Armand Littman

Antacids and Anticholinergic Drugs

Controlled clinical trials have provided some useful evidence of the effectiveness or lack of effectiveness of antacids and anticholinergic drugs. However, few such trials are free of serious methodologic or clinical criticism, and the use of these agents cannot be defined with any degree of scientific certainty. Their principal uses still focus on reduction of gastric acid content, and their best use requires individualization for each patient. With anticholinergic drugs there is little if any pharmacologic effect without some side-effects, and dose adjustment may be more important than the choice among the many drugs considered effective. Some new antacids offer better neutralization than old ones, but are at least as likely to affect colonic function. Although toxicity, side-effects, and interactions with other drugs are minimal, they should be watched for.

Arterenol as an adjunct to the treatment of paroxysmal tachycardia

Abstract The use of l -arterenol is described for maintaining adequate levels of blood pressure during the treatment of paroxysmal tachycardia with intravenous procaine amide. This measure appears to permit the use of larger doses of procaine amide than could otherwise be tolerated and thus facilitates termination of the paroxysm.

A Single Aspiration Caffeine Gastric Analysis in Duodenal Ulcer and Control Patients

In most patients the diagnosis of duodenal ulcer may be definitely established or ruled out by an adequate history and careful radiographic studies. There is, however, a sizable group of patients in whom some or all of the findings are equivocal, and in whom additional diagnostic measures may be useful. Study of the basal or caffeine-induced gastric secretion may offer considerable aid, but these tests have not been used widely. We have attempted to simplify the caffeine test for possible use as a routine procedure. The traditional Ewald meal provides helpful information of several kinds but is of little value in diagnosis. When the convenient single aspiration technique is used, the frequency distribution curves for normal and duodenal ulcer patients are closely similar (1). Using the Rehfuss fractional modification there is less overlapping, but still not enough separation of ulcer from non-ulcer cases to be useful for this purpose (2). Similar overlapping exists for the alcohol (3) and histamine (4, 5) tests. These tests do not afford diagnostic aid in the individual case, except in the relatively few instances of extreme hypersecretion in the range beyond that of non-ulcer subjects, or in the event of achlorhydria after adequate histamine tests. In the latter circumstance benign peptic ulcer can be excluded. A test of basal secretion may give more aid. In the experience of Levin, Kirsner and Palmer (4), only seven per cent of 222 patients with duodenal ulcer had one or more IS-minute periods of anacidity during a one-hour test of unstimulated morning secretion. Furthermore, only one patient in this series had four such periods with absence of acid. Obviously, this test would be of great help in excluding the diagnosis of ulcer, but it is limited by the fact that 55 per cent of normal males and 40 per cent of normal females produced acid in all four periods. In our experience a further limitation is that small volumes of gastric juice are often produced, requiring considerable care and skill in aspiration for accurate results. The test most likely to aid in the diagnosis of individual cases appeared to us to be the caffeine test devised by Roth, Atkinson and Ivy (3), the value of

Book reviews—For what?

Aimed at social work practitioners, this book is for both the experienced and inexperienced. Its publication is timely, given that highlighted within the Victoria Climbié Inquiry was a catalogue of breakdowns in communication between agencies; and a further recent report in response to Valuing People, the First Annual Report of the Learning Disability Task Force identified that Partnership Boards were struggling to include people with learning disabilities.

The Output of Pancreatic Protein after Pancreozymin: A Test of Pancreatic Exocrine Function.

Excerpt Our previous dose-response data on pancreozymin (PZ) in humans indicated progressively better discrimination between normal and pancreatic patients with increasing doses of PZ. With the new...

Acetylcholine in differential diagnosis and treatment of paroxysmal tachycardia

Abstract 1. 1. Increasing doses of acetylcholine hydrochloride were given intravenously to 27 patients with paroxysmal tachycardia. Each dose was given in a volume of 1.0 ml. injected rapidly into the tube of an infusion of 5 per cent glucose, providing uniform “bolus effect.” This method also avoided hydrolysis by cholinesterases incident to barbotage. 2. 2. In 8 of 11 patients with paroxysmal supraventricular tachycardia the episodes were promptly terminated and did not recur. Side reactions were mild or absent. 3. 3. Fourteen patients with paroxysmal auricular flutter with rapid ventricular rate were treated. In none were the episodes terminated without recurrence. However, in all cases there were transitory alterations in A-V conduction which sometimes clarified the diagnosis of the mechanism. In 5 patients with flutter and bundle branch block the important possibility of ventricular tachycardia was excluded when the F waves were revealed during the momentary A-V block.