Musculoskeletal health in newly diagnosed children with Crohn's disease.

We evaluated the impact of Crohn's disease on muscle and bone strength, mass, density, and geometry in children with newly diagnosed CD and found profound muscle and bone deficits; nevertheless, the prevalence of vertebral fractures at this time point was low. INTRODUCTION: Crohn's disease (CD) is an inflammatory condition of the gastrointestinal tract that can affect the musculoskeletal system. The objective of this study was to determine the prevalence of vertebral fractures and the impact of CD on muscle and bone mass, strength, density, and geometry in children with newly diagnosed CD. METHODS: Seventy-three children (26 girls) aged 7.0 to 17.7 years were examined within 35 days following CD diagnosis by lateral spine radiograph for vertebral fractures and by jumping mechanography for muscle strength. Bone and muscle mass, density, and geometry were assessed by dual-energy x-ray absorptiometry and peripheral quantitative computed tomography (pQCT). RESULTS: Disease activity was moderate to severe in 66 (90%) patients. Mean height (Z-score -0.3, standard deviation (SD) 1.1, p = 0.02), weight (Z-score -0.8, SD 1.3, p < 0.01), body mass index (Z-score -1.0, SD 1.3, p < 0.01), lumbar spine areal bone mineral density (BMD; Z-score -1.1, SD 1.0, p < 0.01), total body bone mineral content (Z-score -1.5, SD 1.0, p < 0.01), and total body lean mass (Z-score -2.5, SD 1.1, p < 0.01) were all low for age and gender. pQCT showed reduced trabecular volumetric BMD at the tibial metaphysis, expansion of the bone marrow cavity and thin cortices at the diaphysis, and low calf muscle cross-sectional area. Jumping mechanography demonstrated low muscle power. Only one patient had a vertebral fracture. CONCLUSIONS: Children with newly diagnosed CD have profound muscle and bone deficits; nevertheless, the prevalence of vertebral fractures at this time point was low.

Right heart thrombus: the importance of early intervention.

A case report of mobile, right heart thrombus in the accident and emergency (A&E) department is presented. Though frequently associated with major pulmonary embolism, recognition is usually at postmortem examination. Detection of the presence of mobile thrombus in the right heart by early echocardiogram and prompt treatment may be life saving. Surgical or medical treatment options are dependent on local facilities. Early specialist involvement with a contingency plan in A&E departments are advised.

Acute shortness of breath: an unusual cause.

A case of cold induced pulmonary oedema in a scuba diver is described. This is rare, but with the increasing popularity of the sport it is important for accident and emergency staff to be aware of the condition. Treatment is symptomatic and the outlook is good.

Angiographic evaluation of gastrointestinal haemorrhage complicating pancreatic disease.

Seven patients with gastro-oesophageal varices due to splenic or portal vein obstruction from a diseased pancreas have been seen at the Mater Hospital during the past three years. Four of these patients had episodes of acute and massive gastrointestinal bleeding and this paper emphasises the role of angiography in the management of this complication. In three instances the bleeding was the result of the varices, but in one patient with carcinoma of the head of the pancreas the bleeding was shown to result from invasion of the tumour into the duodenum.