[Postoperative morbidity after bowel resections in patients with Crohn's disease: risk, management strategies, prevention]. / Postoperative Komplikationen nach Darmresektionen bei Patienten mit Morbus Crohn: Risiko, Behandlung, Prävention.

The postoperative morbidity rate following bowel resections for Crohn's disease is higher than for other benign disease. The incidence of postoperative intraabdominal septic complications (anastomotic leak, bowel fistula, intraabdominal abscess, peritonitis) is 5 - 30 %. Preoperative weight loss, prolonged refractory symptoms and penetrating disease behaviour are significant determinants of postoperative complication risk. Preoperative enteral nutrition, antibiotics, percutaneous abscess drainage and cessation of steroids might reduce the risk of surgery, however, more evidence is needed. The intake of immunosuppressive agents (mainly, azathioprine) can be continued perioperatively. The occurrence of postoperative intraabdominal septic complications is associated with an increased risk of surgical recurrence in patients with terminal ileitis, however, the long-term prognosis could be improved in the latter patients by secondary fecal diversion. There is no association between postoperative morbidity and long-term outcome in patients with Crohn's colitis.

Prediction of response to chemoradiation therapy in squamous cell carcinomas of the head and neck using dynamic contrast-enhanced MR imaging.

BACKGROUND AND PURPOSE: Tumor microenvironment, including blood flow and permeability, may provide crucial information regarding response to chemoradiation therapy. Thus, the objective of this study was to investigate the efficacy of pretreatment DCE-MR imaging for prediction of response to chemoradiation therapy in HNSCC. MATERIALS AND METHODS: DCE-MR imaging studies were performed on 33 patients with newly diagnosed HNSCC before neoadjuvant chemoradiation therapy by using a 1.5T (n = 24) or a 3T (n = 9) magnet. The data were analyzed by using SSM for estimation of K(trans), v(e), and tau(i). Response to treatment was determined on completion of chemoradiation as CR, with no evidence of disease (clinically or pathologically), or PR, with pathologically proved residual tumor. RESULTS: The average pretreatment K(trans) value of the CR group (0.64 +/- 0.11 minutes(-1), n = 24) was significantly higher (P = .001) than that of the PR (0.21 +/- 0.05 minutes(-1), n = 9) group. No significant difference was found in other pharmacokinetic model parameters: v(e) and tau(i), between the 2 groups. Although the PR group had larger metastatic nodal volume than the CR group, it was not significantly different (P = .276). CONCLUSIONS: These results indicate that pretreatment DCE-MR imaging can be potentially used for prediction of response to chemoradiation therapy of HNSCC.

[Perianal fistulas in Crohn's disease: treatment results at an interdisciplinary unit]. / Perianale Crohn-Fisteln : Ergebnisse der Behandlung in einer interdisziplinären Sprechstunde.

BACKGROUND: Approximately one third of patients with Crohn's disease develop perianal fistulas. This study was conducted to determinate outcome predictors in patients treated at a specialized multidisciplinary unit. PATIENTS AND METHODS: Between May 2005 and May 2008, all patients with perianal Crohn's fistulas were treated by the same surgeon and a gastroenterologist specialized in managing patients with Crohn's disease. Deep fistulas were treated by fistulotomy. For high fistulas, a noncutting seton was placed followed by maintenance treatment with azathioprine and/or infliximab. "Optimal outcome" was recorded when (a) there was no need for diverting stoma, (b) complete healing was achieved by fistulotomy, or (c) fistula symptoms were under control, i.e. there was no need for treatment extension during follow-up. RESULTS: Thirty-four male and 32 female patients underwent 100 surgical interventions. The most frequent types of fistula were high trans-sphincteric (62%) and high intersphincteric (15%). Eleven of the 32 females presented with rectovaginal fistulae. At the study end, complete healing was observed in 12 patients and 32 had good control of fistula symptoms. Seven required proctectomy, fistula symptoms were not under control in 12, and three required diverting stoma. Altogether 44 patients (67%) achieved optimal outcome. The following factors were predictors of nonoptimal outcome by multivariate analysis: presence of Crohn's colitis (P=0.01), age at the onset of Crohn's disease <20 years (P=0.02), and types of fistula not suitable for fistulotomy (P=0.05). CONCLUSIONS: The multidisciplinary approach at specialized units will lead to successful outcome in >60% of patients with Crohn's perianal fistulas. The presence of Crohn's colitis, young age at disease onset, and presence of high fistulas are indicators of poor prognosis.

Endorectal surface coil MR imaging as a staging technique for rectal carcinoma: a comparison study to rectal endosonography.

BACKGROUND: Preoperative staging of rectal cancer is critical for guiding therapy and prescribing the most appropriate treatment option. The purpose of this investigation was to compare the accuracy of endorectal surface coil magnetic resonance imaging (ERSCMRI) with endosonography (EUS) in staging rectal lesions. METHODS: Fourteen patients with rectal carcinoma, initially detected by barium enema or sigmoidoscopy underwent ERSCMRI and EUS. Subsequent resection of the lesions was performed, and the staging accuracies of these two modalities are compared. RESULTS: MR T-staging agreement with pathologic T-staging was similar to that of EUS, but MR enabled more accurate identification of nodal involvement. CONCLUSION: ERSCMRI produced greater overall accuracy in staging for rectal carcinoma than did EUS.

Ovarian Brenner tumors: MR imaging characteristics.

This study describes the appearance of Brenner tumors on MR imaging and compares quantitative signal intensity measurements of Brenner tumors with that of other ovarian tumors. A search of pathologic and MR records disclosed patients who had MRIs showing Brenner tumors prior to surgical excision. Patients (21) with other surgically proven ovarian masses were randomly selected for comparison. MR imaging was performed at 1.5 T with phased array multicoils and fast spin echo T2-weighted images. Region-of-interest measurements of signal intensity (SI) were made to calculate signal intensity ratios (SIR = mass SI/muscle SI). Brenner tumors showed significantly lower SIR than other tumors on T2-weighted images (p = 0.004) and similar SIR on T1-weighted images. Brenner tumors show lower signal intensity on T2-weighted images than other non-fibrous ovarian tumors. This lower signal intensity may result from the extensive fibrous content of these tumors.

Dilated fallopian tubes: MR imaging characteristics.

PURPOSE: To determine the magnetic resonance (MR) imaging characteristics of hydrosalpinx and the accuracy of MR imaging for distinguishing hydrosalpinx from other adnexal masses. MATERIALS AND METHODS: Cross-referencing of pathologic records and MR studies from two institutions disclosed 41 study patients with surgically proved dilated fallopian tubes. A set of 38 patients with surgically evaluated adnexal masses, but no hydrosalpinx, were randomly chosen as control subjects. All MR examinations included T1-weighted spin-echo and T2-weighted fast spin-echo imaging in multiple planes with a phased-array multicoil. Two blinded readers scored each adnexa for the presence of a dilated fallopian tube or thickened tubal wall and mucosal folds and the signal intensity of the intratubal fluid. Blinded readings were compared with surgical findings of dilated fallopian tube, endometriosis, and salpingitis. Radiologic-pathologic correlation was performed with adnexal specimens imaged in vitro in three study patients. RESULTS: On a per patient basis, the blinded readers correctly identified dilated fallopian tubes in 31 of 41 study patients and correctly excluded dilated tubes in a mean 34 of 38 control subjects. On T1-weighted images, hyperintense tubal fluid was significantly correlated with the presence of endometriosis in the pelvis at surgery (P < .002, chi 2). CONCLUSION: MR imaging can depict most dilated fallopian tubes and differentiate them from other adnexal masses on the basis of morphologic features. On T1-weighted images, high signal intensity is correlated with the presence of endometriosis affecting the tube.