Distribution and pathological features of pancreatic, ampullary, biliary and duodenal cancers resected with pancreaticoduodenectomy.

BACKGROUND: Pancreatic cancer (PC) has the worst survival of all periampullary cancers. This may relate to histopathological differences between pancreatic cancers and other periampullary cancers. Our aim was to examine the distribution and histopathologic features of pancreatic, ampullary, biliary and duodenal cancers resected with a pancreaticoduodenectomy (PD) and to examine local trends of periampullary cancers resected with a PD. METHODS: A retrospective review of PD between January 2000 and December 2012 at a public metropolitan database was performed. The institutional ethics committee approved this study. RESULTS: There were 142 PDs during the study period, of which 70 cases were pre-2010 and 72 post-2010, corresponding to a recent increase in the number of cases. Of the 142 cases, 116 were for periampullary cancers. There were also proportionately more PD for PC (26/60, 43% pre-2010 vs 39/56, 70% post-2010, P = 0.005). There were 65/116 (56%) pancreatic, 29/116 (25%), ampullary, 17/116 (15%) biliary and 5/116 (4%) duodenal cancers. Nodal involvement occurred more frequently in PC (78%) compared to ampullary (59%), biliary (47%) and duodenal cancers (20%), P = 0.002. Perineural invasion was also more frequent in PC (74%) compared to ampullary (34%), biliary (59%) and duodenal cancers (20%), P = 0.002. Microvascular invasion was seen in 57% pancreatic, 38% ampullary, 41% biliary and 20% duodenal cancers, P = 0.222. Overall, clear margins (R0) were achieved in fewer PC 41/65 (63%) compared to ampullary 27/29 (93%; P = 0.003) and biliary cancers 16/17 (94%; P = 0.014). CONCLUSIONS: This study highlights that almost half of PD was performed for cancers other than PC, mainly ampullary and biliary cancers. The volume of PD has increased in recent years with an increased proportion being for PC. PC had higher rates of nodal and perineural invasion compared to ampullary, biliary and duodenal cancers.

Retrospective review of dog bite injuries in children presenting to a South Australian tertiary children's hospital emergency department.

AIM: To describe the characteristics, circumstances and consequences of dog bite injuries in children in order to inform the discourse concerning preventative approaches. METHOD: A retrospective review of children presenting to the emergency department (ED) of the Women's and Children's Hospital (WCH) in South Australia between the years 2009 and 2011 was performed. RESULTS: A total of 277 children presented to the WCH with dog bite injuries between 2009 and 2011. Of those, 141(51.0%) were referred for admission. Injury rates were highest in those aged 0-4, declining thereafter with age. In the 0-4 year age group, 89.5% of children presented after being bitten by a familiar dog with 92.5% occurring at home. The head/neck region constituted the most common location for injuries. We found that 67.5% of dog bite injuries were provoked and occurred between the child and a familiar dog (78.0%). Dogs from the bull terrier group (20.0%) and Jack Russell Terriers (11.0%) were the two most documented breeds. Almost half of the children presenting during the specified timeframe required at least one operation under a general anaesthetic. Two children were referred to a psychologist for management of post-traumatic stress. CONCLUSION: Dog bite injuries are common in children and often require admission for inpatient care. This presents as a significant public health burden. For this reason, prevention initiatives need to be implemented on an ongoing basis.

A case of pancreatic cancer in the setting of autoimmune pancreatitis with nondiagnostic serum markers.

Background. Autoimmune pancreatitis (AIP) often mimics pancreatic cancer. The diagnosis of both conditions is difficult preoperatively let alone when they coexist. Several reports have been published describing pancreatic cancer in the setting of AIP. Case Report. The case of a 53-year-old man who presented with abdominal pain, jaundice, and radiological features of autoimmune pancreatitis, with a "sausage-shaped" pancreas and bulky pancreatic head with portal vein impingement, is presented. He had a normal serum IgG4 and only mildly elevated Ca-19.9. Initial endoscopic ultrasound-(EUS-) guided fine-needle aspiration (FNA) of the pancreas revealed an inflammatory sclerosing process only. A repeat EUS guided biopsy following biliary decompression demonstrated both malignancy and features of autoimmune pancreatitis. At laparotomy, a uniformly hard, bulky pancreas was found with no sonographically definable mass. A total pancreatectomy with portal vein resection and reconstruction was performed. Histology revealed adenosquamous carcinoma of the pancreatic head and autoimmune pancreatitis and squamous metaplasia in the remaining pancreas. Conclusion. This case highlights the diagnostic and management difficulties in a patient with pancreatic cancer in the setting of serum IgG4-negative, Type 2 AIP.