Effect on intragastric pH of a PPI with a prolonged plasma half-life: comparison between tenatoprazole and esomeprazole on the duration of acid suppression in healthy male volunteers.

OBJECTIVE: To compare the inhibitory effect of a novel proton pump inhibitor (PPI), tenatoprazole 40 mg once daily, with esomeprazole 40 mg once daily on intragastric acidity. METHODS: A randomized, investigator-blind, two-way, crossover study was conducted in 30 healthy Helicobacter pylori negative male volunteers. Tenatoprazole 40 mg or esomeprazole 40 mg was administered once daily for 7 consecutive days with a 4-wk washout period between treatments. Ambulatory 24-h intragastric pH was recorded at baseline, after 7 days' treatment, and 3 and 5 days after treatment was stopped. RESULTS: At presumed steady-state (day 7), median 24-h pH values were 5.02 and 4.79 for tenatoprazole and esomeprazole, respectively. There was a significant difference between tenatoprazole and esomeprazole during the nocturnal period when mean pH was 4.64 +/- 0.67 versus 3.61 +/- 0.90, respectively (p < 0.0001), as well as a significantly higher mean percentage of time with pH >4 on tenatoprazole (72.5 +/- 14.9 vs 62.2 +/- 13.6, p < 0.0001). The effect of tenatoprazole was still present 5 days after treatment withdrawal especially during the night-time. The mean area under the plasma concentration-time curve and elimination half-time was significantly higher in the tenatoprazole group as compared with the esomeprazole group. CONCLUSION: Tenatoprazole 40 mg daily provides a prolonged duration of acid suppression and a shorter nocturnal acid breakthrough in healthy volunteers, even after stopping the drug. Thus, tenatoprazole may provide greater clinical efficacy for patients in whom a once daily PPI is ineffective. Further studies are indicated.

Lyon Schuss radiographic view of the knee. Utility of fluoroscopy for the quality of tibial plateau alignment.

OBJECTIVE: The "Lyon schuss" (LS) view is a fluoroscopically assisted radiographic technique of the knee in flexion. The quality of medial tibial plateau (MTP) alignment is a key element for accuracy and sensitivity to change of knee radiography. We collected data on the geometry of the osteoarthritic (OA) knee when positioned under fluoroscopy according to the LS protocol, then applied the results to develop an angulation standard for a nonfluoroscopically guided examination, and evaluated the performance of fluoroscopic and nonfluoroscopic alternatives for good alignment of the MTP. METHODS: 1. For 50 patients with knee pain (100 knee radiographs): Standardized radiographic procedure under fluoroscopy (LS view and lateral weight-bearing radiograph of the 2 knees); measurement of the tibial plateau inclination with the horizontal (TPI-h); evaluation of the quality of MTP alignment; assessment of the mean x-ray beam angle to obtain satisfactory MTP alignment. 2. For 30 patients with knee OA: LS radiograph of the knee performed without fluoroscopy, using a fixed 11 degrees downward x-ray beam angle (mean value of the angle obtained in the first part of the study) and standardized procedure; then assessment of the quality of MTP alignment. RESULTS: With the fluoroscopically assisted protocol, MTP alignment was satisfactory in 88% of cases. The mean x-ray beam angle was 11.2 degrees downward (SD 3.3 degrees, range 4-22 degrees ) and was unrelated to sex, height, weight, body mass index, and joint space width. The mean TPI-h was 19.6 degrees (SD 6.9 degrees, range 3-35 degrees ). Beam angle and TPI-h were correlated only in the satisfactorily aligned radiographs. In the 30 knees radiographed using a standardized procedure without fluoroscopy, the MTP alignment was satisfactory in 60% of cases. CONCLUSION: Fluoroscopy is useful to obtain satisfactory MTP alignment in LS radiographs because of large interindividual variations in anatomy of the knee.