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EMBASE Databases (embase + databases)
Selected AbstractsAntibacterial efficacy of calcium hydroxide intracanal dressing: a systematic review and meta-analysisINTERNATIONAL ENDODONTIC JOURNAL, Issue 1 2007C. Sathorn Abstract Aim, To determine to what extent does calcium hydroxide intracanal medication eliminate bacteria from human root canals, compared with the same canals before medication, as measured by the number of positive cultures, in patients undergoing root canal treatment for apical periodontitis (teeth with an infected root canal system). Methodology, CENTRAL, MEDLINE and EMBASE databases were searched. Reference lists from identified articles were scanned. A forward search was undertaken on the authors of the identified articles. Papers that had cited these articles were also identified through the Science Citation Index to identify potentially relevant subsequent primary research. Review methods, The included studies were pre-/post-test clinical trials comparing the number of positive bacterial cultures from treated canals. Data in those studies were independently extracted. Risk differences of included studies were combined using the generic inverse variance and random effect method. Results, Eight studies were identified and included in the review, covering 257 cases. Sample size varied from 18 to 60 cases; six studies demonstrated a statistically significant difference between pre- and post-medicated canals, whilst two did not. There was considerable heterogeneity among studies. Pooled risk difference was ,21%; 95% CI: ,47% to 6%. The difference between pre- and post-medication was not statistically significant (P = 0.12). Conclusions, Calcium hydroxide has limited effectiveness in eliminating bacteria from human root canal when assessed by culture techniques. [source] Overweight and obesity and incidence of leukemia: A meta-analysis of cohort studiesINTERNATIONAL JOURNAL OF CANCER, Issue 6 2008Susanna C. Larsson Abstract We conducted a meta-analysis to summarize the available evidence from cohort studies on the association between excess body weight and incidence of leukemia. Studies were identified by searching the MEDLINE and EMBASE databases (1966,July 2007) and by examining the references of retrieved articles. A random-effects model was used to combine the results from individual studies. We identified 9 cohort studies with data on body mass index (BMI) or obesity in relation to incidence of leukemia. Compared with nonoverweight individuals (BMI < 25 kg/m2), the summary relative risks (RRs) of leukemia were 1.14 [95% confidence interval (CI), 1.03,1.25] for overweight individuals (BMI 25,30 kg/m2) and 1.39 (95% CI, 1.25,1.54) for obese (BMI , 30 kg/m2) individuals. On a continuous scale, a 5 kg/m2 increase in BMI was associated with a 13% increased risk of leukemia (RR, 1.13; 95% CI, 1.07,1.19). In a meta-analysis of 4 studies reporting results on subtypes of leukemia, the summary RRs associated with obesity were 1.25 (95% CI, 1.11,1.41) for chronic lymphocytic leukemia, 1.65 (95% CI, 1.16,2.35) for acute lymphocytic leukemia, 1.52 (95% CI, 1.19,1.95) for acute myeloid leukemia and 1.26 (95% CI, 1.09,1.46) for chronic myeloid leukemia. This meta-analysis indicates that excess body weight is associated with an increased risk of developing leukemia. © 2007 Wiley-Liss, Inc. [source] Body mass index and risk of multiple myeloma: A meta-analysisINTERNATIONAL JOURNAL OF CANCER, Issue 11 2007Susanna C. Larsson Abstract Excess body weight has been identified as a risk factor for a variety of cancer types. However, whether excess body weight increases the risk of multiple myeloma remains controversial. We conducted a meta-analysis to quantitatively summarize the evidence from epidemiologic studies of the associations of overweight and obesity with the risk of multiple myeloma. We searched the MEDLINE and EMBASE databases (1966 to May 2007) and the reference lists of retrieved articles. Cohort and case,control studies were included if they reported relative risk (RR) estimates with 95% confidence intervals (CIs) for the relation between body mass index and multiple myeloma incidence or mortality. A random-effects model was used to combine study-specific results. A total of 11 cohort studies (involving 13,120 cases) and 4 case,control studies (1,166 cases and 8,247 controls) were included in the meta-analysis. Compared with individuals with normal weight, the risk of multiple myeloma was statistically significantly higher among those who were overweight (cohort studies: RR, 1.12, 95% CI, 1.07,1.18; case,control studies: RR, 1.43; 95% CI, 1.23,1.68) or obese (cohort studies: RR, 1.27, 95% CI, 1.15,1.41; case, control studies: RR, 1.82, 95% CI, 1.47,2.26). Results from this meta-analysis indicate that excess body weight may be a risk factor for multiple myeloma. © 2007 Wiley-Liss, Inc. [source] Genetic Polymorphisms Related to Delirium Tremens: A Systematic ReviewALCOHOLISM, Issue 2 2007Barbara C. Van Munster Background: Delirium tremens (DT) is one of the more severe complications of alcohol withdrawal (AW), with a 5 to 10% lifetime risk for alcohol-dependent patients. The 2 most important neurosystems involved in AW are , -aminobutyric acid and glutamate. It is unknown whether these neurosystems are involved in the pathophysiology of DT as well. The candidate gene approach in DT could contribute to this knowledge and demonstrate a possible genetic predisposition for DT. The purpose of this study is to give an overview of all studied genetic polymorphisms in the diverse candidate genes related to DT and to summarize what these studies contribute to insights into the pathophysiology of DT. Methods: The inclusion criteria for this literature study were articles in English analyzing the association between a genetic polymorphism and DT without other AW syndromes. Studies were identified until February 2006 in MEDLINE and EMBASE databases. Results: We found 25 studies dealing with 30 polymorphisms, located in 19 different genes. Positive associations were found in 3 different candidate genes involved in the dopamine transmission, 1 gene involved in the glutamate pathway, 1 neuropeptide gene, and 1 cannabinoid gene. Two candidate genes involved in the dopamine transmission, dopamine receptor D3, and solute carrier family 6, were each associated with DT in 2 different study populations. The other 4 positive associations were not replicated in other studies. Conclusions: A total of 8 positive associations out of 30 polymorphisms makes a genetic base for DT plausible. Understanding the pathophysiological process of the development of DT has, indeed, been augmented by the reviewed genetic association studies. These studies suggest that the regulation of dopaminergic neurotransmission may play an important role. [source] Does the Early Administration of Beta-blockers Improve the In-hospital Mortality Rate of Patients Admitted with Acute Coronary Syndrome?ACADEMIC EMERGENCY MEDICINE, Issue 1 2010Ethan Brandler MD Abstract Objectives:, Beta-blockade is currently recommended in the early management of patients with acute coronary syndromes (ACS). This was a systematic review of the medical literature to determine if early beta-blockade improves the outcome of patients with ACS. Methods:, The authors searched the PubMed and EMBASE databases for randomized controlled trials from 1965 through May 2009 using a search strategy derived from the following PICO formulation of our clinical question: Patients included adults (18+ years) with an acute or suspected myocardial infarction (MI) within 24 hours of onset of chest pain. Intervention included intravenous or oral beta-blockers administered within 8 hours of presentation. The comparator included standard medical therapy with or without placebo versus early beta-blocker administration. The outcome was the risk of in-hospital death in the intervention groups versus the comparator groups. The methodologic quality of the studies was assessed. Qualitative methods were used to summarize the study results. In-hospital mortality rates were compared using a forest plot of relative risk (RR; 95% confidence interval [CI]) between beta-blockers and controls. Statistical analysis was done with Review Manager V5.0. Results:, Eighteen articles (total N = 72,249) met the inclusion/exclusion criteria. For in-hospital mortality, RR = 0.95 (95% CI, 0.90,1.01). In the largest of these studies (n = 45,852), a significantly higher rate (p < 0.0001) of cardiogenic shock was observed in the beta-blocker (5.0%) versus control group (3.9%). Conclusions:, This systematic review failed to demonstrate a convincing in-hospital mortality benefit for using beta-blockers early in the course of patients with an acute or suspected MI. ACADEMIC EMERGENCY MEDICINE 2010; 17:1,10 © 2010 by the Society for Academic Emergency Medicine [source] Sensitivity of Bedside Ultrasound and Supine Anteroposterior Chest Radiographs for the Identification of Pneumothorax After Blunt TraumaACADEMIC EMERGENCY MEDICINE, Issue 1 2010R. Gentry Wilkerson MD Abstract Objectives:, Supine anteroposterior (AP) chest radiographs in patients with blunt trauma have poor sensitivity for the identification of pneumothorax. Ultrasound (US) has been proposed as an alternative screening test for pneumothorax in this population. The authors conducted an evidence-based review of the medical literature to compare sensitivity of bedside US and AP chest radiographs in identifying pneumothorax after blunt trauma. Methods:, MEDLINE and EMBASE databases were searched for trials from 1965 through June 2009 using a search strategy derived from the following PICO formulation of our clinical question: patients included adult (18 + years) emergency department (ED) patients in whom pneumothorax was suspected after blunt trauma. The intervention was thoracic ultrasonography for the detection of pneumothorax. The comparator was the supine AP chest radiograph during the initial evaluation of the patient. The outcome was the diagnostic performance of US in identifying the presence of pneumothorax in the study population. The criterion standard for the presence or absence of pneumothorax was computed tomography (CT) of the chest or a rush of air during thoracostomy tube placement (in unstable patients). Prospective, observational trials of emergency physician (EP)-performed thoracic US were included. Trials in which the exams were performed by radiologists or surgeons, or trials that investigated patients suffering penetrating trauma or with spontaneous or iatrogenic pneumothoraces, were excluded. The methodologic quality of the studies was assessed. Qualitative methods were used to summarize the study results. Data analysis consisted of test performance (sensitivity and specificity, with 95% confidence intervals [CIs]) of thoracic US and supine AP chest radiography. Results:, Four prospective observational studies were identified, with a total of 606 subjects who met the inclusion and exclusion criteria. The sensitivity and specificity of US for the detection of pneumothorax ranged from 86% to 98% and 97% to 100%, respectively. The sensitivity of supine AP chest radiographs for the detection of pneumothorax ranged from 28% to 75%. The specificity of supine AP chest radiographs was 100% in all included studies. Conclusions:, This evidence-based review suggests that bedside thoracic US is a more sensitive screening test than supine AP chest radiography for the detection of pneumothorax in adult patients with blunt chest trauma. ACADEMIC EMERGENCY MEDICINE 2010; 17:11,17 © 2010 by the Society for Academic Emergency Medicine [source] Systematic review: Helicobacter pylori and the risk of upper gastrointestinal bleeding risk in patients taking aspirinALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 7 2010E. H. Fletcher Aliment Pharmacol Ther 2010; 32: 831,839 Summary Background, Aspirin is widely used to modify the risk of recurrent vascular events. It is, however, associated with increased upper gastrointestinal bleeding risk. The influence of Helicobacter pylori on this risk is uncertain. Aim, To determine the influence of H. pylori on upper gastrointestinal bleeding risk in patients taking aspirin. Methods, MEDLINE and EMBASE databases were searched. All studies providing data regarding H. pylori infection in adults taking aspirin and presenting with upper gastrointestinal bleeding were included. Results, A total of 13 studies that included 1 case,control, 10 cohort studies and 2 randomized-controlled trials (RCTs) were analysed. The case,control study (n = 245) determined H. pylori to be a significant independent risk factor for upper gastrointestinal bleeding. The cohort studies were heterogeneous, varying in inclusion criteria, doses and duration of aspirin used, mode of H. pylori testing and causative GI pathology considered. Comprising 5465 patients, H. pylori infection was tested for in 163 (0.03%) aspirin users with upper gastrointestinal bleeding. The RCTs yielded no significant results. Conclusions, The current data are not sufficient to allow meta-analyses. The widely held belief that H. pylori is a risk factor for upper gastrointestinal bleeding in regular aspirin users is not supported by the very limited evidence available. [source] Meta-analysis: the effects of placebo treatment on gastro-oesophageal reflux diseaseALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 1 2010F. Cremonini Aliment Pharmacol Ther 2010; 32: 29,42 Summary Background, There appears to be a significant placebo response rate in clinical trials for gastro-oesophageal reflux disease. Little is known about the determinants and the circumstances associated with placebo response in the treatment of gastro-oesophageal reflux disease (GERD). Aims, To estimate the magnitude of the placebo response rate in randomized controlled trials for GERD and to identify factors that influence this response. Methods, A meta-analysis of randomized, double-blind, placebo-controlled trials, published in English language, which included >20 patients with GERD, treated with either a proton pump inhibitor or H2 -receptor antagonist for at least 2 weeks. Medline, Cochrane and EMBASE databases were searched, considering only studies that reported a global response for ,heartburn'. Results, A total of 24 studies included 9989 patients with GERD. The pooled odds ratio (OR) for response to active treatment vs. placebo was 3.71 (95% CI: 2.78,4.96). The pooled estimate of the overall placebo response was 18.85% (range 2.94%,47.06%). Patients with erosive oesophagitis had a non-significantly lower placebo response rate than patients without it (11.87% and 18.31%, respectively; P = 0.246). Placebo response was significantly lower in studies of PPI therapy vs. studies of H2 RAs (14.51% vs. 24.69%, respectively; P = 0.05). Conclusions, The placebo response rate in randomized controlled trials for GERD is substantial. A lower placebo response was associated with the testing of PPIs, but not the presence of erosive oesophagitis. [source] Review article: anti-fibrotic agents for the treatment of Crohn's disease , lessons learnt from other diseasesALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 2 2010H. SZABÒ Summary Background, The current therapies for Crohn's disease (CD) are mainly focused on blockade of inflammation. Fibrosis remains one of the major complications of CD often leading to surgery, affecting patients' quality-of-life. Aim, To summarize the published data regarding the potential anti-fibrotic role of drugs commonly used in CD and the most effective anti-fibrotic drugs used in other diseases evaluating their potential use to treat intestinal fibrosis in CD. Methods, A literature search was performed in the PubMed, Medline, Cochrane and EMBASE databases, considering in vitro, animal and human studies on fibrosis in inflammatory bowel disease and other similar chronic pathologies. Results, Treatment of fibrosis in CD is limited to surgery or endoscopic dilatation, although some of the drugs currently used may have anti-fibrotic activity. In other diseases, anti-fibrotic agents are already used or are in preclinical or clinical trials. ACE inhibitors, Angiotensin Receptor Blockers, and HMG-CoA inhibitors merit further investigation in CD because of their role in preventing fibrosis in cardiovascular and renal diseases. Conclusions, Anti-fibrotic drugs are under evaluation or already used in clinical practice in other chronic inflammatory diseases. In CD, there is a great need for investigation into agents that may prevent, reduce or reverse intestinal fibrosis. Aliment Pharmacol Ther,31, 189,201 [source] Diagnostic accuracy of D-dimer test for exclusion of venous thromboembolism: a systematic reviewJOURNAL OF THROMBOSIS AND HAEMOSTASIS, Issue 2 2007M. DI NISIO Summary.,Background: The reported diagnostic accuracy of the D-dimer test for exclusion of deep vein thrombosis (DVT) and pulmonary embolism (PE) varies. It is unknown to what extent this is due to differences in study design or patient groups, or to genuine differences between D-dimer assays. Methods: Studies evaluating the diagnostic accuracy of the D-dimer test in the diagnosis of venous thromboembolism were systematically searched for in the MEDLINE and EMBASE databases up to March 2005. Reference lists of all included studies and of reviews related to the topic of the present meta-analysis were manually searched for other additional potentially eligible studies. Two reviewers independently extracted study characteristics using standardized forms. Results: In total, 217 D-dimer test evaluations for DVT and 111 for PE were analyzed. Several study design characteristics were associated with systematic differences in diagnostic accuracy. After adjustment for these features, the sensitivities of the D-dimer enzyme-linked immunofluorescence assay (ELFA) (DVT 96%; PE 97%), microplate enzyme-linked immunosorbent assay (ELISA) (DVT 94%; PE 95%), and latex quantitative assay (DVT 93%; PE 95%) were superior to those of the whole-blood D-dimer assay (DVT 83%; PE 87%), latex semiquantitative assay (DVT 85%; PE 88%) and latex qualitative assay (DVT 69%; PE 75%). The latex qualitative and whole-blood D-dimer assays had the highest specificities (DVT 99%, 71%; PE 99%, 69%). Conclusions: Compared to other D-dimer assays, the ELFA, microplate ELISA and latex quantitative assays have higher sensitivity but lower specificity, resulting in a more confident exclusion of the disease at the expense of more additional imaging testing. These conclusions are based on the most up-to-date and extensive systematic review of the topic area, including 184 articles, with 328 D-dimer test evaluations. [source] Review article: anti TNF-, induced psoriasis in patients with inflammatory bowel diseaseALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 9 2009G. FIORINO Summary Background, Anti TNF-, agents are used successfully for several autoimmune diseases, including IBD and psoriasis. An emerging challenge is the increasing incidence of anti TNF-, induced psoriasis. A total of 120 cases have been currently reported, of whom 18 patients were treated with biological agents for IBD. Objectives, To analyse all cases of anti TNF-, induced psoriasis in patients with IBD in the literature and to investigate potential mechanisms of action. Methods, A literature review was performed in the PubMed, Medline, Cochrane and EMBASE databases, with simple analysis of demographic data, drug administration and psoriasis onset. Risk and incidence patient/year/duration (pyd) was calculated. Results, A total of 18 patients with IBD treated by anti TNF-, agents developed drug-induced psoriasis of which, 17 patients developed with infliximab, one with adalimumab. The most frequent time of onset is between 3rd and 4th infusion of infliximab. Withdrawal of infliximab led to regression of lesions in 16 patients. In six patients, infliximab was reintroduced with no further recurrence of psoriasis. Conclusions, Although anti TNF-, induced psoriasis is extremely rare, understanding the mechanism will be a key step towards better realizing the role played by TNF-, and its pharmacological inhibitors in immune-mediated diseases. [source] Original Article: A systematic review and meta-analysis of tumor necrosis factor ,-308 polymorphism and Kawasaki diseasePEDIATRICS INTERNATIONAL, Issue 4 2010Sakda Arj-Ong Abstract Background:, There have been genetic studies assessing the association between tumor necrosis factor (TNF)-,-308 and Kawasaki disease (KD) but the results have been conflicting due to lack of power. Therefore, a systematic review and meta-analysis was conducted to increase the power for identifying the association between the TNF-,-308 polymorphism and KD. Method:, Studies were identified from MEDLINE and EMBASE databases and were included if the subjects were children and the frequencies between TNF-,-308 and KD were reported. Data were pooled using a random effect model if heterogeneity between studies was present. Results:, Thirteen studies were identified however only six studies were included. The pooled prevalence of minor A allele was 5.2% (95% confidence interval [CI]: 0.1%,9.5%). Gene effect was assessed using per-allele and per-genotype approaches. The pooled odds ratio of G versus A with the random effect model was 1.13 (95%CI: 0.34,3.27). The genotype effects for GG versus GA+AA was estimated and the pooled odds ratio was 1.08 (95%CI: 0.42,2.92). Conclusion:, This review suggests a trend of association between the TNF-,-308 G-allele and KD. However, the gene effects are heterogeneous and assessing sources of heterogeneity are limited. An updated meta-analysis is needed if more studies are published. [source] Gender differences in the psychosocial experience of parents of children with cancer: a review of the literaturePSYCHO-ONCOLOGY, Issue 9 2009Naomi E. Clarke Abstract Objective: To build a descriptive literature base of investigated and identified gender differences in the psychosocial experience of parents of children with cancer, in order to guide future research in this area. Methods: An extensive literature search was conducted using Medline, PsycINFO, CINAHL and EMBASE databases. Thirty papers were included in the review. Themes from these papers were identified, and on this basis, the review findings were grouped according to five main outcome categories: role perceptions, illness beliefs, psychological distress, coping strategies and perceptions of marital, family and child functioning. Results: Few gender differences were found in perceptions of marital, family and child functioning. There was a tendency toward traditional gender roles in the division of parental tasks. Findings in relation to parent psychological distress and preferred coping strategies were mixed, with trends toward increased distress, more emotion-focused coping and greater social support-seeking in mothers. Conclusions: Further studies using longitudinal designs with solid theoretical groundings will provide valuable information on the unique psychosocial experiences of mothers and fathers throughout the child's illness, which may in turn guide the development of evidence-based interventions. Copyright © 2009 John Wiley & Sons, Ltd. [source] Complete or ultraconservative removal of decayed tissue in unfilled teethAUSTRALIAN DENTAL JOURNAL, Issue 3 2009D Ricketts Background:, The treatment of deep dental decay has traditionally involved removal of all the soft demineralized dentine before a filling is placed. However, this has been challenged in three groups of studies which involve sealing soft caries into the tooth. The three main groups either remove no caries and seal the decay into the tooth, remove minimal (ultraconservative) caries at the entrance to a cavity and seal the remaining caries in, or remove caries in stages over two visits some months apart to allow the pulp time to lay down reparative dentine (the stepwise excavation technique). Objectives:, To test the null hypothesis of no difference in the incidence of damage or disease of the nerve of the tooth (pulp), progression of decay and longevity of restorations irrespective of whether the removal of decay had been minimal (ultraconservative) or complete. Search strategy:, The Cochrane Oral Health Group Trials Register, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, PubMed and EMBASE databases were searched. The reference lists in relevant papers were checked. Selection criteria:, Randomized controlled trials and controlled clinical trials comparing minimal (ultraconservative) caries removal with complete caries removal in unrestored permanent and deciduous teeth. Data collection and analysis:, Outcome measures recorded were exposure of the nerve of the tooth (pulp) during caries removal, patient experience of symptoms of pulpal inflammation or necrosis, progression of caries under the filling, time until the filling was lost or replaced. Due to the heterogeneity of the included studies the overall estimate of effect was calculated using a random-effects model. Main results:, Four studies met the inclusion criteria; two stepwise excavation studies and two ultraconservative caries removal studies. Partial caries removal in symptomless, primary or permanent teeth reduces the risk of pulp exposure. We found no detriment to the patient in terms of pulpal symptoms in this procedure and no reported premature loss or deterioration of the restoration. Authors' conclusions:, The results of this systematic review reject the null hypothesis of no difference in the incidence of damage or disease of the nerve of the tooth (pulp) irrespective of whether the removal of decay had been minimal (ultraconservative) or complete and accepts the null hypothesis of no difference in the progression of decay and longevity of restorations. However, the number of included studies is small and differ considerably. Partial caries removal is therefore preferable to complete caries removal in the deep lesion, in order to reduce the risk of carious exposure. However, there is insufficient evidence to know whether it is necessary to re-enter and excavate further but studies that have not re-entered do not report adverse consequences. [source] Mirtazapine: only for depression?ACTA NEUROPSYCHIATRICA, Issue 3-4 2006Luis San Background:, Mirtazapine is an antidepressant first approved in the Netherlands in 1994 for the treatment of major depressive disorder. However, evidence suggests its effectiveness in a variety of other psychiatric disorders and non-psychiatric medical conditions. Objective:, The present paper reviews the published literature on the off-label indications of Mirtazapine. Methods:, A search of the relevant literature from MEDLINE, PsycLIT and EMBASE databases, included in the Science Citation Index and available up to March 2006, was conducted using the terms mirtazapine, case-reports, open-label trials and randomized controlled trials. Only articles referring to conditions other than major depression were included in this present review. Results:, Off-label use of mirtazapine has been reported in panic disorder, post-traumatic stress disorder, generalized anxiety disorder, social phobia, obsessive-compulsive disorder, dysthymia, menopausal depression, poststroke depression, depression as a result of infection with human immunodeficiency virus, elderly depression, Methylenedioxymethamphetamine (MDMA)-induced depression, hot flashes, alcohol and other substance use disorders, sleep disorders, sexual disorders, tension-type headaches, cancer pain, fibromyalgia, schizophrenia and other less frequent conditions. Conclusions:, So far, data on the off-label usefulness of mirtazapine are limited and mainly based on observations from case reports or open-label studies. However, positive cues suggest that confirmation of these preliminary data with randomized controlled trials may give sufficient evidence to warrant the use of mirtazapine in a broad range of disorders. [source] Local treatment of empyema in children: a systematic review of randomized controlled trialsACTA PAEDIATRICA, Issue 10 2010Katarzyna Krenke Abstract The aim of the study is to systematically evaluate data from randomized controlled trials (RCTs) on the efficacy of using intrapleural fibrinolytic agents in the treatment of complicated parapneumonic effusions or empyema in children. The Cochrane Library, MEDLINE and EMBASE databases were searched in July 2009. Four RCTs, involving 194 children, were included. In two RCTs, intrapleural fibrinolytic treatment was compared with normal saline. One of these RCTs showed a significantly reduced hospital stay in those treated with urokinase compared with those treated with normal saline. Otherwise, no fibrinolytic agent had an effect on any other outcome. Two RCTs that compared fibrinolytic treatment with video-assisted thoracoscopic surgery (VATS) revealed no benefit of VATS. Conclusion:, There is little evidence that intrapleural fibrinolysis is more effective than normal saline in the local treatment of complicated parapneumonic effusions or empyema in children. There is no evidence that VATS is more effective than fibrinolytic treatment. Only a limited number of trials were available for analysis, so some caution must be exercised in interpreting the strength of the evidence presented. [source] | ||||||||||