Young heavy drinkers: if there is a problem,is there a solution?

Alcohol use and misuse amongst adolescents and young adults is a source of political and public concern in the UK. Much energy and capital is invested by Government and Industry in attempts to persuade young people to adopt patterns of sensible drinking. In this paper it is argued that levels of chronic alcohol-related problems amongst this age group are low, and that those alcohol-related problems encountered are those which are least amenable to interventions which attempt to persuade drinkers to behave in a ‘sensible’ or ‘moderate’ way. The paper explores the implications of current knowledge about adolescent drinking behaviours for health professionals working in the community.     

Outlet syndrome: is there a surgical option?

Of 46 patients investigated for constipation, 21 were found to have some other primary abnormality, leaving 25 patients for study: 6 had evidence of the outlet syndrome alone, 5 had slow transit constipation, 8 had both abnormalities and 6 had no apparent physiological disorder in the colon or rectum. Although colectomy and ileorectal anastomosis gave good results for slow transit constipation, partial pelvic floor division provided satisfactory long-term improvement in only one of the 7 patients with the outlet syndrome.     

Acute dysphasia: often there is a readily treatable cause

Three patients, one woman aged 45 years and two men aged 40 and 62 years, presented with acute dysphagia due to oesophageal obstruction by a piece of food. In the woman symptoms of oesophageal perforation developed after the piece of food was removed by rigid endoscopy; she recovered after treatment with a stent, antibiotics and acid inhibitors. The younger man had a stricture of the oesophagus that was dilated. The older man had a Barrett's oesophagus and also oesophagcal adenocarcinoma; he was free of symptoms three years after resection of the oesophagus and the creation of a tubular stomach. In adults, 60% of acute oesophageal obstructions are caused by food impaction, which is associated with a high incidence of secondary pathologic findings in the oesophagus (75-97%). Evaluation of the oesophagus by flexible endoscopy contributes to an adequate diagnosis. Moreover, it can be used to treat the cause of the obstruction. If dilation therapy is started early after detecting a benign stricture in the oesophagus, it reduces the likelihood of recurrence. The detection of early-stage oesophageal malignancies may improve the prognosis of patients with this disorder.