Margareta Dujšin

Resistance index in mural arteries of thickened bowel wall: predictive value for Crohn disease activity assessment in pediatric patients

SummaryObjectiveTo define reliable Doppler parameters in mural arteries of affected bowel loops for quantitative assessment of Crohn disease (CD) activity in pediatric population and compare Doppler parameters with Pediatric Crohn Disease Activity Index (PCDAI).Patients and methodsThirty-four pediatric patients (7 with inactive, 27 with active disease of different severity; 13 male and 21 female; mean age 13; range 7–18) with CD were prospectively evaluated by Doppler ultrasound (DUS) of affected bowel segments. Using semiquantitative color and power Doppler assessment of vascularization of thickened bowel wall and mesentery, patients were divided in four grades. Spectral measurements (peak systolic velocity (PSV), end diastolic velocity (EDV), resistance index (RI)) of mural arteries were compared with PCDAI.ResultsThere was a significant difference in distribution of semiquantitative color values between inactive and active group. PSV and EDV values showed no significant difference between inactive and active group, while mean RI was significantly higher in the inactive group. RI was also significantly negatively correlated with PCDAI.ConclusionIntensity of color and power Doppler signals and RI measurement of mural arteries in thickened bowel wall is linked to CD activity and therefore might be of use in pediatric patients.ZusammenfassungZielDas Ziel dieser Studie war es, die zuverlässigen Doppler-Parameter in den intramularen Arterien der betroffenen Darmschlingen zur quantitativen Bewertung der Aktivität des Morbus Crohn (CD) bei der pädiatrischen Population zu definieren und die Doppler-Parameter mit dem pädiatrischem Morbus Crohn Aktivitätsindex (PCDAI) zu vergleichen.Patienten und MethodenDer Zustand von 34 pädiatrischen Patienten (7 mit inaktiver, 27 mit aktiver Erkrankung unterschiedlichen Schweregrades, 13 männliche und 21 weibliche, Alter 7–18, Durschnittsalter 13) mit M. Crohn wurde prospektiv anhand des Doppler-Ultraschall (DUS) betroffener Darmsegmente ausgewertet. Anhand der semi-quantitativen Farb- und Power-Doppler-Beurteilung der Vaskularisation der verdickten Darmwand und des Mesenteriums wurden die Patienten in 4 Gruppen unterteilt. Die spektrale Messungen (die maximale systolische Strömungsgeschwindigkeit – PSV, die enddiastolische Strömungsgeschwindigkeit – EDV, der Resistance-Index – RI) intramuraler Arterien wurden mit PCDAI verglichen.ErgebnisseEs bestand ein signifikanter Unterschied in der Verteilung der semi-quantitativen Farbwerte zwischen der inaktiven und aktiven Gruppe. PSV und EDV-Werte zeigten keinen signifikanten Unterschied zwischen der inaktiven und der aktiven Gruppe, während der mittlere RI in der inaktiven Gruppe signifikant höher war. Der RI war ebenfalls signifikant negativ mit dem PCDAI korreliert.SchlussfolgerungDie Intensität der Farb- und Power-Doppler-Signale und die RI-Messung in den intramuralen Arterien der verdickten Darmwand stehen im Zusammenhang mit der Aktivität des Morbus Crohn und können daher bei pädiatrischen Patienten von Nutzen sein.

PREHEPATIC PORTAL HYPERTENSION: 43 YEARS OF FOLLOW-UP IN SINGLE INSTITUTION AND 20 YEARS AFTER INTRODUCTION OF SCLEROTHERAPY: PH1-23

Introduction: Surgery was treatment of choice for children with complications of prehepatic portal hypertension until sclerotherapy and band ligation has occurred. Introduction of octerotide was another landmark in treatment. We report a 43- year (first 26 retrospective and next 17 prospective) analysis of 64 patients. Methods: The charts of all patients treated before 1987 were reviewed retrospectively and from that year on a prospective evaluation based on database and registry has been started. Results: Between 1960 and Dec 2003 64 children were followed up between 2 and 43 years with a median of 17.4 years. We have divided our patients in two groups. First consisted of all patients (No 20) treated before the introduction of sclerotherapy (1984. in our hospital), and in the second group were remaining 44 patients. First symptom in historical group was hematemesis in 17 of 20 patients (85%). Thirteen palliative surgical interventions, and 4 shunt (spleno-renal) procedures were done in 14 patients (mortality rate 35%), a 6 patients were treated medically (mortality rate 33%). In group which was treated initially with sclerotherapy hematemesis was leading symptom in 54% of patients, and overall mortality rate is 9%. In this group, 20 patients along the course of their disease, due to failure of conservative therapy or other reasons were assigned for 25 operations. Mortality rate in combination therapy group is 12.5%. Rest of the patients (24) were treated only with sclerotherapy or octreotide. Mortality rate in this subgroup is only 5%. In the last 2 years, there was any new case of prehepatic portal hypertension and we are the only hospital in our country equipped for dealing with such a problem. There is a steady decline in incidence that has been observed for years probably due to disappearance of so far unknown etiological factor and improving neonatal practices. Conclusion: There is a decline in incidence of prehepatic portal hypertension. Sclerotherapy and octreotide have improved outcomes considerably, but there is still subset of patients who have to be operated. Our data support thesis that exist subgroup of patients who should be candidates for primary surgical procedure.