Calculation of esophageal variceal wall tension by direct sonographic and manometric measurements.

BACKGROUND: LaPlace's law determines the wall tension of a tubular system by measuring the radius (r), wall thickness (w), and pressure gradient of a tubular structure: wall tension = pressure gradient x r/w. In theory, the determination of wall tension could provide the most accurate method of predicting the likelihood of esophageal variceal rupture. Using high-resolution endoluminal sonography, we measured the variceal wall thickness and radius. Using direct needle puncture, we measured the intravariceal pressure in three patients. We then calculated the wall tension by the LaPlace equation for each of seven varices. METHODS: A 20 MHz ultrasonographic transducer was used to image esophageal varices. Outer and inner variceal wall circumferences were measured at a cross section of each varix. The radius and wall thickness of each varix were then calculated. Pressure measurements were obtained in the esophageal lumen and variceal lumen by direct needle puncture of the varices. The pressure gradient was then calculated (esophageal lumen - variceal lumen). RESULTS: The wall tension of the varices from three patients was determined. There was a linear relation (r = 0.88) between the wall tension and pressure gradient. CONCLUSIONS: This is a novel technique by which esophageal variceal wall tension can be directly measured. Such information may be useful in the future treatment of patients with portal hypertension by which risk stratification may be determined and pharmacologic response to therapy may be measured.

Correction of deficiencies in flexible fiberoptic sigmoidoscope cleaning and disinfection technique in family practice and internal medicine offices.

To assess whether deficiencies exist in the processing of contaminated flexible fiberoptic sigmoidoscopes in family practice and internal medicine offices and whether training of office personnel results in a correction of identified deficiencies, we conducted a prospective review of sigmoidoscope processing in family practice and internal medicine offices before and after a training course. Participants were questioned on their current endoscope processing for 17 standards before and 2 months after receiving training. The 19 offices had between 4 and 11 deficiencies per office before training, with an average of 6.8 deficiencies per office. After training, deficiencies ranged from 0 to 8, with an average of 0.9 deficiencies per office (P < or = .001; Student t test). Personnel responsible for processing flexible sigmoidoscopes in family practice and internal medicine offices are insufficiently trained for this function. Endoscopes are not being processed according to current standards. After a 2-hour training period, these persons maintain their equipment close to or according to standards.

Fundic gland polyps developing during omeprazole therapy.

OBJECTIVE: Side effects of omeprazole therapy include reversible hypergastrinemia, entero chromaffin-like hyperplasia, and possibly acceleration of atrophic gastritis in the gastric corpus in patients with Helicobacter pylori infection. The objective of this report is to describe six cases of fundic gland polyps that developed while omeprazole was being used for Barrett's esophagus. METHODS: Three women and three men developed fundic gland polyps after 1-5 yr of omeprazole therapy, 20 mg/day. In the index case, fundal polyps developed after 2 yr of continuous omeprazole therapy. Omeprazole was stopped, but because of poor clinical efficacy with H2-blockers, it was reinstated. RESULTS: After 4 yr of therapy, multiple large fundal polyps were present. Histology of all lesions revealed characteristic fundal gland polyps with multiple cystic dilations. None of the patients had H. pylori infection. Serum gastrin was normal in four and slightly increased in two. CONCLUSION: These cases support the possible causal relation between the use of omeprazole and the development of fundic gland polyps in patients without H. pylori gastritis.

A study of stairs in the housing of independently-living elderly people.

This survey study focuses on stairs in the homes of a substantial number of independently living elderly (60+) residents of a community in which there are mostly multistory houses and apartment buildings with stairs. While the majority could climb their stairs without problems, a substantial minority lived with stairs despite difficulty and even inability in climbing them. Most people were satisfied with their homes, and many were unwilling to admit that stairs were a present or potential problem. Most people, including most with stair problems, had no plans to move from their homes, however, a majority was willing to concede under questioning that stair-free living in a presently unplanned next home would be desirable. There is a plea that stairs be of increased concern in the housing of elderly people, and that there be increased planning for stair-free homes.

Pet ownership by elderly people: two new issues.

Two new issues of pet ownership were considered in a mail questionnaire and an interview survey of a large number of elderly people age sixty and over. First, evidence was obtained that pets are an important determinant of housing choice. Second, many elderly pet owners have made no arrangements for the pet if they predecease it or become unable to care for it. Problems related to these issues are discussed.

Metachronous occurrence of collagenous colitis and ulcerative colitis.

Collagenous colitis and ulcerative colitis are distinct disorders. A 67 year old woman with clinical and histological evidence of collagenous colitis had an abrupt symptomatic exacerbation while taking anti-inflammatory treatment with sulphasalazine and prednisone. Repeat colorectal endoscopy showed active mucosal inflammation and colonic biopsy specimens were consistent with active ulcerative colitis. After bowel rest, total parenteral nutrition, intensification of the anti-inflammatory regimen, and withdrawal of non-steroidal anti-inflammatory drugs (which she had taken continuously for osteoarthritis) diarrhoea abated. Colorectal biopsy specimens obtained when the patient's symptoms had improved showed inactive ulcerative colitis with no evidence of collagenous colitis. This may be the first case to be reported of the metachronous association of collagenous and ulcerative colitis.

Syphilitic enteritis.

Relapsing secondary syphilis of which syphilitic enteritis was a major manifestation developed in a 40-year-old man. The enteritis was demonstrated by biopsy. Clinical and histologic resolution of the enteritis followed anti-syphilitic therapy.