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The efficacy and safety of famotidine and ranitidine in the treatment of active duodenal ulcer were compared in a multicenter, randomized double-blind study. The study was carried out at 5 centers and involved a total of 143 patients with endoscopically documented active duodenal ulcer. The patients received either famotidine (1 40 mg tablet at night) or ranitidine 2 150 mg tablets at night). Endoscopic examinations were performed at 4 and 6 weeks of active treatment. Day and nocturnal pain were also monitored, and the laboratory and clinical profiles evaluated. One hundred and thirty-three patients fulfilled the evaluation criteria (66 patients in the famotidine group and 67 in the ranitidine group). Healing rates at weeks 4 or 6 of treatment showed no significant differences between the famotidine group and the ranitidine group. The healing rates were 78% at week 4 and 96% at week 6 in the famotidine group, and 76% at week 4 and 95% at week 6 in the ranitidine group. Similar results were observed in both treatment groups with regard to pain resolution, decrease in antacid intake and safety profile.

In 1972, Magnius and Espmark on confronting different sera containing the surface antigen of hepatitis B with each other, demonstrated a new antigenic item which they called e. In later works the presence of this new antigenic specificity was associated with a greater rate of incidence of chronic hepatic lesion and a greater contagiousness of B virus. In the present study the e system was determined in a group of HBsAG positive blood donors and in a group of patients carrying HBeAG who had been admitted to the hospital for different reasons. The results showed an elevated rate of anti-e antibodies in the asymptomatic donors, and this could be correlated with clinical and biochemical indemnity of the liver function. HBsAg carriers mainly presented renal insufficiency or hematologic disorders, probably related to a deficient immune response. Determination of the e system shows its usefulness in enabling HBsAg positive carriers to be classified according to whether they present or not present hepatic lesion. The presence of HBeAg could be correlated with hepatic lesion, while HBeAc seems to determine some type of protection on those patients who have it in their sera.

Clinical and biological characteristics are studied in 16 patients with polymyalgia arteritica. 12 of them were diagnosed by biopsy of the temporal artery and the other 4 because they presented clinical, biological data and a high response to corticosteroids. There were no differences according to sex. Most patients (75%) had symptoms since 1-6 months, headache being the most common (75%). Fever (56%), polymyalgia (50%), weight loss (37%), intermittent claudication, loss of vision and arthritis (12%) were the symptoms seen in these patients. ERS was high in all cases, hemoglobin was less than 8 g/100 ml in 8 cases and an increase of alfa-2-globuline was found in 8 patients. Temporal artery palpation was abnormal in 11 patients. Two of 5 patients who presented a normal arterial palpation had a positive biopsy. All patients received 6-metil-prednisolone. 3 are well after 3, 4 and 6 months therapy. 8 are also well but receiving small doses of steroids as treatment.

Two cases of histiocytosis X, one of the disseminated form and the other localized to the lung, are reported, in which pleural effusion, probably due to pleural involvement as assessed by biopsy, was one of the initial manifestations of the disease.

The antigenic composition of the pneumoccocal capsule and its easy detection by counterimmunoelectrophoresis led us to carry out a comparative study of this method and the results obtained from cultures. A series of 159 patientes with suspected bacterial pneumonia were included in the study. Blood cultures were prepared for all of the patients; sputum cultures were practiced on 35 and cultures of pleural fluid on 32. Serum from all of the patients, urine from 104, sputum from 34, and pleural fluid from 16 were analyzed by counterimmunoelectrophoresis for pneumoccocal antigen. This method was particularly useful for detecting the germ in sputum and pleural fluid. Furthermore, a higher number of positive indexes in serum were obtained by counterimmunoelectrophoresis than by blood cultures (p less than 0.01). This was also true for tests with sputum and pleural fluid. Urine tests resulted in an even greater number of detections. Counterimmunoelectrophoresis is thus a simple, quick method for detecting pneumococcus and is especially useful when accompanied by cultures tests, since they are complementary. We were able to discover a positive indication of penumoccocus in bacterial pneumonia in 39.6 percent of cases with this technique, as opposed to 15 percent using cultures alone.

The differentiation between gastric lymphomas and pseudolymphomas represents a clinical, surgical, and pathologic problem affecting both prognosis and therapy. Twenty patients were diagnosed for gastric lymphomas or gastric pseudolymphomas. Only those in stages IE or IIE were included in the first group (13 patients). Pseudolymphomas were diagnosed in seven patients on the basis of histopathologic criteria; all seven had peptic ulcers. Survival among the 13 patients diagnosed for lymphomas was low; six of them died within the first year. The seven cases diagnosed as pseudolymphoma progressed favorably over periods between 2 months and 5 years. The histologic parameters on which the differentiation of the two conditions was based included: a) cell type; b) distribution and limits of infiltration; c) presence of peptic ulcers in pseudolymphomas; and c) characteristics of the regional lymph nodes. The various possible mechanisms of pseudolymphomatous reaction are discussed. It is suggested that the relatively good prognosis reported in some series of gastric lymphomas may be due to the inclusion of pseudolymphomas. There is obvious justification for distinguishing between this two conditions.

The value of testing for antikeratin antibodies (AKA) in the diagnosis of rheumatic diseases was investigated. AKA were found in the serum of 71 (54%) of 131 patients with rheumatoid arthritis (RA) (including 10 rheumatoid factor (RF) negative individuals) but only in 7 (2%) of 266 patients with non-RA rheumatic diseases, in 2 (3%) of 69 patients with miscellaneous immunological diseases and in one of 100 healthy controls. AKA positivity in RA patients correlated with their age and the presence of RF, antinuclear antibodies, subcutaneous nodules, as well as the extent and severity of systemic disease manifestations. Our study suggests that determination of AKA would be of value in the assessment of patients suspected of having RA.

In recent years chronic infection by the hepatitis delta virus (HDV) has become an important cause of chronic liver disease among drug addicts. To evaluate the influence of addiction to i.v. drugs on the course of this disease we have analyzed the clinical, histopathological, virological and evolutive features in 18 addicts and 11 non-addicts with chronic delta infection. Recent acute hepatitis D, documented as HDV superinfection, was observed in 14 addicts (77%) and in 2 non-addicts (18%) (P less than 0.02). At the time of evaluation for chronic liver disease, the frequency of symptoms, the degree of biochemical disturbances and the histopathological severity were similar in the two groups but the duration of HDV infection was probably shorter in drug addicts. HBV replication, as indicated by the presence of HBeAg and HBV-DNA in serum and HBcAg in liver, was more frequent in addicts. The amount of HDAg in liver tissue was also greater in addicts (P less than 0.005). Antibodies against the human immunodeficiency virus were detected in all of the addicts (P less than 0.001). Although most patients remained asymptomatic, significant histological worsening occurred in one half of the cases after a relatively short period of follow-up (25.1 +/- 16.3 months). The tendency to deteriorate in addicts (61% of cases) was greater than in non-addicts (36%). These observations suggest that the prognosis of chronic HDV infection is particularly poor in drug addicts in whom rapid deterioration may be related to simultaneous and inadequately controlled replication of hepatotropic viruses.

The authors report eight cases of women suffering from pseudolupus erythematosus, with positive antimitochondrial antibodies. In six in the past history, a vasculotropic drug, Venocuran or Venopyridum, had been taken. All the patients had had episodes of fever, a pericarditis and/or myocarditis. A pleural effusion was present in six and pulmonary infiltrates in four. The course of the disease was for a limited period (1 to 3 months) in four cases and was chronic in the other four. One patient developed severe mitral incompetence and a cardiomyopathy.

A 27-year-old male developed an autoimmune hemolytic anemia during the initial episode of chronic ulcerative colitis. Laboratory studies revealed a positive direct Coomb's test (IgG + C), and the presence of specific anti-Hr antibody. Salicylazosulfapyridine was tested by means of immunohematologic techniques, but results discarded this drug as the responsible agent for autoimmune hemolytic anemia. Association of ulcerative colitis and autoimmune hemolytic anemia is an uncommon finding; around 36 cases have been published in the literature. Hemolytic anemia may develop as a consequence of treatment with salicylazosulfapyridine, the antimicrobial of choice in the management of inflammatory diseases of the bowel.

The histological lesions found in patients with hepatic disease and positive anti-mitochondrial antibodies (AMA) by immunofluorescence were compared with those in 10 subjects of the same age and sex with negative AMA. The majority of the patients with positive AMA were suffering from primary biliary cirrhosis, the diagnosis being based upon the histological appearance (Stage 1 of Scheuer's classification: 40%) or the presence of clinical signs of cholestasis with a compatible histological appearance (40%). None of the remaining patients (20%) with positive AMA nor the 10 individuals with negative AMA showed histological signs suggestive of primary biliary cirrhosis. The absence of certain clinico-biological factors, with the exception of Stage 1 histology, gives a high degree of value to a high level of AMA in the diagnostic of PBC.