THROUGHOUT the literature there are numerous references to the involvement of the cerebellum in poliomyelitis; still clinical evidence of disturbances of this region of the nervous system is generally lacking. This may be due to the fact that it is somewhat difficult and unsatisfactory to examine cerebellar function in patients severely paralyzed with spinal poliomyelitis or critically ill with bulbar or respiratory poliomyelitis. Certainly, in most studies evidence of residual cerebellar disturbances in patients that have recovered from this illness is generally lacking. Because of the volume of our material it was felt that a detailed study of the cerebellum might be of value in indicating the actual nature and extent of the cerebellar lesions in this disease.As early as 1898 M\l=e'\din 1 reported cases of poliomyelitis in which the chief finding was incoordination. He referred to these cases as the ataxic, or cerebellar, form of the disease. He described these patients as having an uncertain, staggering, and wide-based gait, similar to patients with Friedreich's ataxia. Wickman 2 also reported cases in which ataxic symptoms were conspicuous and were associated in many cases with diminution or loss of tendon reflexes. Occasionally the cerebellar disturbances were mild and often hidden by the other, more classical findings of the disease. In a pathologic study of four cases, Wickman observed fairly intense changes in the cerebellum in three. These consisted of perivascular infiltrationsinvolving both the cortex and the white matter primarily of the vermis. The meninges surrounding the cerebellum also showed mild scattered areas of mononuclears.Ataxia has frequently been mentioned in subsequent epidemics by Zappert,3 Lindner and Mally,4 Lemmon,0 Horányi-Hechst," and Fanconi and associates.7 Horányi-Hechst, in a study of 38 fatal cases, observed cerebellar changes in 22, or 58%. Fanconi and his associates described cerebellar changes in only 3.2% of their 375 cases. Lemmon reviewed in detail the clinical symptoms and signs in 49 patients with acute poliomyelitis and found only one case that clinically represented cerebellar poliomyelitis. The symptoms in this case consisted of extreme lateral nystagmus, vertigo, intention tremor, and ataxia.There is a great diversity of opinion in the literature regarding the distribution of the lesions within the cerebellum in poliomyelitis. Generally most investigators feel that the Purkinje cells are spared and that most of the lesions are limited to the

BACKGROUND Epidemiological studies of chronic pancreatitis (CP) and its association with pancreatic ductal adenocarcinoma (PDAC) are limited. Understanding demographic and ethno-racial factors may help identify patients at the highest risk for CP and PDAC. AIM To evaluate the ethno-racial risk factors for CP and its association with PDAC. The secondary aim was to evaluate hospitalization outcomes in patients admitted with CP and PDAC. METHODS This retrospective cohort study used the 2016 and 2017 National Inpatient Sample databases. Patients included in the study had ICD-10 codes for CP and PDAC. The ethnic, socioeconomic, and racial backgrounds of patients with CP and PDAC were analyzed. RESULTS Hospital admissions for CP was 29 per 100000, and 2890 (0.78%) had PDAC. Blacks [adjusted odds ratio (aOR) 1.13], men (aOR 1.35), age 40 to 59 (aOR 2.60), and being overweight (aOR 1.34) were significantly associated with CP (all with P < 0.01). In patients with CP, Whites (aOR 1.23), higher income, older age (aOR 1.05), and being overweight (aOR 2.40) were all significantly associated with PDAC (all with P < 0.01). Men (aOR 1.81) and Asians (aOR 15.19) had significantly increased mortality ( P < 0.05). Hispanics had significantly increased hospital length of stay (aOR 5.24) ( P < 0.05). CONCLUSION Based on this large, nationwide analysis, black men between 40-59 years old and overweight are at significantly increased risk for admission with CP. White men older than 40 years old and overweight with higher income were found to have significant associations with CP and PDAC. This discrepancy may reflect underlying differences in healthcare access and utilization among different socioeconomic and ethno-racial groups.

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