Double-blind Multicenter Comparison of 1,200 mg. and 1,000 mg. Cimetidine in Hospitalized and Ambulatory Duodenal Ulcer Patients

A multicenter double-blind study was made to compare whether 1.000 mg. dosage of cimetidine, the dose commonly employed in the United Kingdom, was as effective as the 1.200 mg. dose recommended in the United States for the treatment of duodenal ulcer. Our second goal was to test whether hospitalization would enhance the efficacy of cimetidine in the healing of duodenal ulcer. There was no difference in healing rate after either one (40%) or four (86%) weeks of therapy. In addition, hospitalization (one week) did not enhance the efficacy of cimetidine therapy.     

Acute Myocardial Ischemia During Pacemaker Implantation: Implication for Threshold Determinations and Potential Complications

The onset of acute myocardial ischemia during pacemaker implantation may strikingly alter measured threshold values so that unnecessarily high generator output parameters are programmed. In addition, ischemia muscle is more vulnerable to malignant arrhythmias if the stimulating electrode is in an ischemic area. Two patients are presented whose threshold values rose sharply during an ischemic attack and returned to baseline after the angina subsided. Relief of angina is a clinically useful determinant of the safety necessary to proceed with implantation and threshold measurements     

The HL-A System in Reiter's Syndrome

The HL-A phenotypes were determined in 50 patients with Reiter's syndrome. HL-A27 was found in 34 (68%) compared to 7.7% of controls. There was an association between the presence of HL-A27 and sacro-iliitis, uveitis and keratoderma blenorrhagica. Reiter's syndrome was found to have occurred in HL-A27 positive identical twins. In four sibships a brother, sharing a haplotype with the proband, was found to have spondylitis. There was evidence that in some HL-A27 positive individuals spondylitis had developed prior to the first attack of Reiter's syndrome, suggesting that spondylitis and Reiter's syndrome may be separate disease processes in the one genetically predisposed individual. When Reiter's syndrome was associated with severe keratoderma blenorrhagica and widespread psoriasiform lesions, sometimes with persisting psoriasis or recurrent uveitis, HL-A27 was present and HL-A17 absent.
There is some evidence that the HL-A phenotype itself does not determine susceptibility to disease in HL-A27 positive individuals but that linked immune response genes may be present.     

ANTIDEPRESSANTS: CLINICAL ASPECTS

Several new agents for the treatment of depression have been introduced in recent years. While there are certain advantages for these agents over existing drugs, their efficacy and speed of onset of action is not different. The efficacy, adverse effects and toxicity of the various classes of antidepressants is reviewed. Newer agents such as the SSRIs or mirtazapine may be better drugs of first choice than the tricyclics in terms of patient acceptability and safety.© 1997 John Wiley & Sons, Ltd.