[Schistosomiasis--a rare cause of iron deficiency anemia]. / Schistosomiasis--seltene Ursache einer Eisenmangelanämie.

We report on a young african women, who had a severe anemia due to iron deficiency. By colonoscopy we found as cause a late stage of intestinal schistosomiasis. On this occasion we agree to the pathophysiology, the epidemiology, the symptomatology, the diagnosis and the therapy of this disease.

[Life threatening epistaxis due to plasma coagulation disorder as a partial manifestation of gluten sensitive enteropathy]. / Lebensbedrohliche Epistaxis infolge plasmatischer Gerinnungsstörung als Teilmanifestation einer glutensensitiven Enteropathie.

We report on a 73 years old female patient receiving a recurrent epistaxis due to a severe plasmatic malcoagulation. In spite of since twenty years remaining diarrhoea coeliac disease has been diagnosed but now causative of the malcoagulation. On the occasion of this report clinical, current pathogenetical, immunological and pathohistological aspects of coeliac disease have been described. At last we agree to the differential diagnosis of anaemia in coeliac disease and in this connection to the metabolism of vitamin K too.

Prospective, randomized, double-blind comparison of benzalazine and sulfasalazine in the treatment of active ulcerative colitis.

Benzalazine (salicylazobenzoic acid, SAB), a 5-azo derivative of 5-aminosalicylic acid, has been designed as a new therapeutic agent for the treatment of inflammatory bowel disease which might lack the frequent side effects caused by the sulfapyridine moiety of the sulfasalazine molecule (SASP). Here, we report on a prospective, randomized, double-blind comparison of SAB and SASP in patients with an acute relapse of ulcerative colitis. 43 patients with an acute relapse of ulcerative colitis proven by the pertinent endoscopic-macroscopic and histologic criteria were randomized to receive a 6-week course of either 1 g SASP (n = 21) or the equivalent dose of 0.72 g SAB (n = 22) three times a day. Both groups were comparable with respect to demographic data, previous duration and extension of the disease as well as clinical, endoscopic and histologic severity of the relapse. 1 patient on SASP had to be removed from the study due to side effects, while 3 patients on SAB were removed due to rapid worsening of the disease requiring either surgery (1 patient with toxic megacolon) or additional steroid treatment (2 patients). 2 SAB patients were lost to follow-up after substantial improvement had been observed within the first 3 weeks of treatment. In the remaining patients (20 SASP, 17 SAB), stool frequency, stool consistency and macroscopic appearance as well as histology of the diseased mucosa were improved within 6 weeks, with no significant difference between the two groups with respect to any of the parameters recorded. Side effects were recorded in 5 patients on SASP (3 with nausea, 1 with pruritus and 1 with a generalized exanthema) and in 3 patients on SAB (all nausea and vomiting; difference not statistically significant). We conclude that SAB and SASP in equivalent doses are of similar efficacy in the treatment of active ulcerative colitis.

[Metronidazole in the treatment of Crohn disease. Results of a controlled randomized prospective study]. / Metronidazol in der Behandlung des Morbus Crohn. Ergebnisse einer kontrollierten randomisierten prospektiven Studie.

In a controlled, randomised prospective study on 52 patients with active ileocolitis Crohn (n = 44) or discharging fistulae (n = 18) metronidazole monotherapy was compared with a combination of cortisone and salazosulfapyridine, and of cortisone, salazosulfapyridine and metronidazole, respectively. Therapeutic efficacy was judged by various clinical, laboratory and haematological activity parameters, as well as by closure of discharging fistulae. Although analysis of variance showed no significant differences in the changes in individual activity parameters between the three groups, the combination of cortisone, salazosulfapyridine und metronidazole normalised the nine activity parameters more often than the other treatments. Metronidazole alone led to complete closure of discharging fistulae in 40% of cases and produced a clear reduction in fistula discharge in a further 20%. A more effective fistulae therapy could not be achieved even when combined with cortisone and salazosulfapyridine. In view of the dose-related serum concentrations of metronidazole and its minimal inhibitory concentration for anaerobic bacteria, the dose of metronidazole in ileocolitis Crohn should not be less than 400 mg/d. After evaluation of all findings, and taking into account the neurological side effects of long-term metronidazole therapy, the main indications for metronidazole in ileocolitis are failure of cortisone and salazosulfapyridine as well as discharging fistulae.

Serum concentrations of metronidazole and its main metabolite in patients with active Crohn's disease: correlation with disease activity and therapeutic efficacy?

Serum concentrations of metronidazole and its main metabolite [1-(2-hydroxyethyl)-2-hydroxymethyl-5-nitroimidazole] have been determined by high performance liquid chromatography in sera of 10 patients with histologically confirmed ileocolitis Crohn, 7 presenting with highly active disease and pathologically increased Crohn's disease activity index (CDAI) and 3 with secreting fistulas but normal CDAI. Metronidazole serum concentrations showed dose-dependent peak characteristics and ranged between 10.62 +/- 0.95 and 24.88 +/- 3.63 micrograms/ml for a metronidazole intake of 1,000 mg/day and between 5.04 +/- 1.13 and 9.21 +/- 1.00 micrograms/ml for a daily intake of 400 mg, whereas its metabolite leveled at constant serum concentrations up to 24 h after onset of therapy, with 7.50 +/- 1.40 micrograms/ml for a metronidazole intake of 1,000 mg/day and 3.20 +/- 0.60 microgram/ml for an intake of 400 mg/day. Considering the known minimum inhibitory concentration of metronidazole for anaerobic bacteria involved in Crohn's disease, this work has shown 400 mg metronidazole to be the minimum daily dosage. Correlation analysis, although limited by the small number of patients investigated so far, indicated a possible positive correlation between metronidazole serum concentrations and disease activity (CDAI, r = 0.480) and therapeutic efficacy (delta CDAI, r = 0.430) in Crohn's disease.

Ten years of colonoscopy.

Over the last 10 years, 6170 colonoscopies have been performed at the Medical Department of the University of Erlangen. On the basis of these examinations, an overview, largely tabular in form, of the developments in the endoscopy of the lower gastrointestinal tract is presented. An assessment of the individual results obtained has intentionally not been undertaken. Present possibilities and requirements are presented by the diagnostic and therapeutic tasks and the solutions thus far employed.