Cochrane Db Syst Rev
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Cochrane Db Syst Rev · Jan 2004
ReviewStrategies for detecting colon cancer and/or dysplasia in patients with inflammatory bowel disease.
Patients with longstanding ulcerative colitis and colonic Crohn's disease have an increased risk of colorectal cancer compared with the general population. This review assesses the evidence that endoscopic surveillance may prolong life by allowing earlier detection of colon cancer or its pre-cursor lesion, dysplasia in patients with inflammatory bowel disease. ⋯ There is no clear evidence that surveillance colonoscopy prolongs survival in patients with extensive colitis. There is evidence that cancers tend to be detected at an earlier stage in patients who are undergoing surveillance and these patients have a correspondingly better prognosis but lead-time bias could contribute substantially to this apparent benefit. There is indirect evidence that surveillance is likely to be effective at reducing the risk of death from IBD-associated colorectal cancer and indirect evidence that it is acceptably cost-effective.
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Acute haematoma of the pinna is a condition where a collection of blood forms beneath the perichondrial layer of the pinna. It is usually caused by blunt trauma, and if untreated will ultimately result in a deformity commonly known as 'cauliflower ear' or 'wrestler's ear'. Various treatments are employed to relieve the haematoma but no clear consensus exists on the best way to do so in order to produce the best cosmetic result with the least permanent deformity. ⋯ There is no clearly defined best treatment for acute auricular haematoma. There are no good quality data to determine either the optimal management strategy or even whether post-drainage intervention (such as splinting or bandaging) is necessary. Further research is required before any specific treatment may be recommended.
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Hip fracture in the elderly usually results from a fall on the hip. Hip protectors have been advocated as a means to reduce the risk of sustaining a hip fracture. ⋯ There is no evidence of effectiveness of hip protectors from studies in which randomisation was by individual patient within an institution, or for those living in their own homes. Data from cluster randomised studies indicate that, for those living in institutional care with a high background incidence of hip fracture, a programme of providing hip protectors appears to reduce the incidence of hip fractures. Acceptability by users of the protectors remains a problem, due to discomfort and practicality.
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Colchicine has been used for patients with primary biliary cirrhosis because of its immunomodulatory and antifibrotic potential. The therapeutical responses to colchicine in randomised clinical trials were inconsistent. ⋯ We did not find evidence either to support or refute the use of colchicine for patients with primary biliary cirrhosis. As we are not able to exclude a detrimental effect of colchicine, we suggest that it is only used in randomised clinical trials.
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Cochrane Db Syst Rev · Jan 2004
ReviewRecombinant Factor VIIa concentrate versus plasma derived concentrates for the treatment of acute bleeding episodes in people with Haemophilia A and inhibitors.
In some people with haemophilia, therapeutic clotting agents are recognised as a foreign protein and anti-FVIII antibodies, known as 'inhibitors', are produced. This review investigates which treatment most effectively arrests acute bleeding in people with haemophilia A and inhibitors. ⋯ No RCTs on the relative effectiveness of Recombinant FVIIa concentrate compared to human plasma-derived concentrates in people with haemophilia A and inhibitors were identified for inclusion in this review. The research evidence on which to base clinical decisions is therefore limited to case reports, and other less robust evidence. There is need for a well-designed, adequately-powered randomised controlled trial to assess the relative benefits and risks of using Recombinant FVIIa concentrate compared to human plasma-derived concentrates in people with haemophilia A and inhibitors.