Fatigue Threshold R-Curves for Dental Lithium Disilicate Glass-Ceramics.

Chemical and mechanical fatigue degradation in ceramic materials is generally inconspicuous yet ubiquitous, to the effect that clinical fractures still consist of the main cause of failure in all-ceramic restorations. Implications of this span wide, from a reduced survival prognosis for the affected teeth, including more frequent and increasingly invasive procedural interventions, to the financial burden borne by individuals and health care systems. To suffice as an effective corrective, restoration lifetimes need only to be extended so to outlive the patient. That opens a box of problems from a materials science standpoint, entailing inherent deficiencies of brittle materials to resist mechanical and environmental challenges. Efforts in developing more damage-tolerant and fatigue-resistant restoratives go thus hand in hand with understanding intrinsic mechanisms of crack growth behavior under conditions that simulate the oral environment. Here we developed experiments using size-relevant sharp precracked specimens with controlled size and geometry (truncated semielliptical crack in the surface-crack-in-biaxial-flexure method) to establish a relationship between crack size and strength. The tangent method was used to construct envelopes for the quasi-static resistance curves (R-curves), which served as template for deriving residual cyclic R-curve analogs. By means of experimentally obtained stress-cycle curves, lifetime and fatigue parameters were employed within a mechanistic framework to reveal constitutive toughening mechanisms during subcritical growth under cyclic loading in a wet environment. Using 3 modern dental lithium disilicate glass-ceramics, we demonstrate the extent of R-curve degradation up to a threshold of 10 million cycles (~30 y in service) and draw parallels between the scope of fatigue degradation and the size of the microstructural units responsible for toughening mechanisms in glass-ceramic materials. Our results indicate that larger microstructural elements endow glass-ceramics with a higher reaching quasi-static R-curve at the onset but degrading more rapidly to comparable levels of lithium disilicates having submicrometric and nanometric crystal phases.

Dimensional changes of CAD/CAM polymer crowns after water aging - An in vitro experiment.

Computer-Aided Design/Computer-Aided Manufacturing (CAD/CAM) polymers can potentially replace traditional materials used for manufacturing indirect restorations. In 2012, Lava Ultimate (LU) was introduced as a highly suitable material for implant-supported single crowns. Three years after its introduction, the manufacturer issued a change in indication for the material, implying that they no longer considered the material to be suitable for crown indications due to debonding issues. A clinical trial with implant-borne Lava Ultimate crowns bonded to zirconia abutments revealed that 80 percent of the LU crowns showed debonding from the abutment within one year, whereas no debonding occurred when an alternative full-ceramic restoration material was used. These results suggest that the material itself had been the cause of the debonding. However, the exact reason for the debonding remained unclear. Water uptake in resin methacrylates like LU is known to cause dimensional changes resulting in mechanical stress on the RelyX Ultimate (RU) cement. The purpose of this study is to quantify the dimensional changes in LU caused by water uptake and relate these dimensional changes to the failure of the RU cement. Twenty-five identical LU-crowns were divided into three groups. 10 LU-crowns with abutment and 10 crowns without abutments were stored in water for 23 days and were only removed for measurement. Five crowns served as a control to calibrate the measurements. The internal diameter was measured eight times with a TS 460 Heidenhain touch probe. For visualization purposes, one crown was also 3D scanned before and after water treatment. The results showed that after 23 days in water the mean increase in diameter for the groups with and without abutment was 36.6 µm (SD = 35,1) and 36.7 µm (SD = 26,5) respectively. Mixed effects modelling indicated no significant between-group differences at any time point. Exposure of LU to water results in dimensional changes causing mechanical stress on the crown-abutment complex. It can be estimated that RU cement fails after an expansion of more than 4 µm. Within the limitations of this in vitro study, it can be concluded that the dimensional changes induced by water uptake can cause debonding issues. As more CAD/CAM polymers for restorative purposes are expected to be developed, the results of this study should stimulate manufacturers to quantify their products' dimensional changes in a wet environment before market release.

Sliding contact wear and subsurface damage of CAD/CAM materials against zirconia.

OBJECTIVE: Most previous work conducted on the wear behavior of dental materials has focused on wear rates and surface damage. There is, however, scarce information regarding the subsurface damage arising from sliding contact fatigue. The aim of this study was to elucidate the wear mechanisms and the subsurface damage generated during sliding contact fatigue in 5 contemporary CAD/CAM materials against a zirconia indenter. METHODS: Forty discs (Ø12mm, 1.55mm thick) were cut out of IPS e.max CAD (e.CAD), Suprinity PC (SUP), Enamic (ENA), Vitablocs Mark II (VMII) and Lava Ultimate (LU) blocks and mirror polished. After cementation onto a dentin-like composite, off-axis mouth-motion cycling was conducted with a spherical zirconia indenter (r=3.18mm) in water (200N load, 2Hz frequency) for 5 different cycling periods (102, 103, 104, 105, 106 cycles, n=8). Analysis of the wear scars was conducted using light-microscopy, scanning-electron-microscopy and optical profilometry. Subsurface damage was assessed using sagittal and transverse sections of the samples. RESULTS: Fatigue wear mechanisms predominated in glassy materials (e.CAD, SUP, VMII), accompanied by extensive subsurface damage, whereas abrasive wear mechanisms were responsible for the large wear craters in the resin composite (LU) with an absolute absence of subsurface fracture. A combination of both mechanisms was observed in the polymer-infiltrated reinforced-glass (ENA), displaying large wear craters and severe subsurface damage. SIGNIFICANCE: Well-controlled laboratory simulation can identify wear and subsurface damage susceptibility of various classes of restorative materials. Both wear and subsurface fracture are determining factors for the long-term success of restorations.

Fluorescent Labeling and 2-Photon Imaging of Mouse Tooth Pulp Nociceptors.

Retrograde fluorescent labeling of dental primary afferent neurons (DPANs) has been described in rats through crystalline fluorescent DiI, while in the mouse, this technique was achieved with only Fluoro-Gold, a neurotoxic fluorescent dye with membrane penetration characteristics superior to the carbocyanine dyes. We reevaluated this technique in the rat with the aim to transfer it to the mouse because comprehensive physiologic studies require access to the mouse as a model organism. Using conventional immunohistochemistry, we assessed in rats and mice the speed of axonal dye transport from the application site to the trigeminal ganglion, the numbers of stained DPANs, and the fluorescence intensity via 1) conventional crystalline DiI and 2) a novel DiI formulation with improved penetration properties and staining efficiency. A 3-dimensional reconstruction of an entire trigeminal ganglion with 2-photon laser scanning fluorescence microscopy permitted visualization of DPANs in all 3 divisions of the trigeminal nerve. We quantified DPANs in mice expressing the farnesylated enhanced green fluorescent protein (EGFPf) from the transient receptor potential cation channel subfamily M member 8 (TRPM8EGFPf/+) locus in the 3 branches. We also evaluated the viability of the labeled DPANs in dissociated trigeminal ganglion cultures using calcium microfluorometry, and we assessed the sensitivity to capsaicin, an agonist of the TRPV1 receptor. Reproducible DiI labeling of DPANs in the mouse is an important tool 1) to investigate the molecular and functional specialization of DPANs within the trigeminal nociceptive system and 2) to recognize exclusive molecular characteristics that differentiate nociception in the trigeminal system from that in the somatic system. A versatile tool to enhance our understanding of the molecular composition and characteristics of DPANs will be essential for the development of mechanism-based therapeutic approaches for dentine hypersensitivity and inflammatory tooth pain.

ADM guidance-ceramics: Fatigue principles and testing.

BACKGROUND: Clinical failure of dental ceramics is usually reported as partial fracture of the restoration (chipping) or as catastrophic fracture of the whole structure. In contrast to metals, ceramics are linear-elastic, brittle materials exhibiting extremely low damage tolerance to failure. Well documented clinical and lab reports have shown this fracture event often occurs at loads far below their fracture strength due to intrinsic fatigue degradation via slow crack growth or cyclic fatigue mechanisms. The presence and development of surface flaws have a dominant role in damage accumulation and lifetime reduction of ceramic structures. AIMS: This ADM guidance document aims to summarize the aspects related to fatigue degradation of dental ceramics, reviewing the concepts of fatigue testing and furthermore aims to provide practical guidance to young scientists entering into fatigue related research. The description of fatigue strength is always accompanied by a clear understanding of the underlying fracture mechanisms.

Fracture Rates and Lifetime Estimations of CAD/CAM All-ceramic Restorations.

The gathering of clinical data on fractures of dental restorations through prospective clinical trials is a labor- and time-consuming enterprise. Here, we propose an unconventional approach for collecting large datasets, from which clinical information on indirect restorations can be retrospectively analyzed. The authors accessed the database of an industry-scale machining center in Germany and obtained information on 34,911 computer-aided design (CAD)/computer-aided manufacturing (CAM) all-ceramic posterior restorations. The fractures of bridges, crowns, onlays, and inlays fabricated from different all-ceramic systems over a period of 3.5 y were reported by dentists and entered in the database. Survival analyses and estimations of future life revealed differences in performance among ZrO2-based restorations and lithium disilicate and leucite-reinforced glass-ceramics.

Dental materials for primary dentition: are they suitable for occlusal restorations? A two-body wear study.

AIM: This was to evaluate the wear resistance of different materials, compomers, resin-modified glass ionomer cements (RMGICs), glass ionomer cements (GICs), used for posterior restorations in primary teeth and to compare the results with the reference material, amalgam. STUDY DESIGN: Eight specimens of each material were subjected to two-body wear test, using a chewing simulator. The wear region of each material was examined under a profilometer, measuring the vertical loss (µm) and the volume loss (mm(3)) of the materials. RESULTS: The results showed significant differences of vertical loss and volume loss of the test materials (p < 0.001). Amalgam had the highest wear resistance. Twinky Star (compomer) had the lowest vertical loss and volume loss. There was no significant difference of vertical loss among compomers, Dyract Extra, Dyract Flow and Dyract Posterior. Riva Self Cure (GIC) had no statistically significant difference compared with the compomers (except Twinky Star). No statistically significant difference was found also between Equia (GIC) and Ketac Moral (GIC) with Dyract Extra (Compomer). RMGICs were found to have the lowest wear resistance. STATISTICS: For the statistical analysis, the PASW 20.0 (SPSS Statistics, IBM, Chicago) package was used. Means and standard deviations were measured with descriptive statistics and analyzed using one-way ANOVA. CONCLUSION: Compomers and some GICs, that have moderate wear resistance, may be sufficient for occlusal restorations in primary dentitions.

Effect of double-layer application on dentin bond durability of one-step self-etch adhesives.

PURPOSE: The aim of this in vitro study was 1) to analyze the influence of a double-layer application technique of four one-step self-etch adhesive systems on dentin and 2) to determine its effect on the stability of the adhesive interfaces stored under different conditions. MATERIALS AND METHODS: Four different one-step self-etch adhesives were selected for the study (iBondSE, Clearfil S(3) Bond, XenoV(+), and Scotchbond Universal). Adhesives were applied according to manufacturers' instructions or with a double-layer application technique (without light curing of the first layer). After bonding, resin-dentin specimens were sectioned for microtensile bond strength testing in accordance with the nontrimming technique and divided into 3 subgroups of storage: a) 24 hours (immediate bond strength, T0), b) six months (T6) in artificial saliva at 37°C, or c) five hours in 10 % NaOCl at room temperature. After storage, specimens were stressed to failure. Fracture mode was assessed under a light microscope. RESULTS: At T0, iBond SE showed a significant increase in microtensile bond strength when the double-application technique was applied. All adhesive systems showed reduced bond strengths after six months of storage in artificial saliva and after storage in 10% NaOCl for five hours; however at T6, iBond SE, Clearfil S(3) Bond, and XenoV(+) showed significantly higher microtensile bond strength results for the double-application technique compared with the single-application technique. Scotchbond Universal showed no difference between single- or double-application, irrespective of the storage conditions. CONCLUSION: The results of this study show that improvements in bond strength of one-step self-etch adhesives by using the double-application technique are adhesive dependent.

Factors involved in mechanical fatigue degradation of dental resin composites.

The design of clinical trials allows for limited insights into the fatigue processes occurring in resin composites and the factors involved therein. In vitro studies, in contrast, can fundamentally narrow study interests to focus on particular degradation mechanisms and, to date, represent the major contributors to the state of knowledge on the subject. These studies show that microstructural features are important in determining strength and fracture toughness, whereas fatigue resistance is mainly related to the susceptibility of the matrix and the filler/matrix interface to mechanical and chemical degradation. In this review, we focus on fracture mechanisms occurring during fatigue, on the methods used to assess them, and on additional phenomena involved in the degradation of initial mechanical properties of resin composites.

A photoelastic assessment of residual stresses in zirconia-veneer crowns.

Residual stresses within the veneer are linked to the high prevalence of veneer chipping observed in clinical trials of zirconia prostheses. We hypothesized that the thermal mismatch between the zirconia infrastructure and the veneer porcelain, as well as the rate used for cooling zirconia-veneer crowns, would be directly proportional to the magnitude of residual stresses built within the veneer layer. Two porcelains with different coefficients of thermal expansion were used to veneer zirconia copings, to create high or low thermal mismatches. The crowns were cooled according to a fast- or a slow-cooling protocol. The retardation of polarized light waves was used to calculate the residual stress magnitude and distribution across the veneer, according to the photoelasticity principle, in 1.0-mm-thick crown sections. While thermal mismatch was an important factor influencing the maximum stress development in the veneer, cooling rate had a minor role. Curved surfaces were preferential sites for stress concentration regardless of thermal mismatch or cooling rate.

[Study of biomimetic apatite formation on dentine surface].

The aim of this study was investigation of the opportunity of biomimetic growth of apatite on a dentine surface at various methods of its processing. Artificial blood human plasma--simulated body fluid (SBF)--was used as a source of ions. According to the scanning electronic microscope (SEM) and confocal laser scanning microscope (CLSM) and energy dispersive X-ray analysis (EDX) they have revealed the growth of crystals of calcium--deficient apatite. The structure of the formed apatite layer differed depending on a kind of processing of a dentine surface. After acid etching the globules of the apatite are located chaotically and the part of a dentine surface remains free. The removal of the collagen fibres by NaClO promotes uniform, controllable growth of crystals, forming a monolithic layer. The hypermineralisated areas of a tooth create the best conditions for growth. The transformation hydroxyl apatite in a superficial dentine layer can be caused by increasing of pressure at preparing with diamond bur. The growth of crystals of brushite in the smear layer is possible at a storage in water at 37 degrees capital ES, Cyrillic. The crystals have lamellar form and are well integrated in a dentin surface.

Restorative materials in the primary dentition of poli-caries patients.

BACKGROUND: Despite an overall caries decline in children, still 50-60% of carious primary teeth of 6-year-olds remain untreated, in 3-year-olds 13%. There are an increasing number of poli-caries patients with insufficiently treated primary teeth. Therefore, early treatment is fundamental. REVIEW: The assessment and indication for the use of restorative materials can be summarized as follows: Glass ionomer cements (GIC) are associated with easy handling and high fluoride release. This makes them attractive especially for Class I cavities in uncooperative children. However, low flexural strength causes high fracture rates in Class II cavities. Further developments (viscous and resin-modified GIC) have improved handling characteristics, but conventional non-resin-modified GIC are still prone to fracture. Compomers exhibit a clear potential as an alternative to amalgam. Long-term results are good even in stress-bearing areas. The compliance of the child should at least last long enough for adhesive application. Resin composites are still the most time-consuming alternative. Under a correct application protocol, resin composites behave in a similar manner to compomers. Therefore, the effort has to be judged individually. Finally, especially in severely decayed teeth and after endodontic treatment, preformed metal crowns should be taken into account as a last and appropriate alternative to direct restorations. CONCLUSION: Based on the high clinical success rates, compomers with self-etch adhesives can be recommended for restorative therapy in anterior and posterior primary teeth.

[Study of wear of restorative materials and teeth-antagonists in vitro].

Since clinical evaluation of wear turns out to be particularly time consuming, a standardized method was developed to model oral mastication. So-called artificial mouth was used to assess the extent of wear caused from different restorative materials in contact with bovine enamel. Ball heads manufactured from modern veneering ceramics, gold alloy, amalgam and resin composite materials were loaded with a contact load of 50 N for 200,000 chewing cycles. Additional thermo-cycling (5 degrees /55 degrees C) for 2,500 cycles was conducted in the artificial mouth. The worn surfaces, both on the material specimens and on the antagonist bovine enamel surfaces were volumetrically scanned under a laser microscope. Negligible wear rates were observed for the veneering ceramics and for the gold alloy. Most veneering ceramics as well as the resin composite materials caused low wear on the antagonist enamel surfaces. In contrast, the antagonist enamel was significantly damaged in contact with amalgam or some of the ceramic materials. However, modern veneering ceramics as well as gold alloys might be recommended in occlusally loaded contact with the antagonist enamel, whereas resin composite materials might be indicated for non load-bearing areas. Ceramics are contraindicated in case of bruxism.

Calcium release and pH-characteristics of calcium hydroxide plus points.

AIM: To evaluate calcium ion release and pH-characteristics of calcium hydroxide plus points (CHPP), conventional calcium hydroxide points (CHP, both Coltène/Whaledent, Langenau, Germany) and aqueous calcium hydroxide suspension (CHS) (Calxyl, OCO, Dirmstein, Germany). METHODOLOGY: Ten CHPP or CHP of size 50 were immersed into 5 mL isotonic sodium chloride solution. Conventional Ca(OH)2-free gutta-percha points served as negative control. Calcium release was measured up to 44 days by means of complexometric titration. Time dependent pH behaviour of all points in comparison with CHS was determined immersing 30 points of size 50 into 2.3 mL 0.9% wt NaCl-solution at time intervals of 0.5-72 h by a microelectrode measuring chain and a pH-meter. The surface morphologies of new and used gutta-percha points were evaluated qualitatively under a scanning electron microscope. Statistical evaluation was carried out using Kolmogorov-Smirnov-tests, Mann-Whitney-tests and multifactorial anova. RESULTS: For CHPP, a threefold greater calcium release was measured compared with CHP. Both types of points as well as CHS showed a maximum pH of approximately 12. Differences between groups were statistically significant for calcium release and pH (multifactorial anova; P < 0.001). Both types of points showed porous surfaces after usage, with a rougher surface for CHPP. CONCLUSIONS: CHPP and CHP increased the pH of isotonic sodium chloride >11 within 3 min. CHPP had a greater release of Ca2+ compared with CHP.

[Cancer prevention with the endoscope. Search not only for polyps!]. / Krebsvorsorge mit dem Endoskop. Fahnden Sie nicht nur nach Polypen!

Through the rigorous application of polypectomy, the colon carcinoma rate can be clearly reduced (66%). The term "polyp" comprises epithelial (hyperplastic or neoplastic) and nonepithelial causes. The majority of carcinomas in the colon develop from adenomatous tissue (adenoma-carcinoma sequence). Pedunculated adenomas (90% of all polyps) are removed with the high-frequency diathermy snare. In some cases, flat (sessile) polyps can be elevated by injections placed below them, and then removed with the diathermy snare (strip biopsy). In the event of larger or large-area flat polyps that cannot be removed with the snare, piecemeal resection is applied. The excision alone of adenomas with a stage I carcinoma is carried out only in so-called low-risk situations. Flat neoplasms make particular demands of the endoscopist, since they often appear merely as a reddish area, but may already have invaded the submucosa when diagnosed. For classification and, where indicated, endoscopic resection, the recommendations of the Japanese Society of Gastroenterological Endoscopy are applied.

Bile and acid reflux in long and short segment Barrett's esophagus, and in reflux disease.

Gastroesophageal acid reflux (GER) is the primary risk factor for gastroesophageal reflux disease (GERD). In long segment Barrett's esophagus (LSBE) duodenogastroesophageal reflux (DGER) parallels acid reflux. The role of GER and DGER in short segment Barrett's esophagus (SSBE) remains to be determined. The aim of the present prospective study was to investigate the esophageal bile and acid reflux in patients with LSBE, SSBE and patients with GERD. Three groups of patients were studied: Patients with LSBE (n = 12), SSBE (n = 20) and patients with GERD without intestinal metaplasia (n = 33). Subjects underwent esophageal manometry and simultaneous 24-h pH and bile monitoring (Bilitec 2000). The thresholds for GER and DGER were a deMeester score > 14.7 and an absorbance value > 0.2 for 10.9% of total period, respectively. GER did not differ between the groups (p > 0.05). However, DGER differed between patients with LSBE, SSBE and GERD (14.7 vs 2.1 vs 2.1, respectively; p < 0.05). H. pylori status did not influence GER and DGER significantly. In contrast to patients with LSBE the DGER does not seem to play an important role in patients with SSBE and patients with GERD. This result indicates a different etiopathology of both long and short segment Barrett's esophagus.

[Peptic ulcer in the elderly--endoscopy in suspected ulcer. Therapy always includes proton pump inhibitor]. / Peptisches Ulkus im Alter--bei Verdacht endoskopieren. Zur Therapie gehören in jedem Fall Protonenpumpenhemmer.

In the elderly patient, peptic ulcer disease is associated with increased morbidity and mortality. Abdominal pain is often absent, and the first sign is blood in the stools. The major risk factors are infection with Helicobacter pylori and the use of non-steroidal antiinflammatory drugs (NSAIDs). Endoscopic and medical treatment of peptic ulcer is independent of the age. The use of proton pump inhibitors is the treatment of choice. In the event of an infection with H. pylori, eradication treatment is usually carried out. Currently, however, H. pylori eradication is not recommended in patients with NSAID-associated ulcers; if possible, the NSAIDs should be discontinued. The development of a new generation of NSAIDs holds out the promise of a marked reduction in gastrointestinal side effects.

Adhesive luting of indirect restorations.

PURPOSE: To describe the potential of adhesive luting procedures with respect to (1) material characteristics and classifications, (2) film thickness, (3) overhang control, (4) bonding to different inlay materials, (5) adhesion to tooth substrates and the problem of hypersensitivities, (6) wear of luting composites, and (7) clinical performance. MATERIALS AND METHODS: A literature review of relevant studies of various in vitro and in vivo studies enables an overview of possibilities and limitations of adhesively luted indirect restorations. RESULTS: (1) Resin-based composites are the material of choice for adhesive luting. Both material properties and wear behavior of fine particle hybrid-type resin-based composites are superior to other materials. The use of compomers is questionable due to hygroscopic expansion and possible crack formation as proven for IPS Empress caps in vitro and in vivo. (2) Recent luting cements exhibit excellent flow characteristics with mean film thicknesses ranging between 8 microm and 21 microm. The ultrasonic insertion technique is recommended for viscous luting composites or conventional restorative composites utilizing their thixotropic properties. (3) For successful overhang control, good fit of the restoration (during luting) and high radiopacity of the cement (after luting) are indispensable. Overhang control is estimated easier when the ultrasonic insertion technique is applied. (4) The pre-treatments of ceramic inlays using hydrofluoric acid or silica coating result in effective bonding; for pre-treatment of resin-based composite inlays, silica coating is promising as well. (5) Bonding to enamel and dentin is proven clinically acceptable, but it should be performed with multi-step systems providing separate primers and bonding agents producing a perfect internal seal with almost no hypersensitivities. Dual-cured multi-step bonding agents provide the most promising potential. (6) The viscosity and filler content of the resin composite used for luting does not influence the wear characteristics within the marginal luting area in vivo. However, the ultrasonic insertion technique involving high viscosity materials provides enhanced handling characteristics for luting of tooth-colored inlays. (7) Clinical results with tooth-colored inlays and veneers are promising over periods of up to 10 yrs, including use in severely destroyed teeth.

[Endosonography controlled transgastric drainage of pancreatic pseudocysts]. / Endosonographisch geführte transgastrale Drainage von Pankreaspseudozysten.

BACKGROUND AND OBJECTIVE: Endoscopic drainage of a pancreatic pseudocyst is an alternative to surgical intervention. But transmural drainage carries the risk of bleeding or perforation. Effectiveness and complication rate of endoscopic ultrasound-guided drainage, to avoid these risks, was investigated. PATIENTS AND METHODS: Eleven patients (eight men, three women; mean age 55 years) with a pancreatic pseudocyst (nine with alcoholic and two with biliary pancreatitis) were studied prospectively between 1996 and 1998. In all of them transpapillary drainage of the cyst had not been technically possible. After an endoscopic ultrasound (EUS) examination, the gastric wall was incised with a fistulotome under EUS guidance. A guide-wire was then advanced through the fistulotome into the pseudocyst. A double pigtail catheter was implanted for drainage. The size of the pseudocyst was monitored sonographically at two-week intervals. RESULTS: A cystogastrostomy was successfully established in ten of the twelve patients without serious complication. The pseudocyst was no longer demonstrated after a mean of 4.2 months (2 weeks to 6 months), while a small pseudocyst (1.6 cm [0.9-2.4 cm) remained in three patients. In two of the latter the size of the pseudocyst increased again after removal of the drainage catheter. Complete drainage by repeat cystogastrostomy succeeded in one of them, while a cystojejunostomy was established in the other. CONCLUSION: Endoscopic ultrasound-guided transgastric drainage of a pancreatic pseudocyst is an effective treatment with few complications.

[Diverticulosis and diverticulitis in the elderly]. / Divertikulose und Divertikulitis beim alten Menschen.

Diverticulosis of the colon is a disease that mainly affects the elderly, presenting in 10 to 20% of this age group. The most common complication--painful diverticular disease, is usually treated conservatively with a high-fiber diet, intermittent use of antispasmodics and possibly regulation of the stools. Diagnostic differentiation is best performed using ultrasonography of the bowel wall, supplemented where necessary by computer tomography and colonoscopy (sigmoidoscopy) or, where this latter is not possible, barium enema using Gastrografin. Conservative treatment of diverticulitis with antibiotics, bowel rest, possibly including parenteral alimentation, is usually applied for three to ten days. In the absence of a response to this treatment, frequent recurrence, immunosuppression or complications (perforation, peritonitis, enterovesicular fistula), surgery is indicated.