Cochrane Db Syst Rev
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Studies in traumatic encephalopathy first led to the insight that the damage seen was not just due to direct consequences of the primary injury. A significant, and potentially preventable, contribution to the overall morbidity arose from secondary hypoxic-ischaemic damage. Brain swelling accompanied by raised intracranial pressure (ICP) resulted in inadequate cerebral perfusion with well-oxygenated blood. Detection of raised ICP could be useful in alerting clinicians to the need to improve cerebral perfusion, with consequent reductions in brain injury. ⋯ There are no data from randomised controlled trials that can clarify the role of ICP monitoring in acute coma.
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Many treatments are available for whiplash-patients, but to date, no evidence exists for their effectiveness. ⋯ It appears that "Rest makes rusty." In other words, rest and immobilization using collars are not recommended for the treatment of whiplash, while active interventions, such as advice to 'maintain usual activities' might be effective in whiplash-patients. Nevertheless, caution is needed when attempting to draw conclusions regarding the efficacy of conservative treatments in whiplash-patients, because of the paucity of high-quality studies. No conclusions can be drawn about the most effective therapy for chronic whiplash-patients because only one low quality trial was identified.
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Intermittent claudication is pain, caused by chronic occlusive arterial disease, that develops in a limb during exercise and is relieved with rest. Buflomedil is a vasoactive agent claimed to have beneficial effects on the microcirculation. It is used chiefly to treat peripheral vascular disease and to a lesser extent for cerebrovascular arterial disease. However, its clinical efficacy for intermittent claudication has not yet been critically examined. ⋯ There is little evidence available to evaluate the efficacy of buflomedil for intermittent claudication. Most available trials are of poor quality and were excluded. The two trials included showed moderately positive results but these are undermined by publication bias since we know of another four unpublished, irretrievable, and inconclusive studies. There is a lack evidence for the efficacy of buflomedil in intermittent claudication.
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Cochrane Db Syst Rev · Jan 2001
ReviewInhaled nitric oxide for respiratory failure in preterm infants.
Inhaled nitric oxide has been proven effective in term infants with hypoxic respiratory failure. The pathophysiology of respiratory failure, and the potential risks, differ substantially in preterm infants. Analysis of the efficacy and toxicities of inhaled nitric oxide in infants born before 35 weeks is therefore necessary. ⋯ The currently published evidence from randomized trials does not support the use of inhaled nitric oxide in preterm infants with hypoxic respiratory failure. There is a possible reduction in the severity of chronic lung disease (shortened duration of assisted ventilation). Because of lack of power, it is not possible to eliminate the possibility of substantial improvements in outcome. Further studies should be performed.
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Cochrane Db Syst Rev · Jan 2001
ReviewNon-corticosteroid treatment for nephrotic syndrome in children.
Eighty to ninety per cent children with steroid sensitive nephrotic syndrome (SSNS) have one or more relapses. About half of these children relapse frequently and are at risk of the adverse effects of corticosteroids. Non-corticosteroid immunosuppressive agents are used to prolong periods of remission in children, who relapse frequently. However these non-corticosteroid agents also have significant potential adverse effects. Currently there is no consensus as to the most appropriate second line agent in children who are steroid sensitive, but who continue to relapse. In this systematic review of randomised controlled trials (RCTs), the benefits and harms of these immunosuppressive agents are evaluated. ⋯ Eight weeks courses of cyclophosphamide or chorambucil and prolonged courses of cyclosporin and levamisole reduce the risk of relapse in children with relapsing SSNS compared with corticosteroids alone. Clinically important differences in efficacy among these agents are possible and further comparative trials are still needed. Meanwhile choice between these agents depends on physician and patient preferences related to therapy duration and the type and frequency of complications.