Self-expanding metallic stents for relieving malignant colorectal obstruction: a systematic review.

OBJECTIVE: To assess the safety and efficacy of self-expanding metallic stents (SEMS) placement for the relief of malignant colorectal obstruction in comparison to surgical procedures through a systematic review of the literature. SUMMARY BACKGROUND DATA: Conventional therapies for relieving colorectal obstructions caused by cancer have high rates of morbidity and mortality, particularly when performed under emergency conditions, and palliative procedures resulting in colostomy creation can be a burden for patients and caregivers. METHODS: A systematic search strategy was used to retrieve relevant studies. Inclusion of papers was established through application of a predetermined protocol, independent assessment by 2 reviewers, and a final consensus decision. Eighty-eight articles, 15 of which were comparative, formed the evidence base for this review. RESULTS: Little high-level evidence was available. However, the data suggested that SEMS placement was safe and effective in overcoming left-sided malignant colorectal obstructions, regardless of the indication for stent placement or the etiology of the obstruction. Additionally, SEMS placement had positive outcomes when compared with surgery, including overall shorter hospital stays, and a lower rate of serious adverse events. Postoperative mortality appeared comparable between the 2 interventions. Combining SEMS placement with elective surgery also appeared safer and more effective than emergency surgery, with higher rates of primary anastomosis, lower rates of colostomy, shorter hospital stays, and lower overall complication rates. CONCLUSIONS: Stenting appears to be a safe and effective addition to the armamentarium of treatment options for colorectal obstructions. However, the small sample sizes of the included studies limited the validity of the findings of this review. The results of additional comparative studies currently being undertaken will add to the certainty of the conclusions that can be drawn.

Unicompartmental knee arthroplasty for the treatment of unicompartmental osteoarthritis: a systematic study.

Unicompartmental knee arthroplasty (UKA), total knee arthroplasty (TKA) and high tibial osteotomy (HTO) may all be used to treat unicompartmental osteoarthritis, but they are often used for different patient groups. However, there is considerable overlap in indications for all three options. The aim of this review was to assess the safety and efficacy of UKA compared with TKA and HTO in unicompartmental osteoarthritis. Studies that compared UKA with either TKA or HTO were identified and included for review. For knee function and postoperative pain, UKA appeared similar to TKA and HTO at 5 years follow up. Range of motion was better in UKA compared with TKA. Complication rates after UKA and TKA appeared similar, although deep vein thrombosis was reported more often after TKA. There were more complications after HTO than UKA. Survival of UKA prostheses was approximately 85-95%, compared with at least 90% for TKA at 10 years follow up. Survivorship for HTO appeared to be less than 85%. It was not clear whether there were more revisions after UKA than TKA, but there appeared to be fewer revisions in UKA compared with HTO. UKA is considered at least as safe as TKA and HTO. For function, UKA appears to be at least as efficacious as TKA and HTO. The survival of UKA compared with TKA and HTO cannot be determined based on the available evidence.

How little is enough? The evidence for post-vasectomy testing.

PURPOSE: Post-vasectomy semen analysis (PVSA) is the traditional method of confirming sterility after vasectomy. However, PVSA protocols vary in the end points accepted, and the number and timing of tests. In this systematic review we make evidence based recommendations on the appropriate PVSA protocol. MATERIALS AND METHODS: Databases (MEDLINE, Current Contents, Cochrane Library and EMBASE) were searched up to and including March 2003. Studies were included if they dealt with post-vasectomy testing and contained data on at least 1 of the time or number of ejaculations to azoospermia, pregnancy, repeat vasectomy and histological analysis of vas specimens. RESULTS: A total of 56 studies were included in the review. Time to achieve azoospermia was variable, although the median incidence of patients with azoospermia was consistently more than 80% after 3 months and after 20 ejaculations. A small percent of patients (14,845 or 1.4%) demonstrated persistent nonmotile sperm, although some of them eventually achieved azoospermia. The reappearance of nonmotile sperm was reported in 7 studies, occurring up to 22 months after vasectomy. CONCLUSIONS: The evidence supports a PVSA protocol with 1 test showing azoospermia after 3 months and 20 ejaculations. If the sample is positive, periodic testing can continue until azoospermia is achieved. Patients with persistent nonmotile sperm in low numbers could be given cautious assurance of success. No evidence was located to support histological testing of the excised vas deferens.

Vaccinations for waste-handling workers. A review of the literature.

A review of the literature relating to the need for vaccination against infectious disease in the solid waste industry was conducted, focusing on hepatitis A, hepatitis B and tetanus. Databases (Medline, PreMedline, EMBASE, CINAHL, Current Contents, Cochrane Database, HTA Database, DARE, OSHROM) were searched up to and including August 2003. Articles were included in the review if they reported the prevalence of immunity to hepatitis A, hepatitis B or tetanus in solid waste workers or the incidence of clinical infection with any of these diseases. Papers about hazardous or medical waste, incineration or other infectious diseases were excluded. Forty-four papers constituted the evidence database. Only one paper studied the prevalence of antibodies to hepatitis A and hepatitis B in solid waste workers compared with sewage plant workers and office workers, and no difference was found between these groups of workers. There was some evidence to support a theoretical risk of infection with hepatitis A, B and tetanus; however, no studies could be found of the risk of these diseases in solid waste workers. No single cases of these diseases being acquired occupationally in solid waste management were identified in the literature. Workers in the solid waste industry may theoretically be at increased risk of acquiring infectious diseases occupationally. However, at present no studies could be found which have documented this risk.