Background and study aim: Capsule endoscopy is widely used for diagnosis of small-bowel disease; however, the impact of capsule endoscopy on clinical management remains uncertain. We conducted a prospective study of the impact capsule endoscopy on clinical management decisions in 128 patients with suspected small-bowel pathology.Methods: Prior to performing each procedure the gastroenterologist predicted the findings of capsule endoscopy and further management based on the clinical history and previous investigations. This prediction was compared with the actual results of capsule endoscopy and the following investigative and therapeutic management.Results: The actual findings of capsule endoscopy and the further management were consistent with clinical prediction in 93/128 patients (73 %) and, irrespective of capsule endoscopy findings, no further procedures were required in 80% of these patients. In 13 patients (10%), gastric or coIonic pathology was discovered that had not been detected on prior gastroscopy or colonoscopy. Thus, capsule endoscopy findings in the small bowel changed clinical management in 22 patients (17%). In 4 patients, positive findings on capsule endoscopy that had not been predicted by the examiner prompted referral for abdominal surgery. Conversely, planned surgery was canceled in four other patients.Conclusion: In this series of patients referred for capsule endoscopy, small-bowel findings and appropriate clinical management were predicted on clinical grounds alone in approximately three-quarters of patients. Repetition of standard upper and lower endoscopy may be useful in many patients prior to small-bowel imaging. Referral for capsule endoscopy should take into account whether the findings will impact on clinical management; however, capsule endoscopy is mandatory in patients in whom surgery for small-bowel bleeding is intended.

In thermoanalytical investigations the determination of the composition of the evolved gases is very important, especially when investigating decomposition processes or gas-solid reactions occurring in multi-component systems. The potential of simultaneous techniques, enabling the qualitative analysis of evolved species, such as TG-MS or TG-FTIR has been further improved by the introduction of the pulse thermal analysis (PulseTA(R)). This method provides a quantitative calibration by relating the mass spectrometric or FTIR signals to the injected quantity of probe gas.The influence of several experimental parameters such as concentration of the analyzed species, temperature and flow rate of the carrier gas on FTIR signals has been investigated. The reliability of quantifying FTIR signals was checked by relating them to the amount of evolved gases measured by thermogravimetry. In order to extend the opportunities for quantifying FTIR signals, the possibility of the injection of liquids into the carrier gas stream was studied. The linear dependence between the injected amount of liquids and the integral intensity of spectroscopic signals (peak area) enabled easy quantification of FTIR data. Systematic studies on a new method based on isothermal vaporization of liquids further widen the application range of in situ calibrations. (C) 2005 Elsevier B.V. All rights reserved.

Simultaneous thermal analysis (TA) and evolved gas analysis by mass spectrometry (MS) and/or Fourier transform infrared spectroscopy (FTIR) is a powerful hyphenated technique combining direct measurement of mass loss and sensitive spectroscopic analysis. In the present study the influence of several experimental parameters which may affect the quantification of FTIR signals have been studied using a combined TA-FTIR-MS system. Parameters studied include: sample mass (1-400 mg), carrier gas flow rate (25-200 mL min -1 ), resolution of the FTIR spectrometer (1-32 cm -1 ), and location of injection of the calibrating gas. MS analysis, which was not significantly affected by the experimental conditions, was used as a reference for assessing the accuracy of quantification by FTIR. The quantification of the spectroscopic signals was verified by the decomposition (NaHCO 3 ) or dehydration (CuSO 4 ·5H 2 O) of compounds with well-known stoichiometry. The systematic study of the parametric sensitivity revealed that spectral resolution and carrier gas flow rate, which affect the acquisition time in the IR-cell, are key parameters that must be adjusted carefully for reliable quantification. The dependence of the reliability of quantification on these parameters is illustrated and conditions leading to proper quantification are discussed. As an example, for a standard spectral resolution of 4 cm -1 and a FTIR gas cell volume of 8.7 mL, the carrier gas flow must be lower than 100 mL min -1 for warranting accurate results (relative deviation <2%). The concentration range of analyzed species is limited but can be extended by proper selection of the wavenumber regions for molecules giving strong IR signals.

Infliximab is a monoclonal chimeric antibody, with high affinity and specificity for tumour necrosis factor alpha (TNFalpha) that plays a central role in the pathogenesis of immune mediated inflammatory disorders including Crohn's disease and ulcerative colitis. Globally over 600000 patients have been treated with infliximab to date. This global experience led to a better definition of the overall safety and efficacy profile of this medication. The goal of the present recommendations is to provide practical information to physicians involved in the care of patients with inflammatory bowel disease.

Manganese–cerium mixed oxide catalysts with different molar ratio Mn/(Mn+Ce) (0, 0.25, 0.50, 0.75, 1) were prepared by citric acid method and investigated concerning their adsorption behavior, redox properties and behavior in the selective catalytic reduction of NOx by NH3. The studies based on pulse thermal analysis combined with mass spectroscopy and FT-IR spectroscopy uncovered a clear correlation between the dependence of these properties and the mixed oxide composition. Highest activity to nitrogen formation was found for catalysts with a molar ratio Mn/(Mn+Ce) of 0.25, whereas the activity was much lower for the pure constituent oxides. Measurements of adsorption uptake of reactants, NOx (NO, NO2) and NH3, and reducibility showed similar dependence on the mixed oxide composition indicating a clear correlation of these properties with catalytic activity. The adsorption studies indicated that NOx and NH3 are adsorbed on separate sites. Consecutive adsorption measurements of the reactants showed similar uptakes as separate measurements indicating that there was no interference between adsorbed reactants. Mechanistic investigations by changing the sequence of admittance of reactants (NOx, NH3) indicated that at 100–150°C nitrogen formation follows an Eley–Rideal type mechanism, where adsorbed ammonia reacts with NOx in the gas phase, whereas adsorbed NOx showed no significant reactivity under conditions used.

AIM First, to assess the clarithromycin resistance (Cla(R)) rate 1) in patients with persistent Helicobacter pylori (H. pylori) infection after eradication,2) in patients with untreated infection and 3) in patients with successful status post eradication. Second, to evaluate the techniques sequencing and line probe hybridisation INNO-LipA for resolution of uniform and mixed populations in archival gastric biopsy samples. METHODS The genomic 2142/43 23s rRNA mutations of the 50S ribosomal subunit conferring Cla(R) were detected by PCR-based assays. RESULTS A total of 130 patients were investigated. Out of 21 patients of a first series with persistent infection after eradication, 19 (90%; CI (95%): 67-99%) exhibited point mutations at position 2142/43. In the second series of untreated patients, primary resistance was observed in 8 out of 93 patients (9%; CI: 4-16%). In a third series of 16 successfully eradicated patients, pure wild type populations (WT; for loci 2142/43) without any minimal mutated part were found (resistance rate 0%; CI: 0-21%). Further, in all 24 biopsies with uniform mutated and in 8 of 11 biopsies with mixed populations the two molecular biological methods yielded concordant results (100%; CI: 86-100% and 73%; CI: 39-94%, respectively). CONCLUSION In the Baden region of Switzerland, most clarithromycin resistant H. pylori strains harbour mutations at position 2142/43. The primary resistance rate is below 10%. Mixed populations, even with minor mutated part, cannot become successfully eradicated. The two investigated techniques are equally valid for resolution of uniform mutated or mixed H. pylori populations in archival biopsy material.

Wir berichten über eine 61-jährige Patientin, die mit den Symptomen eines akuten Abdomens auf die Notfallstation eintrat. Die Computertomographie stellte die Verdachtsdiagnose einer akuten Duodenaldivertikulitis, welche dann endoskopisch und mit einer Magen-Darm-Kontrastmittel-Passage bestätigt wurde. Nach Antibiotika-Therapie konnte die Patientin beschwerdefrei nach Hause entlassen werden.

The potential of pulse thermal analysis (PulseTA®) for measuring gas adsorption is studied. PulseTA® is based on the injection of a given amount of the adsorptive gas into a carrier gas stream and monitoring of changes in mass, enthalpy and gas composition, occurring as a result of adsorption–desorption phenomena. The method allows to study adsorption at atmospheric pressure and temperatures above 30°C. Continuous monitoring of the concentrations of the pulsed probe molecules in the carrier gas provides the opportunity to investigate the dynamics of physisorption processes. The desorption rate of physisorbed species is shown to depend on carrier gas flow and thickness of the sample bed. An important advantage of PulseTA®, compared to classical volumetric methods, is that pretreatment of the adsorbent, determination of the kind and amount of preadsorbed gases, as well as temperature programmed desorption can all be carried out in the same experimental set-up. The efficiency and reliability of PulseTA® for gas adsorption studies is demonstrated by comparing ammonia adsorption measurements on various solids with corresponding volumetric measurements. Solids used as adsorbents include zeolites ZSM-5 and mordenite, a titania–silica aerogel and a commercial nickel catalyst. Integral heats of adsorption and the amount of chemisorbed ammonia were found to agree well with values reported in the literature.

We investigated the palliative effect of self-expanding metallic stents on malignant obstruction of the esophagus in 10 patients. All patients had high grade dysphagia and one had an esophago-bronchial fistula. Endoscopic insertion of the prosthesis was done under sedation. Dilatation of the stricture prior to insertion was rarely necessary. Coated stents were used as secondary treatment for patients with fistulae. The procedure related morbidity was low and no mortality was observed. The stents remained patent during the residual lifetime of the patients. Dislocation or perforation did not occur. The median survival of 8 deceased patients was 3.5 months (range 1.25-14.5 months). At present 2 patients are still alive 2.7 and 1.5 months after the procedure. Self-expanding stents in the esophagus provide good palliative therapy of dysphagia or fistulae caused by malignant tumors. Insertion is relatively simple and safer than in nonexpandable types. These improvements may justify the considerably higher price of these devices.

We investigated the palliative effect of self-expanding metallic stents on malignant obstruction of the esophagus in 10 patients. All patients had high grade dysphagia and one had an esophago-bronchial fistula. Endoscopic insertions of the prosthesis was done under sedation. Dilatation of the stricture prior to insertion was rarely necessary. Coated stents were used as secondary treatment for patients with fistulae. The procedure related morbidity was low and no mortality was observed. The stents remained patent during the residual lifetime of the patients. Dislocation or perforation did not occur. The median survival of 8 deceased patients was 3.5 months (range 1.25-14.5 months). At present 2 patients are still alive 2.7 and 1.5 months after the procedure. Self-expanding stents in the esophagus provide good palliative therapy of dysphagia or fistulae caused by malignant tumors. Insertion is relatively simple and safer than in nonexpandable types. These improvements may justify the considerably higher price of these devices.

The incidence of pancreatitis in bacterial enterocolitis is disputed. Two cases of young patients with S. enteritidis-induced enterocolitis and markedly elevated amylase and lipase blood levels are described. In both patients there were neither clinical nor ultrasonographic signs of pancreatitis. Furthermore, both had increased intestinal permeability for oral 51Cr-EDTA, a condition discussed as "leaky gut" in other publications. In one patient enzyme levels and 51Cr-EDTA resorption became rapidly normal, while in the other the values remained elevated after a 7-month interval with stool culture negative. Enhanced intestinal absorption of 51Cr-EDTA (mw 391) suggests--but does not definitely prove--an inflammatory response of the mucosa leading to increased intestinal permeability, which in turn may allow resorption of amylase (mw 62,000), lipase (43,000) or other macromolecules. Performance of a 51Cr-EDTA resorption test may be helpful in cases of clinical uncertainty.

We describe the clinicopathological features of six patients, two with rheumatoid arthritis and four with osteoarthritis, in whom intake of sustained-release diclofenac for one or more years was associated with ulceration and or stricture of the ascending colon. All were referred for further evaluation of anemia and changes in bowel habits. Three had chronic watery diarrhea, one suffered from progressive constipation and subsequently needed a right hemicolectomy because of complete intestinal obstruction. In five patients, colonoscopy revealed single to multiple semilunar ulcers, predominantly localized on the crest of the haustra of the ascending colon. In five of six cases the lumen was narrowed, from slight accentuation of the haustrum to almost pinhole-like concentric stenosis. All except one patient had multiple diaphragm-like strictures. The macroscopic and microscopic appearances closely resembled those of similar lesions previously described in the terminal ileum in patients treated with nonsteroidal anti-inflammatory drugs. It appears that the slow-release form of a nonsteroidal anti-inflammatory drug, such as sustained-release diclofenac, predisposes to manifestations of such lesions in the ascending colon.

The incidence of pancreatitis in bacterial enterocolitis is disputed. Two cases of young patients with S. enteritidis-induced enterocolitis and markedly elevated amylase and lipase blood levels are described. In both patients there were neither clinical nor ultrasonographic signs of pancreatitis. Furthermore, both had increased intestinal permeability for oral Cr-51-EDTA, a condition discussed as "leaky gut" in other publications. In one patient enzyme levels and Cr-51-EDTA resorption became rapidly normal, while in the other the values remained elevated after a 7-month interval with stool culture negative. Enhanced intestinal absorption of Cr-51-EDTA (mw 391) suggests - but does not definitely prove - an inflammatory response of the mucosa leading to increased intestinal permeability, which in turn may allow resorption of amylase (mw 62,000), lipase (43,000) or other macromolecules. Performance of a Cr-51-EDTA resorption test may be helpful in cases of clinical uncertainty.