Role of multi-row detector CT enterography in evaluation of small bowel disorders

Imaging diagnosis of small bowel diseases has long been technically challenging. Imaging techniques included plain radiography, contrast studies, computed tomography [CT], magnetic resonance imaging [MRI], sonography, scintigraphy and angiography. Multi-row detector CT [MDCT] enterography is a new technique that improved depiction and characterization of small bowel pathology. To assess the role of multi row detector computed tomography [CT] enterography in evaluation of small bowel disorders. The study was conducted on 30 patients suffering from known or suspected small intestinal disease and subjected to CT enterography using multi-detector row CT and iso-osmotic mannitol as neutral enteric contrast material. CT showed symmetrical mural and mucosal changes in 12 patients, seven of them associated with comb sign and creeping fat sign proved to be Crohn's disease and five patients without specific features due to Crohn's, ulcerative colitis, typhoid colitis, ileitis sequel to complicated appendicitis and typhlitis with ileitis. CT showed symmetrical thickening, grey attenuation pattern and aneurysmal dilatation proved to be lymphoma in three patients. CT showed vascular occlusion and mural changes in two patients. CT showed hyperattenuating lesion in two patients due to bowel wall hematoma, CT showed asymmetrical thickening in four patients, two of them showed infiltrative mesenteric mass with calcifications and desmoplastic reaction proved to be due to carcinoid tumour. One patient with asymmetrical thickening showed strongly enhancing lesion in the enteric phase in the second part of duodenum proved to be periampullary carcinoma. The fourth patient with asymmetrical thickening showed heterogeneous enhancement in the venous at distal heal loop with mesenteric stranding, lymph adenopathy and liver deposit proved to be due to adenocarcinoma. CT showed dilated bowel loops with transitional zone in two patients proved to be due to intestinal obstruction, There were five patients with unremarkable CT features that were followed up without definite lesion. CT enterography with iso-osmotic mannitol is a simple, non invasive, economic, effective method for assessing small bowel disease and can replace other imaging modalities

role of multislice CT in evaluation of chronic inflammatory bowel disease

Ulcerative colitis [UC] and Crohn's disease [CD] are the two main subtypes of chronic inflammatory bowel diseases [IBD]. Multidetector computed tomography [CT] has been recognized as a promising modality for the evaluation of Crohn's disease and other small-bowel abnormalities. CT enterography differs from routine abdominal CT in that CT enterography uses multidetector CT. [narrow section thickness and reconstruction interval], intravenous contrast material, and large volumes of a neutral oral contrast agent to improve depiction of the small-bowel wall and lumen. In patients with Crohn's disease, CT enterography is increasingly used to detect enteric inflammation in addition to extra-enteric complications. The aim of the work will be directed to identify the role of MSCT in the evaluation of idiopathic inflammatory bowel diseases. The present work included 30 patients suffering from idiopathic inflammatory bowel disease [ulcerative colitis or Crohn's disease. All patients subjected to CT enterography and/or colonography using multi-detector row CT and iso-osmotic mannitol as neutral enteric contrast material and Ileo-colonoscopy and mucosal biopsy. CT findings include abnormal wall thickening [generally 1 cm] with skip areas of colonic stenosis and dilatation. Associated findings include pericolonic fat stranding, fistulas, abscesses, fibro fatty proliferation, and mesenteric adenopathy. Findings such as mural thickening, mural enhancement, increased attenuation of the perienteric fat, and the Comb sign have been reported to indicate active inflammatory Crohn's disease. MSCT is a great diagnostic tool in detecting and assessing early changes of inflammatory bowel disease as well as monitoring the disease progress and evaluating the complication

Role of helicobacter pylori infection and autoimmunity in chronic idiopathic urticaria

Urticaria is a vascular reaction characterized by transient erythematous or pale swellings of skin and/or mucous membrane representing localized edema caused by dilatation and increased permeability of capillaries and venules result in leakage of plasma into the surrounding connective tissue, marked by development of wheals. If edematous process extends through the dermis into subcutaneous or sub mucous tissue it results in angioedema. Wheats and angioedema often coexist in the same patient but may occur separately. During the last few years some authors reported their experience about cases of CIU related to presence of Helicobacter pylori [Hp] infection. Hp is a micro aerophilic gram positive bacterium, periodic infection with which is associated with reduced gastric acidity secretion where as chronic infection with Hp is associated with increased secretion of acid and pepsin. However recent study found that no relation between Hp infection autoantibody productions in CIU could be proved using direct measures of serum antibodies. Was to evaluate the role of autoimmunity and Helicobacter pylori infection in cases of chronic idiopathic urticaria. Forty patients with chronic urticaria [recurrent hives lasting 4 to 36 hours occurring at least four times/ week for six weeks] were enrolled for this study. All patients were subjected to the following: history taking included, general examination, skin examination, routine laboratory tests and specific tests included: Autologous Serum Skin Test [ASST], Antithvroicl peroxidase autoantibody test [TPO] and Helicobacter pylori IgG antibody test. Forty patients with age ranged between 17 and 58 years, the highest frequency was encountered in age group of 21- 30 years. The control subjects were age matched ranged between 18 and 50 years. Routine laboratory investigations showed no significant findings in CBC, SGPT, serum creatinine, urinalysis and stool analysis. Only ESR was significantly higher in cases of CIU than in control subjects in both first and second hour. Moreover, ESR was significantly higher in patients with positive ASST than those with negative ASST in both hours. The ASST was positive in 4 patients [10%] all of them were females, and negative in 36 patients [90%]. Serum level of TPO was significantly higher in patients with positive ASST than those with negative ASST. Hp IgG level in the sera of patients with CIU did not reveal a significant difference with that of the control subjects. The gastroscopic examination revealed that 55% of patients with CIU had Hp gastritis [only 25 out of 40 patients underwent gastroscopy]. In most patients with chronic idiopathic urticaria, no underlying disorders or cause can be discerned. Diagnostic studies should be directed by the findings elicited by the history and physical examination. There is no recommended standard diagnostic laboratory evaluation for CIU, and routine laboratory tests seems to be of limited value

Prevalence of celiac disease in patients with type 1 diabetes mellitus

Celiac disease is an autoimmune disorder in genetically susceptible individuals after ingestion of gluten. Early diagnosis and treatment of celiac disease could potentially prevent the development of serious complications like osteoporosis, small bowel lymphoma, and infertility. Nowadays, the availability of non-invasive serological tests for celiac disease altered the classical diagnostic pathway, and allows screening of populations at particular risk of developing celiac disease. Celiac disease is associated with many other autoimmune disorders, type 1 diabetic patients may have the risk of developing celiac disease or one of its complication. to determine the prevalence of celiac disease in adult patients with type 1 diabetes mellitus attending the outpatient diabetic clinic of Alexandria University Main Hospital. 200 adult patients with type 1 diabetes mellitus screened for celiac disease by anti-endomysial [EMA] IgA antibodies, and anti-tissue transglutaminase [tTG] IgA antibodies, In addition, Anti-endomysial [EMA] IgG antibodies used to detect patients with IgA deficiency. Distal duodenal biopsy and histopathological examination was performed for any serologically positive patient. Eight [4%] patients showed positive results for all performed serological tests. They all confirmed to be celiac diseased by histopathological examination of distal duodenal biopsy. Anther three patients showed only weak positive liter for tTG-lgA and all of them revealed normal mucosal histopathological finding. Anti- endomysial [EMA] IgA assay showed optimal concordance with histopathological finding. In three patients of the celiac group; the disease was asymptomatic. Symptoms [anemia, fatigue, short stature, diarrhea abdominal distension, recurrent aphthus ulcer, and recurrent hypoglycaemic attacks] in a mild form were significantly higher in the diabetic-celiac group than that in diabetic non-celiac group. There were no significant differences between the diabetic-celiac group and diabetic non-celiac group as regard age, diabetic onset, duration, or glycemic control. Patients with type 1 diabetes mellitus have an increased prevalence of celiac disease. Because most cases are clinically unrecognized, consideration should be given to screening all patients with type 1 diabetes. EMA serological screening and confirmatory histopathological examination of distal duodenal biopsy remain the best screening strategy to detect celiac disease in patients with type 1 diabetes

Oxidative stress in type I diabetic patients with and without macrovascular disease

The aim of the present work was to determine whether, and to what degree, oxidative stress occurs in type I diabetes with and without macrovascular disease and to assess the prooxidant/antioxidant balance in relation to other metabolic control parameters of the disease. The study was carried out on twenty type I diabetic patients without macrovascular disease [group I] and twenty diabetic patients with macrovascular disease [group II].A control group composed of 10 healthy volunteers was also included in this study. All patients and controls were subjected to the following: determination of blood pressure, fasting and postprandial plasma glucose [FPG, PPG], Glycosylated hemoglobin [HbAlc], serum triglycerides [TG], serum total cholesterol [TC], serum high density lipoprotein cholesterol [HDL-C], serum low density lipoprotein cholesterol [LDL-C], plasma malondialdehyde [MDA], whole blood glutathione [GSH], Erythrocyte glutathione peroxidase [GPx] and superoxide dismutase [SOD], plasma vitamins E and C, serum vitamin A and beta-carotene, serum uric acid, plasma transferrin, ceruloplasmin and iron, and serum copper, zinc and selenium. There was a statistically significant increase in systolic and diastolic blood pressure, FPG, PPG, HbAlc, serum TG, TC, and LDL-C, atherogenicity ratio, plasma MDA, and serum iron and copper in group II than in group I and the control group and also in group I than in the control group [P<0.0001]. There was a statistically significant decrease in whole blood GSH, erythrocyte GPx and SOD, plasma vitamin C, transferrin, ceruloplasmin and iron, serum HDL-C, ;vitamin A, beta-carotene, uric acid, copper, zinc and selenium levels in group II than in group I and the control group and also in group I than in the control group [P<0.0001]. As regards vitamin E levels, there was no significant difference among the three studied groups, however, when vitamin E values were normalized by total lipids [so called vitamin E status], there was significant decrease in group II than in group I and also in group I than the control group [P<0.0001]. Oxidative stress is an outstanding feature of type I diabetes and is attributed to imbalance between prooxidants and antioxidants in favor of the former. Such oxidative stress appears to be an important component in the complex pathophysiology of diabetes as well as diabetes related macrovascular disease. Supplementation of antioxidants to diabetic patients with and without macrovascular disease may restore prooxidants/antioxidant balance and may be of a benefit to abort the process of oxidative stress