Clinical Ultrasound in Inflammatory Bowel Disease.

Ultrasound should be the first-line imaging method in the medical care of patients with inflammatory bowel disease. It can be used to differentiate between Crohn's disease and ulcerative colitis and to detect numerous complications like stenoses, fistulas, and abscesses. As the method is also highly suitable for follow-up, stressful endoscopic procedures and examinations involving radiation are less necessary. Comparison studies with MRI and CT show that ultrasound is not an inferior method and it is therefore included in all guidelines. Intensifying physician training in this method will help to ensure its comprehensive use.

Ibuprofen or diclofenac is associated with more severe acute kidney injury in nephropathia epidemica.

OBJECTIVE: In many parts of Europe, nephropathia epidemica (NE) is an endemic zoonosis. After a flu-like prodrome, this viral disease often manifests with acute kidney injury. Use of non-steroidal anti-inflammatory drugs is discouraged during the disease, but no data from clinical investigations are available on the association between disease course and the use of analgesics. MATERIAL AND METHODS: The charts of 59 patients admitted with NE to a hospital in 2007 were retrospectively analysed. Creatinine levels were compared between users of different analgesics. RESULTS: Patients taking analgesics before admission had higher peak creatinine levels, but not after adjustment for confounders. The subgroup taking ibuprofen or diclofenac had higher initial and peak creatinine levels than the group who did not, even after adjustment for confounders. CONCLUSION: Since NE cannot be accurately diagnosed in the early disease phase, metamizole, acetaminophen or acetylsalicylic acid may be preferable analgesics to ibuprofen or diclofenac for flu-like symptoms in endemic areas.

Hepatitis induced by Kava (Piper methysticum rhizoma).

BACKGROUND/AIMS: Botanical drugs are widely used and often contain highly active compounds. Kava root (Piper methysticum rhizoma), used frequently in Europe as a remedy against anxiety, contains kavapyrones with sedative effects. Seven case reports suggested the development of hepatitis after the intake of Kava. METHODS: We analyzed 29 novel cases of hepatitis along with Kava ingestion which occurred between 1990 and 2002 in addition to the seven already published case reports using a clinical diagnostic scale established for adverse hepatic drug reactions. RESULTS: Hepatic necrosis or cholestatic hepatitis were noticed with both alcoholic and acetonic Kava extracts. The majority of the 29 patients and the additional seven published reports were women (27 females, nine males). Both the cumulative dose and the latency to when the hepatotoxic reaction emerged were highly variable. Nine patients developed fulminant liver failure, of which eight patients underwent liver transplantation. Three patients died, two following unsuccessful liver transplantation and one without. In all other patients, a complete recovery was noticed after the withdrawal of Kava. Pathophysiologically, both immunoallergic and idiosyncratic factors may be responsible. CONCLUSIONS: The present report emphasizes the potentially severe hepatotoxicity of Kava which has recently led to the retraction of Kava-containing drugs by the pharmacovigilance authorities in Germany.