[Injuries in Karate Sports: A Survey Performed During the World Championship 2014]. / Verletzungen im Karatesport ­ eine Umfrage während der Weltmeisterschaft 2014.

Background: In literature, the competitive sport of modern karate is almost always characterised as a combat sport involving injuries caused by impact effects and physical contact with opponents. There is a lack of data regarding the outcome after karate injuries, specifically with a view to the contact-free Kata karate. Methods: Performing a random test using a questionnaire, we collected data concerning regular medical treatment, prior surgeries of the locomotor system, and medical care. This study included 300 athletes from 65 countries (average age: 24.1 years; 176 male, 124 female) participating in the Karate World Cup 2014. Seven participants competed in both disciplines, 87 only in the Kata discipline, and 206 only in Kumite (the discipline involving physical contact with opponents). The statistical analysis was performed using a two-sided Chi-square test and the Fisher's exact test. Results: Recurrent medical treatment was most commonly required for the knee region (Kata 28.7 %, Kumite 26.7 %). In Kata the shoulder region came second (22.9 %), in Kumite the ankle region (21.8 %), followed by hand and foot in both groups. Medical treatment of the elbow area was more frequent in the Kata Group (p = 0.033), while in Kumite athletes' hand (p = 0.002) and foot injuries (p = 0.007) prevailed. Prior surgeries of athletes of both disciplines most commonly concerned the knee, followed by the ankle region in the Kata group and by the hand and head region in the Kumite group. Statistically significant differences between the two disciplines were found in head injuries (p = 0.004), which commonly do not occur in the Kata discipline. During the World Cup, 56.0 % of the athletes had no individual medical care and 24.6 % received no sports-related medical care in their home countries. Conclusion: Although the risk of injuries in Kumite Karate has been reduced by the introduction of gumshields, hand and foot protectors as well as a reform of the scoring system, the potential for chronic physical damage should not be underestimated. Since in athletes competing in the Kata discipline the rate of surgeries and injuries is only slightly lower than in the Kumite group, Kumite Karate may be regarded as a martial arts competitive sport with a relatively low risk of injuries. In contrast, the risk of chronic musculoskeletal damage in Kata athletes seems to be underestimated thus far. Suggested improvements concern the training techniques and conditions (i. e. the tatami material), and there is a need for regular medical care, including preventative care, to be provided for these athletes.

Ultrasonography for acute appendicitis - the way it looks today.

Despite sophisticated physical examination and laboratory support, diagnosis of acute appendicitis remained challenging in clinical practice with a negative appendectomy rate of 15 - 30 %. As a remarkable clue and as early as 1986, ultrasonography (US) has been proven a reliable diagnostic method that is also explicitly helpful in difficult cases with atypical presentation and enables to rule out many differential diagnoses.Recent publications emphasized the role of multidetector computed tomography (CT) resulting in a significant reduction of false negative findings at operation. Extensive as well as uncritical application of this method even in children inevitably causes substantial radiation exposure, a sequel to either pure ignorance or unqualified/inadequate performance of US in this particular situation, which in turn can be considered sequel to either egocentric or economic preponderance.Recent data shed new light on the role of US (and CT) in acute appendicitis. Therefore, 1 generation after US with graded compression was etched in stone as the method of choice for diagnosing acute appendicitis (Puylaert), a visual arousal fostering its role and performance in clinical medicine appears justified.

Ultrasonography in acute diverticulitis - credit where credit is due.

Diagnosing diverticulitis implies physical and laboratory examination, cross-sectional imaging (computed tomography [CT] or ultrasonography [US]), and a classification of the type of diverticular disease. This article illustrates the role of ultrasonography in view of the recently published Guidelines on diverticular disease of the Consensus Conference of the German Societies of Gastroenterology (DGVS) and Visceral Surgery (DGAV). The focus is to foster both sensitivity for pictorial analysis and improving practical accomplishments of US in diverticulitis. Based on the German classification of diverticular disease (CDD), characteristic features of each type of diverticulitis are presented and commented along with possible differential diagnoses. In the literature qualified US is equipotent to qualified CT. US is frequently effective for the diagnosis and unsurpassed resolution enables detailed imaging thereby allowing one to differentiate and stratify the relevant types of diverticular disease according to the new classification. This educational review is a guided tour through the different facettes of diverticulitis on ultrasonography thereby expanding and multiplying individual competence to more users. With expert performance, US is in the pole position for diagnosing diverticulitis, however, this does come with the price of responsibility and requires transfer of advanced standards and performance in the broad.

Statement of the section internal medicine of the DEGUM - ultrasound obtains pole position for clinical imaging in acute diverticulitis.

This paper reviews and interprets the role of ultrasonography in view of the recently published Guideline on diverticular disease of the Consensus conference of the German Societies of Gastroenterology (DGVS) and Visceral Surgery (DGAV) implying a new classification of diverticular disease (CDD). Qualified US is not only equipotent to qualified CT and frequently effectual for diagnosis but considers relevant legislation for radiation exposure protection. Unsurpassed resolution allows detailed resolution thereby allowing to differentiate and stratify the relevant types of diverticular disease. Subsequently, US is considered the first choice of imaging in diverticular disease. Vice versa, CT has definite indications in unclear / discrepant situations ­ or insufficient US-performance.

Intestinal Ultrasound in Rare Gastrointestinal Diseases, Update, Part 2.

Intestinal ultrasound has become an established and valid diagnostic method for inflammatory bowel disease, diverticulitis, appendicitis, bowel obstruction, perforation and intussusception. However, little is known about sonographic findings in other rarer intestinal diseases. Ultrasound may display the transformation of the intestinal wall from a normal to a pathological state both in inflammatory and neoplastic disease. Besides demonstrating the transmural aspect, it also shows the mesenteric reaction as well as complications such as fistula, abscesses, stenosis, or ileus. Furthermore, in some diseases intestinal ultrasound may serve as a diagnostic clue if typical patterns of the bowel wall and impaired peristalsis can be demonstrated. This may lead to an important reduction of invasive and expensive (follow-up) procedures. The information gained by ultrasound regarding intestinal disease, however, is as important and valid as e. g. in case of focal lesions of the liver. Serving as tertiary referral centers for a broad spectrum of intestinal diseases, we therefore report some aspects of ultrasound in patients with less often recognized diseases. The article is divided into two parts, the first focusing on examination techniques, infectious diseases and celiac sprue and the second on hereditary, vascular and neoplastic diseases and varia.

[Differential diagnosis of diarrhoea]. / Differenzialdiagnose der Diarrhö

Diarrhoea is a common symptom and numerous differential diagnoses must be considered. This article illustrates approaches for a rational and efficient work-up based on practical facilities in acute diarrhoea and fostered by 4 key questions scrutinising chronic diarrhoea. The applications of imaging methods (endoscopy, ultrasonography) are discussed along with infectious topics and function testing. The aim of this contribution is to help patients to get a precise diagnosis in a most rational way. This implies a transparent and targeted medical strategy, avoiding selective intuitions ("trial and error") as well as extensive diagnostic overdoing in the case of only putative diarrhoea. Knowing the potential of diagnostic methods which are (or can) possibly not performed regularly in the physician's office, and their requirements/limitations is an important component in this situation. The basic fundament for application of such methods, however, and the clue to economic diagnosis as well as the differential diagnosis of diarrhoeal diseases are the history and simple tests.

[Diverticular disease - diagnosis and classification]. / Divertikelkrankheit - Diagnostik und Klassifikation.

A reliable diagnosis is fundamental for operative, interventional and conservative treatment of the different facets of diverticular disease. Not only differential diagnoses but also overlap or coincidence with other entities sharing similar symptoms must be considered. Furthermore, an adequate surgical strategy and correct stratification of complications is mandatory. Subsequently, in the light of currently validated diagnostic techniques, the consensus conference of the German Societies of Gastroenterology (DGVS) and Visceral Surgery (DGAV) has released a new classification of diverticulitis displaying the different facets of diverticular disease. This classification also comprises symptomatic uncomplicated diverticular disease (SUDD), largely resembling irritable bowel syndrome, as well as diverticular bleeding. While detailed history, physical examination and laboratory testing are of great importance for exploring a patient with diverticular disease, they are not sufficient to diagnose (or stratify) diverticulitis without cross-sectional imaging using ultrasonography (US) or computed tomography (CT). The diagnostic value of qualified US is equipotent to qualified CT, complies with relevant legislation for radiation exposure protection and is frequently effective for diagnosis. Therefore, US is considered to be the first choice for imaging in diverticular disease. In contrast, CT has definite indications in unclear, discrepant situations or insufficient US performance. Strengths and weaknesses of both methods are discussed. Endoscopy is not required for the diagnosis of diverticulitis and should not be performed in an acute attack. Colonoscopy, however, is warranted after healing of diverticulitis, prior to elective surgery and in cases of an atypical course. Prior exclusion of perforation is considered mandatory. An unequivocal indication for colonoscopy is diverticular bleeding and the rapid performance (within 12-24 h) allows better identification of sites of bleeding and endoscopic interventions.

13C-breath tests: current state of the art and future directions.

13C-breath tests provide a non-invasive diagnostic method with high patient acceptance. In vivo, human and also bacterial enzyme activities, organ functions and transport processes can be assessed semiquantitatively using breath tests. As the samples can directly be analysed using non-dispersive isotope selective infrared spectrometers or sent to analytical centres by normal mail breath tests can be easily performed also in primary care settings. The 13C-urea breath test which detects a Helicobacter pylori infection of the stomach is the most prominent application of stable isotopes. Determination of gastric emptying using test meals labelled with 13C-octanoic or 13C-acetic acid provide reliable results compared to scintigraphy. The clinical use of 13C-breath tests for the diagnosis of exocrine pancreatic insufficiency is still limited due to expensive substrates and long test periods with many samples. However, the quantification of liver function using hepatically metabolised 13C-substrates is clinically helpful in special indications. The stable isotope technique presents an elegant, non-invasive diagnostic tool promising further options of clinical applications. This review is aimed at providing an overview on the relevant clinical applications of 13C-breath tests.

Antibiotic-associated diarrhea: therapeutic aspects and practical guidelines--an interdisciplinary approach to a common problem.

Antibiotic-associated diarrhea (AAD) is a common complication of antibiotic treatment, most often seen in non-hospitalised patients. In principle, such diarrhea can be triggered by any antibiotic. An interdisciplinary working group discussed the different aspects of AAD in view of its gastroenterological, microbiological, paediatric, general medical and pharmaceutical implications, also in consideration of the position of patients and health insurance funds. This paper implies therapeutic aspects and practical guidelines to raise awareness of these problems also in routine situations and to enable the persons and institutions involved on the various levels of the health-care system (patients, pharmacists, family doctors, specialists and hospitals) to handle the problem of AAD more easily in a standardised way as far as diagnostics, therapy and prevention are concerned.

Antibiotic-associated diarrhea: incidence, risk factors of antibiotics and patients, pathophysiology and differential diagnosis--an interdisciplinary approach to a common problem.

Antibiotic-associated diarrhea (AAD) is a common complication of antibiotic treatment, most often seen in non-hospitalised patients. In principle, such diarrhea can be triggered by any antibiotic. An interdisciplinary working group discussed the different aspects of AAD in view of its gastroenterological, microbiological, paediatric, general medical and pharmaceutical implications, also in consideration of the position of patients and health insurance funds. The incidence, risk factors of antibiotics and patients, the pathophysiology of the various types of AAD and the differential diagnosis are reviewed.

Increased serum bone sialoprotein concentrations in patients with Crohn's disease.

INTRODUCTION: Impaired calcium homeostasis and/or the administration of corticosteroids are considered to be among the factors contributing to the pathogenesis of osteopenia in patients with inflammatory bowel disease. There is an increasing evidence suggesting that certain pro-inflammatory cytokines may also directly influence the bone metabolism in these patients. Routine measurement of bone mass and loss usually include dual energy X-ray absorptiometry as well as urinary and serum assessment of collagen crosslinks. More recent studies include likewise the detection of bone sialoprotein into a specific diagnostics of bone turnover. PATIENTS AND METHODS: We investigated 47 patients with inflammatory bowel disease (Crohn's disease N = 41, ulcerative colitis N = 6) and 17 healthy volunteers to assess and compare serum levels of bone sialoprotein and other routine parameters of bone turnover. Bone sialoprotein levels were measured by using a recently described radioimmunoassay. RESULTS: In comparison to the control group, bone sialoprotein and urinary crosslinks were significantly increased only in patients with Crohn's disease, while other markers of bone turnover (e. g. alkaline phosphatase, carboxylterminal propeptide of typ I procollagen, urinary deoxypyridinoline, vitamin D, phosphate and calcium) did not differ significantly between the patients' groups. CONCLUSION: According to these data, increased serum bone sialoprotein concentrations seem to be an additional valuable and sensitive marker of bone resorption in patients with Crohn's disease.

[Colorectal cancer and folate]. / Kolorektales Karzinom und Folsäure.

Nutritional factors are important contributors to colorectal cancer prevention. There is some evidence to suggest that a high dietary folate intake is associated with a reduced risk of colorectal cancer. Folate, which is found in green leafy vegetables, is involved in C1 group transfer and contributes to purin and thymi-dilate synthesis as well as to DNA methylation. Alterations in gene expression and DNA damage are discussed to result from low folate levels and might be associated with an elevated risk of colorectal malignancies. This hypothesis can be supported by the finding that a common polymorphism in the methylentetrahydrofolate reductase gene enhances the risk of colorectal cancer when folate status is low. Both retrospective and prospective epidemiologic studies confirm the observation that a high intake of folate correlates with a lower risk of colorectal cancer. There is also evidence from epidemiological studies that diets which are low in methyl donors, such as low contents of folate and/or methionine combined with relatively high alcohol consumption, even enhance the risk of colorectal cancer. A small number of intervention trials provide first evidence that folate intakes far above recommended dietary allowances might influence possible biomarkers of colorectal tumours.

Long-term cisapride treatment improves diabetic gastroparesis but not glycaemic control.

BACKGROUND: In patients with diabetic gastroparesis, delayed food delivery to the intestine may become a major obstacle to post-prandial glycaemic control. AIM: To investigate whether cisapride accelerates gastric emptying in the long term or improves diabetes control in patients with diabetic gastroparesis. METHODS: Eighty-five patients with long-standing insulin-dependent diabetes mellitus (glycosylated haemoglobin (HbA1c) > 7.0%), dyspepsia and diabetic neuropathy were tested for impaired gastric emptying of solids by the 13C-octanoate breath test. Nineteen of these patients with severe diabetic gastroparesis (i.e. t1/2 > 170 min) were randomly treated with 10 mg cisapride t.d.s. (n=9) or placebo (n=10) for 12 months. Thereafter, the breath test, dyspeptic symptoms and HbA1c values were reassessed. RESULTS: Half emptying times in nine patients with diabetic gastroparesis were significantly shortened by cisapride (175 +/- 46 min vs. 227 +/- 40 min; P < 0.03). Half emptying times in the 10 patients taking placebo did not change (205 +/- 37 min vs. 211 +/- 36 min, P=0.54). Cisapride significantly reduced dyspepsia (score: 4.1 +/- 1.6 vs. 2.0 +/- 0.5, P=0.002). HbA1c values after 12 months of treatment were not different (cisapride: 7.7 +/- 0.4% vs. 7.6 +/- 0.9%, P=0.76; placebo: 7.5 +/- 0.6% vs. 7.6 +/- 1.5%, P=0.89). CONCLUSIONS: Prokinetic treatment with cisapride accelerates gastric emptying of solids and improves dyspeptic symptoms in diabetic gastroparesis. Glycaemic control, however, is not affected by cisapride.

Correlation between sphincter of Oddi manometry and intraductal ultrasound morphology in patients with suspected sphincter of Oddi dysfunction.

BACKGROUND AND STUDY AIMS: Intraductal ultrasonography (IDUS) makes it possible to study sphincter of Oddi morphology during endoscopy. Two recent IDUS studies have described the sphincter of Oddi as a circumferential hypoechoic layer in the papilla, but there have as yet been few published data from patients with suspected sphincter of Oddi pathology. PATIENTS AND METHODS: Twenty-one consecutive patients with suspected biliary sphincter of Oddi dysfunction (seven men, 14 women; age 54 +/- 17 years) were enrolled in the study. Endoscopic sphincter of Oddi manometry was carried out using a 4-Fr electronic microtransducer device. After this, a wire-guided 6-Fr ultrasound catheter was placed in the common bile duct (CBD), and IDUS was carried out while the ultrasound catheter was being withdrawn from the CBD toward the duodenum. RESULTS: Sphincter of Oddi manometry and IDUS were carried out successfully in 18 of the 21 patients. Sphincter of Oddi manometry revealed sphincter of Oddi hypertension (baseline pressure > 35 mmHg) in eight patients. The mean sphincter of Oddi baseline pressure was 32 +/- 17 mmHg, and the mean phasic sphincter of Oddi pressure was 132 +/- 31 mmHg. During IDUS, a circumferential hypoechoic layer was clearly delineated in all patients. There was a significant correlation between the manometrically determined length of the sphincter of Oddi (8 +/- 2 mm) and the thickness of the hypoechoic layer (6 +/- 2 mm) as assessed by IDUS (r = 0.66, P < 0.001). However, no correlation was found between the baseline or phasic sphincter of Oddi pressures and the thickness of the hypoechoic layer. Accordingly, IDUS did not allow identification of patients with sphincter of Oddi hypertension. Mild pancreatitis was observed in one of the 18 patients (6 %). CONCLUSIONS: The circumferential hypoechoic layer of the papilla visualized by IDUS is the ultrasonographic correlate of the sphincter of Oddi. IDUS of the papilla is technically feasible and safe in patients with suspected sphincter of Oddi dysfunction. IDUS may provide additional information at the sphincter of Oddi level, but cannot be used as a substitute for sphincter of Oddi manometry.

Endoscopic injection of botulinum toxin in patients with recurrent acute pancreatitis due to pancreatic sphincter of Oddi dysfunction.

AIM: To evaluate the technical feasibility, safety, and short-term efficacy of botulinum toxin injection for pancreatic sphincter of Oddi dysfunction and to analyse whether the symptomatic response to botulinum toxin might be a predictor of outcome for endoscopic sphincterotomy. METHODS: Fifteen consecutive patients (nine female, aged 38 +/- 12 years) with frequent attacks (median four) of acute pancreatitis within 6 months, and manometrically proven pancreatic sphincter of Oddi dysfunction underwent endoscopic injection of 100 units of botulinum toxin into the major papilla. All patients underwent prospective follow-up thereafter and in cases of recurrent pancreatitis manometry this was repeated and pancreatic sphincterotomy was performed. RESULTS: No side-effects occurred after botulinum toxin injection in any patient. Within 3 months after botulinum toxin treatment, 12 out of 15 patients remained asymptomatic (80% primary response). Only one out of three patients without symptomatic benefit showed continued elevated pancreatic sphincter pressure at manometry and only this patient benefited from pancreatic sphincterotomy later on. Eleven of the 12 patients initially responding to botulinum toxin injection developed a symptomatic relapse 6 +/- 2 months after botulinum toxin treatment. These patients then achieved long-term clinical remission from pancreatic or combined (biliary and pancreatic, n=5) sphincterotomy (median follow-up, 15 months). CONCLUSION: Endoscopic botulinum toxin injection into the papilla of Vater is a safe procedure for treatment of pancreatic sphincter of Oddi dysfunction that may provide short-term relief in about 80% of the patients. Those patients who respond to botulinum toxin may subsequently gain definitive cure from sphincterotomy.

Differential expression of human alpha- and beta-defensins mRNA in gastrointestinal epithelia.

BACKGROUND: While defensins have received great attention for their role in bronchial innate immune defence, little is known about the expression levels of the four human epithelial defensins (HD5, HD6, hBD1 and hBD2) in the digestive tract. In this study we quantified the alpha- and beta-defensins mRNA in biopsies obtained from the gastrointestinal mucosa and identified the cells expressing the beta-defensin hBD1 mRNA in ileal mucosa. MATERIAL AND METHODS: Biopsies from human stomach (corpus and antrum), duodenum, jejunum, ileum and colon were analysed for their expression of alpha- and beta-defensins. The mRNA of defensins was quantified by semiquantitative reverse transcription-polymerase chain reaction. Cells expressing beta-defensin hBD1 mRNA were identified by in situ hybridization with 35S-labelled RNA probes in tissue sections of human ileum. RESULTS: The hBD1 mRNA was expressed at low levels with little variability throughout the gastrointestinal tract and was detected in all epithelial cells of ileal mucosa. HD5 and HD6 mRNA expression was restricted to the intestine and displayed high interindividual variability. The highest expression levels were observed in jejunum and ileum. Biopsies obtained from duodenum displayed low levels or no expression of HD5 and HD6. The expression level increased considerably in a biopsy obtained from a patient with acute coeliac sprue. In contrast, low levels were observed in a biopsy from a patient with coeliac sprue in remission. CONCLUSIONS: The expression levels of hBD1, HD5 and HD6 throughout the gastrointestinal tract are tissue and peptide specific and these defensins are expressed with high interindividual variability.