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Initial staging of pancreatic ductal adenocarcinoma (PDAC) is performed with computed tomography (CT). Laparoscopy with peritoneal cytology at staging can uncover occult disease undetected by CT. This case series assessed clinical course following staging laparoscopy with cytology in patients with PDAC.This single-center study examined patients with non-metastatic PDAC diagnosed from 2017 to 2020. Patients underwent CT and subsequent laparoscopy with cytology prior to treatment. Demographics, clinicopathologic status, treatment course, and survival were compared.Eight patients were identified. All had negative laparoscopies. Five cytologies were negative, two were atypical, and one was positive. Two patients with negative cytology received neoadjuvant chemotherapy and underwent resection, with an average follow-up time of 32.9 months since diagnosis. Of the three remaining patients with negative cytology, none underwent resection. One received delayed chemotherapy, while the others could not due to medical contraindications. The average survival was 3.5 months (n=2). Of two patients with atypical cytology, neither underwent resection. One could not receive chemotherapy due to medical contraindication, while the other was lost to follow-up shortly after diagnosis. The average survival was 1.3 months (n=1). The patient with positive cytology received definitive chemotherapy without resection and survived for 21.6 months.The patient with positive cytology may have been spared non-therapeutic surgery. Remaining unresected patients showed poor survival, though the lack of immediate chemotherapy may contribute to this finding. Further research is needed to determine optimal candidates for invasive staging and implications of atypical cytology.

ObjectiveTo investigate the neuroprotective potential of statins (ST) against neuro-autoimmune disease (NAD) in patients, and risks of associated comorbidities.BackgroundST have been shown to provide neuroprotective benefits in patients with cardiovascular disease and related risk factors. However, the extent of neuroprotective potential of ST medications in patients with NAD has not been determined.Design/MethodsA retrospective analysis on 34464 patients hospitalized at a tertiary care center in a major metropolitan area was conducted. 7527 patients were in the ST group, while 26937 patients were not taking any statins (nST). 190 patients had a NAD diagnosis and 10818 had diabetes mellitus (DM). 702 patients carried a diagnosis of diabetic neuropathy and/or diabetic retinopathy (DMNR). NAD patients were further categorized as those with or without ST medications (aST and anST). The outcomes compared included the prevalence of NAD, comorbidities, encephalopathy, and overall neurological complications.ResultsThe prevalence of NAD was 0.39% and 0.60% in ST and nST, respectively (p < 0.05). 69% of aST and 27% of anST had DM (p < 0.00001). Patients in aST had a significantly higher amount of DMNR than those in anST (13.8%, 0.62%, p < 0.0001) and high risk comorbidity (45%, 15%, p < 0.01). There was no significant difference between aST and anST in the prevalence of encephalopathy (10%, 6%, p > 0.05) and overall neurological complications (17%, 14%, p > 0.05).ConclusionsThese results suggest that patients taking ST may be associated with a lower risk of NAD with no increase in overall neurological complications during hospitalization. Despite these findings, ST may be associated with an increased burden of disease and higher prevalence of progressive neuropathy.

ObjectiveTo investigate the neuroprotective potential of insulin mimetics (IM) in patients with neuro autoimmune disease (NAD) and high risk comorbidities.BackgroundIM are used to treat patients with diabetes mellitus (DM) and have been shown to protect against progressive neurological damage. Despite their neuroprotective benefits, the extent of their neuroprotection in patients with NAD has not been completely characterized.Design/MethodsA retrospective analysis on 34464 patients hospitalized at a tertiary care center in a major metropolitan area was conducted. 168 patients were taking IM medications. 7848 patients were taking medicine other than IM for their DM (nIM). 7690 patients were taking insulin without IM medications. 26448 patients were not on any DM medication (nDM). The outcomes compared included the prevalence of NAD, diabetic neuropathy and/or retinopathy (DMNR), and the prevalence of high risk comorbidities defined as those with either heart failure, chronic kidney disease, stroke, or encephalopathy.ResultsThe prevalence of NAD was 0.6%, 0.52%, 0.53%, 0.56% among patients in the IM, nIM, insulin, and nDM groups respectively (p > 0.05). 19.5% of NAD and 23.6% of those without NAD had high risk comorbidities (p > 0.05). Among those with autoimmune disease, 31% of those taking any diabetic medication and 16% of nDM had high risk comorbidities (p > 0.05). The prevalence of DMNR was 10% and 8% in IM and nIM groups respectively (p > 0.05).ConclusionsThese results suggest that IM medications may benefit patients with NAD against additional comorbidity as those without NAD and DM are expected to have less high risk disease. However, more studies are needed to determine whether IM medications play a role in neuro-autoimmune disease progression and mortality. A limitation of this study is that data was collected from a single institution and does not represent the general population.

ObjectiveTo investigate the effects of anti-epileptic drugs (AED) on the overall burden of disease in patients with neuro-autoimmune disease (NAD).BackgroundAEDs have shown to provide benefits against neurological damage in patients with various neurological illnesses. However, the extent of AEDs role in neuroprotection and the prevention of additional comorbidity in patients with NAD has not been completely characterized.Design/MethodsA retrospective analysis on 34464 patients hospitalized at a tertiary care center in a major metropolitan area was conducted. 3997 patients were on AED medications, while 30467 patients were not taking any AEDs (nAED). 190 patients had a NAD diagnosis. Patients with NAD were classified according to use of AED or nAED (aAED and anAED). The outcomes compared included prevalence of neurological complications defined as either seizure, blurry vision, delirium, or altered mental status, encephalopathy, length of stay, ICU admission, comorbidity, and death.ResultsThere was no significant difference in the prevalence of NAD between patients in AED or nAED (0.75%, 0.52%, p > 0.05). Among patients with aAED and anAED, there was no significant difference in length of stay (8.7, 7.8, p > 0.5), ICU admission (26.7%, 12.5%, p > 0.05), prevalence of comorbidities (56.7%, 52.5%, p > 0.05), or mortality (6.7%, 3.1%, p > 0.3). 36% of aAED and 16.3% of anAED had high risk comorbidity (p < 0.05). The prevalence of overall neurological complications was 37% and 10% among aAED and anAED, respectively (p < 0.001). Patients in aAED had significantly higher encephalopathy compared to anAED at 23% and 3.8%, respectively (p < 0.0001).ConclusionsThese results suggest that AEDs may be associated with an increase in high-risk comorbidities and neurological complications including encephalopathy among patients with NAD. Work is in progress to assess the contribution of the primary diagnoses for which AEDs were prescribed on the burden of NAD.

ObjectiveTo investigate the burden of disease and their prognosis amongst patients with neuro-autoimmune disease (NAD).BackgroundNAD has been shown to increase overall mortality and early death among patients. However, the overall burden of disease in NAD patients has not yet been fully characterized.Design/MethodsA retrospective analysis on 34464 patients hospitalized at a tertiary care center in a major metropolitan area was conducted. The outcomes compared included the prevalence of comorbidities, high risk comorbidities, and rheumatoid arthritis and/or lupus (RAL) among patients with and without neuro-autoimmune disease (NAD and nNAD). The outcomes of the initial disposition after discharge, length of hospital stay, ICU admission, and death among patients with comorbidities and with or without neuro-autoimmune disease (cNAD and cnNAD) was also determined.ResultsThere is no significant difference in the level of comorbidity (53% vs 54%) or high risk comorbidities (19% vs 24%) between patients in NAD and nNAD, respectively (p > 0.05). 4.7% of NAD and 2.2% of nNAD patients had RAL (p < 0.02). The mortality was 5% in cNAD and 4.3% in ncNAD (p > 0.05). ICU admissions was 16% in cNAD and 20% in ncNAD (p > 0.05). 42% of patients in cNAD and 72% in ncNAD were discharged home (p < 0.0001). The average length of stay was 10 and 6.7 days for patients in cNAD and ncNAD, respectively (p < 0.01).ConclusionsThese results suggest that NAD may not affect the overall burden of disease in patients but may increase the prevalence of RAL. Furthermore, comorbidity status may correlate with length of stay and disposition in patients with NAD.