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PubMed2003

Chemoembolization of hepatocellular carcinoma: results of a metaanalysis.

Transcatheter arterial chemoembolization is considered the mainstay of therapy for unresectable hepatocellular carcinoma. The purpose of this study was to assess the impact of such treatment on survival by performing a metaanalysis of all available randomized clinical trials comparing this form of therapy to supportive care. A MEDLARS search was conducted covering the years 1970 to 2002. Data analysis was performed according to methods described by Peto. The primary outcome of interest was the proportion of patients surviving 3 and 6 months after treatment. All analyses were performed on an intent-to-treat basis. A literature search yielded 1,100 citations, from which four met protocol-specified inclusion criteria. All studies contained an experimental and control arm totalling 268 patients. The odds ratio for 3- and 6-month survival were 1.31 (95% CI: 0.66-2.58) and 0.91 (95% CI: 0.49-1.68), which was not statistically significant. These data fail to show a survival advantage associated with therapeutic embolization versus supportive care alone in patients with unresectable hepatocellular carcinoma. Existing survival data from randomized controlled trials are of poor quality, and the paucity of patients in these trials eliminates the possibility of drawing meaningful conclusions regarding the effect of chemoembolization on patient survival from these studies.

Antineoplastic Agents↗

PubMed1980

Ultrastructural features of chromoblastomycosis.

Ultrastructural features of the Medlar body, the tissue form of cutaneous chromomycosis, are reported. Striking variability in such features reflects the interaction between fungi and host defense mechanisms.

Chromoblastomycosis↗

PubMed1995

A literature assessment of the use of miscellaneous topical agents, growth factors, and skin equivalents for the treatment of pressure ulcers.

BACKGROUND: Agents reviewed for this manuscript were both rare and popular topical treatments for pressure ulcers. OBJECTIVE: To review topical treatments for pressure ulcers and evaluate them based on available literature of controlled, blinded, and randomized trials. METHODS: A MEDLARS database (1966-1993) search and a thorough review of reference article lists of key articles produced over 100 manuscripts. Studies were considered for review if they were conducted on humans with chronic stage II to IV pressure ulcers, in a properly controlled and randomized fashion. RESULTS: The use of zinc acetate and aluminum hydroxide ointment, phenytoin, recombinant platelet-derived growth factor-BB (rPDGF-BB), and basic fibroblast growth factor (bFGF) have been evaluated in a controlled and blinded fashion. Many of the newer agents, cytokine growth factor (eg, rPDGF-BB and bFGF) and skin equivalents, are currently being scrutinized in clinical trials. CONCLUSION: A paucity of data exist that adequately address the efficacy of any topical agent for the treatment of pressure ulcers.

Administration, Topical↗

PubMed2005

MEDLINE in the UK: pioneering the past, present and future.

This article provides a brief history of the development of the MEDLINE database and its huge impact within the UK, from its inception to the present time. The origins of MEDLINE can be traced back to a collection of books in the US Surgeon General's Office during the American Civil War and John Shaw Billings' decision, during 1867, to make this Library as complete as possible. From these beginnings, Index Medicus was developed in the early years of the 20th century, and electronic versions of the database began with the computerized on-demand search service MEDLARS in 1964 and then via CD-ROM and Internet Grateful Med to the web-based and free-to-all service, PubMed, in 1997. The response to PubMed was immediate and startling with usage increasing from 7 million searches per annum in 1996 to 400 million searches per annum in 2001 and the service continues to improve. MEDLINE providers are now offering mapping of natural language queries to the sophisticated indexing vocabulary (Medical Subject Headings, MeSH) and the provision of specific filters for different types of publication to improve searching efficiency, as well as links to full-text versions of the papers where available. The next steps are likely to involve an increased blurring of database and full-text boundaries, incorporating seamless access to the best available evidence within MEDLINE and a wide range of other information resources within a single search and to an increasing amount of full-text via various open-archive initiatives. As ever, the US National Library of Medicine is in the vanguard of research and further applications of its MEDLINE database for users within the UK will be awaited with great interest.

Grateful Med↗

PubMed1996

Single or multiple daily doses of aminoglycosides: a meta-analysis.

OBJECTIVE: To assess relative efficacy and toxicity of aminoglycosides given by single daily dose compared with multiple daily doses. DESIGN: Meta-analysis of 21 randomised trials identified through MEDLARS (1966 to January 1995). Data were overviewed with fixed effects and random effects models and with meta-regression analysis. SUBJECTS: Total of 3091 patients with bacterial infection, most without pre-existing renal disease. INTERVENTIONS: Patients were randomized to receive aminoglycosides once daily or multiple times daily with similar total daily dose. MAIN OUTCOME MEASURES: Clinical failure of treatment, nephrotoxicity, ototoxicity, and mortality. RESULTS: Single daily dose regimen produced a non-significant decrease in risk of antibiotic failures (random effects risk ratio 0.83 (95% confidence interval 0.57 to 1.21)). Benefit of once daily dosing was greater when the percentage of pseudomonas isolates in a trial was larger. Once daily administration reduced risk of nephrotoxicity (fixed effects risk ratio 0.74 (0.54 to 1.00)). Similar trends were noted for patients with febrile neutropenia and for children. There was no significant difference in ototoxicity between the two dosing regimens, but the power of the pooled trials to detect a meaningful difference was low. There was no significant difference in mortality. CONCLUSIONS: Once daily administration of aminoglycosides in patients without pre-existing renal impairment is as effective as multiple daily dosing, has a lower risk of nephrotoxicity, and no greater risk of ototoxicity. Given the additional convenience and reduced cost, once daily dosing should be the preferred mode of administration.

Aminoglycosides↗

PubMed1997

Human toxocariasis and the visceral larva migrans syndrome: correlative immunopathology.

The surface of T. canis is now recognized as a dynamic structure which turns over quite rapidly and serves as a renewable source of large quantities of antigen(s). The major host responses to these antigens include a marked eosinophilia and hyperglobulinemia. Both of these responses are apparently ineffective at ridding the body of infective larvae. Both eosinphils and IgE antibodies are manifestations of the Th2 subset of T helper cells and the cytokines that they secrete. Further, there is reason to believe that the antigens released from T. canis larvae favor the induction of this cellular population. Finally, there is mounting evidence that the chronic production of parasite antigen and its continued stimulation of the host immune system with a concomitant production of eosinophils can lead to a permanent alteration of the normal organization of the cardiopulmonary system. In the absence of any well-documented drugs capable of killing infective larvae, it would seem that immunological intervention may offer the only way to minimize or neutralize this 'gift from man's best friend'. This chapter was not intended to be an exhaustive review of the literature pertaining to toxocariasis. Several other recent publications will hopefully fulfill the need for more detailed information on the biology of this organism and the clinical spectrum of the disease it produces [16, 138-140]. Finally, a MEDLARS search of the current medical literature should bring anyone up to speed in a very short time.

Adolescent↗

PubMed1999

Safety of nifedipine in angina pectoris: a meta-analysis.

-Our objective was to compare cardiovascular event rates in patients with stable angina receiving nifedipine as monotherapy or combination therapy and in active drug controls. A MEDLARS search of published articles from 1966 to 1995 in English, French, German, Italian, or Spanish, supplemented by a manual search of bibliographies, identified 60 randomized controlled trials that met protocol criteria. Blinded articles were extracted by 2 physicians. The pooled risks of death, withdrawal, and cardiovascular event were computed and expressed as odds ratios (ORs) for all nifedipine formulations and relative to same study control drug regimens. Thirty cardiovascular events were reported in 2635 nifedipine exposures (1.14%) and 19 events in 2655 other active drug exposures (0.72%). Unadjusted ORs for nifedipine versus controls were 1.40 (95% CI, 0.56 to 3.49) for major events (death, nonfatal myocardial infarction, stroke, revascularization procedure), 1.75 (95% CI, 0.83 to 3.67) for increased angina, and 1.61 (95% CI, 0.91 to 2.87) for all events (major events plus increased angina). Episodes of increased angina were more frequent on immediate-release nifedipine (OR, 4.19 [95% CI, 1.41 to 12.49]) and on nifedipine monotherapy (OR, 2.61 [95% CI, 1.30 to 5.26]). The OR for immediate-release nifedipine was significantly higher than that for sustained-release/extended-release nifedipine (P=0.001), and the OR for nifedipine monotherapy was higher than that for nifedipine combination therapy (P=0.03). Increased risks of cardiovascular events in patients with stable angina on nifedipine were due primarily to more episodes of increased angina, confined to the immediate-release formulation and to nifedipine monotherapy.

Adrenergic beta-Antagonists↗

PubMed1995

The clinical evaluation for detecting metastatic lung cancer. A meta-analysis.

The objective of this study was to assess the performance of the clinical evaluation in detecting extrathoracic metastases compared with brain and abdomen CT and radionuclide bone scans in patients with newly diagnosed bronchogenic carcinoma. The included studies were selected using the MEDLARS database from 1977 through August 1992 as well as reference lists from published articles or abstracts. Studies eligible for consideration met six criteria. The most important criterion was that results of a clinical evaluation and a CT scan of the head or abdomen or a radionuclide bone scan, obtained during the initial evaluation of a patient with primary lung cancer, must be included. Data were categorized by the type of clinical evaluation performed and whether patients had a clinical evaluation suggesting metastases (positive) or not (negative). The negative predictive value (NPV) of the clinical evaluation was calculated in all studies. The sensitivity, specificity, and the positive predictive value (PPV) were calculated in studies including positive and negative clinical evaluation patients. Twenty-five studies are included in this analysis. A total of 3,089 imaging scans were obtained in the study patients after a clinical evaluation was performed. The mean NPV of the clinical evaluation for CT of the brain, abdomen, and radionuclide bone scan is 95, 94, and 89%, respectively. When an expanded clinical evaluation was performed, the NPV was even higher. The NPV was influenced by the prevalence of metastases, but still performed well in series with high prevalence rates.(ABSTRACT TRUNCATED AT 250 WORDS)

Abdominal Neoplasms↗

PubMed1994

Self-inflicted eye injuries: case presentations and a literature review.

OBJECTIVE: The authors' aim was to determine demographic and clinical correlates of self-inflicted eye injury. METHODS: The authors reviewed 41 cases of patients with self-inflicted eye injuries identified through MEDLARS searches of medical literature for the period from 1980 to 1993 and four cases from the first author's clinical practice. RESULTS: Most patients with self-inflicted eye injuries were male, about 31 years old, and had a diagnosis of schizophrenia, drug or alcohol abuse, depressive disorders, or other psychosis. Some patients experienced cognitive distortions, often involving religious and sexual ideation, and intense fear around the time they injured themselves. Thirty-three percent of the patients with self-inflicted eye injuries also showed other types of self-injurious behavior. CONCLUSIONS: Enucleation of the eye may serve as a defense against witnessing or experiencing a forbidden act. Psychodynamic theories addressing self-mutilation do not explain self-induced eye injury particularly well but may assist the therapist in understanding motivation and in restructuring patients' behavior. Management of these patients requires multidisciplinary, multimodal efforts involving medical specialists, patients, family members, and staff.

Adolescent↗

PubMedDate not supplied

Patency results of percutaneous and surgical revascularization for femoropopliteal arterial disease.

To estimate the patency results of percutaneous transluminal angioplasty and bypass surgery in the treatment of femoropopliteal arterial disease, a Medlars search of the English-language medical literature was performed. Inclusion required that studies 1) report original data, 2) report patency with a life table or Kaplan-Meier analysis with the number at risk or standard errors, 3) define patency as hemodynamic improvement, 4) report the distribution of covariates, and 5) not duplicate other published material. Using a method based on the proportional-hazards model and the actuarial life-table approach, the results were adjusted for differences in case-mix of the study populations and patency was predicted for subgroups at various levels of risk for failure. The unadjusted pooled life tables yielded five-year patencies of 45% (+/- 2%) for angioplasty, 73% (+/- 2%) for bypass surgery using a vein graft, and 49% (+/- 3%) for bypass surgery using a polytetrafluoroethylene graft. Adjusted five-year primary patencies after angioplasty varied from 12% to 68%, the best results being for patients with claudication and stenotic lesions. Adjusted five-year primary patencies after surgery varied from 33% to 80%, the best results being for saphenous vein bypass performed for claudication. The authors conclude that pooling life-table data without adjustment for covariates can be misleading. Indication, lesion type, vein graft availability, and site of the distal graft anastomosis need to be considered in predicting patency results of revascularization for femoropopliteal arterial disease.

Angioplasty, Balloon↗

PubMed1979

Anorexia nervosa: death from complications of ruptured gastric ulcer.

Death from the complications of a ruptured gastric ulcer in a 15 year old girl with anorexia nervosa is reported. A Medlars II search of the literature indicates no previously reported deaths from this cause in anorexia nervosa. This patient presented the classical clinical characteristics of the syndrome and the course of her illness serves to re-emphasize the seriousness of the disease and the importance of early management of anorexia nervosa.

Adolescent↗

PubMed1994

Infection caused by Mycobacterium tuberculosis.

OBJECTIVE: To update readers on the clinical management of infections caused by Mycobacterium tuberculosis, to provide a general description of the organism, culture and susceptibility testing, and clinical manifestations of the disease, and to provide several aspects of the treatment of the disease, including historical perspective, current approaches, and research opportunities for the future. DATA SOURCES: The current medical literature, including abstracts presented at recent international meetings, is reviewed. References were identified through MEDLINE, MEDLARS II, Current Contents, and published meeting abstracts. STUDY SELECTION: Data regarding the epidemiology, clinical manifestations, culture and susceptibility testing, and treatment of tuberculosis are cited. Specific attention has been focused on the clinical management of patients with noncontagious infection and potentially contagious active disease (TB) caused by M. tuberculosis. DATA EXTRACTION: Information contributing to the discussion of the topics selected by the authors is reviewed. Data supporting and disputing specific conclusions are presented. DATA SYNTHESIS: The incidence of TB is increasing in the US, despite the fact that available technologies are capable of controlling the vast majority of existing cases. Fueling the fire is the problem of coinfection with HIV and M. tuberculosis. Very few drugs are available for the treatment of TB, and few of these approach the potency of isoniazid and rifampin. Preventive therapy of patients exposed to multiple-drug-resistant M. tuberculosis (MDR-TB) is controversial and of unknown efficacy. Treatment of active disease caused by MDR-TB requires up to four times longer, is associated with increased toxicity, and is far less successful than the treatment of drug-susceptible TB. Strategies for the management of such cases are presented. The rising incidence of TB in the US reflects a breakdown in the healthcare systems responsible for controlling the disease, which reflects the past budgetary reductions. Although TB control is one of the most cost-effective public health strategies, funding has been cut repeatedly despite the fact that TB was never eliminated. This has helped to produce the current crisis, including the spread of MDR-TB in many urban areas. The elimination of TB will now take decades longer, cost hundreds of millions of dollars more, and result in vastly higher morbidity and mortality rates than would have occurred with timely, adequate measures. CONCLUSIONS: Tremendous effort and far more funding will be required to eliminate TB in the US. The selection of drug therapy must be based on the susceptibility data for each isolate. Multiple-drug therapy must be continued for 6 to > or = 24 months, and patient adherence to prescribed regimens must be verified in all cases of TB. Significant antimycobacterial drug malabsorption has been documented in AIDS patients with TB, and may result in treatment failure. New agents are needed to improve the clinical outcome in patients with MDR-TB.

Adult↗

PubMedDate not supplied

Aminoglycoside pharmacokinetics: volume of distribution in specific adult patient subgroups.

OBJECTIVE: To review the published clinical studies reporting volume of distribution for aminoglycosides in patient population subgroups. Controversies in methods used are discussed. DATA SOURCES: National Library of Medicine Medlars, searched using MEDLINE. STUDY SELECTION: Published articles primarily relating to pharmacokinetic properties of aminoglycosides in specific adult patient subgroups published within the past 20 years were included. Pediatric studies were excluded. DATA EXTRACTION: The methodology, assay technique, and results from clinical studies reporting aminoglycoside volume of distribution were evaluated. DATA SYNTHESIS: Clinical studies reporting aminoglycoside volume of distribution subgroups, including the methods by which their results were derived, are tabulated. CONCLUSIONS: The expected aminoglycoside volume of distribution can vary, depending on a patient's clinical presentation. Data presented will allow a more refined initial estimation of volumes of distribution, which may facilitate the achievement of desired aminoglycoside serum concentrations.

Adult↗

PubMed1995

Comparative role of omeprazole in the treatment of gastroesophageal reflux disease.

OBJECTIVE: To review gastroesophageal reflux disease (GERD) and its treatment, with emphasis on the use and place of omeprazole, a proton pump inhibitor. DATA SOURCES: A compilation prepared by the National Library of Medicine's Interactive Retrieval Services (Medlars II) for the period 1987 to 1994 was used as the data source. STUDY SELECTION: Focus was placed on human comparative clinical studies with well-accepted measures of esophageal healing (endoscopy) and symptom resolution. Safety data were compiled from the clinical trials literature and large postmarketing data studies. Pharmacoeconomic studies selected were judged to meet the criteria of good design, presence of sensitivity testing, and statement of perspective. DATA EXTRACTION: Data were obtained from double-blind, controlled clinical studies. Other data were extracted from pertinent literature of good design and significant results. DATA SYNTHESIS: Overall, the clinical trials of omeprazole for the treatment of patients with erosive GERD demonstrate that omeprazole provides superior therapy in terms of esophageal healing symptom resolution and patient compliance when compared with histamine2-receptor antagonists (H2RAs) and antacids. In addition, studies also indicate that omeprazole is the most effective agent for the treatment of patients with GERD refractory to other treatments. Dosage adjustment is not necessary in patients with impaired renal or hepatic function or in the elderly. Finally, although the acquisition drug cost for daily treatment of patients with GERD is highest with the use of omeprazole, pharmacoeconomic studies indicate that treatment is more cost-effective with the use of omeprazole than with H2RA or antacid treatment alone or combined with nonpharmacologic approaches. CONCLUSIONS: Based on efficacy, safety, and cost-effectiveness, omeprazole is the drug of choice for the treatment of patients with endoscopically confirmed erosive GERD.

Clinical Trials as Topic↗

PubMed1995

Principles and theory in bioethics.

The following citations were selected from BIOETHICSLINE, the online database prepared at the Kennedy Institute of Ethics for the National Library of Medicine's MEDLARS system. Searching the keywords autonomy, beneficence, casuistry, justice, and virtues, as well as the text word principlism produced more than 400 citations. Only the citations concerned with theory and principle in the practice of bioethics are included here -- e.g., works about justice in resource allocation have been deleted.

Bioethics↗

PubMed1992

Computer-aided decision support in hepatology.

The aim of this study was to describe and to evaluate the publications of the last 30 years devoted to computer-aided decision support in clinical hepatology. The search used Medlars and references of articles. Computer-aided decision support (CADS) was classified in two categories: statistical systems and knowledge-based systems. Two specific questionnaires were used for methodologic evaluation, one for statistical systems and one for knowledge-based systems. They were filled out independently by two observers. A total of 31 papers were selected among 55 identified between 1960 and 1991. The maximum possible for the two scores was 24. The methodologic quality ranged from 4 to 22 (median, 12) for statistical systems and from 8 to 12 (median, 9) for knowledge-based systems. The poor level of methodology could explain in part the lack of utilization of computer-aided decision support in the daily clinical practice of hepatologists.

Bayes Theorem↗

PubMedDate not supplied

Lymphangitic chromoblastomycosis.

Chromoblastomycosis (CM), a chronic subcutaneous mycosis, is caused by several dematiaceous fungi, the most common being Fonsecaea pedrosoi. It usually occurs in the lower extremities following traumatic implantation of the organisms. We are reporting a case of chromoblastomycosis on the right lower limb in a sporotrichoid pattern caused by F. pedrosoi. The pattern was probably due to lymphatic spread that seems to be one of the rare presentations. The histopathology showed typical muriform or medlar bodies both intracellularly and extracellularly within the granuloma. Culture revealed sporulating organisms (Cladosporium and Rhinocladiella type) by a combination method, characteristic of F. pedrosoi. Our case responded well to itraconazole.

Adult↗

PubMed2001

Evaluation of the antioxidant properties of Mediterranean and tropical fruits compared with common food additives.

Several Mediterranean and tropical fruits have been analyzed in order to assess their antioxidant activity compared with that of common food additives (butylated hydroxyanisole [BHA], butylated hydroxytoluene [BHT] and propyl gallate). Among Mediterranean fruits, red grape and plum were more effective (P < 0.05) scavengers of peroxyl radicals than BHA, BHT, and propyl gallate. Of the tropical fruits, banana was the most effective scavenger of peroxyl radicals. Mediterranean and tropical fruits showed very good scavenger activity against hydroxy radicals (OH*), protecting deoxyribose better than BHA and BHT. The HOCI scavenging ability of Mediterranean fruits tested was, in decreasing order, lemon > plum > apricot > white grape > melon > red grape > mandarin > watermelon > peach > medlar > apple > orange > cherry > strawberry. However, the four varieties of pear were poor scavengers (P < 0.05). Among tropical fruits, the order of efficiency as HOCI scavengers was passion fruit > lime > passiflora > kumquat > avocado > pineapple > physalis > papaya fruit > carambola > mango > banana. All Mediterranean fruits showed an effect on hydrogen peroxide except peach. Tropical fruits also had a strong effect on hydrogen peroxide except avocado, which had no effect. The effect of Mediterranean and tropical fruits on the protection factor of refined olive oil, analyzed by the Rancimat method and compared with common food additives, was clear. Watermelon conferred a significantly (P < 0.05) greater protection than the other Mediterranean fruits. Among tropical fruits, physalis had the most stabilizing effect.

Antioxidants↗