Abortion across countries.
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Abortion, Legal↗
Biomedical subjects
S K Lam
Publications and source records attributed to S K Lam.
Maintenance therapy for duodenal ulcer: a randomized controlled comparison of seven forms of treatment.
PURPOSE: We performed a randomized controlled trial to compare the efficacy of seven forms of maintenance treatment of duodenal ulcer, including a mealtime regimen of antacids. PATIENTS AND METHODS: We randomized 785 patients with healed duodenal ulcer to receive: (1) no treatment; (2) mealtime antacids with an acid-neutralizing capacity of 80 mmol/day; (3) an antidepressant, trimipramine 25 mg; (4) an anticholinergic, pirenzepine 50 mg; (5) cimetidine 200 mg; (6) cimetidine 400 mg; (7) ranitidine 150 mg; or (8) sucralfate 1 g twice a day. Symptomatology and side effects were assessed every 2 months and endoscopy was performed every 4 months up to 1 year. RESULTS: The patients were comparable in the majority of clinical characteristics before entry. The cumulative percentages of patients with relapse of ulcers at 12 months by life-table analysis were 61% with no treatment, 38% with mealtime antacids, 60% with trimipramine, 52% with pirenzepine, 46% with cimetidine 200 mg, 44% with cimetidine 400 mg, 30% with ranitidine 150 mg, and 40% with sucralfate. Cimetidine 400 mg, antacids, ranitidine 150 mg, and sucralfate were significantly better than no treatment and the other forms of treatment. Ranitidine was significantly better than antacids, cimetidine, and sucralfate in preventing endoscopically documented duodenal ulcer relapse by multiple comparison at 12 months, but not by life-table analysis nor when symptomatic relapses were compared. No significant difference was detected among antacids, cimetidine, and sucralfate. No major side effects occurred with the seven forms of treatment, but those receiving antacids had the highest incidence of minor adverse events (26%). CONCLUSION: This study suggests that mealtime antacids are as effective as H2-receptor antagonists and sucralfate in the maintenance treatment of duodenal ulcer disease, but have to be taken three times a day and had the highest incidence of reported minor adverse events. The relapse rate was lower with ranitidine than with cimetidine, sucralfate, and antacids, but the difference was small and may not be clinically important.
Adult↗
The effect of smoking during pregnancy on the incidence of low birth weight among Chinese parturients.
The incidence and effect of smoking in Chinese parturients are not well known. In a retrospective case-controlled study of 213 patients who smoked during pregnancy, it was found that the incidence of low birth-weight was doubled. On average the babies were smaller by 200 g, shorter by 1 cm and the head circumference was smaller by 0.3 cm. These anthropometric deficits may have significant long-term effects. Although the incidence of smoking in Chinese parturients is low (2%), the rising trend in recent years should prompt all physicians to advise expectant mothers to avoid smoking before and during pregnancy.
Adult↗
Narcotic addiction in pregnancy with adverse maternal and perinatal outcome.
A retrospective case controlled study was carried out on 51 Chinese gravidas who had abused narcotics and who were delivered in a teaching hospital in Hong Kong. Heroin was the most commonly abused drug. The number of patients who changed from heroin to methadone was small. The major antenatal complications were late antenatal booking (average 28 weeks), prematurity (41%), small for gestational age baby (27.5%), antepartum haemorrhage (13.7%) and high prevalence of venereal disease (23.5%). The babies born to drug addicted mothers were on average 629 g lighter at birth, 5 cm smaller in head circumference and 7 cm shorter in body length. Neonatal withdrawal symptoms occurred in 83% of all drug exposed neonates. The perinatal mortality rate was 19.6 per 1,000 total birth which was 2.5 times that of the control group. There was one maternal death in our series. Drug addiction in pregnancy poses a major risk to both mother and child.
Adult↗
The cytoprotective effect of zinc L-carnosine on ethanol-induced gastric gland damage in rabbits.
The effects of zinc L-carnosine on the damaging actions of ethanol were examined in rabbit isolated gastric glands. Ethanol (8%, v/v) incubation produced a 50% viability of the gland populations and released a significant amount (38%) of the total lactate dehydrogenase (an index of membrane injury) of the glands. Zinc L-carnosine pre-incubation for 15 min markedly prevented these actions of ethanol; however, L-carnosine by itself did not have these effects. The findings indicate that zinc ion but not carnosine in the zinc L-carnosine molecule possesses cytoprotective action against ethanol-induced gastric gland damage in rabbits.
Animals↗
Polyethylene glycol: its adverse gastric effects in rats.
The effects of polyethylene glycol (PEG) on gastric function and on lesion formation, evoked by topical applications of absolute ethanol to an ex-vivo stomach chamber preparation have been examined. Parenteral injection (i.p. or s.c.) of PEG with different molecular weights (PEG 300, 400 or 4000), dose-dependently reduced the gastric mucosal blood flow and volume of gastric secretion; these effects were greater in rats given PEG by the i.p. route, which also lowered acid output. Topical application of 1.5 mL absolute ethanol produced severe gastric mucosal injury, which was exacerbated by PEG; this lesion-aggravating effect was higher in the i.p.-injected groups. These findings indicate that when PEG is given by injection, it can adversely affect gastric function and increase the damaging action of alcohol. It is suggested that the use of PEG as a vehicle for injection should be re-assessed.
Animals↗
Life events and daily stress in duodenal ulcer disease. A prospective study of patients with active disease and in remission.
Life events and daily stress were assessed in patients with duodenal ulcer, active or in remission, and in matched disease and normal controls. The mean positive life event scores were significantly lower in duodenal ulcer patients than in disease and healthy controls, and lower in patients with active ulcer than in those in remission. The positive scores and total life change scores decreased significantly after 6 months in the control groups and showed no significant variation in the duodenal ulcer group after 6 months. We conclude that the perception of life events, especially positive ones, is associated with duodenal ulcer.
Adult↗
Problems in dengue control: a case study.
The control of dengue outbreak requires a multi-pronged effort by the various government agencies. It requires co-operation of the community in the control activities, strict adherence to existing control procedures and guidelines by health personnel, increased manpower where necessary and strengthening co-operation between various health agencies to prevent delay in instituting control measures.
Communicable Disease Control↗
Growth and pubertal assessment after treatment in acute leukemia.
To evaluate the effect of leukaemia and its treatment on growth and puberty, we studied retrospectively the serial heights and pubertal development of 37 children with acute leukaemia. The age of diagnosis ranged from 10 months to 13 years, with a duration of follow-up varying from 2 years to 14 years. The SDS (Z score) which reflects the deviation of height measurements from the population mean was used to assess height change at yearly intervals. Pubertal assessment was also made using the Tanner standards. 25 (69%) children showed a falling trend in mean Z scores over a 5 year follow-up period. The difference between the mean Z scores at 0 and 5 years was statistically significant (p < 0.035). However, there was no significant correlation between age of onset of disease and duration of survival with the deviation in the Z score. 11 children did not demonstrate a fall in the Z scores. There were, however, no defined factors such as age of onset, duration of follow-up, and sex distribution which could predict growth failure. Pubertal assessment showed normal development in all children with the pubertal age group (n = 11), except for 3 boys, two of whom had received testicular irradiation.
Acute Disease↗
Recent advances in childhood acute lymphoblastic leukemia.
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Animals↗
Long term endocrine complications of acute leukemia therapy--a case report.
We report a patient with acute lymphoblastic leukemia who underwent treatment comprising chemotherapy, radiotherapy (cranial and testicular) and then a bone marrow transplant from an identical twin. He was cured of his leukemia and has been disease-free for nine years. With long term survival, there were problems, notably those of growth and endocrine insufficiency, which needed special considerations in management.
Adolescent↗
Lessons from Wilms' tumor.
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Base Sequence↗
H. pylori causes cancer: true or false?
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Chronic Disease↗
Effects of adenosine on gastric and cardiovascular systems, and ethanol ulceration in male and female rats.
The time course of the effects of adenosine, a vasodilator, on the ulcerogenicity of ethanol was studied in male and female rats. Gastric secretory function and mucosal blood flow (GMBF), systemic blood pressure and heart rate were monitored during the 90-min experimental period. In the male rats, adenosine 7.5 mg/kg s.c. (injected at 30 min) increased the GMBF at 45 min and depressed it at 75 min. The mean blood pressure was decreased at 45 min and steadily recovered thereafter; the heart rate was unaffected throughout the experimental period. The gastric secretory volume was elevated at 60 min, with a significant drop in gastric acid output at the same time. Ethanol administration from 45 to 90 min produced haemorrhagic lesions in the glandular mucosa. The severity of gastric damage was markedly reduced by adenosine at 45 and 60 min when the GMBF and the secretory volume were increased respectively, but severity was increased at 75 min while the GMBF was significantly reduced. In the female rats, adenosine had no effect on the secretory function but still had a depressive action on GMBF at the 75th min. In these animals, adenosine exacerbated the gastric injury at 60 and 75 min. The blood pressure was also decreased at 45 min. In conclusion, adenosine produces a different pattern of effects on the ulcerogenic action of ethanol in male and in female rats. These differential effects depend on the states of GMBF and gastric secretory volume but not on the changes of systemic blood pressure and gastric acid secretion.
Adenosine↗
Recurrent congenital chylothorax.
Congenital chylothorax is an uncommon but well-described condition. Recurrent congenital chylothorax is extremely rare. Yancy and Spock (1967) reviewed 31 reported cases of spontaneous chylothorax which occurred in the first 2 months of life and noted that male infants were affected twice as commonly as females. Two other cases of recurrent congenital chylothorax in male offspring (Defoort and Thiery, 1978; Reece et al., 1987) led to the suggestion of possible X-linked recessive inheritance. We describe a case of recurrent congenital chylothorax in which two consecutive female infants in a sibship were affected. The underlying cause of this disorder remains unknown. Inheritance as an X-linked recessive is not possible and this case is suggestive of autosomal recessive inheritance. The case also serves to emphasize the need for caution in counselling for recurrence risks when the underlying aetiology of the disorder is unknown.
Adult↗
Effect of omeprazole on duodenal ulcer-associated antral gastritis and Helicobacter pylori.
This study set out to investigate the effects of omeprazole or ranitidine on the progression of antral gastritis and Helicobacter pylori in patients with active duodenal ulcer. A double-blind, double-dummy trial was performed in 270 patients, 241 of whom were studied histologically for the presence of H. pylori. Patients were randomized to receive omeprazole, 10 mg every morning, omeprazole, 20 mg every morning, or ranitidine, 150 mg twice a day, for four weeks. Endoscopy was performed on entry and at weekly intervals during the study; at least two antral biopsies were taken on each occasion to assess the activity and degree of chronic inflammation, as reflected by the degree of polymorphonuclear leukocyte infiltration and mononuclear cell infiltration, respectively. Biopsy specimens also were assessed histologically for H. pylori. The sex, age and maximal acid output were comparable in the three treatment groups. The percentages of patients showing an improvement in the activity of gastritis in the four consecutive weeks of treatment were 9%, 40%, 51%, and 53% for omeprazole, 10 mg (N = 78); 14%, 42%, 49%, and 53% for omeprazole, 20 mg (N = 81); and 2%, 23%, 30%, and 33% for ranitidine, 150 mg twice a day (N = 82) (life table analysis gave P less than 0.01 for both omeprazole regimens compared with ranitidine). The degree of chronic inflammation showed similar changes. The density of H. pylori decreased significantly after treatment with omeprazole, 10 mg or 20 mg, (both, P less than 0.00001) but not with ranitidine.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Pathogenetic role of Helicobacter pylori in duodenal ulcer disease. Multivariate analysis of factors affecting relapse.
The pathogenesis of duodenal ulcer disease is multifactorial and the contribution of Helicobacter pylori in relation to the other factors to the release of duodenal ulcer is unknown. To investigate this, we studied 147 patients with endoscopically proven healed ulcers. These patients were randomized to receive either placebo, misoprostol 200 micrograms or misoprostol 300 micrograms four times daily, and clinical, personal, physiological and endoscopic characteristics were obtained prospectively. Endoscopy was performed at the active phase of the ulcer and when the ulcer healed. Biopsies were taken from the antrum to assess histologically for: (1) the activity of gastritis as assessed by the degree of polymorph infiltration, (2) the degree of chronic inflammation by the degree of chronic inflammatory cells infiltration and degree of mucosal degeneration, and (3) bacteriologically for the presence of H. pylori. The severity of the gastritis and the bacterial density were graded independently by two pathologists. The patients were assessed at two-month intervals for 12 months or until the ulcer relapsed. The results demonstrated that the relapse rates of duodenal ulcer were similar in the three treatment groups. The relapse rate was higher in the group with higher density of the bacteria (P less than 0.05). The degree of gastritis did not affect the relapse rate of duodenal ulcer in either the placebo or misoprostol group or in all patients combined. Stepwise logistic regression analysis identified that increased duodenal inflammation, male sex, early-onset disease, and H. pylori adversely affected relapse of the ulcer. We conclude that multiple factors affect the relapse of duodenal ulcer and H. pylori is one of them.
Adult↗