[Exertion, spinal fracture, intervertebral disk displacement]. / Kraftanstrengung, Wirbelbruch, Bandscheibenvorfall.

If causes which cannot be clearly defined as traumatic, result in vertebral fractures or disc ruptures, the expert frequently finds himself confronted with considerable problems. He must carefully establish the relation between what is due to the trauma and what must be attributed to the pre-existing damage. This requires the pre-existing nox to be objectively cleared, especially with regard to osteoporosis. The diagnosis "osteoporosis" should be subjected to particularly careful investigation, especially if the patient is a male. X-ray photographs, taken at an early stage, are insufficient. As consequences for the patient might be heavy, intensive methods of examination are justified. Anamnesis, progress and effect must be critically weighted, exceptions from the rule must be founded on careful and logical reasoning. The above article deals with such an exception.

Influência da acemetacina e indometacina sobre a eliminaçäo gastrintestinal de sangue em pessoas sadias e em reumáticos / Influence of acemetacin and indometacin on gastrointestinal blood loss in normal volunteers and rheumatic patients

Em um ensaio clínico realizado em 12 voluntários sadios determinou-se a perda total de sangue gastrintestinal através de eritrócitos marcados pelo Cr51. O ensaio duplo-cego cruzado revelou uma diferença altamente significativa (p < 0,001) entre a indometacina e acemetacina após administraçäo oral durante sete dias de ácido 1-(p-clorobenzoil) - 5-metoxi- 2-metilindol- 3-acetoxi-acético (acemetacina, TV 1322, Mostanol) 200mg/dia, indometacina 200mg/dia e placebo. A perda total média de sangue, em um período de sete dias, foi de 12,4ml com indometacina, 4,5ml com acemetacina e 5,0ml com placebo. Em um ensaio clínico com 16 pacientes reumáticos em uso prolongado de medicamentos antiinflamatórios näo-hormonais encontrados habitualmente no mercado, determinou-se de igual modo a perda total gastrintestinal de sangue. Em um ensaio duplo-cego cruzado com período de wash-out foram comparadas as quantidades de sangue eliminadas durante um tratamento de sete dias com acemetacina (240mg/d) com as quantidades eliminadas durante o mesmo período com indometacina (200mg/d). Também chamou atençäo uma diferença altamente significativa (p < 0,001) entre os dois preparados. Com indometacina a eliminaçäo total de sangue por semana foi de 13,8ml, com acemetacina 6,5ml. Durante o período de wash-out foram eliminados em média 6,0ml de sangue por semana. Näo houve diferença entre os resultados de ambos os ensaios. As investigaçöes realizadas em 23 pacientes e 12 voluntários näo revelaram nenhum indício de que a nova droga antiinflamatória acemetacina provoque lesöes da mucosa do trato gastrintestinal evidenciadas por perda de sangue

[Drug concentrations in blood, synovial fluid, synovial membrane, periarticular bone, muscle and adipose tissue in patients with rheumatoid polyarthritis receiving a single intramuscular injection of ketoprofen or acetylsalicylic acid (3 hours after the injection)]. / Teneur en principe actif du sang, du liquide synovial, de la membrane synoviale et des tissus osseux, musculaires et adipeux avoisinants chez des malades atteints de polyarthrite rhumatoïde et ayant reçu une injection intramusculaire unique de kétoprofène ou d'acide acétylsalicylique (trois heures après injection).

The therapeutic activity of antiinflammatory agents in rheumatic joint disease is related to their presence at the target site of action, i.e. the joints. Tissue concentrations of such agents have been previously determined in patients with rheumatic disorders under long-term treatment with acemetacin and indomethacin (Köhler et al., 1981). The purpose of the present study was to determine concentrations of ketoprofen and acetylsalicylic acid in blood as well as synovial fluid, synovial membrane and periarticular bone and adipose tissue, three hours after administration of a single dose. Drug concentrations found in each of these tissues following a single intramuscular injection were sufficient to ensure therapeutic efficiency.

Synovectomy of the ankle joint.

Between 1970 and 1979, 123 synovectomies of the ankle joint were performed on 99 patients. Sixty two of these patients (81 ankles) were followed up for an average period of four years. Using Steinbrocker's classification 10 ankles had Stage I disease, 34 had Stage II, 33 had Stage III and 4 had Stage IV. In more than 80% of the joints pain and swelling significantly decreased after operation, with improvement in the range of motion and of the gait pattern. However the procedure did not change the walking distance or dependency upon walking aids, probably because the ankle joint was rarely the only joint of the lower extremity affected by rheumatoid arthritis.

Comparative study of fluproquazone in the management of post-operative pain.

41 patients suffering from moderate to severe pain were included in a multicentric double-blind study comparing 100 mg 4-(p-fluorophenyl)-1-isopropyl-7-methyl-2(1H)-quinazolinone (fluproquazone) to 250 mg mefenamic acid during a three-day period. Both medications produced a clinically highly relevant analgesic effect in the patient population considered. Fluproquazone appears to be significantly more effective than mefenamic acid after the first dose as well as after 6-h period. Fluproquazone was better tolerated than mefenamic acid: one and four patients, respectively, experienced side-effects in the two treatment groups. These results indicate a significantly better therapeutic profile for fluproquazone as compared to mefenamic acid in the management of post-operative pain.

[The influence of acemetacin and indometacin on gastrointestinal blood loss in normal volunteers and rheumatic patients (author's transl)]. / Uber den Einfluss von Acemetacin und Indometacin auf die gastrointestinale Blutausscheidung bei Gesunden und Rheumatikern.

In a clinical trial on 12 healthy volunteers total gastrointestinal blood loss was measured with 51Cr-labelled erythrocytes. This double-blind cross-over study showed a highly significant difference (p < 0.001) between indometacin and [1-(p-chlorobenzoyl)-5-methoxy-2-methylindol-3-acetoxy[acetic acid (acemetacin, TV 1322, Rantudil¿) after oral application of 200 mg acemetacin, 200 mg indometacin per day and placebo for a week. Average total blood loss within seven days was 12.4 ml after indometacin, 4.5 ml after acemetacin and 5.0 ml after placebo. In a clinical trial on 16 rheumatic patients taking commercial non-steroidal antiinflammatory drugs over a long time total gastrointestinal blood loss was determined likewise. After a preceding wash-out period the blood loss due to acemetacin (240 mg daily) and indometacin (200 mg daily) for seven days was compared. There was a highly significant difference (p < 0.001) between both drugs. Total weekly blood loss was measured as 13.8 ml due to the treatment with indometacin and 6.5 ml due to acemetacin. During the wash-out period blood loss was detected as 6.0 ml weekly. There was no difference between the results of both trials. These clinical trials on 35 patients and volunteers do not give any indication that the new antiinflammatory drug acemetacin may cause mucosal lesions in the gastrointestinal tract evedenced by blood loss.

[Morphological changes in the articular capsule tissue after preliminary synoviorthesis]. / Morphologische Veränderungen am Gelenkkapselgewebe nach vorausgegangener Synoviorthese.

Synovial tissues, surgically removed after synoviorthesis, were investigated microscopically. 198Au metallic desposits were seen until five years after the intraarticular injection. Light fibrotic changes were present, however these tissues exhibited also necrotic changes. 90Y could not be detected microscopically. Inclusions of necrotic cartilage in the synovial membrane may indicate cartilage disturbances due to 90Y. Osmium acid was identified by Xray-microanalysis.

Proliferation of synovial lining cells and fibroblasts.

After in vitro incubation with 3H-thymidine, the proliferation of synovial lining cells and fibroblasts was investigated in surgically-removed articular tissue. Under normal conditions, in nonrheumatoid arthritis and in osteoarthrosis, low proliferation rates for both cell types were observed. In rheumatoid arthritis, the rate of proliferation of both cell types was usually increased. An increased proliferation of the synovial lining cells was especially observed in cases with a hyperplastic lining cell layer and in cases with a minimal lymphocytic and plasma cellular infiltration in the synovial membrane.