CT imaging and staging of carcinoma oesophagus

Background: Over the past decades, computerized tomography (CT) technology has led to an early detection of cancers and thereby decreasing mortality rate. The objective was to demonstrate usefulness of Toshiba Activion 16 slice multi detector computerized tomography (MDCT) scan in staging of oesophageal cancer.Methods: The study was carried out in the Department of Radio diagnosis, Bapuji Hospital and Chigateri Government Hospital attached to Jagadguru Jayadeva Murugarajendra Medical College, Davangere, Karnataka, India over a period of 24 months. After taking a properly informed written consent, complete history and thorough clinical examination was done and these patients were subjected to CT scan.Results: The total numbers of patients studied in present study were 25. Out of which 10 were males and 15 were females. There were 6 patients upto the age of 54 years and 8 patients equal to or greater than 65 years of age, there were 11 patients between 55-64 years of age. Dysphagia was the most common symptom in patients and was present in all the 25 patients of present study. Other common symptoms were weight loss followed by pain in throat. Two different types of wall thickenings of the involved portion have been reported. The most common asymmetrical wall thickening was observed in maximum number of patients 18 (72%) and circumferential wall thickening was observed only in 7 number (28%) of patients out of 25 total patients showing heterogeneous/homogeneous enhancement. Lower third (40%) and middle third (40%) of the esophagus was the most common site of involvement with regards to location of oesophageal cancer followed by upper third (20%) of the esophagus. Homogeneous wall attenuation was observed in most of the cases accounting for (64%). The other type of wall attenuation noted were heterogeneous (36%).Conclusions: By performing endoscopy uncertainty lies in discrimination of muscular layer from serosal layer in most parts of esophagus. However, by employing MDCT technique separation of 2 layers of esophagus can be better judged.  Therefore, MDCT has been found to be the most valuable and preferential technique for planning operational strategy

Radiographic imaging of metabolic bone disorders and their relative management

Background: Bone is a strong dynamic organ of the endoskeleton playing a vital role in structural integrity envisaging to keep proper shape and maintenance of the body, mineral reservoirs, blood production, coagulation and immunity. Metabolic bone diseases are a heterogeneous group of disorders that interrupt the normal homeostasis of bone formation and resorption. Bone regulates as well as acts as a host for hematopoiesis by providing niche for proliferation and differentiation of hematopoietic cell. Bone is a dynamic tissue but metabolically active as it is being constantly formed (modelling) and reformed (remodelling). Metabolic bone diseases comprise of a broad spectrum of inherited and acquired disorders characterized by abnormalities in calcium metabolism and bone cell physiology- that lead to an altered serum calcium concentration and skeletal failure.Methods: After taking a properly informed written consent and complete history, thorough clinical examination was done and these patients were subjected to radiographic imaging and biochemical analysis.Results: Serum alkaline phosphatase is a good marker in rickets and osteomalacia, ICTP in osteoporosis, pyridinoline, deoxypyridinoline in primary hyperparathyroidism, serum PICP in renal osteodystrophy.Conclusions: In cases of rickets and osteomalacia either decreased or normal values of serum calcium and serum phosphorus were obtained. But the cases pertaining to renal failure with rickets values of serum phosphorous were found to be raised. However, in all cases of rickets and osteomalacia values of serum alkaline phosphatase were also found to be raised

Radiographic imaging of metabolic bone disorders in consonance with biochemical parameters

Background: Bone is a strong dynamic organ of the endoskeleton playing a vital role in structural integrity envisaging keeping proper shape and maintenance of the body, mineral reservoirs, blood production, coagulation and immunity. Metabolic bone diseases are a heterogeneous group of disorders that interrupt the normal homeostasis of bone formation and resorption. Bone regulates as well as acts as a host for hematopoiesis by providing niche for proliferation and differentiation of hematopoietic cell. Bone is a dynamic tissue but metabolically active as it is being constantly formed (modelling) and reformed (remodelling). Metabolic bone diseases comprise of a broad spectrum of inherited and acquired disorders characterized by abnormalities in calcium metabolism and bone cell physiology- that lead to an altered serum calcium concentration and skeletal failure.Methods: After taking a properly informed written consent and complete history, thorough clinical examination was done and these patients were subjected to radiographic imaging and biochemical analysis.Results: With regards to fracture relating to different skeletal structures frequency was more in vertebra (38%), the maximum to be reported in 38 cases followed by hip fractures (17%) in 17 cases. Pelvis fractures were reported as (11%) in 11 cases and tibia fractures were reported to be only (7%) in meagre population of 7 cases, while remaining skeletal organs had (27%) fractures with subject to realisation in other 27 cases.Conclusions: In all the osteoporotic cases irrespective to age of patients, values of serum calcium, serum alkaline phosphatase, serum phosphorus, serum potassium, serum sodium, serum calcidiol were within normal limits

Body Image Dissatisfaction among Pediatric Patients with Inflammatory Bowel Disease

Objectives: To determine risk factors for body image dissatisfaction among pediatric patients with inflammatory bowel disease (IBD). Study design: We performed a cross-sectional study of children aged 9-18 years in the IBD Partners Kids & Teens cohort. Participants completed surveys including demographics, disease characteristics and activity indices, and psychosocial outcomes measured by IMPACT-III questionnaires. We defined body image dissatisfaction if participants answered ?I look awful? or ?I look bad.? Bivariate analyses assessed associations between body image dissatisfaction and demographic, disease-related and psychosocial factors; logistic regression models evaluated associations between risk factors and body image dissatisfaction. Results: IMPACT-III was completed by 664 patients, with 74 (11.1%) reporting body image dissatisfaction. Patients with body image dissatisfaction were more likely to be female (P < .01), older (median age 15 vs 13 years, P < .01), and diagnosed with IBD at an older age (12 vs 10 years, P < .01). Those with body image dissatisfaction had greater body mass index percentile (P = .02), more active disease (P < .01), more current steroid use (P < .01), and more depression and anxiety (P < .01). Female sex (OR 2.31; 95% CI 1.22-4.39), depression (OR 4.73; 95% CI 2.41-9.26), and anxiety (OR 5.42; 95% CI 2.48-11.80) were independently associated with body image dissatisfaction. Conclusions: In this cohort, risk factors for body image dissatisfaction include female sex, older age at diagnosis, active disease, current steroid use, greater body mass index, and comorbid mood disorder. Interventions targeting modifiable risk factors for body image dissatisfaction may improve quality of life in pediatric patients with body image dissatisfaction

Minority Pediatric Patients with Inflammatory Bowel Disease Demonstrate an Increased Length of Stay

BACKGROUND: Genetic and other biological factors may lead to differences in disease behavior among children with inflammatory bowel disease of different races, which may be further modified by disparities in care delivery. Using the Kids' Inpatient Database, we aimed to evaluate differences in the management of pediatric patients with inflammatory bowel disease by race, focusing on length of stay (LOS).METHODS: We performed a cross-sectional analysis using 2000 to 2012 data from the Kids' Inpatient Database, a nationally representative database. We identified pediatric patients (ó18 years of age) with discharge diagnoses of Crohn's disease (CD) or ulcerative colitis (UC). We used multivariable logistic regression to evaluate the relationship between race and LOS, controlling for age, payer status need for surgery, and year of admission.RESULTS: We identified 27,295 hospitalizations for children with inflammatory bowel disease (62% CD and 38% UC), Compared with white patients with CD, black (adjusted odds ratio 1.37; 95% confidence interval, 1.22-1.53; P < 0.001) and Hispanic patients (adjusted odds ratio: 1.37; 95% confidence interval: 1.19-1.59; P < 0.001) with CD demonstrated increased odds of a LOS greater than the 75th percentile. When compared with white patients with UC, Hispanic patients also demonstrated increased odds of a LOS greater than the 75th percentile (adjusted odds ratio: 1.20; 95% confidence interval, 1.02-1.42, P = 0.015).CONCLUSIONS: After controlling for age, year of admission, and clinical phenotypes, black and Hispanic patients with CD and Hispanic patients with UC had longer LOS than white patients. These may be due to differences in provider/hospital characteristics, socioeconomic differences, and/or differences in genetics and other biological factors (see Video Abstract, Supplemental Digital Content 1, http://links.lww.com/IBD/B656)

Inflammatory Bowel Disease is Similar in Patients with Older Onset and Younger Onset

Background: As the American population is aging, the number of older people with inflammatory bowel disease is increasing. We used clinical data from the Sinai-Helmsley Alliance for Research Excellence (SHARE), a prospective cohort, to examine disease and treatment differences in older adults. Methods: We performed a cross-sectional study assessing demographics and disease behavior by age at diagnosis with univariate, bivariate, and multivariate analyses. "Older-onset" patients were diagnosed after age 60, "younger-onset" patients were diagnosed before age 60 but are older than 60 years, and the remainder were "young." Results: There were 91 older-onset, 389 younger-onset, and 3431 young patients with Crohn's disease. Older-onset patients had more ileal (37%) and colonic (27%) disease compared with younger-onset and young patients. There were no differences in disease behavior, location, or surgeries between older-onset and young patients with Crohn's disease within 5 years of diagnosis. Older-onset patients with inflammatory disease had a higher odds of being in remission. Young patients reported more anti-tumor necrosis factor and thiopurine use compared with younger-onset and older-onset patients (P < 0.01). There were 98 older-onset, 218 younger-onset, and 1702 young patients with ulcerative colitis. There were no differences in disease extent, activity index, or surgeries. Young patients with ulcerative colitis reported more anti-tumor necrosis factor use (26%) compared with younger-onset patients (17%, P < 0.01). Conclusions: Disease behavior or location was not different between younger and older adults with inflammatory bowel disease. Older patients were less likely to be treated with immunosuppression. If older patients have similar disease behavior, less frequent treatment with immunosuppressives may risk suboptimally controlled disease

Modifiable Risk Factors for Hospital Readmission among Patients with Inflammatory Bowel Disease in a Nationwide Database

Background: Previous studies suggest that disease activity alone does not reliably predict hospital readmission among patients with inflammatory bowel diseases (IBDs). Using a national database, we aimed to further describe the burden of readmissions for IBD and identify modifiable risk factors. Methods: We performed a retrospective cohort study using 2013 data from the Nationwide Readmission Database (NRD). Using International Classification of Diseases, ninth Revision, Clinical Modification (ICD-9-CM) codes, we identified adult patients with discharge diagnoses of ulcerative colitis or Crohn's disease and ascertained diagnoses of anxiety, depression, chronic pain, tobacco use, and other comorbidities during index admission. Logistic regression was used to estimate factors associated with hospital readmission. Results: Among 52,498 hospitalizations of patients with IBD (63% Crohn's disease and 37% ulcerative colitis), 12,407 (24%) were readmitted within 90 days of the index hospitalization, resulting in roughly $576 million in excess charges. In multivariable analysis of patients with Crohn's disease, anxiety (odds ratio [OR] 1.31, 95% confidence interval [CI], 1.21-1.43), depression (OR 1.27, 95% CI, 1.07-1.50), chronic pain (OR 1.31, 95% CI, 1.18-1.46), and tobacco abuse (OR 1.13, 95% CI, 1.06-1.22) were associated with a significant increase in odds of readmission. Among patients with ulcerative colitis, anxiety (OR 1.28, 95% CI, 1.14-1.45), depression (OR 1.35, 95% CI, 1.07-1.70), and chronic pain (OR 1.44, 95% CI, 1.21-1.73) were associated with a significant increase in odds of readmission. Conclusions: Readmission occurs frequently in patients with IBD and is costly. Anxiety, depression, and chronic pain may represent targets for interventions to prevent 90-day hospital readmission in this population

The Burden of Hospital Readmissions among Pediatric Patients with Inflammatory Bowel Disease

Objective To evaluate the burden and predictors of hospital readmissions among pediatric patients with inflammatory bowel disease using the Nationwide Readmissions Database. Study design We performed a retrospective cohort study using 2013 Nationwide Readmissions Database. International Classification of Diseases, Ninth Revision, Clinical Modification codes were used to identify patients 7 days was associated with increased readmissions (aOR 1.69, 95% CI 1.09-2.62). Conclusions Readmission occurs frequently in children with inflammatory bowel disease and is associated with significant cost and resource burdens. Among patients with CD, psychiatric comorbidities such as anxiety and depression are apparent drivers of readmission

Vedolizumab Is Associated With a Lower Risk of Serious Infections Than Anti-Tumor Necrosis Factor Agents in Older Adults

Background & Aims: Despite the increased numbers of older adults with inflammatory bowel diseases (IBDs), there are few studies regarding the safety and effectiveness of IBD treatments in older adults. The aim of this study was to compare the safety and effectiveness of anti–tumor necrosis factor (TNF)-α agents and vedolizumab in older adults with IBD. Methods: We conducted a retrospective cohort study using an active comparator, new-user design for adults age 65 years and older with IBD initiating anti–TNF-α agents and vedolizumab in the Medicare claims database from 2014 to 2017. The primary safety outcome was infection-related hospitalization (excluding intra-abdominal and perianal abscesses). Co-primary outcomes to estimate effectiveness were IBD-related hospitalization, IBD-related surgery, and new corticosteroid use 60 days or more after biologic initiation. We performed propensity score weighting to control for confounding and estimated adjusted hazard ratios and 95% confidence intervals using standardized morbidity ratio–weighted variables. Results: We identified 1152 anti–TNF-α new users and 480 vedolizumab new users. The median age was 71 years in both cohorts and 11% were age 80 years or older. Crohn's disease patients comprised 54% of the anti–TNF-α cohort and 57% of the vedolizumab cohort. There was no significant difference in demographics, health care utilization, or frailty in both cohorts. More than half of both cohorts had a Charlson comorbidity index of 2 or higher. Vedolizumab users had a decreased risk of infection-related hospitalization (adjusted hazard ratio, 0.47; 95% confidence interval, 0.25–0.86). There was no significant difference in the outcomes approximating effectiveness. Conclusions: Older IBD patients treated with vedolizumab had a lower risk of infection-related hospitalization compared with those initiating anti-TNFs. We observed no difference in effectiveness defined by hospitalizations, surgery, or new corticosteroid use