We compared intravenous immunoglobulin (IVIG) and plasma exchange (PLEX) in the treatment of 50 patients with Guillain-Barré syndrome (GBS). Standard outcome measures did not differ for the two groups. Sixty-one percent of the PLEX-treated group and 69% of the IVIG-treated group improved by one disability grade at 1 month. The complication rate was higher in the PLEX-treated group. We conclude that the efficacy of IVIG in the treatment of GBS is comparable with that of PLEX and that it can be used safely, although we had a small number of patients. We did not observe a higher relapse rate with IVIG. The usefulness of combination therapy is unknown at this time.

Aspirin ingestion within the previous 7-10 days is often considered a relative contraindication to performing invasive procedures. However, aspirin is an important component of many patients' treatment and withholding therapy for this time may be dangerous. To measure both the magnitude of the impairment in primary haemostasis induced by aspirin and how much recovery of platelet function occurs within 48 h of stopping aspirin, we studied serial changes in bleeding time (BT) in a randomized, double-blind, placebo-controlled study. Fifty-two healthy volunteers had BT performed before and at 2, 9, 24 and 48 h after a 7-day course of either aspirin 75 mg, 300 mg or placebo. The main outcome recorded was BT at each time. Nearly 25% of subjects had extended BT to more than 10 min, but no BT were greater than 10 min, 48 h after stopping aspirin. There was a small but statistically significant (P < 0.01) difference between the 48-h and baseline BT in both aspirin groups (49 and 64 s in the 75 mg and 300 mg groups, respectively). There was no difference in the magnitude or time course of effect between low and medium dose aspirin (P = 0.392 and P = 0.797, respectively). We conclude that despite considerable inter-individual variability in the magnitude of aspirin effect on primary haemostasis, the time course of effect was consistent. In healthy volunteers, the defect in primary haemostasis had largely disappeared 48 h after the last dose.

To improve the oral bioavailability of poorly water-soluble ibuprofen with poloxamer and menthol, the effects of menthol and poloxamer 188 on the aqueous solubility of ibuprofen were investigated. The dissolution and pharmacokinetic study of ibuprofen delivered by the ibuprofen-loaded preparations composed of poloxamer 188 and menthol were then performed. In the absence of poloxamer, the solubility of ibuprofen increased until the ratio of menthol to ibuprofen increased from 0:10 to 4:6 followed by an abrupt decrease in solubility above the ratio of 4:6, indicating that four parts menthol formed eutectic mixture with six parts ibuprofen. In the presence of poloxamer, the solutions with the same ratio of menthol to ibuprofen showed an abrupt increase in the solubility of ibuprofen. The poloxamer gel with menthol/ibuprofen ratio of 1:9 and higher than 15% poloxamer 188 showed the maximum solubility of ibuprofen, 1.2 mg/mL. The simultaneous addition of menthol and poloxamer 188 significantly improved the dissolution rates of ibuprofen from aqueous solution due to the ibuprofen solubility-improving effect of menthol in the presence of poloxamer. Furthermore, the ibuprofen-loaded preparation with menthol and poloxamer 188 gave significantly higher initial plasma concentrations, Cmax, and AUC of ibuprofen than did the preparation without menthol and poloxamer 188, indicating that the simultaneous addition of menthol and poloxamer 188 could improve the oral bioavailability of ibuprofen in rats. In modern pain management it is always desirable for the ibuprofen-loaded preparation with poloxamer 188 and menthol to show a rapid onset of action with a minimal phase of lag time to feel the decreased pain. From an industry point of view, it is more desirable for a formulation to be fast acting, easy to use, and cost effective. Thus, the ibuprofen-loaded preparation with poloxamer 188 and menthol was a more effective oral dosage form for poorly water-soluble ibuprofen.

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