Comparison between single morning and bedtime doses of 40 mg famotidine for the treatment of duodenal ulcer

The aim of this study was to compare the duodenal ulcer healing effects of morning (08.00 hours) vs. single bedtime (22.00 hours) doses of 40 mg famotidine, bearing in mind that the known efficacy of bedtime doses of H2-antagonists is regarded as evidence of the predominance of nocturnal gastric acidity in the pathogenesis of duodenal ulcer. This randomized double-blind multicentre trial was conducted in a total of 127 patients with endoscopically proven active duodenal ulcer. Nine patients dropped out and thus 118 were included in the final analysis. The duration of treatment was 4 weeks, and this was extended to 8 weeks in patients whose ulcers failed to heal by week 4. The patients in the two treatment groups were well matched for age and sex. The therapeutic efficacy parameters were endoscopic healing of the ulcer lesion and disappearance of pain. Results were compared using the chi-square method. The 4- and 8-week (cumulative) ulcer healing rates in the patients treated with the morning dose of famotidine were 77.2% and 86%, respectively, compared with 78.6% and 91.8% in those who received the bedtime dose. The differences failed to prove statistically significant either at week 4 (P = 0.85) or at week 8 (P = 0.31). The percentages of patients with ulcer pain, evaluated weekly, were similar in the two treatment groups. The equivalent efficacy of the morning and bedtime famotidine regimens raises doubts concerning the predominance of nocturnal gastric acidity in the pathogenesis of duodenal ulcer.     

Relationship between plasma atrial natriuretic factor and opioid peptide levels in healthy subjects and in patients with acute congestive heart failure

We evaluated plasma atrial natriuretic factor (ANF), ß-endorphin,met-enkephalin, dynorphin and noradrenaline levels in 20 healthysubjects and 20 acute congestive heart failure (CHF) patients.In all acute CHF patients plasma values of these hormones werehigher than in healthy subjects. The hormonal pattern differedin patients with the more severe acute CHF (group 1) from patientswith less severe acute CHF (group 2) (ANF 53.8 ± 1.0vs 34.6 ± 1.5 pg.ml^–1, noradrenaline 563.8 ±13.4 vs 202.4 ± 10.6 pg.ml^–1, met-enkephalin 41.0± 3.2 vs 17.0 ± 1.6 fmol. ml^–1, dynorphin46.8 ± 3.7 vs 25.2 ± 2.0 fmol. ml^–1, P <0.01;ß-endorphin 50.6 ± 5.2 vs 41.8 ± 4.1fmol. ml^–1, ns). Administration of an opioid antagonist(naloxone, 8 mg i.v.) did not modify ANF or noradrenaline concentrationin healthy subjects. in group 1 naloxone administration significantlyraised ANF (68.0 ± 1.4 pg. ml^–1), noradrenaline(776.6 ± 18.7 pg. ml^–1), blood pressure and heartrate, whereas in group 2 it significantly decreased ANF values(21.9 ± 0.5 pg. ml^–1)and did not modify the otherparameters. Our findings suggest that the opioid system affectsANF release in acute CHF. In patients with severe CHF opioidpeptides may attenuate ANF secretion reducing noradrenergicstimulation. On the other hand, when CHF is less severe andthe sympathetic activity is moderate, opioid peptides may directlystimulate ANF secretion.     

GERIATRIC NURSES’ ATTITUDES TOWARDS THE USE OF NASOGASTRIC FEEDING-TUBES IN DEMENTED PATIENTS

Geriatric nurses’ attitudes towards the use of nasogastric feeding-tubes in severely demented patients were evaluated. A questionnaire was administered to 232 geriatric nurses asking whether they would favour enteral feeding for demented patients who were unable or refused to eat. The great majority of nurses (73.3%) were favourable; previous experience with nasogastric feeding-tubes and a moderate to high level of religiosity were both significantly associated with this attitude. For the great majority (70.6%) of those favourable the patient's mental status was immaterial to their attitude. Also irrelevant were patients’ and/or caregivers’ wishes and economic and quality of life issues. This survey suggests that the majority of nurses consider enteral feeding as an ordinary basic practice, disregarding the complexity of the problem, which needs an individualized, multifaceted approach.     

Plasma beta-endorphin concentrations during suckling in lactating women

Summary. Beta-endorphin appears to be involved in the hormonal response to suckling in some animals. The peripheral secretory patterns of β-endorphin, prolactin and cortisol were investigated in serial venous blood samples taken during suckling from eight healthy women who were breast-feeding on the third or fourth day of the puerperium. Plasma levels of prolactin and β-endorphin increased significantly during suckling reaching a peak after 20 min, levels of cortisol remained unaffected. It is suggested that the increased β-endorphin derives from an extra-hypophyseal source.     

Caloric Restriction and Toxicity

The modulatory effects of caloric intake on the rate and extentof both spontaneous and induced disease incidence is well known,but the significance of these effects in the interpretationof testing data has only recently become appreciated. This isespecially true relative to the impact of caloric intake onboth survival and background incidence for common tumors. Inorder to enhance the health and survival of animals ongoingchronic toxicity testing it has been suggested that such testsshould restrict food consumption. Although this restrictionwill result in increasing survival of the test animals, it mayalso effect the expression of toxicity by altering agent metabolismand disease progression. Focus in this symposium is on the necessityto control dietary consumption in toxicity tests (dietary control),and if such a need does exist to what level of consumption shouldbe diet be focused (caloric restriction).