摘要:

SUMMARYThis paper reviews the development of the techniques used for liver preservation and describes their clinical use. Recent advances with the introduction of lactobionate based solutions for simple cold storage are described and illustrated by their effect on the Cambridge/King's College Hospital transplant programmes. Better preservation of the liver has simplified the logistics of the transplant procedure, improving organ usage and allowing increased sharing of livers for urgent or paediatric cases.

ISSN:0269-2813    

DOI:10.1111/j.1365-2036.1991.tb00010.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

SUMMARYA model is presented which attempts to unify many of the processes identified in recent years as contributing to the maintenance of mucosal integrity in the stomach. Two concepts, namely acid disposal and rapid repair of superficial injury, are highlighted as being of particular physiological significance. The mechanisms involved in protection of the normal mucosa against luminal aggressors (e.g. acid/pepsin, ethanol, aspirin) must be distinguished from the factors which influence the healing of a pre‐existent ulcer. In this context, the relatively neglected topic of wound healing in the gastric mucosa is considered, and the implications for current therapeutic strategies and for the discovery of new anti‐ulcer drugs are explo

ISSN:0269-2813    

DOI:10.1111/j.1365-2036.1991.tb00011.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

SUMMARYPrevious studies have confirmed the therapeutic value 61 elemental diets in promoting remission in active Crohn's disease, but their long‐term benefit has not been established. Twenty‐seven patients with established Crohn's disease who attained clinical remission after four weeks of enteral feeding were followed prospectively for up to 36 months. Twenty of these were willing to be tested for specific food intolerance using a predefined dietary elimination protocol; the others continued on a normal unrestricted diet. Eighteen patients (67%) have since relapsed; 89% of the relapses occurred within the first 6 months. Of the 15 patients with colonic involvement, 12 (80%) relapsed by 6 months. In contrast only 3 of 11 with isolated small bowel disease experienced early relapse. Of the 14 patients who completed the process of dietary testing, 5 could not identify any trigger foods; the remaining 9 were maintained on exclusion diets, 3 of whom relapsed early. Of the 11 taking a normal diet, 9 relapsed. Disease duration, previous intestinal resection or prior steroid therapy did not affect the relapse rate. Eight patients (31 %) obtained a long‐term remission, mean 23 months (range 12–36 months), without any medication. Long‐lasting remissions can be obtained in about one‐third of patients with Crohn's disease following treatment with a defined formula diet. Colonic involvement is associated with a high early r

ISSN:0269-2813    

DOI:10.1111/j.1365-2036.1991.tb00012.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

SUMMARYGastric application of high doses of colloidal bismuth subcitrate (CBS) stimulates mucosal prostaglandin E2(PGE2) production, which is considered part of the mechanism by which the drug accelerates peptic ulcer healing. Whether therapeutic, orally administered, doses of CBS cause a sustained stimulation of prostaglandin production is not known. We have, therefore, determined gastric luminal release of PGE2during ‘steady‐state’perfusion of the stomach with CBS (10 mg/ml; isotonic mannitol 5 ml/min) and 4 h after the last oral dose of the drug (240 mg b.d.) for 2 weeks (isotonic mannitol 5 ml/min) in 8 healthy volunteers. A significant increase in PGE2concentrations (712 (409–1076)vs.control 334 (252–655) pg/ml; medians withQ50ranges;P<0.02) and PGE2output (12.5 (7.3–14.3)vs.control 4.8 (4.1–7.3) ng/15 min;P<0.02) occurred during gastric perfusion with CBS. A similar increase in PGE2concentrations (630 (297–1429) pg/ml;P<0.02) and PGE2output (12.6 (6.4–22.2) ng/15 min;P<0.02) was observed following treatment with CBS for 2 weeks. These results suggest that therapeutic doses of CBS cause a sustained stimulation of gastric muco

ISSN:0269-2813    

DOI:10.1111/j.1365-2036.1991.tb00013.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

SUMMARYGastric emptying was measured in 9 diabetic patients with autonomic neuropathy (Group 1) and 8 normal controls (Group 2) on 4 occasions after swallowing placebo, 0.5, 1.0 or 2.0 mg of the newly developed prokinetic drug renzapride given double‐blind and in random order. The liquid component of the test meal was labelled with In113mand the solid with Tc99m. Liquid emptying was uni‐exponential. Solid emptying comprised an initial lag phase, followed by a linear component. Following placebo, the mean lag phase of solid emptying was 40 ± 7 (S.E.M.) min in Group 1 and 16 ± 2 min in Group 2 (P<0.01). In Group 1 subjects renzapride reduced the mean lag phase by 20–26 min at all doses (P<0.01). No effect was seen in Group 2. The linear rate of solid emptying was similar in both groups (0.9 ± 0.1 and 1.0 ± 0.2%/min) and was not altered by renzapride. Mean liquidt1/2was similar in Groups 1 and 2 after placebo (30 ± 6 and 29 ± 4 min, respectively) and was decreased with increasing doses of renzapride in both groups. No adverse effects were encountered in any subjects. Renzapride may be useful in the treatment of diabetic ga

ISSN:0269-2813    

DOI:10.1111/j.1365-2036.1991.tb00014.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

SUMMARYThe results of four similarly designed, randomized, double‐blind, placebo‐controlled studies conducted to evaluate ranitidine as prophylaxis for NSAID‐associated damage are reviewed. A total of 673 patients receiving therapeutic dosages of NSAIDs for arthritic or musculoskeletal conditions also received either ranitidine 150 mg twice daily (n= 343) or placebo (n= 330) for four weeks (two studies) or eight weeks (two studies). Endoscopic grading of mucosal lesions was based on a modified Lanza scoring system. All patients had normal baseline endoscopies. After four weeks of treatment a significant protective effect against duodenal mucosal lesions including duodenal ulcers (three studies) and gastric mucosal lesions including gastric ulcers (one study) was observed in patients who received ranitidine compared with those who received placebo. A meta‐analysis of the four studies confirmed that significantly fewer patients receiving ranitidine than placebo developed duodenal ulcers (1%vs.6%,P= 0.01). Endoscopic data at eight weeks from the two longer‐term studies showed that duodenal ulcers occurred in ranitidine‐ and placebo‐treated patients at a rate of 1% (2/137)vs. 8% (10/126) (P= 0.02), respectively, in one trial, and 0% (0/57)vs.8% (4/49) (P= 0.02), respectively, in the other trial. No protective effect in the stomach was evident at eight weeks. We conclude that ranitidine is effective in preventing NSAID‐associated duodenal ulcers and may be appropriate prophylaxis for certain hig

ISSN:0269-2813    

DOI:10.1111/j.1365-2036.1991.tb00015.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

SUMMARYMorphometric measurements have been performed on small intestinal biopsy specimens from patients with untreated coeliac disease before and after six weeks oral treatment with a steroid of low systemic bioavailability (fluticasone propionate). Measurements were obtained by point counting and also by a computer‐aided measuring system with reference to a constant area of the muscularis mucosa.Fluticasone propionate led to a parallel reduction in the intra‐epithelial lymphocyte count within the surface (P<0.001) and crypt epithelium (P<0.01). The intra‐epithelial lymphocyte count assessed by reference to constant areas of the muscularis mucosa and surface epithelium were decreased two‐fold (P<0.01) and seven‐fold (P<0.001) respectively. Fluticasone propionate treatment also led to significant increases in the absorptive surface epithelium as shown by an increase in the villus: crypt ratio (P<0.01), the epithelial cell height (P<0.01) and two‐ to three‐fold increases in the area and length of the surface epithelium (P<0.001).Short‐term fluticasone propionate treatment appears to exert a powerful beneficial effect upon duodenal morphology in patients with coeliac disease. Whether the alterations seen are comparable to a similar period of gluten withdrawal i

ISSN:0269-2813    

DOI:10.1111/j.1365-2036.1991.tb00016.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

SUMMARYA multicentre, double‐blind, randomized, placebo‐controlled trial was undertaken to investigate the therapeutic efficacy of a nocturnal dose of famotidine 20 mg to reduce the 1 year relapse rate of recently healed gastric ulcers. Twenty investigators in eight countries randomized 202 patients with endoscopically confirmed healed gastric ulcers. Repeat endoscopies were performed at 6 and 12 months or for symptoms compatible with ulcer relapse. A per protocol analysis of cumulative life table relapse at 12 months showed that famotidine 20 mg was superior to placebo in reducing gastric ulcer relapse, 24 versus 50%, respectively (P<0.01). Both placebo and famotidine were well tolerated. Since nocturnal dosing with famotidine 20 mg is effective in preventing gastric ulcer relapse over a 1‐year period and is well tolerated, it offers a therapeutic option for the long‐term treatment of patients with gastri

ISSN:0269-2813    

DOI:10.1111/j.1365-2036.1991.tb00017.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

SUMMARYWe determined endogenous gastric prostaglandin synthesis and its correlation with the prevention of duodenal ulcer relapse by misoprostol and ranitidine. Sixty‐one patients with recent endoscopically healed duodenal ulcer were randomly allocated in a double‐blind fashion for one year of treatment with misoprostol 400 μmUg nocte, ranitidine 150 mg nocte or placebo. Patients were followed every two months. Endoscopy was repeated at six and 12 months or beforehand, if relapse was suspected. Antral and fundic biopsies, 3–4 from each region, were obtained at each endoscopy for determination of prostaglandin synthesis. During the one year of treatment, 11 out of the 12 placebo treated patients flared up, as opposed to 10 out of 25 and four out of 24 misoprostol and ranitidine treated patients, respectively. The difference between all treatment groups was significant (P<0.0001). In all subjects who flared up, pretrial endogenous antral and fundic prostaglandin E2synthesis were not different from their respective synthesis in those who did not relapse. These results indicate that one year of treatment with both ranitidine and misoprostol prevents ulcer relapse better than placebo. However, ranitidine is significantly better than misoprostol. Both at six and 12 months there was no significant difference between the two treatment groups in the trend towards enhanced synthesis of gastric prostanoids.These results indicate that one year of treatment with both ranitidine and misoprostol prevents ulcer relapse better than placebo. However, ranitidine is significantly better than misoprostol. Both at six and 12 months there was no significant difference between the two treatment groups in the trend towards enhanced synthesis of gastric prost

ISSN:0269-2813    

DOI:10.1111/j.1365-2036.1991.tb00018.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

SUMMARYA 24‐week, double‐blind, randomized study at 13 centres compared the efficacy and safety of 20 mg famotidine nocte and 150 mg ranitidine h.s. for the prevention of duodenal ulcer recurrence. All participants had been successfully treated for an acute duodenal ulcer with 40 mg famotidine nocte. Patients were endoscoped at baseline and at 24 weeks, unless symptoms warranted earlier examination: of the 208 patients enrolled, 86 who received famotidine and 84 who received ranitidine met all protocol criteria and were considered evaluable.Intention to treat and per protocol analyses showed non‐significant trends in favour of famotidine (P= 0.44 and 0.16, respectively). During the 24‐week observation period, 16.3% of the famotidine group and 25% of the ranitidine group had an ulcer recurrence (95% CI of percentage difference –0.22 + 0.04). At 24 weeks, relief of day and night pain was reported by 81.2% and 91.8% of the famotidine‐treated patients, respectively. The corresponding figures in the ranitidine group were 73.5% and 85.5%.No laboratory abnormalities related to the study‐drugs were noted and only two drug related (possibly or probably) adverse experiences were reported, both in the famotidine group. The data from this study therefore, supports the conclusion that the efficacy of 20 mg famotidine nocte is comparable to that of ranitidine in preventing duodenal ulcer recurrence, with comparable tolerability for long

ISSN:0269-2813    

DOI:10.1111/j.1365-2036.1991.tb00019.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY