Immunohistochemical Predictors for Intestinal and Pancreatobiliary Types of Adenocarcinoma of The Ampulla of Vater

Objectives

To investigate immunohistochemical predictors for intestinal and pancreatobiliary types of adenocarcinoma of ampulla of Vater and identify clinicopathological characteristics associated with the histological types and patient survival.

Methods

Immunohistochemical markers included MUC1, MUC2, MUC5AC, CDX2, CK7, and CK20. The data were analyzed by univariate and multivariate methods. The two-step cluster method was used to determine the best immunohistochemical markers to discriminate the intestinal from the pancreatobiliary type.

Results

This study identified 9 (33.3%) intestinal and 21 (66.7%) pancreatobiliary tumors. CK7 and CDX2 achieved the highest value (=?1) as predictor markers, while CK20, MUC1, and MUC2 showed degrees of importance equal to 0.77, 0.71, and 0.68, respectively. MUC5AC did not reach 0.50 of importance. In the univariate analysis, lymph node involvement, staging (TNM), and angiolymphatic and perineural invasions were associated with histological types. The independent clinicopathological variable in the multivariate model to predict the histological type was angiolymphatic invasion (p?=?0.005), OR?=?17 (95% CI 2.33 to 123.83). The final model showed positive nodes (N1) associated with shorter survival (HR?=?9.5; p?=?0.006). Overall survival at 12, 36, and 60 months was 88.5, 67.0, and 47.6%, respectively.

Conclusions

CDX2 and CK7 were the immunohistochemical markers that best discriminated the intestinal from the pancreatobiliary type. Lymph node involvement had a high impact on survival and proved to be more frequent in the pancreatobiliary type.

     

The effect of case-based discussion of topics with experts on learners’ opinions: implications for spinal education and training

Purpose

This investigation aimed to examine the extent to which case-based discussion with experts could influence the audience’s opinions on the treatment of patients during a continuing medical education event for spine surgeons.

Methods

We conducted a prospective controlled crossover study of 90 surgeons. During a continuing medical education activity using case-based discussion, quiz questions were used which asked participants (attendants and faculty group) their opinions on the best choices about diagnosis and treatment in a number of cases. No answer was considered correct, but we evaluated the number of participants choosing each specific answer among a number of valid options. Quiz questions were collected with an automated response system at the entry and at the end of each case discussion. Change in participant’s opinions was estimated from the change in the preferred answers between the entry and exit quizzes. Chi-square analysis was performed to determine significance.

Results

Sixty-two attendants out of eighty three (75%) and six faculties out of twelve (50%) responded to the survey. After the case discussion, 68.2% (p < 0.04, Chi-square test) of the attendants changed their opinion on the appropriate treatment. The faculty answers, however, showed no significant change in opinions regarding the identification of the appropriate treatment.

Conclusions

On the basis of our results, case-based discussion driven by experts, as a form of teaching, has a measurable effect in terms of changes in the learners’ opinions.

     

Identifying Reasons for Failed Same-Day Discharge Following Primary Total Hip Arthroplasty

Background

As total hip arthroplasty (THA) gains popularity in ambulatory surgery centers, it is important to understand the causes of failed same-day discharge (SDD). The purpose of this study is to (1) identify reasons for an overnight stay among patients selected as candidates for SDD following THA and (2) determine what pre-operative factors are more common among patients who fail SDD.