ISSN:0815-9319    

DOI:10.1111/j.1440-1746.1996.tb01853.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

ISSN:0815-9319    

DOI:10.1111/j.1440-1746.1996.tb00268.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Abstract Suppression of acid secretion with omeprazole is highly effective for the healing of oesophagitis. The aims of the present study were to determine whether recovery of gastro‐oesophageal reflux disease in patients with stricture improves dysphagia and decreases the dilatation need and to compare the efficacy of omeprazole versus H2‐receptor antagonists. Thirty‐eight patients with peptic stricture (grade IV oesophagitis) and erosive oesophagitis underwent endoscopic dilatation and were randomized to omeprazole (40 mg daily;n= 20) versus ranitidine (150 mg twice daily;n=18). Healing was proven endoscopically and patients were interviewed for dysphagia relief. Patients were assessed for relapse by endoscopy 6 months later. The follow‐up period was a further 6 months. Patients received maintenance treatment with 40 mg omeprazole daily or ranitidine 150 mg twice daily and the total duration of treatment was 1 year. At 6 months, omeprazole produced a highly significant (P<0.0001) greater rate of oesophagitis healing and highly significant (P<0.0001) fewer dilatations compared with H2‐receptor antagonists (18 (90%) patientsvsfive (28%) patients, respectively; 3.5vs9.0 dilatations/patient). At 12 months, not one of the 18 successfully treated patients from the omeprazole group had relapsed. The two remaining patients required further dilatation and 40 and 60 mg omeprazole daily for healing. In comparison, all patients on ranitidine had to undergo further bougienage. In conclusion, omeprazole is a safe and effective maintenance treatment for preventing relapse of complicated reflux o

ISSN:0815-9319    

DOI:10.1111/j.1440-1746.1996.tb00269.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Abstract We prospectively evaluated 139 consecutive children presenting to the Sanjay Gandhi Postgraduate Institute of Medical Sciences (Lucknow, India) with gastrointestinal (GI) bleeding from January 1991 to November 1994. Our aims were to find out whether the causes of GI bleeding in a developing country differed from developed countries and how the application of newer diagnostic techniques would help in the diagnosis of GI bleeding. Barium studies, endoscopy, technetium‐99m‐labelled (erythrocytes and pertechnetate) scans, selective abdominal angiography using a digital subtraction technique and rectal endoscopic ultrasonography were performed. Upper GI bleeding (n= 75) was variceal in 71 (95%) children (extrahepatic portal venous obstruction in 65, cirrhosis in six) and non‐variceal in four (5%) cases (Henoch‐Schonlein purpura, idiopathic thrombocytopenic purpura, drug‐induced gastric erosions and pseudoaneurysm of the gastroduodenal artery due to idiopathic chronic calcific pancreatitis). Causes of lower GI bleeding (n= 64) were colitis (27 cases; 42%), colorectal polyps (26 cases; 41%), enteric fever (n= 3), solitary rectal ulcer (n= 3), portal hypertensive colopathy (n= 2), colonic arteriovenous malformation (n= 1) and internal haemorrhoids (n= 1). One patient remained undiagnosed. Angiography performed in four children was diagnostic in two. In one child with massive lower GI bleeding from portal colopathy, the bleeding site (caecum) was localized by intra‐operative colonoscopy, while in the other child with portal colopathy, rectal endoscopic ultrasonography was performed to substantiate the diagnosis. We conclude that the causes of upper GI bleeding in children in developing countries are different from those in developed countries (variceal bleeding due to extrahepatic portal venous obstruction is the most common cause, while peptic ulcer is rare). However, the spectrum of lower GI bleeding is similar to that of developed countries. Application of newer diagnostic techniques is helpful and safe in the identification of the cause of GI bleedin

ISSN:0815-9319    

DOI:10.1111/j.1440-1746.1996.tb00270.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Abstract A 66‐year‐old female, who had been taking low dose aspirin for approximately 6 months, was admitted to hospital with severe gastrointestinal bleeding. The source of bleeding could not be demonstrated despite gastroscopy, mesenteric angiography and99mTc‐labelled red blood cell scanning. Mesenteric angiography was repeated, demonstrating a site of bleeding in the proximal small intestine. Laparotomy revealed blood‐filled jejunal diverticulosis. Resection of the affected segment resulted in cessation of haemorrhage and the patient remains well in follow up. The present report illustrates a rare cause of gastrointestinal haemorrhage, the possible role of aspirin in causation and the difficulty in diagnosis of bleeding from jejunal diver

ISSN:0815-9319    

DOI:10.1111/j.1440-1746.1996.tb00271.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Abstract To investigate the possible absorption and deposition of bismuth or aluminium from agents used in the treatment of peptic ulcers, we have measured levels of bismuth and aluminium in the liver tissue of 15 patients undergoing elective liver biopsy and in the cerebrospinal fluid (CSF) of 15 patients undergoing elective myelography after administration of standard therapeutic doses of tripotassium dicitrato bismuthate (TBS), sucralfate or aluminium hydroxide for 1 month. Aliquots of liver or CSF were separated and levels of both aluminium and bismuth were assayed in each sample by atomic absorption spectrophotometry. The group who received TBS had significantly higher liver bismuth levels than the other two treatment groups, but there was no significant difference in CSF bismuth levels among the three groups. There was no significant difference in either liver or CSF aluminium levels among the three treatment groups. We conclude that tissue accumulation of bismuth may occur after short‐course therapy with colloidal bismuth, although there is no evidence of CNS accumulation of bismuth in the present st

ISSN:0815-9319    

DOI:10.1111/j.1440-1746.1996.tb00272.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Abstract At present, the evaluation of anti‐ulcer drugs is generally accomplished simply by calculating the cumulative healing rate at a certain point of time during treatment, which does not implicate any analysis of the healing speed of the ulcer. If the cumulative healing rate of an ulcer is expressed as a function of drug administration time, t, then it will be possible to calculate parameters concerning the healing speed of ulcers and thus evaluate drug efficacy as the time series analysis of the cumulative healing rate. A new method of evaluating anti‐ulcer drugs by a statistical analysis of healing speed is proposed. A non‐linear regression analysis was performed between two variables, t (time of drug administration: week) and y (non‐healing rate: %), to obtain the exponential function y = Ae−kt. The theoretical values calculated from the exponential equation were in close proximity to the observed values. With this analysis, four parameters concerning the healing speed were defined, namely the healing rate constant, the initiation time of healing, the half‐life of non‐healing rate and the time necessary for 50% healing. With this method, the efficacy of drugs on peptic ulcer healing was dynamically analysed, the non‐healing rate (y) being expressed as an exponential function of length of time (t) of treatment, thus obtaining digital parameters

ISSN:0815-9319    

DOI:10.1111/j.1440-1746.1996.tb00273.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Abstract Studies were performed in three models of acute gastric mucosal damage (induced by oral ethanol, aspirin and indomethacin) and a model of chronic gastritis (induced by 7 day treatment with iodoacetamide) in rats to establish the role of leukotrienes (LTs) in the pathogenesis of these lesions. The protective effects of highly selective 5‐lipoxygenase (5‐LO) inhibitors and leukotriene antagonists were thus examined in rats given these ulcerogens. Ethanol (1 mL, p.o.)‐induced haemorrhagic lesions were significantly reduced by prior oral administration of the 5‐LO inhibitor L‐656 224 (50 mg/kg), whereas lower doses of this drug were ineffective. Prior treatment with oral doses (5 and 10 mg/kg) of the 5‐LO inhibitor L‐655 224 or the LT antagonists L‐649 923 or L‐660 711, failed to affect lesions induced by aspirin (100 mg/kg, p.o.) and indomethacin (400 mg/kg, s.c), whereas higher doses of all three drugs (50 mg/kg) showed protective effects. Repeated prior dosing up to 5 h with the novel five lipoxygenase activating protein (FLAP) inhibitor, MK886 (50 and 100 mg/kg), reduced the lesions developed by indomethacin (30 mg/kg, s.c). Twice daily dosing with the 5‐LO inhibitor L‐656 224 (5 mg/kg) or the LT antagonist L‐649 923 (2 or 5 mg/kg) for 7 days significantly reduced the development of iodoacetamide‐induced gastritis during the period of induction of this condition, but higher doses of these inhibitors were not protective. We conclude that 5‐LO products partially mediate the production of gastric mucosal lesions induced by damaging agents, which varies according to the ulcer model employed; the limited protective effects of the respective 5‐LO inhibitors and LT antagonists depend on their individual pharmacoki

ISSN:0815-9319    

DOI:10.1111/j.1440-1746.1996.tb00274.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Abstract To investigate pathophysiological diversities in the repairing process of gastric ulcer, distribution density of basic fibroblast growth factor (bFGF)‐positive fibroblasts and myofibroblasts and vascular endothelial cells, mucosal haemoglobin content, PAS‐positive mucus amount and glandular index were compared in the peripheral region of an open ulcer (the unhealed group;n= 17), the central region of a red scar (the red scar group;n =32) and the central region of the white scar (white scar group;n =32). Density of bFGF‐positive fibroblasts and myofibroblasts and vascular endothelial cells was highest in the unhealed group, followed by the red scar group, while the white scar group showed a low value close to control. Mucosal haemoglobin content was high in the red scar and unhealed groups. PAS‐positive mucus amount in the unhealed and red scar groups showed lower values compared with that in the white scar group. Glandular index in the unhealed group was the lowest, followed by the red scar group, while the white scar group neared control values. Statistically significant correlations were observed between the density of bFGF‐positive ‘fibroblasts and myofibroblasts' and density of bFGF‐positive vascular endothelial cells, between the density of bFGF‐positive vascular endothelial cells and mucosal haemoglobin content and between the PAS‐positive mucus amount and glandular index. Discriminant analysis demonstrated that the unhealed group could be distinguished from the red and white scar groups, based on glandular index, density of bFGF‐positive ‘fibroblasts and myofibroblasts’, mucosal haemoglobin content and PAS‐positive mucus amount, while the red scar group could be discriminated from the white scar group based on the density of bFGF‐positive ‘fibroblasts and myofibroblasts’, density of bFGF‐positive vascular endothelial cells, glandular index, haemoglobin content and PAS‐positive mucus amount. The white scar group was difficult to discriminate from control. Our present results show that the recovery of glandular formation and mucus production continues throughout the repairing process, whereas the acceleration of angiogenesis and granulation formation is observed only in unhe

ISSN:0815-9319    

DOI:10.1111/j.1440-1746.1996.tb00275.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Abstract Current antibiotic prophylaxis for endoscopic retrograde cholangiopancreatography (ERCP) is not standardized and may be inadequate. We aimed to evaluate the efficacy of 3 days of additional oral antibiotics in the prevention of ERCP‐related sepsis. One hundred and fifty‐six patients were randomized prospectively to receive either intravenous ticarcillin and clavulinic acid (Timentin® SmithKline Beecham, Dandenong, Victoria, Australia), pre‐ERCP (group I) or Timentin® and 3 days of oral amoxycillin and clavulinic acid (Augmentin®; SmithKline Beecham, Dandenong, Victoria, Australia), group II). Blood cultures were taken 30 min after the procedure. The occurrence of sepsis, defined as a temperature over 38°C, occurring in the first 7 days was recorded and the risk factors for the development of sepsis were evaluated. Four patients had significant positive blood cultures despite the prior administration of Timentin.® Sepsis occurred in 10% of group I patients, but only 3% of group II patients (relative risk 3.30; 95% confidence intervals 0.74‐14.8). The performance of sphincterotomy and the presence of common bile duct stones were significant risk factors for the development of sepsis. We would recommend 3 days of additional oral Augmentin® after a single dose of intravenous antibiotics in patients at increased risk of sepsis, which would include those with bile duct stones and/or those undergoing a therap

ISSN:0815-9319    

DOI:10.1111/j.1440-1746.1996.tb00276.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY