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Biomedical subjects

J D Elashoff

Publications and source records attributed to J D Elashoff.

At least 55 records · Page 3Linked to original sources
PubMed1983

Healing of benign gastric ulcer with low-dose antacid or cimetidine. A double-blind, randomized, placebo-controlled trial.

We conducted a 12-week, double-blind, randomized, placebo-controlled trial to determine whether cimetidine (300 mg with meals and at bedtime) or a convenient, liquid aluminum-magnesium antacid regimen (15 ml one hour after meals and at bedtime) would expedite healing or relief of symptoms in patients with benign gastric ulcer. Of the 101 patients who completed the trial according to protocol, 32 received the antacid, 36 cimetidine, and 33 placebo. At 4, 8, and 12 weeks after entry, ulcers had healed in a larger percentage of patients treated with cimetidine than of those treated with placebo: 53, 86, and 89 per cent of the cimetidine group versus 26, 58, and 70 per cent of the placebo group (P = 0.02, 0.01, 0.05), respectively. Healing at the three intervals had occurred in 38, 70, and 84 per cent, respectively, of the antacid-treated patients. Neither cimetidine nor antacid was more effective than placebo in relieving symptoms. The presence or absence of symptoms during the fourth and eighth treatment weeks was a poor predictor of the presence of absence of an ulcer crater. We conclude that cimetidine significantly hastens the healing of benign gastric ulcer.

Adult↗
PubMed1983

Long-term follow-up of duodenal ulcer patients.

The CURE peptic ulcer clinic started in April 1974. Patients (mostly veterans) with documented ulcer disease were interviewed regularly and inpatient hospitalizations were reviewed for follow-up periods of up to 6 years. Data from 245 male ulcer patients, 190 with duodenal ulcer alone and 55 with both documented duodenal ulcer (DU) and gastric ulcer (GU), were analyzed to assess the natural history of ulcer disease and factors predicting the severity of its course. Eleven percent of clinic patients had a complication (bleeding requiring a transfusion, perforation, or obstruction) during follow-up. Complication rates were about 2.7% per year for those with no prior complication, and about 5% per year for those with a prior complication. No patient variables or ulcer markers were related to the likelihood of a complication. Patients with both DU and GU were similar to patients with DU alone on many background variables, but the combined ulcer group had a significantly higher frequency of blood group nonsecretors, increased incidence of cigarette smoking, and greater frequency of complications or ulcer hospitalization prior to entry into the study and during follow-up. These factors, together with our failure to find differences in aggressive factors (acid output and PGI), suggests that DU + GU represents a different disease entity marked by additional defects in mucosal defense.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1983

A reappraisal of time trends in ulcer disease: factors related to changes in ulcer hospitalization and mortality rates.

There has been a dramatic decline in reported hospitalization and mortality rates for peptic ulcer disease in the past two decades. Data from the National Center for Health Statistics and from the Commission on Professional and Hospital Activities were examined to determine the cause(s) for this decline. Gastric and duodenal ulcer mortality rates decreased by 58 per cent and 68 per cent, respectively, from 1962 to 1978; changes in criteria for selecting the underlying cause of death might account for some of this apparent decrease. Hospitalization rates for duodenal ulcers decreased nearly 50 per cent from 1970 to 1978, but hospitalizations for gastric ulcers did not decrease. During this same time period, hospitalizations for peptic ulcers as one of the "all listed" causes remained stable, and hospitalizations for a closely related diagnosis, gastritis/duodenitis, increased. Changes in coding practices, hospitalization criteria, and diagnostic procedures appear to have contributed to the decline in reported hospitalization and mortality rates for peptic ulcer disease.

Hospitalization↗
PubMed1982

Analysis of gastric emptying data.

How should gastric emptying data be summarized to allow comparisons between males or between groups of subjects within a study, and to facilitate comparisons of results from study to study. We review standardization issues for reporting gastric emptying data, discuss criteria for choosing a method of analysis, review methods which have been used to describe gastric emptying data, recommend trial of the power exponential curve, and illustrate its use in the analysis and interpretation of data from several studies involving different types of meals and different types of subjects. We show why nonlinear curves should be fit using nonlinear least squares.

Gastric Emptying↗
PubMed1981

Repeated-measures bioassay with correlated errors and heterogeneous variances: a Monte Carlo study.

The relative potency of two drugs may be estimated from a small experiment in which all K doses of each drug are given in order of increasing dose level to each of n aminals at one testing session. Fiducial limits are often estimated from Fieller's theorem, with the (2K - 1)(n - 1)-degree-of-freedom error term obtained from a two-way analysis of variance. Monte Carlo results indicate that this method can yield limits which are far too narrow when there is serial correlation between successive doses. The jackknife confidence limits are found to behave well for the models investigated.

Analysis of Variance↗
PubMed1981

Statistical considerations in drug trials of peptic ulcer.

Drug trials of peptic ulcer healing and recurrence must be carefully designed, conducted, and reported so that the conclusions drawn from them will be valid. Randomization is best achieved in multicenter studies by double-blind coding of drugs in blocks of six to eight for each participating center. The first step in determining sample size is to assess the magnitude of effects which are of clinical importance. For 4-week studies of healing comparing an active drug to a placebo, trials should consist of at least 40 subjects per group. Comparisons between two active drugs must be based on even larger samples to draw a conclusion that they are equivalent with any degree of certainty. During the study, preliminary analyses of the data should be avoided unless a statistical stopping rule with safeguards for maintaining the double-blind status is employed. When the results are reported, dropouts must be carefully accounted for and a confidence interval for differences in percentage healed or percentage recurred should be given. Predictors of outcome should be investigated and reported in detail.

Clinical Trials as Topic↗
PubMed1980

Trends in hospital admissions and death rates for peptic ulcer in the United States from 1970 to 1978.

During the period 1970-1978, admissions to short-term nonfederal hospitals in the U.S. for duodenal ulcer decreased by 43%, whereas admissions for gastric ulcer did not change significantly. The decline in admissions for duodenal ulcer was greatest for uncomplicated cases, less for those with hemorrhage, and least (and not significant) in those with perforation. During the period 1970-1977, U.S. Vital Statistics reports of deaths from peptic ulcer decreased 31%, with about equal declines in total deaths, those associated with hemorrhage, and those associated with hemorrhage, and those associated with perforation. The fall in death rate involved both gastric and duodenal ulcer in both men and women. The male/female ratio has been falling steadily, and now stands at about 1.2 for hospitalizations and about 1.5 for deaths. From 1970 to 1978 the percentage of persons over 60 yr of age rose from 14 to 15% in the U.S. population as a whole, from 23 to 29% in persons hospitalized for all causes, from 27 to 36% in those hospitalized for duodenal ulcer, and from 40 to 48% in those hospitalized for gastric ulcer.

Adolescent↗
PubMed1980

Physician recommendations of elective surgery for duodenal ulcer patients: a comparision of surgeons and medical specialists.

A questionnarie eliciting physician recommendations of elective surgery versus medical management for hypothetical duodenal ulcer patients with bleeding 2 wk earlier was completed by gastroenterolgists and gastrointestinal surgeons. Surgeons consistenly recommended surgery more often than did gastroenterologists. However, the two groups made similar qualitative use of the factors amount of bleeding, age of patient, and duration of ulcer disease in their decision rules.

Adolescent↗
PubMed1980

Effect of intravenous lipid on gastric acid secretion stimulated by intravenous amino acids.

Intraduodenal fat is a potent inhibitor of all forms of gastric acid secretion in humans. Studies were performed in random order on 3 separate days in 5 normal subjects to determine if intravenous fat (Intralipid) altered gastric acid secretion stimulated by intravenous amino acids in humans. Mean (+/- SE) gastric acid output during a 4-hr intravenous amino acid infusion (21 g L-amino acids; Freamine II) plus glucose (50 g. to maintain isocaloric and isoosmolar solutions) was 43.2 +/- 3.2 meq/4 hr. Intraduodenal fat fusion (20 g of Intralipid) significantly (P < 0.02) suppressed amino acid-stimulated acid output. Interestingly, intravenous fat (20 g of Intralipid) also significantly (P < 0.02) inhibited acid secretion (14.8 +/- 6.3 meq/4 hr); similar to the effect observed with intraduodenal fat (12.7 +/- 4.9 meq/4 hr). Serum levels of CCK, gastrin, and GIP were measured at 30-min intervals throughout each study. Cholecystokinin and GIP increased significantly from basal during intraduodenal fat infusion. There were no other changes in serum CCK, gastrin, or GIP during any of the other tests. It is concluded that in normal subjects intravenous fat is a potent inhibitor of intraveous amino acid-stimulated gastric acid secretion, similar in effect to intraduodenal fat. The inhibitory effect of intravenous fat on amino acid-stimulated gastric acid secretion is probably not mediated by release of either CCK of GIP. Circulating fat may play a role in the control of some forms of gastric acid secretion.

Adult↗