No abstract

The Italian 10-point score for the prediction of death was successfully validated in this independent population of patients with non-variceal gastrointestinal bleeding. The PNED score is accurate and superior to the Rockall score. Further external validation at the international level is needed.

Two cases of intracerebral hemorrhage occurring after evacuation of bilateral chronic subdural hematomas are reported. Possible pathogenic mechanisms included hemorrhage into previously undetected areas of contusion, damage to cerebral vasculature secondary to rapid perioperative parenchymal shift, and sudden increase in cerebral blood flow combined with focal disruption of autoregulation; of these, the latter mechanism seemed most likely to be responsible for the hematoma formation. The need for clinical awareness of this nearly uniformly devastating complication, as well as prompt use of computerized tomography scanning in assessing the postoperative course, are stressed.

INTRODUCTIONProkinetic drugs have been extensively tested in the treatment of functional dyspepsia. This is because gastrointestinal motor abnormalities and, in particular, delayed gastric emptying have been frequently reported in patients suffering from this common syndrome. 1±6These abnormalities are regarded as a likely source of symptoms even if no clear cause±effect relationship between severity of symptoms and degree of delay in gastric emptying has been proven to date.7 Among prokinetic drugs, several placebo-controlled trials have provided evidence on the ef®cacy of cisapride and dopamine receptor antagonists such as metoclopramide, domperidone, and recently levosulpiride in the treatment of functional dyspepsia. 8±28 Metoclopramide, domperidone and levosulpiride have both antiemetic and prokinetic properties because they antagonize dopamine receptors in the central nervous system as SUMMARY Background: The ef®cacy of several prokinetic drugs on dyspeptic symptoms and on gastric emptying rates are well-established in patients with functional dyspepsia, but formal studies comparing different prokinetic drugs are lacking. Aim: To compare the effects of chronic oral administration of cisapride and levosulpiride in patients with functional dyspepsia and delayed gastric emptying. Methods: In a double-blind crossover comparison, the effects of a 4-week administration of levosulpiride (25 mg t.d.s.) and cisapride (10 mg t.d.s.) on the gastric emptying rate and on symptoms were evaluated in 30 dyspeptic patients with functional gastroparesis. At the beginning of the study and after levosulpiride or cisapride treatment, the gastric emptying time of a standard meal was measured by 13 C-octanoic acid

Aim: To assess the oesophageal manometric characteristics and 24‐h pH profiles of patients with both short‐segment and long‐segment Barrett's oesophagus and compare them with those of patients with reflux oesophagitis and controls. Methods: Seventy‐nine patients who had undergone upper digestive endoscopy were recruited: 16 had short‐segment Barrett's oesophagus, 13 had long‐segment Barrett's oesophagus, 25 had grade III oesophagitis according to the Savary–Miller classification and 25 were used as controls. The diagnosis of Barrett's oesophagus was based on the histological detection of specialized intestinal metaplasia, which extended < 3 cm into the oesophagus in patients with short‐segment disease and > 3 cm in patients with long‐segment disease. All subjects underwent oesophageal manometry and basal 24‐h oesophageal pH monitoring. Results: The lower oesophageal sphincter pressure was significantly lower in patients with reflux oesophagitis and short‐segment and long‐segment Barrett's oesophagus than in controls (P=0.0004–0.0001), but there was no difference among the three reflux groups. The peristaltic wave amplitude of patients with long‐segment Barrett's oesophagus was significantly lower than that of controls (P=0.002) and patients with short‐segment Barrett's oesophagus (P=0.02), but was no different from that of patients with reflux oesophagitis. The percentage of non‐propagated wet swallows was significantly higher in patients with reflux oesophagitis and short‐segment and long‐segment Barrett's oesophagus when compared with that of controls (P=0.0004–0.0001). The total percentage of time the oesophagus was exposed to pH < 4.0 was significantly higher in patients with reflux oesophagitis and short‐segment and long‐segment Barrett's oesophagus (P=0.0001) than in controls, and was higher in patients with long‐segment disease than in those with short‐segment disease (P=0.01). Conclusions: Long‐segment Barrett's oesophagus is characterized by a greater impairment of peristaltic wave amplitude and a higher oesophageal acid exposure than is short‐segment Barrett's oesophagus. However, both forms are linked to increased acid reflux.