Two-phase galaxy evolution: the cosmic star formation histories of spheroids and discs

From two very simple axioms: (1) that active galactic nucleus activity traces spheroid formation, and (2) that the cosmic star formation history is dominated by spheroid formation at high redshift, we derive simple expressions for the star formation histories of spheroids and discs, and their implied metal enrichment histories. Adopting a Baldry–Glazebrook initial mass function we use these relations and apply PEGASE.2 to predict the z = 0 cosmic spectral energy distributions (CSEDs) of spheroids and discs. The model predictions compare favourably to the dust-corrected CSED recently reported by the Galaxy And Mass Assembly team from the far-ultraviolet through to the K band. The model also provides a reasonable fit to the total stellar mass contained within spheroid and disc structures as recently reported by the Millennium Galaxy Catalogue team. Three interesting inferences can be made following our axioms: (1) there is a transition redshift at z ≈ 1.7 at which point the Universe switches from what we refer to as ‘hot mode evolution’ (i.e. spheroid formation/growth via mergers and/or collapse) to what we term ‘cold mode evolution’ (i.e. disc formation/growth via gas infall and minor mergers); (2) there is little or no need for any pre-enrichment prior to the main phase of star formation; (3) in the present Universe mass loss is fairly evenly balanced with star formation holding the integrated stellar mass density close to a constant value. The model provides a simple prediction of the energy output from spheroid and disc projenitors, the build-up of spheroid and disc mass and the mean metallicity enrichment of the Universe

Small bowel MR enterography: problem solving in Crohn’s disease

Magnetic resonance enterography (MRE) is fast becoming the first-line radiological investigation to evaluate the small bowel in patients with Crohn’s disease. It can demonstrate both mural and extramural complications. The lack of ionizing radiation, together with high-contrast resolution, multiplanar capability and cine-imaging make it an attractive imaging modality in such patients who need prolonged follow-up. A key question in the management of such patients is the assessment of disease activity. Clinical indices, endoscopic and histological findings have traditionally been used as surrogate markers but all have limitations. MRE can help address this question. The purpose of this pictorial review is to (1) detail the MRE protocol used at our institution; (2) describe the rationale for the MR sequences used and their limitations; (3) compare MRE with other small bowel imaging techniques; (4) discuss how MRE can help distinguish between inflammatory, stricturing and penetrating disease, and thus facilitate management of this difficult condition

Small bowel Crohn’s disease: MR enteroclysis and capsule endoscopy compared to balloon-assisted enteroscopy

New modalities are available to visualize the small bowel in patients with Crohn’s disease (CD). The aim of this study was to compare the diagnostic yield of magnetic resonance enteroclysis (MRE) and capsule endoscopy (CE) to balloon-assisted enteroscopy (BAE) in patients with suspected or established CD of the small bowel. Consecutive, consenting patients first underwent MRE followed by CE and BAE. Patients with high-grade stenosis at MRE did not undergo CE. Reference standard for small bowel CD activity was a combination of BAE and an expert panel consensus diagnosis. Analysis included 38 patients, 27 (71%) females, mean age 36 (20–74) years, with suspected (n = 20) or established (n = 18) small bowel CD: 16 (42%) were diagnosed with active CD, and 13 (34%) by MRE with suspected high-grade stenosis, who consequently did not undergo CE. The reference standard defined high-grade stenosis in 10 (26%) patients. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value of MRE and CE for small bowel CD activity were 73 and 57%, 90 and 89%, 88 and 67%, and 78 and 84%, respectively. CE was complicated by capsule retention in one patient. MRE has a higher sensitivity and PPV than CE in small bowel CD. The use of CE is considerably limited by the high prevalence of stenotic lesions in these patients

Cápsula endoscópica e estudos imagiológicos contrastados: diferentes perspectivas para uma imagem mais completa do intestino delgado

Small bowel evaluation is a challenging task and has been revolutionized by high-quality contrasted sectional imaging (CT enterography - CTE) and magnetic resonance enterography (MRE) as well as by small bowel capsule endoscopy (SBCE).The decision of which technique to employ during the investigation of small bowel diseases is not always simple or straightforward. Moreover, contraindications may preclude the use of these techniques in some patients, and although they are noninvasive procedures, may present with various complications. SBCE plays a crucial role in the investigation of both obscure gastrointestinal bleeding and Crohn's disease, but it is also useful for surveillance of patients with Peutz-Jeghers syndrome, while CTE is very accurate in small bowel tumours and in established Crohn's Disease, and its use in patients presenting with gastrointestinal bleeding is increasing. MRE, an expensive and not widely available technique, is essential for the study of patients with Crohn's Disease, and presents an attractive alternative to SBCE in Peutz-Jeghers syndrome surveillance.These diagnostic modalities are often not competitive but synergistic techniques. Knowing their characteristics, strengths and limitations, indications, contraindications and potential complications, as well as the adaptation to local availability and expertise, is essential to better select which procedures to perform in each patient, both safely and effectively, in order to optimize management and improve patient outcomes.A investigação do intestino delgado, previamente difícil e limitada, sofreu uma revolução com o aparecimento de técnicas imagiológicas contrastadas de elevada qualidade, como a enterografia por tomografia axial computadorizada (enteroTC) e a enterografia por ressonância magnética (enteroRM), assim como pela enteroscopia por cápsula (EC). A decisão na escolha da técnica a utilizar nas diferentes patologias do intestino delgado não é na maioria das vezes simples ou óbvia. Adicionalmente, a presença de contraindicações pode restringir o uso destas técnicas em alguns doentes, e apesar de não serem consideradas técnicas invasivas, não são isentas de riscos e complicações. A EC tem um papel crucial na investigação da hemorragia digestiva de causa obscura e da doença de Crohn, mas tem-se revestido também de utilidade na vigilância de doentes com síndrome de Peutz-Jeghers; a enteroTC revelou uma elevada capacidade diagnóstica para neoplasias do intestino delgado e na doença de Crohn estabelecida, e a sua utilização na hemorragia digestiva de causa obscura tem vindo a expandir. A enteroRM, apesar de dispendiosa e de disponibilidade limitada, tem uma elevada eficácia no estudo da doença de Crohn, e é uma alternativa válida à EC no síndrome de Peutz-Jeghers. Estas técnicas diagnósticas são frequentemente singergísticas e complementares, ao invés de competitivas. O reconhecimento das suas características, das suas capacidades e limitações, assim como das indicações, contraindicações e potenciais complicações, e aliado à adaptação à disponibilidade e competências locais, é essencial na correcta escolha de procedimentos seguros e eficazes para cada doente, de forma a optimizar a abordagem e o prognóstico.(undefined)info:eu-repo/semantics/publishedVersio

Evaluation and Treatment of Iron Deficiency Anemia: A Gastroenterological Perspective

A substantial volume of the consultations requested of gastroenterologists are directed towards the evaluation of anemia. Since iron deficiency anemia often arises from bleeding gastrointestinal lesions, many of which are malignant, establishment of a firm diagnosis usually obligates an endoscopic evaluation. Although the laboratory tests used to make the diagnosis have not changed in many decades, their interpretation has, and this is possibly due to the availability of extensive testing in key populations. We provide data supporting the use of the serum ferritin as the sole useful measure of iron stores, setting the lower limit at 100 μg/l for some populations in order to increase the sensitivity of the test. Trends of the commonly obtained red cell indices, mean corpuscular volume, and the red cell distribution width can provide valuable diagnostic information. Once the diagnosis is established, upper and lower gastrointestinal endoscopy is usually indicated. Nevertheless, in many cases a gastrointestinal source is not found after routine evaluation. Additional studies, including repeat upper and lower endoscopy and often investigation of the small intestine may thus be required. Although oral iron is inexpensive and usually effective, there are many gastrointestinal conditions that warrant treatment of iron deficiency with intravenous iron