The efficacy of cimetidine in the treatment of "resistant" duodenal ulcers.

In a prospective multicenter trial, 43 patients with acute duodenal ulcers unhealed after four weeks of treatment with an H2-receptor antagonist, ranitidine, were switched to treatment with another H2-receptor antagonist, cimetidine. Sixty-eight percent of the unhealed patients were successfully healed; of these patients, 81% were free of daytime pain and 89% were free of nighttime pain. Of those with residual pain, 71% and 50% showed improvement in daytime and nighttime pain severity, respectively. There were no unexpected adverse reactions reported or clinically significant changes in laboratory values measured during the study. It is concluded that cimetidine is highly effective both in healing duodenal ulcers unresponsive to ranitidine therapy and in providing continued relief of daytime and nighttime pain.

Efficacy of once-daily cimetidine in preventing recurrence of duodenal ulcer.

In a prospective multicenter trial, 88 patients with acute duodenal ulcers that were healed with ranitidine were randomly assigned to receive maintenance treatment with either cimetidine 400 mg (n = 45) or placebo (n = 43) at bedtime for six months. Ten percent of the patients experienced moderate or severe pain both during the day and at night while on placebo during the maintenance phase. The average proportion of cimetidine patients experiencing moderate or severe pain during the day or night was 50% and 80% lower than placebo, respectively. Ulcer-like symptoms prompted endoscopy in 44% (19 of 43) of the placebo patients compared with 18% (eight of 45) of patients receiving cimetidine (P = 0.009). At the completion of the maintenance study, cumulative symptomatic ulcer recurrence rates were 28% (12 of 43) for those on placebo compared with 13% (six of 45) for cimetidine patients. The adverse drug effects noted were similar between treatment groups, with no unexpected reactions reported. A low dose of cimetidine (400 mg) at bedtime effectively reduced the incidence of gastrointestinal symptoms that were severe enough to prompt endoscopy as well as the actual recurrence of ulcers in those patients who had responded to initial therapy with ranitidine, but who continued to be at increased risk of reulceration.

Crohn's disease (regional enteritis) in association with Hodgkin's disease.

It has long been known that Crohn's disease may occur in association with certain forms of malignancy, specifically adenocarcinoma and lymphoma of the bowel and carcinoma of the vulva and perianal area. Here, the authors report the rare occurrence of extraintestinal Hodgkin's disease in a patient with documented regional enteritis of five years' duration. They propose explanations for this unusual combination of disease, reported in the literature only once previously, and review the pathophysiology of lymphoma and regional enteritis.

Gastric obstruction from the Angelchik prosthesis.

A 47-year-old woman with gastroesophageal reflux underwent insertion of an angelchik antireflux prosthesis. Five days postoperatively, the prosthesis had slipped and obstructed the stomach, requiring reoperation.

Treatment of acute alcoholic pancreatitis: the roles of cimetidine and nasogastric suction.

A double-blind prospective controlled study designed to determine the effectiveness of the addition of cimetidine to standard treatment of acute alcoholic pancreatitis and to determine the importance of nasogastric suction in this disorder was undertaken. Forty-five patients were randomized to one of four treatment groups: 1) group I received intravenous cimetidine plus a blinded nasogastric tube, 2) group II received intravenous cimetidine plus nasogastric suction, 3) group III received nasogastric suction plus cimetidine placebo, and 4) group IV received a blinded nasogastric tube plus cimetidine placebo. Patients were evaluated via both biochemical and clinical parameters. It was concluded that 1) cimetidine added to more traditional therapy does not hasten improvement in patients with acute alcoholic pancreatitis, 2) cimetidine may delay recovery as measured by both clinical and biochemical measurements, 3) nasogastric suction appears indicated, under most circumstances, only in those patients with ileus and/or nausea and emesis.

Hepatic dysfunction due to intravenous abuse of methylphenidate hydrochloride.

Methylphenidate-induced hepatic injury was documented by abnormal liver function tests including a markedly elevated serum bilirubin, serum glutamic oxaloacetic transaminase, and serum glutamic pyruvic transaminase. Liver biopsy confirmed portal inflammation and hepatocellular disarray. Enzyme changes were reproducible with rechallenge of the drug (Ritalin). The drug is capable of producing hepatic injury, particularly when given in nonstandard doses intravenously.

Treatment of radiation enteritis: a comparison study.

Twenty-four patients with severe radiation injury to the small bowel seen over a 4-year period were randomized to four treatment groups: 1) methylprednisolone 80 mg intravenously plus Vivonex-HN, 2 L/day po, 2) methylprednisolone 80 mg intravenously plus total parenteral nutrition, 2.5 L/day, 3) total parenteral nutrition, 2.5 L/day, and 4) Vivonex-HN, 2 L/day po. Patients received nothing by mouth except water in groups II and III, and only Vivonex-HN in groups I and IV. Patients were treated for 8-wk periods. Improvement was gauged by overall nutritional assessment measurements, nitrogen balance data and by radiological and clinical parameters. No significant difference between groups I, II, III, and IV could be found for age, sex, mean radiation dosage, time of onset after radiation therapy, or initial nutritional assessment data. Differences statistically could be found between groups II and III and I and IV regarding nutritional assessment data, nitrogen balance, radiographic and clinical parameters after therapy, with marked improvement noted in groups II and III. We conclude that a treatment regimen consisting of total parenteral nutrition and bowel rest is beneficial in the treatment of radiation enteritis. Methylprednisolone appears to enhance this effect and indeed, may be responsible for a longer lasting response.

Cimetidine in the treatment of gastric ulcer induced by steroidal and nonsteroidal anti-inflammatory agents.

The study of a group of patients with gastric ulcers induced by anti-inflammatory agents, was undertaken in an attempt to ascertain the effectiveness of cimetidine (Tagamet) when compared with intensified doses of antacids in their treatment. Seventy patients with medication-induced benign gastric ulcers confirmed by endoscopy and biopsy were studied. The agents principally responsible were aspirin, prednisone, ibuprofen, indomethacin, and sulindac in standard pharmacologic doses. The study was carefully controlled to exclude confusing parameters. Patients were divided into two groups. Group 1 (38 patients) received cimetidine plus and antacid (Maalox). Group 11 (32 patients) received placebo tablets plus the same dose of antacid as in Group 1. All anti-inflammatory agents were discontinued and patients were instructed to avoid known gastric irritants. Treatment periods lasted six weeks. Confirmation of healing was by endoscopic evaluation. A significant difference was noted only with respect to treatment response. Twenty-five of the 38 patients (65.7%) in group 1 receiving cimetidine plus antacid had their ulcers healed within the six-week period. Only eight of the 32 patients (25%) in Group 11 receiving placebo plus antacid had ulcer healing within this period of time (P less than .001). We conclude that a regimen of cimetidine plus intensified antacid therapy is far superior to the same dose of antacid alone in the treatment of gastric ulcer induced by anti-inflammatory agents.

Submucous lipoma simulating carcinoma of the colon.

A 43-year-old white man who presented for evaluation of hematochezia was found to have an abdominal mass in the proximal descending colon, suggestive of carcinoma on barium enema and at colonoscopy. Surgery revealed a submucous lipoma. We report the case to show that submucous lipomas may be mistaken for carcinoma of the colon.

Pregnancy and jejunoileal bypass: treatment of complications with total parenteral nutrition.

A 27-year-old pregnant woman with a jejunoileal bypass presented with intractable nausea, vomiting, and diarrhea during the 25th week of gestation. Total parenteral nutrition supported mother and fetus through a difficult portion of the pregnancy, with a successful outcome.

[Diminished peritoneal pain perception in patients with liver cirrhosis and ascites]. / Verminderte peritoneale Schmerzempfindung bei Patienten mit Lebrzirrhose und Aszites.

Complete loss of parietal peritoneal sensitivity observed in a patient with long-standing ascites secondary to cirrhosis of the liver prompted an investigation of peritoneal sensitivity in 22 patients with the same condition. In all of them a decrease of the peritoneal sensitivity to needle perforation was found. All perceived peritoneal perforation as less painful than perforation of the abdominal skin by the same needle. In 8 control patients perforation of the peritoneum caused more discomfort than the perforation of the skin. In 7 cirrhotic patients where a histologic examination of the parietal peritoneum was available a chronic fibrotic peritonitis was present. Peritoneal insensitivity may partly account for mild abdominal symptoms in cirrhotics developing bacterial peritonitis.

Effect of diester and diether phosphatidylcholine on intestinal absorption of neutral and acidic sterols.

The effects of nondigestible diether phosphatidylcholine on intestinal absorption of cholesterol and dihydroxy and trihydroxy conjugated bile salts were studied in bile fistula rats using radioactive substrates. No inhibition of absorption of either dihydroxy or trihydroxy bile salts was observed. Nondigestible phospholipid did, however, significantly inhibit cholesterol absorption. Under control conditions with natural phosphatidylcholine in the intestinal perfusate, absorption of cholesterol was significantly greater when infused with taurocholate (TC) as compared to results obtained after infusion with taurochenodeoxycholate (TCD). Studies were repeated using radioactive rat liver phosphatidylcholine to determine whether the observed decrease in cholesterol absorption could be correlated with a decrease in digestion and absorption of rat liver phosphatidylcholine. No evidence was found for decreased absorption of this phospholipid when given with TCD. It is concluded that less cholesterol is absorbed in the presence of TCD as compared to TC, but the mechanism for this remains unexplained.

Tolazamide-induced hepatic dysfunction.

A case of tolazamide-induced hepatic injury is reported. Injury was documented by abnormal liver tests, including an elevated alkaline phosphatase, 5' nucleotidase and serum glutamic oxaloacetic transaminase. Liver biopsy confirmed the degree and type of injury which consisted of severe portal inflammation, bile duct proliferation and early fibrosis. The case is reported to further establish tolazamide as a drug capable of producing hepatic injury and to report a new form of hepatic injury attributable to a sulfonylurea agent.

Malabsorption in infectious mononucleosis.

A case of infectious mononucleosis, complicated by malabsorption, is presented. Malabsorption was documented by abnormal d-xylose, small bowel series, 72-hour stool fat and jejunal biopsy. Small bowel abnormalities and other gastrointestinal manifestations of infectious mononucleosis are discussed.

Male infertility and 21/1 translocation.

Cultured blood leukocytes of a 27-year-old infertile white man displayed evidence of an A/G translocation. All cells showed an identical abnormal karotype, 46, XY, t(1p-;21q+). The chromosome abnormality, a proposed mechanism for its production, and related chromosome translocations are discussed.

Diabetic visceral neuropathy: treatment with bethanechol chloride.

An 86-year-old diabetic man developed nausea, emesis, abdominal distention, and decreased gastrointestinal motility. A Hollander test confirmed incomplete vagal dysfunction. Treatment with bethanechol chloride resulted in marked improvement which was reproducible after withdrawal and reinstitution of therapy. We believe that treatment with bethanechol chloride deserves further investigation in selected patients with diabetic visceral neuropathy.