The role of computerized tomographic scan in the management of children with cerebral palsy.

AIMS AND OBJECTIVES: The aim of this study was to describe the role of computed tomography (CT) scan in the management and evaluation of children with cerebral palsy (CP) and to categorize the CT findings and then relate them to their respective aetiologies, as well as the types of CP. MATERIALS AND METHODS: The CT findings in 32 children consisted of 16 boys and 16 girls with age range of 2-61 months who were diagnosed of CP and with detailed clinical information were analysed. The 84.4% positive CT findings were analyzed to evaluate their relationship with the clinical types, as well as the aetiological basis for the CP. RESULTS: The spastic type found in 78.1% of the total number of children, had the highest positive findings. The yield was increased in children with birth asphyxia (46.9%) and neonatal jaundice (37.5%). The findings were those of cerebral atrophy in 46.9%, infarcts in 12.5%, hydrocephalus in 9.4% and porencephaly 6.3% of cases. Treatable lesions, such as Dandy Walker syndrome, tumour, hydrocephalus and porencephaly were identified in 25% of cases. CONCLUSION: CT scan is no doubt efficacious in the management and evaluation of children with CP.

British Dietetic Association evidence-based guidelines for the dietary management of Crohn's disease in adults.

BACKGROUND: Crohn's disease is a debilitating chronic inflammatory bowel disease. Appropriate use of diet and nutritional therapy is integral to the overall management strategy of Crohn's disease. The aim was to develop evidence-based guidelines on the dietary management of Crohn's disease in adults. METHODS: Questions relating to the dietary management of Crohn's disease were developed. These included the roles of enteral nutrition to induce remission, food re-introduction diets to structure food re-introduction and maintain remission, and dietary management of stricturing disease, as well as whether probiotics or prebiotics induce or maintain remission. A comprehensive literature search was conducted and relevant studies from January 1985 to November 2009 were identified using the electronic database search engines CINAHL, Cochrane Library, EMBASE, MEDLINE, Scopus and Web of Science. Evidence statements, recommendations, practical considerations and research recommendations were developed. RESULTS: Fifteen research papers were critically appraised and the evidence formed the basis of these guidelines. Although corticosteroids appear to be more effective, enteral nutrition (elemental or non-elemental) can be offered as an alternative option to induce disease remission. After a course of enteral nutrition, food re-introduction diets may be useful to structure food re-introduction and help maintain disease remission. Dietary fibre is contraindicated in the presence of strictures as a result of the risk of mechanical obstruction. The use of probiotics and prebiotics is not currently supported. CONCLUSIONS: As an alternative to corticosteroids, evidence supports enteral nutrition to induce disease remission. Food re-introduction diets provide structure to food re-introduction and help maintain disease remission. These guidelines aim to reduce variation in clinical practice.