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The Cochrane Database of Systematic... Apr 2007Fungating wounds arise from primary, secondary or recurrent malignant disease and are associated with advanced cancer. A small proportion of patients may achieve healing... (Review)
Review
BACKGROUND
Fungating wounds arise from primary, secondary or recurrent malignant disease and are associated with advanced cancer. A small proportion of patients may achieve healing following surgical excision but treatment is usually palliative. Fungating wound management usually aims to slow disease progression and optimise quality of life by alleviating physical symptoms, such as copious exudate, malodour, pain and the risk of haemorrhage, through appropriate dressing and topical agent selection.
OBJECTIVES
To conduct a systematic review of the evidence of the effects of dressings and topical agents on quality of life and symptoms that impact on quality of life in people with fungating malignant wounds.
SEARCH STRATEGY
We searched the Cochrane Central Register of Controlled Trials (CENTRAL) and the Wounds Group Specialised Register in August 2006. The Cochrane Breast Cancer Group and the Pain and Palliative Care Group were contacted for relevant studies. The Allied and Complementary Medicine (AMED) database was searched in January 2007. There was no restriction on language or date of publication.
SELECTION CRITERIA
Randomised controlled trials (RCTs) or, in their absence, controlled clinical trials (CCTs) with a concurrent control group, both published and unpublished, and written in any language, were eligible for inclusion.
DATA COLLECTION AND ANALYSIS
Data extraction was undertaken by one author and checked for accuracy by a second author. Two review authors independently assessed trial quality.
MAIN RESULTS
Two trials involving 63 people were included. One RCT in women with superficial breast lesions compared 6% miltefosine solution with placebo and found that miltefosine delayed tumour progression. However, this trial had methodological limitations. A second trial compared topical metronidazole with placebo and found that metronidazole reduced malodour. However, this trial also had methodological limitations and was underpowered.
AUTHORS' CONCLUSIONS
There is weak evidence from one small trial that 6% miltefosine solution applied topically to people with superficial fungating breast lesions (smaller than 1cm) who have received either previous radiotherapy, surgery, hormonal therapy or chemotherapy for their breast cancer may slow disease progression. There is insufficient evidence in this review to give a clear direction for practice with regard to improving quality of life or managing wound symptoms associated with fungating wounds. More research is needed.
Topics: Anti-Infective Agents, Local; Antineoplastic Agents; Biological Dressings; Disease Progression; Female; Humans; Male; Metronidazole; Odorants; Ointments; Phosphorylcholine; Skin Neoplasms; Skin Ulcer; Wounds and Injuries
PubMed: 17443534
DOI: 10.1002/14651858.CD003948.pub2 -
The Cochrane Database of Systematic... 2000This section is under preparation and will be included in the next issue. (Review)
Review
BACKGROUND
This section is under preparation and will be included in the next issue.
OBJECTIVES
To compare the effect of synthetic surfactant to natural surfactant in premature infants with established respiratory distress syndrome.
SEARCH STRATEGY
Searches were made of the Oxford Database of Perinatal Trials, Medline (MeSH terms: pulmonary surfactant; limits: age groups, newborn infant; publication type, clinical trial), previous reviews including cross references, abstracts, conference and symposia proceedings, expert informants, and journal hand searching in the English language.
SELECTION CRITERIA
Randomized controlled trials comparing administration of synthetic surfactants to administration of natural surfactant extracts in premature infants with respiratory distress syndrome were considered for this review.
DATA COLLECTION AND ANALYSIS
Data regarding clinical outcomes including pneumothorax, patent ductus arteriosus, necrotizing enterocolitis, intraventricular hemorrhage (all intraventricular hemorrhage and severe intraventricular hemorrhage), chronic lung disease, retinopathy of prematurity, and mortality were excerpted by the primary reviewer (R. Soll). Data analysis was conducted according to the standards of the Neonatal Cochrane Review Group.
MAIN RESULTS
The meta-analysis supports a significant reduction in the risk of pneumothorax (typical relative risk 0.68, 95% CI 0.56, 0.83; typical risk difference -0.04 95% CI -0.06, -0.02). No disadvantages to natural surfactant extract treatment are noted regarding other outcomes. A trend towards reduced mortality is noted in association with natural surfactant extract treatment.
REVIEWER'S CONCLUSIONS
Both natural surfactant extracts and synthetic surfactant extracts are effective in the treatment of established respiratory distress syndrome. Comparative trials demonstrate greater early improvement in the requirement for ventilatory support and fewer pneumothoraces associated with natural surfactant extract treatment. On clinical grounds, natural surfactant extracts would seem to be the more desirable choice.
Topics: Biological Products; Drug Combinations; Fatty Alcohols; Humans; Infant, Newborn; Infant, Premature; Phosphorylcholine; Polyethylene Glycols; Pulmonary Surfactants; Respiratory Distress Syndrome, Newborn
PubMed: 10796308
DOI: 10.1002/14651858.CD000144