Evaluation and management of the acutely injured worker.

Approximately 3 million work-related injuries were reported by private industries in 2011, and primary care physicians provided care for approximately one out of four injured workers. To appropriately individualize the treatment of an injured worker and expedite the return to work process, primary care physicians need to be familiar with the workers' compensation system and treatment guidelines. Caring for an injured worker begins with a medical history documenting preexisting medical conditions, use of potentially impairing medications and substances, baseline functional status, and psychosocial factors.

Esophageal disease in patients with angina-like chest pain.

To assess the frequency of esophageal disease in patients with angina-like chest pain and normal coronary arteriograms, 16 patients underwent esophageal manometric studies, acid perfusion (Bernstein) tests, upper gastrointestinal series and cholecystograms. Five patients had evidence of esophageal diseases. Three of the five had manometric criteria of increased nonperistalsis; one patient had idiopathic diffuse esophageal spasm while the other two patients had acid infusion tests which reproduced the presenting chest pain and the manometric findings were regarded as a motor disturbance of the esophagus secondary to chronic gastroesophageal reflux.

Azathioprine-related pancreatitis in patients with Crohn's disease.

Pancreatitis developed in 6 patients in the National Cooperative Crohn's Disease Study. In five of these the diagnosis was confirmed by elevated levels of seum amylase or lipase. All cases were in the 113 patients who received azathioprine and occurred within the first 21 days of treatment.

National Cooperative Crohn's Disease Study: adverse reactions to study drugs.

Adverse reactions to the drugs employed in the National Cooperative Crohn's Disease Study were sought prospectively at each patient visit and by retrospective review of all patient charts. Prednisone caused evident side effects in over 50% of patients on high-dose suppressive therapy and in approximately one-third of patients on prophylactic dose. Thirty-two percent of patients on high-dose, and 26% on prophylactic-dose prednisone required dose reduction or withdrawal because of side effects.

Effect of chronic metoclopramide therapy on serum pituitary hormone concentrations.

The effect of chronic (3--9 months) therapy with metoclopramide on serum levels of pituitary and thyroid hormones was studied in 4 males and 1 female. The mean serum prolactin concentration during metoclopramide therapy was significantly higher than after discontinuation of metoclopramide. Serum prolactin concentrations increased acutely after each dose of metoclopramide.

Effect of one-month treatment with cimetidine on gastric secretion and serum gastrin and pepsinogen levels.

The inhibitory effects of cimetidine on gastric acid and pepsin secretion were studied before and after 1 month of treatment with 300 mg of cimetidine four times a day in 15 male duodenal ulcer patients. Cimetidine inhibited both pentagastrin- and peptone meal-stimulated acid secretion significantly better before, than after, 1 month of treatment. Similarly cimetidine inhibited pentagastrin-stimulated pepsin secretion significantly better before treatment.

Cimetidine versus intensive antacid therapy for duodenal ulcer: a multicenter trial.

In a randomized double blind multicenter trial, patients treated with cimetidine (800 or 1200 mg daily) or an intensive regimen of Al-Mg antacid (210 ml daily) had similar rates of duodenal ulcer healing and pain relief. After 4 weeks of treatment, the proportion of patients with ulcer healing by endoscopy were: cimetidine (1200 mg), 21 of 33 (64 percent); cimetidine (800 mg), 19 of 32 (59 percent); and antacids, 15 of 29 (52 percent). These proportions did not differ significantly.

HLA-B5 associated with duodenal ulcer.

In a search for further genetic factors contributing to ulcer disease we undertook a study of the frequency of HLA antigens in patients with duodenal ulcer. Seventy-seven male patients (of two races) were typed for the HLA-A and-B loci. Thirteen of the 54 (24%) white males were found to have antigen B5 compared to 10% of controls.

Effect of cholestyramine on the symptoms of reflux gastritis. A randomized, double blind, crossover study.

Bile acids have been proposed to be important in the pathophysiology of the syndrome of "bile reflux gastritis" after surgery. To examine the role of cholestyramine, an ion exchange resin that binds bile acids, on symptoms of this syndrome, we did a randomized, double-blind crossover study on 16 patients. No differences in frequency of abdominal pain, nausea, vomiting, or bitter taste were observed among cholestyramine (4 g, three times daily for 3 weeks), placebo, and routine (dietary restriction and ad libitum antacid) treatment periods.

Healing of duodenal ulcer with an antacid regimen.

To determine whether a large-dose antacid regimen is effective in promoting healing of duodenal ulcer, 74 patients with endoscopically proved duodenal ulcer completed a 28-day double-blind clinical trial comparing such a regimen with an inert placebo. The ulcer healed completely in 28 of the 36 antacid-treated as compared to 17 of the 38 placebo-treated patients (P less than 0.005).

Accuracy of physicans' predictions of cholecystography results.

In the decision theory model of medical diagnosis and treatment, optimal choice of diagnostic tests requires accurate estimation of the probability that a given test will be positive. We assessed the ability of physicians to estimate the probability that a specific test (cholecystography) would be positive. For 102 patients, the predicted number of gallstone cases, 35.

A controlled trial of metoclopramide in symptomatic gastroesophageal reflux.

Since metoclopramide increases lower-esophageal-sphincter pressure in patients with gastroesophageal reflux, we compared the effects of metoclopramide, 10 mg four times daily, with those of placebo on symptoms in 31 patients with chronic heartburn. Eighteen patients completed a random-order, double-blind crossover study of two consecutive eight-week periods. The final 13 patients crossed over only if their symptoms were not substantially improved after the first eight weeks.

Antacid and placebo produced similar pain relief in duodenal ulcer patients.

The effectiveness of antacid and placebo in relieving single episodes of spontaneous duodenal ulcer pain were compared in two double blind, controlled, randomized trials. The trials compared the effects on ulcer pain of individual doses of a liquid antacid and placebo, rather than the effects of therapeutic regimens with antacid or placebo. Thirty patients were studied.

Experience with synthetic secretin in the treatment of duodenal ulcer.

Hospitalized male patients with endoscopically verified duodenal ulcer were studied to determine the effect of secretin on the clinical course of their disease. Seven patients received synthetic porcine secretin, 333 mug subcutaneously every 4 hr for 10 days, and 6 patients received placebo injections on the same schedule. Repeat endoscopy was performed within 48 hr of completing the 10-day treatment period.

Comparison of metoclopramide with other dynamic tests of prolactin secretion.

Metoclopramide, a derivative of procainamide, was compared with thyrotropin releasing hormone (TRH), N3im-methyl-TRH and chlorpromazine as a prolactin (PRL) releaser in 11 euthyroid males. The peak response of serum PRL and the maximum increment of serum PRL (max deltaPRL) were greater (P less than 0.0005) after the administration of metoclopramide (deltaPRL 24.

Effect of metoclopramide in chronic gastric retention after gastric surgery.

The effect of metoclopramide, a stimulant of gastric motility, on gastric emptying was tested in 6 patients with chronic gastric retention after vagotomy and gastric resection, unexplained by mechanical obstruction or stomal ulceration. Gastric emptying was measured using a gamma camera technique and a solid meal labeled with 99mtechnetium-labeled diethylenetriaminepentaacetic acid. Metoclopramide produced a 2.