One hundred and seven consecutive patients with hematemesis and/or melena and a diagnosis of duodenal, gastric, or esophageal ulcers were interviewed immediately before or after endoscopy about the use of non-steroid anti-inflammatory drugs (NSAIDs) and symptoms before the hemorrhage. If the patients admitted no symptoms of abdominal pain or discomfort, nausea, vomiting, or heartburn, they were classified as having no ulcer symptoms before the hemorrhage. Patients who had not taken NSAIDs during the last 48 h before the hemorrhage were classified as not having taken NSAIDs. Significantly fewer patients had ulcer symptoms in the group that had used NSAIDs than in the other group (p less than 0.01). This may be interpreted as a possible masking effect by NSAIDs on ulcer symptoms. Physicians and patients should be aware of this possible effect of NSAIDs.
The chromone FPL 52694 is a preparation thought to act by stabilizing mast cell membranes, thus reducing free histamine in the gastric mucosa. The effect of FPL 52694 on overnight gastric secretion was tested in 15 dyspeptic individuals in a double-blind crossover study. Each individual received the chromone preparation or placebo for 1 week. After each of the treatment periods gastric secretion was collected after 6 h of fasting by continuous suction for 8 h during the night. A significant reduction of the total acid secretion was observed after active drug compared with placebo administration, mean reduction being 17% (median, 23%). No difference was observed between 30-min and 60-min periods. FPL 52694 had no significant effect on pepsin, intrinsic factor (IF) or volume secretion. The difference in the effect on pepsin and acid secretion, reflected in a significant increase in the pepsin to acid ratio, indicates that intrinsic histamine, similarly to extrinsic histamine, has a specific effect on parietal cells. The difference in effect on acid and IF secretion indicates that intrinsic histamine not only has a specific effect on parietal cells but also has different effects on the secretory substances contained in this cell. Since IF was not reduced by the use of FPL 52694, it may be that this substance will not influence vitamin B12 metabolism.
There are many different ways of evaluating a doctor-patient relationship and compliance with a therapeutic regimen. One obvious way is to measure the serum level of the prescribed drug or the urine excretion of the metabolites (1). These methods can only be used in a limited number of patients and for a relatively short observation time. The tablet counting is more convenient in the long-term treatment.Also, an interview might lead to better doctor-patient relationship and seems to be a fairly adequate method for evaluating patient compliance (2,3).An indicator of the compliance to therapy over the years in treatment of a chronic disorder like hypertension is probably to study the number of drop-outs from follow-up (4,s).In the Deaconess Hospital (Lovisenberg sykehus), Oslo, we have in collaboration with several general practitioners treated and checked-up thousands of hypertensive patients. In the period 1955-1975 we have registered 745 patients under our own treatment for a minimum of one year and in the mean more than 10 years.After 1965 this method has been followed: 1. The patient is called with a letter to a policlinic interview and investigation at a given date and time. The waiting time is not more than a few minutes. The laboratory study is done at the same time.
The patients are examined about twice ayear or more if necessary. The examination by the physician lasts for about half an hour. The patient's use of tablets is checked on these occasions and side effects are discussed. Also the other parts of the regimen, smoking, diet, etc. are discussed. Blood pressure is measured in sitting and standing position, and standing after five knee bendings. 3. Reports and results concerning laboratory findings are given in a letter to the patient together with a written message about the new dosage of tablets and the new appointment day and hour. The most convenient time for this has already been discussed during the consultation. 4. Blood pressures are plotted on millimetre paper size 21 x 29 cm (A4). The notes for many years are collected in a loose leaf book after a system with cues: Methyldopa, beta-blocker, spironolactone etc. according to the leading drug treatment. 5. Address-cards with cues are collected in special boxes. The main register has signals for cross reference given to this special hypertension register.
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