Phenylbutazone Therapy Research Articles

Evaluation of Urinary Variables as Diagnostic Indicators of Acute Kidney Injury in Egyptian Draft Horses Treated With Phenylbutazone Therapy

The present study was undertaken to evaluate the diagnostic significance of various urinary variables to detect acute kidney injury (AKI) in Egyptian draft horses treated with phenylbutazone (PBZ) therapy. Medical records of 52 draft horses, with a history of musculoskeletal painful conditions and treated frequently with various daily doses of injectable PBZ, were reviewed. Of those 52 horses, 38 were enrolled in this study. AKI was tentatively diagnosed based on thorough history and clinical findings and in conjunction with multiple biochemical screening tests. Accordingly, diseased horses were categorized into two main groups; the first group included 14 horses with prerenal azotemia, whereas the second group included 24 horses with renal azotemia. Biochemically, urinary malondialdehyde, urinary gamma-glutamyl transferase/creatinine (Cr) ratio, urinary protein/Cr ratio, urinary glucose, urinary sodium, fractional excretion of sodium, and renal failure index were significantly higher (P < .05) in horses of group 2 than those of group 1. However, values of urinary Cr, urine/plasma Cr ratio, urinary urea, and urine/plasma urea ratio were significantly decreased (P < .05) in horses of group 2. Analysis of receiver operating characteristic curve showed high sensitivity and specificity of most tested urinary variables as well as their derived indices for detection of AKI in diseased horses. Our findings suggest that the examined urinary variables as well as their ratios are helpful in documenting AKI associated with PBZ nephrotoxicity in Egyptian draft horses; however, their interpretation should be done in the light of the specific clinical setting and in conjunction with a thorough clinical and physical examination.

Factitious increases in serum testosterone concentrations related to phenylbutazone therapy

We report 6 additional observations of a drug/hormone assay interaction between serum testosterone and phenylbutazone intake. This interaction had been described previously only once. We discuss its potential mechanisms, based upon our experimental findings, and its clinical implications.

Predominant cervical involvement in patients with psoriatic arthritis: report of two cases

Cervical spine involvement is common but usually delayed in patients with psoriatic arthritis. We report two cases with early and predominant involvement of the upper cervical spine. Synovitis of the atlanto-odontoid joint and fusion of multiple facet joints were noted in one patient. In the other patient, the main finding was atlanto-axial subluxation with erosions of the odontoid process and anterior arch of C1. No abnormalities were noted in the peripheral joints, sacroiliac joints, or thoracolumbar spine. Analgesics and conventional antiinflammatory agents were only minimally effective. TNFα antagonist therapy (infliximab followed by etanercept) in one patient and phenylbutazone therapy in the other improved the symptoms and led to shrinkage of the pannus.

Right dorsal colitis in the horse: minireview and reports on three cases in Ireland

Right dorsal colitis (RDC) is an ulcerative inflammatory bowel disorder of the horse that has been associated with the administration of non-steroidal anti-inflammatory drugs (NSAIDs), particularly in horses treated when dehydrated or toxaemic. The acute form of RDC may result in profuse diarrhoea, severe colic, dehydration, endotoxic shock and even death; the chronic form may be manifest by mild to moderate intermittent colic, ventral oedema and weight loss with or without diarrhoea. The most consistent laboratory findings are anaemia, hypoproteinaemia, hypoalbuminaemia and hypocalcaemia. Medical management of RDC requires avoidance of NSAIDs, of stressful experiences and of large-volume diets. Specific medications such as sucralfate and metronidazole have been used to treat RDC in the horse. The use of dietary additions such as psyllium and corn oil has been mentioned in the literature.RDC has not been reported previously in Ireland or Britain; here we report that the condition was diagnosed in three horses in Ireland on the bases of a history of phenylbutazone therapy, clinical signs, clinical pathology and ultrasonography. In two of the three horses the diagnosis was confirmed by direct inspection of the affected colon at celiotomy.

Infectious Tenosynovitis

Infectious tenosynovitis is treated similarly to infectious arthritis. The principles of treatment include an early diagnosis and immediate therapy. Therapy should include use of systemic and local antimicrobials and sheath lavage and drainage. Fibrosis and adhesions can be minimized with passive range of motion exercises, intrathecal hyaluronate, and phenylbutazone therapy. Restrictive fibrosis may be treated successfully by annular ligament resection.

Bovine ephemeral fever.

Ephemeral fever remains a viral disease of considerable importance to many countries including Australia. The virus has been only partly characterised and still awaits final classification. Although BEF virus was first thought to contain 6 structural proteins there is increasing evidence to suggest that it contains the 5 proteins characteristic of the Rhabdoviridae. Although BEF is thought to be arthropod borne, the vector has yet to be identified but it is clear from the distribution of BEF that more than one vector is capable of transmitting the disease. Despite rigorous investigation of the clinical signs and the pathology of ephemeral fever, little progress has been made on the pathogenesis of the disease. This has been partly due to the difficulty of propagating BEF virus in vitro and the inability to define the site of replication. However, there is mounting evidence to suggest that BEF is immunopathologic in nature and that the clinical expression of the disease is influenced by the release of one or more mediators of inflammation. The disease is characterised by a number of haematological and biochemical changes and early and prolonged treatment with phenylbutazone is capable of reversing a number of these changes. The intravenous administration of calcium can now be considered a justifiable addition to the treatment regimen together with prolonged phenylbutazone therapy. The vaccines currently available are prepared from either live attenuated or killed virus and may be less than reliable. There appears to be a need for a reliable, inexpensive, cold-chain independent alternative vaccine.

Renal medullary crest necrosis associated with phenylbutazone therapy in horses.

Thirty-five cases of renal medullary crest necrosis morphologically similar to the renal papillary necrosis of analgesic nephropathy as described in man and rats are reported in horses receiving maintenance dosages of phenylbutazone. The primary lesion is a well-demarcated focal medullary necrosis resulting in sequestration of fragments of the renal crest. Renal cortical lesions are considered secondary to the medullary necrosis and consist of segmental pallor as a result of tubular dilatation, filtrate retention, and interstitial edema. Ischemia in concert with phenylbutazone is suggested as the etiology. Renal medullary crest necrosis is presented as more appropriate morphological terminology for this lesion in the equine species than renal papillary necrosis as is used in man and rats.

Phenylbutazone, musculoskeletal disease, and leukemia

Four hundred and nine patients age 30 and over with leukemia or lymphoma and a subset of 127 patients with myelocytic leukemia were compared with equal numbers of matched hospitalized control subjects and matched subscribers to the Kaiser-Permanente Medical Care Program (member controls). Prior use of phenylbutazone was somewhat more frequent in cases than in member controls only, but the difference was not statistically significant and the association appeared to be explained by an underlying relation of musculoskeletal disease to these lymphohematopoietic cancers. The association of musculoskeletal disease with myelocytic leukemia was present even when attention was restricted to the period at least two or five years before leukemia diagnosis. There was no clear association of amount and duration of phenylbutazone therapy with risk of leukemia. Several other drugs used for musculoskeletal conditions showed positive or negative relations to subsequent leukemia.

Acute monoarticular presentation of osteoarthrosis of the knee.

A study of 387 patients aged 65 years and over presenting with an acute hot painful swollen joint as the major or only presentation of osteoarthrosis of the knee is discussed. Short-term phenylbutazone therapy is evaluated. Eighty-nine per cent of patients obtained good to complete relief of acute symptoms within 14 days.

A Controlled Comparative Trial of Butacote and Fenclofenac in the Treatment of Ankylosing Spondylitis

A double-blind crossover trial of fenclofenac was undertaken to compare the short-term effects of phenylbutazone (Butacote) therapy with fenclofenac therapy (1200 mg daily) in 23 patients suffering from ankylosing spondylitis. The patients were randomly allocated to each of the test drugs for a period of two weeks, following wash-out periods of paracetamol for four days. The results favoured Butacote therapy in a dosage of 300 mg daily in the expressed preferences of both the patients and the physicians conducting the trial. Butacote was also better tolerated, as no severe side-effects occurred during treatment, whereas five patients developed a widespread rash during the period of fenclofenac therapy. No significant differences were seen between the two drugs in terms of clinical measurements of pain, morning stiffness, spinal movements, chest expansion, and abduction of the hips. Butacote was shown to cause some significant depletion of haemoglobin level, probably due to water retention, and Butacote also reduced the serum urate level to a significant degree.

Acetanilide oxidation in phenylbutazone-associated hypoplastic anaemia.

Acetanilide like phenylbutazone is paraoxidized by the liver endoplasmic reticulum as a primary biotransformation step. Both compounds were given at different times to each of 10 healthy volunteer subjects and the plasma disappearances measured. Correlation was shown between plasma clearance values of the two compounds (r = + 0.7067; P < 0.05).Eight patients with hypoplastic anaemia after phenylbutazone therapy were investigated. Plasma clearance values and half lives of acetanilide were measured in this group of patients and compared with those of a group of 30 healthy volunteer controls. There was a significant decrease in clearance (P < 0.01) and lengthening of half lives (P < 0.001 in the patients with phenylbutazone-associated hypoplasia. Five patients with idiopathic aplastic anaemia-that is, without history of antecedent phenylbutazone ingestion-were similarly investigated with acetanilide and there was no significant difference between the results in these patients and those in the control group.It is suggested that relatively poor paraoxidation of phenylbutazone producing high blood concentrations on a given dose may be a factor responsible for the drug-associated hypoplasia even though it does not explain the similar pattern of adverse reactions reported in association with oral administration of the metabolite oxyphenbutazone.

Oedema in Rheumatoid Arthritis: Changes in the Coefficient of Capillary Filtration

The rate of formation of tissue fluid for a given increase of venous pressure and for a known volume of tissue has been measured in the forearm. There is a significant increase in this figure in rheumatoid arthritis and a still greater increase in patients who develop recurrent oedema. This increase could not be attributed to steroid or phenylbutazone therapy, nor to a fall in the serum albumin. The results imply that there is some generalized abnormality in capillary function in rheumatoid disease and that this change is not limited to the joints.

Benign Ulcer of the Sigmoid Colon

Simple benign ulceration of the colon is an unusual condition that may simulate carcinoma clinically and radiologically, and complications usually develop before it is recognized clinically (3, 7, 12, 14, 15). Since the initial description by Cruveilhier (8) in 1835, 105 cases have been reported. 52 of them since 1928 (9, 12). Of this latter group, only 8 or 15 per cent were in the sigmoid. No specific etiology of the disease has been found, although it has been reported in systemic disease (13) and in a patient treated with a drug having known ulcerogenic properties (9). A report of this entity seems indicated so that radiologists will be aware of it, may differentiate it from malignant lesions, and may consider it in patients being treated with known ulcerogenic drugs. Case Report M. C., a 70-year-old white male, was admitted to the Yale-New Haven Hospital on Aug. 27, 1966, with severe rectal bleeding. The patient had suffered from severe arthritis of long duration, for which phenylbutazone, six tablets daily, had been given for nine years. Since the beginning of phenylbutazone therapy, the patient had noted several loose bowel movements per day. On two previous occasions during the year prior to his most recent admission, he had been hospitalized for acute rectal bleeding. On these previous admissions, a barium enema examination was unrevealing, and rectal bleeding ceased when phenylbutazone therapy was discontinued. Acute flare-ups of arthritis necessitated the re-institution of phenylbutazone therapy, which resulted in severe rectal bleeding each time. A barium enema examination on the final admission showed a conical narrowing of the sigmoid colon with evidence of ulceration. Minimal changes in the contour of the lesion could be demonstrated (Figs. 1 and 2). These findings were in favor of a benign process; a shelf-like margin at both ends of the lesion, however, suggested tumor. The preoperative diagnosis was a stenosing lesion of the sigmoid, probably benign, but carcinoma could not be excluded. Operation disclosed induration of the sigmoid and proximal descending colon. The induration was most severe in the sigmoid, and this was resected. Grossly, it contained two large 2 × 3 cm ulcers with sharply demarcated edges. Microscopically, the base consisted of granulation tissue with a dense chronic inflammatory infiltrate. No reaction was seen in the adjacent mucosa. Infectious and malignant diseases were excluded. Discussion The majority of reported benign ulcers of the colon of nonspecific etiology occur in the cecum and ascending colon (3, 12). Approximately 15 per cent have been encountered in the sigmoid colon. The diagnosis is usually heralded by an abdominal catastrophe with perforation, abscess formation, and peritonitis. Constipation has been an almost universal complaint. Definite preoperative diagnosis could be made in only one case (4).

Regimen of indomethacin therapy in acute gouty arthritis.

Though colchicine has been famed for centuries for its effect in acute gouty arthritis its relief of pain and inflammation in this condition is not invariable and may not be apparent for 24 hours or more. It was therefore not surprising that when phenylbutazone was introduced colchicine was largely replaced by this preparation, which was more certain in its action. High dosage phenylbutazone therapy, however, was occasionally asso ciated with marrow depression (Mauer, 1955). In 1963 indo methacin was reported to be an effective anti-inflammatory agent in a number of rheumatic diseases (Katz et al., 1963 ; Norcross, 1963 ; Rothermich, 1963). In acute gouty arthritis Hart and Boardman (1963) reported favourable results with the use of 300 mg. of indomethacin given in divided doses during the first 24 hours, with a gradual subsequent reduction to 100-150 mg. daily. The dose was varied from day to day according to the response, and treatment was continued for at least five days, or longer if symptoms persisted. Smyth et al. (1963) also obtained good results with indomethacin in acute gouty arthritis, using doses of 600-900 mg. on the first day and 400 mg. daily in divided doses during the next three to five days. It therefore seemed that indomethacin was useful in acute gouty arthritis, but that dosage schedules varied widely and needed frequent review. Thus there seemed a need for a standardized regimen of treatment which would be uniformly successful but simple enough to leave in the hands either of patients or of nursing staff without constant supervision, and which would vary inherently with the severity of the gout and the response. Such a schedule might well be comparable to the usual schedule of oral colchicine treatment, in which the dosage varied with the response and toxic effects. The above considerations therefore led to the choice of the following thera peutic regimen: 100 mg. of indomethacin four-hourly until most pain was relieved, then 100 mg. eight-hourly for 24 hours, then 75 mg. eight-hourly for 24 hours, and then 50 mg. eight hourly for 24 hours. This regimen was tested for effectiveness in patients with acute gouty arthritis. At the same time undesirable side-effects were sought and opportunities were taken to determine whether improvement in the regimen, such as a reduction in dosage, was possible.

An unusual complication of phenylbutazone therapy--toxic epidermal necrolysis.

An unusual complication of phenylbutazone therapy--toxic epidermal necrolysis.

Iatrogenic diseases of the gastrointestinal tract.

Unprecedented long-term administration of drugs has increased the incidence of iatrogenic disease. Peptic ulcer may result from adrenocorticoid and phenylbutazone therapy. Aspirin may produce gastroduodenal irritation. Rauwolfia alkaloids stimulate gastric acid secretion. Acute staphylococcal enterocolitis, overgrowth of Candida albicans, and anorectal inflammation are occasionally associated with use of antibiotics.

PHENYLBUTAZONE THERAPY IN PATIENTS WITH RHEUMATIC DISEASE AND COINCIDENTAL ESSENTIAL HYPERTENSION

PHENYLBUTAZONE THERAPY IN PATIENTS WITH RHEUMATIC DISEASE AND COINCIDENTAL ESSENTIAL HYPERTENSION

PHENYLBUTAZONE THERAPY IN PATIENTS WITH RHEUMATIC DISEASE AND COINCIDENTAL ESSENTIAL HYPERTENSION

PHENYLBUTAZONE THERAPY IN PATIENTS WITH RHEUMATIC DISEASE AND COINCIDENTAL ESSENTIAL HYPERTENSION

Two cases of myocarditis associated with phenylbutazone therapy.

Medical Journal of AustraliaVolume 1, Issue 19 p. 640-641 Reports of Cases TWO CASES OF MYOCARDITIS ASSOCIATED WITH PHENYLBUTAZONE THERAPY P. R. Hodge, P. R. Hodge Department of Pathology, University of AdelaideSearch for more papers by this authorJ. R. Lawrence, J. R. Lawrence Department of Pathology, University of AdelaideSearch for more papers by this author P. R. Hodge, P. R. Hodge Department of Pathology, University of AdelaideSearch for more papers by this authorJ. R. Lawrence, J. R. Lawrence Department of Pathology, University of AdelaideSearch for more papers by this author First published: 01 May 1957 https://doi.org/10.5694/j.1326-5377.1957.tb57555.xCitations: 12AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume1, Issue19May 1957Pages 640-641 RelatedInformation

Agranulocytosis due to phenylbutazone.

Case Reports1 January 1957AGRANULOCYTOSIS DUE TO PHENYLBUTAZONEFREBURN L. JAMES, A.B., M.D., RICHARD E. GEESAMAN, M.D.FREBURN L. JAMES, A.B., M.D.Search for more papers by this author, RICHARD E. GEESAMAN, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-46-1-152 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptIt is well known that phenylbutazone is a hazardous medication, although it has been very effective therapeutically in relief of pain of arthritis and similar conditions. Bruck et al.1 studied the toxicity of phenylbutazone and reported the following as being the usual toxic effects: epigastric pain and burning, dry mouth, buccal irritation, edema, urticaria, diarrhea, headache, purpura, and precipitation of oliguria and renal failure. Their series did not include agranulocytosis or neutropenia, but this is a recognized danger.Beutler and Bergenstal2reported a case of perforated duodenal ulcer with neutropenia. The bone marrow in this case showed maturation arrest at...Bibliography1. BruckFearnleyMeanockPatley EMEIH: Phenylbutazone therapy; relation between the toxic and therapeutic effects and the blood level, Lancet 1: 225-228 (Jan. 30) 1954. CrossrefGoogle Scholar2. BeutlerBergenstal EDM: Perforated duodenal ulcer with neutropenia and death in a patient receiving phenylbutazone therapy, Gastroenterology 25: 72-74, 1953. CrossrefMedlineGoogle Scholar3. SteelMoffatt SJJL: Stevens-Johnson syndrome and granulocytopenia after phenylbutazone, Brit. M. J. 1: 795 (Apr. 3) 1954. CrossrefMedlineGoogle Scholar4. O'BrienStorey DJG: Death from hypersensitivity due to phenylbutazone, Brit. M. J. 1: 792-794 (Apr. 3) 1954. CrossrefMedlineGoogle Scholar5. ConeHanniganTeicher RBCAR: Erythema multiforme bullosum following phenylbutazone treatment for arthritis. Report of fatal case, Arch. Dermat. and Syph. 69: 674-677 (June) 1954. CrossrefGoogle Scholar6. NassimPilkington JRT: Multiple visceral lesions due to phenylbutazone toxicity, Brit. M. J. 2: 1028-1029 (Oct. 30) 1954. CrossrefMedlineGoogle Scholar7. Wood IH: Fatal case of agranulocytosis following phenylbutazone, Brit. M. J. 1: 802 (Apr. 3) 1954. CrossrefMedlineGoogle Scholar8. EnglemanKruppRinehartJonesGibson EPMAJFRCJR: Hepatitis following the ingestion of phenylbutazone, J. A. M. A. 156: 98-101 (Sept. 11) 1954. CrossrefMedlineGoogle Scholar9. Jespersen K: Butazolidin, Ugesk. f. læger 116: 846-848 (June) 1954. MedlineGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: Boulder, Colorado*Received for publication May 23, 1955.From the Boulder Colorado Sanitarium and Hospital and the Department of Internal Medicine, Boulder Medical Center, Boulder, Colorado.Requests for reprints should be addressed to Freburn L. James, M.D., Pathologist, Port Huron Hospital, Port Huron, Michigan. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byNon-steroidal anti-inflammatory drugs (NSAIDs)RHEUMATISM AND ARTHRITIS: REVIEW OF AMERICAN AND ENGLISH LITERATURE OF RECENT YEARS (THIRTEENTH RHEUMATISM REVIEW)*CHARLEY J. SMYTH, M.D., F.A.C.P., ROGER L. BLACK, M.D., FELIX E. DEMARTINI, M.D., IVAN F. DUFF, M.D., F.A.C.P., EPHRAIM P. ENGLEMAN, M.D., F.A.C.P., DONALD C. GRAHAM, M.D., F.R.C.P.(C), MAX M. MONTGOMERY, M.D., F.A.C.P., HOWARD F. POLLEY, M.D., F.A.C.P., EDWARD F. ROSENBERG, M.D., F.A.C.P., CARLOS F. SACASA, M.D., F.A.C.P., OTTO STEINBROCKER, M.D., HANS WAINE, M.D., GEORGE M. WILSON JR., M.D. 1 January 1957Volume 46, Issue 1Page: 152-155KeywordsDiarrheaEdemaHospital medicineNeutropeniaPainPharyngitisRashesRenal failureToxicityUrticaria Issue Published: 1 January 1957 PDF downloadLoading ...