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BACKGROUND: Lansoprazole is a new proton pump inhibitor which powerfully decreases acid secretion. METHODS: We compared the efficacy and short-term safety of lansoprazole against ranitidine in the healing of gastric ulcer. This was a parallel group, comparative multicentre, prospectively randomized, double-blind study which included 250 patients with gastric ulcer, 219 of whom had follow-up endoscopic data. RESULTS: Both lansoprazole 30 mg and 60 mg daily produced significantly more rapid healing of gastric ulcer than ranitidine 300 mg nightly with healing rates after 4 weeks of 78% (P < 0.05), 84% (P < 0.01) and 61%, respectively. After 8 weeks, the corresponding healing rates were 99%, 97% and 91% (P = 0.08). Symptom relief was similar for all treatment groups, but fewer antacids were used by patients receiving lansoprazole. Sixty-nine patients experienced 91 adverse events; the incidence, pattern and severity was similar across all three treatment groups. CONCLUSIONS: Lansoprazole 30 mg and 60 mg once daily had similar efficacy. Both were superior to ranitidine 300 mg nocte in healing gastric ulcer. The short-term safety profile of lansoprazole was similar to ranitidine. These data indicate that lansoprazole should be used at a dose of 30 mg once daily for the treatment of gastric ulcers.

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Two cases of non-traumatic rupture of the iliac veins have invited a review of eight previous cases reported in the literature. The condition is worthwhile reviewing as the clinical signs and findings very much resemble the picture of a ruptured aneurysm including sudden or fairly rapid onset of hypovolaemia and a tender, lower abdominal mass. In addition, concomitant iliac vein thrombosis is a common finding which is likely to contribute to rupture. The management is resuscitation and repair of the vein.

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Sperm nuclear zinc content (expressed as zinc/phosphorus and zinc/sulphur ratios) was determined with X-ray microanalysis in individual, air-dried, epididymal spermatozoa from elderly men, and in ejaculated spermatozoa from healthy donors. Ejaculated sperm nuclei contained (also after treatment with sodium dodecyl sulphate) more zinc than epididymal spermatozoa. The results indicate that the human spermatozoon accumulates zinc from the prostatic fluid upon ejaculation.

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Eighteen patients with unresectable carcinoma of the esophagus were surgically intubated with the Celestin tube. Twelve patients (66.7%) had good palliation and relief of dysphagia. The operation mortality rate was 16.7%, which is in accordance with figures reported for endoscopic intubation of malignant strictures of the esophagus.

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Defects in many controlled randomized trials in surgery were recently (1980) pointed out by van der Linden. The value of total parenteral nutrition (TPN) in connection with major surgical procedures and in the management of chronic inflammatory disease of the bowel is frequently debated. The present paper concerns some pitfalls in controlled randomized trials dealing with TPN. Emphasis is placed on the value of clinical judgement, common sense and appropriate experience in lieu of such trials, which in many instances are not feasible because of the extremely large numbers of patients required.

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Permanent intubation of benign oesophageal stricture seems to be rather frequently used, but there are few reports on indications and results. The limited experience from 9 intubations in 7 patients presented, is not encouraging. Massive gastro-intestinal bleeding, peptic reflux and tube migration were seen, and 4 of the tubes had to be sacrificed within 6 weeks. Two patients only had full and lasting benefit of the treatment without serious tube complication. Indwelling tubes should be considered in benign strictures only as an alternative to gastrostomy, particularly in those patients feeling strong aversion to permanent stomy.

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Sermatozoa from two brothers who are not twins were found to be straight and immotile. Examinations of the sperm showed that oxygen consumption and lactic acid production were normal; viability tests showed that the percentage of dead sperm was not increased. The ultrastructural appearance of the sperm tail was normal except for a complete lack of dynein arms and some irregularities in the arrangement of the accessory fibers and the longitudinal columns of the fibrous sheath. The mitochondrial apparatus and the sperm head conform to the conventional model. According to the sliding-filament hypothesis first proposed by Afzelius (1959. J. Biophys. Biochem. Cytol. 5:269.), the arms are responsible for the bending movements of the tail. The simplest explanation for the simultaneous lack of arms and sperm motility appears to be that the two brothers have a genetic disorder involving production, assembly, or attachment of the dynein arms.

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The semen from 20 men with varicocele was studied before and after surgical correction of the varicocele. The effect on sperm quality was only marginal and could not explain the fairly high conception rate (20%) after operation. The recommendation that varicocele in men with long-term infertility should be eliminated by ligation of the internal spermatic veins is still justified despite the absence of positive effects on sperm quality.

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PIP: The effects of albumin, magnesium, and zinc on human sperm survival in different fractions of split ejaculates were studied. Of particular interest was the effect of these prostatic factors on the survival of spermatozoa in the last 1/2 of the ejaculate. The survival and motility of human spermatozoa were studied in the first and last halves of more than 50 split ejaculates from 7 men. The 4-hour survival was better in the first 1/2. The addition of human albumin (4%) to the last 1/2 maintained the survival and motility of the spermatozoa at the same level as in the first 1/2. Addition of albumin to the last 1/2 also reduced the uptake of zinc by the spermatozoa in the part of the ejaculate. Addition of magnesium (100 mcg/ml) to the second 1/2 of the ejaculate had a slight beneficial effect on sperm survival; however, the effect was much less than that achieved with albumin. Addition of zinc or colloids (dextran, Ficoll) to the last 1/2 had no effect on the survival of the spermatozoa. Dextran and Ficoll did not reduce the high uptake of zinc characteristic for spermatozoa in the second 1/2. Addition of zinc ions to the second 1/2 increased the uptake of zinc by the spermatozoa.^ieng

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PIP: Changes in the zinc and magnesium content of human spermatozoa with time have been followed over the first 24 hours after ejaculation. Magnesium did not change but marked alternations were noted for the zinc concentration. During the first hour there was a significant decrease followed by a "steady state" for 2 hours. Then a significant increase during the following 4 hours was recorded. Between 7 and 24 hours after ejaculation there was no further increase in the zinc concentration, nor did addition of 100 ug zinc per ml seminal plasma after 24 hours alter the sperm content of this ion. The importance of the seminal plasma for sperm uptake of zinc could be demonstrated. One subject presented semen specimens in which the uptake of zinc by the spermatozoa was very rapid and higher than that in the others. The seminal plasma from this man had biochemical signs of a markedly decreased prostate function. Incubation of normal spermatozoa in this seminal plasma for 4 hours increased their zinc content 3 times over the control values. The observation that the secretory function of the accessory genital glands can influence functional properties of the spermatozoa seems of principal interest from many points of view. Further studies along the same line may give leads to new male contraceptives.^ieng

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