Plasma activities of hepatic enzymes in patients on anticonvulsant therapy.

The object of the study was to discover the changes in the plasma activities of hepatic enzymes in patients on anticonvulsant drugs. The plasma activities of aspartate transaminase (AST), alkaline phosphatase (ALP), alanine transaminase (ALT) and glutamyltransferase (GGT) were studied in 123 unselected patients on anticonvulsants. The results were compared with 123 control patients not on anticonvulsants matched for age and sex. Patients with known liver disease were excluded. The plasma activities of AST and ALP were similar in the two groups. ALT and GGT were raised in patients on anticonvulsants. No patient developed clinical evidence of liver disease. It was concluded that raised ALT and GGT are not in themselves indications to alter anticonvulsant therapy. Changes in AST and ALP would be more specific markers of liver dysfunction in patients on anticonvulsants.

Managing patients after cardiac transplantation.

To care for heart transplant recipients is to walk an endless tightrope, teetering between too little immunosuppression, and consequent rejection episodes, and too much immunosuppression, with its correlated infection and neoplasia risks. Moreover, as long-term survival has become a reality, accelerated coronary vascular disease poses a major threat to the transplanted organ.

Management of refractory idiopathic thrombocytopenia.

In refractory thrombocytopenia one should first evaluate whether the therapeutic approach has more risks to the patient than no treatment at all. The patient may remain relatively asymptomatic and the only incommoding circumstances be cosmetic. Coincidental medical problems such as hypertension and peptic ulceration are particularly worrying in the patient with ITP. Very occasionally a cerebral haemorrhage may occur without any obvious predisposing cause. In most instances, however, refractory thrombocytopenia is a benign condition which rarely directly causes the death of the patient. Since many of the remedies advocated for this problem have significant side effects these must always be carefully balanced and fully discussed with the patient before their introduction.

Bilateral renal oncocytomas: a case report.

We report on a man with bilateral multiple renal oncocytomas who had enlarged kidneys, and presented with loin pain and gross hematuria. A provisional diagnosis of multiple renal oncocytomas was made after renal angiography demonstrated the characteristic appearance of this tumor. The diagnosis was confirmed with histology of an open renal biopsy specimen. This case is unique in that the lesions were multiple and bilateral. The patient had impaired renal function and, hence, the necessity for conservative management once the histological diagnosis had been established. Since in previously reported cases oncocytomas have been removed completely our case provides an opportunity to observe the natural history of the disease.

Naproxen sodium and paracetamol/dextropropoxyphene in sports injuries - a multicentre comparative study.

This paper follows up a previous paper reported in this journal. This study was a single-blind parallel comparison of naproxen sodium ("Synflex") and a paracetamol/dextropropoxyphene combination ("Distalgesic"). It was carried out in 184 patients suffering from soft-tissue disorders recruited from four centres. More patients were considered cured and the pain score was significantly lower after seven days' treatment in the naproxen sodium ("NS") group. For those patients who received 14 days' treatment the total symptom score was significantly lower in the naproxen sodium group at the end of treatment. Two patients in the NS treatment group withdrew from the study due to lack of efficacy. Fewer side-effects were reported in the NS group. Of the eight patients stopping treatment due to side-effects, two were in the naproxen sodium group and six in the paracetamol/dextropropoxyphene ("control") group. The results suggest that a better clinical response to treatment and fewer side-effects may be obtained with naproxen sodium than with paracetamol/dextropropoxyphene in the treatment of soft-tissue injuries.

A comparison of the efficacy of naproxen sodium and a paracetamol/dextropropoxyphene combination in the treatment of soft-tissue disorders.

Ninety-eight patients were admitted to a single-blind parallel study comparing the efficacy of naproxen sodium with a paracetamol/dextropropoxyphene combination in the treatment of soft-tissue disorders. The two study groups were well matched in all respects. After seven days of treatment patients in the naproxen sodium group had less residual symptoms and more of them were considered cured. These patients also had a significantly lower mean-pain-score, tended to have less daily symptoms and recorded a significantly greater initial improvement in their condition. Fewer side-effects were recorded by the naproxen sodium-treated patients. One patient from each group withdrew from the study because of side-effects. It was concluded that in the treatment of non-articular soft-tissue disorders the use of a rapidly-acting withdrew anti-inflammatory drug, naproxen sodium, gave a better clinical response than did treatment with a simple analgesic combination.