PURPOSE: To differentiate tuberculous enteritis and Crohn's disease with barium study using Bayes theory. MATERIALS AND METHODS: The study group consisted of 34 patients with tuberculous enteritis (age range 16-86 years, mean age 43.3 years, M:F=19:15) and 36 patients with Crohn's disease (age range 19-78 years, mean age 35.2 years, M:F=18:18). These diagnoses were confirmed by therapeutic tests (tuberculous enteritis: 15, Crohn's disease:16) or histopathological examinations (tuberculous enteritis: 19, Crohn's disease: 20) conducted from January 1993 to May 2003. Three radiologists (two abdominal specialists and one trainee) analyzed each radiological finding of tuberculous enteritis and Crohn's disease by means of a barium enema and/or small bowel series. We used Fisher's exact test to verify the statistical significance of each radiological finding and p-values less than 0.05 were considered to be significant. We calculated the likelihood ratio (LR) of tuberculous enteritis versus Crohn's disease for each finding by employing Bayes theory. RESULTS: The radiological findings associated with a high likelihood ratio for tuberculous enteritis were the involvement of the cecum (LR=2.65) and ascending colon (LR=1.99), rigid narrowing (LR=1.94), shortening of the bowel (LR=1.99), haustral loss (LR=1.97) and sacculation (LR=3.88). The radiological findings associated with a high LR for Crohn's disease (low LR for tuberculous enteritis) were age between 20 and 29 years (LR=0.53), the involvement of the jejunum (LR=0.12), terminal ileum (LR=0.19), sigmoid colon (LR=0.30) or rectum (LR=0.17), and the presence of skip lesions (LR=0.19) or strictures (LR=0.21). With these LRs, the probability of the subject having tuberculous enteritis versus Crohn's disease could be calculated using Bayes theory. CONCLUSION: The analysis of a barium study using Bayes theory could provide an objective, easy and fast method of differentiating tuberculous enteritis and Crohn's disease.
Barium* ; Bays* ; Cecum ; Colon, Ascending ; Colon, Sigmoid ; Constriction, Pathologic ; Crohn Disease* ; Diagnosis ; Enema ; Enteritis* ; Humans ; Ileum ; Intestine, Small ; Jejunum ; Rectum ; Specialization ; Tuberculosis, Gastrointestinal

Kawasaki disease is a systemic vasculitis in which bilateral nonexudative conjunctivitis and anterior uveitis are common early findings in the course of illness. We report an eleven-year-old boy with atypical Kawasaki disease who was diagnosed with the help of an ophthalmologic examination. The patient presented with fever, epigastric pain with vomiting, erythematous rash, and severe bilateral conjunctival injection, a red throat without strawberry tongue and scarletiniform rash on the chest and back. Cervical lymphadenopathy and changes in the extremities were not shown. Slit lamp biomicroscopic examination three days after admission revealed bilateral bulbar conjuctival injection, superficial punctate erosions, and aquous humor inflammatory reaction(3+/4+ cells and 2+/4+ flare), a manifestation of anterior uveitis. After receiving two consecutive doses of intravenous immunoglobulin(IVIG, total 2.4g/kg) the boy showed no response. He was subsequently treated with high dose methylprednisolone(14mg/kg) intravenously. Two-dimensional echocardiography 2 weeks after admission showed aneurysmal changes on the proximal parts of the left main coronary artery(4.5mm) and right coronary artery(4.0mm). Slit lamp examination early in the course of the illness can help in the diagnosis of Kawasaki disease.
Aneurysm ; Conjunctivitis ; Diagnosis ; Echocardiography ; Exanthema ; Extremities ; Fever ; Fragaria ; Humans ; Lymphatic Diseases ; Male ; Mucocutaneous Lymph Node Syndrome* ; Pharynx ; Systemic Vasculitis ; Thorax ; Tongue ; Uveitis, Anterior ; Vomiting

Choledochoduodenal fistula (CDF) occurring simultaneously with pancreaticoduodenal fistula is extremely rare. CDF has known to be a chronic sequela of cholelithiasis, but it is unknown whether pancreaticoduodenal fistula results from chronic cholelithiasis as well. We report a case of cholelithiasis accompanied with choledochoduodenal and pancreaticoduodenal fistula opening into small suprapapillary diverticulum in a 80-year-old woman.
Aged, 80 and over ; Biliary Fistula/*complications ; Cholelithiasis/complications ; Common Bile Duct Diseases/*complications ; Diverticulum/*complications ; Duodenal Diseases/*complications ; Female ; Humans ; Intestinal Fistula/*complications ; Pancreatic Fistula/*complications

OBJECTIVE: Our purpose was to estimate the prevalence of hepatitis C virus seropositivity and define the risk factors for HCV infection in a group of pregnant women and the effect of HCV infection to mother and baby at the time of delivery. METHODS: From March 1997 to February 1998, 5655 women who delivered over 20 gestational weeks at our hospital were screened for HCV-Antibody(RIA), and the samples of most of HCV-Ab positive cases were analyzed for HCV-RNA by polymerase chain reaction(PCR). We also studied the risk factors for HCV infection, the effect of HCV infection to mothers and neonates at delivery. RESULTS: Of 5655 mothers 25 (0.44%) were HCV-Ab positive, and 20 of HCV-Ab positive mothers were analyzed for HCV-RNA by PCR. Of 20 HCV-Ab positive mothers 12 cases (60%) were HCV-RNA positive. Risk factors significantly more prevalent among HCV-seropositive patients were : a history of habitual intraveneous drug use, a history of smoking, alcohol drinking during pregnancy, having liver cirrhorsis. The proportions who had received a blood transfusion, had a history or ongoing syphilis or were positive for hepatitis B virus surface antigen were not significantly different between seropositive and seronegative women. Liver function test at delivery was abnormal in 4 cases(16%) of HCV-Ab positive group. And the number of abnomal liver function test cases in HCV-Ab negative group were 47(0.83%). This had statistical difference. In neonates at delivery, all 20 neonates of 20 ones having HCV-Ab positive mother were HCV-Ab positive. But only 2 cases of 20 babies were HCV-RNA positive. CONCLUSION: Mothers who have risk factors such as injecting drug use, smoking, alchohol drinking and liver cirrhorsis, should undergo HCV-Ab testing and quantitative HCV-RNA testing by PCR. More advanced studies about vertical transmission of HCV infection are needed.
Alcohol Drinking ; Antigens, Surface ; Blood Transfusion ; Drinking ; Female ; Hepacivirus* ; Hepatitis B virus ; Hepatitis C* ; Hepatitis* ; Humans ; Infant, Newborn ; Liver ; Liver Function Tests ; Mothers ; Polymerase Chain Reaction ; Pregnancy* ; Pregnant Women ; Prevalence ; Risk Factors ; Smoke ; Smoking ; Syphilis