief executives in England shows the skills currently available to support health authority purchasing, and the perceived importance of this wide range of skills to the purchasing process. Future models of purchasing will need to ensure access by purchasers to public health and multi-disciplinary advice.     

Incidence of colorectal cancer and influence of dietary habits in fifteen European countries from 1971 to 2002

Objective

This study aimed to analyze the incidence of colorectal cancer in 15 European countries in recent decades and the relationship between the incidence found and changes in dietary habits.

Methods

Pearson's or Spearman's correlation coefficients were calculated by comparing incidence rates obtained from the International Agency for Research on Cancer for 1971-2002 with data on per capita consumption obtained from the Food and Agriculture Organization of the United Nations using 10-year delay intervals.

Results

Incidence rates increased in all countries except France in men and except Austria, Denmark, England and France in women. Of the dietary variables considered, there were marked increasing trends (linear regression coefficient, R ≥0.5) in red meat consumption in Germany (R = 0.9), Austria (R = 0.7), Finland (R = 0.8), Italy (R = 0.9), Poland (R = 0.5), Spain (R = 2.1), Sweden (R = 0.6), and the Netherlands (R = 0.7).

Conclusions

Changes in dietary habits may be consistent with the observed trends in the incidence of colorectal cancer in the distinct European countries.