Elderly people are more prone to develop NSAID ulcer. Therefore in a society of large elderly population, NSAID ulcer happens to be an important health issue. This iatrogenic disease often leads to complications including gastrointestinal bleeding and perforations that may cause severe morbidity and mortality among the elderly patients. For the treatment and prevention of NSAID ulcer, medication with a feasible minimal dose of NSAID is recommended. When the use NSAID can not be avoided or discontinued, a simultaneous administration of PPI or PG-analogue or a high dose of H2-receptor blocker is required. Proper attention should be paid to NSAID ulcer in the elderly due to its huge negative impacts on quality of life, attributing not only to physical and mental sufferings but also to the burden of medical expenses.

We assessed the effect of long-lasting inhibition of gastric acid secretion on basal and meal-stimulated serum gastrin and gastric acid secretion in 37 patients on long-term maintenance treatment with H2 antagonists for severe relapsing and/or complicated duodenal ulcer disease. After a mean of 142 weeks (range, 28-324 weeks) of continuous treatment, gastric acid secretion, basal plasma gastrin, and gastrin response to a test meal were evaluated. All tests were performed a week after drug discontinuation to exclude rapidly reversible hypergastrinemia. Gastrin levels were above the normal range in seven patients (18.9%). After H2 antagonist were stopped for 6 weeks, basal gastrin returned to normal levels in all cases [from a median of 180 (range, 130-350) pg/ml to 58 (25-90) pg/ml] and peak meal-stimulated gastrin significantly decreased from a median of 500 pg/ml to 245 pg/ml (p = 0.02). In patients with hypergastrinemia, the discontinuation of H2 antagonists for 6 weeks led to a significant decrease of gastric acid secretion. Patients who developed hypergastrinemia spent more weeks on full-dose treatment and had more recurrences during therapy. The results of the present investigation demonstrate that a long-lasting inhibition of gastric acid secretion can induce, in a small percentage of patients, a reversible sustained hypergastrinemia and a consequent increase of acid secretion, which conceivably could lead to more frequent relapses of duodenal ulcer disease.

This study was conducted with Angus, Polled Hereford and Santa Gertrudis straightbred and crossbred cows. The subsequent cow breeding and calf performance of cows that were nonpregnant (NP) were compared with cows that were pregnant (PG) at the time calves were weaned. All NP cows had a calf the year previous to their being nonpregnant. They were diagnosed as physically sound with no detection (by rectal palpation) of an abnormal reproductive tract. The NP and PG cows were aged 4 to 9 yr. Also, the NP cows were compared with replacement females exposed to calve first as 2- and 3-yr-olds (H2 and H3, respectively), and with cows exposed for second calving as 3-yr-olds (C2). Cows were assigned within breed composition and age to sire breeding groups on pasture. Subsequent calving and weaning rates were similar for NP, PG and H2 cows, similar for H3 and H2 cows and lowest (P less than .05) for C2 cows. Calves from NP and H3 cows were born earlier (P less than .05) in the calving period than calves from PG and H2 cows, whereas calves from C2 cows were born later (P less than .05) than those from NP, PG and H3 cows. Calving difficulty was similar for NP, PG and C2 and greatest (P less than .05) for H2 cows. Calf 205-d weights were highest (P less than .05) for NP, similar for PG and H3 and lowest (P less than .05) for C2 and H2 cows. Calf weaning weight per cow exposed for breeding from NP cows was 13.8, 32.3, 55.2 and 1.0 kg higher than from PG, H2, C2 and H3 cows, respectively. Causes for cows being nonpregnant were reported. Also, calving patterns during 6 consecutive calving periods (6 yr) were evaluated.

The decoction of Dalbergia monetaria L. is popularly used in Brazil for the treatment of gastric ulcer and the lyophilized aqueous extract (LAE) of D. monetaria has significant anti-ulcerogenic activity and inhibits gastric ulcer lesions induced by pylorus-ligature, ethanol and hypothermic-restraint stress. This work was conducted to identify the antiulcerogenic mechanisms of action of the LAE of D. monetaria. We analysed the effect of the LAE on prostaglandin E2 (PGE2) synthesis and on the characteristics (pH, volume and total acid content) of gastric juice. The antagonism between the LAE and histamine or carbachol was also analysed. The LAE increased gastric mucosal PGE2 synthesis compared with control (89.7+/-21.5 and 52.6+/-11.8 pg mg(-1), respectively) as assayed by enzyme immunoassay in the rat stomach. The LAE reduced the total acid content of gastric juice, but did not modify pH or gastric volume significantly, in Shay rats. Dose-response curves to histamine were shifted to the right in guinea-pig isolated right atria (pD2 values were 5.77+/-0.2 and 5.42+/-0.3, respectively, in the absence and presence of the LAE), with a significant reduction in maximum response (140+/-15.1 and 98+/-13.0, respectively). The same effect was observed when the agonist was isoprenaline. The LAE had no effect on the dose-response curve to carbachol in rat fundus strips. Thus, the protective effect of the LAE on induced gastric lesions might be because of synergistic effects, e.g. increased PGE2 synthesis and antagonism of H2 histamine and beta-adrenergic receptors, reducing gastric acid secretion. Increased PGE2 synthesis results in increased protection, and antagonism of H2 histamine and beta-adrenergic receptors reduces aggressive factors against the gastric mucosa.

With its detection limit well below 30 pg microl(-1) LC-MS-MS has become a sensitive and thus popular analytical technique for organoarsenical compounds. Collision induced dissociation (CID) is a valuable tool for speciation and facilitates a positive identification of the species detected. However, it is not straightforward to understand the fragmentation pathways of organoarsenical compounds when only CID-MS-MS data is available. In the present paper we have investigated multiple mass spectrometry (MSn, n=1, 2, 3, 4, 5, 6) with electrospray CID fragmentation for a number of organoarsenical compounds likely to occur in the environment. The investigated compounds were tetramethylarsonium, trimethylarsinoxide, monomethylarsonic acid, dimethylarsinic acid, arsenobetaine, arsenocholine, and dimethylarsinoylethanol. By CID of (protonated) organoarsenical cations mostly even-electron fragments are produced after neutral loss processes such as elimination of H2, H2O, CH4, C2H2, C2H4, C2H6, HCHO, CH3OH, C2H5OH, C2H4O, and CH2CO. However, abundant odd-electron fragments are also formed after elimination of radical species. Evidence for reduction of As(V) to As(III) as a driving force in the odd-electron ion formation is obtained.

The Earth's troposphere contains approximately 160 Tg H2 with an average surface mixing ratio approximately 530 nmole mole(-1) (ppb) and lifetime of 2 years. Atmospheric H2 is typically measured using gas chromatography (GC) followed by hot mercuric oxide reduction detection (GC-HgO). Here we describe an alternate method using GC with a pulsed-discharge helium ionization detector (HePPD). HePPD is a universal detector; when applied to H2, the GC-HePDD provides a wide linear range (0.3% over a range of 2000 ppb), a detection limit of approximately 0.03 pg, high precision (0.12%) and a stable response (+/-1.6% over nearly one year). HePPD is compared to HgO reduction using a suite of gravimetrically prepared reference gases spanning remote to urban concentrations. The method is excellent for atmospheric measurements as it provides a wide linear range with high precision, stability and reproducibility. We suggest these characteristics will improve the ability to maintain reference gases and improve measurements of atmospheric H2, thus providing better constraints on potential future changes in its sources and sinks.

A case of Zollinger-Ellison syndromes in a fifty year-old male that was successfully treated with a H+-K+ ATPase inhibitor (Omeprazol) is reported. The patient underwent a partial gastrectomy in 1984, but had been suffering from multiple refractory stomal and jejunal ulcers after the operation. In 1987, hypergastrinemia (760 pg/ml) was detected, and the presence of gastrinomas in the pancreatic head accompanied by a multiple liver metastasis was subsequently confirmed by CT-angiography and by the gastrin level detected in percutaneous, transhepatic, portal venous samples. A secretin provocation test proved to be negative, and the ulcers resisted the H2-receptor antagonists, but the patient was successfully cured shortly after the administration of an H+-K+ ATPase inhibitor.

Interaction of small molecules with collagen has far reaching consequences in biological and industrial processes. The interaction between collagen and selected polyphenols, viz., gallic acid (GA), pyrogallol (PG), catechin (CA), and epigallocatechin gallate (EGCG), has been investigated by various solution NMR measurements, viz., (1)H and (13)C chemical shifts (δH and δC), (1)H nonselective spin-lattice relaxation times (T1NS) and selective spin-lattice relaxation times (T1SEL), as well as spin-spin relaxation times (T2). Furthermore, we have employed saturation transfer difference (STD) NMR method to monitor the site of GA, CA, PG, and EGCG which are in close proximity to collagen. It is found that -COOH group of GA provides an important contribution for the interaction of GA with collagen, as evidenced from (13)C analysis, while PG, which is devoid of -COOH group in comparison to GA, does not show any significant interaction with collagen. STD NMR data indicates that the resonances of A-ring (H2', H5' and H6') and C-ring (H6 and H8) protons of CA, and A-ring (H2' and H6'), C-ring (H6 and H8), and D-ring (H2″and H6″) protons of EGCG persist in the spectra, demonstrating that these protons are in spatial proximity to collagen, which is further validated by independent proton spin-relaxation measurement and analysis. The selective (1)H T1 measurements of polyphenols in the presence of protein at various concentrations have enabled us to determine their binding affinities with collagen. EGCG exhibits high binding affinity with collagen followed by CA, GA, and PG. Further, NMR results propose that presence of gallic acid moiety in a small molecule increases its affinity with collagen. Our experimental findings provide molecular insights on the binding of collagen and plant polyphenols.

The problem of a preoperative histamine H1- + H2 - prophylaxis was tackled by a group of new studies including randomized controlled clinical trials and cross-sectional studies with plasma histamine measurements and administration of H1- + H2 - antagonists to a control group. The first study demonstrated serial histamine release in the induction of anaesthesia up to 4 times in a single patient. Basal plasma histamine levels in resting subjects fell below 100 pg/ml during the time necessary for preparation of the surgical patient. Hence, spikes of elevated plasma histamine concentrations corresponded to histamine release. Although this histamine release very often was less than 1 ng/ml plasma histamine, it created systemic reactions after atracurium. The cut-off point of 1 ng/ml for such anaphylactoid reactions does no longer exist, also lower plasma levels are of patho-physiological significance. The clinical signs of histamine release in the induction of anaesthesia vary from drug to drug. Sometimes tachycardia and hypertension produce the highest likelihood ratio, sometimes tachy- and bradycardia, but no changes in blood pressure as in the case of atracurium. It is concluded that the reasons why histamine release in anaesthesia and surgery is so much underreported and under-estimated include the present paradigms about plasma histamine levels and the "classical picture" of histamine release. Both are no longer valid and need a re-assessment.

A stimuli-responsive tetranuclear complex was assembled into new aggregates with controllable dimensionality through directional hydrogen bonds (HBs). A cyanide-bridged tetranuclear complex cation, [Co2 Fe2 (CN)6 (tp*)2 (bpy*)4 ]2+ (abbreviated to 12+ ) (tp*=hydrotris(3,5-dimethylpyrazol-1-yl)borate and bpy*=4,4'-di-methyl-2,2'-bipyridine) has two terminal cyanide nitrogens and acts as a hydrogen-bond acceptor (HBA) with a linear bridging mode. Co-crystallization of 12+ with p-hydroquinone (H2 Q), a hydrogen-bond donor (HBD) with two donor sites, led to a one-dimensional aggregate, 1(BPh4 )2 ⋅(H2 Q)⋅2 H2 O (2), while a two-dimensional sheet with a honeycomb structure, 13 (PF6 )6 ⋅(H3 PG)2 ⋅4 CH3 CN⋅8 H2 O (3), was obtained by co-crystallization with phloroglucinol (H3 PG) acting as a three-way structure-directing HBD. Magnetic measurements revealed that 2 and 3 exhibited thermal and light-induced electron-transfer-coupled spin transitions (ETCSTs).

The aim of this study was to characterize the antioxidant activity of penicillin G (PG), ampicillin (AMP), oxacillin (OX) and dicloxacillin (DOX) through their reactivity towards reactive oxygen species (superoxide anion radical, O2•̅; hydroxyl radical, HO• ; peroxyl radical, ROO• ; hydrogen peroxide, H2 O2 ; DPPH• ) using various in vitro antioxidant assays with chemiluminescence (CL) and spectrophotometry as measurement techniques. In hydroxyl radical assays , PG, OX and AMP were found to inhibit the CL signal arising from the Fenton-like reaction in a dose-dependent manner with IC50 = 0.480 ± 0.020 mM, IC50 = 0.569 ± 0.021 mM, and IC50 = 0.630 ± 0.019 mM, respectively. The highest reactivity of PG among the tested penicillins towards the HO radical was confirmed in the deoxyribose degradation assay. In the ABAP-derived ROO radical assay, the radical-scavenging ability of the test penicillins was in the following order: AMP>> PG>> DOX>> OX. The number of reduced DPPH radicals by the drugs tested was <1 being the biggest for PG. The weak antioxidant capacity of the test penicillins was confirmed in the trolox antioxidant capacity assay (0.075 ± 0.004; 0.093 ± 0.006; 0.123 ± 0.005; 0.126 ± 0.004) for OX, AMP, DOX, PG, respectively. Use of luminol as a CL probe for estimation of penicillin reactivity towards H2 O2 showed that only AMP was able to quench light emission; the remaining antibiotics demonstrated a strong enhancing effect. All the examined compounds showed a weak antioxidant potential when estimated using the ferric-ferrozine assay. This study is the first to report the evaluation of test penicillins as antioxidants under the same reaction conditions.

Environmental endocrine disruptors in the environment and food, especially 17 β-estradiol (E2), are important factors affecting the growth and development of organisms. In this research, we constructed a fluorescence strategy for two-step amplification that combined two currently popular methods, exponential amplification reaction (EXPAR) and hybridization chain reaction (HCR). E2 competed with the complementary DNA (cDNA) to bind the aptamer modified on the magnetic beads. The free complementary strand in the supernatant was used as a trigger sequence to activate EXPAR, producing a large amount of short single-stranded DNA (ssDNA). The amplified ssDNA can trigger the second HCR amplification, producing many long double-stranded DNA (dsDNA) analogues. According to the principle of fluorescence resonance energy transfer, the carboxyfluorescein (FAM) signals in H1 and H2 hairpins were quenched by black hole quencher (BHQ-1). After the addition of E2 and initiation of amplification, the initially quenched fluorescent signal would be restored. This strategy with a detection limit of 0.37 pg mL^-1 (S/N = 3) showed a good linear relationship in the range of 0.4-800 pg mL^-1. In addition, the recovery rates of the method for milk and water samples were 98.55%-116.95% and 92.32%-107.00%, respectively. This is the first report of the combined detection of EXPAR and HCR, providing a reference for rapid and highly sensitive detection using multiple isothermal amplification methods.

A Gram-positive, aerobic, nonmotile actinomycete strain designated DRQ-2(T) was isolated from the soil sample collected from lime-stone open pit mine from the Gulbarga region, Karnataka province, India. Strain DRQ-2(T) was identified as a member of the genus Nonomuraea by a polyphasic approach. Strain DRQ-2(T) could be differentiated from other members of the genus Nonomuraea on the basis of physiology and 16S rRNA gene sequence analysis. The 16S rRNA gene sequence similarity of strain DRQ-2(T) showed highest sequence similarity to Nonomuraea muscovyensis DSM 45913(T) (99.1%), N. salmonea DSM 43678(T) (98.2%) and N. maheshkhaliensis JCM 13929(T) with 98.0%, respectively. Chemotaxonomic properties showing predominant menaquinones of MK-9 (H4), MK-9(H2) and MK-9(H6), major polar lipids comprised diphosphatidylglycerol, phosphatidylmono methyl ethanolamine (PME), phosphatidylethanolamine (PE), hydroxy-PME (OH-PME), hydroxy PE (OH-PEE), phosphatidylglycerol (PG), ninhydrin-positive phosphoglycolipid and unknown phospholipid, fatty acids with major amounts of i-C16:0, ai-C15:0 and ai-C17:0 supported allocation of the strain to the genus Nonomuraea. Results of DNA-DNA hybridization and physiological tests allowed genotypic and phenotypic differentiation of strain DRQ-2(T) from closely related species. The genomic DNA G+C content of the organism was 72.5 mol%. On the basis of phenotypic, chemotypic and molecular characteristics, strain DRQ-2(T) represents a novel species of the genus Nonomuraea, for which the name N. indica sp. nov. is proposed, with type strain DRQ-2(T) (=NCIM 5480(T)= CCTCC AA 209050(T)).

Trimetoquinol (TMQ) is a non-prostanoid compound that blocks prostaglandin H2/thromboxane A2 (TXA2) receptor-mediated responses initiated by a prostaglandin (PG) H2 analog, U46619, in human platelets and rat aorta. Ring fluorine-substituted TMQ analogs selectively antagonized PG-dependent human platelet activation induced by U46619, arachidonic acid, collagen, ADP or epinephrine; and were about 300-fold less potent as inhibitors of PG-independent responses mediated by thrombin or bacterial phospholipase C. For each inducer of the PG-dependent pathway, the rank order of inhibitory potency was identical (TMQ>> 8-fluoro-TMQ>> 5-fluoro- TMQ). Iodine substitution yielded a similar rank order of antagonism against U46619-induced platelet activation (TMQ>> 8-iodo-TMQ>> 5-iodo-TMQ), and all TMQ analogs inhibited platelet aggregation in whole blood as well as in platelet-rich plasma. Inhibition of specific [3H]SQ 29,548 binding by TMQ analogs was highly correlated with inhibition of functional responses to U46619. Radioligand binding experiments using TMQ analogs with rat platelets showed no interspecies difference in comparison with human platelets. The rank order of inhibitory potencies for the fluorinated (but not iodinated) TMQ analogs changed in rat thoracic aorta with 8-fluoro-TMQ>> TMQ>> or = 5-fluoro-TMQ as antagonists of U46619-induced vascular contraction. These findings demonstrate that the primary mechanism of antiplatelet action of TMQ analogs is related to a blockade of TXA2 receptor sites, and ring-halogenated TMQ analogs distinguish between TXA2-mediated functional responses in vascular smooth muscle and platelets.

BACKGROUND

Total and partial gastric resection may affect the pharmacokinetics of drugs, especially orally administered a few days after surgery. Ketoprofen is a non-steroidal anti-inflammatory drug (NSAID) broadly used to treat postoperative pain, including patients after gastric resection. The aim of the research was to analyse the pharmacokinetics (PK) of orally administered ketoprofen in patients after gastrectomy.

METHODS

The research was carried out on two groups of patients after total (TG; Roux-Y procedure) and partial (PG; Billroth II procedure) gastrectomy. The patients in group TG (n=15; mean [SD] age 61.86 [14.15] years; and BMI 24.20 [3.73] kg/m2) and group PG (n=5; mean [SD] age 62.40 [16.80] years; and BMI 23.98 [3.45] kg/m2) received ketoprofen in a single oral dose of 100mg. The measurement of ketoprofen plasma concentrations was made by means of the HPLC (high performance liquid chromatography) method.

RESULTS

The PK parameters in group TG and PG were as follows: maximum plasma concentration (Cmax), 3.42 [0.99] and 4.66 [0.81] mg/l (p=0.0220); area under the plasma concentration-time curve from zero to infinity (AUC0-∞), 9.12 [2.78] and 9.17 [2.87] mg×h/ml (p=0.9734); area under the first moment curve from zero to the time of infinity (AUMC0-∞), 25.95 [8.52] and 26.53 [11.43] mg×h2/l (p=0.9056); time to reach maximum concentration (tmax), 0.47 [0.25] and 0.55 [0.27] h (p=0.5327), respectively.

CONCLUSIONS

Lower concentrations of ketoprofen in patients after gastrectomy suggest that it might be necessary to apply higher dose of the analgesic.

The conformational space of α-phenylglycine (PG) have been investigated theoretically at both the DFT/B3LYP/6-311++G(d,p) and MP2/6-311++G(d,p) levels of approximation. Seventeen different minima were found on the investigated potential energy surfaces, which are characterized by different dominant intramolecular interactions: type I conformers are stabilized by hydrogen bonds of the type N-H···O=C, type II by a strong O-H···N hydrogen bond, type III by weak N-H···O-H hydrogen bonds, and type IV by a C=O···H-C contact. The calculations indicate also that entropic effects are relevant in determining the equilibrium populations of the conformers of PG in the gas phase, in particular in the case of conformers of type II, where the strong intramolecular O-H···N hydrogen bond considerably diminishes entropy by reducing the conformational mobility of the molecule. In consonance with the relative energies of the conformers and barriers for conformational interconversion, only 3 conformers of PG were observed for the compound isolated in cryogenic Ar, Xe, and N2 matrices: the conformational ground state (ICa), and forms ICc and IITa. All other significantly populated conformers existing in the gas phase prior to deposition convert either to conformer ICa or to conformer ICc during matrix deposition. The experimental observation of ICc had never been achieved hitherto. Narrowband near-IR irradiation of the first overtone of νOH vibrational mode of ICa and ICc in nitrogen matrices (at 6910 and 6930 cm(-1), respectively) led to selective generation of two additional conformers of high-energy, ITc and ITa, respectively, which were also observed experimentally for the first time. In addition, these experiments also provided the key information for the detailed vibrational characterization of the 3 conformers initially present in the matrices. On the other hand, UV irradiation (λ = 255 nm) of PG isolated in a xenon matrix revealed that PG undergoes facile photofragmentation through two photochemical pathways that are favored for different initial conformations of the reactant: (a) decarboxylation, leading to CO2 plus benzylamine (the dominant photofragmentation channel in PG cis-COOH conformers ICa and ICc) and (b) decarbonylation, with generation of CO plus benzonitrile, H2O and H2 (prevalent in the case of the trans-COOH conformer, IITa).

This paper reports the first ebullitive fluxes of hydrogen (H2), carbon monoxide (CO), methane (CH4), carbon dioxide (CO2) and total gaseous mercury (TGM) from the Cornwall Area of Concern (CAC). Although sediments were contaminated with mercury, bubbling was a negligible source of mercury for the global atmosphere. Indeed, the average emission of TGM through ebullition was 0.04 pg m(-2) h(-1). Measurements of H2, CO, CH4 and CO2 trapped gas concentrations and fluxes were used as indicators of diagenesis processes. The CAC represented a significant regional source of CH4 since the estimated ebullitive fluxes (3.5 mg m(-2) h(-1)) were similar to the CH4 emissions measured above typical flooded freshwater wetlands. As molecular diffusion is known as the main pathway of CO2 transport from water to the atmosphere, CO2 ebullitive fluxes were weak (0.39 mg m(-2) h(-1)). Bubbling of CO (1.6 microg m(-2) h(-1)) was 10 folds less important than CO fluxes measured over flooded freshwater wetlands. Finally, H2 emissions (0.001 microg m(-2) h(-1)) were negligible since the level of this trace gas is tightly regulated by microorganisms in anaerobic environments.

A series of Pt nanoparticles supported on carbon nanotubes (CNTs) were synthesized using the incipient-wetness impregnation method. These catalysts were characterized by X-ray photoelectron spectroscopy (XPS), X-ray diffraction (XRD), Raman spectroscopy, and transmission electron microscope (TEM) techniques. The characterization results indicate that the Pt nanoparticles were highly dispersed on the surface of the CNTs, and the mean size was less than 5 nm. These catalysts were utilized to convert cellulose to hexitol, ethylene glycerol (EG), and 1,2-propylene glycol (1,2-PG) under low H2 pressure. The total yields were as high as 71.4% for EG and 1,2-PG using 1Pt/CNTs as the catalyst in the hydrolytic hydrogenation of cellulose under mild reaction conditions.

The effect of hypophysectomy on hypothalamic blood flow autoregulation was studied in anesthetized, artificially ventilated rats. Local hypothalamic blood flow (HBF, H2-gas clearance method) was measured. Efficiency of autoregulation was tested by determining HBF during standardized hemorrhagic hypotension when systemic arterial pressure was lowered to 80, 60 and 40 mm Hg by consecutive, step-wise bleeding. HBF autoregulation was well maintained until 80 mmHg, but not completely at 60 and 40 mmHg arterial pressure in the sham-operated control group. In contrast, autoregulation was abolished at all levels in the hypophysectomized rats: HBF followed the changes in arterial pressure in these animals. Following hypophysectomy, the concentration of immunoreactive beta-endorphin (beta-EP) decreased drastically in plasma but remained unchanged in cerebrospinal fluid. Administration of beta-EP (200 pg/100 g b. wt.) to hypophysectomized rats by the intravenous route had no effect on autoregulation, while intracerebroventricular administration of the same dose restored autoregulation. The present findings suggest that the pituitary plays a role in hypothalamic blood flow autoregulation.

Background: Long-term usage of acid suppression drugs like proton pump inhibitors (PPIs) or H₂ receptor blockers in the elderly population has been found to result in vitamin B₁₂ deficiency. However, the reports are equivocal.

Objective: To determine the serum vitamin B₁₂ levels in elderly patients under chronic acid suppression therapy.

Methods: Patients aged above 60 years and on any of the PPIs or H₂ blockers for at least 6 months were recruited. Out of 77 patients recruited, 60 patients were included for the final analysis. The serum vitamin B₁₂ levels were measured using the AccuDiag™-Vitamin B12 ELISA system.

Results: Out of 60 patients, pantoprazole (40%) and omeprazole (37%) were the commonly prescribed acid-suppressing drugs. Nearly 50% of the patients on prolonged acid suppression therapy were either "deficient" (less than 200 pg/ml) or "insufficient" (200 to 300 pg/ml) in serum vitamin B₁₂ levels. Neither the average serum vitamin B₁₂ levels (p = 0.994) nor the vitamin B₁₂ status (p = 0.226) varied significantly across the drug groups of pantoprazole, omeprazole, and ranitidine.

Conclusions: Prolonged acid suppression therapy with PPIs or H₂ blockers may result in serum vitamin B₁₂ deficiency. However, there was no class (PPIs vs. H₂ receptor blockers)- or drug (pantoprazole vs. omeprazole vs. ranitidine)-based differences found in the vitamin B₁₂ deficiency caused.

Keywords: Histamine H2 antagonists; Omeprazole; Pantoprazole; Proton pump inhibitors; Vitamin B12 deficiency.

A 38-year-old man with multiple endocrine neoplasia type-1 (Wermer's syndrome) is described. The patient had refractory duodenal ulcers and raised basal acid output (55 mmol/hour) and fasting serum gastrin (1190 pg/ml). Abdominal CT scan revealed mass lesions (gastrinomas) in the head of the pancreas. He also had persistent hypercalcemia, hypophosphatemia, right ureteric calculi, increased urinary calcium and phosphorus and enlarged parathyroids on ultrasound and CT of the neck. Parathormone level was raised, but the pituitary gland was normal on CT scan of the head. The patient was managed initially with histamine H2-blockers, omeprazole and parathyroidectomy; enucleation of the tumor masses in the pancreas was done subsequently.

Mechanisms of histamine-induced relaxation in dog mesenteric artery and vein strips were compared. Histamine elicited a concentration-related relaxation in the arterial strips contracted with prostaglandin (PG) F2 alpha; the relaxations induced at 5 x 10(-7) M or higher were composed of phasic and tonic patterns. The phasic component of relaxation was inhibited by chlorpheniramine, but not by cimetidine. Combined treatment with the H1 and H2 antagonists abolished the amine-induced relaxation. The tonic component was inhibited by cimetidine. The phasic relaxation was attenuated by removal of the endothelium. Treatment with indomethacin inhibited the phasic component in the strips with endothelium, but did not influence the relaxation after endothelium denudation. Combined treatment with indomethacin and cimetidine, but not chlorpheniramine, abolished the response. On the other hand, histamine produced a concentration-related, tonic relaxation in the mesenteric vein strips. The relaxation was not influenced by indomethacin, endothelium-denudation, and chlorpheniramine, but was abolished by cimetidine. It may be concluded that the phasic relaxation of dog mesenteric arterial strips is mediated mainly by H1 receptors in the endothelium, resulting in the synthesis and release of PGI2. The tonic relaxation appears to be elicited by activation of H2 receptors in smooth muscle. Mesenteric vein relaxations induced by histamine are likely to be mediated solely by H2 receptors in smooth muscle.

The combination of thromboxane (TX) synthase inhibition and prostaglandin (PG) H2/TXA2 receptor antagonism yields enhanced antithrombotic effects as compared with either intervention alone. However, it is not known whether the enhancing effect of TX synthase inhibition is expressed also in the presence of complete blockade of PGH2/TXA2 receptors. Thus we evaluated the antithrombotic effects of increasing doses of the PGH2/TXA2 receptor antagonist L 670596 alone and in combination with a dose of the TX synthase inhibitor FCE 22178 causing>> 95% inhibition of platelet TXB2 production. In the dog model of electrically induced coronary thrombosis, occlusion time in control animals (n = 14) averaged 72 +/- 29 min. L 670596 alone dose-dependently antagonized platelet PGH2/TXA2 receptors and prolonged occlusion time. The addition of FCE 22178 displaced the dose-occlusion time relation of L 670596 in a parallel fashion without modifying receptor occupancy. In the rabbit model of copper coil-induced carotid artery thrombosis, occlusion was very rapid (14 +/- 4 min) in control animals (n = 17) and was not modified by either aspirin or FCE 22178. L 670596 caused a dose-related receptor blockade and prolongation of occlusion time. The association with FCE 22178 enhanced significantly the antithrombotic effect of L 670596 at all doses. We conclude that the full therapeutic potential of PGH2/TXA2 receptor antagonism is expressed at>> 90% platelet receptor occupancy. The additive effect of TX synthase inhibition suggests that conversion of PGH2 to platelet-inhibitor and vasodilator prostaglandins might be of therapeutic importance, irrespective of the extent of PGH2/TXA2 receptor blockade.