Giant Prepyloric Ulcer Haemorrhage: Patient Characteristics, Treatment, and Outcome in 2003–2012

The aim of the study was to characterize patients with giant prepyloric ulcer haemorrhage, their treatment, and outcome. The data for 929 peptic ulcer haemorrhage (PUH) patients were divided into three groups according to ulcer location: group I: 165 prepyloric ulcer patients, group II: 353 gastric ulcer patients, and group III: 411 duodenal ulcer patients. Among these groups giant ulcer (ulcer diameter ≥ 2 cm) haemorrhage cases were selected for the study and the data for group I were compared with the data for groups II and III. The study shows that the proportion of giant ulcers in all prepyloric ulcers was significantly 2.2 times lower compared with the proportion of giant ulcers in all gastric ulcers and 1.5 times lower than the proportion of giant ulcers in all duodenal ulcers. The share of surgical therapy for haemorrhages from giant prepyloric ulcers did not differ from the share of surgical therapy in the case of giant gastric ulcers but was 3.5 times lower than in the case of giant duodenal ulcers. Generally, treatment for PUH from giant prepyloric ulcers was successful not involving inhospital mortality.

Short term effect of treating claw horn lesions in dairy cattle on their locomotion, activity and milk yield

The immediate effect on dairy cow mobility, daily activity and milk yield following treatment for claw horn disease was examined in 306 lame cows located on four Cheshire dairy farms over twelve months. The daily activity and milk yield of all cows in these herds was recorded on computer using pedometers and in-parlour milk flow meters. Lame cows identified by stockmen were assessed subjectively by locomotion score, then restrained and their claws examined to identify the predominant lesion present. Those with locomotion scores &gt; 2.5 that presented with sole ulcer, haemorrhage and bruising, or white line disease were studied. Claws of the affected limb were trimmed by one paraprofessional claw trimmer using the five-step <em>Dutch method </em>and the affected claw unloaded either by trimming or application of a block to the healthy digit: those on the contra-lateral limb were trimmed similarly. The same observer repeated the locomotion score assessment seven days later: trimming reduced the proportion of lame cows (score &gt;3) by 55% and those with poor gait (score &lt;3&gt;2.5) by 49%, and the proportion of all cows not lame after trimming was 51% (χ2 4.94: P≤0.001). Night time activity levels increased from 76 to 81 steps/hour on day 2 after treatment (P&lt;0.05) but this was not maintained: daily milk yields fell by 2%. Using univariate mixed models, year and season, parity and farm all had significant effects on locomotion and activity levels. This treatment for claw horn disease in lame dairy cows improved their immediate health and welfare.

The patient with haematemesis and melaena

Bleeding from the upper gastrointestinal (GI) tract is a common medical emergency, with an incidence of between 50-150 cases per 100,000 per year.1 A recent audit by the British Society of Gastroenterology showed the mortality rate from upper GI bleeds has fallen from 14%2 in 1993 to 10% in 2007.3 However, despite the use of proton pump inhibitors (ppis), admission rates for peptic ulcer haemorrhage have increased in older age groups,4 probably related to increased use of antiplatelet agents such as aspirin and clopidogrel and anticoagulants in acute coronary syndromes, stroke and atrial fibrillation. The rising age of the population may also have offset further reductions in mortality and morbidity that may have otherwise come about through improved supportive and endoscopic care.