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M A Peppercorn 《Comprehensive therapy》1983,9(11):47-52
Most patients with peptic ulcer disease can be treated successfully and safely with an intensive antacid regimen. A high-potency liquid antacid given at a dose of from 15 to 30 mL one and three hours after meals and at bedtime for a period of six to eight weeks is the recommended regimen. For patients who cannot tolerate this regimen, who will not comply with the antacids, or who are not responding, H2 receptor blockers are effective alternative choices. Most patients will respond to a regimen of either cimetidine 300 mg with meals and at bedtime, or ranitidine 150 mg b.i.d. over a six to eight week period. The addition of an anticholinergic agent before bedtime can be useful, particularly for patients who continue to have nocturnal symptoms. In addition, in the absence of contraindications, an anticholinergic agent may be added one-half hour before meals in patients who are not responding fully to an antacid or H2 blocker regimen. The efficacy of combining all three agents has not been well established clinically, although there is evidence that in this fashion gastric acidity can be further reduced. An attractive new alternative as a primary therapy of peptic ulcer disease is sucralfate. Certainly, in patients who are known to be intolerant to antacids and who cannot take cimetidine or ranitidine due to adverse effects, sucralfate should be considered as initial therapy. It should be given one-half hour before meals and at bedtime for a six to eight week period. 相似文献
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M A Peppercorn 《Comprehensive therapy》1985,11(12):14-19
Both topical steroids and sulfasalazine are useful for patients with ulcerative proctitis and distal colitis. For patients with more extensive ulcerative colitis with moderate symptoms, prednisone and/or sulfasalazine will result in improvement in about 80% of patients. Parenteral corticosteroids or ACTH should be used in the setting of severe colitis and antibiotics added if the patient appears toxic. Sulfasalazine is of proven efficacy as maintenance therapy in ulcerative colitis. Prednisone and sulfasalazine are useful in Crohn's disease, although the latter is of limited use in patients with ileitis alone. Immunosuppressive agents such as azathioprine and 6-mercaptopurine may be especially helpful in Crohn's patients refractory to other drugs or dependent on high doses of steroids. Azathioprine is of proven usefulness as maintenance treatment of Crohn's disease. Metronidazole is as effective as sulfasalazine in Crohn's disease involving the colon and has an important role in severe perineal disease. New forms of steroid enemas and topical and oral forms of 5-aminosalicylate based on sulfasalazine should be available soon for patients with both ulcerative colitis and Crohn's disease. 相似文献
5.
Stephen Weller Julie Borland Shuguang Chen Mark Johnson Paul Savina Brian Wynne Toshihiro Wajima Amanda F. Peppercorn Stephen C. Piscitelli 《European journal of clinical pharmacology》2014,70(1):29-35
Purpose
Dolutegravir (DTG), an unboosted HIV integrase inhibitor (INI), is metabolized by UGT1A1 and to a minor extent by CYP3A. Renal elimination of unchanged DTG is very low (< 1 %). As renal impairment may affect pharmacokinetics (PK), even for drugs primarily metabolized or secreted in bile, this study investigated the effect of renal impairment on the PK of DTG.Methods
This was an open-label, single-dose study of oral DTG 50 mg administered to subjects with severe renal impairment (creatinine clearance [CLcr] <30 mL/min; not on dialysis) and to healthy controls (CLcr >90 mL/min) matched for gender, age and body mass index (8 subjects per group). Serial PK samples were collected up to 72 h post-dose for determination of DTG and DTG-glucuronide (DTG-Gluc) concentrations in plasma. DTG unbound fraction in plasma was determined at 3 and 24 h. PK parameters were determined by non-compartmental methods and compared between groups by analysis of covariance.Results
DTG was well tolerated with a low incidence of Grade 1 adverse events. DTG PK parameters showed significant overlap between groups. DTG mean exposure was lower in subjects with severe renal impairment compared to healthy, matched subjects: AUC(0-∞) and Cmax were 40 % and 23 % lower, while mean DTG-Gluc was increased. Renal impairment did not affect DTG fraction unbound in plasma.Conclusions
The modest reductions in mean PK exposures for DTG and increases for DTG-Gluc in the severe renal impairment group are not considered clinically significant. DTG does not require dose adjustment in patients with renal impairment. 相似文献6.
Sullivan R Peppercorn J Sikora K Zalcberg J Meropol NJ Amir E Khayat D Boyle P Autier P Tannock IF Fojo T Siderov J Williamson S Camporesi S McVie JG Purushotham AD Naredi P Eggermont A Brennan MF Steinberg ML De Ridder M McCloskey SA Verellen D Roberts T Storme G Hicks RJ Ell PJ Hirsch BR Carbone DP Schulman KA Catchpole P Taylor D Geissler J Brinker NG Meltzer D Kerr D Aapro M 《The lancet oncology》2011,12(10):933-980
The burden of cancer is growing, and the disease is becoming a major economic expenditure for all developed countries. In 2008, the worldwide cost of cancer due to premature death and disability (not including direct medical costs) was estimated to be US$895 billion. This is not simply due to an increase in absolute numbers, but also the rate of increase of expenditure on cancer. What are the drivers and solutions to the so-called cancer-cost curve in developed countries? How are we going to afford to deliver high quality and equitable care? Here, expert opinion from health-care professionals, policy makers, and cancer survivors has been gathered to address the barriers and solutions to delivering affordable cancer care. Although many of the drivers and themes are specific to a particular field-eg, the huge development costs for cancer medicines-there is strong concordance running through each contribution. Several drivers of cost, such as over-use, rapid expansion, and shortening life cycles of cancer technologies (such as medicines and imaging modalities), and the lack of suitable clinical research and integrated health economic studies, have converged with more defensive medical practice, a less informed regulatory system, a lack of evidence-based sociopolitical debate, and a declining degree of fairness for all patients with cancer. Urgent solutions range from re-engineering of the macroeconomic basis of cancer costs (eg, value-based approaches to bend the cost curve and allow cost-saving technologies), greater education of policy makers, and an informed and transparent regulatory system. A radical shift in cancer policy is also required. Political toleration of unfairness in access to affordable cancer treatment is unacceptable. The cancer profession and industry should take responsibility and not accept a substandard evidence base and an ethos of very small benefit at whatever cost; rather, we need delivery of fair prices and real value from new technologies. 相似文献
7.
Seah Davinia S. Tayob Nabihah Leone Jose Pablo Hu Jiani Yin Jun Hughes Melissa Scott Sarah M. Lederman Ruth I. Frank Elizabeth Sohl Jessica J. Stadler Zsofia K. Erick Timothy K. Peppercorn Jeffrey Winer Eric P. Silverman Stuart G. Come Steven E. Lin Nancy U. 《Breast cancer research and treatment》2022,192(1):201-210
Breast Cancer Research and Treatment - We sought to understand the attitudes of individuals with abnormal breast imaging findings prompting a diagnostic breast biopsy toward donation of blood,... 相似文献
8.
Identification of in vivo-induced bacterial protein antigens during human infection with Salmonella enterica serovar Typhi 下载免费PDF全文
Harris JB Baresch-Bernal A Rollins SM Alam A LaRocque RC Bikowski M Peppercorn AF Handfield M Hillman JD Qadri F Calderwood SB Hohmann E Breiman RF Brooks WA Ryan ET 《Infection and immunity》2006,74(9):5161-5168
We applied an immunoscreening technique, in vivo-induced antigen technology (IVIAT), to identify immunogenic bacterial proteins expressed during human infection with Salmonella enterica serovar Typhi, the cause of typhoid fever. We were able to assign a functional classification to 25 of 35 proteins identified by IVIAT. Of these 25, the majority represent proteins with known or potential roles in the pathogenesis of S. enterica. These include proteins implicated in fimbrial structure and biogenesis, antimicrobial resistance, heavy metal transport, bacterial adhesion, and extracytoplasmic substrate trafficking as well as secreted hydrolases. The 10 remaining antigens represent proteins with unknown functions. Of the 35 identified antigens, four had no immunoreactivity when probed with control sera from individuals never exposed to serovar Typhi organisms; these four included PagC, TcfB, and two antigens of unknown function encoded by STY0860 and STY3683. PagC is a virulence factor known to be upregulated in vivo in S. enterica serovar Typhimurium infection of mice. TcfB is the major structural subunit of a fimbrial operon found in serovar Typhi with no homolog in serovar Typhimurium organisms. By examining differential immunoreactivities in acute- versus convalescent-phase human serum samples, we found specific anti-PagC and anti-TcfB immunoglobulin G responses in patients with serovar Typhi bacteremia. Serovar Typhi antigens identified by IVIAT warrant further evaluation for their contributions to pathogenesis, and they may have diagnostic, therapeutic, or preventive uses. 相似文献
9.
M A Peppercorn P Goldman 《The Journal of pharmacology and experimental therapeutics》1972,181(3):555-562
10.
Gluten-sensitive enteropathy and systemic lupus erythematosus 总被引:2,自引:0,他引:2
A patient with systemic lupus erythematosus developed gluten-sensitive enteropathy, or celiac sprue. The patient's histocompatibility antigens included HLA-B8 and HLA-DR3, previously found to have a high frequency in gluten-sensitive enteropathy and possibility increased as well in systemic lupus erythematosus. Such histocompatibility antigens are common to a variety of autoimmune disorders. An immune basis for the association is discussed herein. 相似文献