Peptic ulcer therapy—The use of synthetic resins

118

Abstracts

the problem and better able to plan the anesthesia, avoiding spinal, and at operatipn proceed with dispatch to remove the tumor. Should an unusual hypertensive reaction be observed by the anesthesiologist during the course of an elective operation, as in Case IV, the diagnosis of sympathetic adrenal tumor should be considered and if proven by abdominal exploration serious consideration should be given to its removal. The use of epinephrine, in the event of a shock state with pulmonary edema, during the operation for removal of these adrenal tumors is not judicious since actually the state of shock is best explained as the result of left ventricuIar heart strain secondary to increased peripheral resistance owing to an excess circulatory epinephrine. Therapy of the condition includes rapid removal of the tumor and the administration of oxygen, digitalis and perhaps peripheral vasodilating agents. Recovery from the reaction depends chiefly on the patient’s cardiac reserve.

USE OF TETRAETHYLAMMONIUM BRGMXDE AS A DIAGNOSTIC TEST FOR P~OCHROMOCYTOMA JOHN

S. LADUE, M.D. and (by invitation)PAULJ.

MURISON,M.D. and GEORGET. PACK, M.D.

The pre- and postoperative reactions of a patient with a pheochromocytoma to the intravenous administration of histamine diphosphate and of tetraethylammonium bromide offer a diagnostic test for the presence of epinephrine tumors. The patient’s reactions to intravenous injections of 2 ml. of a saline solution containing 0.025 mg. of histamine phosphate, then of a solution containing 100 mg. of tetraethylammonium bromide and finally of 2 ml. of saline are compared. Within one minute after the administration of histamine the patient developed a typical attack associated with ,a rise in bIood pressure from 160/105 to 2801160. The reading returned approximately to normal within five minutes. The pulse rate rose from 94 to 116 and then fell to 96. AIthough the resting blood pressure was

somewhat higher before tetraethylammonium bromide was given, the response was just as pronounced and lasted considerably longer. The reading rose from a basal level of 175/105 to 270/160 in thirty seconds and the elevation lasted fifteen minutes. The pulse rate rose from 75 to 130 and returned to 90. The decrease in the blood pressure when the patient changed from a supine to an erect position was dramatic, the reading falling from 230/125 to 95/80. When the 2 ml. injection of saline was given no detectabIe change in the blood pressure or pulse rate occurred. The above tests were repeated approximately two months postoperatively and the patient evinced no reaction whatsoever to the injection of histamine, tetraethylammonium bromide or saline. According to our observations on this patient the use of tetraethyla~monium bromide as a test for pheochromocytoma has one advantage over that of histamine. When tetraethylammonium was employed, dangerously high levels of the blood pressure could be controlled simply by having the patient sit up or stand. This resulted in a prompt fall in blood pressure and a disappearance of the symptoms. Lyons and his co-workers noted this phenomenon in their studies on normal and hypertensive individuals; hence, it would appear that with the use of a tilting bed or table tetraethylammonium bromide could be employed with perfect safety in testing for the presence of a pheochromocytoma. PEPTIC ULCER

THERAPY-THE

SYNTHETIC

USE OF

RESINS

MANFRED KRAEMER,

M.D.

Fromthe Presbyterian Hospital,Newark,N. J. In 1945 Segal, Hodge, Watson and Scott reported on the use of a polyamine formaldehyde resin in removing hydrochloric acid from solution. One concludes from this article, that although effective, such large amounts of resin would be needed to inactivate the acid in the stomach that the use of resins in clinical medicine would not be practical. The next year, Martin and Wilkinson found that by using a more finely sieved resin, clinical application might prove practicaLrOne Gm. of their resin, AMERICAN

JOURNAL

OF

MEDICINE

113

Abstracts Amberlite

IR 4* took 250 ml. of 0.1 N HCL

to

pH 4. the freshly extracted patients.

experiments

on

gastric juice of one hundred

The free acid in these specimens

6 to 69 clinical

degrees

varied

and in amounts

from 15 to 100 ml. Some of the experiments performed

at room

Toepfer’s

99”~.

Rrsin

temperature

were

and others

at

reagent was used as an indicator.

was added with constant

found that neutralization five minutes.

stirring.

It was

took as long as forty

Approximately

50 ml. of gastric

juice of 25 degrees of acidity was neutralized 0.1

has been avoided

tomy patients

We have made neutralization

from

ever,

Gm.

of resin.

appears

The

viscidity

of the juice

to be a factor in determining

ber of resin particles

exposed

patients

O..? to 1 Gm.,

phate

in treating

four to six times a day. We have as satisfactory

or aluminum

suspensions.

form but because

We

as magnesium

hydroxide

use of the parasympathomimetic of P-methyl The

choline

(urecholine).

drug has been administered

ents who do not have complete nothing

be given subcutaneously. absorption

and

phos-

used it first in powder

strated.

must be determined The

patients

to have the following used metallic

(1) It has no effect

balance

of the body;

the urinary

tract;

nor constipation;

retention

while

taking

done so when Within

salt

on the acid base

(2) it does not alkalinize

(3) it causes neither

diarrhea

(4) it causes no perianal

injection

burn-

urecholine, strated

peristaltic

activity

chloric

PHARMACOLOGICAL PROMOTION OF EVACUATION FROM THE POSTVAGOTOMY STOMACH LORBER, M.D., (6_y invitation) and

THOMAS E. MACHELLA, M.D., and (by invitation) HORACE H. HODGES, M.D.

following

section

ulcer is gastric in those

,

balloon.

The

by a second

patients

This occurs especially

who have

stomach

to

or who do not have an adequately

functioning

stoma.

For

relief

of the retention

some type of a gastroenterostomy been required. * Resinat.

Such surgical

has sometimes

interference,

how-

dose

or by

means

period

of

increase

of

be demonof a

induced

and can be

injection.

swallow

contains

No untoward complained

It does not in free hydro-

Following

neutralizing

sire to evacuate

been

injection

abdominal

cramps bladder

or

orally. of a 10

and salivation

the urinary

the

noted

it is administered

sweating

These phenomena

or when

food substances.

have

the subcutaneous

sometimes

follow

saliva

side-effects of when

may

and a dealso occurs.

are not so severe as those that

a comparable

effects of urecholine

dose

of

mecholyl.

can be neutralized

time by an injection

of atropine,

The at any

more promptly

when it is given intravenously. EFFECT OF ATROPINE GASTRIC

ON THE CEPHALIC

PHASES OF GASTRIC

ACTIVITY MALCOM BLOCK, JOYCE

WILTSEE

not had a gastro-

enterostomy

can

acid in the gastric juice when the patient

is permitted

that has developed

of the vagus nerves for peptic

retention.

or

the subcu-

lasts forty to sixty minutes

AND

Pa.

after

10 mg.

activity

roentgenologically

recording

occur;

reactions.

One of the complications

not

was substituted

of a 5 to

allergic

Philadelphia,

of

the drug but have

five to ten minutes

taneous

mg. dose, flushing,

H.

case.

free of symptoms

a “placebo”

ing- and (5) to date we have noted no toxic or

ST.&NLEY

demon-

for the individual

give rise to a significant

antacids:

or gastric

has not been

remained

in capsule form

commonly

When

The usual dose is 5 to 10 mg., but this

feeling we found its prescription It appears

with

the drug must

Sublingual

of the drug

reproduced

over

retention.

passes into the intestine

odor and sandy

advantages

orally

each of the main meals of the day in those pati-

of its phenolic

more practical.

by the

drug, urethane

when the drug was discontinued.

with peptic ulcer in doses of

found it clinically trisilicate

the num-

to acid.

\Ve have used resin as an antacid forty-seven

by

in six of our postvago-

who had gastric retention

M.D.,

and H. ht. From

versity Mich.

the

Hospital,

H.

University

M.D.

UniAnn Arbor,

Mfdicke,

of Michigan,

on the cephalic

activity

KD.,

(by invitation)

of Internal

of atropine

phases of gastric

BACHRACI-I,

M.D.

POLLARD,

Department

The influence gastric

W.

MASON.,

and

has never been