[Substance abuse among patients in a department of general medicine]. / Rusmiddelmisbruk blant pasienter i en medisinsk avdeling.

We conducted a survey of alcohol and drug habits among patients hospitalized in our department during a six month period. Alcohol and drug abuse was found among 185 (11%) of the patients, with a male-to-female ratio of 2.3. The median age was 52 years for women and 53 for men. Generally, the levels of education and employment were low among the alcohol and drug abusing patients. In contrast to our experience, most general practitioners in our catchment area considered alcohol and drug abuse as a minor problem in their patients. During the last 25 years only seven of 54 medical clinics in Norway have performed a systematic registration of alcohol and drug habits among their patients. Patients with alcohol and drug abuse constituted a marked proportion of hospitalized patients in our clinic, and they consumed a substantial portion of our resources.

[Ischemic colitis. Clinical, coloscopic and biopsy findings illustrated by 10 cases]. / Ischemisk kolitt. Klinikk, koloskopiske og bioptiske funn illustrert med to tilfeller.

Transient ischemia of the colon may be so severe as to cause segmental strictures, but in other cases it may be so slight that the damage heals up without any demonstrable morphological changes. The patients are often older than 60 years. Characteristic clinical features are acute abdominal pain and simultaneous bloody diarrhea. The diagnosis is normally made on the basis of clinical and colonoscopic findings and typical histological changes in biopsies. It is important to make a correct diagnosis at an early stage because close observation is necessary for some days. No specific treatment is needed.

[Body temperature measurement. A comparison of rectal measurement using a mercury thermometer with oral axillary measurement using a new electronic thermometer]. / Måling av kroppstemperatur. Sammenlikning av rektale målinger med kvikksølvtermometer med orale eller aksillaere målinger med et nytt elektronisk termometer.

New methods for measuring body temperature are marketed regularly. In our department we used an electronic thermometer (Craftemp) which measured oral or axillary temperature. Since we doubted the accuracy of the measurements made with this device, we compared the values found using this thermometer with values from a conventional mercury thermometer, both in a thermostatic regulated water bath and when used clinically. There was good conformity between the results in the water bath. However, when the thermometer was used clinically, in half the patients there was a difference of 0.5 degrees C or more from the rectal temperature measured with a mercury thermometer. Most of the beds in our department are occupied by geriatric patients with age-related diseases. Many of them also have mental disturbances (e.g. dementia), which makes adequate cooperation during the measuring procedure uncertain. This study indicates that the electronic thermometer (Craftemp) is not suitable in a department like ours with many old disabled patients.

[Disulfiram and acute liver damage]. / Disulfiram og akutt leverskade.

Few serious side effects have been reported from use of disulfiram. In this article we present a case where therapeutic doses of disulfiram resulted in acute liver damage. We also found neurological symptoms, although such side effects from use of this drug are rare.

Selective vitamin B12 malabsorption in adult coeliac disease. Report on three cases with associated autoimmune diseases.

Three cases of adult coeliac disease with severe vitamin B12 deficiency not accompanied by folate or iron depletion are presented. Two of the patients had the extremely rare combination of coeliac disease and lack of intrinsic factor and autoimmune thrombocytopenic purpura. A close association between coeliac disease and autoimmunity is indicated by the development of autoimmune thyroiditis in the third patient. Vitamin B12 malabsorption caused by coeliac disease is emphasized as a pathogenetic mechanism of megaloblastic anaemia.

Colonoscopy in the diagnosis of colorectal cancer.

Many studies show that colonoscopy is the most accurate method available in the diagnosis of colorectal cancer. Furthermore, in some cases it makes it possible to treat malignant polyps adequately by simple polypectomy. Endoscopic removal of adenomas plays an important role in prevention of colorectal malignancies. It has also been shown that there is a high rate of synchronous premalignant and malignant lesions.

Symptoms in patients with peptic ulcer and hematemesis and/or melena related to the use of non-steroid anti-inflammatory drugs.

One hundred and seven consecutive patients with hematemesis and/or melena and a diagnosis of duodenal, gastric, or esophageal ulcers were interviewed immediately before or after endoscopy about the use of non-steroid anti-inflammatory drugs (NSAIDs) and symptoms before the hemorrhage. If the patients admitted no symptoms of abdominal pain or discomfort, nausea, vomiting, or heartburn, they were classified as having no ulcer symptoms before the hemorrhage. Patients who had not taken NSAIDs during the last 48 h before the hemorrhage were classified as not having taken NSAIDs. Significantly fewer patients had ulcer symptoms in the group that had used NSAIDs than in the other group (p less than 0.01). This may be interpreted as a possible masking effect by NSAIDs on ulcer symptoms. Physicians and patients should be aware of this possible effect of NSAIDs.

The antisecretory effects of RP 40 749 in patients with previous duodenal ulcer.

Thirteen male patients with a history of duodenal ulcer were given 150 mg RP 40 749 or placebo tablets at bedtime in a double-blind crossover study. The medication was given for two periods of 10 days with an 11-day wash-out period between. pH and pepsin concentrations were determined each hour in aspirates of gastric juice for 24 h on day 1, 10, 22, 31, and a 2-h collection of gastric juice was examined in the middle of the treatment and wash-out periods. At defined hours blood samples were examined for gastrin, somatostatin, and pancreatic polypeptide (PP) by radioimmunological methods, and concentrations of RP 40 749 were determined in blood and gastric juice. Meals were served at fixed hours on days 1, 10, 22, and 31. After treatment with RP 40 749 a highly significant elevation of pH was found after the 1st day compared with placebo, most pronounced during night hours. The pepsin activity was slightly elevated. The serum concentrations of gastrin were increased and those of somatostatin and PP decreased during the first 3-4 h after medication, with a subsequent normalization. No side effects were observed.

Overdosage of piroxicam.

A 54-year-old woman took an overdose of 1 800 mg piroxicam. She complained of nausea and abdominal pain. Endoscopy revealed multiple superficial ulcerations in the pyloric antrum and the first part of duodenum. There were no symptoms or signs from other organ system and recovery was uneventful. The highest serum concentration was 241.6 mg/l, which is about 30 times the usual therapeutic level of 5-10 mg/l.