Characteristics and clinical implications of the pharmacokinetic profile of ibuprofen in patients with knee osteoarthritis.

BACKGROUND AND OBJECTIVE: Ibuprofen is a non-selective cyclo-oxygenase (COX)-1/COX-2 inhibitor used to treat pain conditions and inflammation. Limited data have been published concerning the pharmacokinetic profile and clinical effects of ibuprofen in patients with osteoarthritis (OA). In this paper we compared the pharmacokinetic and clinical profile of ibuprofen (at a dosage of from 800 mg/day to 1800 mg/day) administered in patients affected by severe knee OA. METHODS: Ibuprofen was administered for 7 days to patients who were scheduled to undergo knee arthroplasty due to OA. After 7 days, the ibuprofen concentration in plasma and synovial fluid was measured through both high-performance liquid chromatography (HPLC)-UV and gas chromatography-mass spectroscopy (GC/MS), while clinical effects were evaluated through both visual analogue scale (VAS) and Western Ontario and McMaster Universities (WOMAC) scores. The Naranjo scale and the WHO causality assessment scale were used for estimating the probability of adverse drug reactions (ADRs). The severity of ADRs was assessed by the modified Hartwig and Siegel scale. RESULTS: Ibuprofen showed a dose-dependent diffusion in both plasma and synovial fluid, which was related to the reduction of pain intensity and improvement of health status, without the development of ADRs. CONCLUSION: Ibuprofen at higher dosages can be expected to provide better control of OA symptoms as a result of higher tissue distribution.

Plating of the fibula. Its potential value as an adjunct to external fixation of the tibia.

There is added stability when plate fixation of the fibula supplements the external fixator used in treating tibial fractures associated with a segmental defect. An anatomic specimen model of a Grade III open fracture of the tibia with an associated fibular fracture was used in this study. Fibular internal fixation using an AO standard plate was performed on one of each of five matched pairs of legs. These were then subjected to identical loads in compression and torsion. The numeric values obtained during loading in all modes were converted to ratios between each of the tested pair to directly compare the effect of stabilization of the fibula. The final results showed that in each case, the preparation with fibular plating had improved resistance to deformation in axial loading. On average, the plated specimens were 2.2 times stiffer. In torsion, plating the fibula did not appear to affect the resistance of the construct to the applied load. Supplemental plate fixation of the fibula in fractures of the tibia with segmental defects may improve subsequent morbidity. The increased rigidity of the system may be sufficient to allow partial to full weight bearing immediately after surgery. This may have significant value in the management of the polytraumatized patient.

Foreign body in the median nerve: a complication of acupuncture.

Fracture of an acupuncture needle resulted in a foreign body within the carpal tunnel of a patient who then developed median neuropathy. The needle fragment was recovered from within the median nerve during carpal tunnel release, with rapid post-operative relief of symptoms. Development of peripheral neuropathy is a potential complication of acupuncture.

Compartment syndrome as a presentation of non-Hodgkin's lymphoma.

An 80-year-old woman sustained an injury to her left leg and presented having a compartment syndrome. Biopsy at the time of fasciotomy revealed lymphoma infiltrating the muscles of the left leg. We conclude that tumors may present as compartment syndrome and should be included with the differential diagnosis.

Cigarette smoking and Dupuytren's contracture of the hand.

Microvascular occlusion has been implicated as a possible causative factor of Dupuytren's contracture. Cigarette smoking is one of the most significant factors in the development of peripheral vasculopathy. The relationship between smoking and Dupuytren's contracture of the hand is explored in this article. One hundred thirty-two consecutive patients who had a partial fasciectomy for treatment of Dupuytren's contracture from 1980 to 1985, were analyzed retrospectively. There were 111 males and 21 females. Ninety (68.2%) of 132 patients smoked cigarettes compared with 110 (37.2%) of 296 randomized hospitalized control patients (p less than 0.00001). Eighty (72.1%) of 111 men smoked cigarettes compared with 65 (44.2%) of 147 male control patients (p = 0.000015). Cigarette smoking is linked statistically to Dupuytren's disease and may be involved in its pathogenesis by producing microvascular occlusion and subsequent fibrosis and contracture or by some other mechanism.

Asymptomatic innominate vein tamponade with retromanubrial clavicular dislocation. A case report.

Traumatic sternoclavicular joint dislocations are uncommon and posterior dislocations are rare; however, reports in the orthopaedic literature focus predominantly on retrosternal dislocations owing to their potentially dangerous sequelae. We report a case of asymptomatic complete innominate vein obstruction secondary to retromanubrial dislocation of the sternoclavicular joint with restoration of flow after closed reduction.

Effects of verapamil and lidocaine in a canine model of sudden coronary death.

The efficacy of verapamil and lidocaine for treating ischemia-induced arrhythmias was determined in a conscious canine model with a previous myocardial infarction remote from the ischemic area. Temporary (up to 5.5 minutes) occlusion of the circumflex coronary artery was made in eight conscious dogs that had sustained an anterior myocardial infarction 13 to 35 days previously. Each dog served as its own control. Ventricular arrhythmias were observed in 100% of control experiments but in only 25% of experiments after verapamil pretreatment at 0.4 mg/kg body weight. Repetitive ventricular complexes, defined as two or more consecutive ventricular complexes terminating spontaneously in sinus rhythm, were seen in 88% of control experiments and 13% of verapamil experiments, whereas ventricular fibrillation was seen in 6% of control experiments but in no verapamil experiment. Thus, verapamil abolished arrhythmias or reduced the grade of arrhythmias in all dogs. Six of the eight dogs were also tested with lidocaine pretreatment at one or two doses resulting in mean plasma levels of 3.8 +/- 2.0 micrograms/ml. Ventricular arrhythmias were seen in 92% of control experiments and 100% of lidocaine experiments. The incidence of ventricular fibrillation increased from 8% in control to 60% in lidocaine experiments. It is concluded that verapamil may prevent severe ischemia-induced arrhythmias after a recent myocardial infarction, whereas lidocaine may in some cases aggravate arrhythmias.