A multi-centre, double-blind comparative study of the efficacy and safety of aceclofenac and diclofenac in the treatment of rheumatoid arthritis

A long term multi-centre, double-blind, parallel group study was undertaken to investigate the efficacy and safety of aceclofenac (170 patients, 100 mg b.i.d. and placebo once daily) in comparison to diclofenac (173 patients, 50 mg t.i.d.) given for 6 months to patients of both sexes with active rheumatoid arthritis. Efficacy was evaluated in 131 aceclofenac and 130 diclofenac patients at 15 days, 1, 2, 4 and 6 months. Although both treatment groups showed significant improvement in all evaluations of pain and inflammation (assessed by a Visual Analogue Scale and the Ritchie Index) and a progressive reduction in morning stiffness, there were no significant differences between the groups. There was, however, a trend towards greater improvement in hand grip strength with aceclofenac (22% improvement) than diclofenac (17% improvement). Adverse events in both groups were minor, predominantly gastro-intestinal, and fewer patients tended to experience gastro-intestinal events on aceclofenac (13%) than on diclofenac (17%). The overall assessment of tolerance, however, did not differ significantly between groups. In summary, this study supports a therapeutic role for aceclofenac in the treatment of rheumatoid arthritis, and suggests it is an effective and safe NSAID for the treatment of this disease.

A newly designed partial subperiosteal implant and the classical design: a comparative study

Seventy two partial subperiosteal implants were inserted in 52 patients. Thirty six of these implants had a classical design in which the submerged structure had thick primary and secondary connectors. Thirty six implants had a newly designed submerged structure consisting of long and thin primary connectors with grooves along their outer surfaces designed to stop or delay the downgrowth of epithelial mucosa. A six year evaluation revealed a 92.5% success of the newly designed implants and an 84% success for the classical design. A 10 year statistical projection revealed a 50% cumulative success for the classical design and a 92.5% success for the new design.

A simple nonequilibrium thermodynamic description of some inhibitors of oxidative phosphorylation

We propose a macroscopic description of some inhibitors of oxidative phosphorylation based on a simple modification of the phenomenological coefficients appearing in the constitutive equations of linear irreversible thermodynamics. In this theoretical model, we consider protonophores, some ATPase inactivators and some electron-chain inhibitors, and we provide quantitative expressions for their consequences on the protonmotive force, oxidation flux and phosphorylation flux as well as on heat generation.

Non-local thermodynamic effects and efficiency of oxidative phosphorylation

A non-equilibrium thermodynamic model of oxidative phosphorylation is formulated, which allows us to take into account some non-local effects. In this way, we compute the influence of the tangential resistivity of the inner mitochondrial membrane to proton current, as well as that of the distance between active sites, on the stoichiometry and efficiency of energy conversion.

[Clinical problems posed by the consumption of antithrombin III induced by heparin]

Two cases of resistance to the heparin treatment, induced by large consumption of antithrombin III, are reported. Normally small, this consumption does not automatically call for the systematic dosage of Antithrombin III for each treatment using heparin. On the other hand, any clinical or biological resistance to higher doses of heparin, any personal or family history of thrombosis necessitate the administration of Antithrombin III. Where there is an acquired or congenital deficit, an injection of Antithrombin III corrects the disorder and reduces the risk of thrombosis. In the case of a heparin-antivitamin K relay, it is essential to achieve complete biological effectiveness of the antivitamins K to interrupt the administration of the heparin.

[Physiopathology of hemostasis. Which advances are useful for the clinician?]

Progress made in the field of haemostasis 30 years ago was essentially to do with the identification of the different activators of coagulation, the deficits of which provoke hemorrhage. Over the last ten years, progress has been made which is of benefit to research into thrombosis. This wave of progress, still in its infancy, aids both the understanding of the mechanisms involved, and the treatment of thrombosis. The role of the deficits reducing coagulation in the occurrence of thromboses is the most distinctive if not unique, fact. The molecular study of the factors of coagulation constitutes another aspect of recent progress; this gives a better understanding of the pathological phenomena and anticoagulant behaviour. Examples are given of this progress in molecular study and in the aetiological diagnosis of thrombosis.

[Pseudo-tumoral haematoma of the iliac fossa in haemophiliacs (author's transl)]

Pseudo-tumoral blood collections in haemophiliacs are uncommon but must be borne in mind because of their severity and of the need for timely and appropriate treatment. Surgical excision appears to be required as soon as the tendency towards enlargement is recognized and before the volume and complications of the tumour increase the difficulties, particularly in the iliac fossa. Other treatments, especially puncture-aspiration, seem to be ineffective and/or dangerous. A better knowledge of the pathogenic processes involved might lead to new therapeutic approaches.

[Familial recurrent phlebitis due to deficiency of antithrombin III. Apropos of a case]

The authors report the case of a young woman aged 29, mother of 2 children, presenting a post-phlebitic syndrome with hyperalgic capillaritic ulcer, a 10 year history of serious thrombophlebitic episodes with repeated pulmonary embolism despite heparin therapy, and reports of similar episodes in the family, some of which proved fatal. Haematological study showed a clear diminution in progressive antithrombin activity. A discussion follows on the clinical and haematological aspects of this constitutional and familial deficiency, which has been known since 1965 (Egelberg). The relative rarity of this condition should not prevent the routine search (by combined functional, immunological and chromogenic estimation) in the presence of repeated thrombosis, and when the thrombosis is biologically resistant to heparin : in such cases, the indication for long term treatment with vitamin K antagonists is undeniable.