Emergency oesophageal stripping, an aggressive approach to acute, necrotic caustic burns of the oesophagus and stomach.

The authors describe a patient who was admitted with total necrosis of the oesophageal and gastric mucosa after ingestion of concentrated sodium hydroxide solution. An emergency total gastrectomy and blunt, thoracic oesophageal stripping was performed. Three months later, the continuity of the digestive tract was restored by a retrosternal colon interposition. The necessity of an aggressive diagnostic and therapeutic approach after the ingestion of caustics is recommended. An emergency endoscopic evaluation of the upper G.I. tract is mandatory. If a third degree oesogastric mucosal burn is diagnosed urgent laparatomy should be performed to assess transmural wall necrosis. If present an oesophageal gastrectomy should be performed as a life saving intervention.

Selective rupture of the Wirsung duct: a rare form of pancreatic trauma.

A patient with a traumatic pancreatic lesion, confined to the Wirsung duct, is presented. At first laparotomy, the diagnosis was missed. Posttraumatic acute pancreatitis led to endoscopic pancreatography, disclosing the exact localization of the lesion. Left pancreatectomy led to rapid recovery. A late postoperative pancreatic fistula healed without problems.

Indapamide in the treatment of essential arterial hypertension in the elderly.

Twenty-four patients (average age 72 years) took part in a study of the effectiveness and tolerance of indapamide as medication for essential hypertension in elderly subjects. 2.5 mg was administered daily for two months, after which the same amount was given once every other day in order to investigate whether the antihypertensive effect would persist at this dosage. After two months treatment with 1 tablet of indapamide 2.5 mg daily, statistically significant (P less than 0.01) drops in the mean systolic and diastolic blood pressures both erect and supine were observed. In 18 of the patients, the results obtained underwent no statistically significant modifications during the second 2-month treatment period at reduced dosage. In 5 others, dosage had to be maintained at 1 tablet daily. In all cases, the drug was well tolerated clinically. ECG recordings were unchanged. Laboratory results remained within the normal range despite a slight increase in serum uric acid and a slight decrease in potassium.

Intragastric intussusception--a curiosity.

A case of a 53-year-old man with an intragastric intussuscepted small bowel segment is presented. The patient had previously been operated on for recurrent bleeding gastric ulcers. A discussion is presented on the unusual aspects of the intussusception.

Relation of upper gastrointestinal bleeding to non-steroidal anti-inflammatory drugs and aspirin: a case-control study.

We conducted a case-control study in five general hospitals in the region of Antwerp, studying 161 patients (102 men, 59 women) and hospital control subjects matched for age and sex to explore the relation between drug use and upper gastrointestinal bleeding from 'erosive lesions' (peptic oesophagitis, gastric erosions, gastric ulcer(s), or duodenal ulcer(s]. There was a highly significant difference between cases and control subjects in the use of non-steroidal anti-inflammatory drugs (NSAIDs, excluding aspirin) (odds ratio 7.4, p less than 0.001; 95% confidence interval odds ratio 3.7 to 14.7). There also was a significant difference in the use of aspirin (odds ratio 2.2, p = 0.025; 95% CI odds ratio 1.3 to 4.0) and a highly significant difference regarding the presence of antecedents of peptic ulcer disease (odds ratio 5.5, p less than 0.001; 95% CI odds ratio 3.2 to 9.6). There was no significant difference in the use of other drugs, paracetamol and corticosteroids in particular, nor in the use of alcohol or tobacco. The patient group using NSAIDs was older, had more women, and had a higher mortality than the group not using NSAIDs. Among patients with bleeding gastric or duodenal ulcer(s), NSAID users were not more or less likely to have had symptoms of peptic ulcer disease, and had no higher frequency of multiple gastric or duodenal ulcers. The attributable risk for NSAID use was 0.30 (95% CI 0.23 to 0.37) and for aspirin use 0.14 (95% CI 0.08 to 0.20).

Vaterian diverticula as a cause of acute pancreatitis.

The association of duodenal diverticula and pancreatitis is rare. Various types of such diverticula are reviewed, especially intra- and extraluminal Vaterian diverticula in which common and pancreatic duct terminate. The pathogenesis of the pancreatitis in case of interposed Vaterian diverticula is thought to be mechanical by means of the creation of a closed Vaterian pouch in which higher pressures produce reflux of bile and pancreatic enzymes. Two patients with this particular type of duodenal diverticula are presented.