Review article: gastrointestinal bleeding with low-dose aspirin - what's the risk?

This review examines ulcers and gastrointestinal bleeding with low-dose aspirin, focusing on randomized placebo-controlled trials. The single endoscopic trial assessing ulcers showed no significant difference in 12-week ulcer incidence: 6% of 381 given placebo vs. 7% of 387 given 81 mg enteric-coated aspirin.

Gastrointestinal health care resource utilization with chronic use of COX-2-specific inhibitors versus traditional NSAIDs.

Background & Aims: Cyclooxygenase 2 (COX-2)-specific inhibitors (coxibs) decrease gastrointestinal (GI) events in controlled trials, but results in clinical practice are unknown. We assessed GI-related resource use and costs in patients switching from chronic nonsteroidal anti-inflammatory drug (NSAID) therapy to chronic coxib therapy and in patients starting chronic NSAID therapy vs. chronic coxib therapy in a U.

Prevalence of enteric pathogens in HIV-related diarrhea in the midwest.

HIV disease is often associated with the condition of diarrhea, which may be accompanied by enteric infection or gastrointestinal tumor. This study prospectively investigated 27 episodes of chronic diarrhea in 24 patients with HIV infection. Upper endoscopy and sigmoidoscopy with biopsies at three sites (distal duodenum, sigmoid colon, and rectum) and viral and mycobacterial blood cultures were performed.

Once-daily therapy for H. pylori infection: a randomized comparison of four regimens.

Objective: We sought to determine the efficacy and tolerability of novel, once-daily therapies in the treatment of Helicobacter pylori infection.

Methods: One hundred sixty subjects with H. pylori infection documented by endoscopic biopsy or serology plus 13C-urea breath test were randomly assigned to omeprazole 80 mg q.

Twice-daily, 10-day triple therapy with omeprazole, amoxicillin, and clarithromycin for Helicobacter pylori eradication in duodenal ulcer disease: results of three multicenter, double-blind, United States trials.

Objective: We assessed the safety and efficacy of 10-day twice-daily triple therapy for Helicobacter pylori (H. pylori) in three double-blind, controlled trials in patients with duodenal ulcer disease.

Methods: H.

Low rate of emergence of clarithromycin-resistant Helicobacter pylori with amoxycillin co-therapy.

Background: Patients with persistent Helicobacter pylori infection following treatment with clarithromycin or omeprazole plus clarithromycin often develop clarithromycin resistance.

Aim: To assess pre- and post-treatment antibiotic resistance in three double-blind trials of triple therapy with omeprazole, amoxycillin and clarithromycin.

Methods: Patients with H.

Has the impact of Helicobacter pylori therapy on ulcer recurrence in the United States been overstated? A meta-analysis of rigorously designed trials.

Objective: The aim of this study was to assess the effect of H. pylori eradication on ulcer recurrence in North American duodenal ulcer patients by examining only treatment studies that met rigorous methodologic criteria.

Methods: Data sources were computerized bibliographic searches from 1983, review of reference lists, communication with companies that manufacture medications used for H.

US double-blind, controlled trials of omeprazole and amoxycillin for treatment of Helicobacter pylori.

Background: Widely variable Helicobacter pylori eradication rates have been reported with omeprazole/amoxycillin dual therapy. We present the first US double-blind, controlled trials of this dual therapy.

Methods: Three separate studies were performed: Studies 1 and 2 included patients with an active duodenal ulcer and Study 3 included patients with a documented history of duodenal ulcer.

A United States multicentre trial of dual and proton pump inhibitor-based triple therapies for Helicobacter pylori.

Background: One-week proton pump inhibitor-based triple therapies are very popular in the US despite limited US data documenting efficacy. We assessed 1-week proton pump inhibitor triple therapies for Helicobacter pylori, and compared them to dual antibiotic therapies (to assess benefit of omeprazole) and to omeprazole-amoxycillin (to assess benefit of clarithromycin) in a large, randomized, US multicentre study.

Methods: Healthy subjects who were H.

Interobserver agreement and predictive value of endoscopic findings for H. pylori and gastritis in normal volunteers.

Background: Endoscopic findings such as erythema are frequently labeled as gastritis. We sought to determine interobserver agreement for specific endoscopic features and assess the diagnostic value of features with good agreement for Helicobacter pylori and histologic gastritis.

Methods: Fifty-two healthy subjects without ulcers, erosions, or hemorrhages had a full endoscopy recorded on video tape.

Lack of uniformity in evaluation of endoscopic prognostic features of bleeding ulcers.

Management strategies in patients with bleeding ulcers are based on ulcer appearance. We assessed the level of agreement among endoscopists regarding the labeling of endoscopic features of bleeding ulcers and also evaluated the effect of a short teaching session on the level of agreement. Two hundred two endoscopists at the 1992 American College of Gastroenterology Postgraduate Course answered multiple-choice questions using interactive keypads.

Endoscopic ligation compared with sclerotherapy for the treatment of bleeding esophageal varices.

Objective: Comparison of the safety and efficacy of endoscopic sclerotherapy and ligation for the treatment of bleeding esophageal varices.

Design: Randomized, controlled trial.

Setting: An urban county hospital.

Fluconazole compared with ketoconazole for the treatment of Candida esophagitis in AIDS. A randomized trial.

Objective: To determine the clinical and endoscopic response of candida esophagitis to antifungal therapy and to compare the two oral antifungal agents, fluconazole and ketoconazole.

Design: Multicenter, randomized, double-blind trial.

Setting: Fifteen U.

Nonsteroidal antiinflammatory drug-associated gastric ulcers do not require Helicobacter pylori for their development.

Nonsteroidal antiinflammatory drugs (NSAIDs) have been linked with a high incidence of ulcer complications. Histologic gastritis is present in most patients with standard peptic ulcers, and this gastritis is generally related to Helicobacter pylori (HP). We questioned whether gastric ulcers associated with nonsteroidal antiinflammatory drugs (NSAIDs) develop via a novel mechanism, distinct from the usual HP-gastritis-ulcer diathesis.

Percutaneous Achilles tendon lengthening complicated by inadvertent tenotomy.

Thirteen percent (five of 37) of all Hoke percutaneous triple hemisection Achilles tendon lengthenings performed at a teaching hospital in a 4-year period were complicated by inadvertent Achilles tenotomy. Three of the five patients had bilateral procedures and served as their own controls. After 2 months of postoperative short leg walking cast immobilization, the results in patients with inadvertent Achilles tenotomy were indistinguishable from those in whom tendon continuity was maintained.

Assessing arthroscopic notchplasty.

To evaluate the ability to perform a widening arthroscopic intercondylar notchplasty as part of an anterior cruciate ligament reconstruction, 20 patients had notch-width index measurements compared with either preoperative or normal-side values. The notch-width index increased an average of 0.062, correlating with absolute notch widening of 4-6 mm.

Effects of insulin on hypothalamic monoamine metabolism.

The concentration of monoamines and/or their metabolites has been measured using in vivo microdialysis in the ventromedial and lateral hypothalamus following the parenteral administration of insulin. Similar measurements were made in rats with lateral hypothalamic microdialysis cannulas in which insulin was given but food intake delayed for 6 h. Serum norepinephrine and epinephrine both increased following injection of insulin, and food intake rose after a delay of 30-60 min.

Comparative in vitro activity of cefoxitin, cefotaxime alone, and in combination with desacetylcefotaxime against the Bacteroides species.

The agar dilution method was used to determine the inhibitory activity of cefotaxime (CTX) alone, desacetylcefotaxime (dCTX) alone, CTX plus dCTX, and cefoxitin against 74 clinical isolates of the Bacteroides species recovered from diabetic patients with foot ulcers. The study concluded that the addition of dCTX to CTX increased the inhibitory activity from 45% to 73% for all strains tested and from 50% to 81% among the 32 strains of Bacteroides fragilis. This synergistic interaction against B.

A comparative study of testicular involvement in lepromatous and borderline lepromatous leprosy.

To measure the comparative prevalence of testicular involvement in borderline lepromatous (BL) and lepromatous (LL) leprosy patients, serum FSH, LH, and total testosterone levels were measured in 42 LL and 21 BL subjects. Serum FSH levels were elevated in 19% of BL and in 86% of LL patients. Serum LH values were increased in 10% of BL and in 79% of LL patients.

Ultrastructural and paraphenylene studies of degeneration in the primate visual system: degenerative remnants persist for much longer than expected.

It is a widely held belief that the products of axonal degeneration in the CNS are transitory and are caused by metabolic and phagocytic processes. However, recent light microscopic examinations of human and primate brains using the paraphenylene diamine staining method (PPD), which stains degenerating axons, have confirmed that the products of degeneration persist for years in visual pathways. The routine utilization of the PPD method for delineating human visual pathways requires further confirmation of axonal degeneration.