Use of pre-operative steroids in liver resection: a systematic review and meta-analysis

Background

By attenuating the systemic inflammatory response to major surgery, the pre-operative administration of steroids may reduce the incidence of complications.

Methods

A systematic review was conducted to identify randomized controlled trials (RCT) comparing pre-operative steroid administration with placebo during a liver resection. Meta-analyses were performed.

Results

Five RCTs were identified including a total of 379 patients. Pre-operative steroids were associated with statistically significant reductions in the levels of serum bilirubin and interleukin 6 (IL-6) on post-operative day one. There was a trend towards a lower incidence of post-operative complications and prothrombin time (PT), but this did not reach statistical significance.

Conclusion

Pre-operative steroids may be associated with a clinically significant benefit in liver resection.     

抗甲状腺药物诱导的狼疮样综合征循证诊断与治疗的个案分析

狼疮样综合征和抗中性粒细胞胞浆抗体(ANCA)阳性的血管炎合并甲亢在临床中十分罕见.为了找出这三种疾病之间的关系,作者借助循证医学的方法,根据患者病情,提出临床问题,从PubMed(1966～2003年)、中国生物医学文献数据库(CBM)(1978～2003年)、荷兰医学文摘数据库(EMBase)(1974～2003年)查找相关信息.结果发现抗甲状腺药物的副反应是对该病例的最好解释,并据此采取了相应治疗措施,使患者病情获得明显好转.     

Trends in adrenal surgery: institutional review of 528 consecutive adrenalectomies

Purpose

The increasing detection of adrenal tumors and the availability of a more sophisticated biochemical work-up leading to rising numbers of sub-clinical Conn’s and Cushing’s syndromes coincide with a rising number of adrenalectomies worldwide. The aim of our study was to report a single institution’s experience with adrenal surgery.

Methods

We report data of 528 adrenalectomies, operated at our institution before and after the onset of minimally invasive endoscopic surgery (1986–1994, 1995–2008). Gender, age, indication, imaging, surgical approach, operating time, histology, tumor size, hospital stay, and complications were analyzed retrospectively.

Results

A total of 478 patients underwent adrenal surgery during the time observed. The average number of yearly adrenalectomies increased from 14 to 21 (p?=?0.001) after the onset of laparoscopic surgery. Imaging techniques showed a significant shift towards magnetic resonance imaging (p?<?0.001) and preoperative assessment of tumor size was significantly correlated to malignancy: 10.8?% (11/102) and 42?% (21/50) of tumors measuring 4–6?cm and ≥6 cm, respectively, were malignant in the final histology report (p?<?0.001). Patients operated by minimally invasive endoscopy were significantly younger (mean 49.4?years, p?=?0.046), had significantly shorter operating times (mean 118?min, p?<?0.001), had shorter hospital stays (mean 7.1?days, p?<?0.001), and had less complications (6.9?%, p?=?0.004) compared to patients resected through open procedures.

Conclusion

Although adrenalectomy rates increased and minimally invasive endoscopic surgery reduced hospital stay and complications at our institution, the yearly number of procedures was still low with often high surgical complexity. We therefore believe that adrenal surgery remains a highly specialized procedure that should preferably be performed at endocrine surgery centers.     

Serum microRNA profiles as prognostic/predictive markers in the multimodality therapy of locally advanced adenocarcinomas of the gastroesophageal junction

Neoadjuvant multimodality treatment is frequently applied to improve the poor prognosis of locally advanced adenocarcinomas of the gastroesophageal junction. This study aimed to asses if serum microRNA profiles are useable as response indicators in this therapeutic setting. Fifty patients with locally advanced adenocarcinomas of the gastroesophageal junction were included in the study. All patients received neoadjuvant therapy and subsequently underwent surgical resection. Histomorphologic regression was defined as major histopathological response when resected specimens contained less than 10% vital residual tumor cells. Circulating RNA was isolated from pretherapeutic/post‐neoadjuvant blood serum samples. RNA from nine patients was applied to PCR microarray analyses Based on these findings possible predictive miRNA markers were validated by quantitative RT‐PCR analyses. Depending on the histomorphologic regression, a differential serum microRNA profile was identified by microarray analyses. Based on the divergent miRNA pattern, miR‐21, miR‐192, miR‐222, miR‐302c, miR‐381 and miR‐549 were selected for further validation. During neoadjuvant therapy, there was a significant increase of miR 222 and miR‐549. Although on an expanded patient cohort, the six microRNAs could not be validated as markers for therapy response, there was a significant correlation between a high miR‐192 and miR‐222 expression with a high T‐category as well as miR‐302c and miR‐222 expression significantly correlated with overall survival. Comprehensive miRNA profiling showed a differential microRNA expression pattern depending on the histomorphologic regression in the multimodality therapy of locally advanced adenocarcinomas of the gastroesophageal junction. Moreover, using single RT‐PCR analyses a prognostic impact of miR‐222 and miR‐302c was detected.     

美国教学医院教师专业发展的全国性调查

在当前医学教育持续变革的背景中,医学教师的专业发展成为广泛关注的焦点.为了解目前美国以提高教师的教学技能为目标的教师专业发展(faculty development,FD)活动的参与率、课程设计、教学方法和评估策略等情况,美国约翰·霍普金斯大学预防、流行病学和临床研究中心采取邮件调查的方式,对美国277家教学医院进行了调查.     

Pathogenesis and the natural course of chronic pancreatitis

This article gives an overview about current thinking in pathogenesis and natural course /therapy in chronic pancreatitis. Alcohol consumption is still the most relevant factor in the development of chronic pancreatitis, a disease with enormous personal and social impact, shortening life expectancy up to 10-20 yrs. Pathogenesis of chronic pancreatitis has to be considered for different symptoms. Particularly pain, the most bothering symptom, is most likely due to a combination of hypertension in the organ and parenchymal alterations. Pathogenesis of pancreatic head enlargement remains largely elusive. In particular it is not known what triggers growth factors to step into action. Most other symptoms like common bile duct stenosis or portal hypertension are secondary to this enlargement of the head of the pancreas.     

Heterotopic pancreas--clinical presentation and pathology with review of the literature

BACKGROUND/AIMS: Heterotopic pancreas is usually a silent gastrointestinal malformation, but it may become clinically evident when complicated by chronic inflammation or by growth. METHODOLOGY: We report on eleven cases of heterotopic pancreatic tissue. The cases were selected from the records of our Surgical Department and Institute of Pathology. The literature about heterotopic pancreas is reviewed. RESULTS: Nausea and vomiting (27%), epigastric pain (27%), ulceration (27%) and weight loss (18%) were the three most frequent symptoms and signs. The lesions were diagnosed as gastrointestinal tumor or ulcer by gastroduodenoscopy (36%). The other patients were diagnosed during surgery (64%). Definitive diagnosis was only achievable by pathology. Heterotopic pancreas was the reason for surgery in 36% of the cases, in another 45% diagnosis was incidental during surgery and in 18% the diagnosis was established endoscopically and surgery was not necessary. CONCLUSIONS: The diagnosis of heterotopic pancreas is rarely established, most cases remain clinically silent. In symptomatic patients diagnosis should to be secured histologically to exclude malignant disease.