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Combined treatment with cimetidine 1 g daily and cisapride 40 mg daily in patients with endoscopically diagnosed severe reflux oesophagitis was compared with single drug therapy (cimetidine and placebo). At the end of the six to 12 weeks treatment, 11 (46%) of the 24 patients under single drug therapy were endoscopically healed and three were improved. In contrast, 16 (70%) of the 23 patients under combined therapy were healed and all of the remainder were improved (p = 0.025). The severity of diurnal and nocturnal heartburn, decreased significantly more (p less than 0.05) on cimetidine + cisapride than on cimetidine + placebo. The combined treatment was well tolerated. These results suggest that combined therapy with cisapride and cimetidine may be useful in patients with severe reflux oesophagitis. [ABSTRACT FROM PUBLISHER]

The fifth case of a common bile duct carcinoid tumor is reported. The importance of endoscopic retrograde cholangiography on the one hand and specialized staining on the other for diagnosis is emphasized. The slow growing nature of these tumors favors extensive surgery whenever possible. [ABSTRACT FROM AUTHOR]

Exsudative enteropathy was suspected in a 27-year-old man with lower limb edema, hypoprotidemia and hypoalbuminemia. Gastrointestinal mucosa, kidney, liver, and heart were normal. Laparoscopy showed diffuse small intestine lymphangiectasia. This diagnosis was confirmed by the microscopic examination of several biopsies obtained at laparotomy. Pathological examination of peritoneal, lymph nodes, and liver biopsies showed fibrous thickening of the peritoneum and fibrosis of the lymph nodes. Our patient has been followed for 16 years. Substantial improvement of clinical symptoms was obtained by following a special salt-free diet containing short-chain triglycerides. However biochemical abnormalities have persisted. Exsudative enteropathy due to intestinal lymphangiectasia may be observed in heart and liver diseases as well as in malignant affections of mesenteric lymph nodes. If these conditions are excluded, intestinal lymphangiectasia may be considered as a primitive lymph vessel malformation. The discovery of primitive intestinal lymphangiectasia in an adult cannot be attributed to congenital abnormalities alone. Fibrosis encountered in some cases suggests that an inflammatory process of unknown origin may trigger the onset of intestinal lymphangiectasia.

In rats, erythromycin has been shown to induce microsomal enzymes and to promote its own transformation into a metabolite which forms an inactive complex with reduced cytochrome P-450. To determine whether similar effects also occur in humans, we studied hepatic microsomal enzymes from six untreated patients and six patients treated with erythromycin propionate, 2 g per os daily for 7 days. In the treated patients, NADPH-cytochrome c reductase activity was increased; the total cytochrome P-450 concn was also increased but part of the total cytochrome P-450 was complexed by an erythromycin metabolite. The concn of uncomplexed (active) cytochrome P-450 was not significantly modified and the activity of hexobarbital hydroxylase remained unchanged. We also measured the clearance of antipyrine in six other patients; this clearance was not significantly decreased when measured again on the seventh day of the erythromycin propionate treatment. We conclude that the administration of erythromycin propionate induces microsomal enzymes and results in the formation of an inactive cytochrome P-450-metabolite complex in humans. However, the concn of uncomplexed (active) cytochrome P-450 and tests for in vitro and in vivo drug metabolism were not significantly modified.

In rats, it has been shown that troleandomycin induces its own transformation into a metabolite forming an inactive complex with reduced cytochrome P-450. To determine whether similar effects occur in humans, we studied hepatic microsomes from 6 untreated patients and 6 patients treated with troleandomycin, 2 g per os daily for 7 days. In the treated patients, NADPH-cytochrome c reductase activity was increased by 48%; total cytochrome P-450 concentration was also increased, but 33% of total cytochrome P-450 was complexed by a troleandomycin metabolite. The cytochrome P-450 Fe(II)-metabolite complex exhibited properties identical to those of the inactive complex formed in rats: it exhibited a Soret peak at 456 nm, was unable to bind CO, and was destroyed by addition of 50 microM potassium ferricyanide. We also measured the clearance of antipyrine in 6 other subjects. This clearance was decreased by 45% when measured again on te seventh day of the troleandomycin treatment. We conclude that repeated administration of troleandomycin induces microsomal enzymes, produces an inactive cytochrome P-450 Fe(II)-metabolite complex, and decreases the clearance of antipyrine in humans.

Thirteen patients with intestinal lesions consecutive to radiotherapy for carcinoma of the uterus were operated upon between 1973 and 1979. The small bowel was involved in 9 patients and the colon and rectum in 4 patients. Urinary tract lesions were associated in 3 patients of each group. Intestinal necrosis, progression of the lesions and extensive pelvic fibrosis were the only criteria of poor prognosis. Twenty-two operations were performed: 4 for urinary tract lesions and 18 for intestinal lesions. Five patients died during the immediate post-operative period and five died within 2 to 30 months after surgery, including 4 whose carcinoma recurred. The operative technique should be selected according to the extent and severity of radiation-induced damage, as determined by pre-operative examination and thorough exploration of the abdominal cavity once opened. Limited lesions of the small bowel can be treated by resection, but intestinal bypass with latero-lateral anastomosis seems to be preferable in cases with extensive lesions. Patients with colorectal lesions should have defunctioning colostomy prior to any other procedure dictated by the state of affairs. Multiple anastomosis, extensive resections and excessive dissections should be avoided.

A 78-year-old patient previously operated upon for rectal carcinoma and who had no sign of immune system deficiency developed septicaemia. Blood cultures were positive for Yersinia enterocolitica (chemotype 4, serotype 0 : 3, lysotype VIII) and the histocompatibility antigen HLA B 27 was present. The disease responded to gentamicin and doxycycline. Colonoscopy was performed on the 8th day through the permanent colostomy opening and showed lesions of the ascending colon typical of Yersinia enterocolitis : whitish, oval ulcerations on an erythematous background. This appears to be the first published case of Yersinia septicaemia where lesions of intestinal Yersinia infection were found on colonoscopy.

The authors report the case of a 22 year old woman with a recognized pulmonary sarcoidosis with disorders of the alveolo-capillary diffusion, admitted to hospital for feverish diarrhea. The discovery of right colic radiological lesions with no obvious origin, led to an exploring laparotomy which revealed large mesocolic and mesenteric adenopathies: histologically they were granulomatous lesions, of epithelioid and giant cells, tending to sclerosis. Colic and ileal mucosae were normal. From this observation the authors analyze the difficulties in diagnosing granulomatoses of the intestine and mesenteric lymph nodes and their eventual sarcoidic nature. Because of the lack of arguments in favour of tuberculosis and of the normal appearance of the intestinal coats, the sarcoidic etiology of these adenopathies appears most probable.

Plasma concentrations and urinary excretion of para-aminobenzoic acid (PABA) were measured over a 6-hour period after administration of N-benzoil L-tyrosyl aminobenzoic acid (NBT-PABA) to 15 patients with chronic pancreatitis and 15 controls. The sum of plasma PABA concentrations at 1 hour and 2 hours was calculated for each subject. The resulting value proved to have a specificity of 100% and a sensitivity of 80%, as opposed to 86% and 67% respectively for urinary concentrations.

Two men aged 28 and 33 were found to have subcapsular haematoma of the spleen secondary to chronic alcoholic pancreatitis. One of the patients presented with a pancreatic pseudo-cyst, left amylase pleural effusion and thrombosis of the splenic vein. Selective coeliac and mesenteric angiography and, chiefly, echotomography pointed to the diagnosis, which was confirmed on abdominal incision and histopathological study of the lesions. From these two cases and a review of 63 cases previously published the authors describe the clinical symptoms (acute anaemia with abdominal tumour), pathogeny (vascular or enzymatic) and diagnosis of the condition. Echotomography of the pancreas seems to be the best non invasive method to detect splenic complications of chronic pancreatitis.

Three hundred and eighty three patients with epigastric pain underwent radiological and endoscopic examination of the bulb of the duodenum. Clinical, radiological and endoscopic characteristics were compared in the 79 patients with a duodenal ulcer and in the 68 with duodenitis only. Pain and a past history of ulcer disease were of no use in differentiating duodenal ulcer from duodenitis only. Radiological deformity of the bulb appeared to be a sign of duodenitis and not of duodenal ulcer, in contrast to a crater and convergence of the folds. No endoscopic sign was of value in differentiating duodenitis only from duodenitis associated with an ulcer. Active duodenal ulcers could be differentiated from scarred duodenal ulcers only on the basis of endoscopic findings. Endoscope is the best means for the study and diagnosis of duodenal disease. On the basis of these results and data already published, an analysis was undertaken of the relationship between duodenal ulcer and duodenitis only, and it is felt that many arguments are in favour of a unitary hypothesis, duodenal ulcer and duodenitis possibly being two forms of duodenal ulcer disease.

The efficacy and safety of a combination of buzepide metiodide and haloperidol was assessed in a placebo-controlled double-blind trial during 2 months in 224 patients (154 women, 79 men) with the irritable bowel syndrome. The 2 groups were comparable at inclusion. The efficacy was assessed at days 15, 30 and 60. Inclusion and assessment criteria were clinical, abdominal pain being considered as the main assessment criterion. The combination proved statistically better than placebo on the frequency of symptoms at all visits and on the intensity of the most frequent symptoms (abdominal pain and distension) at the final visit. A previously defined global assessment score was found significantly better in favor of the treated group at day 15 and day 30. At the final visit, the score of a visual scale assessing the patient's global impression was also found significantly better on the combination, There was no serious side-effect. In conclusion, this study demonstrates the efficacy and safety of a combination of buzepide metiodide and haloperidol in patients with the irritable bowel syndrome.