In PAOD patients, there is a progressive reduction in urinary nitrate and cGMP excretion rates, which may be caused in part by accumulation of ADMA, an endogenous inhibitor of NO synthase.

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1 Ten patients with bilateral knee joint effusions were treated topically with a gel containing 1 g diclofenac/100 g (80 mg three times daily). They were randomized to receive diclofenac gel to one knee and a placebo gel preparation to the other knee. 2 Diclofenac was assayed in synovial fluid and blood plasma by GC/ECD as the pentafluorobenzyl-ester derivative. 3 Total concentrations of diclofenac in synovial fluid (day 4) were significantly higher in the diclofenac gel treated knee than in the contralateral placebo treated knee (25.5 ± 3.6 ng ml-1 vs 21.6 ± 2 ng ml-1; P < 0.05). These concentrations were lower than total plasma drug concentrations (40.6 ± 4.7 ng ml-', n = 10, P < 0.01). Unbound concentrations of diclofenac in synovial fluid from either the diclofenac gel treated or the placebo treated knee were not significantly different from each other or from plasma free concentrations (115 ± 16 and 99 ± 12 vs 108 ± 19 pg ml-'). 4 Clinical parameters showed improvement of joint mobility and a small reduction of swelling (circumference) in both knees with time. However, the differences between knees were not significant. 5 We conclude that direct transport of diclofenac from the skin into the ipsilateral knee joint after cutaneous application is minimal. Distribution seems to be predominantly via the blood. Whether the observed improvements of clinical parameters were due to drug effects or to the spontaneous course of the underlying disease cannot be distinguished.

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In a placebo-controlled double-blind study, we examined the effect of perioperative oral administration of 6 mg dexamethasone, given once 12 h before and once 12 h after osteotomy of two impacted molar teeth, on postoperative edema, limitation of jaw opening, and intensity of postoperative pain. On the first day after surgery the difference in the increase in cheek swelling was 54.3% (P < 0.001) as measured with a tape, 46% (P < 0.001) measured with a gauge in the first molar area and 29% (P < or = 0.056) by sonographic measurement of the cheek diameter in the molar area. The limitation in the jaw opening was reduced by 17.7% (P < 0.002) after dexamethasone. Pain assessed by visual analog scale was reduced by dexamethasone by 50% (P < 0.01). The amount of analgesics required postoperatively (codeine phosphate) was reduced by 37% (P = 0.02) following dexamethasone administration. Seventy-six percent of our patients preferred perioperative medication of dexamethasone.

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