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The term colitis suggests mucosal inflammation as the key event. However, it may be that the disease starts with mucosal hyperproliferation, and inflammation of the impaired mucosa is a succeeding event. Therefore we studied the activity of the intestinal diamine oxidase (DAO) in ulcerative colitis (UC). This enzyme was shown to have a mucosal antiproliferative function. Biopsy specimens of 30 patients having a normal rectosigmoidal mucosa showed a DAO activity of 22.8 nmol/min g. In 12 UC patients the DAO activity was 2.7 nmol/min g (p = 0.01). In 3 patients where UC was in remission the DAO activity was 103, 107 and 208 nmol/min g, indicating an antiproliferative rebound effect. Together with the strongly reduced monoamine oxidase (MAO) activity, the decrease in DAO activity indicates that the large bowel in UC is unable to produce a proliferation terminating substance (probably gamma-aminobutyrate) derived from polyamine metabolism by oxidative deamination (DAO) or by the interconversion pathway (MAO).

The case of an upper oesophageal perforation as a concomitant injury of an isolated fracture of the upper thoracic spine without neurological compromise has not been described so far. A Case report and review of the literature is presented here. Concomitant oesophageal perforations carry a high risk of being missed initially. CT alone can visualize the subtle indirect signs like peri-oesophageal air. The literature revealed that only peri-oesophageal air might be a valid indicator of oesophageal injury. There are no systematic data on thoracic spine fractures with concomitant oesophageal perforations. Mediastinitis secondary to oesophageal perforation might be treated conservatively with endoscopic stent placement rather than surgically. As the radiological signs of concomitant soft tissue injury, like oesophageal perforations, in fractures of the upper thoracic spine are subtle and easily missed initially only anticipation of concomitant injuries by the treating physician based on the trauma mechanism ensures a timely diagnosis.

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Zusammenfassung ! Hintergrund: Elektive Ösophagogastroduodeno-skopien (EGD) werden oft ohne Sedierung durchgeführt. Transorale (TO) und transnasale (TN) EGD haben unterschiedlichen Patientenkomfort und Komplikationen. Patienten und Methoden: In einer kontrollierten, randomisierten, klinischen Studie wurde die TN-EGD mit der TO-EGD ohne Sedierung verglichen, und zwar Gruppe 1 (93 Patienten, TN-EGD mit dünnem Endoskop) mit Gruppe 2 (90 Patienten, TO-EGD mit Standardendoskop). Gruppe 3 (Kontrolle) enthielt 118 Patienten, die früher eine TO-EGD hatten und nun eine TN-EGD bekamen. Arztbewertete Untersuchungszeit und Komplikationen sowie patientenbewertete Nebenwirkungen und Vorlieben wurden verglichen. Ergebnisse: Zwischen Gruppe 1 und 2 gab es keinen signifikanten Unterschied in der Untersuchungszeit. Übelkeit (p = 0,047) und Epistaxis (p < 0,001) waren signifikant häufiger bei der TN-EGD. Die Konversionsrate von TN-zu TO-EGD war mit 4.3 % niedrig. Die TN-EGD wurde besser toleriert (p < 0,001), der Würgereiz war geringer (p < 0,001). Für eine erneute EGD bevorzugen Patienten, die beide Techniken kennen (Gruppe 3), die TN-EGD (80 %). Alle Gruppen wünschen für zukünftige Untersuchungen keine Sedierung (90 %/90 %/89 %). Resultate: Epistaxis nach einer TN-EGD kann meist konservativ behandelt werden. Die TN-EGD ist der TO-EGD überlegen in Bezug auf Wür-gereiz und Akzeptanz der Untersuchung. Patienten, die beide Methoden kennen, bevorzugen die TN-EGD. Die TN-EGD ohne Sedierung wird für den Patientenkomfort empfohlen.Abstract ! Background and Study Aims: Routine esophagogastroduodenoscopy (EGD) is increasingly performed without sedation. Transoral (TO) and transnasal (TN) EGD offer different patient comfort and complications. Patients and Methods: For a controlled, randomized, clinical trial comparing TN-EGD with TO-EGD without sedation, patients were assigned to TN-EGD using a thin endoscope (group 1, 93 patients), or TO-EGD using a standard endoscope (group 2, 90 patients). Physician-rated procedural time and complications as well as patient-rated side effects and preferences were compared. In group 3, patients (118) who had previously undergone TO-EGD, now underwent TN-EGD. Results: Between group 1 and 2 there was no significant difference for procedural time. Nausea (p = 0.047) and epistaxis (p < 0.001) were significantly more frequent for TN-EGD. Conversion rate from TN-to TO-EGD was low with 4.3 %. For TN-EGD, patients' tolerance was better (p < 0.001), gagging was less (p < 0.001). In case of a future EGD, patients who know both procedures (group 3), strongly vote for TN-EGD (80 %). All groups vote against sedation for future procedures (90 %/90 %/ 89 %). Conclusions: Epistaxis can be relevant after TN-EGD, but can mostly be managed conservatively. TN-EGD is superior to TO-EGD regarding subjective and objective gagging as well as procedural tolerance. Patients who experienced both access routes, prefer TN-EGD. TN-EGD without sedation should be aspired for patient comfort and is recommended for routine use.Downloaded ...

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Restorative restproctectomy as single-port surgery through the ostomy site is safe and feasible. No additional incision is necessary. The trauma of conventional laparoscopic access can be further reduced.