Cochrane Db Syst Rev
-
Cochrane Db Syst Rev · Jan 2013
Review Meta AnalysisDiagnostic accuracy of laparoscopy following computed tomography (CT) scanning for assessing the resectability with curative intent in pancreatic and periampullary cancer.
Surgical resection is the only potentially curative treatment for pancreatic and periampullary cancer. A considerable proportion of patients undergo unnecessary laparotomy because of underestimation of the extent of the cancer on computed tomography (CT) scanning. Laparoscopy can detect metastases not visualised on CT scanning, enabling better assessment of the spread of cancer (staging of cancer). There has been no systematic review or meta-analysis assessing the role of diagnostic laparoscopy in assessing the resectability with curative intent in patients with pancreatic and periampullary cancer. ⋯ Diagnostic laparoscopy may decrease the rate of unnecessary laparotomy in patients with pancreatic and periampullary cancer found to have resectable disease on CT scan. On average, using diagnostic laparoscopy with biopsy and histopathological confirmation of suspicious lesions prior to laparotomy would avoid 23 unnecessary laparotomies in 100 patients in whom resection of cancer with curative intent is planned.
-
Cochrane Db Syst Rev · Jan 2013
ReviewLow molecular weight heparin for prevention of microvascular occlusion in digital replantation.
The success of digital replantation is highly dependent on the patency of the repaired vessels after microvascular anastomosis. Antithrombotic agents are frequently used for preventing vascular occlusion. Low molecular weight heparin (LMWH) has been reported to be as effective as unfractionated heparin (UFH) in peripheral vascular surgery, but with fewer adverse effects. Its benefit in microvascular surgery such as digital replantation is unclear. ⋯ Current limited evidence based on two small-scaled low-to-medium quality randomised trials found no differences in the success rate of replantation between LMWH and UFH, but a lower risk of postoperative bleeding and hypocoagulability after the use of LMWH. Further well-designed and adequately powered clinical trials are warranted.
-
Cochrane Db Syst Rev · Jan 2013
ReviewProstaglandins before caesarean section for preventing neonatal respiratory distress.
Respiratory distress (RD) can occur in both preterm and term neonates born through normal vaginal delivery or caesarean section (CS). It accounts for about 30% of neonatal deaths and can occur at any time following birth. Respiratory distress syndrome (RDS), transient tachypnoea (rapid breathing) of the newborn and persistent pulmonary hypertension (increased blood pressure of pulmonary vessels) of the newborn are the most frequent clinical presentations of neonatal RD. Prostaglandins are used in routine obstetric practice to ripen the uterine cervix and to trigger labour, with those of the E series being preferred over others due to the fact that they are more uteroselective. Administration of prostaglandins to an expectant mother before delivery causes reabsorption of lung fluid from the fetal lung and promotes surfactant secretion by inducing a catecholamine surge. As a result, significant reduction in neonatal respiratory morbidity following a CS could be obtained, leading to reduced long-term complications such as bronchopulmonary dysplasia (chronic lung disease with lung tissue modification) and asthma. ⋯ Although the trial authors reported a significant increase in catecholamine levels in the intervention group, there was no significant difference in the respiratory outcomes between intervention and control groups. The quality of evidence was graded as low because the sample size was small and there were few events. No definite conclusions can thus be drawn on the effects of prostaglandins on neonatal respiratory outcomes from this review.
-
Cochrane Db Syst Rev · Jan 2013
ReviewAntiepileptic drugs for the primary and secondary prevention of seizures after subarachnoid haemorrhage.
Subarachnoid haemorrhage may result in seizures both acutely and in the longer term. The use of antiepileptic drugs (AEDs) in the primary and secondary prevention of seizures after subarachnoid haemorrhage is uncertain, and there is currently no consensus on treatment. ⋯ There was no evidence to support or refute the use of antiepileptic drugs for the primary or secondary prevention of seizures related to subarachnoid haemorrhage. Well-designed randomised controlled trials are urgently needed to guide clinical practice.
-
Cochrane Db Syst Rev · Jan 2013
Review Meta AnalysisSumatriptan plus naproxen for acute migraine attacks in adults.
Migraine is a common disabling condition and a burden for the individual, health services, and society. Effective abortive treatments include the triptan and non-steroidal anti-inflammatory classes of drugs. These drugs have different mechanisms of action and combining them may provide better relief. Sumatriptan plus naproxen is now available in combination form for the acute treatment of migraine. ⋯ Combination treatment was effective in the acute treatment of migraine headaches. The effect was greater than for the same dose of either sumatriptan or naproxen alone, but additional benefits over sumatriptan alone are not large. More participants achieved good relief when medication was taken early in the attack, when pain was still mild. Adverse events were more common with the combination and sumatriptan alone than with placebo or naproxen alone.