1150

mainstay of medical treatment in some 20 patients. I believe this has been of benefit in some of these cases and that in Crohn’s disease it is more effective than sulphasalazine. Several patients have taken co-trimoxazole continuously for over a year with no side-effects. If any or all of these agents are at all effective, their action may lie in the reduction or alteration of bacterial flora in the small-bowel lumen, thus removing a potentially destructive or antigenic stimulus. If so, it is strange that all these drugs have notable powers of diffusion into the tissues, which suggests the possibility of some more direct action at the site of the lesion.

Department of Health and Social Security, comes first to mind because this office has been proved to be most efficient whilst using the facilities currently available to it. An extension of such an established service seems logical. Should this not be practicable, then the field is open to others to provide this national comprehensive computerised service. The Bath prototype should certainly test the feasibility of such a project.

a

Pharmacy Department,

Royal Lancaster Infirmary,

R. I. COOPER

Lancaster LA1 4RP.

Gastrointestinal Unit,

Birmingham Hospital, Birmingham 139 5ST.

STREPTOZOTOCIN IN THE ZOLLINGER-ELLISON SYNDROME

East

R. DARRAGH MONTGOMERY

SIR,-Dr Sadoff and Dr Franklin describe PREPARATION FOR COLONIC SURGERY

SIR,-Mr Goldring and his colleagues (Nov. 22, p. 997) provide further support for the belief that preparation of the colon with oral antimicrobial agents is associated with a significant reduction in the incidence of septic complications after elective colonic surgery.’ Their results suggest that the combination o kanamycin and metronidazole is especially useful in the suppression of Bacteroides and in the prevention of Bacteroides wound infection. However, preoperative antimicrobial therapy may be of limited value in operations complicated by poor mechanical preparation of the bowel or significant faecal contamination during surgery. We are engaged in a prospective clinical trial of preoperative intestinal preparation with neomycin and metronidazole (versus neomycin alone). The results so far in 25 patients indicate that the problem of abdominal wound infection is largely related to the efficiency of mechanical preparation and the avoidance of faecal contamination during surgery rather than the type of antimicrobial therapy used. Wound infection has occurred in 4 out of 8 cases complicated by one or both of these factors, whereas only 2 of the 17 uncomplicated, well-prepared cases, had wound infection. University Surgical Unit, Royal Infirmary,

a

favourable

effect of

-

-

streptozotocin in a Z.E. patient with liver metastases (Sept. 13, p. 504). In 1968 Murray-Lyon et al.’ described a decrease in gastric-acid secretion and a conversion of gastrin bioassay from positive to negative in a patient with metastatic pancreatic tumour with signs of overproduction of insulin, glucagon, and gastrin, after treatment with streptozotocin. In a later report concerning this patient2 further infusions of streptozotocin did not significantly alter the fasting plasma-gastrin level and the patient died from a perforated duodenal ulcer. Stadil and Rehfeld3 found streptozotocin effective in the treatment of metastatic gastrinoma after administration of this drug via the hepatic

or

In

in

coelic artery.

department streptozotocin had no favourable patients with gastrinoma and liver metastases.

our

two

effect

CASE 1.-In January, 1973, a Billroth-I gastrectomy was performed because of duodenal-ulcer bleeding in a 40-year-old woman. Histological

THOMAS T. IRVIN

Sheffield S6 3DA.

HOW DO DOCTORS LEARN ABOUT DRUGS? SIR,-Dr Padfield and others (Nov. 15, p. 985) and other correspondents rightly stress the importance of the accumulation and dissemination of up-to-date information about drugs. Having seen the Bath prototype computerised system in action, I am convinced that only by using modern techniques can we hope to tackle the problem comprehensively. Most district general hospitals have a drug information service which should be able to deal with 90-95% of queries. The remaining 5-10% are difficult. It would be wasteful to equip all the regional drug information services with computers, in an attempt to store vast quantities of information, because each region would be duplicating the work done by others. The regional services might well develop along the lines of providing useful digests of information, and designing and operating the most effective means of teaching doctors, pharmacists, and nurses about drugs. They could draw upon centrally stored material for this and other purposes. A single national drug information computer service is surely indicated. It would be just as easy to telephone a national centre as a regional one. Such a national service would need to be staffed by pharmaceutically qualified computer operators who would know how to put the right questions to the computer. The site is not crucial. The Martindale Office of the Pharmaceutical Society, backed financially by the

1973 1973

Fig.

I.-Case 1:

,

1974 19T4

serum-gastrin levels during treatment with streptozotocin.

examination of a biopsy specimen from a liver nodule revealed non-&bgr;islet-cell-tumour tissue. The diagnosis of /.1. syndrome was confirmed postoperatively by a high basal gastric acid output (B.A.o. 32.1 meq H+/hr) and elevated serum-gastrin levels (4520 pg/ml). In April, 1973, she underwent total gastrectomy. The decrease in serum-gastrin level (fig. 1) was not accompanied by a reduction in liver tumour mass. Because of progressive extension of liver metastases, associated with fever, weight-loss, and an increase in serum-gastrin levels, treatment with streptozotocin was started in August, 1973. During 9 weeks, wcckty doses of 2 g of streptozotocin were administered intravenoush, without any effect on liver size or symptoms. Treatment was stopped in October, 1973, because of this ineffectiveness and post-mfusion complaints of vomiting and anorexia. In March, 1974, the patient’s condition was further impaired and streptozotocin treatment was re1.

I. M., Eddleston, A L W. F., Williams, R., Brown, M., Hogbin, B. M., Bennet, A., Edwards, J. C., Taylor, K. W. Lancet, 1968, n,

Murray-Lyon, 895.

I. M, Cassar, J., Coulson, R C, Williams, R, Ganguli, P C., Edwards, J. C., Taylor, K. W. Gut, 1971, 12, 717. 3. Stadil, F., Rehfeld, J. F. Personal communication. 2.

1.

Rosenberg, 1. L., Graham, Surg. 1971, 58, 266.

N.

G., de Dombal, F. T., Goligher, J. C. Br. J.

Murray-Lyon,

Letter: Preparation for colonic surgery.

1150 mainstay of medical treatment in some 20 patients. I believe this has been of benefit in some of these cases and that in Crohn’s disease it is m...
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