Maciej Romanowski

Background: Diclofenac is a phenylacetic acid derivative classified as a non-selective COX inhibitor. Similar to other NSAIDs, it is characterized by anti-inflammatory, antipyretic, and analgesic effects. Long-term therapy with diclofenac might also lead to severe gastrointestinal, renal, or cardiovascular systems disorders. Aim of the study was to compare own formulation prepared from pharmaceutical raw materials with ready-to-use diclofenac product. Methods: In the in vitro permeation experiments, human skin was excised from the abdomen of living patients as a result of plastic surgery. The transdermal semi-solid formulations were compounded using Pentravan^®, a ready-to-use transdermal base and hydrophilic gel base (Celugel). In vitro Penetration Studies, HPLC analysis, optical microscopy imaging, and a spreadability test were conducted. Rheological analysis provided insights into flow behavior, structure, and thixotropy. Results: Combination of Celugel with diclofenac sodium and the addition of substances acting as absorption enhancers, e.g., menthol, may provide an interesting alternative for enteral drugs, especially in patients with multimorbidity and polypharmacy. Conclusions: Topical diclofenac sodium with of addition of permeation enhancers like menthol might provide higher drug concentrations in the surrounding tissues and better analgesic and anti-inflammatory effects in compare to commercially available product and may provide optimum effectiveness with minimal risk of adverse effects, particularly in elderly and polymedicated patients.

The compositions based on Pentravan^® vehicle were prepared with (S)-naproxen, and its salt —(S)-naproxenate of L-prolinium isopropyl ester as active pharmaceutical ingredients, and two penetration enhancers from the group of sensates—menthol and Capsicum Tincture. Thermophysical properties of the mixtures of each naproxen form with enhancers were determined by DSC method. The stability of the prepared compositions after one- and three-month storage and the rheological properties were investigated. The permeation of active ingredients through the human skin was evaluated based on the in vitro study in Franz diffusion cells using the prepared compositions with each naproxen form. Increase in the permeability of the naproxen salt, especially in the presence of Capsicum Tincture, provides much faster and greater penetration of the skin by the drug. It seems to be promising the use of the developed composition in the form of pain relief and anti-inflammatory creams, occlusive compresses or topical patches. Moreover, the developed compositions can be crucial for the topical compositions made in compounding pharmacies by physicians’ recipes in individual pain pharmacotherapy.

Tailgut cysts are rare lesions which are found in the rectorectal space. They develop in the final section of the intestine from which the rectum and anus extend and vary from being asymptomatic to symptomatic due to pressure on organs or nerves. Tailgut cysts are more common in females, usually between 30 and 60 years of age. They are thought to be benign, with variable malignancy risks. Surgical excision followed by histological examination is the gold standard of treatment, but access and approach to tailgut cysts depend on the location and morphology of the lesion. We present two symptomatic cases of this very rare pathology. In both cases, the cyst and coccyx bone were successfully excised using different approaches. The first patient was a 40-year-old woman with a large cyst which caused morning tenesmus, urinary outflow disorders and painful ovulation. Due to the cyst size, laparotomy was performed, and a combined approach was used. The second patient is a 36-year-old woman with co-existing endometriosis and a cyst causing pain in the sacral spine, constipation and tenesmus. The tumor was excised using a Kraske approach, and due to the infiltration of the coccyx bone it was removed using an osteotome. In this patient, perforation of the cyst was also observed. Both patients completed follow-ups involving regular surgical check-ups and MRI scans. Descriptions of different symptoms and surgical approaches make our study an important source of knowledge for diagnosing and treating these very rare tumors.