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Background: According to the revised Atlanta classification, severe and moderately severe acute pancreatitis (AP) includes patients with pancreatic and peripancreatic collections with or without organ failure. These collections suggest the presence of pancreatic juice leakage. The aim of this study was to evaluate the efficacy of a percutaneous catheter drainage (PCD) protocol designed to control leakage and decrease disease severity., Methods: Among 663 patients with clinical AP, 122 were classified as moderately severe or severe AP (all had collections). The computed tomography severity index (CTSI) score was calculated. The indication for PCD was based on progressive clinical signs and symptoms. Drain patency, position, and need for additional drainage sites were assessed using CT scans and drain studies initially every 3 days using a proactive protocol. Drain fluid was examined for amylase concentration and microbiological culture. Clinicopathological variables for patients with and without PCD were compared. Since there was no mortality, we used prolonged drainage time to measure the success of PCD. Within the group treated with PCD, variables that resulted in prolonged drainage time were analyzed., Results: PCD was used in 47/122 (39 %) patients of which 33/47 (70 %) had necrosis. PCD cases had a median CTSI of 8 and were classified as moderately severe AP (57 %) and severe AP (43 %). Inhospital mortality was zero. Surgical necrosectomy was not required for patients with necrosis. Independent risk factors for prolonged drainage time were persistent organ failure >48 h (P = 0.001), CTSI 8-10 (P = 0.038), prolonged duration of amylase-rich fluid in drains (P < 0.001), and polymicrobial culture fluid in drains (P = 0.015)., Conclusions: A proactive PCD protocol persistently maintaining drain patency advanced to the site of leak controlled the prolonged amylase in drainage fluid resulting in a mortality rate of zero.

Background: Although the increased risk of developing pancreatic cancer (PC) in families with a strong history of the disease is well known, characteristics and outcomes of patients with familial PC is not described well., Aims: This study aims to evaluate outcomes following resection in patients with familial PC., Methods: We studied 208 patients who underwent resection of PC from 2000 to 2007 and had prospectively completed family history questionnaires for the Biospecimen Resource for Pancreas Research at our institution. We compared clinical characteristics and outcomes of familial and sporadic PC patients., Results: Familial (N = 15) and sporadic PC patients (N = 193) did not have significantly different demographics, pre-operative CA19-9, pre-operative weight loss, R0 status, or T-staging (all p ≥ 0.05). Familial PC patients had lower pre-operative total serum bilirubin concentrations (p = 0.03) and lesions outside of the pancreatic head more frequently (p = 0.02) than sporadic PC patients. There was no difference in survival at 2 years between familial and sporadic PC patients (p = 0.52)., Conclusions: Familial PC patients appear to develop tumors outside of the pancreatic head more frequently than sporadic PC patients. This difference in tumor distribution may be due to a broader area of cancer susceptibility within the pancreas for familial PC patients.

Background: Preoperative serum values of CA 19-9 have been reported to be associated with survival in patients undergoing resection of pancreatic adenocarcinoma., Hypothesis: Preoperative CA 19-9 levels are associated with margin and/or lymph node status in patients undergoing pancreatoduodenectomy for pancreatic carcinoma., Methods: We conducted a review of 143 patients undergoing pancreatoduodenectomy for pancreatic adenocarcinoma from July 2001 through April 2006 at our institution. Preoperative serum values of CA 19-9 and total bilirubin, pathologic findings, and survival were analyzed. A cutoff value for CA 19-9 (120 U/ml) was determined using a Cox proportional hazards model for survival., Results: Overall survival at 1, 3, and 5 years for patients with CA 19-9 < or = 120 U/ml was 76%, 41%, and 31%, respectively, versus 64%, 17%, and 10% for patients with CA 19-9 > 120 U/ml (p = 0.002). CA 19-9 > 120 U/ml was not associated, however, with a greater chance of an R1 or R2 resection (p = 0.86), tumor involving the SMA margin (p = 0.88), tumor at the portal vein groove (p = 0.14), or lymph node metastases (p = 0.89)., Conclusions: Our findings do not support a cutoff value for CA 19-9 that is associated with margin or lymph node involvement. Preoperative CA 19-9 < or = 120 U/ml is, however, associated with increased overall and recurrence-free survival.

The effects of two insole materials within the shoe are compared using neural network analysis. Seven male subjects without locomotor disorders walk on a treadmill at a controlled speed and cadence wearing a common shoe and no socks, under three conditions; these are two types of insole of the same thickness, and a no insole condition. Pressure-related data from under the foot, within the shoe, are obtained by the MICRO-EMED system during walking. A back-propagation neural network is trained to associate sets of pressure-related data with the insole conditions. Subsequently neural network analysis is performed to reveal the abstract rules that govern the decision-making processes within the neural network, based on the synergistic interactions between the measured variables. Data are also analysed using ANOVA. The neural network analysis finds trends in the way in which the trained neural network responds. The interpretation of those trends gives a delicate description of the dynamic behaviour of the insoles despite the fact that no significant differences are found using ANOVA. It is concluded that neural network analysis can distinguish between insole behaviour during use, even though these differences are not significantly different based on statistical tests.