Carbon dioxide insufflation in colonoscopy is safe: a prospective trial of 347 patients.

Available evidence suggests that the use of CO(2) insufflation in endoscopy is more comfortable for the patient. The safety of CO(2) use in colonoscopy remains contentious, particularly in sedated patients. The objective of the present prospective trial was to assess the safety of CO(2) colonoscopies. Methods. 109 patients from our previous randomized CO(2) colonoscopy study and an additional 238 subsequent consecutive unselected patients who had a routine colonoscopy performed in a private practice were enrolled from April 2008 through September 2008. All but 2 patients were sedated. All patients were routinely monitored with transcutaneous CO(2) measurement. Volumes of CO(2) administered were correlated with capnographic measurements from transcutaneous monitoring. Results. Of the 347 patients examined, 57% were women; mean (SD) age of participants was of 60.2 years (12.8). Mean propofol dosage was 136 mg (64 mg). Mean CO(2) values were 34.7 mm Hg (5.3) at baseline, 38.9 mm Hg (5.5) upon reaching the ileum, and 36.9 mm Hg (5.0) at examination's end. Mean maximum increase of CO(2) was 4.5 mm Hg (3.6). No correlation was observed between volume of CO(2) administered and increase in level of CO(2) (correlation coefficient: 0.01; P value: 0.84). No complications were observed. Conclusions. The present prospective study, which was based on one of the largest sedated patient sample reported to date in this setting, provides compelling evidence that CO(2) insufflation in colonoscopy is safe and unassociated with relevant increases in transcutaneously measured levels of CO(2).

Juxtapapillary duodenal diverticula: MDCT findings in 1010 patients and proposal for a new classification.

The aim of this study is to analyze the MDCT findings of juxtapapillary duodenal diverticula (JPDD) and to propose a new radiological classification. CT-examinations of 1010 consecutive patients, all examined by 16-row MDCT of the abdomen over a time period of 20 months were retrospectively analyzed. All study patients were examined by triple phase CT (native, arterial and portal venous CT scan) of the abdomen and all recieved positive oral contrast prior to the examination. Thirty-three patients showed a juxtapapillary duodenal diverticulum, which could be seen on all CT scans, but jusually was depicted most clearly on the thin collimated arterial phase CT images. Size of diverticula range from 4 mm to 4.5 cm (mean 1.7 cm). In 17 cases the diverticulum was located ventrally to the vaterian sphincter complex, extending less or more into the pancreas at the site where the dorsal and the ventral anlage of the pancreas have fused (type I). 12 diverticula were located dorsally to the sphincter complex (type II). Three patients presented with a bilobated juxtapapillary diverticulum extending to both sides, ventrally and dorsally (type III) and one patient showed a little diverticulum ventrally to the minor papilla (type IV).Three patients presented with food impaction in the diverticulum but only one of these patients with a large IPDD showed a Lemmel-syndrome, whereas the other three patients with non-calculous extrahepatic cholostasis showed larger diverticula without food impaction. MDCT allows to identify four different types of juxtapapillary duodenal diverticula and using the proposed classification may be helpful for a more exact, anatomy based radiological description of this CT finding.

[Chronic musculo-skeletal pain in Switzerland: patient care from the view of physicians and patients]. / Chronische muskuloskelettale Schmerzen in der Schweiz: Die Betreuungsqualität aus Sicht der Arzte und der Patienten.

A considerable percentage of the population suffers from chronic musculoskeletal pain (CMP) and patient management does not appear to be optimal. The aim of the present investigations was to assess and evaluate epidemiologic data and discover eventual deficits in patient management. This investigation included several sequential steps: First a European study including Switzerland evaluated the prevalence and characteristics of patients with CMP as well as of the treating physicians. The results were discussed and elaborated in two workshops, where general practitioners and patients were included. In a further step the results of these workshops were evaluated again in a telephone survey addressing patients and physicians both in the French and German speaking parts of Switzerland. Considerable deficits were discovered in the management of patients with CMP: In 35% no firm diagnosis was established, the life quality was considerably reduced in about 13 of the patients, the patients' information on their disorders were found to be rather limited, furthermore, there were misconceptions about medical treatment. The two workshops confirmed the results of the first study. The causes of pain often remained unclear, there were considerable communication problems between patient and physician, medical treatment appeared to be inappropriate, and there were deficits in the time management during consultations. The telephone survey confirmed these deficits. In conclusion management of patients with CMP is characterized by considerable deficits such as missing or unclear diagnosis, misconceptions in medical contexts and treatment. Many of the deficits may be improved and call for measures for optimizing the management of patients with CMP.

[Incapacity to work, occupational disability and disability in inflammatory bowel disease]. / Arbeitsunfähigkeit, Erwerbsunfähigkeit und Invalidität bei entzündlichen Darmkrankheiten.

Crohn's disease (CD) and ulcerative colitis (UC) are chronic-inflammatory bowel diseases with unknown etiology. The major symptoms in CD are pain and abdominal discomfort, sometimes associated with weight loss and a series of intestinal and/or extraintestinal symptoms. UC, on the other hand, is characterized by diarrhea which can be bloody and lead to iron deficiency anemia. The course of both diseases can be quite variabel: the extent of the disease, the severity and the complications are variable and unpredictable. Many patients have acute flare-ups followed by long phases of remission. Flare-ups can be associated with complications. From the perspective of an insurance, the variable course of disease, the unpredicatable complications and the variable quality of life make it difficult to make valid judgements and predictions. This is partly due to the fact that very little longterm data are available. It is therefore important to generate this information in the next few years.

[What is motility all about?]. / Was ist Motilität?

The digestive system is regulated by a complex system. Within this system, the bowel can determine its own patterns of behaviour The aim of the digestive process is to digest and absorb nutrients and to expel all material that cannot be digested. The regulatory patterns largely depend on the luminal content of the gut independently of the input from the central nervous system. Any disturbance in this control system can induce symptoms, which are often associated with transit changes. The major regulatory system of the gut is the enteric nervous system (ENS). Disturbances in the communication and interaction of the ENS with the central nervous system can lead to symptoms such as nausea, pain, diarrhea, constipation and bloating: All these symptoms have been associated with motility and transit disturbances.

[Treatment of Crohn's disease]. / Behandlung des Morbus Crohn.

In this chapter, the state-of-the-art treatment of Crohn's disease is summarized; the chapter intends to provide an uptodate knowledge of current treatment strategies of Crohn's disease. The indications for steroids and for immunomodulators are described and compared to newer approaches based on neutralizing tumor necrosis factor by specific antibodies (Infliximab). An attempt was made to clearly differentiate between evidence-based treatment schemes and those which are not supported by good evidence. The chapter was written for daily practice; the proposed treatment algorithms should support the physician in his daily work.