Epidermal growth factor (EGF) has been implicated in mitogenesis and oncogenesis in the gastrointestinal tract. To determine the role of EGF in oesophageal disease, its quantity and distribution in the oesophageal mucosa of control subjects and patients with oesophageal disease were studied. Oesophageal biopsy specimens, taken 20-40 cm from the incisors in 72 patients, were graded histologically and adjacent specimens were taken for immunohistochemical analysis of the distribution of EGF. In patients with Barrett's columnar lined oesophagus, specimens were also taken from the gastric cardia for comparison. Twenty two biopsy specimens showed oesophagitis, 20 Barrett's mucosa, and 30 were histologically normal. EGF was found in the
Epidermal growth factor (EGF) has been implicated in mitogenesis and oncogenesis in the gastrointestinal tract. To determine the role of EGF in oesophageal disease, its quantity and distribution in the oesophageal mucosa of control subjects and patients with oesophageal disease were studied. Oesophageal biopsy specimens, taken
The purpose of the study was to compare beta-adrenoceptor responsiveness to salbutamol (beta-2 selective agonist) and isoprenaline (non-selective) in young (n = 10, age 23 y) and elderly (n = 7, age 71 y) subjects. Subjects were given cumulative doubling doses of inhaled isoprenaline or salbutamol (500-4000 micrograms), and placebo, in a single-blind randomised cross-over design. Plasma potassium, electrocardiographic (R-R, T-wave, Q-Tc) and blood pressure responses were measured at baseline and at each dose step. There were no difference between baseline values for each of the three study days within each group of subjects. Hypokalaemia was significantly greater in response to salbutamol compared with isoprenaline in both the young (as change from baseline): -0.61 versus -0.10 mmol.l-1: and in the elderly: -0.68 versus -0.20 mmol.l-1. There were no differences between young and elderly responses. T-wave amplitude fell significantly in response to isoprenaline and salbutamol, although this effect was progressively attenuated with increasing doses of isoprenaline. Maximum T-wave response (change from baseline) was greater with salbutamol than isoprenaline in the young: -0.22 versus -0.11 mV: and in the elderly: -0.17 versus -0.08 mV, and there were no differences between the two groups. There were no differences between the effects of isoprenaline and salbutamol on Q-Tc prolongation or heart rate. Chronotropic responses to salbutamol were greater in the elderly: 39 versus 24 beats.min-1. There were larger increases in SBP with isoprenaline in both groups. Falls in DBP in response to isoprenaline and salbutamol were significantly greater in the elderly.(ABSTRACT TRUNCATED AT 250 WORDS)
We have examined the effects of magnesium replacement therapy upon post-exercise heart rate and incidence of ventricular premature beats (VPB) in digitalised patients with AF. In 11 such patients, all of whom had serum magnesium concentrations of less than 0.85 mmol/l, treatment with magnesium glycerophosphate was associated with a significant reduction in number of VPBs (982 v. 416 VPB/24 h). Five patients had a high prevalence of ventricular ectopy (greater than 300 VPB/24 h) and these subjects showed particularly marked decreases in VPBs during magnesium treatment (1998 v. 690 VPB/24 h). Three patients had slightly increased QTc intervals but these did not change during magnesium replacement. No significant changes were seen in the mean post-exercise heart rate although 2 subjects did show falls of 25% or more during magnesium replacement. We conclude that treatment with magnesium glycerophosphate may be associated with a decreased prevalence of ventricular ectopy in some digitalised patients with chronic AF and mild-moderate hypomagnesaemia.
All practising clinicians will be aware of the increased number of elderly patients requiring drug treatment as the proportion of people over the age of 65 increases in our Western society. The elderly as a group have much to benefit from modern drug therapy, but, historically, are also the group most prone to adverse drug reactions. Such reactions have often been due to inappropriate drug prescribing based on an incomplete knowledge of changes in drug handling with age. In recent years there has been an increased understanding of the physiological changes of ageing and the changes in drug handling consequent upon these changes. This review will concentrate on the clinical sequelae of changes in drug handling and suggest areas where modification in prescribing practice may yield clinical benefits and lessen the toll of adverse drug reactions.
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