Cutaneous vascular responses and thermoregulation in relation to age

1. Sympathetic vasoconstrictor responses to inspiratory gasp and contralateral arm cold challenge were assessed in fingertip skin in relation to age and were correlated with vasoconstrictor ability during body cooling. The above relationship was also examined in diabetic patients in whom vasoconstrictor responses to inspiratory gasp and contralateral arm cold challenge had been shown previously to be markedly impaired. 2. Vasoconstrictor responses to inspiratory gasp and contralateral arm cold challenge, measured by laser Doppler flowmetry, were significantly reduced in the elderly group, although individual responses varied from normal to absent, and they also had a considerably greater variability as measured on three separate occasions than seen in young subjects. Discriminant analysis showed that, from each of three occasions, 65% of vasoconstrictor responses were abnormal in the elderly group. 3. Body cooling was performed by reducing the environmental temperature from 40 degrees C to 12 degrees C, and the time taken for blood flow to fall to 75%, 50% and 25% of the pre-cooling level (VC75, VC50, VC25, respectively) was calculated. Vasoconstriction was rapid in young subjects and was consistent with good vasoconstrictor responses to inspiratory gasp and contralateral arm cold challenge. In the elderly group, vasoconstriction was slower, but only the VC25 value differed significantly [elderly group, 13.3 (7.9-31.0) min, young group, 5.7 (2.7-15.5) min; median (interquartile range); P less than 0.05].(ABSTRACT TRUNCATED AT 250 WORDS)

The effects of unilateral and multifocal lesions on the WAIS-R: a factor analytic study of stroke patients

An exploratory maximum likelihood factor analysis of the inter-correlations among the 11 subtests of the WAIS-R was undertaken for 167 patients who had a primary diagnoses of cerebrovascular accident (right hemisphere, n = 79; left hemisphere, n = 55; diffuse or multifocal, n = 33). On the WAIS-R, this sample performed below normative standards (average scaled score = 7.1), but demonstrated a pattern of variability among subtests similar to the normative groups. Interestingly, VIQ-PIQ discrepancy analyses revealed V > P profiles for patients with lesions in either or both hemispheres. The best fit for the WAIS-R matrix was an oblique two-factor model comprised of the Verbal and Performance subtests. This factor solution, which was moderately correlated (.52), accounted for 58.8% of the total variance. The stability of a two-factor structure in this neurologic impaired population suggests that the WAIS-R is a robust measure, even when used within such a rehabilitation population. Only two of the eleven subtests (i.e., Comprehension and Picture Arrangement), however, were related to lesion site. Rehabilitation settings may need to rely more on neuropsychological procedures that measure the more "fluid" areas of neurocognitive ability, in contrast to the WAIS-R which appears less sensitive to the neurological impairment associated with stroke.

Risk of ulceration with long-term indomethacin: endoscopic and histological changes in upper gastro-intestinal mucosa

Twenty patients taking long-term indomethacin were chosen for the study because all had a normal endoscopic examination; biopsies, however, from the oesophagus, gastric antrum and duodenal bulb revealed histological inflammation in all patients in at least one site. After 8 weeks during which indomethacin therapy was continued, a further endoscopy revealed lesions in 5 patients--peptic ulcer in 3 and erosions in 2--but only 1 of these had any change in gastro-intestinal symptoms. Irrespective of whether mucosal lesions are seen on endoscopy in patients established on non-steroidal anti-inflammatory drug therapy, they remain in danger of developing both ulcers and erosions which are likely to be asymptomatic. At no time can one justifiably feel this patient group is not at risk of peptic ulceration.

The effects of thromboxane receptor blockade on platelet aggregation and digital skin blood flow in patients with secondary Raynaud's syndrome

Raynaud's syndrome (RS) is characterized by intense blood vessel spasm resulting in finger blanching. Treatment primarily involves vasodilation. Thromboxane A2 (TXA2) has been shown to be a potent vasoconstrictor and platelet aggregant. It may be possible to produce a vasodilatory and anti-thrombotic effect by blockade of the TXA2 receptors. ICI 192,605 is a potent TXA2 receptor antagonist and we studied its effects on platelet aggregation and digital blood flow in patients with RS. Sixteen patients with RS completed this double-blind, randomized, placebo controlled study. Each patient was seen on three separate occasions and was given ICI 192,605 (100 mg orally) on one occasion and matching placebo tablets on the other two. We measured platelet aggregation using platelet rich plasma (PRP) stimulated by U46619, a thromboxane (TX) mimetic. The concentration of U46619 required to cause just over 50% platelet aggregation before the administration of either ICI 192,605 or placebo (pre-dose) was noted. The same concentration of U46619 was used to stimulate the PRP sample at 1 h after the administration of ICI 192,605 or placebo (post-dose) and the percentage of platelet aggregation was again noted. Fingertip skin blood flow was also measured 1.25 h post-dose using a laser Doppler flowmeter. Patients were seated in a temperature controlled chamber which was initially heated to 40 degrees C to induce centrally mediated vasodilatation. The temperature was then lowered to 12 degrees C followed by rewarming to 40 degrees C. Steady blood flow values at these temperatures were measured and the rates of cooling and rewarming were also noted.(ABSTRACT TRUNCATED AT 250 WORDS)

Impairment of vasomotor reflexes in the fingertips of leprosy patients

A method is described for eliciting fingertip vasomotor reflexes by inspiratory gasp and contralateral hand cold challenge. The results of the two tests are reproducible on replicate testing and, when taken together, have proved reliable for detection of impairment of autonomic reflexes in 10 newly registered leprosy patients who did not have any obvious deformity. Similar, but less severe, impairment of vasomotor reflexes was noted in a group of 10 fully treated, apparently cured ex-leprosy patients, none of whom showed clinically obvious neuropathy. Both the new patients and the ex-patients were significantly different from healthy contacts and from healthy Europeans, who were indistinguishable by this test. Evidence is presented suggesting that impairment of these vasomotor reflexes is mainly due to damage to the efferent pathway in the peripheral nerves. The method might prove valuable for investigation of early nerve damage in new patients or during reversal reactions in leprosy at a stage before irreversible damage is done.

Momentum transfer in relativistic heavy ion charge-exchange reactions

Relativistic heavy ion charge-exchange reactions yield fragments (delta Z = +1) whose longitudinal momentum distributions are downshifted by larger values than those associated with the remaining fragments (delta Z = -1, -2, ...). Kinematics alone cannot account for the observed downshifts; therefore, an additional contribution from collision dynamics must be included. In this work, an optical model description of collision momentum transfer is used to estimate the additional dynamical momentum downshift. Good agreement between theoretical estimates and experimental data is obtained.

Pilonidal sinus in an amputee

A pilonidal sinus developed in the superio-medial aspect of the thigh of an above-knee amputee. This is an unusual site for the condition to develop. We suggest that the same aetiological factors that were responsible for the "Jeep Bottom" of World War II were also responsible for this problem in the amputation stump of a Falklands campaign casualty.

Calculations of hadronic dissociation of 28Si projectiles at 14.6A GeV by nucleon emission

An optical potential abrasion-ablation collision model is used to calculate hadronic dissociation cross sections for one, two, and three nucleon removal for the first time for a 14.6A GeV 28Si beam fragmenting in aluminum, tin, and lead targets. These estimates are compared with recent semi-inclusive measurements. Significant differences between some calculated and measured semi-inclusive cross sections exist which cannot be resolved without measurements of the exclusive channel hadronic cross sections. Calculations for each exclusive reaction channel contributing to the semi-inclusive cross sections are presented and discussed.

Quantification of sympathetic vascular responses in skin by laser Doppler flowmetry

An improved physiological test of focal sympathetic nervous function using a laser Doppler flowmeter is presented. The test evaluates rapid reflex changes in skin blood flow at the finger tip where there are abundant arteriovenous anastomoses with dense sympathetic innervation. Indirect body heating was employed in all subjects to induce central vasodilation and to obtain stable comparable finger tip blood flows prior to stimulus. The reflex vasoconstriction which occurs following inspiratory gasp and contralateral hand cold challenge was quantified and its reproducibility investigated on three separate occasions in 20 young subjects. The variability in responses both within and between young subjects was small. The test was applied to 10 diabetic patients with autonomic neuropathy and to 10 age-matched control subjects. Vasoconstrictor reflexes were significantly lower in the diabetic group (p less than 0.005) with responses lower than 2 SD from the mean for age-matched controls. In conclusion, the test provides an assessment of focal autonomic damage which can be applied to other regions of the body rich in arteriovenous anastomoses and may have application in clinical studies investigating autonomic activity.

Optical model description of momentum transfer in relativistic heavy ion collisions

An optical model description of momentum transfer in relativistic heavy ion collisions, based upon composite particle multiple-scattering theory, is presented. The imaginary component of the complex momentum transfer, which comes from the absorptive part of the optical potential, is shown to be the main contributor to the momentum loss of the projectile. Within the context of the Goldhaber formalism, predictions of fragment momentum distribution observables are made and compared with experimental data. Use of the model as a tool for estimating collision impact parameters is also discussed.

The effect of oxygen supplementation on post-occlusive reactive hyperaemia in human forearm skin

The effects of raised tissue oxygen levels on reactive hyperaemia (RH) in the skin following arterial occlusion of short duration were investigated. Oxygen levels were increased by breathing 100% oxygen at 1 and 2 atmospheres absolute (ATA) in a hyperbaric chamber. Superficial skin blood flow and oxygen tension were measured throughout using a laser Doppler flowmeter and a transcutaneous oxygen monitor. The basal pre-occlusion and the maximum post-occlusion blood flows (Flb and Flmax), the time taken for flow to fall to half maximum (TR1/2), and the time for flow to return to its basal level (TR) were measured. Pre- and end-occlusion transcutaneous oxygen levels were also recorded. Oxygen breathing at 1 ATA significantly reduced TR1/2 (p less than 0.05) and at 2 ATA significantly reduced TR1/2 and TR (p less than 0.005 and p less than 0.0001) compared with control measurements during air breathing at 1 ATA. Flmax was not significantly reduced breathing oxygen at 1 or 2 ATA. These findings support the view that maximum post-occlusion blood flow in superficial skin is determined mainly by myogenic mechanisms, whereas the recovery of blood flow to basal levels is influenced largely by oxygen tension. We conclude that the direct vasoconstrictor effect of high oxygen levels is small and that the faster recovery at high tissue oxygen tensions may result from a decrease in vasodilators formed during hypoxia.

Moments of dipole oscillator-strength distribution for the helium sequence

The moments S(mu) for -6 < or = mu < or = 2 and L(mu) for mu = 0, 1 and 2 are calculated for the helium sequence for atomic numbers Z up to 30 under a screened hydrogenic model. In this model, one describes the atom by single-particle hydrogenic wavefunctions and treats the initial and the final state as characterised by two different effective charge parameters Zi and Zf, respectively. An asymptotic expansion is made of the differential oscillator strength of the screened hydrogenic model. Assuming the value 287.6 for the coefficient of the term epsilon -7/2 for helium atom as given by Salpeter and Zaidi, the parameter Zf is determined for the helium sequence. This approach has resulted in values which are in reasonable agreement with the various moment values of other authors.

Pattern of acute myocardial infarction in a district hospital in Brunei Darussalam--a pilot study

The objective of the authors was to study the pattern of presentation, risk factors, and natural course of acute myocardial infarction in the general population of Belait District in Brunei Darussalam. A prospective study was done of 100 consecutive cases of acute myocardial infarction admitted to the coronary care beds of a District General Hospital. The patients were followed up to 12 weeks after admission to hospital. There were three times more males than females (75 males, 25 females). Nine cases out of 75 males were below the age of 40 years, 3 being below 30 years. The mean age of the male denominator was 57.4 years while that of the female counterpart was 67.48 years showing a mean difference of 10.08 years. There were significant association with hypertension (31%), smoking (30%) and diabetes mellitus (27%). The majority of the patients had prodromal symptoms, the most common presenting symptoms were chest pain (63%) and shortness of breath (27%). Only 4% of the patients had silent infarction. Acute myocardial infarction is common in Brunei forming 2.6% of all the patients admitted to the medical wards and the relative rate is 3 times higher in males than in females. There is significant association of IHD with 3 main risk factors namely hypertension, smoking and diabetes mellitus.

Screened hydrogenic radial integrals

The screened hydrogenic radial integral both for discrete-discrete and discrete-continuum transitions is expressed in forms suitable for obtaining closed-form expressions for specific transitions. Two effective charge parameters Zi and Zf, respectively, for the initial state and for the final state are retained in these formulas. As examples, explicit expressions for a few transitions are derived and a method for obtaining a series for a discrete-discrete radial integral, suitable for large final-state principal quantum numbers, is indicated.

Deficient neurogenic innervation of the myenteric plexus with normal submucous plexus involving the entire small and large bowel

A newborn presented with a picture of intestinal obstruction. Multiple biopsies of the small and large bowel showed an unusual neurogenic innervation. The myenteric plexus of Auerbach was severely depleted of ganglion cells and nerve fibers, while the submucous plexus of Meissner was normally innervated. An ileostomy failed to function and extended trial with experimental smooth muscle stimulant (Cisapride) was equally ineffective. The patient was finally treated by a myectomy from the duodenum to the descending colon with a sigmoid colostomy. This procedure, coupled with a Nissen fundoplication, stopped the vomiting and allowed normal defecation through the colostomy. The patient is presently taking increasing increments of oral fluids with a concomitant decrease in the volume of parenteral nutrition. The myectomy initiated marked hypertrophy of the muscularis mucosa. Could this muscular hypertrophy account for the improvement in bowel function? Possible etiology will be discussed. We caution that rectal submucosal suction biopsy alone may be misleading if normal ganglion cells and nerve fibers are found, yet the patient's clinical symptoms fail to improve. A full thickness bowel wall biopsy is then recommended.

Differential oscillator strengths and dipole polarizabilities for transitions of the helium sequence

The dipole radial integral for an initial discrete 1s state and a final continuum state has been calculated under the screened hydrogenic model. In this model, single-electron hydrogenic wave functions are employed and the initial and the final states are treated by two different effective-charge parameters. Numerical values of differential oscillator strengths for transitions from 1s 21S to the continuum for the helium sequence ions are obtained. Also calculated are the dipole polarizabilities, which are found to be in excellent agreement with the results of other authors.

Asymptotic screened hydrogenic radial integrals

The screened hydrogenic radial dipole integral for discrete-discrete transitions from initial state n'l' to final state nl is asymptotically expanded to the lowest order such that the final quantum number n --> infinity. The analytical expression obtained is in terms of confluent hypergeometric functions, and explicit expressions for a few of the specific transitions are derived from them as examples.

Pneumonia in the elderly: a review

Elderly persons are at increased risk of acquiring pneumonia. Morbidity and mortality rates from pneumonia are also higher. Clinical manifestations of pneumonia in the elderly are frequently very subtle; however, a high index of suspicion will induce the physician to obtain a chest roentgenogram. A new lung infiltrate will confirm the diagnosis. Although the Gram's stain of a sputum smear is most helpful in the initial selection of a specific antibiotic, a good quality sputum is not usually available in the elderly, and empiric therapy reduces the morbidity and mortality from pneumonia.

The effect of prazosin on skin microcirculation as assessed by laser Doppler flowmetry

1. Laser Doppler flowmetry was used in six normal volunteers to record changes in fingertip skin blood flow after the administration of prazosin to block postsynaptic alpha 1-adrenoceptors. 2. Prazosin (0.5 mg orally) did not alter systolic or diastolic blood pressure or heart rate. 3. Prazosin did significantly increase basal skin blood flow 2 h after its administration but this effect was no longer evident after contralateral hand warming. Prazosin markedly reduced the skin vasoconstrictor response to deep inspiration and to contralateral hand cooling. 4. This study suggests that postsynaptic alpha 1-adrenoceptors are involved in maintaining skin vasoconstrictor tone at rest and are also involved in the rapid skin vasoconstriction seen in response to a deep inspiration and to contralateral hand cooling.

1s2 1S-1s np 1P transitions of the helium isoelectronic sequence members up to Z = 30

Radial integrals have been calculated under the one-electron hydrogenic model. Two different values of the effective charge parameter, one for the initial state and the other for the final state, are retained in these formulae. The model is able to reasonably reproduce the existing dipole oscillator strength values with little effort. The dipole oscillator strength values are given for many ions for the first time.

Computer-derived equations for predicting survival postoperatively. Their usefulness and limitations

We used multivariate analysis to determine whether survival following perforations of the gastrointestinal tract could be accurately predicted from preoperative data. Of 12 variables tested, four were found to have predictive value. These were age, pulmonary disease, preoperative shock, and the attending surgeon. When these four variables were employed in a logistic regression equation on 42 patients, it correctly predicted which 21 patients died before leaving the hospital. To produce an equation useful for other hospitals, we recalculated it without the attending surgeon variable. Again, the equation was used to predict survival. The correlation of predicted vs observed outcome remained high, and, using a 2 x 2 chi 2 test, the correlation was significant. We then cross validated the three-variable model on data from a second hospital. The model accurately predicted the new data equally well. We believe that predictive models can identify risk factors in a variety of patient populations and can determine who is likely to benefit from specific treatment modalities.

Static multipole polarisabilities and second-order Stark shift in francium

The multipole polarisability of the ground state of francium is calculated by utilising both the variational technique of Davison and the quantum defect theory underlying the Bates-Damgaard method. This approach is also shown to yield reasonable results for other alkali atoms. Second-order Stark shift for the ground state of francium is presented as a function of field strength for possible future experimental comparison.

Pneumomediastinum after cocaine smoking

We have reported two cases of pneumomediastinum occurring in previously healthy young men after smoking cocaine and performing the Valsalva maneuver to intensify the euphoria. Pneumomediastinum is thought to result from increased intrathoracic pressure produced by the Valsalva maneuver, with resultant rupture of marginal alveoli. With the increasing popularity of inhaling free-base cocaine, physicians should be aware of this complication.

Treatment of respiratory tract infections with ciprofloxacin

The efficacy and safety of ciprofloxacin in an oral dose of 750 mg twice daily, in the treatment of respiratory infections was studied in 129 patients. Ciprofloxacin showed broad in-vitro antibacterial activity and was highly effective in both Gram-negative and Gram-positive infections with a clinical cure rate of 96%. The major side effect was an interaction with theophylline particularly in the elderly patients.

Lymphocyte traffic effects of systemic and local lidocaine in sheep

The traffic of lymphocytes through lymphoid tissues is of importance in both the initiation and development of the immune response. The effects of lidocaine on lymphocyte traffic through primary peripheral lymph nodes of sheep (popliteal and pre-femoral) was investigated by three routes of lidocaine administration. Infiltration of lidocaine above the study node and as the sole anesthetic agent for study node efferent lymphatic cannulation produced mild depressions in lymphocyte outputs into study node efferent lymph. This depression was comparable to that encountered with regional epidural anesthesia for similar operations, but was significantly less than that associated with general anesthesia (P less than 0.000015). In animals with established chronic cannulation of study node efferent lymphatics, both study node drainage area injection of lidocaine and systemic administration of lidocaine (intravenously by bolus injection at a distant site) produced prompt and sharp depressions in lymphocyte traffic as mirrored in the output of lymphocytes into study node efferent lymph. The output of both small recirculating lymphocytes and of blast lymphocytes was affected.

Alterations in plasma amino acid levels in children with asthma: a preliminary investigation

Concentrations of plasma amino acids and cortisol were measured in 27 children with status asthmaticus, moderate, or mild asthma and in 7 controls without lung disease. Individuals with conditions potentially altering amino acid levels were excluded. Measurements were made at 8 A.M. and 4 P.M. on the same day. Of the 24 amino acids analyzed, threonine, serine, citrulline, tyrosine, proline, alanine, cystine, isoleucine, ornithine, lysine, and arginine were decreased at 8 A.M. or 4 P.M. and plasma cortisol was elevated at 4 P.M. in patients with status asthmaticus when compared with the other groups (p less than 0.05). Normal diurnal variations of amino acids and cortisol were preserved in all groups. Sequential daily determinations in eight patients with status asthmaticus showed progressive increases in total and many individual amino acids as symptoms subsided. These studies demonstrate a decrease of certain gluconeogenic amino acids in the plasma in status asthmaticus. This diminution could reflect the need for maintenance of normal glucose concentrations in status asthmaticus. The decrease in gluconeogenic amino acid levels may play a role in the severity of asthma.

Spinal tuberculosis revisited

Although the incidence of tuberculosis is decreasing, spinal tuberculosis is still an important disease. Delay in diagnosis and treatment results in long-term disability. We reviewed our cases of spinal tuberculosis diagnosed between 1975 and 1982, with special reference to those features that permit early diagnosis. Among the nine cases diagnosed, roentgenographic evidence of pulmonary tuberculosis (7/9) and positive PPD test (8/8) were found to be highly suggestive diagnostic clues. Computerized tomography (CT) of the spine was a useful way of determining the extent of the disease and following response to therapy. Various modes of therapy were used, and the outcome was related to the extent of the disease and duration of symptoms before initiation of therapy. In early stages, medical therapy alone is adequate; surgical intervention is necessary in cases with neurologic features.

Depression of lymphocyte traffic in sheep by induced systemic arterial hypotension and by acute arterial occlusion

Shock and arterial insufficiency have been observed to be associated with increased levels of sepsis and mortality. As the vast majority of small recirculating lymphocytes reach lymph nodes in arterial blood, the haemodynamic components of lymph node function would appear to be of importance. Lymphocyte traffic in sheep, as mirrored by the output of lymphocytes into the efferent lymph of popliteal lymph nodes, obtained by chronic cannulation of efferent lymphatics, was found to be sharply depressed both by intravenous nitroprusside infusion induced systemic arterial hypotension and by acute femoral arterial ligation on the side of the study node. In the nitroprusside infusion induced arterial hypotension studies, the depressions in lymphocyte traffic were closely related to the depressions in systemic arterial blood pressure. Excellent colateral circulation and compensatory physiological mechanisms in the sheep limited the duration of these depressions in lymphocyte traffic.

Aspergillomas complicating sarcoidosis. A prospective study in 100 patients

During a ten-year study period, we evaluated 100 histologically-proven sarcoid patients for the development of aspergillomas. Serum precipitins against Aspergillus antigens were used to screen all patients regardless of sarcoid stage. Twelve patients had serum precipitins and were further investigated with tomography and serial serum precipitins testing. Ten of these 12 patients had aspergillomas and two patients died of massive hemoptysis. No aspergillomas occurred in stages I, II, or non-cystic stage III patients. All ten aspergillomas developed in the 19 stage III patients with cystic parenchymal damage. We believe that aspergillomas in sarcoidosis are not as rare as previously reported, but occur commonly in chronic cystic sarcoidosis. Additionally, we found serial testing for serum precipitins to be valuable both for the screening of cystic sarcoid patients for aspergillomas and for the management of this complication.

Pirenzepine, cimetidine and placebo in the long-term treatment of duodenal ulceration. A comparative study

Sixty patients with endoscopically proven healed duodenal ulcers were treated for a year with either pirenzepine (Gastrozepin; Boehringer Ingelheim) 100 mg daily, cimetidine 400 mg at night, or placebo, The monthly relapse rate (patients per month) in the first 3 months (pirenzepine 2,3, cimetidine 2,3, placebo 3,0) and in the next 9 months (pirenzepine 0,33, cimetidine 0,44, placebo 0,56) is lower for pirenzepine and cimetidine than for placebo. This trend is in favour of pirenzepine and cimetidine as effective means of keeping duodenal ulcers in remission. Asymptomatic relapses were also less common with pirenzepine (50%) and cimetidine (45%) than with placebo (64%). No serious side-effects of pirenzepine were observed during the trail.

Bicitropeptide powder and placebo in the treatment of duodenal ulcers. A double-blind endoscopically controlled clinical trial

In a double-blind study comprising 50 patients with endoscopically proven uncomplicated duodenal ulcers a powder formulation of bicitropeptide (BCP-Compound) was found to be superior to placebo. On endoscopic examination 19 patients (76%) treated with bicitropeptide powder had healed, while 3 (12%) showed some degree of healing, a total success rate of 88%. Only 5 patients (20%) on placebo had healed completely while 3 (12%) showed some degree of healing (chi 2 = 17,9667; P less than 0,0005). Blood and urine bismuth levels were measured before and after 6 and 12 weeks of therapy, and showed an increase after the first 6 weeks. By 12 weeks the levels had decreased, although they were still higher than the initial values. The blood levels were, however, significantly lower than postulated toxic levels.

Factors affecting duodenal ulcer healing. Four double-blind trials in 193 patients

An analysis of four double-blind endoscopically controlled trials carried out in 1978 -1980 is presented. Drugs utilized were (patient numbers in brackets): a new histamine H2-receptor antagonist ranitidine (25) v. placebo (22), the colloidal bismuth ulcer-coating preparation bicitropeptide (24) v. cimetidine (26), the tricyclic antidepressant trimipramine (20) v. placebo (19), and the disaccharide coating preparation sucralfate (29) v. placebo (28). Factors analysed were smoking, alcohol consumption, age, length of history, sex and race. The prevalence of smoking and alcohol use, age and length of history varied in the four trials. Pronouncements regarding these factors based on small trials are therefore unreliable. There were no overall diffeences in healing rates whether the patient smoked, consumed alcohol, was above or below 40 years of age, or had a history shorter or longer than 1 year. Comparison of drug and placebo responses revealed that the differences between these were most significant in: non-smokers (P=0,0010) compared with smokers (P=0,0288); teetotallers (P<0,005) compared with alcohol consumers (NS); history under 1 year (P<0,005) compared with over 1 year (P<0,025); males (<0,01) compared with females (NS); and Indians (P<0,005) compared with Blacks (NS).

Tri-potassium di citrato bismuthate chewing tablets and cimetidine tablets in the treatment of duodenal ulcers. A double-blind double-dummy comparative study

A randomized, double-blind, double-dummy comparative 6-week study of tri-potassium di-citrato bismuthate (TDB) (Ulcerone; De-Nol) chewing tables and cimetidine was carried out in 60 patients suffering from duodenal ulceration. The data on 51 patients (27 on TDB and 24 on cimetidine) were analysed (9 patients absconded). Both treatments appeared to be highly effective in ulcer healing at the 6-week endoscopic assessment. The healing rate for TDB chewing tablets was 89% and that for cimetidine tablets 92%. Both forms of therapy were comparable in respect of improvement of pain and effect on all other observed symptoms. Neither drug had a statistically significant effect on any of the haematological or clinical chemical parameters tested during the trial, except that the cimetidine-treated group showed a significant linear reduction in white blood cell count. No side-effects were reported. It is suggested that TDB chewing tablets are a safe, effective and cheaper alternative to cimetidine in the treatment of patients with duodenal ulceration.

Ranitidine in uncomplicated duodenal ulceration. A double-blind endoscopically controlled trial

Fifty patients with endoscopically proven uncomplicated duodenal ulcers were given either ranitidine 150 mg twice daily or placebo for 4 weeks in a randomized double-blind study. After 4 weeks 76% of patients on ranitidine showed healing. Fifteen (60%) were completely healed, 5 (20%) were partly healed, and 5 had active unchanged ulcers. Of the patients on placebo 6 (27%) were completely healed, 6 (27%) were partly healed, 10 had active unchanged ulcers and 3 had absconded. Grouping partly healed with active ulcers, a Z value of 2,23 was obtained in the Mantel-Haenszel test (P = 0.013 in favour of ranitidine over placebo). Of 10 patients who were partly healed or had active ulcers after being given ranitidine in the first stage of the study, 7 healed on one further course in an open study and 3 still had active ulcers after two further courses. Of 16 patients who were partly healed or had active ulcers after 4 weeks on the placebo, 3 healed on one course of ranitidine, 6 healed on two courses, 6 still had active ulcers after two courses, and 1 absconded. No side-effects were noted. Ranitidine is a safe and effective drug for the treatment of active duodenal ulceration.

A double-blind endoscopically controlled trial of ranitidine in a high incidence area

Fifty patients with endoscopically diagnosed uncomplicated duodenal ulcers were given ranitidine 150 mg twice daily, or placebo for 4 weeks in a randomised double-blind study. After 4 weeks, 76% of patients on ranitidine showed healing. Fifteen (60%) were completely healed, 5 (20%) were partly healed, and 5 had active unchanged ulcers. On placebo, 6 (27%) were completely healed, 6 (27%) were partly healed, 10 had active unchanged ulcers and 3 had absconded. Grouping partly healed with active ulcers, a Z value of 2.23 was obtained in the Mantel-Haenszel Test; p = 0.013 in favour in ranitidine over placebo. Of ten patients who were partly healed or active after ranitidine in Stage 1, 7 healed on one further course in an open study, and 3 were active after 2 further courses. Of 16 patients who were partly healed or active after placebo, 3 healed on one course of ranitidine, 6 healed on 2 courses of ranitidine, 6 remained active after 2 courses, and 1 absconded. No side-effects were noted. Ranitidine is a safe and effective therapy for active duodenal ulceration.