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Background: Acinar score calculated at the pancreatic resection margin is associated with postoperative pancreatic fistula (POPF) after pancreatoduodenectomy (PD). The present study evaluates the association between (i) computed tomography (CT) density of the pancreas and the acinar score of the pancreatic resection margin, and (ii) CT density of the pancreas and POPF after PD.Methods: Consecutive patients who underwent PD were included for analysis. CT densities of the pancreatic head, neck, body and tail were measured in non-contrast (NC), arterial (ART) and portal venous (PV) phases. Histologic slides of the pancreatic resection margin were scored for acinar cell density.Results: Ninety patients were included for analysis. Non-contrast density of the pancreatic tail was a good predictor of POPF (AUROC 0.704, p = 0.036), and a cut-off value of >40 Hounsfield units predicted POPF with 70.0% sensitivity and 73.4% specificity. The ratio of densities between PV and NC phases in the pancreatic tail was also a good predictor of POPF (AUROC 0.712, p = 0.030), and a cut-off value of <2.29 predicted POPF with 70.9% sensitivity and 80% specificity. Conclusion:Non-contrast CT density of the pancreatic tail correlates with acinar cell density of the pancreatic resection margin and predicts the development of POPF after PD.

Background Postoperative pancreatic fistula (POPF) is a potentially lethal complication of pancreatic surgery. POPF rate is consistently higher after distal pancreatectomy (DP) compared with pancreatoduodenectomy (PD). The acinar score of the remnant pancreas is associated with postoperative pancreatitis and POPF. This study aimed to: (i) confirm the difference in POPF rate after DP vs PD; (ii) confirm the association between acinar score and POPF; and (iii) evaluate the difference in acinar scores between DP and PD. Methods Patients undergoing DP or PD at a single institution from 2011 to 2017 were included. Hematoxylin and eosin‐stained slides of the pancreatic resection margin were evaluated for all patients and scored for acinar cell density. Clinicopathological data were retrieved from a prospectively maintained database. Results Two hundred and ninety‐four patients were included in the analysis (206 PD, 88 DP). The POPF rate was significantly higher after DP than PD (20.4% vs 11.2%, P = .043). Acinar score >50 was independently associated with the development of POPF (OR 6.457, P = .003). DP was associated with a higher median acinar score than PD (65 vs 50, P < .001). Conclusion The POPF rate is significantly higher after DP compared with PD and is attributable to a higher acinar score of the pancreatic resection margin.

Background and Objectives: Thyroid cancer incidence is increasing globally. There is limited data regarding the epidemiology of thyroid cancer in the Middle East and North Africa region. This region has also experienced socioeconomic changes recently that have influenced the histopathological and epidemiological pattern of thyroid cancer. The aim of this study is to evaluate the histological, epidemiologic, and surgical factors of thyroid cancer patients who underwent thyroidectomy at Cleveland Clinic Abu Dhabi. Materials and Methods: A retrospective review of patients who underwent thyroidectomy and found to have thyroid cancer over a 2-year period from July 2015 - July 2017. The histopathological data were reviewed based on the College of American Pathologists Protocol for Carcinomas of Thyroid Gland (American Joint Committee on Cancer, 7th edition, 2010). Results: One hundred patients underwent surgery for thyroid carcinoma in our patient population. In these cancer patients, the female to male ratio was 5.25:1 and 71 patients (71%) were below 45 years of age. The most common surgery performed was total thyroidectomy at 75.7%. Papillary thyroid carcinoma (PTC) was the most common pathology in 89%, followed by follicular thyroid carcinoma (FTC) in 9%, one case of mixed papillary follicular carcinoma, and one case of Hurthle cell carcinoma. Hypocalcemia was the most common postoperative complication (20.6%). Conclusion: PTC, traditionally seen in iodine sufficient regions, is the most common histologic subtype of thyroid cancer and its rates are increasing in the United Arab Emirates (UAE). Female gender and age <45 were associated with thyroid carcinoma in our UAE patient cohort.

Background: Eosinophilic cystitis is a rare inflammatory cystitis of unknown origin. Common symptoms include urinary frequency, urgency, pain, and recurrent urinary tract infections. Currently used treatments include corticosteroids, anti-inflammatory drugs, antihistamines, and antibiotics. Here we present a case of successful treatment of eosinophilic cystitis with mepolizumab. Case presentation: A 41-year-old female presented with urinary frequency, urgency, and suprapubic pain. She underwent multiple tests including cystoscopy and biopsy, which revealed a diagnosis of eosinophilic cystitis in 2000. She was initially managed with oral antihistamines and oral steroids. However, over the years her symptoms increased in frequency, intensity, and duration. Montelukast 10 mg daily started which did not show any improvement. In 2017 Mepolizumab 100 mg every 4 weeks started. The patient noted improvement after a few months, and she was tolerating her injections well without side effects and had no further flares of her condition. Discussion: We present a case of eosinophilic cystitis which was refractory to multiple treatments and responded well to mepolizumab. There are no definite guidelines for the management of EC and there is no curative treatment for this disease. Mepolizumab is an anti-IL-5 monoclonal antibody and the use of mepolizumab in the management of EC that is refractory to treatment have been reported in a few cases. The use of mepolizumab has been described in different diseases associated with eosinophilic inflammation such as severe eosinophilic asthma, eosinophilic esophagitis, eosinophilic chronic obstructive pulmonary disease, and severe nasal polyposis. Conclusion: Mepolizumab can be considered a treatment option in EC cases refractory to the standard treatment. At this time, larger studies are needed to evaluate the efficacy and safety of mepolizumab in EC.