ABSTRACT
BACKGROUND AND STUDY AIMS: Although discrete ulcers are a recognized complication of Barrett's esophagus, it is not clear how common discrete ulceration is in Barrett's mucosa. Furthermore, the relationship of gastrointestinal hemorrhage to Barrett's ulceration is unknown. These issues were investigated in this paper. METHODS: Seventy-eight patients with histologically confirmed Barrett's esophagus were monitored by endoscopic surveillance over 1 to 11 years (mean 3.3 years). The incidence of a Barrett's ulcer was noted and its site recorded. The frequency of gastrointestinal hemorrhage at diagnosis or on follow-up was documented and the source of the bleeding was identified. RESULTS: Discrete ulcers were identified in 36 of 78 patients (46%) at some time over the period of follow-up. Eight patients had two or more ulcers. Most of ulcers were in the distal esophagus; 86% of these were within 3 cm of the anatomic gastroesophageal junction. Nineteen patients (24%) either presented with active gastrointestinal bleeding or had bleeding at follow-up. In 15 of the 19 patients with bleeding (79%) a discrete Barrett's ulcer was the source of the hemorrhage. CONCLUSIONS: Ulceration is a common complication of Barrett's esophagus. These ulcers are usually located close the gastroesophageal junction and have a high incidence of bleeding.
Subject(s)
Barrett Esophagus/complications , Gastrointestinal Hemorrhage/epidemiology , Peptic Ulcer/epidemiology , Adult , Aged , Aged, 80 and over , Barrett Esophagus/pathology , Data Collection , Esophagoscopy , Female , Follow-Up Studies , Gastrointestinal Hemorrhage/etiology , Gastrointestinal Hemorrhage/pathology , Humans , Incidence , Male , Middle Aged , Peptic Ulcer/etiology , Peptic Ulcer/pathology , Prognosis , Risk FactorsABSTRACT
The implantation rate of cardiac pacemakers in Northern Ireland rose from 55.8 per million population in 1979 to over 180 per million in 1988, with the emergence of a second pacemaker implantation centre. However, the implantation rate in Northern Ireland remains less than that of many other countries. Over the period complete heart block fell as an indication from 45% to 34% and sinus node disease rose from 16% to 28%. Symptoms necessitating pacing remained unchanged, syncope being the most common. Ventricular demand pacemakers constituted a lower proportion of implants than anywhere else in the world and more atrial demand and dual chamber pacemakers were implanted than in most other countries. Insufficient patients are being referred for pacing in Northern Ireland but a high proportion of those who are referred receive modern sophisticated pacemakers.
Subject(s)
Heart Diseases/surgery , Pacemaker, Artificial/statistics & numerical data , Practice Patterns, Physicians'/trends , Heart Diseases/epidemiology , Humans , Northern Ireland/epidemiology , Pacemaker, Artificial/trendsABSTRACT
Three enzymes concerned in purine degradation, 5'nucleotidase (5'NT), adenosine deaminase (ADA) and purine nucleoside phosphorylase (PNP) have been measured biochemically in the bone marrow or peripheral blood blasts from 75 patients with acute leukaemia, from 18 patients with blast crisis of chronic granulocytic leukaemia and in the bone marrow and peripheral blood lymphocytes from 14 normal donors. Characteristic patterns among the different sub-types of acute leukaemia have been detected, with high ADA, low 5'NT and PNP in Thy-ALL, high 5'NT and ADA in c-ALL, high PNP and low ADA in AML. The cells in CGL blast transformation resembled the enzymatic pattern of either AML or c-ALL respectively. However, no significant correlation was found between any pair of enzymes in any group of leukaemia, normal bone marrow or peripheral blood lymphocytes studied here.
