Diagnostic dilemma in acute upper quadrant abdominal pain

A retrospective study over a period of one year was carried out on all patients presenting with acute onset right hypochondrial pain. Clinical diagnosis by consultant surgeons was found to be acute cholecystitis. Comparison was made between the provisional clinical diagnosis and the final diagnosis [confirmed by investigations] to find the diagnostic error. Out of the 128 patients studied, 90 were found to have gall stones, 24 patients had other diagnosis and in 12 patients no definite diagnosis could be established. Clinical diagnosis of acute cholecystitis was accurate in 72% of patients. This result should dispel any ideas about over confidence in clinical diagnosis. Diagnostic error of 28% justifies careful investigations in all such patients

Comparative trial of cimetidine 400 mg [BID] and 1G [QID] conducted at Mayo Hospital, Lahore

Forty patients with duodenal ulceration were treated with cimetidine for eight weeks, randomly allocated to a Q.I.D. [1g daily] or B.I.D. [800mg daily] regimen. Ten patients were lost to follow-up. Thirty patients completed eight weeks of treatment and 27 of these were symptom-free. Two patients on the B.I.D. and one patient on the Q.I.D. regimen failed to heal by eight weeks, though they had some improvement in symptoms and on endoscopy their ulcers were smaller. The drug was well tolerated and no serious side-effects were recorded. Routine laboratory tests revealed no persistent abnormalities. These findings are similar to the results of European studies and support the conclusion that the B.I.D. dosage of cimetidine is as effective as the Q.I.D. regimen in healing duodenal ulceration. Compliance with B.I.D. dosage was better than that with the Q.I.D. regimen, though the difference did not reach statistical significance