A comparison of diazepam and phenoperidine in premedication for upper gastrointestinal endoscopy: a randomized double blind controlled study.

A variety of agents are used as premedication for upper gastrointestinal endoscopy (U.G.E.). To our knowledge, no double blind studies have been performed to compare their value. In this study phenoperidine (2 mg i.v.) was compared with diazepam (t mg i.v.) in 200 consecutive patients undergoing elective U.G.E. The study was randomized and double blind in regard to both endoscopists and patients. All patients were given atropine (0.4 mg i.v.) and a throat spray with 2% amethocaine. Patients who needed supplemental medication were given diazepam and excluded from final analysis. A graded questionnaire was recorded by endoscopists and patients after U.G.E., and a further anonymous questionnaire was returned by patients four days later. Statistical analysis revealed that phenoperidine was superior at facilitating intubation and providing more relaxation as judged by the endoscopist. Patient questionnaires, four days after U.G.E., indicated less distress during intubation and examination with phenoperidine. Nausea, vomiting, amnesia and phlebitis were uncommon after either phenoperidine or diazepam.

Fractionated dose cholecystography: a comparison between iopanoic acid and sodium ipodate.

Two randomised groups of 100 subjects each, undergoing oral cholecystography, were given either a 6 g fractionated dose of iopanoic acid (Telepaque) or sodium ipodate (Biloptin) to determine the relative merits of this dose schedule. Exclusions to the study were pregnancy and iodine sensitivity. Calculi or abnormal gallbladder opacification were present in 45% of subjects. Both agents were equally effective in demonstrating abnormalities, although bile duct visualisation was better using iopanoic acid (P less than 0.05). Of 46 subjects with abnormal cholecystograms subsequently undergoing surgery, all had the diagnosis confirmed. Side effects occurred in 63% of all subjects, being twice as common in those taking iopanoic acid (P less than 0.01). Sodium ipodate in a large fractionated dose is favoured because of the lower occurrence of side effects without loss of diagnostic accuracy.

Iron deficiency anaemia--a prospective study.

A prospective study was performed over 15 months to determine the cause of iron deficiency in adult males and postmenopausal females attending a general hospital. The laboratory computer identified all subjects with a haemoglobin less than 10.6 g/dl and a mean corpuscular volume less than 86 fl. Patients becoming anaemic after trauma or recent surgery were excluded. The iron status of each patient was assessed by serum iron studies, serum ferritin or sternal marrow aspiration. Reduced red cell indices and blood film morphology were not diagnostic of iron deficiency. Of 215 patients assessed, about half (103) were found to be iron replete. This group had a variety of disorders--malignancy, chronic inflammation, chronic renal and non-malignant haematological diseases. The other group of 104 patients satisfied criteria for iron deficiency, and 100 of these were investigated further. The cause of iron deficiency was found in all but three subjects. Inadequate dietary intake was a contributing factor in over half of the patients and 40 regularly took salicylates. Investigation defined a source of chronic gastrointestinal blood loss in most instances.

The Mallory-Weiss lesion: a five-year experience.

A retrospective survey has been made of patients with the Mallory-Weiss lesion who presented with upper gastrointestinal tract bleeding during the period 1972 to 1976. The lesion was diagnosed endoscopically in 78 cases, representing 7.7% of the total number of patients admitted with upper gastrointestinal tract bleeding. Patients ranged in age from 18 to 86 years (mean 43 years). The male-female ratio was 3:1. A history of retching and vomiting clearly preceded the bleeding in 60 patients. Significant alcohol intake within 48 hours of bleeding was reported in 53% of patients. Other upper gastrointestinal tract conditions, or migraine, may have induced vomiting in some instances. Previously known Mallory-Weiss lesions were rare (two patients), but 21% of patients had well documented past upper gastrointestinal tract bleeding from other causes. The tears were situated at the cardio-oesophageal junction in 47% of patients and were entirely gastric in 30%; 23% were oesophageal. Blood replacement was required in 31 patients (40%), and 16 of these were transfused with five or more units. Of those patients requiring transfusion, half had other significant pathological lesions. The mean hospital stay was four days and prolonged stay in hospital was usually necessary only in the presence of other disease. In no instance was surgery required primarily to control bleeding from mucosal tears. This study suggests that the Mallory-Weiss lesion is a relatively common cause of upper gastrointestinal tract bleeding, but that it is usually a benign condition, unless it complicates some other disorder.

The significance of widening of the presacral space at contrast radiography in inflammatory bowel disease.

The width of the presacral space was measured prospectively at various levels in 100 persons without organic colonic or rectal disease who had barium enema X-ray examinations. A standard technique was employed. The most consistent measurement was obtained at the level opposite the S3-S4 disc space; readings varied between 2 mm and 16 mm. Using 16 mm as the upper limit of normal, and a similar technique of barium enema examination, the width of the presacral space at the S3-S4 disc level was measured in 66 patients with inflammatory bowel disease (ulcerative colitis--49; Crohn's colitis--17). The width did not correlate with the severity of the disease process as indicated by sigmoidoscopic examination in proximity in time to the radiological examination. There was a relationship between increased width of the presacral space and the duration of the disease process.

Colonoscopy and bacteraemia.

A prospective study was performed on 35 patients undergoing colonoscopy. Aerobic and anaerobic blood cultures before, during and after the investigation failed to demonstrate bacteraemia in any instance.

Endoscopic diagnosis of metastatic disease of the stomach and duodenum.

The commonest tumours which metastasise to the upper gastrointestinal tract are from malignant melanoma, carcinoma of the breast and lung. Over a period of 12 months, three persons with known malignant disease were submitted to endoscopy by reason of upper gastrointestinal symptoms which could have been due to associated non-malignant disease. Two patients had known malignant melanoma and one a carcinoma of the breast. In each instance, endoscopy and biopsy demonstrated evidence of metastatic disease.

Bleeding mucosal lesions in the upper gastrointestinal tracts of patients with oesophageal varices and hepatic cirrhosis.

Thirty panendoscopic examinations were carried out on 24 patients with oesophageal varices and hepatic cirrhosis who presented with gastrointestinal hemorrhage. A mucosal lesion, focal or diffuse, was found in the upper gastrointestinal tract in all but three instances. The findings confirmed previous reports that hemorrhage in patients with oesophageal varices frequently occurs from a source other than variceal. This study has also demonstrated that where hemorrhage occurs from oesophageal varices, erosions of the oesophageal mucosa may play a major role in its pathogenesis.