Prevention of heterotopic ossification after total hip replacement with NSAIDs

Introduction: non steroidal antiinflammatory drugs ((NSAIDs) and prophylactic radiotherapy can prevent ectopic bone formation around the hip after total hip arthroplasty. Methods: We retrieved from Medline, Embase and the Cochrane Register (clinical)) trials and other relevant literature on the prevention of heterotopic ossification (HO) from 19902002 for further review.Results: Review of these clinical trials shows that HO is effectively prevented by a postoperative NSAID treatment with indomethacin for at least seven days. The best evidence is available for indomethacin, although naproxen, diclofenac and ibuprofen are also well documented. Short term use of ibuprofen is not effective. If NSAIDs are contraindicated, preoperative or postoperative radiotherapy is a very effective therapeutic option to prevent HO. Discussion and conclusion: Because of the potential of serious gastrointestinal side effects of NSAIDs and their interaction with anticoagulant drugs, rofecoxib and other COX2 specific NSAIDs may be a safer option for the treatment of HO. However, randomised controlled studies are needed to confirm the results of the rofecoxib study.     

Oxazolone and diclofenac-induced popliteal lymph node assay reactions are attenuated in mice orally pretreated with the respective compound: potential role for the induction of regulatory mechanisms following enteric administration

The murine popliteal lymph node assay (PLNA) was examined as a preclinical assay with the potential to identify low-molecular-weight compounds (LMWCs) that are likely to be associated with immune-mediated drug hypersensitivity reactions (IDHRs) in humans. We hypothesized that the contact sensitizer oxazolone (OX) would cause a strong PLN reaction in naive mice and that the PLN reaction would be attenuated in mice orally pretreated with OX due to the induction of oral tolerance. In naive mice, OX induced a strong PLN reaction and caused dose-dependent increases in PLN size, weight, cellularity, percentage of CD4(+) PLN T cells, and percentage of PLN B cells, with a concomitant decrease in the percentage of CD8(+) PLN T cells. Next, the PLNA was conducted in mice gavaged three times with either OX or vehicle alone (olive oil). Mice pretreated with OX had suppressed PLN reactions following the footpad injection of OX (decrease in PLN size, weight, and cellularity), which was associated with an increase in the percentage of PLN CD8(+)T cells. In contrast, oral pretreatment with OX had no observable effect on the PLN reaction induced following footpad injection of the irrelevant hapten dinitrochlorobenzene (DNCB). Adoptive transfer studies were conducted to examine the mechanism of PLN hyporesponsiveness. It was found that either (1) unfractionated splenocytes or (2) purified CD8(+) splenocytes, but not (3) purified CD4(+) splenocytes isolated from mice gavaged with OX adoptively transferred PLN suppression to naive BALB/c mice. Because OX is not a pharmaceutical, we also examined the NSAID diclofenac (DF) (Voltaren). Like OX, DF caused dose-dependent increases in PLN size, weight, and cellularity in naive mice. Furthermore, like OX, the diclofenac-induced PLN reaction was attenuated in mice that had been orally pretreated three times with DF. However, splenocytes from mice orally treated with DF were not able to adoptively transfer PLN hyporesponsiveness. Collectively, these observations demonstrate that both OX and DF are potent immunostimulators in the PLNA. As importantly, these results demonstrate that the immunostimulating potential of OX and DF in the PLNA is significantly decreased in mice orally exposed to the respective drug, possibly due to the presence of a cellular mechanism of oral tolerance. For OX, the mechanism appears to involve, in part, CD8(+) T cells, whereas the mechanism(s) associated with PLN hyporesponsiveness using DF remain to be defined.     

Ondansetron versus diclofenac sodium in the treatment of acute ureteral colic: A double blind controlled trial

The aim of this study is to compare the effectiveness of the 5-HT₃ antagonist, ondansetron and a non-steroidal anti-inflammatory agent, diclofenac sodium, as a pain reliever in the treatment of acute ureteral colic. Sixty four patients with severe or moderate pain who were clinically diagnosed as having ureteral colic associated with microscopic or gross hematuria were included in the study. Thirty three patients were administered ondansetron and 31 patients were administered diclofenac sodium. Exclusion critera were known kidney or liver disease causing dysfunction, known hypersensitivity to ondansetron or diclofenac sodium, pregnancy, lactation, duodenal ulcer or bleeding. After pain assessment with a verbal scale and a visual analog scale (VAS), we randomized patients and administered 8 mg ondansetron intravenously to 33 patients and 75 mg diclofenac sodium intramuscularly to 31 patients and pain scores were recorded every 15 minutes. If significant pain relief was not achieved within 60 minutes, IV meperidine was given as rescue pain medication. Ondansetron was effective as a primary pain reliever in 14 (42.4%) patients, whereas 19 patients required additional medication. Diclofenac sodium was effective as a primary pain reliever in 24 (77.4%) patients, whereas 7 patients required additional medication. Ondansetron was not superior to diclofenac sodium in relieving pain in patients with acute ureteral colic.     

精方风湿骨痛胶囊治疗类风湿关节炎临床观察

观察精方风湿骨痛胶囊治疗类风湿关节炎(风寒阻络兼血瘀型)临床疗效.采用开放随机对照法,设治疗组(精方风湿骨痛胶囊治疗)45例,对照组(扶他林治疗)30例,疗程2周.结果治疗组关节功能改善,血沉降低,临床症候疗效为71.11%,显著优于对照组33.33%(P＜0.05);总体疗效比较,治疗组总有效率为53.33%,与对照组相同.提示精方风湿骨痛胶囊是治疗风寒阻络兼血瘀型类风湿关节炎的有效药物.     

电针治疗慢性踝关节损伤临床观察

目的观察电针治疗慢性踝关节损伤的疗效。方法设治疗组和对照组各23例，治疗组采用电针治疗为主，对照组以外用扶他林乳剂治疗，疗程均为4周。结果治疗组有效率为86．96％，对照组为52．17％（P〈0．05）。结论电针疗法对于慢性踝关节损伤有着良好的治疗效果。     

Symptomatic intravenous antipyretic therapy: efficacy of metamizol,diclofenac, and propacetamol

Fever is a common symptom in cancer patients. The most frequent causes of fever are infections, malignancy itself, various medications, transfusions, and allergy. Although it is necessary to treat the cause of fever, if possible, symptomatic fever management is also important. Surprisingly, little attention is paid to this topic in the medical literature, despite the fact that it is a very frequent problem. In order to support symptomatic fever therapy, we wanted to study the patients' discomfort accompanying fever and the beneficial effects of the symptomatic fever management. To the best of our knowledge, there is an absence of studies in this area, despite the fever discomfort can be an important reason for the antipyretic treatment, mainly in cancer patients. In this non-randomized open label pilot study, three intravenous antipyretics were tested in five groups of patients: diclofenac (75 mg, brief intravenous [IV] infusion) vs. metamizol (2500 mg or 1000 mg, brief IV infusion) vs. propacetamol (2000 mg or 1000 mg, slow IV injection or brief IV infusion). The study included 254 febrile episodes mainly in hemato-oncological patients with axillary temperature at least 38°C. The main study endpoints were: changes in axillary temperature, improvement in patient comfort, and number and nature of adverse events. To support justification for symptomatic fever management in febrile patients, we asked the first 45 study subjects to fill in a questionnaire concerning their opinions about fever, fever-associated discomfort, and relief upon antipyretic therapy. All study medications had a significant antipyretic effect. However, metamizol at the dose 2500 mg was considered as the most effective, while propacetamol at the dose 1000 mg showed the lowest antipyretic efficacy. Concerning tolerability and adverse events, there were significant differences among the treatment groups. Diclofenac and metamizol (both 2500 mg and 1000 mg) were tolerated at best. All tested antipyretics significantly improved comfort in febrile patients. Overall, 87% of patients declared improvement in their comfort after administration of antipyretics. Based on the results of the present study, the choice of the antipyretic drug should depend on the clinical status of patient, contraindications, and potential adverse events and risks of the selected agent. It is advisable to use proparacetamol at the higher dosage and to administer it as a brief IV infusion in order to avoid injection-related adverse events. The symptomatic antipyretic treatment in febrile cancer patients is supported by patients themselves and has a significant role in the complex supportive care. Discomfort of patients during fever episodes may be greater than previously thought.     

阿昔洛韦和双氯芬酸钠、贝复舒联合治疗单纯疱疹病毒性角膜炎

目的观察阿昔洛韦联合双氯芬酸钠、重组牛碱性成纤维细胞生长因子(贝复舒)滴眼液治疗单纯疱疹病毒性角膜炎的效果。方法对150例(172眼)患者随机分为治疗组75例(90眼)和对照组75例(82眼)。治疗组患者滴0.1%阿昔洛韦滴眼液、双氯芬酸钠滴眼液和贝复舒滴眼液;对照组滴用阿昔洛韦滴眼液。结果治疗组治愈(91.00%),对照组治愈率(75.60%),经统计学处理,差异有统计学意义(P<0.01);治疗组有效率(96.67%),对照组有效率(89.00%),差异有统计学意义(P<0.05)。结论阿昔洛韦联合贝复舒、双氯芬酸钠治疗单纯疱疹病毒性角膜炎疗效较肯定,治愈率高,是较合理安全的用药方法。     

中药熏蒸法对软组织挫伤中后期治疗的效果观察

目的：探讨中药熏蒸疗法对软组织挫伤中后期治疗的效果。方法：将50例软组织挫伤患者随机分为实验组和对照组,对照组给予口服双氯芬酸钠治疗,实验组用熏蒸疗法治疗,观察疗效。结果：患肢肿胀程度对照组与实验组相比较示P〈0.01;患肢疼痛的目测类比评分对照组与实验组相比较,P〈0.01,差异有统计学意义。结论：中药熏蒸治疗软组织挫伤中后期的患者,能活血通络,松弛痉挛,并能减轻疼痛。     

多模式镇痛治疗老年膝关节骨关节炎的临床研究

目的：根据多模式镇痛原理选择双氯芬酸凝胶联合双氯芬酸钠片治疗老年膝关节骨关节炎,观察并评估其近期临床疗效。方法：2010年1～6月门诊诊治的120例老年膝关节骨关节炎患者,随机分为治疗组（双氯芬酸钠片＋双氯芬酸凝胶）和对照组（双氯芬酸钠片）。治疗组60例,给予双氯芬酸钠片25mg/次,Tid,口服＋扶他林乳胶1～2g/次,日3次,共2周;对照组60例,给予双氯芬酸钠片25mg/次,Tid,口服,共2周。选择膝关节疼痛VAS评分、WOMAC评分标准（部分）及不良事件发生率作为疗效评价标准。分别记录两组治疗7、14d膝关节VAS评分、WOMAC评分标准及不良事件发生率,统计分析并进行术前术后及组间比较。结果：治疗后7、14d,疼痛VAS评分：治疗组分别为（3.2±1.0）、（2.1±0.8）分,对照组分别为（3.5±1.5）、（2.5±1.3）分;WOMAC评分：治疗组分别为（40±8）、（42±13）分,对照组分别为（33±10）、（30±12）分;治疗后14d不良事件发生率治疗组为48%（24/50例次）,对照组为71%（39/55例次）。统计学分析,治疗组、对照组分别与术前进行组内比较,术后7、14d内与术前比较在VAS评分、WOMAC评分及不良事件发生率均差异有统计学意义（P〈0.05）。治疗组与对照组在术后7、14d行组间比较,在VAS评分、WOMAC评分及不良事件发生率均具有显著差异。结论：双氯芬酸凝胶联合双氯芬酸钠片行多模式镇痛可显著改善膝关节骨关节炎症状及治疗效果,降低不良事件发生率,提高患者整体评价,为老年膝关节骨关节炎门诊治疗提供了一种选择。