A comparison of low-dose maintenance treatment with enprostil against ranitidine in the prevention of duodenal ulcer recurrence

Enprostil, a prostaglandin E2 analogue, is effective in healing acute duodenal ulcer but its value in preventing recurrence, when given daily for maintenance therapy, is uncertain. In this three-centre study we compared enprostil and ranitidine maintenance therapy; the latter is known to reduce duodenal ulcer relapse rates. Patients whose duodenal ulcers had been healed by treatment with an H2-receptor antagonist were randomized to receive single-blind treatment with either 35 micrograms enprostil (n = 64) or 150 mg ranitidine (n = 64) at bedtime for periods of up to 1 year. Endoscopy was routinely performed at 3 months at one centre, and at 6 and 12 months at all three centres, or whenever ulcer symptoms recurred. Clinical assessment and laboratory investigations were performed every 3 months. Relapse, defined as recurrent ulcer with or without pain, or erosions with pain, was significantly greater in patients on enprostil, the comparative rates at 3, 6 and 12 months were: enprostil 23, 31 and 36% ranitidine 6, 12 and 17% (P = 0.013; P = 0.03 and P = 0.03, respectively). Thirty-one patients reported adverse events, the most common being headache (enprostil = 6, ranitidine = 2) and mild diarrhoea (enprostil = 6, ranitidine = 0). Four patients on enprostil were withdrawn for adverse events, although none terminated because of diarrhoea. There were no clinically significant changes in haematology or biochemistry. Enprostil may reduce duodenal ulcer relapse but at a dose of 35 micrograms nightly, it is less effective than 150 mg ranitidine nightly.     

An autologous blood program coordinated by a regional blood center: a 5- year experience

The Southern Arizona Regional Red Cross blood program offers preoperative autologous blood deposit to all patients and intraoperative autotransfusion services to all hospitals in the region. During a 5-year period, the amount of preoperatively deposited autologous blood and intraoperatively salvaged red cells available increased from 0.3 to 19.6 percent of the community's total collections. Further increases in the availability and use of autologous blood may be achieved by community-wide integration of services.     

Cell biology of cultured anogenital warts

A simple, reliable culture system for keratinocytes from anogenital warts is described. Using this technique we found that it was possible to produce multiple confluent keratinocyte cultures from two-thirds of the surgically-excised anogenital wart specimens received in our laboratory. Some morphological and cultural differences between these cells and normal keratinocytes derived from neonatal foreskins were observed, although there was no evidence that wart-derived keratinocytes were 'transformed'. The cultures were tested for evidence of HPV-DNA replication using 32P-labelled HPV-DNA probes, for the production of viral capsid proteins using peroxidase-antiperoxidase staining and for whole virus particles using electron microscopy. Fifty-seven per cent (8 of 14) of the wart cultures tested showed persistence of HPV-DNA (5-100 copies HPV-DNA/cell genome equivalent). However, no viral proteins or particles were detected in any culture. This system may prove to be a useful in vitro model for the study of virus-cell interaction and the role of HPV in the malignant conversion of epithelial cells.     

Nonoperative management of benign postoperative biliary strictures

Selected benign biliary strictures can be treated safely and successfully by percutaneous balloon dilatation. Primary biliary strictures appear to be less responsive to balloon dilatation alone and require stenting with large catheters (16-20 F) for several months to permit scarring around the catheter. A long period of healing around such a large-bore stent is crucial to the success of such treatment. The most important physiologic indicators for successful dilatation are a long period of stricture challenge with a catheter placed proximal to the dilated segment to allow bile to drain internally across the previously strictured segment, and a near anatomic result as demonstrated by cholangiogram.     

The Radiograpy, Haematology and Biochemistry of Pulmonary Tuberculosis in the Aged

SUMMARY Ninet-three elderly patients with pulmonary tuberculosis wersurveyed prospectively to determine the extent and severityof radiological, haematological and biochemical abnormalities. Radiological features of inflammator changes were present inall patients; 7 per cent of these were purely apical, 48 percent were in mid and basal zones and in 46 per cent there wasa mixed picture. Cavities were seen in 33 per cent of radiographs;half of these occured in the apical and half in the mid andbasal zones. A pleural reaction was present in 46 per cent ofcases. Hilar gland enlargement was not seen. A pleural reactionwas present in 46 per cent of cases. Hilar gland enlargementwas not seen. Thus radiographs ‘atpical’ for pulmonarytuberculosis were usual with the major changes being basal andperipheral. Haematological abnormalities were normochromic normocticanaemia (66 per cent), neutrophilia (69 per cent), thromoboctosis(33 per cent), rapid erthrocte sedimentation rate (90 per cent),and lmphoctopenia and monoctosis in 22 and 28 per cent respectivel.Biochemical abnormalities were hponatraemia (60 per cent), hypokalaemia(42 per cent), hypoalbuminaemia (83 per cent), and (before treatmenta)elevation of bilirubin (20 per cent), alkaline phosphatase (62per cent), aspartic transaminase (77 per cent) and lactic dehdrogenase(74 per cent). The abnormal liver function tests may reflectunsuspected extrapulmonar disease. Radiologically mild opacification occurring frequently in thelower zones and associated with a pleural reaction in half ofcases is compatible with tuberculosis. The unexplained presenceof an of these haematological and biochemical abnormalitiesshould raise suspicion of the disease.     

Improved HL–A Typing of Cadaveric Renal Donors. I. Quantitation of HL–A Gene Dosage

A quantitative microabsorption technique has been used to determine a gene dosage effect on HL–A. This allows homozygosity or heterozygosity of HL–A antigens to be determined prospectively in cadaver donors of renal allografts where less than four antigens were detected by standard lymphocytotoxicity. This in turn provides more precise matching of donor and recipient.     

HLA-A, B and C and HLA-DR antigens in intrinsic and allergic asthma

Some 103 patients with asthma and 100 healthy volunteers have been typed for HLA-A, B and C and HLA-DR antigens. The 103 patients consisted of thirty-three with intrinsic asthma, thirty-four with extrinsic asthma, and thirty-six known to have precipitins to Aspergillus fumigatus. No increase in frequency of any of the A, B, C, or DR antigens was found to be significant after correction for the number of comparisons was made. However certain trends comparable to findings in other immunopathic disorders were noted. For example B12 was increased in the allergic asthmatics (46 vs 29% controls) and it is suggested that B12 is associated with the ability to produce the IgE antibodies. A3/B7/DRw2 (which are in linkage disequilibrium) all show a decreased frequency in intrinsic asthma (24, 12 and 9%vs 32, 26 and 24% respectively in controls). Finally B8 and DRw3, which showed a moderate increase in frequency in all three groups of asthmatics, were found in five of seven patients with low atopy but persisting antibodies to A. fumigatus. Further detailed studies of these asthmatic subgroups is warranted.     

Serum and salivary immunoglobulin A and free secretory component in ulcerative colitis

Patients with ulcerative colitis have been investigated for evidence of defects in secretory immunity. Total serum IgA concentration, serum IgA antibody titres to Candida albicans, salivary IgA and free secretory component concentrations have been measured in thirty-six patients with ulcerative colitis and thirty-six normal controls. None of the parameters was significantly different between patients with proctitis and patients with extensive colitis or between the colitis patients and normal controls.