Ten cases of small intestinal obstruction seen over a period of 6 years (1971-6) in young girls within the narrow age range of 13-18 years are described. The patients were all within 2 years of menarche. In all these cases the obstruction was due to a membrane encasing the small intestine in the manner of a cocoon. There was no previous history of abdominal operation, peritonitis or prolonged drug intake. The clinical features, operative findings and management of the cases are presented. Possible causes of the condition are discussed. In view of the similar clinical presentation in all these patients, their conditions can be grouped as a clinical entity--'the abdominal cocoon'.
SUMMARYThis study determined the effect of Ibuprofen on tooth sensitivity from in-office bleaching with 38% hydrogen peroxide. A double-blind, randomized-controlled clinical trial was performed on healthy non-smoker patients who retain all anterior teeth (N=31). Patients with anterior restorations, calculus or heavy stain, and those who were taking medications or desensitizer products were excluded. After signing the informed consent, the patients were randomly divided into a Placebo group (n=16) that received a placebo (tinted oil in clear capsule) ( Clinical RelevanceThe use of an analgesic may help to reduce tooth sensitivity during in-office bleaching. Within the limitations of this study, Ibuprofen (600 mg, PO single dose) reduced tooth sensitivity during, but not after the treatment period. 132Operative Dentistry tivity levels during each period on a scale from 0 to 100 (0=no sensitivity, 100=unbearable sensitivity). The VAS scores were statistically analyzed to compare the groups' scores at different times and to compare the scores within each group at various times (Wilcoxon rank sum tests). The mean score and standard deviation of the Ibuprofen group immediately after bleaching was 5.0 ± 9.9, at 1 hour-31.5 ± 32.1 and at 24 hours-25.8 ± 30.8; the placebo group at the time of treatment was 26.6 ± 31.0, at 1 hour-30.9 ± 30.5 and at 24 hours-31.1 ± 32.6. When comparing the two groups at different times, the Ibuprofen group showed statistically significantly lower sensitivity scores immediately postbleaching than the placebo group (p=0.0216) but not at 1 hour (p=0.84) or 24 hours post-bleaching (p=0.54). When comparing times within the Ibuprofen group, the mean VAS score immediately after bleaching was significantly lower than 1 hour post-bleaching (p=0.0024) and 24-hours post-bleaching (p=0.0110), but the mean VAS score at 1 hour post-bleaching and 24-hours post-bleaching were not significantly different (p=0.64). For the placebo group, the intragroup time effect was not significant. Within the limitations of the current study, the authors concluded that the use of an analgesic may help to reduce tooth sensitivity during in-office bleaching. In the current study, Ibuprofen (600 mg, PO single dose) reduced tooth sensitivity during but not after the treatment period.
Rabbits with a bilateral antigen-induced arthritis were injected intra-articularly in one joint with methotrexate as the free drug or entrapped in liposomes. Free methotrexate (1 mg) injected as a single dose at the time of antigen challenge, suppressed the development of joint swelling and the rise in skin surface temperature of treated joints by 20-30% compared with contralateral control arthritic joints. The beneficial effect of methotrexate occurred within 24 h of injection and was maintained for at least 56 days. However, methotrexate was ineffective in suppressing arthritis when injected 7 days after antigen challenge. Liposomal methotrexate suppressed the development of arthritis at a dose one-tenth that of the free drug and it was also effective in suppressing arthritis of 7 days duration, although significant beneficial effects of liposomal methotrexate were delayed for 10 to 14 days after injection. Neither free nor liposomal methotrexate was effective in suppressing an established arthritis, having no significant effect on joint swelling or skin surface temperature when injected 21 and 35 days after antigen challenge. At the end of the study, 8 or 9 weeks after induction of arthritis, the joints were examined morphologically and histologically. Free methotrexate generally had no significant effect on joint pathology. However, liposomal methotrexate suppressed the development of synovial hyperplasia, cellular infiltration and the erosion of cartilage and bone when injected at the time of antigen challenge or 7 days later, but affected none of these parameters in an established arthritis of 3 weeks duration.
Normal or arthritic rabbits were injected intra-articularly (i.a.) with free [3H]methotrexate ([3H]MTX) or liposomes containing [3H]MTX with [14C]cholesteryl oleate as a lipid marker. The distribution of 3H and 14C in the injected joint and other tissues was determined. Free [3H]MTX was rapidly cleared from the joint, 79% being excreted in the urine within 24 h of injection. Liposome-entrapment retarded [3H]MTX clearance from the joint (P less than 0.001), 45.5% being recovered from the joint 24 h after injection. Uptake of liposomes by the inflamed synovium was lower than expected, 4% liposomal [3H]MTX injected being associated with the synovium after 24 h. Nevertheless, this was 40-fold greater than when free [3H]MTX was injected. Liposome entrapment should improve the efficacy and reduce the side effects of drugs injected directly into the joint cavity.
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