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Decrease in the size of a cell, tissue, organ, or multiple organs.

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Menopausal Symptoms: Comparative Effectiveness of Therapies [Internet]

To systematically review and synthesize evidence evaluating the comparative effectiveness of treatments for menopausal symptoms, along with potential long-term benefits and harms of those treatments.

Comparative Effectiveness Reviews - Agency for Healthcare Research and Quality (US).

Version: March 2015
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Using creams, pessaries or a vaginal ring to apply oestrogen vaginally relieves the symptoms of vaginal atrophy, although some creams may cause adverse effects.

Vaginal atrophy is a common condition in women after menopause. It causes vaginal dryness and itching and can make intercourse painful. The female hormone oestrogen is a treatment option for vaginal atrophy, but can cause adverse effects such as bleeding and breast tenderness. Women can take oestrogen through tablets or injections. Alternatively, they can apply the hormone locally using creams, pessaries (tablets placed in the vagina) or a hormone‐releasing ring placed in the vagina. The review found that all methods of delivering oestrogen relieved the symptoms. However, some creams may cause adverse effects and women preferred vaginal rings.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2010

Drug treatment for spinal muscular atrophy type I

Spinal muscular atrophy (SMA) is a severe neuromuscular disease with onset in childhood and adolescence that results in progressive muscle weakness. There are three main types of SMA. Drug treatment for SMA types II and III is discussed in a separate Cochrane review. The age of onset of SMA type I, also known as Werdnig‐Hoffmann disease, is before six months. Children with SMA type I will never be able to sit without support and usually die by the age of two years. It is one of the most important causes of death due to a genetic disease in childhood. There was only one small randomised trial in the original review, which assessed the efficacy of riluzole for 10 children with SMA type I. In this trial all three children in the placebo group died, but three of the seven children treated with riluzole were still alive at the ages of 30, 48 and 64 months. However, none of the children in the riluzole or placebo group developed the ability to roll, sit or stand. For several reasons the overall quality of the study was low, mainly because the study was too small to detect an effect and there were baseline differences that resulted in risk of bias. Evidence is insufficient to recommend riluzole for SMA type I. No further trials were identified for this 2011 update. No drug treatment has been shown to have significant efficacy for SMA type I.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Drug treatment for spinal muscular atrophy types II and III

Spinal muscular atrophy (SMA) is a neuromuscular disorder that results in progressive muscle weakness with onset in childhood and adolescence. There are three main types of SMA. Drug treatment for SMA type I is discussed in a separate Cochrane review. This review is of drug treatment for SMA types II and III. Both of these reviews were first published in 2009 and are now updated. The age of onset of SMA type II is between six and 18 months. Children with SMA type II will never be able to walk without support; they survive beyond two years and may live into adolescence or longer. The age of onset of SMA III, also known as Kugelberg‐Welander disease, is after 18 months. Children with SMA type III develop the ability to walk at some time and their life expectancy is normal. From six randomised controlled trials, there is no evidence for a significant effect on the disease course when patients with SMA types II and III are treated with creatine (55 participants), phenylbutyrate (107 participants), gabapentin (84 participants), thyrotropin releasing hormone (9 participants), hydroxyurea (57 participants) or combination therapy with valproate and acetyl‐L‐carnitine (61 participants). The risk of bias of the included trials was systematically analysed and none of the studies were completely free of bias. Thus, there is still no known efficacious drug treatment for SMA types II and III.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Diagnostic performance of iodine-123-metaiodobenzylguanidine scintigraphy in differential diagnosis between Parkinson's disease and multiple-system atrophy: a systematic review and a meta-analysis

BACKGROUND AND PURPOSE: This study was designed to review the diagnostic performance of iodine-123-metaiodobenzylguanidine (MIBG) scintigraphy in differential diagnosis between Parkinson's disease (PD) and multiple-system atrophy (MSA).

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2011

[Meta analysis of acupuncture in the treatment of optic atrophy]

OBJECTIVE: To evaluate the efficacy and safety of acupuncture for optic atrophy.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2013

Treatment effect on brain atrophy correlates with treatment effect on disability in multiple sclerosis

OBJECTIVE: To evaluate the extent to which treatment effect on brain atrophy is able to mediate, at the trial level, the treatment effect on disability progression in relapsing-remitting multiple sclerosis (RRMS).

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2014

The efficacy and safety of ospemifene in treating dyspareunia associated with postmenopausal vulvar and vaginal atrophy: a systematic review and meta-analysis

INTRODUCTION: Ospemifene, a novel selective estrogen receptor modulator, has been developed for the treatment of vulvovaginal atrophy and dyspareunia in postmenopausal women.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2014

Meta-analysis of CSF and MRI biomarkers for detecting preclinical Alzheimer's disease.

BACKGROUND: Abnormal levels of biomarkers in cerebrospinal fluid (CSF) and atrophy of medial temporal lobe (MTL) structures on magnetic resonance imaging (MRI) are being used increasingly to diagnose early Alzheimer's disease (AD). We evaluated the claim that these biomarkers can detect preclinical AD before behavioural (i.e. memory) symptoms arise.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2010

Are phosphodiesterase type 5 inhibitors associated with vision-threatening adverse events? A critical analysis and review of the literature

INTRODUCTION: Phosphodiesterase type 5 (PDE5) inhibitors are the first line drugs for treatment of erectile dysfunction. Sildenafil (Viagra(R)), tadalafil (Cialis(R)), and vardenafil (Levitra(R)) are from the same class of drugs that inhibit PDE5. Transient visual symptoms such as change in color perception and increased light sensitivity are well-known adverse effects of these drugs and occur in 3-11% of sildenafil users. Vision-threatening (serious) ocular complications, such as nonarteritic ischemic optic neuropathy and cilio-retinal artery occlusion have rarely been reported in PDE5 inhibitor users.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2011

Orthodontic treatment of periodontal defects: a systematic review

Several studies have been published focusing on the possibility to treat patients affected by periodontal defects by means of orthodontic treatment. The aim of this systematic review is to evaluate the efficacy of the orthodontic treatment applied to the therapy of infraosseous defects, gingival recessions, and furcation lesions. To establish an appropriate search strategy, the PICO assessment worksheet was used. Only Randomized Controlled Trials and Systematic Reviews were selected for this review. The electronic search (from January 1966 to January 2008) and the hand search (from January 1988 to January 2008) were conducted by three independent reviewers. There were no language restriction. No Randomized Controlled Trials and Systematic Reviews were identified during the investigated period and therefore it was not possible to perform meta-analysis. It appears important to encourage the researchers to produce Randomized Controlled clinical Trials aimed to investigate the efficacy of the orthodontic treatment, alone or in combination with the periodontal therapy, for the resolution of periodontal defects.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2010

The long-term impact of Helicobacter pylori eradication on gastric histology: a systematic review and meta-analysis

This review investigated the long-term effects of Helicobacter pylori eradication on gastric histology. It concluded that significant improvements in gastric atrophy, but not intestinal metaplasia, were observed with eradication. As the strength of the included evidence appeared weak (although there were few study details and no quality assessment to confirm this), the reliability of the authors' conclusion is uncertain.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2007

Vypro II mesh for inguinal hernia repair: a meta analysis of randomized controlled trials

The authors concluded that there was no significant difference between Vypro II and polypropylene mesh in short-term effectiveness. Use of Vypro II mesh was associated with reduced feeling of a foreign body inside. The conclusions appear reliable. The small number of included studies for each pooled analysis should be borne in mind.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2010

Denosumab, Raloxifene, and Zoledronic Acid for the Treatment of Postmenopausal Osteoporosis: Clinical Effectiveness and Harms [Internet]

Osteoporosis is a skeletal disorder characterized by compromised bone strength, predisposing patients to an increased risk of fracture. The postmenopausal form of osteoporosis affects more than 1.5 million Canadians, with prevalence increasing from 6% of women aged 50 to 59 years to more than 40% of women aged 80 years and older. Consequences of sustaining a fracture may be serious and include increased risk of subsequent fractures, hospitalization or institutionalization, decreased quality of life, and premature mortality, with a related burden on the health care system. Antiresorptive agents such as oral bisphosphonates are the standard treatment for postmenopausal osteoporosis, in conjunction with non-pharmacologic measures. Other treatment options include an intravenous bisphosphonate (zoledronic acid), a monoclonal antibody (denosumab), a bone-forming agent (teriparatide), and a selective estrogen receptor modulator (raloxifene). This systematic review was undertaken following a request from provincial drug formularies to evaluate the clinical effectiveness and harms of three of these agents, denosumab, raloxifene, and zoledronic acid, in postmenopausal women with osteoporosis. The evidence gathered is expected to clarify uncertainty regarding these agents and to inform policy-making in the population of interest.

Rapid Response Report: Systematic Review - Canadian Agency for Drugs and Technologies in Health.

Version: February 2012
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Nutritional Supplements for Age-Related Macular Degeneration: A Systematic Review [Internet]

Age-related macular degeneration (AMD) is the leading cause of irreversible vision loss in the developed world. In 2004, AMD affected 1.75 million persons in the United States, a number that is expected to rise to nearly 3 million by 2020 due to the aging of the population.

Evidence-based Synthesis Program - Department of Veterans Affairs (US).

Version: January 2012
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Comparative Effectiveness of Management Strategies for Renal Artery Stenosis: 2007 Update [Internet]

This report is an update to a Comparative Effectiveness Review on management strategies for renal artery stenosis (RAS) from October 2006. The systematic review included all studies of patients with atherosclerotic RAS (ARAS) that compared two or more interventions. It also reviewed recent prospective cohort (single arm) studies of angioplasty with stent placement, prospective cohort studies of medical interventions, cohort studies of RAS natural history, and prospective or large retrospective studies of surgical bypass. This update evaluated the same questions and used the same eligibility criteria, updating the literature search through April 23, 2007. This report does not address the management of fibromuscular dysplasia, renal transplant recipients, or patients who have a previous failed revascularization.

Comparative Effectiveness Reviews - Agency for Healthcare Research and Quality (US).

Version: November 2007
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Glaucoma: Diagnosis and Management of Chronic Open Angle Glaucoma and Ocular Hypertension

This guideline covers adults (18 and older) with a diagnosis of chronic open angle glaucoma or ocular hypertension and those with chronic open angle glaucoma or ocular hypertension associated with pseudoexfoliation or pigment dispersion. In addition, the guideline will cover populations who have a higher prevalence of glaucoma and may have worse clinical outcomes including people with a family history of glaucoma, younger people (<50 years) and people who are of black African or black Caribbean descent. Options for pharmacological, surgical, laser and complimentary or alternative treatments are considered in terms of clinical effectiveness and cost effectiveness.

NICE Clinical Guidelines - National Collaborating Centre for Acute Care (UK).

Version: April 2009
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Evaluation and Treatment of Cryptorchidism [Internet]

We assessed the effectiveness of imaging for identifying and correctly locating testicles, the use of hormonal stimulation for treatment planning and hormones for achieving testicular descent, and choices among surgical treatments, including surgical approach (open vs. laparoscopic).

Comparative Effectiveness Reviews - Agency for Healthcare Research and Quality (US).

Version: December 2012
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Heavy Menstrual Bleeding

Heavy menstrual bleeding (HMB) has an adverse effect on the quality of life of many women. It is not a problem associated with significant mortality. Many women seek help from their general practitioners and it is a common reason for referral into secondary care.

NICE Clinical Guidelines - National Collaborating Centre for Women's and Children's Health (UK).

Version: January 2007
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Comparative Effectiveness of Nonoperative and Operative Treatments for Rotator Cuff Tears [Internet]

The objective of this review is to provide a comprehensive synthesis of the evidence examining the effectiveness of nonoperative and operative interventions for the treatment of rotator cuff tears. The report is intended for a broad audience, including professional societies developing clinical practice guidelines, patients and their care providers, as well as researchers conducting studies on treatments of this condition. Outcomes of interest include health-related quality of life, shoulder function, time to return to work, cuff integrity, pain, range of motion and strength of the shoulder.

Comparative Effectiveness Reviews - Agency for Healthcare Research and Quality (US).

Version: July 2010
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