Gallstone disease in the Himalayas (Sikkim and north Bengal): causation and stone analysis.

OBJECTIVES: To know the extent of gallstone disease in Sikkim and North Bengal. METHODS: 487 (14.4%) patients with gallstones were diagnosed among 3375 patients with dyspepsia in 3 years. All patients with gallstone were evaluated based on a predefined questionnaire. Abdominal sonography was performed and obesity index was calculated. Gallstones retrieved at surgery from 29 patients were subjected to infra-red spectroscopic analysis. RESULTS: The patients with gallstones included 375 women with average age of 40 years and 112 men with average age of 48.7 years. 15.7% of the women were nulliparous, 12% had one child and 23% had two children each. 73% of patients were of normal weight and 97% were non-vegetarians. Only cholesterol gallstones were found in these patients. CONCLUSIONS: Gallstones are common in Sikkim and North Bengal among dyspeptics. A majority of patients are of normal weight. The disease occurs a decade earlier in women, most of whom have only up to two children.

Stress reduction through listening to Indian classical music during gastroscopy.

The purpose of this study was to examine the effects of music on elevated state of anxiety as many patients become stressed and anxious during diagnostic procedures. The study was conducted on 104 consecutive patients undergoing GI endoscopy for various reasons. Patients were randomly assigned to two groups regardless of sex, age and underlying disease. One group of 54 patients were made to listen to a recorded Indian classical instrumental music before and during the procedure, while the other group of 50 patients did not. Blood pressure, heart rate and respiratory rate were recorded at the beginning of consultation and end of procedure. Perception of procedure using a three point attitude scale was assessed. Our results indicate that the background Indian classical music is efficacious in reducing psychological distress during a gastroscopic examination. We suggest that music could be applied to other medical situations as well, which tend to generate undue psychological stress and anxiety. Music, as a familiar personal and culture medium, can be used to ease anxiety, to act as distractor, to increase discomfort and pain threshold.

Use of a multinational survey to provide clinical guidelines for upper gastrointestinal bleeding in developing countries.

The OMGE multinational survey of patients with upper gastrointestinal bleeding demonstrated that it was possible to predict patient outcome, using a computer and a database of information from many centres. It remained to be seen whether this database could be used in specific remote areas of the world. To answer this question, two areas have been studied, Sikkim and China. In Sikkim, when the computer-aided prognostic system was used, 69% of patients put into a high-risk group for rebleeding actually did so; and 54% died. By contrast, only 2% of patients placed into a low-risk group for rebleeding did so. As there is little computer technology in Sikkim, a simplified scoring system was developed which gave the same predictive accuracy as the computer system. In China there was a slightly lower accuracy with both systems. Hence a new database and scoring system were created, using only information from Chinese patients. This database improved the results. From the studies it is suggested that these types of systems can be of value to patients in remote areas by targeting patients at high risk rebleeding or dying, so that the scarce resources available can be best used.

Prognostic factors in upper G.I. bleeding.

This presentation draws upon the experience of the O.M.G.E. Multi-national Upper G.I. Bleeding Survey, using data collected during 1980-1982 by 185 clinicians from 44 centres in 21 countries to discuss two questions. First, can prognostic factors be identified in patients presenting to hospital with upper G.I. bleeding, and if so what are they? Second, is it possible - by combining the two technologies of endoscopy and computers - to provide an individual patient with a short-term prognostic prediction sufficiently accurate to affect patient management. Amongst 4,010 patients, a number of clinical factors were found to affect short-term prognosis. These included patient age, previous history of heart or liver disease, confusion and dehydration on admission, jaundice, and ascites. Identification of the bleeding source via endoscopy was shown to aid short-term prognosis - especially in the period of the 2nd to 10th days post-admission. Use of computer analysis enabled "high risk" patients to be defined (of whom 63.8% suffered further bleeding and 30.0% died), and also a comparable "low risk" group (of whom only 4% suffered further bleeding and none died). Finally, "time-dependence" studies have been used to identify a group of patients who (by the 2nd day post-admission) have a residual risk of further bleeding sufficiently low (well under 1%) to suggest that considerable resources can be saved by the judicious use of endoscopy and computer science.