Non-neoplastic epithelial pancreatic cysts are rare, benign lesions. In our institutional experience, these lesions are often indistinguishable from cystic neoplasms of the pancreas preoperatively. As such, many of these lesions are resected unknowingly. It is important for the clinician to be well informed of the nature of these lesions, in the hopes to avoid unnecessary resection whenever possible.

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.

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Background: Sudden Cardiac Arrest (SCA) is a leading cause of global mortality. In India, 700,000 people die from SCA annually, many of which are under the age of 50. Immediate bystander CPR improves chances of survival, however, CPR education and training are difficult in a developing country such as India. In collaboration with University of Illinois Global Health Program, the Indian American Medical Association (Illinois), SHARE INDIA, and the American Heart Association we studied native rural Indian populations, hoping to enhance CPR education and skills training. This is the first rural community CPR project in India involving a university residency-training program from the USA. Methods: We conducted hands-only CPR training (based on the latest AHA guidelines) in the Telangana State in India, recruiting 582 participants with the help of local health outreach workers. A pre-training survey was used to assess baseline knowledge and impressions of CPR. This was followed by training in hands-only CPR consisting of an oral presentation followed by interactive CPR manikin training. A post-course survey was conducted after training. Chi square test and McNemar’s test were used for the analysis of data using SAS. Results: Of 582 participants, 65% were males and the mean age was 19.4 + 5.9. Gender was not associated with pre/post-test CPR knowledge, comfort with CPR, or belief in CPR efficacy. However, in paired analysis, there were significant differences (p<0.0001) in all knowledge and perception measures from pre-to-post training. While only 6% knew the correct compression rate pre-training, 96% knew the correct answer post-training (4% vs. 94% in females, 6% vs. 96% in males). Similar results were seen for the compression depth variable. Training also improved comfort level in performing CPR (64% vs. 87% in females and 70% vs. 89% in males) and belief that CPR can save lives (49% vs. 96% in females and 51% vs. 97% in males). Conclusions: The program was successful in enhancing knowledge, comfort, and perceptions of CPR. Given the high prevalence of SCA in India, training the public in hands-only CPR can be a cost-effective care strategy in resource-limited areas. Due to the success of this pilot, we are planning to continue the program.

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