Small bowel MRI in adult patients: not just Crohn’s disease—a tutorial

To provide an overview of less well-known small bowel and mesenteric diseases found at small bowel magnetic resonance (MR) enterography/enteroclysis and to review the imaging findings. MR enterography and enteroclysis are important techniques for evaluation of small bowel diseases. In most centres these techniques are primarily used in Crohn's disease, and most radiologists are familiar with these MRI findings. However, the knowledge of findings in other diseases is often sparse, including diseases that may cause similar clinical symptoms to those of Crohn's disease. We present a spectrum of less common and less well-known bowel and mesenteric diseases (e.g. internal hernia, intussusception, neuroendocrine tumour) from our small bowel MR database of over 2,000 cases. These diseases can be found in patients referred for bowel obstruction, abdominal pain or rectal blood loss. Further, in patients with (or suspected to have) Crohn's disease, some of these diseases (e.g. neuroendocrine tumour, familial Mediterranean fever) may mislead radiologists to erroneously diagnose active Crohn's disease. Radiologists should be familiar with diseases affecting the small bowel other than Crohn's disease, including diseases that may mimic Crohn's diseas

JPN Guidelines for the management of acute pancreatitis: epidemiology, etiology, natural history, and outcome predictors in acute pancreatitis

Acute pancreatitis is a common disease with an annual incidence of between 5 and 80 people per 100 000 of the population. The two major etiological factors responsible for acute pancreatitis are alcohol and cholelithiasis (gallstones). The proportion of patients with pancreatitis caused by alcohol or gallstones varies markedly in different countries and regions. The incidence of acute alcoholic pancreatitis is considered to be associated with high alcohol consumption. Although the incidence of alcoholic pancreatitis is much higher in men than in women, there is no difference in sexes in the risk involved after adjusting for alcohol intake. Other risk factors include endoscopic retrograde cholangiopancreatography, surgery, therapeutic drugs, HIV infection, hyperlipidemia, and biliary tract anomalies. Idiopathic acute pancreatitis is defined as acute pancreatitis in which the etiological factor cannot be specified. However, several studies have suggested that this entity includes cases caused by other specific disorders such as microlithiasis. Acute pancreatitis is a potentially fatal disease with an overall mortality of 2.1%–7.8%. The outcome of acute pancreatitis is determined by two factors that reflect the severity of the illness: organ failure and pancreatic necrosis. About half of the deaths in patients with acute pancreatitis occur within the first 1–2 weeks and are mainly attributable to multiple organ dysfunction syndrome (MODS). Depending on patient selection, necrotizing pancreatitis develops in approximately 10%–20% of patients and the mortality is high, ranging from 14% to 25% of these patients. Infected pancreatic necrosis develops in 30%–40% of patients with necrotizing pancreatitis and the incidence of MODS in such patients is high. The recurrence rate of acute pancreatitis is relatively high: almost half the patients with acute alcoholic pancreatitis experience a recurrence. When the gallstones are not treated, the risk of recurrence in gallstone pancreatitis ranges from 32% to 61%. After recovering from acute pancreatitis, about one-third to one-half of acute pancreatitis patients develop functional disorders, such as diabetes mellitus and fatty stool; the incidence of chronic pancreatitis after acute pancreatitis ranges from 3% to 13%. Nevertheless, many reports have shown that most patients who recover from acute pancreatitis regain good general health and return to their usual daily routine. Some authors have emphasized that endocrine function disorders are a common complication after severe acute pancreatitis has been treated by pancreatic resection

Rectal involvement by prostatic carcinoma: barium enema findings.

A retrospective study was performed to determine the radiographic features of prostatic carcinoma invading the rectum on double-contrast barium enemas. In 11 such patients, these examinations revealed localized narrowing and/or speculation of the rectum (four cases); a smooth, extrinsic mass impression on the rectosigmoid colon (two cases); an umbilicated submucosal mass in the rectosigmoid colon (one case); and rectosigmoid narrowing with spiculated, pleated mucosal folds in the narrowed segment of bowel (four cases). Thus, most patients (64%) had localized involvement of the rectosigmoid colon with sparing of the distal rectum. The anatomic-pathologic basis for the localized spread of prostatic carcinoma to the rectosigmoid colon is illustrated on MR scans. Thus, prostatic carcinoma invading the rectum may be manifested on double-contrast barium enema by a spectrum of radiographic findings, and most patients have localized rectosigmoid involvement with sparing of the distal rectu

Lateral laryngopharyngeal diverticula: a videofluoroscopic study of laryngopharyngeal wall in wind instrumentalists

CONTEXT: This paper analyze healthy musicians who play wind instruments. OBJECTIVE: To identify possible diverticular formations on the laryngopharyngeal wall produced by pharyngeal overpressure during the use of these instruments. METHODS: Through a videofluoroscopic method, 22 professional musicians had their pharynx analyzed in frontal face and profile, by swallowing 20 mL of barium sulfate solution and blowing against resistance. RESULTS: All the volunteers showed lateral laryngopharyngeal diverticula (3 unilateral and 19 bilateral) with areas ranging from 0.7 to 6 cm². Trumpet and clarinet players showed larger diverticula, on both the right and left sides. Any important complaints were noted spontaneously or after questions. In the barium-swallow analyses, the 41 diverticula previously identified in the blowing tests were not seen or appeared to be smaller, because of the free flux passage from the pharynx to the esophagus. Despite the existence of the other, less resistant areas on the laryngopharyngeal segment, no other protrusions could be found in this group of wind instrumentalists. CONCLUSIONS: The lateral laryngopharyngeal diverticula that occur in blow instrumentalists is distinct of diverticula produced by laryngopharyngeal overpressure determined by abnormally high resistance to flux passage from pharynx to esophagus. In musicians is the persistent and continuous pharyngeal overpressure induced by the resistance of the instrument's mouthpiece will strongly distend the anatomically less resistant areas of the pharynx, producing a large protrusion. Laryngopharyngeal overpressure without abnormal resistance to flux passage explain the way blow instrumentalists protrusions did not appear as full sacs in a barium-swallow test, despite their larger dimensions. As final conclusion the musician-acquired diverticula must be considered as an "occupational overuse syndrome"