Risk and significance of endoscopic/radiological evidence of recurrent Crohn's disease.

BACKGROUND & AIMS: The aim of this study was to determine the risk of endoscopic/radiological recurrence of Crohn's disease postoperatively and the long-term outcome. METHODS: A randomized placebo-controlled trial was performed to determine the effectiveness of mesalamine in preventing recurrent Crohn's disease postoperatively. Patients in the control group were examined endoscopically/radiologically before entry into and annually during the trial. Findings were classified as minimal or severe. RESULTS: There were 76 patients (49 men and 37 women; mean age, 37.1 +/- 13.2 years). Fifty (61.7%) had terminal ileal resections. Overall, 55 endoscopic/radiological recurrences were observed in 51 patients (67.1%). Expressed actuarially, the recurrence rate was 27.5% at 1 year (95% confidence interval [CI], 15.8%-37.6%), 60.8% at 2 years (95% CI, 46%-71.3%), and 77.3% at 3 years (95% CI, 62.7%-86.3%). Nineteen (37%) were symptomatic and 12 (24%) were initially asymptomatic but later became symptomatic (mean, 13.0 +/- 8.8 months), whereas 20 (39%) remained asymptomatic (mean, 16.9 +/- 17.4 months). Patients with severe endoscopic/radiological disease were significantly more likely to be or become symptomatic than those with minimal disease (23 of 32 vs. 8 of 19, respectively; P = 0.0437). CONCLUSIONS: This study suggests that postoperative endoscopic/radiological recurrences occur later than previously reported. Furthermore, many of these patients, especially with minimal disease, will remain asymptomatic.

Antegrade placement of a ureteric stent by a pull-through technique.

Internal double-J ureteric stents are valuable in the treatment of ureteric obstruction, obviating the need for an external drainage catheter. Retrograde placement of these stents is often performed by the urologist, or, if such placement fails, antegrade placement is performed by the interventional radiology service. In cases of high-grade obstruction it may be possible to pass a guide wire through the stricture but impossible to do so with a catheter. The authors describe a pull-through technique, which was used to place a ureteric stent in a 65-year-old man with bilateral hydronephrosis. The method consists of gaining control of the distal end of the guide wire by retrieving it through the penile urethra to allow the stenosis to be crossed with a catheter.

Expandable metallic bronchial endoprosthesis.

The authors report the successful insertion, under fluoroscopic guidance, of an expandable metallic endoprosthesis in a 60-year-old woman with recurrent obstructive pneumonia secondary to metastasis. This procedure allowed 93 days of palliation for the patient, who had previously required multiple endoscopic treatments for the recurrent bronchial obstruction.

Relationship between the pericardial and pleural spaces in cross-sectional imaging.

Sixty patients, including 15 with large pericardial effusions, five with large left pleural effusions, and nine with both, were studied prospectively with two-dimensional echocardiography to verify the relation of pericardial effusions and posterior paramediastinal pleural effusions to the descending thoracic aorta. It was found that large pericardial effusions lie anterior to the descending aorta both at the level of the left atrium and the left ventricle, whereas large posterior paramediastinal pleural effusions lie posterior, lateral, or posterolateral to the descending aorta. A retrospective study of 148 M-mode echocardiograms showed similar findings; but the descending thoracic aorta was less reliably identified, and the lateral position of pleural effusions with respect to the aorta could not be evaluated.