Search

Gastrointestinal symptoms and diseases increase with ageing, and the commonest lesions are carcinoma (of the stomach or large bowel), peptic ulc?ration, intestinal obstruction (herniae or diverticular disease of the colon), hiatus hernia, and gallstones. The first three of these caused most of the 20% of deaths directly due to lesions of the digestive system in Mc Keown's series of 1,500 necropsies in patients aged 70 or over.1 This incidence was second only to diseases of the cardiovascular system as causes of death, and numerically only a little less. Carcinomas of the gastrointestinal system made up nearly half of the total of fatal malignant disease, and half of these were in the large bowel. Disease of the biliary tract has been said to be the commonest pathological finding requiring abdominal sur gery in the aged.2 In elderly patients with abdominal pain, Ponka et al. found that gallbladder disease was the cause in 27-5%.3

Oral administration of 3-methyl salicylic acid (3MS) to diabetic and non-diabetic patients in modest doses (0.9–1.8 g/day) over several months produced a significant increase in plasma insulin levels, one hour after a glucose load. In 2 diabetic subjects, acute doses had a similar effect. — Improvement in glucose tolerance after chronic administration of 3 MS to diabetic patients was inconsistent, and could not be conclusively related to the action of the drug. Although acute doses of 3 MS caused a fall in plasma FFA after 3–6h, chronic treatment gave no predictable change in fasting plasma FFA levels. — Because of side effects, 3 MS was not considered suitable for introduction as a therapeutic agent. The results, however, are of academic interest since it is the first demonstration of increased plasma insulin after an oral salicylate.

The established test for disease in the internal carotid artery using continuous wave Doppler is to listen for flow velocity changes over the supraorbital artery with ipsilateral temporal (or facial) artery compression. This is only reliable when there is a reduction in mean pressure (and flow) distal to disease in the internal carotid artery, ie reduction of lumen diameter by more than 85%. In this study, 101 vessel segments (48 with disease at the carotid junction, 53 normal) were compared with the results of angiography. Seven gave a positive temporal artery occlusion test, all of which showed severe disease. However, spectral analysis of the Doppler signals from supraorbital and common carotid arteries showed sonagram changes both with ageing and with disease. In particular, the ratio of primary peak (A) to secondary peak (B) in systole falls, the A/B ratio being lower in disease than in health. At A/B ratios less than 1.05 there was an 88% probability of disease at the carotid junction. 36/48 (75%) diseased junctions were detected, including almost all major lesions. The method did not so reliably detect small lesions (less than 2 mm plaques, less than 60% lumen diameter stenosis, and 'minimal atheroma'). In 5/53 normal junctions the A/B ratio was in the disease range. Scanning the carotid junction for turbulence yielded additional information in some cases.