Pulmonary complications occur in an estimated 0.21% of patients with inflammatory bowel disease. The most common presentation of pulmonary manifestations is large airway disease, such as tracheobronchitis, chronic bronchitis or bronchiectasis. Small airway disease, such as constrictive bronchiolitis or bronchiolitis obliterans with organizing pneumonia, is less frequently reported, and is described as occurring in isolation from large airway disease. A case of a postcolectomy ulcerative colitis in a patient who has both large airway involvement, tracheobronchitis and bronchiectasis, and constrictive bronchiolitis is presented.
The Bt horizon is the diagnostic horizon of the Luvisolic Order in Canada. According to the Canadian System of Soil Classification (CSSC), the Bt must be formed from clay illuviation through the processes of lessivage (i.e., physical transport of clay). In a study of a Luvisol catena in the central Saskatchewan, we demonstrate that Ae/Bm horizons overlying IIBt horizons are formed in a sandy mantle overlying till (i.e., a lithological discontinuity) and that the sandy mantle contributed negligible amounts of illuvial clay despite the presence of clay skins on ped surfaces in the IIBt horizon. We extended the results of this study to the regional scale by examining sand fractions in 63 pedons of Luvisol-dominated soil associations from soil surveys in the Northern Forest Reserves (between latitudes 53°N and 55°N). Of the 63 pedons, 13 had lithological discontinuities identified in their profile description and a further 27 had discontinuities identified through shifts in the sand fractions between horizons. For the profiles with discontinuities, inherited particle size differences are a more likely cause of coarse-over-fine textural contrasts than lessivage. A regional analysis of the distribution of Luvisol-dominated associations showed distinct zonations that account, in part, for the differences in the occurrence of lithological discontinuities. Based on these results, we suggest that the criteria for Bt horizons in the CSSC should be broadened to include nonilluvial coarse-over-fine texture-contrast horizons and that the criteria for the Luvisolic order also be broadened to include these nonilluvial Bt horizons.
Abstract Isolated single coronary artery (SCA) is a rare anomaly. Current classification of left and right is further classified based on the course of the anomalous vessel. We report two SCA L cases where right coronary artery (RCA) arose from mid‐left anterior descending coronary artery (LAD). Our observation is a variation from the current Lipton classification SCA L Type II where RCA arose from left coronary artery before the LAD, in our cases the RCA arose from mid LAD after the first septal perforator. We believe that this variant should be described as SCA L Type II variant 2 (V2) while the original Lipton classification should be described as SCA L Type II variant 1 (V1).
Routine testing of diagnostic radiology equipment performance has shown that more than 10% of equipment has not been properly setup. It also identifies equipment which is deteriorating in use as well as faults which need immediate correction. There is little doubt it is cost-effective and has also been shown to be effective in reducing the collective dose to the population from diagnostic radiology.
ObjectiveThe objective of this study was to determine if air trapping, as detected on expiratory high-resolution CT (HRCT), is useful as an indicator of bronchiolitis obliterans (BO) in lung transplant recipients.Materials and methodsCorresponding inspiratory and expiratory HRCT images at five different levels and spirometry were obtained in 21 lung transplant recipients. Eleven patients had BO proved by transbronchial biopsy specimens; the remaining 10 patients had no pathologic or functional evidence of airways disease. Two "blinded" observers assessed the inspiratory images for the presence of bronchiectasis and mosaic pattern of lung attenuation, and the expiratory images for presence and extent of air trapping. Statistical comparison of the frequency of HRCT findings between patients with and without BO was performed using Fisher's Exact Test.ResultsOn inspiratory images, bronchiectasis and mosaic pattern of lung attenuation were present in 4 (36%) and 7 (64%) of 11 patients with BO, and 2 (20%) and 1 (10%) of 10 patients without BO (p>0.05 and p<0.05), respectively. The sensitivity, specificity, and accuracy of bronchiectasis and mosaic pattern for BO were 36%, 80%, and 57%, and 64%, 90%, and 70%, respectively. On expiratory images, air trapping was found in 10 of 11 (91%) patients with BO compared to 2 of 10 (20%) patients without BO (p<0.002). Air trapping was found to have a sensitivity of 91%, specificity of 80%, and accuracy of 86% for BO. Air trapping was identified in one patient with BO who had normal results of baseline spirometric function tests.ConclusionAir trapping, as detected on expiratory HRCT, was the most sensitive and accurate radiologic indicator of BO in the lung transplant population. The objective of this study was to determine if air trapping, as detected on expiratory high-resolution CT (HRCT), is useful as an indicator of bronchiolitis obliterans (BO) in lung transplant recipients. Corresponding inspiratory and expiratory HRCT images at five different levels and spirometry were obtained in 21 lung transplant recipients. Eleven patients had BO proved by transbronchial biopsy specimens; the remaining 10 patients had no pathologic or functional evidence of airways disease. Two "blinded" observers assessed the inspiratory images for the presence of bronchiectasis and mosaic pattern of lung attenuation, and the expiratory images for presence and extent of air trapping. Statistical comparison of the frequency of HRCT findings between patients with and without BO was performed using Fisher's Exact Test. On inspiratory images, bronchiectasis and mosaic pattern of lung attenuation were present in 4 (36%) and 7 (64%) of 11 patients with BO, and 2 (20%) and 1 (10%) of 10 patients without BO (p>0.05 and p<0.05), respectively. The sensitivity, specificity, and accuracy of bronchiectasis and mosaic pattern for BO were 36%, 80%, and 57%, and 64%, 90%, and 70%, respectively. On expiratory images, air trapping was found in 10 of 11 (91%) patients with BO compared to 2 of 10 (20%) patients without BO (p<0.002). Air trapping was found to have a sensitivity of 91%, specificity of 80%, and accuracy of 86% for BO. Air trapping was identified in one patient with BO who had normal results of baseline spirometric function tests. Air trapping, as detected on expiratory HRCT, was the most sensitive and accurate radiologic indicator of BO in the lung transplant population.
OBJECTIVE: To investigate the association between the PiBsaskatoon variant of alpha‐1 protease inhibitor ( α 1 Pi), present in the heterozygous state and the development of emphysema. DESIGN: Twenty‐year follow‐up in the third generation of a family with the variant, naturally controlled with regard to both environmental influences and other genetic factors. SETTING: University teaching hospital. POPULATION STUDIED: Ten siblings, five with PiBsaskatoonM phenotype and five with PiM phenotype, 33 to 46 years of age. INTERVENTIONS: Respiratory symptoms and smoking histories; pulmonary function tests, including static lung volumes, dynamic lung volumes before and after salbutamol 200 μ g, and diffusing capacity; allergen prick skin tests; serum α 1 Pi level, chest radiographs and high resolution computerized tomography lung scans. MAIN RESULTS: The two groups of siblings had similar mean ages, smoking histories and prevalence of current mild respiratory symptoms. Pulmonary function data showed normal mean values and no statistically significant differences for all the variables between the two groups. Chest radiographs were normal in all subjects. High resolution computerized tomography scans were normal in eight subjects, and demonstrated mild and very mild centrilobular emphysema in the two subjects with greatest smoking histories (approximately 30 pack‐year each); both of these were PiBsaskatoonM phenotype. CONCLUSION: There is no evidence of an association between α 1 Pi phenotype PiBsaskatoonM and the development of emphysema.
Purpose To assist clinicians in the diagnosis and management of ocular siderosis. Methods The diagnosis and management of three cases of ocular siderosis secondary to a retained ironcontaining intraocular foreign body are described. Results Noteworthy features included: 1) the characteristic features of a tonic or Adies pupil (one case) and 2) the failure of highresolution computed tomography scanning and plain film radiography to detect the intraocular foreign body (two of three cases). In contrast, ultrasonography demonstrated the intraocular foreign bodies in all cases and accurately localized them to the inferior retinal quadrants. A third noteworthy finding was that a preoperative electroretinogram reduction in amplitudes of as much as 40% compared with that of the uninvolved eye was compatible with excellent vision, and that the electroretinogram returned to normal after the intraocular foreign body was removed. Conclusions Ocular siderosis should be considered in the differential diagnosis of tonic or Adies pupil. To detect an occult intraocular foreign body, clinicians should not rely exclusively on computed tomography scanning or plain film radiography, but should also use Bmode echography with careful study of the inferior quadrants. In ocular siderosis a preoperative electroretinogram reduction in amplitudes of as much as 40% may be reversible after intraocular foreign body removal.
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