Traumatic anterior glenohumeral instability: quantification of glenoid bone loss by spiral CT.

PURPOSE: We evaluated the role of computed tomography (CT) for quantifying glenoid bone defects in patients with anterior glenohumeral instability and assisting in planning the most appropriate type of surgery. MATERIALS AND METHODS: From January to November 2006, 93 patients were studied by spiral CT with multiplanar reconstructions (MPR) for recurrent posttraumatic anteroinferior instability, chronic multidirectional instability and recurrent glenohumeral dislocation after surgical stabilisation. RESULTS: Quantitative CT enabled us to measure bone defects of the anteroinferior glenoid in terms of area (mm(2)) or surface percentage. Glenoid osseous defects were classified as small (<15%), medium (15%-20%), and large (>20%). CONCLUSIONS: CT quantification of glenoid bone loss is very accurate as well as rapid, simple and easily reproducible. CT therefore provides an important contribution to preoperative selection of patients, assisting in directing those with <20% bone loss towards arthroscopic capsular repair.

Synchronous primary adenocarcinoma and adenosquamous carcinoma of the esophagus.

Multiple malignant esophageal tumors of the same cell type are described. In the esophageal mucosa, widespread carcinomatous transformation may be observed and multicentric invasive squamous cell carcinomas may develop. The concomitance of two independent esophageal malignant neoplasms of different epithelial histogenesis is uncommon. Synchronous adenocarcinoma and squamous cell carcinoma of the esophagus is reported. Adenosquamous carcinoma of the esophagus is a rare tumor. Adenocarcinoma of the esophagus represents 10% of esophageal cancer. We report a case of a synchronous primary invasive adenosquamous carcinoma and adenocarcinoma of the esophagus. Both tumors were demonstrated radiographically. The peculiarity of this neoplastic association and the importance of complete radiographic esophageal evaluation in patients with one obvious obstructing tumor of the esophagus are emphasized.

Accuracy of enteroclysis in Crohn's disease of the small bowel: a retrospective study.

The aim of this study was to evaluate the accuracy of enteroclysis in the diagnosis of Crohn's disease of the small bowel in a group of consecutive patients. From January 1992 to December 1995, 165 patients with suspected Crohn's disease of the small bowel presented to our institution for enteroclysis. In 14 patients up to three enteroclysis exams were performed. Most patients (78%) underwent colonoscopy and retrograde ileoscopy. In the remaining patients clinical follow-up was used as gold standard. In 79 patients no radiographic abnormalities were found. Sixty-one patients (40 men and 21 women; mean age 34.2 years) had a radiological diagnosis of Crohn's disease. This involved the terminal ileum in 39 patients (64%) either alone (n = 25) or in association with the pelvic ileum (n = 14). In 12 of these patients retrograde ileoscopy was not feasible. Twenty-one patients underwent surgery. In 4 patients pathology revealed diseases other than Crohn's. These patients had all ileocecal diseases (tuberculosis = 2; non-Hodgkin's lymphoma = 1; adenocarcinoma = 1). One false-negative result was observed. Overall, enteroclysis showed a sensitivity of 98.2% and a positive predictive value of 93.4%. Enteroclysis is a sensitive technique in evaluating both the extent and the severity of small bowel involvement in Crohn's disease, although the overlap of radiographic findings may hamper its accuracy when the disease is confined to the ileocecal area.

[Diagnostic accuracy and clinical significance of combined small bowel enema and scintigraphy with pure fractions of neutrophil granulocytes labeled with HMPAO-Tc99m in chronic intestinal inflammation]. / Accuratezza diagnostica e rilevanza clinica dell'integrazione tra enteroclisi del tenue e scintigrafia con frazioni pure di granulociti neutrofili marcati con HMPAO-Tc99m nell'infiammazione cronica intestinale.

Enema is the primary imaging method in the diagnosis of Crohn's disease in the small bowel, with clinical follow-up examinations performed by gastroenterologists as the gold standard. The information provided by small bowel enema, in addition to endoscopic findings, is usually sufficient for the gastroenterologist to make the definitive diagnosis and to plan the whole treatment. Scintigraphy with leukocytes labelled with HMPAO-Tc99m has several unique characteristics favoring its use as a diagnostic imaging method in Crohn's disease and ulcerative colitis. It is a noninvasive method requiring no bowel preparation and it is safe in severely ill patients in whom such conventional imaging methods as barium enema or colonscopy might be hazardous. In this study, the authors report the results of their experience with diagnostic small bowel enema and leukocyte scintigraphy with HMPAO-Tc99m in 28 patients with inflammatory bowel disease (Crohn's disease in 18 patients, ulcerative colitis in 7 and radiation-induced inflammatory stenosis of the sigma-rectum, bowel inflammation after appendicectomy and bladder surgery, respectively, in 1 patient each). Scintigraphy with autologous granulocytes with HMPAO-Tc99m was positive in 26 patients and negative in 2. Twenty-five patients were true positives and 1 was a false positive. Fifteen patients were also submitted to small bowel enema: 12 of them were positive (true positive) and 3 negative (1 false negative and 2 true negative). The results of granulocytes scintigraphy were compared with those of small bowel enema: the radionuclide study appeared superior in the assessment of bowel inflammation associated with Crohn's disease and ulcerative colitis. Indeed, scintigraphy depicted granulocyte uptake in the colon where enema had shown no major findings in 4 patients with Crohn's disease. In the author's opinion, the overall sensitivity, specificity and positive predictive value of combined leukocyte scintigraphy and small bowel enema play a major role in the early diagnosis of Crohn's disease and ulcerative colitis and in the assessment of disease extent and activity.

[Celiac disease as a risk factor for digestive neoplasms]. / La celiachia come fattore di rischio per neoplasie digestive.

Coeliac disease is a primary malabsorption syndrome, whose gastrointestinal symptomatology regresses following a gluten-free diet. Several authors report an increased incidence of intestinal lymphoma in patients with longstanding coeliac disease; on the other hand the association of this malabsorption syndrome with malignant tumors of the esophagus, stomach or large bowel is not very common. The authors describe three cases of coeliac disease complicated after 5, 12 and 18 years by neoplasms of the esophagus, stomach and small bowel. It is stressed that in this disease patients must be monitored with periodic radiologic examinations, in the hope of detecting any malignancy at an early and perhaps treatable stage.

[Morpho-functional evaluation of the small intestine patients with Crohn disease. Enema of the small intestine versus post-heparin plasma diamine oxidase]. / Valutazione morfo-funzionale dell'intestino tenue nei portatori di morbo di Crohn. Clisma del tenue versus DAO plasmatica post-eparinica.

Our study was directed not only towards the diagnosis of small bowel Crohn's disease, but especially to a quantitative analysis, for a correct therapeutical approach. This experimental trial is based on the relationship between radiological evidence, measured during small bowel enema, and the seriousness of the morphological and functional damage to the intestinal mucosal membrane, evaluated with a post-heparin diamine-oxidase activity test. With this method we studied 35 selected patients; 16 of them were affected by the disease with an exclusive localization in the small bowel and 5 have been considered separately, because 3 patients had already been operated and the other 2 showed different localizations. In our results, the two parameters were not constantly related to each other. In other words the enema's morphological data sometimes do not accord with the mucosal membrane integrity index expressed by the enzyme. Anyway the importance of this study is the attempt of making an objective comparison between an anatomic situation and its functional consequence. These aspects have a great significance in Crohn's disease.

[Usefulness and limitations of edema of the small intestine in malabsorption syndromes]. / Utilità e limiti del clisma dell'intestino tenue nelle sindromi da malassorbimento.

Malabsorption syndrome is a clinical condition that can be determined by several situations which can ensue by many etiopathogenetic mechanisms. While the diagnostic approach is, for this reason, complex and uses a lot of clinical, laboratory and instrumental techniques, the therapeutic approach could be surgical or medical. The aim of our research is to establish the diagnostic utility of the radiologic examination of the small intestine by enteroclysis, on the basis of our personal experience and the data referred in literature. We took particular care of the radiological study of primitive malabsorption.

[Segmental ischemic lesions of the mesenteric small intestine]. / Le lesioni ischemiche segmentarie dell'intestino tenue mesenteriale.

Segmental ischemic disease consists of segmental infarctions and ischemic stenoses. Vasculitis (LES, polyarteritis nodosa, Schönlein-Henoch syndrome), thrombosis, arteriosclerotic changes, mechanical obstructions (adhesions, hernia, volvulus, traumas), hemorrhagic disorders are the most common causes of these intestinal lesions. The authors report their experience achieved during three years on 428 small bowel examinations; among these, 197 were double contrast enemas. Ten patients showed roentgenographic features referred to vascular diseases: 1 LES, 1 Schönlein-Henoch syndrome, 3 polyarteritis nodosa, 5 spontaneous hemorrhagic disorders or due to treatment with anticoagulants. The authors, after a review of the radiological findings, emphasize the high sensitivity and low specificity of double contrast small bowel enema. Furthermore they underline the usefulness of this method in demonstrating and monitoring intestinal pathologic changes.

[The role of enemas in the small intestine in the study of ileal subocclusion]. / Apporto del clisma del tenue allo studio delle subocclusioni ileali.

In mechanical subocclusions, when there isn't immediate urgency, is it possible and necessary to probe radiologic examination, for a better surgical evaluation. The authors describe their own experience, achieved in about 3 years, on small bowel double contrast enema. They examined 143 patients; 16 of them were suboccluded. The security and the diagnostic reliability of used method are stressed by the authors to define lesions' morphology and localization.