THE PREVENTION AND HEALING OF ACUTE NON-STEROIDAL ANTI-INFLAMMATORY DRUG-ASSOCIATED GASTRODUODENAL MUCOSAL DAMAGE BY MISOPROSTOL

This double-blind study assessed the acute development of NSAID-associatedgastroduodenal (GD) damage and its prevention by misoprostol.Patients requiring chronic NSAID therapy were stratified intotwo groups depending on initial endoscopic appearance, Group1: normal (n = 223); Group 11: non-ulcer lesions (n = 78). After2 weeks of therapy with NSAID and either misoprostol 400–800µg daily or placebo the incidence of severe mucosal damage(including ulcers) was significantly reduced by misoprostol(odds ratio; 95% CI). Group 1: 4.52; 1.94, 10.51 (P = 0.018);Group II: 10.93; 1.09, 109.60 (P = 0.014); Groups I and II combined:5.95; 3.23, 10.94 (P = 0.0003). Misoprostol exerted a significantprotective effect against progression of minor to severe damagein Group II (P<0.001). Endoscopic findings did not correlatesignificantly with gastrointestinal symptoms and misoprostoldid not interfere with the NSAID efficacy. Significant GD damageoccurs early in the course of NSAID treatment and misoprostolsignificantly reduces the incidence of such damage. KEY WORDS: Gastroduodenal damage, Non-steroidal anti-inflammatory drugs     

Ionized Copper as Contraceptive in Male Rhesus Monkey

Zusammenfassung: Ionisiertes Kupfer als empfängnisverhütendes Mittel beim männlichen Rhesusaffen
Kupfer wurde mittels Iontophorese bei einer Stromstärke von 7 mAmp. über fünf Minuten im Vas deferens des Rhesusaffen eingelagert. Nach der Ioniesierung wurde ein Verlust der Motilität der Spermatozoen bei Zunahme der toten und abnormalen Formen gefunden. Auf der Seite der Kupfer-Deponierung ließen sich atrophische Veränderungen im Vas deferens (Erosionen, Schichtung des hochcylindrischen Epithels in diesen Bezirken, engeres Lumen, keine Spermatozoen) nachweisen. Am epididymalen Ende zeigte das Vas deferens normale histologische Struktur mit beweglichen Spermatozoen (kein Lumenverlust). Der Hormonstatus blieb unverändert. Dieses Verfahren war über einen Zeitraum von 7 Monaten wirkungsvoll.     

Lansoprazole versus ranitidine for the treatment of reflux oesophagitis

Background: Lansoprazole is a H⁺, K⁺-ATPase (proton pump) inhibitor with an anti-secretory action and is therefore potentially useful in the treatment of gastro-oesophageal reflux. Methods: This study was conducted to determine the efficacy and short-term safety of lansoprazole at doses of 30 mg or 60 mg once daily, compared with ranitidine 150 mg twice daily, in the treatment of patients with reflux oesophagitis. This was a double-blind, stratified, randomized, comparative, parallel group study conducted in five centres in the UK. A total of 229 patients (155 men) aged 18–79 years with endoscopically-confirmed oesophagitis were randomized to receive lansoprazole 30 mg p.o. daily, lansoprazole 60 mg p.o. daily, or ranitidine 150 mg p.o. b.d. Efficacy was assessed by endoscopic examination at 4 weeks and 8 weeks, together with symptom relief and antacid usage. Results: Lansoprazole 30 mg and 60 mg were superior at 4 and 8 weeks (P < 0.01) to ranitidine in healing reflux oesophagitis: respective healing rates being 84%, 72% and 39% after 4 weeks and 92%, 91% and 53% after 8 weeks. Relief of heartburn with lansoprazole 30 mg and 60 mg was superior to that achieved with ranitidine at both week 4 (P < 0.01) and week 8 (P < 0.02). Sixty-four patients experienced a total of 85 adverse events, one-third of which were considered drug-related. The incidence and severity were similar in the three groups. Conclusion: Lansoprazole 30 mg and 60 mg once daily are more effective than ranitidine 150 mg twice daily in the short-term treatment of reflux oesophagitis.     

Copper Iontophoresis in Male Contraception

Kupferiontophorese als Kontrazeptionsmethode beim Mann
Mittels Iontophorese wurde Kupfer in die Vasa deferentia von Tieren eingebracht, bei Ratten mit einer Stromstärke von 1 mA über 39–90 sec, bei Kaninchen mit 3 mA über 60 sec. Über einen Zeitraum von 9 Monaten war dies eine wirksame Kontrazeptionsmethode. Der Effekt des Metalls blieb auf den Ort der Anwendung beschränkt und betraf keine weiteren Fortpflanzungsorgane. Das Paarungsverhalten und die Testosteronspiegel blieben unbeeinflußt. Die Brauchbarkeit dieser Methode für die männliche Kontrazeption wird diskutiert.     

Duodenal mucosal histology and histochemistry in active, treated and healed duodenal ulcer: Correlation with duodenal prostaglandin E2 production

We investigated whether impaired duodenal mucosal prostaglandin E₂ (PGE₂) production previously observed in duodenal ulcer (DU) was a primary pathophysiological abnormality or secondary to mucosal architectural changes that accompany ulceration. One hundred patients were studied: at endoscopy, paired duodenal biopsies were taken in patients with normal endoscopies and from the ulcer edge or scar and background mucosa in active or healed DU. One of the pair of biopsies was used to estimate PGE₂ synthesis ability, the other was processed for histology and histochemistry. The following features graded: goblet cell numbers and staining with Periodic acid-Schiff reagent (PAS), epithelial staining with PAS, villous atrophy, columnar cell height, inflammatory cell infiltrate and micro-erosions and gastric metaplasia taken as a whole. Patients were found to have normal endoscopy (n= 31), active untreated DU (n= 20), active DU on treatment with either cimetidine or ranitidine (n= 13), healed DU on maintenance treatment (n= 27) and healed DU off treatment (n= 9). Active duodenal ulceration was found to be associated with decreased numbers of goblet cells, loss and blunting of villi, increased columnar cell height, increased epithelial cell PAS staining and with gastric metaplasia. After healing, only villous blunting remained. These changes were present, but less marked, at sites removed from the ulcer and were not apparent in the patient groups with healed ulcers. A strong correlation between overall gastric metaplasia and epithelial cell PAS staining and the reduced ability to synthesize PGE₂ (P < 0.001) was only apparent when biopsies from all patients were grouped together, but not within individual patient subgroups. There was no consistent correlation between PGE₂ generation and individual parameters of pathological change in the duodenum. We conclude that, although inflammatory and mucosal changes may contribute, the evidence suggests that the impaired PGE₂ generation in DU disease is, to a large extent, independent of histological and histochemical features.