Misoprostol heals gastroduodenal injury in patients with rheumatoid arthritis receiving aspirin

High-dose aspirin therapy for rheumatoid arthritis is frequently associated with severe gastrointestinal injury. To explore the possibility of reversing such damage, we conducted a double-blind, multicenter study with misoprostol, a prostaglandin E1 analog, which has demonstrated mucosal protective, gastric antisecretory, and ulcer healing properties. We also studied possible interference of misoprostol with continuing aspirin treatment in the management of patients with rheumatoid arthritis. Patients with confirmed rheumatoid arthritis and endoscopically documented gastroduodenal lesions were randomly assigned to receive 200 micrograms of misoprostol four times a day (123 patients) or placebo (116 patients). Each concurrently received 650 to 1300 mg of aspirin four times a day. After eight weeks of treatment, misoprostol was statistically superior to placebo in healing gastric mucosal injury (70% vs 25%) and duodenal mucosal injury (86% vs 53%). Patients with gastric or duodenal ulcers on admission had superior ulcer healing rates with misoprostol (67% vs 26%). There was no evidence of interference with the antirheumatic properties of aspirin. Mild to moderate adverse experiences were equally noted in misoprostol and placebo groups. Misoprostol, coadministered with aspirin, is well tolerated and highly effective in healing aspirin-associated gastroduodenal lesions in patients with rheumatoid arthritis without altering the therapeutic benefits of aspirin.

Osler-Weber-Rendu disease: MR findings in the liver

We report the magnetic resonance (MR) findings in the liver of a patient with known Osler-Weber-Rendu disease, a rare disorder characterized by arteriovenous malformations involving multiple organ systems. To the best of our knowledge, the MR findings in liver involvement have not been previously reported.

Pancreatic immunoreactive somatostatin and diabetes mellitus

Pancreatic secretions were collected during endoscopic retrograde cholangiopancreatography from 15 subjects without pancreatic, biliary, or hepatic diseases, 11 patients with non-insulin-dependent diabetes, and 11 patients with insulin-dependent diabetes. Pancreatic secretion was stimulated by the intravenous administration of one unit of secretin per kilogram of body weight. Immunoreactive somatostatin (IRS) in the pancreatic juice of the nondiabetic subjects ranged from 43 to 97 pg/ml, in non-insulin-dependent diabetics from 5 to 3872, and in the insulin-dependent diabetics from 0 to 2093. IRS in insulin-dependent diabetics under good plasma glucose control ranged from 0 to 281 pg/ml, compared to those under poor control who ranged from 518 to 2093 pg/ml. These results indicate that IRS in pancreatic juice is higher in poorly controlled insulin-dependent diabetics than in well controlled insulin-dependent diabetics and nondiabetics. Whether these changes in IRS are purely secondary phenomena or play some pathogenetic role in the disturbed metabolism of diabetes remains to be proven. The chromatographic profile of IRS in pancreatic juice on both gel filtration and high-performance liquid chromatography has indicated that these IRS moieties represent somatostatin 14 and somatostatin 28.

Role of Tromaril as anti-prostaglandin drug on blood aqueous barrier

In this experimental work, it was observed that after anterior chamber paracentesis there was more effusion of protein into the anterior chamber. Pretreatment with aspirin/indomethacin and a new drug, enfenamic acid (Tromaril), decreased this trauma-induced increase in aqueous protein content. It was further observed that this inhibition was more marked with Tromaril pretreatment in comparison with other drugs. Prostaglandin-mediated disruption of blood aqueous barrier can also be decreased with Tromaril pretreatment. Tromaril, a prostaglandin synthetase inhibitor, may help us to control the reactions to surgical ocular trauma and other ocular inflammatory diseases.

Role of tromaril--a new anti-inflammatory drug in eye diseases

In this clinical study, the role of enfenamic acid (Tromaril), a new anti-inflammatory and nonsteroidal drug, on various eye diseases such as trauma, on inflammatory diseases such as uveitis, and after cataract surgery was evaluated. The drug was administered to 30 patients (group A) while 29 patients (group B) were given a placebo. Twenty-one patients showed good response, and of these, 15 patients (76%) belonged to group A, to whom Tromaril had been administered. Of the patients who were given Tromaril, none showed any side effects in general. It can be concluded that Tromaril is a strong and effective anti-inflammatory drug for use in various eye diseases.

Mucosal irritant potential of a potassium-sparing diuretic and of wax-matrix potassium chloride

To measure their relative upper gastrointestinal irritant potential, either 5 mg amiloride and 50 mg hydrochlorothiazide (twice daily) or 24 mEq wax-matrix potassium chloride (three times a day) were given to 30 normal subjects with no prior endoscopic abnormalities in the esophagus, stomach, or duodenum. All subjects received glycopyrrolate, 2 mg (3 times a day) to slow gastric emptying. Repeat endoscopy after 7 days of treatment with wax-matrix potassium chloride revealed that 10 of 15 (67%) of the subjects developed one or more gradable upper gastrointestinal lesions (esophageal ulcer, gastric ulcer, eight cases of one or more mucosal erosions, and four cases of hyperemia or edema of the esophagus, stomach, or duodenum). Four subjects (27%) taking amiloride/hydrochlorothiazide developed either mild hyperemia or edema, but there were no erosions or ulcers in this group.

Inhibition of nocturnal gastric secretion in normal human volunteers by misoprostol: a synthetic prostaglandin E1 methyl ester analog

Misoprostol (SC-29333) is a synthetic prostaglandin E1 analog that has been found to be a potent inhibitor of gastric secretion in animals. Nocturnal gastric antisecretory activity of misoprostol, in tablet form, was studied in 16 adult volunteers, under basal condition. The study was a randomized, double-blind, cross-over, comparison of placebo, and three graded doses of misoprostol (50, 100, and 200 micrograms). Misoprostol exhibited a statistically significant inhibition of total acid output only at the 200 micrograms dose and this inhibition was maintained for 3 h postadministration of the drug. The antisecretory effects of misoprostol were characterized by suppression of H+ ion but not of the volume of gastric secretion. No untoward effects were noted in the volunteers. As a consequence of the gastric antisecretory effects, the present studies indicate that misoprostol is a promising therapeutic agent for the treatment of peptic ulcer.

On a new Telorchis sp. with a redia inside the miracidium

Adult and miracidium of Telorchis lucknowensis n. sp. from the intestine of Kachuga kachuga in India have been described. The new species is characterised by length of oesophagus, ratio of cirrus sac and metraterm, position of ovary, extension of vitellaria, and the unusual size of eggs containing a miracidium with a well developed redia. This is the first report on the occurrence of miracidia containing a redia in Plagiorchiata. The non-oculate miracidium has bullet shaped body, 2 pairs of penetration glands, and one pair of flame cells. The redia is elongate oval in shape with well developed pharynx, short gut and germ balls.