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Summary Up to now, strategies for the verification of the correct localization of gastric tubes have not been internationally standardized. In Germany, most units rely on the auscultation method, whereas in the United States a radiological control after tube placement is considered mandatory. In this pilot study, the feasibility of a simple sonographic method for the correct localization of a gastric tube in intensive care units is evaluated. In 60 gastric tube insertions (with 50 patients being on artificial ventilation) performed on a medical intensive care unit, the correct placement of the tube was controlled by 1) auscultation, 2) pH measurement of the aspirate, and 3) sonography. In sonography, correct placement of the tip of the tube in the stomach was ascertained by detecting a 50 ml air jet applied with a syringe via the gastric tube. Results of ultrasound and the other control methods were compared to radiological control of the tube. In 43 patients (72%), the correct placement of the gastric tube was documented by ultrasound, compared to only 23% of patients in which a pH value of less than 4 allowed the proof of correct localization. In 2/20 patients without a detectable air jet on sonography, the gastric tube was located in the esophagus. We conclude that ?bedside? sonography is a fast and easy to perform method for the ascertainment of the correct positioning of a gastric tube and may in most cases be able to replace radiology for this indication. [ABSTRACT FROM AUTHOR]

Unlike in the USA and many other countries, the discipline of infectious diseases is not established as a specialty or a subspecialty in Germany. In order to assess the impact of this structural difference, the knowledge of clinical infectious diseases was compared among 64 German and 82 American physicians and medical students using a 33-question, multiple-choice questionnaire. Participants in the USA had significantly better scores, and, among them, the number of correct answers increased steadily along with clinical experience. In contrast, among the German participants only a minor increase in knowledge was observed after the first 2 years of postgraduate training. The superior knowledge of infectious diseases demonstrated by physicians and medical students in the USA is presumably due to better training in this field during medical school and residency. Additionally, repeated exposure to infectious disease consultation in daily practice is likely to provide continuous medical education. The results of this study may provide a rationale for establishing infectious diseases as a recognized medical subspecialty in Germany.

The chimeric anti-TNF antibody Remicade (Infliximab) has recently been approved for human use by the FDA and is now available on the market. Since there is considerable interest in this kind of treatment among patients with Crohn's disease, an international working group has summarized the presently available information about efficacy, side effects and possible problems of this treatment. Studies show that Remicade is effective in the treatment of active Crohn's disease, maintaining remission and fistulae. The working group does not see Infliximab as a first-line treatment for Crohn's disease. It may be used in active phase recurrent disease, chronic active disease and fistulae if standard treatment was not successful. For the surveillance special attention has to be given to the unknown malignancy rate of Infliximab. Infusion should be performed in an institution, routinely performing intravenous infusions and a two-hour surveillance of the patients should be guaranteed to recognize anaphylactic reactions or acute side effects. There is presently no information indication that the combination with immunosuppressants might increase risks or side effects of this treatment. Due to the limited information available the working group would prefer to use Remicade in studies only and recommends central collection and documentation of all data on efficacy and side effects for the next year.