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Introduction: Three challenges that physicians and decision makers in the health care systems have to meet are a remarkable proportion of medical decisions without a sufficient base of scientific evidence, a slow and opaque process of integrating scientific knowledge into medical practice and a steadily decreasing half-life period of the medical knowledge., Discussion: During the last two decades, a number of projects have faced these problems and forced the development of evidence-based medicine (EBM). This concept claims the explicit conscientious use of current evidence from clinical research combined with the personal expertise in the process of medical decision making. The following article explains the main steps of practising and teaching EBM illustrated by a clinical example.

Among the many inflammatory diseases of the colon, Crohn's disease and ulcerative colitis occur most frequently. For primary evaluation, endoscopy has widely replaced the barium enema (BE) as diagnostic method. BE, however can provide important additional informations in the differential diagnosis of chronic inflammatory colonic diseases. Purpose of this article is the demonstration of typical, but also of atypical radiological changes in different stages of Crohn's disease and ulcerative colitis, as well as calling attention to the importance of CT. A BE demands a refined examination technique using double contrast. All CT-examinations have to be scrutinized for changes of the bowel and mesentery. A dedicated spiral-CT examination might be indicated in a known disease in order to obtain special informations. The advantage of a BE over endoscopy is a clear and reproducible demonstration of the patterns of distribution and character of the disease as well as the detection of fistulae. The classification into one or the other disease entity can be better accomplished. CT is superior in detecting bowel wall thickening, extraintestinal disease and complications. In diagnostic imaging of chronic inflammatory bowel diseases, endoscopy and radiologic techniques are used complementarily.

Background: Some randomised controlled trials (RCTs) done in German-speaking Europe are published in international English-language journals and others in national German-language journals. We assessed whether authors are more likely to report trials with statistically significant results in English than in German., Methods: We studied pairs of RCT reports, matched for first author and time of publication, with one report published in German and the other in English. Pairs were identified from reports round in a manual search of five leading German-language journals and from reports published by the same authors in English found on Medline. Quality of methods and reporting were assessed with two different scales by two investigators who were unaware of authors' identities, affiliations, and other characteristics of trial reports. Main study endpoints were selected by two investigators who were unaware of trial results. Our main outcome was the number of pairs of studies in which the levels of significance (shown by p values) were discordant., Findings: 62 eligible pairs of reports were identified but 19 (31%) were excluded because they were duplicate publications. A further three pairs (5%) were excluded because no p values were given. The remaining 40 pairs were analysed. Design characteristics and quality features were similar for reports in both languages. Only 35% of German-language articles, compared with 62% of English-language articles, reported significant (p < 0.05) differences in the main endpoint between study and control groups (p = 0.002 by McNemar's test). Logistic regression showed that the only characteristic that predicted publication in an English-language journal was a significant result. The odds ratio for publication of trials with significant results in English was 3.75 (95% CI 1.25-11.3)., Interpretation: Authors were more likely to publish RCTs in an English-language journal if the results were statistically significant. English language bias may, therefore, be introduced in reviews and meta-analyses if they include only trials reported in English. The effort of the Cochrane Collaboration to identify as many controlled trials as possible, through the manual search of many medical journals published in different languages will help to reduce such bias.

The ever growing tide of results from great numbers of clinical studies clearly outweighs the abilities of the individual clinician to keep abreast of the actual state of scientific evidence and to apply it in his clinical decision-making in a timely and valid manner. Evidence-based medicine, with its central demand to link best individual clinical knowledge with best available external, scientific evidence to achieve optimal patient care, has clearly identified the urgent need for scientific techniques which allow the synthesis of scientific evidence, as collected in numerous singular studies, in an explicit, reproducible, and critically appraisable report format, and to update these reports regularly. The methods of Systematic Reviews, encompassing the techniques of meta-analysis, were developed for this purpose. They are explained and presented here in detail as they relate to the field of cardiology. Various problematic aspects have recently dominated cardiologists' discussion of meta-analyses. We point out that the techniques of Systematic Reviews hold promising solutions for many of them and that work on technical improvements is ongoing. The International Cochrane Collaboration is introduced as a global network of scientists and experts from varying fields of medicine with the aim of producing highest quality Systematic Reviews on a wide scope of topics. However, to date only few cardiologists have joined the rapidly rising numbers of Cochrane collaborators.

The gastrointestinal tract is the most common extranodal site for non-Hodgkin's lymphoma. Primary gastrointestinal lymphoma (PGIL) represents a specific entity and has to be differentiated from nodal lymphomas because of its different biological behaviour, prognosis and treatment. Imaging methods are important for detection and staging of PGIL. Gastrointestinal lymphomas produce a spectrum of pathological and radiological appearances. PGIL is encountered often enough to warrant familiarity with the clinical, radiological and therapeutic options.

The purpose of this work was to assess retrospectively the yield of enteroclysis in 124 unselected patients presenting with obscure gastrointestinal bleeding. Of 1000 consecutive patients who were examined by enteroclysis 124 presented with occult gastrointestinal bleeding. A total of 61 patients with an unknown source of bleeding at the time of discharge, but with established gastrointestinal bleeding, were followed up by questionnaire to correlate the initial degree of bleeding with the incidence of recurrence of bleeding. Enteroclysis was normal in 109 cases. An abnormality was found subsequently be the cause of bleeding in the small intestine in 16 patients. Enteroclysis was positive in 14 cases, negative in 2 and false positive in 1. There was positive correlation between the initial degree of haemorrhage and the rate of recurrence. Enteroclysis detected the cause in 11% of patients who presented with bleeding of unknown origin. In patients with minor haemorrhage there was no recurrence of bleeding in most cases.

Sarcomas of the small bowel are rare and particularly unusual to originate within the Meckel's or jejunal diverticula. We report two cases of malignant tumors involving neural or muscular fibers in the wall of small bowel diverticula, and briefly review the pertinent literature.

These are the principal questions of this study: are the early functions of negation, such as REJECTION, and the later emerging DENIAL no developmentally related? And when do children start to deny? So far, evidence for the questions at hand has been almost exclusively observational. We decided on a simple elicitation procedure instead, asking 48 children (ages between 1;1 and 2;7) easy yes/no-questions. The most likely age range for the appearance of denial no was 1;8-2;1. Its error-free acquisition supports the continuity theory of negation development, which holds that essentials of denial no carry over from the earlier functions of no. Finally an attempt is made to account for the beginnings of denial in terms of semantics and the representational theory of child cognition.

We report on the interstitial treatment of prostatic cancer with 125-iodine-seeds and additional plastic orchiectomy done without staging-lymphadenectomy to enable a minimal invasive procedure in old men. First results from three years appear promising.

Gastroenterologists are displaying increasing interest in small-bowel motility disorders. This paper reports on the investigation of motility disorders of the small bowel with a standardized enteroclysis technique with barium and methylcellulose. The method can detect both disturbed motility and morphological changes. Examples of different causes (neurogenic-humoral factors, malabsorption, intestinal wall disease, ischemia and vascular disorders) are described. In some patients the finding of disturbed motility is the only observation of any clinical significance. In others it may be helpful in establishment of correct diagnosis or narrowing of the differential diagnosis. The efficiency and accuracy of small-bowel radiology can be improved by this method.

A modified technique of the small bowel enema is described. Diluted barium followed by an aqueous suspension of 0.5% methylcellulose is injected through a duodenal tube. Pathologic findings can be better recognized by the resulting double-contrast images than by other techniques. A detailed description of this method, and of our own experience, is given.

Seven patients had a percutaneous transluminal removal of catheter fragments using a Dormier stone-basket within the last 14 months. An immediate intervention should be performed because serious complications are expected from catheter embolization. The percutaneous transluminal catheter retrieval as a method of low risk and of little discomfort to the patient should always precede surgical procedures. The Dormier-basket proved to be a successful and easy handling catheter instrument in all our cases.

The radiologic findings on small bowel enema examination using barium and methylcellulose (SBE + Ba + MC) in a patient with Whipple's disease before and after treatment are described. The changes on SBE + Ba + MC corresponded well to the clinical and morphologic picture. The advantages of this double contrast technique compared to the enteroclysis with barium alone are demonstrated. The SBE + Ba + MC is a good method to demonstrate the manifestations of Whipple's disease involving the small bowel and the mesentery.

Investigations on hemostasis with the infrared contact coagulator (ICC) after renal pole resections in dogs with and without clamping of the renal vessels are reported. Clamping the renal vessels led to less bleeding, but the coagulation time was distinctly prolonged. In addition the use of ICC in renal pole amputations in humans is described in two cases of urogenital tuberculosis. In both cases we were able to stop the bleeding quickly and satisfactorily without clamping the renal vessels. The results of animal experiments and the significance of using the ICC in man are discussed.

It has been shown in an animal experiment that alterations of the renal vasculature and parenchyma after hemostasis performed by Infrared-Contact-Coagulation are best shown by intravital magnification angiography (magnification factor 2.22). Following pole resection and hemostasis the final morphologic state is reached 6 weeks postoperatively. The resulting scar penetrates into the parenchyma up to 1 cm. The loss of function corresponds to the parenchymal defect. There was no additional loss of renal function or damage to the parenchyma on nuclear medicine or histologic examinations.

A beam-expanding and spatial-filtering device, the prefocused objective-pinhole unit (POP unit), is presented. The design is primarily aimed at greater simplicity in handling and construction than the commercially available lens-pinhole spatial filters (LPSF), for once the pinhole is fixed in the correct position with respect to the objective, the alignment of the whole unit can be made an easy matter.