Backgrounds/Aims: Pancreatic leak and fistula formation following pancreatic resection is a dreaded complication associated with significant morbidity and mortality. The perioperative use of inotropes has been implicated in anastomotic dehiscence in other types of gastrointestinal surgery but their impact in pancreatic surgery remains unclear and a potentially modifiable risk factor for pancreatic leak. This study aims to assess the impact of perioperative inotrope infusion on the incidence of pancreatic leak following pancreaticoduodenectomy. Methods: Retrospective data analysis of all patients undergoing pancreaticoduodenectomy at a tertiary HPB institute. Multivariate analysis and regression models assessed the impact of inotrope use against other known risk factors such as pancreatic duct size and gland texture. Pancreatic fistulae were graded as per ISGPF as Grade A (biochemical leak), Grade B and Grade C fistula. Results: One-hundred and twenty-three (123) patients were included. A total of 52 patients (42%) developed a leak (29 grade A, 15 grade B, and 8 Grade C). In the fistula group, 28 patients (55%) received perioperative inotropes compared to 26 (35%) in the no fistula group. On univariate analysis, patients receiving inotropes (p=0.04) and patients with a soft pancreatic texture (p=0.003) had a statistically higher incidence of developing a pancreatic fistula of any grade. On multivariate analysis, only inotrope use was associated with an increased risk of developing a pancreatic fistula of any grade (OR 2.46, p=0.026), independent of pancreatic texture and pancreatic duct size. Conclusions: Perioperative inotrope use is associated with an increase incidence of pancreatic leak following pancreaticoduodenectomy and should therefore be used judiciously. (Ann Hepatobiliary Pancreat Surg 2019;23:392-396)
The SASSI computer code was developed in the early 1980's to solve SoilStructure-Interaction (SSI) problems and is commonly used today in the solution of SSI problems for U.S. Department of Energy (DOE) facilities. Two solution methods are available in SASSI, the "direct" method and the "subtraction" method which is computationally more efficient.Recent reviews by regulators have questioned the validity of SASSI results for particular sites, especially when the subtraction method is used. This paper presents a methodology for validating SASSI for use with a particular site profile. Ground motion at the surface is deconvolved in SHAKE to the bottom of the soil column and then brought back to the surface in a SASSI embedded box model. SASSI response spectra at the ground and foundation levels are compared with spectra derived from SHAKE results to validate SASSI properly transmits motion through the soil profile. Two case studies are presented: 1) a deep soil site at the Savannah River Site (SRS) and 2) a shallow stiff soil site at the Hanford Waste Treatment Plant (WTP).Results indicate that for the two cases examined, SASSI properly transmits motion through the soil profile and embedded box structure. Results also indicate that the direct and subtraction methods produce identical results for the soil profiles examined.
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