摘要:

SUMMARYThere are a variety of methods for dissolving gallstones in the biliary tree, which include oral therapy and direct contact dissolution. Cholesterol gallstones are most amenable to dissolution. Developments in non‐operative physical methods to remove gallstones (particularly endoscopic papillotomy and extracorporeal shock‐wave lithotripsy have diminished the use of chemical dissolution. However, in selected patients, there remains a place for chemical dissolution, but often in conjunction with the physical techniq

ISSN:0269-2813    

DOI:10.1111/j.1365-2036.1989.tb00207.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

SUMMARYVariable drug release from solid oral dosage forms has been an important cause of bioavailability problems in the past, and is a factor now carefully controlled in pharmaceutical products. In two reviews, we describe briefly the composition and manufacture of tablets and capsules, and the two main processes by which they release drugs; disintegration and dissolution. We will explain what is presently understood of the actual mechanisms of drug release and the physico‐chemical factors that affect the release process. The strategies adopted by pharmaceutical scientists in designing modern oral solid dose forms to release drugs at reproducible and therapeutically optimal rates will be discussed. Finally, the role of gamma scintigraphy in assessing dosage form performancein vivowill be describe

ISSN:0269-2813    

DOI:10.1111/j.1365-2036.1989.tb00208.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

SUMMARYOne hundred and sixteen children (less than 2 years old) admitted to a London hospital with acute gastroenteritis were randomized to receive either an oral rehydration solution (ORS) with low sodium and high glucose concentration (Na+35, glucose 200 mmol/L), an ORS with a high sodium but low glucose concentration (Na+60, glucose 111 mmol/L), or an ORS containing glycine and a glucose polymer (Na+50, glucose 50, glycine 50 mmol/L). Clinical, biochemical and haematological features of the three groups were similar on admission. Rotavirus was common (31%); the majority of children had minimal dehydration or acid–base disturbance.The clinical outcome, including ORS intake, prevention of dehydration, rehydration, and duration of hospital stay was similar in the three treatment groups. All initial electrolyte abnormalities were corrected; no child developed hypernatraemia or hyponatraemia. At 24 h, the mean serum urea was higher in those who received the ORS containing glycine than in other groups, and it had not fallen significantly since admission. Eighteen per cent of children had carbohydrate intolerance : four children with ≥2% reducing substances in their stool had all received ORS with a high glucose content and had numerous watery green stools containing rotavirus.All ORS solutions were safe and effective for rehydration and correction of biochemical abnormalities, however carbohydrate intolerance was more prevalent in children who received the ORS with a high glucose cont

ISSN:0269-2813    

DOI:10.1111/j.1365-2036.1989.tb00209.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

SUMMARYThe histomorphological effect of multidose administration of 6 mg/kg pentagastrin b.d. for 5 weeks, and 1000 mg/kg sodium bicarbonate b.d. for 13 weeks, on the rat fundic mucosa has been examined. Sodium bicarbonate induced a significant hypergastrinaemia (plasma gastrin concentrations were 370.5 pg/ml in the control versus 642.6 pg/ml in sodium bicarbonate‐treated rats after 13 weeks,P<0.01). Both treatment regimens induced fundic neuroendocrine cell hyperplasia. The cellular proliferation that occurred following hypergastrinaemia of endogenous or exogenous origin suggests that systemic gastrin concentrations play a major role in the control of fundic neuroendocrine cell population

ISSN:0269-2813    

DOI:10.1111/j.1365-2036.1989.tb00210.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

SUMMARYTwenty‐four‐hour intragastric acidity was measured in 10 patients with past history of duodenal ulcer on the fourth day of dosing with placebo, and either 150 mg ranitidine given twice or four times daily. The order the treatments was randomized and a double‐blind design was employed. Ranitidine (150 mg) b.d. decreased median integrated 24‐h intragastric acidity by 65.1%, nocturnal acidity by 89.1%, and daytime acidity by 54.6% (allP<0.01 compared to placebo). The corresponding decreases with 150 mg ranitidine q.d.s. were 62.3, 89.9 and 48.8%, respectively (allP0.05).This study shows that giving extra doses of 150 mg ranitidine during the day does not increase the degree of suppression of intragastric

ISSN:0269-2813    

DOI:10.1111/j.1365-2036.1989.tb00211.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

SUMMARYH2‐receptor antagonists administered in conventional dosage regimens fail to heal a significant proportion of patients with moderate or severe reflux oesophagitis. We have compared the effects of a higher dose of ranitidine (300 mg q.d.s.) with the currently recommended dosage regimen (150 mg b.d.) in 138 patients suffering from reflux oesophagitis. After 4 weeks of treatment 29% of patients who received 150 mg ranitidine b.d., and 63% of patients who received 300 mg ranitidine q.d.s. had complete endoscopic healing of their lesions (P<0.0001). After 8 weeks these proportions had increased to 54% and 75%, respectively (P<0.01). After 4 weeks of treatment, compete symptomatic relief had been achieved in 46% of patients who received 150 mg ranitidine b.d and in 67% of patients who received 300 mg ranitidine q.d.s. (P<0.05). After 8 weeks these proportions were 64% and 84%, respectively (P<0.05). Both dosage schedules were well‐tolerated. We conclude that more rapid symptom relief and healing in reflux oesophagitis can be achieved with 300 mg ranitidine q.d.s. than with 150 mg ranitidine

ISSN:0269-2813    

DOI:10.1111/j.1365-2036.1989.tb00212.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

SUMMARYCimetropium bromide is a new antimuscarinic compound with strong antispasmodic activity. The aim of this study was to evaluate the effects of oral cimetropium bromide on total gut transit time in patients with irritable bowel syndrome. Forty patients, divided according to their initial total gastrointestinal transit times and presenting symptoms, were treated with cimetropium bromide 50 mg t.d.s. or placebo for 1 month according to a double‐blind, parallel group design. Before and after treatment all subjects ingested 24 radio‐opaque markers. The total intestinal transit time was determined by evaluating the rate of disappearance of markers from plain X‐ray films of the abdomen taken every 24 h for 4 days. Pain and bowel habits were also monitored. Seven patients did not complete the study. Cimetropium bromide significantly (P<0.01) shortened the whole gut transit time in patients with prolonged transit time (80.8 ± 4.0 h beforevs60.8 ± 6.7 h after treatment) and improved the global clinical condition significantly compared with placebo (P= 0.029). In patients with a short total intestinal transit time, cimetropium bromide had no effect on whole gut transit time and did not significantly improve symptoms. The results of this study indicate that oral cimetropium bromide is effective both objectively and subjectively in a subgroup of irritable bowel syndrome patients with const

ISSN:0269-2813    

DOI:10.1111/j.1365-2036.1989.tb00213.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

SUMMARYPharmacokinetic data suggest that current treatment regimens of metronidazole in abdominal surgery are not always appropriate. We have examined antibiotic concentrations during emergency and elective surgery using a specific and sensitive high pressure liquid chromatography assay. Serum and tissue concentrations were measured after intravenous infusion during intra‐abdominal surgery and after suppositories given before appendicectomy. After intravenous dosage, bactericidal concentrations were reached in serum (13.6 ± 7.8 μ/ml), bowel (9.0 ± 6.6 μ/g), tumour (9.9 ± 7.1 μ/g) and subcutaneous fat (4.9 ± 3.2 μ/g). After suppositories the concentrations were: serum 4.6 ± 2.7 μ/ml, appendix 1.1 ± 0.6 μ/g, fat 1.5 ± 0.9 μ/g and peritoneal fluid 4.7 ± 4.3 μ/g. These values were obtained at a mean interval of 86.9 ± 27.5 min following administration of the drug.Serum concentrations were measured during post‐surgical infusion of 500 mg i.v. 8 or 12 hourly. Mean concentrations after 8 hourly doses were 16.3 ± 4.85 μ/ml pre‐dose and 28.7 ± 6.76 μ/ml post‐dose, with evidence of drug accumulation by detection of metabolites. Twelve hourly infusions gave pre‐dose levels of 7.4 ± 3.86 μ/ml and post‐dose levels of 17.1 ± 3.69 μ/ml.Metronidazole (500 mg) intravenously at induction of anaesthetic gives effective prophylactic concentrations in all tissues including tumour, but a metronidazole 1g suppository before appendicectomy does not provide reliable tissue concentrations. Metronidazole (500 mg) i.v. 12 hourly gives effective bactericidal concentration

ISSN:0269-2813    

DOI:10.1111/j.1365-2036.1989.tb00214.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

SUMMARYThe aim of this study was to compare the duodenal ulcer healing effects of morning (08.00 hours) vs. single bedtime (22.00 hours) doses of 40 mg famotidine, bearing in mind that the known efficacy of bedtime doses of H2–antagonists is regarded as evidence of the predominance of nocturnal gastric acidity in the pathogenesis of duodenal ulcer.This randomized double‐blind multicentre trial was conducted in a total of 127 patients with endoscopically proven active duodenal ulcer. Nine patients dropped out and thus 118 were included in the final analysis. The duration of treatment was 4 weeks, and this was extended to 8 weeks in patients whose ulcers failed to heal by week 4. The patients in the two treatment groups were well matched for age and sex.The therapeutic efficacy parameters were endoscopic healing of the ulcer lesion and disappearance of pain. Results were compared using the χ‐square method.The 4–and 8–week (cumulative) ulcer healing rates in the patients treated with the morning dose of famotidine were 77.2% and 86%, respectively, compared with 78.6% and 91.8% in those who received the bedtime dose. The differences failed to prove statistically significant either at week 4 (P= 0.85) or at week 8 (P= 0.31). The percentages of patients with ulcer pain, evaluated weekly, were similar in the two treatment groups.The equivalent efficacy of the morning and bedtime famotidine regimens raises doubts concerning the predominance of nocturnal gastric acidity in the pathogenesis of duod

ISSN:0269-2813    

DOI:10.1111/j.1365-2036.1989.tb00215.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

SUMMARYSodium ion (Na+) transport, a principal function of the gallbladder epithelium, was studied by measuring the flux of22Na across isolated human gallbladder mucosa maintained in a modified‘Ussing’flux chamber. Tissue was obtained from cholecystectomy specimens in symptomatic patients with cholelithiasis. Out of 26 gallbladders studied, 13 had a net Na+flux from mucosa to serosa which indicated active Na+absorption. The hormone secretin, when added to the serosal fluid, reversed the direction of net flux in these gallbladders and caused a secretion of Na+from serosa to mucosa. These results suggest that secretin may be involved in the physiological regulation of fluid transport in the human gallbladder, and also suggest a possible role for this hormone in gallbladder empty

ISSN:0269-2813    

DOI:10.1111/j.1365-2036.1989.tb00216.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY