The Endoscopic Management of Pain in Chronic Pancreatitis

Pain resulting from chronic pancreatitis is often debilitating and difficult to manage. Many approaches have been used to treat these patients, including narcotic analgesia, antidepressants, pancreatic enzymes, octreotide, denervation procedures, such as celiac plexus block, and various palliative, decompression, or drainage procedures. Many of these procedures can be performed endoscopically, while others require a more invasive, surgical approach. The effectiveness of these therapies is not only highly variable but also often controversial. This review will discuss the endoscopic options for pain management in patients with chronic pancreatitis and their utility in treating this difficult disease

Physician and patient barriers to adherence with cholesterol guidelines

Several national studies have shown poor compliance with National Cholesterol Education Program II (NCEP) goals. A study we conducted of patients in the General Internal Medicine Clinic at the Marshall University Joan C. Edwards School of Medicine in Huntington showed that 46% of them were not at NCEP goals. We hypothesized that both patient and physician barriers were responsible for these findings so we administered two surveys about barriers to cholesterol management to 261 random patients identified with hypercholesterolemia and to all 50 residents and faculty at the clinic. We identified insufficient knowledge of low cholesterol foods as a patient barrier (31.6% of patients), and inadequate time to review NCEP guidelines as a physician barrier (45.5% of physicians). We conclude that many patients in our practice lack the knowledge of what foods are low in cholesterol and that our physicians may not use the NCEP guidelines because they are inconvenient to access in our clinic. Future research should explore ways to improve patient knowledge of low cholesterol foods and accessibility of guidelines for use during patient visits

Search for Sub-TeV Gamma Rays Coincident with BATSE Gamma Ray Bursts

Project GRAND is a 100m x 100m air shower array of proportional wire chambers (PWCs). There are 64 stations each with eight 1.29 m^2 PWC planes arranged in four orthogonal pairs placed vertically above one another to geometrically measure the angles of charged secondaries. A steel plate above the bottom pair of PWCs differentiates muons (which pass undeflected through the steel) from non-penetrating particles. FLUKA Monte Carlo studies show that a TeV gamma ray striking the atmosphere at normal incidence produces 0.23 muons which reach ground level where their angles and identities are measured. Thus, paradoxically, secondary muons are used as a signature for gamma ray primaries. The data are examined for possible angular and time coincidences with eight gamma ray bursts (GRBs) detected by BATSE. Seven of the GRBs were selected because of their good acceptance by GRAND and high BATSE Fluence. The eighth GRB was added due to its possible coincident detection by Milagrito. For each of the eight candidate GRBs, the number of excess counts during the BATSE T90 time interval and within plus or minus five degrees of BATSE's direction was obtained. The highest statistical significance reported in this paper (2.7 sigma) is for the event that was predicted to be the most likely to be observed (GRB 971110).Comment: To be presented at the XXVIII International Cosmic Ray Conference, Tsukuba, Japa