Diagnostic work-up in peripheral neuropathy: an analysis of 171 cases

This study was set up to evaluate retrospectively the efficacy of a standard diagnostic procedure, including non-invasive and invasive (spinal tap, nerve/muscle biopsy) investigations, in the diagnosis of peripheral neuropathy. The medical records of 171 in-patients with the final diagnosis of peripheral neuropathy of determined or undetermined cause were reviewed and each individual diagnostic work-up was analysed. Basic investigations included the patient's history, a clinical examination and basic laboratory tests. Depending on the individual presentation, course, and severity, further non-invasive and invasive examinations were added according to the department's standard diagnostic procedure. The aetiology could be clarified in 124 patients (73%) and remained unclear in 47 cases. Excluding cases with acute and chronic inflammatory polyneuropathy (n=14), the number of idiopathic peripheral neuropathies dropped to 33. Non-invasive investigations were sufficient to reveal the underlying aetiology in 114 cases (83 %). It is concluded that, with the application of a standard procedure for the diagnosis of peripheral neuropathy, the aetiology can be clarified in 81% of patients. In the other 19% of patients the aetiology remains idiopathic. In the majority of cases, non-invasive investigations were sufficient for diagnosis.     

Meta-analysis of benzodiazepine use in the treatment of acute alcohol withdrawal

OBJECTIVE: To analyse the evidence for the efficacy and potential harmful effects of benzodiazepines compared with other therapies in the treatment of acute alcohol withdrawal. DATA SOURCES: MEDLINE and the Cochrane Controlled Trials Registry were searched for English-language articles published from 1966 to December 1997 that described randomized controlled trials (RCTs) of benzodiazepines in the treatment of acute alcohol withdrawal. Key words included "benzodiazepines" (exploded) and "randomized controlled trial." Bibliographies of relevant articles were reviewed for additional RCTs, and manufacturers of benzodiazepines were asked to submit additional RCT reports not in the literature. STUDY SELECTION: Articles were considered for the meta-analysis if they were RCTs involving patients experiencing acute alcohol withdrawal and comparing a benzodiazepine available in Canada with placebo or an active control drug. Of the original 23 trials identified, 11 met these criteria, representing a total of 1286 patients. DATA EXTRACTION: Data were extracted regarding the participants, the setting, details of the intervention, the outcomes (including adverse effects) and the methodologic quality of the studies. DATA SYNTHESIS: The meta-analysis of benefit (therapeutic success within 2 days) showed that benzodiazepines were superior to placebo (common odds ratio [OR] 3.28, 95% confidence interval [CI] 1.30-8.28). Data on comparisons between benzodiazepines and other drugs, including beta-blockers, carbamazepine and clonidine, could not be pooled, but none of the alternative drugs was found to be clearly more beneficial than the benzodiazepines. The meta-analysis of harm revealed no significant difference between benzodiazepines and alternative drugs in terms of adverse events (common OR 0.67, 95% CI 0.34-1.32) or dropout rates (common OR 0.68, 95% CI 0.47-0.97). INTERPRETATION: Benzodiazepines should remain the drugs of choice for the treatment of acute alcohol withdrawal.     

Meta-analysis of benzodiazepine use in the treatment of insomnia

OBJECTIVE: To systematically review the benefits and risks associated with the use of benzodiazepines to treat insomnia in adults. DATA SOURCES: MEDLINE and the Cochrane Controlled Trials Registry were searched for English-language articles published from 1966 to December 1998 that described randomized controlled trials of benzodiazepines for the treatment of insomnia. Key words included "benzodiazepines" (exploded), "randomized controlled trial" and "insomnia." Bibliographies of relevant articles were reviewed for additional studies and manufacturers of benzodiazepines were asked to submit additional randomized controlled trial reports not in the literature. STUDY SELECTION: Articles were considered for the meta-analysis if they were randomized controlled trials involving patients with insomnia and compared a benzodiazepine with placebo or another active agent. Of the 89 trials originally identified, 45 met our criteria, representing a total of 2672 patients. DATA EXTRACTION: Data were extracted regarding the participants, the setting, details of the intervention, the outcomes (including adverse effects) and the methodologic quality of the studies. DATA SYNTHESIS: The meta-analyses of sleep records indicated that, when compared with placebo, benzodiazepines decreased sleep latency by 4.2 minutes (non-significant; 95% confidence interval (CI -0.7 to 9.2) and significantly increased total sleep duration by 61.8 minutes (95% CI 37.4 to 86.2). Patient-reported outcomes were more optimistic for sleep latency; those randomized to benzodiazepine treatment estimated a sleep latency decrease of 14.3 minutes (95% CI 10.6 to 18.0). Although more patients receiving benzodiazepine treatment reported adverse effects, especially daytime drowsiness and dizziness or light-headedness (common odds ratio 1.8, 95% CI 1.4 to 2.4), dropout rates for the benzodiazepine and placebo groups were similar. Cognitive function decline including memory impairment was reported in several of the studies. Zopiclone was not found to be superior to benzodiazepines on any of the outcome measures examined. INTERPRETATION: The use of benzodiazepines in the treatment of insomnia is associated with an increase in sleep duration, but this is countered by a number of adverse effects. Additional studies evaluating the efficacy of nonpharmacological interventions would be valuable.     

Misoprostol in labour induction of term pregnancy: a meta-analysis

Objective To evaluate the efficacy and safety of misoprostol in term labour induction. Data sources Data from published English and Chinese literatures about misoprostol in term labour induction were identified from Medline and CBMdisk (using the search terms “misoprostol” and “labour induction”) before 2001; hand searches of reference lists of original studies and reviews (including meta-analyses) and contact with investigators in this field before 2001. Study selection Studies were included if they had data on misoprostol and labour induction. Altogether 623 articles were found and 124 were admitted, including 19 287 cases. Data extraction Data were collected on efficacy and incidence of side-effects of misoprostol and oxytocin. Data were checked for consistency within the published articles and converted into a standard format for incorporation into a central database. Data synthesis The average successful induction rate, rates of caesarean section; incidence of tachysystole, hypertonus of uterus and precipitous labour, and rates of meconium stained amniotic fluid between the misoprostol and oxytocin groups were significantly different (P<0.05). There were no significant differences between the two groups concerning the average interval from the administration of misoprostol and oxytocin to the onset of labour, duration of the total stage of labour, incidence rate of foetal distress, neonatal asphyxia (1-minute Apgar score≤7), postpartum haemorrhage or amount of blood loss in postpartum.Conclusions Misoprostol is a superior agent over oxytocin on the induction of term labour, but its application might increase the risk of precipitatous labour, abnormal uterine contractions or meconium stained amniotic fluid. Therefore, the doasges and regimens of the agent need further investigation.     

Effect of ambulance 12-lead ECG recording on times to hospital reperfusion in acute myocardial infarction

OBJECTIVE: To review the evidence that recording a prehospital 12-lead electrocardiogram (ECG) reduces time from hospital arrival to initiation of reperfusion therapy for acute myocardial infarction (AMI). DATA SOURCES: Medline search from 1966 to the present (articles in all languages) and examination of bibliographies. STUDY SELECTION: Published studies of prehospital 12-lead ECG recording that included control groups and reported time intervals from hospital arrival to start of reperfusion therapy. DATA EXTRACTION: Eight articles satisfied selection criteria (two randomised controlled trials, four non-randomised interventional studies and two prospective observational studies). DATA SYNTHESIS: Widely varying study methodologies precluded meta-analysis. All studies had methodological problems, but hospital delays were consistently reduced. Such improvements appear to be small in hospitals where delays are already minimal. CONCLUSIONS: Little evidence is available to support routine prehospital 12-lead ECG recording if the median hospital time to reperfusion is already less than 30 minutes. Improvement of in-hospital treatment times may be a better initial strategy than prehospital 12-lead ECG recording, as this will benefit more patients and allow ambulance services to better allocate their available resources.     

A comparison of results of meta-analyses of randomized control trials and recommendations of clinical experts. Treatments for myocardial infarction.

OBJECTIVE--To examine the temporal relationship between accumulating data from randomized control trials of treatments for myocardial infarction and the recommendations of clinical experts writing review articles and textbook chapters. DATA SOURCES--(1) MEDLINE search from 1966 to present; search terms used were myocardial infarction, clinical trials, multicenter studies, double-blind method, meta-analysis, and the text word "random:"; (2) references from pertinent articles and books; and (3) all editions of English-language general medical texts and manuals and review articles on treatment of myocardial infarction. STUDY SELECTION--Randomized control trials of therapies for reducing the risk of total mortality in myocardial infarction (acute and secondary prevention). Review articles and textbook chapters dealing with the general clinical management of patients with myocardial infarction. DATA EXTRACTION--Two authors read the material and recorded the results; disagreements were resolved by conference. DATA SYNTHESIS--We used the technique of cumulative meta-analysis (performing a new meta-analysis when the results of a new clinical trial are published) and compared the results with the recommendations of the experts for various treatments for myocardial infarction. Discrepancies were detected between the meta-analytic patterns of effectiveness in the randomized trials and the recommendations of reviewers. Review articles often failed to mention important advances or exhibited delays in recommending effective preventive measures. In some cases, treatments that have no effect on mortality or are potentially harmful continued to be recommended by several clinical experts. CONCLUSIONS--Finding and analyzing all therapeutic trials in a given field has become such a difficult and specialized task that the clinical experts called on to summarize the evidence in a timely fashion need access to better databases and new statistical techniques to assist them in this important task.     

The association between haemospermia and severe hypertension

The association between haemospermia and hypertension was examined in a case-control study comparing 5 hypertensive patients with haemospermia to 20 age-matched hypertensive men. Patients with haemospermia had much higher blood pressures than hypertensive controls (200/131 mmHg vs 147/90 mmHg; P less than 0.0005/P less than 0.0001), higher left ventricular voltage on ECG (P less than 0.02), and higher concentrations of serum creatinine, proteinuria and renovascular disease (all P = 0.06 vs controls). Haemospermia is associated with severe uncontrolled hypertension. It is not, however, associated with hypertension per se, as the prevalence of hypertension in published series of patients with haemospermia is no higher than that expected in the general population. Men presenting with haemospermia should have their blood pressure measured carefully as they may require antihypertensive treatment urgently.     

Research on autosomal dominant polycystic kidney disease in China

Objective To review the history and recent development of research on autosomal dominant polycystic kidney disease （ADPKD） in China. Data sources Both Chinese and English literatures were searched in MEDLINE/CD ROM （1979 - 2006） and the Chinese Biomedical Literature Disk （1979 - 2006）. Study selection Published articles about ADPKD from mainland of China were selected. Data were mainly extracted from 58 articles which are listed in the reference section of this review. Results Some preliminary reports on cyst decompression surgeries and mutation analysis represent the contribution to the ADPKD research from China in the history. A serial of basic research and clinical studies on ADPKD in recent years also have been summarized. A technique platform for ADPKD research was firstly established. The genomics/proteomics/bioinformatics approach was introduced, which provide a lot of valuable information for understanding the pathogenesis. By denature high performance liquid chromatography （DHPLC） technique the entire PKD1 and PKD2 gene sequence screening system for Chinese Han population has been successfully established. Based on the characteristic data of Chinese patients, an integrated therapy protocol was put forward and won an advantage over the traditional therapy. Some novel experimental studies on therapy also were encouraging. Condusions Remarkable progress of ADPKD research in China have been made recently. Still many works, including the government support, international collaboration and active participation of more Chinese nephrologists, should be enhanced to advance this process in the near future.     

肺癌中医证候诊断规范研究现状及思考

目的:通过梳理肺癌中医证候诊断研究相关文献,分析其研究对象、研究类型、研究要素、关键技术及中医辨证参考依据等,为肺癌中医证候诊断标准的建立提供思路.方法:检索PubMed、Embase、中国知网、万方数据库、维普网、中国生物医学文献数据库收集肺癌证候诊断研究文献,建立肺癌中医证候诊断研究数据库,对纳入文献的研究对象、研...     

Pharmacologic management of refractory depression.

OBJECTIVE: To review published clinical trials of the pharmacologic management of refractory depression. DATA SOURCES: MEDLINE was searched for relevant articles published from 1983 to 1990. The bibliographies of review articles were searched for additional references. Studies of nonpharmacologic treatments, such as electroconvulsive therapy, were not included. STUDY SELECTION: Eleven studies were found that did not contain obvious digressions from several methodologic assessment criteria (adapted from the McMaster guidelines for the evaluation of clinical trials). Further scrutiny by a nonblind reviewer resulted in the selection of four reports that were considered acceptable. An assessment by a second reviewer, blind as to author, results and journal name, confirmed this judgement. DATA EXTRACTION: Data describing response to the treatments were extracted by a single (nonblind) reviewer. Post-hoc power estimates and 95% confidence intervals were calculated whenever possible. DATA SYNTHESIS: The efficacy of augmenting an antidepressant regimen with lithium carbonate, triiodothyronine or reserpine was not supported by findings from the clinical trials reviewed. However, many trials with negative results lacked adequate statistical power to exclude the possibility of the drug's efficacy. The use of a monoamine oxidase inhibitor was supported by the one study that met the review's methodologic criteria. However, this study was not conducted under double-blind conditions. CONCLUSION: The generally recommended strategies for the pharmacologic treatment of refractory depression are not supported by methodologically sound studies.     

Differentiation therapy for acute promyelocytic leukemia with all-trans retinoic acid: 10-year experience of its clinical application

OBJECTIVE To summarize the experiences in using all-trans retinoic acid (ATRA) for the differentiation therapy for acute promyelocytic leukemia (APL) since our introduction of its use in clinic in 1986.

METHODS Data resources came from Chinese Journal of Hematology, English-language literature using MEDLINE (1988-1998), book entitled "Treatment of Malignancies by Inducing Differentiation and Apoptosis" published by Shanghai Publishing House on Sciences and Technology, and our recent data to be published.

METHODS Thirty-five articles related to the purpose of this review were reviewed.

METHODS Data were checked for their quality, reliance and originality.

RESULTS ATRA combined with chemotherapy can decrease the incidence of retinoic acid syndrome and produce a very high remission rate (90%-95%). Post-remission treatment should include chemotherapy and ATRA, the 5-year survival probability was able to attain 0.71 +/- 0.06. The main problem in the treatment is early tolerance to ATRA and relapse of the disease. The most effective treatments for relapsed APL is to use arsenic trioxide.

CONCLUSIONS The combination of ATRA, chemotherapy and arsenic oxide in the treatment of APL for elevating the remission rate and prolonging survival time deserves further study.

     

Westernisation, insulin resistance and diabetes in Australian aborigines

OBJECTIVE: To examine the published data on the impact of westernisation on obesity, non-insulin dependent diabetes mellitus (NIDDM), and coronary heart disease (CHD) in Australian Aborigines. DATA SOURCES: Fifty-five articles from Australian and international sources (primarily peer-reviewed journals) are cited. STUDY SELECTION: Twenty-eight reports providing data on the diet, lifestyle, health and "lifestyle diseases" of Australian Aborigines before and after westernisation are included in this review. A further 27 articles on obesity, NIDDM, CHD, insulin resistance, and the impact of diet and exercise were used to help interpret the Aboriginal data. DATA EXTRACTION: Information on dietary composition, anthropometry, disease and risk factor prevalence, and relevant biochemical measurements were used for comparative and interpretive purposes. DATA SYNTHESIS: The traditional hunter-gatherer lifestyle of Australian Aborigines, characterised by high physical activity and a diet of low energy density (low fat, high fibre), promoted the maintenance of a very lean body weight and minimised insulin resistance. In contrast, for most Aborigines a Western lifestyle is characterised by reduced physical activity and an energy-dense diet (high in refined carbohydrate and fat) which promotes obesity and maximises insulin resistance. When they make the transition from their traditional hunter-gatherer lifestyle to a westernised lifestyle, Aborigines develop high prevalence rates for obesity (with an android pattern of fat distribution), non-insulin dependent diabetes, impaired glucose tolerance, hypertriglyceridaemia, hypertension and hyperinsulinaemia. The striking improvements in carbohydrate and lipid metabolism in diabetic and non-diabetic Aborigines after a temporary reversion to a traditional hunter-gatherer lifestyle highlight the potentially reversible nature of the detrimental effects of lifestyle change, particularly in young people who have not yet developed diabetes. CONCLUSION: It is suggested that insulin resistance was important to the survival of Aborigines as hunter-gatherers, but is also the underlying metabolic characteristic predisposing them to obesity, NIDDM and CHD after westernisation. Intervention strategies to prevent chronic diseases related to insulin resistance should be directed at lifestyle modification. To be effective such programmes will have to be developed and implemented at the community level.     

Gastrointestinal endoscopy: an accurate and safe primary diagnostic and therapeutic modality.

OBJECTIVE: To review the place of gastrointestinal endoscopy in the management of upper and lower gastrointestinal disorders. DATA SOURCES: We reviewed articles on endoscopy reported over two decades. A Medline search complementing our experience and knowledge of the literature was used to identify the articles. STUDY SELECTION: Papers were selected which focused on indications, comparison with radiology, including clinical outcome measures, and complications. One hundred papers, including those from radiology journals, were reviewed. DATA EXTRACTION: Results of studies are referenced as appropriate. DATA SYNTHESIS AND CONCLUSIONS: Endoscopy allows direct visualisation of the mucosa of the upper gastrointestinal tract, colon and terminal ileum. Subtleties of colour change, vascular pattern abnormalities and scarring are easily detected at endoscopy and are often of diagnostic importance. Endoscopy also provides access for tissue biopsy and allows a wide variety of therapeutic interventions. Traditionally barium studies have been the first step in the evaluation of many gastrointestinal symptoms and still retain cost advantages over endoscopy. However, endoscopy is frequently more sensitive and specific than barium studies. Costs associated with incorrect diagnoses may undermine the apparent cost benefits of barium studies. Advances in endoscopic design have allowed wider therapeutic options and increased safety. Gastrointestinal endoscopy should now be the first line of investigation where diagnostic precision is required or where therapeutic intervention is likely.     

Dangers of immunosuppressive therapy in hepatitis B virus carriers.

OBJECTIVE: To identify the risk of hepatic failure in hepatitis B virus (HBV) carriers given intermittent immunosuppressive therapy. DATA SOURCES: The key words "immunosuppression" and "hepatitis B" were used to search MEDLINE for relevant articles in English published from 1970 to 1990; the bibliographies of these articles were reviewed for additional publications. Also included were articles published in 1991. STUDY SELECTION: Articles were included if they documented the use of immunosuppressive drugs to treat chronic hepatitis B or another condition in patients at high risk for the HBV carrier state. RESULTS: Long-term immunosuppressive therapy has not improved the survival of patients with chronic hepatitis B. The withdrawal of such therapy from HBV carriers has resulted in a flare-up of potentially fatal hepatitis in 20% to 50%, regardless of whether underlying liver disease was present. The presence of replicating viral DNA in the serum of HBV carriers may identify those who are at high risk of the deleterious effects of immunosuppressive therapy. CONCLUSIONS: Long-term immunosuppressive therapy is not advised for liver disease in HBV carriers. For other conditions in such people continuous rather than intermittent therapy is safer. Patients at high risk for hepatitis B should be screened for this virus when immunosuppressive therapy is contemplated.     

Why don't physicians follow clinical practice guidelines? A framework for improvement.

CONTEXT: Despite wide promulgation, clinical practice guidelines have had limited effect on changing physician behavior. Little is known about the process and factors involved in changing physician practices in response to guidelines. OBJECTIVE: To review barriers to physician adherence to clinical practice guidelines. DATA SOURCES: We searched the MEDLINE, Educational Resources Information Center (ERIC), and HealthSTAR databases (January 1966 to January 1998); bibliographies; textbooks on health behavior or public health; and references supplied by experts to find English-language article titles that describe barriers to guideline adherence. STUDY SELECTION: Of 5658 articles initially identified, we selected 76 published studies describing at least 1 barrier to adherence to clinical practice guidelines, practice parameters, clinical policies, or national consensus statements. One investigator screened titles to identify candidate articles, then 2 investigators independently reviewed the texts to exclude articles that did not match the criteria. Differences were resolved by consensus with a third investigator. DATA EXTRACTION: Two investigators organized barriers to adherence into a framework according to their effect on physician knowledge, attitudes, or behavior. This organization was validated by 3 additional investigators. DATA SYNTHESIS: The 76 articles included 120 different surveys investigating 293 potential barriers to physician guideline adherence, including awareness (n = 46), familiarity(n = 31), agreement (n = 33), self-efficacy (n = 19), outcome expectancy (n = 8), ability to overcome the inertia of previous practice (n = 14), and absence of external barriers to perform recommendations (n = 34). The majority of surveys (70 [58%] of 120) examined only 1 type of barrier. CONCLUSIONS: Studies on improving physician guideline adherence may not be generalizable, since barriers in one setting may not be present in another. Our review offers a differential diagnosis for why physicians do not follow practice guidelines, as well as a rational approach toward improving guideline adherence and a framework for future research.     

Hereditary aspects of prostate cancer.

OBJECTIVE: To review current literature on the hereditary aspects of prostate cancer and to evaluate the importance of family history in history taking and screening for prostate cancer. DATA SOURCES: MEDLINE was searched for articles in English or French published between Jan. 1, 1956, and Oct. 31, 1994, with the use of MeSH headings "prostatic neoplasms," "genetics" and "chromosomes." Additional references were selected from the bibliographies of articles found during the search. STUDY SELECTION: Case-control studies involving the incidence of prostate cancer and relative risk (RR) of such cancer in the families of men with this disease, compared with a control group, were included. Only studies in which prostate cancer was diagnosed on the basis of histologic tests were included. Animal investigations were excluded. DATA EXTRACTION: Ten case-control studies were evaluated critically in terms of design, case and control groups, the size of the samples and statistical results. The incidence of prostate cancer in the families of cases, compared with that in the families of controls, and differences in RR were reviewed. DATA SYNTHESIS: The lifetime risk of prostate cancer is 9.5% and of death from prostate cancer is 2.9% for a man 50 years of age. For first-degree male relatives of men with prostate cancer, the calculated RR ranges from 1.7 to 8.73. "Hereditary" prostate cancer is a term applied to a specific subset of patients with prostate cancer. This form of prostate cancer is transmitted by a rare, autosomal, dominant allele with high penetrance; it accounts for an estimated 43% of early-onset disease (affecting men less than 55 years of age) but only 9% of all prostate cancer in men up to 85 years of age. A greater number of affected family members and early onset among family members are the most significant predictors of risk. CONCLUSIONS: Recent confirmation of the familial clustering and Mendelian inheritance patterns of some prostate cancer has important implications. It increases the potential for directed research into the causes of prostate cancer and for refinements in the current screening practices to detect this common disease. Manoeuvres to detect prostate cancer should be started earlier among men with one or more first-degree relatives with the disease than among other men.     

Pegylated interferons in the treatment of chronic hepatitis C

Purpose To review the efficacy and safety of pegylated interferons (peginterferons) in the treatment of chronic hepatitis C.Data sources An English language literature search (MEDLINE 1988 -2001 ) was performed and a total of 19 original articles related to the issue were selected.Data extraction After careful review of the selected papers, the meaningful results and conclusions were extracted using scientific criteria. The papers reviewed pertained mainly to the efficacy and safety profiles of peginterferons in the treatment of chronic hepatitis C.Results Peginterferon can effectively prolong the half-life of interferon and can be effectively administered conveniently as a once-a-week dose. The antiviral effect using peginterferon was enhanced compared with that of standard interferon, but the frequency and severity of adverse events were typical of those associated with interferon-a.Conclusions Based on its efficacy, safety and convenient dosing, peginterferon is more favorable than standard interferon in the treatment of chronic hepatitis C.     

Coronary artery stents

CONTEXT: Intracoronary stents are now used for the majority of patients undergoing percutaneous coronary revascularization, and the body of scientific knowledge about stents has expanded rapidly in the last several years. OBJECTIVE: To review the evidence supporting the widespread use of intracoronary stents. DATA SOURCES: The MEDLINE database was searched for articles from 1990 through January 2000 using the indexing terms stents, coronary artery disease, and angioplasty. Additional data sources included bibliographies of articles identified on MEDLINE, bibliographies in textbooks on percutaneous coronary interventions, and preliminary data presented at recent national and international cardiology conferences. STUDY SELECTION: We selected for review studies that assessed the effects of stenting on the immediate and long-term outcome of patients undergoing percutaneous coronary revascularization. If data from randomized controlled trials were not available for specific patient subsets or lesion characteristics, observational studies were included. DATA EXTRACTION: The methodologic characteristics of studies in coronary stenting were extracted and summarized according to key components of research design, including lesion type, location, and adjunctive therapy used. Studies were classified according to the strength of the available data into proven and unproven indications for stent use. DATA SYNTHESIS: Coronary artery stents increase the safety of interventional procedures, increase procedure success rates, and decrease the need for emergency coronary artery bypass graft surgery. CONCLUSIONS: Intracoronary stents have become an essential component of the catheter-based treatment of coronary artery disease. The evidence indicates that elective stenting, rather than provisional stenting or balloon angioplasty alone, improves clinical outcomes in the months following percutaneous coronary revascularization in a wide variety of clinical settings and lesion types. JAMA. 2000;284:1828-1836.     

Risques de complications de la grossesse pendant la résidence.

OBJECTIVE: To determine, through a review of published articles, whether a higher prevalence of pregnancy complications is associated with residency in medicine. DATA SOURCES: Articles published between January 1980 and December 1992 found through a MEDLINE search using the MeSH terms "pregnancy complications" and "internship and residency" and through a review of the bibliographies of articles found. STUDY SELECTION: Of the 17 articles found, 6 contained data on the prevalence of pregnancy complications in residents. DATA EXTRACTION: The methodologic quality of the studies was evaluated systematically with the use of a grid. Data on the prevalence of the six most common pregnancy complications were retained. DATA SYNTHESIS: Four of the six articles had methodologic weaknesses (missing or inappropriate control groups, poorly controlled historical bias). The best study showed a higher prevalence of premature labour, pre-eclampsia and voluntary abortion in the residents than in the control subjects. CONCLUSIONS: It is difficult to draw definitive conclusions from a single study that met the criteria for methodologic quality. More and better-controlled studies involving larger numbers of subjects are needed.