Medical services for the elderly.

The percentage of acute medical beds in Galway Regional Hospital, occupied by patients over 65 years old is more than 50%. This use of acute medical services by elderly, will increase over the next three decades, in line with population projections. Further development of the geriatric service, and more emphasis on training in geriatric medicine is necessary.

Ulcerative enteritis--atypical features.

A 40 year old man with two month history of vomiting and weight loss, was found to have multiple strictures in his small bowel. Investigations outruled known causes of small bowel ulceration, and the flat bowel mucosa did not respond to a gluten free diet. Treatment with steroids conferred a temporary benefit, however, small bowel ulceration persisted.

Impaired coagulation in accidental hypothermia of the elderly.

Six elderly patients with accidental hypothermia were prospectively evaluated for impaired coagulation. All patients had abnormal coagulation profiles. Three patients with severe coagulopathies and serious underlying conditions died while hypothermic. Despite investigation, no cause for disordered coagulation was found in four patients. We conclude that hypothermia per se contributes to disordered coagulation in the elderly.

Coeliac proctitis.

An increased association of ulcerative colitis and coeliac disease has been reported, as have the results of several small-bowel biopsy studies in ulcerative colitis. Forty-two patients from a population of 438 patients with coeliac disease had rectal biopsies. Fourteen of these showed inflammation of various degrees of severity, including three compatible with a diagnosis of ulcerative colitis. The presenting complaint in 34 of these patients was diarrhoea or steatorrhoea. Twenty-seven patients had coeliac disease diagnosed at the same time or after their rectal biopsy. The other 15 were previously diagnosed coeliacs. Twelve of the 14 patients with abnormal rectal biopsy specimens were known to have subtotal/total villous atrophy at the time of rectal biopsy. Proctitis as seen in these coeliac patients had no unique features to differentiate it from proctitis caused by other disorders. The diarrhoea/steatorrhoea stopped in all patients on commencement of a gluten-free diet, except in those with ulcerative colitis. Proctitis is common in patients with coeliac disease presenting with diarrhoea/steatorrhoea. This study supports the finding of an increased association of coeliac disease and ulcerative colitis and is, to our knowledge, the first rectal biopsy study of a coeliac population.

Fatal hepatitis associated with diclofenac.

Non-steroidal anti-inflammatory agents (NSAIDS) are a well recognised cause of hepatotoxicity. Diclofenac, a relatively new NSAID, was first introduced into the UK in 1979. Five cases of hepatitis have recently been reported, principally in the French literature. We report the first fulminant case of hepatitis in the English literature in a patient taking diclofenac and indomethacin.

Long-term effects of pinacidil in hypertensive dialysis patients.

In an open study, thirteen chronic dialysis patients with nonvolume dependent uncontrolled hypertension were treated with pinacidil for a mean period of 43 weeks. Seven patients were taking concomitant antihypertensive therapy. Twelve patients achieved long-term blood pressure control on a mean dose of 33 mg/day. The baseline supine blood pressure was 184/116 mmHg. After 1 week it had fallen to 161/95 mmHg and blood pressure control was maintained over the study period. Patient weight remained stable. The baseline reading was 61.6 kg and at the end of the study it was 59.7 kg. Pulse rate did not change significantly. For the eight patients not taking beta-blockers the mean change in pulse rate was 7.6 beats/min supine and 6.3 beats/min erect (NS). Pretrial urea and creatinine were 27.6 mmol/l and 1027 mumol/l and after 25 weeks they were 29.6 mmol/l and 1087 mumol/l, respectively (NS). Four patients had ECG evidence of left ventricular hypertrophy before the study and one on completion of the trial. Five patients showed correction of T-waves on their ECG's. Six patients experienced side effects, none of which warranted withdrawal of treatment. These findings suggest that pinacidil is a valuable alternative treatment for hypertensive dialysis patients.

Treatment of essential hypertension and hypertension associated with renal impairment with pinacidil: a new vasodilator.

Twenty patients with uncontrolled hypertension were treated with pinacidil for a mean period of 43 weeks (range 10-63 weeks). All patients achieved and maintained significant reductions in blood pressure. The supine blood pressure at baseline was 184/116 mmHg; after one week it was 161/95 mmHg and at 43 weeks it was 138/79 mmHg. The mean dose of pinacidil was 30 mg/day. There was no significant difference between the two groups with respect to the dose of pinacidil or the blood pressure response. Pulse rate and weight remained stable for the group as a whole. Five patients were not taking beta-blockers. The mean baseline pulse rate for this group was 78 beats/min and when maintained on pinacidil it was 82 beat/min (NS). Six patients were not taking diuretics. The mean baseline weight for this group was 78.5 kg and while maintained on pinacidil it was 79.2 kg (NS). There was no occurrence of oedema, hirsutism or first dose phenomenon. The mean glomerular filtration rate and renal plasma flow for the renal plasma flow for the renal group was 35.4 ml/min and 192.3 ml/min before pinacidil and after six months they were 32.7 ml/min and 183.2 ml/min (NS) respectively. Six patients experienced minor side-effects. We conclude that pinacidil is a potent, well tolerated antihypertensive agent which merits further study.