[In situ broken 27-gauge spinal needle in a repeated caesarean delivery : Case report and literature review]. / In situ abgebrochene 27-Gauge-Spinalnadel bei einer Re-Resectio : Fallbericht und Übersicht über die Literatur.

We report the rare case of an in situ fracture of a spinal needle within the setting of repeated caesarean delivery in a 28-year-old pregnant woman and discuss the responsible underlying factors. In particular, a wrong technique, limited experience, difficulties to identify the anatomical landmarks, as well as the use of spinal needles smaller than 25 G might promote such a complication. In order to ensure the stability of the spinal needle and to avoid an in situ fracture, the spinal needle should be never moved without the stylet. In case of repeated bone contact, a well-experienced anaesthetist should be consulted, the spinal needle should be replaced and the use of ultrasound is recommended. Next, the use of an atraumatic spinal needle greater than 27 G should be considered to facilitate intrathecal puncture and to avoid the in situ fracture of a spinal needle. Within this context, the risk of post-spinal puncture headache should be balanced. If an in situ fracture of a spinal needle happens, its subsequent removal should be planned without delay by an interdisciplinary team and the anaesthetic method should be chosen with consideration of patient-specific risk factors.

Colon capsule endoscopy versus standard colonoscopy in assessing disease activity of ulcerative colitis: a prospective trial.

BACKGROUND: The aim of our study was to compare colon capsule endoscopy (CCE) with standard colonoscopy (SC) in the assessment of mucosal disease activity and localization of inflammatory colonic mucosa in patients with known ulcerative colitis (UC). METHODS: Thirteen symptomatic patients (8 males, 5 females, mean age 38.5 ± 12.0 years) with known UC (mean duration of colitis: 9.7 ± 8.1 years) and indication for endoscopy due to suspected disease activity were included. All patients underwent CCE (first generation capsule, Given Imaging Ltd., Yokneam, Israel) on day 1 followed by SC on day 2 in a single center non-randomized, non-placebo-controlled diagnostic study (NCT00837304). SC and CCE were video recorded, and analysis was independently performed by 6 experienced endoscopists. The modified Rachmilewitz score was calculated, and Wilcoxon signed-rank test was used for analysis. Difference in recognition of disease activity by the endoscopists was assessed by application of the Kruskal-Wallis test. RESULTS: Assessment of disease activity revealed a significantly higher Rachmilewitz score of 7.3 ± 2.9 in the SC group compared to 4.8 ± 3.4 in the CCE group. Significantly, more detection of vessel vulnerability, granulated mucosa and mucosal damage was seen by SC. Disease extension was underestimated by CCE compared to SC. Disease activity assessment by means of SC or CCE did not differ statistically between the investigators (p = 0.26 and p = 0.1, respectively). After CCE, the capsule egestion rate was 77 %. The overall acceptance of both procedures was similar. CONCLUSION: Considering the significantly different assessment of disease activity and significantly more appropriate assignment of the horizontal spread of inflammation by SC versus CCE, we recommend the preferential use of SC in the assessment of inflammation in UC patients.