Background
As advances in oncological treatment continue to prolong the survival of patients with non-resectable pancreatic ductal adenocarcinoma (PDAC), decision-making regarding palliative surgical bypass in patients with a heavy disease burden turns challenging. Here we present the results of a pancreatic surgery referral center.
Methods
Patients that underwent palliative gastrojejunostomy and/or hepaticojejunostomy for advanced, non-resectable PDAC between January 2010 and November 2018 were retrospectively assessed. All patients were taken to a purely palliative surgery with no curative intent. The postoperative course as well as short and long-term outcomes was evaluated in relation to preoperative parameters.
Results
Forty-two patients (19 females) underwent palliative bypass. Thirty-one underwent only gastrojejunostomy (22 laparoscopic) and 11 underwent both gastrojejunostomy and hepaticojejunostomy (all by an open approach). Although 34 patients (80.9%) were able to return temporarily to oral intake during the index admission, 15 (35.7%) suffered from a major postoperative complication. Seven patients (16.6%) died from surgery and another seven within the following month. Nine patients (21.4%) never left the hospital following the surgery. Mean length of hospital stay was 18 ± 17 days (range 3–88 days). Mean overall survival was 172.8 ± 179.2 and median survival was 94.5 days. Age, preoperative hypoalbuminemia, sarcopenia, and disseminated disease were associated with palliation failure, defined as inability to regain oral intake, leave the hospital, or early mortality.
Conclusions
Although palliative gastrojejunostomy and hepaticojejunostomy may be beneficial for specific patients, severe postoperative morbidity and high mortality rates are still common. Patient selection remains crucial for achieving acceptable outcomes.
Background The COVID-19 pandemic has transformed and affected every aspect of health care. Like any catastrophic event, the stress on hospitals to maintain a certain level of function is immense. Acute surgical pathologies cannot be prevented or curtailed; therefore, it is important to understand patterns and outcomes during catastrophes in order to optimize care and organize the health care system. Methods In a single urban tertiary care center, a retrospective study examined the first complete lockdown period of Israel during the COVID-19 pandemic. This was compared to the same time period the previous year. Results During the pandemic, time to hospitalization was significantly decreased. There was also an overall reduction in surgical admissions yet with a higher percentage being hospitalized for further treatment (69.2% vs 23.5%). The patients admitted during this time had a higher APACHE-II score and Charlson comorbidity index score. During the pandemic, time to surgery was decreased, there were less laparoscopic procedures, and more RBC units were used per patient. There were no differences in overall complications, except when sub-analyzed for major complications (9.7% vs 6.3%). There was no significant difference in overall in-house mortality or morbidity. Length of hospitalization was significantly decreased in the elderly population during the pandemic. Conclusion During the COVID-19 pandemic, despite a significantly less number of patients presenting to the hospital, there was a higher percentage of those admitted needing surgical intervention, and they were overall sicker than the previous year.
Background: The purpose of this study is to explore changes in blood-brain barrier (BBB) function and volumetry associated with Parkinson’s disease (PD) levodopa-induced-dyskinesia (LID).
Methods: Twenty-six PD patients [matched pairs, 13 with LID (LID+) and 13 without (LID-)], performed high resolution 3D FSPGR MRI, applying a novel methodology developed for calculating delayed- enhancement-subtraction-maps, representing BBB function. Segmentation software calculated volumes of pre-determined brain structures and the mean BBB function was calculated for each structure. Comparisons between the LID+ and LID- paired patients and within patient, between the more and less affected hemisphere (MAH, LAH) and correlation tests with lateralized UPDRS motor scores were performed.
Results: There were no significant differences in volumetric or BBB map characteristics between the matched LID+ and LID- patients regarding most brain areas except for the inferior parietal cortex (IPC) of the MAH that displayed a higher BBB disruption in LID+ vs. LID- patients. A positive correlation was found with the motor score of the side contralateral to the MAH(r = 0.58, p<0.038) among the LID+ patients.
Conclusions: We demonstrated an association between slight BBB disruption in the IPC and LID in patients with PD using a new MRI methodology. As currently there is no known straightforward biological explanation for this positive finding, it might be genuine and novel, or spurious. Further studies to explore BBB functioning in the various stages of PD and its motor complications are needed, as well as further investigation of the IPC clinical importance and correction for epiphenomenon.
We identified CGMA patterns in sensitive brain regions which give insight and better understanding of the progression of cortical gray matter loss in relation to dissemination in space and time. These patterns may serve as markers to modulate therapeutic interventions to improve the management of MS patients.
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