Three patients experienced rapidly reversible azotemia related to the use of naproxen or ibuprofen but tolerated full-dose sulindac. This article discusses renal toxicity of nonsteroidal anti-inflammatory drugs (NSAIDs), with emphasis on the role of inhibition of prostaglandin synthesis, and reviews evidence supporting a renal-sparing property of sulindac. The current literature assumes that all NSAIDs possess a similar potential for renal toxicity. The data presented suggest that sulindac has less potential for renal toxicity and may be the preferred NSAID for use in patients with impaired renal function.

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SUMMARY A middle-aged man with diabetes mellitus and cardiomyopathy developed both cryptococcal arthritis and cellulitis. Unusual aspects included the benign nature of the joint effusion and lack of contiguous osteomyelitis.Cryptococcal arthritis is rare, with only 7 well described cases reported in the English-language literature. It is usually associated with an underlying osteomyelitis.' Cryptococcal cellulitis is equally rare and almost invariably occurs in an immunosuppressed host.2 The patient in this report had both cryptococcal arthritis and cellulitis associated with diabetes mellitus and an idiopathic cardiomyopathy. Unusual features included a noninflammatory synovial fluid and an absence of any osteomyelitis. Case reportA 54-year-old black man was admitted to Washington Hospital Center for treatment of congestive heart failure in July 1981. Five days earlier he had first noted pain and swelling in his left knee. The patient reported having 'pneumonia' at age 8 with resultant 'heart disease,' and was told he had an irregular heart rate and murmur at age 16. The patient had diabetes mellitus for 4 years, refused insulin therapy, and received an oral hypoglycaemic agent with only fair control. Serum glucose was typically in the 150-250 mg/dl (8-3-13-9

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This report describes 2 cases of metallosis from metal-on-polyethylene total hip replacements. Case 1 involved a Stryker rejuvenate implant, which has since been recalled. This patient had minimal symptoms, an elevated cobalt level, and loosening. The patient in case 2 had a Dupuys Pinnacle system, with symptoms of weakness, rash, and hip pain. Abnormal laboratory values include elevated sedimentation rate, C-reactive protein, creatinine, cobalt, and decreased hematocrit. Magnetic resonance imaging revealed synovial thickening and extracapsular edema. Although metallosis is a well-established complication of metal-on-metal implants, emerging data reveal that it also may be a problem in non-metal-on-metal implants such as either metal-on-polyethylene or ceramic-on-polyethylene implants, perhaps related to modular corrosion.

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