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SUMMARY Forty-two patients with endoscopically diagnosed duodenal ulcer were studied in a double-blind trial after their ulcers had been healed with cimetidine. Cimetidine was effective in preventing relapse, only five of the 20 patients allocated to cimetidine 400 mg twice daily relapsing during the six months' treatment, compared with 16 of the 22 on placebo treatment (p < 0.01). Cimetidine was safe in the dosage and duration used, no symptomatic, haematological, or biochemical abnormalities occurring during the trial. Subsequent follow-up at the end of the trial when treatment had been stopped showed that relapse was frequent, particularly in the cimetidine group, making the cumulative relapse rate eight months after completion of the trial similar in the two groups (75% in the cimetidine group; 86% in the placebo group). It seems likely that maintenance cimetidine treatment has to be continued indefinitely in patients with duodenal ulcer, and, until such treatment is shown to be safe and effective, surgical treatment remains a logical option for many patients.

No abstract

Four children, whose ages ranged from 1 to 13 years, with malacoplakia of the gastrointestinal tract were treated at King Faisal Specialist Hospital between 1979 and 1983. All patients had either a preceding or a coexisting chronic illness. In one patient, malacoplakia was an incidental finding, while the remaining three patients presented with bloody diarrhea, abdominal pain, recurrent fever, and severe malnutrition. Colonoscopy in two patients revealed markedly inflamed and friable mucosa with focal ulceration alternating with patches of normal mucosa and pseudopolyposis. They were treated with antibiotics and cholinergic agonists. Three patients responded favorably, while one patient continued to have extensive active disease. Although the response to therapy is unpredictable, patients may respond if the treatment is continued on a long-term basis.

A case of hemobilia due to a hepatic artery aneurysm is described. Despite 2 arteriograms and 2 laparotomies, the cause of the bleeding remained undetected until a further selective cannulation of the celiac axis artery was performed. Endoscopic retrograde cholangiography demonstrated that postoperative jaundice was not due to obstruction and outlined the aneurysm within a hepatic duct.

A case of the Yellow Nail Syndrome is described. The characteristic nail changes were associated with pleural effusions, lymphoedema of the face and legs and upper respiratory symptoms. The finding of extremely hard ear wax has not been reported previously. A satisfactory response to combination diuretic therapy was seen. The case of recognition of the Syndrome is emphasized together with the danger of excessive investigation if the nails are not inspected. Possible mechanisms for the formation of extremely hard cerumen are discussed.

SummaryThe first case of the Zollinger-Ellison syndrome treated from the outset continuously for more than a year with the histamine H2-receptor antagonist cimetidine is reported.

Malacoplakia of the colon and rectum is uncommon with only 30 cases having been reported in the literature. This paper documents two additional cases involving the colon and rectum. The first patient had extensive disease involving virtually the entire rectum and colon and portions of the terminal ileum. The clinical course was marked by several perianal and cutaneous fistulae and repeated abscesses in the retroperitoneum. The second case had more limited disease involving the left and transverse colon. Lesional tissues from both cases were studied by light and electron microscopy. Light microscopic appearance was characterized by the presence of large numbers of histiocytes with typical intracytoplasmic Michaelis-Gutmann bodies. Ultrastructurally, the histiocytes had numerous phagolysosomes and several Michaelis-Gutmann bodies seen as round structures with concentric rings of calcification. These appeared to be derived from large phagolysosomes. In one of our cases, intracytoplasmic clusters of bacillary bodies were also seen within malacoplakic histiocytes.