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The use of "ecstasy" (Methylenedioxymethamphetamine) as a recreational drug is increasing in europe since the 1980's. Aside intended psychological effects the use of ecstasy can be followed by symptoms of intoxication; complications include toxic hepatic damage up to acute hepatic failure. This case-report is about a 17-year old female patient who regularly used "ecstasy" over a six-month period. Two days after the last use of "ecstasy", she reported to her general practitioner with nausea, vomiting, abdominal pain and jaundice. Within 10 days the patient developed acute liver failure. With criteria for liver transplantation fulfilled she was listed for orthotopic liver transplantation of high urgency which was carried out only one day later. Histological examination of the explanted liver showed evidence for a toxic fulminant hepatitis. After transplantation the patient made a full recovery and was released from hospital on day 26 after transplantation. At the first control after six months the patient was in good physical and nutritional condition, serological parameters were normal and ultrasound examination of the transplanted liver was unremarkable. The ethiopathology of "ecstasy"-induced hepatotoxicity, which can occur dose-independently with a symptom-free period from days to weeks after ingestion is not yet fully understood. Possible mechanisms of hepatic damage include influence of MDMA on body temperature regulation, harmful effects of the substance or further components of the "ecstasy"-tablets on the liver cell or a genetic vulnerability of some individuals against amphetamines and amphetamine derivates. There are no parameters existing which could predict the course and severity of "ecstasy"-induced hepatopathy. Especially in young patients with symptoms of hepatic damage frequent controls of clinical status and relevant laboratory parameters are of great importance. Patient transfer to a specialised centre should follow as early as possible; at the latest, when coagulopathy occurs.

In the face of a hardly predictable course of illness--potentially effecting a severe diminution of daily activities--the quality of life (QOL) represents a chief outcome measure in the treatment of inflammatory bowel diseases (IBD). For the German-speaking area an economical disease-specific instrument measuring QOL has been missing, so far. Therefore, we translated and adapted the recently validated "Short Inflammatory Bowel Disease Questionnaire" SIBDQ (11). Bowel symptoms, systemic symptoms, moods, and social activities are represented by a total of 10 items. Along with this questionnaire 7 accepted instruments assessing QOL-components were administered to 125 outpatients (54 ulcerative colitis, 71 Crohn's disease) and 51 healthy controls. The psychometric properties are good. Consistency is alpha = .84, thereby slightly surpassing the Anglo-American SIBDQ (alpha = .78). Retest-reliability after 26 weeks is r = .60. Systematic covariations with accepted QOL-instruments give evidence for its convergent and discriminatory validity. Differences between groups (high vs. low inflammatory activity vs. healthy controls) substantiate its sensitivity. Thus, the German adaptation of the accepted SIBDQ supplies an economic, reliable, and valid instrument that proved able to assess clinically relevant differences in QOL in patients with IBD. We suggest that it should be used by its overall score rather than its subscales. The instrument is appropriate to be used in therapy outcome and evaluation studies. It allows international comparison.

BACKGROUND: In recent years, data from questionnaires have demonstrated increasing criticism from junior physicians regarding their work conditions. Ideally, such subjective statements should be compared to accurate objective data regarding workload. However, such data is not available in the research literature. Therefore the aim of the current study is to deliver exact data about physicians’ work in different gastroenterology departments to analyze and to optimize work routines. METHOD: An observational real-time study was conducted by shadowing 21 gastroenterologists individually during weekday shifts at three hospitals in urban German settings. A total of 585 hours of observations were recorded by using an ultra mobile computer. RESULTS: The observation results have shown that a gastroenterologist’s working day lasted on an average 9 hours 16 min (SD = 1:11:18 h). The following amount of time was given to varying tasks within this time period: 30.21 % for meetings (SD = 8.54 %), 13.42 % for documentation duties (SD = 7.74 %), 15.53 % for indirect patient care (SD = 6.32 %), 7.98 % for hospital admissions and ward rounds (SD = 5.49 %). Doctor patient communication was restricted to 4.05 % of the working day (SD = 2.71 %). CONCLUSION: This is the first real time analysis on how hospital gastroenterologists spend their working hours. Some of the problems with work routine reported by the doctors themselves were partly confirmed. With regard to the study results a rearrangement of job tasks coupled with technological solutions may prove helpful in reducing the burden on gastroenterologists and thereby improving the quality of medical care.