A study of incidence and relationship of intestinal metaplasia of gastric antrum and gastric metaplasia of duodenum in patients with nonulcer dyspepsia

The incidence and relationship of intestinal metaplasia of the gastric antrum and gastric metaplasia of the first part of the duodenum were studied in endoscopic biopsies from 120 patients with nonulcer dyspepsia. Intestinal metaplasia was present in 29% of antral biopsies and gastric metaplasia in 39% of duodenal biopsies, with 9% of patients having both. Intestinal metaplasia was not related to alcohol consumption, but was significantly higher in patients who smoked 10 cigarettes or more daily. (P<0.002). Gastric metaplasia was associated with duodenitis. Its incidence was significantly higher in males (P<0.001) and in patients with a history of high/moderate alcohol intake (P<0.02); these findings are reminiscent of the presence of a similar relationship between these factors and duodenal ulcers and support the suggestion that duodenitis and duodenal ulcers probably represent different parts of a single disease spectrum. The presence of both types of metaplasia in 9% of the patients suggest that factors other than gastric acidity may influence the development of metaplasia.Dr. S. Khan is supported by the Cancer Research Campaign.     

Achalasia secondary to carcinoma of prostate

Summary Esophageal achalasia secondary to malignancy has been described in gastric and pancreatic adenocarcinoma as well as bronchogenic carcinoma and lymphoma. This report describes a man with achalasia due to metastatic prostatic adenocarcinoma. The distinguishing features from idiopathic achalasia and the pathogenesis of tumor-induced achalasia are reviewed.     

Controlled Ventilation Using the Lack Circuit with an Injector Device

A Lack breathing system with an injector device has been used for controlled ventilation. Oxygen was delivered through an injector device, which was positioned between the Lack circuit and the catheter mount, whilst nitrous oxide was delivered from the anaesthetic machine. The circuit was fully tested on two model lungs. Satisfactory tidal volumes were obtained and with fresh gas flow rates of about 4 l X min-1, rebreathing was not detected. The circuit was then studied on ten patients undergoing surgery and it was found that an end-tidal carbon dioxide concentration of 5-6% could be maintained. The use of this system during general anaesthesia is discussed.     

Liver function and structure in survivors of acetaminophen poisoning

A series of 30 patients, hospitalized with acetaminophen overdose, were studied during initial admission and again three months later. The quantity of acetaminophen ingested varied from 5 to 50 g and 19 patients developed raised transaminase levels in the serum during the initial period. Liver damage, on the basis of needle biopsy findings, was categorized as severe in 5, moderate in 7, and mild or minimal in 18 patients. At three months' follow-up all but one of the biochemical indicatns of liver damage had reverted to normal in all patients. The exception was the serum total bile acids. Residual changes found on liver biopsy at three months were minimal and nonspecific, apart from one previously severely affected patient in whom there was evidence of scarring. It is concluded that in the usual spectrum of acetaminophen poisoning requiring hospitalization there is no evidence of lasting liver damage.Part of this work was supported by a grant from the University Hospitals Scientific and Research Committee.     

Plasma catecholamine levels during exposure to an environment of hyperbaric oxygen

Plasma catecholamine levels were measured before, during and after hyperbaric oxygen therapy in nine subjects. Adrenaline levels were elevated immediately prior to hyperbaric oxygen therapy, but then fell and stabilized once treatment commenced. No significant fluctuations in plasma dopamine or noradrenaline levels were noted during the treatment period.This study does not support the premise that there is a suppression of endogenous plasma catecholamine levels during hyperbaric oxygen as has been previously reported. The observed initial increase in adrenaline can be attributed to stress/anxiety and the subsequent decline in this stress, rather than the result of the hyperbaric oxygen treatment itself.