Symptomatic paediatric Meckel's diverticulum: stratified diagnostic indicators and accuracy of Meckel's scan.

PURPOSE: The aim of the study was to delineate stratified diagnostic indicants and evaluate the diagnostic accuracy of technetium-99m (Tc)-pertechnetate scintigraphy in children with symptomatic Meckel's diverticulum (MD). MATERIALS AND METHODS: This was a prospective linear observational study conducted over a period of 5 years on 73 children with a diagnosis of symptomatic MD. The independent variables assessed were age, sex, weight-for-age z-scores, clinical presentation, complications of MD, laparoscopic findings, haematologic and biochemical results, radiological results, and histological findings. Stepwise multiple logistic regression analysis was performed to determine the diagnostic markers. The sensitivity and specificity of Tc-pertechnetate scintigraphy were assessed. RESULTS: The incidence of MD with complications was 44%. The prevalence of ectopic gastric mucosa in histological specimens was 84%. There was a good correlation between rectal bleeding and the presence of ectopic gastric mucosa [r=0.94; 95% confidence interval (CI): 0.77-0.98]. Haematochezia associated with a drop in haemoglobin (>2 g/dl) was diagnostic of MD with ectopic gastric mucosa in children (n=42, 58%; P=0.006; odds ratio 1.99; 95% CI: 1.14-2.42). Bilious vomiting was diagnostic of complicated MD (n=12, 16%; P=0.007; odds ratio 1.89; 95% CI: 1.12-3.22). The sensitivity of Tc-pertechnetate scintigraphy was 84% and specificity was 22%. The positive predictive value was 0.64 and the negative predictive value was 0.22. The sensitivity and specificity of Tc-pertechnetate scintigraphy were dependent on the quantity and functional quality of the heterotopic gastric mucosa. The preoperative median z-score was -1.4 and the postoperative median z-score was -1.2. CONCLUSION: Tc-pertechnetate scintigraphy had a truncated predictive value. Its contribution in clinical decision making was poor. Clinical suspicion of MD should be high in children presenting with haematochezia associated with a drop in haemoglobin by more than 2 g/dl. Laparoscopy is an effective diagnostic and therapeutic tool.

Correlation between the clinical pretest probability score and the lung ventilation and perfusion scan probability.

PURPOSE: Aim of the study was to determine the accuracy of the clinical pretest probability (PTP) score and its association with lung ventilation and perfusion (VQ) scan. MATERIALS AND METHODS: A retrospective analysis of 510 patients who had a lung VQ scan between 2008 and 2010 were included in the study. Out of 510 studies, the number of normal, low, and high probability VQ scans were 155 (30%), 289 (57%), and 55 (11%), respectively. RESULTS: A total of 103 patients underwent computed tomography pulmonary angiography (CTPA) scan in which 21 (20%) had a positive scan, 81 (79%) had a negative scan and one (1%) had an equivocal result. The rate of PE in the normal, low-probability, and high-probability scan categories were: 2 (9.5%), 10 (47.5%), and 9 (43%) respectively. A very low correlation (Pearson correlation coefficient r = 0.20) between the clinical PTP score and lung VQ scan. The area under the curve (AUC) of the clinical PTP score was 52% when compared with the CTPA results. However, the accuracy of lung VQ scan was better (AUC = 74%) when compared with CTPA scan. CONCLUSION: The clinical PTP score is unreliable on its own; however, it may still aid in the interpretation of lung VQ scan. The accuracy of the lung VQ scan was better in the assessment of underlying pulmonary embolism (PE).

Role of chronic infection and inflammation in the gastrointestinal tract in the etiology and pathogenesis of idiopathic parkinsonism. Part 1: eradication of Helicobacter in the cachexia of idiopathic parkinsonism.

BACKGROUND: Neuronal damage in idiopathic parkinsonism may be in response to ubiquitous occult infection. Since peptic ulceration is prodromal, Helicobacter is a prime candidate. AIM: To consider the candidature of Helicobacter in parkinsonism with cachexia. METHODS: We explore the relationship between being underweight and inflammatory products in 124 subjects with idiopathic parkinsonism and 195 controls, and present the first case-series evidence of efficacy of Helicobacter eradication, in parkinsonism advanced to the stage of cachexia. RESULTS: Association of a low body mass index with circulating interleukin-6 was specific to parkinsonism (p = .002), unlike that with antibodies against Helicobacter vacuolating-toxin and cytotoxicity-associated gene product (p < .04). Marked reversibility in both cachexia and disability of idiopathic parkinsonism followed Helicobacter heilmannii eradication in one case, Helicobacter pylori eradication in another, follow-up being > or = 3.5 years. The latter presented with postprandial bloating, and persistent nausea: following eradication, radioisotope gastric-emptying returned towards normal, and upper abdominal symptoms regressed. Reversibility of their cachexia/disability contrasts with the outcome of anti-Helicobacter therapy where eradication repeatedly failed (one case), and in non-Helicobacter gastritis (three cases). Anti-parkinsonian medication remained constant. Intestinal absorption and barrier function were normal in all. CONCLUSION: Categorization, according to presence or absence of Helicobacter infection, was a useful therapeutic tool in late idiopathic parkinsonism.