Upper gastrointestinal hemorrhage in Jordan: an analysis of causes, characteristics and outcome

Two hundred twenty-four patients presenting consecutively with massive upper gastrointestinal hemorrhage were endoscoped within 24 hours to determine the site of bleeding. Outcome was evaluated in relation with presenting variables. Duodenal ulcer was found to be the most common source of bleeding. Endoscopy demonstrated 33% of all patients had more than one potential bleeding site. Patients with duodenal ulcer were significantly younger than patients with gastric ulcer [41 +/- 17 years versus 58 +/- 19 years, respectively]. There was a tendency for upper gastrointestinal hemorrhage to present more often in the winter months. Eighty-one percent of duodenal ulcer patients and 57% of gastric ulcer patients had dyspepsia prior to the presentation of bleeding. There was a strong correlation between presence of concomitant disease and the age of the patient. Forty-three percent of patients had ingested aspirin or other nonsteroidal anti-inflammatory agents in the week prior to the bleed compared with 18% in a control group. All nine patients with bleeding diathesis [including that induced by anticoagulant maintenance therapy] had an underlying source of bleeding. Sixty-nine percent of the patients had spontaneous resolution of their bleeding within 24 hours while 25% underwent emergency surgery. The overall mortality rate was 10%. Age, underlying chronic liver disease, and transfusion requirements were found to be independent predictors of mortality when assessed by multivariate regression analysis

Spontaneous transverse mesocolic hernia with transverse colon obstruction

A case of spontaneous transverse mesocolic hernia, associated with secondary amyloidosis, is presented. The points of particular interest are: [1] The presentation of the patient with chronic intermittent colonic obstruction, [2] The unusual mobility of the right colon, [3] The association of secondary amyloidosis with chronic intermittent obstruction and symptomatic improvement after repair of the hernia. Hernias through the mesentery are rare. Herniation through the mesentery of transverse mesocolon accounts for only 16 percent of the cases[1]. Fewer than 85 spontaneous transverse mesocolic hernias have been reported and most of them before 1949[2-4]. This patient presented with chronic large bowel obstruction associated with generalized amyloidosis

Liver size in normal subjects as estimated by percussion

Clinical estimation of liver size is of daily practical value. Three hundred forty normal adult volunteers [244 males and 96 females] were examined for liver size by percussion. Mean liver span in the mid-clavicular line was greater in males than females and related most significantly to the height of the subject. Liver span also correlated significantly with age and lean body mass in males but not females. A normogram was derived predicting the expected range of liver dullness from the height of the subject, thus providing a reference table useful in the estimation of liver size by percussion. Clinical estimation of liver size is of daily practical value for determining whether it lies within the normal range or whether hepatomegaly exists. The common practice for the clinical estimation of liver size is measurement of the projection of its lower border below the right costal margin. However, a poor correlation has been found between this method and liver size assesed by scintiscans or radiography[12]. Percussion of the upper and lower border of the liver has been reported to be a more accurate method of assessing liver size[1-3], and has been used in estimating the liver size of normal subjects[4,5]. The present investigation was carried out to a] study the liver size by percussion of its upper and lower borders in the mid-clavicular line in healthy adults and, b] to look for a relationship between the liver size and the age, sex, weight, height and lean body mass of the subjects. The resultant normal values obtained may thus provide reference data useful in the clinical estimation of hepatomegaly

Trithiozine in the treatment of duodenal ulcer a controlled double blind trial of the effect of trithiozine on duodenal ulcer

Fifty six patients with endoscopically confirmed duodenal or pyloric ulcers received either trithiozine [26] or placebo [30], for four weeks in a double-blind clinical trial. At four weeks there was complete endoscopic ulcer healing significantly more in patients receiving trithiozine [46.2 per cent] compared with those receiving placebo [20 per cent] [chi[2] = 4.26; p<0.05]. Patients treated by trithiozine consumed significantly less antacids than the placebo treated patients [p<0.01], but there was no difference in the symptomatic assessment of both groups. The trithiozine group had a significant reduction in their basal acid output when measured after two weeks, but when compared to the placebo group, this reduction did not reach significance. Headache, fatigue, dizziness, impotence and proteinuria occurred more in patients taking trithiozine, and myalgias and arthralgias were severe enough to cause three patients taking trithiozine to drop out of the trial. Trithiozine 4 -[3,4,5 trimethoxythiobenzoyl] tetrahydro-1, 4-oxazine1 has been shown to possess some gastric antisecretory properties[2,7]. The site of activity is not known. Studies have suggested that trithiozine heals duodenal ulcer along with symptomatic improvement and without untoward side effect[8,13]. However, we considered the results of studies regarding its antisecretory properties and clinical use as being inconclusive, and so undertook a double-blind controlled trial of trithiozine with the purpose of examining [a] the effect of trithiozine on duodenal ulcer healing, [b] the degree of symptomatic improvement in these patients, [c] the effect on acid output during therapy, and [d] the side effects of the drug

endoscopic and morphometric study of the gastric and duodenal mucosa in asymptomatic volunteers

In order to establish reliable diagnostic criteria for gastroduodenal mucosal disease, the visual appearance and morphometric parameters of normal mucosa need to be defined. Thirty six asymptomatic volunteers were endoscoped and biopsies were taken from stomach and duodenal cap for morphometric measurements. A wide variation in visual appearance of the gastroduodenal mucosa was noted. In addition three subjects had incidental duodenal erosions, one a chronic duodenal ulcer and another small antral submucosal mass of undefined nature. Morphometry showed significantly more round cells in the antrurn than the body of the stomach [p < 0.02], and in the duodenum than either area of the stomach [p< 0. 00 1]. In view of the wide range of findings, it is felt that age-matched control groups are important in studies involving the gastroduodenal mucosa