The effects of lansoprazole on erosive reflux oesophagitis are influenced by CYP2C19 polymorphism

BACKGROUND: The acid suppressive effect of lansoprazole is influenced by the P450 2C19 (CYP2C19) polymorphism. AIM: To investigate whether the CYP2C19 genotype is related to the healing of erosive reflux oesophagitis during treatment with lansoprazole. METHODS: Eighty-eight Japanese patients with erosive reflux oesophagitis were treated with a daily oral dose of 30 mg lansoprazole for 8 weeks. The CYP2C19 genotype, Helicobacter pylori infection status and serum pepsinogen I/II ratio were assessed before treatment. At 4 and 8 weeks, the healing of erosive reflux oesophagitis was evaluated endoscopically. RESULTS: The healing rates were 57.1%, 69.2% and 72.7% at 4 weeks and 77.4%, 95.0% and 100% at 8 weeks in homozygous extensive metabolizers, heterozygous extensive metabolizers and poor metabolizers, respectively. At 8 weeks, the healing rate of erosive reflux oesophagitis was significantly lower in homozygous extensive metabolizers than in the other two groups (P < 0.05). The H. pylori status and serum pepsinogen I/II ratio had less influence than CYP2C19 polymorphism on the healing rate of erosive reflux oesophagitis. CONCLUSIONS: The therapeutic effect of lansoprazole on erosive reflux oesophagitis is influenced by the CYP2C19 genotype status. Therefore, a test of CYP2C19 genotype may be useful for the medical treatment of reflux oesophagitis with lansoprazole.     

A New Steroid-Eluting Screw-In Electrode

A new lead design was tested that combined a small microporous steroid-eluting electrode with an insulated, exposed helix for active fixation. This lead (model 5078, Medtronic, Inc., group I. n = 10) was compared to a conventional model (model Y 60 BP, Biotronik) with a larger surface of polished platinum-iridium, equipped with a fixed, noninsulated screw but without steroid elution (group II, n = 10). The two lead models were studied in the atrial position of dual chamber pacing systems, which all had a tined ventricular lead (model 5024, Medtronic, Inc.), with essentially the same steroid-aluting tip as the new active fixation lead design. Sensing and pacing data were recorded acutely and during 1 year of follow-up, via the telemetry of a Relay pulse generator (Intermedics. Inc.). Intraoperatively, unfiltered atrial electrogram amplitudes did not differ between groups (group I; 7.12 ± 2.56 mV vs group II: 6.42 ± 1.87 mV; P > 0.05), nor did sensing thresholds 1 year after implantation (group I: 5.33 ± 1.70 mV vs group II: 4.26 ± 1.40 mV; P > 0.05). Atrial pacing thresholds as measured during surgery at a pulse width of 0.5 msec were lower in group I (0.49 ± 0.15 V) than in group II (0.68 ± 0.19 V; P < 0.05). From day 5 through day 360 of follow-up, the difference in atrial pacing thresholds was highly significant (P < 0.01). with a smaller peaking of early thresholds and a much lower scattering of data for the steroid screw-in leads than for controls. Chronic thresholds as measured 1 year postimplant in terms of minimum charge delivered for capture were 0.20 ± 0.03 μC in group I versus 0.54 ± 0.11 μC in group II (P < 0.01). There was no difference between groups on the ventricular level, both acutely and during follow-up. If the active fixation atrial lead was compared to its tined ventricular counterpart in group I, pacing thresholds only differed within the early days postimplant, but they were virtually identical from week 3 through 1 year. It is concluded that the novel pacing lead design effectively combines low energy pacing with more versatility in electrode positioning by use of the active fixation mechanism.     

REM syndrome: reticular erythematous mucinosis (round-cell erythematosis), a new entity?

Four patients, three females and one male, were observed in Cologne with sheet- or net-like erythema of the upper chest and of the back, with a tendency to spread to the abdomen. The patients had no symptoms with the exception of itching in one case and itching after sunburn in another. Histo-logically the epidermis was normal, apart from slight hydropic degeneration and some minor degree of spongiosis. The main features were: dilated blood vessels in the dermis, with a more or less pronounced perivascular infiltrate of round cells, and, in addition, deposits of a substance which stained with alcian blue. Oral treatment with Rhetis was of some benefit, otherwise therapy, including corticosteroids, was not successful. Other antimalarial drugs were not used. There was some relation to sun exposure, but the full spectrum of xenon-light did not cause any abnormal reactions. Since it was not possible to relate these findings to any known syndrome, a combination of the main signs, reticular erythema and mucinosis, was used to name this entity REM syndrome.     

A double-blind study of the effect of zinc and oxytetracycline in acne vulgaris

With a double-blind technique, the effects of oral zinc and tetracyclines were compared in 37 patients with moderate and severe acne. No difference in effect between the treatments was seen and no side-effects were noted in any group. After 12 weeks of treatment, the average decrease in the acne score was about 70% in both groups.     

A comparative study of three different approaches to the comfortable zone

By means of a screw jack device, applied to thirteen edentulous subjects, the comfortable zone was approached in three different ways, by the central, the internal and the external approaches. Correspondingly, the zonal borders behaved differently. Applying the central approach it was found that the initial height of the screw jack had a lingering effect upon subsequent adjustments of the screw. Moreover, lower border data collected by the external approach distinguished themselves from other zonal border data by showing a significantly lower susceptibility to successive adjustments. The study suggests that muscle activity is a factor on which the perceptual mechanism relies, when a zonal border is assessed subjectively by a patient.     

The Distribution of the HL-A Antigens and Genes in a German Population

The frequency of HL-A antigens and genes was determined in a population of 600 unrelated German people. The results confirmed the two loci concept for the HL-A system, and showed that the gene frequencies, the phenotype distributions and the haplotype frequencies are very similar to those observed in other Caucasian populations.     

Effect of the Atrial Blanking Time On the Detection of Atrial Fibrillation in Dual Chamber Pacing

NOWAK, B., et al. : Effect of the Atrial Blanking Time On the Detection of Atrial Fibrillation in Dual Chamber Pacing. Patients with paroxysmal atrial fibrillation (PAF) and dual chamber pacemakers frequently have short postventricular atrial blanking times and sensitive atrial sensing thresholds used to provide reliable detection and mode switching during AF. However, short atrial blanking times increase the risk of atrial sensing of ventricular far‐field signals. We evaluated if the length of the atrial blanking time influences the detection of AF. The study included ten patients with a VDDR (n = 7 ) or DDDR system (n = 3 ), who presented with AF at 18 follow‐up visits. Bipolar atrial sensing was programmed to the most sensitive value. Atrial blanking times were programmed from 100 to 200 ms in 25‐ms steps in each patient. Using marker annotation, the following parameters were measured at ten consecutive ventricular beats: VAF = the interval between ventricular stimulus and first sensing of AF; AFS = the number of atrial‐sensed events between two ventricular events; and XAF = the interpolated number of atrial‐sensed events during atrial blanking time. The intervals between ventricular events and between atrial‐sensed event markers showed no significant differences for the five blanking times tested. There was no significant influence of the atrial blanking time onto the measured parameters (least square means ± standard error) with VAF between 281 ± 12 and 300 ± 12 ms (P = NS ), AFs between 3.4 ± 0.2 and 3.6 ± 0.2 beats (P = NS ) and XAF between 1.84 ± 0.12 and 2.03 ± 0.12 beats (P = NS ). At ventricular rates < 100/min, the atrial sensing of AF in dual chamber pacemakers demonstrated no evidence for deterioration by an increase of the atrial blanking time from 100 to 200 ms. Thus, the risk of ventricular far‐field sensing may be reduced without compromising atrial sensing.     

A follow-up study of patients with recurrent urticaria and hypersensitivity to aspirin, benzoates and azo dyes

We have studied seventy-five patients with recurrent urticaria and angio-oedema of more than 4 months duration and with positive provocation tests to aspirin, azo dyes, and/or benzoates. Crossreactions between the test compounds were common. The patients were recommended to be on a diet free from salicylates, benzoates, and azo dyes. They were then followed for 6–24 months. At the follow-up, 24% were free from symptoms, 57% considered themselves much better and 19% stated that they were slightly better or unchanged. All patients had followed the diet for at least 1–3 months. Most of those who became totally free of symptoms did not continue with the diet, while most of the patients who considered themselves much better found that it was necessary to continue on the recommended diet. They usually developed symptoms as soon as they ingested something containing azo dyes or benzoates. To be able to maintain such a diet, it is important that the content of additives in food and drugs be properly declared.     

Age changes in the two-point discrimination threshold in human oral mucosa

Fifty young and fifty elderly subjects were tested by a two-point discrimination method applying an aesthesiometer to the mucous membrane of lips, cheeks and tongue. Two changes characteristic of ageing were disclosed: (1) higher threshold values were found in the older age group concomitant with (2) a greater range of variation in these values. The importance of the perception of tactile stimuli from the structures tested is discussed in relation to adaptation to full dentures. It is suggested that signals arising from lips, cheeks and tongue assist the process of adaptation, whereas signals from the denture foundation can, on occasion, prevent adaptation.