Nedocromil sodium in the prevention of exercise-induced bronchospasm in athletes with asthma

The aim of this study was to determine the efficacy of nedocromil sodium in the prevention of exercise-induced bronchospasm (EIB) in 13 top athletes affected by bronchial asthma. At a dose of 4 mg the drug significantly reduced the fall in FEV1 compared with placebo but not with respect to basal values. In 9 athletes, 4 mg nedocromil sodium produced a good protective effect and reduced the mean fall in FEV1 to 4% with respect to baseline values, while in the remaining 4 subjects, the protective effect was not satisfactory. In these 4 "non responders" 6 mg nedocromil was effective, and in 2 cases induced prolonged bronchodilatation. In conclusion, the effect of nedocromil sodium in the prevention of EIB may be dose-dependent in relation to the degree of bronchial hyperreactivity or to interference of other factors.

Nedocromil sodium inhibits the increase in airway reactivity induced by platelet activating factor in humans

To investigate the effect of nedocromil sodium on changes in airway reactivity to methacholine induced by platelet activating factor, we studied 12 nonasthmatic, nonatopic subjects (24 to 41 years) in a double-blind trial. The FEV1 and airflow at 30 percent of vital capacity from a partial forced expiration (V30p) were used to assess changes in airway caliber. Two concentration-response curves to doubling concentrations of MCh (from 0.3 mg/ml) were performed 48 h apart. The concentrations of MCh causing a 20 percent fall in FEV1 (PC20FEV1) or a 40 percent fall in V30p (PC40V30p) were calculated. After the first MCh challenge, subjects were matched by airway reactivity and randomly assigned to nedocromil sodium (two puffs qid 2 mg/puff) or placebo treatment. Two days after the second MCh challenge, PAF was inhaled, and changes in airway caliber were recorded. Administration of either nedocromil sodium or placebo was ended at this time and airway response to MCh was assessed two days after PAF. The two concentration-response curves to MCh obtained before PAF exposure were superimposable. The PAF caused a dose-related bronchoconstriction in both groups; the maximal fall in V30p was 27.6 +/- 6.6 percent (mean +/- SE) in the nedocromil sodium group and 37.4 +/- 4.6 percent in the placebo group. Two days after PAF, the PC20FEV1 did not change in subjects who received nedocromil sodium (4.86 vs 4.32 mg/ml; geometric mean), but it fell from 6.59 to 1.12 mg/ml (p less than 0.05) in placebo-treated subjects. These results indicate that nedocromil sodium inhibits PAF-induced increase in airway reactivity.

Nedocromil sodium: a review of clinical studies

Nedocromil sodium is a new compound for the long-term treatment of bronchial asthma. Its effect has been studied in prevention of bronchospasm induced by a variety of stimuli showing a broader spectrum of activity than SCG. Its clinical efficacy has been demonstrated in a number of trials involving patients regardless of asthma type.

Sodium cromoglycate: a review

Sodium cromoglycate is a drug widely used in the treatment of bronchial asthma. In vitro and animal models show that its effect is related to mast cell stabilization and to a direct action on inflammatory cells or the broncho-obstructive reflex. In man, sodium cromoglycate is able to prevent bronchoconstriction induced by a variety of stimuli including the 'late' reaction to allergen. It is also able to prevent the allergen-induced increase in hyperresponsiveness. Long-term therapeutic trials have confirmed its validity in the treatment of asthmatic patients.

Diagnosis and treatment of asthma across Europe

It is widely recognized that the mortality rate for asthma is at an unacceptably high level. Many physicians take the view that, if this situation is to be reversed, emphasis should be placed on the earlier and regular use of preventive therapies, which manage the fundamental pathophysiology of asthma, rather than merely treating symptoms. It, therefore, appears appropriate to reappraise sodium cromoglycate in terms of its role in normalizing respiratory function by its effect on inflammatory mediators and, thus, in improving the quality of life for asthmatics.

A double-blind group comparative study of nedocromil sodium in the treatment of seasonal allergic rhinitis

Thirty-eight patients with seasonal rhinitis due to grass pollen allergy took part in this double-blind study comparing 1% nedocromil sodium and placebo. Treatment was allocated by randomised coding sheet and consisted of 1% nedocromil sodium nasal spray or placebo given four times daily for four weeks during the peak pollen season. Highly significant (p less than 0.001) differences in favour of nedocromil sodium were seen for all signs and symptoms recorded at clinical assessments, and for diary card assessments of symptoms. In addition, time to effect and patient and clinician opinions of treatment significantly (p less than 0.001) favoured nedocromil sodium. Laboratory data on blood and urine samples taken before and after treatment showed no significant effects, and both treatments were well tolerated. Nedocromil sodium 1% nasal spray taken four times daily was shown to be an effective treatment for grass pollen rhinitis.

Prevention of non-specific bronchial hyperreactivity. Dose-dependent effect of sodium cromoglycate metered dose aerosol

The protective effect of different doses of sodium cromoglycate (4 mg, 12 mg and 20 mg) given as pressurized aerosol on fog-induced bronchoconstriction were investigated in three different groups of asthmatic patients. Premedication with the active drug was compared versus absence of premedication. The authors discuss their results by a statistical analysis of the FEV1 variations. Sodium cromoglycate effectively prevents fog-induced bronchoconstriction with a clear dose-dependent effect.

Lumbar disc herniation: diagnosis, surgical treatment, recurrence. A review of 872 operated cases

This review is based on 972 cases treated surgically for lumbar disc herniation between 1974 and 1984. The authors discuss several problems related to this condition. The importance of the history and clinical assessment are emphasized, as well as the role of instrumental tests such as radiculography and CT scan. The authors report what they believe to be the treatment of choice to avoid recurrence, based on an analysis of two groups of patients. The first group consisted of patients in whom lumbar and radicular pain persisted after operation. The second group consisted of patients in whom these symptoms recurred after an interval of complete relief. This analysis leads to the following conclusions: 1) clinical examination is pre-eminent; CT scan and radiculography are complementary to an accurate neurological examination; 2) hemilaminectomy is the operation of choice because it is sufficient to ensure accurate exploration of both root and disc; 3) most recurrences are due to errors in diagnosis or surgical technique.

Double-blind crossover trial to compare the activity of nedocromil sodium and placebo in antigen challenge

In a double-blind crossover placebo controlled study, the inhibitory effects of three different doses of nedocromil sodium on the immediate bronchoconstrictor response to antigen challenge were compared with a placebo. All the test treatments were inhaled three hours before challenge. Four asthmatic patients took part in the study and the test treatments were taken in a randomized order. All three doses of nedocromil sodium significantly reduced the bronchoconstrictor response and protected the patients against antigen challenge, compared with placebo. The highest dose of 2 mg was the most effective dose. All test doses of nedocromil sodium were safe and well tolerated by the patients.

The treatment of fractures of the acetabulum involving both anterior and posterior columns

Over a period of 20 years, 35 cases of fracture of the acetabulum involving both columns were treated by operation in our unit. These were followed up after a minimum of 8 to a maximum of 20 years. The Iselin approach, even when extended forwards by partial disinsertion of the gluteal muscles, allowed good reduction only when there was little or no displacement of the ilio-pubic column. In the other cases, it was necessary to use a combined anterior and posterior approach, or the Letournel approach, but the latter was reserved for cases with very severe displacement or comminution of the fragments when it is essential to have access and control of the iliac and acetabular complex in its entirety. The clinical and radiographic results of fractures involving both columns are not unlike those observed in other complex fractures of the pelvis: good reduction and osteosynthesis is synonymous with good function even in the long term.

Transverse fractures of the acetabulum

From a total case material of 356 fractures of the acetabulum we have been able to analyse in depth 188 fractures treated surgically--77 transverse, 21 T-fractures and 90 transverse associated with posterior rim fractures. These lesions, although sharing certain anatomical and radiographic features, have peculiar characteristics which are important to define for purposes of treatment. Posterior dislocation of the femoral head is frequently associated with posterior rim fractures and central dislocation with transverse and T-fractures. Traumatic arthritis as a late complication was studied with particular reference to the quality of reduction of the fracture. When this results in an irregular articular surface early arthritis is the usual outcome; when it results in an acetabular cavity wider than the diameter of the femoral head, arthritis is delayed usually for more than 10 years, and subsequently progresses very slowly.

The transtibio-fibular graft in the treatment of pseudarthrosis of the tibia with loss of bone substance

The transtibio-fibular graft is the treatment of choice in pseudarthrosis of the tibia with significant loss of bone, particularly in the presence of infection or potential infection. A personal series of 28 cases is reported. The method consists of stabilizing the pseudarthrosis, usually after radical surgical cleansing, by applying the grafts through healthy tissues from a postero-lateral approach. The authors stress that this operation is only called for when the amount of bone loss is substantial. In the less severe cases the operation restores sufficiently strong union to prevent future fatigue fractures, whilst even in cases of more extensive bone loss it still offers an excellent prospect of avoiding such possible future complications.

[Action of Trivé 1000 on hemostasis and hematocrit]

The action of lipids on haemostasis has already been shown. The authors study possible changes of haemostasis induced by the use of a substance: Trive 1000 containing 3.8 g of Soya oil and 0.3 g of Soya lecithin per 100 ml. Twenty patient received 1 litre per day over a period of ten days and were compared with 16 controls receiving glucose and amino acides without lipids. Studies of haemostasis included: overall coagulation by the thrombo-elastogram, P.R.P. (platelet rich plasma), estimation of the co-factors of the prothrombin complex, thrombin and reptilase times, platelet count, platelet stickiness using the method of HELLEM, platelet aggregation using the method of Born, plasminogen and plasmin activity by the pH STAT method, and P.D.F. levels. These examinations were carried out on the 1st, 3rd, 5th, 7th and 9th postoperative days. The results in the patients receiving Trive 1000 were as follows: no change in blood coagulation, progressive fall in platelet activity in the sense of hypoaggregability which was significant from the 5th day onwards only. There was no change in fibrinolysis. By contrast, there was anaemia, as determined on the basis of a fall in haematocrit, maximal on the 5th day and attributed by the authors to the haemolytic properties of triglycerides. In conclusion, Trive 1000 had no signifcant influence on haemostasis, apart from platelet hypoaggregability of moderate degree after prolonged treatment and perhaps haemolytic anaemia.