Cimetidine 1 g daily is often continued for a fixed period beyond the time of healing of duodenal ulcer on the assumption that it might reduce the subsequent relapse rate. To test this, 194 patients whose ulcers had healed after one month of cimetidine 1 g daily were allocated at random to three groups for further treatment with cimetidine 1 g daily for two months (n -63) or five months (n 66) or placebo (n = 65). Thereafter all patients received placebo. Endoscopy was done routinely every three months, or earlier if symptoms recurred. During follow-up in the placebo phase, which lasted for up to 25 months, the estimated total proportions of patients in the three groups with symptomatic recurrences of ulcer were 80%, 90%, and 77%, respectively; the corresponding proportions with silent plus symptomatic relapses were 92%, 90%, and 100%. The relapse rates were also similar in all three groups. Statistical analysis showed a significant variation in relapse rate but the differences were regarded as clinically unimportant.These findings show that full-dose cimetidine continued for several months beyond the time of healing of duodenal ulcer does not decrease the risk of subsequent relapse.

SummaryComparison of cimetidine and placebo in the prevention of recurrence of ulceration was carried out in the study of 696 patients with recently healed duodenal ulcers. Treatment with cimetidine 400 mg at bedtime or twice daily for up to 12 months very significantly reduced recurrence of symptomatic ulceration. Asymptomatic ulceration occurred in treated and untreated patients but was found significantly less often in cimetidine-treated patients. There were no serious untoward effects of cimetidine treatment. Only 3 patients (08%) were withdrawn for possible drugrelated reasons. Evidence from other studies suggests that the natural history of duodenal ulcer remains unaltered when cimetidine treatment is stopped after one year. Investigations have been planned to study the efficacy and safety of longer periods of treatment.

and will be fewer in number than those at present receiving limited-period oxygen. We would take issue with the conclusions of Dr Jones and his colleagues. Current domiciliary oxygen supply is costly, inefficient, and uses outdated equipment. Changes will have to be made, but only on the basis of a clearer knowledge of the type of patient likely to benefit, the duration and quantity of daily therapy required for clinical benefit, and a thorough evaluation of new techniques of delivery, "G" size cylinders, oxygen concentrators, or portable liquid oxygen systems.

Objective: To characterize viscoelastic testing profiles of children with multisystem inflammatory syndrome in children (MIS-C). Methods: This single-center retrospective review included 30 patients diagnosed with MIS-C from January 1 to September 1, 2020. Thromboelastography (TEG) with platelet mapping was performed in 19 (63%) patients and compared to age- and gender- matched controls via Student’s t-test and Wilcoxon rank sum test. Pearson’s and Spearman correlation were used to assess relationships between TEG parameters and inflammatory markers. Results: Patients with MIS-C had abnormal TEG results compared to controls, including decreased K time (1.1 vs. 1.7 min, P<0.01), increased alpha angle (75.0 vs. 65.7 degrees, P<0.01), increased maximum amplitude (70.8 vs. 58.3 mm, P<0.01), and decreased Ly-30 (1.1 vs. 3.7%, P=0.03); consistent with increased clot formation rate and strength, and slower fibrinolysis. TEG maximum amplitude was moderately correlated with erythrocyte sedimentation rate (r=0.60, P=0.02), initial platelet count (r=0.67, P<0.01), and peak platelet count (r=0.51, P=0.03). TEG alpha angle was moderately correlated with peak platelet count (r=0.54, P=0.02). 17 (57%) patients received aspirin (ASA) and anticoagulation, 5 (17%) received only ASA, and 3 (10%) received only anticoagulation. No patients had a thrombotic event. 6 (20%) patients had a bleeding event, none of which was major. Conclusions: Patients with MIS-C had evidence of hypercoagulability on TEG. Increased erythrocyte sedimentation rate and platelets were associated with higher clot strength. Treatment with ASA or anticoagulation was well tolerated. Further multi-center study is required to characterize the rate of thrombosis and optimal thromboprophylaxis algorithm in this patient population.