Ranitidine and high-dose antacid in reflux oesophagitis. A randomized, placebo-controlled trial

The liquid antacid Novaluzid (10 ml seven times daily) was compared with ranitidine (150 mg twice daily) and with placebo in 57 patients with symptoms and endoscopic signs of oesophagitis and gastro-oesophageal reflux. A randomized three-period change-over design with the double-dummy technique was used. Each treatment period lasted 6 weeks. Only 37 patients (64.9%) completed the entire trial. In retrospect, five patients receiving placebo were withdrawn because of insufficient effect, six patients because of side effects while taking Novaluzid and two while taking ranitidine. The remaining seven dropouts/withdrawals were for reasons without evident relationship to the treatment given. Statistical analyses based both on the 37 completers and on the 43 patients who had at least two treatment periods showed that ranitidine and Novaluzid were superior to placebo with regard to pain score (p less than 0.005) but not with regard to regurgitation, dysphagia, histology, and appearance on endoscopy (p greater than 0.05). It was impossible to distinguish statistically between ranitidine and Novaluzid. In conclusion, ranitidine and high-dose antacids are of equal effectiveness in the short-term treatment of reflux oesophagitis, and both are superior to placebo with regard to symptomatic relief.

Generalized dominant epidermolysis bullosa simplex: decreased activity of a gelatinolytic protease in cultured fibroblasts as a phenotypic marker

To characterize biochemical traits associated with various forms of epidermolysis bullosa (EB), we used skin fibroblast cultures to measure a gelatin-specific neutral metalloprotease. Compared to normal cultures, levels of this gelatinase were 7-fold decreased in cell cultures from 3 patients from 3 kindreds with generalized dominant EB simplex of the Koebner type (DEBS-K) (p less than 0.001). The specificity of this trait was shown in several ways. The growth kinetics and total protein synthesis of the cells were unaltered. The activity of lactic dehydrogenase, a cytoplasmic enzyme, was also unaltered, indicating the integrity of the cells was not compromised. The decrease in gelatinase activity is specific for generalized DEBS-K, since cultures from recessive dystrophic EB, recessive junctional EB, dominant dystrophic EB, and a second genetic type of DEBS all fail to show this defect. However, since it has been suggested that DEBS-K and the localized form of DEBS, the Weber-Cockayne type (DEBS-WC), may represent allelic mutations of varying severity, we measured gelatinase activity in cell cultures of 13 patients of this type. The levels displayed a biphasic segregation in which 7 of 13 values were equal to, or greater than, the mean activity of control cells. Cultures from the remaining 6 patients were greater than 1 SD below the mean control value and approximated those seen in the generalized DEBS-K patients. These studies suggest that the decrease in gelatinolytic activity is a marker for DEBS-K and that DEBS-K and DEBS-WC may be closely related genetic disorders in which the defect in gelatinolytic protease represents a pleiotropic effect of the gene for DEBS or is genetically linked to the DEBS gene.

[Mitral valve replacement in an infant with disseminated lupus erythematosus and Libman-Sacks endocarditis]

The authors report a case of Libman-Sacks endocarditis of the posterior mitral leaflet in a child treated for disseminated lupus erythematosus for 8 years. Mitral valve replacement was performed. Libman-Sacks vegetations are hardly ever recognised in vivo and have never been previously reported in a child. The incidence of this cardiac complication of lupus erythematosus is probably higher than indicated in the literature. Attentive cardiac examination and systematic echocardiography should be part of routine follow-up of patients with disseminated lupus erythematosus.

Comparative study of the nerve endings of the outer and inner hair cells in the organ of Corti

The synaptic region and nerve endings have been studied both in the outer and inner hair cells by using optic and electron microscopy, nerve staining and Acetyl Cholinesterase activity. The findings are described, with a discussion of the results.

An integrated methodological approach to the computer-assisted gas chromatographic screening of basic drugs in biological fluids using nitrogen selective detection

This paper presents the methodological aspects of a computerized system for the gas-chromatographic screening and primary identification of central nervous system stimulants and narcotic analgesics (including some of their respective metabolites) extracted from urine. The operating conditions of a selective nitrogen detector for optimized analytical functions are discussed, particularly the effect of carrier and fuel gas on the detector's sensitivity to nitrogen-containing molecules and discriminating performance toward biological matrix interferences. Application of simple extraction techniques, combined with rapid derivatization procedures, computer data acquisition, and reduction of chromatographic data are presented. Results show that this system approach allows for the screening of several drugs and their metabolites in a short amount of time. The reliability and stability of the system have been tested by analyzing several thousand samples for doping control at major international sporting events and for monitoring drug intake in addicts participating in a rehabilitation program. Results indicate that these techniques can be used and adapted to many different analytical toxicology situations.

Factors in the pathogenesis of acute schistosomiasis mansoni

Acute schistosomiasis mansoni was studied in 26 Puerto Rican patients whose clinical presentations differed widely in severity. Severity of illness was found to be positively correlated (r = 0.79) with the intensity of infection as measured by the concentration of eggs of Schistosoma mansoni in stool specimens. However, some patients had severe illness but relatively light infections. The disappearnace of symptoms and return toward normal of laboratory measures of disease activity were not associated with any diminution in the fecal egg count. Elevations of IgG, IgM, IgE, and of titers of anibody in serum indicated that the illness is associated with intense immune activity. The magnitude of the IgG and IgE responses was related to intensity of infection. The fact that incubation periods were shorter than the time needed for schistosomes to reach adulthood and lay eggs suggests that the syndrome can be initiated by parasite stages present before oviposition. No marked changes in complement (C3, C3p, C4, and CH50) and no signs of renal disease were noted in any of these patients.

[Shunt glomerulonephritis: clinical and histopathological manifestations]

In patients with cerebrospinal fluid internal shunts, immune complex glomerulonephritis sometimes develops. Of two new cases the first was classic, while the second was in an adult who had had a ventriculoatril shunt for 8 years; furthermore, the patient had acute renal failure and is the first to have been reported to have Peptococcus septicemia. Shunt glomerulonephritis is characterized by the following: (a) its occurrence following, most often, Staphylococcus albus infection in a patient who usually has a ventriculoatrial shunt; (b) transitory improvement of the symptoms by antibiotherapy only; and (c) full recovery if the prosthesis is removed. Laboratory studies show a low serum concentration of the C3 component of complement, the presence of cryoglobulins and a positive rheumatoid factor test. These abnormalities are reversible with removal of the prosthesis. Optical microscopy of a renal biopsy specimen in the two cases showed cellular proliferation of the glomerular tuft, electron microscopy demonstrated subepithelial deposits and immunofluorescent studies revealed intramembranous and intramesangial immune complexes. These features are similar to those observed in experimental nephritis induced in animals by foreign protein.

Chondrosarcoma of the hand

A case of chondrosarcoma of the hand recurred 4 times over a period of 32 years. Forty-seven cases of hand chondrosarcomas have been found in the literature. Histological diagnosis is difficult in differentiating chondrosarcomas from benign chondromas. Pain and swelling are the main symptoms of recurrence. The diagnosis is established by arteriography and excisional biopsy. Extraskeletal hand chondrosarcomas do not metastasize and other hand chondrosarcomas do so only rarely. Block excision of localized amputation is the treatment of choice.

Changes in the rectal mucosa induced by hypertonic enemas

The aspect of the rectal mucosa after administration of hypertonic enemas is occasionally confused with the macroscopic appearance of quiescent ulcerative colitis. Criteria for a diagnosis of enema reaction were derived from a retrospective series and tested prospectively on 11 healthy volunteers. Photographs and biopsies were obtained before and after administration of a sodium phosphate hypertonic enema. Three observers evaluated blindly the "before" and "after" macroscopic and microscopic pictures, graded the features, and made an overall diagnosis. In random studies, two observers mistakenly classified a macroscopic picture, but all correct histologic diagnoses of "before" and "after" biopsies. In decreasing order of discriminating power, the following features of an enema reaction were found to be useful: separation and mucous depletion of the glands (no observer variation), increase in mucosal fragility in 91 per cent of cases (82--100 per cent), edema of the lamina propria in 88 per cent (73--100 per cent), straightening of the basal membrane in 82 per cent (73--91 per cent) and an increase in extruded mucus in 70 per cent (18--100 per cent). In 39 per cent of cases (36--45 per cent), erythrocytes appeared focally in the lamina propria. The effects of hypertonic enemas can be recognized on biopsy.

Ovarian structure of the marsupial frog Gastrotheca riobambae (Fowler)

The mature ovary of Gastrotheca riobambae presents large oocytes (3 mm in diameter) of pale yellow color. After ovulation and the beginning of embryonic incubation, the empty postovulatory follicles can be recognized in the ovary for about 30 days. The granulosa of these follicles never fills the follicular lumen and this cavity becomes filled with fluid during the first five days of incubation. Later, at 18 days of incubation, the lumen is mostly empty and contains few cells of the granulosa. Shrinkage results in the disappearance of the follicular cavity by approximately the thirtieth day of incubation. The thecae are thick and become separated by a space. This space is filled progressively with cells, blood capillaries and fluid. After the thirtieth to fortieth day of incubation, these follicles become regressive and disappear. The postovulatory follicles of Gastrotheca may correspond to corpora lutea. The evidence suggests that pouch vascularization and the formation of embryonic chambers of pouch tissue may be under ovarian control. In addition, the process of vitellogenesis is influenced by incubation, as most growth of the ovarian oocyte occurs after birth of the tadpoles. Follicular atresia is common and is similar to that of other frogs.

Ultrastructure of the organ of Jacobson and comparative study with olfactory mucosa

The organ of Jacobson has been studied in lizards, rats, guinea pigs, rabbits and dogs by means of embedding in nitrocellulose, semithin sectioning, and electron microscopy. The various elements of the organ in the species studied have been analysed and a comparative study carried out between the sensory portion of the organ and the olfactory epithelium.

[Immunofluorescent deposits in normal rheumatoid skin]

Predominantly IgM immunofluorescent deposits have been found in 30% of normal, non exposed skin in a group of rheumatoid arthritis patients. Neither clinical nor biological correlation have been found. Because one case with cryoglobulinemia was positive, study of other non lupus, cryoglobulinemic, immune complexe type of diseases has been done. The results were negative. Further investigations are needed to explain this observation.