Prophylactic sclerotherapy for esophageal varices in men with alcoholic liver disease: a randomized, single-blind, multicenter clinical trial

Article Abstract:

Alcoholics can develop enlarged veins (varices) in the esophagus that are potentially life-threatening because they can rupture and bleed extensively. To evaluate the effectiveness of sclerotherapy (a method of treating esophageal varices that uses injections of a hardening solution) for this condition, a controlled study was carried out with 281 male alcoholics. The patients all suffered from alcoholic liver disease and had at least three esophageal varices. None had experienced a prior episode of esophageal variceal bleeding. Patients underwent endoscopy (visualization of the esophagus through a tube using a bright light) and were randomly assigned to treatment by either injection of a sclerosing (hardening) agent (143 patients) or a placebo (inactive) solution (138 patients). The solutions were injected directly into the enlarged veins. Patients were followed at regular intervals to determine whether episodes of bleeding from the upper digestive tract had occurred and whether certain other complications had occurred. Although the study was to continue for five years, it was stopped after 22 months when a significant difference in mortality was seen in 10 of the 12 participating Veteran's Administration medical centers: the death rate was higher among patients who underwent sclerotherapy (32.2 percent) than among those who underwent placebo treatment (17.4 percent). When treatment was stopped, the difference in mortality between the two groups was no longer apparent. Causes of the greater mortality among sclerotherapy patients could not be identified; in fact, these patients had fewer episodes of variceal bleeding. The results indicate that prophylactic sclerotherapy in men with alcoholic liver disease should not be carried out. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Patient outcomes, Mortality, Complications and side effects, Alcoholics, Esophageal varices, Sclerotherapy

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Discontinuing prophylactic transfusions used to prevent stroke in sickle cell disease

Article Abstract:

Children with sickle cell disease who had a high risk of stroke on the basis of transcranial Doppler screening examination and who had received transfusions for 30 months or longer, during which time the Doppler readings became normal are studied. Discontinuation of transfusion for the prevention of stroke in children with sickle disease results in a high rate of reversion to abnormal blood-flow velocities on Doppler studies and stroke.

United Kingdom, Risk factors, Sickle cell anemia, Stroke (Disease), Stroke, Blood transfusion

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A multicenter, randomized trial of prophylactic fluconazole in preterm neonates

Article Abstract:

A multicenter, randomized, double-blind, placebo-controlled trial of fluconazole is performed for the prevention of fungal colonization and infection in very-low birth-weight neonates, which indicated that prophylactic fluconazole reduces invasive candida infection.

Science & research, Research, Infants (Premature), Birth weight, Low, Premature infants, Low birth weight, Fluconazole, Clinical report

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