BACKGROUND: This study aimed to document the radiological features and distribution of small bowel Crohn disease (CD) in adults by using a barium follow-through (BaFT) technique and to determine whether disease would be missed or its distribution underestimated if only colonoscopy with ileoscopy were performed. METHODS: The BaFT examinations of 121 adults with proven CD were reviewed retrospectively with respect to the stage and distribution of disease. Colonoscopy with attempted ileoscopy was performed in 37 of these subjects, and the results were compared with radiological findings. RESULTS: A normal villous pattern was visualized in 89 studies (74%). BaFT showed small bowel CD in 71 (59%) of 121 patients studied. The terminal ileum (TI) was the most common site of disease, affecting 62 (87%) of patients with small bowel CD. Forty-six patients (65%) had more proximal small bowel disease, including nine (13%) with a normal TI. BaFT showed early mucosal changes of CD in 52 subjects (73%), which was the sole manifestation in 15 (21%). Ileoscopy was possible in the majority of patients colonoscoped but was not achieved in 14 (38%), nine of whom had CD on BaFT. Of the 23 patients in whom ileoscopy was performed, findings agreed with BaFT assessment of the TI in 22. CONCLUSION: BaFT adequately demonstrates the stage and extent of small bowel CD. The majority of patients with small bowel CD have disease proximal to the TI, which cannot be diagnosed by ileoscopy.

Adult↗

PubMedDate not supplied

Augmentation genioplasty: when bone is not enough.

PURPOSE: Augmentation genioplasty is indicated to correct microgenia. When a large defect must be corrected, the additional use of a soft alloplastic implant may be indicated. METHODS: A 22-year-old patient is presented who required correction of microgenia. A 15-mm advancement of the chin was required to obtain an acceptable cosmetic result. RESULTS: An augmentation genioplasty achieved an 8-mm correction. This was supplemented by a silicone gel-filled implant inserted subperiosteally. This resulted in an outstanding cosmetic result. CONCLUSIONS: Chin contour is an important aspect of facial aesthetics. The sliding genioplasty is ideally suited for correcting most chin deformities; however, the insertion of an alloplast may augment patients with severe microgenia. Avoidance of the donor-site morbidity associated with the use of autogenous bone is a major benefit of this procedure.

Adult↗

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Bloody drainage following endoscopic retrograde pancreatography as a presentation of a pseudoaneurysm-containing pseudocyst.

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Aneurysm↗

PubMedDate not supplied

Adolescent initiation of injection drug use.

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Adolescent↗

PubMedDate not supplied

Who are "street children?" A hierarchy of street use and appropriate responses.

"Street children" have come to public attention again as they did in the guise of the "street Arabs," "blackguards," and "war-vagrants" at periods of European history. Is this classification useful when considering education/welfare policy, or does it artificially mark a group for special attention in a manner that is misleading? There are two perspectives: (a) that this classification is imperfect, which leads to incorrect intervention; or (b) that unclassified can mean unrecognized and that labels are a prerequisite of motivating a response. From a comparative analysis, this paper proposes a working compromise based on a hierarchy of street use, from minimal to total dependency on the streets. Four overlapping levels are discussed: (a) beneficial street use; (b) an "assumed adult" status; (c) those who suffer school exclusion; and (d) a state of "degenerative estrangement." The aim of the hierarchy is to demonstrate the need for different types of education/welfare intervention at different levels. Intervention needs to emphasize three types of change: (a) in awareness of street life for those making little use of the streets; (b) in the capabilities of those using the street as a major resource; and (c) of the condition of those totally dependent on the street environment.

Adolescent↗

PubMedDate not supplied

Preventing illicit drug use in adolescents: long-term follow-up data from a randomized control trial of a school population.

National survey data indicate that illicit drug use has steadily increased among American adolescents since 1992. This upward trend underscores the need for identifying effective prevention approaches capable of reducing the use of both licit and illicit drugs. The present study examined long-term follow-up data from a large-scale randomized prevention trial to determine the extent to which participation in a cognitive-behavioral skills-training prevention program led to less illicit drug use than for untreated controls. Data were collected by mail from 447 individuals who were contacted after the end of the 12th grade, 6.5 years after the initial pretest. Results indicated that students who received the prevention program (Life Skills Training) during junior high school reported less use of illicit drugs than controls. These results also support the hypothesis that illicit drug use can be prevented by targeting the use of gateway drugs such as tobacco and alcohol.

Adolescent↗