608
cimetidine, the patient still had epigastric vomiting. At endoscopy no ulcer was found but the whitish pseudomembranes were still present: a culture of duodenal material taken by biopsy forceps again grew Penicillium sp. Cimetidine treatment was stopped and oral nystatin was given for a week after which both endoscopic and laboratory findings were negative for mycosis, and the patient was symptom-free. Repeated biopsy forceps cultures done before this case and since have never grown such mycetes, so mycosis of the duodenal bulb, due to Penicillium, seems to be rare. Our patient had not been treated with other drugs (notably antibiotics) and
After
a
pain,
nausea, and
month
on
routine
her immunohaematological globulins. No malignancy of the gastrointestinal tract or elsewhere was detected. The mycosis was seen after 1 month of treatment with carbenoxolone sodium, a drug that does not affect the gastric pH but is believed to change the composition of gastric mucus, which becomes richer in hexosamines and fucose.4 The mycosis persisted during cimetidine therapy. This suggests that changes in the composition of the gastric mucus and rises in gastric pH may be responsible, during carbenoxolone and cimetidine treatment, for the mycetes growth in the tests were
normal
as were
gastrointestinal tract. Since the duodenal mycosis symptoms were very similar to those of active duodenal-ulcer disease, the differential diagnosis being possible only by means of endoscopy, we suggest that if a carbenoxolone or cimetidine treated patient is still complaining of peptic-ulcer-like symptoms at the end of treatment, the possibility of duodenal mycosis should be explored. LUCIO LOMBARDO ANGELO PERA LOREDANA GENOVESIO GIORGIO VERME
Department of Gastroenterology, and Central Laboratory, Ospedale Mauriziano U.I., 10128 Turin, Italy
ANTICOAGULANTS AND "FEELING COLD"
SIR,-Patients taking warfarin sodium (’Marevan’) have us that the drug makes them feel cold, but Mr H. E. Bye (Duncan Flockhart & Co.) was unable to substantiate this claim, and the effect is not recorded as a side-effect in reference
told
texts.5-8 We decided
the suggestion that warfarin produces a of coldness subjective feeling by a controlled study. At this hospital, venesection for all routine blood-tests is done in a central laboratory and 202 miscellaneous patients taking drugs and attending for a blood test were asked by the nurse "Do your tablets make you feel cold?" The answer was recorded, and only then were the patients asked to list their medications. 42 (45%) of 94 patients taking warfarin believed that their tablets made them feel cold, compared with only 24 (22%) of the 108 not taking warfarin (ylO-5, p
cimetidine, the patient still had epigastric vomiting. At endoscopy no ulcer was found but the whitish pseudomembranes were still present: a culture of duodenal material taken by biopsy forceps again grew Penicillium sp. Cimetidine treatment was stopped and oral nystatin was given for a week after which both endoscopic and laboratory findings were negative for mycosis, and the patient was symptom-free. Repeated biopsy forceps cultures done before this case and since have never grown such mycetes, so mycosis of the duodenal bulb, due to Penicillium, seems to be rare. Our patient had not been treated with other drugs (notably antibiotics) and
After
a
pain,
nausea, and
month
on
routine
her immunohaematological globulins. No malignancy of the gastrointestinal tract or elsewhere was detected. The mycosis was seen after 1 month of treatment with carbenoxolone sodium, a drug that does not affect the gastric pH but is believed to change the composition of gastric mucus, which becomes richer in hexosamines and fucose.4 The mycosis persisted during cimetidine therapy. This suggests that changes in the composition of the gastric mucus and rises in gastric pH may be responsible, during carbenoxolone and cimetidine treatment, for the mycetes growth in the tests were
normal
as were
gastrointestinal tract. Since the duodenal mycosis symptoms were very similar to those of active duodenal-ulcer disease, the differential diagnosis being possible only by means of endoscopy, we suggest that if a carbenoxolone or cimetidine treated patient is still complaining of peptic-ulcer-like symptoms at the end of treatment, the possibility of duodenal mycosis should be explored. LUCIO LOMBARDO ANGELO PERA LOREDANA GENOVESIO GIORGIO VERME
Department of Gastroenterology, and Central Laboratory, Ospedale Mauriziano U.I., 10128 Turin, Italy
ANTICOAGULANTS AND "FEELING COLD"
SIR,-Patients taking warfarin sodium (’Marevan’) have us that the drug makes them feel cold, but Mr H. E. Bye (Duncan Flockhart & Co.) was unable to substantiate this claim, and the effect is not recorded as a side-effect in reference
told
texts.5-8 We decided
the suggestion that warfarin produces a of coldness subjective feeling by a controlled study. At this hospital, venesection for all routine blood-tests is done in a central laboratory and 202 miscellaneous patients taking drugs and attending for a blood test were asked by the nurse "Do your tablets make you feel cold?" The answer was recorded, and only then were the patients asked to list their medications. 42 (45%) of 94 patients taking warfarin believed that their tablets made them feel cold, compared with only 24 (22%) of the 108 not taking warfarin (ylO-5, p
