Search PubMed⌕ Search

Biomedical subjects

M G Korman

Publications and source records attributed to M G Korman.

At least 55 records · Page 3Linked to original sources
PubMed1984

Ranitidine and cimetidine in prevention of duodenal ulcer relapse. A double-blind, randomised, multicentre, comparative trial.

In a comparative trial of preventive medication for duodenal ulceration with 51 participating centres, 484 patients were recruited for a year's maintenance treatment with the recommended bedtime dose of ranitidine (150 mg; n = 243) or cimetidine (400 mg; n = 241). These outpatients had recently healed duodenal ulcers, confirmed by endoscopy before and after healing, and ulcer relapse was monitored by endoscopy every 4 months. The distribution of factors likely to influence ulcer recurrence was similar in the two treatment groups. A life-table method of analysis showed that the ulcer relapse rate was consistently and significantly lower on ranitidine that on cimetidine (8% v 21%, p = 0.0018 at 4 months; 14% v 34%, p less than 0.0001 at 8 months; and 23% v 37%, p = 0.004 at 12 months). Crude relapse rate calculations, which underestimate the probability of ulcer recurrence, also confirmed the significant superiority of ranitidine 150 mg over cimetidine 400 mg nightly in preventing ulcer recurrence throughout the year.

Adult↗
PubMed1984

Cholestyramine induced hyperchloremic metabolic acidosis.

The first reported case, in an adult, of cholestyramine induced hyperchloremic metabolic acidosis is a 70 year old female with a two year history of primary biliary cirrhosis confirmed by histologic and immunologic criteria. After taking cholestyramine II sachets twice daily for two months she presented with lethargy, confusion and drowsiness. Examination revealed confusion, jaundice, signs of chronic liver disease, portal hypertension and hepatic encephalopathy. Laboratory investigations confirmed a metabolic acidosis (pH 7.15) and hyperchloremia. Multiple cultures failed to reveal sepsis and a urinary pH of 4.85 together with tests of renal acidification, excluded renal tubular acidosis. She received 600 mEq of sodium bicarbonate intravenously over 36 hours by which time her mentation, electrolytes and pH were normal. It is presumed that her hyperchloremic metabolic acidosis was secondary to cholestyramine because of the similarity to pediatric reports; the rapid and lasting response to intravenous sodium bicarbonate; the absence of another etiology; normal serum potassium, chloride and bicarbonate despite continued spironolactone therapy after recovery.

Acidosis↗
PubMed1983

Reduction in mortality from upper gastrointestinal haemorrhage.

A study of 2377 cases of haemorrhage from the upper gastrointestinal tract shows a significant fall in mortality rate--from 15.5% in the period of retrospective study from 1961 to 1970 to 7% in the prospective study from 1972 to 1982. The fall in mortality rate from non-variceal bleeding was from 12.8% to 5%. In the second five years of the prospective study, the total mortality rate was 5.8%, with 4.5% for non-variceal haemorrhage. This improvement occurred despite a significant rise in the proportion of patients of 60 years of age and over, and was particularly evident in patients with bleeding chronic gastric ulcers. There was also a significant reduction in mortality in the 60 years and over age group in the latter five years of the prospective study. The data suggest that there were three aspects of management which were important in the reduction of mortality. These were early fibreoptic endoscopic diagnosis, improved resuscitation and postoperative care, and early control of bleeding from oesophageal varices by balloon tamponade and surgery in selected cases. These complicated procedural aspects of management are best applied in a special unit for the treatment of patients with haemorrhage from the upper gastrointestinal tract. It is concluded that there has been significant progress in the treatment of this problem during the last decade.

Age Factors↗
PubMed1983

The influence of smoking on the healing of duodenal ulcer treated with oxmetidine or cimetidine.

The influence of smoking on duodenal ulcer healing was examined during a double blind study of 83 patients randomly allocated to oxmetidine or cimetidine treatment. Smoking habits were recorded but patients were not advised to change these. Smokers and nonsmokers were similar clinically and did not differ in compliance with medication. Both H2-receptor antagonists were equally effective and after four weeks of treatment ulcers were healed in 76% of patients. Ulcer healing occurred significantly less frequently in smokers (69%) than nonsmokers (89%). Smokers with healed ulcers consumed fewer cigarettes per day (mean +/- SE: 15.8 +/- 1.4) than those whose ulcers did not heal (22.2 +/- 2.7). When smokers were grouped according to daily cigarette consumption, a direct relationship was found between increasing cigarette consumption and decreasing frequency of ulcer healing. No reduction in ulcer healing was apparent in patients who smoked nine cigarettes a day, or less.

Cimetidine↗
PubMed1983

Collagenous colitis: a recently recognised reversible clinicopathological entity.

A case of collagenous colitis is reported in an 86 year old man who presented with watery diarrhea. This case differs from previous reports in that five of the six reported cases involved women, mostly in their mid-forties, and that previously the collagenous band has been demonstrated in the mucosa of the left side of the colon only. This case is the first report to demonstrate the collagenous band in the right side of the colon as well as the left, and is the thickest band reported to date. In keeping with the two reported cases with follow-up, the subepithelial collagenous band was shown to have disappeared three months after the initial biopsy with a corresponding clinical improvement after symptomatic treatment only. The diagnosis needs to be considered in all patients presenting with watery diarrhea, and can only be confirmed after rectal or colonic biopsy.

Aged↗
PubMed1983

Influence of cigarette smoking on healing and relapse in duodenal ulcer disease.

There are conflicting reports on the influence of cigarette smoking on healing in patients with duodenal ulcer; some studies show an adverse effect on healing rate and others no effect. This study reports the influence of smoking on short-term healing and relapse rate in 135 patients with duodenal ulcer who were treated with cimetidine (90), ranitidine (25), and oxmetidine (20), all powerful H2-receptor antagonists. Ulcer healing and relapse were documented endoscopically and all studies were performed in a double-blind manner. In the short term, 95% of nonsmokers healed compared with 63% smokers (p less than 0.01) and there was a positive correlation between failure to heal and number of cigarettes smoked. During a 12-mo follow-up examination after healing and on no treatment, 53% of nonsmokers and 84% of smokers relapsed (p less than 0.01). These results show that smoking adversely affects healing of duodenal ulcer with H2-receptor antagonists and that continued smoking leads to a higher relapse rate.

Adolescent↗
PubMed1983

Management of upper gastrointestinal haemorrhage.

Upper gastrointestinal haemorrhage is a life threatening situation. Peptic ulcer disease, oesophageal varices and Mallory-Weiss tear are the major causes. Initial management usually includes hospital admission and, ideally, care by a specialized team involving Physician, Surgeon and Nursing Staff. Prompt and adequate blood replacement is the most important measure followed by diagnosis, usually based on flexible endoscopy. Specific treatment protocols for peptic ulcer and oesophageal varices aid definitive management. Prognosis is influenced by age, presence of complicating disease, aetiology and the severity of the bleed.

Adult↗
PubMed1982

Twice-a-day dosage of cimetidine in the short-term treatment of peptic ulcer.

The effect of cimetidine (400 mg twice a day) on the short-term healing of chronic peptic ulcer is reported. In benign gastric ulcer, 17 of 25 patients (68%) healed in six weeks and 23 of 25 patients (92%) by 12 weeks. In duodenal ulcer, 33 of 42 patients (80%) healed in six weeks and 40 of 42 patients (95%) by 12 weeks. In stomal ulcer after a previous Polya gastrectomy, eight of 10 patients (80%) healed in six weeks and 10 of 10 patients (100%) by 12 weeks. In this study, the cimetidine regimen of 400 mg twice a day has produced healing rates in gastric, duodenal or stomal ulcer which compare favourably with those reported for the currently recommended regimen of 200 mg three times a day and 400 mg at night. Twice a day dosage is likely to improve patient compliance, costs less, and may reduce dose-related side effects. Perhaps 400 mg of cimetidine twice a day should become the recommended dosage for the initial treatment of peptic ulcer.

Adult↗
PubMed1982

Management of bleeding oesophageal varices: an eight-year prospective study.

Ninety-one patients (56 men) were admitted with bleeding oesophageal varices on 132 occasions from 1972 to 1980 to the haematemesis and melaena unit of Prince Henry's Hospital, Melbourne. For 73 patients, alcoholic liver disease was the cause of portal hypertension. The management protocol for varices included early endoscopy, medical-surgical liaison, balloon tamponade for continued bleeding and strict criteria for surgery. The endoscopic diagnosis rate was 92%. There were 24 deaths (26%) during the initial admission to hospital and a further 12 patients (13%) died within one year. The mean transfusion requirement was 9.7 units per admission. Balloon tamponade was necessary on 103 occasions and failed to control bleeding on six of them. The results suggest that mortality from bleeding oesophageal varices can be reduced by a protocol which includes early endoscopy, intensive care, balloon tamponade, close medical-surgical liaison and portacaval shunt for recurrent bleeding in "good' risk patients.

Adult↗
PubMed1982

An 8-year prospective experience with balloon tamponade in emergency control of bleeding esophageal varices.

The use of balloon tamponade in the emergency control of bleeding from esophageal varices is controversial. This paper reports a prospective study over an 8-year period in which balloon tamponade has been the sole means employed for the early control of bleeding varices. During 1972-1980 all patients referred to Prince Henry's Hospital with upper gastrointestinal bleeding were admitted to a special unit. Ninety-one had bleeding esophageal varices, and 17 were admitted on one or more occasions for bleeding for a total of 132 admissions. After early endoscopy, balloon tamponade was used during 103 of these admissions with failure to control bleeding on six occasions; five of these patients died from hemorrhage and the sixth recovered after emergency portacaval shunt. Another patient died from rebleeding not treated by tamponade. Reinsertion of the balloon for rebleeding was necessary on 28 occasions with successful control in all cases. Balloon tamponade was not used during 29 admissions because bleeding had ceased or the patient was considered to have terminal liver disease. In this group there were four deaths from severe liver disease and hemorrhage. Balloon tamponade was used in 78% of admissions and controlled bleeding in more than 90% of patients. This suggests that tamponade may be the method of choice early control of bleeding from esophageal varices.

Adult↗
PubMed1982

Ranitidine in duodenal ulcer: incidence of healing and effect of smoking.

The effect of ranitidine, a new H2-receptor antagonist, on the healing of duodenal ulcer has been assessed in a double-blind study. Fifty patients with endoscopically proven duodenal ulcer were randomly assigned to ranitidine 150 mg twice daily or placebo for 4 weeks. Endoscopic examination at this time showed that 20 of 25 patients (80%) on ranitidine healed compared to 4 of 25 patients (16%) on placebo (P less than 0.01). Smoking adversely affected the incidence of healing: 70% of nonsmokers healed compared to 30% of smokers (P less than 0.03). There were no side effects noted on ranitidine. Review at 6 months after cessation of therapy showed relapse of duodenal ulcer in 10 of 20 patients (50%) healed with ranitidine and 1 of 4 patients (20%) healed with placebo. Thus, ranitidine (300 mg/day) produces similar healing rates to those reported for cimetidine (1000 mg/day); also like cimetidine, the incidence of healing on ranitidine is adversely influenced by smoking and the relapse rate on cessation of therapy is high.

Adult↗
PubMed1981

Influence of smoking on healing rate of duodenal ulcer in response to cimetidine or high-dose antacid.

Fifty consecutive patients with symptomatic endoscopically proven duodenal ulcer were randomized double-blind to Mylanta II or cimetidine treatment schedules. Smoking habits were noted, but patients were not advised to alter these. Healing was determined by reendoscopy at 6 wk. Eighty percent of patients on active cimetidine and 52% on active Mylanta II had healed at 6 wk (not significantly); 85% of nonsmokers healed compared to 44% of smokers (p less than 0.03). In smokers, cimetidine achieved healing in 50%, Mylanta II in 39% (not significantly); while in nonsmokers, cimetidine achieved healing in 100%, Mylanta II in 67% (not significantly). These results indicate a significant and equally adverse effect of smoking on the healing rate of duodenal ulcer achieved by either cimetidine or Mylanta II.

Adolescent↗
PubMed1980

Relapse rate of duodenal ulcer after cessation of long-term cimetidine treatment: a double-blind controlled study.

Patients with a healed duodenal ulcer and who were symptom-free following 12 months of maintenance treatment with cimetidine 400 mg twice daily were randomized double-blind to a further 6 months therapy with either cimetidine 400 mg twice daily or placebo 2 tablets twice daily. Twenty-six patients received placebo and 15 patients cimetidine. Relapse was defined as symptoms for 3 out of 7 consecutive days and ulcer recurrence was confirmed by independent endoscopy. One of 15 patients on cimetidine relapsed: 20 of 26 patients on placebo relapsed. This relapse rate (77%) is similar to that found in previous studies after only 6 weeks cimetidine therapy (71%). This study suggests that 12 months cimetidine does not change the tendency of duodenal ulcer to recur and that the relapse rate is no greater than after 6 weeks cimetidine.

Adolescent↗
PubMed1980

Pancreatic polypeptide. Release following surgery for duodenal ulcer disease.

The pancreatic polypeptide (PP) response to food has been measured by radioimmunoassay in patients with duodenal ulcer and 3 months following proximal gastric vagotomy (PGV), 18 and 49 months following truncal vagotomy and pyloroplasty (TV), 35 months following Billroth II gastrectomy (BII), and 35 months following truncal vagotomy and antrectomy (TV&A). Basal PP levels and those in response to food were similar in DU and PGV, but these values were significantly higher than those 18 months or 49 months after TV, or after BII and TV&A. The responses in the latter four groups were similar and in particular, the levels 18 and 49 months after TV were the same. These results indicate that the release of PP by food in unoperated patients consists of two phases, a primary phase which requires both intact vagi and an intact stomach and a secondary phase which also depends on vagal innervation and normal gastric anatomy. Disturbances in vagal innervation or gastric integrity lead to profound changes in PP release which may be due to interruption of neural arcs or loss of gastric hormones. Unlike others, we have been unable to document a return of PP secretion towards normality with time after TV.

Adult↗
PubMed1980

The management of bleeding gastric ulcer: a prospective study.

In a prospective study of six years' experience with a haematemesis and melaena unit from 1972 to 1978, there were 98 admissions of patients with bleeding gastric ulcer. There were ten deaths, giving a mortality of 11%. Forty-one patients were treated by emergency surgery with seven deaths, an operative mortality of 17%. All ten deaths occurred in the first four years; there were no deaths during the final two-year period (38 admissions). In retrospective studies at Prince Henry's Hospital, Melbourne, it was found that the mortality for bleeding gastric ulcer was 17% to 18% for the period 1951 to 1970. It is concluded that a prospective system of management with an active policy of early endoscopy and surgery and regular audit of results reduces the mortality from bleeding gastric ulcer.

Female↗
PubMed1980

Acute gastric ulceration--a prospective study of incidence and results of management.

During a prospective six year study from 1972-1978 there were 894 admissions to a haematemesis and melaena unit. In 162 admissions bleeding was due to acute gastric ulceration, an incidence of 18%. The group comprised 157 patients, five patients being admitted on two occasions. There were 12 deaths (7%), seven after surgery and five in conservatively treated patients. A significant fall in incidence of admissions was noted in the final two year period of study. The reason for this is unknown as no other cause of haematemesis and melaena showed a similar fall in incidence. In addition over this two year period patients with acute ulceration followed a more benign course and required surgery less often.

Australia↗