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杂志全名及年卷期：Ann Surg. 2007 May;245(5):745-54
文题： Early assessment of pancreatic infections and overall prognosis in severe acute pancreatitis by procalcitonin (PCT): a prospective international multicenter study.
作者：Rau BM, Kemppainen EA, Gumbs AA, Buchler MW, Wegscheider K, Bassi C, Puolakkainen PA, Beger HG.
英文摘要：BACKGROUND: Pancreatic infections and sepsis are major complications in severe acute pancreatitis (AP) with significant impact on management and outcome. We investigated the value of Procalcitonin (PCT) for identifying patients at risk to develop pancreatic infections in severe AP. METHODS: A total of 104 patients with predicted severe AP were enrolled in five European academic surgical centers within 96 hours of symptom onset. PCT was measured prospectively by a semi-automated immunoassay in each center, C-reactive protein (CRP) was routinely assessed. Both parameters were monitored over a maximum of 21 consecutive days and in weekly intervals thereafter. RESULTS: In contrast to CRP, PCT concentrations were significantly elevated in patients with pancreatic infections and associated multiorgan dysfunction syndrome (MODS) who all required surgery (n = 10) and in nonsurvivors (n = 8) early after onset of symptoms. PCT levels revealed only a moderate increase in patients with pancreatic infections in the absence of MODS (n = 7), all of whom were managed nonoperatively without mortality. A PCT value of > or =3.5 ng/mL on 2 consecutive days was superior to CRP > or =430 mg/L for the assessment of infected necrosis with MODS or nonsurvival as determined by ROC analysis with a sensitivity and specificity of 93% and 88% for PCT and 40% and 100% for CRP, respectively (P < 0.01). The single or combined prediction of the two major complications was already possible on the third and fourth day after onset of symptoms with a sensitivity and specificity of 79% and 93% for PCT > or =3.8 ng/mL compared with 36% and 97% for CRP > or =430 mg/L, respectively (P = 0.002). CONCLUSION: Monitoring of PCT allows early and reliable assessment of clinically relevant pancreatic infections and overall prognosis in AP. This single test parameter significantly contributes to an improved stratification of patients at risk to develop major complications.
PMID： 15095306

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2007-05-25 23:28 浏览 : 9993 回复 : 116

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zwqql 编辑于 2007-06-25 10:42

• 建立【基层普外常规手术交流专栏】

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杂志全名及年卷期： Annals of Surgery. 2007 Jun;245(6):831-842
文题：A Randomized, Controlled Trial of Postoperative Adjuvant Interferon Therapy After Resection of Hepatocellular Carcinoma
作者:Lo CM, Liu CL, Chan SC, Lam CM, Poon RT, Ng IO, Fan ST, Wong J.
英文摘要:OBJECTIVE:: We conducted a randomized controlled trial of adjuvant interferon therapy in patients with predominantly hepatitis B-related hepatocellular carcinoma (HCC) to investigate whether the prognosis after hepatic resection could be improved. SUMMARY BACKGROUND DATA:: Recurrence is common after hepatic resection for HCC. Interferon possesses antiviral, immunomodulatory, antiproliferative, and antiangiogenic effects and may be an effective form of adjuvant therapy. PATIENTS AND METHODS:: Since February 1999, patients with no residual disease after hepatic resection for HCC were randomly assigned with stratification by pTNM stage to receive no treatment (control group), interferon alpha-2b 10 MIU/m (IFN-I group) or 30 MIU/m (IFN-II group) thrice weekly for 16 weeks. Enrollment to the IFN-II group was terminated from January 2000 because adverse effects resulted in treatment discontinuation in the first 6 patients. By June 2002, 40 patients each had been enrolled into the control group and IFN-I group. The baseline clinical, laboratory, and tumor characteristics of both groups were comparable. RESULTS:: The 1- and 5-year survival rates were 85% and 61%, respectively, for the control group and 97% and 79%, respectively, for the IFN-I group (P = 0.137). After adjusting for the confounding prognostic factors in a Cox model, the relative risk of death for interferon treatment was 0.42 (95% CI, 0.17-1.05; P = 0.063). Exploratory subset analysis showed that adjuvant interferon had no survival benefit for pTNM stage I/II tumor (5-year survival 90% in both groups; P = 0.917) but prevented early recurrence and improved the 5-year survival of patients with stage III/IVA tumor from 24% to 68% (P = 0.038). CONCLUSION:: In a group of patients with predominantly hepatitis B-related HCC, adjuvant interferon therapy showed a trend for survival benefit, primarily in those with pTNM stage III/IVA tumors. Further larger randomized trials stratified for stage are needed.
PMID: 17522506
中文翻译:
题目:肝细胞癌切除术后干扰素辅佐疗法的随机对照试验研究
摘要:目标：我们主要对乙型肝炎相关肝细胞癌的患者进行了肝细胞癌切除术后干扰素辅佐疗法随机对照实验研究以观察是否能改善肝切除术后的预后
背景概要：乙型肝炎相关肝细胞癌行肝切除术后的复发很普遍。干扰素具有抗病毒，调节免疫，抗增殖和抗血管生成的作用，所以可能是一种有效辅助疗法方式。
病人和方法：自1999年2月以来，乙型肝炎相关肝细胞癌行肝切除术且没有并发症患者按TNM分期进行随机分组分别接受：无治疗（对照组），a-干扰素2b 10 MIU/m2 （干扰素治疗一组）和a-干扰素2b 30 MIU/m2 （干扰素治疗二组）每周三次共持续16周。由于副作用,最初的6名患者中断治疗，以致干扰素二组的编入工作在2000年1月终止。到2002年6月，分别各有40名患者编入对照组和干扰素治疗一组。我们对两组的临床基线，实验室和肿瘤特性都分别进行了比较。
结果：对照组第一年和第五年的生存率分别是85%和61%，而干扰素治疗一组分别是97%和79%，P=0.137.按照Cox模型对预后相关因素进行混杂设计调整后,干扰素治疗死亡相关风险是0.42(95% CI, 0.17-1.05; P = 0.063). 亚类探查分析显示干扰素辅助疗法不能提高TNM I/II 期肿瘤的生存率(两组五年生存率都是90%;P=0.917)但是能阻止肿瘤的早期复发并且使TNMIII/IVA 期患者的生存率从24%提高到68%(P = 0.038).
结论:在乙型肝炎相关肝细胞癌的病人,干扰素辅助疗法对起生存率的提高有促进作用,尤其是TNMIII/IVA 期的肿瘤.更大型的随机分层试验有待进一步进行研究.

2007-05-26 20:33

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• 《关于加强基层医疗卫生机构绩效考核的意见

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感谢斑竹的加分鼓励,信心大增呵呵,再发一篇然后睡觉:)

杂志全名及年卷期：Annals of Surgery 2007 May;245(5):674-83
文题:Early antibiotic treatment for severe acute necrotizing pancreatitis: a randomized, double-blind, placebo-controlled study
作者:Dellinger EP, Tellado JM, Soto NE, Ashley SW, Barie PS, Dugernier T, Imrie CW, Johnson CD etc.
英文摘要:BACKGROUND & AIMS: In patients with severe, necrotizing pancreatitis, it is common to administer early, broad-spectrum antibiotics, often a carbapenem, in the hope of reducing the incidence of pancreatic and peripancreatic infections, although the benefits of doing so have not been proved. METHODS: A multicenter, prospective, double-blind, placebo-controlled randomized study set in 32 centers within North America and Europe. Participants: One hundred patients with clinically severe, confirmed necrotizing pancreatitis: 50 received meropenem and 50 received placebo. Interventions: Meropenem (1 g intravenously every 8 hours) or placebo within 5 days of the onset of symptoms for 7 to 21 days. Main Outcome Measures: Primary endpoint: development of pancreatic or peripancreatic infection within 42 days following randomization. Other endpoints: time between onset of pancreatitis and the development of pancreatic or peripancreatic infection; all-cause mortality; requirement for surgical intervention; development of nonpancreatic infections within 42 days following randomization. RESULTS: Pancreatic or peripancreatic infections developed in 18% (9 of 50) of patients in the meropenem group compared with 12% (6 of 50) in the placebo group (P = 0.401). Overall mortality rate was 20% (10 of 50) in the meropenem group and 18% (9 of 50) in the placebo group (P = 0.799). Surgical intervention was required in 26% (13 of 50) and 20% (10 of 50) of the meropenem and placebo groups, respectively (P = 0.476). CONCLUSIONS: This study demonstrated no statistically significant difference between the treatment groups for pancreatic or peripancreatic infection, mortality, or requirement for surgical intervention, and did not support early prophylactic antimicrobial use in patients with severe acute necrotizing pancreatitis.
PMID: 17457158

中文翻译:
题目:急性重症出血性胰腺炎早期应用抗生素：随机双盲安慰剂对照研究
背景和目标：在急性重症出血性胰腺炎的病人中，早期应用广谱抗生素非常普遍，而且通常是碳青霉烯类，期望能减低胰腺和胰周炎所带来的不利影响，然而这种做法的效用还有待证明。
方法：在北美和欧洲32中心展开一个多中心，前瞻性，双盲和安慰剂对照研究。入选者：临床确诊的100名重症出血性胰腺炎患者：50名用美罗培南进行治疗另外50名则使用安慰剂。干预：在出现初始症状5天内应用美罗培南（1g/8h）或者安慰剂7到21天。数据获取措施：初始点：对42天内胰腺或者胰周炎的发展进行随机取样。其他点：对42天内胰腺炎发病至胰腺或胰周炎过程中所有死亡，需要外科手段干预及胰腺炎停止发展进行随机取样
结果：应用美罗培南组18%的患者（50人中有9人）胰腺或胰周炎继续发展，而安慰剂组为12%（50人中有6人）。应用美罗培南组患者死亡率为20%（50人中有9人）而安慰剂组为18%（50人中有9人）(P = 0.799). 需要外科手段干预的分别为26%（50人中有13人）和20%（50人中有10人） (P = 0.476).
结论：这项研究表明，在胰腺或胰周炎治疗组死亡率和需要外科手段干预方面没有统计学上显著差异，并且不支持对急性重症出血性胰腺炎患者早期预防性使用抗生素。

2007-05-26 23:10

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• 抗菌治疗应该优先使用杀菌药？

谍影重重

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杂志全名及年卷期：Br J Surg. 2007 May 18;94(6):696-701 [Epub ahead of print] Related Articles, Links

文题：Fifteen-year follow-up of a randomized clinical trial of ultrasonographic screening for abdominal aortic aneurysms.

作者：Ashton HA, Gao L, Kim LG, Druce PS, Thompson SG, Scott RA.

英文摘要：BACKGROUND:: Long-term benefits of screening for abdominal aortic aneurysm (AAA) are uncertain. These are the final results of a randomized controlled screening trial for AAA in men, updating those reported previously. Benefit and compliance over a median 15-year interval were examined. METHODS:: One group of men were invited for ultrasonographic AAA screening, and another group, who received standard care, acted as controls. A total of 6040 men aged 65-80 years were randomized to one of the two groups. Outcome was monitored in terms of AAA-related events (surgery or death). RESULTS:: In the group invited for screening, AAA-related mortality was reduced by 11 per cent (from 1.8 to 1.6 per cent, hazard ratio 0.89) over the follow-up interval. Screening detected an AAA in 170 patients; 17 of these died from an AAA-related cause, seven of which might have been preventable. The incidence of AAA rupture after an initially normal scan increased after 10 years of follow-up, but was still low overall (0.56 per 1000 person-years). CONCLUSION:: Screening with a single ultrasonography scan still conferred a benefit at 15 years, although the results were not significant for this population size. Fewer than half of the AAA-related deaths in those screened positive could be prevented. Registration number: ISRCTN 00079388 (http://www.controlled-trials.com). Copyright (c) 2007 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.

PMID: 17514666 [PubMed - as supplied by publisher]

中文翻译：

题目：一项腹主动脉瘤超声筛查随机临床试验的15年随访

摘要：背景：腹主动脉瘤筛查的长期效果尚无定论。报道迄今为止，这是一项在人类腹主动脉瘤随机对照筛查实验中的最近结果。该试验评估15年（中位数）之长筛查手段的效果和顺从性。方法：一组病人运用超声筛查腹主动脉瘤，另一组已接受标准化监护的病人作为对照。总计6040例年龄为65～80岁受试者随机分到这两组中之一。通过腹主动脉瘤相关事件（手术或死亡）监测结果。结果：在所进行筛查的组别中，腹主动脉瘤相关死亡率在随访间期减少了11%（从1.8％到1.6％，危害比为0.89）。在170例患者中筛查检测出一例腹主动脉瘤；这些患者中17例死于一种腹主动脉瘤相关病因，而其中的7例本可以预防。在初始正常扫描后腹主动脉瘤破裂发生率在10年后随访时增加，但对于总体而言仍低（即1000人.年中为0.56人）。结论：尽管结果对于人口数量并不具有显著意义，但单用超声扫描筛查仍可在15年后获得效果。在那些筛查阳性腹主动脉瘤死亡的患者中，有少于一半的患者是可以预防的。

2007-05-26 23:27

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• 纵隔肿瘤，请你来定性。（结果已公布）

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