Rioprostil and ranitidine in the prevention of duodenal ulcer relapse.

One hundred and ninety duodenal ulcer patients who had relief of pain and endoscopically proven ulcer healing after a short treatment period are allocated at random to double-blind maintenance treatment with a synthetic dehydroprostaglandin-E1, rioprostil, 300 micrograms, or ranitidine, 150 mg, at bedtime for 6 months. Patients are monitored every two months and examined by endoscopy after six months of treatment, or more often if warranted. The cumulative relapse rate in the rioprostil group at six months is 32% (25/78) vs. 28% (20/72) in the ranitidine group. This difference is not significant. The percentage of side effects observed is 17% in the rioprostil group vs. 5% in the ranitidine group, but discontinuation of treatment is observed with the same frequency in the two groups.

[Ranitidine inhibition of gastric secretion stimulated by pentagastrin. Results in 30 cases of duodenal ulcer]. / Inhibition par la ranitidine de la sécrétion gastrique stimulée par la pentagastrine. Résultats chez 30 ulcéreux duodénaux.

The aim of this study was to investigate the effects of ranitidine on the pentagastrin stimulated gastric secretion (6 micrograms.kg.h) in 30 patients with duodenal ulcer. The drug was administered directly into the gastric lumen. Five different doses were tested: 15 mg (3 patients), 25 mg (7 patients), 50 mg (6 patients), 75 mg (5 patients), 150 mg (4 patients) and 300 mg (5 patients). Ranitidine produced a dose-dependent inhibition of maximal acid secretion (p less than 0.001). Fifty per cent inhibition was obtained with a dose of 0.342 mg.kg-1 corresponding to a dose of 22 mg for a patient weighing 65 kg. The inhibitory effect resulted from a decrease in both volumes and H+ concentrations, the influence of the later being prevalent at high dosages. A decrease in the peptic secretion has been noticed. For small dosages, it chiefly depends on the reduction of the volumes of gastric secretions, although at high dosages the concentration of pepsin was significantly reduced. These results showed that the ranitidine is a potent antisecretory drug; the dosage of 150 mg twice a day which is considered as the regular treatment for ulcer disease seems adequate. However, the authors suggest that a new controlled therapeutic trial should be started with a dosage of 150 mg per day only, divided in four unequal doses (3 X 25 mg + 75 mg). Furthermore a satisfactory control only of the nocturnal secretion, could be obtained with an unique dose of 100 (or 150) mg at bedtime.

[Inhibition by a 2-pyridyltetrahydrothiophene derivative (40749 RP) of gastric secretion stimulated by pentagastrin. Results in 30 duodenal ulcer patients]. / Inhibition par un dérivé pyridyl-2 tétrahydrothiophène (40749 RP) de la sécrétion gastrique stimulée par la pentagastrine. Résultats chez 30 ulcéreux duodénaux.

The aim of this study was to investigate the effects of a new antisecretory compound (40749 RP) on the pentagastrin stimulated gastric secretion (6 micrograms.kg-1 b. w. h-1) in 30 patients with duodenal ulcer. The drug was administered directly into the gastric lumen. Four different doses were tested: 50 mg (7 patients), 100 mg (6 patients), 150 mg (8 patients), and 200 mg (9 patients). 40749 RP produced a dose-dependent inhibition of maximal acid secretion (p less than 0.001). Fifty per cent inhibition was obtained with a dose of 0.916 mg.kg-1 b. w. corresponding to a dose of 60 mg per day for a patient weighting 65 kg. The inhibitory effect resulted from a decrease in both volumes and H+ concentrations, the influence of the later being prevalent at high dosages. Peptic concentrations were not significantly decreased and inhibition of peptic secretion correlated only with the reduction of volumes. These results showed that 40749 RP is a potent antisecretory drug which could be of benefit in the treatment of peptic ulcer disease. With regard to the duration of action of 40749 RP, a 60 to 100 mg dose administered once a day at bedtime appeared to be optimal regimen for future therapeutic trials.

[Incomplete dissolution of calculi. Calcification, cholecystectomy, after treatment of biliary lithiasis with chenodeoxycholic acid]. / Dissolutions incomplètes des calculs. Calcifications, cholécystectomies, après traitement de la lithiase vésiculaire par l'acide chénodésoxycholique.

Among 54 patients with radiolucent asymptomatic gallstones treated by chenodeoxycholic acid (CDCA), 32 failures were observed. In 15 cases the size of gallstones did not change. In 11 cases the size of gallstones decreased but dissolution was not complete. In 6 cases the treatment had to be interrupted early because of the side-effects. In 10 patients (8.7 p. 100 of the treated patients) calcifications of gallstones occurred. In 9 patients (16.7 p. 100), a cholecystectomy had to be performed because of complications. The incidence of biliary complications necessitating cholecystectomy was significantly higher (p less than 0.001) in patients in whom CDCA failed to induce changes in gallstone size than in patients in whom CDCA was successful. Overall, a decrease of gallstones size was observed in 61 p. 100 of the 54 treated patients. However complete dissolution occurred in only two thirds of these patients. Patients in whom gallstone size decreased seldom presented with a biliary complication. Our data suggest that, when no obvious diminution of gallstones size is evident within six months of treatment, it is not advisable to continue the administration of CDCA. In case of failure, the responsibility of CDCA in the appearance of calcifications or even of complications necessitating cholecystectomy has to be discussed.

[Recurrence and prevention of recurrence after dissolution of gallbladder lithiasis by chenodeoxycholic acid in 22 patients]. / Récidives et prévention des récidives après dissolution de la lithiase vésiculaire par l'acide chénodésoxycholique chez 22 patients.

Dissolution of gallstones was observed 33 times in 22 patients. For 11 of them a recurrent lithiasis was dissolved by means of a second or third medical treatment. 21 patients have been followed for 3 to 6 years (median over 4 years). Without longstanding treatment the recurrence rate was 50 p. 100 in 3 years and 87.5 p. 100 in 6 years. Most of the patients should have relapsed in less than 9 years. Recurrences were always successfully treated with the same treatment but relapsed if the treatment was stopped (21 recurrences in 14 patients). A-1 month every 4 months-long standing treatment did not prevent recurrences in 8 patients whereas treatment every other month prevented recurrences in 5. It is therefore suggested to give long treatment after dissolution of gallstones to avoid recurrences. Its duration should be undefinite. Alternatives might include: 1) repeated dissolving treatments in case of recurrences, if relapses occur lately; 2) or longstanding treatment in case of early recurrences.

[Crohn's disease (acute regional colitis) (author's transl)]. / Maladie de Crohn colique pure d'évolution rapide.

This article reports the observation of acute form of Crohn's disease, limited to colonic involvement, in a 40-year old female. Diagnosis was based upon pathologic examination of biopsy. The patient died after four months of acute disease. Clinical and paraclinical justification of the diagnosis of Crohn's disease (colonic), as well as description of treatment are given.

[Statistical evaluation of biochemical data by the method of discrimination analysis. Selection of the discriminant biochemical variables. Attempted biochemical discrimination of intrahepatic cholestasis, extrahepatic obstruction and liver cancer]. / Traitement statistique des données biochimiques par la méthode d'analyse discriminante. Sélection des variables biochimiques discriminantes. Essai de discrimination biochimique de la cholostase intrahéatique de l'obstacle extrahépatique et du cancer du foie

An original method of statistical treatment of biological data is proposed. It permits satisfactory biochemical classification of 322 patients divided up into 3 groups : intrahepatic cholestasis (235 patients), extrahepatic obstruction (44 patients) and carcinoma of the liver (43 patients). On the basis of 32 tests, it was possible to define discriminating areas permitting satisfactory diagnosis in 95 per cent of published cases. The reduction in the number of tests necessary for diagnosis was considered. The selection technic used was original to the extent that it dose not require, like most methods used today, the determination of better individual discriminators, but the establishment of a better discriminating subunit, obtained from the initial subunit composed of a group of variables. From the 32 parameters contained in the standard liver function tests, a search for a better discriminating subunit consisting of the best four tests, permitted the authors to select a group of 10 tests : bilirubin, alkaline phosphatase, 5-nucleotidase, Thymolturbidity, Cetavlon test, serum albumin, total LDH, TGP (ALAT), OCT, GLDH, of which the discriminating value remains very satisfactory.