摘要:

SUMMARYThis paper reviews the modern management of viral hepatitis: hepatitis A, hepatitis B, hepatitis D and non‐A non‐B hepatitis. It describes the treatment of uncomplicated acute viral hepatitis, complicated acute viral hepatitis, and chronic viral hepatitis. The roles for corticosteroids, synthetic nucleotides, and interferons are reviewed. Finally, passive and active immunization against viral hepatitis are discus

ISSN:0269-2813    

DOI:10.1111/j.1365-2036.1989.tb00186.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

SUMMARYBismuth concentration was measured in plasma, dried leucocytes and urie in nine patients before, during and after treatment with tripotassium dicitrato bismuthate (De‐Noltab 2 b.d.) for 6 weeks. During treatment there was an 8.5‐fold rise in median plasma bismuth concentration (P<0.01), a non‐significant doubling of leucocyte bismuth content, and a 349‐fold rise in 24‐h urinary bismuth excretion (P<0.01). The significantly increased urinary bismuth excretion continued for at least 3 months after cessation of treatment with tripotassium dicitrato bismuthate, indicating accumulation of bismuth during treatment with

ISSN:0269-2813    

DOI:10.1111/j.1365-2036.1989.tb00187.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

SUMMARYTwo studies measured plasma concentrations of bismuth during dosing with tripotassium dicitrato bismuthate (De‐Noltab). The first study compared 24 h plasma bismuth concentration and urinary bismuth excretion in six patients who had already received 29–131 days (median 47 days) of treatment with De‐Noltab 2 b.d., and six healthy subjects who only received De‐Noltab 2 b.d. on the day of study. There was a prompt rise in plasma bismuth concentration after each dose of De‐Noltabs. The median 24 h integrated plasma bismuth concentration was similar in both groups, but the median 24 h urinary bismuth excretion was 5.4‐fold higher in the patients.The second study compared the plasma bismuth concentrations after the first and third doses of De‐Noltab 2 b.d. in 16 healthy subjects. The median peak bismuth concentration occurred 30 min (range 15–105 min) post‐dosing. The peak plasma bismuth concentration was greater than 50 ng/ml in 14 of the 16 subjects, and greater than 100 ng/ml in nine of the subjects. There was no significant difference in the median integrated 10‐h plasma bismuth concentration after the first or third dose of De‐Noltabs.The results of these studies confirm that bismuth is absorbed and sequestrated during dosing with De‐Noltabs. Bismuth is absorbed rapidly after oral dosing with De‐NoItabs, to produce peak plasma bismuth concentrations hitherto considered to be in the range associated w

ISSN:0269-2813    

DOI:10.1111/j.1365-2036.1989.tb00188.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

SUMMARYChronic ingestion of bile‐acid sequestrants has been shown to decrease the serum cholesterol concentration and coronary events in hypercholesterolaemic patients. To develop improved sequestrants, a rapid, convenient method for testing the bile‐acid binding efficacy of sequestrants is needed. Serum bile‐acid concentrations could be used to detect bile‐acid binding by an administered sequestrant, since the serum bile‐acid concentration is determined largely by the rate of intestinal absorption in healthy individuals. To test this, serum bile‐acid concentrations were measured at frequent intervals over 24 h in five otherwise healthy hypercholesterolaemic subjects during the ingestion of three standard meals, with or without the addition of 5 g colestipol granules administered 30 min before each meal.Total serum bile‐acid concentration was measured with a previously reported bioluminescent enzymic assay, that uses a 3α‐hydroxysteroid dehydrogenase, an oxido‐reductase, and a bacterial luciferase co‐immobilized on to Sepharose beads. Bile acids in 1 ml of serum were isolated by solid‐phase extraction chromatography with reverse

ISSN:0269-2813    

DOI:10.1111/j.1365-2036.1989.tb00189.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

SUMMARYA large number of clinical studies have been performed to establish the safety and efficacy of H2‐receptor antagonist therapy. Few if any of these studies have attempted to address the rationale for the dosage and/or dosage regimens being studied. This study is the first large‐scale clinical trial, the purpose of which is to validate the chosen regimen and to address the issue of an optimal therapy for a specific patient population. A regimen of a single nightly dosage is generally acknowledged to offer the potential for improved patient compliance. Furthermore, recent research had suggested that suppression of nocturnal acid secretion is all that is required to heal duodenal ulcers. Hence such a regimen offered the potential for an effective lowered dosage of cimetidine with minimal interference with gastric physiology, increased safety and substantial efficacy. This multicentre, double‐blind, placebo‐controlled trial therefore evaluated a 4‐week course of single night‐time dosage of cimetidine. After 4 weeks of treatment the cumulative, endoscopically proven, ulcer healing rate with an 800 mg regimen was 73%, which was statistically higher and significantly superior to the 41% healing seen with placebo (P<0.001). The 400 mg nocte dosage regimen of cimetidine normally used as maintenance therapy was significantly inferior to the 800 mg nocte regimen (P = 0.01), and increasing the dosage to 1600 mg nocte for 4 weeks failed to provide a significant improvement in healing over the 800 mg nocte regimen. This 800 mg nocte regimen provided rapid pain relief, with 75 YO of the patients being free of night‐time pain and 65% free of day‐time pain, by the end of the first week. The 400 mg ‘maintenance dosage’ was unable to provide this degree of rapid, complete and early relief to patients with a duodenal ulcer. Furthermore, increasing the dosage to 1600 mg nocte failed to increase the level of early pain relief significantly, perhaps because the extensive response of duodenal ulcer patients to the 800 mg nocte regimen leaves little room for improvement. Based both on the early symptom relief and the ulcer healing rate during 4 weeks of treatment, it is concluded that an 800 mg night‐time dosage of cimetidine may be an optimal regimen for many duodenal ulcer patients, particularly those who in the physician's opinion will benefit from

ISSN:0269-2813    

DOI:10.1111/j.1365-2036.1989.tb00190.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

SUMMARYOne‐hundred and seventy‐one patients with endoscopically proven duodenal ulcers were allocated at random to double‐blind treatment with 10 or 20 mg of omeprazole in the morning for up to 4 weeks. Patients completed the study if ulcer healing and pain relief had occurred at 2 weeks. A total of 155 patients completed the trial. Patients treated with 20 mg of omeprazole daily responded significantly more rapidly than those treated with 10 mg of omeprazole daily (P<0.001; Cochran‐Mantel‐Haenszel test covering both time points), cumulative healing rates at 2 and 4 weeks were 74% (58/78) and 91% (71/78), respectively. The corresponding rates in the group treated with 10 mg daily were 48% (39/81) and 75% (58/77). Pain relief was again more pronounced during treatment with the larger dose (P<0.05; stratified Wilcoxon test). No major clinical or biochemical side effects were noted. An omeprazole dose of 20 mg daily is preferable to a lower dose for the treatment of duodenal ulcer disease in the s

ISSN:0269-2813    

DOI:10.1111/j.1365-2036.1989.tb00191.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

SUMMARYNineteen diabetic patients with autonomic neuropathy were enrolled in a double‐blind crossover study of cisapride, metoclopramide and placebo. Symptoms were evaluated from diary cards and from assessments undertaken at the end of each eight week treatment period. Measurements of oesophageal transit, gastric emptying and whole gut transit were made before treatment began and at the end of each treatment period. Three patients dropped out early in the study, and the results from 16 patients were analysed.The severity of autonomic neuropathy, judged from cardiovascular reflex tests, correlated with delayed oesophageal transit and prolonged gastric emptying, but abnormal oesophageal transit and gastric emptying were often unrelated to the presence of upper gastrointestinal symptoms. Neither cisapride nor metoclopramide had a statistically significant effect on oesophageal transit, gastric emptying or whole‐gut transit, nor was any significant effect on symptoms identified, although a trend towards reduced nausea and vomiting with metoclopramide and reduced epigastric fullness and diarrhoea with cisapride was sugges

ISSN:0269-2813    

DOI:10.1111/j.1365-2036.1989.tb00192.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

SUMMARYIn a double‐blind parallel‐group study, 98 patients with symptomatic duodenal ulcer received omeprazole 20 mg o.m. and 91 cimetidine 800 mg nocte for 2 or, if then not healed, 4 weeks. After 2 weeks the healing rates on an intention‐to‐treat basis were: for omeprazole 62% and for cimetidine 33% (P<0.001), and at 4 weeks 85% and 61%, respectively (P<0.001). The proportions symptom‐free at 2 weeks were 83% of the omeprazole and 63% of the cimetidine‐group (P<0.01) and at 4 weeks 84% and 72% (P= 0.01). Patients receiving omeprazole took fewer antacid tablets than those receiving cimetidine. Patient tolerance of both drugs was similar and good. In the treatment of duodenal ulcer, omeprazole 20 mg o.m. gives faster symptom relief than cimetidine 800 mg nocte, as well as healing a greater proportion of ulcers within 2

ISSN:0269-2813    

DOI:10.1111/j.1365-2036.1989.tb00193.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

SUMMARYThe influence of paracetamol on antroduodenal motility and gastric pH was studied in 11 healthy subjects and the relationship between gastroduodenal motility and gastric emptying rate time,tmax, to peak concentration of serum paracetamol,Cmax, was evaluated. The incidence of antral phase III activity and the duration of phase III was diminished with paracetamol (P<0.05). The other motility parameters assessed were unchanged.Three patterns of motility and absorption were observed. One group (n= 5) were fast absorbers with atmaxof 1 h and a motility pattern characterized by antral activity, a high motility index and a short duration of phase II (33–60 min); the phase IIIs were complete except in one case. The second group (n= 4) hadtmaxat 1.5 h and their phase II motility was characterized by a longer duration (80–133 min) (P

ISSN:0269-2813    

DOI:10.1111/j.1365-2036.1989.tb00194.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

SUMMARYThe efficacy and safety of famotidine and ranitidine in the treatment of active duodenal ulcer were compared in a multicentre, randomized, double‐blind study. The study was carried out in five centres which included a total of 143 patients with endoscopically documented active duodenal ulcer. The patients received either famotidine (one tablet of 40 mg at night) or ranitidine (two tablets of 150 mg at night). Endoscopic examinations were performed at 4 and 6 weeks of active treatment. Daytime and nocturnal pain were also monitored, and the laboratory and clinical profiles evaluated. One hundred and thirty‐three patients fulfilled the evaluation criteria (66 patients in the famotidine group and 67 in the ranitidine group). Healing rates at 4 or 6 weeks of treatment showed no significant differences between the famotidine and ranitidine groups. The healing rates were 80% at week 4 and 97% at week 6 in the famotidine group, and 77% at week 4 and 96% at week 6 in the ranitidine group. Similar results were observed in both treatment groups with regard to pain resolution, decrease in antacid intake and safety prof

ISSN:0269-2813    

DOI:10.1111/j.1365-2036.1989.tb00195.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY