Chemonucleolysis versus surgical discectomy. Comparison of costs and results in workers' compensation claimants.

A retrospective review of insurance claim files was conducted to compare the costs of chemonucleolysis with surgical discectomy. Twenty-nine surgeons performed 61 chemonucleolysis procedures and 44 surgical discectomies on SAIF (State Accident Insurance Fund, Inc.--a major Oregon workers' compensation insurance company) claimants between December 1982 and April 1984. Clinical data and treatment costs were tabulated during February 1985. In this population of 105 workers' compensation claimants, the average cost/claim of the workers treated by chemonucleolysis was higher than the average cost/claim of workers treated initially by surgical discectomy. The average cost/claim was somewhat lower in successful chemonucleolysis cass than in successful surgical discectomy cases, but the average cost/claim of unsuccessful chemonucleolysis cases was much higher than unsuccessful surgical discectomy cases. In order for chemonucleolysis to be a cost effective method compared to initial surgical discectomy, it would be necessary to attain a much higher chemonucleolysis success rate than observed in this group of patients.

Brucellosis and rheumatic syndromes in Saudi Arabia.

Seventy-three episodes of brucellosis in 55 patients are reported. Twenty-two had a systemic illness, 10 arthritis, 10 spondylitis, and four arthritis and spondylitis. Cultures were positive in 77% of cases where appropriate methods were used. A number of rheumatic syndromes may be mimicked by brucellosis and others may coexist with it. A high index of suspicion should prevail in the evaluation of patients from endemic areas.

High dose, low frequency parenteral gold administration.

A dosage plan of up to 200 mg of aurothioglucose at approximately 4-week intervals was tested. Moderate or major improvement occurred in 20 of the 30 patients entered. Mean erythrocyte sedimentation rate fell from 46 to 26 mm/h, mean grip strength rose from 99 to 179 mm Hg (best hand) and mean number of swollen joints declined from 10.9 to 3.3. Maximum improvement occurred at a mean cumulative dose of 649 mg and after an average of 18 weeks and 5 visits. These data suggest that more efficient strategies for gold administration can be devised.

JPC-80, a new slow acting antirheumatoid drug.

JPC-80 has been administered to man for the first time. Twelve patients received doses up to 300 mg daily for up to 12 weeks. Three suffered significant, but not serious, side effects: 1 skin rash, 1 elevation of liver enzymes, 1 diarrhea. All signs or symptoms returned to normal on discontinuation of drug. Four of 8 patients receiving cumulative doses of over 20 g showed moderate or major improvement. In patients with clinical improvements the mean erythrocyte sedimentation rate fell from 51 to 21, and rheumatoid factor titers fell from 1444 to 647. This pilot study justifies additional controlled studies.

An overview of nonsteroidal antiinflammatory agents (NSAIA).

Since the rediscovery of willow bark extract (salicin) in 1763, there has been a continuing effort to improve efficacy and reduce the side effects of antiinflammatory agents through chemical modification and innovation. The second-generation NSAIA's, phenylbutazone and indomethacin, provided clear support for the idea that these objectives were obtainable. The success of steroid programs in enhancing potency and modifying side effects, coupled with the development of effective screening techniques for identifying antiinflammatory activity, stimulated an enormous effort to develop new NSAIA's. The products of this effort are now coming to the clinic. Although less successful than the steroid program in enhancing potency, the effort has succeeded in changing and reducing side effects. As a result, the clinician has a greater choice of agents for dealing with individual patient variability and achieving greater patient acceptance.