No abstract

This study confirms the contention that both formation and closure of defunctioning colostomies are associated with significant complications; furthermore, approximately one-half of patients will not have their colostomy closed.

Both coumarin (1,2-benzopyrone) and warfarin (4-hydroxycoumarin) have been shown to prevent the recurrence of malignant melanoma. Their action is macrophage-dependent and the dosage is critical. In 1984 a multicentre, prospective, randomised, double-blind trial of coumarin, given as a daily 50-mg dose for 2 years after surgery in patients with high-risk melanoma, was started. the patients had lesions greater than 1.70 mm thick and TNM stage IB or stage II disease. To date there are 4 recurrences in the coumarin-treated group of 13 patients, and 10 recurrences in the placebo-treated group of 14 patients (P < 0.01). There were no toxic effects.

Over an 18-month period at a single clinic, 43 new cases of colonic inflammation have been diagnosed (19 proctitis only). Crohn’s colitis has been excluded from this analysis. In all these subjects a careful drug history has been taken in a prospective manner and in 4 of these 43 patients colonic inflammation appeared to be directly related to nonsteroidal anti-inflammatory drug (NSAID) administration (mefenamic acid, 2; piroxicam, 2). In all 4 patients there was a time interval (mean 3 months) between initiation of treatment with NSAID and presentation with diarrhoea and weight loss. Pathological findings were minor and biochemical changes insignificant, in contrast to the protracted troublesome symptoms. Resolution of symptoms was very rapid on discontinuation of NSAID medication but 2 patients experienced immediate return of symptoms following inadvertent rechallenge. Approximately 10% of newly diagnosed colitis may be related to NSAID administration. Subjects taking NSAID medications appear to be five times more likely to develop colonic inflammation than the general population.

Summary: Autonomic nervous system integrity has been assessed in 30 alcoholic subjects and 30 agesex matched controls using five simple tests of cardiovascular responses. There was evidence of parasympathetic neuropathy alone in five of the alcoholic subjects (16%) and of combined parasympathetic and sympathetic neuropathy in an additional six (20%). None ofthe controls showed any abnormality. Within the alcoholic group, those with autonomic neuropathy were older, were more likely to be female and to have established alcoholic liver disease. Symptoms were a poor guide to the presence or absence of autonomic neuropathy.

Although prednisone and prednisolone have been in use for a number of years for a wide variety of conditions, there have been few kinetic studies over the wide clinical dosage range. 5 • 9, 10, 12, 13, 15 It has been documented same subject are reproducible. 14 The conclusions from two recent studies lo , 12 in a small number of subjects given 5 to 50 mg of prednisolone or prednisone have shown that there are dose-dependent changes in the kinetics of prednisolone in man with a prolongation of half-life (t1/2)/0, 12 an increase in volume of distribution (V d)10 and plasma clearance 10,12 with increasing dose. In addition, it was noted by Meikle and TylerB that the 24-hr doseresponse to 70 mg prednisone deviated significantly from dose-response curves at lower dosages.that there is considerable interindividual variation in pharmacokinetic measurements at any single dose,4, 15 although separate studies on the Prednisone has very little intrinsic glucocorticoid activity I and has to be converted to pred-0009-9236/79/050571+08$00.80/0

SUMMARY Ten patients with cirrhosis and portal hypertension received an initial 20 mg oral test dose of propranolol and subsequently 160 mg of a slow release preparation, orally, each day for seven days. Protein binding, serial plasma propranolol concentrations and effects on heart rate were studied. Protein binding was slightly reduced (mean 85%, range 78'9-88. 1%) compared with four normals (mean 87 9%). In patients with severe liver disease (serum albumin <30 g/l) propranolol remained detectable in plasma 24 hours after the single 20 mg dose and high steady state concentrations (mean 266 5 ng/ml, range 84-406) were observed during regular dosing. At steady state there was a significant correlation between log total plasma propranolol concentrations and the percentage fall in heart rate (r=0.659, p<0.05). We suggest that in patients with severe liver chronic disease (serum albumin <30 g/l), propranolol therapy should be initiated in hospital. The starting dose should be low (20 mg of the conventional formulation tds or 80 mg of the slow release preparation daily) and that regular monitoring of the heart rate should be carried out.

The development of a SIBDQ for patients with ulcerative colitis did not reveal any clear advantage over the original version of the SIBDQ. Further studies are required to determine the role of the SIBDQ in routine clinical practice.