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Biomedical subjects

M J Collen

Publications and source records attributed to M J Collen.

71 records · Page 4Linked to original sources
PubMed1984

Comparison of ranitidine and cimetidine in the treatment of gastric hypersecretion.

The H2-histamine receptor antagonists, cimetidine and ranitidine, were compared for their abilities to control acid secretion on a short- and long-term basis in 13 patients with gastric hypersecretory disorders. The rate of onset of action did not differ between the two drugs. The actions of both drugs were increased by an anticholinergic agent, and there was a close correlation between the daily maintenance dose of each drug needed to control acid secretion. However, ranitidine was threefold more potent than cimetidine and no male patient developed breast changes or impotence while taking ranitidine. Treatment with high doses of ranitidine for 6 to 25 months was not associated with hepatic or hematologic toxicity or alterations of serum gastrin levels, but was associated with a significantly lower serum creatinine level than that seen with cimetidine therapy. These studies show that ranitidine can adequately inhibit acid secretion in patients with gastric hypersecretory disorders, is safe at high doses, does not cause the antiandrogen side effects frequently seen with high doses of cimetidine, and is threefold more potent than cimetidine. Patients who are relatively resistant to cimetidine will have proportional resistance to ranitidine.

Adult↗
PubMed1984

Esophageal cryptococcosis in a patient with the hyperimmunoglobulin E-recurrent infection (Job's) syndrome.

Patients with the hyperimmunoglobulin E-recurrent infection (Job's) syndrome, which is characterized by an elevated immunoglobulin E level, recurrent staphylococcal infections, and an abnormality of neutrophil chemotaxis, have been reported to have visceral Candida infections in addition to their more frequent pyogenic infections. We report a patient with Job's syndrome who presented with massive hematemesis secondary to esophageal cryptococcosis. A thorough evaluation for an occult neoplasm or extraesophageal cryptococcosis was negative. The patient received a 6-wk course of amphotericin B (970 mg) and 5-fluorocytosine with complete radiographic and endoscopic resolution of the lesion. He is doing well 18 mo after therapy. The patient was not anergic, and his response to T-cell mitogens, helper-to-suppressor T-cell ratio, total number of T cells, and immunoglobulin-producing capability were all normal. This case is unusual in that it is the first documentation of a cryptococcoma of the esophagus and underscores the importance of culturing abnormal specimens for unsuspected pathogens in unusual clinical circumstances.

Adult↗
PubMed1983

Diagnosis and management of the Zollinger-Ellison syndrome.

In the last 10 years, the basis for the diagnosis and treatment of gastric hypersecretion in Zollinger-Ellison syndrome has changed dramatically. The diagnostic criteria have changed because gastrin hypersecretion by a non-beta islet tumor is now known to be responsible for gastric hypersecretion, and gastrin radioimmunoassays are now widely available. The treatment of the gastric hypersecretion in Zollinger-Ellison syndrome has changed since development of histamine H2-receptor antagonists and the demonstration that gastric acid secretion can be controlled medically in most patients, obviating routine total gastrectomy. In this paper, we review currently available and newer antisecretory drugs, the results of long-term medical treatment, potential problem areas, and our current approach to controlling gastric hypersecretion in patients with Zollinger-Ellison syndrome.

Gastric Acid↗
PubMed1983

Zollinger-Ellison syndrome: current concepts and management.

Over the last few years the approach to managing patients with the Zollinger-Ellison syndrome has changed dramatically. The establishment of gastrin hypersecretion by a non-beta islet cell tumor as responsible for the gastric acid hypersecretion, and the subsequent development and widespread availability of gastrin radioimmunoassays have changed the criteria generally used for diagnosis and have led to an increased understanding of syndromes that can mimic Zollinger-Ellison syndrome. With the availability of histamine H2-receptor antagonists, gastric acid hypersecretion can be controlled medically in almost all patients with Zollinger-Ellison syndrome, obviating routine total gastrectomy. With the reduced mortality from gastric acid hypersecretion, increased attention is being focused on the natural history of the gastrinoma. Newer methods of localizing tumors are being investigated with a view to surgical removal of the gastrinoma, and the importance of developing an affective chemotherapeutic regimen is becoming increasingly apparent.

Adolescent↗
PubMed1983

Reliability of symptoms in assessing control of gastric acid secretion in patients with Zollinger-Ellison syndrome.

In the present study we explored whether the presence or absence of symptoms could provide a reliable way of assessing the adequacy of control of gastric secretion in patients with Zollinger-Ellison syndrome who were treated medically. Over a 5-yr period, 26 Zollinger-Ellison syndrome patients were entered into a prospective study which examined the presence or absence of symptoms that are associated with gastric hypersecretion, the presence of absence of upper gastrointestinal pathology, and the degree of control of gastric acid secretion. During their last admission, 15 of the 26 patients (58%) were symptomatic, but post-drug gastric acid secretion for the 2 h before the next dose of medication was not significantly different from that in asymptomatic patients. This lack of correlation between the presence or absence of symptoms and post-drug gastric acid secretion was evident for the group as a whole, as well as for 8 to 12 patients who underwent multiple admissions. Of 23 patients who underwent upper gastrointestinal endoscopy of x-ray, or both, on their last admission, 12 had pathology. Post-drug gastric acid secretion was less in patients without pathology than in those with pathology. Furthermore, in patients in whom post-drug gastric acid secretion was less than or equal to 10 mEq/h, the criterion of acceptable control used in this study, pathology did not occur. These findings demonstrate that the presence or absence of symptoms cannot be used to assess the adequacy of medical control of gastric acid secretion in patients with Zollinger-Ellison syndrome. In our opinion, maintenance of post-drug gastric acid secretion less than or equal to 10 mEq/h for the 2 h before the next dose of medication is an acceptable criterion for long-term control of gastric secretion in patients with Zollinger-Ellison syndrome.

Adult↗
PubMed1982

Action of cholera toxin on dispersed acini from rat pancreas. Post-receptor modulation involving cyclic AMP and calcium.

In dispersed acini from rat pancreas, cholera toxin caused a significant increase in cellular cyclic AMP but little or no change in amylase secretion. The presence of a secretagogue that causes mobilization of cellular calcium (e.g., cholecystokinin, carbamylcholine, bombesin or ionophore A23187) caused a substantial increase in the effect of cholera toxin on enzyme secretion. Cholera toxin did not alter calcium transport or the changes in calcium transport caused by other secretagogues, and secretagogues that mobilize cellular calcium did not alter cellular cyclic AMP or the increase in cyclic AMP caused by cholera toxin. These results indicate that in dispersed acini from rat pancreas there is post-receptor modulation of the action of cholera toxin by secretagogues that mobilize cellular calcium and that this modulation is a major determinant of the effect of the toxin on enzyme secretion.

Amylases↗
PubMed1982

Postreceptor modulation of action of VIP and secretin on pancreatic enzyme secretion by secretagogues that mobilize cellular calcium.

In dispersed acini from rat pancreas, secretagogues that act through or mimic the action of AMP [vasoactive intestinal peptide (VIP), secretin, or 8-bromo-AMP] caused a twofold increase in amylase secretion. Secretagogues that mobilize cellular calcium (carbamylcholine, C-terminal octapeptide of cholecystokinin, bombesin, or A23187) caused a sevenfold augmentation of the actions of VIP, secretin, or 8-bromo-cAMP on enzyme secretion. Carbamylcholine and the C-terminal octapeptide of cholecystokinin also augmented the action of VIP on amylase secretion from mouse pancreatic acini. Secretagogues that mobilize cellular calcium did not alter binding of 125I-VIP, cellular cAMP, or the increase in cellular cAMP caused by VIP or secretin. Similarly, secretagogues that increase cellular cAMP did not alter 45Ca outflux or the increase in 45Ca outflux caused by carbamylcholine, C-terminal octapeptide of cholecystokinin, bombesin, or A23187. These results indicate that in dispersed acini from rat pancreas there is postreceptor modulation of the actions of VIP and secretin on enzyme secretion by secretagogues that mobilize cellular calcium and that this modulation is a major determinant of the magnitude of the effect of VIP and secretin on enzyme secretion. This modulation, in turn, reflects the ability of cellular calcium, mobilized from intracellular stores, to amplify the action of cellular cAMP on the enzyme secretory process.

8-Bromo Cyclic Adenosine Monophosphate↗
PubMed1980

Cimetidine vs placebo in duodenal ulcer therapy. Six-week controlled double-blind investigation without any antacid therapy.

We studied the healing efficacy of cimetidine or placebo in 23 endoscopically proven duodenal ulcer outpatients in a randomized, controlled, prospective, double-blind trial. There were 11 patients in the cimetidine (1200 mg daily) treatment group and 12 patients in the placebo-treated group. No antacid was allowed, but a placebo antacid with no neutralizing capacity was given as needed for pain. The incidence of complete endoscopic healing at 2, 4, and 6 weeks was 54%, 63%, and 72% in the cimetidine-treated patients and 8%, 50%, and 67% in the placebo-treated patients. There was a statistically significant difference (P < 0.05) in complete duodenal ulcer healing between both treatment groups after 2 weeks of therapy, but there was no significant difference at the 4- and 6-week observation periods. The incidence of complete pain relief at 2 and 4 weeks was 64% and 82% in the cimetidine-treated patients and 67% and 75% in the placebo-treated patients. At 6 weeks of treatment there was no increase in the number of patients with complete pain relief in either group. There was no significant difference between the two groups in the incidence of ulcer pain relief at any of the three observation periods. Duodenal ulcer healing rates and duodenal ulcer pain relief were compared at 2, 4, and 6 weeks. There was no statistical association between ulcer healing and complete pain relief in the placebo treatment group at the 2-week evaluation period, but there was statistical association (P < 0.05) in the cimetidine treatment group at 2 weeks and both treatment groups at the 4- and 6-week evaluation periods. The results of this study demonstrate that in duodenal ulcer out-patients treated for 6 weeks: (1) cimetidine increases the incidence of duodenal ulcer healing during the first 2 weeks of treatment; (2) more than 50% of duodenal ulcers will spontaneously heal during a 4 to 6-week observation period which is not statistically modified by cimetidine treatment; (3) the complete relief of duodenal ulcer pain is not influenced by treatment with cimetidine when compared to placebo.

Administration, Oral↗
PubMed1980

Azulfidine-induced oligospermia.

A patient with Crohn's ileitis was treated with azulfidine (4 gm./day) for 18 months. During the treatment period he was infertile with quantitative and qualitative abnormalities of his spermatozoa. Upon termination of the azulfidine, his semen analysis became normal and his wife subsequently became pregnant. In some patients there appears to be an effect of azulfidine on spermatogenesis that is completely reversible when the drug is withdrawn.

Adult↗
PubMed1980

Cimetidine vs placebo: complete gastric ulcer pain relief. Six week controlled double blind study without any antacid therapy.

We studied the efficacy of cimetidine or placebo in relieving ulcer pain on 27 endoscopically-proven gastric ulcer outpatients in a randomized controlled prospective double blind trial. There were 12 patients in the cimetidine (1,200 mg daily) treated group and 15 patients in the placebo treated group. No antacid was allowed, but a placebo antacid with no neutralizing capacity was given as needed for pain. The incidence of complete pain relief at 2 and 4 weeks was 58% and 67% in the cimetidine treated patients, and 60% and 80% in the placebo treated patients. At 6 weeks of treatment there was no increase in the number of patients with complete pain relief in either group. There was no significant difference between the 2 groups in the incidence of ulcer pain relief at any of the 3 observation periods. Gastric ulcer healing rates and gastric ulcer pain relief were compared at 2 and 4 weeks. The cimetidine treated group healed 17% with 58% pain relief, and the placebo treated group had no ulcers healed at 2 weeks with 60% complete pain relief. There was no statistical association between ulcer healing and pain relief in both treatment groups at the 2 week evaluation period, but there was statistical association (P less than .05) at 4 weeks. The results of this study demonstrated that in gastric ulcer outpatients treated for 6 weeks: 1) the complete relief of gastric ulcer pain is not influenced by treatment with cimetidine when compared to placebo, and 2) there is no association between complete pain relief and the presence of an endoscopically proven gastric ulcer during the first 2 weeks of treatment with either cimetidine or placebo.

Aged↗
PubMed1980

Modification of endoscopic retrograde cholangiopancreatography (ERCP) septic complications by the addition of an antibiotic to the contrast media. Randomized controlled investigation.

We studied the efficacy of gentamicin or placebo to decrease the incidence of septic complications after ERCP in 61 inpatients with possible pancreatic or biliary tract disease. The antibiotic or placebo was added to the Renograffin-60 contrast media and the study was conducted in a randomized controlled fashion. There were 29 patients who received gentamicin and 32 patients who were in the placebo group. No patient received parenteral antibiotic prior to, during, or after the ERCP unless a septic complication developed and each was followed daily with complete blood counts and oral temperatures. The incidence of febrile episodes in the gentamicin group was one (3%). All blood cultures were negative. One patient (3%) in the placebo group developed a febrile episode with subsequent blood cultures growing Escherichia coli. There was no statistical difference in the incidence of septic episodes between the two study groups. The results of this study demonstrate that the incidence of septic complications during ERCP is not modified by the addition of gentamicin to the contrast media.

Adolescent↗
PubMedDate not supplied

Limited benefit of atropine as premedication for colonoscopy.

A prospective double-blind trial was performed comparing atropine (0.5 mg) by slow intravenous administration to placebo as premedication for colonoscopy, to assess the possible beneficial effects of this vagolytic agent on the performance and safety of the procedure. A total of 77 patients was randomly assigned to receive atropine (38 patients) or placebo (39 patients) before colonoscopy in conjunction with our standard initial medications for conscious sedation (meperidine, 0.4 mg/kg and midazolam, 0.03 mg/kg). Total procedure time was 31 min for the atropine group and 35 min for the placebo group (p greater than 0.05), and there was no overall difference in the total amount of intra-procedural medications required. No statistically significant differences were observed relative to the number or severity of vagal episodes, and neither the endoscopist nor the patients noted any differences in the ease or tolerance of the procedure (p greater than 0.05). Although these results fail to demonstrate a significant benefit of atropine when given routinely as premedication for colonoscopy, this study does not rule out the potential usefulness of atropine in counteracting vagal episodes when they occur.

Arrhythmias, Cardiac↗
PubMedDate not supplied

Addition of enemas to oral lavage preparation for colonoscopy is not necessary.

To evaluate whether the addition of enemas to oral electrolyte lavage is helpful for colonoscopic preparation, we conducted a prospective, randomized, observer-blinded trial to compare oral lavage plus enemas with oral lavage alone. The quality of preparation, mucosal visualization, and the volume of retained colonic fluid did not differ between the two groups. Twenty-two percent of the patients in the group who received oral lavage plus enemas compared with 12% of the patients in the group that only received oral lavage stated that they would refuse to repeat the preparation for future colonoscopic examination. Seventeen percent of the patients in the group that received oral lavage plus enemas demonstrated anorectal trauma or inflammation compared with only 5% in the group that received oral lavage alone (p = 0.09). These results indicate that the addition of enemas to oral lavage preparation for colonoscopic evaluation cannot be routinely recommended. However, enemas may be considered on an individual basis in the occasional patient unable to consume the complete oral lavage or in whom residual stool is found during colonoscopic evaluation after oral lavage preparation.

Colonoscopy↗
PubMedDate not supplied

Barrett's oesophagus.

Explore the source record for details and available documents.

Adenocarcinoma↗