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Crohn's disease associated dysmotility has been attributed to fibrosis and damage to enteric nerves but injury to interstitial cells of Cajal (ICC) could also be involved. We assessed ICC in specimens obtained from patients with Crohn's disease and determined the relation between ICC and the inflammatory infiltrate, particularly mast cells (MC) using quantitative immunohistochemistry and electron microscopy. Ultrastructural injury to ICC was patchy in all ICC subtypes but ICC-Auerbach's plexus (AP) showed damage more frequently, i.e. swelling of mitochondria, decreased electron density, autophagosomes and partial depletion of the cytoplasm. Light microscopy confirmed a significant decrease in c-kit immunoreactivity for ICC-AP and an increased number of MC in the muscularis externa. Electron microscopy showed MC exhibiting piecemeal degranulation and making frequent and selective membrane-to-membrane contact with all types of injured ICC which suggests chronic release of granule content to affect ICC. Extent of ICC injury was not associated with duration of the disease. In conclusion, ultrastructural injury and loss of ICC-AP is evident in Crohn's disease. Epidemiological and morphological data suggest that ICC have the capacity to regenerate in spite of the chronic insult. The muscularis hosts a marked number of MC that exhibit piecemeal degranulation associated with ICC and may facilitate ICC maintenance.

Measurement TechniquesNon-invasive quantification of diaphragm kinetics using m-mode sonography Purpose: The standard conditions of spirometry (i.e., wearing a noseclip and breathing through a mouthpiece and a pneumotachograph) are likely to alter the ventilatory pattern. We used "time-motion" mode (M-mode) sonography to assess the changes in diaphragm kinetics induced by spirometry during quiet breathing.Methods: An M-mode sonographic study of the right diaphragm was performed before and during standard spirometry in eight pa~ents without respiratory disease (age 34 to 68 yr).Results: During spirometry, the diaphragm inspiratory amplitude (DIA) increased from 1.34 + 0.18 cm to 1.80 + 0, 18 cm (P = 0,007), whereas the diaphragmatic inspiratory time (T, diaph) increased from 1.27 -+_ 0.15 to 1.53 + 0.23 sec, (P = 0.015), without change in diaphragmatic total time interval (-I-tot diaph). Therefore, the diaphragm duty cycle (T, diaph /Ttot diaph) increased from 38% +--I% to 44% _ 496 (P = 0.023). The diaphragm inspiratory (DIV) and expiratory (DEV) motion velocity increased (P = 0.007).Conclusion: M-mode sonography enabled us to demonstrate that the wearing of a nose clip and breathing through a mouthpiece and a pneumotachograph induce measurable changes in diaphragm kinetics.Object-if : Les conditions de la spirom&ne standard (c.-,~-d. le port du pince-nez et la respiration ~ travers un embout buccal et un pneumotacographe) sont susceptibles d'altErer la morphologie de la ventilation. Nous avons utilisE le mode ~temps-amplitude,, (mode M) de la sonographie pour 6valuer les changements de la cinEtique diaphragmatique provoquEs par la spiromEtne pendant la respiration de repos.R~sultats : Pendant la spiromEtrie, I'amplitude inspiratoire diaphragmataque augmentait de 1,34 + 0, 18 ~ 1,80 +-0, 18 cm (P = 0,007), alors que le temps diaphragmatique inspiratoire (T, diaph) augmentmt de 1,27 _+ 0, I 5 ,~ 1,53 z 0,23 sec (P = 0,015), sans changement du temps diaphragmatique total (Trot diaph). Par consequent, le temps de I'activitE diaphragmatique (T, diaph/Ttot diaph) augmentait de 38 +_ I 96 ,~ 44 + 496 (P=0,023). La v41ocit4 de I'amplitude inspiratolre et expiratoire augmentait (P = 0,007).Conclusion : La sonographie en mode M nous a permis de dEmontrer que le port du pince-nez et la respiration h travers un embout buccal et un pneumotacographe provoquent des changements tangibles de la cin4tique diaphragmatique.From the

Thirty-nine consecutive patients with consolidated lung confirmed radiologically underwent sonography, and their sonograms were compared with results for 100 healthy subjects. The hyperechoic line of normal aerated lung and its air artifacts showed respiratory motions ("gliding sign," n = 100). Patients with pneumonia demonstrated distinct sonographic patterns. Strong linear echoes with characteristic air artifacts (air bronchogram) and anechoic tubular structures (fluid bronchogram) were visualized in 36 of 39 patients (92.30%). The superficial lung showed a homogeneous hypoechoic band termed "superficial fluid alveolograms" (n = 39) with respiratory motions in 35 of 39 patients. We conclude that sonography can evaluate pulmonary consolidation and may provide additional roentgenographic information, especially when fluid bronchograms are visualized.