CT enterography and fistulizing Crohn's disease: clinical benefit and radiographic findings.

BACKGROUND: To estimate the clinical benefit of CT enterography (CTE) in patients with fistulizing Crohn's disease and describe the appearance of fistulas at CTE. METHODS: Crohn's patients who had undergone CTE, which diagnosed an abscess or fistula, were identified. A gastroenterologist reviewed clinical notes prior to and following CTE to assess the pre-CTE clinical suspicion for fistula/abscess, and post-CTE alteration in patient management. A radiologist reassessed all fistula-positive cases, which were confirmed by a non-CT reference standard, to describe their radiologic appearance. RESULTS: Fifty-six patients had CT exams identifying 19 abscesses and 56 fistulas. There was no or remote suspicion of fistula or abscess at pre-imaging clinical assessment in 50% of patients. Thirty-four patients (61%) required a change in or initiation of medical therapy and another 10 (18%) underwent an interventional procedure based on CT enterography findings. Among 37 fistulas with reference standard confirmation, 30 (81%) were extraenteric tracts, and 32 (86%) were hyperenhancing compared to adjacent bowel loops. Most fistulas (68%) contained no internal air or fluid. CONCLUSION: CTE detects clinically occult fistulas and abscesses, resulting in changes in medical management and radiologic or surgical intervention. Most fistulas appear as hyperenhancing, extraenteric tracts, usually without internal air or fluid.

Celiac disease: how common is jejunoileal fold pattern reversal found at small-bowel follow-through?

OBJECTIVE: Celiac disease, or nontropical sprue, is a cause of mucosal malabsorption. A decreased number of jejunal folds and an increased number of ileal folds (jejunoileal fold pattern reversal) found at small-bowel follow-through have been reported for patients with celiac disease. We asked three questions regarding jejunoileal fold pattern reversal found at small-bowel follow-through in patients with celiac disease. (1) How often is it present, either partially or completely? (2) How often is it associated with other findings of malabsorption? (3) How reliably can it be distinguished from the normal pattern? MATERIALS AND METHODS: Twenty-eight small-bowel follow-through examinations performed on 25 adult patients with celiac disease (confirmed by characteristic small-bowel biopsy and clinical response to a gluten-free diet) were reviewed retrospectively by two authors, who agreed by consensus on partial or complete jejunoileal fold pattern reversal and on other findings of malabsorption. Two methods were used to control for retrospective bias. (1) The prospective and retrospective readings of fold pattern reversal were compared for agreement. (2) The author who had not participated in the retrospective review was asked to distinguish, on the basis of the presence or absence of fold pattern reversal, 24 cases of celiac disease (all of which showed partial or complete fold pattern reversal on retrospective review) from 25 normal control cases (patients with diarrhea) (conformed by normal small-bowel biopsy). RESULTS: Partial or complete jejunoileal fold pattern reversal was identified retrospectively in 24 of the 28 small-bowel examinations (86%) performed on patients with celiac disease. One-half lacked other findings of malabsorption. The prospective and retrospective readings of fold pattern reversal agreed in 21 of the 28 examinations (75%). Forty-four of 49 examinations (90%) were correctly identified by the third author on the basis of fold pattern reversal. CONCLUSION: In patients with celiac disease, partial or complete jejunoileal fold pattern reversal discovered at small-bowel follow-through is common, is often not associated with other findings of malabsorption, and can be reliably distinguished from the normal pattern. Identification of jejunoileal fold pattern reversal found at small-bowel follow-through should prompt an appropriate clinical evaluation for celiac disease.

Stereoacuity and fusional amplitude in foveal suppression.

A retrospective study of 100 cases with suppression of one fovea was carried out to discover the relationship between the residual angle of strabismus (if present), the quality of stereopsis and fusional amplitudes. No direct linear relationship was present. However, the following conclusion could be reached. The greatest number of patients with one fovea suppressed who exhibited normal fusional amplitude have a residual esotropia between 5 and 10 prism dioptres. Stereoacuity, as well, tended to be superior in this group. From a practical standpoint, in patients with permanent suppression of one fovea, under binocular conditions, the eradication of any residual tropia, provided it is under 10 prism dioptres, will not improve binocular visual function.