Abstract: The aims of our study were to: determine the effect of metoclopramide parenterally and orally on delayed gastric emptying of a radionuclide test meal in symptomatic patients with diabetic gastroparesis not explained by ulceration or other mechanical problems; and evaluate in a double-blind crossover fashion the efficacy of metoclopramide in relieving the symptoms of diabetic gastroparesis. Thirteen patients with subjective evidence of gastric stasis had delayed gastric emptying of an isotope-labeled semisolid meal which was significantly accelerated (p less than 0.05) after 10 mg of metoclopramide parenterally. Patients then received metoclopramide 10 mg and placebo before meals and prior to retiring for 3 weeks in a randomized double-blind crossover design. During metoclopramide therapy nausea, vomiting, anorexia, fullness, and bloating were significantly (p less than 0.05) ameliorated compared to placebo with an overall mean symptom reduction of 52.6%. Gastric emptying studies after completion of the trial is seven patients, subjectively improved and receiving open-labeled metoclopramide, showed significantly less gastric retention. Individual improvements in gastric emptying after parenteral or oral metoclopramide, however, could not be correlated with symptom change during the treatment trial. We conclude that metoclopramide is an important therapeutic adjunct in the management of diabetic gastroparesis and its therapeutic effects are mediated through its prokinetic properties as well as centrally mediated antiemetic actions.

Abstract: Sucralfate is an unabsorbed antiulcer drug that binds to gastrointestinal tissue and protects it from acid and pepsin Twenty-two arthritic patients taking nonsteroidal anti-inflammatory drugs (NSAIDs) were given sucralfate concomitantly for two weeks in an attempt to lessen gastrointestinal side effects Changes from baseline in abdominal discomfort were assessed after 2, 7, 10 (or 11), and 14 days of treatment Sucralfate administration was accompanied by the disappearance of heartburn, epigastric pain, epigastric distress, or epigastric burning in 42 of 59 occurrences, and by statistically significant reductions in bloating There was a trend toward significance in decreased nocturnal abdominal pain and in belching Overall improvement, assessed at the completion of each patient's treatment, also was statistically significant

Abstract: To the Editor .—This communication presents an uncommon gynecologic cause of pneumoperitoneum: dehiscence of the vaginal cuff after transvaginal hysterectomy. Report of a Case .—A 41-year-old woman, gravida O, with a two-year history of biliary colic, complained of a feeling of upper abdominal fullness and bloating with right upper abdominal quadrant pain that lasted for seven hours and was not relieved by glycopyrrolate. She attempted to relieve the pain by sitting in her whirlpool bath and, while there, felt a sudden "pop" in her left lower abdominal quadrant and groin followed by generalized abdominal pain with radiation to the right shoulder. Coughing and abdominal motion significantly exacerbated the pain. The patient had no other gastrointestinal tract or gynecologic symptoms and specifically denied recent coitus or unusual sexual activity. Her medical history was pertinent for an appendectomy performed 20 years previously and a transvaginal hysterectomy performed for contraception four months prior