Cochrane Db Syst Rev
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Misoprostol is a synthetic prostaglandin which has been used to induce labour. Oral use of the drug misoprostol may be convenient, but an overdose could cause uterine hyperstimulation and precipitate labour which may be life-threatening for both mother and fetus. ⋯ Oral misoprostol may be an effective method for labour induction. However, the data on safety are lacking. It is possible that clinically effective oral regimens may have an unacceptably high incidence of complications such as uterine hyperstimulation and possibly uterine rupture.
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Severe narrowing (or stenosis) of the carotid artery is an important cause of stroke. Surgical removal of the atheromatous material from the inside of the carotid artery (endarterectomy) may reduce the risk of stroke, but carries a risk of operative complications. ⋯ Carotid endarterectomy reduced the risk of disabling stroke or death for patients with stenosis exceeding ECST-measured 70% or NASCET-measured 50%. This result is generalizable only to surgically-fit patients operated on by surgeons with low complication rates (less than 6%).
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Cochrane Db Syst Rev · Jan 2000
ReviewNon-steroidal anti-inflammatory drugs for preventing heterotopic bone formation after hip arthroplasty.
Heterotopic bone formation (HBF) in the soft tissues surrounding the hip joint is a frequent complication of hip surgery. Non-steroidal anti-inflammatory drugs (NSAIDs) administered in the immediate perioperative period reduce the risk of HBF. However, the magnitude of the effect on HBF, and the effects on other associated outcomes are uncertain. ⋯ Perioperative NSAIDs appear to produce between a one half and two thirds reduction in the risk of HBF. With routine use, such agents may be able to prevent 15-20 cases of HBF (3-4 severe) among every 100 total hip replacements performed. However, while medium to high doses of perioperative NSAIDs clearly produce a substantial reduction in the incidence of radiographic HBF, there remains some uncertainty about short-term side effects of treatment and substantial uncertainty about effects on long-term clinical outcomes such as chronic pain and impaired physical function. The net effect of routine HBF prophylaxis with NSAIDs requires formal assessment in a randomised trial designed to determine the balance of benefits and risks for all outcomes.
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Cochrane Db Syst Rev · Jan 2000
ReviewThrombolysis (different doses, routes of administration and agents) for acute ischaemic stroke.
Thrombolytic therapy is effective for acute myocardial infarction, a vascular disease with some similarities to acute ischaemic stroke. ⋯ There is not enough evidence to conclude whether lower doses of thrombolytic agents might be safer or more effective than higher doses in acute ischaemic stroke. It is not possible to conclude whether one agent might be better than another, or which route of administration might be best. No comparative data for streptokinase have been found.
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Cochrane Db Syst Rev · Jan 2000
ReviewEndotracheal intubation at birth for preventing morbidity and mortality in vigorous, meconium-stained infants born at term.
On the basis of evidence from non-randomised studies, it has been recommended that all babies born through thick meconium should have their tracheas intubated so that suctioning of their airways can be performed. The aim is to reduce the incidence and severity of meconium aspiration syndrome. However, for term babies who are vigorous at birth endotracheal intubation may be both difficult and unnecessary. ⋯ Routine endotracheal intubation at birth in vigorous term meconium-stained babies has not been shown to be superior to routine resuscitation including oro-pharyngeal suction. This procedure cannot be recommended for vigorous infants until more research is available.