Successful use of vancomycin hydrochloride in the treatment of lactulose resistant chronic hepatic encephalopathy

Article Abstract:

Chronic hepatic encephalopathy (CHE) is a neurological syndrome caused by liver disease. It results when products of digestion escape breakdown by liver processes and enter the circulation. Ammonia, a product of protein metabolism, is a probable contributor to CHE. CHE is usually treated by restricted dietary protein and by lactulose, a synthetic sugar that alters colonic bacteria and is a cathartic, but such treatment is not always effective. Vancomycin, an antibiotic, has previously been shown to be effective in treating CHE. The effects of vancomycin on 12 patients with cirrhosis and lactulose-resistant CHE was studied. Encephalopathy resolved completely in 10 patients within two to three days, and only minimum grade encephalopathy persisted in the other patients. When patients who had improved were given lactulose again, and vancomycin was not use, their condition worsened. The medical improvement correlated with a decrease in blood ammonia levels and colonic anaerobic bacteria. The study suggests that the colonic bacteria may be responsible for a large part of the ammonia levels found in encephalopathy. Other mechanisms may also be important in the disorder as well. Further study is needed to determine why vancomycin is so effective in treating lactulose-resistant CHE. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Usage, Evaluation, Vancomycin, Hepatic encephalopathy, Liver encephalopathy

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Rebound nocturnal hypersecretion after four weeks treatment with an H2 receptor antagonist

Article Abstract:

In eight male patients with duodenal ulcers, measurements were taken of the acidity level in their stomachs during the day, levels of gastrin (the hormone which produces gastric acid) before and after meals, and nighttime acid output. The measurements took place before, during and two days after the patients received nizatidine every night for four weeks. Nizatidine is a new H2 receptor antagonist that has a measurable effect on nocturnal acid secretion. The average acid output at night decreased during treatment, but two days after discontinuing treatment the acid output at night increased. Overall average daytime acidity level in the stomach was unchanged on the final day of treatment and two days after completing therapy, compared with the pretreatment values. Gastrin measured before breakfast and the integrated gastrin response to breakfast were also similar during and after treatment, compared with pretreatment values. The high ulcer relapse rates after stopping treatment may be related to the rebound nighttime over-secretion.

Abnormalities, Measurement, Physiological aspects, Antineoplastic agents, Stomach, Gastrointestinal cancer, Digestive system cancer, Gastric juice

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Rapid reduction of left ventricular hypertrophy in acromegaly after suppression of growth hormone hypersecretion

Article Abstract:

Octreotide may be an effective treatment for left ventricular hypertrophy (LVH), which is an enlargement of the left ventricle of the heart, in patients with acromegaly. Acromegaly is progressive enlargement of the head, face, hands and feet that is caused by increased secretion of growth hormone (GH) and insulin-like growth factor 1 (IGF-1). Among 16 patients with acromegaly who were treated with subcutaneous injections of octreotide for two months, 10 were suffering from LVH and six were not. Two months after beginning treatment with octreotide, secretion of GH and IGF-1 was significantly lower in both patients with LVH and those without LVH. Patients with LVH experienced a decrease in the mass of the left ventricle of their heart which was associated with decreased secretion of GH and IGF-1. The mass of the left ventricle of the heart did not change in patients without LVH.

Acromegaly, Heart enlargement, Heart hypertrophy, Octreotide acetate

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