Abstract:
OBJECTIVE:A randomized, controlled, multicenter trial was undertaken in 102 patients with objective evidence of severe acute pancreatitis to evaluate whether selective decontamination reduces mortality. SUMMARY BACKGROUND DATA:Secondary pancreatic infection is the major cause of death in patients with acute necrotizing pancreatitis. Controlled clinical trials to study the effect of selective decontamination in such patients are not available. METHODS:Between April 22, 1990 and April 19, 1993, 102 patients with severe acute pancreatitis were admitted to 16 participating hospitals. Patients were entered into the study if severe acute pancreatitis was indicated, on admission, by multiple laboratory criteria (Imrie score > or = 3) and/or computed tomography criteria (Balthazar grade D or E). Patients were randomly assigned to receive standard treatment (control group) or standard treatment plus selective decontamination (norfloxacin, colistin, amphotericin; selective decontamination group). All patients received full supportive treatment, and surveillance cultures were taken in both groups. RESULTS:Fifty patients were assigned to the selective decontamination group and 52 were assigned to the control group. There were 18 deaths in the control group (35%), compared with 11 deaths (22%) in the selective decontamination group (adjusted for Imrie score and Balthazar grade: p = 0.048). This difference was mainly caused by a reduction of late mortality (> 2 weeks) due to significant reduction of gram-negative pancreatic infection (p = 0.003). The average number of laparotomies per patient was reduced in patients treated with selective decontamination (p < 0.05). Failure of selective decontamination to prevent secondary gram-negative pancreatic infection with subsequent death was seen in only three patients (6%) and transient gram-negative pancreatic infection was seen in one (2%). In both groups of patients, all gram-negative aerobic pancreatic infection was preceded by colonization of the digestive tract by the same bacteria. CONCLUSION:Reduction of gram-negative colonization of the digestive tract, preventing subsequent pancreatic infection by means of selective decontamination, significantly reduces morbidity and mortality in patients with severe acute necrotizing pancreatitis.
journal_name
Ann Surgjournal_title
Annals of surgeryauthors
Luiten EJ,Hop WC,Lange JF,Bruining HAdoi
10.1097/00000658-199507000-00010subject
Has Abstractpub_date
1995-07-01 00:00:00pages
57-65issue
1eissn
0003-4932issn
1528-1140journal_volume
222pub_type
临床试验,杂志文章,多中心研究,随机对照试验abstract:INTRODUCTION:The use of extended criteria donors (ECDs) could minimize shortage of suitable donor livers for transplantation. In 3 years, the aggressive use of ECD livers has reduced the wait list at our center from 257 to 30 patients with a median wait time of 18 days without using living donors. This study compares t...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/01.sla.0000234896.18207.fa
更新日期:2006-09-01 00:00:00
abstract::The aim of this study was to define the post-traumatic changes in body fluid compartments and to evaluate the effect of plasma colloid osmotic pressure (COP) on the partitioning of body fluid between these compartments. Forty-two measurements of plasma volume (green dye), extracellular volume (bromine), and total body...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198909000-00015
更新日期:1989-09-01 00:00:00
abstract::The results of surgical treatment in 100 patients with intrahepatic gallstones are reported including follow-up on 61 patients who survived more than three years. Nine patients died in the follow-up period, and of the remainder, 44 showed complete rehabilitation (72%). The results of follow-up examinations were best s...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198007000-00005
更新日期:1980-07-01 00:00:00
abstract:OBJECTIVE:To review the literature with regard to outcome of surgical management for hilar cholangiocarcinoma (Klatskin tumor). BACKGROUND:Hilar cholangiocarcinoma is a rare tumor with a poor prognosis. Surgical resection provides the only possibility for cure. Advances in hepatobiliary imaging and surgical strategies...
journal_title:Annals of surgery
pub_type: 杂志文章,评审
doi:10.1097/SLA.0b013e3181afe0ab
更新日期:2009-08-01 00:00:00
abstract:OBJECTIVE:To test the hypothesis that pancreatic ductal anatomy may predict the likely success of percutaneous drainage of pseudocysts of the pancreas. SUMMARY BACKGROUND DATA:Various modalities are currently applied to pseudocysts, with little or no data to aid in the choice of management strategy. Pancreatic ductal ...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-200206000-00001
更新日期:2002-06-01 00:00:00
abstract:OBJECTIVE:To evaluate the perioperative morbidity and mortality of patients with COVID-19 who undergo urgent and emergent surgery. SUMMARY BACKGROUND DATA:Although COVID-19 infection is usually associated with mild disease, it can lead to severe respiratory complications. Little is known about the perioperative outcom...
journal_title:Annals of surgery
pub_type: 杂志文章,多中心研究
doi:10.1097/SLA.0000000000004420
更新日期:2021-01-01 00:00:00
abstract:OBJECTIVE:This study was intended to identify prognostic biomarkers for lymph node (LN)-positive locoregional esophageal squamous cell carcinoma (ESCC) patients. SUMMARY OF BACKGROUND DATA:Surgery is a major treatment for LN-positive locoregional ESCC patients in China. However, patient outcomes are poor and heterogen...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0000000000003369
更新日期:2019-04-30 00:00:00
abstract:OBJECTIVE:To summarize the long-term efficacy and safety of tacrolimus in orthotopic liver transplant (OLT) recipients, as well as to examine the factors that influence long-term morbidity and mortality rates. BACKGROUND:Tacrolimus (FK506, Prograf) was introduced as primary immunosuppression for primary liver transpla...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-199909000-00016
更新日期:1999-09-01 00:00:00
abstract::Low mortality rates for elective surgical treatment of abdominal aortic aneurysms justify an aggressive approach in most patients. However, in high-risk patients with small aneurysms and no symptoms, the decision to operate remains a delicate balance of risk and benefit. Our observations include 99 high-risk patients ...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198409000-00003
更新日期:1984-09-01 00:00:00
abstract::A prospective study of factors predisposing to infection in badly injured patients has disclosed: the dominant roles of two specific parameters: monocyte antigen presenting capacity, and opsonic capacity of diluted serum; the potential value of further assessment of: the predictive value of plots of activated T-cells/...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:
更新日期:1986-09-01 00:00:00
abstract::Twenty-two patients developed one or more aortoenteric fistulae following aortic reconstruction with a dacron graft. Endoscopy was performed on 11 of these patients on 17 occasions and a preoperative diagnosis was made in eight patients. Fistulous communication was most common between the aorta and duodenum (60%), and...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198203000-00011
更新日期:1982-03-01 00:00:00
abstract::Hereditary spherocytosis is a clinically heterogeneous, genetically determined red blood cell membrane disorder resulting in hemolytic anemia. A deficiency of spectrin, the largest and most abundant structural protein of the erythrocyte membrane skeleton, results in the formation of spherocytes which lack the strength...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198601000-00007
更新日期:1986-01-01 00:00:00
abstract:BACKGROUND/OBJECTIVE:The National Surgical Quality Improvement Program (NSQIP) has demonstrated quality improvement in the VA and pilot study of 14 academic institutions. The objective was to show that American College of Surgeons (ACS)-NSQIP helps all enrolled hospitals. METHODS:ACS-NSQIP data was used to evaluate im...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0b013e3181b4148f
更新日期:2009-09-01 00:00:00
abstract:OBJECTIVES:The objectives of this study were to evaluate the effect of radiotherapy (RT) on sexual function in patients undergoing oncologic resection for rectal cancer, and to develop a mathematical model for quantifying the risk of sexual dysfunction through time for this group of patients. METHODS:Data were prospec...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/01.sla.0000183608.24549.68
更新日期:2005-10-01 00:00:00
abstract:OBJECTIVES:The purpose of this study was to perform the first statewide, population-based, time-series analysis of the frequency of ruptured abdominal aortic aneurysm (RAAA), to determine the outcomes of RAAA, and to assess the association of patient, physician, and hospital factors with survival after RAAA. The hypoth...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-199605000-00005
更新日期:1996-05-01 00:00:00
abstract:OBJECTIVE:Mycophenolate mofetil (MM) is a new immunosuppressive agent that reversibly inhibits guanine nucleotide synthesis and DNA replication. Its activity is highly selective for T and B lymphocytes. Two open-label multicenter trials of MM in renal transplantation have been performed. This report summarizes the resu...
journal_title:Annals of surgery
pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
doi:10.1097/00000658-199305010-00007
更新日期:1993-05-01 00:00:00
abstract:OBJECTIVES:We recently reported increased CD4 CD25 T regulatory (Treg) activity after burn injury in mice. This study sought to determine if Tregs mediate the reduction in TH1-type immunity after serious injury in man and if Treg function is altered by injury. METHODS:Peripheral blood was withdrawn from 19 consenting ...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/01.sla.0000239031.06906.1f
更新日期:2006-10-01 00:00:00
abstract::The tumors from approximately 50% of patients with breast cancer contained estrogen receptor (ER). ER appeared more often and at higher levels in the tumors of postmenopausal women. Eleven out of 12 patients who had multiple ER assays from various metastatic sites showed no significant discrepancies in ER values. ER l...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-197601000-00017
更新日期:1976-01-01 00:00:00
abstract:OBJECTIVE:To determine the early effects of therapy of endotoxin (ET) shock with epinephrine, norepinephrine, or dopexamine on splanchnic circulation, oxygen metabolism, sigmoid mucosal pHi, bacterial translocation, and morphologic integrity of the ileal, colonic, and sigmoid mucosa. SUMMARY BACKGROUND DATA:Conflictin...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-199808000-00014
更新日期:1998-08-01 00:00:00
abstract::Prior experience with the rare combination of horseshoe kidney and significant atherosclerotic vascular disease suggests difficulty in intraoperative management, often requiring division of the renal isthmus or sacrifice of some renal tissue. Seven patients have been managed successfully over the past ten years at The...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-197807000-00012
更新日期:1978-07-01 00:00:00
abstract:BACKGROUND:Retrospective single-center studies have shown that diffusion-weighted magnetic resonance imaging (DWI) is promising for identification of patients with rectal cancer with a complete tumor response after neoadjuvant chemoradiotherapy (CRT), using certain volumetric thresholds. OBJECTIVE:This study aims to v...
journal_title:Annals of surgery
pub_type: 杂志文章,多中心研究
doi:10.1097/SLA.0000000000000909
更新日期:2015-12-01 00:00:00
abstract::Eight patients after vagotomy and Jaboulay gastroduodenostomy had their gastroduodenostomy closed to treat dumping and diarrhea. Eight gastroduodenostomies were closed once and four were closed twice, a total of 12 procedures. Of these, ten were "simple" closures (direct suture of the opening into the duodenum via a g...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198308000-00005
更新日期:1983-08-01 00:00:00
abstract:OBJECTIVE:To determine the role of the microvascular endothelium in the regulation of regenerating liver mass after partial hepatectomy. SUMMARY BACKGROUND DATA:Angiogenesis is critical for both pathologic and physiologic processes. The ability of certain tissues, such as the liver, kidney, and spleen, to regenerate a...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/01.SLA.0000059986.96051.EA
更新日期:2003-04-01 00:00:00
abstract:OBJECTIVE:To determine if certain outcomes of incisional hernia repair have improved in recent eras. SUMMARY BACKGROUND DATA:Technological developments have been reported to improve outcomes in the repair of abdominal wall incisional hernias. METHODS:This retrospective, population-based cohort study was conducted usi...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-200301000-00018
更新日期:2003-01-01 00:00:00
abstract:BACKGROUND:Length of postoperative stay (LOS) has gained increasing attention as a potential indicator of surgical efficiency. Our objective was to examine the feasibility of assessing LOS at 182 hospitals to identify institutions with outlying performance. METHODS:Patients were identified who underwent colorectal sur...
journal_title:Annals of surgery
pub_type: 杂志文章,多中心研究
doi:10.1097/sla.0b013e3181b2a948
更新日期:2009-12-01 00:00:00
abstract::Continuous epidural anesthesia offers special advantages for patients with vascular disease. In 193 patients who had this technique employed for aortofemoral arteriography, profound pain relief was provided and the accompanying vasodilation produced superior demonstration of collateral and small distal vessels. Eleven...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198206000-00015
更新日期:1982-06-01 00:00:00
abstract::The peripheral nitrogen wasting and loss of functional capacity caused by the malnutrition of disease and the immobilization of hospitalization may not be readily reversed by refeeding alone. In order to examine submaximal exercise as an adjunctive anabolic stimulus to intravenous refeeding (IVF) in depleted subjects,...
journal_title:Annals of surgery
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00000658-198803000-00012
更新日期:1988-03-01 00:00:00
abstract::Human lymphocyte antigen (HLA) class I and class II antigens and beta 2 microglobulin (B2M) were identified in peritoneal dialysate (PD) and serum from patients with end-stage renal disease (ESRD) using monoclonal antibodies in an enzyme-linked immunoassay. The HLA class I and class II antigens each exhibited approxim...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-199106000-00009
更新日期:1991-06-01 00:00:00
abstract::The combined Cambridge/King's College Hospital series of 64 orthotopic liver grafts' experience dates back to 1968. Many patients were referred for liver grafting late in the course of their diseases and were operated on when they were too ill or died before suitable livers could be found. Complications of biliary dra...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-197709000-00006
更新日期:1977-09-01 00:00:00
abstract::The hypothesis that optimizing hemodynamics using pulmonary artery (PA) catheter (preoperative 'tune-up') would improve outcome in patients undergoing limb-salvage arterial surgery was tested. Eighty-nine patients were randomized to preoperative tune-up either in the surgical intensive care unit (SICU) (group 1) or th...
journal_title:Annals of surgery
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00000658-199109000-00011
更新日期:1991-09-01 00:00:00