Gut
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The temperature at which people chose to take a hot drink was measured in 59 patients with endoscopically proven peptic disorders of the upper gastrointestinal tract and 65 asymptomatic controls. The patients in the disease group drank significantly hotter tea or coffee than the control group (medians 62 degrees and 56 degrees Celsius respectively, P less than 0.0001). ⋯ In the control group the temperature of choice tended to decrease with age though linear regression just failed to reach statistical significance (p = 0.06); this trend was not apparent in the disease group (p = 0.64). Thermal injury as a result of drinking hot fluids may be a causative factor in some peptic disorders.
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Clinical Trial Controlled Clinical Trial
Do H2 receptor antagonists have to be given at night? A study of the antisecretory profile of SKF 94482, a new H2 receptor antagonist which has a profound effect on daytime acidity.
Evening dosing has become standard for H2 receptor antagonists, because available agents inhibit nocturnal basal acid secretion more effectively than daytime stimulated secretion. We studied the optimal time of administration of a new high affinity long acting H2 receptor antagonist, SKF 94482, for the suppression of intragastric acidity using intragastric telemetry. ⋯ All treatment regimens were effective in increasing time above pH 4 (p less than 0.01). The efficacy of the morning dose of SKF 94482 indicates that the best time to give H2 receptor antagonists depends on their pharmacological properties.
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Case Reports
Treatment of end stage chronic intestinal pseudo-obstruction by subtotal enterectomy and home parenteral nutrition.
Three cases are described of end stage chronic intestinal pseudo-obstruction successfully treated by subtotal enterectomy and home parenteral nutrition (HPN). In all three patients prior use of drugs to stimulate gastrointestinal motility, antibiotics to suppress bacterial overgrowth and surgical bypass of dilated bowel had failed to alleviate the symptoms of chronic intestinal obstruction. ⋯ The treatment of end stage chronic pseudo-obstruction should relieve intestinal obstruction and correct nutritional deficiency. In our experience this is best achieved by subtotal enterectomy, restoration of continuity by end-to-end anastomosis and total parenteral nutrition.
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The influence of various inflammatory inhibitors on the damaging effects of ischaemia in the small intestinal mucosa has been investigated. A rat experimental model was used, in which a ligated loop of the distal ileum was subjected to ischaemia and revascularisation and the ensuing mucosal damage assessed by lysosomal enzyme release and intestinal permeability measurements. The mucosal content of malondialdehyde - a lipid peroxidation product - and its activity of myeloperoxidase - a neutrophil granulocyte marker was also determined. ⋯ All these effects were inhibited by the phospholipase A2 inhibitors, quinacrine and nordihydroguaiaretic acid (NDGA), while the lipoxygenase inhibitor, BW755C, had no influence and the cyclooxygenase inhibitor, indomethacin, potentiated the increases in mucosal permeability and N-acetyl-glucosaminidase release. BN 52021, a specific platelet activating factor antagonist, did not influence the myeloperoxidase activity, but it decreased the formation of malondialdehyde and the increases in mucosal permeability and N-acetyl-beta-glucosaminidase release, although not to the same extent as quinacrine and NDGA. These findings indicate that phospholipase A2 inhibition prevents mucosal damage associated with small intestinal ischaemia and suggest that at least part of the ischaemic damage is mediated by products of phospholipase A2 activity that are not arachidonic acid metabolites.