作者： Wang, Hsun-Shuan(小港 泌尿科 王巽玄); Shih, Ming-Chen(附院 影像醫學部 石明誠) N Engl J Med 2016; 375:879September 1, 2016DOI: 10.1056/NEJMicm1507124
摘要：
A 42-year-old man with diabetes presented to the emergency department with severe dysuria and incontinence, which he had had for several days. Laboratory studies were notable for pyuria on urinalysis, leukocytosis (a white-cell count of 10,820 per cubic millimeter), elevated C-reactive protein levels (134.1 mg per liter), hyperglycemia (glucose level, 900 mg per deciliter [50 mmol per liter]), and an elevated level of glycated hemoglobin (11.4%). Radiography of the kidney, ureter, and bladder showed an atypical focus of gas accumulation behind the right pubic ramus (Panel A, arrows). Subsequent computed tomography (CT) of the abdomen revealed emphysematous prostatitis of the right prostate lobe (Panel B, arrows). A Foley catheter was placed, and CT-guided percutaneous drainage of the prostate was performed. Broad-spectrum antibiotics and intravenous fluid therapy were initiated, and strict blood sugar control was implemented with an insulin drip. Urine and blood cultures grew Klebsiella pneumoniae. The patient remained in the hospital for 1 month and was treated for infection, sepsis, poor control of blood sugar levels, and acute kidney injury. His condition gradually improved, and he was discharged home. Emphysematous prostatitis is a rare sequela of complicated urinary tract infection and is more commonly found in patients with immunosuppression, diabetes mellitus with poor glycemic control, liver cirrhosis, alcoholism, or recent urethral instrumentation. The most common pathogen in patients with diabetes, as in this case, is K. pneumoniae.
題目： Long-term Effects of Hepatitis B Immunization of Infants in Preventing Liver Cancer.
摘要：
BACKGROUND & AIMS: The incidence of hepatocellular carcinoma (HCC) increases with age, but protective antibody responses decrease with time after infants are immunized against hepatitis B virus (HBV). We investigated whether immunization of infants against HBV prevents their developing HCC as adults. We also searched for strategies to maximize the cancer-preventive effects.
METHODS: We collected data from 2 Taiwan HCC registry systems on 1509 patients (6-26 years old) diagnosed with HCC from 1983 through 2011. Data on history of HBV immunization and prenatal maternal levels of HBV antigens of all HCC patients born after July 1984 were retrieved from the HBV immunization data bank of the Taiwan Center for Disease Control. We collected data on birth cohort-specific populations (6-26 years old) of Taiwan using the National Household Registry System. Rates of HCC incidence per 10(5) person-years were derived by dividing the number of patients with HCC by the person-years of the general population. Relative risks (RR) for HCC were estimated by Poisson regression analysis in vaccinated vs unvaccinated birth cohorts. We stratified patients by age group to evaluate the association of birth cohorts and HCC risks.
RESULTS: Of the 1509 patients with HCC, 1343 were born before, and 166 were born after, the HBV vaccination program began. HCC incidence per 10(5) person-years was 0.92 in the unvaccinated cohort and 0.23 in the vaccinated birth cohorts. The RRs for HCC in patients 6-9 years old, 10-14 years old, 15-19 years old, and 20-26 years old who were vaccinated vs unvaccinated were 0.26 (95% confidence interval [CI], 0.17-0.40), 0.34 (95% CI, 0.25-0.48), 0.37 (95% CI, 0.25-0.51), and 0.42 (95% CI, 0.32-0.56), respectively. The RR for HCC in 6- to 26-year-olds was lower in the later vs the earlier cohorts (born in 1992-2005 vs 1986-1992; P < .001 and 1986-1992 vs 1984-1986; P < .002). Transmission of HBV from highly infectious mothers and incomplete immunization were associated with development of HCC.
CONCLUSIONS: Based on an analysis of 1509 patients with HCC in Taiwan, immunization of infants against HBV reduces their risk of developing HCC as children and young adults. Improving HBV vaccination strategies and overcoming risk factors could reduce the incidence of liver cancer.
