Splenic vein thrombosis: an unusual case of gastric bleeding.

Acute and/or recurrent gastrointestinal bleeding due to ruptured gastric varices from an isolated thrombosed splenic vein is a distinct entity. Incidence of this syndrome is probably less than 1%. Typical clinical features of this syndrome include evidence of splenic hypertension without liver disease and no demonstrable cause of gastrointestinal hemorrhage. Diagnosis can easily be missed unless the surgeon is familiar with this syndrome. Typical findings at the time of surgery are an enlarged spleen, varicose veins usually involving the upper third of the stomach, and pancreatic and peripancreatic inflammation. Portal vein and portal pressure will be normal. Meso-portography is a convenient and safe procedure and will lend support to suspicion when a retrograde nonfilling of the splenic vein is present. Splenectomy offers the expectation of a long-range cure. A representative case of a 39-year-old man is discussed. He had at least six episodes of gastric bleeding in less than 3 years. At a previous laparotomy, the cause of bleeding could not be determined. A splenectomy in December 1970 has been able to control the gastric bleeding since then.

The characteristics of cocaine users among young adults in Sydney.

OBJECTIVE: To describe the prevalence and pattern of cocaine use among young Sydney adults interviewed during a study of the "market position" of cocaine. DESIGN: A telephone survey of young Sydney adults. PARTICIPANTS: A total of 499 young Sydney men and women aged between 14 and 35 were selected to ensure a sample of 300 persons who used alcohol and tobacco at least weekly, and who had been offered or had tried at least one illicit drug. MAIN OUTCOME MEASURES: These were the prevalence of having ever used cocaine, the frequency of cocaine use, the prevalence of daily alcohol and tobacco use, and of ever having tried marijuana, sedatives, designer drugs, amphetamines and heroin. RESULTS: Thirteen per cent of the sample (95% confidence interval [CI], 10%-16%) had ever tried cocaine, of whom only 20% (CI, 15%-25%) were current users. Cocaine users were distinguished from non-users by being more likely to be daily users of tobacco (odds ratio, 2.1; CI, 1.3-3.6) and alcohol (odds ratio, 3.0; CI, 1.7-5.6), and to have tried marijuana (odds ratio, 7.1; CI, 3.2-15.9), sedatives (odds ratio, 11.4; CI, 6.4-20.7), designer drugs (odds ratio, 17.2; CI, 9.2-32.2), amphetamines (odds ratio, 27.1; CI, 14.3-51.3), and heroin (odds ratio, 36.5; CI, 14.0-94.9). The odds of having tried cocaine increased with the number of different types of illicit drugs that the person had tried. CONCLUSIONS: The prevalence of ever having tried cocaine was low among a sample of young adults selected to ensure an over-representation of illicit drug users. Cocaine users were more likely to have experimented with a variety of different types of illicit drugs. Only a minority of those who had ever tried cocaine were current users.