Roxatidine versus ranitidine in the treatment of duodenal ulcers: A randomized double-blind controlled multicentre study in Singapore

Roxatidine acetate, a new H₂ receptor antagonist, was compared with ranitidine in the treatment of duodenal ulcers in a double-blind multicentre study. Eighty-four patients with endoscopically proven duodenal ulcer were randomized to receive 150 mg roxatidine acetate or 300 mg ranitidine at bedtime. Repeat endoscopy was performed after 4 weeks (25–33 days) and if the ulcer had not healed, another endoscopy was performed after a further 4 weeks of treatment. Using per protocol analysis 73.6% of ulcers treated with roxatidine healed at 4 weeks compared to 72.2% of ulcers treated with ranitidine (P=NS). The healing rates at 8 weeks were 92% with roxatidine and 83.3% with ranitidine (P=NS). Using equivalence tests, the healing rate of roxatidine was found to be equivalent to that of ranitidine within a 20% region. Roxatidine users took significantly less antacids than ranitidine users (P < 0.05). There were no significant adverse effects due to roxatidine or ranitidine. Roxatidine is a safe effective drug in the treatment of duodenal ulcers with a healing rate comparable to that of ranitidine.     

Ungewöhnliche Verläufe traumatischer Epiduralhämatome

Within one year in 71 cases of skull injury trepanations were done. There were 36 epidural hematomas among these, 10 of them presented an atypical course or peculiar symptoms. The analysis of our cases shows that in skull and brain injury with fractures and atypical neurological signs an active diagnosis is needed. The computerized tomography makes it possible to demonstrate the position and the extent of intracranial hemorrhages. The method is non-invasive and reliable. If in patients with a skull injury the computerized tomography is used consequently, epidural hematomas will be recognized more frequently. It will be possible to reduce the number of cases with a fatal outcome.     

Adapting the chronic care model to treat chronic illness at a free medical clinic

This pilot project was designed to determine the feasibility and effectiveness of an adaptation of the chronic care model applied to uninsured patients in a free medical clinic staffed by volunteer physicians. Of the 149 enrolled patients, 117 had hypertension, 91 had diabetes, and 51 had hyperlipidemia. Patients were enrolled in a chronic disease registry from March 1, 2001 through September 30, 2002 at the Salvation Army Free Clinic (SAFC). Two part-time registered nurses served as care managers providing disease-specific management using evidence-based guidelines. Consistent specialty consultation was available via phone, e-mail, or physician visit. Patient self-management was encouraged through collaborative goal setting. There were 40 patients lost to follow-up; 109 completed the study. A clinically significant improvement was obtained in at least one chronic disease for 79 patients. The chronic care model was a useful template for the delivery of effective chronic disease care to a group of uninsured patients at a free medical clinic.     

Poly(vinyl alcohol) membranes for adhesion prevention

The abnormal joining of anatomic structures after abdominal and pelvic surgery can lead to such major complications as bowel obstruction or infertility. Poly(vinyl alcohol) (PVA) membranes and hydrogels were placed over the injured tissue to act as a physical barrier and prevent such adhesions from occurring in a rabbit sidewall model. The membranes were sutured into place to prevent their slipping or curling on the moist tissue. Various in vitro experiments (including testing for swelling and mechanical strength) were conducted in order to better understand the behavior of these membranes in the wound. The results showed that both the PVA membranes and PVA hydrogels significantly reduced the number and severity of adhesions in the rabbit sidewall model, and even indicated a distinct improvement over SEPRAFILM as antiadhesion barriers. Contact-angle measurements were taken in order to evaluate the surface properties of the membranes and hydrogels. Three approaches were taken to render the membranes more bioadhesive, and forego the need for future additional suturing: imprinting a texture onto the membrane, coating the membrane with carboxy methyl cellulose (CMC), and producing bi-layered, porous PVA membranes through a process of lyophilization. Though the surface of the PVA hydrogels is more hydrophilic than the surface of the PVA membranes, neither would adhere untreated to moist tissue. However, all three approaches aimed at improving their bioadhesion yielded excellent results and demonstrated that PVA could indeed be considered a viable method of adhesion prevention.     

Ultrastructural analysis of an infected collagen-coated vascular graft

The incidence of infection following arterial reconstruction using synthetic graft materials varies from less than 1 to 5%. One of three mechanisms is thought to be responsible: 1. intraoperative contamination, 2. extension from adjacent infected or colonized tissue, or 3. hematogenous or lymphogenous seeding. We present ultrastructural data of a patient with a polymicrobial graft infection due to a prostheto-enteric fistula 16 years after reconstruction of an aortobifemoral graft. The polymer surface showed signs of biodegradation and was completely covered with a layer of plasma proteins. Disrupted fibroblasts on the intersegmental graft surface were surrounded by bundles of collagen. Gram-negative rods and grampositive cocci were embedded in an extracellular EPS matrix. Bacterial culture confirmed growth of Eikenella corrodens, Fusobacterium nucleatum and Peptostreptococcus species. Fibrin and granulation tissue from the neoadventitia started to mark off the inflammatory process. Transmission electron microscopy is a valuable tool for the investigation of alloplastic arterial devices. After 16 years of implantation the graft shows different signs of biodegradation.     

Experimental investigations onto the biocompatibility of coated vascular grafts as a function of the primary disease in various patients groups

INTRODUCTION: This work presents initial experimental results obtained with co-incubation of human neutrophilic granulocytes from patients with various diseases (5 patients each group) and collagen- or silver-coated polyester grafts (25 patients each graft). METHODS: After two-hour co-cultivation of the graft with human granulocytes of different patients (normal controls; peripheral occlusive vascular disease; diabetes mellitus; carcinoma/chemotherapy; sepsis), the following parameters were determined by flow cytometry: CD11b, CD62L, fMLP, CXCR2. RESULTS: The change in the receptor expression was taken as a measure of responsiveness, with statistically significant differences seen within and between the groups. For the silver-coated graft, such differences were mainly noted for the fMLP receptor (p=0.01). For the two-hour incubation with collagen coating, the receptors CD62L and CXCR2 were indicative of differences between the various diseases (CD62L p=0.01; CXCR2 p=0.01). Comparison between the grafts revealed statistically significant differences for the CXCR2 and the fMLP receptors (CXCR2 p=0.00; fMLP p=0.03). CONCLUSIONS: The differences noted between the grafts and between the patients groups are suggestive of an altered responsiveness of the granulocytes to the grafts. This enables new aspects with respect to the genesis of accompanying clinical symptoms.