Outcomes analysis of laparoscopic resection of pancreatic neoplasms.

BACKGROUND: Experience with laparoscopic resection of pancreatic neoplasms remains limited. The purpose of this study is to critically analyze the indications for and outcomes after laparoscopic resection of pancreatic neoplasms. METHODS: The medical records of all patients undergoing laparoscopic resection of pancreatic neoplasms from July 2000 to February 2006 were reviewed. Data are expressed as mean +/- standard deviation. RESULTS: Laparoscopic pancreatic resection was performed in 22 patients (M:F, 8:14) with a mean age of 56.3 +/- 15.1 years and mean body mass index (BMI) of 26.3 +/- 4.5 kg/m2. Nine patients had undergone previous intra-abdominal surgery. Indications for pancreatic resection were cyst (1), glucagonoma (1), gastrinoma (2), insulinoma (3), metastatic tumor (2), IPMT (4), nonfunctioning neuroendocrine tumor (3), and mucinous/serous cystadenoma (6). Mean tumor size was 2.4 +/- 1.6 cm. Laparoscopic distal pancreatectomy was attempted in 18 patients and completed in 17, and enucleation was performed in 4 patients. Laparoscopic ultrasound (n = 10) and a hand-assisted technique (n = 4) were utilized selectively. Mean operative time was 236 +/- 60 min and mean blood loss was 244 +/- 516 ml. There was one conversion to an open procedure because of bleeding from the splenic vein. The mean postoperative LOS was 4.5 +/- 2.0 days. Seven patients experienced a total of ten postoperative complications, including a urinary tract infection (UTI) (1), lower-extremity deep venous thrombosis (DVT) and pulmonary embolus (1), infected peripancreatic fluid collection (1), pancreatic pseudocyst (1), and pancreatic fistula (6). Five pancreatic fistulas were managed by percutaneous drainage. The reoperation rate was 4.5% and the overall pancreatic-related complication rate was 36.4%. One patient developed pancreatitis and a pseudocyst 5 months postoperatively, which was managed successfully with a pancreatic duct stent. There was no 30-day mortality. CONCLUSIONS: Laparoscopic pancreatic resection is safe and feasible in selected patients with pancreatic neoplasms. With a pancreatic duct leak rate of 27%, this problem remains an area of development for the minimally invasive technique.

Abstracting data from medical examiner/coroner reports: concordance among abstractors and implications for data reporting.

The purpose of this study was two-pronged: 1) to determine the level of concordance (agreement) between multiple records abstractors who extracted defined data elements from printed medical examiner/coroner (ME/C) death investigation records; and 2) to identify data items for which improved reporting could facilitate the effective use of ME/C reports and data. Four hundred ninety four printed death investigation records were obtained from 224 medical examiner/coroner offices throughout the United States. Trained abstractors were asked to extract information for 110 data elements from investigative reports. Additional data elements for each toxicology workup were abstracted from toxicology laboratory reports and six-digit AIS codes were also abstracted for each injury as described in autopsy reports. The ability of multiple abstractors to identify each data element and identically abstract the data was assessed using Kappa statistical methods. Level of agreement for many data elements was very good (>0.9), but for some data elements agreement was marginal to poor, especially for items related to toxicology, the nature of specific injuries, and dates, times of the occurrence of death and injury. Many data items can be easily abstracted from ME/C records. However, some data items seem difficult to abstract reliably in all cases. Standardizing the report formats used by ME/Cs and/or standardizing the electronic storage of ME/C data would make the abstraction of such data easier and improve the usefulness of ME/C data.

Quality of death rates by race and Hispanic origin: a summary of current research, 1999.

OBJECTIVES: This report provides a summary of current knowledge and research on the quality and reliability of death rates by race and Hispanic origin in official mortality statistics of the United States produced by the National Center for Health Statistics (NCHS). It also provides a quantitative assessment of bias in death rates by race and Hispanic origin. It identifies areas for targeted research. METHODS: Death rates are based on information on deaths (numerators of the rates) from death certificates filed in the states and compiled into a national database by NCHS, and on population data (denominators) from the Census Bureau. Selected studies of race/Hispanic-origin misclassification and under coverage are summarized on deaths and population. Estimates are made of the separate and the joint bias on death rates by race and Hispanic origin from the two sources. Simplifying assumptions are made about the stability of the biases over time and among age groups. Original results are presented using an expanded and updated database from the National Longitudinal Mortality Study. RESULTS: While biases in the numerator and denominator tend to offset each other somewhat, death rates for all groups show net effects of race misclassification and under coverage. For the white population and the black population, published death rates are overstated in official publications by an estimated 1.0 percent and 5.0 percent, respectively, resulting principally from undercounts of these population groups in the census. Death rates for the other minority groups are understated in official publications approximately as follows: American Indians, 21 percent; Asian or Pacific Islanders, 11 percent; and Hispanics, 2 percent. These estimates do not take into account differential misreporting of age among the race/ethnic groups.

Synthesis of a series of sulfinic acid analogs of GABA and evaluation of their GABAB receptor affinities.

A series of gamma-aminobutyric acid (GABA) 1 analogs was prepared in which the carboxylic acid group of GABA was replaced with a sulfinic acid group and their affinity for the GABAB receptor investigated.

The abstractability and consistency of medical examiner/coroner reports: results from the 1993 National Mortality Followback Survey pilot.

UNLABELLED: The 1993 National Mortality Followback Survey (NMFS) is designed to provide national estimates of important characteristics of the 2,218,940 people aged 15 years and older who died in 1993. One topic of special interest in the survey is injury-related deaths. Previous followback surveys have not obtained data from medical examiner and coroner offices (ME/Cs), who investigate most injury-related deaths. In this study, we sought to determine the feasibility of collecting data from various ME/C offices for the NMFS and the usefulness and limitations of data derived from their records. METHODS: We 1) developed a pilot survey instrument, the Medical Examiner/Coroner Abstract (MECA); 2) attempted to collect ME/C records on 159 deaths from 55 ME/C offices in four states with a variety of death investigation systems; and 3) assessed the feasibility of abstracting data from these records using the MECA. RESULTS: We received records on 105 deaths from 39 ME/C offices in three states. We identified items that could be abstracted from the records of most deaths and found that different abstractors could reproducibly and reliably identify information on these core items. Using the results of this study, we revised the MECA for use in the NMFS.

Antiinflammatory activity of substituted 6-hydroxypyrimido[2,1-f]purine-2,4,8(1H,3H,9H)-triones. Atypical nonsteroidal antiinflammatory agents.

A novel class of antiinflammatory drugs, which are substituted derivatives of the fused tricyclic system 6-hydroxypyrimido[2,1-f]purine-2,4,8(1H,3H,9H)-trione, is described. Synthetic procedures and structure determination with the assistance of X-ray crystallography are discussed. Semiempirical molecular orbital calculations are used to investigate the relative stability of the possible isomers and tautomers of the title compounds. A biological profile of the class, and of several of the more potent analogues, in several antiinflammatory models, including the adjuvant-induced arthritis and the collagen II models, is defined. Several members of the class are shown to possess extremely low ulcerogenic effects in spite of exhibiting cyclooxygenase inhibition. A preliminary bioavailability study of two of the lead structures is presented. The compounds 6-72 appear to constitute a class of drugs that shows interesting potential antiarthritic activity and also exhibits an activity profile different from that of the standard classical NSAI drugs, as determined by a comparison of the profile of this class of drug with that of several standard agents. Certain findings from toxicological studies have precluded the further development of compounds within this group, although related structural types are being investigated.