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Abstract

The aim of the study was to compare the results of ultrasonography (US) and laparoscopy in a series of 210 patients referred to our institution for the diagnosis of widespread liver diseases. Among 205 patients, laparoscopy revealed cirrhosis in 114, chronic widespread disease in 70 (chronic persistent hepatitis in 21, chronic active hepatitis in 28, steatosis in 14, acute hepatitis in 5, fibrosis in 2), and absence of liver disease in 21. Four of these cases had minor complications. A corroborative diagnosis was obtained in 122 patients (59.5%). Overall sensitivity of US was 84% with a low specificity due to the high rate of false negatives. From the results of this study we conclude that laparoscopy is a safe and essential diagnostic tool in the final diagnosis of widespread liver diseases and that US is not a reliable screening method because of its incidence of false negatives.

Systematic reviews of the clinical effectiveness and cost-effectiveness of proton pump inhibitors in acute upper gastrointestinal bleeding

“…Five trials were published as abstracts only; [67][68][69][70][71] all were in English. The remaining 19 trials were full peer-reviewed publications; 9,72-89 of these, two were published in French, 73,84 one in Spanish, 85 one in Chinese 89 and the remaining 15 in English. Of the 19 trials that were full peer-reviewed publications, only one was not indexed in MEDLINE.…”

“…Fourteen trials had been performed in Europe. [67][68][69][72][73][74][75][76]79,80,[84][85][86]88 One trial was conducted predominantly in Europe, but also included some patients from Canada and South Africa; 70 eight trials were conducted in Asia; 9,77,78,82,83,87,89 one trial was performed in the USA. 71…”

“…Seven trials compared PPI treatment with placebo; 9,[75][76][77][78]81,86 three of these used intravenous mannitol as placebo. 75,76,86 Seventeen trials compared PPI treatment with H 2 RA treatment: oral ranitidine; 84 intravenous ranitidine; [67][68][69][70][71][72][73][74]79,80,85,87,88 intravenous cimetidine; 82,83 intravenous famotidine. 89 Fried, 1999 97 Dual publication with Fried (1999) 69 (both published as abstracts of conference presentations)…”

“…Fifteen trials allowed for the consistent application of some form of EHT to welldefined high-risk patients, before randomisation. [68][69][70][71]74,[76][77][78][79]81,82,84,[86][87][88] Nine trials 9,67,72,73,75,80,83,85,89 had not consistently managed patients with EHT before randomisation, although two 75,85 applied some form of EHT to a minority of the high-risk patients. With the exception of one trial, 89 all trials published in 1998 or later consistently used EHT before randomisation.…”

“…9,70,71,[75][76][77][78][81][82][83]86,88 • Grade B (uncertain), 11 trials. [67][68][69][72][73][74]79,80,84,87,89 • Grade C (inadequate concealment) in one trial, 85 where patients were allocated to control treatment or to PPI treatment depending on whether their age in years was an even or an odd number respectively. • Grade D (not randomised), none of the trials.…”