Minocycline-induced liver injury.

Tetracycline may cause fatty infiltration of the liver; more recently, it has been reported to cause intrahepatic cholestasis with bile duct depletion. However, minocycline, a derivative of tetracycline, is not generally recognized to be hepatotoxic. We report a series of six cases of presumed minocycline-induced liver injury; five of these patients had acute hepatitic illness, whereas one had a more prolonged course with histological evidence of chronic hepatitis. In addition, three patients demonstrated abnormal anti-nuclear antibody levels, and one had positive double-stranded DNA.

Cimetidine reduces the risk of rebleeding from duodenal ulcers displaying signs of recent haemorrhage.

The presence of endoscopic signs of recent haemorrhage (SRH) greatly increases the risk of rebleeding from peptic ulcers. Fifty-five patients with acute bleeding from chronic duodenal ulcers with SRH completed a randomized double-blind trial to assess the effect of administration of cimetidine (800 mg daily intravenously for 2 days, then 1000 mg daily orally for 10 days in divided doses) versus placebo on rebleeding and need for emergency surgery. In the cimetidine group (n = 29), 5 rebled, compared with 11 receiving placebo (n = 26) (p less than 0.05; relative risk, 0.28, 95% confidence interval, 0.08-0.97). This reduction in rebleeding rate in the cimetidine-treated patients was observed only in subjects over 60 years of age. Fifteen patients receiving cimetidine required blood transfusion (mean, 2.3 +/- 0.6 (SEM) units per patient) compared with 19 receiving placebo (3.5 +/- 0.5) (p greater than 0.1). Emergency surgery to arrest bleeding was required in three patients receiving cimetidine and four receiving placebo (p greater than 0.5). Cimetidine therapy should be considered in patients more than 60 years old who present with haemorrhage from a chronic duodenal ulcer with SRH and who are at high risk of rebleeding.

The healing rate of chronic gastric ulcer in patients admitted to hospital.

A study was made of the effect of age, sex, ulcer size, bed rest, carbenoxolone sodium and anticholinergic drug therapy, and advice to cease smoking on the healing rate of chronic gastric ulcer determined radiologically over 21 days in a factorially designed experiment in 54 patients admitted to hospital. It was found that carbenoxolone sodium, anticholinergic drug therapy, bed rest in hospital, and advice to cease smoking did not accelerate ulcer healing. Age and ulcer size had a slight effect on ulcer healing, the larger ulcers and those in older patients healing more slowly. The results can be explained by the hypothesis that chronic ulcers heal at a maximal rate after hospital admission and other factors that alone may have a beneficial effect in hospitalized patients.

Crohn's disease: a review of 122 cases.

One-hundred-and-twenty-two patients with Crohn's disease were admitted to Royal Prince Alfred Hospital from 1966 to 1977. Thirty-seven had disease confined to small bowel, 37 to colon and 48 had combined small and large bowel involvement. The disease was twice as common in females as in males. Pain was the major symptom in patients with small bowel disease and was associated with diarrhoea if both small and large bowel were involved. Disease confined to the colon most commonly produced diarrhoea with bleeding. Perianal disease occurred more often in patients with colonic disease. Systemic complications were also more frequent in the group with disease confined to colon, and these complications were often multiple. Medical treatment with corticosteroids, salazopyrine or azathioprine, was generally unsuccessful. One in two patients required surgery, usually in the form of resection. Following resection, recurrence occurrred in more than one half of the patients but was less frequent in those with colonic disease. Three-quarters of patients with a recurrence required a further resection, emphasising the unsatisfactory long-term results of surgery in this disease.