Surgical haemorrhage in patients given subcutaneous heparin as prophylaxis against thromboembolism.

raising the intragastric pH even if PAO is low. Symptoms are relieved in most patients, but in a few some remain, and these may be functional. Results were satisfactory in 80% in this study, but only in 32% with previous medical treatment.' Despite reports of possible acute vascular problems,4 cimetidine is unlikely to have caused the death of our two patients. One patient died of a pulmonary embolus only two days after starting cimetidine. The other patient aged 76 had ischaemic heart disease and severe peripheral vascular disease, and died suddenly, presumably of myocardial infarction due to his known atherosclerosis and unconnected with cimetidine. Management ofpatients after the ulcer has healed remains uncertain. All of our patients were put on 400 mg of cimetidine at night; they have been followed now for two to 18 months and no ulcer has yet been known to have recurred. Further studies are needed to discover if long-term results are as good with cimetidine as with surgery. Nevertheless, cimetidine may be used successfully in patients unfit for operation.