[Characteristics and predictors of postoperative outcome of Crohn disease patients requiring abdominal surgery: a series of 1 048 cases from a single inflammatory bowel disease centre].

Objective: To examine the clinical characteristics, the potential relative factors for postoperative abdominal septic complications, and prognosis factors of surgical recurrence of Crohn disease (CD) patients after the first surgery. Methods: All the CD patients from Department of General Surgery, Jinling Hospital, Medical School of Nanjing University who had undergone at least one abdominal surgery from January 2007 to December 2017 were included for retrospective analysis. Hospital records were reviewed for information on clinical characteristics. Relative factors of postoperative abdominal septic complications were accessed by Logistic regression models, and prognosis factors of surgical recurrence were accessed by Cox proportional hazards regression models. Results: There were 1 048 patients included (733 males and 315 females), accounting for 1 513 operations. The age was 31(17) years and the length of resected small bowel was 30.0(40.0) cm at the first resection, 20.0(35.0) cm at the second resection, and 20.0(23.5) cm at the third resection. The length of resected small bowel was 25.0(40.0) cm at any resection. At the first abdominal surgery, 70.99%(744/1 048) patients were aged between 17 and 40 years, 66.98%(702/1 048) patients had ileocolonic disease, and 60.40%(633/1 048) patients had penetrating behavior. Penetrating behavior (OR=8.594, 95%CI: 3.397 to 21.740, P<0.01) and current smoking status (OR=2.671, 95%CI: 1.044 to 6.832, P=0.040) were significantly associated with an increased risk of postoperative septic complications, whereas staged operation (OR=0.360, 95%CI: 0.184 to 0.707, P=0.003) was associated with a decreased risk. Male gender (HR=1.500, 95%CI: 1.128 to 1.995, P=0.005), upper gastrointestinal disease (HR=1.526, 95%CI: 1.033 to 2.255, P=0.034), penetrating behavior (HR=1.506, 95%CI: 1.132 to 2.003, P=0.005) and emergency surgery (HR=1.812, 95%CI: 1.375 to 2.387, P<0.01) were significantly associated with an increased risk of postoperative surgical recurrence, whereas staged operation (HR=0.361, 95%CI: 0.227 to 0.574, P<0.01) was significantly associated with a decreased risk. Conclusions: In this cohort of CD patients receiving abdominal surgery from an inflammatory bowel disease center, the median age was 31 years and the median length of resected small bowel was 30 cm, at first resection. Patients who have risk factors of adverse postoperative outcome may be benefited from staged surgical approach.

Differentiating Components of Cerebral Arteriovenous Malformations Using T1-Weighted Gradient Recall Echo MR Imaging.

Cerebral arteriovenous malformation (AVM) typically shows signal void on conventional MR images, making differentiation of each component difficult. We analyzed the MR signal intensity of AVM components on T1-weighted gradient recalled echo pulse sequence images. We retrospectively studied 29 patients with AVM between 2006 and 2008. Patients were excluded if they had 1) intracranial hemorrhage, 2) previous intervention for AVM. All patients underwent MR study on a 3T system (Magentom TIM Trio, Siemens). Pulse sequences included T1-weighted gradient recalled echo (T1GRE), T2-weighted (T2), time-of-flight (TOF), and contrast-enhanced T1-weighted (cT1) images. Digital subtracted angiography (DSA) was performed in all patients as a diagnostic standard. Signal intensity of each AVM component was recorded and compared between pulse sequences. Nine patients were studied (five men; mean age 39.1 years) and nine AVM were identified (mean size, 3.9 cm). Three different signal intensities (hypo-, iso-, and hyper-intensity) were observed in all nine patients on T1GRE. Only one signal intensity was seen on T2 (flow void) and cT1 images (hyperintensity) in nine patients. Two different signal intensities were observed in all seven patients with TOF images. The T1GRE image showed the largest number of different signal intensities of AVM when compared with other pulse sequences, thus providing clearer structural delineation. Routine use of the T1GRE pulse sequence can help pre-therapeutic planning or follow-up of AVM.

Aerosolized vancomycin therapy facilitating nursing home placement.

OBJECTIVE: To demonstrate a novel method of eliminating nasopharyngeal colonization by methicillin-resistant Staphylococcus aureus (MRSA) in a debilitated, hospitalized patient. DESIGN: Single-patient, nonblind, nonplacebo, case study. SETTING: Community hospital, Brooklyn, NY. PATIENT: Hospitalized patient with recalcitrant nasopharyngeal MRSA colonization that could not be eliminated by conventional therapeutic interventions. INTERVENTIONS: Aerosolized vancomycin hydrochloride 120 mg q6h administered in room air via face mask together with vancomycin nasal drops, 2 drops to each nostril q6h. MAIN OUTCOME MEASURE: Elimination of MRSA from the nasopharynx of the patient. RESULTS: Successful elimination of MRSA colonization after four days of therapy. CONCLUSIONS: Aerosolized vancomycin in combination with vancomycin nasal drops is beneficial in eliminating nasopharyngeal colonization by MRSA. Clinical trials are warranted to confirm this clinical observation.

Pulmonary artery involvement in aorto-arteritis. An analysis of DSA.

Angiographic features of the pulmonary artery were studied in 24 patients with aortoarteritis (Takayasu's arteritis) by digital subtraction angiography. The pulmonary artery involvement was found in nine cases (37.5%). The right side was involved in eight and the left side in five cases. The right pulmonary artery was involved in two cases, the lobar artery in six, the segmental artery in six, and subsegmental as well as peripheral branches in four. The angiographic features were stenosis and/or occlusion as were the changes of the systemic arteries in aorto-arteritis. The aorta and its main branches were involved in all nine patients, but the severity of pulmonary vascular changes was not always related to the systemic vascular changes. Bronchial angiography demonstrated enlarged and tortuous bronchial arteries in four cases. Lung ECT revealed abnormalities in four cases.

Dynamic CT scan of intracranial tumors.

Of ninety-eight patients with intracranial tumors examined by dynamic CT scanning, 66 were confirmed operatively and pathologically. Our study showed that: 1) Dynamic CT can be performed safely and easily in outpatients; 2) Acoustic neurinoma, meningioma, pituitary chromophobe adenoma, astrocytoma and metastatic tumor have varying levels of time-density curves; 3) The tissue-blood ratio (TBR) at peak time (TBRp) is a useful indicator of the vascularity of tumoral tissues, and analysis of the time-density curve combining with TBRp is helpful to the differential diagnosis of tumors; 4) Differential diagnosis between tumors and vascular abnormalities such as aneurysm and arteriovenous malformation could be made easily with dynamic CT.

[Preliminary investigation on dynamic CT scan of intracranial tumors].

74 patients with various intracranial tumors were studied by means of dynamic CT, among them 45 cases were confirmed by operation and pathology. In analyzing the time-density curve and the ratio of increase in CT number of the tumoral tissue to that in the arterial lumens (tissue-blood ratio, TBR), we found that: (1) Dynamic CT technique is safe and easy to perform suitable for out-patients; (2) The time-density curves in acoustic neurinoma, meningioma, glioma and metastatic tumors are different from each other because of difference in vascularity and the degree of B.B.B. breakdown. Meningioma curve shows a rapid rise to the peak followed by a subsequent plateau; (3) TBR at the peak time (TBRp) is useful as an index for tumor. Combined analysis of time-density curve and TBRp is helpful for tumor differentiation.

CT in diagnosis of acoustic neuromas.

A detailed analysis of the CT findings in 75 cases of acoustic neuroma is presented. The method of examination included plain and enhanced CT, metrizamide CT cisternography (M-CTC), and gas CT cisternography (gas-CTC). The common CT appearances of acoustic neuromas were as follows: 93.6% appeared as isodense or hypodense on precontrast scan; homogeneous enhancement was observed in 53.8% on postcontrast scan; the tumor center, mostly located at the level of the internal acoustic canal, was spherical in shape with an acute angle between the lateral tumor border and petrous bone; and there was widening of the internal acoustic canal or destruction of petrous bone. However, the presence of an acoustic neuroma could not be excluded if widening of the internal acoustic canal was absent. It was not certain whether contrast filling of the internal acoustic canal occurred at M-CTC in the four cases so examined. One case of intracanalicular neuroma was diagnosed by gas-CTC, which is the most sensitive and reliable technique for detecting and excluding small tumors. The significance of various CT appearances, early diagnosis, and differential diagnosis of acoustic neuroma from other cerebellopontine-angle tumors, particularly meningioma, are discussed.

Osteoporosis--an early radiographic sign of endemic fluorosis.

Radiological investigation of skeletal fluorosis was carried out among the inhabitants from two areas where the fluoride content of water was high, using both conventional radiography and radiographic measurements of bone mineral content (BMC). Of 139 cases in the first group, 68 presented bone abnormalities while 21 of 54 cases in the second group showed a similar change. Four essential types of bony lesion were classified. Osteoporosis, especially in the long bones, was the earliest change to be observed. The results of measurements at the distal end of the ulna indicated the presence of a low BMC even among inhabitants with a good nutritional status. It is concluded that osteoporosis towards the ends of long bones is an early radiographic sign of endemic fluorosis especially in an individual under the age of 40 years.