High altitude arterialised capillary earlobe blood gas measurement using the Abbott i-STAT.

Introduction: Measurement of physiological parameters in extreme environments is essential to advancing knowledge, prophylaxis and treatment of altitude sickness. Point-of-care testing facilitates investigation in non-specialist and remote settings, as well as becoming increasingly popular at the bedside for real-time results in the clinical environment. Arterialised capillary earlobe blood gases are recommended as a valid alternative to arterial sampling in research.

Recurrent acute hepatic dysfunction in severe anorexia nervosa.

Anorexia nervosa (AN) is an eating disorder predominantly affecting young women. Abnormal liver function tests (LFT's) resulting from AN is well-described but to date few cases of dramatic rises in liver enzymes have been described. We report a 32-year-old women with severe anorexia having dramatic rise in LFT's with liver failure during extremely poor nutritional status.

UK acquired hepatitis E--An emerging problem?

Eight cases of hepatitis E acquired in the UK are reported. These cases presented to an inner city hospital in Birmingham, UK, over a 5-month period in 2005. HEV is considered unusual in the UK and generally occurs after travel to endemic regions.

Medroxyprogesterone at high altitude. The effects on blood gases, cerebral regional oxygenation, and acute mountain sickness.

Objective: To study the effect of medroxyprogesterone on blood gases and cerebral regional oxygenation at high altitude, alone and in conjunction with acetazolamide, and to assess the effect on acute mountain sickness (AMS).

Design: Two placebo-controlled trials during rapid ascent to high altitude.

Participants: In the first trial, 20 participants, and in the second trial, 24 participants.

Near-infrared spectroscopy in the assessment of cerebral oxygenation at high altitude.

Hypoxia plays a key role in the pathogenesis of acute mountain sickness (AMS), but individual susceptibility is variable and cerebral symptoms do not always correlate with PaO2 measurements. Cerebral hypoxia may be more relevant than PaO2. We studied trends in cerebral regional oxygen saturation by the technique of near-infrared spectroscopy in 20 subjects ascending rapidly to 4680 m.

Percutaneous endoscopic gastrostomy in a general hospital: prospective evaluation of indications, outcome, and randomised comparison of two tube designs.

The indications for percutaneous endoscopic gastrostomy (PEG) and patient outcome, were examined prospectively in the setting of a general hospital. In the course of 26 months, 76 patients underwent PEG (median age 62 years (range 18-99)) and were followed up for 6887 patient days. The median (range) duration of PEG feeding was 93 (3-785) days.

Prevention of rebleeding from oesophageal varices: two-year follow up of a prospective controlled trial of propranolol in addition to sclerotherapy.

A prospective randomised trial comparing propranolol and sclerotherapy to sclerotherapy alone was conducted over a 2-year follow up in a district hospital setting of unselected patients. Rebleeding and survival were analysed. Thirty-nine patients were randomised to propranolol plus sclerotherapy and 34 to sclerotherapy alone.

Use of automatic computerised pump to maintain constant intragastric pH.

We used continuous variable rate infusions of famotidine in eight normal volunteers under fasting conditions to raise intragastric pH to 5.0. An intragastric glass electrode continuously monitored acidity and this information was automatically computed to regulate an intravenous infusion system (GastroJet).

Portal hypertension secondary to sigmoid colon arteriovenous malformation.

A case of portal hypertension secondary to an arteriovenous malformation of the sigmoid colon is presented. The importance of mesenteric angiography in the diagnosis of this condition is discussed. The dramatic clinical improvement in this case following surgery emphasizes that arteriovenous malformations of the gastrointestinal tract represent a potentially curable cause of portal hypertension.

Small intestinal bacterial overgrowth in patients with chronic lymphocytic leukaemia.

As part of a study to assess the possible contribution of lymphoid infiltration of the gastrointestinal mucosa to occult blood loss or malabsorption 20 patients with chronic lymphocytic leukaemia (CLL) had a lactulose hydrogen breath test. In 10 cases (50%) a small intestinal peak was detected, suggesting small bowel bacterial overgrowth, and this was confirmed in seven patients by the positive culture of jejunal aspirate. Of the patients with a positive hydrogen breath test, radiological examination showed a duodenal diverticulum in two but no anatomical abnormalities in the other cases.

Significance of venous and lymphatic invasion in malignant polyps of the colon and rectum.

Three hundred and sixty seven neoplastic colorectal polyps removed at endoscopy of which 34 were complicated by invasive carcinoma, were reviewed clinically and histologically to assess the prevalence and clinical significance of venous and or lymphatic invasion. Traditional stains for histological assessment were supplemented by immunohistochemical methods. Venous and or lymphatic invasion was present in six cases (17.

Pneumatosis cystoides intestinalis. Histological mucosal changes mimicking inflammatory bowel disease.

In 10 cases of pneumatosis cystoides intestinalis affecting the colon in adults, the overlying mucosa exhibited abnormal glandular architecture. The importance of this feature lies in the possible confusion histologically with inflammatory bowel disease, especially Crohn's disease.

Human gastric perfusion: evidence for non-uniformity of blood flow.

Post-mortem injection studies have demonstrated marked differences in the course and distribution of arterioles in the stomach, but evidence of differential perfusion in man is lacking. Using the non-invasive laser Doppler technique, we studied 38 patients referred for gastroscopy for dyspeptic symptoms. Flux measurements were made at nine sites: distal oesophagus, cardia, mid-body and antrum on lesser and greater curves, and pre- and post-pylorus.

The effect of altitude on tests of reaction time and alertness.

Psychomotor performance was assessed in 20 subjects on each of 2 mountaineering expeditions. During the first, which reached 5,008 m, simple reaction time and alertness were measured, on the second to 4,790 m these were replaced by a three-choice reaction time test. In both, mean reaction times increased significantly at altitude in subjects with marked symptoms of Acute Mountain Sickness (AMS), whereas the alertness tests showed no effects.

Ulcerative colitis complicated by disseminated intravascular coagulation.

We report a case of chronic ulcerative colitis complicated by clinical evidence of disseminated intravascular coagulation and pathological evidence of intestinal ischaemia secondary to venular and capillary fibrin thrombi. This may well represent an example of univisceral Shwartzman reaction occurring in a sensitized target organ.

Immunogold-silver technique applied to showing malignant B cell infiltration of gastrointestinal tract in patients with chronic lymphocytic leukaemia and non-Hodgkin's lymphoma.

Gastric, duodenal, and rectal biopsy specimens from 20 patients with chronic lymphocytic leukaemia (CLL) and non-Hodgkin's lymphoma (NHL), not primarily of gastrointestinal origin, were examined using the immunogold-silver staining (IGSS) technique. In paraffin sections the presence of kappa and lambda surface immunoglobulin in lymphoid infiltrates was shown. Using this technique, nine patients were shown to have infiltration of the gastrointestinal mucosa by monoclonal B cells at one or more sites.

Intestinal absorption at high altitude.

Three tests of small intestinal function were performed at 3100 m and 4846 m to seek evidence of malabsorption of high altitude. Xylose tolerance did not change in 11 subjects but, in three who ascended to 5600 m, one-hour xylose levels were significantly lower. The results of an oxalate loading test did not suggest significant fat malabsorption.

Effect of acetazolamide on blood gases and 2,3 DPG during ascent and acclimatization to high altitude.

Blood gases and red cell 2,3 DPG concentrations were measured during ascent and a stay for 6 days at 4846 m in 20 subjects. Acetazolamide improved Pa,O2 and reduced pH and Pa,CO2. 2,3 DPG concentrations were lower in the acetazolamide group during ascent and at high altitude.

The origin of proteinuria at high altitude.

Urinary protein excretion was measured before and after the intravenous infusion of lysine in 14 normal subjects after 4-6 days' acclimatization at 4846 m. Urinary albumin excretion before lysine was elevated in 11 subjects but alpha 1-microglobulin was detected in only four. After lysine a large increase in albumin excretion occurred in all subjects.