Multidetector-row CT enteroclysis: indications and clinical applications.

This paper examines the diagnostic potential of multislice computed tomography enteroclysis (MSCT-E) to detect and assess different diseases affecting the small bowel, emphasising the increasingly important role assumed by the technique in the study of this anatomical region. After a short summary of the technical aspects, we discuss the different findings that can be observed during an MSCT-E study and that enable detection of small-bowel disease and, if necessary, assessment of the extent and stage of disease.

Relationship between site of disease and familial occurrence in Crohn's disease.

Concordance in the extent of disease among the family members of patients with Crohn's disease has not been widely investigated. Furthermore, the relationship between the site of the disease and familial occurrence has never been studied. Our aim was to evaluate the familial occurrence of Crohn's disease in the various sites. Nine hundred thirty-four patients with Crohn's disease, observed consecutively in two gastrointestinal departments, were investigated to determine first-degree familial incidence (in both Crohn's disease and ulcerative colitis). Whenever two or more members were attending the same clinic, only one was regarded as a propositus. The analysis, therefore, was carried out on 882 patients. The exact site of the disease was determined in all patients either at diagnosis or during the follow-up by colonoscopy and by small bowel enema. The rate of concordance in the extent of disease and familial occurrence in the various sites was evaluated and the difference was calculated by chi-square test. Sixty-one propositi were identified among all the patients. Forty-nine had familial occurrence for the same disease (concordant patients), whereas 12 had at least one relative with ulcerative colitis (discordant patients). In 44 propositi with only one relative affected, the rates of concordance in the extent of the disease were 84, 68, 18, and 0% respectively, for the ileum, the ileum-right colon, the ileum-total colon, and the colon. The number of propositi in the various sites was as follows: 4 of 162 (2.4%) patients with the disease located in the colon, 1 of 9 (11%) with the jejunum site, 24 of 380 (6.3%) with the ileum site, 16 of 165 (9.7%) with the ileum and right colon site, and 16 of 164 (9.7%) with the ileum and total colon site. The chi-square values of propositi distribution among other sites and the colon was, respectively, as follows: jejunum, 2.2 (N.S.); ileum, 3.4 (P = 0.06); ileum and right colon, 7.4 (P = 0.006); and ileum and total colon, 7.4 (P = 0.006). This study shows a pronounced concordance in the site of the disease for family members with Crohn's disease and suggests that familial occurrence in Crohn's disease is less frequent when the disease is located in the colon rather than elsewhere.

Radiographic indicants of adult celiac disease assessed by double-contrast small bowel enteroclysis.

The number of folds and lumen diameter of the proximal jejunum and distal ileum were retrospectively measured in 40 double-contrast small bowel enteroclysis studies of patients with a biopsy-proven diagnosis of adult celiac disease (ACD) and in 46 healthy control subjects. For both parameters an inverse radiographic pattern was found in celiacs compared to control subjects, in whom the number of folds and lumen calibers are physiologically greater in proximal jejunum than in the distal ileum. Mean differences in the jejuno-ileal number of folds (-7.1) and lumen calibers (-1.3 cm.) were in fact negative in ACD patients, in whom the values of both the parameters are less in the proximal jejunum than in the distal ileum. Particularly, the sign of "reversal of jejuno-ileal caliber" was both sensitive and specific for diagnosis of ACD in this retrospective series. Double-contrast small bowel enteroclysis can play an important role in excluding or confirming the presence of ACD, provided that an assessment of reproducibility and a prospective re-evaluation of operative characteristics of such radiographic signs are performed.

[Primary lymphoma of the small intestine. Radiographic image of enteroclysis with double-contrast media]. / Linfomi primitivi dell'intestino tenue. Aspetto radiografico nell'enteroclisi a doppio mezzo di contrasto.

The authors retrospectively reviewed the radiographic (double-contrast small-bowel enema) examinations of 20 patients with primitive small intestinal lymphomas. The diagnosis was histologically confirmed in all cases. The technique was very sensitive (100%) in detecting small-bowel abnormalities. On the contrary, a definite differential diagnosis was difficult to make (65%), except for 4 cases of lymphoma complicating celiac disease in which the presence of a nodular pattern and of thickened and irregular mucosal folds seemed to be highly specific. The most difficult differential diagnosis was with Crohn's disease. In all the cases with surgical confirmation (17), disease extent exactly corresponded to that suggested by small-bowel enema. Primitive small intestinal lymphoma is not radiologically distinguishable from secondary involvement during systemic lymphoma. From the analysis of radiological abnormalities, the authors observed that, different from previous reports, severe luminal narrowing was frequent, whereas "aneurysmal" dilatations of intestinal loops were never observed. CT was confirmed as the best technique for staging. Clinical implications of double-contrast enema in the diagnosis of primitive small intestinal lymphomas are discussed; radiographic patterns are reviewed.

[Enteroclysis of the small intestine in celiac disease in adults: changes in the jejuno-ileal caliber and the number of folds]. / Enteroclisi del tenue nella malattia celiaca dell'adulto: alterazioni del calibro e del numero di pliche digiuno-ileali.

The authors retrospectively reviewed the radiographic findings (obtained with double-contrast small bowel enema) of 27 patients with adult celiac disease and of 27 healthy control subjects. Two parameters were measured in two different locations; lumen diameter and number of folds both in the proximal jejunum and in the distal ileum. Statistical differences in mean values between cases and controls were calculated, and correlations between the four variables were assessed. Sensitivity, specificity and their 95% confidence limits were calculated for all the variables. The best parameter in discriminating cases from controls seems to be the caliber of distal ileum (greater than 3 cm), with 93% sensitivity and 100% specificity. The value of the obtained results is discussed.

[Current views on the subject of vertical transmission and prevention of hepatitis B]. / Attualità in tema di trasmissione verticale e di profilassi dell'epatite B.

After stressing the different incidence of hepatitis B in the various geographic areas, with notable differences even from one region to another in Italy, and after paying particular attention to the problem of the vertical transmission of the virus from mother to child, stress is laid on the importance of active and passive immunoprophylaxis in newborns of HBsAg positive mothers for the purpose of both preventing possible severe complications in these subjects at risk and of eliminating an important link in the chain of HBV diffusion. Finally a vaccination protocol using a low number of doses compared to that generally recommended without protection being compromised, as evidenced by the personal series of 75 newborns of HBsAg positive mothers and 67 children living with HBsAg positive subjects is outlined. Of the 75 newborns, 21 were vaccinated with four doses of 5 mcg of Hevac Pasteur vaccine and 54 with three doses only; of the latter, only 42 completed the vaccination cycle, with an amply protective antibody response as in the previous group of 21 newborns. The same low protocol of three doses of vaccine was applied to the 67 children living with HBsAg positive subjects and fo the 49 children who completed the cycle only 3 did not present seroconversion.