Cochrane Db Syst Rev
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Cochrane Db Syst Rev · May 2010
ReviewSurgery versus radical endotherapies for early cancer and high grade dysplasia in Barrett's oesophagus.
Barrett's oesophagus is one of the most common premalignant lesions in the world. Currently the mainstay of therapy is surgical management of advanced cancer but this has improved the five-year survival very little in the last 30 years. As a consequence, improved survival relies on early detection through endoscopic surveillance programmes. Success of this strategy relies on the fact that late stage premalignant lesions or very early cancers can be cured by intervention. Currently there is considerable controversy over which method is best: i.e. conventional open surgery or endotherapy (techniques involving endoscopy). ⋯ This Cochrane review has indicated that there are no randomised control trials to compare management options in this vital area, therefore trials should be undertaken as a matter of urgency. The problems with such randomised methods are standardising surgery and endotherapies in all sites; standardising histopathology in all centres; assessing which patients are fit or unfit for surgery; and making sure there are relevant outcomes for the study i.e. long term survival (over five or more years) and no progression of high grade dysplasia.
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Cochrane Db Syst Rev · May 2010
ReviewWITHDRAWN: Proton pump inhibitor treatment for acute peptic ulcer bleeding.
Randomised controlled trials (RCTs) evaluating the clinical effect of proton pump inhibitors (PPIs) in peptic ulcer (PU) bleeding yield conflicting results. ⋯ PPI treatment in PU bleeding reduces rebleeding and surgery compared with placebo or H(2)RA, but there is no evidence of an overall effect on all-cause mortality.
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Cochrane Db Syst Rev · May 2010
ReviewWITHDRAWN: Pharmacological interventions for treating acute heterotopic ossification.
Heterotopic ossification (HO) is the formation of mature lamellar bone in soft tissue sites outside the skeleton. HO frequently complicates burns, arthroplasty, fractures, and spinal cord and brain injuries. It can impair joint function. ⋯ Given the absence of long term radiographic outcomes in the included studies, there is insufficient evidence to recommend the use of disodium etidronate or other pharmacological agents for the treatment of acute HO. It has been previously suggested that disodium etidronate acts by delaying, rather than preventing, the mineralization of HO, and that mineralization may occur after treatment cessation in many cases, thereby negating the benefit of disodium etidronate on eventual HO grade. Further studies are required to assess all pharmacological treatments for acute HO with sufficient follow-up duration.