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  • 1
    Electronic Resource
    Electronic Resource
    Efficacy of bile acid therapy for gallstone dissolution: a meta-analysis of randomized trials (1993)
    Oxford, UK : Blackwell Publishing Ltd
    Alimentary pharmacology & therapeutics 7 (1993), S. 0 
    Details
    ISSN: 1365-2036
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: To define better the efficacy of bile acid therapy for dissolution of radiolucent gallstones, we performed a meta-analysis of published trials from January 1966 to September 1992. Studies were identified using a MEDLINE computer search followed by an extensive manual search. The inclusion criteria used were: randomized trial, radiolucent gallstones in a visualizing gallbladder on oral cholecystography, and complete stone dissolution confirmed by oral cholecystography or ultrasound. Study results were pooled into 6 groups: placebo: high- and low-dose chenodeoxycholic acid (CDCA) (≥10 mg.kg/day and 〈 10 mg.kg/day); high- and low-dose ursodeoxycholic acid (UDCA) (〈 7 mg. kg/day and 〈 7 mg. kg/day) and combined CDCA plus UDCA. Homogeneity calculations were performed and the percentage of complete stone dissolution calculated for each group with 95% confidence intervals. Of 66 trials identified, 23 comprising 1949 patients met the inclusion criteria. A total of 1062 patients were treated with CDCA, 819 with UDCA and 78 combination therapy. In studies 〉 6 months' duration, high-dose UDCA completely dissolved stones in 37.3% of patients (95% C.I. 33–42%), low-dose UDCA in 20.6%) and high-dose CDCA 18.2% (95% C.I. 15–21%). Based on only two studies, combination therapy achieved dissolution in 62.8% (95% C.I. 51–74%) of patients. Stones less than 10 mm dissolved significantly more frequently than stones larger than 10 mm. This analysis shows that UDCA in doses greater than 7 mg. kg/day taken for greater than 6 months will dissolve radiolucent gallstones in 38% of patients. The combination of UDCA and CDCA may be more efficacious but this observation is based upon only 78 patients and requires confirmation in further randomized trials.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1365-2036.1993.tb00082.x
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  • 2
    Electronic Resource
    Electronic Resource
    A randomized, double-blind, placebo-controlled trial of CDP571, a humanized monoclonal antibody to tumour necrosis factor-α, in patients with corticosteroid-dependent Crohn's disease (2005)
    Oxford, UK : Blackwell Science Ltd
    Alimentary pharmacology & therapeutics 21 (2005), S. 0 
    Details
    ISSN: 1365-2036
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Aim : To evaluate CDP571, a humanized monoclonal antibody to tumour necrosis factor-α, for the treatment of corticosteroid-dependent Crohn's disease.Methods : Patients with corticosteroid-dependent Crohn's disease (use of prednisolone 15–40 mg/day or budesonide 9 mg/day for at least 8 weeks, a previous failed attempt to discontinue corticosteroids within 8 weeks, and Crohn's Disease Activity Index score 150 points or less) were enrolled in a 16-week, randomized, double-blind, placebo-controlled trial. The patients received intravenous CDP571 (20 mg/kg at week 0 and 10 mg/kg at week 8) or placebo. Corticosteroid therapy was decreased following a predefined schedule. The primary efficacy end-point was the percentage of patients with corticosteroid-sparing [i.e. no disease flare (Crohn's Disease Activity Index score ≥220 points) and no longer requiring corticosteroid therapy] at week 10. The major secondary efficacy end-point was corticosteroid-sparing at week 16.Results : Seventy-one patients received treatment. Corticosteroid-sparing was achieved by 19 of 39 (48.7%) CDP571 patients and 13 of 42 (40.6%) placebo patients (P = 0.452) at week 10, and by 18 of 39 (46.2%) CDP571 patients and seven of 32 (21.9%) placebo patients (P = 0.032) at week 16. CDP571 therapy was well-tolerated and the incidence of serious adverse events was similar to placebo.Conclusions : The CDP571 was effective for corticosteroid-sparing at week 16 but not week 10, and was well-tolerated in patients with corticosteroid-dependent Crohn's disease.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1365-2036.2005.02336.x
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  • 3
    Electronic Resource
    Electronic Resource
    Review article: treatment of Clostridium difficile infection (1997)
    Oxford, UK : Blackwell Science Ltd
    Alimentary pharmacology & therapeutics 11 (1997), S. 0 
    Details
    ISSN: 1365-2036
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: A systematic review of controlled trials of therapy of Clostridium difficile intestinal infection using methodology described by the Cochrane Collaboration.〈section xml:id="abs1-2"〉〈title type="main"〉Methods:Trials were identified by searching computer databases over the years 1978–1996. Trials were included if they were (a) prospective randomized, controlled trials and (b) included patients with symptomatic disease. The primary end-point was clinical resolution of diarrhoea. Secondary end-points were clinical relapse and stool clearance of C. difficile and C. difficile toxin.〈section xml:id="abs1-3"〉〈title type="main"〉Results:Nine trials (469 patients) satisfying the inclusion criteria were identified. Two trials were placebo controlled. Six trials compared vancomycin to other antibiotics (fusidic acid, bacitracin, teicoplanin and metronidazole). For clinical resolution response rates ranged from 21 (placebo) to 100% (vancomycin). On pooling the trials, no antibiotic showed clear therapeutic superiority. Rates of clinical relapse ranged from 5 to 42%. Only one trial showed significant advantage of one antibiotic over another for prevention of relapse (teicoplanin vs. fusidic acid).〈section xml:id="abs1-4"〉〈title type="main"〉Conclusion:The published data are limited, and further studies are required.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1365-2036.1997.00269.x
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  • 4
    Electronic Resource
    Electronic Resource
    Effect of oral contraceptive use on reoperation following surgery for Crohn's disease (1992)
    Springer
    Digestive diseases and sciences 37 (1992), S. 1377-1382 
    Details
    ISSN: 1573-2568
    Keywords: risk factors ; Crohn's disease ; oral contraceptives ; recurrence
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The influence of oral contraceptive (OCP) use as a risk factor for the development of Crohn's disease is disputed. We wished to determine if OCP use affected the risk of recurrence (defined as need for a second surgery) in women who had already undergone a resection for Crohn's disease. We hypothesized that if contraceptive use was a risk factor for disease development, it could influence recurrence. Using a mail questionnaire, we surveyed 138 women regarding their OCP use following surgery for Crohn's disease. All participants were between ages 16 and 35 at the time of their initial surgery which occurred between 1966 and 1984. Ninety-seven women (70%) responded. Mean follow-up was 9.9 years (range 4–27). Forty-six women required a second surgery. The recurrence rate as determined by actuarial analysis, was 27.2% (95% confidence intervals (CI95 16.5–38.1) and 58.0% (CI95 37.8–78.2) at 5 and 10 years, respectively. Thirty-two women took OCP in the first year following surgery. Eleven OCP users (34.4%) required additional surgery compared to 34 (53.1%) of nonusers. Using life table analysis, the percentage requiring a second surgery was 25.0% (CI95 6.9–43.1) and 40.7% (CI95 1.5–80%) at 5 and 10 years, respectively, for users compared to 28.4% (CI95 6.9–43.1) and 64.0% (CI95 40.5–87.5) for nonusers (Lee Desu, P〉0.05). When surveyed about their reasons for using OCP, most women stated that their disease did not affect their decision to use contraceptives. There were no significant differences in terms of reasons for using OCP between those who required surgery and those who did not. In conclusion, there was little evidence to support the hypothesis that OCP use increased the risk of requiring a second operation in women who had undergone surgery for Crohn's Disease. The small sample size may have prevented detection of a modest effect.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01296007
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  • 5
    Electronic Resource
    Electronic Resource
    Frequency of hereditary nonpolyposis colorectal cancer in southern Alberta (1991)
    Springer
    Digestive diseases and sciences 36 (1991), S. 1441-1447 
    Details
    ISSN: 1573-2568
    Keywords: Lynch ; family cancer syndrome ; colorectal cancer ; cohort study
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The frequency of hereditary nonpolyposis colorectal cancer was evaluated in a group of colorectal cancer patients under age 50 diagnosed in southern Alberta between 1973 and 1987. Families were identified as positive for this syndrome if three-first-degree relatives in the kindred had colorectal cancer. Of the 390 patients with adenocarcinoma, 318 patients participated. The frequency of hereditary nonpolyposis colorectal cancer was 3.1% (12 families) in this group (Ci95 1.6–5.3%). Clinical characteristics reported on from the index patients include tumor location, Dukes stage at presentation, frequency of synchronous and metachronous tumors, frequency of second primaries, and survival. The 5- and 10-year actuarial survival was 86% and 69%, respectively.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01296813
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