Cochrane Db Syst Rev
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Cochrane Db Syst Rev · Jan 2002
Review Meta AnalysisOral theophylline for chronic obstructive pulmonary disease.
Oral theophylline has, for many years, been used as a bronchodilator in patients with COPD. Despite the introduction of new drugs, and its narrow therapeutic index, theophylline is still recommended for COPD treatment. ⋯ Theophylline has a modest effect on FEV1 and FVC and slightly improves arterial blood gas tensions in moderate to severe COPD. These benefits were seen in patients receiving a variety of different concomitant therapies. Improvement in exercise performance depended on the method of testing. There was a very low dropout rate in the studies that could be included in this review, which suggests that recruited patients may have been known by the investigators to be theophylline tolerant. This may limit the generalisability of these studies.
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Cochrane Db Syst Rev · Jan 2002
ReviewTranscutaneous electrical nerve stimulation and acupuncture for primary dysmenorrhoea.
Dysmenorrhoea is the occurrence of painful menstrual cramps of the uterus. Medical therapy for dysmenorrhoea commonly consists of nonsteroidal anti-inflammatory drugs or the oral contraceptive pill both of which work by reducing myometrial (uterine muscle) activity. However, these treatments are accompanied by a number of side effects, making an effective non-pharmacological method of treating dysmenorrhoea of potential value. Transcutaneous electrical nerve stimulation (TENS) is a treatment that has been shown to be effective for pain relief in a variety of conditions. Electrodes are placed on the skin and electric current applied at different pulse rates (frequencies) and intensities is used to stimulate these areas so as to provide pain relief. In dysmenorrhoea. TENS is thought to work by alteration of the body's ability to receive or perceive pain signals rather than by having a direct effect on the uterine contractions. Acupuncture may also be indicated as a useful, non-pharmacological method for treating dysmenorrhoea. Acupuncture is thought to excite receptors or nerve fibres which, through a complicated interaction with mediators such as serotonin and endorphins, blocks pain impulses. Acupuncture typically involves penetration of the skin by fine, solid metallic needles, which are manipulated manually or by electrical stimulation. ⋯ High frequency TENS was found to be effective for the treatment of dysmenorrhoea by a number of small trials. The minor adverse effects reported in one trial requires further investigation. There is insufficient evidence to determine the effectiveness of low frequency TENS in reducing dysmenorrhoea. There is also insufficient evidence to determine the effectiveness of acupuncture in reducing dysmenorrhoea, however a single small but methodologically sound trial of acupuncture suggests benefit for this modality.
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Cochrane Db Syst Rev · Jan 2002
ReviewHeliox for treatment of exacerbations of chronic obstructive pulmonary disease.
Due to its low density properties, helium-oxygen mixtures have the potential to decrease the work of breathing and possibly avoid the need for intubation and mechanical ventilation in patients with respiratory failure. ⋯ There is currently insufficient evidence to support the use of helium-oxygen mixtures to treat acute exacerbations of COPD in either ventilated or nonventilated patients. Suitably designed randomised controlled trials with the endpoint being the avoidance of mechanical ventilation may be justified.
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Cochrane Db Syst Rev · Jan 2002
Review Meta AnalysisInterventions for replacing missing teeth: preprosthetic surgery versus dental implants.
Preprosthetic surgery refers to the surgical procedures that can modify the oral anatomy to facilitate the retention of conventional dentures. Osseointegrated implants offer an alternative treatment to improve denture retention. A denture may be connected by special attachments to implants placed into the jaw. ⋯ There is weak evidence from the results of one randomised controlled trial including 60 subjects that patients are generally less satisfied with preprosthetic surgery and a conventional denture than with an implant retained denture. There is a need for more well designed trials comparing the success and cost-effectiveness of preprosthetic surgery and implant supported dentures. Such trials should be reported according to the CONSORT guidelines (http://www.consort-statement.org/). However, since preprosthetic surgery is considered to be an obsolete treatment nowadays, almost completely replaced by dental implants, it may be that new RCTs on this topic will not be designed.
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Cochrane Db Syst Rev · Jan 2002
ReviewRapid correction of early metabolic acidaemia in comparison with placebo, no intervention or slow correction in LBW infants.
Metabolic or mixed (metabolic and respiratory) acidosis are commonly encountered problems in the low birth weight (LBW) infant after delivery, and they may contribute to mortality and morbidity. Causes for the lactic acidosis are multiple and include maternal, placental and fetal factors. It is unclear whether metabolic acidaemia in the first 24 hours of life in LBW infants should be corrected by rapid infusion of alkali. ⋯ There is no evidence available from randomised controlled trials to support or refute the rapid correction of metabolic acidaemia, in LBW infants in the first 24 hours of life, as compared with slow or no correction.