Effects of changing the type of H2-blocker in the treatment of H2-blocker-resistant ulcers: comparison of roxatidine acetate hydrochloride and other H2-blockers.
Yasutake K. Amano M. Mizokami Y. Kubota S. Fukumoto H. Imamura Y. Yokoya H. Irie K.
Department of Gastroenterology, Hyogo Medical Center for Adults, Akashi, Japan.
The efficacy of switching from one type of H2-receptor antagonist (H2-blocker) to another, in the treatment of H2-blocker-resistant ulcers was investigated using H2-blockers with five-membered rings (five-membered-ring agents)--such as cimetidine, ranitidine and famotidine--and an H2-blocker with a six-membered ring, roxatidine. By switching from a five-membered-ring agent to roxatidine in the treatment of five-membered-ring resistant ulcers (study I), gastric ulcers were healed in nine of 19 patients (47%) and duodenal ulcers were healed in eight of nine patients (89%). By switching from roxatidine to one of the five-membered-ring agents in the treatment of roxatidine-resistant ulcers (study II), gastric ulcer was healed in six of 15 patients (40%), and duodenal ulcer was healed in 4 of 10 patients (40%). Particularly in the case of duodenal ulcers, the switch to treatment with roxatidine, which has a different chemical structure from the five-membered-ring agents, may be useful in the treatment of five-membered-ring-resistant ulcers.
Immune profiles in hepatosplenic schistosomiasis mansoni after surgical treatments.
Petroianu A. Antunes LJ.
Department of Surgery, Medical School, Federal University of Minas Gerais, Belo Horizonte, Brazil.
The hepatosplenic form of schistosomiasis mansoni sometimes induces bleeding in oesophageal varices that requires surgical treatment. Although splenectomy is often necessary these patients rarely present with septic events, a finding that may be related to changes in the immunological system. To investigate the immunological profiles of patients with schistosomiasis, we studied the B- and T-lymphocyte counts and the immunoglobulin A, G and M (IgA, IgG and IgM) levels in patients treated surgically and in those who were not operated on. Patients who underwent distal splenorenal shunt, preserving the spleen, showed significantly increased T-lymphocyte counts compared with healthy controls. The IgM and IgG levels were significantly increased compared with the healthy controls in patients submitted to partial and total splenectomy, respectively. The IgM level also tended to increase in patients who were not operated on compared with the controls. These results suggest that chronic schistosomiasis may influence the immune system.
New technique for mediastinal temperature measurement in hyperthermic cancer treatment: balloon catheter in the azygos vein.
Murata T. Nagata K. Akagi K. Nasu R. Imamura M. Kimura H. Tanaka Y.
Department of Radiology, Kansai Medical University, Osaka, Japan.
The temperature in the mediastinum during hyperthermia is difficult to determine accurately. We measured the temperature in the azygos vein, using a new technique, and compared the measurements with temperatures in the oesophagus. Eight patients with mediastinal tumours resulting from lung cancer or oesophageal cancer were given hyperthermo-radiotherapy. The temperatures in the azygos vein and in the oesophagus were measured before and during blockage of the blood flow of the azygos vein using an angiographic balloon catheter. None of the patients had complications as a result of these procedures, and hyperthermia by capacitative heating was safely performed. The temperature in the azygos vein increased by a mean of 1.7 degrees C (0.2-2.8 degrees C) after blockage of the blood flow. The temperature in the oesophagus was 0.83 +/- 1.09 degrees C (mean +/- SD) higher than that in the azygos vein. Measurement of the temperature in the azygos vein gives a more accurate estimate of mediastinal temperature than does oesophageal temperature but it is an invasive procedure.
Adequate relief as an endpoint in clinical trials in irritable bowel syndrome.
Mangel AW. Hahn BA. Heath AT. Northcutt AR. Kong S. Dukes GE. McSorley D.
Department of Gastroenterology Clinical Research, Glaxo Wellcome Inc., Research Triangle Park, NC, USA.
Irritable bowel syndrome is characterized by recurrent abdominal pain and altered bowel function. In designing studies to evaluate new treatments for this disease, however, it is difficult to select appropriate endpoints to reflect improvement in the range of symptoms of the syndrome. In the present study we evaluated the parameter of adequate relief of abdominal pain and discomfort, as perceived by the patients, as a key endpoint for efficacy in the treatment of patients with irritable bowel syndrome. Abdominal pain and bowel function data were collected daily from 370 patients with the disease during treatment with placebo or a novel potent 5HT3 receptor antagonist. Once every 7 days adequate relief of pain and discomfort was assessed. Quality-of-life data were collected using self-administered questionnaires. The endpoint of adequate relief was significantly (P < 0.05) correlated with improvement in pain severity scores, percentage of pain-free days, percentage of days with urgency, improvement in stool frequency and consistency, and quality-of-life parameters. Adequate relief of pain and discomfort is significantly correlated with changes in multiple parameters associated with irritable bowel syndrome and can be used as an endpoint for assessing response to therapy in these patients.
Changes in mucosal levels of transforming growth factor-alpha from the oxyntic region and ulcer site during duodenal ulcer healing with ranitidine or sucralfate.
Louw JA. Modlin IM. Tang L. Young GO. Lucke W. Marks IN.
Gastrointestinal Clinic, University of Cape Town, Observatory, South Africa.
Changes in the levels of transforming growth factor-alpha (TGF-alpha) in gastric mucosa during ulcer healing were studied in 24 patients with endoscopically confirmed duodenal ulcers, treated either with ranitidine (300 mg daily, at night) or with sucralfate (2 g twice daily). Endoscopic biopsies were taken from the gastric fundus and from the ulcer margin at baseline and after 7-10 days of treatment. TGF-alpha levels were determined by radioimmunoassay in paired samples from 22 patients (fundal) and 18 patients (duodenal). There were no significant changes in TGF-alpha levels in the fundus of the whole group or of either treatment group. At the ulcer site, however, there was a significant increase in TGF-alpha levels in the whole group (from 16.4 to 33 pg/mg protein (medians); P < 0.005), and an increasing trend was seen in both treatment groups but was statistically significantly only in the group treated with sucralfate (P < 0.03).