Findings on optical colonoscopy after positive CT colonography exam

BACKGROUND & AIMS:  The aim of this study is to evaluate the findings on optical colonoscopy (OC) after a positive CT colonography (CTC) exam and characterize the type of polyps seen on OC but not reported by CTC.
METHODS:  Over an 18-month period a total of 159 asymptomatic adults had polyps seen on computed tomography colonography examination and subsequently underwent planned therapeutic optical colonoscopy. The colonoscopists were aware of the findings on CT colonography prior to further evaluation of the colon. Characteristics of polyps and adenomas seen on subsequent optical colonoscopy but not seen or reported on CT colonography were examined.
RESULTS:  The adenoma miss rate for CT colonography overall was 18.9% (25/132) including 6.2% (4/65) for polyps >9 mm and 18.2% (8/44) for polyps 6–9 mm. Three of the adenomas >9 mm not seen on CTC were sessile, and two were found in patients with technically difficult CT colonography studies due to poor colonic distention. No adenomas with advanced pathology <6 mm were found on optical colonoscopy but not reported on CT colonography. False-positive CTC referral where no polyp was seen on colonoscopy was 5.0%.
CONCLUSIONS:  CT colonography has adenoma miss rates similar to miss rates historically found with optical colonoscopy, with most missed adenomas being <10 mm and sessile in shape.     

Was ändert sich für die Rheumatologie im G-DRG-System 2006?

Zusammenfassung Durch die erneut umfassende Überarbeitung des G-DRG-Fallpauschalenkatalogs 2006 wird eine nochmals exaktere Darstellung insbesondere spezialisierter Leistungen möglich. Die neu eingeführte DRG I97Z (Rheumatologische Komplexbehandlung bei Krankheiten und Störungen an Muskel-Skelett-System und Bindegewebe) erlaubt eine sachgerechtere Darstellung der Behandlungsrealität rheumatologischer Fachkliniken und -abteilungen in Deutschland. Durch die spezifischere Abbildung kann der finanzielle Druck, der aus der zunehmend Budget-wirksamen Umverteilung im zweiten Jahr der Konvergenzphase resultiert, abgemildert werden. Voraussetzung ist, dass sich die betroffenen Krankenhäuser mit der Fallmengenplanung und Kalkulation unbewerteter DRGs für die Entgeltverhandlung 2006 auseinandersetzen.Darüber hinaus werden die weiteren relevanten Änderungen des neuen DRG-Systems im Bereich der Zusatzentgelte, der Abrechnungsregeln und der Kodierung vorgestellt und ihre Bedeutung für rheumatologische Kliniken diskutiert.     

Retinoids in the treatment of skin aging: an overview of clinical efficacy and safety

Aging of skin is an intricate biological process consisting of two types. While intrinsic or chronological aging is an inevitable process, photoaging involves the premature aging of skin occurring due to cumulative exposure to ultraviolet radiation. Chronological and photoaging both have clinically differentiable manifestations. Various natural and synthetic retinoids have been explored for the treatment of aging and many of them have shown histological and clinical improvement, but most of the studies have been carried out in patients presenting with photoaged skin. Amongst the retinoids, tretinoin possibly is the most potent and certainly the most widely investigated retinoid for photoaging therapy. Although retinoids show promise in the treatment of skin aging, irritant reactions such as burning, scaling or dermatitis associated with retinoid therapy limit their acceptance by patients. This problem is more prominent with tretinoin and tazarotene whereas other retinoids mainly represented by retinaldehyde and retinol are considerably less irritating. In order to minimize these side effects, various novel drug delivery systems have been developed. In particular, nanoparticles have shown a good potential in improving the stability, tolerability and efficacy of retinoids like tretinoin and retinol. However, more elaborate clinical studies are required to confirm their advantage in the delivery of topical retinoids.