摘要:

SUMMARYSurgical resection offers the only realistic hope of cure in hepatocellular carcinoma (HCC) but is usually not possible, either because the tumour is widespread throughout the liver at diagnosis, or because liver function is adversely affected by concomitant cirrhosis. The results of operation in early asymptomatic disease are, however, encouraging and efforts should be made to screen regularly the cirrhotic population at risk of HCC development.The prognosis for inoperable patients remains gloomy, though exciting new treatment methods exist which require extensive evaluation. An anthracycline given as single agent intravenous therapy is probably the current treatment of choice for inoperable patients, though only 20–30% will show a response. Intra‐arterial therapy has not yet been convincingly shown to have any advantages over intravenous therapy.The evaluation of clinical trials in HCC would be made easier if response criteria were standardized and universally adopted, and if trials were properly controlled and of sufficient sample size to test adequately the hypothesis in quest

ISSN:0269-2813    

DOI:10.1111/j.1365-2036.1988.tb00688.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

SUMMARYPurified intestinal macrophages obtained at resections for colonic neoplasms were investigated for chemotaxis to leukotriene B4(LTB4) by the Millipore filter assay and leading front technique. Possible inhibition by drugs effective in the treatment of chronic inflammatory bowel disease (sulphasalazine, olsalazine, its active moiety 5‐aminosalicylic acid (5‐ASA), and the 5‐ASA metabolite N‐acetylated‐5‐ASA (ac‐5‐ASA)) was tested at therapeutic colonic concentrations of 0.01–10 mm. Leukotriene B4at a dose of 10 nmwas equipotent with casein (5 g litre—1) as regards chemoattraction of macrophages. Sulphasalazine, olsalazine and 5‐ASA were potent inhibitors of macrophages chemotaxis to LTB4with IC50values of 0.43, 0.39 and 0.24 mm, respectively. These concentrations are below the lowest concentration of 5—ASA (2 mm) in the colonic lumen during conventional sulphasalazine treatment of patients with chronic inflammatory bowel disease. The inhibition of macrophage chemotaxis by these drugs may be important for this limitation of the local inflammatory process in chronic inflammatory bowel disease, and may in part explain the beneficial effect of systemic and local treatment with sulphasalazine. Leukotriene B4appears to be an important inflammatory mediator for the activation of macrophages

ISSN:0269-2813    

DOI:10.1111/j.1365-2036.1988.tb00689.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

SUMMARYA correlation between the levels of plasma cortisol, gastric mucosal prostaglandins and the degree of gastric ulceration produced by stress in rats was examined. Four groups of rats were evaluated. Group A, the cold stressed group; group B, their controls; group C, those receiving intraperitoneal indomethacin; and group D, those receiving intraperitoneal saline. Group A developed stress ulcers and their gastric mucosal prostaglandin levels (prostaglandin E2(PGE2) and prostacyclin levels, as measured by its stable metabolite 6—keto‐prostaglandin F1α(6—keto‐PGF‐1α, but not thromboxane) were significantly reduced when compared with their respective non‐stressed controls. The plasma cortisol levels in both group A and B increased slightly in the first hour but there was no statistical difference between the two groups and there was no change at 2, 3 or 4 h of stress. Group C (indomethacin) also developed ulcers and had low gastric mucosal prostaglandin levels when compared with group D (saline). The plasma cortisol levels did not alter in either group C or D. It has been postulated that stress ulcers may involve the depletion of gastric mucosal prostaglandin levels which, in turn, may be a consequence of a higher plasma cortisol level. A decrease in gastric prostaglandins independent of any change of plasma cortisol levels was demonstrated in this study and the mechanism of production of stress gastric ulcers re

ISSN:0269-2813    

DOI:10.1111/j.1365-2036.1988.tb00690.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

SUMMARYAmbulatory 24‐h pH monitoring in the distal oesophagus was performed in seven patients with erosive or ulcerative reflux oesophagitis to compare the effects of omeprazole and ranitidine in the management of gastro—oesophageal reflux disease. In a double‐blind, crossover study patients were treated with either 60 mg o.m. omeprazole or 150 mg b.d. ranitidine. The pH measurements were performed before treatment and on the fourteenth day of treatment with either regimen. The total acid exposure time (percentage total time pH<4) was abnormal in six out of seven patients before treatment. During treatment with omeprazole the acid exposure time of five patients was normal in comparison with only two patients during ranitidine therapy. However, even with a rather high dose of omeprazole, pathological gastro‐oesophageal reflux may stil

ISSN:0269-2813    

DOI:10.1111/j.1365-2036.1988.tb00691.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

SUMMARYThe present study attempts to assess the alteration in patterns of gastro‐oesophageal reflux as assessed by 24‐h oesophageal pH monitoring by varying degrees of H2‐receptor blockade with famotidine. Subjects were 12 patients with complaints of daily heartburn who demonstrated at least 6% of acid mucosal contact time by 24‐h ambulatory oesophageal pH monitoring. All subjects had a positive Bernstein test, and nine of the 12 subjects had erosive oesophagitis. The study was conducted as a double‐blind crossover design utilizing 40 mg nocte, 20 mg b.d., and 40 mg b.d. and placebo treatments. Results indicated that all treatments significantly reduced the 24‐h percentage acid contact time (P<0.05) compared to placebo. The two b.d. treatment regimens also significantly (P<0.05) reduced the number of episodes lasting longer than 5 min. Only the b.d. regimens successfully lowered the percentage of upright acid exposure. All treatments significantly (P<0.01) reduced the percentage of supine acid contact time, as well as the number of episodes lasting more than 5 min. It is concluded that gastro‐oesophageal reflux disease may well require a b.d. dosing regimen with farnotidine in order to achieve optimal mucosal healing and day time sy

ISSN:0269-2813    

DOI:10.1111/j.1365-2036.1988.tb00692.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

SUMMARYBalsalazide (BSZ) is a pro‐drug which releases 5‐aminosalicylic acid (5ASA) and 4‐aminobenzoyl‐β‐alanine (an inert carrier) in the colon of various species including man. BSZ was compared with sulphasalazine (SASP) (both 1 g b.d. orally) in the maintenance of remission in patients with ulcerative colitis (UC). Seventy‐nine patients (5.3 male, 26 female), mean age 49 years (range 19–79 years), with UC were randomly allocated to either treatment (41 BSZ, 38 SASP) for 6 months. The groups were similar in respect of age, sex, duration and extent of disease. Seven patients defaulted (3 BSZ, 4 SASP) leaving 38 on BSZ and 34 on SASP. Two male patients, both receiving SASP, were withdrawn because of severe side‐effects. One of these patients, with an exfoliative rash, was maintained satisfactorily on open BSZ. Remission rates at 6 months (51% BSZ, 63% SASP) were not significantly different (life‐table analysisP<0.1). Twelve patients (15%) reported troublesome side‐effects (2 BSZ 5%, 10 SASP 26%,P= 0.017 Fisher Exact Test). Mean haemoglobin concentrations, similar on entry, increased after 6 months with BSZ (0.2 g/dl) but decreased with SASP (0.5 g/dl) (P<0.0002). BSZ was not significantly different from SASP in maintaining remission in patients with UC but ha

ISSN:0269-2813    

DOI:10.1111/j.1365-2036.1988.tb00693.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

SUMMARYThe ability of ranitidine to protect the human gastric mucosa against aspirin‐induced damage was investigated by timed measurements of blood loss collected by gastric washing. Ranitidine (150 mg) 1 h or 5 h before 900 mg aspirin (5 doses of each) over 48 h reduced subsequent mean bleeding from 7.7 μi/10 min to 2.6 μl/10 min or 3.4 μl/10 min, respectively. Both regimens were antisecretory at the time of aspirin administration, as judged by a rise in the pH of the aspirated washings. The prolonged protection against aspirin‐induced bleeding achieved with twice daily dosing with ranitidine has dinical potential in the management of patients taking anti‐inflammato

ISSN:0269-2813    

DOI:10.1111/j.1365-2036.1988.tb00694.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

SUMMARYForty children (≤ 2 years of age) were admitted to hospital with acute gastroenteritis and were randomly assigned to receive either an oral rehydration solution (ORS) containing bicarbonate (Na 35, K 20, CI 37, HCO318, glucose 202 mmol litre−3) or an identical solution in which bicarbonate was replaced by chloride ions. Groups were matched for age, sex, ethnic origin, duration of diarrhoea and nutritional status. On admission, degree of dehydration, biochemical and haematological parameters were similar. The majority had minimal or no dehydration and only 30% had moderate to severe dehydration. All children were treated successfully with no complications. Oral rehydration solution intake by each group was similar. Clinical outcome, as judged by speed of rehydration or maintenance of hydration, duration of diarrhoea, stool frequency and length of hospital stay, was the same in both groups. After 24 h of ORS there was no difference between groups in venous pH, serum bicarbonate, urea and electrolytes. In hospitalized children with acute gastroenteritis in the United Kingdom an ORS without bicarbonate is a safe, effective means to prevent dehydration and maintain hydration and acid—base status where dehydration is not severe. Exclusion of bicarbonate would simplify production, increase stability and reduce the cost of ORS without apparent impairment of eff

ISSN:0269-2813    

DOI:10.1111/j.1365-2036.1988.tb00695.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

SUMMARYThe effect of 7 days of oral dosing with 5 mg day−1and 20 mg day−1omeprazole on basal and pentagastrin‐stimulated gastric acid output was studied in nine duodenal ulcer patients. Basal acid output measured 5–6 h post‐dosing was decreased by a mean of 75% on 5 mg omeprazole and by 90% on 20 mg omeprazole (P<0.05 andP<0.01, respectively). Peak acid output measured 6–7 h post‐dosing was decreased by a mean of 75% on 5 mg omeprazole and 90% on 20 mg omeprazole (P<0.01 for each). There was a wide interindividual variation in response to the 5 mg dose, with five of the nine patients having more than 90% inhibition of peak acid output, but two patients having less than 40% inhibition. This unpredictable response to daily low‐dose omeprazole therapy makes it unsuitable for mainte

ISSN:0269-2813    

DOI:10.1111/j.1365-2036.1988.tb00696.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

SUMMARYA case with WDHA syndrome due to VIPoma is reported. Injection of somatostatin analogue SMS 201‐995 was followed by prompt suppression of vasoactive intestinal polypeptide levels (VIP), decreased stool volume, and restoration of the serum potassium concentration to normal. Long‐term treatment with SMS 201‐995 for up to 20 weeks produced excellent clinical control and a decrease in tumour size. No adverse effects were noted except for localized pain at the site of injection. This was overcome by using a continuous subcutaneous infusion pump which also enabled the effective daily dosage to be reduced and thereby adverse reactions to be av

ISSN:0269-2813    

DOI:10.1111/j.1365-2036.1988.tb00697.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY