Value of magnetic resonance imaging in spontaneous extradural spinal hematoma due to vascular malformation: case report

A case of spinal cord compression due to spontaneous extradural spinal hematoma is reported. A spinal arteriovenous malformation was suspected on the basis of magnetic resonance imaging. Early surgical exploration allowed a complete neurological recovery. The vascular malformation was histopathologically confirmed. The role of magnetic resonance imaging in the evaluation of acute spinal cord compression syndromes is stressed.     

Leukotriene B4 receptor antagonist LY293111 induces S-phase cell cycle arrest and apoptosis in human pancreatic cancer cells

We have previously shown that the leukotriene B4 receptor antagonist, LY293111 inhibits proliferation and induces apoptosis in human pancreatic cancer cells both in vitro and in vivo. In the current study, we investigated the molecular mechanisms of LY293111-induced apoptosis and cell cycle arrest. Two human pancreatic cancer cell lines were used in this study, MiaPaCa-2 and AsPC-1. Cell cycle analysis by flow cytometry showed a dramatic increase in the percentage of apoptotic cells as well as S-phase arrest after treatment with 250 nmol/l LY293111 for up to 48 h. Western blotting indicated that LY293111 treatment induced cytochrome c release from the mitochondria into the cytosol, accompanied by caspase-9, caspase-7 and caspase-3 activation, and cleavage of poly ADP-ribose polymerase. Caspase-8 was not activated by LY293111. A decrease was found in the expression of the antiapoptotic proteins, Bcl-2 and Mcl-1, and an increase in the proapoptotic protein, Bax. LY293111 reduced the expression of CDK2, cyclin A and cyclin E, consistent with the S-phase arrest observed in these cells. The expression of cyclin-dependent kinase inhibitors, p21 and p27 was not affected by LY293111 treatment. In conclusion, LY293111 induces apoptosis in human pancreatic cancer cells through the mitochondria-mediated pathway. LY293111 also induces S-phase arrest with downregulation of CDK2, cyclin A and cyclin E. Blockade of leukotriene B4 metabolic pathway may provide a novel treatment for human pancreatic cancer.     

Quality of pancreatic cancer care at Veterans Administration compared with non-Veterans Administration hospitals

BACKGROUND: National efforts are underway to monitor the quality of patient care at Veterans Administration (VA) hospitals. The objective of this study was to examine treatment utilization and outcomes for localized pancreatic cancer at VA compared with non-VA hospitals. METHODS: Using the National Cancer Data Base, patients with pretreatment clinical stage I/II pancreatic adenocarcinoma were identified. Treatment utilization and outcomes were assessed at VA compared with academic and community hospitals. RESULTS: Of 35,009 patients, 2% were seen at VA, 38% at academic, and 54% at community hospitals. VA hospitals were more likely to use surgery (odds ratio 2.20, 95% confidence interval 1.73-2.79) and to administer adjuvant chemotherapy (odds ratio 1.77, confidence interval 1.28-2.46) compared with community hospitals. Adjusted perioperative mortality and 3-year survival rates after surgery were similar at VA and academic hospitals. CONCLUSIONS: For localized pancreatic cancer, patients treated at VA hospitals receive stage-specific treatments and have risk-adjusted perioperative and long-term survival rates that are comparable with those for patients treated at academic centers.     

Complete Lymph Node Dissection for Sentinel Node-Positive Melanoma: Assessment of Practice Patterns in the United States

Background Currently, complete lymph node dissection (CLND) is recommended after identification of a metastatic lymph node by sentinel lymph node biopsy (SLNB). Guidelines suggest that CLND should be performed as a separate procedure, and a sufficient number of nodes should be examined. Our objective was to examine the utilization, timing, and adequacy of CLND for melanoma in the United States. Methods From the National Cancer Data Base, patients diagnosed with stage I to III melanoma during 2004–2005 were identified. Multiple logistic regression was used to assess factors associated with CLND utilization, timing (separate operation from SLNB), and adequacy (examination of ≥10 nodes). Results Of the 44,548 patients identified, 47.5% were pathologic stage IA, 23.8% stage IB, 14.1% stage II, and 14.6% stage III. Of the 17% (2942 of 17,524) with nodal metastases on SLNB, only 50% underwent a CLND. Patients were significantly less likely to undergo a CLND after SLNB if >75 years old or had lower extremity melanomas. Of the patients who underwent a CLND, only 42% underwent the CLND at a separate procedure after the SLNB. Of those who underwent a CLND, 69.2% had ≥10 nodes examined. Patients were significantly less likely to have ≥10 nodes examined if they were >75 years old or had lower extremity melanomas. Patients treated at NCCN/NCI-designated centers were significantly more likely to undergo nodal evaluation in concordance with established guidelines. Conclusions Only half of patients with sentinel node-positive melanoma underwent CLND. Quality surveillance measures are needed to monitor, standardize, and improve the care of patients with malignant melanoma. Presented in part at the Society of Surgical Oncology Annual Meeting, March 14, 2008, Chicago, IL.     

Sequential reconstruction of complex femoral fractures with circular hybrid Sheffield frame in polytrauma patients

The timing of definitive fixation for major fractures in polytrauma patients is controversial. We investigated the outcome of the Sheffield hybrid system (SHF) as a solution in the role of primary and definitive fixator for patient with open femoral fractures in whom definitive osteosynthesis with intramedullary nail can be associated with higher rate of complications. Eleven patients (7 men and 4 women), mean age of 40.4 years (range 14–75 years) with previous injury severity score (ISS) greater than or equal to 16 were treated from a damage control orthopedics perspective. Time in the fixator averaged 28 weeks (range 10–64 weeks). Mean follow-up was 3 years (2–4.5). All fractures united. Paley functional and bone results in most cases were good to excellent. Final mean knee range of motion was 113 degrees. We found that SHF for complex fractures of the femur combine maximum support for the bone and preservation of soft tissues. SHF is an effective technique compared to internal nails and earlier external fixator devices, attributable to its advantages such as continuity of frame till union, preventing any second-hit phenomenon, early mobilization, and restoration of primary defect due to bone loss by differential distraction osteogenesis without additional surgery.     

Rectus abdominis atrophy after ventral abdominal incisions: midline versus chevron

Purpose

Although many outcomes have been compared between a midline and chevron incision, this is the first study to examine rectus abdominis atrophy after these two types of incisions.

Methods

Patients undergoing open pancreaticobiliary surgery between 2007 and 2011 at our single institution were included in this study. Rectus abdominis muscle thickness was measured on both preoperative and follow-up computed tomography (CT) scans to calculate percent atrophy of the muscle after surgery.

Results

At average follow-up of 24.5 and 19.0 months, respectively, rectus abdominis atrophy was 18.9% greater in the chevron (n = 30) than in the midline (n = 180) group (21.8 vs. 2.9%, p < 0.0001). Half the patients with a chevron incision had >20% atrophy at follow-up compared with 10% with a midline incision [odds ratio (OR) 9.0, p < 0.0001]. No significant difference was observed in incisional hernia rates or wound infections between groups.

Conclusion

In this study, chevron incisions resulted in seven times more atrophy of the rectus abdominis compared with midline incisions. The long-term effects of transecting the rectus abdominis and disrupting its innervation creates challenging abdominal wall pathology. Atrophy of the abdominal wall can not be readily fixed with an operation, and this significant side effect of a transverse incision should be factored into the surgeon’s decision-making process when choosing a transverse over a midline incision.