Cimetidine versus antacid in scleroderma with reflux esophagitis. A randomized double-blind controlled study.

The effectiveness of cimetidine vs. antacid in the treatment of patients with scleroderma and symptomatic reflux esophagitis was studied in a double-blind cross-over controlled trial. Fifteen patients were initially randomized to either cimetidine (300 mg four times daily) with placebo antacid, or placebo tablet (1 four times daily) with Mylanta II (30 ml four times daily and PRN). After 8 wk of therapy on the initial regimen, each patient was crossed over to the alternate regimen for an additional 8 wk of therapy. The severity of symptoms during each treatment period was estimated by patient interviews and changes in esophagitis were evaluated endoscopically. Cimetidine gave significantly greater relief of heartburn than antacid regardless of the initial randomization. Cimetidine also resulted in significant endoscopic improvement of the esophageal mucosa whereas antacid was without effect. Neither cimetidine nor antacid produced any improvement in esophageal stricture size or lower esophageal sphincter pressure. Cimetidine was without toxicity whereas antacid therapy frequently produced diarrhea.

Antithrombin III deficiency appearing as mesenteric vein thrombosis.

Mesenteric vein thrombosis is a relatively uncommon but devastating problem. Absence of any of the generally accepted etiologic factors of mesenteric vein thrombosis has lead to the diagnosis of "primary" mesenteric vein thrombosis in 25-55% of all cases. In this report we identify a young man with antithrombin III deficiency presenting as "primary" mesenteric vein thrombosis with massive bowel infarction. It again raises the possibility that other cases of "primary" mesenteric vein thrombosis may have been associated with this coagulopathy. Factors influencing antithrombin III levels are discussed in relation to diagnosis of the familial deficiency state in a patient with mesenteric vein thrombosis. The association of intra-abdominal venous occlusion and antithrombin III deficiency is emphasized.

Dose-response effects of indomethacin and PGE2 on electromechanical activity of in vivo rabbit ileum.

We determined dose-response characteristics of indomethacin and prostaglandin E2 on the myoelectric activity in ileum of anesthetized New Zealand White rabbits. Monopolar electrodes and an intraluminal saline-filled catheter were used to simultaneously record electrical and mechanical activity. Thirty minutes after injection of 3.0, 5.0, and 10.0 mg/kg indomethacin, the percentage of slow waves with action potentials increased significantly from 10% to over 80%; at 60 min action potential activity decreased but remained dose dependent and significantly greater than controls. Action potential activity correlated with phasic increases in intraluminal pressure. Low-dose indomethacin (1.5 mg/kg) did not significantly alter action potential activity. Action potential activity induced by indomethacin (5 mg/kg) decreased dose dependently after infusion of prostaglandin E2 (PGE2, 1-28 micrograms/kg). In summary, dose-dependent action potential activity was induced by indomethacin and reversed by PGE2. Endogenous inhibitory prostaglandins (PGE2 or others) appear to modulate activity of specific excitatory neuromuscular circuits in in vivo ileum.

Idiopathic cholestasis of pregnancy. The response to challenge with the synthetic estrogen, ethinyl estradiol.

PIP: The possible role of estrogens in the pathogenesis of pruritus gravidarum and cholestatic jaundice of pregnancy was examined. 13 women of childbearing age who had been studied during at least 1 of their previous pregnancies were the subjects in the investigation. 7 of these women had symptoms during pregnancy; 3 had pruritus gravidarum and 4 cholestatic jaundice. 6 women who had been free of symptoms during pregnancy served as controls. A dose of .5 mg twice daily was given to 10 subjects; 2 received .5 mg daily, and 1, .5 mg, 3 times a day. 10 subjects recieved estrogen for 2 weeks, but in 3 who had been symptomatic during pregnancy, the development of severe symptoms or jaundice necessitated earlier cessation of hormone administration. In women with normal pregnancies the only symptom during estrogen treatment was mild early-morning nausea and liver function was not significantly impaired. In those with a history of itching or jaundice during pregnancy, ethinyl estradiol administration precipitated symptoms similar to those experienced during pregnancy. In these women liver function was significantly impaired by estrogen.^ieng