SUMMARY BackgroundDiagnostic imaging plays a pivotal role in the diagnosis and management of inflammatory bowel disease (IBD); however, increasing use has led to concerns about the malignant potential of ionising radiation. Several studies have demonstrated that diagnostic imaging can result in exposure to potentially harmful levels of ionising radiation in IBD patients.

In 2012, the Indian Society of Gastroenterology's Task Force on Inflammatory Bowel Diseases undertook an exercise to produce consensus statements on Crohn's disease (CD). This consensus, produced through a modified Delphi process, reflects our current recommendations for the diagnosis and management of CD in India. The consensus statements are intended to serve as a reference point for teaching, clinical practice, and research in India.

A 44-year-old woman was admitted with recurrent hematemesis. She had a history of intermittent upper abdominal pain, which was investigated by computed tomography (CT) scan 1 year prior to the presentation (• " Fig. 1). She was taking aspirin for ischemic heart disease. On examination, her heart rate was 110 bpm and she had postural hypotension. She was febrile (38.7°C) and had epigastric tenderness. Blood results were abnormal: white blood cells 17.0 × 10 3 cells/ μL, C-reactive protein 136 mg/L, and alkaline phosphatase 515 IU/L (normal range 70 -300 IU/L). Glasgow-Blatchford and Rockall scores were elevated at 11 and 8, respectively. Findings at gastrointestinal endoscopy and CT scan are shown in Fig. 2 and• " Fig. 3.Biliary-enteric fistula (BEF) is a rare cause of upper gastrointestinal bleeding. Cholecysto-duodenal fistula (CDF) is the commonest type of BEF [1]. The common causes of CDF include gallstones, peptic ulcer disease, malignancy, and trauma/ surgery. Definitive management is cholecystectomy, resection of the fistula, and intraoperative cholangiography. Diagnosis is made by CT, endoscopic retrograde cholangiopancreatography, or laparoscopic cholecystectomy [2]. Proximal CDFs located in the posterior wall of the duodenal bulb are usually secondary to peptic ulcer disease whereas distal CDFs, which are located in the periampullary region, connect to the distal 2 cm of the bile duct and are more commonly associated with biliary stones [3]. Our patient had symptoms of biliary colic and had gallbladder calculi on initial CT scan. She had recurrent hematemesis during episodes of cholangitis. She was treated conservatively with antibiotics and underwent successful elective open cholecystectomy with repair of the CDF. BEFs involving the duodenal bulb secondary to cholelithiasis are uncommon. CT allows visualization of the fistulas, air in the bile duct, and contraction of the gallbladder, and differentiates between cholecysto-enteric and choledocho-enteric fistulas [4]. We believe that this case highlights the importance of CT imaging in patients with upper gastrointestinal bleeding and unusual endoscopic findings. 3 Curved coronal portal phase computed tomography image demonstrating a gas-filled biliaryenteric fistula extending from the gallbladder to the duodenum (arrows). There is also gas in the gallbladder. A high attenuation metallic hemostasis clip can be seen at the medial end of the fistula. Cases and Techniques Library (CTL) E250Mohammed N et al.

No abstract

Aims: To study the anatomical variations of osteomeatal complex and the importance of preoperative computed tomography (CT) in patients with chronic sinusitis undergoing functional endoscopic sinus surgery. We studied the different variations and their frequency of occurrence. Materials and methods: A total of 100 patients undergoing endoscopic sinus surgery were studied by nasal endoscopy, CT scanning, and at the time of definitive surgery, variations were recorded. Results: The frequency of occurrence of sinonasal anatomical variations was septal deviation in 76%, agger nasi cells in 71%, concha bullosa in 61%, medialized uncinate process in 48%, prominent bulla ethmoidalis in 41%, paradoxical middle turbinate in 33%, accessory maxillary ostium in 28%, frontal cell in 22%, intumescentia septi nasi anterior in 21%, lateralized uncinate in 15%, pneumatized uncinate process in 4%, Haller cells in 12%, and Onodi cells in 8%. Conclusion: The high incidence of variations emphasizes the need for proper preoperative assessment for safe and effective endoscopic sinus surgery.

been used to improve quality and define minimum standards for colonoscopy across the UK.1 JAG also provides a clear competency based framework to assess trainee performance; however, there is reluctance in some units to allow independent senior registrars, who have passed JAG assessment, to practise independently. At our teaching centre we encourage appropriately trained registrars to perform their own lists. Supervision is available if needed and departmental protocols define limits of therapy to be undertaken independently (eg, large polypectomies). Attendance at training lists to continue development is also actively encouraged. Our aim was to evaluate whether this provided a quality of service comparable to national standards. Methods We used data collected retrospectively from endoscopy reporting software (Ascribe-Scorpio) on the caecal intubation rate, polyp detection rate, sedation usage and complication rate, to evaluate the performance of senior gastroenterology trainees between 2007 and 2011, against the JAG auditable outcomes for colonoscopy.Results Over a 4-year period, 17 senior gastroenterology registrars performed a total of 2917 colonoscopies. 2221 (76.1%) procedures were unsupervised and 696 (23.9%) were supervised. An uncorrected caecal intubation rate of 94.9% was achieved during unsupervised procedures, 96.6% with supervision (p¼0.93, X 2 ). Polyp (all type) detection rate was 30%. Average sedation dose for patients aged >70 years, was pethidine 30 mg and midazolam 1.96 mg; aged <70 years, pethidine 35.5 mg and midazolam 2.54 mg. Flumazenil was used on four occasions and naloxone on one occasion. There were two major complications. One perforation, following argon therapy to an angiodysplasia, treated conservatively and one major post polypectomy bleed, treated endoscopically but admitted for observation. None of the registrars were outliers on the comfort score data. Conclusion Our findings show that given appropriate training and support, independently practising senior UK gastroenterology registrars contribute significantly to service delivery, providing high quality colonoscopy, meeting JAG auditable outcome standards.Competing interests None declared. REFERENCE1.

No abstract

<p class="abstract"><strong>Background:</strong> Osteonecrosis of femoral head (AVN) is a disabling condition with ill-defined etiology and pathogenesis. In more than 60% it leads to osteoarthritis of hip joint. Treatment for this condition includes both operative and non-operative methods with variable success rates. Surgical options being aimed at both conservation of femoral head and arthroplasty of hip joint. Aim of our study was to evaluate the efficacy of tensor fascia lata muscle pedicle grafting in the management of osteonecrosis of femoral head.</p><p class="abstract"><strong>Methods:</strong> 27 cases with a mean age of 38.7 years (range from 24 to 52) who underwent tensor fascia lata muscle pedicle grafting in the management of  osteonecrosis  of femoral head were prospectively evaluated with a  mean follow up period of  7.3 years (range from 3 to 12 years). Watson-Jones approach was used in all patients. Average hospital stay was 12 days. Harris hip score was used for the evaluation of clinical outcome.<strong></strong></p><p class="abstract"><strong>Results:</strong> In our series of 27 cases, the Harris hip score was excellent (90-100) in 19, good (80-89) in 5, fair (70-79) in 2 and  poor  (&lt;70) in 1 case at final follow up.</p><p class="Default"><strong>Conclusions:</strong> Tensor fascia lata muscle pedicle grafting is an effective, technically easier, pain relieving head-preserving procedure and will improve outcome in properly selected patients with osteonecrosis of femoral head. </p>