Nephrotoxicity studies on aspirin and diflunisal. Some of the difficulties encountered in investigations of long-term drug nephrotoxicity are reviewed, and the evidence for acute and chronic renal damage induced by aspirin is discussed. Two studies were carried out to investigate the acute effects of diflunisal on the kidney, and to compare its effects with those of aspirin. Measurements were made before, during and after drug intake, of epithelial cells and lysosomal enzyme (beta-d-n-acetyl glucosaminidase) excretion in urine. Diflunisal caused no change in cell excretion and no increase in enzyme secretion in 6 normal volunteers. In a comparative study against aspirin, two groups of 12 patients being treated for osteoarthrosis were observed over an 8-week period. Enzyme excretion increased in both groups and appeared to be dose related. The increase, however, was relatively greater in the aspirin group. The possible significance of these findings is discussed.


Diflunisal versus aspirin: a comparative study of their effect of faecal blood loss, in the presence and absence of alcohol. Faecal blood loss was measured in normal male volunteers using 51Cr-labelled red cells. In a double-blind parallel study in 10 subjects, the effect of 250 mg diflunisal twice daily was compared with 750 mg aspirin 4-times daily. Drugs were taken during two 7-day periods separated by a 1-week control period. Mean daily faecal blood loss during the two treatment periods was 0.32 ml and 0.53 ml in the diflunisal group versus 6.87 ml and 3.20 ml in the aspirin group. Diflunisal did not significantly increase blood loss, while aspirin had a significant effect. In a double-blind crossover study in 12 subjects, the effect of 250 mg diflunisal twice daily was compared with 600 mg aspirin 4-times daily. Alcohol (120 ml, 40%) was added during the last 2 days of each 6-day treatment period. Faecal blood loss was not significantly affected by diflunisal and there was also no significant effect on blood loss when alcohol was co-administered. Aspirin significantly increased faecal blood loss and this effect was significantly enhanced by the addition of alcohol.


A controlled study of diflunisal in sprains and strains. A preliminary double-blind, randomized trial was carried out in general practice to compare the efficacy of treatment with diflunisal (500 mg) twice daily and a combination of dextropropoxyphene (65 mg) plus paracetemol (650 mg) 3-times daily for 3 days in relieving pain associated with strains and sprains. Analysis of the results from 51 patients showed that both treatments were equally effective in releiving spontaneous pain and pain on movement after 1 and 3 days, and there were no differences between the two groups in patients' overall evaluation of treatment or physicians' assessment of therapeutic response. Both treatments were well tolerated during the short-term period of the trial.


Burn injuries. Initial evaluation and treatment. Treatment of burned patients begins at the scene of the accident, continues in the emergency department, and terminates in the burn center. The "burn team" of specialists includes the paramedic at the scene of the accident, the physician and nurses in the emergency room, and the burn center staff. Since the early stages of treatment often predetermine the final outcome, every physician or nurse who may someday be involved with the initial assessment and management of a severely burned patient should review a plan of evaluation and treatment. Thus, patient salvage from devastating burn injuries will continue to improve.


Pulmonary complications in the burn patient. Pulmonary complications--carbon monoxide poisoning, upper airways obstruction, and acute pulmonary insufficiency--occur frequently in patients hospitalized because of burns and/or smoke inhalation. The morbidity and mortality of these complications are quite high; therefore, early diagnosis and early institution of therapy are mandatory.


Cardiorespiratory effects of flexible fiberoptic bronchoscopy in critically ill patients. The flexible fiberoptic bronchoscope is used increasingly often as a multipurpose instrument in critical care medicine. In poor risk patients who need continuous mechanical ventilation, rigid open tube bronchoscopy is a problem. With the flexible fiberoptic bronchoscope, however, diagnostic and therapeutic procedures can be carried out without interruption of ongoing mechanical ventilation. This procedure offers the possibility of bronchoscopy with reduced risk in debilitated patients. However, in these critically ill patients, the cardiopulmonary system is functioning at the borderline of its ability. Therefore, even the small changes in ventilation pattern caused by flexible fiberoptic bronchoscopy (FFB) may in some cases cause dangerous cardiopulmonary distress. For example, changes of intrabronchial pressure, tidal volume, PaO2, PaCO2 and cardiac output may be caused by the procedure. Further, it is of great importance to restrict suction through the instrument to short periods to avoid dangerous alterations in the ventilation perfusion relationship. Since serious complications may occur, it is mandatory that the bronchoscopist be aware of the potential pathophysiologic effects of FFB during mechanical ventilation of critically ill patients.


Diagnostic value of fiberoptic bronchoscopy in metastatic pulmonary tumors. The fiberoptic bronchoscopic procedure (with brushings, washings, and biopsies) was performed and specimens of sputum were obtained before the procedure in 37 patients with cancer metastatic to the lung. Of the 37 patients studied, endobronchial lesions were visualized at bronchoscopic examination in 14 (group 1), and no endobronchial lesion was seen in 23 (group 2). The yield of bronchial brushing and washings was not significantly different in group 1 and 2, whereas examination of sputum obtained before the bronchoscopic procedure and bronchial biopsy in group 1 yielded higher results than the same procedures in group 2. The radiographic findings did not influence the yield with any of the bronchoscopic procedures. The overall positive diagnostic yield from fiberoptic bronchoscopic procedures among these patients was 54 percent (20/37), regardless of their bronchoscopic or radiologic findings.


High altitude pulmonary edema. Epidemiologic observations in Peru. The incidence of high altitude pulmonary edema was examined by a survey (via questionnaire) of residents living at 3,750 meters (12,303 feet) in the mining community of La Oroya, Peru. Ninety-seven subjects made a total of 1,157 ascents to high altitude after a stay at sea level of longer than 14 days. Sixty-four subjects experienced at least one episode of high-altitude pulmonary edema. The incidence was higher in subjects aged 13 to 20 years, where 17 percent (15) of 90 ascents resulted in episodes of high-altitude pulmonary edema, than in subjects 21 years or older (3 percent; 18/686 ascents). Young subjects (2 to 12 years old) had more severe episodes of high-altitude pulmonary edema (81 percent; 30/37 episodes) than adults (22 percent; 4/18 episodes). No episodes were observed in children under two years old. Five subjects under 21 years of age experienced recurrent episodes. Our estimated incidence of severe episodes of high altitude pulmonary edema per ascent in adults (0.6 percent; 4/686) is similar to that reported by other workers (incidence of 0.15 to 0.57 percent) in various parts of the world.


Assessment of the sterility of long-term cardiac catheterization using the thermodilution Swan-Ganz catheter. Fifty-seven patients  requiring catheterization with a thermodilution Swan-Ganz catheter in the surgical intensive care unit were prospectively studied to determine the incidence and significance of positive pulmonary arterial blood cultures. Nonseptic (group 1) and septic (group 2) patients were identified, with subdivision of the groups into A and B classes contingent upon a negative or positive pulmonary arterial blood culture respectively. In the nonseptic group, there were no positive blood cultures, provided there was only one catheterization (Swan-Ganz), less than three repositionings of the catheter, and discontinuation of the catheterization within 72 hours after insertion. Although the septic group followed this pattern, 25 percent incidence of positive pulmonary arterial blood cultures was present within the 72-hour period. We believe that the thermodilution Swan-Ganz catheter is presently a valuable clinical tool and does not predispose the patient to an excessive infectious disease risk.