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Introduction: The influence of a SARS-CoV-2 infection on inflammatory bowel disease (IBD) has not yet been well characterized and it is unclear whether this requires an adaptation of the immunosuppressive therapy., Methods: A national register was established for the retrospective documentation of clinical parameters and changes in immunosuppressive therapy in SARS-CoV-2 infected IBD patients., Results: In total, only 3 of 185 IBD patients (1.6 %) were tested for SARS-CoV-2 infection because of abdominal symptoms. In the course of COVID-19 disease, 43.5 % developed diarrhea, abdominal pain or hematochezia (risk of hospitalization with vs. without abdominal symptoms: 20.0 % vs. 10.6 %, p < 0.01). With active IBD at the time of SARS-CoV-2 detection, there was an increased risk of hospitalization (remission 11.2 %, active IBD 23.3 % p < 0.05). IBD-specific therapy remained unchanged in 115 patients (71.4 %); the most common change was an interruption of systemic therapy (16.2 %)., Discussion: New abdominal symptoms often appeared in SARS-CoV-2 infected IBD patients. However, these only rarely led to SARS-CoV-2 testing. A high IBD activity at the time of SARS-CoV-2 detection was associated with an increased risk of hospitalization., Competing Interests: NT erhielt Vortrags- und Beratungshonorare von Abbvie, Celltrion, Janssen, Falk Foundation, MSD, Takeda und Vifor.RS erhielt Vortrags- und Beratungshonorare von Abbvie, BMS/Celgene, Janssen, Pharmacosmos, MSD, Takeda, Falk Foundation. JW erhielt Referenten- und/oder Beratungshonorar von Abbvie, Janssen, Pfizer Pharma und Takeda.TK erhiehlt Vortrags- und Beratungshonorare von AbbVie, MSD, Pfizer, Ferring, Takeda, JanssenCM erhielt Vortrags- und Beratungshonorare von Abbvie, Biogen, Dr. Falk PharmaGmbH, Galapagos, Gilead, Janssen, MSD Sharp & Dome GmbH, Pfizer, Roche, Samsung, TakedaPharmaGmbH, Vifor PharmaWM erhielt Vortrags- und Beratungshonorare von Abbvie, alanta health service, Almirall, Amgen, Aptalis, biogen, Falk, Gilead, Hexal, Janssen, MSD, Pfizer, Synformulas, Takeda Tillotts, Vifor.HHW erhielt Vortrags- und Beratungshonorare von Abbott, Abbvie, Altimmun, Bayer, Biotest, BMS, BTG, Dicerna, Eisai, Falk, Gilead, Gore, Intercept, Janssen, Merck, MSD, Merz, MYR GmbH, Norgine, Roche und Siemens.CB erhielt Vortrags- und Beratungshonorare von Abbott, Amgen, Biogen, Falk Foundation, Galapagos, GlaxoSmithKline, Janssen, MSD, Pfizer, Shield, Takeda, ViforPCG erhielt Vortrags- und Beratungshonorare von Abbvie, Janssen, Pfizer, TakedaPH erhielt Vortrags- und Beratungshonorare von Falk foundation, Abbvie, MSD, Pfizer, Janssen und Takeda MH erhielt Beratungshonorare von TakedaStS erhielt Vortrags- und Beratungshonorare von Abbvie, Amgen, Biogen, Falk, Janssen, MSD, Pfizer, Takeda, TillottsUvA erhielt Vortrags- und Beratungshonorare von Abbvie, MSD, Takeda, Esocap, Janssen, Falk Foundation, Recordati Pharma, Vifor Pharma.AS erhielt Vortrags- und Beratungshonorare von Abbvie, Amgen, Astellas, Biogen, Celltrion, Consal, CSL Behring, Falk Foundation, Ferring, Galapagos, Gilead, Institut Allergosan, Janssen, MSD, Norgine, Pfizer Pharma, Recordati Pharma, Roche, Shire, Summit Therapeutics und Takeda.ECB, TB, OE, BH, CL, SN, MK, KSt und KSch berichten keine Interessenkonflikte, (Thieme. All rights reserved.)

The complete and reliable documentation of endoscopic findings make up the crucial foundation for the treatment of patients with inflammatory bowel diseases such as Crohn´s disease and ulcerative colitis. These findings are, on the one hand, a prerequisite for therapeutic decisions and, on the other hand, important as a tool for assessing the response to ongoing treatments. Endoscopic reports should, therefore, be recorded according to standardized criteria to ensure that the findings of different endoscopists can be adequately compared and that changes in the course of the disease can be traced back. In consideration of these necessities, fifteen members of the Imaging Working Group of the German Kompetenznetz Darmerkrankungen have created a position paper proposing a structure and specifications for the documentation of endoscopic exams. In addition to the formal report structure, the recommendations address a large number of attributes of acute and chronic inflammatory alterations as well as endoscopically detectable complications, which are explained in detail and illustrated using exemplary images. In addition, more frequently used endoscopic activity indices are presented and their use in everyday clinical practice is discussed., Competing Interests: CS erhielt Beratungshonorare von AbbVie, Biogen, Ewopharma, Janssen-Cilag, MSD Sharp & Dohme, Pfizer und Takeda, AbbVie, Berlin Chemie, Biogen, Ewopharma, Dr. Falk, Janssen-Cilag, med update, Merckle, MSD Sharp & Dohme, Norgine, Novartis, Pfizer, Shire, Shield Therapeutics und Takeda sowie Forschungsunterstützung von AbbVie, Olympus und Pentax. OB erhielt Beratungshonorare von AbbVie, AMGEN, Hexal, Immundiagnostik, Dr. Falk Pharma, FERRING Arzneimittel, Janssen-Cilag, MSD Sharp & Dohme, Shield Therapeutics, Takeda Pharma, Tillotts Pharma sowie Referentenhonorare von AbbVie, Astellas Pharma, Biogen, Bristol-Myers Squibb, Dr. Falk Pharma, FERRING Arzneimittel, Janssen-Cilag, MSD Sharp & Dohme, Pfizer Pharma, Takeda Pharma. DCB hat keine Interessenkonflikte angegeben. MG erhielt Berater- bzw. Vortragshonorare von Janssen, Falk, MSD, Galapagos, AbbVie und Takeda. OD hat keine Interessenkonflikte angegeben. TK erhielt Beratungs- und Vortragshonorare von AbbVie, Allmiral, Arena Pharmaceuticals, Celgene/BMS, Celltrion, Ferring, Falk, Gilead Sciences, Galapagos, Janssen, Medtronic, Mundipharma, MSD, Pfizer, Shire, Sterna Biologicals, Takeda, Tillotts Pharma, JL hat folgende Verbindungen zu Unternehmen offenzulegen (Forschungsunterstützung: Vortragshonorar Berater/Gutachtertätigkeit) Medizinverlage Stuttgart; Celgene GmbH, Falk Foundation, Ferring Arzneimittel GmbH; Repha GmbH biologische Arzneimittel, Steigerwald Arzneimittelwerke GmbH, Sanofi, Dr. Willmar Schwabe; TechLab. JMa erhielt Beraterhonorar von AbbVie, Janssen-Cilag, Pharmacosmos und Takeda sowie Referentenhonorar und Reisekostenerstattungen von AbbVie, Cellgene, Falk Foundation, Ferring, Fujifilm, Janssen-Cilag, MSD, Pfizer und Takeda. WM erhielt Beratungshonorare von AbbVie, Amgen, Hexal, Janssen, MSD, Pfizer, Synformulas, Takeda, Vortragshonorare und Reiseunterstützung von AbbVie, alanta health service, Almirall, Aptalis, biogen, Falk, Gilead, Janssen, Pfizer, MSD, Takeda, Tillots, Vifor, Honorare für Studien von AbbVie, Janssen, MSD, Pfizer, Takeda. Er gibt Tätigkeiten in öffentlich-rechtlichen Gremien an als Mitglied der Vertreterversammlung der Landesärztekammer Saarland, der Beratungskommission der Prüfungsstelle für das Saarland, des beratenden Fachausschusses Fachärzte der KV Saarland, des Landesausschusses der Ärzte und Krankenkassen sowie des erweiterten Landesausschusses Saarland. Er ist abhängig beschäftigt im Konzern der alanta health group GmbH, Hamburg, und hält Aktien der Firmen AbbVie und Gilead. JMu macht folgende Angaben: Kooperationsvertrag mit Pentax, Vortragstätigkeiten für Pentax und Olympus, Vortragstätigkeiten für Helios Deutschland. MR erhielt Vortragshonorare von AbbVie, Janssen-Cilag und Ovesco. Der Arbeitgeber von AS erhielt Honorare für Vortrags- oder Beratungstätigkeit von AbbVie, Biogen, Cellgene, Falk Foundation, Pfizer, Janssen-Cilag, MSD, Pfizer und Takeda. TK erhielt Beratungshonorare von AbbVie, Arena, Biogen, BMS, Celgene, Celltrion, Hospira, Mundipharma, Dr. Falk Pharma GmbH, Gilead, Janssen, MSD Sharp & Dome GmbH, Novartis, Roche, Takeda Pharma GmbH und UCB sowie Referentenhonorare von AbbVie, Dr. Falk Pharma GmbH, Ferring Arzneimittel GmbH, MSD Sharp & Dome GmbH, Pfizer, Roche, Takeda Pharma GmbH und UCB. DW gibt Vortrags- und/oder Beratertätigkeiten für die Firmen AbbVie, Takeda, Janssen, MSD, Ferring, Celgene, Pharmacosmos, Celltrion, Tillotts Pharma und Falk Pharma an. RA hat folgende Verbindungen zu Unternehmen offenzulegen (Beratendes Gremium oder Komitee; Referententätigkeit; Beratungstätigkeit; Forschungsförderung): AbbVie, Amgen, Arena Pharmaceuticals, Biogen, Boehringer Ingelheim, Cellgene, Celltrion Healthcare, Dr. Falk Pharma, Ferring, Galapagos, Gilead, InDex Pharmaceuticals, Janssen-Cilag, Kliniksa Pharmaceuticals, MSD Sharp & Dohme, Novartis, Pandion Therapeutics, Pfizer, Roche Pharma, Samsung Bioepsis, Takeda Pharma, Tillotts Pharma AG., (Thieme. All rights reserved.)

Central pulmonary embolism represents one of the most threatening complications in surgical patients. In most cases deep vein thrombosis of the lower extremities is the source of emboli. Despite the introduction of hypocoagulative drugs in standard surgical concepts the incidence of deep vein thrombosis remains about 10% in trauma patients. Estimated numbers of unknown cases of pulmonary embolism are supposed to be rather high too. In haemodynamically symptomatic pulmonary embolism events and especially when the patient has to be reanimated, mortality rates of up to 93% are reported in literature. After introduction of the heart- and lung-machine in the surgical concept of therapy, survival rates have increased significantly. We report on three cases of successful surgical embolectomy after CPR. In a review of literature current concepts of treatment in central pulmonary embolism are discussed.

Diclofenac is an anti-inflammatory analgesic which is widely used in the therapy of inflammatory joint pain. Diclofenac hepatotoxicity ranges from asymptomatic elevation of transaminase activity to significant liver disease. 31 cases of diclofenac-induced hepatitis with five associated deaths have been already reported in the English, French and Spanish literature. We report the case of a 64-year-old patient who was admitted to the hospital with an icteric hepatitis of sudden onset. The only drug that was taken before admission was diclofenac in a daily dose of 150-200 mg because of a spondylodiscitis. Work-up of the patient included ERCP, laparoscopy and liver biopsy and excluded other reasons of a cholestatic hepatitis. Discontinuation of diclofenac resulted in normalization of transaminase activity and bilirubin concentration within four months. The frequent use of diclofenac and the possibility of fatal liver damage highlights the need that diclofenac-toxicity should be considered in the differential diagnosis of acute cholestatic hepatitis.

Following the development of new techniques in echocardiography and especially of Doppler color flow imaging, a new dimension of cardiac surgery has been brought about. The use of transesophageal probes facilitates routine surgery to be performed without interferences and, also, comparability between repeated ultrasonic measurements. Originally, echocardiography was mainly applied for quality control by comparing pre- and postoperative echocardiograms. Now it is equally important in perioperative strategy planning guiding the surgeon's decision throughout the operation as well as in cardiac emergencies. Using intraoperative echocardiography routinely in cardiac surgery establishes a more and more close cooperation between surgeons, cardiologists, and anesthesiologists. In order to evaluate the clinical relevance of echo findings, they have to be repeatedly correlated to surgical realities and to long term results of clinical outcome.

Several dermatoglyphic studies of patients suffering from genetically determined disorders which are not manifest at birth, indicate an early direct or indirect influence of the causative factors on the formation of dermatoglyphics. On the basis of these observations the present study gives an analysis of the quantitative and qualitative dermatoglyphic characteristics of fingers, palms and soles, as well as body and head measurements and morphological traits of the head and face of nine patients with adult polycystic kidney disease (APCD) type III and of their first and second degree relatives. No malformations nor any significant variation of these variables were observed, i.e. no differences were recorded between patients and controls or patients and their healthy relatives. Yet some interesting trends appeared in dermatoglyphic ridge counts when special methods for intrafamilial comparison were applied. Thus, APCD type III ridge counts on fingers and palms were somewhat lower when plotted against their mid-parent values than those of their healthy sibs. Nevertheless, only studies of additional family material may permit the conclusion that such a constellation is due to type III APCD, and not merely a spurious finding.

55 of 59 patients with artial septal defect, who had been operated in adult age, were examined postoperatively. The mean time interval from the operation was 43,8 months. Two patients had died immediately after the operation; there were no late deaths. The majority of the reexamined subjects was free of symptoms, in no case was there congestive heart failure. Persistence of postoperative symptoms increased with increasing age at the time of operation, but only up to the fourth decade of life. In 26 cases hemodynamics were examined. Mean pulmonary arterial pressure was normal at rest and during a slight ergometric load. In 5 patients there was moderate pulmonary hypertension. In 8 subjects there was minimal, in one patient moderate increase of pulmonary vascular resistance. Heartsize in chest roentgenogramm was increased in about 25% of cases, in more than 50% the pulmonary vessels were accentuated. Irregularities of cardiac rhythm were not more frequent postoperatively, than they had been prior to surgery. However, surgery was followed by a marked decrease of right axis deviation and of EKG signs of right ventricular hypertrophy. Pulmonary function studies revealed a slight decrease of vital capacity and of maximal breathing capacity. These results are favourable compaired to medically treated groups of patients as described in the literature. It is concluded, that even in later adult age the atrial septal defect as a rule is an indication for surgery.

Based on a series of 44 surgical patients with hamartochondromas proven by histology the x-ray appearance and clinical aspects are shown. The percentage of calcified hamartochondromas is slightly higher than in the literature. Only one hamartochondroma was situated endobronchially.

31 infants with anterior abdominal wall defects were treated over the past 10 years. Despite the falling birth rate gastroschisis occurred almost twice as often as omphalocele (19 and 12 cases, respectively). The mortality rate of 71% in omphalocele were related to large defects, rupture of the sac and associated cardiac malformations. The 73% incidence of prematurity, additional malformations and sepsis contributed to the mortality rate of 58% in gastroschisis.

The usefulness of exercise testing and long term-ECG recording in old age was evaluated in a retrospective study. During a period of 24 months 317 long-term-ECGs in 195 patients greater than 70 years and 208 exercise tests in patients greater than 70 years were performed. The mean age of the patients was 73 +/- 3 years. Long-term ECG revealed a high incidence of supraventricular arrhythmias, while PVCs were found in only 28.7% of patients and PVCs greater than 30/h in only 7.3% of patients. Complex ventricular arrhythmias occurred in 25% of patients. Long-term ECG recording appeared to be of particular value in detecting abnormal regulation of heart rate and bradycardia, although symptom correlation with arrhythmias recorded was rare. Exercise testing revealed a higher incidence of PVCs with PVCs recorded in 67% of patients and PVCs greater than 2/min in 42% of patients. The incidence of complex ventricular arrhythmias was slightly greater compared to long-term recording with 29% of all patients. Exercise testing was particularly useful in detecting complex arrhythmias in patients with additional signs of myocardial ischemia (ST-segment depression and/or angina pectoris during increasing levels of exercise). Thus comparing both exercise testing and long-term ECG both appeared to be useful methods to uncover arrhythmias in symptomic patients older than 70 years and have to be considered as complementary tools. Exercise testing is particularly useful in recovering complex ventricular arrhythmias in patients with signs of myocardial ischemia during exercise. Long-term ECG on the other hand allows better recognition of bradycardias and conduction defects that may also be present and may contribute to the patients symptoms.

Familial prevalence of some congenital cardiopathies leads to the conclusion that genetic factors might be involved. The case histories are presented of three families with atrial septal defect, Type II (ASD II) in which autosomal dominant inheritance was assumed on account of the pedigree analysis. Each family member was examined serologically, morphologically and morphometrically. One family was also tested for cytogenetic abnormalities. It is highly probable that the gene responsible for the defect is linked to the HLA system (Lod score = + 3.612) and is, therefore, located on the short arm of chromosome 6. The morphological examinations demonstrated uniformity of individual ear traits in related patients; moreover, the palmar dermatoglyphics showed a tendency to shortening of main line C, to ulnar and distal shifting of the carpal triradius and to an increase in hypothenar patterns. In addition a study was carried out of patients with apparently sporadic cardiopathy. A similar trend as to palmar configuration was observed. An attempt was made to connect known factors causing malformations with the results of this investigations.

The risk of sudden death in our material, is 13.6% of all deaths. 2. In 5 patients (1.6%) death was caused by failure of the pacemaker (PM), or the electrode. 3. Patients with an asynchronous PM have no higher risk for sudden death, than patients with demand PM. 4. In 9 of 44 patients, a dysfunction of the PM or electrode, can not be excluded. Thus, it must be strictly advised in all patients with an implanted PM, that an autopsy and control of the explanted PM and electrode should be performed. 5. Patients who have a higher risk for sudden death (total AV-Block, Adams-Stokes-Attacks) should be kept hospitalized at least 4 weeks after implantation, controlled more frequently than others, and should be labelled as high risk patients in their PM passport. 6. Control of the resistance in the patients circuit can detect impending failure of the electrode and prevent life threatening complications.

Thromboembolic complications represent the main limiting factor in cardiac replacement by totally artificial hearts in calves at present. Thrombus formation within artificial hearts is caused by the appearance of stagnation areas. The ellipsoid heart eliminates stagnation areas by virtue of its production as a one-piece membrane. The heart is driven pneumatically and functions as a diaphragmatic blood pump. The stroke volume is 178 cm3 and the maximal cardiac output 15.8l/Min. Three acute experiments demonstrated a high degree of haemodynamic efficiency without compression of, or interference with surrounding structures, especially the inferior vena cava or the right atrium.

Immediately after open heart operations (extracorporeal circulation) 22 patients were investigated in 2 groups at the intensive care unit. Whereas the control group received Ringer lactate as postoperative infusion (RL-group), the 2nd group was given 50% glucose (0.5 g/kg/h) and insulin (250 U/1,000 cc) (GI-group). In case of need (blood glucose level) additional insulin up to 200 U/h, maximum 800 U/10 h, was supplied. On the 1st postoperative day 500 ml 10% crystalline amino acid solution was added. Before the start of postoperative infusion therapy postoperative serum insulin levels were low in spite of considerably elevated blood glucose levels (glucose utilisation disorder, insulin suppression). In contrast with the RL-group there was in the GI-group a significant decrease of FFA-serum level and cAMP serum level which developed during the infusion. Urine output and urinary glucose excretion was nearly equal in both groups. Urinary potassium excretion in the GI-group remained significantly one third lower than that of the RL-group, in spite of the potassium supply to the GI-group being nearly twice and serum potassium level approximately equal. Urinary sodium excretion of GI-group on the other hand was approximately 15% higher than that of RL-group. In relation to preoperative values postoperative urinary N-excretion of the GI-group was unchanged, whereas in RL-group the postoperative N-excretion was significantly 30% increased; in postoperative alpha-amino-N-excretion there was only a small difference between the groups, which indicates an insulin-modifiable increase in protein breakdown rather than a decreased protein synthesis. According to the obviously improved situation in energetic considerations, cell membrane potential restoration and N-balance resp. protein synthesis in the insulin treated group, the question is discussed whether this therapy (APA) which shifts metabolism to an anabolic state, is of a certain value as a therapeutic measure in the postshock phase.

To determine the influence of interventions on infarct size numerous studies have attempted a comparison between treatment and control groups. This has been complicated by the great variability in the quantity of necrosis due to the differences in coronary bed size and collateral flow. An experimental model is presented in which it is possible to determine an "area at risk of infarction" at several time points during the evolution of the infarct. This model allows to estimate infarct size that may be expected under the present conditions, prior to interventions, early, in vivo and in the same experiment. It is possible to quantitate topographically changes in collateral flow and to investigate the effect of intervention in the same experiment. We found a correlation of life-threatening arrhythmias including ventricular fibrillation with the size of the "myocardium at risk of infarction" and with the size of the infarcts measured post mortem. Several beneficial interventions were studied.