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Biomedical subjects

D Hetzel

Publications and source records attributed to D Hetzel.

12 recordsLinked to original sources
PubMed1998

Acid pump inhibitors. The treatment of gastroesophageal reflux.

BACKGROUND: The place of acid pump inhibitors at the top of the efficacy table in the league of reflux therapies, and their eager patient acceptance, has aroused debate on their role. OBJECTIVE: To understand the role of gastric acid and its inhibition in the pathogenesis and treatment of gastroesophageal reflux disease. DISCUSSION: Gastroesophageal reflux disease results from excessive exposure of the oesophagus to acidic contents. Acid pump inhibitors provide the most effective medical control of gastric acid throughout day and night, returning oesophageal pH to normal levels. They provide fast symptom relief and rapidly restore quality of life in all reflux patients more effectively than H2 receptor antagonists or prokinetic drugs. APIs heal oesophagitis of all grades of severity and provide safe, effective maintenance of healing with prevention of complications in longer term use.

2-Pyridinylmethylsulfinylbenzimidazoles↗
PubMed1995

Staging and recurrence of disease in squamous cell carcinoma of the vulva.

In order to determine the prognostic significance of applying the revised FIGO staging system and identify factors contributing to survival after documentation of recurrent disease, a retrospective chart review of our vulvar cancer population was performed. Over a 17-year interval 135 patients were uniformly treated with primary surgical treatment consisting of radical vulvectomy and bilateral groin dissection. Factors contributing to disease-free survival were analyzed using a Cox proportional hazards model. Covariates of survival after recurrence of disease were analyzed using the log-rank method. Neither the clinical assessment of the groin nodes, nor the presence or absence of perineal involvement were related to outcome. Only lesion size and surgical status of the inguinal nodes were significant predictors of disease-free survival (P = 0.02 and P = 0.03, respectively). In addition, there was a statistically significant relationship between the extent of groin involvement (negative, unilateral positive, and bilateral positive nodes) and associated decrement in disease-free survival (P = 0.01). Thirty patients developed recurrence of disease from 2.0 to 47.3 months following surgery. The location of the recurrence, interval from primary therapy to recurrence, and status of the groin nodes at initial surgery were significant prognostic factors in subsequent survival. The revised staging system demonstrated an improvement in patient stratification compared to the criteria of the prior classification. The data are also consistent with the distinction made between Stage III and IV disease in the new classification. The status of the groin nodes at original surgery remained an important prognostic factor even in those patients who later demonstrated recurrence of disease.

Actuarial Analysis↗
PubMed1995

Evaluation of the intestinal absorption of erythromycin in man: absolute bioavailability and comparison with enteric coated erythromycin.

To determine the role of acid hydrolysis on the gastrointestinal absorption of erythromycin, six healthy subjects received erythromycin as a 240 mg intravenous dose, a 250 mg oral solution administered via endoscope directly into the duodenum and bypassing the stomach, and an enteric-coated 250 mg capsule. Blood samples were collected for 6 hours and serum erythromycin quantified by a microbiological method. The time to achieve maximum serum concentrations for the solution was 0.25 +/- 0.08 (mean +/- SD) hours and for the capsule was 2.92 +/- 0.55 hours. The absolute bioavailability of erythromycin from the capsule was 32 +/- 7% and for the duodenal solution 43 +/- 14%. The ratio of the areas under the serum erythromycin concentration-time curve of capsule to solution was 80 +/- 28% (range 38 to 110%). There is substantial loss of erythromycin apart from gastric acid hydrolysis, which cannot be accounted for by hepatic first-pass metabolism. Attempts to further improve the oral bioavailability of erythromycin beyond 50% by manipulation of formulation are likely to be futile.

Administration, Oral↗
PubMed1989

Peptic ulcer therapy. Drug options and management strategies.

Peptic ulcer is a common and chronic problem with a plethora of drug treatments available that accelerate healing in the short term. Unfortunately none of these therapies eliminates the fundamental causes of ulcer, nor changes the long term course of the disease. Good management demands an appreciation of risk factors and how they can be modified, with recognition of the need for long term therapy in those at risk of complications.

Australia↗
PubMed1988

Preliminary experience with a combined-modality approach to the management of oesophageal cancer.

A synchronous chemoradiotherapy schedule of modest dosage has been used in 36 patients with oesophageal cancer since July 1984 at the Royal Adelaide Hospital. The schedule, which comprises two five-day continuous infusions of 5-fluorouracil, each of which is followed by a short cisplatin infusion, together with 30-35 Gy of megavoltage irradiation over three weeks, has been used alone, or before surgical resection or further chemo-irradiation. It has been extremely well tolerated and has caused complete endoscopic resolution of disease before surgery or further chemo-irradiation in 69% of patients. At the end of the full course of treatment, complete relief of dysphagia has been achieved in 27 (84%) of the 32 patients in whom this symptom was present at the start of treatment. The median duration of relief has not yet been reached with a median follow-up of over one year. This degree of palliation is significantly better than that which was achieved in a series of patients who were treated radically either by surgery or radiation alone between the years 1978 and 1983 at the Royal Adelaide Hospital. The 12- and 18-month actuarial survival figures of 72% and 55%, respectively, for the 30 patients in this series whose disease remained apparently localized to the thorax at presentation, compare very favourably with the corresponding figures for the much more highly-selected group of patients who were treated surgically between 1978 and 1983.

Actuarial Analysis↗