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Colloidal bismuth subcitrate (CBS) in the form of a chewable tablet has been compared with ranitidine in the short-term treatment of benign gastric ulcers. Eighty patients were admitted to this randomised single blind study. Endoscopic control was carried out after 4 weeks, and after 8 weeks when healing was incomplete or had not occurred at the 4-week examination. After 1 month of therapy the healing rates were 70% with CBS and 62.5% with ranitidine (P = not significant). At two months the corresponding cure rates were 87.5% and 79%, respectively (P = not significant). Antacid consumption was higher in the group treated with ranitidine, but the difference was not statistically significant. Patient cooperation was good and similar in the two groups. These findings confirm that CBS, in tablet form, is at least as effective as ranitidine in the acute treatment of benign gastric ulcers.

Assuming the shake-off process and Coster-Kronig theory of the origin of the satellites accompanying L alpha 1, the separations and relative intensities of these satellites are calculated for 77Ir, 79Au and 92U. Contours of the satellite structure are obtained and compared with the results of Richtmyer and Ramberg for gold.

Omeprazole is the most effective antisecretory agent available today. Open and dose-comparative studies have documented that at dosages of 20 mg/day or more, the drug produces duodenal ulcer healing rates of 90-100% after 4 weeks. Controlled trials show that omeprazole, 20-40 mg/day, is superior to cimetidine and ranitidine in healing duodenal ulcer, with a median therapeutic gain of 21% at 2 weeks and 15% at 4 weeks. Ulcer symptom relief is also more pronounced and faster with omeprazole than with H2-receptor antagonists. No significant side-effects attributable to treatment with omeprazole have appeared in any of these studies or in the accumulated experience from several thousand patients treated with omeprazole. No tendency to an increase in recurrence rate after discontinuation of treatment with omeprazole has been shown. In summary, omeprazole constitutes a major advance in the short-term treatment of duodenal ulcer, giving fast and pronounced healing and symptom relief.

The X-ray satellite structure accompanying the L alpha 1 emission for the elements iridium (Z=77), gold (Z=79) and uranium (Z=92) has been studied with a curved-crystal spectrometer. The observed satellite contour has been compared with theoretical curves which were computed assuming doubly ionised atoms.

The magnetic interaction has been shown to produce inversion of 1s2p $^{3}\mathrm{P}_{1}$ and 1s2p $^{3}P_{0}$ for Z\ensuremath{\le}3 and Z\ensuremath{\ge}46. In this paper we have used the multiconfiguration Dirac-Fock method to compute with high precision the 2 $^{3}\mathrm{P}_{1}$\char21{}2 $^{3}P_{0}$ separation energy, including relativistic contributions to electron-electron correlations and radiative corrections. This energy happens to be very small around the crossing, so that the hyperfine interaction can mix both levels significantly. We have then computed the effect of this mixing on both the energy and lifetime of those levels. This calculation shows that a precise measurement of the ${2}^{3}$${\mathit{P}}_{0,\mathit{F}=\mathit{I}\mathrm{\ensuremath{-}}1}$\char21{}1${\mathit{S}}_{0}$F=I lifetime will enable us to measure the ${2}^{3}$${\mathrm{P}}_{1}$\char21{}2 $^{3}P_{0}$ separation energy accurately even though the radiative width of the 2 $^{3}P_{1}$ level is actually larger than the level separation.

Cigarette smoking has been linked with duodenal ulcer disease although the mechanism of this association is unclear. This study assessed basal gastric secretory response to acute smoking of smokers with an active duodenal ulcer; in addition the possible effects of chronic smoking on gastric secretory capacity, as expressed by pentagastrin stimulated gastric acid secretion and fasting serum pepsinogen I (PG I) concentrations, were investigated in patients with active duodenal ulcer, or non-ulcer dyspepsia. In 10 smokers with duodenal ulcer smoking four cigarettes during 40 minutes did not influence basal gastric secretion of acid and pepsin, or serum PG I and gastrin concentrations. In 136 patients with duodenal ulcer and 90 controls with non-ulcer dyspepsia, pentagastrin stimulated acid secretion and fasting serum PG I concentrations were significantly higher among habitual heavy smokers than among non-smokers. These findings suggest that in heavy smokers with duodenal ulcer acid- and pepsin-secreting cell function is not affected by acute cigarette smoking. By contrast, chronic cigarette smoking seems to be associated either with an increase of parietal- and chief-cell mass, or with an enhancement of their secretory capacity.

Inelastic X-ray differential scattering cross sections of Ne have been computed to compare the effect of three non-relativistic approximations: Waller-Hartree, impulse and excited state. The same Hartree-Slater wavefunctions were employed throughout, and momentum transfer 0.1

Approximately 5-10% of duodenal ulcers fail to heal after 8 weeks of treatment with full doses of H2 blockers. Although the causes of this refractoriness still remain unknown, these ulcers may be successfully managed today, at least in the short-term period, by medical therapy. The development of resistance, however, probably means a worsening of the prognosis for many patients, since ulcer remission becomes difficult to be maintained.

Des cibles de Ag ont ete bombardees par des protons de 0,6-1,8 MeV produits par l'accelerateur Van de Graaff de 2 MV, a Sacavem, Portugal. Obtention des spectres Lβ d'emission X de Ag a l'aide d'un spectrographe a cristal plan et d'un detecteur de localisation. Calcul des rapports σ 2 /σ 1 et σ 3 /σ 1 en fonction de l'energie des protons

The efficacy and safety of the new prostaglandin E1 (PGE1) synthetic analogue, rioprostil, 300 micrograms b.d. and cimetidine, 400 mg b.d., on duodenal ulcer healing are compared in an international, multicentre, double-blind study. A total of 257 patients have entered the study; 243 are considered eligible for efficacy analysis and 207 for safety analysis. After 4 and 6 weeks of treatment, the endoscopic healing rates do not significantly differ between the two groups, being 55% and 83% respectively with rioprostil vs. 60% and 78% respectively with cimetidine. The major adverse effect attributable to rioprostil is diarrhoea, which was documented in 11% of patients compared with 1% of patients taking cimetidine. However, central nervous system complaints are twice as frequent in the cimetidine group. Monitoring of clinical laboratory tests show no significant abnormalities when compared with the baseline values during the administration of either drug. This study documents that rioprostil, at the dosage of 300 micrograms b.d., is as effective and safe as cimetidine in the short-term therapy of duodenal ulcer.

The use of colloidal bismuth subcitrate (CBS) has been recently suggested for cimetidine-resistant duodenal ulcers. We have therefore compared the activity of CBS with that of two different doses of cimetidine in patients whose duodenal ulcers had not healed after 8 weeks of therapy with cimetidine, 1.2 g, or ranitidine, 300 mg/day. Forty-three patients (35 men and 8 women) were randomly allocated to one of the following oral regimens: CBS, 120 mg 4 times a day, or cimetidine (C), 400 mg 3 times a day, or cimetidine, 400 mg at meals plus 800 mg at bedtime, for 4-8 weeks. The interim analysis after 4 weeks of treatment showed similar percentages of healing in the two cimetidine schedules (46.7% with C, 1.2 g, and 42.9% with C, 2 g, respectively); conversely, CBS treatment resulted in a significantly higher healing rate as compared with both C, 1.2 g, and C, 2 g (P less than 0.05). These findings suggest that resistant duodenal ulcers are more responsive to cytoprotective agents than to antisecretory compounds.

The effectiveness of midazolam as premedication for upper gastrointestinal endoscopy was examined and compared with that of diazepam in a double-blind crossover study involving 23 patients. The degree of sedation and cooperation of patients during the procedure and the speed of recovery from sedation were comparable for the two drugs. The effects of both compounds on arterial blood pressure and heart rate were quite similar. However, midazolam induced significantly more amnesia than diazepam (91% vs. 39%). Also, patients' acceptability for the procedure was significantly higher in the midazolam than in the diazepam group (78% vs. 26%). Therefore, when amnesia is desirable, as in the case of repeated endoscopies, midazolam should be the drug of choice.

Antisecretory drugs, although able to promote ulcer healing, have been shown to be unable to modify the course of ulcer disease. Relapse rates after short-term cures and after prophylactic long-term therapy are equivalent to those observed during placebo treatment. Conversely, evidence shows that colloidal bismuth subcitrate (CBS)--by means of a mechanism as yet unclear--reduces the risk of ulcer relapse after a short cure for acute disease. This has been shown in several controlled trials and in two studies on duodenal ulcer patients undertaken by our group. Our experience has shown that 12 months after treatment the relapse rate in patients treated with CBS only during the acute phase was: a) equivalent to that observed in patients whose acute ulcers had healed with cimetidine and had thereafter been treated prophylactically with cimetidine 400 mg at night (69% versus 68%), and b) significantly lower than that of patients whose ulcers had healed with ranitidine and who were subsequently placed under medical observation (67% versus 84%; P less than 0.05). It is concluded that CBS is a valid alternative in the prophylactic treatment of duodenal ulcer.

The use of tripotassium dicitrato bismuthate (TDB) has been suggested recently for cimetidine resistant duodenal ulcers. This study compares the efficacy of TDB with two different cimetidine dosages in the treatment of duodenal ulcer patients who failed to respond to an eight week therapy with H2-blockers. Fifty two patients (40 men, 12 women) were randomly allocated to one of the following three oral regimens: (1) TDB 120 mg quid, (2) cimetidine 400 mg tid, (3) cimetidine 400 mg with meals plus 800 mg at bedtime. Endoscopy was carried out after four weeks; if the ulcer had not healed patients continued with the same treatment for a further four week period when they were endoscopically reassessed. After four weeks similar percentages of ulcer healing were registered in the two cimetidine schedules (39% with 1.2 g and 44% with 2 g), whereas TDB resulted in a significantly higher healing rate (82%) compared with cimetidine 1.2 g (p = 0.01) and with cimetidine 2 g (p = 0.025). After eight weeks the cumulative percentages of healing were 65% on cimetidine 1.2 g, 75% on cimetidine 2 g, and 94% on TDB (TDB v cimetidine 1.2 p = 0.042). These results confirm previous data that resistant duodenal ulcers are more responsive to an agent which strengthens the mucosal defences than to antisecretory compounds.

Anti-ulcer prostaglandins (PG)--misoprostol, enprostil and rioprostil--have been given to more than 5000 patients in short-term studies on gastric and duodenal ulcer. Analysis of these studies shows the drugs to be safe. Their side effects appear to be dose-dependent and mainly restricted to the gastrointestinal system, the major syndromes being diarrhoea and abdominal pain. The clinical relevance of PG-related unwanted effects, though in average exceeding that of H2-blockers, seems to be sufficiently low. In terms of safety efficacy, however, they appear inferior to H2-antagonists, so their routine use in preference to the latter compounds is still premature.

Foram analisados retrospectivamente 42 pacientes com aneurismas multiplos (17,8% do total de pacientes com aneurismas) atendidos no periodo de 1975 a marco de 1986. Vinte e sete eram do sexo feminino e 15 do masculino, com idade variando da terceira a setima decadas. Trinta e um pacientes tinham 2 aneurismas (15 uni e 16 bilaterais), 6 tinham 3 (2 uni e 4 bilaterais), 3 tinham 4 (todos bilaterais) e 2 tinham 5 (bilaterais), totalizando 102 aneurismas (61 na carotida interna, 27 na cerebral media, 9 no complexo cerebral anterior/comunicante anterior, 3 na basilar e 2 na cerebral anterior distai). Todos os casos foram internados por hemorragia subaracnoidea e 11 foram classificados em grau I, 12 em grau II, 15 em grau III e 4 em grau IV na internacao. Os pacientes foram mantidos em repouso absoluto, sob sedacao e a evolucao pre-operatoria mostrou melhora clinica da maioria dos pacientes (29 operados em grau I, 7 em grau II e 6 em grau III). A cirurgia foi realizada tardiamente na maioria dos casos (28 entre o 11o e o 30o dia) e os 42 pacientes foram submetidos a 57 craniotomias para clipagem dos aneurismas. Dos 24 pacientes com aneurismas bilaterais, 15 foram operados dos dois lados (11 estao assintomaticos e 1 com hemiparesia e 3 faleceram tardiamente por outras causas que nao hemorragia subaracnoidea). Dos 9 pacientes submetidos a craniotomia unilateral, 4 faleceram e 5 estao bem. Dos 18 pacientes com aneurismas unilaterais, 11 estao assintomaticos, 2 apresentam hemiparesia, 1 apresenta diplegia e disturbios do comportamento e 4 faleceram. A mortalidade global foi de 26,1% durante todo o seguimento, a mortalidade operatoria foi 11,9% e nao houve mortalidade nos casos operados nos ultimos 5 anos. A conduta preconizada para o tratamento destes pacientes e discutida.

Since peptic ulcer disease is a multifactorial disease, the ideal therapeutic approach would be to use different drugs for different ulcers. In the past few years some studies have been published suggesting that subgroups of patients with peptic ulcer might particularly benefit from specific forms of therapy. In the present report the available evidence has been critically reviewed.

The discovery that natural prostaglandins (PGs) of the E series inhibit gastric acid secretion [1] and prevent, at nonantisecretory dosage, experimentally induced ulcer caused by various noxious agents [2], suggested their potential usefulness as treatment for peptic ulcer. However, the progress toward the market for antiulcer PG has beenhampered by some major disadvantages of natural PGE: first, a rapid metabolism which is responsible for the lack of activity after oral administration [3]; secondly, a wide variety of side effects due to their ubiquitous biological role in the human body [4]; and finally, a high chemical instability [5]. These problems have been to a great extend overcome by the development of PG synthetic analogues. At present, numerous PGE1 and PGE2 derivatives are under study as antiulcer agents; among these, four compounds have already reached phase III of pharmacological investigations: arbaprostil, misoprostol, enprostil, and rioprostil. Misoprostol and enprostil have proved to be effective in healing duodenal and gastric ulcer, both in placebo- and H2 blocker-controlled studies [6] and they will soon be marketed in several countries.

Oral and esophageal candidiasis represents a common infection in patients with acquired immune deficiency syndrome (AIDS). Because the relationship between the infection in both sites is not well known, we submitted to routine upper digestive endoscopy 57 patients with AIDS. Furthermore, we evaluated the diagnostic accuracy of oral candidiasis and esophageal symptoms as markers of Candida esophagitis. Oral and esophageal candidiasis were found in 52% and 48% of patients, respectively, whereas symptoms of esophageal origin were referred to by 60% of patients successively documented to have an esophageal infection. The sensitivity of esophageal symptoms and oral candidiasis alone, as indexes of an esophageal infection, was 60% and 88%, and their specificity was 100% and 81%, respectively. The combination of these two parameters improved their degree of diagnostic accuracy (sensitivity 93%, and specificity 100%), whereas the predictive value of their simultaneous presence or absence was 100% and 96%, respectively. These results document that routine endoscopy to verify the presence of esophageal candidiasis in all of the patients with AIDS is unnecessary; it could be reserved for selected subgroups such as those with esophageal symptoms despite systemic antifungal treatment, and for patients with AIDS-related complex presenting oral candidiasis without symptoms of esophageal origin.

Forty patients with endoscopically proven duodenal ulceration have cooperated in a clinical trial to compare the ulcer healing effect of colloidal bismuth subcitrate (CBS) at standard dosage administered either twice or four times a day. No statistically significant difference was found to exist between ulcer healing in the two groups after 4 weeks (70% and 95%, respectively), and it is concluded that twice daily CBS is an effective treatment for duodenal ulcer with clear advantages as regards patient cooperation.

The effectiveness of cimetropii bromidum (10 or 20 mg i.v.) as premedication for upper gastro-intestinal tract endoscopy was examined and compared with that of placebo in a double-blind crossover study involving 160 patients. The drug effects were assessed from the degree of opening of the pyloric sphincter and the endoscopist's rating of drug performance. The study showed that the effects of cimetropii bromidum differed highly significantly (p < 0·0001) from those of placebo, on either count. No adverse effects were noted.

Pirenzepine is a new antimuscarinic drug with a peculiar affinity for gastric parietal cells' acetylcholine receptors. Previously it has been shown that the drug effectively inhibits both basal and gastric acid secretion stimulated by several secretagogues. The aim of the present work has been to evaluate, in double-blind, placebo controlled, randomized studies on 6 male patients, the effect of pirenzepine (50 mgs orally) on gastric secretion stimulated by peptone meal, gastric emptying and gastrin release. The results show a significant decrease of gastric secretion (48 per cent in the 1st and 30 per cent in the 2nd hour) without any effect on gastric emptying and gastrin release.

The effects of pirenzepine and ranitidine alone and combined, on gastric acid secretion and gastrin release stimulated by liquid peptone meal were evaluated in 12 duodenal ulcer patients. Six patients received placebo and ranitidine 150 mg per os and the other six patients were given placebo, pirenzepine 50 mg and pirenzepine 50 mg plus ranitidine 150 mg per os, according to randomized sequences. In the first experiment ranitidine markedly inhibited (69%) gastric acid secretion for entire two hours period (p less than 0.01). In the second experiment acid secretion after pirenzepine, was reduced by 39% while the combination of pirenzepine plus ranitidine almost completely inhibited the meal stimulated acid secretion (99%). Mean integrated gastrin responses after pirenzepine and ranitidine alone as well as pirenzepine plus ranitidine were not significantly different from placebo. The results of these studies show that in duodenal ulcer patients, the simultaneous block of muscarinic and H2-receptors, suppresses meal stimulated gastric acid secretion, without affecting gastrin release. This therapeutic combination might be used in clinical situations (non-responders, Zollinger-Ellison syndrome) in which complete inhibition of gastric acid secretion is needed.