From facts to arguments: A study of the 2014 Swiss controversy over systematic mammography screening

Objective

The Swiss Medical Board (SMB) has recently revived the controversy over mammography screening by recommending to stop the introduction of new systematic mammography screening programs. This study aimed to examine the Swiss media coverage of the release of the SMB report.

联合门静脉-肠系膜上静脉切除的胰腺癌根治术:现状、争议与展望

由于胰头与门静脉系统解剖上的毗邻关系和胰腺癌侵袭性的生物学特性,胰腺癌极易侵犯门静脉系统.联合门静脉-肠系膜上静脉(PV/SMV)切除的胰腺癌根治术也许能为门脉受侵犯的胰腺癌患者带来潜在的益处,但这一手术的预后仍存在争议.目前尚无明确证据显示,联合PV/SMV切除的胰腺癌根治术能提高患者的生存率.为形成临床指导原则,仍...     

区域麻醉或镇痛联合全麻的临床应用与争议

背景近年全麻手术中加入区域阻滞的应用日益增多。尽管有证据支持区域阻滞比全麻具有更好的镇痛作用,但其对总体术后转归的改善仍未完全清楚。目的评价区域阻滞对患者中长期术后转归的影响以及实施区域阻滞的风险和争议。内容硬膜外阻滞减少血管大手术或高危患者的心血管并发症;尽管区域阻滞对早期术后康复有一定改善,但对长期术后康复的影响不...     

Algoritmo para el diagnóstico y el seguimiento de la tromboembolia pulmonar aguda

The urgent diagnosis of acute pulmonary thromboembolism benefits from the use of evidence-based clinical guidelines that improve patients’ prognoses and reduce the unnecessary use of imaging tests. This article explains the diagnostic algorithms for pulmonary thromboembolism most recently published by the relevant scientific societies both for the general population and for special situations, trying to clear up common doubts and analyzing persistent controversies. It also discusses the need to follow up the thromboembolism after anticoagulation treatment, which is not currently recommended in the guidelines.     

Common controversies in total knee replacement surgery: Current evidence

Total knee replacement (TKR) is a widely used operation that has radically improved the quality of life of millions of people during the last few decades. However, some technical details, concerning the surgical procedure and the rehabilitation following total knee arthroplasty, are still a matter of a strong debate. In this review of the literature, we have included the best evidence available of the last decade, in an effort to shed light on some of the most controversial subjects related to TKR surgery. Posterior-stabilized or cruciate-retaining prosthesis? To use a tourniquet during operation or not? Do patients need continuous passive motion for their post-surgery rehabilitation? To resurface patella or not? These are some of the most controversial topics that until now have been persistent dilemmas for the orthopedic surgeon. Results of this systematic review of the literature are highly controversial. These conflicting results are an indication that larger and more well conducted high quality trials are needed in order to gain more secure answers. At the same time, it is becoming apparent that a meticulous operative technique, respecting the soft tissue envelope and knowing the principles of alignment and soft tissue balancing, are some of the parameters that might contribute more to achieving the optimal results for the patients.     

原发性膜性肾病治疗的几点争议

原发性膜性肾病（IMN）是肾病综合征常见病理类型之一,有关IMN的治疗存在一些争议,主要集中在：IMN存在自发缓解,是否需要等待其自发缓解？早期治疗是否优于晚期治疗、不良反应是否更少？何种免疫抑制方案最佳？ACEI/ARB阻断肾素-血管紧张素系统（RAS）降低蛋白尿的方法在治疗IMN中的意义。目前临床对上述问题尚未达成共识,对IMN发病机制的研究将有助于改进治疗方法。     

玻璃体切割术治疗眼内恶性肿瘤的热点与争议

视网膜母细胞瘤(RB)是婴幼儿最常见的原发性眼内恶性肿瘤,而脉络膜黑色素瘤是成人眼部最常见的原发性恶性肿瘤。随着眼内肿瘤诊断和治疗方法和技术的不断进步,患者的生存率显著提高,生存时间明显延长,眼内恶性肿瘤治疗目的也从单纯的挽救患者生命逐渐转变为在挽救生命的基础上尽量保全眼球。尽管目前眼内恶性肿瘤的治疗方案多样,但是对于部分难治性肿瘤,达到保全眼球的目标仍然具有很大挑战。近年来随着手术设备和操作技术的改进,玻璃体切割术再次成为难治性眼内期RB及脉络膜黑色素瘤的治疗方法之一,为这些眼内恶性肿瘤患者保全眼球带来了希望。然而,这种疗法仍有一定的并发症,因此存在争议,在治疗过程中一定要谨慎选择病例,小心实施手术,积极结合其他化学疗法和/或放射治疗及局部治疗方案,并且严密随访。     

甲状腺微小乳头状癌规范化诊疗的进展与争议

国内外针对发病率持续增加的甲状腺微小乳头状癌(PTMC)制定了多个指南与专家共识,内容涵盖PTMC的诊断、治疗等多方面.然而由于PTMC相对惰性的肿瘤生物学特性和良好的预后,其疾病管理策略的选择相对多样,围绕该疾病的规范化诊疗,特别是治疗的争议也与日俱增.本文就PTMC规范化诊疗的进展和争议作一述评.