Medical treatment of peptic ulcer disease

Our understanding of PUD and its treatment has improved dramatically during the past 15 years. During this time, many new effective drugs have been approved by the FDA, and possibly even more potent and effective therapies are now being evaluated. The H2-blockers, sucralfate, and antacids heal over 90% of duodenal ulcers in 6 to 8 weeks, and H2-blockers heal about 80% of gastric ulcers by 8 weeks and over 90% by 12 weeks. The new, more potent pump blockers (omeprazole) promise to be even more effective drugs, even for the healing of patients who are taking NSAIDS. However, the potential hazards of marked, long-term acid suppression must still be evaluated. Maintenance therapy with H2-blockers or sucralfate, ideally used for patients who would otherwise have frequent symptomatic recurrences of duodenal ulcer disease or who have had complications, reduces the relapses, especially symptomatic relapses. Maintenance therapy with H2-blockers also seems to reduce the recurrences of GUD, but this use has not yet received FDA approval. Elimination of H. pylori infection with antibiotics may prove to reduce recurrent ulcer disease and negate the need for maintenance therapy. Colloidal bismuth subcitrate alone, which suppresses but does not eradicate H. pylori infection, seems to be an effective ulcer drug and may even reduce the rate of early recurrences. Effective ulcer therapy, especially if it prevents recurrent disease, may reduce the complications of PUD, but this expectation has yet to be established. The use of prophylactic cytoprotective prostaglandins (misoprostol) reduces the incidence of NSAID-induced GUD.

The dizzy patient: etiologic treatment

The basis for the vestibular complaint in dizzy patients should be viewed as having an etiology rather than a description of its clinical presentation. Effective treatment of vestibular disorders is based on the stabilization of the vestibular abnormality, to allow for central vestibular compensation. While not all of the etiologies for dizziness have been described, there are effective etiologic treatments available. These fit into categories of neurotransmitters, blood sugar and blood fat control, hormones, minerals, and treatments for autoimmune dizziness.

Etiologic diagnosis in neurotologic disease

The inner ear is a converter (transducer) of mechanical to electrical energy for both hearing and balance functions. This task is accomplished as a result of the presence of the chemicals within the perilymph and endolymph. Maintaining normal hearing and balance function is dependent upon the availability of the proper chemicals to perform this transduction task. The inner ear functions as an internal body organ and its efficiency in regard to performing its tasks related to hearing and balance function are chemically dependent upon many body systems.

How do we use state of the art vestibular testing to diagnose and treat the dizzy patient? An overview of vestibular testing and balance system integration

The physician must be the captain of the vestibular diagnostic team based on his interest, knowledge, and capability. It is not the battery of vestibular or etiologic function tests used that provides diagnostic answers. It is the intelligent application and use of the indicated vestibular tests that are practically correlated and clinically evaluated that will give the knowledgeable physician significant information. This can best be accomplished when testing is done in physical proximity to the responsible physician and when the tests used are knowledgeably ordered and evaluated. Under such circumstances, vestibular function testing is always cost-effective and therapeutically useful.

Efficacy of alternative tests for delayed-cyclic food hypersensitivity

With the oral challenge food test (OCFT) used as the standard for delayed-cyclic food hypersensitivity diagnosis, blinded comparison studies were accomplished with 175 in vitro food specific IgE and 180 IgG radioallergosorbent tests, 180 food enzyme-linked immune complex assays, and 155 in vivo Multi-Test prick tests. The study was multi-centered, eight physicians and 37 patients participating. All of the compared tests were shown to be approximately 50% efficient when compared with the OCFT results, and, thus, nonefficacious.

Allergy and the immunologic aspects of otitis media with effusion

We reviewed the literature since 1980, and discovered that there is a distinct small subset of patients with otitis media with effusion (OME) in whom the middle ear acts as a shock organ for an IgE-mediated, type I allergic reaction. In the majority of patients, however, no direct relationship between the type I reaction and OME can be drawn. Both the type III and type IV reactions are strongly incriminated in the pathogenesis of OME. Much work remains to be done to clarify the exact role of the immune system in OME.

Site of lesion vestibular function testing

The results of conventional electronystagmography (ENG) sometimes are confusing. The Hallpike alternate binaural bithermal (ABB) caloric test is helpful diagnostically except for the group of "sick patients that have a normal test." Conventional ENG tests also fall short in the area of objective confirmation of patient progress. What does each test tell us regarding site of lesion? 1. Alternate binaural bithermal stimulation gives us information about the semicircular canals -- particularly the horizontal semicircular canal -- pickup head. 2. Simultaneous binaural bithermal stimulation gives information brain stem connections -- switching and relay. 3. Rotation testing gives information about the processing by the brain -- central control.

Identification of the APUD endocrine cells of rat fundic mucosa by means of combined amine fluorescence and electron microscopy

Rat fundic mucosa contains numerous APUD endocrine cells that can take up 5-hydroxytryptophan (5-HTP) and decarboxylate it to 5-hydroxytryptamine (serotonin), detectable by its formaldehyde-induced yellow fluorescence. To identify these cells by electron microscopy, pieces of rat gastric mucosa were incubated with DL-5-HTP. Some specimens were fixed in 4% formaldehyde-0.5% glutaraldehyde, while others were frozen, freeze-dried, and exposed to paraformaldehyde vapors. Thick sections of the Epon-embedded specimens were examined and photographed by fluorescence microscopy, and fluorescing and nonfluorescing cells were identified by electron microscopy in serial thin sections. Control specimens, not incubated with 5-HTP, revealed fluorescence of only the mast cells and EC cells, which were abundant in the pylorus, but rare in fundic mucosa. Specimens incubated with 5-HTP also exhibited numerous yellow fluorescent endocrine cells in fundic mucosa, which cells were found to be the ECL cells; the A-like cells did not fluoresce. In pyloric mucosa, many G and D (D1) cells also exhibited weak or moderate fluorescence after 5-HTP incubation. Thus, this study supports the contention of previous radioautographic studies that the ECL, but not the A-like, cells are the APUD endocrine cells of rat fundic mucosa, that G and D cells also possess some APUD activity, and that EC cells represent the enterochromaffin cells, which normally synthesize and store demonstrable quantities of serotonin.

Vestibular function testing: where are we in 1983?

Conceptual, technological, electronic and computer revolutions have transformed the methodology for evaluating the patient with dysequilibrium. What has been said and written for the past 25 years is not currently applicable. Present day, cost effective, clinical evaluation format is presented, including changes and deletions in the conventional ENG test battery. It also includes the addition of computer technology in the rotation and ocular tracking tests. These deletions and additions in technique provide the clinician with more useful practical data for diagnosis. There is also capability for patient follow-up and monitoring. These concepts are presented from the clinical vantage point and are supported with patient evaluation examples.

Harmonic acceleration as a measure of vestibular compensation

The results of conventional electronystagmography (ENG) sometimes are confusing. The Hallpike alternate binaural bithermal (ABB) caloric test is helpful diagnostically except for the group of "sick patients that have a normal test". Conventional ENG tests also fall short in the area of objective confirmation of patient progress. What does each test tell us regarding site of lesion? Alternate binaural bithermal stimulation gives us information about the semicircular canals--particularly the horizontal semicircular canal--pickup head. Simultaneous binaural bithermal stimulation gives information about brain stem connections--switching and relay. Rotation testing gives information about the processing by the brain--central control.

Harmonic acceleration tests as a measure of vestibular compensation

The material presented in excerpted from patient evaluations. The study was performed with the use of the Contraves rotary chair. This testing modality was used at each patient visit. All other conventional auditory and ENG tests were also performed. These patients have been selected to illustrate the value of the harmonic acceleration (HA) test as a modality for monitoring patient progress. The HA graphs produced were a result of the presence or absence of central vestibular compensation. The findings on these investigations further confirm that HA test provide an objective monitor for vestibular abnormality.

An electron microscopic radioautographic identification of the APUD endocrine cells in the rat gastric pyloric glands

The rat stomach was shown some years ago to contain numerous endocrine cells with APUD ability--cells that could take up the amino acids L-5-hydroxytryptophan (5-HTP) or L-dihydroxyphenylalanine (L-DOPA) and could decarboxylate them to their respective amines, 5-hydroxytryptamine (5-HT, serotonin) and dopamine, by means of the enzyme DOPA-decarboxylase. In a recent study, most of the APUD endocrine cells in the rat oxyntic mucosa were shown by electron microscopic radioautography to be the enterochromaffinlike cells, while the A-like cells were shown to lack APUD ability. To identify the APUD cells in the pyloric mucosa, pieces of rat pylorus were incubated in organ culture with 3H-5-HTP and were processed for light microscopic and electron microscopic radioautography. Additional specimens were incubated with 3H-5-HTP and carbidopa, an inhibitor of DOPA-decarboxylase, used to block the decarboxylation of 3H-5-HTP to 3H-5-HT, or with 3H-5-HT, used to determine where exogenous 3H-5-HT localizes in the pyloric mucosa. The 3H-5-HTP labeled all three types of endocrine cells identified within the pyloric glands--the G, enterochromaffin, and D cells. As this labeling was inhibited by carbidopa, and as exogenous 3H-5-HT labeled these cells only lightly, the labeling must have resulted from the uptake and intracellular conversion of the 3H-5-HTP of 3H-5-HT. Thus despite their morphologic differences, all rat pyloric endocrine cells possess APUD ability, a property shared by many, but not all, of the peptide- and amine-producing endocrine cells located throughout the body.

Staging Meniere's disease and reporting results in Meniere's disease: symposium panel discussion

At its recent spring meeting, the American Neurotologic Society devoted a portion of its program to a symposium on staging Meniere's disease and reporting results. One of the problems discussed, was which preoperative audiogram should be used for reporting results of any treatment. I think that it is very important that we, as otologists, try to look at Meniere's disease or any inner ear dysfunction in a more scientific way. Some of you may feel, on initial evaluation of this material, that it is too cumbersome to be practical in your daily clinical work. However, we feel we have put forth a reasonable staging system and method of reporting results that can be quite helpful once the simple routine of using them has become established. The vertigogram, for example, which is designed to be very simple and not require any sophisticated equipment, should be as easy to read as an audiogram. If we try to approach the vagaries of Meniere's disease or any inner ear dysfunction in a more scientific fashion, I am sure that in several years we will be in a much better position collectively to evaluate our results and to help our patients. This type of comprehensive staging system for all of the components in Meniere's disease or any inner ear dysfunction will enable us to objectify diagnoses and treatment results so that they can be easily compared. We have put forth some of the ideas and methods that we think will help us arrive at a consensus for reporting results. We encourage you to try some of the suggestions presented in this article and welcome your comments and ideas for improving this staging system and method for reporting results.

Sinusoidal harmonic acceleration test in clinical practice

The author's experience during the first year of use of the Sinusoidal Harmonic Acceleration test in clinical practice is presented. The advantages of this test both in the diagnostic and monitoring areas are illustrated with patient evaluation summaries. Further, use of this test on a daily basis in the office practice of neurotology will define its role in the evolution and follow-up of neurotologic problems.

Electron microscopic radioautographic identification of the ECL cell as the histamine-synthesizing endocrine cell in the rat stomach

Rat gastric oxyntic glands contain argyrophil "enterochromaffin-like" endocrine cells that synthesize and store histamine and also have APUD ability--they can take up exogenous L-5-hydroxytryptophan (5-HTP), can decarboxylate it to 5-hydroxytryptamine (5-HT, serotonin) by the enzyme DOPA-decarboxylase, and can store the amine. Previous cytochemical studies suggested that these cells correspond to both the ECL and A-like cells, the two predominant endocrine cells identified by electron microscopy (EM) in rat oxyntic glands. In a recent study, however, we demonstrated that the ECL but not the A-like cell exhibited APUD ability when rat gastric mucosa was incubated with H3-5-HTP and studied by EM radioautography. The purpose of the present study was to identify by EM radioautography the histamine-synthesizing endocrine cells in the rat stomach. Pieces of rat (male Sprague-Dawley) gastric mucosa were incubated in organ culture with L-H3-histidine (50 muCi, 1.8 x 10(-5) M) with and without inhibitors and were processed for LM and EM radioautography. H3-histidine labeled the ECL cells heavily but the A-like and other endocrine cells only lightly. The labeling of ECL cells was only modestly reduced by cycloheximide, an inhibitor of protein synthesis, whereas the labeling of A-like and other endocrine cells was almost abolished. In contrast, the labeling of ECL cells was markedly reduced by 4-bromo-3-hydroxybenzyloxyamine (NSD-1055), an inhibitor of histidine decarboxylase and DOPA decarboxylase, but was not appreciably affected by carbidopa, an inhibitor of only the DOPA decarboxylase. Incubations with H3-histamine (50 muCi, 0.9 x 10(-5) M) failed to label endocrine cells. Thus, this study demonstrates that the ECL but not the A-like cell is the histamine-synthesizing endocrine cell of the rat stomach.