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In the present study, the benefits and difficulties of planning and conducting patient surveys in veterinary medicine were examined using 2 examples. One focus was placed on the comparison of the subjective assessment and perception of patient owners with regard to long-term investigation of disease progression.An owner survey was conducted in dogs with chronic enteropathy (CE) and degenerative mitral valve disease (DMVD). In both surveys, the case system of the Clinic for Small Animals of the University of Veterinary Medicine Hannover was used to identify suitable cases based on appropriate diagnoses. Owners were contacted and invited to complete (digitally or postally) a multipart questionnaire on their dogs. The results of the survey were evaluated regarding their agreement with literature data. Based on the results of this evaluation, the study design, reliability of owner perception and the benefit of the survey were examined critically.The search in the clinic's case system provided 125 suitable cases for CE and 145 for DMVD. A total of 81 (CE, response rate 64.8 %) and 72 (DMVD, response rate 49,7 %) owners answered the questionnaire. The owners provided considerably different information concerning the diagnostic examination of their animals. While the statements on the course and forms of disease in CE corresponded to the information from the literature, this was not always the case with DMVD.Patient owner surveys may provide important information about disease progression from the owner's perspective. This is particularly valuable in chronic diseases, the management of which requires good owner compliance. An identical approach to patient selection may lead to results differing in their informative value depending on the disease.In der Studie wurden Nutzen von und Schwierigkeiten bei der Planung und Durchführung von Patientenbesitzerbefragungen in der Kleintiermedizin anhand von 2 Beispielen untersucht. Ein Augenmerk lag auf dem Vergleich der subjektiven Einschätzung und Wahrnehmung der Patientenbesitzer in Bezug zu der durchgeführten Diagnostik und Therapie sowie dem Krankheitsverlauf und der Lebensqualität ihres Tieres.Die beiden Befragungen richteten sich an Besitzer von Hunden mit chronischer Enteropathie (CE) bzw. degenerativer Mitralklappenerkrankung („degenerative mitral valve disease“, DMVD). Das Fallsystem der Klinik für Kleintiere der Tierärztlichen Hochschule Hannover wurde jeweils anhand entsprechender Diagnosen nach geeigneten Fällen durchsucht, die Patientenbesitzer wurden kontaktiert und gebeten, einen mehrteiligen Fragebogen zu ihren Hunden auszufüllen (digital oder postalisch). Die Ergebnisse der Befragung wurden statistisch ausgewertet und in Bezug auf die Übereinstimmung der Wahrnehmung der Patientenbesitzer mit aus der Literatur bekannten Erkenntnissen zu den jeweiligen Erkrankungen verglichen. Anhand der Ergebnisse dieser Auswertung wurden Studiendesign, Zuverlässigkeit der Besitzerwahrnehmung und Nutzen der durchgeführten Befragung kritisch hinterfragt.Die Suche im Fallsystem der Klinik lieferte 125 geeignete Fälle zur CE und 145 zur DMVD. Insgesamt 81 Patientenbesitzer (CE, Rücklaufquote 64,8 %) bzw. 72 (DMVD, Rücklaufquote 49,7 %) beantworteten den Fragebogen. Die Angaben zur diagnostischen Abklärung der Hunde fielen sehr unterschiedlich aus. Während die Aussagen zu Krankheitsverlauf und -formen bei der CE mit den Angaben aus der Literatur übereinstimmen, wichen sie bei der DMVD teilweise deutlich ab.Patientenbesitzerbefragungen können wichtige Hinweise über Krankheitsverläufe aus der Sicht des Besitzers liefern. Dies ist insbesondere bei chronischen Erkrankungen, deren Management eine gute Besitzer-Compliance voraussetzt, wertvoll. Ein identisches Vorgehen bei der Patientenauswahl kann in Abhängigkeit von der Erkrankung zu unterschiedlich aussagekräftigen Ergebnissen führen.

Durch die weltweit zunehmende Inzidenz und Prävalenz der chronisch entzündlichen Darmerkrankungen Morbus Crohn und Colitis ulcerosa sowie der bis dato nicht geklärten Pathophysiologie der Erkrankungen und der aktuell somit nicht ursächlich wirkenden Medikation ist es notwendig, den Blick Richtung neuer Therapieoptionen zu richten, zu welchen die fäkale Mikrobiomtransplantation (FMT) gehört. Ziel der vorliegenden Arbeit war es, das aktuelle Bild der fäkalen Mikrobiomtransplantation von Patienten mit Morbus Crohn und Colitis ulcerosa darzustellen, um daraus Schlüsse hinsichtlich des Informationsstandes, der Therapiebereitschaft, dem generellen Patientenwunsch und Problematiken im Bild dieser neuen Therapieoption zu ziehen. Hierzu wurde eine Querschnittsstudie mit Hilfe eines 57 Fragen umfassenden Fragebogens im Patientenkollektiv der Ambulanz für chronisch entzündliche Darmerkrankungen an der Universitätsklinik Ulm durchgeführt. Insgesamt konnten die Daten von 302 Patienten ausgewertet werden. Bezüglich der fäkalen Mikrobiomtransplantation war die Mehrzahl gegenüber der Therapie aufgeschlossen. Es fanden sich Hinweise, dass insbesondere ein Mangel an Informationen über das Verfahren oder seine Chancen bei den Unentschlossenen relevant war. Mindestanforderungen an die Therapie waren eine Remissionswahrscheinlichkeit von 64,2% und Ausprägung der Symptome von 3,72 auf einer Skala bis 5; wobei die Therapie als last line Option vor einer möglichen Operation gesehen wird. Die am besten akzeptierte Methode zur Durchführung der FMT ist die Gabe per Kapsel. Hauptgründe für eine ablehnende Haltung sind Bedenken bezüglich Infektionsübertragungen und Ekel.

The aim of the present study was to investigate the degree of correlation between ultrasonographic findings of the stomach and the obtained reflux volume in horses with secondary gastric distension.In this prospective, controlled clinical study, warmblood horses presented with secondary gastric distension at the Clinic for Horses between 2017 and 2018 were included. Gastric fluid content was assessed sonographically by evaluating the number of intercostal spaces with detectable fluid level as well as the maximum height of gastric fluid. These findings were compared to the amount of reflux obtained.Eleven horses with a total of 52 examinations were included into the study. Gastric fluid levels were detectable over a median of 6 intercostal spaces (interquartil range [IQR] 3). The maximum extension recorded was over 9 intercostal spaces. Median obtained reflux amounted to 7 liters (IQR 6.5), with a maximum of 14 liters. The number of intercostal spaces with detectable fluid levels and obtained reflux volume exhibited a strong correlation with a correlation coefficient of 0.77 (p ≤ 0.001). Moderate correlation (correlation coefficient 0.59 with p ≤ 0.001) was observed between the maximum height of fluid levels and the obtained volume of reflux. Based on number of intercostal spaces with measurable gastric fluid levels estimation values for the obtainable reflux volume were established. When fluid levels are detectable over 5 or 6 intercostal spaces approximately 5.7-7.4 liters of reflux are to be expected. The maximum height of gastric fluid levels may be considered insufficient for an accurate prediction of reflux volume due to the moderate correlation of these 2 parameters.Due to the high correlation between number of intercostal spaces with sonographically detectable fluid levels and the obtained reflux volume, this parameter seems to be adequate to predict reflux amount. Based on this estimation, management of horses with paralytic ileus may be optimized.Ziel der Studie war zu klären, inwieweit ein Zusammenhang zwischen den Ultraschallbefunden am Magen und der gewonnenen Menge an Reflux bei Pferden mit sekundärer Magenüberladung besteht.In der prospektiven kontrollierten Studie wurden Warmblutpferde mit sekundärer Magenüberladung einbezogen, die in den Jahren 2017 bis 2018 in der Klinik für Pferde vorgestellt worden waren. Die gewonnene Menge an Reflux wurde sowohl der Anzahl der Interkostalräume mit sonografisch erfassbarem Flüssigkeitsspiegel als auch der maximalen Höhe des Flüssigkeitsspiegels im Magen gegenübergestellt.Im Untersuchungszeitraum erfolgten 52 Untersuchungen an 11 Pferden. Die Anzahl der Interkostalräume mit darstellbarem Flüssigkeitsspiegel im Magen betrug im Median 6 Interkostalräume (Interquartilsabstand, IQR 3). Die größte Ausdehnung umfasste 9 Interkostalräume. Die Menge an gewonnenem Reflux lag im Median bei 7 Litern (IQR 6,5) mit einem Höchstwert von 14 Litern. Zwischen der Anzahl der Interkostalräume mit erfassbarem Flüssigkeitsspiegel und gewonnener Refluxmenge wurde eine starke Korrelation mit einem Korrelationskoeffizienten von r = 0,77 (p ≤ 0,001) festgestellt. Bei der Korrelation zwischen maximaler Höhe des Flüssigkeitsspiegels und Refluxmenge ergab sich ein moderater Zusammenhang mit einem Korrelationskoeffizienten von r = 0,59 (p ≤ 0,001). Anhand der Zahl der Interkostalräume mit erfassbarem Flüssigkeitsspiegel konnten Vorhersagewerte für die zu erwartende Refluxmenge ermittelt werden. Bei einem darstellbaren Flüssigkeitsspiegel über 5 bzw. 6 Interkostalräume ist mit ca. 5,7 bzw. 7,4 Litern Reflux zu rechnen. Die Nutzung der Höhe des Flüssigkeitsspiegels erscheint aufgrund der moderaten Korrelation hierfür weniger geeignet.Aufgrund der starken Korrelation zwischen der Anzahl der Interkostalräume mit erfassbarem Flüssigkeitsspiegel und gewonnener Refluxmenge erscheint dieser Messwert zur Vorhersage des zu erwartenden Refluxes geeignet. Mithilfe dieser Vorhersage lässt sich das Management um den Patienten mit einem paralytischen Ileus optimieren.

Patients with severely orally decompensated malsaborption due to surgical rescetion suffer from short bowel syndrome (SBS). The resultant decrease in intestinal surface area after rescetion of parts of the intestines leads to chronic functional intestinal insufficiency or even complete failure (cIF) which requires parenteral fluid and nutrient restoration for establishment of metabolc stability. Since the introduction of glucagon-like peptide (GLP)-2 analogues such as teduglutide functional rehabilitation of the remaining gastrointestinal tract has become a causal treatment option. Teduglutide functionally and effectively enhances intestinal absorption of fluid as well micro- and macronutrients allowing a reduction of parenteral nutrition and/or volume with even complete weaning off in some patients. This results increased metabolic stability, oral autonomy, quality of life and putatively less complications.Das chronische Darmversagen (CVD) bei Kurzdarmsyndrom (KDS) wird sowohl durch die postoperative Anatomie als auch funktionell anhand des parenteralen Kalorien- und Volumenbedarfs klassifiziert.Die postoperative Anpassungsreaktion nach Darmresektion verläuft in 3 Phasen, die jeweils eines interdisziplinären Managements bedürfen.Ziel der Therapie ist eine ausreichende Kalorien- und Nährstoffversorgung unter Vermeidung einer Hyperalimentation bzw. die Linderung/Beherrschung der Diarrhöen. CHIRURGISCHE MAßNAHMEN EINSCHLIEßLICH TRANSPLANTATION: Die chirurgische Wiederherstellung der Kontinuität ausgeschalteter Darmabschnitte ist unverzichtbar. Es bestehen prinzipiell verschiedene Optionen der Transplantation, der Nachweis für eine Verbesserung der Gesamtprognose steht allerdings noch aus. FUNKTIONELLE INTESTINALE REHABILITATION DURCH GLP-2-ANALOGA: Durch die Einführung von Glucagon-like-peptide-2-Analoga (GLP-2-Analoga) in die funktionelle intestinale Rehabilitation von KDS-Patienten ist nunmehr eine kausale Behandlung dieses Malabsorptionssyndroms möglich. Durch die GLP-2-Analoga-vermittelte Steigerung der Flüssigkeits-, Nährstoff- und Kalorienabsorption ist eine Reduzierung der parenteralen Substitution (PS), im Idealfall mit kompletter Entwöhnung, möglich.

Sitosterolemia or phytosterolemia is a rare autosomal recessive hereditary lipid storage disorder. It is caused by homozygous or compound heterozygous mutations in one of the two ABCG5 and ABCG8 genes encoding the intestinal and hepatic heterodimer ABCG5 (sterolin 1)/ABCG8 (sterolin 2) efflux transporters. These mutations lead to intestinal hyperabsorption and reduced hepatic secretion of cholesterol and plant sterols with subsequent accumulation of phytosterols and cholesterol in plasma and deposition in tissue (xanthoma). Phytosterols are found mainly in vegetable oils, margarine, nuts, grains, soybeans and avocados. Patients with sitosterolemia show extreme phenotypic heterogeneity from almost asymptomatic individuals to those with combined severe hypercholesterolemia at a young age, leading to increased atherosclerosis and premature cardiac death. Early abnormalities include hemolytic anemia with stomatocytosis, macrothrombocytopenia and splenomegaly. In addition to strict avoidance of phytosterol-containing foods, the use of the sterol absorption inhibitor ezetimibe, possibly in combination with the bile acid-binding resin cholestyramine, is the most effective treatment option.

A 72-year-old female presented with a therapy-resistant diarrhea.In the case of negative stool cultures and inconspicuous radiological imaging, further endoscopic diagnostics were performed. Histological implicated the image of a celiac disease in the duodenum and lymphocytic colitis reaching into the terminal ileum. In the case of negative antibody detection for celiac disease, a medication side effect was considered by differential diagnosis.When olmesartan was discontinued, she developed a rapid improvement of the symptoms.For the angiotensin receptor antagonist olmesartan, the occurrence of a sprue-like enteropathy has rarely described. Microscopic colitis is an exception.Wir berichten von einer 72–jährigen Patientin mit einer therapieresistenten Diarrhö.Bei negativem Keimnachweis und unauffälliger Bildgebung erfolgte eine endoskopische Diagnostik. Histologisch imponierte das Bild einer Zöliakie im Duodenum sowie einer lymphozytären Kolitis bis in das terminale Ileum und eine mikroskopische Kolitis. Bei negativem Antikörpernachweis für eine Zöliakie ergab sich die Verdachtsdiagnose einer Medikamentennebenwirkung.Nach Absetzen des Sartans Olmesartan kam es zu einer raschen Besserung der Symptomatik.Für den AT

Gastric Bypass: Weight Loss with Complications Abstract. Roux-en-Y gastric bypass (RYGBP) is the most often performed bariatric operation worldwide with internal hernia as one of the main long-term complications. To our knowledge, we report the first case of post-ischemic small-bowel strictures observed after a successful operation of an internal hernia after RYGBP. During emergency surgery a Petersen and a Brolin hernia were diagnosed and repaired. The initially ischemic small intestine was recovered. However, a week later the patient presented herself again due to ischemia-induced small-bowel strictures. These were treated successfully by endoscopic balloon dilatation.Zusammenfassung. Der Roux-Y-Magenbypass (RYGBP) stellt weltweit die am häufigsten durchgeführte bariatrische Operation dar – innere Hernien zählen zu den wichtigsten Langzeitkomplikationen. Unser Bericht einer 30-jährigen Patientin beschreibt erstmalig einen Fall einer ischämisch bedingten Dünndarmstenose nach RYGBP. Bei der Erstvorstellung wurden eine Petersen- und eine Brolin-Hernie diagnostiziert und laparoskopisch erfolgreich verschlossen. Der minderperfundierte Dünndarmanteil erholte sich in der Folge gut. Die Zweitvorstellung folgte eine Woche darauf bei postprandialem Erbrechen aufgrund postischämischer Dünndarmstenosen. Diese wurden mittels Ballondilatation erfolgreich behandelt.

We report three cases of severe olmesartan-associated chronic diarrhea with weight loss and malassimilation syndrome. Histologically, a sprue-like enteropathy was diagnosed in each case, while serological tests for celiac disease were negative. After stopping the medication, symptoms improved within a few days. Histologically, remission was documented after 3 months. Olmesartan-associated enteropathy is an underestimated entity and an important differential diagnosis in patients with chronic diarrhea.

In the last 10 years, we have learned much about the pathogenesis, diagnosis, and management of intestinal fibrosis in patients with inflammatory bowel diseases. Just a decade ago, intestinal strictures were considered to be an inevitable consequence of long-term inflammation in patients who did not respond to anti-inflammatory therapies. Inflammatory bowel diseases−associated fibrosis was seen as an irreversible process that frequently led to intestinal obstructions requiring surgical intervention. This paradigm has changed rapidly, due to the antifibrotic approaches that may become available. We review the mechanisms and diagnosis of this serious complication of inflammatory bowel diseases, as well as factors that predict its progression and management strategies.

A 47-year-old woman with spina bifida and an ileal conduit since childhood presented with left-sided flank pain, bilateral hydronephrosis and oliguria suspicious for a recurrent stenosis at the ureteral implantation site. Her history revealed a recent increase in her pain medication with opioids for treatment of neuropathic pain. After insertion of percutaneous nephrostomy on the left side and confirmation of the stenosis, open reimplantation of the ureter was already discussed with the patient. However after dose reduction of the opioid therapy hydronephrosis resolved. Thus opioid-induced bowel spasm was probably the cause for the obstruction.

This review describes the gasterointestinal entities, their pathophysiology, clinical presentation, diagnostic workup and therapy that typically involve weight loss as the major presenting symptom. The differentiation of malassimilation into maldigestion and malabsorption is clinically mostly not helpful. Instead primary malasssimilation can be distinguished from secondary due to another disease. Celiac disease, lambliasis, small bowel CD, CVIDS and Whipple's disease result in loss of absorptive surface. Chronic intestinal pseudobstruction leads to weight loss through dysmotility and postprandial pain. Microscopic colitis involves some weight loss and needs to be considered because of its high prevalence. Exocrine pancreatic insufficiency and the various protein loosing enteropathies may be primary or secondary syndromes. Dumping, bile acid malabsorption and short bowel syndrome occur after typical operative procedures. Chronic radiation enteritis, chronic intestinal ischemia and intestinal diabetic polyneuropathy are due to chronic intestinal injury.

Intestinal failure is characterized by intestinal water and electrolyte losses as well as malabsorption of macronutrients. It often requires individually composed parenteral support (so call compounding). Teduglutide, a DPP-IV resistant GLP2 analogue, is available a pharmacologic treatment, which stimulates intestinal absorption and can facilitate infusion free days. Catheter infections are the most common complication of home parenteral support. The incidence can be minimized using Taurolidin as a catheter block solution.

The radiological diagnostics of diseases of the small intestine have undergone a great change in the last two decades. Through rapid progress with new treatments and an increasing therapeutic focus on transmural healing, a complete evaluation of the gastrointestinal tract is now crucial.With the introduction of endoscopy, gastrointestinal imaging with a relatively high radiation exposure had only limited applications. The development of cross-sectional imaging allowed a much broader radiological evaluation of abdominal diseases. Due to rapid investigation techniques, excellent soft tissue contrast and the distinct advantage of eliminating exposure to radiation, magnetic resonance imaging (MRI) of the gastrointestinal tract has gained increasing importance. With sufficient filling of the intestinal lumen, simultaneous imaging of all the intestinal wall layers, the perienteric structures and associated abdominal pathologies is now possible.New MR sequences, such as diffusion-weighted sequences, dynamic contrast-enhanced sequences and MR fluoroscopy, enable the detection of morphological changes, with additional characterization of affected bowel loops as well as the assessment of functional pathologies with dynamic information about intestinal motility disturbances.Recent guidelines of European radiological and gastroenterological organizations have confirmed the importance of cross-sectional imaging and particularly of MRI for diagnostics and follow-up in patients with Crohn's disease. Due to the possibility of assessment of all the layers of the intestinal wall and the presence of extramural complications, MRI has a significant impact on further therapeutic treatment in patients with inflammatory bowel disease.Especially in patients with inflammatory bowel disease, MR enterography and MR enteroclysis should be the methods of choice for the evaluation of small bowel pathologies because of radiation issues and the great diagnostic value they provide. A variety of MR sequences has enabled not only the detection but also the characterization of pathological changes of the small intestine, which are vital for further treatment of these patients.

Diverticular disease is associated with a high incidence, morbidity and burden of the healthcare system. However, the pathogenesis is not yet satisfactorily clarified and thought to be multifactorial. Non-influenceable risk factors include increasing age, genetic predisposition and rare congenital connective tissue diseases. Influenceable risk factors are low-fiber diet, increased meat consumption and obesity. Alterations of connective tissue lead to a weakening of preformed emergence sites of diverticula ("loci minoris resistentiae") and may explain the increased incidence of diverticular disease in diseases caused by a systematic connective tissue disorder. The impact of neuromuscular alterations and disturbed colonic motility on triggering diverticula formation has been previously underestimated. Moreover, intestinal innervation disorders are considered to be responsable for persisting recurrent pain symptoms in chronic diverticular disease.

Every surgical intervention is associated with the risk of intraoperative complications. These occur in approximately 2-12% of patients but significantly influence the postoperative outcome, overall complication and mortality rates. This article presents the treatment of typical intraoperative complications during surgery of the lower gastrointestinal tract with a focus on the prevention and identification of risk factors. Especially changes in the regular anatomy caused by previous surgery, inflammation, tumors and emergency situations carry the risk of iatrogenic injuries to the bowels, spleen, ureter and blood vessels. These risk factors must be considered when choosing a surgical procedure, a surgical approach or an appropriate surgeon. The early detection of complications with a definitive restoration is the essential step for a successful treatment without long-term sequelae. Every delay in therapy is associated with an increased morbidity and mortality and should be avoided.

Perioperative complications following surgical procedures of the lower gastrointestinal tract still represent a relevant problem. The perioperative morbidity may negatively affect short and long-term outcomes of treatment of individual patients. The additional diagnostics and treatment required also lead to additional costs that burden the healthcare system. Ideally, complications should be avoided by preventive measures. In the event of a complication, early detection is essential for appropriate treatment.Surgical site infections (SSI) have been described as the most common complication in the postoperative period and may occur in up to 30% of cases. Through various perioperative measures up to 40-60% of SSI are preventable. Depending on the location, the reported anastomotic leakage rate ranges from 1% to 23%. The therapeutic strategy ranges from conservative measures through interventional methods up to surgical revision. An early postoperative burst abdomen occurs in about 3% of cases. A midline closure with small stitches and small suture distances (suture length to wound length ratio of 4) seems to be superior to large stitches with long distance intervals. A rare but potentially fatal complication is bleeding. The identification of patients with relevant risk factors is of great importance. This article summarizes the prevention, recognition and treatment of perioperative complications after surgery of the lower gastrointestinal tract.

We report a case of a 77-year old female patient with abdominal pain in the upper right part. In the computertomography we had the suspicion of a rare small bowel diverticulitis which was confirmed in laparoscopic and histopathologic diagnostics. After surgical excision the patient was free of symptoms.Wir berichten über eine 77-jährige Patientin, die sich mit Oberbauchschmerzen rechts vorstellte. Computertomographisch wurde der Verdacht einer seltenen Dünndarmdivertikulitis im Jejunum gestellt, die laparoskopisch und histopathologisch im Exzidat bestätigt wurde. Postoperativ war die Patientin anhaltend beschwerdefrei.

The present paper focuses on clinical issues concerning the psychopharmacological treatment of severe forms of post-traumatic stress disorder (PTSD).Using a case study, we discuss problems in this field against the background of psychodynamic and psychotraumatological theories. We also present strategies for the appropriate use of psychotropic drugs in the psychotherapy of PTSD.

Despite modern surgical and intensive-care concepts, diffuse peritonitis remains a major source of high morbidity and mortality. The aim of this study was to critically evaluate the value of relaparotomy on demand (ROD) for patients with diffuse peritonitis.In a retrospective analysis, the clinical course of 231 patients with diffuse peritonitis was analysed. The mean Mannheim Peritonitis Index (MPI) was 25.3. Overall lethality in this cohort was 14.3 %. In 214 patients, source control was successful during the index operation, and these patients were treated according to an on-demand strategy. For 178 of these patients, there was no demand for a relaparotomy, whereas 36 of these patients required further surgical interventions. Lethality for these subgroups was 9 % (no relaparotomy) and 27 % (relaparotomy), respectively.This retrospective analysis confirms that an on-demand strategy is reasonable and feasible after successful source control and lavage. However, it still remains of clinical importance to identify parameters that may assist in selecting those patients who require a relaparotomy.

The correct therapeutic management of acute sigmoid diverticulitis (SD) is still controversially discussed. Essential to the success of therapy is primarily the long-term resolution of Patient symptoms after surgical or conservative therapy. The aim of this study was to compare the long-term outcome after conservative and surgical treatment of Patients with acute SD.Consecutive admissions of all Patients with acute SD were prospectively recruited from January 2005 to June 2008 with the exception of a free perforation. The following data were recorded: age, sex, first or recurrent episode of SD, computed tomography (CT) stage, white blood cell count, C-reactive protein, persistent symptoms and recurrence after conservative and surgical therapy. Furthermore, information on the rates of postoperative sexual and bladder dysfunction was collected. The long-term outcome was evaluated by a standardized questionnaire. In June 2008 all Patients were contacted using a standardized questionnaire.A total of 153 Patients were included in the study of whom 70 (45.8 %) presented with the first episode, 83 (54.2 %) had a prior history of SD and 40 Patients were treated conservatively whereas 113 Patients were surgically treated by sigmoid resection. Uncomplicated SD was seen in 16 Patients (conservative 4, surgical 12, p = 0.961), phlegmonous SD was seen in 88 cases (conservative 29, surgical 59, p = 0.026) and covered perforated SD in 49 cases (conservative 7, surgical 42, p = 0.022). The median follow-up was 32 months (range 12-52 months). At follow-up 25 % of conservative and 8.8 % of Patients treated surgically complained about persistent symptoms (p = 0.009). The following symptoms occurred (conservative vs. surgery): painful defecation (22.5 % versus 8.8 %, p = 0.024.), constipation (25 % versus 8.8 %, p = 0.009), abdominal cramp (22.5 % versus 4.4 %, p = 0.001) and painful flatulence (25 % versus 8.8 %, p = 0.009). Sexual or bladder dysfunction occurred postoperatively in 7 % and 9 %, respectively. Of the conservatively treated Patients 32.5 % had a recurrence of SD during follow-up compared to 3.5 % of surgically treated Patients (p 0.001).Surgical treatment of acute SD is more effective than conservative therapy for the prophylaxis of recurrent SD and avoidance of persistent symptoms.

The treatment in acute diverticulitis has undergone a considerable shift from an offensive to a more restrictive and individual indication for surgery. This review of the very recent literature with special regard to long-term observation of conservatively treated patients clearly shows that surgery is not required in any case of a first episode of severe diverticulitis, but should be recommended in high-risk patients under immunosuppression or chronic renal failure. In all other groups of patients the indication for surgery should be weighed on an individual basis after each episode, again aiming for the laparoscopic procedure. A therapeutic algorithm is proposed according to the Hansen-Stock classification.

The barium meal with plain X-ray films of the small intestine has for decades been the undisputed gold standard in imaging of the small intestine. More recently, X-rays and fluoroscopy with an overall accuracy of 73% have been replaced by multislice computed tomography (MSCT) or modern magnetic resonance imaging (MRI). Ultrasound is suitable for the orienting investigation of the small intestine in the context of general abdominal sonography as well as for dedicated examinations with a sensitivity of 67-96% and a specificity up to 97%. The endoscopic examinations of the small bowel, such as video capsule endoscopy and double-balloon enteroscopy are expensive and time-consuming techniques, which provide valuable information in special indications. Other than with the stomach or colon, the diagnostics of primary small intestine tumors plays a relatively subordinate role due to the low incidence of 3-5% of all gastrointestinal (GI) neoplasms but with a high sensitivity of 84% and a specificity of up to 97% for computed tomography (CT) and MRI. Predominant questions are those concerning ileus or the diagnostics of passage disturbances after preceding operations, to depict bowel obstructions, adhesions or the involvement of the small bowel in peritoneal carcinomatosis. The sensitivity per lesion in the initial evaluation of Crohn's disease (CD) is 47-68% for capsule endoscopy, 43% for MRI and 21% for CT enterography. In cases of known CD, the sensitivity is 70% for capsule endoscopy and 79% for MRI. A further indication is the evaluation of acute or occult gastrointestinal bleeding.

Ultrasound in addition to endoscopy and radiological methods has become widely accepted for diagnosis and evaluation of therapeutic success of gastrointestinal diseases. In addition to the lumen and more importantly the wall (layering) and the surroundings of the gastrointestinal tract functional processes (peristalsis, bloodflow) can be analysed as well. The current role of gastrointestinal ultrasound was discussed during the Davos meeting 2011 of the «Schweizerische Gesellschaft für Ultraschall» (SGUM) and the literature is summarised in this article.

Ziel der Studie war es, anhand klinischer, verdauungsphysiologischer und immunologischer Parameter und anhand des Einflusses der Intervention auf die Mikrobiota des Verdauungstraktes die Effizienz des Probiotikums als (unterstützende) Therapie bei Hunden mit chronischer Enteropathie zu evaluieren. Dazu wurden an drei verschiedenen Einrichtungen über zwei Jahre 32 Hunde rekrutiert, die eine chronische oder chronisch intermittierende Diarrhoe aufgrund einer chronisch entzündlichen Erkrankung des Dünn- und/ oder Dickdarmes aufwiesen. Es handelte sich um eine doppelblinde, plazebokontrollierte und randomisierte Interventionsstudie, in der die Tiere über einen Zeitraum von 90 Tagen beobachtet wurden. Die Tiere erhielten entweder ein Plazebo oder das aus dem kaninen Gastrointestinaltrakt isolierte Bifidobacterium animalis NCIMB 41199 in einer Dosierung von 1,85-3,20 x 10(hoch9) KbE einmal täglich per os. Klinische und verdauungsphysiologische Parameter wurden entweder täglich mithilfe von Tagebüchern erhoben (Aktivität, Appetit, Erbrechen, Kotkonsistenz, Kotabsatzfrequenz, Hämatochezie, Auftreten mukoider Fäzes) oder mithilfe einer klinischen Untersuchung und durch Fragebogen (Körpermasse, Chronic Inflammatory Bowel Disease Activity Index (CIBDAI), Futterakzeptanz, Entwicklung der Erkrankung im Laufe der Studie, Body Condition Score (BCS), Flatulenzen, Borborygmen, Bauchschmerzen, Unbehagen) im Studienzeitraum erfasst (Tage 0, 14, 30, 60, und 90). Die Blutuntersuchungen zu Beginn und Abschluss der Studie umfassten hämatologische und klinisch-chemische Parameter sowie die Bestimmung von Trypsin-like Immunoreactivity (TLI), Cobalamin, Folsäure und C-reaktivem Protein. Im Blut wurden die Anteile verschiedener Lymphozytenoberflächenmarker (CD21, CD5, CD4 und CD8) erfasst. Die Mikrobiota der Fäzes wurde zu Beginn, in der Mitte der Studie und zum Abschluss mithilfe molekularbiologischer Verfahren selektiv charakterisiert. Der Untersuchungszeitraum wurde in Perioden unterteilt und diese im Gruppenvergleich ausgewertet. Zusätzlich wurden innerhalb der Gruppen Änderungen der verschiedenen Parameter zwischen Beginn und Abschluss verglichen. Unterschiede mit einer Irrtumswahrscheinlichkeit von p, The aim of the study was to evaluate the influence of the probiotic as a (supportive) therapeutic agent on dogs with chronic enteropathies by examining digestive and immunologic parameters and the evaluation of changes in the microbiota of the digestive tract. For over the course of 2 years, 32 dogs were recruited at 3 different animal hospitals, which were shown to have had persistent or recurrent diarrhoea due to chronic inflammatory disease of the small and/or large intestine. The study was a double-blinded, placebo- controlled and randomized trail. The dogs were observed for over a period of 90 days. The animals received the placebo or the probiotic Bifidobacterium animalis NCIMB 41199 at a dosage of 1.85-3.2 x 10(to the power of 9) CFU once a day per os. Clinical parameters and physiological parameters of digestion were surveyed by keeping diaries of the dog´s activities, appetites, and parameters such as vomiting, consistency of faeces, frequency of defecation and occurrence of fresh blood and/or mucus in the faeces. Questionnaires concerning the body weight, Chronic Inflammatory Bowel Disease Activity Index (CIBDAI), acceptance of the diet, changes of the symptoms throughout the study, Body Condition Score (BCS), flatulence, borborygmi, abdominal pain and discomfort were conducted five times throughout the study. Blood examinations at the beginning and end of the study consisted of haematology, clinical chemistry, differential blood cell count as well as determination of the serum TLI, cobalamine, folic acid and C-reactive protein (CRP) concentrations. Lymphocyte phenotyping was conducted to determine the populations of CD21, CD5, CD4 and CD8. Microbial analysis of the faeces using real time polymerase chain reaction was conducted at the beginning of the study, when half of the study was completed, and at the end of the study. Before assessing the data, the study period was divided into four periods and those were evaluated for both groups. Additional changes from the beginning to the end point of the study were compared for each group. The level of significance was set at p < 0.05. Data which were not normally distributed were evaluated by Mann- Whitney-U-Test, and those which were normally distributed by a Student´s t-Test. Despite the randomized distribution of the dogs, the severity of the disease was not equally distributed within the groups. The dogs of the probiotic group showed a significantly higher CIBDAI at the beginning of the study with greater modified parameters recorded in the diaries and questionnaires than the dogs of the placebo group. Throughout the study, both groups showed clinical improvements, but there was a difference: While the dogs of the placebo group showed better results than the dogs of the probiotic group at the beginning of the study, the probiotic group showed better results between days 31 and 60. At the end of the study, the dogs of the placebo group showed improved consistency of faeces, but the rest of the assayed parameters showed no differences. Analysis of the questionnaires for the probiotic group revealed improved results at the end of the study. They were similar in frequency of defecation and the CIBDAI. While the dogs of the probiotic group showed a higher defecation rate than the dogs of the placebo group at the beginning of the study, the placebo group showed a higher defecation rate in periods 2 and 3. There were no differences between the groups at the end of the study. Blood and immunological parameters were not significantly influenced by the probiotic. The influence of Bifidobacterium animalis NCIMB 41199 on the microbiota of the faeces was low. Probiotic DNA was only detected in the faeces of the probiotic group after half of the study was completed and at the end of the study. It was not detected in either group at the beginning, nor in the faeces of the dogs of the placebo group. The achieved data cannot be interpreted without a doubt due to heterogeneity of patients and individually adjusted medication. There is evidence for a positive influence on disease history in the probiotic group compared to the placebo group. For further investigations it would be useful to regard the state of the disease.

The application of imaging methods in patients that are highly dependent on medical support is limited. Ultrasound has a prominent impact due to its flexibility, bedside availability, rapid results, and cost-effectiveness - especially in the assessment of cardiovascular and abdominal diseases. Ultrasound artifacts at the pleura-air interface play an emerging role in the diagnosis of thoracic disease. X-ray imaging is increasingly limited to the assessment of medical artifacts and the follow-up of pulmonary disorders. Daily routine chest X-rays should be abandoned. Multidetector computed tomography has evolved as the gold standard in the definitive diagnosis of many acute critical disorders despite the need for patient transportation. The application of magnetic resonance tomography is in contrast restricted to specific central nervous system diseases.

Multidetector-row CT has shown over the past years that it is able to provide reliable diagnoses in various acute intestinal conditions. The presented article provides an overview of non-inflammatory acute intestinal pathologies, ranging from obstruction to ischemia.

Endometriosis is a disease of the uterus with displacement of endometrium-like tissue outside the endometrium. Endometriosis is a common benign chronic often debilitating disease that primarily affects young woman. The estimated prevalence is about 10 %. In addition to the uterus and ovaries, clinically important localisations are the rectovaginal space, rectum, sigmoid colon, urinary bladder, ureter and peritoneum. The most common localisation outside the pelvis is the abdominal wall. Today, MRI is one of the most important tools in the diagnosis of endometriosis. The detection of peritoneal manifestations and the exact definition of the depth of infiltration in the rectum, sigmoid colon and bladder walls are limitations of MRI.