Biomedical subjects
Publications and source records attributed to M Cabooter.
Helical CT colography is improved by multislicing due to thinner slices. The case reported shows the potential of multislice HCT colography to demonstrate gas-filled cysts on axial images as well as on CT endoscopy, and consequently the extent of the disease exceeding the sigmoid, as was diagnosed by conventional coloscopy.
As compared to single slice helical CT, multislice helical CT does not only improve the quality of the individual images (in terms of slice sensitivity profile and image artifacts) and the range of scan coverage, it also enforces the CT postprocessing possibilities. The advantage of post-processing thin collimation bowel CT images with overlap and cine-viewing or paging is reported. The case report illustrates that cine-viewing of overlapping thin collimation images obtained with multislice helical CT, allows an excellent evaluation of the bowel loops resulting in the diagnosis of a perforated sigmoid carcinoma and its complications.
OBJECTIVE: Acute lower gastrointestinal bleeding is a rare complication of Crohn's disease, which represents a diagnostic and therapeutic challenge. The aim of this study was to define epidemiological characteristics and therapeutic options of hemorrhagic forms of Crohn's disease. METHODS: Thirty-four cases of hemorrhagic forms of Crohn's disease were studied retrospectively. Acute lower gastrointestinal hemorrhage was defined as acute rectal bleeding originating in diseased bowel and requiring a transfusion of at least 2 units of red blood cells within 24 h. Upper gastrointestinal tract hemorrhage or anal lesions and postoperative bleeding were excluded. RESULTS: Mean age at time of hemorrhage was 34.2 +/- 14 yr. Mean duration of disease before the hemorrhage was 5.6 +/- 6 yr. The hemorrhage occurred during a flare up of the disease in 35% of cases. The hemorrhage revealed Crohn's disease in 23.5% of cases. The hemorrhage was more frequent in colonic disease (85%) than in isolated small bowel disease (15%) (p < 0.0001). The origin of bleeding was identified in 65% of cases, by colonoscopy (60%), by angiography (3 patients), or at surgery (1 patient). The bleeding lesion was an ulcer in 95% of cases, most often in the left colon. The treatment was surgical in 20.5% (colectomy in 36%), endoscopical (7 patients, including 5 successes), or medical. Hemorrhage recurred in 12 patients (35%) within a mean time of 3 yr (4 days-8 yr), requiring surgery in 3 cases. No death was observed. CONCLUSIONS: This study performed in a series characterized by a nonsurgical recruitment, the largest to date, shows that hemorrhagic forms of Crohn's disease may reveal disease in 23.5%, occurs in quiescent Crohn's disease in two-thirds of cases. Given the potential efficacy of endoscopical or medical treatment, as well as the absence of mortality, a conservative approach may be suggested as first-line therapy in the majority of patients.
The detection of small (diameter 5-12 mm) mucosal jejunal polyps and small (diameter 14-26 mm) submucosal rectal polyps with helical C.T.-scanning in a patient with neurofibromatosis is described. Because a volume is scanned with helical CT, overlapping image reconstructions can be made allowing to produce a contiguous image set for cine mode display. The combination of 'volume scanning' with cine mode display helps in the dynamic visualization of the course of the intestinal loops. This might result in a better depiction of small lesions within the bowels and in a better differentiation between mucosal folds and the lesions.
BACKGROUND: Primary gastrointestinal lymphoma currently is considered to be an uncommon complication of chronic inflammatory bowel disease. All tumors reported in which recently developed techniques, such as immunohistochemical markers, were used for lymphoma classification proved to be non-Hodgkin lymphomas. Gastrointestinal lymphomas developing in Crohn disease are a very heterogeneous group, with tumors of both B-cell and T-cell lineage represented, along with some tumors of equivocal phenotype. By contrast, gastrointestinal lymphomas complicating ulcerative colitis all have proved to be so-called polymorphic B-cell lymphomas. METHODS: The current report describes another case of primary gastrointestinal lymphoma complicating chronic inflammatory bowel disease occurring in the ileum of a 34-year-old man with a 3-year history of Crohn disease. RESULTS: Histopathologic findings were in keeping with nodular sclerosing Hodgkin disease. Broad birefringent collagen bands divided the tumor into well-defined nodules consisting of typical Reed-Sternberg cells and lacunar variants admixed with a polymorphous lymphoid infiltrate. By immunohistochemical studies, Reed-Sternberg cells and lacunar variants stained positively for Leu-M1 (CD15) and Ber H2 (CD30). The background lymphocytes were primarily of T-cell phenotype. CONCLUSIONS: To the knowledge of the authors, this article reports the first case of primary gastrointestinal Hodgkin disease in association with chronic inflammatory bowel disease that has been confirmed by immunohistochemical studies.
Obstruction of the common hepatic duct due to pressure from an impacted stone in the cystic duct or in the gallbladder infundibulum is known as Mirizzi's syndrome. The obstruction is due to direct impression of the stone on the common hepatic duct or to the concomitant inflammatory infiltrate. The diagnostic features are illustrated by 6 recently observed cases. Clinical features, sonography and CT scan do not always contribute to a correct diagnosis. Endoscopic retrograde cholangiography usually provides the diagnosis but confusion with gallbladder carcinoma, metastatic malignancies at the porta hepatis and even cholangiocarcinoma is possible. The therapy of the Mirizzi syndrome is essentially surgical. In obstructive jaundice preoperative direct cholangiography is always warranted even with a history suggestive of cholelithiasis. Especially in case of associated cholangitis non-surgical biliary drainage procedures are a valuable temporary treatment facilitating surgery. If, however, in a probably malignant obstruction of the common hepatic duct biliary stenting is considered as the only treatment, careful exclusion of Mirizzi's syndrome is required.
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