Non-steroidal Anti-inflammatory Medicines Research Articles

Direct repair of spondylolytic defects in young competitive athletes

Background context: Operative treatment of symptomatic spondylolysis is rare. A variety of surgeries have been described. In general, reported operative success rates are high, although in most studies the successful return to sport of the competitive athlete is not detailed. Purpose: To review outcome, specifically return to sport, in a group of competitive athletes after direct pars repair for symptomatic spondylolysis. Study design/setting: This was a retrospective case series of a single surgeon. Patient sample: Series of four athletes who underwent direct pars repair over an 18-month period. Outcome measures: Return to their sport. Methods: Chart review of all patients who had undergone a single-level pars repair over an 18-month period. All patients had normal discs above the level of the repair. Postoperative clinical course was determined for all patients. Results: The patients participated in different sports. All were able to return to their presymptomatic level of activity with no restriction. One had periodic low back pain that required nonsteroidal anti-inflammatory medicine as needed. The others were entirely asymptomatic. Conclusions: This small series suggests that with specific inclusion criteria, a select group of motivated athletes can expect to return to their sport after direct pars repairs for symptomatic spondylolysis that has failed conservative treatment.

Alcoholic drinks: Important triggers for asthma

Background: Although anecdotally alcoholic drinks seem to be common triggers for asthma, little is known of the prevalence, the characteristics, or the mechanisms underlying these reactions. Objectives: The primary aim of this study was to determine the frequency and characteristics of asthmatic reactions triggered by alcoholic drinks in a community-based cohort of asthmatic subjects. Investigations of other food sensitivities were also completed to explore some of the possible components of alcoholic drinks that may be responsible for these asthmatic responses. Methods: A validated food allergy questionnaire was used to assess the characteristics of alcoholic drink–induced asthma in 366 adult patients recruited from the Asthma Foundation of Western Australia. The food allergy questionnaire was sent out by mail and self-administered by recipients. Results: Thirty-three percent of respondents indicated that alcoholic drinks had been associated with the triggering of asthma on at least 2 occasions. Wines were the most frequent triggers, with responses being rapid in onset (<1 hour) and of mild to moderate severity. Logistic regression analysis indicated that wine-induced asthmatic reactions were reported more often by women (P = .032), by those taking oral steroids (P = .021), by individuals who had reported their first asthma attack at a younger age (P < .001), and by those who had previously visited an alternative health practitioner for asthma (P = .041). A significant association between wine-induced asthma and asthma triggered by sulfite-containing foods (P < .001) and by aspirin and nonsteroidal anti-inflammatory medicines (P = .01) was also observed. Conclusion: Alcoholic drinks, and particularly wines, appear to be important triggers for asthmatic responses. Sensitivity to the sulfite additives in wines seems likely to play an important role in many of these reactions. Sensitivities of individuals to salicylates present in wines may also play a role. (J Allergy Clin Immunol 2000;105:462-7.)

Analysis of Medications Used in the Treatment of Cervical Disk Degeneration

This review focuses on the scientific design and concepts of drug management of cervical disk disorders. Steroids, nonsteroidal anti-inflammatory medicines, narcotics, antidepressants and muscle relaxants are discussed.

The Use of Night Splints for Treatment of Recalcitrant Plantar Fasciitis

This study reports the results of the use of molded ankle foot orthosis night splints for the treatment of recalcitrant plantar fasciitis on 14 patients with a total of 18 symptomatic feet. All patients had symptoms for greater than 1 year and had previously undergone treatment with non-steroidal anti-inflammatory medicines, cortisone injections, shoe modifications, and physical therapy without resolution. All patients were provided with custom-molded polypropylene ankle foot orthoses in 5 degrees of dorsiflexion to be used as a night splint. With continued use of nonsteroidal anti-inflammatory medication, Tuli heel cups, Spenco liners, and general stretching exercises, successful resolution occurred in 11 patients in less than 4 months. There were three failures. It is felt that the use of night splints provides a useful, cost-effective adjunct to current therapeutic regimens of plantar fasciitis.

Factors affecting the kinetics of two benzothiazine non-steroidal anti-inflammatory medicines, piroxicam and isoxicam

The pharmacokinetics of isoxicam and piroxicam were compared in 12 young adults (less than 40 years) and 12 elderly subjects (greater than 65 years). After a single oral dose of 200 mg isoxicam or 20 mg piroxicam blood samples were taken for 168 h and the plasma drug concentrations determined by HPLC. The elimination half life of piroxicam for the adults was 57.1 +/- 16.4 h (mean +/- SD; harmonic mean 52.9 h) and for the elderly subjects was 57.8 +/- 22.1 h (harmonic mean 52.1 h). The corresponding values after isoxicam were 34.3 +/- 13.6 h (harmonic mean 31.6) for the adults and 39.1 +/- 22.7 h (harmonic mean 33.5) for the elderly subjects. Similarly no differences were noted in either the AUC0-infinity after piroxicam (adults 154.1 +/- 52.2 micrograms . h/ml, elderly 163.6 +/- 99.1 micrograms . h/ml) and isoxicam (adults 642.7 +/- 241.9 micrograms . h/ml, elderly 787.9 +/- 613.1 micrograms . h/ml) or the apparent oral clearance of piroxicam (adults 2.39 +/- 0.80 ml/min, elderly 2.51 +/- 0.90 ml/min) and isoxicam (adults 5.84 +/- 2.04 ml/min, elderly 5.59 +/- 2.12 ml/min). One adult and two elderly subjects exhibited slower elimination of both medicines than the remainder of each group. However determination of the oxidation phenotype using sparteine metabolism showed that this was not a likely determinant of the reduced clearance.