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.

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.

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The effect ofmisoprostol, a synthetic analogue of prostaglandin E, on prostalandin concentrations in synovial fluids was investigated in a randomised placebo controiled, double blind study. The synovil fluid concentrations of prostaglandin E1, 6-keto-prostaglandin Flag and thromboxane B2 were measured at the beginning and end of a 24 hour period in 25 patients with effusions of the knee joint. During this period the patients were treated with diclofenac (50 mg every eight hours) and either misoprostol (400 pAg) or After an initial drug washout period of at least three days, during which paracetamol was provided for the relief of pain, the patients were randomly allocated to treatment with either misoprostol or a placebo. The two groups received diclofenac (50 mg) at time 0, 8 and 16 hours, with either misoprostol (400 [Lg) at time 0 and 12 hours, or matching placebo. The study was double blind in design with all preparations given by mouth.The presence or absence of clinical signs of inflammation (warmth, tenderness, synovial thickening) was recorded for both knees at the beginning and end of the study period.At time 0 and 24 hours synovial fluid was aspirated from the same knee without the use of local anaesthesia. Between two and four millilitres, of the synovial fluid was immediately mixed with 0-05 ml of 0-2% indomethacin in a glass tube, then frozen and stored at -20°C until required. The prostaglandin E series was measured by assaying the stable metabolite 11-deoxy-13,14-dihydro-15-keto-11,16-cycloprostaglandin E2 and the analogous E1 metabolite, prostacyclin was assayed as 6-ketoprostaglandin Fla, and thromboxane as thromboxane B2 using radioimmunoassay kits supplied by Amersham (TRK 800, RPA 515 and RPA 516, respectively) with the methods described in the accompanying data sheets. All the assay procedures were validated before this study. Synovial fluid samples were assayed in five batches, the two samples from a given patient beingassayed in the same batch. STATISTICALMETHODSOwing to the distributional form of the results of the prostaglandin assay, analyses were performed on the logarithms of the data. The treatments were compared by the analysis of 797 on 11 May 2018 by guest. Protected by copyright.