2008 March 25

Prophylactic antibiotics cannot reduce infected pancreatic necrosis and mortality in acute necrotizing pancreatitis: evidence from a meta-analysis of randomized controlled trials.

Mar 252008

Prophylactic antibiotics cannot reduce infected pancreatic necrosis and mortality in acute necrotizing pancreatitis: evidence from a meta-analysis of randomized controlled trials.

Am J Gastroenterol. 2008 Jan;103(1):104-10

Authors: Bai Y, Gao J, Zou DW, Li ZS

BACKGROUND: There is no agreement whether intravenous prophylactic antibiotics can reduce infected pancreatic necrosis and mortality in acute necrotizing pancreatitis (ANP). We performed a meta-analysis comparing intravenous antibiotics with placebo or no treatment in randomized controlled trials (RCTs). METHODS: Databases including MEDLINE, EMBASE, the Cochrane controlled trials register, the Cochrane Library, and Science Citation Index were searched to find relevant trials. Outcome measures were infected necrosis and mortality. RESULTS: Seven trials involving 467 patients were included. Analysis suggested infected pancreatic necrosis rates were not significantly different (antibiotics 17.8%, controls 22.9%), RR 0.81 (95% CI 0.54-1.22). There was nonsignificantly decreased mortality with antibiotics (9.3%) versus controls (15.2%), RR 0.70 (95% CI 0.42-1.17). Subsequent subgroup analysis confirmed antibiotics were not statistically superior to controls in reduction of infected necrosis and mortality. CONCLUSIONS: Prophylactic antibiotics cannot reduce infected pancreatic necrosis and mortality in patients with ANP.

PMID: 17925000 [PubMed - indexed for MEDLINE]

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Prolonged cholestasis following successful removal of common bile duct stones: beware patients on estrogen therapy.

World J Gastroenterol Start a Discussion »

Mar 252008

Prolonged cholestasis following successful removal of common bile duct stones: beware patients on estrogen therapy.

World J Gastroenterol. 2007 Dec 14;13(46):6277-80

Authors: Dunn JM, McNair A

There are various well described forms of chronic cholestatic jaundice in adults, such as autoimmune cholangitis, drug-induced cholangitis and intrahepatic cholestasis of pregnancy. We present two cases of prolonged cholestasis following removal of gallstones at endoscopic retrograde cholangiopancreatography (ERCP) and subsequent clear cholangiography. Both patients were taking oral estrogens at the time of presentation, which were subsequently withdrawn. The first case responded rapidly to corticosteroid treatment, and the second case had a much slower resolution with ursodeoxycholic acid. Both cases highlighted the significance of estrogen-induced cholestasis in female patients with protracted jaundice following ERCP and removal of intra-ductal stones. After oral estrogens are discontinued, a short course of steroids needs to be considered.

PMID: 18069774 [PubMed - indexed for MEDLINE]

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Independent prognostic value of C-reactive protein and coronary artery disease extent in patients affected by unstable angina.

Atherosclerosis Start a Discussion »

Mar 252008

Independent prognostic value of C-reactive protein and coronary artery disease extent in patients affected by unstable angina.

Atherosclerosis. 2008 Feb;196(2):779-85

Authors: Niccoli G, Biasucci LM, Biscione C, Fusco B, Porto I, Leone AM, Bona RD, Dato I, Liuzzo G, Crea F

BACKGROUND: Previous studies have reported conflicting results on the association between C-reactive protein (CRP) and extent of atherosclerosis, suggesting that the association between CRP and outcome in patients with acute coronary syndromes is independent of coronary artery disease extent. We tested this hypothesis in a selected population of patients with unstable angina undergoing coronary angiography. METHODS: Ninety-seven consecutive patients with unstable angina were enrolled in this single-centre study. All patients underwent coronary angiography. CRP was measured by an ultrasensitive nephelometric method. We also measured serum levels of soluble CD40 ligand by ELISA and plasma fibrinogen levels by use of the Clauss method. Atherosclerotic disease severity and extent were assessed by angiography using the Bogaty score. The extent index refers to the proportion of the coronary tree affected by detectable atheroma on angiography. The primary end-point at 6 months was a composite of: (a) death, (b) myocardial infarction, and (c) recurrence of unstable angina requiring hospitalization. Cardiac death was the secondary end-point. RESULTS: No significant correlation was found between baseline CRP serum levels and angiographic measures of atherosclerotic disease severity and extent, whereas a trend for a significant correlation was found between soluble CD40 ligand and extent index (p=0.06). Diabetic patients exhibited a higher extent index compared to non-diabetic patients (0.94+/-0.1 versus 0.7+/-0.04, p=0.04). Predictors of primary end-point at both univariate and multivariate analysis were: extent index (p=0.04 and 0.04, respectively), CRP levels (p=0.05 and 0.02, respectively), and lack of revascularization (p=0.03 and 0.02, respectively). Fibrinogen levels were the only independent predictor of cardiac death at follow-up (p=0.04). CONCLUSION: In this study we demonstrate that in patients with unstable angina, CRP serum levels and coronary atherosclerosis are not correlated, but both are independently associated with a worse outcome at 6-month follow-up.

PMID: 17306806 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

Metabolic syndrome and risk of development of atrial fibrillation: the Niigata preventive medicine study.

Circulation Start a Discussion »

Mar 252008

Metabolic syndrome and risk of development of atrial fibrillation: the Niigata preventive medicine study.

Circulation. 2008 Mar 11;117(10):1255-60

Authors: Watanabe H, Tanabe N, Watanabe T, Darbar D, Roden DM, Sasaki S, Aizawa Y

BACKGROUND: The metabolic syndrome consists of a cluster of atherosclerotic risk factors, many of which also have been implicated in the genesis of atrial fibrillation (AF). However, the precise role of the metabolic syndrome in the development of AF is unknown. METHODS AND RESULTS: This prospective, community-based, observational cohort study was based on an annual health check-up program in Japan. We studied 28 449 participants without baseline AF. We used 2 different criteria for the metabolic syndrome--the guidelines of the National Cholesterol Education Program Third Adult Treatment Panel (NCEP-ATP III) and those of the American Heart Association/National Heart, Lung, and Blood Institute (AHA/NHLBI)--to study the risk of development of new-onset AF. The metabolic syndrome was present in 3716 subjects (13%) and 4544 subjects (16%) using the NCEP-ATP III and AHA/NHLBI definitions, respectively. During a mean follow-up of 4.5 years, AF developed in 265 subjects (105 women). Among the metabolic syndrome components, obesity (age- and sex-adjusted hazard ratio [HR], 1.64), elevated blood pressure (HR, 1.69), low high-density lipoprotein cholesterol (HR, 1.52), and impaired insulin tolerance (HR, 1.44 [NCEP-ATP III] and 1.35 [AHA/NHLBI]) showed an increased risk for AF. The association between the metabolic syndrome and AF remained significant in subjects without treated hypertension or diabetes by the NCEP-ATP III definition (HR, 1.78) but not by the AHA/NHLBI definition (HR, 1.28). CONCLUSIONS: The metabolic syndrome was associated with increased risk of AF. The metabolic derangements of the syndrome may be important in the pathogenesis of AF.

PMID: 18285562 [PubMed - indexed for MEDLINE]

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Radiofrequency ablation of renal tumors.

Tech Vasc Interv Radiol Start a Discussion »

Mar 252008

Radiofrequency ablation of renal tumors.

Tech Vasc Interv Radiol. 2007 Jun;10(2):132-9

Authors: Stone MJ, Venkatesan AM, Locklin J, Pinto P, Linehan M, Wood BJ

Radiofrequency ablation (RFA) of renal tumors is a promising technique that plays a unique and increasingly important role in urologic oncology practices. RFA is appealing as a minimally invasive therapy that may be performed on an outpatient basis. It enables treatment of an area 3 to 5 cm in diameter, with relatively low morbidity and mortality rates. Most interventional radiologists (IRs) are familiar with RFA of liver tumors, and several principles and techniques used in the liver may be extrapolated for use in the kidney. However, it is crucial to bear in mind that local tumor ablation in the kidney presents unique challenges, secondary to the kidney's unique anatomic and physiologic features. Clinical and technical considerations, risks, and complications pertaining to RFA of renal tumors are reviewed here, including approaches commonly used in our practice.

PMID: 18070691 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

Statins and sepsis.

Br J Anaesth Start a Discussion »

Mar 252008

Statins and sepsis.

Br J Anaesth. 2008 Mar;100(3):288-98

Authors: Gao F, Linhartova L, Johnston AM, Thickett DR

Severe sepsis and septic shock is common and frequently fatal. Over the last few years, the primary treatments demonstrated to improve outcome from several major clinical trials have finally emerged. However, translating these recent therapeutic advances to routine clinical practice has proven controversial, and new approaches of additional strategies are continued to be developed. Given their pleiotropic effects related to many pathophysiological determinants of sepsis, statin therapy could be the next step in the search for adjuvant therapy. A future challenge may be to test both the efficacy and the safety by large randomized controlled clinical trials ascertaining the effects of statins administered at the onset of sepsis and in patients with severe sepsis or septic shock admitted into intensive care units.

PMID: 18276651 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

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