These data suggest that cystic pancreatic neoplasms 1) occur in 0.7% of patients, 2) increase in 19% over 16 months, and 3) are likely (60%) to be malignant in patients older than 70 years. Therefore, we recommend surgical excision for pancreatic cysts that are increasing under observation, symptomatic, or detected radiologically in fit older patients.

To determine associations between objective assessments (swallowing function and weight change) and subjective quality-of-life (QOL) measures. Design: Observational case series using clinical testing and questionnaires. Setting: University hospital-based tertiary clinical practice. Patients: Convenience sample of 5-year survivors of head and neck cancer (62 nonlaryngectomy survivors were studied). Interventions: Objective testing included examination, weight history, videofluoroscopic swallow studies (VFSS), and oropharyngeal swallowing efficiency (OPSE). Subjective testing included QOL questionnaires (University of Washington Quality-of-Life [UWQOL] Scale, Performance Status Scale for Head and Neck Cancer Patients [PSS-HN], Functional Assessment of Cancer Treatment-General [FACT-G] Scales, and Functional Assessment of Cancer Therapy-Head and Neck [FACT-H&N] Scale). Main Outcome Measures: Aspiration (identified by VFSS), weight change, and QOL measures. Results: Aspiration was associated with the decreased QOL scores in chewing, swallowing, normalcy of diet, and additional concerns of the FACT-H&N Scale. No association was found between aspiration and willingness to eat in public, subjective understandability, or any of the FACT-G scales. Of the nonlaryngectomy survivors, 27 (44%) demonstrated some degree of aspiration during VFSS. Associations were found between aspiration, primary tumor T stage, weight change, and OPSE. Aspirators lost a mean of 10.0 kg from precancer treatment weight, while nonaspirators gained a mean of 2.3 kg (PϽ.001). Mean OPSE scores were 69 for nonaspirators and 53 for aspirators (P=.01). Conclusions: Almost half of long-term nonlaryngectomy head and neck cancer survivors demonstrated at least some degree of aspiration. The presence of aspiration is associated with substantial weight loss, advanced initial tumor stage, diminished oropharyngeal swallowing efficiency, and lower scores on a variety of QOL scales.

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In this case series, ERCP was found to be useful as a diagnostic and therapeutic method for managing noniatrogenic traumatic biliary injuries in patients who had undergone previous surgery for abdominal trauma. The ERCP results were similar to those for iatrogenic bile duct injuries.

Epidural abscess is a rare complication of fistulizing Crohn's disease (CD), potentially appearing as neurologic symptoms or back and leg pain. We report a case of a large epidural abscess resulting from uncontrolled fistulizing CD, which was rapidly defined using gadolinium-enhanced magnetic resonance imaging (MRI). Whenever caudal neurologic symptoms, back pain, and fever arise in CD patients, diagnostic MRI of the pelvis in addition to conventional computerized tomography should be considered to identify perirectal fistulization to the spine.