Lansoprazole, clarithromycin and metronidazole for seven days in Helicobacter pylori infection

Background : This study determines the efficacy and safety of a 1-week triple therapy regimen of lansoprazole, clarithromycin and metronidazole in an area with a high prevalence of pre-treatment metronidazole-resistant strains of Helicobacter pylori .
Methods : Seventy-five H. pylori positive patients with gastritis or duodenal ulcer were entered into an open study of lansoprazole 30 mg o.m., clarithromycin 250 mg b.d. and metronidazole 400 mg b.d. H. pylori status was determined by CLOtest, histology, culture and by ¹³C-urea breath test (repeated 28 days after treatment).
Results : Seventy-one patients completed the treatment and returned for follow-up. H. pylori was eradicated in 61 of 71 (86%) patients by per-protocol analysis, and in 61 of 75 (81%) patients by intention-to-treat analysis. H. pylori was eradicated in 12 of 16 (75%) patients with metronidazole-resistant strains compared with 22 of 24 (92%) in patients with metronidazole-sensitive strains of H. pylori ( P = 0.14). Forty-five patients reported at least one adverse event, and three patients stopped treatment due to them (two with headaches and one with diarrhoea).
Conclusions : A 1-week course of lansoprazole 30 mg o.m., clarithromycin 250 mg b.d. and metronidazole 400 mg b.d. eradicates H. pylori in up to 86% of patients. It is of proven benefit in patients with pre-treatment metronidazole-resistant strains of H. pylori .     

CONTROL OF GONADOTROPHIN SECRETION BY STEROID HORMONES IN CASTRATED MALE TRANSSEXUALS. II. EFFECTS OF ANDROGENS ALONE AND IN COMBINATION WITH OESTRADIOL ON THE SECRETIONS OF FSH AND LH

Twenty-nine infusions in twenty castrated male transsexual volunteers were carried out over a period of 7 h with subjects lying in the supine position. The effects of different doses of testosterone and its Sα-reduced metabolites as well as the effect of testosterone in combination with oestradiol on gonadotrophin secretion were evaluated. Different and varying degrees of suppression of plasma levels of FSH and LH were observed. The infusions of 2·4 mg testosterone, 5α-androstan-3α-17β-diol (3α-diol), 5α-androstan-3β17β-diol (3β-diol) but not dihydrotestosterone (DHT) caused significant suppression of LH. FSH, on the the other hand was not significantly inhibited by the androgens at this rate. At higher doses all four androgens suppressed LH secretion significantly. FSH was similarly suppressed by the androgens except by DHT. A differential effect on FSH and LH secretions was noted with the combined regime of testosterone and oestradiol. The combined regime did not cause a significantly higher degree of FSH suppression compared with either 200 μg of oestradiol or 12 mg of testosterone infused alone. The level of LH, however, was suppressed to a greater extent than either of the hormones when given alone. The inhibitory effect of testosterone demonstrated in this study could be due to the parent hormone or its 5α-reduced metabolites. Pharmacological doses of testosterone could exert a greater degree of LH suppression through its conversion to oestradiol. It is likely that oestradiol and testosterone act on gonadotrophin secretion through different mechanisms and that they have an additive suppressive effect on the secretion of LH but not FSH. The potencies for the androgens to suppress gonadotrophin secretion can be ranked as: 3α-diol = 3β-diol > testosterone > dihydrotestosterone.     

ADRENORECEPTORS IN THE HUMAN PENIS

• 1 Adrenaline, noradrenaline and phenylephrine caused contraction of the corpus cavernosum muscle of the human penis. These sympathomimetic amines did not produce inhibitory effects even in the presence of the α-adrenoreceptor blocker, phentolamine. The effect of dopamine was similar to that produced by these three sympathomimetic amines. Higher doses of isoprenaline and salbutamol also contracted this preparation.
• 2 Cocaine and guanethidine enhanced the motor response to adrenaline, noradrenaline and phenylephrine while the action of dopamine was blocked by these two drugs.
• 3 The motor response to adrenaline, noradrenaline and phenylephrine was antagonized by phentolamine and often potentiated by the β-adrenoreceptor blocking drug, propranolol. The contractions produced by high doses of salbutamol and isoprenaline were also abolished by phentolamine. These findings indicate that the motor response to sympathomimetic amines is the result of activation of α-adrenoreceptors in the corpus cavernosum muscle.
• 4 At low doses, isoprenaline and salbutamol relaxed the corpus cavernosum muscle strip. The inhibitory action was blocked by low concentrations of the β-adrenoreceptor antagonist, propranolol but not by practolol (β₁-adrenoreceptor antagonist) and butoxamine (β₂-adrenoreceptor antagonist). β-adrenorecepcors are present in the corpus cavernosum muscle but these are unlikely to be either of the β₁ or β₂ type. The possible existence of a third type of β-adrenoreceptor is suggested.

     

Late presentation of esophageal cancer: Observations in a multiracial South–East Asian population

OBJECTIVE: Esophageal cancer (ECA) is an important cancer in Malaysia. The aim of the study is to review the demographic data and clinical presentation of patients with ECA seen at the University of Malaya Medical Centre, Kuala Lumpur. METHODS: Patients with histologically proven ECA were recruited for the study. Patients' case notes, endoscopy and operating theater records were reviewed. All cases were histologically confirmed. RESULTS: A total of 143 patients with ECA was diagnosed between 1998 and 2003. The mean age of the patients was 63.1 ± 12.1 years with a male : female ratio of 1.8:1. Of these 50.3 percent were Indians, 32.9 percent, Chinese and 16.8 percent Malays. The overall hospital-based prevalence rates per 100 000 admissions according to races were: Malay; 23.5, Chinese; 57.4 and Indian; 134.1. The location of the tumors was: upper; 16 (11.2%) middle; 52 (36.4%) and lower; 75 (52.4%). The histological type of ECA were: squamous cell carcinomas; 113 (79.0%) and adenocarcinomas; 30 (21.0%). The ECA stage at diagnosis, was: II; 18 (12.6%), III; 23 (16.1%) and IV; 102 (71.3%). Only 24 (16.8%) patients underwent surgery and13 (9.1%) were considered curative. Overall 114 (79.7%) patients underwent palliative endoscopic stenting and six (4.2%) were given other palliative therapy including radiotherapy. CONCLUSIONS: Squamous cell cancer was the predominant type. ECA presents late in our patients and only a minority of patients underwent curative surgery.     

CONTROL OF GONADOTROPHIN SECRETION BY STEROID HORMONES IN CASTRATED MALE TRANSSEXUALS. I. EFFECTS OF OESTRADIOL INFUSION ON PLASMA LEVELS OF FOLLICLE-STIMULATING HORMONE AND LUTEINIZING HORMONE

Twenty-four infusions of oestradiol (E₂) in graded doses ranging from 0–200 μg administered over a period of 7 hours were carried out in eleven healthy male transsexuals who had undergone sex reassignment at least 3 months previously. Plasma levels of follicle-stimulating hormone (FSH), luteinizing hormone (LH) and E₂ were analysed by radioimmunoassay, while sex hormone binding globulin (SHBG) was measured using ³H-testosterone as the saturating ligand. Infusion of 5–200 μg of E₂ raised plasma E₂ to levels ranging from 38·4–367·8 pg/ml which represent 83%–800% of levels found in a control group of sixty-three normal males. SHBG capacity remained unchanged at all doses of E₂ studied. No change in plasma levels of FSH and LH was observed in control infusions and infusion of 5 μg of E₂. From 10 μg-200 μg, suppression of plasma levels of FSH was noted at the 5–7 hour period. The suppression increased up to 20 μg and thereafter the levels of FSH remained constant. On the other hand, the suppression of LH increased up to the highest E₂ dose (200 μg) studied. Further, significant suppression of LH occurred earlier than the 5–7 hours as the dose of E₂ increased. These observations are consistent with the conclusions that: (1) E₂ plays a part in the regulation of secretion of FSH and LH in men; and (2) at doses higher than physiological, E₂ exerts a differential effect on the secretion of FSH and LH.