Significance of white matter lucencies in posthypoxic-ischemic encephalopathy: comparison of clinical status and of computed and positron emission tomographic findings.

The clinical status and the computed and positron tomographic findings were compared in 10 patients with sequelae of hypoxic-ischemic encephalopathy after cardiopulmonary arrest and successful resuscitation. Conscious patients with moderate neuropsychiatric deficits had no significant computed tomography (CT) scan changes and normal values of regional cerebral blood flow and oxygen consumption, while patients in vegetative state had definite cerebral atrophy on CT scan and a severe and widespread decrease of regional cerebral blood flow and oxygen consumption. This decrease was even more pronounced in vegetative patients with the worst neurological score and with CT scans demonstrating additional diffuse white matter lucencies and hypodensities in the basal ganglia. In this group of patients increased regional oxygen extraction rates mainly in the white matter indicated the occurrence of delayed ischemic changes. The positron emission tomography and CT findings correlated well with the degree of posthypoxic-ischemic damage and the clinical status of the studied subjects.

[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.