Acid inhibition on the first day of dosing : comparison of four proton pump inhibitors

RESUME Introduction: Les inhibiteurs de la pompe à protons sont actuellement considérés comme les médicaments de choix pour le traitement des affections peptiques comme l'ulcère gastroduodénal et l'oesophagite de reflux. La rapidité, ainsi que le degré d'inhibition de la sécrétion gastrique acide sont importants pour le contrôle optimal des symptômes ainsi que pour le traitement de ces affections. But : Le but principal de cette étude a été de comparer, chez les sujets asymptomatiques non infectés par H. pylori, par pH-métrie intragastrique de 24 heures, la rapidité et la durée de l'action antisécrétoire de doses uniques de rabéprazole 20 mg, d'oméprazole capsule 20 mg, d'oméprazole en comprimé MUPS (« Multiple Unit Pellet System ») 20 mg, de pantoprazole 40 mg et de lansoprazole 30 mg, respectivement. Matériel et méthodes : Cette étude, effectuée en double aveugle et randomisée, a été conduite de manière croisée chez 18 sujets H. pylori-négatifs. Une pH-métrie de 24 heures a été effectuée le jour de l'administration du médicament (dose unique de rabéprazole 20 mg, de lansoprazole 30mg, de pantoprazole 40 mg, d'oméprazole capsule 20 mg, d'oméprazole MUPS comprimé 20mg, ou de placebo). Résultats : Le pH intragastrique médian (3.4 vs. 2.9, 2.2, 1.9 et 1.8, respectivement; p≤ 0.03) et le temps avec un pH supérieur à 4 pendant les 24 heures suivant la prise du médicament (8.0 heures vs. 7.4, 4.9, 2.9, et 3.0, respectivement; p≤ 0.003) ont été statistiquement plus élevés avec le rabéprazole qu'avec le lansoprazole, le pantoprazole, l'oméprazole capsule, l'oméprazole comprimé MUPS, ou le placebo. Les valeurs du pH pendant les périodes diurnes et nocturnes étaient plus hautes avec le rabeprazole et le lansoprazole qu'avec le pantoprazole, l'oméprazole capsule, et l'oméprazole comprimé MUPS (p≤0.04). Conclusion : Le rabéprazole s'est montré le plus efficace de tous les inhibiteurs de pompe à protons étudiés durant le premier jour de l'administration du médicament. SUMMARY Background: Rapid and consistent acid suppression on the first day of dosing may be important in treating acid-related disorders. Aim: To compare the antisecretory activity and onset of action of single doses of rabeprazole, lansoprazole, pantoprazole, omeprazole capsule, omeprazole multiple unit pellet system (MUPS) tablet and placebo in healthy Helicobacter pylori-negative subjects. Methods: This cross-over, double-blind, randomized study was performed in 18 H. pylori-negative subjects. Twenty-four-hour intragastric pH monitoring was performed on the day of treatment (once-daily dose of rabeprazole 20 mg, lansoprazole 30 mg, pantoprazole 40 mg, omeprazole capsule 20 mg, omeprazole MUPS tablet 20 mg or placebo). Results: The intragastric pH (3.4) and time at pH > 4 during the 24 h post-dose (8.0 h) were significantly greater with rabeprazole than with lansoprazole, pantoprazole, omeprazole capsule, omeprazole MUPS tablet or placebo (P ≤ 0.04 for rabeprazole vs. the others). Daytime and night-time pH values were higher with rabeprazole and lansoprazole than with pantoprazole, omeprazole capsule and omeprazole MUPS tablet (P ≤ 0.04). Conclusion: Rabeprazole was the most potent acid inhibitor of all the proton pump inhibitors tested during the first day of dosing.

Avulsion fracture of peroneus longus tendon at the first metatarsal insertion: a case report : P16

Introduction: Isolated avulsion fracture at the plantar lateral base of the first metatarsal (M1) is very rare. Case report: A 35 year old overweight woman sustained an eversion strain of her right foot. Despite pain along M1 she was able to continue walking for three days before presenting to her family doctor. Swelling on the plantar aspect of the foot was noticed, there was also pain at eversion of the foot and extension of the ankle. Plain X-ray showed no abnormalities. A MRI showed minimal bone bruise at the basis of M1 and a partial rupture of the peroneus longus tendon at its insertion. The patient was allowed to walk with partial weight bearing with a soft ankle brace. After 6 months she presented at our hospital because of persistent pain. There was still a painful insertion of the peroneus longus but active plantarflexion of M1 was possible. Plain X-rays were poorly contributive except for a discrete flattening of the longitunal arch. CT-scan showed a non displaced fracture at the M1-basis. A protocol with partial weight-bearing in a short-leg cast and partial weight-bearing orthosis each for 6 weeks was unsuccessfully attempted. Therefore, an excision of the non healed bone fragment at the basis of M1 and a first tarsometatarsal joint arthrodesis were performed. Postoperatively the patient wore a partial weight-bearing short leg cast for 6 weeks followed by a weight-bearing short leg cast for 6 weeks with favourable outcome. Discussion: Initial internal fixation has been reported to lead to good results [1, 2]. In our case the conservative treatment failed and leaded to non union. At that time we considered as too risky (overweight) to excise the fragment and reattach the peroneus longus tendon. Therefore, we excised the fragment and fused the first tarsometatarsal joint. This procedure allowed, at least partially, to compensate for the function of the peroneus longus tendon. 1 Murakami T, et al. Avulsion fracture of the peroneus longus at the first metatarsal insertion: a case report. Br J Sports Med. 2004. 2 Kwak HY, and Bae SW. Isolated avulsion fracture at the plantar lateral base of the first metatarsal: a case report. Foot Ankle Int 2000.

Rationale and first results of developing at-risk (prodromal) criteria for bipolar disorder.

Bipolar affective disorder (BD) is a severe, recurrent and disabling disorder with devastating consequences for individuals, families and society. Although these hazards and costs provide a compelling rationale for development of early detection and early intervention strategies in BD, the development of at-risk criteria for first episode mania is still in an early stage of development. In this paper we review the literature with respect to the clinical, neuroantomical and neuropsychological data, which support this goal. We also describe our recently developed bipolar at-risk criteria (BAR). This criteria comprises the peak age range of the first onset of bipolar disorder, genetic risk, presenting with sub-threshold mania, cyclothymic features or depressive symptoms. An initial pilot evaluation of the BAR criteria in 22 subjects indicated conversion rates to proxies of first-episode mania of 23% within 265 days on average, and high specificity and sensitivity of the criteria. If prospective studies confirm the validity of the BAR criteria, then the criteria would have the potential to open up new avenues of research for indicated prevention in BD and might therefore offer opportunities to ameliorate the severity of, or even prevent BD.