A prospective study of dyspepsia was carried out in a primary referral hospital between 1974-1987 including 1540 patients of whom 1433 were seen as outpatients. The study protocol was agreed in advance and a structured questionary was used to elicit relevant clinical information: up to three diagnoses were permitted for each patient. The commonest principal diagnoses were duodenal ulcer (26%), functional dyspepsia (22%), and irritable bowel sydrome (IBS) (15%); alcohol related dyspepsia (4%) was as common as gastric carcinoma or symptomatic gail stones. Multiple diagnoses were common (31% given two diagnoses, and 6% given three) so that in ali 2111 diagnoses were given to 1540 patients; the functional disorders (IBS and functional dyspepsia) considered together accounted for 39% of ali diagnoses made. Whereas organic conditions were diagnosed by clinicians with confidence (63-98% considered 'certain'), even when given as the principal or first diagnosis IBS was considered 'certain' in only 61% and functional dyspepsia 48%. The demographic symptom data, together with information on tobacco and alcohol use, and work lost are described in detail.

Metoclopramide hydrochloride belongs to the orthopramide series of drugs and is characterized chemically as 4-amino-5-chloro-N-(2-(diethylamino) A preliminary study made on 95 consecutive patients referred for barium meal examination supported these findings. Of 47 patients who received 20 mg metoclopramide intravenously, 18 showed complete gastric emptying in one hour and in 32 the barium had reached the caecum in one hour, while of the remaining 48 who did not receive this substance only one showed complete gastric emptying at one hour and in only six did the barium reach the caecum in this time. These results were sufficiently encouraging to merit confirmation by double blind trial. Observations were also made on the antiemetic effect of metoclopramide in a group of patients undergoing intravenous cholangiography.

SummaryThere is evidence to suggest that platelet activation occurs in Raynaud’s syndrome. We evaluated the effect of prostacyclin (PGI2) a potent antiplatelet and vasodilator agent in 5 female patients with Raynaud’s syndrome. Outpatient visits were made at weekly intervals for 4 weeks. At the first visit buffer solution (Wellcome Laboratories) was infused intravenously for 5 hrs, thereafter three five hr infusions of PGI2 at a peak dose of 10 ng/ Kg/min were given. Six weeks after the infusions patients were reviewed. Symptomatic improvement, including healing of ischaemic ulcers, occurred in 4 out of 5 patients. Thermography confirmed an increase in hand temperature after PCI2. Subjective and objective improvement has persisted for at least 6 weeks after the last treatment.

By considering a tumour as a localized heat source of constant heat output, and a blood vessel as a constant temperature source, a study is presented of the effect of natural and forced convection on the surface temperature distribution produced by both types of source a t different depths. The effects are derived theoretically and compared with results of measurements on a phantom and on patients.

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