Biomedical subjects

R Mårvik

Publications and source records attributed to R Mårvik.

At least 19 recordsLinked to original sources

PubMed2003

Effect of carbon dioxide pneumoperitoneum on tissue blood flow in the peritoneum, rectus abdominis, and diaphragm muscles.

BACKGROUND: Changes in local blood flow may play a role in the pathogenesis of port-site metastasis. This study aimed to investigate the effect of pneumoperitoneum induced by carbon dioxide (CO2) on the blood flow in the peritoneum and abdominal wall muscle layers, which are target structures for this phenomenon. METHODS: The study was performed on domestic farm swine of both genders weighing 20 to 25 kg. Intraabdominal pressures (IAP) of 0, 5, and 10 mmHg were produced by either CO2 ( n = 9) or helium (He) ( n = 6) insufflations. The colored microsphere technique was used to measure blood flow distributions in the parietal peritoneum, rectus abdominis, and diaphragm muscles. RESULTS: Insufflation of CO2 was associated with a threefold increase in blood flow of the parietal peritoneum at both 5 and 10 mmHg IAP ( p < 0.001 for both pressure levels). In contrast, insufflation of He caused a significant decrease in blood flow in the parietal peritoneum at both 5 and 10 mmHg ( p < 0.05). In the rectus abdominis and diaphragm muscles, blood flow remained unchanged after insufflation of CO2 at both 5 and 10 mmHg IAP. However, after insufflation of He, there was a substantial decrease in blood flow both in the rectus abdominis and diaphragm muscles at both 5 mmHg ( p < 0.01 and p < 0.05, respectively) and 10 mmHg ( p < 0.001 and p < 0.01, respectively). CONCLUSIONS: Despite high intraabdominal pressure, tissues surrounding the abdominal cavity, particularly the peritoneum, respond to insufflation of CO2 with increased blood flow, which may favor the growth of tumor cells.

Animals↗

PubMed2003

3D ultrasound-based navigation for radiofrequency thermal ablation in the treatment of liver malignancies.

BACKGROUND: The aim of the study was to compare three methods for ultrasound-based guidance of a radiofrequency probe into liver tumors in a model setup. METHODS: The liver model tumors were placed inside excised calf livers, and the radiofrequency probe was guided into the center using either a new 3D navigation method or two conventional 2D methods-freehand scanning and a method based on a biopsy guide. We performed 54 experiments, measuring the physical distance (all methods) and image distance (3D method only) from the tip of the probe to the center of the tumors. RESULTS: Based on the physical measurements alone, the biopsy-based guiding performed better than both the 2D freehand and the 3D navigation method. However, the 3D image measurements showed that the tip of the probe was better positioned in the center of the model tumors for the 3D navigation method as compared to the physical measurement results for the 2D methods. CONCLUSION: Although it was easier to position the radiofrequency probe accurately using the 3D image display technique, movement of the model tumor during 3D navigation is a challenge.

Animals↗

PubMed2002

Laparoscopic antiperistaltic versus isoperistaltic gastrojejunostomy for palliation of gastric outlet obstruction in advanced cancer.

The purpose of the study was to compare the impact of the peristaltic orientation of laparoscopic gastrojejunal anastomoses (LGJ) in patients with malignant gastric outlet obstruction (GOO) on postoperative delayed-return gastric emptying (DRGE) rates. GOO was defined as complete holdup of contrast at barium meal and/or failure of gastroscope to pass beyond stricture. DRGE was defined as inability to eat regular diet by day 10. Thirty-four patients undergoing antiperistaltic LGJ were compared with 21 patients undergoing isoperistaltic LGJ at two institutions during the same period. Thirty-day mortality was 5.4%, and median survival was 6.2 months. Thirty-day morbidity was 20%, and conversion rate was 3.6%. DRGE rates were increased after isoperistaltic LGJ (0 vs. 3; P < 0.05), but patient groups were not well matched for type of primary cancer (P < 0.05). All patients with DRGE resumed food intake 12 to 16 days after surgery. There were 21 admissions before death, with a reoperation rate of 11.5% and a recurrent GOO rate of 3.8%. Although no conclusions could be drawn about whether the peristaltic orientation of the anastomosis had a bearing on DRGE rates, LGJ resulted in an overall 6% rate of DRGE.

Aged↗

PubMed2001

Effect of increased intraabdominal pressure on cardiac output and tissue blood flow assessed by color-labeled microspheres in the pig.

BACKGROUND: Studies of the hemodynamic effects associated with the pneumoperitoneum have had controversial results. We set out to investigate the effect of increased intraabdominal pressure (IAP) on cardiac output and tissue blood flow in various intraabdominal and extraabdominal organs using the color-labeled microsphere (CLM) technique. METHODS: IAP was induced by CO2 insufflation in anesthetized pigs; 0, 5, and 10 mmHg was used in the low-pressure group and 0, 15, and 24 mmHg in the high-pressure group. Tissue blood flow (ml.min-1.g-1) and cardiac output (CO) (ml/min) were determined by the CLM technique. RESULTS: CO decreased at IAP > or = 15 mmHg. Arterial PaCO2 and hydrogen ion concentration increased in response to all levels of IAP. Arterial PaO2, oxygen saturation, and bicarbonate ion concentration remained unchanged. Low IAP did not influence tissue blood flows in most of the organs. However, in the spleen, pancreas, esophagus, and gastric mucosal specimens, tissue blood flow was significantly decreased at 24 mmHg. CONCLUSION: The level of IAP used in current practice (10-12 mmHg) appears to be safe with regard to hemodynamic variables and tissues blood flow; however, higher levels may induce a decrease in cardiac output and tissue blood flow.

Animals↗

PubMed2000

Initial experience with stereoscopic visualization of three-dimensional ultrasound data in surgery.

Initial in vivo and in vitro experiments were performed to evaluate the feasibility of stereoscopically displaying three-dimensional (3D) ultrasound data from neurosurgery, laparoscopic surgery, and vascular surgery. Stereoscopic visualization was illustrated by four video sequences, which can be downloaded from http://www.us.unimed. sintef.no/. These sequences show a brain tumor, hepatic arteries in relation to the gallbladder, a model that mimics a neuroendoscope in a cyst, and a "flight" into model of an artery with an intima flap. The experiments indicate that stereoscopic display of ultrasound data is feasible when there is sufficient contrast between the objects of interest and the surrounding tissue. True 3D vision improves perception, thus enhancing the ability to understand complex anatomic structures such as irregular lesions and tortuous vessels.

Filtration↗

PubMed2000

Oxyntic lesions may be provoked in the rat both by the process of acid secretion and also by gastric acidity.

BACKGROUND: Gastric ischaemia appears to be a common pathogenetic factor for stress ulcers. These ulcers occur predominantly in the oxyntic mucosa, suggesting that the acid secretory process or its stimulation is involved in the pathogenesis. METHODS: We examined separately the role of the acid secretory process and gastric luminal acidity in the pathogenesis of gastric lesions using the isolated vascularly perfused acid-secreting rat stomach. RESULTS: Pentagastrin-stimulated acid secretion induced submucosal bleeding in the oxyntic mucosa whether accompanied by perfusion of the gastric lumen with saline or a phosphate buffer at pH 7.0. On the other hand, acidity, whether endogenous or introduced by luminal perfusion, induced erosions in both the oxyntic and antral mucosa. CONCLUSION: It is concluded that the acid secretory process itself contributes to the particular vulnerability of the oxyntic mucosa to ischaemia. Histamine released upon stimulation of gastric acid secretion or shortage of energy due to the requirements for acid secretion may both contribute to this vulnerability. Furthermore, these findings suggest that inhibition of gastric acid secretion should be superior to antacids in preventing stress ulcers.

1-Methyl-3-isobutylxanthine↗

PubMed2000

A comparative experimental study evaluating the performance of surgical robots aesop and endosista.

The aim of this study was to experimentally assess and compare the accuracy of the surgical robots Aesop and Endosista as camera holders for use in laparoscopic surgery. The performance of these two robotic systems was examined for linear (upwards, downwards, diagonal), complex, and "in and out" movements using laparoscopic training boxes. Standard distances and tests were used for each system, and the time required to achieve each task was measured. The majority of the linear movements of the verbal and preprogrammed modes of Aesop were quicker than those of Endosista. Diagonal movements were significantly faster with the preprogrammed-mode Aesop. Complex or three-dimensional movements were also significantly faster with both modes of Aesop than with Endosista. Under the experimental conditions, Aesop, particularly in the preprogrammed mode, is quicker and more accurate than Endosista.

Evaluation Studies as Topic↗

PubMed1999

Open vs laparoscopic repair of perforated peptic ulcer.

BACKGROUND: Most studies have found that the only advantage to the laparoscopic treatment of perforated peptic ulcer is a reduced need for postoperative analgesia. Therefore, we set out to assess the short-term outcome of open (OR) versus laparoscopic (LR) repair of perforated peptic ulcer. METHODS: A total of 62 consecutive OR patients were compared with a concurrent cohort of 17 diagnosis-matched LR controls treated at the same hospital between 1991 and 1996. RESULTS: The OR and LR patients were comparable for age, weight, American Society of Anesthesiologists (ASA) grade, Acute Physiology and Chronic Health Evaluation (APACHE II) score, Boey score, ulcer site, Mannheim Peritonitis Index (MPI), delay of surgery, Helicobacter pylori infection, nonsteroidal antiinflammatory drug (NSAID) intake, and previous abdominal surgery. More LR than OR patients were operated on by staff surgeons (chi2 = 46.9, 1 d.f., p << 0.01). Mortality (OR: 12, LR: two), morbidity (OR: eight, LR: two), estimated blood loss (OR: 120 ml, LR: 95 ml), solid food intake resumption (OR: 5 days, LR 4 days), NSAID consumption (OR: 2,225 mg, LR: 1,815 mg), delayed gastric emptying (OR: two, OR: one), and hospital stay (OR: 9 days, LR: 7 days) were not significantly different for the two groups. Four LR patients (23. 5%) were converted to OR due to failure to progress (n = 3) or posterior perforation (n = 1). Operating time was shorter in OR patients (65 min versus 92 min, p << 0.01). LR patients had reduced opioid consumption (256 mg versus 134 mg, p << 0.01). One LR and 16 OR patients were lost to follow-up. Median follow-up was 14 months (range, 2-55) and 18 months (range, 1-62) in OR and LR patients, respectively. There were more LR than OR patients with Visick score I (p = 0.002) and more OR than LR patients with Visick score II (p = 0.0001). Scores III and IV did not differ significantly. CONCLUSION: The laparoscopic repair of perforated peptic ulcer does not yield any additional benefits over the open repair.

Adult↗

PubMed1999

Selective endoscopic retrograde cholangiography prior to laparoscopic cholecystectomy for gallstones.

BACKGROUND: To assess the outcome of endoscopic retrograde cholangiography (ERC) before laparoscopic cholecystectomy (LC) for symptomatic gallbladder and suspected duct stones. METHODS: During 3 years, one or more of four criteria led to ERC: jaundice, choledocus >8 mm, cholestasis, and severe biliary pancreatitis. Endoscopic extraction (ESE) of ductal stones was attempted before LC. RESULTS: In all, 990 patients were prospectively included. There were no exclusions. There were no deaths. A multivariate logistic regression analysis identified jaundice (P = 0.001), pancreatitis (P = 0.001), and cholestasis (P = 0.001) as statistically significant predictors of ductal stones. Choledocus >8 mm was not a significant predictor (P = 0.12). A total of 155 (16%) patients underwent ERC for suspected stones: 21 of 155 (13%) patients had no stones; and 6 of 134 (4%) patients had stone impaction cleared at open surgery. ERC clearance rate was 95% (128 of 134). LC was performed in 149 of 155 patients after a median interval of 3 days (range 1 to 7). Morbidity rates were 3% (4 of 134), 2% (3 of 149), and nil (0 of 6) after ESE, LC, or open surgery, respectively. Median hospital stay was 11 days. A total of 835 patients underwent LC with a 1.5% complication rate. Laparoscopic fluoro-cholangiography showed < or =3 mm-sized stones in 10 of 835 (1.2%) patients. No stones were reported at a median follow-up of 4 months including 990 patients. CONCLUSIONS: Ninety-five percent of patients with ductal stones can be successfully and safely managed by ERC prior to LC.

Adolescent↗

PubMed1998

Carbachol stimulation of gastric acid secretion and its effects on the parietal cell.

1. The acid secretagogue effect of gastrin is mainly mediated by the release of enterochromaffin-like (ECL) cell histamine, but the mechanism of muscarinic stimulation of acid secretion remains unclear. The results of studying aminopyrine uptake in isolated parietal cells, and histamine release in isolated ECL cells suggest that muscarinic agents may act both directly on the parietal cell and indirectly via histamine release from ECL cells. 2. We examined parietal and ECL cell responses to the muscarinic agent carbamylcholine (carbachol) in conscious rats and in rat isolated vascularly perfused stomachs. 3. Intravenous carbachol stimulated acid secretion in conscious gastric fistula rats and increased H+K+ ATPase mRNA abundance, indicating activation of parietal cells. In these experiments there was no increase in portal venous histamine, or in oxyntic mucosal histidine decarboxylase (HDC) enzyme activity and HDC mRNA abundance. 4. In rat isolated stomachs stimulated with carbachol in the dose range 10 nM(-1) mM only the 1 microM concentration increased venous histamine significantly. 5. We concluded that the muscarinic agent carbachol stimulates acid secretion and H+K+ ATPase mRNA in vivo by a direct effect on the parietal cell, that does not depend on the release of ECL cell histamine.

Animals↗

PubMed1998

Open versus laparoscopic gastrojejunostomy for palliation in advanced pancreatic cancer.

To assess short-term outcome of open (OGJ) versus laparoscopic (LGJ) gastrojejunostomy in palliation of gastric outlet obstruction (GOO) caused by advanced pancreatic cancer, 22 OGJ patients were compared with 9 diagnosis-matched LGJ controls operated on at the same hospital between 1991 and 1996. Patients undergoing OGJ and LGJ were comparable for age, gender, weight, American Society of Anesthesiologists grading, and previous extensive abdominal surgery, but not for gastroenterostomy performed as a prophylactic procedure (9 vs. 0, respectively). Mortality (5 vs. 1, p = 1.5), overall morbidity (9 vs. 3, p = 0.42), operating time (113.6 +/- 24.5 minutes vs. 125 +/- 15.2 minutes, p < 0.5), time to oral solid food intake (7.2 +/- 0.9 days vs. 5.3 +/- 1.3 days, p < 0.5), nonsteroidal anti-inflammatory drug consumption (7,563.6 +/- 3,381.3 mg vs. 2,044 +/- 673 mg, p < 0.5), opioid consumption (688.5 +/- 258.6 mg vs. 2,910.5 +/- 2,659.9 mg, p < 0.5), delayed-return gastric emptying (5 vs. 1, p = 0.12), postoperative hospital stay (14.6 +/- 1.9 days vs. 10.1 +/- 1.8 days, p < 0.5), survival (5.7 +/- 0.8 months vs. 4.6 +/- 0.6 months, p < 0.5), and further hospital stay before death (9.8 +/- 3.3 days vs. 11.6 +/- 3.4 days, p > 0.5) were not significantly different in 22 OGJ and 9 LGJ patients, respectively. Estimated blood loss was significantly lower in LGJ patients (270.2 +/- 45.8 ml vs. 66 +/- 15.7 ml, p < 0.01). When 13 of 22 patients undergoing OGJ for treatment were compared with 9 LGJ patients, only estimated blood loss (p < 0.01) and hospital stay (p < 0.05) were significantly reduced in LGJ patients. Recurrent GOO before death occurred in one patient (1 of 22, 4.5%) 9 months after OGJ. LGJ for palliative treatment of GOO in advanced pancreatic cancer offered (in spite of the learning curve) reduced estimated blood loss and hospital stay when compared with OGJ.

Aged↗

PubMed1997

[Laparoscopic sigmoidectomy].

The laparoscopic approach has emerged as an alternative to trephine stoma construction. In the present series, eight patients underwent laparoscopic faecal diversion. We performed two endsigmoidostomies and six sigmoid loop ostomies. Indications for diversion included inoperable obstructing pelvic carcinoma in three patients, perianal fistulas in another three--and faecal incontinence in one patient. A temporary loop-sigmoidostomy was performed in one patient after anal sphincteroplasty. Three or four ports were used. After mobilisation, the sigmoid colon was pulled through the abdominal wall. When an end-sigmoidostomy was performed the bowel was transected intra-abdominally. There were no operative complications and all stomas functioned early and well. Laparoscopic sigmoidostomy is safe and allows intra-abdominal exploration and mobilisation of the colon without the inconvenience of a mid-line surgical wound.

Adult↗

PubMed1997

Gastrin stimulates histamine release from the isolated pig stomach.

BACKGROUND: Gastrin has been shown to give an immediate and dose-dependent histamine release preceding acid secretion in the totally isolated, vascularly perfused rat stomach. METHODS: In the present study we prepared isolated, vascularly perfused stomachs taken from pigs and examined the effect of pentagastrin in a concentration of 520 pM on the histamine release to the vascular bed. Pentagastrin was given for three 5-min periods at 10-min intervals, and histamine was determined by a radioimmunoassay method. RESULTS: Each pentagastrin dose resulted in stimulation of histamine release in the three pig stomachs examined. The various histamine concentrations increased to levels previously shown to stimulate aminopyrine accumulation in isolated pig parietal cells. CONCLUSION: The present study shows for the first time that gastrin induces histamine release to the vascular bed in the pig, as previously shown for the rat and dog.

Animals↗

PubMed1996

Gastrin-evoked secretion of pancreastatin and histamine from ECL cells and of acid from parietal cells in isolated, vascularly perfused rat stomach. Effects of isobutyl methylxanthin and alpha-fluoromethylhistidine.

The ECL cells in the rat stomach release pancreastatin and histamine in response to gastrin stimulation. The present study compares the release of pancreastatin and histamine from the ECL cells and the secretion of acid from the parietal cells in response to gastrin, and examines how a markedly reduced histamine content in the ECL cells will affect the gastrin-evoked release of pancreastatin and the secretion of gastrin acid. Totally isolated, vascularly perfused stomachs were prepared from fasted rats. Some of the rats had been pre-treated for 24 h with (alpha-fluoromethylhistidine (alpha-FMH), resulting in 80% depletion of oxyntic mucosal histamine (mainly ECL-cell histamine). The stomachs were perfused with rat gastrin-17, alpha-FMH, isobutyl methylxanthine (IBMX), or vehicle in various combinations for 8 h. The venous outflow was collected (30-min samples) for determination of histamine and pancreastatin-like immunoreactivity (LI) and the gastric luminal outflow was collected for determination of H+. Gastrin raised the outflow of pancreastatin-LI and histamine but did not raise the acid output unless IBMX was added. The outflow of pancreastatin-LI and histamine was greater after gastrin + IBMX (at least during the first 4-h period) than after gastrin alone. alpha-FMH reduced gastrin-evoked histamine outflow but did not affect gastrin-evoked pancreastatin-LI outflow. Also the acid output in response to gastrin + IBMX was much reduced by alpha-FMH. In conclusion, increased levels of intracellular cAMP enhanced the gastrin-evoked release of pancreastatin-LI and histamine from the ECL cells and made it possible for histamine, released from the ECL cells, to cause acid secretion from the parietal cells. ECL-cell histamine depletion reduced the gastrin-evoked acid secretion; it did not affect the gastrin-evoked release of pancreastatin-LI.

1-Methyl-3-isobutylxanthine↗

PubMed1996

[Transanal endoscopic microsurgery].

Transanal endoscopic microsurgery was introduced by Buess and co-workers in 1984 for transanal removal of tumours up to 20 cm above anus. In the present study, 18 transmural and two mucosal resections were performed for rectal adenomas (16) and early rectal cancer (4). Median operation time was 85 minutes (55-140 minutes) and the median postoperative stay in hospital was 3 days (1-5). All tumours were removed radically and in none was there tumour involvement of the resection margin. There were no serious complications. After a median observation time of 10 months (1-17 months) there have been no recurrences. Functional results are excellent; none of the patients have developed incontinence. It is concluded that transanal endoscopic microsurgery (TEM) is an adequate method for removal of benign rectal tumours and, in selected cases, early rectal cancer.

Adenoma↗

PubMed1995

Bioassay of gastrin using the isolated vascularly perfused rat stomach. A new, simplified and sensitive method.

Radioimmunoassays are sensitive and specific methods for measurement of the concentrations of regulatory peptides. However, aspects of physiological, pathophysiological and pharmacological research require knowledge about the biological activity which does not necessarily vary concomitantly with immunological activity. The present work describes a simplified bioassay for gastrin based on the gastric histamine releasing properties of this peptide, using an isolated vascularly perfused rat stomach preparation with a crystalline perfusate and a specific radioimmunoassay for histamine. The establishment of a dose-response curve is described, as well as the utilization of the bioassay on sera from patients with hypergastrinaemia. The method is sensitive for gastrin in the low (4 pmol L-1) picomolar range.

Anemia, Pernicious↗

PubMed1995

Neuroendocrine differentiation in colorectal carcinomas.

OBJECTIVE: To evaluate neuroendocrine differentiation in tumours from patients with colorectal carcinomas by immunostaining with antibodies against human chromogranin A (CgA) and neuron-specific enolase (NSE), and to correlate these finding with serum levels of CgA and pancreastatin-like immunoreactivity (PST-LI). We also investigated the degree of neuroendocrine differentiation found in colorectal carcinomas of different embryonic origins (hindgut and midgut). PATIENTS AND METHODS: The presence of CgA and NSE in tumours from 91 patients with colorectal carcinoma was investigated using immunohistochemistry; levels of CgA and PST-LI in sera from 55 of these patients were determined using radioimmunoassays. RESULTS: Immunostaining for CgA and NSE was found in 15 and 36% of tumours, respectively. One or both markers of neuroendocrine differentiation were demonstrated in 40% of the colorectal carcinomas. In patients who died during the study, 23 and 51% expressed CgA and NSE in their tumours, respectively, while the corresponding values in survivors were 11 and 27% (P = 0.14 and P = 0.025, respectively). The median survival time tended to be lower in patients with neuroendocrine differentiation of their tumours than in those without such differentiation (P = 0.1). The expression of NSE was significantly higher in colorectal carcinomas derived from the midgut than in those of hindgut origin. Elevated serum levels of CgA and PST-LI were found in 38 and 43% of the patients, respectively; 62% had elevated levels of one or both markers. Of the patients with elevated serum levels of CgA or PST-LI, 44% had positive immunohistochemistry for either NSE or CgA compared with 29% of those with normal serum levels of CgA and PST-LI (P = 0.27). Serum levels of CgA were increased in a significantly higher percentage of patients with colorectal carcinomas of midgut than of hindgut origin (63 and 28%, respectively, P = 0.03). Of patients with hindgut-derived carcinomas who died during the study, 64% had raised serum values of CgA compared with 19% of those who survived (P = 0.023). The corresponding figures for PST-LI elevation were 75 and 44%, respectively (P = 0.096). In the midgut group, no difference was demonstrated for these parameters between survivors and non-survivors. CONCLUSION: Neuroendocrine differentiation was demonstrated in 40% of the colorectal carcinomas investigated and was more frequent in midgut-derived carcinomas than in those of hindgut origin. We have shown for the first time that serum levels of CgA and PST-LI are elevated in patients with colorectal carcinomas. In accordance with previous studies, our data support the value of neuroendocrine differentiation as an indicator of poor prognosis; they also suggest a role for serum CgA and PST-LI as prognostic markers.

Biomarkers, Tumor↗

PubMed1994

The effect of tripotassium dicitrato bismuthate on the rat stomach.

BACKGROUND: Bismuth has been used as symptomatic treatment of dyspepsia for many years. It promotes healing of peptic ulcers and reduces their recurrence. The beneficial effect of bismuth on duodenal ulcer disease is thought to be due to an effect on Helicobacter pylori, although it has a rather weak bactericidal effect on H. pylori in vitro. Eradication of H. pylori in duodenal ulcer patients by a combination of bismuth, tetracycline and metronidazole has been reported to increase the density of somatostatin-producing D cells in the antrum. A reduced D cell density in the antral mucosa of duodenal ulcer patients could explain their exaggerated gastrin release. AIMS/METHODS: To test the possibility that bismuth could affect the neuroendocrine cells independently of the presence of H. pylori or not, we gave rats a diluted tripotassium dicitrato bismuthate solution by gastric gavage for 14 days. RESULTS: Tripotassium dicitrato bismuthate treatment did not affect maximal pentagastrin-stimulated acid secretion or histamine release in isolated rat stomachs or the density of argyrophil cells in the oxyntic and antral mucosa. However, it significantly reduced the duodenal concentration of gastrin and calcitonin gene-related peptide, and the density of G cells in the antrum and duodenum. CONCLUSION: The effect of tripotassium dicitrato bismuthate on the G cell may be of significance for its beneficial effect on duodenal ulcer disease.

Administration, Oral↗