Antibiotic treatment of acute appendicitis - initial observations.
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Acute Disease↗
Biomedical subjects
A S Salim
Publications and source records attributed to A S Salim.
KTP-Laser and fibrin glue for treatment of fistulae in ano.
Fistulae-in-ano remains a significant surgical problem due to the limitations pertinent to accurate assessment and the magnitude, shortcomings and side effects of the various procedures currently employed for their management. Six consecutive fistulae-in-ano patients (males, age range 30 to 58 years) were successfully treated by KTP laser (20-watt continuous aim for 20 to 30 seconds delivering a total energy of 400 to 600 joules) with rapid solidification fibrin glue then followed up for 3 months without recurrence. This approach offers a simple, expeditious and effective treatment for fistulae-in-ano thereby overcoming many of the restrictions associated with other methods.
Adult↗
Perspectives in pancreatic pain.
This review describes some of the mechanisms which are thought to be important in the causation of pain in chronic pancreatitis. Both medical and surgical techniques for treating this pain are described.
Chronic Disease↗
Role of free radicals in gastrointestinal cancer.
Incomplete reduction of oxygen in vivo generates oxygen-derived free radicals, which are highly reactive species capable of extensive cellular injury. The experimental and clinical evidence for a role of free radicals in the process of development and spread of gastrointestinal cancer is examined in the present review article.
Animals↗
Role of free radical scavengers in the management of refractory duodenal ulceration. A new approach.
This prospective randomized double blind study examined the influence of free radical scavengers on the healing and recurrence of refractory duodenal ulceration. To this end, allopurinol (50 mg, four times a day) -a hydroxyl radical scavenger and an inhibitor of xanthine oxidase, the enzyme which forms superoxide radicals--and dimethyl sulfoxide (DMSO, 500 mg, four times a day)--a hydroxyl radical scavenger--were administered orally. Three hundred and sixty-three consecutive patients with duodenal ulceration that did not heal despite 3 months of treatment with cimetidine, who were cigarette smokers and social drinkers, were randomized to receive 800 mg cimetidine twice a day alone or with either allopurinol or DMSO. In 315 patients who were evaluable for efficacy analysis, the healing rate at 8 weeks was, for cimetidine alone, 60%; for cimetidine with DMSO, 100%; and for cimetidine with allopurinol, 100%. The healing efficacy of cimetidine was therefore significantly (P < 0.01) heightened by DMSO and allopurinol. The patients whose ulcers healed were instituted on maintenance treatment for 1 year and received 800 mg cimetidine at bedtime alone or with either DMSO or allopurinol. In 218 patients who were evaluable for efficacy analysis, the cumulative relapse rate at 1 year was, for cimetidine alone, 29%; for cimetidine with DMSO, 8%; and for cimetidine with allopurinol, 7% DMSO with cimetidine and allopurinol with cimetidine were, therefore, superior to cimetidine alone (P < 0.01) in preventing ulcer relapse. The results suggest that oxygen-derived free radicals are implicated in the mechanism of refractory duodenal ulceration and that scavenging these radicals stimulates healing and reduces recurrence of the ulceration.
Adult↗
The permissive role of oxygen-derived free radicals in the development of colonic cancer in the rat. A new theory for carcinogenesis.
The colonic carcinogen 1,2-dimethylhydrazine (DMH) was given to male rats at 10 weeks of age in the form of weekly s.c. injections for 28 weeks. The results obtained show that the incidence of colonic cancer is directly dependent on dietary fat intake and that carcinogens which produce colonic cancer in the presence of a high-fat diet are rendered harmless when a low-fat diet is consumed. These results suggest that dietary fat is permissive for colonic carcinogenesis. Administration of the radical scavengers allopurinol and dimethyl sulfoxide afforded dose-dependent protection against this permissive role.
1,2-Dimethylhydrazine↗
Reducing the recurrence rate of duodenal ulceration after highly selective vagotomy: a study in the rat and in man.
Acid secretion after highly selective vagotomy (HSV) gradually increases with time and may be related to the rate of duodenal ulcer recurrence following this operation. Studies were carried out in the rat and in man to examine whether preventing recommunication of the vagal branches with their distal stumps reduces the rate of acid secretion recovery and duodenal ulcer recurrence after HSV. Male rats were allocated at random to three groups: (i) sham HSV, (ii) HSV, (iii) HSV with a polytetrafluoroethylene patch stitched against the denervated area of lesser curve. After housing for 2 years, the basal acid output of the HSV group was significantly (P < 0.01) depressed relative to control values (6.9 +/- 0.2 vs 14.1 +/- 0.4 mumole/hr, mean +/- SEM, n = 39 and 40, respectively). HSV with a patch had a basal acid output significantly (P < 0.01) lower than that of the HSV group (1.4 +/- 0.1 mumole/hr, mean +/- SEM, n = 41). Insulin significantly (P < 0.001) stimulated acid secretion in the HSV group but failed to do so in the group provided with a patch (1.4 +/- 0.1 vs 2.3 +/- 0.2 mumole/hr, mean +/- SEM, n = 41). Subcutaneous infusion of pentagastrin (4 micrograms/kg min) and carbachol (0.8 micrograms/kg min) for 24 hr produced duodenal ulceration in all of the control animals and in 20% of those in the HSV group, but in none of the HSV with a patch group.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Pilot study on alcohol-induced chemonecrosis of hepatic metastases from colonic cancer. A new approach for percutaneous localized dynamic destruction of the hepatic spread.
Administration of 98% ethanol destroys tissues by coagulative necrosis. In the rat bearing 1,2-dimethylhydrazine-induced colonic carcinoma which has spread to the liver, direct injection of 0.1-0.2 ml ethanol into each of the hepatic metastases at the time of total colectomy afforded a significant survival advantage relative to colectomy alone (20.1 +/- 0.2 vs 12.8 +/- 0.2 months of age, mean +/- SEM, n = 20, p < 0.01 by the Mann-Whitney U test). A pilot study was, therefore, carried out (2 women and 4 men, age range 43 to 71 years--mean 56) to examine the clinical significance of these observations in patients with multiple hepatic metastases from carcinoma of the sigmoid colon. The tumour was resected then all palpable hepatic secondaries were injected with 1-1.5 ml of 98% ethanol. Two weeks post-operatively and thereafter once every two months any hepatic lesions detected ultrasonically were similarly treated percutaneously. All the patients tolerated this treatment without any observed distress or adverse effects. Their mean survival measured from the time of tumour resection until death from any cause was 20 months (range 17 to 26 months). The survival gain afforded by chemonecrosis in addition to its simplicity and safety deserves further consideration to assess the exact role of this method in the treatment of liver metastases from colonic cancer.
1,2-Dimethylhydrazine↗
Sulphydryl-containing agents and the prevention of duodenal ulcer relapse.
This prospective randomized double-blind controlled study investigated whether sulphydryl-containing agents protect against the recurrence of duodenal ulceration. To this end, DL-cysteine (200 mg 4 times daily) and DL-methionine-methyl sulphonium chloride (MMSC, 500 mg 4 times daily) were administered orally. Three hundred and six consecutive smokers with previous symptomatic endoscopy-proven duodenal ulceration which had been shown endoscopically to have healed were randomized to receive for 1 year either placebo, cimetidine 400 mg at bedtime, cysteine, or MMSC. In 221 patients evaluable for efficacy, the cumulative relapse rate at 1 year was: placebo 64%, cimetidine 30%, cysteine 11% and MMSC 12%. Cimetidine was significantly effective in preventing ulcer relapse (p < 0.01), however cysteine and MMSC were more effective in this respect (p < 0.05). In the patients who relapsed, ulcer recurrence tended to occur early on placebo but to be evenly distributed over the year on active therapy. In all the study groups, the relative frequency of symptomatic to silent relapse was similar in the first and second halves of the year and was comparable among these groups. These results show that sulphydryl-containing agents significantly reduce the recurrence rate of duodenal ulceration.
Adolescent↗
Scavengers of oxygen-derived free radicals prolong survival in advanced colonic cancer. A new approach.
The influence of oxygen-derived free radicals on survival in advanced colonic cancer was assessed in a prospective randomized controlled double-blind trial using the radical scavengers dimethyl sulphoxide (DMSO) and allopurinol. Following palliative sigmoid colectomy for carcinoma at Dukes' stage D, 306 patients were randomized to the control group or to electrocoagulation of liver secondaries alone or with allopurinol (50 mg by mouth 4 times a day) or DMSO (500 mg by mouth 4 times a day). In 193 fully evaluable patients who were studied for 5 years, allopurinol and DMSO incurred a significant (p < 0.05) survival advantage over the whole period of study. The similarity in efficacy between allopurinol and DMSO and the fact that the only action they share is scavenging oxyradicals, suggest that these radicals mediate the detrimental effects of malignancy and that removing them incurs a survival advantage for patients with advanced colonic cancer.
Adenocarcinoma↗
Chemonecrosis for localized dynamic destruction of hepatic metastases of colonic cancer. A new approach.
Injection of ethyl alcohol in high concentrations into tissues produces coagulative necrosis. The benefits of direct injection of 98% ethanol into hepatic metastases from 1,2-dimethylhydrazine (DMH)-induced colonic cancer was investigated in groups of 20 Sprague-Dawley rats of either sex. At 10 weeks of age, rats were subcutaneously injected every week with 10 mg/kg DMH for 28 weeks. They were then housed for 3 months. At the end of this period all the animals had developed colonic carcinoma with multiple hepatic metastases. Total colectomy and the fashioning of an ileostomy coupled with direct injection of 0.1-0.2 ml of ethanol into each of the hepatic metastases, after mobilizing the liver by dividing its fascial attachments to facilitate easier tumour detection by inspection and palpation, afforded a significant survival advantage relative to colectomy alone (20.1 +/- 0.2 months of age, vs, 12.8 +/- 0.2 months of age, mean +/- SEM, n = 20, p < 0.01 by the Mann-Whitney U test). The clinical implications of these observations were, therefore, examined in a pilot study carried out on 6 patients (2 women and 4 men with an age range of 43-71 years, mean 56) who had adenocarcinoma of the sigmoid colon with multiple hepatic secondaries. The colonic tumour was resected and an end-to-end anastomosis effected, then all palpable hepatic metastases were slowly injected with 1-1.5 ml of 98% ethanol. Two weeks post-operatively and thereafter once every 2 months any hepatic lesions detected ultrasonically were similarly treated percutaneously. This treatment produced no adverse effects of any significance. None of the patients died during the first post-operative year. Death was due to disease spread in all the patients. The mean survival measured from the time of tumour resection until death from any cause was 20 months (range 17-26 months). It thus appears that chemonecrosis for the treatment of liver metastases from colonic cancer is a simple and safe therapeutic modality which offers a survival gain.
Adenocarcinoma↗
The relationship between Helicobacter pylori and oxygen-derived free radicals in the mechanism of duodenal ulceration.
This prospective randomized study investigated the possibility that duodenal ulcer relapse associated with Helicobacter Pylori infection is mediated by oxygen-derived free radicals. To this end, the radical scavengers allopurinol (50 mg 4 times daily) and dimethyl sulphoxide (DMSO, 500 mg 4 times daily) were administered orally. One hundred and forty-six consecutive patients with previous symptomatic endoscopy proven duodenal ulceration, which had been shown endoscopically to have healed in the presence of gastric mucosal infection with Helicobacter Pylori, were randomized to receive for the period of one year either placebo, or cimetidine 400 mg at bedtime, or allopurinol, or DMSO. In one hundred and twenty-six patients evaluable for efficacy, the cumulative relapse at one year was: placebo 47%, cimetidine 24%, allopurinol 6% and DMSO 6%. Cimetidine was significantly effective in preventing the relapse (p < 0.01), however allopurinol and DMSO were superior to cimetidine in this respect (p < 0.05). In the patients who relapsed, ulcer recurrence tended to occur early in those on placebo and cimetidine and to be evenly distributed over the year in those on free radical scavenging therapy. In all groups, ulcer recurrence throughout the maintenance year was more frequently symptomatic than silent. The incidence of infection with Helicobacter Pylori was not influenced by any of the regimens employed and the bacterium was detected with every relapse noted in this study and during the follow-up endoscopy which was carried out at 6 months and at 12 months during the maintenance year. The results suggest that oxygen-derived free radicals are involved in the relapse of duodenal ulceration in patients infected with Helicobacter Pylori.
Adult↗
Oxygen-derived free radical scavengers: a new approach to the problem of refractory peptic ulceration.
Refractory peptic ulceration refers to ulcers which are slow to heal despite active treatment for at least three months. Oxygen-derived free radicals are cytotoxic and promote tissue injury. Twelve consecutive patients with refractory peptic ulceration (eight with duodenal ulcers and four with solitary pre-pyloric gastric ulcers) were treated using the radical scavengers allopurinol or dimethyl sulphoxide. This treatment was well tolerated by all patients and produced no adverse effects. Endoscopic examination four weeks later demonstrated complete healing (an intact gastric or duodenal mucosa without any breaches) in all patients. The results suggest that oxygen-derived free radicals perpetuate the process of peptic ulceration and exert an adverse effect on healing. Scavengers of these radicals stimulate the healing of refractory gastric and duodenal ulceration.
Adult↗
Sulfhydryl-containing agents in the treatment of gastric bleeding induced by nonsteroidal anti-inflammatory drugs.
In a double-blind study involving 172 patients, the author investigated the effect of sulfhydryl-containing agents (cysteine and methylmethionine sulfonium chloride [MMSC]) on hematemesis resulting from erosive gastritis induced by nonsteroidal anti-inflammatory drugs. The 56 patients who received cysteine (200 mg orally four times a day) and the 59 patients who received MMSC (500 mg orally four times a day) were significantly (p < 0.01) more hemodynamically stable, with no rebleeding, than the 57 patients who made up a control group. Endoscopy carried out 48 hours after admission demonstrated that gastric erosions were still present in a significantly (p < 0.01) higher number of patients in the control group (20 [35%]) than in patients receiving cysteine (6 [11%]) and in patients receiving MMSC (7 [12%]). Eighteen patients (32%) in the control group required blood transfusion because of continued bleeding or rebleeding compared with only 3 patients (5%) receiving cysteine and 2 patients (3%) receiving MMSC (p < 0.01). Emergency surgery was necessary in 13 patients (23%) in the control group and in 1 patient (2%) in the group receiving cysteine who had rebleeding. Four patients in the control group died postoperatively. The results show that sulfhydryl-containing agents stimulate the healing of erosive gastritis induced by nonsteroidal anti-inflammatory drugs and protect against the complications of bleeding produced by the gastritis.
Adult↗
A new approach to the treatment of nonsteroidal anti-inflammatory drugs induced gastric bleeding by free radical scavengers.
The effect of the free radical scavengers allopurinol (50 milligrams) and dimethyl sulfoxide (DMSO) (500 milligrams), taken orally four times a day, on the clinical outcome of hematemesis resulting from nonsteroidal anti-inflammatory drugs (NSAID) induced erosive gastritis was examined in a prospective randomized double-blinded controlled trial. In 180 fully evaluable patients with osteoarthritis or rheumatoid arthritis, administration of allopurinol (n = 63) or DMSO (n = 58) enabled significantly (p < 0.01) larger numbers of patients to remain hemodynamically stable with no rebleed relative to those in the control group (n = 59). The results of endoscopic examination 48 hours after admission demonstrated that gastric erosions were still present in significantly more patients in the control group (p < 0.01; n = 20; 50 percent) than in the allopurinol (n = 5; 9 percent) or DMSO (n = 4; 7 percent) groups. The radical scavengers also reduced the number of patients requiring blood transfusion because of a rebleed or continued bleeding and emergency operation relative to control values. It is, thus, construed that oxygen derived free radicals mediate the mechanism of NSAID induced erosive gastritis. Scavenging these radicals impairs the gastritis, stimulates healing and protects against the complications of its hemorrhagic episodes.
Allopurinol↗
Role of sulfhydryl-containing agents in the healing of erosive gastritis and chronic gastric ulceration in the rat.
One milliliter of 1, 2, or 5% DL-cysteine (cysteine) or DL-methionine methylsulfonium chloride (MMSC) was instilled into the rat stomach 1, 24, and 48 h after giving ethanol (1 mL of 40% solution) by gavage. One hour following the administration of ethanol, gastric mucosal injury was seen in all the animals (22.6 +/- 1.1 mm2, mean +/- SEM; n = 10). Twenty-four hours after giving the ethanol, all the rats treated with cysteine or MMSC still had the mucosal injury. Treatment with 2% cysteine or MMSC significantly (p less than 0.01) reduced the extent of this injury (10.2 +/- 0.6 and 10.1 +/- 0.5 mm2, respectively, versus 20.7 +/- 1.2 mm2, mean +/- SEM; n = 10), an action that was similarly achieved by the 5% solutions (10.1 +/- 0.5 and 9.9 +/- 0.3 mm2, respectively, versus 20.7 +/- 1.2 mm2, mean +/- SEM; n = 10). Forty-eight hours following the administration of ethanol, 30% of the animals given 1% cysteine or MMSC still had gastric mucosal injury, which was significantly (p less than 0.001) less extensive than that seen with ethanol alone (3.8 +/- 0.3 and 4.1 +/- 0.3 mm2, respectively, versus 13.1 +/- 0.8 mm2, mean +/- SEM; n = 10). At this time period, however, none of the animals treated with 2 or 5% solutions of cysteine or MMSC still had any injury. Healing of the ethanol-induced injury was confirmed microscopically and was achieved by regeneration.(ABSTRACT TRUNCATED AT 250 WORDS)
Animals↗
Protection against chronic gastric ulceration in the rat with sulfhydryl-containing agents.
Reserpine (intraperitoneal, 5 mg/kg every day for 5 days) produced chronic ulceration of the rat stomach 2 weeks postdose. Gavage with 1% DL-cysteine or DL-methionine-S-methylsulfonium chloride at 1 mL/day for 2 weeks and 5 days protected against ulceration in 30% of the rats, and this protection extended to 80% of cases with 2% solutions. Similar gavage with 5% solutions protected all rats against ulceration without significantly influencing the basal H+ output [13.1 +/- 0.3 and 14.2 +/- 0.2 mumol for DL-cysteine and DL-methionine-S-methylsulfonium chloride, respectively, versus 15.1 +/- 0.4 mumol (mean +/- standard error of the mean; n = 10)]; that is, cytoprotection was achieved.
Animals↗
Use of scavenging oxygen-derived free radicals to protect the rat against aspirin- and ethanol-induced erosive gastritis.
Oxygen-derived free radicals are cytotoxic and produce tissue damage. The effect of the radical scavengers allopurinol and dimethyl sulfoxide (DMSO) on aspirin- and ethanol-induced acute gastric mucosal injury was studied in the rat. Orogastric instillation of aspirin at 200 mg/kg produced, after 4 h, gastric mucosal injury in 30% of rats without pyloric ligation [score, 3.1 +/- 0.8 mm2, mean +/- standard error of the mean (SEM); n = 10] and in 80% of rats with this ligation (score, 10.4 +/- 1.2 mm2, mean +/- SEM; n = 10). Gavage with 1 mL of 2 or 5% allopurinol or DMSO at 24 h before and again just before aspirin administration completely protected rats with or without pyloric ligation against injury. Orogastric instillation of ethanol (1 mL of a 40% solution) produced, after 1 h, gastric mucosal injury in all rats with or without pyloric ligation (24.1 +/- 1.7 and 14.1 +/- 1.3 mm2, respectively, mean +/- SEM; n = 10). Gavage with 1 mL of 5% allopurinol or DMSO at 24 h before and again just before ethanol administration completely protected rats with or without pyloric ligation against injury. Protection against the aspirin- and ethanol-induced injury was not associated with any significant effect on the H+ output. The results suggest that oxygen-derived free radicals are directly implicated in the mechanism of aspirin- and ethanol-induced acute gastric mucosal injury and that scavenging these free radicals protects against injury by maintaining the integrity of the gastric mucosa.
Allopurinol↗