Identical 24-hour intragastric pH response to low continuous infusion doses of famotidine in active gastric ulcer patients.

UNLABELLED: In order to establish the therapeutic plasma concentration of famotidine, the 24-h intragastric pH response to low-dose intravenous (i.v.) continuous infusion of 40 (group A) or 20 mg/day (group B), administered over more than two days, was studied in 10 adult patients with active gastric ulcers (GU). In group A, the mean age was 64.8 years and in group B, 54.2 years. On the second day, 4 blood samples were collected for famotidine assay and 24 h intragastric pH monitoring was performed. RESULTS: the mean 24 h pH did not differ significantly (P less than 0.01) between group A at 6.9 and group B at 7.2. In group A, the percentage of time with pH above 6.0 and above 7.0 were 94.8 and 59.0, respectively, and the mean famotidine dose and plasma concentration were 0.81 mg/kg/day and 140.89 ng/ml. In group B, the percentage of time with pH above 6.0 and 7.0 were 97.6 and 65.4, and the mean dose and famotidine concentration were 0.34 mg/kg/day and 45.42 ng/ml. In conclusion, in fasting patients with active gastric body ulcers, continuous infusions of low-dose famotidine maintain both the therapeutic plasmatic concentration and the intragastric pH to near anacidity level.

[Excretion of antibiotics into bile and urine in patients with external cholecystostomy done in order to treat obstructive jaundice].

Biliary and urinary concentrations and recoveries of 3 different antibiotics (piperacillin (PIPC), cefbuperazone (CBPZ) and cefoperazone (CPZ], after intravenous bolus injection were studied using the crossover method with external cholecystostomies done in order to treat obstructive jaundice due to complete obstruction of the lower biliary tract; the concentrations of antibiotics in bile and urine were determined by means of a high performance liquid chromatography method. Drug concentrations and recoveries in the bile after intravenous injection of these antibiotics were at levels in the order of CPZ greater than CBPZ greater than PIPC. Since our patients were inflicted with various malignancies which made them impaired in terms of biliary excretion of antibiotics, the concentrations of those drugs in the bile were lower than those previously reported by several investigators. However, CBPZ and CPZ showed sufficient levels of excretion into the bile and their amounts were high enough when compared to the value of MIC 80% reported recently against Escherichia coli and Klebsiella pneumoniae, which are known to be main pathogens of biliary system infections. The excretion of CPZ into the bile was invariably found to be 2 times or more as high as the other 2 drugs tested. Concentrations and recoveries of the 3 antibiotics excreted into urine were similar to the cefotaxime excretion, of which into urine had been reported to be excellent. Thus, CBPZ and CPZ appeared to be effective against biliary system infections, even with blockage of antibiotics excretion into the bile.

[UFTM therapy in patients with unresectable pancreatic cancer].

The therapeutic use of UFTM (UFT plus Mitomycin C) was performed in three patients with unresectable advanced pancreatic carcinoma. According to the criteria of Koyama et al., all patients showed partial response. Thrombocytopenia, (less than 8 x 10(4)/microliter) was observed in one of the three patients treated with UFTM. Nevertheless, in that patient, thrombocytopenia was reversed by stopping Mitomycin C injection and continuous administration of UFT was possible. The survival time in all treated patients tended to the longer: 7.1 months, 13.6 months and 14.1 months. From these results it is suggested that UFTM therapy might offer an alternative treatment for improved survival in patients with unresectable advanced pancreatic carcinoma.

The clinical epidemiological investigation of diagnostic modalities in breast cancer detection--a comparison of ultrasonography and mammography.

We reviewed the medical records and images of 39 women with palpable breast masses, including 18 cases with breast cancer and 21 cases with benign breast mass, to compare diagnostic accuracy and clinical agreement between ultrasonography and mammography in breast cancer detection. We showed that the operating characteristics of ultrasonography, including sensitivity, specificity and positive likelihood ratio, were superior to that of mammography. We also confirmed that the established malignant criteria for malignancy, including lobulated shape, irregular contour and non-uniform internal echo in ultrasonography, and stellate mass in mammography, were statistically significant in distinguishing breast cancer from benign breast lesion. Moreover, the interobserver agreement kappa of ultrasonography and mammography were 0.64 and 0.59, respectively. Ultrasonography was also superior to mammography in attaining clinical agreement between the different observers in breast cancer detection.

[Mechanical ventilation and long-term respiratory care in the intensive care unit of a general hospital].

We studied the need for mechanical ventilation in 265 patients with respiratory failure who came to our medical ICU over the past 3 years. The time required for weaning from mechanical ventilation and the percentage of patients who needed oxygen therapy or mechanical ventilation at home after their condition was no longer acute were also studied. Of the patients treated in the medical ICU, 143 (54%) required mechanical ventilation; 104 (39%) had acute respiratory failure and the others had acute exacerbations of chronic respiratory failure. Some causes of acute respiratory failure were aspiration pneumonia, bronchial asthma, and drug use. Three-fourths of those with chronic respiratory failure had pulmonary emphysema, sequela of pulmonary tuberculosis, or idiopathic interstitial pneumonia. In patients with chronic respiratory failure, success in weaning could be predicted from the respiratory index (PaO2/FIO2), the serum albumin level, and the length of time that they were ventilated with more than 60% oxygen. Thirteen patients with chronic respiratory failure died while receiving mechanical ventilation. Of those who survived, 11 underwent tracheostomies, and 4 of those 11 were mechanically ventilated at home with portable devices. Ten other survivors received home oxygen therapy. Chest physicians bear the greatest responsibility for managing mechanical ventilation in medical emergencies. Moreover, the prognosis for patients with chronic respiratory failure can be improved with a long-term program for respiratory care that includes home mechanical ventilation and home oxygen therapy.

The antitumor effects of locally injecting human peripheral blood mononuclear cells treated with OK-432 into the tumor site: the possible role of a tumor growth inhibitory factor (TGIF).

The production of a tumor growth inhibitory factor (TGIF) was induced in human peripheral blood mononuclear cells (PBMC) by a streptococcal preparation, OK-432, in vitro. The antitumor effect of locally injecting PBMC treated with OK-432 into the tumor site was studied. PBMC were collected from patients with gastric cancer 5 to 12 days before their operation, and cultured with OK-432 for 24 hr in vitro. After the culture, the PBMC were washed thoroughly to eliminate the OK-432. The washed PBMC went on producing TGIF for more than 72 hr in vitro in the absence of OK-432. A small number of TGIF-producing PBMC, approximately 10(7) cells, were injected around the lesion under endoscopic observation. A remarkable antitumor effect was observed in 2 out of 10 cases of resectable gastric cancer. Histological examinations indicated that the antitumor effect is due to antitumor cytokines such as TGIF produced by PBMC rather than to the OK-432-activated PBMC themselves.

A case of blue rubber bleb nevus syndrome with familial onset.

We experienced a case of blue rubber bleb nevus syndrome with familial onset. The patient was a 32-year-old male with a gallstone and many bluish rubber bleb-like hemangiomas on the skin. He suffered from repeated rectal bleeding and underwent a sigmoidectomy at age 17. Gastrointestinal hemangiomas were recognized in the esophagus, stomach, ileum and colon. An angiogram revealed multiple small poolings in the liver, suggesting the presence of hemangiomas. During the cholecystectomy, surgeons noted the presence of hemangiomas on the surface of the liver, serosa of the small intestine and retroperitoneum. Out of 73 blood relatives, 24 also had bluish skin hemangiomas, suggesting them to be inherited by an autosomal dominant trait. More than sixty cases of this syndrome had been reported in the world, eight of which had family histories of skin lesions. However, in only three cases, including our own, was the presence of skin and gastrointestinal hemangiomas recognized. Because the clinical indications for diagnosis of blue rubber bleb nevus syndrome consist of minimal to massive bleeding from the gastrointestinal tract, the possibility that this syndrome is present should be considered when diagnosing a bleeding patient with multiple bluish rubber bleb-like skin lesions, in addition to taking a detailed family history.