Peri-articular injection of tenoxicam for painful shoulders: a double-blind, placebo controlled trial.

Eighty out-patients (50 F, 30 M), aged 58 +/- 12 years (range: 26-84) and weighing 72 +/- 10 kg (range: 50-97), presenting with an acute or subacute (< 3 months) episode of rotator cuff tendinitis without (n = 28) or with movement restriction (n = 52) of the shoulder and having a pain intensity of at least 4 on VAS for pain at rest or on active movement, were treated at random and in double blind conditions for 1 to 4 weeks with 1 weekly periarticular anterior injection of tenoxicam 20 mg or placebo. Tenoxicam treated patients improved more than placebo-injected patients in a statistically highly significant manner with regard to clinical index, pain on VAS during active movement and at rest, active mobility (degrees), pain or pressure and clinical global impression (assessed by investigator and patient). There was a nonsignificant opinion that placebo treated patients consumed more rescue medication. Safety assessments were not significantly better in the placebo-treated patients through local tolerability tended to be better in that group. These results indicate that tenoxicam 20 mg injected locally is effective in alleviating pain and in improving shoulder mobility in patients with a painful shoulder episode and suggest that such a treatment is safe and well tolerated. Local injection of tenoxicam seems to be a promising new treatment of acute, painful, local inflammatory processes in Rheumatology, Orthopaedics, Physical Medicine and Sports Medicine. Further studies in other pathologies are warranted.

MRI and CT features of polycystic liver disease.

The authors report two cases of polycystic liver (PCL) disease with no other organ involvement. PCL, an uncommon disease that usually is asymptomatic, was diagnosed using computed tomography for one patient and magnetic resonance imaging for the other patient.

Double-blind, randomized crossover study of the percutaneous efficacy and tolerability of a topical indomethacin spray versus placebo in the treatment of tendinitis.

Percutaneous efficacy and tolerability of a new topical indomethacin spray compared with a corresponding placebo product were evaluated in a double-blind, randomized crossover study in 30 patients with tendinitis, i.e. 28 patients with peri-arthritis of the shoulder and two with epicondylitis. Each patient was treated with 4% indomethacin spray or the corresponding placebo product three to five times daily for a period of 14 days and then received the other treatment for the same period of time. The indomethacin spray demonstrated a clear efficacy compared with the placebo based on both objective criteria (elevation, abduction and internal rotation) and subjective criteria (spontaneous pain, pain on movement, pressure-induced pain, functional disturbances and sleep disturbances). Tolerability was excellent: only two patients had minor local cutaneous irritation with the indomethacin spray, which did not require interruption of treatment. Treatment with indomethacin spray appeared to be effective in 80% and well-tolerated in 93% of the patients studied.

Comparative clinical evaluation of the activity of Ser-316 suppository in the treatment of lumbar osteoarthrosis.

In a double-blind, randomized study, 47 patients suffering from lumbar osteoarthrosis were treated with either Ser-316 suppository (horse immune serum directed against bone and parathyroidal glands) or placebo over a period of 6 months at a dose of 3 suppositories/week. Efficacy was assessed based on the reduction in severity of pain on motion, consumption of paracetamol tablets, functional disability in normal and professional life; on the improvement of motility as shown by fingers-floor distance, Schober Index, extension, lateral flexions; and on the global evolution of the disease. Statistically significant improvements for fingers-floor distance, lateral flexions, paracetamol consumption, pain on motion, disability in normal life and evolution of the disease were seen in the Ser-316 group compared with the results obtained in placebo-treated patients, and were evident mainly from the third month of treatment. Globally, 17 (74%) of 23 patients receiving Ser-316 were considered by both patients and physician to have shown a good or excellent response compared with only 3 (14%) of 22 patients on placebo. There were no reports of any adverse reactions in either treatment group.

Sixth nerve schwannoma: MR and CT demonstration.

A sixth nerve schwannoma arising in the region of the pons and midbrain is reported. The magnetic resonance and CT characteristics are discussed.

Varied appearance of cardiac pseudoaneurysms on blood pool images.

Three cases of cardiac pseudoaneurysms were presented, with findings at the time of gated blood pool imaging. In only one of three was there the finding of a small neck connecting the ventricular cavity with the pseudoaneurysm. In the other two patients, there was a considerably larger communication. The size of the pseudoaneurysm itself was also of little diagnostic assistance. In one case it was small, while in a second patient it was larger in size. The third case revealed a pseudoaneurysm of enormous size (larger than the ventricular cavity). Gated blood pool imaging apparently can be called upon to demonstrate the presence of an abnormality. It may not be able to definitely establish the diagnosis of pseudoaneurysm, but should suggest the use of cardiac angiography to distinguish these life threatening lesions from true aneurysms.

A double-blind study of topical massage with Rado-Salil ointment in mechanical low-back pain.

Forty patients with acute mechanical low-back pain were treated in a double-blind manner with either Rado-Salil or placebo for 14 days. Statistically significant improvements in spontaneous pain, muscular contracture and in both the patient's and physician's opinions occurred by day 3. These improvements persisted at day 14 and, in addition, there were statistically significant improvements in the finger-floor distance and the degree of lumbar extension. Treatment with Rado-Salil also allowed significant reduction in the use of oral analgesics. Only a few localized transient side-effects, requiring no specific treatment, were observed.

Double-blind study on antitissue immunoglobulin injections versus placebo in the treatment of acute lumbar pain with muscular spasms.

A double-blind study was carried out on antitissue immunoglobulins (Sérocytol Neuro-Vasculaire) administered by intradermal injections to 44 patients (24 women, 20 men; age range 36-76 years) suffering from acute lumbar pain accompanied by muscular spasms. In the treated group of 21 patients, excellent or good results were recorded in 14 cases (67%) and moderate results or no effect in 7 (33%). The mean number of injections necessary was 3.7 per patient. Injections were given every four days. In the placebo group of 20 patients (an addition 3 having dropped out), excellent or good results were obtained in 6 cases (30%) and moderate results or no effect in 14 (70%). The mean number of injections required was 4.6 per patient. The parameters considered included pain (night wakings, spontaneous pain and pain on pressure) and mobility (Schober's index, distance from fingertips to ground, extension, lateroflexion). The investigating physician's evaluation of the efficacy of antitissue immunoglobulins was similar to that of the patients. Tolerance of the product was excellent in all cases.

Hepatic angiosarcoma: mimicking of angioma on three-phase technetium-99m red blood cell scintigraphy.

A [99mTc]RBC study in a 63-yr-old man showed intrahepatic lesions which initially had less activity than surrounding liver tissue. When viewed 3 hr later, these had "reversed" and the lesions revealed increased uptake of the radiolabeled red cells. Some extrahepatic areas showed the same pattern (these were in the mesentery of the small bowel). The lesions proved to be angiosarcomas. Hence, the behavior of labeled red cells in these angiosarcomas mimicked that in benign hemangiomas.

Exophthalmos caused by excessive fat: CT volumetric analysis and differential diagnosis.

CT has proven to be excellent in identifying orbital pathology responsible for proptosis. Occasionally, no discrete mass or extraocular muscle enlargement to explain the exophthalmos is found, only an appearance suggestive of an abnormal increase in orbital fat volume. Fifteen patients were studied with proptosis apparently resulting from increased orbital fat. Clinical follow-up revealed that four of them had Graves orbitopathy, unilateral in one; two had Cushing disease/syndrome; and nine were obese without endocrinopathy. The orbital volume and percentage orbital fat volume were measured by CT software analysis in these patients and in a control group of 16 patients without proptosis. Measurements of proptosis and thickness of the scalp fat pad at the inion level were also performed. Significantly greater values for orbital fat volume, percentage fat volume, and proptosis were found in the proptosis group compared with the control group. There was excellent correlation between proptosis and percentage fat volume, supporting the contention that increased orbital fat is responsible for the proptosis. The thickness of the scalp fat pad at the inion level was significantly greater in obese and Cushing patients than in control subjects, but the thickness was not significantly greater in Graves patients than in controls. Proptosis and inion fat were well correlated (r = 0.74) in the control and obese patients, which suggests a relation between general body fat and orbital fat volume.

Computed tomography of familial pineoblastoma.

Although certain tumors such as retinoblastoma have a known familial pattern of transmission, the familial occurrence of pineoblastoma has not been reported previously. We report pineoblastomas occurring in a mother and daughter and suggest that this type of tumor may have an inheritable mode of transmission.

A double-blind comparison of slow-release and standard tablet formulations of fentiazac in the treatment of patients with tendinitis and bursitis.

Two double-blind studies were carried out to compare the effectiveness and tolerance of a slow-release tablet formulation of 300 mg fentiazac, given once daily, with the standard tablet formulations of 100 mg, given 4-times daily, or 200 mg, given twice daily. A total of 60 patients suffering from acute bicipital tendinitis and/or subdeltoid bursitis was studied, 15 patients on the slow-release and 15 on one of the two standard tablets in each of the two trials. Patients were assessed on entry and at Days 7 and 14 of treatment. The results in both studies showed that there was significant improvement in tenderness, pain on movement, overall pain and in the range of movement after treatment, there being no significant difference between those receiving the slow-release form or the standard tablets. Tolerance was good in all groups and only a few minor or moderate side-effects, mainly of a gastro-intestinal type, were reported.

A double-blind, parallel trial of oxaprozin versus naproxen in the treatment of osteoarthritis.

A double-blind trial was carried out in 24 patients with osteoarthritis of the knee or hip to compare the efficacy and tolerance of oxaprozin with that of naproxen. Patients were assigned at random to receive fixed doses of either 1200 mg oxaprozin once daily or 250 mg naproxen 3-times daily over a period of 8 weeks. Assessments made on entry and after 4 and 8 weeks of treatment showed that in the oxaprozin group there were significant mean decreases, indicating improvement in patient's condition, with respect to observer's opinion, patient's opinion, pain intensity and activity impairment at both on-therapy visits. In the naproxen group, there were significant mean decreases with respect to observer's opinion, patient's opinion, pain intensity and time to walk 15 metres. None of the mean differences between the groups was statistically significant. Adverse effects were reported for 3 of the 12 oxaprozin patients and 6 of the 12 naproxen patients. The specific adverse effects noted for more than 1 patient were diarrhoea for oxaprozin and dyspepsia for naproxen. No difference between the groups was statistically significant from this point of view. Laboratory determinations showed no toxicity in either group. It is concluded that once-daily oxaprozin is an effective and well-tolerated form of treatment for osteoarthritis, equivalent to naproxen given 3-times daily.

Treatment of periarthritis of the shoulder: a comparison of ibuprofen and diclofenac.

Fifty patients with periarthritis of the shoulder were entered into this randomized double-blind trial, twenty-five on ibuprofen 1600 mg daily and twenty-five on diclofenac 100 mg daily, in order to compare the efficacy and side-effects of these two drugs over a 14-day treatment period. Based on forty-six patients with adequate follow-up data, statistically significant improvements within both treatments (p less than 0.001) were noted during the course of the study with respect to all of the variables studied: degree of pain, amplitude of rotation, amplitude of abduction and patient treatment efficacy as assessed by both the patient and the clinician. Approximately one-half of the patients on each treatment reported either 'good' or 'very good' treatment results at Day 14. No significant difference between the treatments was noted with respect to the amount of improvement shown for any of the variables studied. Side-effects, the majority of which were gastro-intestinal in nature, were reported for five patients on ibuprofen and six patients on diclofenac. They were severe enough to cause treatment to be stopped in six patients, three on each treatment. This trial demonstrates that ibuprofen and diclofenac are of virtually equal efficacy and tolerability in the treatment of patients with periarthritis of the shoulder.

Fentiazac in the treatment of osteoarthritis and tendinitis.

In a double-blind trial in 20 patients with osteoarthritis, treatment was given at random with either 200 mg fentiazac or 50 mg indomethacin twice daily for 6 weeks. Both treatments produced marked improvement in pain and the other variables studied but, apart from blood pressure which was raised in the indomethacin group, no significant differences between treatments were observed. In a second double-blind trial involving 24 patients with acute non-articular rheumatism, mainly tendinitis, 200 mg fentiazac twice daily was compared with 200 mg phenylbutazone twice daily over a period of 2 weeks. No significant difference in improvement was found between treatments in any of the clinical variables studied, although there was a trend in favour of fentiazac, particularly in the relief of tenderness. No difference was noted in the incidence or nature of side-effects, which were mainly gastro-intestinal in origin, reported by patients in the treatment groups in either study.