Carprofen is a Non Steroidal Anti-Inflammatory Drug (NSAID) which is widely used for the treatment of musculoskeletal disorders in horses. The commercial preparation is a racemic mixture of two enantiomers (R and S carprofen). We used HPLC to measure plasma and synovial fluid R and S carprofen concentrations following a single intravenous (i.v.) dose, and computer modelling to determine the pharmacokinetic parameters of the enantiomers in these two body fluids. A comparison was made with results from an identical experiment using ketoprofen. The plasma elimination half lives of R and S carprofen were 20 and 16 times longer than those of R and S ketoprofen, and clearance was considerably slower for carprofen than ketoprofen. Plasma R carprofen concentrations were higher than S carprofen concentrations throughout the 48-h period. Ketoprofen was no longer detectable in synovial fluid after 5 h (S enantiomer) or 12 h (R enantiomer), whereas synovial fluid carprofen concentrations did not peak until 12 h and were still detectable at 48 h. Synovial fluid concentrations of both carprofen enantiomers were significantly lower than plasma concentrations, probably due to high plasma protein binding which could limit transfer through the synovial membrane. Our results indicate significant differences between carprofen and ketoprofen and between the two carprofen enantiomers.

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A viewpoint on Evidence-Based Medicine from a clinician previously unaware of the degree of controversy that appears to exist surrounding the subject is presented together with an attempt to provide a fresh approach for the future.

Nosocomial pneumonia in mechanically ventilated patients receiving antacid, ranitidine, or sucralfate as prophylaxis for stress ulcer. A randomized controlled trial. Ann Intern Med 1994; 120: 653±62 5 Yoshida N, Yoshikawa T, Tanaka Y, et al. A new mechanism for anti-in¯ammatory actions of proton pump inhibitorsÐinhibitory effects on neutrophil±endothelial cell interactions. Aliment Pharmacol Ther 2000; 14 [Suppl.]: 74±81 6 Okajima K, Harada N, Uchiba M. Ranitidine reduces ischemia/ reperfusion-induced liver injury in rats by inhibiting neutrophil activation.

pre-use checklist) re-audit of 102 completed checklists showed 20 tests revealing faults on 59 occasions All the anaesthetic machines in one District General (range 1.0-11.6%), 16 (27%) day to day and 43 (73%) Hospital were tested for faults on three occasions for non-recurring. COVERS supported by scheduled both audit and re-audit using an extended checklist regular comprehensive checking delegated to another based on that devised by the Association of Antime and performer is recommended as the mandatory aesthetists of Great Britain and Ireland. Ninety compre-use checklist. pleted checklists were analysed for the audit and 24 tests revealed 236 individual faults (range 1.1-64%). Sixty-five (27.5%) could have occurred on a day-today basis and 171 (72.5%) of the faults were non-