Abstract:
BACKGROUND:Because of the disability associated with surgery for anal fissure and the risk of incontinence, medical alternatives for surgery have been sought. Most recently, pharmacologic methods that relax the anal smooth muscle, to accomplish reversibly what occurs in surgery, have been used to obtain fissure healing. OBJECTIVES:To assess the efficacy and morbidity of various medical therapies for anal fissure. SEARCH STRATEGY:Search terms include "anal fissure randomized". Timing from 1966 to May 2006. Further details of the search below. SELECTION CRITERIA:Studies in which participants were randomized to a non-surgical therapy for anal fissure. Comparison groups may include an operative procedure, an alternate medical therapy or placebo. Chronic fissure, acute fissure and fissure in children are included in the review. Atypical fissures associated with inflammatory bowel disease or cancer or anal infection are excluded. DATA COLLECTION AND ANALYSIS:Data were abstracted from published reports and meeting abstracts, assessing method of randomization, blinding, "intention to treat" and drop-outs, therapies, supportive measures (applied to both groups), dosing and frequency and cross-overs. Dichotomous outcome measures included Non-healing of the fissure (a combination of persistence and recurrence), and Adverse events (including incontinence, headache, infection, anaphylaxis). Continuous outcome measures included measures of pain relief and anorectal manometry. MAIN RESULTS:48 different comparisons of the ability of medical therapies to heal anal fissure have been reported in 53 RCTs. Eleven agents were used (nitroglycerin ointment (GTN), isosorbide dinitrate, Botulinum toxin (Botox), diltiazem, nifedipine (Calcium channel blockers or CCBs), hydrocortisone, lignocaine, bran, minoxidil, indoramin, and placebo) as well as anal dilators and surgical sphincterotomy.GTN was found to be marginally but significantly better than placebo in healing anal fissure (48.6% vs. 37%, p < 0.004), but late recurrence of fissure was common, in the range of 50% of those initially cured. Botox and CCBs were equivalent to GTN in efficacy with fewer adverse events. No medical therapy came close to the efficacy of surgical sphincterotomy, though none in these RCTs was associated with the risk of incontinence. AUTHORS' CONCLUSIONS:Medical therapy for chronic anal fissure, acute fissure and fissure in children may be applied with a chance of cure that is marginally better than placebo, and, for chronic fissure in adults, far less effective than surgery.
journal_name
Cochrane Database Syst Revjournal_title
The Cochrane database of systematic reviewsauthors
Nelson Rdoi
10.1002/14651858.CD003431.pub2subject
Has Abstractpub_date
2006-10-18 00:00:00pages
CD003431issue
4issn
1469-493Xpub_type
杂志文章,meta分析,评审abstract:BACKGROUND:Retinitis pigmentosa (RP) comprises a group of hereditary eye diseases characterized by progressive degeneration of retinal photoreceptors. It results in severe visual loss that may lead to legal blindness. Symptoms may become manifest during childhood or adulthood, and include poor night vision (nyctalopia)...
journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,评审
doi:10.1002/14651858.CD008428.pub2
更新日期:2013-12-19 00:00:00
abstract:BACKGROUND:The evidence of tapered methadone's efficacy in managing opioid withdrawal has been systematically evaluated in the previous version of this review that needs to be updated OBJECTIVES:To evaluate the effectiveness of tapered methadone compared with other detoxification treatments and placebo in managing opi...
journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,meta分析,评审
doi:10.1002/14651858.CD003409.pub4
更新日期:2013-02-28 00:00:00
abstract:BACKGROUND:This is an update of a previously published version of the review (Issue 10, 2011).Epithelial ovarian cancer (EOC) is the seventh most common cause of cancer death among women worldwide. Treatment consists of a combination of surgical debulking and platinum-based chemotherapy. Between 55% and 75% of women wh...
journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,meta分析
doi:10.1002/14651858.CD007927.pub4
更新日期:2018-10-16 00:00:00
abstract:BACKGROUND:A large proportion of people with advanced cancer will experience moderate to severe pain. Tapentadol is a novel, centrally acting analgesic medicine acting at the μ-opioid receptor and inhibiting noradrenaline reuptake. The efficacy of tapentadol is stated to be comparable to morphine and oxycodone. OBJECT...
journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,meta分析,评审
doi:10.1002/14651858.CD011460.pub2
更新日期:2015-09-25 00:00:00
abstract:BACKGROUND:Fetal movement counting is a method by which a woman quantifies the movements she feels to assess the condition of the baby. The purpose is to try to reduce perinatal mortality by alerting caregivers when the baby might have become compromised. This method may be used routinely, or only in women who are cons...
journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,评审
doi:10.1002/14651858.CD004909.pub2
更新日期:2007-01-24 00:00:00
abstract:BACKGROUND:Several agents are used to clear secretions from the airways of people with cystic fibrosis. Mannitol increases mucociliary clearance, but its exact mechanism of action is unknown. The dry powder formulation of mannitol may be more convenient and easier to use compared with established agents which require d...
journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,meta分析,评审
doi:10.1002/14651858.CD008649.pub3
更新日期:2018-02-09 00:00:00
abstract:BACKGROUND:Patients with acute asthma treated in the emergency department (ED) are frequently treated with inhaled beta(2)-agonists and systemic corticosteroids after discharge. The use of inhaled corticosteroids (ICS) following discharge may also be beneficial in improving patient outcomes after acute asthma. OBJECTI...
journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,meta分析,评审
doi:10.1002/14651858.CD002316.pub2
更新日期:2012-12-12 00:00:00
abstract:BACKGROUND:Managing children is a challenge that many dentists face. Many non-pharmacological techniques have been developed to manage anxiety and behavioural problems in children, such us: 'tell, show & do', positive reinforcement, modelling and hypnosis. The use of hypnosis is generally an overlooked area, hence the ...
journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,评审
doi:10.1002/14651858.CD007154.pub3
更新日期:2017-06-20 00:00:00
abstract:BACKGROUND:Rheumatoid arthritis (RA) is a systemic auto-immune disorder, involving persistent joint inflammation. NSAIDs are used to control the symptoms of RA, but are associated with significant gastro-intestinal toxicity, including a risk of potentially life threatening gastroduodenal perforations, ulcers and bleeds...
journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,meta分析,评审
doi:10.1002/14651858.CD003831
更新日期:2002-01-01 00:00:00
abstract:BACKGROUND:This section is under preparation and will be included in the next issue. OBJECTIVES:To assess the effect of prophylactic intratracheal administration of natural surfactant extract in preterm newborns at risk for developing respiratory distress syndrome (RDS). SEARCH STRATEGY:Searches were made of the Oxfo...
journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,评审
doi:10.1002/14651858.CD000511
更新日期:2000-01-01 00:00:00
abstract:BACKGROUND:Respiratory syncytial virus (RSV) bronchiolitis and pneumonia hospitalize hundreds of thousands of infants every year. Treatment is largely supportive therapy, (for example, oxygen, fluids and occasionally mechanical ventilation). Ribavirin, an antiviral agent, is licensed for severe RSV infection, although ...
journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,评审
doi:10.1002/14651858.CD004883.pub2
更新日期:2006-10-18 00:00:00
abstract:BACKGROUND:Memantine, a low affinity antagonist to glutamate NMDA receptors, may prevent excitatory neurotoxicity in dementia. OBJECTIVES:To determine efficacy and safety of memantine for people with Alzheimer's disease (AD), vascular (VD) and mixed dementia. SEARCH STRATEGY:The Specialized Register of the Cochrane D...
journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,meta分析,评审
doi:10.1002/14651858.CD003154.pub3
更新日期:2005-04-18 00:00:00
abstract:BACKGROUND:Quetiapine is a novel atypical antipsychotic with low propensity for movement disorder adverse effects. It is used for treatment of schizophrenia and other psychoses. OBJECTIVES:To determine the effects of quetiapine for schizophrenia in comparison to placebo, classical and other atypical antipsychotics. S...
journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,评审
doi:10.1002/14651858.CD000967
更新日期:2000-01-01 00:00:00
abstract:BACKGROUND:Cystic fibrosis is an inherited condition causing disease most noticeably in the lungs, digestive tract and pancreas. People with cystic fibrosis often have malnutrition and growth delay. Adequate nutritional supplementation does not improve growth optimally and hence an anabolic agent, recombinant growth ho...
journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,meta分析,评审
doi:10.1002/14651858.CD008901.pub2
更新日期:2013-06-05 00:00:00
abstract:BACKGROUND:Patients who are entered in clinical trials after a transient ischaemic attack (TIA) or non disabling ischaemic stroke have an annual risk of important vascular events (death from all vascular causes, non-fatal stroke, or non-fatal myocardial infarction) of between 4 and 11 percent. Aspirin, in a daily dose ...
journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,评审
doi:10.1002/14651858.CD001342
更新日期:2001-01-01 00:00:00
abstract:BACKGROUND:This is an updated version of the original Cochrane review published in Issue 2, 2007. The role of radiotherapy (both pelvic external beam radiotherapy (EBRT) and vaginal intracavity brachytherapy (VBT)) in stage I endometrial cancer following hysterectomy remains controversial. OBJECTIVES:To assess the eff...
journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,meta分析,评审
doi:10.1002/14651858.CD003916.pub3
更新日期:2012-03-14 00:00:00
abstract:BACKGROUND:The integration of HIV/AIDS and maternal, neonatal, child health and nutrition services (MNCHN), including family planning (FP) is recognized as a key strategy to reduce maternal and child mortality and control the HIV/AIDS epidemic. However, limited evidence exists on the effectiveness of service integratio...
journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,meta分析,评审
doi:10.1002/14651858.CD010119
更新日期:2012-09-12 00:00:00
abstract:BACKGROUND:Total knee arthroplasty is a common intervention for patients with arthritis. Post-surgical rehabilitation often includes continuous passive motion. However, it is not clear whether continuous passive motion is effective. OBJECTIVES:To evaluate the effectiveness of continuous passive motion following total ...
journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,meta分析,评审
doi:10.1002/14651858.CD004260.pub2
更新日期:2010-03-17 00:00:00
abstract:BACKGROUND:Preterm infants are usually growth restricted at hospital discharge. Feeding preterm infants after hospital discharge with nutrient-fortified breast milk (rather than unfortified breast milk) may facilitate more rapid catch-up growth and improve neurodevelopmental outcomes. OBJECTIVES:To determine the effec...
journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,评审
doi:10.1002/14651858.CD004866.pub2
更新日期:2007-10-17 00:00:00
abstract:BACKGROUND:Lead poisoning is associated with physical, cognitive and neurobehavioural impairment in children and trials have tested many household interventions to prevent lead exposure. This is an update of the original review by the same authors first published in 2008. OBJECTIVES:To determine the effectiveness of h...
journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,meta分析,评审
doi:10.1002/14651858.CD006047.pub4
更新日期:2014-12-15 00:00:00
abstract:BACKGROUND:Concerns regarding the safety of transfused blood have led to the development of a range of interventions to minimise blood loss during major surgery. Anti-fibrinolytic drugs are widely used, particularly in cardiac surgery, and previous reviews have found them to be effective in reducing blood loss, the nee...
journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,meta分析,评审
doi:10.1002/14651858.CD001886.pub3
更新日期:2011-01-19 00:00:00
abstract:BACKGROUND:Physiological monitoring studies indicate that some preterm infants experience episodes of oxygen desaturation, apnoea, or bradycardia when seated in standard car safety seats. The American Academy of Pediatrics recommends that all preterm infants should be assessed for cardiorespiratory stability in their c...
journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,评审
doi:10.1002/14651858.CD005386.pub2
更新日期:2006-01-25 00:00:00
abstract:BACKGROUND:Guillain-Barré syndrome is a potentially serious, acute, paralysing, probably autoimmune disease caused by inflammation of the peripheral nerves. Recovery has been shown to be speeded by plasma exchange which replaces the patient's own plasma with a plasma substitute. Intravenous immunoglobulin purified from...
journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,评审
doi:10.1002/14651858.CD002063
更新日期:2001-01-01 00:00:00
abstract:BACKGROUND:Injecting drug users are vulnerable to infection with HIV and other blood borne viruses as a result of collective use of injecting equipment as well as sexual behaviour. OBJECTIVES:To assess the effect of oral substitution treatment for opioid dependent injecting drug users on rates of HIV infections, and h...
journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,meta分析,评审
doi:10.1002/14651858.CD004145.pub2
更新日期:2004-10-18 00:00:00
abstract:BACKGROUND:Routine use of caesarean section for breech presentation is widespread. However, poor outcomes after breech birth might be the result of underlying conditions causing breech presentation rather than damage during delivery. OBJECTIVES:The objective of this review was to assess the effects of planned caesarea...
journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,评审
doi:10.1002/14651858.CD000166
更新日期:2001-01-01 00:00:00
abstract:BACKGROUND:Cancer patients are 1.4 times more likely to be unemployed than healthy people. Therefore it is important to provide cancer patients with programmes to support the return-to-work (RTW) process. This is an update of a Cochrane review first published in 2011. OBJECTIVES:To evaluate the effectiveness of interv...
journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,meta分析,评审
doi:10.1002/14651858.CD007569.pub3
更新日期:2015-09-25 00:00:00
abstract:BACKGROUND:Historically, whole brain radiation therapy (WBRT) has been the main treatment for brain metastases. Stereotactic radiosurgery (SRS) delivers high-dose focused radiation and is being increasingly utilized to treat brain metastases. The benefit of adding SRS to WBRT is unclear. This is an updated version of t...
journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,meta分析,评审
doi:10.1002/14651858.CD006121.pub3
更新日期:2012-09-12 00:00:00
abstract:BACKGROUND:Migrants who have been forced to leave their home, such as refugees, asylum seekers, and internally displaced persons (IDP), are likely to experience stressors which may lead to mental health problems. The efficacy of interventions for mental health promotion, prevention, and treatment may differ in this pop...
journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章
doi:10.1002/14651858.CD013458.pub2
更新日期:2020-09-04 00:00:00
abstract:BACKGROUND:Breastfeeding (BF) is well recognised as the best food for infants. The impact of antenatal BF education on the duration of BF has not been evaluated. OBJECTIVES:To evaluate the effectiveness of antenatal BF education for increasing BF initiation and duration. SEARCH METHODS:We searched the Cochrane Pregna...
journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,评审
doi:10.1002/14651858.CD006425.pub2
更新日期:2011-11-09 00:00:00
abstract:BACKGROUND:Clinicians must balance the risks of bleeding and thrombosis after percutaneous coronary intervention (PCI) in people with an indication for anticoagulation. The potential of non-vitamin K antagonists (NOACs) to prevent bleeding complications is promising, but evidence remains limited. OBJECTIVES:To review ...
journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,meta分析
doi:10.1002/14651858.CD013252.pub2
更新日期:2019-12-19 00:00:00