Extra-intestinal findings on magnetic resonance enterography in children with inflammatory bowel disease.

AIM: To determine the occurrence of extra-intestinal findings on magnetic resonance enterography (MRE) in a large cohort of children with known or suspected inflammatory bowel disease, characterise those findings, determine the technique and frequency of follow-up imaging, and associated costs. MATERIALS AND METHODS: Imaging reports from 757 MRE examinations in 671 children with known or suspected IBD from 2011 through 2012 were analysed retrospectively. Reported extra-intestinal findings were categorised by two radiologists in consensus as normal, normal variants or commonly seen findings without clinical significance, or abnormal. Prior imaging reports of the patients with abnormal findings were reviewed to identify which findings were new or substantially changed. Subsequent imaging examinations, their associated costs, and additional work-up of extra-intestinal findings were recorded in each group. RESULTS: A total of 403 extra-intestinal findings were reported in 290 MRE (38.3%) examinations performed in 269 children (40.1%). Of these, 189 (46.9%) findings were abnormal and new or significantly changed from prior imaging, 88 (21.8%) were abnormal and stable, 50 (12.4%) were normal variants or commonly seen findings with no clinical significance, and 76 (18.9%) were normal. Abnormal findings included 34.7% associated with IBD and 65.3% considered unrelated. Follow-up imaging was performed for 69 (17.1%) mostly abnormal findings in 94 patients (8.3%). Magnetic resonance imaging (51%) and ultrasound (28%) were the most commonly utilised imaging methods. CONCLUSION: MRE identifies a large number of previously unknown extra-intestinal abnormalities in children with known or suspected IBD, most unrelated to IBD. Although <10% of children having MRE undergo subsequent imaging of extra-intestinal abnormalities, given the rapid uptake of MRE in the paediatric population, emphasis should be given to avoiding techniques utilising ionising radiation at follow-up.

Systematic review with meta-analysis: magnetic resonance enterography signs for the detection of inflammation and intestinal damage in Crohn's disease.

BACKGROUND: In the treatment of Crohn's disease (CD), mucosal healing has become a major goal, with the hope of avoiding intestinal damage from chronic inflammation. Magnetic resonance enterography (MRE) has emerged as a non-invasive means of monitoring inflammation and damage. AIMS: As part of the development of MRE-based multi-item measures of inflammation and damage for paediatric studies, we carried out a systematic review and meta-analysis to identify MRE variables used to describe these two distinct concepts. METHODS: 2501 studies of MRI and CD were identified. Studies written in any language reporting individual MRE signs for patients diagnosed with CD were included. Two-hundred-and-forty-four studies were fully reviewed and 62 were included (inflammation, n = 51; damage, n = 24). Sensitivity, specificity and associated confidence intervals were calculated, and hierarchical summary ROC curves were constructed for each MRE sign. RESULTS: A total of 22 MRE signs were used to reflect inflammation, and 9 to reflect damage. Diagnostic accuracy of MRE signs of inflammation and damage was heterogeneous; however, wall enhancement, mucosal lesions and wall T2 hyperintensity were the most consistently useful for inflammation (most sensitivities >80% and specificities >90%), and detection of abscess and fistula were most consistently useful for damage (most sensitivities >90%, specificities >95%). CONCLUSIONS: Identifying the best MRE variables to reflect inflammation and damage will maximise the utility of this rapidly emerging technique and is the first stage of constructing MRE-based indices for evaluating inflammation and intestinal damage.

Therapeutic bronchoscopy in a child with sand aspiration and respiratory failure from near drowning--case report and literature review.

Foreign matter aspiration occurs relatively commonly in drowning and near-drowning events. In most cases, stomach contents are aspirated. Sand aspiration rarely occurs and there are no reported cases in children with near drowning. Limited data are available on clinical presentation and management of sand aspiration with accidental burial. We report a 3-year-old boy who nearly drowned while swimming in brackish waters and was found face down in sand. Sand aspiration was suspected when the child continued to have persistent wheezing and high ventilatory requirement despite intensive bronchodilator and corticosteroids therapy with an inability to wean after 4 days post-near-drowning event. Radiology was non-specific in the absence of sand bronchogram. Presence of sand in the airways was confirmed when a bronchoscopy was undertaken and sand seen in the bronchoalveolar lavage fluid. Sequential lung washing followed by exogenous surfactant administration (3 ml/kg) was undertaken and lead to significant improvement such that within 12 hr post-therapeutic lavage, his ventilatory requirements reduced substantially. The child was extubated 4 days post-lavage and on review 2 months post-event, was clinically well with airway resistance within normal predicted values measured on forced oscillatory spirometry (IOS).

Glomerulocystic disease with hepatoblastoma in a neonate: a case report.

Glomerulocystic disease (GCD) is a very rare condition. Only two previous reports have linked this condition with hepatoblastoma. We report a neonate with US evidence of grossly enlarged echogenic kidneys and features typical of hepatic fibrosis, complicated by the presence of a hepatoblastoma. The report discusses the differential diagnosis and highlights GCD as one cause of large, bright kidneys on US. It also adds further evidence to the suggested association between GCD and hepatoblastoma.

RXPERT: a prototype expert system for formulary decision making.

OBJECTIVE: RXPERT, a prototype, computer-based, expert system that models the decision-making processes for an ambulatory (non-hospital) formulary, is described as an example of how expert systems may be used to support pharmacy decision making. Basic information about expert-system technology is provided through this example. BACKGROUND: Computer-assisted decision making is becoming an important and accepted aspect of complex, health-related decisions. Because expert-system support may become an integral component of future, complex, pharmacy decision making, it is important for pharmacists to become familiar with this technology and its possibilities for supporting pharmacy decisions. METHOD: Expert systems offer the potential advantages of making the human decision-making process explicit, more consistent, easily duplicated in many locations simultaneously, and easy to update and document. Although an expert system is seldom intended to replace human decision makers, it can provide valuable support for complex, multivariable decisions. Typical knowledge-acquisition and knowledge-engineering techniques, as well as the characteristics and structure of expert systems, are described, relative to the development of the RXPERT prototype. CONCLUSIONS: Although RXPERT is not yet in use, the process for using an expert system to support an individual committee member's personal assessment of a drug product is described. Decision-support expert systems are potentially useful to pharmacists in complex decision-making tasks.

Computers in healthcare: overview and bibliography.

OBJECTIVE: The objective of this article is to provide an overview of computer technology and an associated bibliography, emphasizing institutional-based healthcare applications and pharmacoinformatics. DATA SOURCES: References were selected from the authors' files and from a computerized search over the last five years on computers in healthcare/medical informatics and in pharmacy. STUDY SELECTION: Articles selected for review and discussion were considered to be important contributions to the respective areas listed in the bibliography and representative of advancements in computer applications in healthcare and pharmacy. DATA SYNTHESIS: The computer has become an important support tool for healthcare professionals. Medical informatics and the discipline related to pharmacy, called pharmacoinformatics, have evolved from the cognitive underpinnings of medicine, pharmacy, and computer science. Recent developments in computer technology have resulted in computers that are fast, increasingly portable, and user friendly. Hospital information systems employ computers in various ways to deal with the vast amount of information used by various departments. Standards for electronic data exchange are being developed to increase the integration potential of these systems. Hospital pharmacists have used computers for drug distribution, financial analysis and inventory control, drug interaction detection, pharmacokinetic dosing, drug information, and drug therapy monitoring. Expert systems are being developed in several areas of drug therapy. Pharmacy educators have developed interactive courseware to help students learn problem-solving skills in the areas of calculations, therapeutics, and drug information. CONCLUSIONS: Pharmacists need to become more involved with applications of technology to pharmacy. Properly implemented, computers can provide more time for pharmacists to use their cognitive skills in the delivery of pharmaceutical care.