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‣ Systematic review of tests to identify the disc, SIJ or facet joint as the source of low back pain

Hancock, M. J.; Maher, C. G.; Latimer, J.; Spindler, M. F.; McAuley, J. H.; Laslett, M.; Bogduk, N.
Fonte: Springer-Verlag Publicador: Springer-Verlag
Tipo: Artigo de Revista Científica
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Clinical practice guidelines state that the tissue source of low back pain cannot be specified in the majority of patients. However, there has been no systematic review of the accuracy of diagnostic tests used to identify the source of low back pain. The aim of this systematic review was therefore to determine the diagnostic accuracy of tests available to clinicians to identify the disc, facet joint or sacroiliac joint (SIJ) as the source of low back pain. MEDLINE, EMBASE and CINAHL were searched up to February 2006 with citation tracking of eligible studies. Eligible studies compared index tests with an appropriate reference test (discography, facet joint or SIJ blocks or medial branch blocks) in patients with low back pain. Positive likelihood ratios (+LR) > 2 or negative likelihood ratios (-LR) < 0.5 were considered informative. Forty-one studies of moderate quality were included; 28 investigated the disc, 8 the facet joint and 7 the SIJ. Various features observed on MRI (high intensity zone, endplate changes and disc degeneration) produced informative +LR (> 2) in the majority of studies increasing the probability of the disc being the low back pain source. However, heterogeneity of the data prevented pooling. +LR ranged from 1.5 to 5.9...

‣ Anatomy of large animal spines and its comparison to the human spine: a systematic review

Sheng, Sun-Ren; Wang, Xiang-Yang; Xu, Hua-Zi; Zhu, Guo-Qing; Zhou, Yi-Fei
Fonte: Springer-Verlag Publicador: Springer-Verlag
Tipo: Artigo de Revista Científica
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Animal models have been commonly used for in vivo and in vitro spinal research. However, the extent to which animal models resemble the human spine has not been well known. We conducted a systematic review to compare the morphometric features of vertebrae between human and animal species, so as to give some suggestions on how to choose an appropriate animal model in spine research. A literature search of all English language peer-reviewed publications was conducted using PubMed, OVID, Springer and Elsevier (Science Direct) for the years 1980–2008. Two reviewers extracted data on the anatomy of large animal spines from the identified articles. Each anatomical study of animals had to include at least three vertebral levels. The anatomical data from all animal studies were compared with the existing data of the human spine in the literature. Of the papers retrieved, seven were included in the review. The animals in the studies involved baboon, sheep, porcine, calf and deer. Distinct anatomical differences of vertebrae were found between the human and each large animal spine. In cervical region, spines of the baboon and human are more similar as compared to other animals. In thoracic and lumbar regions, the mean pedicle height of all animals was greater than the human pedicles. There was similar mean pedicle width between animal and the human specimens...

‣ Injection therapy and denervation procedures for chronic low-back pain: a systematic review

Henschke, Nicholas; Kuijpers, Ton; Rubinstein, Sidney M.; van Middelkoop, Marienke; Ostelo, Raymond; Verhagen, Arianne; Koes, Bart W.; van Tulder, Maurits W.
Fonte: Springer-Verlag Publicador: Springer-Verlag
Tipo: Artigo de Revista Científica
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Injection therapy and denervation procedures are commonly used in the management of chronic low-back pain (LBP) despite uncertainty regarding their effectiveness and safety. To provide an evaluation of the current evidence associated with the use of these procedures, a systematic review was performed. Existing systematic reviews were screened, and the Cochrane Back Review Group trial register was searched for randomized controlled trials (RCTs) fulfilling the inclusion criteria. Studies were included if they recruited adults with chronic LBP, evaluated the use of injection therapy or denervation procedures and measured at least one clinically relevant outcome (such as pain or functional status). Two review authors independently assessed studies for eligibility and risk of bias (RoB). A meta-analysis was performed with clinically homogeneous studies, and the GRADE approach was used to determine the quality of evidence. In total, 27 RCTs were included, 14 on injection therapy and 13 on denervation procedures. 18 (66%) of the studies were determined to have a low RoB. Because of clinical heterogeneity, only two comparisons could be pooled. Overall, there is only low to very low quality evidence to support the use of injection therapy and denervation procedures over placebo or other treatments for patients with chronic LBP. However...

‣ Fibromyalgia—: A Review for the Psychiatrist

Nihalani, Nikhil D.; Schwartz, Thomas; Chlebowski, Susan
Fonte: Matrix Medical Communications Publicador: Matrix Medical Communications
Tipo: Artigo de Revista Científica
Publicado em /04/2006 Português
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This paper is a review article that collects and synthesizes up-to-date information about the complex etiological theories and treatment regimens associated with Fibromyalgia. The authors have written the paper in an evidence-based model in order to show the reader where adequate data exist in regards to these pharmacological, psychological, and physical strategies. A thorough MEDLINE search was utilized to collect many papers dedicated to this topic spanning 1970-2005. Measurements: The relevant papers were divided, based upon intervention used for the treatment of FM (pharmacological vs. non-pharmacological). They were also divided based on their scientific merit; randomized controlled trials were given the most evidence-based weight and the case studies the least. Results: The authors first review current epidemiologic and etiologic theories regarding fibromyalgia. A formal literature review is next presented to allow the reader to understand the evidence base that supports treatment of this disorder. In conclusion, a commentary regarding the treatment of this disorder in psychiatric practice occurs where pharmacodynamics and management strategy is discussed. Conclusion: There is much literature available regarding treatment of fibromyalgia. This complex illness has reasonable controlled studies for monotherapy treatments; however...

‣ Axial pain after posterior cervical spine surgery: a systematic review

Wang, Shan-Jin; Jiang, Sheng-Dan; Jiang, Lei-Sheng; Dai, Li-Yang
Fonte: Springer-Verlag Publicador: Springer-Verlag
Tipo: Artigo de Revista Científica
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Posterior operative approach has been the standard treatment for cervical compressive myelopathy, and axial pain after laminoplasty or laminectomy as a postoperative complication is now gradually receiving more and more attention. The objective of this study was to provide a systematic review of the current understanding of axial pain after cervical laminoplasty and laminectomy, and summarize clinical features, influence factors and preventive measures of axial pain after posterior decompressive surgery based on a review of literature published in the English language. Axial pain distributes over nuchal, periscapular and shoulder regions. Posterior surgery is not the major cause of axial pain, but axial pain can be worsened by the procedure. There are many clinical factors that influence postoperative axial pain such as age, preoperative axial pain, different surgical technique and postoperative management, but most of them are still controversial. Several surgical modifications have been innovated to reduce axial pain. Less invasive surgery, reconstruction of the extensor musculature, avoiding detachment of the semispinalis cervicis muscle and early removal of external immobilization have proved to be effective. Axial pain is under the influence of multiple factors...

‣ Prevalence of age-related hearing loss in Europe: a review

Roth, Thomas Niklaus; Hanebuth, Dirk; Probst, Rudolf
Fonte: Springer-Verlag Publicador: Springer-Verlag
Tipo: Artigo de Revista Científica
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Populations are becoming progressively older thus presenting symptoms of diminished organ function due to degenerative processes. These may be physiological or caused by additional factors damaging the organ. Presbyacusis refers to the physiological age-related changes of the peripheral and central auditory system leading to hearing impairment and difficulty understanding spoken language. In contrast to epidemiological data of other continents, the prevalence of age-related hearing loss (ARHL) in Europe is not well defined, due in part to the use of different classification systems. We performed a systematic literature review with the aim of gaining a picture of the prevalence of ARHL in Europe. The review included only population and epidemiological studies in English since 1970 with samples in European countries with subjects aged 60 years and above. Nineteen studies met our selection criteria and additional five studies reported self-reported hearing impairment. When these data were crudely averaged and interpolated, roughly 30% of men and 20% of women in Europe were found to have a hearing loss of 30 dB HL or more by age 70 years, and 55% of men and 45% of women by age 80 years. Apparent problems in comparing the available data were the heterogeneity of measures and cut-offs for grades of hearing impairment. Our systematic review of epidemiological data revealed more information gaps than information that would allow gaining a meaningful picture of prevalence of ARHL. The need for standardized procedures when collecting and reporting epidemiological data on hearing loss has become evident. Development of hearing loss over time in conjunction with the increase in life expectancy is a major factor determining strategies of detection and correction of ARHL. Thus...

‣ Health economic evaluation in lumbar spinal fusion: a systematic literature review anno 2005

Soegaard, Rikke; Christensen, Finn B.
Fonte: Springer-Verlag Publicador: Springer-Verlag
Tipo: Artigo de Revista Científica
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The goal of this systematic literature review was to assess the evidence for cost-effectiveness of various surgical techniques in lumbar spinal fusion in conformity with the guidelines provided by the Cochrane Back Review Group. As new technology continuously emerges and divergent directions in clinical practice are present, economic evaluation is needed in order to facilitate the decision-makers’ budget allocations. NHS Economic Evaluation Database, MEDLINE, EMBASE and Cochrane Library were searched. Two independent reviewers (one clinical content expert and one economic content expert) applied the eligibility criteria. A list of criteria for methodological quality assessment was established by merging the criteria recommended by leading health economists with the criteria recommended by the Cochrane Back Review Group. The two reviewers independently scored the selected literature and the disagreement was resolved by means of consensus following discussion. Key data were extracted and the level of evidence concluded. Seven studies were eligible; these studies reflected the diversified choices of economic methodology, study populations (diagnosis), outcome measures and comparators. At the conclusion of quality assessment, the methodological quality of three studies was judged credible. Two studies investigated posteolateral fusion (PLF) ± instrumentation in different populations: one investigated non-specific low back pain and one investigated degenerative stenosis + spondylolisthesis. Both studies reflected that cost-effectiveness of instrumentation in PLF is not convincing. The third study concerned the question of circumferential vs anterior lumbar interbody fusion and found a non-significant difference between the techniques. In conclusion...

‣ Toothbrush Contamination: A Review of the Literature

Frazelle, Michelle R.; Munro, Cindy L.
Fonte: Hindawi Publishing Corporation Publicador: Hindawi Publishing Corporation
Tipo: Artigo de Revista Científica
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Toothbrushes are commonly used in hospital settings and may harbor potentially harmful microorganisms. A peer-reviewed literature review was conducted to evaluate the cumulative state of knowledge related to toothbrush contamination and its possible role in disease transmission. A systematic review was conducted on adult human subjects through three distinct searches. The review resulted in seven experimental and three descriptive studies which identified multiple concepts related to toothbrush contamination to include contamination, methods for decontamination, storage, design, and environmental factors. The selected studies found that toothbrushes of healthy and oral diseased adults become contaminated with pathogenic bacteria from the dental plaque, design, environment, or a combination of factors. There are no studies that specifically examine toothbrush contamination and the role of environmental factors, toothbrush contamination, and vulnerable populations in the hospital setting (e.g., critically ill adults) and toothbrush use in nursing clinical practice.

‣ Institutional review board (IRB) and ethical issues in clinical research

Kim, Won Oak
Fonte: The Korean Society of Anesthesiologists Publicador: The Korean Society of Anesthesiologists
Tipo: Artigo de Revista Científica
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Clinical research has expanded tremendously in the past few decades and consequently there has been growing interest in the ethical guidelines that are being followed for the protection of human subjects. This review summarizes historical scandals and social responses chronologically from World War II to the Death of Ellen Roche (2001) to emphasize the lessons we must learn from history. International ethical guidelines for studies with human subjects are also briefly described in order to understand the circumstances of clinical research. The tasks and responsibilities of the institutions and investigators in human subject research to preserve the safety and welfare of research subjects are summarized. Next, several debated ethical issues and insights are arranged as controversial topics. This brief review and summary seeks to highlight important arguments and make suggestions to institutional review boards (IRBs) to contribute to the future evolution of ethics in clinical research as we advance forward.

‣ Pulmonary drug delivery strategies: A concise, systematic review

Patil, J. S.; Sarasija, S.
Fonte: Medknow Publications & Media Pvt Ltd Publicador: Medknow Publications & Media Pvt Ltd
Tipo: Artigo de Revista Científica
Publicado em //2012 Português
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Because of limitations associated with the conventional treatment of various chronic diseases a growing attention has been given to the development of targeted drug delivery systems. Pulmonary route of drug delivery gaining much importance in the present day research field as it enables to target the drug delivery directly to lung both for local and systemic treatment. Over the last 2 decades, the systemic absorption of a broad range of therapeutics after pulmonary application has been demonstrated in animals as well as in humans. This review was prepared with an aim to discuss the technical, physiological, and efficacy aspects of the novel pulmonary route of drug targeting. The review also focuses on the mechanisms of pulmonary drug administration along with compatibility of the excipients employed, devices used, and techniques of particulate dosage production. This review was prepared based on the method of extensive literature survey on the topics covering all the aspects discussed in the present subject. Hence, the better understanding of complexes and challenges facing the development of pulmonary drug delivery system offer an opportunity to the pharmaceutical scientist in minimizing the clinical and technical gaps.

‣ The Role of Transoral Robotic Surgery in the Management of Oropharyngeal Cancer: A Review of the Literature

Dowthwaite, Samuel A.; Franklin, Jason H.; Palma, David A.; Fung, Kevin; Yoo, John; Nichols, Anthony C.
Fonte: International Scholarly Research Network Publicador: International Scholarly Research Network
Tipo: Artigo de Revista Científica
Publicado em 23/04/2012 Português
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Background. Transoral robotic surgery (TORS) is an emerging treatment option for the treatment of head and neck malignancies, particularly for oropharyngeal squamous cell carcinoma (OPSCC). Preliminary studies have demonstrated excellent oncologic and functional outcomes that have led to a resurgence of interest in the primary surgical management of OPSCC. The aim of the present study was to review the evidence base supporting the use of TORS in OPSCC. Methods. Studies evaluating the application of TORS in the treatment of head and neck squamous cell carcinoma (HNSCC), and more specifically OPSCC, were identified for review. Further searches were made of reference lists for complete evaluation of minimally invasive surgery (MIS) in treating OPSCC. Results. Seventeen results relating to the application of TORS in treatment of OPSCC were identified. Further results relating to the role of transoral laser microsurgery (TLM) in OPSCC were included for review. Feasibility, oncologic, and functional data is summarized and discussed. Discussion. Management strategies for patients with OPSCC continue to evolve. Minimally invasive surgical techniques including TORS and TLM offer impressive functional and oncologic outcomes particularly for patients with early T-classification and low-volume regional metastatic disease. Potential exists for treatment deintensification...

‣ Localization of impacted maxillary canines using cone beam computed tomography. Review of the literature

Rossini, Giulia; Cavallini, Costanza; Cassetta, Michele; Galluccio, Gabriella; Barbato, Ersilia
Fonte: CIC Edizioni Internationali Publicador: CIC Edizioni Internationali
Tipo: Artigo de Revista Científica
Publicado em 03/05/2012 Português
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This review analyzed the literature focused on Cone- Beam Computed Tomography (CBCT) diagnostic accuracy and efficacy in detecting impacted maxillary canines, and evaluated the possible advantages in using CBCT technique compared with traditional radiographs. PubMed and Embase searches were performed selecting papers since 1998 up to September 2011, moreover reference lists were hand searched. Two reviewers selected relevant publications on the basis of predetermined inclusion criteria. The literature search yielded 94 titles, of which 5 were included in the review. Three studies used CBCT technique to 3D localize maxillary impacted canines and assess root resorption of adjacent teeth. Other two publications compared traditional radiographs with CBCT images in the diagnosis of maxillary impacted canines. Only three studies presented the results using statistical analysis. The present review highlighted that the use of CBCT has a potential diagnostic effect and may influence the outcome of treatment when compared with traditional panoramic radiography for the assessment of impacted maxillary canines. Furthermore it underlines the need of future studies performed according with high level methodological standards, investigating diagnostic accuracy and effectiveness of CBCT in the diagnosis of maxillary impacted teeth.

‣ The role of nuclear technologies in the diagnosis and control of livestock diseases—a review

Viljoen, Gerrit J.; Luckins, Antony G.
Fonte: Springer Netherlands Publicador: Springer Netherlands
Tipo: Artigo de Revista Científica
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Nuclear and nuclear-related technologies have played an important role in animal health, particularly in relation to disease diagnosis and characterization of pathogenic organisms. This review focuses primarily on how and where nuclear technologies, both non-isotopic and isotopic methods, have made their impact in the past and where it might be expected they could have an impact in the future. The review outlines the extensive use of radiation attenuation in attempts to create vaccines for a multiplicity of pathogenic organisms and how the technology is being re-examined in the light of recent advances in irradiation techniques and cryopreservation/lyophilization that might obviate some of the problems of maintenance of viable, attenuate vaccines and their transport and use in the field. This approach could be used for a number of parasitic diseases where vaccination has been problematic and where investigations into the development of molecular vaccines have still failed to deliver satisfactory candidates for generating protective immune responses. Irradiation of antigens or serum samples also has its uses in diagnosis, especially when the samples need to be transported across international boundaries, or when handling the pathogens in question when carrying out a test presents serious health hazards to laboratory personnel. The present-day extensive use of enzyme immunoassays and molecular methods (e.g....

‣ On-Farm Mitigation of Transmission of Tuberculosis from White-Tailed Deer to Cattle: Literature Review and Recommendations

Walter, W. David; Anderson, Charles W.; Smith, Rick; Vanderklok, Mike; Averill, James J.; VerCauteren, Kurt C.
Fonte: Hindawi Publishing Corporation Publicador: Hindawi Publishing Corporation
Tipo: Artigo de Revista Científica
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The Animal Industry Division of the Michigan Department of Agriculture and Rural Development (MDARD) has been challenged with assisting farmers with modifying farm practices to reduce potential for exposure to Mycobacterium bovis from wildlife to cattle. The MDARD recommendations for on-farm risk mitigation practices were developed from experiences in the US, UK and Ireland and a review of the scientific literature. The objectives of our study were to review the present state of knowledge on M. bovis excretion, transmission, and survival in the environment and the interactions of wildlife and cattle with the intention of determining if the current recommendations by MDARD on farm practices are adequate and to identify additional changes to farm practices that may help to mitigate the risk of transmission. This review will provide agencies with a comprehensive summary of the scientific literature on mitigation of disease transmission between wildlife and cattle and to identify lacunae in published research.

‣ Association of pregnant women periodontal status to preterm and low-birth weight babies: A systematic and evidence-based review

Shanthi, Vanka; Vanka, Amit; Bhambal, Ajay; Saxena, Vrinda; Saxena, Sudhanshu; Kumar, Sahana Shiv
Fonte: Medknow Publications & Media Pvt Ltd Publicador: Medknow Publications & Media Pvt Ltd
Tipo: Artigo de Revista Científica
Publicado em //2012 Português
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The mouth serves as a mirror to general health and also as a portal for disease to the rest of the body. Since the old wives’ tale of “the loss of a tooth for every pregnancy”, oral health during pregnancy has long been a focus of interest. In the past decade, there has been mounting scientific evidence suggesting that periodontal disease may play an important role as a risk factor for adverse pregnancy outcomes. Considering all the above stated factors this systematic review is aimed to focus on the association of periodontal diseases to preterm and low-birth weight (LBW) babies. In view of the large body of literature the review is limited to studies identified by computer searching. Hand searching of journals and gathering of unpublished reports and conference proceedings was outside the scope of the review. The PubMed database was searched using the search terms: periodontitis, preterm, LBW. The titles, authors, and abstracts from all studies identified by the electronic search were printed and reviewed independently on the basis of keywords, title and abstract, to determine whether these met the inclusion criteria. The electronic search identified 68 papers. After review of the study title, keywords and abstracts, 62 papers were identified potentially meeting inclusion criteria. Generally...

‣ Effectiveness of Yoga for Menopausal Symptoms: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Cramer, Holger; Lauche, Romy; Langhorst, Jost; Dobos, Gustav
Fonte: Hindawi Publishing Corporation Publicador: Hindawi Publishing Corporation
Tipo: Artigo de Revista Científica
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Objectives. To systematically review and meta-analyze the effectiveness of yoga for menopausal symptoms. Methods. Medline, Scopus, the Cochrane Library, and PsycINFO were screened through April 2012. Randomized controlled trials (RCTs) were included if they assessed the effect of yoga on major menopausal symptoms, namely, (1) psychological symptoms, (2) somatic symptoms, (3) vasomotor symptoms, and/or (4) urogenital symptoms. For each outcome, standardized mean differences (SMDs) and 95% confidence intervals (CIs) were calculated. Two authors independently assessed risk of bias using the risk of bias tool recommended by the Cochrane Back Review Group. Results. Five RCTs with 582 participants were included in the qualitative review, and 4 RCTs with 545 participants were included in the meta-analysis. There was moderate evidence for short-term effects on psychological symptoms (SMD = −0.37; 95% CI −0.67 to −0.07; P = 0.02). No evidence was found for total menopausal symptoms, somatic symptoms, vasomotor symptoms, or urogenital symptoms. Yoga was not associated with serious adverse events. Conclusion. This systematic review found moderate evidence for short-term effectiveness of yoga for psychological symptoms in menopausal women. While more rigorous research is needed to underpin these results...

‣ Protocol: Effect of intravitreal bevacizumab (avastin) in the treatment of macular edema: A systematic review of randomized controlled trials

Qazi, Hammad A.
Fonte: Medknow Publications & Media Pvt Ltd Publicador: Medknow Publications & Media Pvt Ltd
Tipo: Artigo de Revista Científica
Publicado em /12/2012 Português
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Cystoid macular edema (CME) is a relatively common painless condition usually accompanied by blurred vision. The prevalence of CME varied from 5% to 47% depending on cause of pathology. There are several treatments available for ME including intravitreal use of bevacizumab that has been used in different doses in few studies. However, there is still scarcity of data available on the use of bevacizumab for the treatment of ME. A systematic review is needed to provide a foundational base to discuss and synthesize the available information on the effectiveness and safety of intravitreal bevacizumab in macular edema, so that recommendations and policies can be built regarding controversial use of bevacizumab in macular edema. We have planned to perform a systematic review with an objective to compare the effects of a single injection of 1.25 mg intravitreal bevacizumab (avastin) in the improvement of visual acuity, macular edema, and thickness with other interventions/controls for the treatment of macular edema at 3 and 6 months interval using randomized controlled trials. This is only a protocol of the review and we will be conducting a full length review, addressing the issue in future.

‣ Attenuating the Systemic Inflammatory Response to Adult Cardiopulmonary Bypass: A Critical Review of the Evidence Base

Landis, R. Clive; Brown, Jeremiah R.; Fitzgerald, David; Likosky, Donald S.; Shore-Lesserson, Linda; Baker, Robert A.; Hammon, John W.
Fonte: American Society of ExtraCorporeal Technology Publicador: American Society of ExtraCorporeal Technology
Tipo: Artigo de Revista Científica
Publicado em /09/2014 Português
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A wide range of pharmacological, surgical, and mechanical pump approaches have been studied to attenuate the systemic inflammatory response to cardiopulmonary bypass, yet no systematically based review exists to cover the scope of anti-inflammatory interventions deployed. We therefore conducted an evidence-based review to capture “self-identified” anti-inflammatory interventions among adult cardiopulmonary bypass procedures. To be included, trials had to measure at least one inflammatory mediator and one clinical outcome, specified in the “Outcomes 2010” consensus statement. Ninety-eight papers satisfied inclusion criteria and formed the basis of the review. The review identified 33 different interventions and approaches to attenuate the systemic inflammatory response. However, only a minority of papers (35 of 98 [35.7%]) demonstrated any clinical improvement to one or more of the predefined outcome measures (most frequently myocardial protection or length of intensive care unit stay). No single intervention was supported by strong level A evidence (multiple randomized controlled trials [RCTs] or meta-analysis) for clinical benefit. Interventions at level A evidence included off-pump surgery, minimized circuits, biocompatible circuit coatings...

‣ Midline Cervical Cleft: Review of an Uncommon Entity

Puscas, Liana
Fonte: Hindawi Publishing Corporation Publicador: Hindawi Publishing Corporation
Tipo: Artigo de Revista Científica
Português
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Introduction. Midline cervical cleft is a rare congenital malformation which nonetheless has a classic presentation. This study presents one of the largest single series of new patients with MCC and provides an exhaustive review and catalogue of publications from the international literature. Materials and Methods. Retrospective chart review performed in two academic medical centers and literature review performed with primary verification of all quoted references. Results. Ten patients with MCC were identified (8 boys and 2 girls). All patients presented with the classic findings of this congenital anomaly, and the length of the skin defect correlated with an increase in the patient's age. Surgical excision was complete in all cases. Thorough international literature review yielded only 195 verifiable previously reported cases. Conclusions. This is one of the largest series of new patients with midline cervical cleft presented in the world literature. Although rare (with less than 200 cases published to date) this entity does have a reliable presentation that should lead to rapid and accurate diagnosis. Complete surgical excision at an early age is appropriate since the anomaly increases in length commensurate with the patient's age.

‣ A review of tip apex distance in dynamic hip screw fixation of osteoporotic hip fractures

Abdulkareem, Imran Haruna
Fonte: Medknow Publications & Media Pvt Ltd Publicador: Medknow Publications & Media Pvt Ltd
Tipo: Artigo de Revista Científica
Publicado em //2012 Português
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Fractured neck of femur is a common problem seen in elderly osteoporotic females, mostly in Western countries, among which are the extra-capsular fractures such as intertrochanteric and pertrochanteric fractures also known as peritrochanteric fractures, and commonly treated with dynamic hip screw (DHS) or compression hip screw (CHS). The DHS is based on tension band principle and allows the screw to slide within the barrel to enable compression of the fracture when the patient begins to bear weight. This principle only works in the presence of intact medial wall and so cannot be successful in a reverse oblique fracture of the proximal femur. However, it is important that the technique of screw placement is precise and should ideally be central in the femoral neck, on both AP and lateral radiographs. This is why the concept of tip apex distance (TAD) is critical to the outcome of fixation and can accurately predict failure or survival of the screw. A systematic review of articles published in PubMed/Medline, from 1991 to 2011 (twenty years), was carried out to critically analyse common practice with regards to DHS fixation of extra-capsular femoral neck fractures, and review the recommendations of previous authors, with regard to the effect of TAD in DHS fixation. Search words used include TAD...