Double-blind comparison of two dosage regimens of misoprostol in the treatment of duodenal ulceration

A multicenter double-blind study was conducted in 416 patients (306 male, 110 female) with active endoscopically proven duodenal ulcers who were randomly allocated to receive the prostaglandin E1 methyl ester analog (Misoprostol/Cytotec), either in a dose of 400 micrograms twice daily (206 patients) or 200 micrograms four times daily (210 patients). No significant difference in the healing rates between the two groups was observed at four or eight weeks. In patients treated twice daily, the ulcer healing rate at four weeks for the intent-to-treat cohort was 124/205 (60.5%) and for the evaluable cohort was 96/136 (69.1%). In patients treated four times daily, the healing rate was 124/207 (59.9%) for the intent-to-treat cohort and 96/148 (64.9%) for the evaluable cohort. Similarly, the healing rates achieved at eight weeks for the twice- and the four-times-daily dosages in the intent-to-treat cohort were 72.2% and 74.4%, respectively, and for the evaluable cohort were 88.0% and 86.6%, respectively. Significantly more patients receiving misoprostol twice daily were free of ulcer pain after four weeks of treatment than were those receiving misoprostol four times daily, namely, 71.4% as compared with 57.9%, respectively (P = 0.003) and for a median period of 21 as compared with 17 days (P = 0.002). Diarrhea was more common in patients receiving the drug twice daily, (15.5%) than in those treated four times daily (5%) (P = 0.001). Diarrhea, three or more stools daily, was often transient and self-limiting and only necessitated withdrawal from the trial in nine (4.4%) of those treated with misoprostol twice daily and in one patient (0.5%) of those treated four times daily.(ABSTRACT TRUNCATED AT 250 WORDS)     

Fetal erythropoiesis in steel mutant mice. III. Defect in differentiation from BFU-E to CFU-E during early development

Erythroid progenitor cells in +/+ and Sl/Sld fetal livers manifested as burst-forming units-erythroid (BFU-E) and colony-forming units- erythroid (CFU-E) were assayed in vitro during early development. The proportion of BFU-E was higher as mutant than in normal fetal livers. On the other hand, the proportion of CFU-E was less in the mutant than in the normal. These results suggest that the defect in Sl/Sld fetal hepatic erythropoiesis is expressed at the steps of differentiation that effect the transition from BFU-E to CFU-E.     

Propranolol in the prevention of recurrent variceal hemorrhage in cirrhotic patients. A controlled trial

A double-blind controlled study of long-acting propranolol in the secondary prevention of variceal hemorrhage was conducted in 81 cirrhotic patients. After the index hemorrhage, all patients were treated with injection sclerotherapy on one occasion to secure hemostasis and then randomized within 72 h to propranolol or placebo therapy which was continued for 2 yr. Study endpoints were severe recurrence of variceal hemorrhage or death. Forty-two patients did not fulfill the entry criteria for the study. Thirty-eight patients received propranolol of whom 18 (47%) had further hemorrhage, 14 died, eight had side-effects (2 withdrawals), and 3 did not complete follow-up. Forty-three patients received placebo of whom 33 (77%) had further hemorrhage, 19 died, 5 had side-effects (2 withdrawals), and 5 failed to complete follow-up. The median time from onset of hemorrhage to starting drug therapy was 6 days for both groups. Life table analysis showed an equivalent incidence of further hemorrhage in both groups over the first 60 days, following which the propranolol group did consistently better than the placebo group. There was a significantly lower incidence of rebleeding in modified Child's C patients receiving propranolol (39%) than those on placebo (90%). No statistically significant effect on mortality was seen. In this study, propranolol reduced the incidence of late recurrence of variceal hemorrhage in patients with cirrhosis.     

Prevalence and predictors of Toxoplasma seropositivity in women with and at risk for human immunodeficiency virus infection

We assessed the prevalence and predictors of latent Toxoplasma infection in a large group of human immunodeficiency virus (HIV)-infected and HIV-uninfected at-risk US women. The prevalence of latent Toxoplasma infection was 15% (380 of 2525 persons) and did not differ by HIV infection status. HIV-infected women aged > or =50 years and those born outside of the United States were more likely to have latent Toxoplasma infection, with prevalences of 32% and 41%, respectively.     

种植牙——人类的第三副牙齿

研究显示,若全口无牙,人的全身机能将下降40％～60％,佩戴假牙之后,全身机能也只能恢复到正常的81％-95％．种植牙的诞生为彻底解决缺牙带给患者咀嚼功能和语言发音障碍,影响面容美观和心理伤害等长期困扰其健康和生活质量问题提供了一个重要出路．伴随技术的成熟,种植牙也因此被誉为继乳牙、恒牙之后,人类的第三副牙齿．它是生命科学和材料与工程科学完美结合所诞生的产物,是近半个世纪以来口腔医学献给人类健康的一份厚礼．种植牙作为天然牙齿的替代体,人工牙根可以和牙床完全融合,     

Severe cholestatic hepatitis following cloxacillin treatment

We describe a 77-year-old woman who developed fatigue, fever, a maculopapular rash and severe cholestatic hepatitis two weeks after receiving cloxacillin and ofloxacin.     

Neonatal treatment with 192 IgG-saporin produces long-term forebrain cholinergic deficits and reduces dendritic branching and spine density of neocortical pyramidal neurons

The role of basal forebrain-derived cholinergic afferents in the development of neocortex was studied in postnatal rats. Newborn rat pups received intraventricular injections of 192 IgG-saporin. Following survival periods ranging from 2 days to 6 months, the brains were processed to document the cholinergic lesion and to examine morphological consequences. Immunocytochemistry for choline acetyltransferase (ChAT) and in situ hybridization for ChAT mRNA demonstrate a loss of approximately 75% of the cholinergic neurons in the medial septum and nucleus of the diagonal band of Broca in the basal forebrain. In situ hybridization for glutamic acid decarboxylase mRNA reveals no loss of basal forebrain GABAergic neurons. Acetylcholinesterase histochemistry demonstrates a marked reduction of the cholinergic axons in neocortex. Cholinergic axons are reduced throughout the cortical layers; this reduction is more marked in medial than in lateral cortical areas. The thickness of neocortex is reduced by approximately 10%. Retrograde labeling of layer V cortico-collicular pyramidal cells reveals a reduction in cell body size and also a reduction in numbers of branches of apical dendrites. Spine densities on apical dendrites are reduced by approximately 20-25% in 192 IgG- saporin-treated cases; no change was detected in number of spines on basal dendrites. These results indicate a developmental or maintenance role for cholinergic afferents to cerebral cortical neurons.      

The haematological management of patients with cyanotic congenital heart disease: A time for consensus?

AIMS: Recurrent venesection of patients with cyanotic congenital heartdisease may be detrimental, with an increased risk of cerebrovascularevents and symptomatic iron-deficiency. The aim of this studywas to determine the venesection policies as practised in hospitalswithin a U.K. region and to determine if these policies followedcurrent recommendations. METHODS AND RESULTS: Fifty-eight consultants (56% response rate) in cardiac specialtiescompleted self-assessment questionnaires regarding the indicationsfor and practice of venesection. Sixty-one percent of thoseresponding were involved directly in the care of patients withcyanotic congenital heart disease and of these clinicians 97%used venesection. Indications for venesection varied, with 51%of those responding using an elevated haemoglobin per se (6·5–21·0g.dl^–1); 78% an elevated haematocrit (0·55–0·75)and 83% symptoms. Desired maintenance haemoglobin and haematocritlevels also varied greatly. Fifty percent of the consultantsresponding routinely screened their patients for iron deficiencyand 23% felt there was no indication for investigating a lowmean corpuscular volume. Only 18% of the policies describedfollowed any evidence based principles. CONCLUSIONS: The practice of venesecting patients with congenital cyanoticheart disease varies greatly. Policies in many hospitals donot reflect the minimal benefits and considerable risks associatedwith recurrent venesection.