Cochrane Db Syst Rev
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Cochrane Db Syst Rev · Jan 2006
Review Meta AnalysisSystemic antibiotics versus topical treatments for chronically discharging ears with underlying eardrum perforations.
Chronic suppurative otitis media (CSOM) causes ear discharge and impairs hearing. ⋯ Topical quinolone antibiotics can clear aural discharge better than systemic antibiotics; topical non-quinolone antibiotic (without steroids) or antiseptic results are less clear. Evidence regarding safety was weak. Further studies should clarify topical non-quinolones and antiseptic effectiveness, assess longer-term outcomes (for resolution, healing, hearing, or complications), and include further safety assessments, particularly to clarify the risks of ototoxicity and whether there may be fewer adverse events with topical quinolones than other topical or systemic treatments.
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Cochrane Db Syst Rev · Jan 2006
ReviewSurgery versus radiosurgery for patients with a solitary brain metastasis from non-small cell lung cancer.
Non-small cell lung cancer is one of the leading causes of death in the developed countries. Patients die of local progression, disseminated disease or both. Brain metastases are often seen in non-small cell lung cancer patients and although they are frequently multiple, a subset of patients with a solitary brain metastasis (with controlled primary tumour) is regularly seen in clinical practice. Treatment of a solitary brain metastasis has usually been surgery, when possible, but the development of new stereotactic techniques of radiotherapy using a linear accelerator or the 'gamma knife' have provided new treatment options. ⋯ The reviewers felt that the inclusion of studies less rigorous than randomised trials would result in misleading findings. Cohort or single arm studies only provide partial information and have the risk of significant bias. From the evaluated studies, we found that a variety of different criteria were used for the definition of solitary brain metastasis. We observed that the term "single brain metastasis" was misused as synonymous with solitary brain metastasis. Some of the single arm or cohort studies come from single institutions where the availability of both techniques (radiosurgery and surgery) is not described. Therefore, a tendency to use the most accessible technique could be suspected. Finally, in order to determine which technique is superior for patients with a solitary brain metastasis from non-small cell lung cancer, an appropriate randomised trial should be designed. Based on the available evidence a meaningful conclusion cannot be drawn.
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Cochrane Db Syst Rev · Jan 2006
Review Meta Analysis Comparative StudyRoutine surgery in addition to chemotherapy for treating spinal tuberculosis.
Tuberculosis is generally curable with chemotherapy, but there is controversy in the literature about the need for surgical intervention in the one to two per cent of people with tuberculosis of the spine. ⋯ The two included trials had too few participants to be able to say whether routine surgery might help. Although current medication and operative techniques are now far more advanced, these results indicate that routine surgery cannot be recommended unless within the context of a large, well-conducted randomized controlled trial. Clinicians may judge that surgery may be clinically indicated in some groups of patients. Future studies need to address these topics as well as the patient's view of their disease and treatment.
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Bipolar disorder is a common recurrent illness with high levels of chronicity. Treatment resistance persists despite the use of established medications, such as lithium and valproate. New medications are required for the treatment of refractory cases. Retrospective and open-label trials have suggested that the anticonvulsant topiramate may be efficacious in bipolar disorder. There is a need to clarify the evidence available in the form of randomised controlled trials for its use in bipolar disorder. ⋯ There is insufficient evidence on which to base any recommendations regarding the use of topiramate in any phase of bipolar illness, either in monotherapy or as an adjunctive treatment.
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Cochrane Db Syst Rev · Jan 2006
ReviewAntibiotic strategies for eradicating Pseudomonas aeruginosa in people with cystic fibrosis.
Lower respiratory tract infection with Pseudomonas aeruginosa (P. aeruginosa) occurs in most people with cystic fibrosis. Once chronic infection is established, P. aeruginosa is virtually impossible to eradicate and is associated with increased mortality and morbidity. Early infection may be easier to eradicate. ⋯ From the three trials included in this review, there is some evidence that antibiotic treatment of early P. aeruginosa results in short-term eradication but it remains uncertain whether there is clinical benefit to people with cystic fibrosis.