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Biomedical subjects

I N Marks

Publications and source records attributed to I N Marks.

At least 91 records · Page 5Linked to original sources
PubMed1986

The effect of aspirin and anti-ulcer drugs on gastric mucosal prostaglandin E.

The effect of single doses of aspirin, cimetidine, ranitidine, sucralfate, dextran, colloidal bismuth subcitrate, carbenoxolone and antacid on gastric mucosal prostaglandin E (PGE) content was studied in normal subjects. Endoscopic gastric specimens were taken from the body and antrum before and 90 minutes after drug ingestion and the PGE content was measured by radio-immunoassay. There was more PGE in the antrum than in the body (4.02 +/- 3.09 v. 2.80 +/- 2.31 ng PGE/mg protein; P less than 0.001). Aspirin, sucralfate and antacid reduced the amount of PGE in the antral mucosa (2.85 +/- 0.54-1.44 +/- 0.44; P less than 0.001; 3.04 +/- 1.01-1.94 +/- 0.74; P less than 0.03; and 5.06 +/- 0.91-3.54 +/- 0.73; P less than 0.006; ng PGE/mg protein respectively). None of the drugs had any effect on the levels measured in the body mucosa.

Adult↗
PubMed1986

Comparison of pirenzepine with cimetidine in duodenal ulcer disease. A short-term and maintenance study.

Sixty-seven patients with endoscopically proven duodenal ulceration were entered into a double-blind study and randomized to treatment with pirenzepine (PZ) (Gastrozepin; Boehringer Ingelheim) 50 mg twice daily or cimetidine (CM) (Tagamet; Smith Kline & French Laboratories) 400 mg twice daily, given 30 minutes before breakfast and supper. Patients underwent endoscopic examination before entry, at 4 weeks, and at 8 weeks if unhealed at 4 weeks. Once healing was achieved, 43 patients were entered into a single-blind maintenance study with either PZ 50 mg at night or CM 400 mg at night according to their original randomization. CM had a slight, but not significant, advantage over PZ after 4 weeks, but the 8-week data showed identical healing rates. The relapse rate appeared to be higher in the PZ-treated group, but this difference was also not significant. It is suggested that the evening dose of PZ be amended to 50 or perhaps 100 mg before bed in the short-term treatment of duodenal ulcer, and that a dose of 100 mg at night be considered for maintenance therapy in certain high-risk populations.

Adult↗
PubMed1986

The epidemiology of inflammatory bowel disease in Cape Town 1980-1984.

Patients with inflammatory bowel disease diagnosed in the greater Cape Town area between the years 1980 and 1984 inclusive were studied to establish the incidence and presenting features of these diseases. Case details were obtained from the records of the Groote Schuur Hospital group and Tygerberg Hospital as well as from questionnaires completed by 97% of 731 medical practitioners in the area. There were 134 patients with Crohn's disease, 197 with ulcerative colitis and 16 with indeterminate colitis. The incidences of Crohn's disease in the coloured, white and black population groups were calculated to be 1.8, 2.6 and 0.3/100 000 per year respectively and those for ulcerative colitis 1.9, 5.0 and 0.6/100 000 respectively. Among Jews the incidence was higher for both Crohn's disease (10.4/100 000) and ulcerative colitis (17.0/100 000). Of patients with ulcerative colitis 35% had limited proctitis, 26% proctosigmoiditis, 12% left-sided disease and 27% total colitis. Of patients with Crohn's disease 27% had colonic involvement alone, 37% ileocolitis and 36% small-bowel involvement alone. The incidence of inflammatory bowel disease has increased in the greater Cape Town area over the last 10 years, while the pattern of disease has remained similar to that previously reported for this geographical area.

Adolescent↗
PubMed1986

Tuberculous perforation of the bowel. A report of 8 cases.

Eight patients with tuberculous perforation of the bowel, representing 15% of all cases of intestinal tuberculosis, were seen over a 13-year period. A wide spectrum of presentations was encountered. A history of acute abdominal pain was not always obtained, but it could be the first indication of the presence of associated intestinal involvement in a patient receiving treatment for pulmonary tuberculosis. Free subdiaphragmatic air was detected radiologically in only 2 cases (25%). It is suggested that emergency surgery should be limited to dealing with only the perforated and any obviously obstructed bowel, and the advantages of delaying additional procedures are stressed. Despite the invariable accompanying suboptimal nutritional status and associated medical problems found in this group of patients, only 2 died.

Adolescent↗
PubMed1986

Diagnostic yield of endoscopic retrograde cholangiopancreatography in carcinoma of the pancreas.

The results of 117 consecutive endoscopic retrograde cholangiopancreatographic (ERCP) examinations in patients with adenocarcinoma carcinoma of the pancreas, performed over a six year period, are reported. The diagnostic accuracy of this procedure (80.3 per cent) was higher than that of computed tomography (63.6 per cent) and ultrasonography (54.0 per cent). Fewer false negative diagnoses were made by retrograde cholangiopancreatography (7.7 per cent) than with the other procedures (28 per cent each). Analysis of the total ERCP experience during the study period revealed a false positive rate for malignancy of 5.6 per cent. In situations where investigations are performed by individuals with a broad spectrum of expertise, ERCP is superior to other methods in diagnosing pancreatic carcinoma, even in areas with a high prevalence of chronic pancreatitis.

Adenocarcinoma↗
PubMed1986

Biochemical vitamin E deficiency in chronic pancreatitis.

In order to study the frequency of biochemical vitamin E deficiency in chronic alcohol-induced pancreatitis, we measured plasma vitamin E and total blood lipids in 44 patients with chronic pancreatitis and 83 control subjects (44 normal controls; 39 Crohn's disease controls). Mean plasma vitamin E and mean ratio vitamin E/total blood lipids, a more sensitive indicator of vitamin E status, were significantly lower in chronic pancreatitis when compared with either control group. A low vitamin E/total lipids ratio was found in 75% of patients with pancreatitis. Within the chronic pancreatitis group, mean plasma vitamin E and the ratio vitamin E to total lipids were significantly lower in those with steatorrhoea (23 patients--pancreatic steatorrhoea subgroup) than in those without (21 patients--pancreatic non-steatorrhoea subgroup). 91% of the pancreatic steatorrhoea subgroup had a low vitamin E/total lipids ratio. However, patients without pancreatic steatorrhoea also had significantly lower levels of plasma vitamin E and the ratio vitamin E/total lipids when compared to controls. We conclude that biochemical vitamin E deficiency is common in chronic alcohol-induced pancreatitis, particularly in patients with steatorrhoea, and that factors other than fat malabsorption may be responsible for vitamin E deficiency in pancreatic non-steatorrhoea.

Adolescent↗
PubMed1986

Peptic ulcer. A follow-up study.

One hundred and ten patients who had been entered into an ulcer healing study 2 to 4 years previously were recalled during an 8-week period for clinical assessment and endoscopy. Fifty-five gastric ulcer patients were followed-up after an average period of 21.2 months. Nine of these had undergone gastric surgery; of the remaining 46 patients, recurrent ulceration was found in 16 (35%). Fifty-five patients with duodenal ulcer disease were also followed-up after an average of 35.6 months. Five of these patients had undergone surgery and of the remaining 50, 25 (50%) had a recurrent duodenal ulcer. About one-third of both gastric and duodenal ulcer recurrences were asymptomatic. Smoking had no effect on recurrence rates.

Duodenal Ulcer↗
PubMed1986

A comparison of sucralfate dosage schedule in duodenal ulcer healing. Two grams twice a day versus one gram four times a day.

The conventional dosage schedule for sucralfate is 1 g 4 i.d., but a dose of 2 g 2 i.d. may be equally effective in duodenal ulcer healing. We compared the efficacy of these two regimens in duodenal ulcer healing. Seventy-seven patients with endoscopically proven duodenal ulceration were entered into a double-blind, controlled study and randomized to treatment with sucralfate 2 g 2 i.d. (on waking and at bedtime) or 1 g 4 i.d. (1/2 h before meals and at bedtime). The patients were endoscoped before entry into the study, after 4 weeks, and after 8 weeks if unhealed at 4 weeks. Of the patients considered suitable for analysis at 4 weeks, 79% (26/33) of those taking 2 g 2 i.d. had healed ulcers in comparison to 72% (23/32) of those taking 1 g 4 i.d. After 8 weeks, cumulative healing rates were 85% (28/33) and 80% (24/30), respectively. The results suggest that the more convenient dosage schedule of 2 g 2 i.d. is as effective as the 1 g 4 i.d. regimen in the short-term treatment of duodenal ulcer.

Adult↗
PubMed1986

Multicenter pathological study of chronic pancreatitis. Morphological regional variations and differences between chronic calcifying pancreatitis and obstructive pancreatitis.

To examine previous work carried out at a single center, i.e., France, on the pathologic features of chronic pancreatitis and to examine geographic differences, 359 cases of chronic pancreatitis from five centers were studied pathologically and the results analyzed according to appropriate statistical methods. It was found that it was easy to separate chronic calcifying pancreatitis from obstructive pancreatitis occurring distal to obstruction to the pancreatic duct by pathological means. On the other hand, geographic differences between France, Italy, Brazil, and South Africa, although present, were not sufficient for identification of a specific profile for each of the countries studied, and it was found that the minor differences were probably dependent on environmental rather than racial factors.

Brazil↗
PubMed1985

Disproportionate steatorrhoea in alcohol-induced calcific pancreatitis.

The pancreatograms, as assessed by endoscopic retrograde cholangiopancreatography, of 51 patients with alcohol-induced calcific pancreatitis (AICP), were compared after division of the patients into three groups according to their insufficiency patterns. The first group, consisting of 18 patients, was labelled as having 'disproportionate steatorrhoea' characterized either by overt steatorrhoea and mild or no diabetes or by mild steatorrhoea and a normal glucose tolerance test result. The second group of 15 patients had severe diabetes associated with overt, mild or no steatorrhoea and constituted the 'insufficiency' group. The third group consisted of 18 patients with little or no pancreatic insufficiency. Twelve of the 18 patients with disproportionate steatorrhoea had a proximal complete or incomplete obstruction of their main pancreatic ducts, compared with 3 out of 15 in the insufficiency group and 4 out of 18 in the group with little or no pancreatic insufficiency. In this study an increased incidence of complete or incomplete obstruction (P less than 0,002) was found in the patients with disproportionate steatorrhoea compared with the other two groups. This suggests that obstruction to pancreatic flow may account for the dominant clinical presentation of steatorrhoea in some patients with AICP.

Alcoholism↗
PubMed1985

Maintenance therapy with sucralfate reduces rate of gastric ulcer recurrence.

Seventy-two patients with recently healed gastric ulcers were entered into a double-blind, placebo-controlled, six-month maintenance trial to assess whether sucralfate, 1 g in the morning and 2 g at night, reduces the propensity for recurrent ulceration. Patients were assessed clinically at 0, 6, 12, 18, and 24 weeks. Endoscopy was performed at the time of entry into the study and at 24 weeks, or earlier if clinical relapse occurred during this period. Eleven patients were excluded from the study because they defaulted or for other protocol violations. The other 61 patients were followed for six months or until evidence of ulcer relapse. Endoscopic recurrence was found in five of 31 patients (16 percent) randomly assigned to receive sucralfate and in 21 of 30 patients (70 percent) assigned to receive placebo. Most recurrences occurred during the first 12 weeks, with relapse rates of 10 percent and 53 percent, respectively for the sucralfate- and the placebo-treated groups. Three of the recurrences noted at 24 weeks were asymptomatic; two of these were in the sucralfate-treated group. The results indicate that a 3 g per day maintenance dose of sucralfate offers meaningful protection against recurrent gastric ulceration.

Adult↗
PubMed1985

Importance of hypovolaemic shock and endoscopic signs in predicting recurrent haemorrhage from peptic ulceration: a prospective evaluation.

The incidence of rebleeding was studied prospectively in 177 patients with acute gastrointestinal haemorrhage from peptic ulceration with reference to the degree of haemodynamic insult on admission and the presence of endoscopic signs of recent haemorrhage on initial endoscopy. Rebleeding occurred in two (2%) of 114 patients without shock, in seven (18%) of 38 with tachycardia (pulse rate greater than 100 beats/min, systolic blood pressure greater than 100 mm Hg), and in 12 (48%) of 25 with shock (systolic blood pressure less than 100 mm Hg). A similar gradient was noted with the presence of endoscopic signs alone. Rebleeding occurred in four (5%) of 79 patients with no endoscopic signs, in none of 40 with black spot only, in 11 (23%) of 48 with a clot, and in five (50%) of 10 with a visible vessel on endoscopy. When the incidence of rebleeding was assessed in shocked patients, however, it was significantly higher in those with important signs (clot or visible vessel), in 11 (79%) out of 14 patients, than in those with no signs, in one (9%) out of 11 (p less than 0.001). These data suggest that the association of shock with important endoscopic signs is a stronger predictor of rebleeding than either shock or important signs alone. More aggressive treatment may be warranted in this small group of patients.

Adult↗
PubMed1985

Recurrence of duodenal ulceration in patients on maintenance sucralfate. A 12-month follow-up study.

A single-blind, 1-year follow-up study of 70 patients with recently healed duodenal ulcers was undertaken to assess the value of sucralfate (Ulsanic; Continental Ethicals) in preventing recurrence and to establish the lowest dose required to achieve this. Endoscopy was repeated on clinical relapse and routinely at 6 and 12 months. Fifty of the 70 patients were followed up for 12 months or to recurrence proved on endoscopy; the remaining 20 patients were excluded from analysis because of default or protocol violation. Endoscopic evidence of recurrence was found in 6 of 19 patients (32%) given sucralfate 1 g twice a day (group B), in 7 of 15 (47%) on sucralfate 1 g at night (group A), and in 13 of 16 controls (81%). The recurrence rates in groups A and B were significantly lower than in the control group (P less than 0,05 and P less than 0,005 respectively), and there was a significant gradient between the number of patients in remission at 12 months and the amount of medication (P less than 0,05).

Adult↗
PubMed1985

Endoscopic manometry of the pancreatic duct and sphincter zone in patients with chronic pancreatitis.

A possible mechanism for pain in alcohol-induced chronic pancreatitis is increased pancreatic duct pressure. A study has been done to compare sphincter of Oddi and pancreatic duct pressures in normal controls and patients with alcohol-induced chronic pancreatitis who had recently had pain or who were pain-free. Pressures were measured in the sphincter of Oddi in 10 controls and 33 patients, in the pancreatic duct in six controls and 15 patients, and in the common bile duct in four controls and five patients during station pull-through at the time of an endoscopic retrograde cholangiopancreatogram. There was no significant difference in the mean pressures in the pancreatic duct, sphincter of Oddi (basal and phasic), and frequency of papillary contraction when comparing patients with alcoholic pancreatitis and controls. There was also no difference between patients with or without pain and patients with or without strictures. This study has not confirmed the hypothesis that increased pancreatic duct pressures may be incriminated as a possible mechanism of pain in alcoholic-induced chronic pancreatitis.

Alcoholism↗