Georges Delpre

Sublingual therapy for cobalamin deficiency as an alternative to oral and parenteral cobalamin supplementation

Effectiveness of sublingual cobalamin-replacement therapy was studied in 18 people with cobalamin deficiency. Administration was efficacious and convenient, and compliance was high.

Induction of esophageal injuries by doxycycline and other pills. A frequent but preventable occurrence.

Many specialists and general physicians remain unaware of the potential for and pathogenesis of drug-induced esophageal ulcerations. To promote a greater awareness of the importance of this problem, we have reviewed the literature, particularly in regard to the mechanisms of action and the clinical and therapeutic implications of these chemical injuries to the esophagus. There can be no doubt that the frequency of occurrence of drug-induced esophageal ulceration far exceeds that reflected in the reported cases appearing in the medical literature. Nor can we deny that much of the responsibility for this situation lies in the failure of the prescribing physician to educate his patients (and himself!)in the art of taking potentially harmful pills and capsules, particularly tetracycline, doxycycline, potassium chloride, and quinidine preparations. Although most such drug injuries are self-limited events, there have been a number of fatalities reported and at the very least they involve acute discomfort.

Case report. Immunological studies in a case of hepatitis following methyldopa administration.

Jaundice with evidence of hepatocellular damage of moderate severity was observed in a patient who received methyldopa. The diffuse mononuclear infiltration of the liver tissue was found to consist of 90% E-rosette-forming cells. Peripheral lymphocytes gave a markedly positive macrophage migration inhibition (MIF) test against methyldopa. The number of T lymphocytes in the peripheral blood was at the lower limit of normal but they proved to be functionally inactive, as demonstrated by the results of a local xenogeneic graft-vs-host reaction test. The liver disease was associated with hyperglobulinemia, a decrease of the third and fourth components of complement and the presence of incomplete erythrocytic antibodies, leukoagglutinins, antinuclear factor, and smooth muscle antibody. Follow-up after discontinuation of the drug revealed a gradual return to normal of liver function and MIF tests, normalization of cellular immunity, and disappearance of the humoral antibodies. It is assumed that sensitization by methyldopa triggered the autoaggressive phenomena and their ultimate manifestation in the liver.

Case Report Hepatitis Following Cimetidine Administration

There have been only two reports of cimetidine-induced hepatitis. Such a low incidence suggests a hypersensitivity type of reaction. The case of an adult who developed both hepatic dysfunction and an impaired macrophage migration after exposure to cimetidine is discussed.

Barrett's mucosa of distal esophagus with concomitant isolated Crohn's disease and intramucosal adenocarcinoma

SummaryThe presence in the esophagus of three distinct entities-Barretts mucosa, Crohns disease, and adenocarcinoma-is a very rare finding. In a 60-year-old man with a long history of heartburn and recently developed dysphagia, narrowing of the distal esophagus was found to be related to the presence of Barretts mucosa. A short time later repeated endoscopy revealed adenocarcinoma in this area. The patient underwent esophagogastrectomy and died a few days after surgery. Findings in the surgical specimen and upon autopsy were consistent with isolated Crohns disease of the distal esophagus as well as with intramucosal adenocarcinoma. Analysis of the data available in the literature reveals that Crohns disease of the esophagus, although rare, clearly possesses some definite characteristics of its own. It is suggested that the presence of these three features in a single patient constitutes no more than a chance coexistence.

Endoscopic biopsy diagnosis of oat cell carcinoma of the lung penetrating the esophagus

ach. The occurrence of the adenoid cystic carcinoma of the esophagus in a patient having a craniopharyngioma has previously been reported. 16 The relatively slow course of the tumor both in its size and clinical symptoms in this patient is also remarkable. At endoscopy, bile was observed to freely regurgitate into the esophagus, bathing the entire area of the tumor. Insofar as a role of bile detergents has been postulated in the genesis of other neoplasms, it is interesting to speculate on the possible association in this case.

Case Report: Urticaria During Triple Therapy for Helicobacter pylori Infection (Clinical Implications)

The widespread use of an ever-increasing numberof drugs is responsible for the multiple adversereactions observed by the clinician. Current practiceadvocates eradication of Helicobacter pylori infections, and this is achieved quite well by the use oftriple therapy (1). However, a survey of the recentliterature revealed that the safety of such regimens hasoften been discussed but never properly investigated (1-3). We describe a case in which adverseeffects were noted to each of the three components oftherapy.

Duodenal Bleeding Secondary to a Metastatic Squamous Cell Carcinoma of the Lung

We describe a 71-year-old man who presented with a bleeding duodenal ulcer 4 years after undergoing left pneumonectomy for primary squamous cell carcinoma. As the ulcer did not heal and continued to b