Further observations upon gastric function in rats after prolonged administration of an anticholinergic drug,propantheline bromide

Gastric function was assessed in Wistar rats which received propantheline bromide by daily injection for 20 weeks. The results were compared with those from two control groups, one of which was injected daily with saline for 20 weeks. Gastric acid secretion, as measured by test meal and after ligation of the pylorus, was similar in all three groups. Acid secretion, as measured by test meal with pentagastrin 100 µg/kg body weight, gastric emptying, and fundic mucosal volume, expressed in terms of body weight, were all significantly increased in rats given propantheline. Only those measurements of acid secretion obtained by test meal with pentagastrin showed a significant correlation with fundic mucosal volume. Hence, since this method provides the most accurate indication of secretory capacity, it is concluded that the prolonged parenteral administration of propantheline may lead to an increase in parietal cell mass and its correlate, maximal secretory capacity. The mechanism by which these changes are produced is obscure.The author is grateful to Mr. Howard Ireson for his expert technical assistance, and to Mr. Ralph Marshall, Department of Medical Illustration, Cardiff Royal Infirmary, for the photography employed.Propantheline bromide (Pro-Banthine) was generously supplied by G. D. Searle and Co., Ltd.     

Is this bone infected or not? Differentiating neuro-osteoarthropathy from osteomyelitis in the diabetic foot

Osteomyelitis (bone infection) and neuro-osteoarthropathy (Charcot arthropathy) are limb-threatening complications of diabetic neuropathy with very different therapies. Distinguishing between them may be difficult, but it is important. In Charcot arthropathy, noninfectious soft tissue inflammation accompanies rapidly progressive destruction, first of joints, then of bone. This occurs in a well-vascularized and severely neuropathic, but nonulcerated, foot. In osteomyelitis, chronic soft tissue ulceration precedes infection of bone, which may be physically exposed. Magnetic resonance imaging and bone biopsy are the preferred diagnostic tests, provided adequate technical and interpretive skills are available.     

Effect of luminal acidification on guinea pig gastric mucosa

H⁺ secretion was studied in guinea pig fundic mucosa incubated in (A) bicarbonate-Ringer's gassed with 95% O₂-5% CO₂, or (B) HEPES gassed with 100% O₂ before and after luminal pH was lowered to 2.0 for periods up to 90 min. At pH 2.0 for 60 min, H⁺ secretion in group A tissues fell by 35±4% (P=0.02) from a control rate of 1.35±0.09 eq/cm²/hr and in group B tissues by 50±11% (P=0.01) from a control rate of 1.59±0.08 eq/cm²/hr. After 90 min at pH 2.0, H⁺ secretion in group A fell by 53±8% (P=0.02) from a control rate of 1.47±0.07 eq/cm²/hr and in group B fell by 44±6% (P=0.01) from a control rate of 1.38±0.07 eq/cm²/hr. Histamine 1×10^–4 M stimulation following exposure to pH 2.0 for 90 min increased secretion in group A tissues from 0.80 ±0.14 to 1.06±0.13 eq/cm²/hr (P<0.05), compared with an increase in nonacidified controls from 1.15±0.22 to 1.80±0.20 eq/cm²/hr (P<0.05) and in group B tissues from 1.27±0.10 to 1.56±0.19 eq/cm²/hr (P<0.05) compared with nonacidified controls from 1.43±0.22 to 2.23±0.41 eq/cm²/hr (P<0.05). Secretory function and electrical characteristics were adversely affected by luminal acidification to pH 2.0 and suggested a breach in the mucosal barrier with damage to parietal cells.This study was funded by the National Institute of Health Grant No. AM 15681.     

Changes in Quality of Life after 3 months of Usual Care in a Large Sample of Patients with Noncancer Pain: The “QOOL: Quality of Life and Pain” Study

Large‐scale observational studies can provide useful information on changes in health outcomes over time. The aim of this study was to investigate the effect of 3 months of usual care on quality of life (QOL) and pain outcomes in noncancer chronic pain patients managed by pain specialists and to examine factors associated with changes in QOL. This was assessed using the EQ‐5D and pain outcomes using the Brief Pain Inventory (BPI). Changes in QOL and pain were studied for the overall sample and in subgroups defined by baseline pain severity. Multivariate regression was used to investigate factors associated with change on EQ‐5D. Three thousand and twenty‐nine patients were included for analysis. After 3 months of usual care, a mean of 40.9% of patients showed improvement on individual EQ‐5D dimensions, with the highest rates of improvement seen on the pain/discomfort (50.8%) and anxiety/depression (48.3%) dimensions. The EQ‐5D Index increased from a mean (SD) of 0.35 (0.2) to 0.58 (0.21) points between baseline and month 3, and the thermometer from 41.5 (19.4) to 58.7 (17.8), indicating a large effect. Improvements in QOL were larger in those with severe baseline pain. The BPI severity summary score improved from a mean (SD) of 6.5 (1.4) to 4.1 (1.7) and the interference summary score from 6.6 (1.5) to 4.2 (1.9). Changes on the BPI severity and interference scores were associated with changes in the EQ‐5D Index and thermometer. In conclusion, 3 months of usual care in noncancer pain patients led to substantial improvements in QOL and pain outcomes.     

Prosthetic joint infection

Total joint replacement has been one of the most remarkable successes of modern medical technology. Once John Charnley had solved the problems of implant design, choice of materials, implant fixation, and infection (initial rates of infection were approximately 10%), the way was clear for the widespread use of this valuable treatment, which is highly effective at removing pain and restoring function. Unfortunately, infection still remains an important, though less common, problem. It is associated with serious morbidity (pain, loss of function, wound breakdown, wound discharge, implant failure) and sometimes mortality. It may be impossible to eradicate or suppress infection in the long term without removal of the prosthesis, and most clinicians would consider it unwise to re-implant a new prosthesis in the presence of infection. Hence, patients with infected prosthetic joints generally require multiple additional operations and prolonged periods of antibiotic therapy. Even radical attempts at cure may fail (in 10% to 15% of cases in most series), requiring further cycles of treatment with progressively deteriorating function. Thus, the treatment of prosthetic joint infection is arduous for the patient and the health care team, with no guarantee of success.