Medical treatment of esophageal achalasia. Double-blind crossover study with oral nifedipine, verapamil, and placebo.

Calcium channel blockers have been previously shown to decrease lower esophageal sphincter (LES) pressure and improve symptoms in achalasia. We performed a placebo-controlled, double-blind, crossover study to assess the effects of oral nifedipine and verapamil on LES pressure, amplitude of esophageal body contraction, and clinical symptomatology in eight patients with symptomatic achalasia diagnosed by endoscopy, barium swallow, and manometry. Patients were randomized to receive up to 20 mg nifedipine, 160 mg verapamil, or placebo and underwent esophageal manometry before (baseline) and after four weeks on each drug.

Watery diarrhea syndrome due to an adrenal pheochromocytoma secreting vasoactive intestinal polypeptide.

A 55-year-old woman presented with several protracted episodes of diarrhea; it was found to be secretory in origin. In the course of evaluating the diarrhea, an ultrasound of the abdomen was performed which disclosed a large right adrenal mass. Endocrinologic studies revealed elevated serum levels of gastrin, vasoactive intestinal polypeptide (VIP), catecholamines, and its metabolites.

Hypothermia in a patient with anorexia nervosa.

A young woman with anorexia nervosa had severe recurrent hypothermia. Initial evaluation revealed a thiamine deficiency. Administration of pharmacologic doses of thiamine improved voluntary food intake, and her temperature normalized.

Orogenital contact and the isolation of Neisseria gonorrhoeae, Mycoplasma hominis, and Ureaplasma urealyticum from the pharynx.

Men and women who came to clinics in Boston underwent pharyngeal examinations, and pharyngeal specimens were obtained for cultures for Neisseria gonorrhoeae, Mycoplasma hominis, and Ureaplasma urealyticum. Fifty-one (4.9%) of 1,037 participants had gonococcal pharyngeal infection.