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OBJECTIVE: We compared the efficacy of three different doses of the proton pump inhibitor lansoprazole in the management of reflux esophagitis. METHODS: Two hundred ninety-two patients with endoscopically confirmed reflux esophagitis were enrolled in a double-blind, multicenter study and were randomized to lansoprazole 15, 30, or 60 mg or placebo administered once daily for 8 wk. RESULTS: Healing rates after 4 wk of lansoprazole 15, 30, and 60 mg/d were 67.6%, 81.3%, and 80.6%, respectively. These were all significantly superior (p < 0.001) to placebo, which produced endoscopic healing in only 32.8% of the patients after 4 wk. The 4-wk healing rates with lansoprazole 30 or 60 mg were significantly higher than that with lansoprazole 15 mg (p < 0.05), confirming a dose-response effect. Cumulative healing rates after 8 wk of treatment were 52.5% with placebo and 90.0%, 95.4%, and 94.4% with lansoprazole 15, 30, and 60 mg, respectively (p < 0.001 for all doses of lansoprazole vs placebo). Lansoprazole was also significantly superior to placebo in relieving symptoms in patients with reflux esophagitis. Lansoprazole was well tolerated, and no serious treatment-related adverse events were encountered. Up to 3 months after discontinuation of treatment, all lansoprazole-treated groups had more patients free of endoscopic evidence of esophagitis than the group treated with placebo. CONCLUSIONS: Lansoprazole was safe and effective for the treatment of reflux esophagitis in this trial. This study indicates that the optimum daily dose of lansoprazole for reflux esophagitis is 30 mg.

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BACKGROUND: Lansoprazole is a new proton pump inhibitor for the treatment of peptic ulcer disease. METHODS: A double-blind, multicentre study was undertaken in 296 patients with endoscopically proven duodenal ulcer to compare the efficacy and safety of lansoprazole 15, 30 or 60 mg with placebo. Ulcer healing was documented by endoscopy at 2 and 4 weeks; patients whose ulcers healed after 4 weeks were followed for up to 6 months post-treatment. RESULTS: Four-week healing rates of 89.4%, 91.7% and 89.9% were obtained with lansoprazole 15, 30 and 60 mg, respectively, compared with 46.1% on placebo (P < 0.001). All three doses of lansoprazole produced rapid symptom relief, although patients taking 60 mg lansoprazole required fewer antacids than did those taking 15 mg. At 6 months, the percentages of patients healed were 45.3%, 40.0% and 38.4% in the lansoprazole 15, 30 and 60 mg dosage groups, respectively, and 25.3% for the placebo group. No significant adverse events were documented during the period of this trial. CONCLUSION: Lansoprazole is an effective and safe treatment for duodenal ulcer and the 15 mg dose is as effective as 30 or 60 mg.

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Assessed condom use, barriers to condom use, oral contraceptive use, partnership status and STD history in 457 15-30 year-old women attending four family planning clinics. Subjects were classified into three condom use groups: Non Users (37%); Current Users (33%); and Past Users (30%). Factor analysis revealed five barriers to condom use: Partner's Perception, Peer's Perception, Pleasure/Intimacy, Communication, and Low Perceived Need. Multivariate analyses revealed significant group differences on only two barrier factors: Pleasure/Intimacy and Low Perceived Need. Low Perceived Need accounted for 13.5% of the variance in condom use. Women with low perceived need to use condoms were more likely to use oral contraceptives.

PIP: A survey of 457 female clients, 15-30 years old, recruited from 4 Vermont (US) Planned Parenthood clinics in 1990 identified low perceived need as a significant barrier to condom use. Although study subjects averaged 2.5 sexual partners in the preceding 2 years and 21.6% had a history of a sexually transmitted disease (STD), condoms were used an average of only 1.1 times out of the last 5 acts of intercourse. 37% of the clients had never used condoms, 30% were past users, and 33% had used condoms at least once during their last 5 sexual encounters. 82.1% of study subjects were current oral contraceptive (OC) users. Discriminant analysis identified 6 obstacles that predicted, cumulatively, 21.5% of the condom use category variance: low perceived need (13.5%), use of the pill (4.0%), number of sexual partners in the past 2 years (1.9%), age (0.8%), education (0.8%), and pleasure/intimacy (0.5%). These variables correctly identified 71% of condom nonusers, 65% of current users, and 18% of past users. When women were crudely divided into 2 categories based on estimated actual risk for STDs, there was no difference between the high and low risk groups in terms of perceived need score or condom use category. In addition, low perceived need was unrelated to knowledge, number of sexual partners, STD history, age, or education. There was, however, a positive association between low perceived need and OC use. These family planning clinic clients appear to be focused almost exclusively on pregnancy prevention rather than on a strategy that would confer simultaneous protection against STDs.

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We describe a new method for determining the biological activity of heparin in plasma with use of thrombin and the substrate Tos-Gly-Pro-Arg-pNA. The procedure is based on the photometric determination of the inactivation of thrombin after incubation with plasma in the presence of endogenous antithrombin III (At III). The method allows the specific determination of heparin concentrations from 0.02 USP to 0.8 USP/ml of plasma in the presence of normal At III levels. It has been carried out manually by use of an Eppendorf spectrum line photometer or automatically by use of a Vitatron Akes analyzer. For evaluation, the results were compared with two standard samples which contained heparin in the low and high therapeutic range, respectively.

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A 65-year-old man developed adenocarcinoma arising in Barrett's epithelium of the esophagus. He died three months after unsuccessful surgery to remove the tumor. The columnar-cell-lined esophagus may represent a premalignant condition, and it is suggested that patients with this condition undergo regular follow-up examination.

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