Analgesia for outpatient surgery: placebo versus naproxen sodium (a non-steroidal anti-inflammatory drug) given before or after surgery.

One hundred and eighty patients scheduled for day-care surgery were allocated randomly to one of three groups to receive naproxen sodium 1100 mg 1 h prior to surgery, naproxen sodium 1100 mg immediately after surgery, or placebo. The pre-surgery naproxen sodium group had significantly lower pain scores 1 h post-operatively and at discharge than the placebo group. At discharge both treatment groups were better than placebo. At 24 h post-operatively only the post-operative naproxen sodium group had lower pain scores. There was no difference in post-operative analgesic requirements until discharge between the groups, but at 24 h post-operatively the placebo group had required significantly more analgesics than the treatment groups. A questionnaire concerning general acceptability of anaesthesia/analgesia showed similar results. Our conclusion is that naproxen is better than placebo for treatment of post-operative pain. The time of administration pre- or post-operatively is important for the immediate post-operative pain, but we found no support for the existence of 'pre-emptive analgesia'.

Endothelin-1 and cerebral blood flow: influence of hypoxia, hypercapnia and indomethacin on circulating endothelin levels in healthy volunteers.

We investigated the effect of moderate (FiO2 13%) and light hypoxia (FiO2 17%) and hypercapnia (CO2 2-4%) with or without indomethacin on circulating levels of endothelin/endothelins (ET) and cerebral blood flow (CBF) in healthy volunteers. In protocol A, 23 subjects were exposed to moderate hypoxia. In protocol B, 29 subjects were randomized to one of four groups: (1) placebo, (2) indomethacin, (3) indomethacin+light hypoxia and (4) indomethacin+hypercapnia. Indomethacin was given as an intravenous bolus dose of 0.4mgkg-1 body weight followed by continuous infusion of 0.4mgkg-1h-1 for 6h. Two different FiO2 were chosen, light hypoxia in protocol B was chosen due to application of a known cerebral vasoconstrictor with unknown effect on cerebral autoregulation. We found, that moderate hypoxia (protocol A) induced a significant increase in CBF from 59.0 to 73.0 ml 100 g-1 brain tissue min-1 (p < 0.00005) with an increase in circulating levels of ET from 1.7 to 1.9fmol ml-1 plasma. However, this difference did not reach statistical significance (p = 0.14). We found, that indomethacin given intravenously (protocol B groups 2-3-4) significantly elevated circulating levels of ET from 2.1 to 3.9fmol ml-1 plasma (p < 0.00005) and decreased CBF from 60.5 to 39.5 ml 100g-1 brain tissue min-1 (p < 0.00005) compared to baseline values. Exposure to light hypoxia/hypercapnia in the indomethacin group increased CBF to values not significantly different from baseline values. Although there was no statistical correlation between ET and CBF with and without indomethacin, our results suggest that ET may be involved in the cerebral vasoconstriction produced by indomethacin given intravenously.

N-acetylcysteine by metered dose inhaler in the treatment of chronic bronchitis: a multi-centre study.

Sixty-five patients with chronic bronchitis were studied at five different centres in a double-blind, randomized trial. Two parallel groups were treated with either N-acetylcysteine or placebo by metered dose inhalers for 16 weeks. Following a 1-week run-in period, each patient recorded subjective impressions of the drug action on their bronchitic symptoms in a diary once a week. In addition, exacerbations were registered. Lung function testing and adverse effects were evaluated by four visits to the chest clinics during the 16 weeks. We could not demonstrate that N-acetylcysteine by metered dose inhalers had any significant effect on patients' feeling of well-being, sensation of dyspnoea, intensity of coughing, mucus production, or expectoration or lung function. Its effect in reducing exacerbations could not be estimated because of a very low number of exacerbations reported. N-acetylcysteine inhalation was safe when used over a 16-week period.

[Steroid response after long-term treatment with oral N-acetylcysteine in patients with chronic obstructive bronchitis]. / Steroidrespons efter langtidsbehandling med oral N-acetylcystein hos patienter med kronisk obstruktiv bronchitis.

The significance of long-term treatment with N-acetylcystein (NAC) for the steroid response on pulmonary function and general symptoms was investigated in patients with chronic bronchitis and moderate respiratory obstruction. All of the patients had received preliminary treatment with oral NAC in a dosage of 1,200 mg daily (Mucomyst Retard) or a placebo for 22 weeks in a double-blind design. After the conclusion of the long-term treatment but before the code was revealed, 37 non-allergic patients with irreversible respiratory obstruction participated in a follow-up investigation with 30 mg prednisone daily for 14 days. The peak flow was measured twice daily and the symptoms of bronchitis were registered by completion of 13 visual analogue scales. Pulmonary function was measured by means of spirometry on days 0, 7 and 14, respectively. In both of the treated groups, slight increase in the daily registered peak flow was found but no changes in the results of spirometry or the symptoms. Comparison between the groups revealed a significantly greater increase in the evening peak flow in the group which had received preliminary treatment with NAC. It is concluded that, in this investigation, no clinically relevant effect of long-term preliminary treatment with NAC on the results of a steroid test was observed in patients with chronic bronchitis and moderate respiratory obstruction.

Farmer's lung in infants and small children.

A boy and a girl, 10 weeks and 3 years of age, respectively, were admitted to our department with low temperature, dry cough, fatigue and weight loss. In both patients pulmonary X-rays showed diffuse, bilateral, micronodular infiltrations, and sparse signs of fibrosis. Serum IgG and blood eosinophils were abnormally high. After a stay in hospital for 3 weeks, the patients recovered slowly. However, after a few days at home, they were readmitted with the same symptoms. Family histories revealed that the children lived on farms with huge grain magazines and dryers, where moist grain and straw were stored. Massive amounts of mould spores were cultured from the residential areas, and, in addition, the male patient had an elevated titer to Micropolyspora faeni and the female patient, elevated titers to Thermoactinomyces vulgaris, Micropolyspora faeni, Aspergillus fumigatus and Alternaria alternans. The patients and their families moved from the farms and, for approximately a year, have been without lung symptoms. Farmer's disease in infants and small children is extremely rare. However, the incidence may be increasing due to the tendency in latter years to decentralize grain dryers and store moist grain and straw in big magazines, often close to residential areas.

Thrombocytosis in patients with malignant pleural mesothelioma.

Platelet counts were studied retrospectively in a series of 64 patients suspected of primary malignant pleural mesothelioma. Only platelet counts taken before chemotherapy and radiotherapy and surgery other than thoracocentesis were considered. Thirty-two patients had malignant pleural mesothelioma and 32 patients had other malignant disease in pleura. In both groups 34% had slightly elevated platelet counts. In a subgroup consisting of 18 patients with primary pulmonary adenocarcinoma 28% had thrombocytosis. The distribution of platelet counts did not differ in the diagnostic subgroups, and thrombocytosis had no differential diagnostic value in patients with malignant disease in any stage in the pleurae. The frequency of thromboembolic episodes was low.