RESUMO
In a randomized, double-blind trial, sucralfate therapy, 1 g four times daily, was compared with placebo in 143 symptomatic patients to assess the treatment of gastrointestinal symptoms and gastric mucosal damage associated with nonsteroidal anti-inflammatory drugs (NSAIDs). All patients followed a fixed regimen of NSAIDs, were assigned to one of two groups based on the presence or absence of gastric erosions at baseline endoscopy, and were then assigned randomly to receive sucralfate or placebo for four weeks. Patients were then followed for up to six months while receiving open-label sucralfate 1 g twice daily to up to 1 g four times daily. After four weeks of double-blind therapy, patients taking either nonsalicylate NSAIDs or long half-life NSAIDs and who were treated with sucralfate experienced a significant reduction in both peptic symptom frequency and intensity (p less than 0.03) as compared with patients receiving placebo. Sucralfate-treated patients with baseline endoscopic lesions showed a significant reduction in lesion scores (p less than 0.005) at four weeks as compared with baseline, whereas no improvement was observed in gastric mucosal lesions of patients given placebo. Long-term sucralfate therapy resulted in continued improvement in gastrointestinal symptoms and gastric lesion scores in patients receiving all types of NSAIDs. The results indicate that sucralfate used in conjunction with NSAIDs may allow patients to continue therapy by relieving gastrointestinal symptoms and mucosal damage associated with NSAID therapy.
Assuntos
Anti-Inflamatórios não Esteroides/efeitos adversos , Mucosa Gástrica/efeitos dos fármacos , Gastroenteropatias/induzido quimicamente , Mucosa Intestinal/efeitos dos fármacos , Sucralfato/uso terapêutico , Idoso , Anti-Inflamatórios não Esteroides/metabolismo , Artrite/patologia , Ensaios Clínicos como Assunto , Método Duplo-Cego , Endoscopia , Feminino , Seguimentos , Mucosa Gástrica/patologia , Gastroenteropatias/tratamento farmacológico , Humanos , Mucosa Intestinal/patologia , Masculino , Pessoa de Meia-Idade , Cooperação do Paciente , Distribuição Aleatória , Sucralfato/efeitos adversosRESUMO
We describe our experience with 100 musicians in whom occupation-related difficulties developed. The majority, pianists, experienced hand difficulties in midcareer (average age, 31 years). These were described as "pain, tightening, or weakness" of the right hand or arm or drooping of the fourth or fifth fingers. These difficulties led to loss of control (34%) or diminished facility (18%), endurance (18%), or speed (18%) while playing trills, arpeggios, or octaves requiring fast, forte finger movements. Most commonly found were inflammatory disorders of tendon or joint (45%) or disorders of motor control (24%). Less likely were entrapment of peripheral nerves and noninflammatory tendon or joint disorders.
