An evaluation of urinaryd-glucaric acid excretion during acute hepatitis in man

The excretion of urinaryd-glucaric acid (d-GA), one of the final metabolites of glucuronic acid was determined in 49 patients with acute hepatitis. A 3.7-fold increase ofd-GA was found at an early stage of the disease (37.13 mol/24hr±3.08se vs 9.91 mol/24hr±1.18se in normal controls), when serum transaminases and bilirubin were very high (SGOT 589 I.U.±41se; SGPT 954 I.U.±61se; serum bilirubin 8.41 mg/100 ml±0.76se). A lower but significantly elevatedd-GA excretion was also found in the recovery phase of hepatitis at a time when both serum transaminases and bilirubin were considerably reduced (SGOT 89 I.U.±14se; SGPT 185 I.U.±30se; serum bilirubin 1.05 mg/100 ml±0.20se). Urinary glucuronides and free glucuronic acid, measured as total glucuronic acid, were also significantly increased in early hepatitis (1164 mg/24hr±54se vs 782 mg/24hr±84se in normal subjects), but no correlation was found withd-GA excretion. A short treatment with phenobarbital which led to a 3-fold increase ofd-glucaric acid in 12 normal subjects did not cause any further change in the patients with early acute hepatitis. While the mechanism of the urinaryd-GA increase in hepatitis still remains underfined, the findings of this study support the conclusion that its increase may not reflect an induction of liver microsomal enzymes.     

Beclomethasone dipropionate enemas versus prednisolone sodium phosphate enemas in the treatment of distal ulcerative colitis

Aim:

To compare beclomethasone dipropionate 3 mg/60 mL enema (BDP) and prednisolone sodium phosphate 30 mg/60mL enema (PP) once daily in patients with active distal ulcerative colitis.

Methods:

One hundred and fifty-seven patients were enrolled in a multicentre, 4-week, randomized, double-blind trial. Patients were assessed at baseline, 2 and 4 weeks.

Results:

Both treatment groups showed statistically significant improvement of clinical activity after 2 and 4 weeks. Endoscopy and biopsy showed a reduction in the activity score at the end of the treatment period in both groups. No statistically significant difference was observed between the two treatment groups. After 4 weeks, 29% of patients in the BDP group and 25% in the PP group were considered to be in clinical remission; an improvement was observed in 40% of patients on BDP and in 47% on PP. Mean morning plasma cortisol levels showed a slight but significant reduction in the PP group, while the ACTH test showed that neither drug interfered with the hypothalamic–pituitary–adrenal (HPA) axis function. No significant changes were observed in the laboratory tests. Finally, there was a low incidence of adverse events in both groups.

Conclusions:

It is concluded that, in the topical treatment of active distal ulcerative colitis, BDP 3 mg enemas are as efficacious as PP 30 mg enemas, without interference with the HPA axis.