Laparoscopy is a morphological examination and is employed in the examination of the liver and other visceral organs. Further, as a result of recent remarkable progress in endoscopy it has become possible to examine not only the intraperitoneal organs but also the pancreas, a retroperitoneal organ, by means of laparoscopy. With a view to expanding the application of laparoscopy, we attempted, despite many difficulties, to measure the pancreatic blood flow in man, using the hydrogen gas clearance method. The mean pancreatic blood flow for persons with a normal pancreas was 87.8 +/- 20.6 ml/min/100 g, and the mean value for patients with chronic pancreatitis was 58.0 +/- 33.3 ml/mn/100 g. Laparoscopy has been used merely as a means of morphological examination, but should also be turned to account in the investigation of various intraperitoneal organs for physiological function.
The effects of liver disease on the pharmacokinetics and protein binding of cefazolin and cephalothin were studied in patients with cirrhosis, chronic active hepatitis or normal liver function. The T1/2 and mean residence time of cefazolin were significantly shorter in cirrhosis. Cephalothin clearance was decreased by cirrhosis. Plasma protein binding of cefazolin, but not cephalothin was significantly reduced in cirrhosis. It is suggested that no dose reduction is necessary for either drug in severe hepatic impairment.
Laparoscopy has been employed mainly in liver diseases. Although there have been many reports dealing with intraabdominal lesions other than those of the liver, there have been few concerning the pancreas. Because of its anatomical characteristics, the laparoscopic approach to the pancreas has been extremely difficult. For endoscopic diagnosis of pancreatic lesions, we have developed a 2-channel operating laparoscope. Using a supragastric approach through the lesser omentum, the scope is inserted into the lesser peritoneal sac for direct inspection of the pancreas. In this paper, the method of lesser omentotomy and the diagnostic results are described.
SUMMARY The efficacy of ranitidine (150 mg nocte), and sulcralfate (1 g tds) as maintenance therapy to prevent gastric ulcer relapse was evaluated in a 12 month trial in 363 patients. The relapse rates were 8.8% at three months, 14.7% at six months, 18/1% at nine months, and 21V0% at 12 months for the ranitidine group and 1477%, 21/3%, 29.9%, and 30.2% respectively for the sucralfate group. At nine and 12 months the cumulative relapse rates for the ranitidine group were significantly lower than those for the sucralfate group (p<005). In both groups ulcers recurred mainly from red scars observed at the endoscopic scarring stage. This indicated the necessity of drug treatment up to the white scar stage. The results suggest that ranitidine is effective in preventing gastric ulcer relapse.Gastric acid is generally considered to be a key factor in peptic ulcer development and the histamine H receptor blockers which inhibit its formation have become standard therapy for treatment of both duodenal and gastric ulcer.On average duodenal ulcer patients secrete more gastric acid than healthy control subjects. Many clinical trials have therefore been conducted with H, blockers to evaluate their use as to prevent duodenal ulcer relapse.Ì n contrast gastric ulcer patients as a group secrete less acid than normal and are usually considered to have an imbalance between agressive and defensive factors resulting from impaired gastric defence.This imbalance may, in theory, be rectified by therapeutic intervention which acts to increase mucosal defence or to inhibit gastric acid and pepsin. As there is no definitive information on the relative merits of these two approaches to treatment we have conducted a large clinical trial to compare the effects of ranitidine, an agent which inhibits gastric acid secretion and sucralfate, a mucosal protective agent in the prevention of gastric ulcer relapse. Methods PATIENTSPatients whose gastric ulcers had healed after any active treatment were recruited if endoscopy had confirmed the ulcer and its healing and if they were suitable for outpatient management. DOSAGE AND ADMINISTRAIIONThe effects of ranitidine (Glaxo, UK), 150 mg/day at bedtime, and sucralfate (Chugai Pharmaceutical Co, Japan), 1 g tds, on the rate of gastric ulcer relapse were compared in a one year maintenlance trial conducted by investigators in 72 centres.Each patient received either four 250 mg tablets of sucralfate three times a day (before breakfast and lunch and at bedtime) or four placebo tablets before breakfast and lunch and one 150 mg ranitidine tablet with three placebo tablets at bedtime. In order to maintain blindness, all the drugs and placebo tablets were prepared in packages which were indistinguishable in their appearance.
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