Módulo 2 (Cont ) Clase 9 - ariadna franco

Vista previa del material en texto

INGLÉS 
Alfabetización Académica y 
Científica 
 
 
Material de cátedra para las carreras de 
Farmacia y Bioquímica 
 
MÓDULO 2: Los géneros discursivos de las 
ciencias de la salud 
Clase 9: El estudio de caso 
 Karina De Francesco – Laura Roseti 
 
 
Cátedra de INGLÉS 
Profesoras de cátedra: Lic. Laura Roseti – Lic. Karina De Francesco 
Jefes de Trabajos Prácticos: Lic. Sandra Lauría – Lic. Natalia Bron – Lic. Érika 
Barochiner 
Ayudantes de Cátedra: Trad. Marisa Tumbeiro – Lic. Leandro Carreño – Trad. Victoria 
Fernández – Prof. María Laura Castiglioni – Prof. Brenda Ertel – Lic. Constanza Barbariol 
 
 
 
 
 
 
 PRE-READING SECTION 
 
1. We have reached our ninth text. Read the title and the key points and zoom in on the 
familiar words and expressions to come up with the general topic of the text. What 
do you think it is about? 
 
2. State a general reading hypothesis based on the information collected so far. 
 
 
 
 
 
 
 
3. Let’s advance a bit further and focus on the rhetorical organisation of this new text. 
What distinctive features can you identify now? Does this text have any 
characteristics in common with the previous ones? Does it correspond to the genres 
we have analysed so far? Why? /Why not? Account for your answer. You might find 
it useful to refer to “Teóricos Nº 6 & Nº 7”. 
 
 
4. Have you identified the different moves? Now, fill in the following table. Have a look 
at the example provided. If it is necessary, refer to the text again. 
 
 
General reading hypothesis: 
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TEXT 9: Probst, Mareike & Kühn, Jens-Peter & Modeß, Christiane & Scheuch, 
Eberhard & Seidlitz, Anne & Hosten, Norbert & Siegmund, Werner & Weitschies, 
Werner. (2017). Muscle Injury After Intramuscular Administration of Diclofenac: A 
Case Report Supported by Magnetic Resonance Imaging. Drug Safety - Case 
Reports. 4. 10.1007/s40800-017-0049-9. 
1 
Does this text 
include this 
information? 
Yes/No 
If so, where? 
How is it 
introduced? 
If not, why do 
you think so? 
Does it state an 
objective? Yes 
In the abstract (The aim 
of this study was to 
evaluate local toxicity in 
a patient using magnetic 
resonance imaging)1 
 
Does it provide any 
information about the 
state of the arts or 
antecedents? 
 
 
Does it pose a problem? 
 
Does it put forward a 
hypothesis? 
 
Does it present any 
materials/ procedures/ 
methods? 
 
 
Does it mention and 
depict the participants 
involved? 
 
 
Does it 
compare/contrast other 
researchers’ 
conclusions/positions? 
 
 
Does the discussion 
analyse the results 
yielded in this work? 
 
 
Is the discussion based 
on the analysis of other 
trials? 
 
 
Does it come to any 
conclusions based on an 
experimental trial? 
 
 
1 Where else is the objective stated? In which of the other moves? Remember that it is always stated twice. 
2 
 
5. Let’s make the most of our discipline-specific genre competence and select two 
moves that will provide you with a general overview of the text. Once you have 
chosen them, scan them to find central ideas. Did you finally identify the genre? It 
would be a good idea to discuss your selection with a peer. 
 
 
6. It is now time to state a very specific reading hypothesis based on the information 
collected so far. 
 
 
 
 
 
1. The prereading section has just finished. Now, read the text in full. 
 
7. The pre-reading section has just finished. Now, read the text in full. 
 
 WHILE-READING SECTION 
 
8. Let’s concentrate on the problem now. Explain the scenario the authors have 
detected. How do they account for the niche that needs to be filled? 
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9. List the main procedures carried out in this study. How are these procedures 
expressed? What verbal forms are used to express them? 
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Specific reading hypothesis: 
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3 
10. Complete the table below with the main findings. 
 
 
INDICATORS 
 
MAIN FINDINGS 
Pain or other symptoms at the 
site of diclofenac 
administration 
 
Recovered volume at injection 
site 
 
Depot volume 
T2-weighed signal 
enhancement 
 
Plasma concentration 
Plasma creatine kinase activity 
Plasma concentrations 
of CRP, PCT and IL-6 
 
 
11. Explain the paradox about the signs and clinical symptoms in this case. 
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4 
 
 
 
12. Summarise the main conclusions and recommendations in your own words. Is the 
hypothesis confirmed or rejected? 
 
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 Focus on linguistic and discursive aspects 
 Focus on causative verbs 
 
The authors have resorted to several to show cause and 
effects in this study. Let’s concentrate on the discussion move. 
 
“Initially, the tissue damage was most likely by local ion 
disequilibrium by infiltration of the highly hypertonic solution.” 
 
This rapid enhancement of the T2-weighted MR signal (…).” 
 
“Cell death is likely by activation of the caspase signalling cascade, 
proteolytic fragmentation of DNA and degradation of the cells (…).” 
 
 
 
13. Now, find other examples of causative verbs, transcribe them below and explain the 
sense expressed by them. 
 
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5 
 
 Focus on impersonality 
 
 is a recurrent feature in scientific discourse. 
is one of the resources to show in a given 
scenario because the and or doer of the action. 
Let’s have a look at the following examples taken from the methods and 
discussion moves: 
“Diclofenac organ injury indirectly by inhibition of 
cyclooxygenase or by metabolic activation of reactive metabolites (…).” Who 
knows what? Who induces organ injury? 
 
“This treatment .” Who tolerates what? Who is the doer 
of the action? 
 
“All measurements according to the instructions.” Is the doer 
of the action mentioned? What is the result of this action? 
 
 
 
 
14. There are many other examples in the methods and results moves. Why do you think 
so? Transcribe the examples you find and provide a Spanish equivalent for each of 
them. 
 
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6 
 
 Focus on negative sense 
 
 
• 
Expressing is a central dimension in scientific 
discourse, especially when scientists aim to convey niches, problems and 
vacant aspects that science has not studied or solved yet. Thus, we will now 
focus on , which are 
. 
Let’s have a look at the following example extracted from the discussion 
move.“The contradiction between the impressive morphological and laboratory signs 
and of clinical symptoms might also result from long-lasting tissue 
deposition of diclofenac, which is known to exert local anaesthetic effects.” 
 
As we can see, this is a noun that is not negative in form, but in fact 
conveys absence (of clinical symptoms). 
If we refer to the abstract, we will find the same concept though 
expressed with a negative element in form (not) and a non-assertive item 
(any). 
“Interestingly, the patient did complain about clinical symptoms at the 
injection site.” 
 
There are other which are very frequent in 
scientific discourse, such as: , , , , , , , 
, , , , , , , , , , 
among others. Pay close attention to them because they can be tricky if you fail 
to interpret the involved. 
 
 
 
 
 
7 
 
 
 
 
 
 
 
 
 
Problems and scientific niches are also expressed by means of 
. Let’s have a look at these 
examples taken from the abstract and introduction moves: 
“Intramuscular injection of diclofenac is still frequently practiced, although 
there is ample evidence that the risk of local tissue intolerability is highly 
.” 
 
“Therefore, obligatory guidelines for safe intramuscular injection, 
including site, dose, and injection technique, are provided by the 
manufacturers of parenteral diclofenac dosage forms; however, the safety 
issue seems to be highly .” 
 
There are many other examples headed by which are 
very frequent in scientific discourse, such as: , , 
, , , (in this text), 
(in this text, too), , , , , , 
, , , , , , , 
among others. Pay close attention to these as they can also be 
problematic if you do not interpret the negative meaning involved. 
 
 
 A bit more on subjectivity: presenting concluding remarks 
 
At the end of a case study, authors discuss the main findings and come 
to conclusions, in which they . In this final 
move, we are likely to find expressions showing , such as 
“injection of diclofenac ”. 
 
 
 
 
8 
15. Go over the text and find other expressions showing explicit subjectivity. Remember 
that they convey the subject’s position towards a scenario. 
 
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16. Select three linking adverbials which are used to express key concepts in the text. 
Analyse the relationship established and the concepts each of them links. 
 
Linking 
adverbial 
Relationship 
expressed 
Concept 1 Concept 2 
 
 
 
 
17. Explain why you selected the linking adverbials above. 
 
………………………………………………………………………………………………………………….……………
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9 
 
 AFTER-READING SECTION 
18. Write the main idea discussed in this text in ONE summative sentence. It must be 
coherent, conceptually correct, complete and specific. Remember your discourse 
must stage an epistemic ethos. Go back to “Teórico Nº 1” to reflect upon the interplay 
between epistemic ethos and scientific discourse. You may also refer to “Teórico Nº 
3” for further information on main ideas. 
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 Bonus track on the ninth text: focus on discourse features of case study reports 
 
 
 We have analysed a . This discourse genre refers to a study 
research paper which examines a person, place, event, phenomenon, or other type 
of subject of analysis in order to extrapolate key themes and results that help 
predict future trends, illuminate previously veiled issues that can be applied to 
practice, and/or provide a means for understanding an important research problem 
with greater clarity. A case study report usually examines a single subject of analysis 
but can also be designed as a comparative investigation that shows relationships 
between two or among more than two subjects. 
• The methods used to study a case can rest within a quantitative, 
qualitative, or mixed-method investigative paradigm. 
• It is highly descriptive. 
 It refers to other voices of authority.
 It shows a high degree of modality expressions to refer to deduction, 
possibility and probability.
 It also shows signs of explicit subjectivity in the discussion and conclusion 
moves.
10 
CASE REPORT
Muscle Injury After Intramuscular Administration of Diclofenac:
A Case Report Supported by Magnetic Resonance Imaging
Mareike Probst1 • Jens-Peter Kühn2,3 • Christiane Modeß4 • Eberhard Scheuch4 •
Anne Seidlitz1 • Norbert Hosten2 • Werner Siegmund4 • Werner Weitschies1
Published online: 25 March 2017
� The Author(s) 2017. This article is an open access publication
Abstract Intramuscular injection of diclofenac is still
frequently practiced, although there is ample evidence that
the risk of local tissue intolerability is highly underesti-
mated. The aim of this study was to evaluate local toxicity
in a patient using magnetic resonance imaging. A patient
who gave written informed consent received a medically
indicated intramuscular administration of diclofenac
75 mg/2 mL. Simultaneously with magnetic resonance
imaging of the depot, a clinical–chemical evaluation and
quantification of diclofenac in plasma was performed. A
manifold enhancement of the T2-weighted magnetic reso-
nance signal was observed in a muscle area of approxi-
mately 60 mL volume, with maximum signal intensity
30 min after injection, the time of maximum diclofenac
plasma exposure. Plasma creatine kinase activity was ele-
vated approximately sixfold within 8 h and normalized
within 1 week, whereas the magnetic resonance enhance-
ment disappeared within 5 weeks. Interestingly, the patient
did not complain about any clinical symptoms at the
injection site. Asymptomatic tissue injury after intramus-
cular injection of diclofenac, caused by intramuscular
dosing, can be reliably evaluated by magnetic resonance
imaging and should be applied early during the develop-
ment of parenteral dosage forms.
Clinical Trials Registration Number: BB130/16 (Ethics
Committee of the University Medicine Greifswald).
Key Points
Local tissue injury following intramuscularly
administered diclofenac can be proven noninvasively
by magnetic resonance imaging.
Introduction
The relief of acute pain syndromes by administration of
intramuscular injections of diclofenac is still frequently
practiced and seems to be a safe and well-tolerated treat-
ment option. The incidence of local adverse events seems
to be rather low—0.05% for abscesses and 0.02% for
necrosis [1]. Common reasons for local complications are
bacterial contamination [2], wrong injection technique, and
wrong injection site [3]. Therefore, obligatory guidelines
for safe intramuscular injection, including site, dose, and
injection technique, are provided by the manufacturers of
parenteral diclofenac dosage forms; however, the safety
issue seems to be highly underestimated. In a survey con-
ducted between 1978 and 2003, only 171 cases with local
& Mareike Probst
mareike.probst@uni-greifswald.de
1 Department of Biopharmaceutics and Pharmaceutical
Technology, Center of Drug Absorption and Transport
(C_DAT), Ernst Moritz Arndt University Greifswald, Felix-
Hausdorff-Straße 3, 17487 Greifswald, Germany
2 Institute of Diagnostic Radiology and Neuroradiology,
University Medicine Greifswald, Ferdinand-Sauerbruch-
Straße, 17475 Greifswald, Germany
3 Institute of Radiology, University Medicine, Carl Gustav
Carus UniversityDresden, Fetscherstraße 74, 01307 Dresden,
Germany
4 Department of Clinical Pharmacology,Center of Drug
Absorption and Transport (C_DAT), University Medicine
Greifswald, Felix-Hausdorff-Straße 3, 17487 Greifswald,
Germany
Drug Saf - Case Rep (2017) 4:7
https://doi.org/10.1007/s40800-017-0049-9
http://orcid.org/0000-0001-5350-928X
http://crossmark.crossref.org/dialog/?doi=10.1007/s40800-017-0049-9&domain=pdf
http://crossmark.crossref.org/dialog/?doi=10.1007/s40800-017-0049-9&domain=pdf
https://doi.org/10.1007/s40800-017-0049-9
injuries, including necrosis, abscess, necrotizing fasciitis
and myositis, were related to the consumption of 100
million ampules of Voltarol�, and only nine patients
complained of pain at the injection site [4].
Since local tissue injury after diclofenac is rarely asso-
ciated with relevant subjective symptoms, it can be
assumed that many cases are not recognized in clinical
practice. The issue may be more severe than assumed to
date. In a recent experimental study in rats to investigate
the disposition of intramuscularly injected depots, we
incidentally observed that all animals that received an
aqueous solution or oily suspension of diclofenac respon-
ded with local inflammatory intolerance [5]. This included
long-lasting fluid accumulation at the site of intramuscular
injection and infiltration of the muscle tissue with neu-
trophil granulocytes, as well as the development of necrotic
changes as confirmed by magnetic resonance (MR) imag-
ing and histopathological evaluation. The severity of
inflammation was dependent on dose and the pharmaceu-
tical formulation of the drug. To support our hypothesis
that intramuscular injection of diclofenac leads to muscle
damage in humans, we provide the clinical case report of a
patient who gave written consent to take extra blood
specimens for laboratory evaluations and determination of
diclofenac pharmacokinetics, as well as for MR imaging
after a medicinally indicated intramuscular diclofenac
injection.
Methods
A physician (aged 65 years, body weight 90 kg, body
height 182 cm) who is familiar with the safety issue
described above, prescribed himself an intragluteal injec-
tion of diclofenac (Diclofenac-Ratiopharm� 75 mg/2 mL;
Ratiopharm, Ulm, Germany) as a result of a painful
enthesopathy of the right musculus gluteus minimus, and
initiated additional clinical–chemical evaluations and MR
imaging of the left gluteal region to evaluate a potential
muscle injury at the injection site. The diagnosis was
confirmed by MR imaging approximately 1 year prior to
commencement of the study. The patient commonly
swallowed ibuprofen lysine (684 mg) or diclofenac
(50 mg) on demand, i.e. after the occurrence of pain fol-
lowing stronger physical exercise. This treatment has been
well tolerated. The additional diagnostic procedures have
been approved by the local ethics committee under registry
number BB130/16. The osmolality of the aqueous
diclofenac solution was 2850 ± 121 mOsmol/kg (Vapour
Pressure Osmometer; Knauer, Berlin, Germany) and the
pH was 8.19 ± 0.03 (Five Easy; Mettler Toledo, Grei-
fensee, Switzerland). MR imaging in the supine position
was performed using a 3-Tesla scanner (Verio; Siemens
Healthcare, Erlangen, Germany) before and 2, 12, 22, 32,
47, 62, 92, 122, 182, 242 min after, as well as 7.5 h and 1,
2, 7 and 14 days after intramuscular administration. A T2-
weighted turbo spin echo sequence including fat saturation
was applied with the following parameters: 6960 ms rep-
etition time, 91 ms echo time, 60 slices of 2-mm thickness
and 2-mm spacing in between, 150 � flip angle,
450 9 370 mm field of view, and 256 9 170 mm matrix.
Volume and signal intensity of the depot was assessed
using the OsiriX Imaging Software 3.9 32-Bit (Pixmeo
Sarl, Bernex, Switzerland). Blood was sampled via an
indwelling cannula placed in a forearm vein before and 10,
20, 30 and 45 min after, as well as 1, 1.5, 2, 2.5, 3, 3.5, 4, 5,
6, 8 and 24 and 48 h after administration to measure
plasma concentrations of diclofenac and the biomarkers
creatine kinase (CK), C-reactive protein (CRP), Procalci-
tonin (PCT) and Interleukin-6 (IL-6). Quantitative analysis
of diclofenac concentration in plasma was performed using
a validated liquid chromatography-tandem mass spec-
trometry (LC–MS/MS) method as previously described [5].
The biomarkers were quantified using commercially
available kits for PCT (ADVIA Centaur; Siemens Health-
care, Eschborn, Germany), IL-6 (Brahms, Hennigsdorf,
Germany; and Cobas e411, Roche, Mannheim, Germany),
CRP and CK (Dimension Vista; Siemens Healthcare,
Eschborn, Germany). All measurements were carried out
according to the instructions of the manufacturer, and
complied with the national regulations on laboratory
quality assurance [6].
Results
The patient did not complain of pain and other symptoms
at the site of diclofenac administration, neither immedi-
ately nor some time after the injection, despite the
expectant attitude of the informed subject. The contralat-
eral tendinous gluteal pain was relieved for approximately
4 h but occurred again thereafter, however with tolerable
intensity.
Shortly after intragluteal administration of diclofenac
75 mg in 2 mL aqueous solution, the recovered volume at
the injection site was approximately 6 mL, as measured
using T2-weighted, MR-based volumetry. The depot vol-
ume increased to 37 mL within 45 min, then decreased to
17 mL after approximately 4 h, before it increased again to
reach a maximum of 60 mL 24 h after injection. The
watery inhomogeneity was seen in the MR images over
several weeks. The T2-weighted signal enhancement,
quantified as contrast-to-noise ratio (CNR), reached its
maximum just immediately after injection, and then
declined rapidly within 2 h to a long-lasting plateau level
that disappeared after several weeks (Figs. 1, 2).
7 Page 2 of 5 M. Probst et al.
After intramuscular injection, diclofenac reached a
maximum plasma concentration of approximately 1.4 lg/
mL after 30 min and was eliminated in a biphasic manner,
with half-lives of 0.63 h (a-slope) and 1.36 h (b-slope).
Plasma creatine kinase activity was elevated more than
sixfold within 8 h after diclofenac injection, and returned
to baseline levels after 1 week (Fig. 2). Plasma concen-
trations of CRP, PCT and IL-6 were not changed from
baseline after diclofenac administration.
Fig. 1 T2-weighted transverse magnetic resonance images of the left gluteal region before and after a 2 mL injection of diclofenac watery
solution. Arrows indicate the site of injection and volume of the enhanced muscle tissue
MRI Study of Intramuscular Diclofenac Page 3 of 5 7
Discussion
The single MR-guided intramuscular injection of diclofe-
nac 75 mg in 2 mL solution unexpectedly damaged
approximately 60 mL of gluteal muscle tissue of the
patient, as confirmed by long-lasting, manifold enhance-
ment of the T2-weighted MR signal in that area and ele-
vation of the plasma CK activity for longer than 48 h.
Initially, the tissue damage was most likely triggered by
local ion disequilibrium caused by infiltration of the highly
hypertonic solution (2850 mOsmol/kg). This resulted in
rapid enhancement of the T2-weighted MR signal, with
maximum signal intensity approximately 30 min after
injection, which was also the time of maximum diclofenac
plasma exposure. This means that diclofenac must have
been almost fully absorbed from the injection depot at that
time. Consequently, the highest volume of the injured
muscle area being detected 24 h after the injection cannot
be explained by the osmotic pressure of the injected solu-
tion alone.
Diclofenac is known to induce organ injury indirectly by
inhibition of the cyclooxygenase (e.g. gastrointestinal
erosions and bleedings, renal tubular damage) or by
metabolic activation of reactive metabolites that exert cell
stress, impair mitochondrial functions, or trigger specific
immune reactions in genetically predisposed subjects (e.g.
drug-induced liverinjury) [7]. However, tissue injury after
intramuscular injection into the recommended gluteal
region is most likely caused by direct cytotoxicity, as
already observed in gastric mucosal cells [8], osteoblasts
[9], and tumor cells [10]. Cell death is likely induced by
activation of the caspase signaling cascade, leading to
proteolytic fragmentation of DNA and degradation of the
cells [11], even though the activation mechanisms of the
proapoptotic signal pathways by diclofenac have not been
fully understood to date. However, local toxicity of
diclofenac can be influenced by the pH-dependent solu-
bility of the drug [12]. Traces of diclofenac might precip-
itate at the injection site even after a minor drop in the pH
value, as caused by local tissue congestion, ion disequi-
librium, or inflammatory changes, leading to longer lasting
exposure of the affected area and perpetuation of the local
toxicity. The plasma CK activity, a biomarker for the
muscle tissue injury, was already elevated 1 h after injec-
tion of the drug and reached its maximum, at the earliest,
after 8 h (Fig. 2). The biphasic elimination profile, with
half-lives of 0.63 and 1.4 h, supports the hypothesis that
parts of the dose are absorbed from a depot with a slower
input rate. Furthermore, the patient did not complain of any
pain at the injection site, as expected by the extent of the
putative muscle injury visualized by MR imaging. The
contradiction between the impressive morphological and
laboratory signs and lack of clinical symptoms might also
result from long-lasting tissue deposition of diclofenac,
which is known to exert local anesthetic effects [13, 14]. In
that context, it should be reminded that every single rat in
our previous experimental study showed a massive T2
enhancement at the injection site [5].
Conclusion
Asymptomatic tissue injury after intramuscular adminis-
tration of diclofenac seems to be a frequent or regular local
finding, even though the injection technique is fully in
adherence with the obligatory guidelines for intramuscular
Fig. 2 CNR of the T2-
enhanced muscle area (filled
square), plasma concentrations
of diclofenac (ng/mL, filled
circle), and activity of creatine
kinase (lkatal/L, filled triangle)
after intramuscular injection of
diclofenac 75 mg in a 2-mL
solution. CNR contrast-to-noise
ratio
7 Page 4 of 5 M. Probst et al.
administration in humans. Therefore, intramuscular injec-
tion of diclofenac should be carefully practiced, focusing
on the individual benefit–risk balance. To our experience,
local toxicity caused by intramuscular dosing of drugs can
be reliably evaluated by non-invasive MR imaging, and
should be applied in the very early stages of the evaluation
of parenteral dosage forms.
Acknowledgements The authors thank Gitta Schumacher, Sabine
Bade, Danilo Wegner, Andrea Seidel, and Stefan Hadlich for excel-
lent technical assistance.
Compliance with Ethical Standards
Funding This work was supported by the InnoProfile grant COM_-
DAT [03IPT612X] of the German Federal Ministry of Education and
Research (BMBF).
Conflicts of interest Mareike Probst, Jens-Peter Kühn, Christiane
Modeß, Eberhard Scheuch, Anne Seidlitz, Norbert Hosten, Werner
Siegmund and Werner Weitschies declare that they have no conflicts
of interest.
Ethical approval All procedures performed in studies involving
human participants were in accordance with the ethical standards of
the institutional and/or national research committee and with the 1964
Helsinki declaration and its later amendments or comparable ethical
standards.
Informed consent Informed consent was obtained from all individ-
ual participants included in the study.
Open Access This article is distributed under the terms of the
Creative Commons Attribution-NonCommercial 4.0 International
License (http://creativecommons.org/licenses/by-nc/4.0/), which per-
mits any noncommercial use, distribution, and reproduction in any
medium, provided you give appropriate credit to the original
author(s) and the source, provide a link to the Creative Commons
license, and indicate if changes were made.
References
1. Serratrice G. Study of diclofenac injectable. Tribune Med.
1982;46:43–8.
2. Rygnestad T, Kvam AM. Streptococcal myositis and tissue
necrosis with intramuscular administration of diclofenac (Volta-
ren). Acta Anaesthesiol Scand. 1995;39:1128–30.
3. Hegan T. Non steroidals, needles and negligence. Medical Pro-
tection Society casebook. Leeds: Medical Protection Society;
2002. p. 12–3.
4. O’Sullivan DP. Intramuscular diclofenac: 25 years worldwide
safety perspective is vital to consider. Response to: Wright PJ,
English PJ, Hungin APS, Marsden SNE. Managing acute renal
colic across the primary-secondary care interface: a pathway of
care based on evidence and consensus. BMJ. 2002;325:1408–12.
5. Probst M, Kühn J-P, Scheuch E, Seidlitz A, Hadlich S, Evert K,
et al. Simultaneous magnetic resonance imaging and pharma-
cokinetic analysis of intramuscular depots. J Control Release.
2016;227:1–12.
6. Revision of the. ‘‘Guideline of the German Medical Association
on Quality Assurance in Medical Laboratory Examinations—
Rili-BAEK’’ (unauthorized translation). J, Lab Med.
2015;39:26–69.
7. Aithal GP, Ramsay L, Daly AK, Sonchit N, Leathart JBS,
Alexander G, et al. Hepatic adducts, circulating antibodies, and
cytokine polymorphisms in patients with diclofenac hepatotoxi-
city. Hepatology. 2004;39:1430–40.
8. Kusuhara H, Matsuyuki H, Matsuura M, Imayoshi T, Okumoto T,
Matsui H. Induction of apoptotic DNA fragmentation by nons-
teroidal anti-inflammatory drugs in cultured rat gastric mucosal
cells. Eur J Pharmacol. 1998;360:273–80.
9. Chang J-K, Wang G-J, Tsai S-T, Ho M-L. Nonsteroidal anti-
inflammatory drug effects on osteoblastic cell cycle, cytotoxicity,
and cell death. Connect Tissue Res. 2005;46:200–10.
10. Kim T, Jin S, Kim W, Kang E, Choi K, Kim H, et al. Prolonged
activation of mitogen-activated protein kinases during NSAID-
induced apoptosis in HT-29 colon cancer cells. Int J Colorectal
Dis. 2001;16:167–73.
11. Gómez-Lechón MJ, Ponsoda X, O’Connor E, Donato T, Jover R,
Castell JV. Diclofenac induces apoptosis in hepatocytes. Toxicol
In Vitro. 2003;17:675–80.
12. Ledwidge MT, Corrigan OI. Effects of surface active character-
istics and solid state forms on the pH solubility profiles of drug–
salt systems. Int J Pharm. 1998;174:187–200.
13. Cairns BE, Mann MK, Mok E, Dong X-D, Svensson P.
Diclofenac exerts local anesthetic-like actions on rat masseter
muscle afferent fibers. Brain Res. 2008;1194:56–64.
14. Nakamura M, Jang I-S. pH-dependent inhibition of tetrodotoxin-
resistant Na? channels by diclofenac in rat nociceptive neurons.
Prog Neuropsychopharmacol Biol Psychiatry. 2016;64:35–43.
MRI Study of Intramuscular Diclofenac Page 5 of 5 7
	Muscle Injury After Intramuscular Administration of Diclofenac: A Case Report Supported by Magnetic Resonance Imaging
	Abstract
	Introduction
	Methods
	Results
	Discussion
	Conclusion
	Acknowledgements
	References