Cimetidine and ranitidine tests: the influence on the basal values of serum gastrin

U istraživanju utjecaja histaminskih H2 blokatora na vrijednosti bazalnog serumskog gastrina (BSG) provedena su testiranja bolesnika suvremenim antiulkusnim lijekovima — cimetidinom i ranitidinom. Testiranje cimetidinom provedeno je u dvije grupe bolesnika sa različitim patološkim stanjima gastrointestinalnog sustava. Prva grupa od 14 bolesnika testirana je sa 200 mg cimetidina intravenski svakih šest sati tijekom 24 sata. Identičan test sa 400 mg cimetidina proveden je u drugoj grupi sa 9 bolesnika. Suprotno očekivanju, u prvoj grupi svi bolesnici, osim dvojice s duodenalnim ulkusom, pokazali su pad BSG. Pri tom je za 11 bolesnika s duodenalnim ulkusom razlika statistički značajna (t = 2,26, p< 0,025). Pad BSG u drugoj grupi nije bio tako očit, ali se ističe pad BSG u dva bolesnika s pernicioznom anemijom. Rezultati su interpretirani kao indirektan dokaz djelovanja cimetidina i na G stanice preko H2 ili nekih drugih receptora. Peroralno testiranje rantidinom 150 mg tri puta dnevno prvog dana, te 2x 150 tijekom slijedeća dva dana, nakon čega je terapija prekidana, provedeno je u 13 bolesnika. Vrijednosti bazalnog serumskog gastrina su određivane tijekom 4 dana, ujutro neposredno po buđenju. Dobiveni rezultati upućuju na zaklju­ čak da ranitidin neznatno povisuje vrijednosti BSG.Investigating the influence of histamine H2 receptor antagonists on the levels of basal serum gastrin (BSG), two modern drugs were used - cimetidine and ranitidine. Two groups of patients with various pathological conditions of the gastrointestinal system were tested with cimetidine. In the first group, 14 patients were given 200 mg of cimetidine i.v. every six hours during 24 hours. The same test with 400 mg of cimetidine was performed with 9 patients of the second group. Contrary to the expectations, the level of BSG in the first group of patients decreased, except in two of them with duodenal ulcer. There is a statistically significant difference for 11 patients of this group suffering from duodenal ulcer (t = 2.26; p<0.025). The decrease of BSG in the second group was not so obvious, but in two patients with pernicious anemia the decrease of BSG was remarkable. These results can be interpreted as the indirect proof of cimetidine influence on G-cells, as well, over H2 or some other receptors. Peroral ranitidine testing, with 150 mg 3 times a day the first day and then twice a day in the next two days, was performed in 13 patients. The levels of BSG were measured within 4 days, every morning after awakening. The results show a slight BSG increase

Comparison of epidemiological characteristics of duodenal erosions and duopdenal ulcer

Na Internoj klinici Medicinskog fakulteta Sveučilišta u Zagrebu, Opće bolnice Osijek u razdoblju od 01. siječnja 1987. do 31. prosinca 1989. godine napravljeno je 10209 ezofagogastroduodenoskopija i u 27,9% bolesnika nađene su erozije, a peptički ulkus u 48,9% bolesnika. Erozije su najčešće bile locirane u duodenumu (38%), a 18% bolesnika imalo je erozije i u duodenumu i u antrumu. Erozije su nađene u 24,9% bolesnika s peptičkim ulkusom. Duodenalne erozije nađene su u 56% bolesnika s erozivnom bolešću. Oko 40% bolesnika s duodenalnim erozijama imalo je i peptički ulkus (duodenalni 37%, a želučani 3% bolesnika). Pojava ulkusne i/ili erozivne duodenalne bolesti najčešća je u jesen (40%), a najrjeđa ljeti (16%). Iz epidemiološke analize 360 bolesnika, koji su bili podijeljeni u tri grupe s obzirom na to imaju li nezavisne duodenalne erozije, erozije i ulkus ili nezavisni duodenalni ulkus, proizlazi da prioritetan štetan utjecaj na nezavisne duodenalne erozije ima neredovita, loša prehrana i pretjerana uporaba mirodija, dok brzo jedenje i/ili nedovoljno žvakanje hrane ima utjecaj na pojavu ulkusne bolesti. Postoji i mala povezanost između slobodnih zanimanja i ulkusne bolesti, te između erozivne bolesti i prekida radnog odnosa. Određen utjecaj na udruženu erozivnu i ulkusnu patologiju imaju i psihoemocionalne komponente u obitelji, mjestu stanovanja i na radnom mjestu. Konzumiranje alkohola (125 g/dan i više) ima više utjecaja na pojavu erozija, a pušenje cigareta (25/dan i više) i pijenje crne kave (5 šalica/dan i više) na pojavu duodenalne ulkusne bolesti. Uočena je i veza između uporabe lijekova koji oštećuju sluznicu i nezavisne erozivne bolesti.In the period from January the 1st 1987, till December the 31st 1989, it was done 10209 endoscopy examinations on the Internal Clinic of General Hospital Osijek. In 27,9% of the patients erosions and in 48,9% of the patients peptic ulcer has been found. Erosive lesions were localized mainly in duodenum (38%) and in 18% of the cases erosive lesions were localized both in duodenum and in antrum. In 24,9% of the cases duodenal erosions coexist with ulcerative peptic disease (duodenal 37%, gasrtic 3%). The appearance of ulcer and/or erosive duodenal disease was mainly in autumn (40%) and less often in summer (16%). From an epidemiological study on 360 cases, which were divided into 3 groups: cases with autonomus duodenal erosive disease, those with erosions and ulcer and those with autonomous duodenal ulcer, we can see that in duodenal erosive disease predisposing factors are irregular, poor nutrition and excessive use of flavours, while fast eating and/or insufficiently chewing of the food are predisposing factors for ulcerative disease. Besides, there is a slight association between free-lance activity and ulcerative disease and between erosive disease and temporary or permanent interruption of work. The psycho-emotional component in family and work situations does have a determining effect on the erosive and ulcerative associated pathology. It is interesting to notice the relationship between erosive disease and abuse of alcohol (125 g/day or more) and between duodenal ulcerative disease and abuse of nicotine (25 cigarettes/day or more) and coffee (5 cups/day or more). Besides, it is notice the relationship between mucosa- damaging drugs and autonomous erosive disease

Economic and medical advantages of digestive tract endoscopy

U ovom radu analizirana je medicinska i financijska vrijednost određenih dijagnostičkih i opera tivno-terapijskih zahvata (kod gastroenterohepatoloških bolesnika) koji se mogu obaviti endoskopskim i rendgenološkim, odnosno kirurškim putem. To je dosta važno s obzirom na sve lošije financijsko stanje u zdravstvu. U pogledu dijagnostike digestivnih bolesti, endoskopiji treba dati primat nad rendgenologijom, jer osim medicinskih prednosti (nema žračenja bolesnika, mogućnost vizualnog pregleda i uzimanja uzorka za histološku analizu), ona je i jeftinija. S obzirom na doktrinski stav da, iako imamo pozitivan rendgenološki nalaz, produženje dijagnostike mora biti endoskopijom uz uzimanje uzoraka za histološku analizu, dolazi do dupliranja pretraga, a time do gubitka velike sume novca. Iz toga je jasno da je ušteda više nego očita primjenom samo primarne endoskopije. Prednost operativno-terapeutskih endoskopskih zahvata nad kirurškim su očite, kako u medicinskom (niska smrtnost, manje komplikacija, kraći period rehabilitacije, humaniji pristup), tako i u financijskom pogledu. Iz svega toga proizlazi da svako ulaganje u razvoj endoskopije znači više obavljenih dijagnostičkih i operativnih endoskopskih zahvata, a time ukidanje rendgenoloških i kirurških, što će doprinijeti ogromnoj uštedi novca.The paper analyzes medical and financial values of certain diagnostic and therapeutic procedures in patients with gastroenterohepatic diseases which can be performed endoscopically, radiographically or surgically. Considering the miserable financial condition of the health care system, this comparison is very important. In the diagnostics of digestive diseases endoscopy must be preferred to radiography, since in addition to medical advantages (no radiation of the patients, possibility of visual examination and sampling for histological analysis), it is cheaper, as well. Besides, following of the doctrine that in case of positive radiograms the diagnostics must be continued by endoscopy and taking samples for histological analysis duplicates the examinations and causes a considerable loss of money. Thus, primary endoscopy evidently means economization. The therapeutical endoscopic procedures have the advantage over surgery, both from the medical (low mortality, less complications, shorter period of rehabilitation and humane treatment) and the financial point of view. Accordingly, any investment into the development of endoscopy means more diagnostic and therapeutical endoscopic procedures performed as well as the abolition of radiographic and surgical procedures, which would contribute to saving considerable amounts of money

Malignant melanoma of the liver

Autori prikazuju slučaj četrdeset-trogodišnje bolesnice, obrađivane zbog bolova desnog hemiabdomena, u trajanju dva mjeseca, i hepatomegalije. Glavni anamnestički podatak bila je dijagnoza malignog melanoma lijevog oka i enukleacije tog oka prije jedanaest godina. Patološki testovi jetrene funkcije, posebno povećane vrijednosti AST, ALT, gama GT, alkalne fosfataze; te scintigrafija, ultrazvuk i CT nisu bili dovoljni za postavljanje dijagnoze. Perkutornom biopsijom jetre, pod kontrolom CT-a, postavljena je definitivna dijagnoza: metastaza malignog melanoma.The case of a 43-year-old woman with two-month history of right hemiabdominal pain and hepatomegaly is presented. The main anamnestic data were the diagnosed left eye malignant melanoma and the enucleation of that eye 11 years ago. Abnormal results of the liver function tests, particularly elevated AST, ALT, gamma GT and alkaline phosphatase levels as well as scintiscan, ultrasound and CT could not provide a presumptive diagnosis. Percutaneous needle biopsy of the liver under CT control enabled the diagnosis of malignant melanoma metastases

Duodenal erosions and hemorrahage from the upper digestive tract

Na Internoj klinici Opće bolnice Osijek, u periodu od 21. siječnja 1989. do 20. siječnja 1990. godine, napravljeno je 3935 ezofagogastroduodenoskopija. U 122 bolesnika povod za endoskopski zahvat bilo je krvarenje iz gornjeg dijela probavnog trakta. Od toga broja bilo je 87 muškaraca i 35 žena s prosječnom dobi od 43,5 godina. Najčešći primarni uzrok krvarenja bio je peptički ulkus (duodenalni u 43,4% i želučani u 13,1%), a nakon njega erozije (želučane u 15,6% i duodenalne u 8,2%). Krvarenje iz variksa jednjaka bilo je u 7,4% bolesnika, a krvarenje pri Mallory-Weissovu sindromu i piloričnom ulkusu u po 4,9% bolesnika. U 2,5 bolesnika krvarenje je bilo iz tumora. Krvarenje iz duodenalnih erozija bilo je u 22 bolesnika, i to u 10 bolesnika kao primarno, a u 12 kao sekundarno. Uzrok krvarenja u 9 bolesnika bilo je masivno konzumiranje alkohola, a u 5 bolesnika uzimanje lijekova. Od 22 bolesnika, 8 ih je imalo i duodenalni ulkus. U 4 bolesnika primarno krvarenje bilo je iz erozija. Od 122 bolesnika, u 35 pronađene su multiple lezije. Endoskopska injekcijsko-sklerozirajuća terapija bila je uspješna u 117 bolesnika, dok je 5 bolesnika bilo operirano.Af the Department of Internal Medicine of the Osijek General Hospital, 3,935 esophagogastroduodenscopies were performed in the period of January 21, 1989, to January 20, 1990. In 122 patients, bleeding from the upper digestive tract was the reason for endoscopy. Out of this number, there were 87 males and 35 females, mean age 43,5 years. Peptic ulcer (duodenal in 43% and gastric in 13.1% of the cases) was the most common primary cause of bleeding, followed by erosions (gastric in 15.5% and duodenal in 8.2% of the cases). The hermorrhage from the esophageal varix occurred in 7.4% of the patients, while the hemorrhage in Mallory-Weiss syndrome and pyloric ulcer in 4.9% of the patients. In 2.5% of the patients, hemorrhage came from the tumor. The hemorrhage from duodenal erosions occurred in 22 patients, primary in 10 and secondary in 12 patients. The massive alcohol consumption was the cause of bleeding in 9 patients and drug ingestion in 5 patients. Out of 22 patients, 8 suffered from duodenal ulcer. In 4 patients, primary hemorrhage came from erosions. Out of 122 patients, multiple lesions were found in 35 patients. Endoscopic sclerosing injection therapy was successful in 117 patients, while 5 patients underwent operative procedure

Epidemiological characteristic of duodenal erosions

Na Internoj klinici Opće bolnice Osijek učinjena je prospektivna studija gdje je napravljeno 3950 ezofagogastroduodenoskopija i u 238 bolesnika nađene su duodenalne erozije. U 99 bolesnika one su bile udružene s peptičkim ulkusom. Bolesnici s duodenalnim erozijama (u obje grupe) bili su uglavnom u dobi od 30 do 59 godina. Omjer muškaraca prema ženama u bolesnika s nezavisnim erozijama bio je 4,8:1, a u bolesnika koji su imali erozije udružene s peptičkim ulkusom 6,1:1. Duodenalne erozije su u 143 bolesnika diseminirane, a u 81 bolesnika zonalno raspoređene (uglavnom na prednjoj i stražnjoj stijenci). Pojedinačne erozije nađene su u 14 bolesnika. Pojava duodenalnih erozija u obje grupe bila je najčešća u jesen, a najrjeđa ljeti. Pojava konzumiranja alkoholnih pića, crne kave i pušenja cigareta slični su u bolesnika s duodenalnim erozijama i u općoj populaciji podvrgnutoj ezofagogastrođuodenoskopiji. Ti rezultati pokazuju da su epidemiološke karakteristike duodenalnih erozija dosta slične onima kod duodenalnog ulkusa i zbog toga ova patologija treba biti uključena u široko poglavlje peptičke bolesti.In the prospective investigation on the Internal Clinic of General Hospital Osijek 3950 endoscopic examinations has been done and in 238 patients duodenal erosions has been found. In 99 patients duodenal erosions coexist with ulcerative peptic disease. The patients with duodenal erosions (in both groups) were predominantly between 30 and 59 years old. The ratio of men to woman in patients with autonomous erosions was 4,8:1, and in patients with erosions connected with ulcerative peptic disease was 6,1:1. In 143 patients duodenal erosions werde disseminated and in 81 patients were zonally disributed (mainly in the anterior and posterior walls). In 14 patients single erosions have been found. In both groups duodenal erosions were mainly observed in autumn, and rarely in summer. The intake of alcohol, coffe and cigarettes were quite similar in patients with duodenal erosions and in the general population submitted to endoscopic examinations. In conclusion, the analysis of our data presen epidemiological characteristics of duodenal erosions very similar to those pertaining to duodenal ulcer and therefore this pathology has to be included in the wide chapter of the peptic diseases