Clinical predictors of resectability of pancreatic adenocarcinoma

Identifying patient-related factors as well as symptoms and signs that can predict pancreatic cancer at a resectable stage, which could be used in an attempt to identify patients at an early stage of pancreatic cancer that would be appropriate for surgical resection and those at an unresectable stage be sparred unnecessary surgery. A retrospective chart review was conducted at a major tertiary care, university hospital in Riyadh, Saudi Arabia. The study population included individuals who underwent a computed tomography and a pancreatic mass was reported as well as the endoscopic reporting database of endoscopic procedures where the indication was a pancreatic mass, between April 1996 and April 2012. Any patient with a histologically confirmed diagnosis of adenocarcinoma of the pancreas was included in the analysis. We included patients' demographic information [age, gender], height, weight, body mass index, historical data [smoking, comorbidities], symptoms [abdominal pain and its duration, anorexia and its duration, weight loss and its amount, and over what duration, vomiting, abdominal distention, itching and its duration, change in bowel movements, change in urine color], jaundice and its duration. Other variables were also collected including laboratory values, location of the mass, the investigation undertaken, and the stage of the tumor. A total of 61 patients were included, the mean age was 61.2 +/- 1.51 years, 25 [41%] were females. The tumors were located in the head [83.6%], body [10.9%], tail [1.8%], and in multiple locations [3.6%] of the pancreas. Half of the patients [50%] had Stage four, 16.7% stages two B and three, and only 8.3% were stages one B and two A. On univariable analysis a lower hemoglobin level predicted resectability odds ratio 0.65 [95% confidence interval, 0.42-0.98], whereas on multivariable regression none of the variables included in the model could predict resectability of pancreatic cancer. A CA 19-9 cutoff level of 166 ng/mL had a sensitivity of 89%, specificity of 75%, positive likelihood ratio of 3.6, and a negative likelihood ratio of 0.15 for resectability of pancreatic adenocarcinoma. This study describes the clinical characteristics of patients with pancreatic adenocarcinoma in Saudi Arabia. None of the clinical or laboratory variables that were included in our study could independently predict resectability of pancreatic adenocarcinoma. Further studies are warranted to validate these results.

Vanishing bile duct syndrome in a Hodgkin's lymphoma patient with fatal outcome despite lymphoma remission

Vanishing bile duct syndrome [VBDS] is a condition resulting from severe bile duct injury, progressive destruction, and disappearance of intrahepatic bile ducts [ductopenia] leading to cholestasis, biliary cirrhosis, and liver failure. VBDS can be associated with a variety of disorders, including Hodgkin's lymphoma [HL]. We describe a 33-year-old male patient who presented with lymphadenopathy and jaundice, and was diagnosed to have HL. Serum bilirubin worsened progressively despite chemotherapy, with a cholestatic pattern of liver enzymes. Diagnosis of VBDS was established on liver biopsy. Although remission from HL was achieved, the patient died of liver failure. Presence of jaundice in HL patients should raise the possibility of VBDS. This report discusses the difficulties of delivering chemotherapy in patients with liver dysfunction. HL-associated VBDS carries a high mortality but lymphoma remission can be achieved in some patients. Therefore, liver transplantation should be considered early in these patients.

Violence against medical staff: prevalence and effects of violence against psychiatrists in Kuwait

To determine the prevalence and effects of violence against psychiatrists in Kuwait. Questionnaire-based study. Hospital for Psychological Medicine, Kuwait. All the consenting psychiatrists working in the only psychiatric hospital in the country were administered two questionnaires; a 12-item frequency-weighted questionnaire to measure the rates, frequency, and severity of violence and another 5-item, duration-weighted questionnaire to measure the effects of violence. 1] The frequency and the type of the violent incidents and 2] the after effects of violence on the victim, over the past one year. Fifty-three [69%] out of 77 psychiatrists completed and returned the questionnaires. Fifty-one [96%] psychiatrists reported having experienced one or another kind of violent incident; twenty-three [49%] experienced physical violence involving a single act of violence and another nineteen [36%] were subjected to physical violence involving multiple assaults or use of a weapon or a gun. The consequences of violence, in order of frequency, included flashbacks [53%], taking time off [41%], fearfulness [32%], and sleeplessness [26%]. The prevalence and severity of violence against psychiatrists are higher than the emergency department [ED] doctors but after-effects of violence were more severe amongst the ED doctors. Introduction of formal protocols, documentation of violent incidents, prosecution of offenders, and organizational support are some of the measures likely to help bring safety at workplace. In view of the small sample size, firm conclusions are difficult to draw