Cochrane Db Syst Rev
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Cochrane Db Syst Rev · Jan 2000
ReviewAntifibrinolytic therapy for aneurysmal subarachnoid haemorrhage.
Re-bleeding is an important cause of death and disability in people with aneurysmal subarachnoid haemorrhage. This is probably due to dissolution of the clot by natural fibrinolytic activity. ⋯ Antifibrinolytic treatment does not appear to benefit people with aneurysmal subarachnoid haemorrhage. However, the trials were all done more than 10 years ago. New strategies may counteract the ischaemia-inducing potential of antifibrinolytic treatment and lead to improved outcome. A trial of combined antifibrinolytic and anti-ischaemia treatment is underway.
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Cochrane Db Syst Rev · Jan 2000
ReviewEarly emergency department treatment of acute asthma with systemic corticosteroids.
The airway edema and secretions associated with acute asthma are most effectively treated with anti-inflammatories such as corticosteroids delivered by inhaled, oral, intravenous or intra-muscular routes. There is an unresolved debate about the use of systemic corticorticoids in the early treatment of acute asthma for emergency department patients. ⋯ Use of corticosteroids within 1 hour of presentation to an ED significantly reduces the need for hospital admission in patients with acute asthma. Benefits appear greatest in patients with more severe asthma, and those not currently receiving steroids. Children appear to respond well to oral steroids.
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Cochrane Db Syst Rev · Jan 2000
ReviewProphylactic vitamin K for vitamin K deficiency bleeding in neonates.
Vitamin K deficiency can cause bleeding in an infant in the first weeks of life. This is known as Hemorrhagic Disease of the Newborn (HDN). HDN is divided into three categories: early, classic and late HDN. Early HDN occurs within 24 hours post partum and falls outside the scope of this review. Classic HDN occurs on days one to seven; common bleeding sites are gastrointestinal, cutaneous, nasal and from a circumcision. Late HDN occurs from week 2-12; the most common bleeding sites are intracranial, cutaneous, and gastrointestinal. Vitamin K is commonly given prophylactically after birth for the prevention of HDN, but the preferred route is uncertain. ⋯ A single dose (1.0 mg) of intramuscular vitamin K after birth is effective in the prevention of classic HDN. Either intramuscular or oral (1.0 mg) vitamin K prophylaxis improves biochemical indices of coagulation status at 1-7 days. Neither intramuscular nor oral vitamin K has been tested in randomized trials with respect to effect on late HDN. Oral vitamin K, either single or multiple dose, has not been tested in randomized trials for its effect on either classic or late HDN.
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Obstructive sleep apnoea is the periodic reduction (hypopnoea) or cessation (apnoea) of airflow during sleep. The syndrome is associated with loud snoring, disrupted sleep and observed apnoeas. Beside conservative treatments there are a range of 8 broad categories of operative treatments for this condition. Surgical treatments aim to relieve the obstruction by either increasing the surface area ⋯ There is an urgent need for high quality randomised controlled trials to be carried out in the field of surgery for obstructive sleep apnoea. More research should also be undertaken to identify and standardise techniques to determine the site of airways obstructions.
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Vascular surgeons construct femoro-popliteal bypass grafts, from the groin to the knee, to save limbs that might otherwise require amputation in patients with severe arterial disease, and to improve walking distance in patients with less severe arterial disease. During the operation, the blocked native artery is bypassed using either a section of the patient's own vein (autologous vein), human umbilical vein (HUV), or an artificial graft e.g. Dacron or polytetrafluoroethylene (PTFE). ⋯ There is no clear evidence which type of graft is best for femoro-popliteal grafting. In terms of autologous graft patency, in-situ and reversed vein grafts are equally successful, while HUV performs better than PTFE. A distal vein cuff may improve primary patency for below-knee PTFE femoro-popliteal grafts.