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Ranitidine is a safe, widely prescribed drug for the treatment of peptic ulcer disease and is rarely associated with serious adverse reactions. This report describes a patient who suffered three episodes of acute pancreatitis associated with ranitidine prescribed for duodenal ulcer disease. On each occasion the pancreatitis resolved after withdrawal of ranitidine and recurred upon re-exposure. Underlying biliary and pancreatic disease was excluded. There has been no recurrence of pancreatitis in the five years of follow-up since ranitidine was discontinued.

How many of us give a "full" dose of chemotherapy to an obese patient-even in the curative setting? Dose calculation in the obese is a confusing but important puzzle for the oncologist and is becoming a more frequent issue because of the obesity epidemic in Western societies. Although it is clear that body size plays only a minor role in interpatient variability of systemic exposure, it is an easily defined parameter and probably gains more significance at the extremes of body size.Imagine this scenario: You need to prescribe adjuvant chemotherapy for an otherwise well woman with high-risk breast cancer and who has a body surface area (BSA) of 2.3 m 2 . Your pen is poised over the order sheet. Do you grit your teeth and prescribe 170 mg of docetaxel, 115 mg of doxorubicin, and 1,150 mg of cyclophosphamide? You understand that this is the correct thing to do. Studies have shown that obese patients with breast cancer frequently receive a reduced dose of chemotherapy because of a desire to avoid toxicity. 1,2 If anything, obese patients seem to be less likely to develop neutropenic sepsis, even if actual body weight (ABW) is used. [2][3][4] Furthermore, obese patients who receive arbitrary dose reductions have a worse outcome. 4,5 However, 170 mg of docetaxel is a big dose in anyone's book and it is a drug that can be unforgiving. You do not want your patient to succumb to overwhelming sepsis.So maybe your courage falters so you cap her BSA at 2.0 or 2.1 or something else? Perhaps you decide that, today, ideal body weight has its merits after all? Let's be honest -we all do it. In our department, we have a weekly chemotherapy write-up in which all the consultants and trainees meet together to order the treatment for the coming week. When a trainee proceeds to calculate a treatment dose for an obese patient, the inevitable discussion ensues, often in hushed tones, regarding what the dose should be. It is sobering to listen to the conversation between an experienced oncologist, the oncology pharmacist and trainee as they struggle with a solution that never seems to have a satisfactory answer-and one that may change from week to week. There is still a persistent reluctance for medical oncologists to prescribe doses based on actual body weight for obese patients even though this has been shown to be safe. 4,5 The article by Sparreboom et al,6 in this issue of the Journal of Clinical Oncology gives us further insight into dose calculation in the obese. The investigators tackled this problem by reevaluating data subsets from previously published studies of eight anticancer drugs and compared results for patients with a body mass index (BMI) of more than 30 (obese patients) to those with a BMI of less

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AbstractsConclusions Recommendations developed and spread by a Working Group have approached the management of acute pediatric poisonings in Spain to international guidelines based on scientific evidence. Main results 1. 1007 patients presented with abdominal pain with a female preponderance. A peak in incidence about the age of 6-7 in both sexes was noted. The incidence in both sexes then stabilised till a pubertal rise in female incidence. PAEDIATRIC ABDOMINAL PAIN: A CALL FORThere is a seasonal variation with approx 25% more pain presentations in winter. No such seasonal effect was seen for appendicitis.Overall abdominal pain is more likely to present after midday, while appendicitis presents throughout the day. 81 of 1007 patients had appendicectomies, 61 with appendicitis. Adolescent females were much more likely to have normal appendixes removed, with p<0.001.2. Mean WCC was 15.1 for those with true appendicitis, compared to 11.4 for those with normal appendices: WCC sensitivity 87% and specificity 90%.In those who had ultrasound, the appendiceal visualisation rate was 57%. Conclusion Paediatric abdominal pain presentations vary in incidence depending on sex, age, season and time of day. Conditions requiring operation are relatively uncommon, and the patient's background, history and a priori likelihood of disease should be considered before ordering investigations or operation.