Splenic vein thrombosis is associated with an increase in pancreas-specific complications and reduced survival in patients undergoing distal pancreatectomy for pancreatic exocrine cancer.

Distal pancreatectomy and splenectomy (DPS) is the procedure of choice for the surgical treatment of pancreatic exocrine cancer localized to the body and tail of the pancreas. Splenic vein thrombosis (SVT) can occur in patients with malignant pancreatic exocrine tumors secondary to direct tumor invasion or compression of the splenic vein by mass effect. This study examines the effect of preoperative SVT on postoperative outcomes. In this retrospective cohort study, we queried our pancreatic surgery database to identify patients who underwent DPS from October 2005 to June 2011. These cases were evaluated for evidence of preoperative SVT on clinical records and cross-sectional imaging (CT,MRI, endoscopic US). Outcomes for patients with and without SVT were compared. From an overall cohort of 285 consecutive patients who underwent DPS during the study period, data were evaluated for 70 subjects who underwent surgery for pancreatic exocrine cancer (27 with SVT, 43 without SVT). The preoperative demographics and co-morbidities were similar between the groups, except the average age was higher for those without SVT (p<0.05). The median estimated blood loss was significantly higher in the SVT group (675 versus 250 ml, p=<0.001).While the overall morbidity rates were similar between the two groups (48 % SVT versus 56% no SVT, p=NS), the group with SVT had a significantly higher rate of pancreas-specific complications, including pancreatic fistula (33 versus 7 %,p<0.01) and delayed gastric emptying (15 versus 0%, p<0.02). Hospital readmission rates were similar between the groups(30 versus 28 %, p=NS). Patients without SVT had a trend toward longer median survival (40 versus 20.8 months),although the difference was not statistically significant (p=0.1). DPS for pancreatic ductal adenocarcinoma can be performed safely in patients with SVT, but with higher intraoperative blood loss, increased pancreas-specific complications, and a trend towards lower long-term survival rates. This paper was presented as a poster at the 53rd annual meeting of the Society for Surgery of the Alimentary Tract and at the 46th annual meeting of the Pancreas Club, San Diego, CA, May 2012.

Effects of acutely lowering intraocular pressure on the results of multifocal visual evoked potential testing.

PURPOSE: There have been many reports in the literature on the apparent reversal of optic nerve cupping in patients with glaucoma after lowering intraocular pressure (IOP) on clinical examination, as well as improvement in visual field testing, and increased nerve fibre layer thickness on optical coherence tomography. No studies to date have looked at improvement of multifocal visually evoked potentials (mfVEP) after lowering IOP. METHODS: This was a prospective study of twenty consecutive patients with elevated IOP seen in the glaucoma department of Wills Eye Institute. Patients who met the inclusion criteria for this study had a complete eye examination including IOP measurement and underwent testing with mfVEP, Heidelberg Retinal Tomograph (HRT) and static achromatic automated perimetry with SITA-Standard 24-2 program Humphrey visual field (HVF) studies at baseline and 2 h post-IOP reduction. A minimum of 30% IOP reduction was required. IOP changes were then compared with various parameters of mfVEP, HRT and HVF using Spearman rank correlation coefficients. RESULTS: The Spearman rank correlation values between change in IOP versus various parameters were calculated: Accumap severity index (ASI), 0.37 (p = 0.14); Accumap superior hemifield, 0.049 (p = 0.85); Accumap inferior hemifield, 0.030 (p = 0.91); HVF mean deviation, 0.081 (p = 0.76); HRT rim area, 0.17 (p = 0.51); HRT cup area, -0.006 (p = 0.98). Weak positive but insignificant correlations were seen for all parameters except cup area. CONCLUSIONS: This pilot study failed to confirm statistically significant correlations between IOP reduction and changes in Accumap, HVF and HRT measures, although positive correlations were seen for most measures.