Zeitschrift für Gastroenterologie
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During a 15-year-period 62 adult patients were admitted with diagnosis of Schoenlein-Henoch purpura in our hospital. 25 female and 37 male patients ranged from 30-87 years (mean: 59.5 years) presenting with cutaneous, joint, renal and particularly abdominal involvement were investigated retrospectively. During the course of the disease, all patients developed purpuric rash (100 %), 14 (22,5 %) patients had joint symptoms and renal involvement occurred in 12 (19,3 %) patients. In this study, we discuss 15 (24 %) patients with gastrointestinal symptoms appearing in Henoch's purpura. ⋯ Surgical consultation was obtained for 4 of the 15 patients and laparotomy was performed in 2 patients. All the patients underwent lower and upper endoscopic examination, in 3 cases the authors saw purpuric mucosal lesions in duodenum and in 8 patients were also found coin-like elevated lesions, additionally, biopsy from colonic lesions showed leukocytoclastic vasculitis. It is concluded that endoscopy may play a very important role in the diagnosis and treatment of Schoenlein-Henoch purpura.
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Prospective payment systems using the diagnosis related groups (DRG) payment mechanism have been introduced in many countries all over the world. In June 2000 the Australian Refined Diagnosis Related Groups System (AR-DRG) was chosen as the model which will be introduced in 2003 as the control instrument for the hospital dependent public health system in Germany. Background and possible implications for gastroenterologists and hepatologists are discussed.
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Traumatic rupture of the gallbladder is a very rare event associated with high mortality. Since clinical symptoms are nonspecific, diagnosis is difficult. ⋯ Initially, he was misdiagnosed to have ascites caused by liver cirrhosis. This case demonstrates, that the combination of patients history, clinical investigation and ultrasound allows the diagnosis of traumatic rupture of the gallbladder.
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Comment Letter
Long-term follow-up of patients with iron deficiency anemia.
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Meckel's diverticulitis is a rare disease. In addition to physical examination, abdominal ultrasound can help to pinpoint the diagnosis. By presenting a case report we would like to demonstrate the typical ultrasonographic findings in acute Meckel's diverticulitis and differentiate it from acute appendicitis. ⋯ The major ultrasonographic difference between an inflamed Meckel's diverticulum and acute appendicitis is its anatomical location. In contrast to the appendix there is no association with the cecum. A diameter of up to 40 mm and a well-defined wall of small bowel with 3 definite layers visible by ultrasound may help to distinguish between a Meckel's diverticulum and the appendix.