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Physicians' rounds have traditionally been used to assess and plan patients' treatments and to teach medical students. According to the studies analysed in the review, patients have mostly been satisfied with the information received in the course of the physicians' rounds and eager to be involved in planning and decision-making concerning their treatment. The development challenges are related to improving the confidentiality of information. Interaction between doctor, patient and nurse is slight, as is the involvement of nurses in processing matters. Various checklists would make rounds more systematic. Despite their essentially passive role, medical students see that rounds create useful learning environments.

Tromboembolic complications are 2-4-fold more likely in patients with inflammatory bowel disease (IBD) than in healthy individuals; active IBD may increase the relative risk even 15-fold. Deep vein thrombosis and pulmonary embolism are the most common involvements, but also atypical forms occur. We describe such uncommon thrombotic manifestations in two IBD patients: one had mesenterial vein and the other cavernoid sinus thrombosis. The risk of thrombotic complications should be estimated individually, and prophylactic management with low molecular weight heparin should be considered in hospitalized IBD patients.

Dietary deviations and continuous usage of gluten even in small amounts are the most common causes of poor treatment response for celiac disease. In rare refractory celiac disease symptoms and small bowel mucosal morphological damage do not heal despite a strict diet. In such cases it is important to distinguish between type I and II refractory celiac disease by using small bowel lymphocyte markers and clonality of inflammatory cells. Increased risk of small intestinal lymphoma is especially associated with type II disease, which has a poorer prognosis. Type I is often treated with corticosteroids and azathioprine.

The actual prevalence of celiac disease in the Finnish adult population is already more than 2%. By using sensitive and precise celiac disease antibody tests it is possible to find the correct patients for further investigations. The diagnosis is still based on the gluten-induced villous atrophy found in a biopsy of the small intestine, but celiac disease begins before the development of villous damage. Elevated levels of anti-endomysium or anti-tissue transglutaminase antibodies in a patient with normal intestinal villi are indicative of a developing celiac disease. On a perpetual gluten-free diet, patients remain asymptomatic and capable of working and functioning.