Spontaneous disappearance of gallstones.

A case of spontaneous disappearance of gallstones in a 55-year-old woman is presented. Examination of biliary lipids after the stones had disappeared revealed supersaturated bile with cholesterol. This suggests that the stones migrated from the gallbladder to the small intestine via the biliary ductal system.

Factitial bleeding: successful management with psychotherapy.

A young female nurse presented with unusual upper and lower-gastrointestinal bleeding, shown to be factitial. Following detection, she was successfully confronted and treated with psychotherapy. A plan for successful management of the Munchausen syndrome is discussed.

Transient subcutaneous granulomatosis of the upper extremities in Crohn's disease.

Skin lesions occur fairly commonly in patients with Crohn's disease of the colon (14%). Erythema nodosum and pyoderma gangrenosum are the most frequently recognized. Granulomatosis of the skin, continuous with bowel involvement, has been reported. Involvement of the subcutaneous tissue, discontinuous with intestinal disease, is unusual and we wish to report a case of Crohn's disease of the colon complicated by infraepidermal perivascular granulomas of the forearms. The lesions disappeared spontaneously.

Cimetidine and placebo in the treatment of benign gastric ulcer: a multicenter double blind study.

A randomized, prospective, multicenter trial of the effects of cimetidine on benign gastric ulcer was conducted in 60 outpatients. Endoscopic assessment was used as the criterion for healing. Although none of the differences was statistically significant, mean healing rates were higher and mean decreases in ulcer size were greater with cimetidine than they were with placebo. Twenty-four per cent of the ulcers healed completely in 2 weeks when cimetidine was administered, compared with a placebo healing rate of 14 percent. At 6 weeks in the incidence of healing increased to 60 percent in the cimetidine group and 41 percent in the placebo group. The mean percentage of decrease in ulcer size was greater at both 2 and 6 weeks in the cimetidine group than it was in the placebo group. In both, the cimetidine and placebo groups, relatively liberal intake of a potent antacids in treatment of gastric ulcers has not been defined definitively. Thus, a possible beneficial effect of cimetidine may have been obscured. For more clear discimination between the effects of cimetidine and placebo in healing of gastric ulcer, studies utilizing either no antacid or antacids of low neutralizing capacity will be needed.

Alcohol and the upper gastrointestinal tract and pancreas.

Alcohol relaxes the lower esophageal sphincter, stimulates acid secretion, and reduces the gastric mucosal barrier to hydrogen ion back-diffusion. These actions may result in esophagitis, acute gastritis, and ulcer formation. Although excessive alcohol consumption commonly produces acute and chronic pancreatitis, and pathogenesis is unclear.

Myxedema ascites.

A 74-year-old man presented with mental obtundation and massive ascites without evidence of significant impairment of liver function. Thyroid function studies suggested hypothyroidism. Aspirated ascitic fluid had the characteristics of an exudate. Thyroid replacement therapy resulted in rapid clinical improvement with resolution of the ascites. Prompt recognition of myxedema ascites may prevent the inappropriate use of diuretic agents, therapeutic paracentesis, and sometimes unnecessary laparotomy.