The usefulness of naftidrofuryl in severe peripheral ischaemia--a symptomatic assessment using linear analogue scales

The effect of Naftidrofuryl (Nafronyl) on the symptoms of severe peripheral vascular disease has been studied in 40 hospital inpatients. Assessment of ischaemic symptoms and of symptoms which may occur with any type of chronic pain was made using a linear analogue system. Patients treated with naftidrofuryl showed a significant symptomatic improvement compared to patients treated without vasoactive drug therapy. These results show that this drug has a useful place in the treatment of severe ischaemic symptoms during assessment for vascular reconstruction and in those patients found to be unsuitable for limb-salvage operations.

Problems in the measurement of putative serum immune complexes by the method of Beaumont

A methodological investigation of the procedure used by Beaumont et al for measuring a "serum immune complex" precipitated by 25% ammonium sulfate and alleged to contain an ethynyl-estradiol binding immunoglobulin has found major problems with reproducibility and with the correlation of total protein as measured by the Lowry method and the IgG content as determined by a specific nephelometric procedure.

Saline Flush: A Simple Method of Reducing Diazepam-Induced Thrombophlebitis

Five hundred outpatients undergoing endoscopy were admitted into a controlled trial comparing the incidence of thrombophlebitis following intravenous diazepam administered in the usual way, with the effects of either a saline flush following the diazepam or diluting the drug with the patient's own blood before injection (‘barbotage’). The results were assessed using a questionnaire completed by patients two weeks after endoscopy; 80% replied. A saline flush reduced the incidence of local side effects, particularly pain ( P < 0.05). ‘Barbotage’ gave the highest incidence of side effects. Saline flush is therefore recommended as a means of reducing the thrombophlebitis which may follow intravenous diazepam.

Antibiotic prophylaxis in open and closed fractures: a controlled clinical trial

The value of prophylactic antibiotics in fracture surgery was studied in a series of 90 patients with open fractures of various bones and 180 patients with closed malleolar fractures treated by open surgery. Dicloxacillin and benzyl penicillin were compared to saline (placebo). The soft tissue lesions of the open fractures were divided into Grade I wounds and Grade II & III wounds. Of the patients with Grade I wounds, 17 received dicloxacillin, 21 benzyl penicillin and 17 saline. No major infections occurred. Twelve patients with Grade II & III wounds were treated with dicloxacillin, 10 with benzyl penicillin and 13 with saline. In the saline group, 2 patients developed a deep infection. Fifty-eight patients with closed malleolar fractures received dicloxacillin, 59 benzyl penicillin and 63 saline. Two infections developed in the placebo group. A statistically significant difference was found between the number of infections in the antibiotic groups and the number in the placebo group. Superficial thromboplebitis following the antibiotic infusion occurred in 16 per cent of the dicloxacillin treated patients and in 1 per cent of those treated with benzyl penicillin or placebo.

Incidence of thrombophlebitis in humans with the diazepam vehicle

Forty-one adult males volunteered for a study designed to investigate the thrombogenicity of the Valium® vehicle. Utilizing a standardized protocol, each subject received a sedative dose of Injectable Valium® in the antecubital fossa of one arm and an equivalent volume of vehicle in the contralateral arm. Both were administered with a continuous infusion drip of 5 per cent dextrose in water. Post-operative evaluation extended over 10 weeks and included clinical observation and palpation. Ultrasonic tests for occluded or impaired blood flow were performed with a Doppler Flowmeter.Five subjects (12.2 percent) had venous sequelae with the Valium® and two (4.8 percent) developed sequelae with the vehicle. The incidence of venous sequelae reported in the present study was considerably lower than in previous investigations (66.6 per cent and 37.5 per cent) utilizing the same protocol. The present study indicates that time of continuous infusion appears to contribute to thrombophlebitis subsequent to intravenous injection of Valium®. It also appears that the diazepam vehicle is not the major factor in the occurrence of thrombophlebitis.

Reduction of venous sequelae of i.v. diazepam with a fat emulsion as solvent

Venous sequelae were studied in 93 female patients undergoing minor gynaecological procedures. They were premedicated with diazepam i. v. dissolved in a fat emulsion (Diazemuls) injected to a superficial vein of the right hand. The patients observed the site of injection for 14 days and recorded their findings. Twenty-eight per cent reported mild tenderness and 7.5% mild or moderate swelling of short duration. Signs of thrombophlebitis were found in 2.2%. Thrombophlebitis after injection can be prevented effectively and safely using fat emulsion as a solvent for diazepam.

Local discomfort and thrombophlebitis following intravenous injection of diazepam. A comparison between a glycoferol-water solution and a lipid emulsion

Diazepam is frequently used for pre- and peroperative sedation. However, at i.v. injection local pain and thrombophlebitis are not uncommon, probably due to tissue irritancy of the various organic solvents necessary to keep diazepam in aqueous solution. In this study the incidence of local adverse effects following i.v. injection of Diazemuls, a new lipid emulsion formulation, was compared with that of Apozepam, a glycoferol-water solution. We found that the latter preparation caused local pain and thrombophlebitis as often as reported with propyleneglycol-phenylcarbinol-ethanol preparations (Stesolid, Valium) and in a statistically higher incidence that the lipid emulsion form, which therefore seems more suitable for intravenous use.

Venous complications after i.v. administration of Diazemuls (diazepam) and Dormicum (midazolam)

Local venous reactions during and after the injection i.v. of diazepam in oil (Diazemuls) and the water-soluble benzodiazepine midazolam (Dormicum) were studied in 100 patients undergoing gastroscopy. Observation time was 2 weeks. Of the patients receiving diazepam in oil, 8% experienced pain on injection and 6% subsequently developed clinical evidence of thrombophlebitis. Corresponding figures for midazolam were 6% and 10% respectively. No significant differences were observed between the effects of the two drugs.

Chemical phlebothrombosis of large veins. A not uncommon complication of total parenteral nutrition

Thrombosis of large veins during total parenteral nutrition (TPN) is considered uncommon. Recently, clinical and phlebographic evidence of large-vein thrombosis were encountered in five patients among 200 consecutive patients receiving TPN. The symptoms, signs, and phlebographic findings occurred within one to two days, sometimes as early as a few hours after cannulation. It is suggested that thrombosis of large veins during TPN is not uncommon and is the result of chemical phlebothrombosis due to a hypersensitivity reaction of the venous wall to the polyvinyl catheter material. Early removal of the offending catheter is advocated.