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Sixty patients with active upper gastrointestinal bleeding were randomized to received either continuous intravenous infusions of vasopressin (29 patients) or placebo (31 patients) at a rate of 40 U/h. Six hours after beginning the study, 13 patients in the vasopressin group and 11 in the placebo group] had ceased bleeding (p = 0.46). By 24 hours. 17 patients in the vasopressin group and 14 in the placebo group had stopped bleeding (p = 0.30). Restriction of the analysis to patients bleeding from varices showed no advantage with vasopressin treatment after 6 or 24 hours. No consistent trend favoring use of vasopressin to stop hemorrhage was noted during the 30-month study period. There was little difference between the two groups in the number of patients needing surgery (13 on vasopressin, 18 on placebo; p = 0.30) or the number of deaths (eight on vasopressin, 11 on placebo; p = 0.51); the transfusion requirement was the same. In our patients, a continuous intravenous infusion of vasopressin neither controlled bleeding nor altered outcome.

Due to demographic developments in Germany, it is inevitable that the number of age-related diseases will grow. The aim of this survey is to forecast the extent of this development in ophthalmology. How many people will be blind or visually impaired in 25 years from now? According to the German Federation of Blind and Visually Impaired People, the number of blind people in Germany is about 145,000 and the number of the partially sighted people can be estimated at approximately 500,000. These figures are based on the legal definitions of blindness and visual impairment, which are stricter in Germany than in other countries. Due to the ageing population, there will be one third more blind people and about 60% more new cases of blindness in 25 years time. In particular, the incidence rate of blindness due to age-related macular degeneration will rise sharply, but the number of blind people and new cases of blindness are only the top of the "iceberg". The number of people suffering from age related eye diseases in future will be even larger. This large number of future patients already should be part of health economic considerations.

The familial occurrence of achalasia has been previously recorded and a genetic origin for the disease has been postulated. We present the first case of achalasia in monozygotic twins and suggest that concordance for the disease is consistent with a genetic factor in the etiology of achalasia.

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