Biomedical subjects
Publications and source records attributed to M Deakin.
Oesophageal problems are common. There are three areas where drug treatment can be helpful, namely in the control of gastro-oesophageal reflux and its symptoms, the treatment of oesophageal motility disorders and when oesophageal infection occurs. In this review the management of these three disorders is considered.
If the poor prognosis for patients with adenocarcinoma of the stomach is to be improved, it is important to make the diagnosis at an early stage. In order to evaluate our routine diagnostic practice, we have performed a retrospective study of patients in the Portsmouth and Oxford Health Districts who were diagnosed as having adenocarcinoma of the stomach during 1979 and 1980. Three hundred and forty-two patients were identified; the great majority had advanced disease at the first presentation. Only 9 patients (2.6%) were identified as having early gastric carcinoma and a total of 46 patients (13.4%) had either Stage 1 or 2 disease. Despite the provision of an endoscopy service, gastric carcinoma is still being diagnosed at an advanced stage. Initial false negative investigations caused a delay in diagnosis in 18.4% of patients. During the year preceding diagnosis (when tumour was likely to have been present), the false negative rate for barium meal examination was 25.5% and for endoscopy 13.5%. Negative results should not deter us from pursuing the diagnosis of tumour in those patients with persisting symptoms.
The pharmacologic response to cimetidine was studied in 8 patients with duodenal ulcers in remission whilst smoking and during abstinence. No significant difference was found in overnight intra-gastric acidity, acid or pepsin output. These data do not support the hypothesis that pharmacologic response to H2 receptor antagonists is impaired in smokers.
Sixty women with genuine stress incontinence were consecutively assigned to one of four physiotherapy groups who were treated for 6 weeks by either (1) pelvic floor exercises (PFE) in hospital; (2) PFE and faradism; (3) PFE and interferential therapy; (4) PFE at home. Assessment before and after treatment was by 7-day bladder charts, urethral pressure profiles and perineometry. Approximately two-thirds of the hospital-treated patients (groups 1, 2 and 3) experienced marked or moderate subjective improvement and at 6 months, 27% were dry or almost dry. There was little difference in outcome between groups 1, 2 and 3 but hospital-based therapy was more effective than home treatment. Statistical analyses showed that there were significant improvements in the objective indices measured in the 45 hospital-treated patients. Successful treatment was more likely in younger patients, in those with lesser degrees of genuine stress incontinence and those who had had no previous pelvic floor surgery.
The effects of single doses of cimetidine 800, 1200, and 1600 mg, given at 2300 h or 800, and 1600 mg at 1800 h, have been studied in patients with duodenal ulcer disease in symptomatic remission, and compared with cimetidine 400 mg bd (0800 h and 2300 h) and ranitidine 300 mg (given at 1800 h) respectively. A dose related reduction in intragastric acidity was seen. All single nocturnal (2300 h) doses of cimetidine produced anacidity overnight. This was not achieved with dosing at 1800 h although the duration of inhibition of gastric acidity was longer. Inhibition of overnight acid and pepsin outputs were similarly dose and timing related, but inhibition of peptic activity was much less after dosing at 1800 h. Cimetidine 1600 mg and ranitidine 300 mg were similar in their effects.
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A case of a large and ulcerated Brunner's gland adenoma presenting as chronic blood loss and resected endoscopically with complete resolution of symptoms. The pathological features of the tumour and the therapeutic approaches are discussed with particular reference to endoscopic surgery.
Intragastric pH was monitored during 24 hours in eight volunteers with duodenal ulcer disease in remission, while on placebo, cimetidine 400 mg bd, pirenzepine 50 mg bd, cimetidine 400 mg bd + pirenzepine 50 mg bd, cimetidine 200 mg bd + pirenzepine 25 mg bd. The control of intragastric acidity during the 24 hour period by the combination of low dose cimetidine and pirenzepine was significantly better than with cimetidine, or pirenzepine alone in full dosage. This difference was most apparent after breakfast but was still present after lunch when cimetidine had no significant effect. Combination treatment is a logical approach when continuous control of intragastric acidity is needed, but a three times daily regimen will be necessary to cover the 24 hours.
We have studied the effect of a prostaglandin E2 analogue (enprostil), on intragastric acidity, gastric acid and pepsin outputs during a 24 hour period in nine patients with duodenal ulcer in remission. Enprostil 35 micrograms bd dose inhibited 24 hour intragastric acidity by 38% and a 70 micrograms nocturnal dose by 33%. Decrease in nocturnal pepsin secretion was both volume and concentration related.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
People with severe learning disabilities and challenging behaviours can present such noisy and disruptive behaviour that attempts to conduct individual work and teaching programmes with them are constantly interrupted or split. Staff have to concentrate on managing the disruption. This paper describes five initiatives used in a day centre to address this problem.