Is there any acid peptic disease that is refractory to proton pump inhibitors?

Non-healing and delayed healing during acid inhibition treatment depend on the extent to which acid and 'non-acid' factors are causative in the particular acid peptic disease, and on the effectiveness and duration of acid suppression. Refractoriness (defined arbitrarily) occurs less often with proton pump inhibitors than with H2-receptor antagonists as the former decrease acid more effectively; H2-receptor antagonist-refractory disease usually responds to treatment with proton pump inhibitors. In Rotherham, 5-10% of duodenal ulcer and gastric ulcer patients are refractory (not healed after > or = 3 months of standard-dose H2-receptor antagonist).

A dual-isotope method for studying protein kinetics in pleural effusions in humans.

A method is described for studying protein kinetics in pleural effusions in humans. In 15 patients with pleural effusions from a variety of causes, protein inflow was monitored by measuring the rate of appearance in the effusion of the plasma protein transferrin, radiolabelled in vivo by intravenous injection of 113InmCl3. Protein outflow was measured from the rate of appearance in the blood of intrapleurally administered 125I-albumin.

A misleading case of central pontine myelinolysis. Risk factors for psychiatric patients.

Central pontine myelinolysis (CPM) is an uncommon disorder initially described in alcoholic or malnourished patients. Recent reports suggest an aetiological association with abnormalities of serum sodium. A physically unwell non-alcoholic chronic schizophrenic patient, whose symptoms led to psychiatric referral, died of CPM.

Alzheimer's disease: a 'cobalaminergic' hypothesis.

An association between Alzheimer's Disease (AD) and low CSF and serum vitamin B12 (B12) has recently been described (1, 2, 3). This is apparently independent of nutritional intake (4). It has been suggested that such patients may exhibit an atypical form of cobalamin deficiency (3, 4).

Exaggerated and prolonged thyrotrophin releasing hormone (TRH) test responses in tertiary hypothyroidism.

A 60 year old man with panhypopituitarism due to a large meningioma and prolonged and exaggerated thyroid stimulating hormone (TSH) responses is described. Initial investigations showed a subnormal urinary free cortisol concentration, a low serum cortisol taken at 0900 hours, and a low free T4 concentration. The TSH was towards the upper end of the normal range.

Treatment of acute exacerbations of chronic obstructive airways disease--a comparison of amoxycillin and ciprofloxacin.

Ciprofloxacin and amoxycillin were compared in the treatment of acute exacerbations of chronic obstructive airways disease. One hundred and forty patients were evaluable for overall outcome: 60 patients' sputum specimens yielded positive bacteriological cultures. The predominant pathogens were Haemophilus influenzae (43.

Delusional misidentification of familiar inanimate objects. A rare variant of Capgras syndrome.

A 52-year-old woman presented exclusively with delusional misidentification of inanimate objects in the context of a short-lived acute psychotic episode. Certain theories are useful in understanding the formation of delusions of doubles in the patient (e.g.

A new filter technique permitting traditional histopathological assessment of fine needle aspiration specimens.

We describe a new filtration method based on a transport medium technique which allows histopathological assessment of the tissue fragments present in many fine needle aspirates. Fine needle aspiration cytology and biopsy preparations obtained from equally divided transport medium specimens were compared in a study comprising 104 palpable breast lesions and 29 other miscellaneous lesions. In general, fine needle aspiration biopsy provided better information on tumour origin and differentiation than fine needle aspiration cytology, particularly with systemic aspirates and those which were heavily bloodstained.

Oral cancer and precancer: treatment.

The main purpose of this article is to explain what happens when a patient with oral cancer, or suspected of having one, is referred to a joint oral cancer clinic, and what might happen thereafter. The principles of disease staging and treatment planning are reviewed, followed by an outline account of the main forms of treatment available. Emphasis is placed on the factors and techniques underlying the use of radiotherapy and of surgery, and the use of lasers, chemotherapy and immunotherapy is also mentioned.

Ciprofloxacin versus amoxycillin/clavulanic acid in the treatment of urinary tract infections in general practice.

An open, randomized general practice study was performed to assess the comparative efficacy and tolerability of ciprofloxacin and amoxycillin/clavulanic acid in the treatment of uncomplicated urinary tract infection. One hundred and eighty nine patients were recruited into the study. In comparison of pre- and post-treatment urine cultures and symptomatology, ciprofloxacin was significantly more effective (P less than 0.

Comparison of continuous paravertebral and extradural infusions of bupivacaine for pain relief after thoracotomy.

Pain was controlled in 20 post-thoracotomy patients using a continuous infusion of 0.25% bupivacaine through an extradural or para-vertebral catheter. Both techniques provided good analgesia.

Monitoring pulmonary vascular permeability using radiolabeled transferrin.

A simple, noninvasive technique for monitoring pulmonary vascular permeability in patients in critical care units is discussed. High vascular permeability is observed in patients with clinically defined adult respiratory distress syndrome (ARDS) but not in patients with hydrostatic pulmonary edema or in patients with minor pulmonary insults who are considered to be at risk of developing ARDS. The technique has been used in the field of therapeutics and pharmacology to test the effects of the putative antipermeability agents methylprednisolone and terbutaline sulfate.