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In a double-blind between-patient study of 69 patients with sports injuries of the knee, diclophenac sodium (Voltaren) was significantly superior to oxyphenbutazone (Tanderil) and placebo in improving the degree of swelling and the condition of the injured knee. Both drugs were superior to placebo with regard to analgesia by the second day of treatment. In addition, diclophenac sodium significantly improved the condition of the injured knee by the end of the trial. Three patients dropped out of the trial for reasons not related to the drug. Two patients in the diclophenac sodium group failed to complete the trial due to rapid recovery and 1 each in the diclophenac sodium and oxyphenbutazone groups because of poor tolerability. Nine patients who completed the trial reported mild to moderate side-effects, consisting mainly of drowsiness and nausea.

The histories of 269 patients whose death certificates did not mention a drug as the cause of aplastic anaemia or agranulocytosis were investigated. Eighty-three deaths were probably caused by drugs, the most common cause of aplastic anaemia being treatment with phenylbutazone (28 deaths) and oxyphenbutazone (11 deaths). Thirteen out of 17 deaths from agranulocytosis were attributed to co-trimoxazole treatment. A separate survey of general practitioners' prescriptions enabled the mortality to be estimated. With the addition of one death due to oxyphenbutazone and four deaths due to phenylbutazone that were reported independently to the committee, the mortality from oxyphenbutazone was 3-8 per 100 000 and from phenylbutazone 2-2 per 100 000. With phenylbutazone the rates varied from under 1 death per 100 000 for men aged under 65 years to 6 per 100 000 for women aged 65 and over. Small numbers precluded estimates for oxyphenbutazone in these subgroups, although a similar trend was suggested. No particular indication for treatment seems to carry a higher risk, the main concern being the use of these two drugs in elderly patients.

Fixed drug eruptions exclusively involving the genitalia of 60 male patients were investigated. Forty-two of the 60 patients completed tests designed to identify the causative drug. Tetracycline, aspirin, metamizole, and trimethoprim-sulfamethoxazole were found to be common etiologic agents. The sites affected were the glans penis, coronal sulcus, and preputial skin. Superficial ulceration or pigmented areas surrounded by an erythematous halo were the main clinical findings at the time of presentation.

A woman who had taken oxyphenbutazone for 4 years because of back pain presented with goitre and hypothyroidism. This was shown to be due to an organification defect, caused or aggravated by oxyphenbutazone.

A review of the literature on the gastrointestinal side effects of the analgesic drugs has disclosed a disparity between generally held views and the scientific evidence. This is largely due to the paucity of large long term controlled trials since the cost of these is very high. The problems in mounting a large observational study with population controls are discussed against a backgrwound of exploratory work in Australia and New Zealand and the conclusion is reached that a comprehensive survey is needed. The difficulties in mounting such a survey are discussed.

Cases of drug-induced aplastic anaemia, haemolytic anaemia, thrombocytopenia, and agranulocytosis reported to the Swedish Adverse Drug Reaction Committee during the five-year period 1966-70 have been analysed and compared with cases of the same cytopenias from "all" causes. Oral diuretics were a dominant cause of drug-induced thrombocytopenia, methyldopa of haemolytic anaemia, and oxyphenbutazone of aplastic anaemia. Computer systems should help such studies, particularly in showing a changing pattern of complications and causes.