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Biomedical subjects

R Jaszewski

Publications and source records attributed to R Jaszewski.

At least 37 records · Page 2Linked to original sources
PubMed1993

Duodenal and gastric ulcer prevention with misoprostol in arthritis patients taking NSAIDs. Misoprostol Study Group.

OBJECTIVES: To determine the efficacy of misoprostol for the prevention of nonsteroidal anti-inflammatory drug (NSAID)-induced duodenal and gastric ulcers in arthritis patients receiving NSAID therapy. DESIGN: A randomized, double-blind, multicenter, placebo-controlled trial. SETTING: Six hundred thirty-eight private, Veterans Affairs, health maintenance, and academic practices. PATIENTS: Six hundred thirty-eight patients with chronic inflammatory or noninflammatory arthritis who were taking an NSAID but who did not have a gastric or duodenal ulcer on screening endoscopy received treatment with ibuprofen, piroxicam, naproxen, sulindac, tolmetin, indomethacin, or diclofenac daily for 3 months. Four hundred fifty-five (71%) patients completed the trial. INTERVENTIONS: Patients meeting the entry criteria were randomized to receive either misoprostol, 200 micrograms, or placebo, four times a day for 12 weeks. MAIN OUTCOME MEASURES: The endoscopy was repeated at 4, 8, and 12 weeks. The development of a duodenal or gastric ulcer (defined as a circumscribed mucosal defect > or = 0.5 cm in diameter and with perceptible depth) was regarded as prophylactic failure. RESULTS: By 12 weeks, a duodenal ulcer developed in 2 of 320 (0.6%; 95% CI, 0.2% to 3.9%) patients randomized to receive misoprostol, compared with 15 of 323 (4.6%; CI, 2.8% to 8%) patients receiving placebo (P = 0.002). A gastric ulcer developed in 6 of 320 (1.9%; (CI, 0.8% to 4.4%) patients, compared with in 25 of 323 (7.7%; CI, 5.1% to 11.4%), respectively. CONCLUSION: Misoprostol significantly lowers the frequency of both duodenal and gastric ulcer development in patients who require long-term therapy with NSAIDS.

Adult↗
PubMed1993

Changes in gastric mucosal ornithine decarboxylase and tyrosine phosphorylation of proteins in postgastrectomy patients.

There is evidence to suggest that partial gastrectomy is associated with an increased risk of developing gastric carcinoma in humans. Since ornithine decarboxylase (ODC) and tyrosine phosphorylation of proteins are involved in the regulation of cell proliferation, the present study was undertaken to examine the time-dependent changes of these variables in the postgastrectomy stomach. Thirty-seven postgastrectomy patients (Billroth I (BI), n = 7, and Billroth II (BII), n = 30) underwent gastroscopy. For comparison, five patients with intact stomachs (three healthy and two postvagotomy and pyloroplasty) were also studied. Gastric mucosal biopsy specimens were obtained within 5 cm of the anastomosis and analyzed for ODC activity. In addition, tyrosine phosphorylation of membrane proteins was also determined in representative samples of BII patients. Gastric mucosal ODC activity was significantly higher in BII patients in whom gastrectomy had been performed > 15 years earlier compared with those in whom it had been performed < 15 years earlier (p < 0.001) or controls (p = 0.004). Although the mean ODC activity was higher in BII than in BI patients, the difference was not significant (p = 0.103). Isolated patients with high ODC activity demonstrated increased phosphorylation of tyrosine membrane proteins with M(r) of 55-60.

Adult↗
PubMed1992

Treatment of nonsteroidal antiinflammatory drug-induced gastric ulcers with misoprostol. A double-blind multicenter study.

One hundred sixty-two patients chronically ingesting ibuprofen, piroxicam, or naproxen for osteoarthritis, who had abdominal pain and an endoscopically proven gastric ulcer were evaluated for eight weeks in a randomized, double-blind trial comparing misoprostol (200 micrograms four times daily with meals and at bedtime) (N = 77) with placebo (N = 85). Patients discontinued their usual daily dose of antiarthritic medication throughout the study period, and an endoscopy was performed at four weeks and eight weeks (if necessary) to assess ulcer healing. Gastric ulcers were defined as circumscribed breaks in the gastric mucosa of 0.3 cm in diameter or greater. Misoprostol therapy significantly accelerated the rate of gastric ulcer healing compared to placebo (P = 0.033). The cumulative percent healed after four and eight weeks of therapy for misoprostol versus placebo were: 83% vs 61% at four weeks and 96% vs 90% at eight weeks (P = 0.0028 and P = 0.0977, respectively by lifetable analysis). Relief of abdominal pain did not differ significantly between the treatment groups. Misoprostol significantly accelerates the healing of ibuprofen-, piroxicam-, or naproxen-induced gastric ulcers.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1992

[Surgical treatment of secondary complications of myocardial infarction].

The results are presented od surgical treatment of 18 patients operated on in the Cardiosurgery Department, Institute of Cardiology, Medical Academy in Lódź, in the years 1985-1989, for complications of myocardial infarction. The material includes such complications as: post-infarction perforation of the septum, and post-infarction aneurysm of the left ventricle. The usefulness of specialized examinations is shown in qualifying the patients for operation, and the method is presented of carrying out operations in these patients in extracorporeal circulation. Good results of surgical treatment were achieved.

Adult↗
PubMed1991

Supplemental calcium suppresses colonic mucosal ornithine decarboxylase activity in elderly patients with adenomatous polyps.

Epidemiological and animal studies suggest a role for calcium in the chemoprevention of colorectal neoplasia. This study was designed to investigate whether supplemental oral calcium has a suppressant effect on colonic mucosal ornithine decarboxylase (ODC) and tyrosine kinase activities in patients with adenomatous polyps or a history of adenomatous polyps and whether this is affected by age. ODC and tyrosine kinase activities were measured in rectal mucosal biopsies of 19 male patients (age, years 46-85 years; mean, 66 years) with adenomatous polyps or a history of adenomatous polyps before and after 1 week of calcium supplementation p.o. (CaCO3; 2500 mg/day) and 2 weeks after cessation of calcium treatment. The basal rectal mucosal ODC activity of patients greater than or equal to 64 years old was nearly 4-fold higher than that of patients less than 64 years old (P less than 0.005). In patients greater than or equal to 64 years old, there was a significant decrease in rectal mucosal ODC activity following 1 week of calcium p.o. compared to those age less than 64 years (P less than 0.05). Overall tyrosine kinase activity did not differ significantly in either patient group before or after calcium supplementation p.o. However, the concentration of phosphotyrosine membrane proteins with molecular weights between 40,000 and 60,000 and between 80,000 and 100,000 were suppressed in patients age greater than or equal to 64 years after 1 week of calcium treatment p.o. These patients also had a corresponding decrease in their rectal mucosal ODC activity. Alternatively, patients whose ODC was not affected by calcium showed no apparent change in the relative concentration of rectal mucosal phosphotyrosine membrane proteins. Our data indicate that there is an age-related increase in basal rectal mucosal ODC activity in patients with adenomatous polyps which can be suppressed with calcium supplementation p.o., suggesting a role for dietary calcium in the chemoprevention of colorectal neoplasia.

Aged↗
PubMed1991

Neutrophil chemotaxis in gastric mucosa. A signal-to-response comparison.

This prospective study compares levels of neutrophil chemotactic activity (NCA) in gastric juice to the neutrophil count in gastric biopsies. Sixty-three male patients enrolled in the study and had antral biopsies following collection of gastric juice during esophagogastroduodenoscopy. Biopsies were examined for the magnitude of gastritis, tissue PMN count, and presence of Helicobacter pylori. Secretions were assayed for neutrophil chemotactic activity. Results show an increase in NCA and in tissue PMN counts with increasing severity of gastritis. H. pylori-positive patients had higher levels of NCA and PMN than H. pylori-negative patients. Wide variability in NCA levels preclude a direct correlation between NCA and PMN counts.

Biopsy↗
PubMed1990

Increased colonic mucosal angiotensin I and II concentrations in Crohn's colitis.

To define a potential role for the angiotensin system in Crohn's colitis, the colonic mucosal levels of angiotensin I and II were measured in endoscopic biopsy samples from patients with active Crohn's colitis (n = 20), ulcerative colitis (n = 13), other forms of colitis (n = 3), and normal controls (n = 17). Colonic mucosal levels of angiotensin I and II were greater in patients with Crohn's colitis than in normal subjects (p less than 0.001 and p less than 0.001, respectively). Mucosal levels of angiotensin I and II were also higher in Crohn's colitis than in ulcerative colitis (p less than 0.001 and p less than 0.001, respectively), and levels of angiotensin II were higher in Crohn's than in other forms of colitis (p = 0.014). Mucosal levels of angiotensin I and II correlated well with the degree of macroscopic inflammation in Crohn's colitis (r = 0.86, p less than 0.001 and r = 0.68, p less than 0.001, respectively). Mucosal levels of angiotensin I correlated fairly well with the Crohn's Disease Activity Index (r = 0.46, p less than 0.05) while angiotensin II levels correlated poorly. These studies suggest that angiotensin I and II may have a role in the inflammation associated with Crohn's colitis.

Angiotensin I↗
PubMed1990

A report of three multiclinic trials evaluating arbaprostil in arthritic patients with ASA/NSAID gastric mucosal damage. The Upjohn Company Arbaprostil ASA/NSAID Gastric Mucosal Damage Treatment Study Groups.

Three randomized, placebo-controlled multiclinic trials involving arbaprostil dosages of (a) 10 micrograms; (b) 25 micrograms; and (c) 10, 25, or 50 micrograms orally for 4 wk in patients older than 18 yr with rheumatoid arthritis or osteoarthritis who had endoscopically documented nonsteroidal antiinflammatory drug-associated gastric mucosal damage were conducted in the United States. All patients continued taking the nonsteroidal antiinflammatory drugs and were reendoscoped after 4 wk of therapy. Success at that time was defined as complete resolution of all gastric mucosal damage. Six hundred fifty-eight patients were enrolled in the three trials. Significantly more patients experienced healing in the arbaprostil treatment groups in all trials compared with those who received placebo. The healing rates in the various trials were 68% and 32% (10 micrograms vs. placebo; p = 0.007); 77% and 23% (25 micrograms vs. placebo; p less than 0.001); and 52%, 46%, 35%, and 16% (50, 25, and 10 micrograms vs. placebo; p less than 0.001, less than 0.001, and 0.002, respectively). Diarrhea, mostly of a mild nature, was the only arbaprostil-associated side effect and was found with the 25- and 50-microgram dosages (33% and 59%, respectively). No exacerbation of arthritis signs or symptoms was found. Arbaprostil at doses with varying effects on gastric acid secretion (25 and 50 micrograms) was documented in these trials to be an effective and safe agent for healing gastric mucosal damage associated with aspirin or other nonsteroidal antiinflammatory drugs in patients with either rheumatoid arthritis or osteoarthritis without adversely affecting joint symptomatology.

Administration, Oral↗
PubMed1990

Frequency of gastroduodenal lesions in asymptomatic patients on chronic aspirin or nonsteroidal antiinflammatory drug therapy.

Endoscopy in 49 patients without upper gastrointestinal symptoms and who were receiving chronic aspirin or nonsteroidal antiinflammatory drug therapy showed the frequency of gastric and duodenal mucosal lesions to be 76 and 27%, respectively. Fifteen (31%) had gastric ulcers, 31 (63%) had gastric erosions, and 10 (20%) had gastric mucosal hemorrhages. Gastric mucosal lesions were noted in 9 (90%) patients taking plain aspirin, in 25 (74%) receiving nonsteroidal antiinflammatory agents, and in 3 (60%) patients taking enteric-coated aspirin. Duodenal lesions were noted in 30 and 26% of patients taking plain aspirin and nonsteroidal antiinflammatory drugs, respectively. Patients taking enteric-coated aspirin had less severe duodenal injury than patients receiving ibuprofen or indomethacin, but the difference was not statistically significant. Endoscopy in 20 normal subjects not taking aspirin or nonsteroidal antiinflammatory drugs showed no gastroduodenal ulcers, erosions, or hemorrhage. Patients chronically taking antiarthritic drugs, including enteric-coated aspirin, have a high frequency of asymptomatic gastroduodenal lesions.

Adult↗
PubMed1990

Myocardial perfusion scintigraphy with thallium-201 for prediction of graft patency early after internal mammary artery graft surgery.

Myocardial perfusion scintigraphy with thallium-201 was performed in fifty-four patients after internal mammary artery (IMA) graft to the left descending coronary artery to determine the influence of the flow rate in the IMA on myocardial perfusion after the procedure. The flow rate in the IMA was 40 to 200 ml/minute (mean 103 +/- 26.6 ml/min). Myocardial perfusion after IMA surgery was good in 44 patients (82%). There was a correlation between IMA flow rate and surgical results. Only 53% of patients with IMA flow rates below 100 ml/min to atmosphere showed good myocardial perfusion.

Adult↗
PubMed1989

Persistence of gastric ulcers caused by plain aspirin or nonsteroidal antiinflammatory agents in patients treated with a combination of cimetidine, antacids, and enteric-coated aspirin.

Twenty-three patients chronically ingesting plain aspirin or nonsteroidal antiinflammatory drugs, who had endoscopically proven solitary or multiple gastric ulcers, were treated for eight weeks with cimetidine and antacids. Plain aspirin and nonsteroidal antiinflammatory drugs were discontinued in all patients. Seven patients received enteric-coated aspirin throughout the treatment phase and continuously for the entire study period (2.5-12 months). The remainder of patients (N = 16) did not receive enteric-coated aspirin. An endoscopy was performed to assess ulcer healing. None of seven patients receiving enteric-coated aspirin had complete healing of their ulcer(s) while 15 of 16 patients not receiving enteric-coated aspirin demonstrated complete healing of their ulcer(s) (P less than 0.001). An eight-week course of cimetidine and antacids is ineffective in completely healing gastric ulcers caused by plain aspirin or nonsteroidal antiinflammatory drugs while enteric-coated aspirin is continued.

Antacids↗
PubMed1989

Reassessment of the association between gastrointestinal arteriovenous malformations and aortic stenosis.

PURPOSE AND PATIENTS AND METHODS: The purported association between aortic stenosis and gastrointestinal arteriovenous malformations (AVMs) has not been rigorously evaluated. The diagnosis of aortic stenosis in most the prior studies has been based on clinical examination. We therefore utilized two-dimensional and Doppler echocardiography to document the presence or absence of aortic stenosis in 29 men with gastrointestinal AVMs documented by endoscopy. RESULTS: Of the 29 patients studied, 22 (76 percent) had ejection systolic murmurs and 18 (62 percent) had echocardiographic evidence of aortic sclerosis. However, none of the patients had any evidence of aortic stenosis as assessed by Doppler echocardiography. CONCLUSION: Although previous case reports and retrospective studies have suggested an association between gastrointestinal AVMs and aortic stenosis, our study does not support this association and suggests the need for a prospective trial.

Aortic Valve Stenosis↗
PubMed1989

Efficacy of screening flexible sigmoidoscopy for colorectal neoplasia in asymptomatic subjects.

PURPOSE: Although flexible sigmoidoscopy is recommended in patients over age 40 to complement fecal occult blood screening for colorectal neoplasia, the yield of this procedure in asymptomatic, average-risk subjects has varied between studies. In addition, the efficacy of flexible sigmoidoscopy in detecting early curable carcinoma has been the subject of debate. We therefore undertook this study to assess the efficacy, safety, and cost of the procedure for early detection of colorectal neoplasia in asymptomatic subjects. PATIENTS AND METHODS: Flexible sigmoidoscopy with a 60-cm scope was performed in 412 asymptomatic veterans (mean age, 63.2 years). Subjects with positive fecal occult blood and those at increased risk for colorectal neoplasia were excluded. Costs were estimated on the basis of Medicare payments. RESULTS: A mean length of 56.1 cm of sigmoid and descending colon was examined. A total of 132 polyps were detected in 93 subjects (22.6%). Thirty-five percent of the polyps were located at a distance of greater than 30 cm from the anal verge. Of 122 polyps removed, 26% were 1 cm in size or larger. A total of 77 polyps (63%) were adenomas, and six polyps (5%) were carcinomas. Of the six carcinomas detected (two carcinoma in situ, one Astler Coller stage A, two stage B1, and one stage C1), five were in a localized stage and thus potentially curable. The cost of detecting each potentially curable carcinoma was $47,174. No complications from flexible sigmoidoscopy were noted. CONCLUSION: In conclusion, 60-cm flexible sigmoidoscopy is a safe, high-yield procedure for the initial screening of colorectal neoplasia in asymptomatic, average-risk subjects over the age of 50. Because the carcinomas detected were still in an early stage, such screening may improve survival.

Adenoma↗
PubMed1988

Management of the malignant polyp.

Colonoscopy and endoscopic polypectomy are being utilized more frequently these days with the increased emphasis on the prevention, early detection, and treatment of colon cancer. Consequently, the problem of managing the malignant polyp is likely to be more frequently encountered. Many attempts have been made to clarify the management principles involved. Although the studies conducted have been imperfect in their design, the variety of information obtained from these studies is making the picture clearer. A more conservative approach is evolving. Many malignant polyps may be managed by endoscopic polypectomy alone. The criteria for which patients are to be managed in this fashion seem to be relatively simple ones, though technical problems with polypectomy performance and histologic evaluation are still frequently encountered. More carefully designed long-term studies are needed to create firm guidelines for the management of malignant polyps. Should screening and surveillance result in the discovery of earlier and more readily treatable forms of invasive colon cancer, endoscopic polypectomy will most certainly be a cornerstone of their treatment.

Adenocarcinoma↗
PubMed1988

Failure of a cytoprotective dose of Arbacet to heal acute gastric ulcers.

Twenty outpatients with an endoscopic diagnosis of gastric ulcer were evaluated for 6 wk in a randomized, double-blind trial comparing 15(R)-15-methyl prostaglandin E2 (Arbacet) (10 micrograms, 0.5 h before each meal and at bedtime) with placebo. Endoscopy was performed at 3 wk and 6 wk during the study period. Five of nine patients (56%) taking Arbacet and seven of 11 patients (64%) in the placebo group had complete healing of their gastric ulcer. Healing occurred in four patients from the Arbacet group and three patients in the placebo group at 3 wk. A cytoprotective dose of Arbacet (40 micrograms daily) is not significantly better than placebo in healing gastric ulcers.

Acute Disease↗
PubMed1987

The effect of 15(R)-15-methyl prostaglandin E2 (Arbacet) on the healing of aspirin or nonsteroidal antiinflammatory drug-induced gastric mucosal lesions: an endoscopic study.

Twenty-nine outpatients chronically ingesting daily aspirin or nonsteroidal antiinflammatory drugs for rheumatological disease, who had endoscopically proven gastric mucosal lesions worse than erythema, were evaluated for 4 wk in a randomized, double-blind trial comparing 15(R)-15-methyl prostaglandin E2 (Arbacet) (10 micrograms, 0.5 h before each meal and at bedtime) with placebo. Patients continued their usual daily dose of antiarthritic medication throughout the study period, and an endoscopy was performed on the final day to assess healing. Five of 14 patients (36%) taking Arbacet and two of 15 patients (13%) in the placebo group had complete healing of their gastric lesions after 4 wk. Arbacet at a daily dose of 40 micrograms is not significantly better than placebo in healing gastric lesions caused by aspirin or nonsteroidal antiinflammatory drugs, if antiinflammatory therapy is continued.

Anti-Inflammatory Agents, Non-Steroidal↗