Randomized, prospective double-blind trial of metoclopramide and placebo for gastroesophageal reflux in infants

The effect of metoclopramide on gastroesophageal reflux was studied in 30 infants less than 1 year of age. Gastroesophageal reflux was documented in all infants by extended pH monitoring before enrollment in the study. Patients were randomly assigned to receive metoclopramide 0.1 mg/kg or placebo four times a day, 1/2 hour before feeding for 1 week, followed by the alternate regimen for 1 week. The infants were reevaluated with extended pH monitoring and scintigraphy after 4 to 7 days of each treatment. A symptom score was derived by determining the average number of occurrences of all symptoms recorded daily by parents on a symptom checklist during pretreatment, placebo, and metoclopramide treatment periods. There was a difference between pretreatment evaluation and placebo periods with respect to daily symptom scores (p less than 0.005), reflecting a significant placebo response. However, no difference in scintigraphic study was found between placebo and metoclopramide periods. A significant difference between placebo and metoclopramide periods was noted in the percentage of time esophageal pH was less than 4.0 (p less than 0.001). However, although metoclopramide decreased the proportion of time esophageal pH was less than 4.0, pH remained less than 4.0 for more than 5% of the time in most patients. Substratification of the total group into infants younger and older than 3 months revealed that older infants had greater average daily weight gain during the metoclopramide treatment period (34.3 gm/day) than in the placebo treatment period (6.6 gm/day, p = 0.05). We conclude that metoclopramide in the dosage 0.1 mg/kg four times daily reduces reflux in infants and may be useful for infants with poor weight gain and other serious complications of gastroesophageal reflux.     

Acute carcinoma of the breast

The timely discovery of curable carcinoma through screening and early treatment is compromised by the existence of acute carcinoma with adverse properties. The existence of an acute carcinoma must be considered in planning and promoting any public health program for the control of carcinoma of the breast. These carcinomas will surface under any contemporarily available screening or detection program through no physician or patient error. These carcinomas have identifiable properties, and their occurrence should not be the basis of a malpractice suit, since their evolution is not presently preventable. The available data on actual doubling times obviously provide truncated distributions, since they contain no data on the faster subsets of carcinomas that surface in the intervals between screenings too quickly to permit measurement of size and calculation of DT (act).     

Hematoma and distraction arthroplasty for basal thumb osteoarthritis

Many surgeons have abandoned the simple trapeziectomy for the treatment of thumb basal joint arthritis secondary to reports of postoperative weakness. More recently, ligament reconstruction techniques have been the favored surgical procedure for the treatment of trapezial arthritis, but the necessity of such an extensive procedure that requires tendon harvest and rerouting has come into question. Simple trapeziectomy modified with distraction pinning, without interposition grafting, allows for a stable, pain-free thumb that has superior strength and motion when compared with the more complicated ligament reconstruction techniques.