A double-blind double-dummy study of citalopram comparing infusion versus oral administration.

BACKGROUND: This study compares antidepressant efficacy and tolerability of citalopram given either orally or as a slow drop infusion. METHODS: Citalopram (40 mg/day) was administered double-blindly as tablets or slow-drop infusion during the first 10 days and then open, orally, up to treatment Day 42. RESULTS: In 60 moderately to severely depressed patients, the Hamilton depression total score (17-items) at baseline was 23.9 and 23.6 in the active infusion (n = 30) and active tablet (n = 30) group, respectively. These scores dropped in both groups to 15.6 and 16.9 on Day 10, and to 10.3 and 10.2 on Day 42. Response rates (delta Hamilton > or = 50%) amounted to 33.3% and 17.9% on Day 10, and 66.2% and 63.3% on Day 42, without a relevant group difference in citalopram plasma concentration. CONCLUSION: Slow-drop infusion with citalopram shows a similar risk/benefit relationship to oral citalopram. The design of this study allowed us to evaluate pharmacological but not psychological factors which may contribute to response to slow-drop infusion.

How often does peptic ulcer produce "typical" ulcer symptoms?

Subjective symptoms of 876 hospitalized patients who underwent upper fiber-panendoscopy were evaluated in a prospective study. Ulcer-like symptoms were defined as pain-like discomfort with a regular food-related rhythm. These symptoms indicate ulcer disease with high specificity (96%) but low sensitivity (28%). In particular old patients with second disease rarely have ulcer-like symptoms. In spite of their high specificity, however, ulcer-like symptoms are not proof of active ulceration. Patients with scars but no ulcers may also have ulcer-like symptoms.

Aluminum-magnesium antacids and the bioavailability of ketoscilium in man.

The bioavailability of the gastric secretory inhibitor 3-hydroxy-8-(p-phenylphenacyl)-1 alphaH, 5 alphaH-tropanium bromide (-)-tropate (ketoscilium, Ulcesium) is not affected by a single dose of an aluminum-magnesium antacid although binding occurs in vitro.

[Are loss of glistening of normal colour and increased friability normal aspects of the oesophagus in old age? (author's transl)]. / Glanzverlust, Farbveränderungen und erhöhte Lädierbarkeit der Speiseröhre: altersbedingte Normvarianten?

Friability of the esophageal mucosq increases with old age. Old patients without esophageal disease also show loss of glistening and of the normal pink color of the mucosa. These findings on their own are therefore no signs of esophagitis,

[Tetracycline ulcer of the oesophagus: clinical features and in-vitro studies (author's transl)]. / Das Tetracyclin-Ulkus der Speiseröhre. Klinisches Bild und In-vitro-Untersuchungen.

During treatment with doxycycline capsules three patients (aged 24, 34, and 39 years, respectively) developed acute oesophageal ulcers with dysphagia as the cardinal symptoms. They became symptom-free and the ulcers healed promptly on symptomatic treatment. In-vitro experiments in rats indicated that doxycycline accumulates within the erythrocyte membrane and epithelial cells of the oesophagus. This accumulation is followed by cell destruction. It is assumed that doxycycline capsules remain within the oesophageal lumen and release doxycycline, causing epithelial destruction. This will occur more often after dry swallows of the capsules before going to bed.

[Controlled trials of premedication of fiberendoscopy (author's transl)]. / Kontrollierte Studien zur Prämedikation von oberen Fiberendoskopien.

In four controlled studies on 771 consecutive patients we tested the value of premedication before passing a fiberendoscope. Following local anaesthesia of the throat, 10 mgs of diazepam in patients less than 60 years and 5 mgs in those over 60 years quickly injected intravenously caused a sufficient premedication for fiberendoscopy. Premedication with diazepam is better than placebo. We fell that omission of premedication is not justifiable. Flunitrazepam, for premedication, in doses of 1-2 mgs did not prove to be suitable. 20 patients were radiologically controlled for signs of aspiration following premedication and endoskopy. They showed no signs of aspiration.

[Dissolution of gallstones by chenodeoxycholic acid]. / Auflösung von Gallensteinen durch Chenodeoxycholsäure.

A 2-year prospective study with chenodeoxycholic acid (CDCA) (750 mg per day) was performed in 34 asymptomatic patients with radiolucent gallstones. 17 patients dropped out before completion of the trial. In 5 cases (29%) the stones dissolved and in 5 additional cases they decreased in size, while in 2 cases (13%) they increased in size during treatment. Favorable criteria for dissolution were round stones without edges and fissures on radiological appearance and a stone diameter of less than 1 cm. In 3 cases drug-induced nausea or diarrhea were so pronounced that treatment could not be continued. CDCA treatment also caused a significant rise in SGPT for at least one year. Thus, CDCA is at best moderately effective in a highly selective group of patients with gallstones.

[Endoscopic diagnosis of oesophagitis: problems of differentiation from normal (author's transl)]. / Endoskopische Diagnose der Osophagitis Wo liegt die Grenze zum Normalen

The diagnostic significance of endoscopically early signs of oesophagitis in the absence of macroscopic evidence of epithelial abnormalities has been studied prospectively. Changes from the usually observed shininess, pale-pink colour, smooth texture, regular capillaries, sharp Z-line and a decreased mechanical resistance of the mucosa to mechanical damage do not indicate oesophagitis. Nor should one infer gastro-oesophageal reflux from these endoscopic findings. They are presumably ageing changes in the oesophagus.

[Endoscopic diagnosis of acute perianal hemorrhage]. / Endoskopische Diagnose der akuten peranalen Blutung

Emergency upper endoscopy was performed in 22 consecutive patients with acute peranal hemorrhage. In 8 patients with negative upper endoscopy emergency coloscopy was subsequently performed. In 6 cases the bleeding source was located in the colon. Overall, the correct diagnosis was made by endoscopy in 21 of the 22 patients. Thus, emergency coloscopy is a useful diagnostic procedure in cases with acute peranal hemorrhage and negative upper endoscopy.

Gastro-oesophageal reflux disease: correlation of subjective symptoms with 7 objective oesophageal function tests.

Seven tests which have been recommended for the diagnosis of gastro-esophageal reflux were applied in 24 healthy controls and in 48 patients with symptoms of reflux disease. The correlation coefficient of test results with the subjective symptoms of the patient decreased in the following order: 1) acid clearance from the distal esophagus (r = 0.558, p less than 0.001), 2) suction biopsy 5 cm above lower esophageal sphincter (LES) with evaluation of granulocytic infiltrates (r = 0.450, p less 0.001), 3) radiological demonstration of hiatal hernia (r = 0.435, p less than 0.001), 4) reflux provocation test (r = 359, p less than 0.01), 5) modified Bernstein test (r = 0.322, p less than 0.01), 6) acid relux test (r = 0.252, p less than 0.05), 7) resting pressure of LES (r = 0.246, p less than 0.05). Results of the Maudsley Personality Inventory were not correlated with subjective symptoms (r = 0.188, p greater than 0.1). By stepwise multiple regression analysis it was shown that optimal diagnosis of reflux is achieved by combination the following 4 procedures: 1) acid clearance, 2) modified Bernstein test, 3) suction biopsy, and 4) radiology.

[Organization of mobile intensive care in Zurich]. / Organisation der mobilen Intensivbehandlung in Zürich

A mobile intensive care unit (Kardiomobil) has been in operation in the Zurich area (600 000 inhabitants) since March 27, 1972. This unit is staffed by a doctor and a nurse experienced in coronary and intensive care and two ambulance drivers. Although primarily designed for pre-hospital coronary care, it is equipped and operated as a "mobile intensive care unit".

Esophageal function in progressive systemic sclerosis.

A prospective study was performed in 13 consecutive patients with systemic progressive sclerosis (PSS). For the diagnosis of impaired esophageal peristalsis cineradiography and manometry are equally useful. Esophageal suction biopsy allows the diagnosis of esophagitis but not of scleroderma. Mild to severe esophageal involvement was observed in 12 patients. In only one patient the esophagus was virtually normal. Dysfunction of the esophageal body may occur early in the course of the disease while incompetence of the lower esophageal sphincter is observed on an average after 7 to 8 years. Both impairment of peristalsis and pressure of the lower esophageal sphincter may lead to delayed esophageal clearance. Relaxation of LES is normal even in the absence of primary peristalsis. Extensive esophageal damage including severe gastroesophageal reflux may be present in the absence of esophageal symptoms.

Effect of calcium infusions of serum calcium and gastric acid secretion.

37 patients were studied with calcium infusions. Of these, 20 had previously undergone truncal vagotomy and pyloroplasty for duodenal ulcer disease, and 17 were unoperated patients with duodenal ulcer disease. Calcium was given intravenously either at a dose of 5 mg/kg/h for 3 h, or 4 mg/kg/h for 4 h. Gastric juice was collected by continuous suction. Results showed the 3-hour infusion raised calcium more than the 4-hour infusion. Top serum calcium achieved, however, did not correlate with calcium-stimulated gastric acid output, either with or without vagotomy. Stimulated gastric acid secretion was markedly less with vagotomy than without. It is suggested that the level of gastric acid stimulated by infusions might discriminate complete, from incomplete, vagotomies better than insulin, and that the 4-hour infusion is safer.