Doxepin and cimetidine in the treatment of duodenal ulcer: an open clinical and endoscopic study.

In an open clinical endoscopic study, 50 patients with duodenal ulcer showed no significant difference in ulcer healing during a 6-week treatment period with doxepin HCl (50 mg h.s.) versus cimetidine (1000 mg/day in divided doses). Possible tricyclic mechanisms of action in the treatment of peptic ulcer, e.g., histamine H2 blockade, are discussed.

Combined tinidazole and doxycycline prophylaxis in colorectal surgery. An interhospital trial.

There were no significant differences between randomized groups on either preoperative tinidazole or placebo added to pre-, per, and postoperative doxycycline. Cases of anaerobic infection among the placebos patients as well as a general trend of the parameters studied suggest that tinidazole gives added protection, i.e. that antibiotic prophylaxis should also comprise anaerobic microbes.

Graded gastrectomy for duodenal ulcer -- a five-year prospective study.

One hundred and twelve consecutive patients selected for surgical treatment for duodenal ulcer disease were treated by a graded gastrectomy according to the Moynihan modification of the Billroth II partial gastrectomy. A large partial gastrectomy (R) (2/3-3/4 gastrectomy) was done in patients who after maximal stimulation with histamine showed a high acid output (MAO greater than 30 mEa/hr), and a small resection (r) (1/3-1/2 gastrectomy) in low secretors (MAO less than 30 mEq/hr). The material was prospectively controlled by admission to hospital at 3 months, 1 year and 5 years postoperatively. The preoperative values of MAO found in R and r were 42.8 and 21.5 mEq/hr (p less than 0.001), respectively. The postoperative MAO values at the 3-month control were 4.5 and 3.0 mEq/hr by R and r, respectively, which shows that the grading of resection had been successful. Atrophic gastritis increased in frequency from 4% at the time of operation to 72% at the 1-year control...

Prophylactic regimens in colorectal surgery. Comparison between metronidazole used alone or in combination with either ampicillin or doxycycline.

Sixteen hospitals are participating in this study, that started in October 1982 and will be concluded when 456 patients have been admitted. The study includes patients eligible for elective colorectal surgery. Inclusion criteria, surgical techniques, definition of recognizable infection, sampling of specimens for bacteriological investigations, bacteriologic techniques, and evaluation criteria were standardized. Patients were divided into 2 main groups. Patients in Group 1 received either a single intravenous dose of 1500 mg metronidazole or this dose was combined with a single, intravenous dose of 6 g ampicillin. Patients in group 2 received either a single intravenous dose of 1500 mg metronidazole or this dose combined with a single intravenous dose of 400 mg doxycycline. Dosage regimens were allocated randomly. The current results concern 136 patients. Postoperative infections were seen in 6.7% of the patients receiving metronidazole alone, and 2.9% of the patients receiving metronidazole + ampicillin (Group 1). In Group 2, postoperative infection occurred in 17.1% of the patients receiving metronidazole alone, and in 2.7% of those receiving metronidazole + doxycycline.

[Postoperative enteral nutrition]. / Postoperativ enteral ernaering.

The need for postoperative nutrition is often discussed, but no consensus has been reached regarding the assessment of this need. The common opinion is that patients who are unable to feed themselves by 5-7 days after the operation need nutritional support. This is commonly given parenterally via a central venous catheter. This method may lead to sepsis. Owing to the serious complications, alternatives have been searched for. Methods for enteral ways of support and suitable preparations have been evaluated. We have tried one of these methods together with one of the many preparations. Peptison has been administered continuously through a peroperatively placed jejunal catheter. This technique and its possible advantages are described. By this method patients can be given sufficient nutritional support with no or only few complications. We consider this method to be a good alternative to parenteral infusion.

[Self-regulated intake of food and drinks after abdominal surgery]. / Selvbestemt inntak av mat og drikke etter abdominaloperasjoner.

106 consecutive patients who had undergone laparotomy were allowed to drink freely from the first and to eat from the second day after operation. Only patients with an operated oesophagus were excluded. Nasogastric suction was not used. Our study shows that if patients are allowed to choose, they like to drink and to eat soon after the operation. They prefer water, juice and soup during the early days. Most of them soon drank more than 1,500 ml of liquids per day. They often start to drink and to eat before the passage of first flatus. Only five patients (4.7%) needed to have a nasogastric tube inserted. We found no major complications associated with our regimen. All our patients are now allowed to drink and eat according to their own wishes.

Popliteal entrapment syndrome.

Three surgically treated cases of popliteal entrapment syndrome are reported. Two of the patients were consanguineous. This unusual syndrome is caused by an anomalous relationship between the popliteal artery and the musculature in the popliteal fossa. Arterial compression usually results in ischaemic calf pain. Popliteal entrapment syndrome seems to be underdiagnosed. Pathogenesis, diagnosis and treatment are discussed.

Penetration of metronidazole to tissues.

One dose of 500 mg metronidazole (M) was given to 21 patients before appendectomy and the concentrations of the parent compound and the major metabolite hydroxymetronidazole (OH-M), assayed in serum and tissue homogenates of appendix and subcutaneous tissues by high pressure liquid chromatography. Based on determinations in one specimen per patient during the initial 1.25-4 h after end of the 50 min infusion, the levels of M in relation to serum were 60.8% (+/- S.D. 19.8) for the appendix and 29.0% +/- 8.7 for subcutaneous tissue. The corresponding values for OH-M were 103.9 +/- 28.2 and 57.0% +/- 16.8. The slope of the log-linear regression curves of M corresponded to elimination half-life (T 1/2) values of 5.2 h in serum, 2.7 h in appendix and 2.6 h in subcutis tissue, but the differences were not statistically significant. The values of OH-M were similar for serum and appendix. OH-M had T 1/2 of 7.9 and 6.1 h for serum and subcutaneous tissue and 21.3 h in the appendix, but the values were not significantly different.

Continent ileostomy. A pilot study in dogs.

Nipple valve ileostomies with and without a performed pouch as well as conventional ileostomies were compared in dogs. In both groups with a nipple valve, a 150-200 ml reservoir developed. It was about 30 cm long when not preformed by an operation. Equal dilatation of the proximal bowel was observed in both groups with a nipple valve and both these groups had a substantial loss of weight which seemed to correspond with mucosal changes indicating malabsorption. For continent ileostomy function in dogs, the performed pouch thus seems unnecessary.

Prophylaxis of venographically diagnosed deep vein thrombosis in gastrointestinal surgery. Multicentre trials 20 mg and 40 mg enoxaparin versus dextran.

OBJECTIVE: To compare enoxaparin and dextran 70 for the prophylaxis of venographically diagnosed deep vein thrombosis (DVT) after gastrointestinal operations. DESIGN: Part 1: randomised double blind trial; Part 2: single blind study with historical controls. SETTING: Eight Norwegian hospitals. SUBJECTS: 381 Patients undergoing elective gastrointestinal operations. INTERVENTIONS: Part 1 (n = 329): enoxaparin 20 mg subcutaneously starting two hours before operation and continuing until the patient was fully mobilised or had had 10 injections and a placebo infusion of 0.9% sodium chloride, or dextran 70,500 ml at the start of the operation, on the evening of operation, and on the first, third, and fifth postoperative days and placebo subcutaneous injections. Part 2 (n = 52): enoxaparin 40 mg in the same regimen as part 1 (compared with 39 historical controls). Venograms 4-6 days post-operatively. MAIN OUTCOME MEASURE: Venographically confirmed DVT. RESULTS: Part 1: Because of the high overall incidence of DVT an interim analysis was done which showed 33/101 DVT (33%) among high risk patients in the enoxaparin 20 mg group and 33/107 (31%) in the dextran 70 group. The corresponding figures for patients at medium risk were 2/27 (7%) for enoxaparin 20 mg and 5/27 (19%) for dextran 70 (95% confidence interval (CI) for the difference--11.9 to 9.8). Part 2: the dose of enoxaparin was therefore increased to 40 mg and prophylaxis restricted to patients with cancer. There were 6/49 DVT (12%), which was compared with a random sample from the dextran 70 group from part 1 (historical controls) in which the incidence was 15/39 (38%, 95% CI of the difference 4.0 to 8.4). There were no pulmonary emboli, only 4 thrombi were above the knee and there were 4, 1 and 3 clinical DVT in the 20 mg and 40 mg enoxaparin, and dextran 70 groups, respectively. CONCLUSIONS: Enoxaparin 20 mg and dextran 70 are effective prophylaxis for patients at medium risk, but enoxaparin 40 mg is required for those at high risk.

A single dose tinidazole and doxycycline prophylaxis in elective surgery of colon and rectum. A prospective controlled clinical multicenter study.

Antimicrobial prophylaxis with agents active against aerobic and anaerobic micro-organisms leads to a significant reduction of infectious complications following colorectal surgery. A single dose (1600 mg) of tinidazole (a nitroimidazole derivate) and doxycycline (400 mg) will provide serum and tissue values well above minimum inhibitory concentration (MIC) values for more than 24 hours. To reduce the unwanted side effects and cost of prolonged antimicrobial prophylaxis, a prospective controlled clinical multicenter study comparing the effect of a single dose before operation of tinidazole and doxycycline to five days of prophylaxis before operation in 234 patients undergoing elective colorectal surgery was undertaken. Six patients given a single dose of prophylaxis before operation (n = 118) developed infectious complication (5.1%). Prolongation of prophylaxis before operation for four days after operation (n = 116) did not lead to any further reduction of infectious complications. A single dose of tinidazole and doxycycline before operation is a simple and effective prophylaxis against infectious complications following elective colorectal surgery.