Epiploic appendagitis: the great mimicker.

Epiploic appendagitis is a benign, self-limited, clinicopathological, and radiological entity that has become more commonly recognized. The clinical presentation resembles a variety of other medical and surgical intra-abdominal conditions and may easily be confused with many of them. Computed tomography (CT) demonstrates characteristic features that help make the diagnosis in most cases, thus avoiding unneeded treatment or surgery. Here, we discuss a case series of five patients who presented with abdominal pain and were ultimately diagnosed with epiploic appendagitis.

Nissen fundoplication and gastrointestinal-related complications: a guide for the primary care physician.

Gastroesophageal reflux disease is a common condition affecting many individuals in the Western world. Most patients are managed successfully with acid suppression, while others may require more invasive interventions. The majority of patients undergoing antireflux surgery will have favorable outcomes. A small percentage, however, will be considered surgical failures and will either present with new or recurrent symptoms, or develop postoperative complications. These include, but are not limited to, symptoms such as dysphagia, gas-bloat syndrome, and bowel dysfunctions that may significantly impair the patient's health and quality of life. As the number of antireflux procedures for this condition continue to increase, the number of complications is also likely to become more prevalent. The primary care physician will be challenged to recognize them and initiate appropriate management. In this review, we address the more common gastrointestinal complications of laparoscopic Nissen fundoplication and offer general guidelines in their diagnosis and management.

Obesity and complicated diverticular disease: is there an association?

OBJECTIVE: Obesity is becoming a growing health concern in the general population. Multiple studies have linked diverticular disease to obesity. Furthermore, recent research has shown fat to be a critical element in the regulation of immunity and the inflammatory response. In this study, we sought to determine if body mass index (BMI) is associated with a higher incidence of complicated diverticulitis. METHODS: A retrospective review of patients hospitalized with complicated diverticulitis between 1997 and 2006 was conducted. Medical, surgical and CT (Computed Tomography) guided interventions were evaluated in reference to age, gender, BMI and length of hospital stay (LOS). RESULTS: Charts of 104 controls and 614 patients hospitalized with complicated diverticulitis were reviewed based on specified inclusion and exclusion criteria. There was no significant difference between groups by either gender (P = 0.066) or BMI (P = 0.648). There was a significant difference in age and LOS between three of the analyzed groups. No correlation was noted between BMI and LOS in any of the groups. DISCUSSION: There has been increasing interest in obesity and its ramifications in all areas of medicine, including diverticular disease. Numerous studies have shown a strong correlation between acute diverticulitis and obesity, particularly in the young population. This study was undertaken to identify a possible link between complicated diverticulitis and obesity. Anecdotal reports and a few studies have found a parallel association. However, in this retrospective study, no correlation was found between BMI and the incidence of complicated diverticulitis.

Serum sickness-like reactions in patients receiving intravenous infliximab.

Infliximab, a monoclonal antibody against tumor necrosis factor (TNF) has been used successfully for the treatment of certain forms of Crohn's disease and rheumatoid arthritis. Both acute and delayed hypersensitivity reactions have been associated with the intravenous use of this drug. The delayed forms may present as a serum sickness-like illness and recognition of the clinical manifestations becomes crucial for early diagnosis and treatment. With the dramatic increase in the use of infliximab, there will likely be increased numbers of patients with this type of reaction. These patients may have received this drug days or even weeks before the clinical presentation. These types of reactions also have been reported with the use of other monoclonal antibodies.

Cerebellar vermis involvement in cocaine-related behaviors.

Although the cerebellum is increasingly being viewed as a brain area involved in cognition, it typically is excluded from circuitry considered to mediate stimulant-associated behaviors since it is low in dopamine. Yet, the primate cerebellar vermis (lobules II-III and VIII-IX) has been reported to contain axonal dopamine transporter immunoreactivity (DAT-IR). We hypothesized that DAT-IR-containing vermis areas would be activated in cocaine abusers by cocaine-related cues and, in healthy humans, would accumulate DAT-selective ligands. We used BOLD fMRI to determine whether cocaine-related cues activated DAT-IR-enriched vermis regions in cocaine abusers and positron emission tomography imaging of healthy humans to determine whether the DAT-selective ligand [11C]altropane accumulated in those vermis regions. Cocaine-related cues selectively induced BOLD activation in lobules II-III and VIII-IX in cocaine users, and, at early time points after ligand administration, we found appreciable [11C]altropane accumulation in lobules VIII-IX, possibly indicating DAT presence in this region. These data suggest that parts of cerebellar vermis mediate cocaine's persisting and acute effects. In light of prior findings illustrating vermis connections to midbrain dopamine cell body regions, established roles for the vermis as a locus of sensorimotor integration and motor planning, and findings of increased vermis activation in substance abusers during reward-related and other cognitive tasks, we propose that the vermis be considered one of the structures involved in cocaine- and other incentive-related behaviors.

Early laminar organization of the human cerebrum demonstrated with diffusion tensor imaging in extremely premature infants.

Diffusion tensor imaging (DTI) was used to delineate early laminar organization of the cerebrum in two extremely premature infants imaged postnatally at estimated ages of 25 and 27 menstrual weeks. The diffusivity and anisotropy of the cortical plate, subplate zone, intermediate zone, subventricular and periventricular zones, and germinal matrix are examined. Automated segmentation of diffusion tensor images to reveal the laminar architecture of the developing human cerebrum is also demonstrated.