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Introduction: Capsule endoscopy (CE) is firmly established as a standard procedure in the diagnostic algorithm of mid gastrointestinal (GI) bleeding. Despite its excellent diagnostic yield, missing expertise, reading time and financial expenditure limit an area-wide availability. A multicentric cooperation might compensate these disadvantages., Methods: The CE device was bought by a centrally located hospital (CH). CE-equipment is transported to the network partner (NP) on request and the procedure performed at the spot. Video reading is exclusively done in the CH., Results: Between January 2002 and July 2013, 1026 CE (548 m, 478f; 64 ± 16, 13 - 93 yrs.) were performed within the network. 744/1026 (73 %) CE were done at 17 NP, 282/1026 (27 %) in the CH. Between 2002 (n = 39) and 2012 (n = 136) the annual number of CE increased threefold. Leading indication for CE was suspected mid GI-bleeding (80 %). Mean latencies between requested date and actual examination were less than 24 h and 2 days between CE performance and report. 95 % of the capital investment in each cooperating hospital could be avoided by sharing one workstation within the network., Conclusion: The experience from more than 1000 CE show that long-term multicentric utilization of CE equipment is feasible. Such a network runs at stable procedural quality levels similar to an in-house supply, allows an economic as well as area-wide availability of CE and improves reading expertise by centralized video evaluation., (© Georg Thieme Verlag KG Stuttgart · New York.)

Background: The aim of our prospective analysis was to show the incidence of bleeding disorders among a tonsillectomy patient population and in case of bleeding disorders., Patients and Methods: This study comprised 92 consecutive patients who underwent tonsillectomies from 1 January 2007 to 31 December 2007 at the Department of Otorhinolaryngology, University Medical Center Mainz. In addition to gender, age, date of bleeding, Quick, aPTT and platelet count, the following blood values were determined: vWF:AG, vWF:RCo, vWF:RCo/vWF:AG, factor XIII, factor VIII:C, PFA 100™ ADP and PFA 100™ epinephrine (special coagulation analysis)., Results: Twelve of 92 patients (13%) showed evidence of coagulopathy. Four of these 12 patients had a postoperative hemorrhage. In eight patients a factor XIII deficiency was diagnosed, with two of them suffering a hemorrhage. In four patients, von Willebrand disease was diagnosed; two of them bled. No correlation between the presence of a coagulopathy and the bleeding rate could be determined., Conclusion: Routine preoperative performance of special coagulation analysis in all patients does not significantly contribute to the detection of increased postoperative hemorrhage risk.

Background: Nutrition of children with end-stage renal disease and peritoneal dialysis (PD) is often difficult. Tube feeding via a gastrostoma is discussed controversially, and some authors consider this as a contraindication because of the risk of peritonitis., Methods: In our centre 16 infants and children with end-stage renal disease were treated with PD and tube feeding over a gastrostoma in the last 12 years. The patients showed dystrophy (mean BMI -1.73 SDS) and were too small (mean body length -4.56 SDS). Seven of them (median age 11 months) received a gastrostoma before insertion of a Tenkhoff-catheter and start of PD. Nine children (median age 5 months) had PD primarily before insertion of the gastrostoma and start of tube feeding., Results: Patients with start of PD while a gastrostoma was already inserted had 15 events with peritonitis in the observation time of 91 months (1.98 per patient year). Patients with primary start of PD had 12 events with peritonitis in a total time of 43 month (3.34 per patient year), after insertion while PD was already running the number of events fell significantly to 25 peritonitis events in a total of 271 months (1.11 per patient year, p < 0.01). The children had a benefit from tube feeding via a gastrostoma in regard of body weight (BMI + 1.61 SDS, p < 0.01) as well as growth (body height + 2.29 SDS, p < 0.05)., Conclusion: Tube feeding via a gastrostoma is a good and safe option for alimentation, even under peritoneal dialysis. A decrease of PD-associated peritonitis under tube feeding was observed while physical development was positively influenced., (Georg Thieme Verlag KG Stuttgart. New York.)

Introduction: The introduction of double-balloon enteroscopy for the investigation of the small bowel in 2001 was a milestone in GI endoscopy because it allows us to carry out therapeutic interventions as well as diagnostic procedures in the small bowel. Because interventional procedures in endoscopy increase the risk of complications, e.g., in colonoscopy and only limited data were reported regarding the risk of DBE, we introduced a double-balloon enteroscopy register (DBE Register) in Germany., Aim and Methods: The purpose of this study was to evaluate the complication rate of DBE in a larger group of patients. We contacted all endoscopic units using DBE in Germany in January 2006 and asked for their participation in the register, the examination data and their present complications beginning in January 2003 until 15.07.2006 using a questionnaire., Results: The participation rate of 85 endoscopic centres using the DBE technique was 75 % (64 centres). They reported 3894 DBE examinations (2685 using the oral route, 1209 using the anal route) with 1086 interventions. 48 complications were reported (1.2 %). Acute pancreatitis occurred in 9 patients with 1 lethal course of disease, all of them receiving a DBE using the oral route. Thus, the pancreatitis rate after oral DBE was 0.34 %. Perforation happened in 8 cases, all of them needed surgery. One patient died during the course of the disease. 6 perforations occurred after polypectomy, so the perforation rate after polypectomy during DBE is 3.4 % in this study. In 6 cases major bleeding was reported, 4 in the context of polypectomy and 2 after biopsy. All patients received endoscopic treatment and recovered from this complication., Conclusion: DBE is in this by now largest collection of cases a safe endoscopic procedure with an overall complication rate of approximately 1%. For diagnostic DBE pancreatitis is the most frequent complication and has to be taken in consideration in the written informed consent.

The epidemiological pattern of gastrointestinal bleed in western countries has been steadily changing over the last few years given the rising prevalence of an elderly population. In a one year prospective study at a referral hospital in Zurich, Switzerland, hospitalised patients were investigated with regards to the epidemiology of gastrointestinal (GI) bleeding. Of 7406 hospitalisations, a total number of 224 GI bleeds were registered (53% women, mean age 71 +/- 16, 63% with relevant co morbidities). Of 197 patients with GI bleeds, 51% had upper and 37% lower gastrointestinal bleedings. 2% had concurrent upper and lower gastrointestinal bleedings and 10% remained unexplained. The following spectrum of lesions identified as bleeding sources was: 24% ulcer bleedings, 16% diverticular bleedings, 10% colitis, 10% esophagitis and 6% Mallory-Weiss lesions. The frequency of bleeds significantly increased with patient's age. In addition, diverticular bleeding in the elderly was highly associated with intake of Aspirin. The prognosis of gastrointestinal bleeding in elderly patients in this study was excellent with a bleeding associated mortality of only 3.1%.

Due to progress in general medicine and especially in gastroenterology, the incidence of acute gastrointestinal hemorrhage could be expected to have decreased during the last 25 years. However, published epidemiological data cannot, in general, fulfill this hope. The interpretation of potential trends is, however, often limited by low study quality. For example, questionable bleeding sources such as erosions in the upper gastrointestinal tract or colon diverticula are often rather uncritically named the definitive causes of bleeding. However, there is clear evidence of changes in grouping of patients. After the almost complete disappearance of Helicobacter pylori in younger indigenous populations of most industrialized countries, it is mostly elderly comorbid people with additional risk factors (NSAID use, low-dose aspirin, anticoagulation) who are affected. Not unexpectedly, this group has generally experienced no change in incidence and in fact shows a deterioration of prognosis in case of acute bleeding.

In gastrointestinal bleeding, the diagnosis is predominantly made by endoscopy. However, if the bleeding site is in a part of the intestine that cannot be reached by endoscopy, than the diagnosis is based on radiological and scintigraphic methods. In the past 5 years 35 patients with such cases of gastrointestinal bleeding had angiography and/or scintigraphy (n = 15) in our department. Based on our retrospective study of those cases, we advocate a management protocol for such patients based on the hemodynamic presentation.

Up to 80% of patients with liver cirrhosis develop esophageal variceal bleeding which is lethal in up to 30% after the first bleeding episode. Parameters suitable to identify patients being on risk to bleed from their varices are severe liver disease (Child's C), large varices with red color sign and red wall markings and high intra-variceal pressure above 12 mmHg.

Over a period of 2,541 days (7 years) patients with the diagnosis groups acute oesophageal and gastrointestinal haemorrhage, respectively (n = 395), cerebrovascular insufficiency (n = 689) and acute myocardial infarction (n = 701) were registered. From the individual meteorological data registered in the same period the temperature the evaporation warmth of the water, the specific warmth capacity of the air, the air pressure and a constant calculation factor were used for the calculation of the equivalent temperature. Thus by its means a measure for the warmth content of the air was at our disposal which is determined by a series of factors. Between the emergency situations mentioned and the equivalent temperature established a correlation test for significance was performed. In these cases was the result that there are significant relations between the cerebrovascular insufficiency. Though already a larger number of meteorological parameters entered into our investigations, the result supposes that further important meteorological data should not be neglected, such as phases of weather and front transits. This shall be taken into consideration in future investigations.

Among 5776 patients operated on under general anaesthesia there was an increased risk of postoperative gastro-intestinal bleeding from stress lesions among those aged over 70 years, after major surgery, or with complications such as hypovolaemia, septicaemia or respiratory failure (n = 551). In this group of patients the incidence of fatal haemorrhage was 0.5%. Stress lesions were a certain cause of bleeding from the gastro-intestinal tract in 5.1% and a probable one in 5.1%. Time of year, sex, past history of peptic ulcer, or anticoagulation did not increase the risk of bleeding.

5463 operations for gallstone disease were followed eleven times (0,2%) by haemorrhage. 16 intragastric (1,2%) and 11 haemorrhages into the peritoneal cavity (0,8%) could be observed after a total of 1370 operations for gastric or duodenal ulcer. For the most part haemorrhage into the peritoneal cavity frequently occurred within the first 24 hours, whereas the intragastric bleeding appeared later. Both manifestations showed the signs of haemorrhagic shock. While haemorrhage into the peritoneal cavity had to be treated mostly by secondary laparotomy after adequate shock therapy, intragastric haemorrhage could be cured most without surgical treatment.

The results of 1416 endoscopic polypectomies of the upper gastrointestinal tract are reported, realised in 15 endoscopic centers of the GDR. In 2,8% a polypoid carcinoma, in 0,7% a carcinoid and in 1,3% mesenchymic polyps were found. Complications was bleedings in 3,1% and perforations in 0,7%. Then the whole rate of complications was 3,17%. 5 patients (0.35%) had to be operated as a consequence of complications. One patient (0.07%) died from a fulminat hepatitis after transfusion. These results correspond with those reported in international literature on endoscopic polypectomies in the upper gastrointestinal tract.

In the period between 1965-1974 564 patients with gastrointestinal hemorrhages were admitted in the medical clinic of the District Hospital St. Georg Leipzig. Of them 112 patients (20%) were at once or after failure of a conservative therapy admitted in the surgical clinic for operation. 82 patients died (18%) of the conservatively treated patients). The most frequent sources of haemorrhage duodenal ulcers with 32%, ventricular ulcers with 25% and carcinomas of the stomach with 19%. In 13% of the patients haemorrhages induced by drugs could be assumed. In 13% the case were recidivation haemorrhages. Severe gastrointestinal haemorrhages were observed only in 4% of the patients and consequently were less important in our patients. A further improvement of the diagnostic exactness is possible by perfection of the early diagnosis (emergency gastroscopy and angiography), which may be important with regard to a surgical intervention.

The influence of zinc content in the diet on cadmium retention in the liver and kidney was studied in growing chicks. Cadmium and zinc concentrations used were similar to those occurring in normally feeds. Increasing cadmium levels in feeds resulted in increasing cadmium concentrations in organs. The cadmium levels in liver were about half as high as in kidneys. Physical conditions and growth rate of the chicks remained unaffected by the cadmium feeding. Cadmium retention in liver and kidneys was related to the zinc content of the diet. Feeding zinc-deficient diets resulted in a 40% higher cadmium retention than feeding adequate zinc diets (50 mg/kg). Excessive zinc levels had no additional effect on cadmium retention.

There will be analyzed the postoperative results in 1351 resected patients with bronchial carcinoma from 1957 to 1975 with special reference to the problem of postoperative complications.1. The rates of complications and lethality have been dropped remarkably during the last years. The frequency of complications is now 11.9% and the lethality 4.1%. The mean value of all patients: 19.2% complications; 6.2% lethality. 2. On the top of all complications there are the empyemas, embolisms, haemorrhages-also those of the gastrointestinal tract-and the insufficiency of the cardiorespiratory system, which has a lethality of about 50%. 3. Age, lung-function and the extent of the resection are influencing the complication rate. 4. Excluding wound healing disturbances central tumors show twice as much complications (20%) as peripheral tumors (10%). But wound healing disturbances have the highest rate in intermediate tumors (9.9%), in contrast to the central tumors (3.9%) and peripheral neoplasms (6.2%). 5. The postoperative lethality has a direct and remarkable effect on to the 5 year-healing results. 6. In view of the therapy of the empyemas the plastic surgical methods should be reduced in favour to new standards of conservative therapy, which have to be worked out.