Severity of postoperative recurrence in Crohn's disease: Correlation between endoscopic and sonographic findings

Background: Crohn's disease (CD) recurrence is currently assessed by ileocolonoscopy. Small intestine contrast ultrasonography (SICUS) visualizes the small bowel lesions in CD, although its role after curative resection is undefined. We aimed to investigate the accuracy of SICUS in assessing CD recurrence after ileocolonic resection when using ileocolonoscopy as a gold standard. The correlation between the bowel wall thickness (BWT) measured by SICUS and the endoscopic score of recurrence was also assessed. Methods: The analysis included 72 CD patients with ileocolonic resection requiring ileocolonoscopy, undergoing SICUS within 6 months. Recurrence was assessed by ileocolonoscopy using the Rutgeerts' score. SICUS was performed after PEG ingestion and findings compatible with recurrence included: increased BWT (>3 mm), bowel dilation (>25 mm) or stricture (<10 mm). Results: Ileocolonoscopy detected recurrence in 67/72 (93%) patients. SICUS detected findings compatible with recurrence in 62/72 (86%) patients (5 false negative (FN), 4 false positive (FP), 1 true negative (TN), 62 true positive (TP)), showing a 92.5% sensitivity, 20% specificity, and 87.5% accuracy for detecting CD recurrence. The BWT detected by SICUS was correlated with the Rutgeerts' score (P = 0.0001; r = 0.67). The median BWT, the extent of the ileal lesions, and the prestenotic dilation were higher in patients with an endoscopic degree of recurrence ≥3 versus ≤2 (P < 0.001) and the lumen diameter was lower in patients with a Rutgeerts' score ≥3 versus ≤2 (P < 0.0001). Conclusions: Although SICUS and ileocolonoscopy provide different views of the small bowel, SICUS shows a significant correlation with the endoscopic findings. SICUS may represent an alternative noninvasive technique for assessing CD recurrence after ileocolonic resection. Copyright © 2009 Crohn's & Colitis Foundation of America, Inc

Wearable augmented reality platform for aiding complex 3D trajectory tracing

Augmented reality (AR) Head-Mounted Displays (HMDs) are emerging as the most efficient output medium to support manual tasks performed under direct vision. Despite that, technological and human-factor limitations still hinder their routine use for aiding high-precision manual tasks in the peripersonal space. To overcome such limitations, in this work, we show the results of a user study aimed to validate qualitatively and quantitatively a recently developed AR platform specifically conceived for guiding complex 3D trajectory tracing tasks. The AR platform comprises a new-concept AR video see-through (VST) HMD and a dedicated software framework for the effective deployment of the AR application. In the experiments, the subjects were asked to perform 3D trajectory tracing tasks on 3D-printed replica of planar structures or more elaborated bony anatomies. The accuracy of the trajectories traced by the subjects was evaluated by using templates designed ad hoc to match the surface of the phantoms. The quantitative results suggest that the AR platform could be used to guide high-precision tasks: on average more than 94% of the traced trajectories stayed within an error margin lower than 1 mm. The results confirm that the proposed AR platform will boost the profitable adoption of AR HMDs to guide high precision manual tasks in the peripersonal space

Non-invasive techniques for assessing postoperative recurrence in Crohn's disease

Postoperative recurrence after ileo-colonic resection is a feature of Crohn's Disease (CD), almost 73% of patients show endoscopic recurrence at 1 year and 90% at 3 years. After surgical resection for CD, symptoms may be related to the surgical resection itself. Moreover, the development of an early severe endoscopic recurrence within 1 year represents a risk factor for early clinical recurrence. On the basis of these observations, the early detection and assessment of asymptomatic endoscopic recurrence may allow a timely and appropriate treatment of CD patients after ileo-colonic resection. At this purpose, conventional colonoscopy with ileoscopy currently represents the gold standard for assessing CD recurrence, graded according to the Rutgeerts' score. Lesions compatible with CD recurrence can be also detected by conventional radiology, including small bowel follow through and enema, both associated with a high radiation exposure. Due to the ineluctable course of CD after resection, and to the need of a proper follow up for assessing CD recurrence, several alternative, non invasive techniques have been searched in order to assess the post-operative recurrence, including: faecal alpha 1-antitrypsin clearance, faecal calprotectin, 99Tc-HMPAO scintigraphy, virtual colonoscopy, ultrasonography and, more recently, wireless capsule endoscopy (WCE) and Small Intestine Contrast Ultrasonography (SICUS). Among these, current evidences suggest that in experienced hands, ultrasound examination by SICUS represents a non-invasive technique useful for assessing recurrence in CD patients under regular follow up after surgery. The same findings are suggested for WCE, although the impact risk related to the recurrence or to the surgical anastomosis itself limits the use of this non-invasive technique for assessing CD recurrence after surgery. © 2008 Editrice Gastroenterologica Italiana S.r.l

Wireless capsule endoscopy and proximal small bowel lesions in Crohn's disease

AIM: To investigate the prevalence of proximal small bowel (SB) lesions detected by wireless capsule endoscopy (WCE) in Crohn's disease (CD). METHODS: WCE was performed in 64 patients: 32 with CD of the distal ileum, and 32 controls with iron-deficiency anemia (IDA) or diarrhea. WCE was performed using the Given SB-WCE, followed by small intestine contrast ultrasonography (SICUS). Findings compatible with CD by using WCE included erosions, aphthoid or deep ulcers, and strictures/stenosis. RESULTS: WCE detected proximal SB lesions in 16/32 (50%) patients (14 aphthoid ulcers, 2 deep ulcers, one stricture), which appeared not to be related to clinical parameters [epigastric pain, age, smoking, non-steroidal anti-inflammatory drugs (NSAIDs), IDA]. Among patients with proximal SB lesions, 6 (37%) were smokers, 3 (19%) NSAID users, 3 (19%) had epigastric pain and 4 (25%) had IDA. SICUS detected proximal SB lesions in 3/32 patients (19%) also showing lesions with WCE. No correlations were observed between proximal SB lesions assessed by WCE or by SICUS (χ2 = 1.5, P = 0.2). CONCLUSION: The use of WCE allows the detection of previously unknown upper SB lesions in a high proportion of patients with a previous diagnosis of CD involving the distal ileum. © 2010 Baishideng

Small intestine contrast ultrasonography vs computed tomography enteroclysis for assessing ileal Crohn's disease

Aim: To compare computed tomography enteroclysis (CTE) vs small intestine contrast ultrasonography (SICUS) for assessing small bowel lesions in Crohn's disease (CD), when using surgical pathology as gold standard. Methods: From January 2007 to July 2008, 15 eligible patients undergoing elective resection of the distal ileum and coecum (or right colon) were prospectively enrolled. All patients were under follow-up. The study population included 6 males and 9 females, with a median age of 44 years (range: 18-80 years). Inclusion criteria: (1) certain diagnosis of small bowel requiring elective ileo-colonic resection; (2) age between 18-80 years; (3) elective surgery in our Surgical Unit; and (4) written informed consent. SICUS and CTE were performed ≤ 3 mo before surgery, followed by surgical pathology. The following small bowel lesions were blindly reported by one sonologist, radiologist, surgeon and histolopathologist: disease site, extent, strictures, abscesses, fistulae, small bowel dilation. Comparison between findings at SICUS, CTE, surgical specimens and histological examination was made by assessing the specificity, sensitivity and accuracy of each technique, when using surgical findings as gold standard. Results: Among the 15 patients enrolled, CTE was not feasible in 2 patients, due to urgent surgery in one patients and to low compliance in the second patient, refusing to perform CTE due to the discomfort related to the naso-jejunal tube. The analysis for comparing CTE vs SICUS findings was therefore performed in 13 out of the 15 CD patients enrolled. Differently from CTE, SICUS was feasible in all the 15 patients enrolled. No complications were observed when using SICUS or CTE. Surgical pathology findings in the tested population included: small bowel stricture in 13 patients, small bowel dilation above ileal stricture in 10 patients, abdominal abscesses in 2 patients, enteric fistulae in 5 patients, lymphnodes enlargement (> 1 cm) in 7 patients and mesenteric enlargement in 9 patients. In order to compare findings by using SICUS, CTE, histology and surgery, characteristics of the small bowel lesions observed in CD each patient were blindly reported in the same form by one gastroenterologistsonologist, radiologist, surgeon and anatomopathologist. At surgery, lesions related to CD were detected in the distal ileum in all 13 patients, also visualized by both SICUS and CTE in all 13 patients. Ileal lesions > 10 cm length were detected at surgery in all the 13 CD patients, confirmed by SICUS and CTE in the same 12 out of the 13 patients. When using surgical findings as a gold standard, SICUS and CTE showed the exactly same sensitivity, specificity and accuracy for detecting the presence of small bowel fistulae (accuracy 77% for both) and abscesses (accuracy 85% for both). In the tested CD population, SICUS and CTE were also quite comparable in terms of accuracy for detecting the presence of small bowel strictures (92% vs 100%), small bowel fistulae (77% for both) and small bowel dilation (85% vs 82%). CONCLUSION: In our study population, CTE and the non-invasive and radiation-free SICUS showed a comparable high accuracy for assessing small bowel lesions in CD

Ileal lesions in patients with ulcerative colitis after ileo-rectal anastomosis: Relationship with colonic metaplasia

Aim: To assess whether in ulcerative colitis (UC) patients with ileo-rectal anastomosis (IRA), ileal lesions may develop in the neo-terminal-ileum and their possible relation with phenotypic changes towards colonic epithelium. Methods: A total of 19 patients with IRA under regular follow up were enrolled, including 11 UC and 8 controls (6 Crohn's disease, CD; 1 familial adenomatous polyposis, FAP; 1 colon cancer, colon K). Ileal lesions were identified by ileoscopy with biopsies taken from the ileum (involved and uninvolved) and from the rectal stump. Staining included HE and immunohistochemistry using monoclonal antibodies against colonic epithelial protein CEP (Das-1) and human tropomyosin isoform 5, hTM5 (CG3). Possible relation between development of colonic metaplasia and ileal lesions was investigated. Results: Stenosing adenocarcinoma of the rectal stump was detected in 1 UC patient. The neo-terminal ileum was therefore investigated in 10/11 UC patients. Ileal ulcers were detected in 7/10 UC, associated with colonic metaplasia in 4/7 (57.1%) and Das-1 and CG3 reactivity in 3/4 UC. In controls, recurrence occurred in 4/6 CD, associated with colonic metaplasia in 3/4 and reactivity with Das-1 and CG3 in 2/3. Conclusion: Present findings suggest that in UC, ileal lesions associated with changes towards colonic epithelium may develop also after IRA. Changes of the ileal content after colectomy may contribute to the development of colonic metaplasia, leading to ileal lesions both in the pouch and in the neo-terminal ileum after IRA

Associação entre incidência de dengue e variáveis climáticas

OBJECTIVE: To describe the occurrence of autochthonous dengue cases according to sex, age, suspected infection site and its relation with climatic variables. METHODS: Autochthonous dengue cases reported in São Sebastião, Southern Brazil, from 2001 to 2002 and confirmed in laboratory were studied. Larval density was verified by three indexes: building, recipients and Breteau. The relationship between rainfall, temperature and number of cases was analyzed through Spearman's correlation using time lag. RESULTS: The annual incidence coefficients for 2001 and 2002 were 80.3 and 211.1 per 10,000 inhabitants, respectively. Most dengue cases (n=1,091; 65%) were reported in the district's central area. Females (n=969; 60%) and the age groups 20 to 29 and 30 to 39 years old of both sexes were mostly affected. Significant associations were not observed between climatic variables and the number of dengue cases in the first month; however, this association became evident in the second month throughout the fourth month. CONCLUSIONS: The association between the number of dengue cases and abiotic factors identified the time lag in which rain and temperature favored the occurrence of new cases. These aspects, associated to tourist vulnerability in the coastal area, promoted conditions for dengue occurrence. The urbanization without sanitary infrastructure possibly affected mosquito density and dengue incidence. Such factors may have contributed to mosquito dispersion and dissemination of different dengue serotypes.OBJETIVO: Descrever a ocorrência de casos de dengue autóctone segundo sexo, faixa etária e local provável de infecção e sua relação com variáveis climatológicas. MÉTODOS: Os registros de casos autóctones em São Sebastião, SP, de 2001 a 2002, e confirmados laboratorialmente foram estudados. A densidade larval foi verificada pelos índices de predial, recipientes e Breteau. A relação entre dados de pluviosidade, temperatura e número de casos foi analisada pela correlação de Spearman utilizando-se o conceito time-lag. RESULTADOS: Os coeficientes de incidência anuais para 2001 e 2002 foram de 80,31 e 211,1 por 10.000 habitantes, respectivamente. A maioria dos casos de dengue (n=1.091; 65%) foi registrada na área central do município. O sexo feminino foi o mais acometido (n=969; 60%) e ambos os sexos nas faixas etárias entre 20 e 29 e 30 e 39 anos. Não foi observada correlação entre variáveis climatológicas e número de casos do mesmo mês, entretanto, esta associação ocorre a partir do segundo mês estendendo-se até o quarto mês. CONCLUSÕES: A associação entre o número de casos de dengue e fatores abióticos identificou o intervalo de tempo em que a chuva e a temperatura contribuíram na geração de novos casos. Tais aspectos, associados à vulnerabilidade turística da região litorânea, propiciaram condições para ocorrência da doença. A urbanização sem a devida estrutura de saneamento possivelmente influenciou na densidade de mosquitos e na incidência de dengue. Esses fatores podem ter contribuído para a dispersão do mosquito e disseminação dos vários sorotipos da doença

TRAF3IP2 gene is associated with cutaneous extraintestinal manifestations in Inflammatory bowel disease

Background and aims: Genome-wide association (GWA) studies recently identified a novel gene, TRAF3IP2, involved in the susceptibility to psoriasis. Common immune-mediated mechanisms involving the skin or the gut have been suggested. We therefore aimed to assess the role of TRAF3IP2 gene in IBD, with particular regard to the development of cutaneous extraintestinal manifestations (pyoderma gangrenosum, erythema nodosum). The association with psoriasis was also assessed in a secondary analysis. Methods: The analysis included 267 Crohn's disease (CD), 200 ulcerative colitis (UC) patients and 278 healthy controls. Three TRAF3IP2 SNPs were genotyped by allelic discrimination assays. A case/control association study and a genotype/phenotype correlation analysis have been performed. Results: All three SNPs conferred a high risk to develop cutaneous manifestations in IBD. A higher risk of pyoderma gangrenosum and erythema nodosum was observed in CD patients carrying the Rs33980500 variant (OR 3.03; P=0.026)In UC, a significantly increased risk was observed for both the Rs13190932 and the Rs13196377 SNPs (OR 5.05; P=0.02 and OR 4.1; P=0.049). Moreover, association of TRAF3IP2 variants with ileal (OR = 1.92), fibrostricturing (OR = 1.91) and perianal CD (OR = 2.03) was observed. Conclusions: This is the first preliminary report indicating that TRAF3IP2 variants increase the risk of cutaneous extraintestinal manifestations in IBD suggesting that the analysis of the TRAF3IP2 variants may be useful for identifying IBD patients at risk to develop these manifestations. © 2012 European Crohn's and Colitis Organisation