Objective To correlate renal calculi and other clinical factors with urinary biochemical analytes in patients with inflammatory bowel disease, and to investigate the relative importance of hyperoxaluria (associated with fat malabsorption) or reduced stone inhibitors in the development of calculi in these patients. Patients, subjects and methods Samples were obtained from 25 patients with Crohn's disease (CD), 15 with ulcerative colitis (UC) and 17 normal subjects (controls). Evidence for the presence of renal calculi was obtained from plain films, ultrasonography or intravenous urography. Urine oxalate and citrate were analysed using commercial enzymatic assays; magnesium was measured using atomic absorption and other analytes assayed using standard methods on automated analysers. Results Renal calculi were found in two patients with CD and in none with UC. Hyperoxaluria was present in 36% of patients with CD but was absent in those with UC. Analysis of covariance showed an association between low urinary citrate/creatinine ratio and renal stones (P=0.02), and between a combined urinary citrate and magnesium deficit relative to calcium, as expressed in the CMC index ((citrater magnesium)/calcium), and renal stones (P=0.017). Changes in urinary calcium, oxalate, urate, magnesium or the calcium oxalate index were not associated with the presence of stones. There was no independent relationship between any clinical factor and the presence of stones. Conclusion Lower urinary concentrations of magnesium and citrate (stone inhibitors), relative to calcium (stone promoter; the CMC index) may be more important in lithogenesis in inflammatory bowel disease than is hyperoxaluria. In patients with a functioning colon, a low CMC index may predict likely stone-formers; this requires a prospective evaluation. Avoiding low urinary levels of magnesium and citrate may aid in preventing and treating renal calculi.

This study demonstrates a significant overuse of antibiotics, especially intravenous forms, despite a paucity of positive sepsis parameters and chest X-ray findings in these patients The duration of treatment could be shortened and an early switch policy introduced if culture results and sepsis profiles were taken into consideration, as there was a large number of unproven infections. Suggestions are made about how these improvements in prescribing could be made within the current administrative set-up of AMAUs.

Fifty-five elderly patients with chronic antral gastritis (CAG) were studied to assess the relationship between Helicobacter pylori (H. pylori) status and CAG subtypes as specified in the Sydney System for Gastritis Classification. Twenty-eight patients (51%) were H. pylori positive and 27 (49%) H. pylori negative. H. pylori-positive patients had a significantly greater association with features of severe active CAG (chronic inflammation and polymorph activity) than H. pylori-negative patients. No association was apparent between H. pylori and more advanced stages of CAG (atrophy and intestinal metaplasia) thought to carry pre-malignant potential. The recognized association between dyspeptic symptoms in elderly people and an H. pylori-positive gastritis was confirmed. Use of NSAIDs correlated with a predominantly H. pylori-negative gastritis which was relatively asymptomatic.

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We report a case of spontaneous iliopsoas haemorrhage following intravenous streptokinase which serves to remind physicians of the potential dangers of this form of therapy.

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She had had total colectomy and ileostomy 8 years previously for ulcerative colitis. She had had her ileostomy refashioned 3 times for parastomal hernia, parastomal abscess and retraction.Several unsuccessful attempts were made to reduce the 'prolapse' of her ileostomy. Examination under anaesthesia revealed proximal ileum intussuscepting through the stoma. The intussusceptum was about 15 cm from the most distal part of the ileostomy spout. The ileum was slightly congested with no other pathology. Retrograde reduction was unsuccessful and laparotomy was carried out.At laparotomy it was noticed that there was herniation of one wall of the ileum through a defect in the abdominal wall next to the stoma. This part of the ileum went on to prolapse through the spout and was followed by more ileum to form the intussusceptum. Reduction was achieved by gentle traction, the lateral space to the stoma was closed and the ileum was attached to the anterior abdominal wall with absorbable sutures. She was managed post-operatively on ritodrine hydrochloride, a myometrial relaxant.She went into labour at 35 weeks gestation and had emergency lower segment Caesarian section for fetal distress. Both babies were normal.A case of intussusception in ileostomy in a pregnant woman has been described by Priest et al.4 and in a patient with loop colostomy by Keane and Whittaker.5 In both cases and in the case presented above, there were no aetiological factors and the patients all survived. Diagnosis is easily confused with prolapse,5 which is easily reducible and for which local revision is usually adequate.'-3 Surgical management was different in the 3 cases. In the case described by Priest et al., the patient was managed by revision of her ileostomy4 and in the case of Keane and Whittaker, by resection and refashioning of the colostomy.5Intussusception as a complication of stomata is not described in textbooks and should be considered if an apparent prolapse proves difficult to reduce or manage locally.