No abstract

In this study we examined factors of possible prognostic value about outcome in a consecutive series of 2217 patients with hematemesis and melena. Death occurred in 189 (8.5%) patients, and 243 (11%) patients experienced rebleeding. Death was significantly associated with rebleeding, age over 60 years, and the finding of blood in the stomach at endoscopy. Rebleeding was significantly associated with melena, identification of a gastric or duodenal ulcer, endoscopic stigmata of hemorrhage such as blood, clot, and active bleeding, and the finding of shock at admission. However, female gender, previous history of ulceration, or indigestion of ulcerogenic drugs, especially nonsteroidal antiinflammatory drugs, were poor predictors of either death or rebleeding. We conclude that the identification of patients at a high risk could contribute to improved management of patients with gastrointestinal bleeding, including early therapeutic intervention.

Hyperthyroidism is found 2.5-fold more often in hip fracture patients than in controls. Hence, hyperthyroidism appears to be a significant risk factor for hip fracture and should be investigated by clinical and, when necessary, laboratory means in hip fracture patients. In contrast, no increased risk for hip fracture could be detected after exposure to levothyroxine.

SUMMARY Previous studies have consistently found strong positive associations between refined sugar intake and Crohn's disease (CD) and recently between smoking and CD. As refined sugar intake and smoking are themselves associated we have enquired about smoking and added sugar intake (AS) and smoking in CD using a postal questionnaire sent to 104 CD patients and 153 community controls. Smoking and AS were associated with one another. After adjusting for AS, smoking showed a significant association with CD with a relative risk of 1.8. After adjusting for smoking habit, AS was also strongly associated with CD in never and exsmokers and in a dose response pattern, with the relative risks for no AS, <50 g/day and >50 g/day being respectively 1.0, 1.8, and 4-6 (X2=12-1; p<0005). No association between CD and AS was evident in smokers. The AS relationship was supported by a separate association between frequency of confectionery consutnption and CD. These findings indicate that while smoking and AS are individually associated with CD combined exposure results in no further increase in risk, suggesting that they may operate through a common mechanism. Increased refined sugar consumption by patients withCrohn's disease (CD) was first reported by Martini and Brandes in 1976 and has since been demonstrated in many studies, although some have suggested that the increased consumption is secondary to the development of CD.'-9 We, and subsequently others, have recently found a strong association between smoking and CD which antedates disease onset."''5 Smoking has previously been found to be positively associated with sugar consumption.'6`7 It therefore seemed possible that the association of smoking or sugar consumption with CD might be due to confounding, that is, any increase in smoking, or sugar consumption, in CD patients might be accounted for by the one habit being associated with the other. We have therefore reapproached subjects from our earlier study with a second questionnaire designed to determine whether the association of smoking and CD was related to increased sugar consumption by smokers with CD.

Summary:The outcome in 1017 patients with haematemesis and malaena referred to two major hospitals in Nottingham within a 2-year period has been prospectively evaluated. Ninety one (9%) patients died during the time period under consideration and all but four were found to have been over 60 years of age. There were 13 (14%) deaths following rebleeding, of whom 5 (5%) could have been potentially avoided by alterations in management. Some improvement of mortality might result from intensive-care facilities with better management of transfusions and earlier detection of rebleeding allowing earlier endoscopy or surgery. The majority of patients (81%), however, died from concomitant disease which was exacerbated by gastrointestinal haemorrhage or bleeding developed in patients with an already existing end-stage disease. These results show that a reduction of mortality in patients with gastrointestinal bleeding is hampered by the high number ofpoor-risk patients. The rise in the proportion ofelderly patients with this disorder seems to continue.