Effects of a new effervescent cimetidine formulation on gastric acidity in healthy subjects.

The effect of a new effervescent formulation of 800 mg cimetidine on intragastric acidity was studied in 10 fasting healthy male volunteers. Using a randomised, cross-over design, the effect of this new cimetidine formulation was compared with that of a standard dose of a liquid aluminium/magnesium hydroxide antacid (Maalox). Intragastric pH was continuously monitored with a combination glass electrode and a digital data recorder. After a baseline period of 1 h the effect of the drugs was studied for 5 h. Both drugs increased the intragastric pH instantaneously, but the effect of Maalox ceased after 45.3 +/- 31.0 min (mean +/- SD), whereas that of effervescent cimetidine persisted for the entire 5 hr study period. Time with pH greater than 3.5, time with pH greater than 2, greater than 3, greater than 4, greater than 5 and greater than 6, and areas under the pH-time curves were significantly (P less than 0.001) higher for effervescent cimetidine than for Maalox. It is concluded that the new cimetidine formulation studied effectively combines, at least in healthy male volunteers, the immediate effect of a pH buffer with the prolonged systemic effect of an H2 blocker.

Dysphagia after Nissen fundoplication.

Nissen fundoplication is a commonly used antireflux operation. After this operation symptoms such as dysphagia, inability to belch and vomit, and gas bloating are frequently reported in the literature. In 32 patients who underwent Nissen fundoplication 3.5-18 years ago, postprocedure dysphagia was studied using conventional manometry and 24 h ambulatory pressure and pH recording. Our study indicates that dysphagia tends to decrease after surgery. Neither conventional nor ambulatory pressure recording revealed motor abnormalities that could be held responsible for the dysphagia. Therefore, the data do not support the concept that dysphagia is a major complication of Nissen fundoplication.

[Temporary and permanent recurrent laryngeal nerve paralysis following thyroid surgery. Modifying factors: the educational status of the surgeon]. / Die passagere und permanente Rekurrenzparese nach Schilddrüsen-operationen. Beeinflussende Faktoren: der Ausbildungsstand des Chirurgen.

17 of 525 patients (3.2%) showed an laryngoscopically established palsy of the recurrent laryngeal nerve after surgery for struma. The analysis of these operations, performed by five surgeons during or within three years after the period of surgical training, revealed that the operations performed under assistance of the senior surgeons were high grade selected (p = 0.026). Thus 14.8% of the operations performed because of simple goiter but only 4.8% of the operations performed because of thyroid cancer/recurrent goiter/extensive nodular goiter were assisted in this way. On the other hand it was necessary to call for help of a senior surgeon because of intraoperative difficulties in only 1.26% of the cases operated on for simple goiter, but in 19.6% of the more complex forms of goiter (p less than 0.001). The risk of recurrent laryngeal nerve palsy was nearly 10 times higher in the complex forms of goiter than in the simple forms (p less than 0.001). More extensive surgical training in the forms of complex goiters should be able to improve the results.

[Long-term laryngoscopic follow-up in vocal cord paralysis following struma surgery]. / Die langfristige laryngoskopische Nachkontrolle bei Einschränkung der Stimmbandmotilität nach Strumaoperation.

Of 525 patients 17 (3.2%) showed a laryngoscopically established palsy of the recurrent laryngeal nerve after surgery due to goiter. A laryngoscopic follow-up of all these patients, performed at least one year after the operation, revealed that 76.5% of the recurrent nerve palsies were temporary and 23.5% were permanent. Danger of permanent palsy increased in the sequence--uncomplicated nodular goiter--struma maligna--recurrent goiter. The outcome of long-term follow-up showed a palsy rate of 0.8%, which was much lower than the corresponding rate reported by short-term control (p = 0.005). Therefore laryngoscopic long-term follow-up in cases of postoperative abnormal laryngoscopic function should be a standard part of follow-up in thyroid gland surgery.