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PubMed2002

Prophylactic antibiotic administration in pregnancy to prevent infectious morbidity and mortality.

BACKGROUND: Some previous studies suggested that prophylactic antibiotics given during pregnancy improved maternal and perinatal outcomes, some did not show any benefit and some even reported adverse effects. OBJECTIVES: To determine the effect of prophylactic antibiotics during second and third trimester of pregnancy on maternal and perinatal outcomes. SEARCH STRATEGY: The Cochrane Pregnancy and Childbirth Group trials register (April 2002), the Cochrane Controlled Trials Register (The Cochrane Library, Issue 1, 2002) and reference lists of articles were searched. SELECTION CRITERIA: Randomized controlled trials comparing prophylactic antibiotic treatment with placebo or no treatment for women in the second or third trimester of pregnancy before labour. DATA COLLECTION AND ANALYSIS: Trial quality assessment and data extraction were done by the reviewers. MAIN RESULTS: There were six randomized controlled trials which recruited 2184 women to detect the effect of prophylactic antibiotic administration in the second or third trimester on pregnancy outcomes. Antibiotic prophylaxis in unselected pregnant women reduced the risk of prelabour rupture of membranes (Peto odds ratio (OR) 0.32, 95% confidence interval (CI) 0.14 to 0.73). In women with a previous preterm birth there was a risk reduction in low birth weight (OR 0.48, 95% CI 0.27 to 0.84) and postpartum endometritis (OR 0.46, 95% CI 0.24 to 0.89). There was a risk reduction in preterm delivery (OR 0.48, 95% CI 0.28 to 0.81) in pregnant women with a previous preterm birth associated with bacterial vaginosis (BV) during the current pregnancy but there was no risk reduction in pregnant women with previous preterm birth without BV during pregnancy (OR 1.06, 95% CI 0.68 to 1.64). However, vaginal antibiotic prophylaxis during pregnancy did not prevent infectious pregnancy outcomes and there is a possibility of adverse effects such as neonatal sepsis (OR 8.07, 95% CI 1.36 to 47.77). REVIEWER'S CONCLUSIONS: Antibiotic prophylaxis given during the second or third trimester of pregnancy reduces the risk of prelabour rupture of the membranes when given routinely to pregnant women. Beneficial effects on birth weight and the risk of postpartum endometritis were seen for high risk women.

Antibiotic Prophylaxis↗

PubMed2001

Herbal therapy for treating osteoarthritis.

BACKGROUND: The increasing popularity of complementary and alternative medicine appears to be particularly evident amongst people with chronic disease. In the treatment of osteoarthritis, one therapy that has been identified as having potential benefit, is herbal medicine (phytotherapy). OBJECTIVES: To determine the effectiveness of herbal therapies in treating osteoarthritis. SEARCH STRATEGY: Databases for mainstream and complementary medicine were searched using terms to include all forms of arthritis combined with herbal medicine. We searched the following electronic databases: MEDLINE, EMBASE, CISCOM, AMED, CINAHL, Cochrane Controlled Trials Register (CCTR), Cochrane Musculoskeletal specialized register, Dissertation Abstracts, BIDS ISI and the Cochrane Complementary Medicine Fields Specialized Register. We also searched the reference lists from retrieved trials. SELECTION CRITERIA: All randomized trials of herbal interventions in osteoarthritis, compared to placebo. Studies were included according to the a priori protocol and agreement between two reviewers who independently read each selected paper for content and for assessment of quality. Papers of any language were included. DATA COLLECTION AND ANALYSIS: Data were extracted independently by the same two reviewers. MAIN RESULTS: Five studies (four different herbal interventions) met the review criteria. Two studies were suitable for data pooling. It was not possible to draw firm conclusions from the single studies but two studies of avocado/soybean unsaponifiables showed beneficial effects on functional index, pain, intake of NSAIDs and global evaluation. No serious side effects were reported. REVIEWER'S CONCLUSIONS: The evidence for avocado-soybean unsaponifiables in the treatment of osteoarthritis is convincing but evidence for the other herbal interventions is insufficient to either recommend or discourage their use.

Chronic Disease↗

PubMed2001

Herbal therapy for treating rheumatoid arthritis.

BACKGROUND: The increasing popularity of the use of complementary and alternative interventions or treatments appears to be particularly evident amongst people with chronic disease. In the treatment of rheumatoid arthritis, one therapy that has been identified as having potential benefit, is herbal medicine (phytotherapy). OBJECTIVES: To assess the effectiveness of herbal therapies in the treatment of rheumatoid arthritis. SEARCH STRATEGY: We developed a search strategy using terms to include all forms of arthritis combined with herbal medicine. We searched the following electronic databases from 1966 to 2000: MEDLINE, EMBASE, CISCOM, AMED, CINAHL, Cochrane Controlled Trials Register (CCTR), Cochrane Musculoskeletal specialized register, Dissertation Abstracts, BIDS ISI and the Cochrane Complementary Medicine Fields Specialized Register. This was supplemented by searching the reference lists from retrieved trials. SELECTION CRITERIA: All randomized trials of herbal interventions in rheumatoid arthritis, compared to placebo. Two reviewers independently read and selected each potential study according to the criteria published in an a priori protocol. Papers of any language were included. DATA COLLECTION AND ANALYSIS: Data were extracted independently by the same two reviewers and an assessment of methodological quality was conducted. MAIN RESULTS: Eleven studies met the inclusion criteria. Seven of the studies compared gamma-linolenic acid (GLA) to placebo although three of these were not suitable for data pooling. The remaining studies considered four different herbal interventions and were assessed individually. All of the GLA studies found some improvement in clinical outcomes but methodology and study quality was variable, making it difficult to draw conclusive results. However, the better quality studies suggest potential relief of pain, morning stiffness and joint tenderness. With the exception of one intervention (Tripterygium wilfordii hook F), no serious side effects were reported. REVIEWER'S CONCLUSIONS: There appears to be some potential benefit for the use of GLA in rheumatoid arthritis although further studies are required to establish optimum dosage and duration of treatment. The single studies are inconclusive.

Arthritis, Rheumatoid↗

PubMed2006

Corticosteroids for treating dengue shock syndrome.

BACKGROUND: Dengue shock syndrome is the most severe from of dengue haemorrhagic fever, one of the leading causes of death in children. Observational studies have suggested corticosteroids may benefit people with dengue shock syndrome. OBJECTIVES: To compare corticosteroids with placebo or no corticosteroids for treating dengue shock syndrome. SEARCH STRATEGY: We searched the Cochrane Infectious Disease Group Specialized Register (January 2006), CENTRAL (The Cochrane Library 2005, Issue 4), MEDLINE (1966 to January 2006), EMBASE, (1974 to January 2006), LILACS (1982 to January 2006), and reference lists. We also contacted researchers. SELECTION CRITERIA: Randomized and quasi-randomized controlled trials comparing corticosteroids with no corticosteroids or placebo in people diagnosed with dengue shock syndrome. DATA COLLECTION AND ANALYSIS: Two authors independently applied the inclusion criteria, extracted data, and assessed methodological quality. We calculated the relative risk (RR) for dichotomous data and weighted mean difference for continuous data, and presented them with 95% confidence intervals (CI). MAIN RESULTS: Four trials involving 284 participants met the inclusion criteria. Corticosteroids were no more effective than placebo or no treatment for reducing the number of deaths (RR 0.68, 95% CI 0.42 to 1.11; 284 participants, 4 trials), the need for blood transfusion (RR 1.08, 0.52 to 2.24; 89 participants, 2 trials), or the number of serious complications (convulsions and pulmonary haemorrhage) as reported in one trial (63 participants). AUTHORS' CONCLUSIONS: There is insufficient evidence to justify the use of corticosteroids in managing dengue shock syndrome. As corticosteroids can potentially do harm, clinicians should not use them unless they are participating in a randomized controlled trial comparing corticosteroids with placebo.

Adrenal Cortex Hormones↗

PubMed1996

Pilot-controlled trial of the extracorporeal liver assist device in acute liver failure.

The objective of this pilot controlled study was to evaluate the extracorporeal liver assist device (ELAD) in patients with acute liver failure who were judged to still have a significant chance of survival (approximately 50%) and in those who had already fulfilled criteria for transplantation. Twenty-four patients were divided into two groups, 17 with a potentially recoverable lesion (group I) and 7 listed for transplantation (group II), and then randomly allocated to ELAD haemoperfusion or control. The median period of ELAD haemoperfusion was 72 hours (range 3-168 h). Biocompatibility of the device was good, with no acceleration in platelet consumption, and haemodynamic stability was maintained. Two patients were withdrawn from the study because of worsening of preexisting disseminated intravascular coagulation in one case and a hypersensitivity reaction in the other. Deterioration with respect to encephalopathy grade was more frequent in the control patients, 7 of 12 (58%), than in the ELAD-treated patients, 3 of 12 (25%). In group I where survival for the ELAD cases was 7 of 9 (78%), there was a higher than expected survival in the controls, 6 of 8 (75%). For group II cases, survival was 1 of 3 (33%) for the ELAD-treated patients, and 1 of 4 (25%) for the controls. Both of the survivors underwent transplantation. Assessment of additive function for the device revealed an improvement in galactose elimination capacity after 6 hours of haemoperfusion. Based on the results of this pilot-controlled trial, better indices of prognosis will be required, in addition to those used to select for transplantation, if patients at an earlier stage of clinical deterioration are to be included in future studies.

Adolescent↗

PubMed1999

Factors associated with self-rated health in patients with Paget's disease of bone.

Multiple studies show that poor self-rated health (SRH) increases the risk of mortality up to 5-fold when compared to excellent SRH. This powerful association remains even with objective health status and risk factors controlled. However, few studies have examined the determinants of SRH, especially as they relate to specific chronic diseases. Here we identify personal characteristics and disease-related attributes that are strongly associated with SRH in a sample of patients with Paget's disease of bone to determine whether any factors can be modified. Two thousand people randomly selected from the Paget Foundation mailing list received a survey asking for information on demographics, general health and functioning, and the impact of Paget's disease. Nine hundred and fifty-eight PD patients returned the completed survey and answered the question, "How would you rate your overall health?" Answers ranged from excellent (1) to poor (5). Ordinary least squares regression was used, with SRH as the dependent variable, to identify those variables significantly associated with SRH. The overall regression model was significant (p = 0.0001; R2 = 0.44). Age (p = 0. 005), satisfaction with family help (p = 0.0001), number of comorbid conditions (p = 0.0001), functional limitations (p = 0.0003), disease impact (p = 0.0002), health compared to 5 years ago (p = 0. 0001), and depressive symptoms (p = 0.012) were significant predictors. Of these, satisfaction with family help, functional limitations, disease impact, and depressive symptoms are potentially modifiable with appropriate interventions. Future longitudinal studies should examine the effectiveness of such interventions in improving SRH.

Aged↗

PubMed1989

Visual search, eeg, and psychopathology in schizophrenic patients.

Twenty acutely admitted schizophrenic inpatients diagnosed according to RDC and 8 normal controls were instructed to search for a randomly located target letter (Z) in ten lists of 284 distractor letters of either rounded or angular shape projected on a screen (23 degrees x 15 degrees). Eye movements were recorded using infrared corneal reflection-pupil centre measurement. Search performance was defined as the search time in seconds from onset of the display until localization of the target. The EEG was recorded simultaneously in schizophrenics, in whom assessment took place shortly after admission and before discharge. The psychopathological status was assessed at the same time with the Brief Psychiatric Rating Scale and the Scale for the Assessment of Negative Symptoms. Search performance was not significantly different in schizophrenics and normal controls, but was heavily affected by target/distractor similarity in both groups. Moreover, search performance in schizophrenics was not significantly affected by illness severity. However, search performance was differently related to negative and positive symptoms. Schizophrenics and normal controls differed with respect to the relationship between search performance and visuomotor microbehaviour. Additionally, two relatively time-stable eye movement patterns in schizophrenics could be distinguished, which were differently related to psychopathology, performance measures and EEG.

Adult↗

PubMed2000

Application of stratum-specific likelihood ratios in mental health screening.

BACKGROUND: The accuracy of a diagnostic procedure is commonly assessed by measuring sensitivity, specificity and positive and negative predictive values. Likelihood ratios provide an alternative method for describing these results, though they are typically reported only for dichotomized outcomes. However, likelihood ratios can also be applied to ordinal or continuous results. METHODS: The present paper discusses the application of stratum-specific likelihood ratios in a primary care setting using the General Health Questionnaire (GHQ-12) and the Symptom Check List 90-R (SCL-90-R). A randomly selected sample (n = 408) of adult outpatients from primary care offices in Düsseldorf was screened using the German versions of the GHQ-12 and the SCL-90-R. RESULTS: Logistic regression analysis indicated that stratum-specific or multilevel likelihood ratios preserve more information than a fixed threshold approach with a single cutoff point. For each test, five clinically useful strata with monotonically increasing stratum-specific likelihood ratios were selected. CONCLUSIONS: Stratum-specific likelihood ratios have enormous practical value, and they are becoming an important way of expressing and comparing the usefulness of different tests. Stratum-specific likelihood ratios reduce the spectrum bias that might arise if only two categories (cases and non-cases) are chosen. Additionally, multilevel likelihood ratios can be used as bedside information to obtain the post-test probability from the pre-test probability of the disorder.

Adult↗

PubMed1988

Characteristics of noncontraceptive hormone users.

Because noncontraceptive hormone use is not randomly distributed in the population, selection factors for hormone use need to be critically examined to clarify the nature of the relationship between hormone exposure and disease endpoints. The characteristics of hormone users were examined using sociodemographic and health-related information obtained in a telephone survey of 2,137 women (ages 40-52), randomly selected from a driver's license list of Pittsburgh area women. Results showed that 6% of the women surveyed reported current noncontraceptive hormone use, and that 71% of the users had undergone hysterectomy and/or oophorectomy, hereafter called the surgical group. Among all women, hormone users were older and thinner than nonusers, and the frequency of use was two times as high among whites than among blacks. Because rates of use varied dramatically by surgical status, separate univariate and multivariate analyses were conducted for women with and without a hysterectomy/oophorectomy. Body mass index was inversely related to hormone use, and alcohol consumption was positively related to hormone use among both groups. Whites had higher rates of hormone use than blacks among women with hysterectomy/oophorectomy, and a higher level of education was positively related to hormone use among nonsurgical women. The findings show that the distribution of hormone use varies markedly in the community by surgical status, body mass index, race, education, and alcohol use.

Adult↗

PubMed2004

Influencing advance directive completion rates in non-terminally ill patients: a systematic review.

PURPOSE: To conduct a systematic review of educational advance care planning interventions directed at patients without terminal illness to determine their influence on the completion rate of advance directives (AD). MATERIALS AND METHODS: We searched MEDLINE; Cochrane Library, and reference lists of all pertinent retrieved articles for randomized trials (RCTs), restricted to English language and adults > or =18 years. Two investigators independently and in duplicate determined trial eligibility. We included published RCTs evaluating an educational intervention comprised of at least one of; written, audio, or video materials, or direct counseling, and if an outcome included AD completion rate. RESULTS: Nine RCTs (N=3,206) were included. Overall, methodologic quality and reporting transparency were poor. The median composite quality score was 5 (range, 0-10). The odds ratios for AD completion rates ranged from 0.41 to 106.0 across the trials (test of heterogeneity P <.001). The summary odds ratio for these educational interventions was 3.71 (95% C.I. 1.46, 9.40). Trials with greater methodologic rigor and reporting transparency produced a more conservative estimate of effect, 2.42 [0.96, 6.10] versus 28.69 [5.08, 162.06] for less rigorous and poorly reported trials (P =.013). CONCLUSIONS: Advance directive completion rates documenting patient preferences for end-of-life care may be increased by simple patient-directed educational interventions.

Adult↗

PubMed2004

Does enteral nutrition compared to parenteral nutrition result in better outcomes in critically ill adult patients? A systematic review of the literature.

OBJECTIVE: Nutritional support is part of the standard of care for the critically ill adult patient. In the average patient in the intensive care unit who has no contraindications to enteral nutrition (EN) or parenteral nutrition (PN), the choice of route for nutritional support may be influenced by several factors. Because EN and PN are associated with risks and benefits, we systematically reviewed and critically appraised the literature to compare EN with PN the critically ill patient. METHODS: We searched computerized bibliographic databases, personal files, and relevant reference lists to identify potentially eligible studies. Only randomized clinical trials that compared EN with PN in critically ill patients with respect to clinically important outcomes were included in this review. In an independent fashion, relevant data on the methodology and outcomes of primary studies were abstracted in duplicate. The studies were subsequently aggregated statistically. RESULTS: There were 13 studies that met the inclusion criteria and, hence, were included in our meta-analysis. The use of EN as opposed to PN was associated with a significant decrease in infectious complications (relative risk = 0.64, 95% confidence interval = 0.47 to 0.87, P = 0.004) but not with any difference in mortality rate (relative risk = 1.08, 95% confidence interval = 0.70 to 1.65, P = 0.7). There was no difference in the number of days on a ventilator or length of stay in the hospital between groups receiving EN or PN (Standardized Mean Difference [SMD] = 0.07, 95% confidence interval = -0.2 to 0.33, P = 0.6). PN was associated with a higher incidence of hyperglycemia. Data that compared days on a ventilator and the development of diarrhea in patients who received EN versus PN were inconclusive. In the EN and PN groups, complications with enteral and parenteral access were seen. Four studies documented cost savings with EN as opposed to PN. CONCLUSION: The use of EN as opposed to PN results in an important decrease in the incidence of infectious complications in the critically ill and may be less costly. EN should be the first choice for nutritional support in the critically ill.

Costs and Cost Analysis↗

PubMed2000

Increased risk of learning disabilities in low birth weight boys at age 11 years.

BACKGROUND: Few studies have examined learning disabilities among low birth weight (< or =2500 g) children, and those that have, have focused on very low birth weight children (<1500 g). We tested the hypothesis that low birth weight increases the risk of reading and math disabilities, examined possible sex differences in the effect of low birth weight, and assessed risk across the entire range of low birth weight. METHODS: Low birth weight and normal birth weight children were randomly selected from the 1983-1985 newborn lists of an urban and a suburban hospital in southeast Michigan. Children with neurological impairments were excluded. Children were evaluated at age 6 years and at age 11 years. Of the 823 children in the initial assessment, 717 (87.1%) participated in the second assessment. The Wechsler Intelligence Scale for Children--Revised and the Woodcock-Johnson Psycho-Educational Battery--Revised were used to identify children with learning disabilities. Learning disabilities were estimated in 574 children with IQs of > or =85. RESULTS: Low birth weight was associated with increased risk for reading and math disability in male children (odds ratio = 3.3 and odds ratio = 6.5, respectively) but not in female children. The increased risk of learning disabilities among male children applied to the entire range of low birth weight and was observed in both the urban and suburban communities. CONCLUSIONS: The effect of low birth weight on learning disabilities appears to be specific to male children. Although this sex-specific effect is consistent with previous findings of a greater vulnerability of male children to pregnancy and birth complications, it remains to be replicated and clarified.

Apgar Score↗

PubMed1980

Attentional bias and visual field asymmetry.

In mixed list tachistoscopic presentation of abstract words and random shapes, the probability of word and shape stimuli was varied to generate attentional bias and selective activation of the left or right hemispheres. While a right visual field advantage in accuracy was observed for words, and an effect of stimulus probability was observed across both visual fields in reaction time, no interactions were found between attentional bias and visual field asymmetry. The results can therefore be explained without reference to the attentional model and did not provide evidence of hemispheric activation or priming.

Adult↗

PubMed2000

Trouble sleeping and anxiety/depression in childhood.

The purpose of this report was to estimate the association between children's trouble sleeping and anxiety/depression at ages 6 and 11, cross-sectionally and prospectively. Data come from a study of the psychiatric sequelae of low birth weight (LBW: <2500 g). LBW and normal birth weight children were randomly selected from the 1983-1985 newborn lists of an urban and a suburban hospital. Eight hundred and twenty-three children participated at age 6 and, of those, 717 (87.1%) participated at age 11. Achenbach's Child Behavior Checklist (CBCL) and the Teacher Report Form (TRF) were used to obtain ratings of psychiatric problems. The CBCL asked if the child had trouble sleeping during the past 6 months. Children with trouble sleeping had significantly increased odds of anxiety/depression based on mothers' reports (OR=6.9, 95% CI 4.1-11. 4) but not teachers' reports (OR=1.1, 95% CI 0.4-2.7). There was a greater association between sleep and depression at age 11 than at age 6, and among suburban than among urban children. These findings remained when adjusted for birthweight, sex, and mother's history of major depressive disorder. Profile analysis indicated a stronger association of trouble sleeping with anxiety/depression than other psychiatric problems. The association of trouble sleeping at age 6 with incidence of depression at age 11 was not statistically significant (suburban children RR=2.22, 95% CI 0.53-9.23; urban children RR=0.92, 95% CI 0.20-4.18).

Anxiety↗

PubMed1999

Risk factors for excess mortality in Harlem. Findings from the Harlem Household Survey.

INTRODUCTION: In 1980, age-adjusted mortality rates in Central Harlem were the highest among New York City's 30 health districts. This population-based study was designed to describe the self-reported frequency of selected health conditions, behavioral risk factors, preventive health practices, and drug use in the Harlem community. METHODS: From 1992 to 1994, in-person interviews were conducted among 695 adults aged 18 to 65 years who were randomly selected from dwelling-unit enumeration lists for the Central Harlem health district. Descriptive statistics were computed for men and women separately, and compared to other population-based surveys. RESULTS: Self-reported medical insurance coverage in Harlem was unexpectedly high (74% of men, 86% of women) as was lifetime use of preventive health practices, e.g., blood cholesterol screening (58% of men, 70% of women). However, lifetime rates of substance use, e.g. crack cocaine (14%) and self-reported history of traumatic events, e.g., witnessing someone seriously injured or violently killed (49% of men, 21% of women) were also high in Harlem, especially in comparison to other populations. CONCLUSIONS: This study has identified important patterns of similarities and differences in risk behaviors between Harlem and other populations. Potential solutions to the health problems of Harlem may lie in the creation of strategies that operate at the community, municipal, and regional level, as well as at the level of individual behavior and risk-taking.

Adolescent↗

PubMed2003

Future intentions of registered nurses employed in the western New York labor market: relationships among demographic, economic, and attitudinal factors.

Demographic, economic, and attitudinal factors may affect the work participation behavior of full and part-time RNs in hospital and non-hospital settings. The sample (N = 776) included randomly selected RNs from the 1997 registration lists of the New York State Department of Professional Licensing. Classical t-tests and chi-square tests were used to test for differences between hospital, non-hospital, full-time and part-time RNs. Only RNs employed in hospital settings were significantly less satisfied and less committed to their organization than were non-hospital based nurses; however these attitudes, frequently shown to be related to turnover behavior, did not result in intentions to leave. Differences in satisfaction and commitment across job settings begin to explain work participation behavior of nurses, as distinct from organizational behavior.

Adult↗

PubMed1998

Low dehydroepiandrosterone sulfate and heart disease in middle-aged men: cross-sectional results from the Massachusetts Male Aging Study.

PURPOSE: Serum concentrations of the adrenal androgen dehydroepiandrosterone (DHEA) and its sulfate ester (DHEAS), both of which decline with age more markedly than other sex hormone levels, have been alternately credited and discredited as "protective" correlates of heart disease. Baseline data from the Massachusetts Male Aging Study (MMAS), collected in 1987-89, provided a large population-based random sample (n = 1709) in which to examine cross-sectionally the relation of DHEA and DHEAS levels to heart disease, while controlling for a comprehensive set of potential confounders including serum lipid and hormone levels as well as smoking, alcohol intake, obesity, hypertension, diabetes, diet, medication, physical activity, and psychological measures. METHODS: The subjects were men aged 40-70 years, randomly sampled from the Massachusetts state census listing, measured and interviewed at home. Nonfasting blood samples were assayed for hormones and lipids. RESULTS: In all strata of age, smoking, and alcohol intake, the age-adjusted odds ratio for self-reported heart disease was between 0.55 and 0.85 per standard deviation (SD) of log DHEA and DHEAS concentration. Multiple logistic regression analysis indicated a strong independent role for DHEAS as a predictor of self-reported heart disease, controlling for age and the potential confounders listed above. The multiply-adjusted odds ratio for heart disease was 0.64 per SD log DHEAS concentration, with 95% confidence interval (CI) 0.50-0.83 (P = 0.0002). The DHEAS effect was not diminished by controlling for use of cardiac, vasodilator, antihypertensive, or lipid-lowering medication. CONCLUSIONS: These findings suggest that serum DHEAS levels bear an inverse relationship to heart disease, independently of a large set of established cardiovascular risk factors. The cross-sectional nature of this study requires that the findings be interpreted with caution.

Aged↗

PubMed2001

Transcatheter interventions for the treatment of peripheral atherosclerotic lesions: part I.

Transcatheter endovascular procedures are increasingly used to treat symptomatic peripheral atherosclerosis. This two-part review identifies the existing evidence supportive of the application of transcatheter treatments for peripheral atherosclerotic lesions. The first part addresses the treatment of obstructive lesions that cause limb claudication and critical ischemia, renovascular hypertension and azotemia, and mesenteric ischemia. Studies were identified via a search of MEDLINE (January 1993 through April 1999) and reference lists of identified articles. When multicenter prospective randomized trials or other high-quality studies were unavailable, a preference was given to studies with at least 50 patients per treated group and a minimum mean follow-up duration of 6 months. Data presented in tables are proportionally weighted averages from included studies. For each application, the authors assessed the quality of evidence (QOE; efficacy, safety, and, where available, cost-effectiveness) and made recommendations with appropriate caveats. There is higher QOE supporting the more established treatments such as lower limb percutaneous transluminal angioplasty (PTA) with stent placement and thrombolysis. Treatments such as renal artery PTA and stent placement and mesenteric and brachiocephalic PTA are in wide use, but high QOE supporting general application is lacking. Blanket recommendations based on established efficacy and cost-effectiveness cannot be made. However, the use of transcatheter therapies can be supported in specific circumstances based on an expected reduction in procedure-related morbidity and/or mortality rates. It is hoped that the identification of deficiencies in the literature will inform and inspire critically needed research in this area.

Angioplasty, Balloon, Coronary↗