Safety and efficacy of etodolac compared with piroxicam in patients with degenerative joint disease of the knee.

The efficacy and safety of etodolac and piroxicam were compared in a double-blind, randomized, parallel-group outpatient study at four sites. Patients with active osteoarthritis of the knee were assigned to receive etodolac 600 mg/day (57 patients) or piroxicam 20 mg/day (59 patients) for 6 weeks. Efficacy assessments were made at the pretreatment screening, at baseline, and at treatment weeks 2, 4, and 6 for patient and physician global evaluations, night pain, spontaneous pain intensity, weight-bearing pain variables, measures of inflammation, morning stiffness, and knee flexion. An analysis was also done based on each patient's final evaluation, regardless of the week at which it occurred. Safety assessments were made before treatment and at the completion of therapy. A therapeutic response was obtained in both treatment groups by the end of the second week of treatment. At the final evaluation, both groups showed significant improvement (P less than or equal to 0.05) from baseline for most efficacy assessments. The physician's global assessment indicated improvement in the condition of 60% of the etodolac-treated patients and 39% of the piroxicam-treated patients at the final evaluation. There was no significant difference between treatment groups in the number of patient withdrawals due to adverse reactions or in the number of patients reporting side effects. The results of this study indicate that, compared with piroxicam 20 mg/day, etodolac 600 mg/day is effective and well tolerated in the treatment of patients with osteoarthritis.

The outcome of angiography in patients with Raynaud's phenomenon: an unexpected role for atherosclerosis and hypercholesterolemia.

OBJECTIVE: Upper extremity angiography can make an important contribution to the diagnosis in vasculopathy. The present study was designed to assess the diagnostic role of upper extremity angiography in patients with disturbed circulation of the hand, according to a standardised protocol. METHODS: The study was carried out in an outpatient setting in 103 patients suffering from bilateral Raynaud's phenomenon without any obvious underlying disease and who were unresponsive to nifedipine and aspirin. All patients had angiographies taken according to a standardized technique using vasodilating medication, and reviewed according to a standardised protocol that covered all the known characteristics of angiopathy such as diminished flow, stops, tortuosity, irregularity of the wall, tapering, collaterals and blushing. RESULTS: Standardised angiograms showed vasculopathy compatible with primary vasospasm in 42 patients [all women; mean age 35.1 years], atherosclerotic vascular disease in 44 patients [M/F 9/35; mean age 46.7 years], peripheral embolism in 8 patients [M/F 4/4; mean age 38.4 years], vasculitis in 3 patients [3 women; mean age 38 years] and Buerger's disease in 3 patients [3 men; mean age 47 years]. Inter-observer differences were present in 4 cases, but consensus could be reached through open discussion. An unexpected 47% of patients with atherosclerotic vascular disease had dyslipidemia, frequently of familial origin. CONCLUSIONS: The standardised angiography protocol proved to be helpful in the assessment of upper extremity angiography. Surprisingly, a high prevalence of angiographic abnormalities compatible with atherosclerotic vascular disease could already be diagnosed in relatively young patients with Raynaud's phenomenon, of whom 47% showed hypercholesterolemia.

Value of determination of beta 2-microglobulin in toxic nephropathy and interstitial nephritis.

Beta 2-microglobulin (beta 2-m) is a low molecular weight protein of importance in the evaluation of the reabsorptive capacity of the proximal kidney tubule. This is based on the properties of beta 2-m: the daily production is constant and it leaves the body almost exclusively by glomerular filtration; 99.9% of the filtered amount is reabsorbed by the proximal tubule. The urinary excretion of beta 2-m is elevated (greater than 370 micrograms/day) in patients suffering from proximal tubular dysfunction with disturbance of tubular reabsorption. It is of great value as a marker of tubular involvement in toxic nephropathies, interstitial nephritis and the non-invasive method of choice to distinguish between renal and lower urinary tract infections.

[Kidney tubule dysfunction caused by acetic acid]. / Niertubulusfunctiestoornissen door azijnzuur.

Two patients admitted after ingestion of 80% acetic acid are described. Only the first patient developed haemolysis, slight intravascular coagulation and oliguric kidney insufficiency. They were treated with a nasogastric tube and total parenteral feeding. During the first week after admission urinary excretion of beta 2-microglobulin, alanine-aminopeptidase and N-acetyl-glucosaminidase was significantly increased. The patients remained haemodynamically stable and did not develop fever. The above-mentioned elevated excretions returned to normal levels. Both patients showed similar patterns of tubular proteinuria. The observations in the second patient suggest a direct toxic effect of acetic acid on the proximal tubule of the kidney.

Comparison of reliability of tests to distinguish upper from lower urinary tract infection.

The results of scintiphotography with gallium-67 (67Ga), renography with technetium-99m diethylene triamine penta-acetic acid, immunofluorescence of antibody coated bacteria, and determination of renal beta 2 microglobulin excretion were compared in 19 patients with upper and 15 patients with lower urinary tract infection. All patients with acute pyelonephritis showed an appreciable unilateral or bilateral uptake of 67Ga and an increased excretion of beta 2 microglobulin, whereas immunofluorescence of antibody coated bacteria yielded positive results in only 10. In patients with lower urinary tract infections excretion of beta 2 microglobulin and uptake of 67Ga were always normal, whereas immunofluorescence of antibody coated bacteria was positive in three cases. Scintiphotography with 67Ga and determination of renal beta 2 microglobulin excretion are currently the most reliable non-invasive methods of detecting acute pyelonephritis.