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THE ROENTGENOGRAPHIC demonstration of fundal gastric varices by the conventional upper gastrointestinal examination is notoriously difficult.1-3 Though it is generally believed that most patients with esophageal varices will also have gastric varices, the latter are rarely verified with the conventional upper gastrointestinal examination.2 The normal gastric rugae frequently have a rather coarse, beaded contour that effectively conceals the dilated veins in the wall of the fundus of the stomach.Gastric fundal varices may assume either a localized polypoid configuration or produce multiple, rounded, submucosal projections throughout the gastric fundus.4 In either of these situations, the diagnosis of gastric varices may be suspected if the patient has evidence of portal hypertension or pancreatic disease. Doublecontrast examination of the stomach usually provides optimal delineation of polypoid masses in the fundus. Absolute roentgenographic diagnosis depends on opacification of the dilated veins by angiography or splenoportography.1,2,5The possibility of gastric

A multicenter, double-blind, randomized controlled trial comparing the efficacy and safety of famotidine with ranitidine in the treatment of acute, benign gastric ulcer disease was coupled with a community-based gastric ulcer disease registry. One hundred ninety-five patients with endoscopically documented gastric ulcer disease were enrolled in the trial and randomly allocated to treatment with either famotidine 40 mg at bedtime or ranitidine 150 mg twice a day. Healing rates were similar in both groups: at four weeks 49% vs 48%, at six weeks 71% vs 69%, and at eight weeks 83% vs 81% for famotidine and for ranitidine, respectively. Pain relief, antacid tablet use, and adverse experiences were also similar in the two groups. Only 25% of patients entered in the gastric ulcer registry were enrolled in the trial. Given that patients with more severe or complicated gastric ulcer disease should be excluded from controlled trials of new drugs, the screening criteria used in the present study resulted in the findings being representative of a quarter of the patients seen in these practices. Therefore, coupling a patient registry with a clinical trial helps determine the applicability of its results. Famotidine 40 mg at bedtime is an effective and well-tolerated treatment of acute, benign gastric ulcer disease and is comparable in efficacy and safety to ranitidine 150 mg twice a day.

Postcibal duodenal contents and the enterohepatic circulation of intravenously administered sodium taurocholate-24-14C were studied in 8 patients with ileal disease and the data compared with that of a control group. Seven patients had an interrupted enterohepatic circulation of taurocholate; all had a normal fasting cholate pool size. Studies on the postcibal duodenal contents showed that 7 patients had concentrations of cholate and aqueous phase lipid comparable to controls during the first 30 minutes after feeding, whereas these values were comparably reduced during the subsequent 90 minutes. Four patients required special considerations. One patient with steatorrhea had an unstimulated release of bile salts into his duodenum, with resultant low cholate and aqueous phase lipid values during the entire postcibal study. One patient with Crohn's disease was physiologically normal. Two patients had no steatorrhea despite an interrupted enterohepatic taurocholate circulation. These results point up the value of correlative studies and suggest that certain patients may successfully compensate, as regards lipid absorption, for an interrupted enterohepatic circulation of bile salts.

The author comments on the Merton Rule which requires new developments in Great Britain to obtain at least 10 percent of their energy from site-installed renewable sources. He explains the disadvantage of requiring a minimum percentage of power generation on a development from renewables. He expresses uncertainty about the long-term effectiveness of these measures. He suggests the best way to reduce carbon emissions.

The author reflects on the concept of carbon offsetting. According to the author, being sustainable is about taking responsibility. He cites several issues to consider before committing to the concept as a way forward, which includes the whole idea of carbon offsetting as a panacea for global warming. He stresses that the people cannot afford to opt out of their responsibility for the effects of their chosen lifestyle.

The article discusses the benchmark against which to judge performance and plan improvement for a sustainable business practice in the construction industry. The concept of sustainability encompasses the state of the environment and the effect of various activities on the environment, as well as economical and societal needs. There are different tools used by manufacturers in the construction industry to assess the environmental impact of their products and activities. These tools include the Life Cycle Assessment from BRE and the Sustainability Project Appraisal Routine (SPeAR) from Arup. Kingspan Insulation is the only construction-material manufacturer to have undertaken a SPeAR appraisal as of 2006.

The article discusses the need to consider the economical, environmental and sociological aspects of sustainable development to ensure its success. One must have as much knowledge about the issue to be able to make an informed choice. The processes used to retrieve and recycle material can affect the environment. Conducting a Life Cycle Assessment is recommended to determine the environmental impact of a product. Knowing the nature and practices of a company can also help in making an informed choice.

The article talks about the final versions of the Approved Documents L of Building Regulations in Great Britain. A certain amount of caution needs to be exercised in the complicated task of achieving compliance, in order to avoid leaving a building vulnerable to either failure on completion or deterioration in the future. Since the time of waiting for the Regulations is over, it is time to really tackle the issue of carbon dioxide emissions and provide this country with cost-effective, energy-efficient buildings.

The article discusses concerns over the consultation document on the Code for Sustainable Homes in Great Britain. It states that the Ecohomes system asks for greater energy efficiency than the current Building Regulations standard. It offers an overview of the minimum standards for essential elements of the code. It argues that the code has no real grasp of the concept of sustainability.