[Interdisciplinary Diagnosis and Treatment of Deep Infiltrating Endometriosis]. / Interdisziplinäre Diagnostik und Therapie der tief infiltrierenden Endometriose.

Endometriosis is the second most common benign female genital disease after uterine myoma. This review discusses the interdisciplinary approach to the treatment of deep infiltrating endometriosis. Endometriosis has been defined as the presence of endometrial glands and stroma outside the internal epithelial lining of the cavum uteri. As a consequence, endometriosis can cause a wide range of symptoms such as chronic pelvic pain, subfertility, dysmenorrhea, deep dyspareunia, cyclical bowel or bladder symptoms (e.g., dyschezia, bloating, constipation, rectal bleeding, diarrhoea and hematuria), abnormal menstrual bleeding, chronic fatigue or low back pain. Approx. 50 % of teenagers and up to 32 % of women of reproductive age, operated for chronic pelvic pain or dysmenorrhoea, suffer from endometriosis. The time interval between the first unspecific symptoms and the medical diagnosis of endometriosis is about 7 years. This is caused not only by the non-specific nature of the symptoms but also by the frequent lack of awareness on the part of the cooperating disciplines with which the patients have first contact. As the pathogenesis of endometriosis is not clearly understood, a causal treatment is still impossible. Treatment options include expectant management, analgesia, hormonal medical therapy, surgical intervention and the combination of medical treatment before and/or after surgery. The correct treatment for each patient should take into account the severity of the disease and whether the patient desires to have children. The treatment should be as radical as necessary and as minimal as possible. The recurrence rate among treated patients lies between 5 and > 60 % and is very much dependent on the integrated management and surgical skills of the respective hospital. Consequently, to optimise the individual patient's treatment, a high degree of interdisciplinary cooperation in diagnosis and treatment is crucial and should, especially in the case of deep infiltrating endometriosis, be undertaken in appropriate centres.

Evaluation of a rapid new stool antigen test for diagnosis of Helicobacter pylori infection in adult patients.

The evaluation of a new rapid stool antigen test showed different levels of sensitivity for final readings of test results at 20 min (59.1%) and 30 min (76.9%). Significant differences in performance were observed between the two sexes and the various age categories, with higher efficiency in male patients and young adults. Generally, this test is efficient and can be used to detect H. pylori infection in adults. However, further studies are required to confirm its accuracy.

Clinical relevance of CagA-specific antibodies related to CagA status of Helicobacter pylori isolates using immunofluorescence test and PCR.

BACKGROUND: The cagA (cytotoxin-associated gene A) protein is found in about 50% of Helicobacter pylori strains; its clinical relevance in gastroduodenal disease is uncertain. PATIENTS AND METHODS: The frequency of IgG antibodies to cagA was studied by using a commercial Western blot assay in sera of 189 patients with endoscopically and histologically confirmed gastroduodenal disease. In addition, 38 H. pylori strains isolated from biopsies were analyzed by immunofluorescence test (IFT) and PCR for detection of cagA protein and cagA gene sequences, respectively. RESULTS: 54.3-60.0% of all patients with gastrointestinal diseases (chronic gastritis, gastric or duodenal ulcer and chronic duodenitis) and 28.6% with a normal mucosa were found to be positive for anti-cagA IgG antibodies. There was no significant difference in anti-cagA IgG seroprevalence between the different clinical entities. CagA-positive (cagA+) H. pylori strains were detected in 44.7% and 50% of the 38 isolates by PCR and IFT, respectively. 22 of 23 patients infected with cagA+ strains had anti-cagA antibodies. Using PCR as a gold standard, the sensitivity and specificity of the cagA IgG Western blot were 100.0% and 35.0%, respectively; the sensitivity and specificity of the cagA IFT were 76.5% and 71.4%, respectively. The incidence of the cagA+ H. pylori strains detected either by PCR or IFT was significantly higher (p < 0.05 and p < 0.01, respectiveLy) in patients with chronic duodenitis, gastric or duodenal ulcer compared to patients with chronic gastritis (66.7%, 80% and 30.4%, respectiveLy). CONCLUSION: In this study the cagA-specific serological status in H. pylori infections as diagnosed by IgG Western blot was of no predictive value for severity of disease. In contrast, the cagA status of H. pylori isolates, diagnosed by IFT or PCR, was a predictive marker for severe disease and, therefore, also of clinical relevance in the assessment of the virulence of the infecting strain.

[Primary varices of the colon. A rare cause of gastrointestinal bleeding]. / Primäre Varikosis des Kolons. Eine seltene Ursache der gastrointestinalen Blutung.

HISTORY: A 34-year-old patient presented with a two-day history of passing bright-red blood with his stools. There was no contributory past or family history and he had no accompanying symptoms. INVESTIGATIONS: Colonoscopy revealed many varices in the colon and terminal ileum without an active source of bleeding. Angiography failed to demonstrate any bleeding or vascular anomaly in the splanchnic region. Abdominal ultrasound and gastroscopy as well as biochemical tests did not indicate portal hypertension or liver cirrhosis. TREATMENT AND COURSE: On the night of admission there was a renewed fall in haemoglobin concentration. Emergency colonoscopy again failed to discover a source of bleeding. After transfusion of four units of erythrocyte concentrate the further course was uneventful. 8 months and 3 years later there were further episodes of marked bleeding per rectum. At the latest admission no source for the bleeding was found but there was some blood oozing in the sigmoid colon. Biochemical tests were unremarkable. The large varices were again seen in the colon and terminal ileum. Gastroscopy, Doppler sonography of the liver and repeat abdominal sonography again failed to demonstrate portal vein thrombosis, liver cirrhosis or portal hypertension. CONCLUSION: In case of colonic varices the differential diagnosis should include portal hypertension with chronic liver disease, portal vein thrombosis, vascular anomalies or postoperative complications. The treatment of primary varices, which are rare, is conservative.