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PubMed2006

An evidence-based systematic review of herb and supplement interactions by the Natural Standard Research Collaboration.

Reported utilisation of prescription drug use concurrently with herbal or vitamin products have increased, placing an estimated 15 million patients at risk of potential drug-supplement interactions. This systematic review aims to consolidate relevant herb and supplement interactions data available for some of the more common classes of interactions experienced by clinicians. These classes include: hypoglycaemic/hyperglycaemics; hypotensive/hypertensives, diuretics, sedatives, cardiac glycosides, monoamine oxidase inhibitors, selective serotonin reuptake inhibitors, laxatives, immunomodulators, agents that may increase the risk of bleeding or clotting, agents that may be hepatotoxic, agents that may have hormonal properties, and agents with cytochrome P450 enzyme activity. The format is designed to promote use as a decision support tool for healthcare providers.

Evidence-Based Medicine↗
PubMed1998

"Whiplash associated disorders: redefining whiplash and its management" by the Quebec Task Force. A critical evaluation.

STUDY DESIGN: The two publications of the Quebec Task Force on Whiplash-Associated Disorders were evaluated by the authors of this report for methodologic error and bias. OBJECTIVES: To determine whether the conclusions and recommendations of the Quebec Task Force on Whiplash-Associated Disorders regarding the natural history and epidemiology of whiplash injuries are valid. SUMMARY OF THE BACKGROUND DATA: In 1995, the Quebec Task Force authored a text (published by the Societe de l'Assurance Automobile du Quebec) and a pullout supplement in Spine entitled "Whiplash-Associated Disorders: Redefining Whiplash and its Management." The Quebec Task Force concluded that whiplash injuries result in "temporary discomfort," are "usually self-limited," and have a "favorable prognosis," and that the "pain [resulting from whiplash injuries] is not harmful." METHODS: The authors of the current report reviewed the text and the supplement for methodologic flaws that may have threatened the validity of the conclusions and recommendations of the Quebec Task Force. RESULTS: Five distinct and significant categories of methodologic error were found. They were: selection bias, information bias, confusing and unconventional use of terminology, unsupported conclusions and recommendations, and inappropriate generalizations from the Quebec Cohort Study. CONCLUSION: The validity of the conclusions and recommendations of the Quebec Task Force regarding the natural course and epidemiology of whiplash injuries is questionable. This lack of validity stems from the presence of bias, the use of unconventional terminology, and conclusions that are not concurrent with the literature the Task Force accepted for review. Although the Task Force set out to redefine whiplash and its management, striving for the desirable goal of clarification of the numerous contentious issues surrounding the injury, its publications instead have confused the subject further.

Accidents, Traffic↗
PubMed1990

Concurrent intradural and extradural meningiomas of the cervical spine.

A case of an extradural spinal meningioma presenting with a separate intradural meningioma at the same cord level is reported. Review of the English literature on spinal epidural meningiomas reveals a high incidence of concurrent intradural tumors in patients with epidural meningiomas. This leads to the conclusion that the intradural space should be evaluated carefully when an epidural meningioma is encountered.

Adult↗
PubMedDate not supplied

[A combination of an aneurysm of the bifurcation of the internal carotid artery with agenesis of its trunk].

A case of agenesis of the internal carotid artery with ipsilateral aneurysm of the anterior middle cerebral artery is first described in the literature. This is a 23-year-old male with seizures in whom computed tomography and magnetic resonance imaging (MRI) revealed a large left paracellular calcified formation. MRI showed no ipsilateral aneurysms of the internal carotid artery and carotid canal. Agenesis was confirmed by intraoperative data at removal of thrombotic aneurysm. The paper provides a brief account of the outcome of surgery and a review of literature on agenesis of the internal carotid artery concurrent with cerebral aneurysms.

Adult↗
PubMed1998

Individual and social determinants of shiftwork tolerance.

This paper reviews evidence published on individual and social determinants of shiftwork tolerance since 1993. In agreement with earlier reviews, individual differences show only some low and inconsistent concurrent covariation with shiftwork tolerance, and no predictive power for these measures has been found. It is thus not possible to predict future shiftwork tolerance from individual differences. Social conditions are also related to shiftwork tolerance, although again predictive power has not been demonstrated. An examination of the reasons for this state of the art suggested means of improving the relevance and usability of future research in this area.

Circadian Rhythm↗
PubMed2003

Brief report: efficacy and treatment-limiting toxicity with the concurrent use of lopinavir/ritonavir and a third protease inhibitor in treatment-experienced HIV-infected patients.

To investigate the efficacy and tolerability of using lopinavir/ritonavir concurrently with a third protease inhibitor (PI), the authors reviewed the medical records of 47 HIV-infected patients treated with antiretroviral regimens containing lopinavir/ritonavir and amprenavir, saquinavir, indinavir, or nelfinavir. The baseline mean HIV RNA level was 4.6 log(10) copies/mL, and the median CD4 cell count was 123/mm3. By week 40, one patient (2%) was lost to follow-up, and 21 (44%) discontinued their lopinavir/ritonavir plus a third PI regimens: 4 (8%) due to virologic failure as determined by the clinician; 13 (28%) due to toxicity; and 4 (8%) due to social reasons. By intent-to-treat analysis, 12 (26%) of 47 patients had an HIV RNA level of less than 400 copies/mL at 40 weeks. By multivariate analysis, factors associated with virologic response were no prior lopinavir exposure (p =.03) and no prior exposure to nonnucleoside reverse transcriptase inhibitors among patients taking a nonnucleoside reverse transcriptase inhibitor (p =.05). Some HIV-infected patients concurrently treated with lopinavir/ritonavir and a third PI have viral suppression; many eventually discontinue therapy because of toxicity or virologic failure.

Adult↗
PubMed1999

Treatment of schizoaffective disorder and schizophrenia with mood symptoms.

OBJECTIVE: Patients with concurrent schizophrenic and mood symptoms are often treated with antipsychotics plus antidepressant or thymoleptic drugs. The authors review the literature on treatment of two overlapping groups of patients: those with schizoaffective disorder and those with schizophrenia and concurrent mood symptoms. METHOD: MEDLINE searches (from 1976 onward) were undertaken to identify treatment studies of both groups, and references in these reports were checked. Selection of studies for review was based on the use of specified diagnostic criteria and of parallel-group, double-blind design (or, where few such studies addressed a particular issue, large open studies). A total of 18 treatment studies of schizoaffective disorder and 15 of schizophrenia with mood symptoms were selected for review. RESULTS: For acute exacerbations of schizoaffective disorder or of schizophrenia with mood symptoms, antipsychotics appeared to be as effective as combination treatments, and there was some evidence for superior efficacy of atypical antipsychotics. There was evidence supporting adjunctive antidepressant treatment for schizophrenic and schizoaffective patients who develop a major depressive syndrome after remission of acute psychosis, but there were mixed results for treatment of subsyndromal depression. There was little evidence to support adjunctive lithium for depressive symptoms and no evidence concerning its use for manic symptoms in patients with schizophrenia. CONCLUSIONS: Empirical data suggest that both groups of patients are best treated by optimizing antipsychotic treatment and that atypical antipsychotics may prove to be most effective. Adjunctive antidepressants may be useful for patients with major depression who are not acutely ill. Careful longitudinal assessment is required to ensure identification of primary mood disorders.

Anticonvulsants↗
PubMed1996

Unenhanced helical CT of ureteral stones: incidence of associated urinary tract findings.

OBJECTIVE: The objective of this study was to determine the incidence of urinary tract findings associated with ureteral stones on unenhanced helical CT scans of patients with acute renal colic. MATERIALS AND METHODS: One hundred forty-one consecutive patients with suspected renal colic were referred by the emergency department for a helical CT scan that was obtained without oral or IV contrast. The CT scans of 54 of these patients were interpreted as positive for ureteral calculi, and these CT scans were reviewed retrospectively. The size and location of each ureteral calculus and of any concurrent urinary tract calculi were recorded. The presence or absence of hydronephrosis, hydroureter, perinephric edema or soft-tissue stranding, and periureteral edema was also noted. RESULTS: We reviewed the original 5-mm axial images from the 54 CT scans. Calculi were present in the proximal, mid, and distal ureter in eight, four, and 14 patients respectively, and at the ureterovesicular junction in 28 patients. Only two patients had more than one ureteral calculus, and none had a contralateral ureteral calculus. Concurrent renal parenchymal and/or nonobstructing calculi in the renal pelvis were seen in five patients with proximal, mid, or distal ureteral stones and in 16 patients with ureterovesicular junction stones. Hydronephrosis was found in 37 patients, hydroureter in 36 patients, and perinephric soft-tissue changes in 35 patients. Periureteral edema could not be evaluated in the 28 patients with ureterovesicular junction calculi because of the adjacent bladder, but periureteral edema was clearly seen immediately adjacent to the ureteral stone in 17 of the other 26 patients. Only two of the 54 patients had no evidence of hydronephrosis, hydroureter, or perinephric soft-tissue changes. CONCLUSION: In patients with ureteral calculi imaged with unenhanced CT for acute renal colic, associated findings included hydronephrosis, hydroureter, perinephric soft-tissue changes, and periureteral edema. These common findings provided supportive evidence that an acute obstructive process was present.

Adolescent↗
PubMed1999

Acute pancreatitis after gynecologic and obstetric surgery.

OBJECTIVE: Our goal was to evaluate the prevalence and comorbidity of acute postoperative pancreatitis after gynecologic and obstetric surgery. STUDY DESIGN: We reviewed the Mayo Medical Center surgical database (January 1953-January 1997) to identify all confirmed cases of acute pancreatitis occurring within the standard 6-week postoperative convalescence after obstetric and gynecologic surgical procedures. Pancreatitis as a result of concurrent pancreatic or biliary surgery was excluded. Pertinent clinical data were reviewed. RESULTS: Eleven cases of postoperative pancreatitis were identified, with an overall incidence of 1 in 17,000 surgical procedures. Postoperative pancreatitis was more common after obstetric surgery. Identifiable risk factors were noted in 45% of cases, with occult cholelithiasis the predominant factor. Presenting signs and symptoms were primarily epigastric pain, oliguria, and ileus. Significant morbidity or mortality was noted in 27% of the cases. CONCLUSIONS: Acute postoperative pancreatitis is a rare complication after gynecologic and obstetric surgery. Signs and symptoms of pancreatitis are nonspecific in the postoperative setting. Prompt diagnosis and supportive therapy are essential to minimize morbidity and mortality.

Acute Disease↗
PubMed1985

Thoracic spinal angiomyolipoma: case report and literature review.

A rare case of thoracic spinal angiomyolipoma presenting with evidence of vertebral body infiltration and concurrent epidural spinal cord compression is described. Clinicopathological correlates, aspects of radiological diagnosis, considerations for surgical management, and histopathological features denoting possible unique attributes of biological behavior for this entity are discussed in conjunction with a review of the previous literature on angiolipomas in general.

Adult↗
PubMed2000

Accuracy of the Papanicolaou test in screening for and follow-up of cervical cytologic abnormalities: a systematic review.

PURPOSE: To evaluate the accuracy of conventional and new methods of Papanicolaou (Pap) testing when used to detect cervical cancer and its precursors. DATA SOURCES: Systematic search of English-language literature through October 1999 using MEDLINE, EMBASE, other computerized databases, and hand searching. STUDY SELECTION: All studies that compared Pap testing (conventional methods, computer screening or rescreening, or monolayer cytology) with a concurrent reference standard (histologic examination, colposcopy, or cytology). DATA EXTRACTION: Two reviewers independently reviewed selection criteria and completed 2 x 2 tables for each study. DATA SYNTHESIS: 94 studies of the conventional Pap test and three studies of monolayer cytology met inclusion criteria. No studies of computerized screening were included. Data were organized by cytologic and histologic thresholds used to define disease. For conventional Pap tests, estimates of sensitivity and specificity varied greatly in individual studies. Methodologic quality and frequency of histologic abnormalities also varied greatly between studies. In the 12 studies with the least biased estimates, sensitivity ranged from 30% to 87% and specificity ranged from 86% to 100%. CONCLUSIONS: Insufficient high-quality data exist to estimate test operating characteristics of new cytologic methods for cervical screening. Future studies of these technologies should apply adequate reference standards. Most studies of the conventional Pap test are severely biased: The best estimates suggest that it is only moderately accurate and does not achieve concurrently high sensitivity and specificity. Cost-effectiveness models of cervical cancer screening should use more conservative estimates of Pap test sensitivity.

Cervix Uteri↗
PubMed2000

Radiation with concurrent late chemotherapy intensification ('chemoboost') for locally advanced head and neck cancer.

The aim of this study was to review our experience with a treatment regimen that combined conventionally fractionated radiation therapy (70 Gy over 7 weeks) with chemotherapy (cisplatin and fluorouracil), given concurrently in the last 2 weeks of radiation therapy in patients with previously untreated advanced squamous cell cancer of the head and neck region.Twenty-eight patients, all but two having UICC stage IV disease, were treated at the Peter MacCallum Cancer Institute between November 1995 and April 1998. Planned chemotherapy consisted initially of continuous infusion at 10 mg/m(2) per day of cisplatin and 400 mg/m(2) per day of fluorouracil on days 1-5 of weeks 6 and 7 of a conventionally fractionated course of radiotherapy. After the first 14 patients, the dose of fluorouracil was reduced to 360 mg/m(2) per day because of acute toxicity.36.8 months), with an estimated 50% surviving at 2 years (CI, 29-71%). Sixteen patients (57%) developed confluent mucositis and 11 (39%) developed patchy mucositis. The median duration of mucositis for these 27 patients was 1.5 months. Seventeen patients (61%) required nutritional support for a median duration of 1.4 months. Fourteen patients (50%) had grade three skin reactions, and 12 (43%) had one or more other significant (Grade 3) toxicities, predominantly infective. Grade 3 late toxicity has been observed in three patients to date (three xerostomia, including one with severe depression), and one patient had chronic ulceration of the oral tongue (grade 4). This chemoradiation regimen achieved an excellent complete response rate and good locoregional control at 2 years in patients with a poor initial prognosis. Acute toxicity was significant but manageable. The regimen offers an alternative to surgery and postoperative radiation therapy in locally advanced head and neck cancer.

Adult↗
PubMed2005

Concurrent coronary and carotid artery surgery: factors influencing perioperative outcome and long-term results.

AIMS: To assess risk factors for early and late outcome after concurrent carotid endarterectomy (CEA) and coronary artery bypass grafting (CABG). METHODS AND RESULTS: Records of all 311 consecutive patients having concurrent CEA and CABG from 1989 to 2002 were reviewed, and follow-up obtained (100% complete). In the group (mean age 67 years; 74% males), 62% had triple-vessel disease, 57% unstable angina, 31% left main coronary stenosis, 19% congestive heart failure, and 35% either a history of vascular procedures or existing vasculopathies. Preoperative assessment revealed transient ischaemic attack in 16%, stroke in 7%, and bilateral carotid disease in 20%. There were 7% emergent and 19% urgent operations, and ascending aorta was described as atheromatous or calcified in 21%. Hospital death occurred in 19 patients, myocardial infarction in seven, and permanent stroke in 12. Significant multivariable predictors of hospital death were aortic calcifications, coexisting vasculopathy, and emergent procedure. Significant predictors of postoperative stroke were calcified or dilated aorta, and of prolonged hospital stay were advanced age, unstable angina, and coexisting vascular disease. For hospital survivors, 10-year actuarial late event-free rates were: death, 50%; myocardial infarction, 84%; stroke, 93%; percutaneous angioplasty, 95%; redo CABG, 98%; and all morbidity and mortality, 48%. Significant multivariable predictors of late deaths were coexisting vasculopathy, age, renal insufficiency, previous cardiac surgery, tobacco abuse, calcified or atheromatous aorta, and duration of intensive care unit stay. CONCLUSION: Concurrent CEA and CABG can be performed with acceptable operative mortality and morbidity, and good long-term freedom from coronary and neurologic events. Atheromatous aortic disease is a harbinger of poor operative and long-term outcome.

Adult↗
PubMed2004

Concurrent chemotherapy and reduced-dose cranial spinal irradiation followed by conformal posterior fossa tumor bed boost for average-risk medulloblastoma: efficacy and patterns of failure.

PURPOSE: To review the efficacy and patterns of failure in average-risk medulloblastoma patients treated with concurrent chemotherapy and reduced-dose cranial spinal irradiation and a conformal tumor bed boost. METHODS AND MATERIALS: Thirty-three patients with average risk (defined as < or =1.5 cm(2) of residual tumor after resection, age >3 years, and no involvement of the cerebrospinal fluid or spine [M0]) medulloblastoma were diagnosed at our institution between January 1994 and December 2001. They were enrolled in an institutional pilot protocol consisting of concurrent chemotherapy (vincristine), reduced-dose cranial spinal irradiation (2340 cGy), a conformal primary tumor bed boost (3240 cGy), followed by eight cycles of chemotherapy (vincristine, cisplatin, and lomustine or cyclophosphamide). The median age at diagnosis of the 33 patients was 7 years (range, 3-21 years). The male/female patient ratio was 2.4:1. The median follow-up of the entire group was 37 months (range, 6-96 months), and the median follow-up of the survivors was 44 months (range, 10-96 months). RESULTS: The 5-year estimated disease-free survival rate, as determined by Kaplan-Meier plots, was 86% (+/-12.6%, 95% confidence interval). The 5-year estimated disease-free posterior fossa control and primary tumor bed control rates were both 94% (+/-8.2%, 95% confidence interval). The patterns of failure included 2 patients with distant central nervous system failure only, 1 patient who developed local primary tumor bed failure, posterior fossa failure, and diffuse leptomeningeal spread simultaneously, and 1 patient with failure in the high-dose, primary tumor bed field. No patient experienced isolated posterior fossa failure outside the high-dose boost region. CONCLUSION: The treatment of average-risk medulloblastoma with chemotherapy, reduced-dose cranial spinal irradiation, and a conformal tumor bed boost results in survival rates and local control rates comparable to those in contemporary studies. A reduction in the amount of posterior fossa treated to the high dose is possible. These results need to be corroborated in a large, cooperative group study.

Adolescent↗
PubMed1996

Meningioangiomatosis and oligodendroglioma in a 15-year-old boy.

A case of meningioangiomatosis occurring in a 15-year-old boy is reported. The patient did not show signs of neurofibromatosis on physical examination, and his medical history included only one previous episode of loss of consciousness, which was accompanied by a self-limited focal seizure. The lesion was associated with an oligodendroglioma and was incidentally discovered during the macroscopic sampling of the neurosurgical specimen. The literature relating to this uncommon entity is reviewed and discussed. To the best of our knowledge, the concurrence of meningioangiomatosis and oligodendroglioma has not been documented previously.

Adolescent↗
PubMedDate not supplied

CT staging of esophageal carcinoma in patients treated by primary radiation therapy and chemotherapy.

Primary radiation therapy with concurrent chemotherapy is under study as definitive and palliative therapy for patients with esophageal carcinoma. To evaluate the correlation between CT staging and outcome, we retrospectively reviewed the CT scans of 48 patients treated with primary radiation therapy and concurrent chemotherapy and correlated CT staging with disease-free survival, overall survival, and site of relapse. Excluding one patient who was understaged and six patients who died of problems unrelated to esophageal carcinoma, mean survival of CT stage I, II, and III patients was 14.7, 21.3, and 5.2 months, respectively. When the CT stage is modified by the presence of nodal involvement on CT, the mean survival of stage IIn and IIIn (nodes greater than 1.5 cm in diameter) and stage IV patients (distant metastases) was 16.4, 19.2, and 10.6 months, respectively. Despite thickening of the esophageal wall greater than 3.0 cm in five patients with stage IIn cancer, mean survival was still 19.2 months. Patients with pericardial effusion had the worst survival of only 4.3 months. Stage II patients had a significantly longer (p less than 0.05) disease-free period than all other groups and the difference between stage II and III patients was highly significant (p less than 0.01). Stage II patients were also more likely to be disease-free at the time of death or last follow-up (p less than 0.05). Computed tomographic staging of esophageal carcinoma is useful in radiation therapy treatment planning and predicting outcome of patients managed with a nonsurgical technique of concurrent radiation and chemotherapy.

Adult↗
PubMedDate not supplied

The effectiveness of primary care-based interventions to promote breastfeeding: systematic evidence review and meta-analysis for the US Preventive Services Task Force.

PURPOSE: We wanted to systematically review whether primary care-based interventions improve initiation and duration of breastfeeding. METHODS: Studies were found by searching MEDLINE (1966-2001), Health-STAR, the Cochrane Database of Systematic Reviews, the National Health Service Centre for Reviews and Dissemination Databases, and bibliographies of identified trials and review articles. Studies were included if they originated in the primary care setting and were conducted in a developed country, written in English, and contained a concurrent control group. RESULTS: Thirty randomized and nonrandomized controlled trials and 5 systematic reviews of breastfeeding counseling were included. Educational programs had the greatest effect of any single intervention on both initiation (difference 0.23; 95% confidence interval [CI], 0.12-0.34) and short-term duration (difference 0.39; 95% CI, 0.27-0.50). Support programs conducted by telephone, in person, or both increased short-term (difference 0.11; 95% CI, 0.03-0.19) and long-term duration (difference 0.08; 95% CI, 0.02-0.16). In contrast, written materials such as pamphlets did not significantly increase breastfeeding. Data were insufficient to determine whether the combination of education with support was more effective than education alone. CONCLUSIONS: Educational programs were the most effective single intervention. One woman would breast-feed for up to 3 months for every 3 to 5 women attending breastfeeding educational programs. Future research and policy should focus on translating these findings into more widespread practice in diverse primary care settings.

Advisory Committees↗