Chenotherapy for gallstone dissolution. I. Efficacy and safety.

Clinical experience with chenodeoxycholic acid therapy for dissolving gallstones is reported, with particular attention to determinants of response. Of 12 patients receiving 15 mg/kg/day or more, ten responded (83%); only 15 of 40 patients (38%) receiving less than 15 mg/kg/day responded. Large solitary stones and stones in gallbladders that visualized poorly after oral cholecystography had a lower response rate. Radiopaque stones did not respond in 18 patients. Five of ten patients with stones in the common bile duct responded. Small, dose-related elevations in SGOT were the only biochemical abnormality observed. Liver biopsy specimens showed no notable abnormality. Diarrhea was an infrequent problem. Stones recurred in three of 15 patients during six to 48 months of observation without treatment. Chenodeoxycholic acid, when given in adequate dosage, continues to appear promising as medical therapy for asymptomatic radiolucent gallstones in radiologically visualizing gallbladders.     

Influence of anaesthetics on tumour-cell kill and repopulation in B16 melanoma treated with melphalan.

The influence of anaesthetics on the in vivo response of B16 melanoma to melphalan was studied using an in vitro cell-survival assay. Three anaesthetics were used, Saffan (Althesin) Sagatal (Nembutal) and Hypnorm. When Saffan was administered to tumour-bearing animals before melphalan there was a significant increase in tumour-cell kill. This effect was not observed with Sagatal or Hypnorm. Maximum increase in tumour-cell kill was achieved when Saffan was administered about 1 h before melphalan, and was dependent on Saffan dose. Clonogenic tumour-cell repopulation after melphalan was rapid (TD - 1 day) and the rate was similar from 2 levels of cell kill. When Saffan was combined with melphalan the repopulation rate was the same as with melphalan alone, and the increased cell kill was reflected in increased growth delay. The in vitro response of B16 melanoma cells to melphalan was unaltered by pretreatment with, or simultaneous exposure to Saffan. The results suggest that the mechanism of the enhanced cell kill in vivo is probably due to an indirect systemic effect, rather than a direct effect on the tumour cells.     

The Use of Electrocutting and Electrocoagulation in Surgery

Electrocutting and electrocoagulation are convenient aids to surgical technique, but their we is avoided by some surgeons because of a believed risk of increased wound morbidity-Medical literature contains little information concerning morbidity after the use of electro-surgery as compared with its occurrence after standard alternative techniques. This paper describes such experiments, which compare tensile strengths of healing wounds and the incidence of intraperitoneal sequel? following extensive use of electrosurgery and use of other alternative procedures.     

Diphenylhydantoin and phenobarbital in the relief of psychoneurotic symptoms

This study is a double-blind comparison of the clinical effects of diphenylhydantoin (DPH) and phenobarbital among 80 adult psychoneurotic, non-epileptic outpatients. Patients were assigned at random to eight weeks of treatment with DPH 300 mg or phenobarbital 90 mg daily. During this time, patients were followed in brief bi-weekly interviews by one of two treating psychiatrists.At each visit, the patient's clinical condition was evaluated by the patient's ratings of distress on a factored list of 65 common psychoneurotic symptoms, on a mood adjective checklist, on the Psychiatric Evaluation Profile and on a global scale of change, and by the doctor's ratings on several global scales of change. Each criterion was analyzed with respect to initial score, medication, doctor and the medication by doctor interaction. The one doctor's patients responded better than the other doctor's patients.The results suggested that DPH and phenobarbital in the doses employed had similar effects on psychoneurotic symptoms. More extensive analyses of one patient rating and one doctor rating were performed to look for characteristics of the patient or the treatment situation that might affect medication responses. No useful predictors of differential response to the two medications appeared. Patients with brief illnesses, no prior psychiatric care and no previous phenothiazines or antidepressants responded better than their counterparts to both medications.Some patients who terminated prematurely reported very marked improvement—even more than most patients who completed the prescribed course of treatment. This observation challenges the usual assumption that drop-outs represent treatment failures. The equivocal results with regard to medication effects point up the potential value of studies designed to produce dose-response information.This investigation was supported by research grants from the Dreyfus Medical Foundation and by Research Scientist Development Award No. 2-K3-MH-18611 from the National Institute of Mental Health. Computations were performed at the Computing Center of the Johns Hopkins Medical Institutions, which is supported by grant No. FR-00004 from the Division of Research Resources of the National Institutes of Health, and at the Biomedical Computation Facilities of the University of Chicago, which are supported by grant No. FR-00013 from the Division of Research Resources of the National Institutes of Health.Miss Jil Culver, Miss Elizabeth Grether, Mrs. Mark Hollander, Mr. Clay Kallman, Mrs. Helen Russell, and Mrs. Marie Stephens provided technical assistance.