Changes in the plasma clearance and protein binding of carbenoxolone with age, and their possible relationship with adverse drug effects.

Comparison by equilibrium dialysis of plasma protein binding sites for carbenoxolone in people under 40 years of age and in people over 65 years of age showed that the number of binding sites was reduced in the elderly and that this fall was associated with a reduction in plasma albumin levels. Although carbenoxolone has some aldosterone-like effects, these properties could not be shown to be due to displacement of aldosterone from its protein binding sites by competitive protein binding of carbenoxolone. Single doses of carbenoxolone were found to be removed considerably more slowly from the plasma of elderly individuals than from the young.

Uses of barium meal examination in dyspeptic patients under 50.

No abnormality was found in 76 of 100 dyspeptic out-patients under the age of 50 who underwent barium meal examination, while various non-malignant lesions were found in the remaining 24. Only 10% of those under 30, and 10% of those with symptoms for less than a year proved to have any abnormality. Because of the radiographic results treatment was altered in only 11 patients, and most of these changes were small.

A prospective, randomised study of endoscopy and radiology in acute upper-gastrointestinal-tract bleeding.

318 patients admitted to hospital with acute upper-gastrointestinal-tract bleeding were entered into a prospective randomised comparison of investigation by either endoscopy or radiology. Although the diagnostic yield was higher in the endoscopy group than the radiology group, there was no difference between the two groups in management or survival, and the accuracy of the findings as judged independently at operation and/or necropsy was also similar in the two groups. These findings case doubt on the need to provide emergency endoscopic facilities for the investigation of patients with acute upper-gastrointestinal-tract bleeding where radiological services are already adequate.

Controlled trial of active immunotherapy in management of stage IIB malignant melanoma.

The prognosis for patients who undergo surgery for stage IIB malignant melanoma is poor. Animal studies have suggested that BCG and tumour cell vaccines given together may provide effective immunotherapy. To assess the effectiveness of this treatment 15 patients with stage IIB malignant melanoma who had their tumour excised were studied.

Survival and death from subdural haematoma on medical wards.

All patients with subdural haematoma presenting to medical wards in Nottingham over a 5-year period have been reviewed. Of twenty-one such patients eight were first diagnosed at post-mortem, whilst all of the remaining thirteen patients in whom the diagnosis was made in life survived following neurosurgical evacuation of the haematoma. Diagnostic failure was caused mainly by failure to consider the possibility of subdural haematoma or misinterpretation of negative investigations.

Zinc in ulcerative colitis: a therapeutic trial and report on plasma levels.

A double-blind controlled trial of oral zinc sulphate as adjuvant treatment in idiopathic ulcerative colitis or proctitis in relapse is reported. Fifty-one patients were treated, and the clinical and sigmoidoscopic improvement in the zinc treated patients was similar to that in patients receiving placebo. No difference was found between plasma zinc levels in a further 46 patients with idiopathic ulcerative colitis or proctitis and those obtained in a group of healthy controls.

Case-control method for seeking evidence of contagion in Crohn's disease.

All cases of Crohn's disease in the Nottingham area were ascertained and dates and places of domicile and work before and after onset of symptoms were noted. Similar information was taken from matched control subjects and the Pike and Smith (Biometrics 30:263-279, 1974) case control technique for evaluating clustering of patients in time and space was applied. These results do not support the infectious hypothesis.

Gastric and duodenal ulcer and their associated diseases.

Assessments of likely associations between ulcer and other diseases are hindered by the frequent lack of controls, by controls which are inadequate, and by inadequate descriptions of techniques used. The inherent biases in some of the techniques have also probably been insufficiently appreciated. Ulcer is common in the community and much of the evidence adduced to suggest ulcer/other-disease associations may well be describing oridinary ulcer frequency which has been underestimated.

Hospital admissions for peptic ulcer during 1958-72.

Unpublished data from the Hospital In-patient Enquiry in England, Wales, and Scotland between 1958 and 1972 show that the frequency of admissions to hospital for peptic ulcer, particularly gastric ulcer, has fallen. This seems more likely to have been due to a true fall in the incidence of ulcer than to changes in treatment. Some three times as many people are admitted to hospital with duodenal ulcer in the north as in the south, but the frequency of admissions for gastric ulcer seems to vary little.

The demographic and social characteristics of patients with Crohn's disease in the Nottingham area.

All 260 patients diagnosed as having Crohn's disease between 1958 and 1973, in the Nottingham area, were sought and demographic and social characteristics obtained by personal interview. These were compared with the general population, using the 1971 census data. We found significantly high proportions of patients who were female; married; in the age groups 20-39 and 60-54; and in managerial or skilled manual occupations.

Gastric ulcer: natural history and treatment.

The fragmentary knowledge of gastric ulcer aetiology is contrasted with the developing repertoire of short term drug treatments. Reasons are also advanced for believing that gastric ulcer may be a disease of diminishing importance and that this is due to environmental changes rather than to the introduction of effective treatments.

Carbenoxolone sodium: its role in ulcer healing.

In summary, carbenoxolone is a useful drug in accelerating short-term ulcer healing during ambulatory treatments. Provided treatment is responsibly controlled the adverse effects should not present frequent or severe problems; however, there is a clear need for an analogue which is substantially side-effect free.