Asher Winkelstein

One hundred and sixty-nine studies in gastric secretion during the night

1. The curve of gastric secretion during the night has been studied in 169 patients. 2. Normals have little or no free hydrochloric acid during the night. 3. Patients with duodenal, gastric, and jejunal ulcer have a high nocturnal curve and a high titre of free acid. 4. Gastric neuroses have a low nocturnal curve of secretion. 5. In gastric carcinoma, the gastric contents during the night resemble those found in the usual day test meal, i. e., a low acidity with increased mucus and blood. 6. The nocturnal hypersecretion and hyperchlorhydria in peptic ulcer cannot be controlled by alkalies, olive oil, atropine and aspiration. 7. In our opinion the best medical method of controlling the gastric secretion during the night is the milk drip. Surgically, partial gastrectomy frequently accomplishes the same result. 8. The significance of these findings particularly in the problem of peptic ulcer is discussed. Finally, the injurious effect on the gastric mucosa of an increased fastingor interdigestive secretion is emphasized.

Bile salt therapy in gall bladder disease

(1) 3 groups of patients with gall bladder disease are described. (2) The use of a low fat diet and large amounts of bile salts is advocated in the treatment of these cases. (3) In the group (13 cases) with the type of postcholecystectomy syndrome not due to organic obstruction, relief was obtained in most of the cases with this form of therapy. (4) In two other groups, i.e., those with stones and normally functioning gall bladders (14 cases) and those with chronic gall bladder disease in whom the gall bladder failed to visualize (11 cases) considerable relief from symptoms was also obtained. (5) In the cases in whom gastric hyperacidity was present atropin and alkalies were helpful adjuvants in the therapy. (6) In view of these results, the use of this mode of therapy in a larger group of cases seems advisable.

The use of concentrated and purified antitoxic b. coli serum in the treatment of indeterminate ulcerative colitis

1. Indeterminate ulcerative colitis is a disease in which B. coli may play an important pathogenic role as a secondary invader. 2. Whole and concentrated horse serum strongly antitoxic to B. coli has been prepared according to the principles of the Shwartzman Phenomenon. 3. The present communication deals with 29 new cases treated with concentrated antitoxic B. coli horse serum which supplements a previous report dealing with 41 cases in a high percentage of which beneficial effects were obtained by means of the antitoxic whole horse serum. 4. Of the 29 cases described in this paper, 20 were greatly benefited; in two cases the results were questionable and the remaining 7 failed to show improvement. 5. In view of the encouraging results, the intramuscular use of concentrated antitoxic B. coli horse serum (Shwartzman) is advocated for treatment of severe and intractable cases of indeterminate ulcerative colitis.

ACTH and cortisone therapy in ulcerative colitis

Conclusions and Summary1. Twenty-seven patients with acute or chronic ulcerative colitis who did not respond to conventional medical therapy were treated with ACTH, cortisone, or hydrocortisone.2. Steroids were found to be of value in inducing or hastening the onset of a remission in 21 out of 34 trials. No evidence for a curative effect was seen. Extracolonic manifestations of ulcerative colitis (erythema nodosum, arthritis, conjunctivitis) reacted more promptly to therapy than did the colonic disease.3. No death occurred during treatment. Two perforations and 1 severe hemorrhage were encountered.4. Nine patients ultimately required surgery for intractability of symptoms and lack of response to therapy, including steroids, and their surgical course was uneventful.5. Caution in administration and careful selection of patients for steroid therapy is advised in view of the danger of serious side effects.6. The theories concerning the mechanism of action of steroids in ulcerative colitis have been discussed.

Some clinical studies on the psycho-somatic background of peptic ulcer

A psychiatric examination of 33 young adult males with duodenal or gastric ulcer has been carried out. Space permits only the presentation of 4 illustrative cases in detail. The entire group revealed characteristic psychic backgrounds. These patients are suffering from chronic frustration and inward direction of re-pressed, strong emotional stimuli with strong masochistic and sadistic tendencies. This chronic state of inward tension or drive bears a close relation to the incidence and recurrence of peptic ulcer. While much further work is necessary before one can draw a final conclusion, nevertheless, a review of the observations of others plus our own experience impresses one with the strong probability that peptic ulcer is a psychosomatic disease.

A new type of serum therapy for the treatment of non-specific ulcerative colitis

1. There is described a method of treatment ofnon-specific, ulcerative colitis in which is employed antitoxic, anti-coli horse serum of a high neutralizing titer, as determined by means of the phenomenon of local skin reactivity toB. coli. 2. In 21 cases so treated, the clinical results were good in 18 instances; failure was encountered in three patients. 3. The preparation of an improved concentrated serum is suggested; further studies upon the significance of various strains ofB. coli (etiologically and therapeutically), with respect to non-specific ulcerative colitis would appear to offer a fruitful field of investigation.

Peptic esophagitis, marginal ulceration, and peptic ulcer of the esophagus; recent concepts.

T IlE CLINICAL SYMPTOMS associated with peptic (reflux) esophagitis are well-known. T-hey include dysphagia, substernal pain, regurgitation, anemia, hemorrhage, and loss of weight. These will not be discussed here. Nor will the therapeutic details, such as antiuleer diet, drip therapy, mechanic dilatation, or surgical procedures detain us. It seems preferable to present the various problems in the form of questions. These will be answered briefly and our concept of the present status of peptic esophagitis, marginal ulceration, and solitary peptic ulcer of the esophagus will be summarized.