Cochrane Db Syst Rev
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Cochrane Db Syst Rev · Jan 2002
ReviewDopamine versus no treatment to prevent renal dysfunction in indomethacin-treated preterm newborn infants.
Indomethacin therapy for closure of patent ductus arteriosus frequently causes oliguria, and occasionally more serious renal dysfunction. Low dose dopamine has been suggested as a means for preventing this side effect. ⋯ There is no evidence from randomized trials to support the use of dopamine to prevent renal dysfunction in indomethacin-treated preterm infants.
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The results from animal studies suggest that opioid antagonists may prevent the reinforcing effects of alcohol consumption. Based on the results of those animal studies, some opioid antagonists, such as, naltrexone, nalmefene, have been studied for their benefits in treating alcohol dependence. ⋯ NTX at the dose of 50 mg/day is effective for alcohol dependence in short-term treatment. The optimal duration of NTX treatment may be longer than 3 months. The evidence so far may be too little to support the superiority of NTX to acamprosate and the inferiority of NTX to disulfiram. NTX treatment should be concurrently given with a psychosocial intervention. Other patterns of NTX administration should not be used at present, e.g., a dose of three times a week, combined NTX with other biological treatments. NMF has no role for the treatment of alcohol dependence in clinical practice. Randomised, double-blind, placebo-controlled trials of NTX treatment in patients with alcohol dependence are still needed. Some issues should be concerned in further studies. Firstly, further trials should be conducted in larger sample sizes and over longer periods of time. Secondly, other than the outcomes relevant to alcohol use, some important outcomes should also be measured, e.g., functioning, health-related quality of life, economic cost. Thirdly, the comparisons between NTX and other treatments for alcohol dependence, both biological and psychosocial, should be investigated. Fourthly, combined treatments of NTX and other biological treatments for alcohol dependence may be in issue of interest. Lastly, high discontinuation rate in both treatment and control groups should be concerned.
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Bone is the most common site of metastatic disease associated with breast cancer, and affects more than half of women during the course of their disease. Bone metastases are a significant cause of morbidity due to pain, pathological fractures, hypercalcaemia and spinal cord compression, and contribute to mortality. Bisphosphonates, which inhibit osteoclast-mediated bone resorption, are standard care for tumour-associated hypercalcaemia, and have been shown to reduce bone pain, improve quality of life, and to delay skeletal events and reduce their number in patients with multiple myeloma. Several randomized controlled trials have evaluated the role of bisphosphonates in breast cancer. ⋯ In women with advanced breast cancer and clinically evident bone metastases, the use of bisphosphonates (oral or intravenous) in addition to hormone therapy or chemotherapy, when compared with placebo or no bisphosphonates, reduces the risk of developing a skeletal event and the skeletal event rate, as well as increasing the time toskeletal event. Bisphosphonates may also reduce bone pain in women with advanced breast cancer and clinically evident bone metastases. In women with early breast cancer the effectiveness of oral clodronate in reducing the incidence of bone metastases remains an open question for research.
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Cochrane Db Syst Rev · Jan 2002
Review Meta AnalysisNonoxynol-9 for preventing vaginal acquisition of HIV infection by women from men.
There is a need for female-controlled methods of HIV prevention. Vaginal microbicides, substances inserted into the vagina to prevent women acquiring HIV and sexually transmitted infections (STIs) from men, could be useful in this regard. One potential vaginal microbicide is the widely used spermicide, nonoxynol-9 (N-9). ⋯ There is no evidence that nonoxynol-9 protects against vaginal acquisition of HIV infection by women from men. There is evidence that it may do harm by increasing the frequency of genital lesions.
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Cochrane Db Syst Rev · Jan 2002
ReviewEpidural blood patching for preventing and treating post-dural puncture headache.
Dural puncture is a common procedure, but leakage of CSF from the resulting dural defect may cause postural headache after the procedure, and this can be disabling. Injecting an epidural blood patch around the site of the defect may stop this leakage, and so may have a role in preventing or treating post dural puncture headache. ⋯ Further, adequately powered, randomised trials (including at least a few hundred patients) are required before reliable conclusions can be drawn about the role of epidural blood patching in the prevention and treatment of post-dural puncture headache.