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Not enough evidence on effectiveness of the drug albendazole, alone or in combination, for killing or interrupting transmission of threadlike worms that cause lymphatic filariasis

Filariasis affects about 120 million people in more than 80 countries and is spread by mosquitoes. Adult worms take up residence in lymph channels and when paired, produce larvae that circulate in the blood. The adult worms can live in the lymph system for five years or more. The infection can cause severe disability, due to massive enlargement of limbs, genitals, and breasts. On the other hand, many infected people have no symptoms, but do contribute to the perpetuation of the infection in the community. This review of trials found insufficient evidence to say whether a single dose of the drug albendazole kills the worms, or whether, if given in combination with diethylcarbamazine or ivermectin, it enhances the killing of these worms or the larvae they produce.

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

Version: 2009

Mass chemotherapy options to control lymphatic filariasis: a systematic review

Understanding the efficacy of microfilaricidal drugs is important in guiding the global programme for the elimination of lymphatic filariasis as a public-health problem. We did a systematic review of the available literature to determine which currently available drug intervention most effectively decreases circulating Wuchereria bancrofti microfilaria in individuals and populations. 57 randomised studies of drug efficacy were identified. Data were combined and compared using weighted mean effect estimates taking into account the longitudinal nature of the data. Combined treatment with diethylcarbamazine plus ivermectin, diethylcarbamazine plus albendazole, and ivermectin plus albendazole resulted in average microfilarial intensity decreases that were 0.7%, 4.6%, and 12.7% of the pre-treatment values, respectively. Drug combinations containing diethylcarbamazine were the most effective against microfilarial prevalence and intensity relative to single drugs or other combinations. The relative efficacies of drug combinations have not been well documented from existing studies and therefore limit the application of evidenced-based recommendations for chemotherapy-based interventions to control lymphatic filariasis. These results provide valuable estimates of drug effect using existing data, but highlight the need for more comprehensive comparative drug studies.

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

Version: 2005

A meta-analysis of the relationship between lymphatic microvessel density and the survival of patient with colorectal cancer

Colorectal cancer (CRC) is a frequently observed malignant neoplasm that is a leading cause of cancer death despite recent advances in treatment and research. The role of lymphangiogenesis in CRC development is a source of controversy in current research. We undertook this study to examine the relationship between lymphatic microvessel density (LMVD) and the overall survival (OS) or disease free survival (DFS) of CRC using meta-analysis of recent studies. PubMed and Embase databeases were searched and nine relevant studies including 799 total patients were included. Six studies including 575 patients focused on overall survival (OS) and 3 studies with 224 patients focused on disease free survival (DFS). We performed a meta-analysis to estimate the prognostic role of lymphatic microvessel density by combining separately estimated hazard ratios. A remarkable correlation between LMVD and DFS was observed in pooled analyses using a fixed-effect model (HR 2.29; 95% CI 1.11, 3.48). LMVD and OS showed a pooled HR value of 1.02 (95% CI 0.71,1.33), indicating no significant correlation between LMVD and OS. There was no evidence for significant heterogeneity or publishing bias in both DFS and OS (I2 = 0.0%, P = 0.861; I2 = 48.1%, P = 0.086, respectively). A close relationship was observed between LMVD and DFS, though no correlation between LMVD and OS was apparent. The current meta-analysis suggests that LMVD may be a poor prognostic factor for CRC patients. However, these results should be regarded cautiously and future confirmatory studies are necessary.

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

Version: 2013

Lymphatic microvessel density and vascular endothelial growth factor-C and -D as prognostic factors in breast cancer: a systematic review and meta-analysis of the literature

The use of lymphatic microvessel density (LVD) and pro-lymphangiogenic mediators as prognostic factors for survival in breast cancer remains controversial. We searched the electronic databases PubMed and EMBASE without language restrictions for relevant literature to aggregate the survival results. To be eligible, every study had to include the assessment of the LVD or the expression of vascular endothelial growth factor (VEGF)-C or -D in patients with breast cancer and provide a survival comparison, including disease-free survival (DFS) or overall survival (OS), according to the LVD, VEGF-C or VEGF-D status. Across all studies, 56.64 % of patients were considered to have a VEGF-C-positive tumor, and 65.54 % of patients had VEGF-D-positive tumors. High LVD had an unfavorable impact on DFS, with a pooled hazard ratio (HR) of 2.222 (95 % CI 1.579-3.126) and an OS with a HR of 2.493 (95 % CI 1.183-5.25). According to the different lymphatic makers, the subgroup HR in the D2-40 studies was 2.431 (95 % CI 1.622-3.644) for DFS and 4.085 (95 % CI 1.896-8.799) for OS. VEGF-C overexpression, as assessed by immunochemistry, was a prognostic factor for decreased DFS (HR 2.164; 95 % CI 1.256-3.729) and for decreased OS (HR 2.613; 95 % CI 1.637-4.170). VEGF-D overexpression was a significant although weak prognostic factor for DFS only when assessed by immunochemistry, with a HR of 2.108 (95 % CI 1.014-4.384). Our meta-analysis demonstrated that LVD, VEGF-C and VEGF-D could predict poor prognosis in patients with breast cancer. However, standardization of the assessment of LVD and for the expression of lymphangiogenesis factors is needed.

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

Version: 2012

Could lymphatic mapping and sentinel node biopsy provide oncological providence for local resectional techniques for colon cancer: a review of the literature

The authors concluded that there was insufficient evidence to determine if lymphatic mapping and sentinel lymph node biopsy could be used to select patients for endoscopic resection in early colon cancer. There were limitations in the reporting of review methods, but overall the authors? conclusions reflect the limited and diverse evidence and are likely to be reliable.

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

Version: 2008

High population coverage of DEC‐medicated salt maintained over at least six months in a community is effective at reducing transmission of lymphatic filariasis and can, if maintained over a long enough period, completely interrupt transmission

Filariasis is a parasite infection of threadlike worms, affecting about 120 million people in more than 83 countries. The infection is transmitted by mosquitoes. Larval forms take up to a year to develop into adult worms, which mate and release thousands of microfilariae (mf) into the blood over the course of their lives. Mf are ingested by mosquitoes from the blood of an infected individual, completing the cycle. This infection may lead to severe disability in the form of lymphoedema and eventually elephantiasis of limbs, and hydrocoele. Though most infected people remain asymptomatic, the lymph vessels are often damaged. A drug, diethylcarbamazine (DEC) has been shown to kill mf, but repeated doses are needed before adult worms are killed or sterilized. This review looked at the effectiveness of giving entire communities DEC‐medicated salt. The review of studies found evidence that DEC when given in a low dose over a period of months or years is effective in reducing the prevalence of filariasis in communities, with no recognized adverse events.

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

Version: 2009

How do cancer cells grow and spread?

The human body is made up of billions of cells. Cells are the tiny building blocks of our tissues and organs. We all started life as a single cell. That cell made an internal copy of itself (replication) and then divided into 2 cells.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: March 19, 2010

Quality of haematological and oncological care in children: Executive summary of final report V06-01, Version 1.0

The aim of the investigation was to evaluate the quality of current medical care in Germany for children with haemato-oncological diseases.

Institute for Quality and Efficiency in Health Care: Executive Summaries [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: August 13, 2009

P27Kip1 expression and its prognostic implication in breast carcinoma: a meta-analysis

OBJECTIVE: To evaluate the relationship between p27Kip1 low expression in breast cancer and its prognostic implication in breast carcinoma patients. Methods All data that were associated with the study of the relationship between p27Kip1 and the prognosis for breast cancer was pooled from Cochrane library, PubMed, Embase and Medlinebase. The outcome was measured using the risk ratio (RR). Data pooling was performed by RevMan 4. 2. Results 6457 patients from 20 studies were included in this meta-analysis. RR estimate of overall survival (OS) for patients with low level p27Kip1 was 2.07 [1.66,2.60] (P<0.01). For disease free survival (DFS), the pooled RR was 1.27 [1.10,1.47] (P<0.05). The combined RR estimate of relapse free survival (RFS) for patients with low level of p27Kip1 was 1.49 [0.92, 2.42] (P >0.05). In patients with lymph node negative breast carcinoma, the combined RR for OS and RFS were 1.98 [1.34,2.91] (P <0.01) and 1.28 [0.45,3.65] (P > 0.05), respectively. Among the patients with lymph node positive breast carcinoma, the combined RR for OS and RFS was 1.92 [1.31, 2.82] (P=0.0009) and 1.35 [0.96,1.89] (P>0.05) respectively. Conclusions Low level of p27Kip1 appears to be an independent prognostic factor to OS and DFS of breast cancer patients but not to RFS. Additional studies with large patient number and widely accepted practical methods are required to derive the precise prognostic significance of p27Kip1 expression in breast cancer patients.

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

Version: 2008

Extended lymphadenectomy versus conventional surgery for rectal cancer: a meta-analysis

The authors concluded that extended compared with non-extended lymphadenectomy for rectal cancer did not confer any significant cancer-specific benefit, but was associated with increased urinary dysfunction. The review was generally well conducted and the authors? conclusions appear to be appropriately cautious, given their reliance upon mainly non-randomised studies.

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

Version: 2009

Referral Guidelines for Suspected Cancer in Adults and Children [Internet]

The guideline is divided into sections which cover in detail specific topics relating to twelve groups of cancers: lung, upper gastrointestinal cancers, lower gastrointestinal cancers, breast cancer, gynaecological cancers, urological cancers, haematological cancers, skin cancers, head and neck including oral cancers, brain/central nervous system cancers, bone and sarcoma, and children’s and young people’s cancers.

NICE Clinical Guidelines - Clinical Governance Research and Development Unit (CGRDU), Department of Health Sciences, University of Leicester.

Version: June 2005
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Diagnosis and Management of Metastatic Malignant Disease of Unknown Primary Origin

The term “cancer of unknown primary” refers to a condition in which a patient has metastatic malignancy without an identified primary source. This is a very heterogeneous disease in which the type of tumour, the extent of spread, and the outcome of treatment all vary widely. When categorising patients with cancer of unknown primary, one important factor initially considered is the cell type of origin of the metastatic disease. The majority of patients have malignancy which appears to derive from epithelial cells, and hence are regarded as having carcinoma of unknown primary. Patients with tumours of non-epithelial lineage (melanoma, sarcoma, lymphoma, germ-cell) form a distinct and important minority, since subsequent management can often be satisfactorily undertaken even in the absence of an identifiable primary source. Such patients are not considered in this guideline, since their care is adequately defined in existing guidelines for their specific tumour type. The term “carcinoma of unknown primary” (CUP) is used henceforth to refer to those patients with metastatic malignancy of epithelial, neuroendocrine or undifferentiated lineage whose investigation and management is considered within the scope of this guideline.

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

Version: July 2010
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Colorectal Cancer: The Diagnosis and Management of Colorectal Cancer

This guideline is relevant to all healthcare professionals who come into contact with patients with colorectal cancer or suspected of having colorectal cancer, as well as to the patients themselves and their carers. It is also expected that the guideline will be of value to those involved in clinical governance in both primary and secondary care to help ensure that arrangements are in place to deliver appropriate care for the population covered by this guideline.

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

Version: November 2011
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Advanced Breast Cancer: Diagnosis and Treatment

Breast cancer is the most common cancer for women in England and Wales, with about 37,000 new cases diagnosed and 11,000 deaths recorded in England and Wales each year. In men breast cancer is rare, with about 270 cases diagnosed, and 70 deaths in England and Wales each year. Of these new cases in women and men, around 10% are diagnosed in the advanced stages, when the tumour has spread significantly within the breast or to other organs of the body. In addition, there is a significant number of women who have been previously treated with curative intent who subsequently develop either a local recurrence or metastases. Over recent years there have been important developments in the investigation and management of these patients including new chemotherapy, and biological and hormonal agents. There is some evidence of practice variation across the country and of patchy availability of certain treatments and procedures. A clinical guideline will help to address these issues and offer guidance on best practice.

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

Version: February 2009
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Safety of Probiotics to Reduce Risk and Prevent or Treat Disease

To catalog what is known about the safety of interventions containing Lactobacillus, Bifidobacterium, Saccharomyces, Streptococcus, Enterococcus, and/or Bacillus strains used as probiotic agents in research to reduce the risk of, prevent, or treat disease.

Evidence Reports/Technology Assessments - Agency for Healthcare Research and Quality (US).

Version: April 2011
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Hodgkin’s lymphoma in adults: What is the benefit of stem cell transplantation with an unrelated donor?

Blood stem cell transplantation can be a treatment option for people with Hodgkin’s lymphoma, if other therapies were unsuccessful. However, there are not enough studies on the chances and risks of stem cell transplantation with unrelated donors.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: May 10, 2011

Drug Class Review: Newer Antiemetics: Final Report Update 1 [Internet]

Nausea and vomiting are major concerns for patients undergoing chemotherapy, radiation therapy and surgery with general anesthesia. Risk factors associated with chemotherapy-induced nausea and vomiting include emetogenicity of the chemotherapy regimen, dose, speed of intravenous infusion, female gender, age under 50 years, history of ethanol consumption, and history of prior chemotherapy. Factors predictive of radiation therapy-induced nausea and vomiting include site of irradiation (in particular, total body irradiation and radiation fields that include the abdomen), total field size, dose per fraction, age, and predisposition for emesis (history of sickness during pregnancy or motion sickness). Female gender, a history of motion sickness or prior postoperative nausea and vomiting, nonsmoking status, and use of postoperative opioids have been suggested as factors predictive of postoperative nausea and vomiting. The objective of this review was to evaluate the comparative effectiveness and harms of newer antiemetic drugs including the 5-HT3 and NK-1 antagonists.

Drug Class Reviews - Oregon Health & Science University.

Version: January 2009
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Prostate Cancer: Diagnosis and Treatment

Prostate cancer is one of the commonest cancers in men. Each year there are about 27,773 new cases in England and Wales, and 9161 deaths. Prostate cancer is predominantly a disease of older men but around 20% of cases occur in men under the age of 65. Over the past 10 to 15 years there have been a number of significant advances in its management but also a number of major controversies, especially about the clinical management of patients with early, non-metastatic disease. These uncertainties clearly cause anxieties for patients and their families. There is evidence of practice variation around the country and of patchy availability of certain treatments and procedures. A clinical guideline will help to address these issues and offer guidance on best practice.

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

Version: February 2008
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Causes and signs of edema

Edema means swelling. The condition called edema arises when part of the body becomes swollen because fluid gathers in the tissue. It most commonly affects the arms and legs. That is called peripheral edema.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: November 21, 2013

Cervical Cancer Treatment (PDQ®): Health Professional Version

Expert-reviewed information summary about the treatment of cervical cancer.

PDQ Cancer Information Summaries [Internet] - National Cancer Institute (US).

Version: August 15, 2014

Medical Encyclopedia

  • Lymphatic obstruction
    Lymphatic obstruction is a blockage of the lymph vessels that drain fluid from tissues throughout the body and allow immune cells to travel where they are needed. Lymphatic obstruction may cause lymphedema, which means swelling due to a blockage of the lymph passages.
  • Anthrax
    Anthrax is an infectious disease due to a bacterium called Bacillus anthracis. Infection in humans most often involves the skin, gastrointestinal tract, or lungs.
  • Glomerulonephritis
    Glomerulonephritis is a type of kidney disease in which the part of your kidneys that helps filter waste and fluids from the blood is damaged.
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Systematic Reviews in PubMed

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