Lactulose: A Simple Sugar in a Complex Encephalopathy.

Hepatic encephalopathy is a common encephalopathy and one of the very few that are treatable. Lactulose has remained a standard pharmaceutical intervention and is listed as one of the World Health Organization's Essential Medicines. The discovery of lactulose, the acid dialysis proof of concept, and the role of Bircher are not well known. This historical vignette reviews the gradual understanding of the complex liver-brain connection, the effective treatment of hepatic stupor with lactulose, and the immediate relevance of lactulose to the practice of consultative neurocritical care.

Jawarish, a Persian traditional gastrointestinal dosage form.

Medical sciences including pharmacy flourished in Persia throughout medieval times. The oldest pharmacopeias which discussed pharmaceutical formulations were created by them, called Qarabadin. Among various dosage forms which were described, Jawarish was a gastrointestinal dosage form which was made from different ingredients for different purposes such as stomach tonic, digestive, carminative, laxative, astringent, visceral analgesic, antihaemorrhoid, antiemetic, emetic, antireflux and anticolic. This paper, introduces their preparation, general considerations and five common examples of Jawarish.

Overview of 50 years' progress in upper gastrointestinal diseases.

There have been numerous and dramatic advances in our understanding of the mechanisms, causes and treatments of upper gastrointestinal diseases in the past 50 years. This review focuses on a few, not dealt with elsewhere in this special issue of the Journal. The early history of the recognition that nonsteroidal anti-inflammatory drugs are a major cause of peptic ulcer is described, with particular attention to the work of the pioneering Australian investigators. The story of the development of the histamine H(2)-receptor antagonists and the proton pump inhibitors is also outlined.

Landmarks in the understanding and treatment of reflux disease.

The last 50 years have seen a transformation in the understanding and treatment of reflux disease. The development and wide use of flexible endoscopy and progressively more sophisticated approaches to measurement of pathophysiological factors have been major drivers of advances. The recognition and progressive elucidation of the mechanical events that comprise the transient lower esophageal sphincter relaxation and how they lead to reflux provide a novel and firm foundation for tailoring therapies that act directly to reduce occurrence of reflux episodes, either surgically or pharmacologically. Novel GABA(B) agonist drugs have been shown to inhibit transient relaxations and are currently being evaluated in clinical trials on patients with reflux disease. Better understanding has extended to recognition of the extraordinarily high prevalence of reflux disease and of the ability of proton pump inhibitor drugs to deliver major benefits to a high proportion of patients with reflux disease. The life of the Gastroenterological Society of Australia has spanned the period of these major advances. A large number of the members of the Society and their associates have contributed substantially to these advances.

Advances in the nontransplant medical and surgical management of intestinal failure.

PURPOSE OF REVIEW: Although intestinal transplantation is uniquely suited for the treatment of patients with intestinal failure suffering from life-threatening complications, patient survival at 5 years remains suboptimal at approximately 50-60%. RECENT FINDINGS: The introduction of effective medications to improve intestinal absorption, alternate intravenous lipid preparations that may reduce cholestasis and a technically easier nontransplant intestinal lengthening procedure have largely changed the available options for nontransplant interventions. Multidisciplinary teams created to manage the complexities of this population have shown improved outcomes and the ability to prevent or slow progression of life-threatening complications that would otherwise lead to intestinal transplantation in a large number of patients with short bowel syndrome. SUMMARY: Here, we review the historical options, recent advances and cutting-edge research that will likely provide the basis for further advances in the treatment of patients with short bowel syndrome as the cause of their intestinal failure.

Control de síntomas y tratamiento del cólera durante las primeras epidemias del siglo XIX / Cholera symptom control and treatment during the first epidemics of the 19th century

El cólera, enfermedad infectocontagiosa cuyo organismo responsable es el Vibrio Cholerae, endémica en ciertos países asiáticos, se desborda en el segundo cuarto del siglo XIX, con cuatro oleadas sucesivas que convierten la endemia en auténtica epidemia. Partiendo de la base de la inexistencia en 1833 (primera epidemia en España) de un tratamiento específico que curase la enfermedad, se llevaron a cabo múltiples esfuerzos para combatirla. Su cualidad de epidémica explica la importancia concedida a este tipo de enfermedades desde el punto de vista histórico. El pánico que las acompaña llega también a hacerse epidémico, extendiéndose infinitamente más que la propia enfermedad, mal que ha inspirado mayor terror acaso que ningún otro. El objetivo del presente trabajo ha consistido en realizar un repaso de esos esfuerzos. En la primera parte se muestran descripciones del cólera según autores de la época, se repasan las principales teorías patogénicas sobre el morbo (nerviosa, espasmódica, humoral y gastroentérica o inflamatoria) y en la segunda se muestran los métodos utilizados en el control de síntomas y tratamiento (sangría, vomitivos y purgantes, diaforéticos, estimulantes externos, narcóticos, etc.), resaltando la gran anarquía imperante en cuanto aterapéutica se refiere (AU)

Cholera, an infectious disease caused by the Vibrio Cholera organism, is endemic in certain Asian countries and rose to its height in the second quarter of the 19th century with four successive waves which marked it as a true epidemic. Taking into account that in 1833 (first epidemic in Spain) there was no specific treatment that cured the disease, several actions were carried out to fight it. The epidemic feature of this disease explains the importance given to these kinds of diseases from a historical perspective. The panic that accompanies infectious also becomes an epidemic, spreading much further than the actual disease and creating unrivalled terror. The objective of this study is to carry out a review on the efforts taken. In the first part of this study, we look at several definitions of cholera pertaining to different authors who lived at the time, as well as the main pathogenic theories of disease manifestation (nervous, spasmodic, humoral and gastroenteric or inflammatory manifestations). The second section presents the methods used for symptom control and treatment (bloodletting, induced vomiting and purging, diaphoretics, external stimulants, narcotics, etc), highlighting the anarchy that reigned regarding treatment (AU)

Review article: the history of acute infectious diarrhoea management--from poorly focused empiricism to fluid therapy and modern pharmacotherapy.

BACKGROUND: Acute diarrhoea management has progressed from largely ineffective measures in the early years to a more effective physiologic approach in recent years. AIM: To review the history of acute diarrhoea management. METHODS: Citations in PubMed were reviewed on 'acute diarrhoea treatment' along with an extensive file maintained by the corresponding author. RESULTS: Freedom from diarrhoea was equated in early military conflicts with bravery and strength where diarrhoea-free soldiers had the 'guts' to fight. Until early 20th century, colonic irrigants, purgatives and emetic drugs were used to help eliminate undesired intestinal contents. Only a few early authorities suggested the need for replacement of fluids and salt, now standard treatment. Drugs aimed at diarrhoea symptom control have been broadly used for more than 100 years. The evolving history of one of those drugs, kaopectate is unappreciated. Once understanding the pathophysiology and infectious aetiology of acute diarrhoea, new oral fluids, pharmacologic agents designed to block specific secretory alterations and anti-infective drugs have been identified. CONCLUSIONS: Physiologic and antimicrobial approaches to controlling diarrhoea can lead to reduction of stool number and enteric complaints, important in industrialized areas, with the potential for decreasing threat of fatal illness among infants in developing regions.

Experimental production of peptic ulcer, gastric damage and cancer models and their use in pathophysiological studies and pharmacological treatment--Polish achievements.

The common acid related diseases of the upper GI tract could be considered as primarily due to the defect in barrier function either of the gastric mucosal or duodenal epithelium leading to the formation of gastric or duodenal ulcers. An attempt was made in this chapter to discuss the history of peptic ulcer disease in humans and methods for the production of acute gastric lesions and ulcers in experimental animals with the special attention focused to the contribution of Polish scientists and investigators into this field. Early surgical advances in the management of peptic ulcers were emphasized that were then subsequently replaced by pharmacological treatment (histamine H(2)-receptor antagonists, proton pump inhibitors) and considered as the major strategy against the acid disorders. This included the immense body of work performed by numerous group of investigators, including Polish researchers, to identify the effects of acid, bile salts, aspirin and other non-steroidal anti-inflammatory drugs (NSAID), stress, Helicobacter pylori (H. pylori) infection, prostaglandins (PG) and nitric oxide (NO) on the integrity of the gastrointestinal mucosa, which all were discussed in this chapter. The concept of major defensive mechanism in the stomach called "cytoprotection", originally proposed by Andre Robert is recalled in the relevance to the great contribution of Polish scientist working at the Jagiellonian University in Cracow. These experimental studies gave a new insight into the mechanism of action of arachidonate cascade products such as PGs, tromboxanes and leukotrienes and had opened the new therapeutic avenues for the gastroprotective treatment of the acute gastric mucosal damage. Detailed studies revealed, however, that PG-induced cytoprotection offers a short-term protection against gastric lesions induced by corrosive agents but unfortunately this phenomenon gives a little, if any, impact to the process of ulcer healing. The experimental studies on healing of gastric ulcers that become supportive for the clinical trial in humans, performed also by Polish pioneers and the effect of numerous growth factors (EGF, TGF alpha), NO inhibitors, cyclooxygenase- (COX)-1 and COX-2 inhibitors and new safer derivatives of NSAID releasing NO in protection and ulcer healing are discussed. Finally, the major discovery by Warren and Marshall of H. pylori that have been studied world-wide in experimental animals including also Polish investigators, allowed for the better insight to the pathological consequences of this germ infection in the gastric mucosa and helped to establish the anti-H. pylori eradication therapy.