Pancreatic cancer: Surgery is a feasible therapeutic option for elderly patients

<p>Abstract</p> <p>Background</p> <p>Compromised physiological reserve, comorbidities, and the natural history of pancreatic cancer may deny pancreatic resection from elderly patients. We evaluated outcomes of elderly patients amenable to pancreatic surgery.</p> <p>Methods</p> <p>The medical records of all patients who underwent pancreatic resection at our institution (1995-2007) were retrospectively reviewed. Patient, tumor, and outcomes characteristics in elderly patients aged ≥ 70 years were compared to a younger cohort (<70y).</p> <p>Results</p> <p>Of 460 patients who had surgery for pancreatic neoplasm, 166 (36%) aged ≥ 70y. Compared to patients < 70y (n = 294), elderly patients had more associated comorbidities; 72% vs. 43% (p = 0.01) and a higher rate of malignant pathologies; 73% vs. 59% (p = 0.002). Operative time and blood products consumption were comparable; however, elderly patients had more post-operative complications (41% vs. 29%; p = 0.01), longer hospital stay (26.2 vs. 19.7 days; p < 0.0001), and a higher incidence of peri-operative mortality (5.4% vs. 1.4%; p = 0.01). Multivariable analysis identified age ≥ 70y as an independent predictor of shorter disease-specific survival (DSS) among patients who had surgery for pancreatic adenocarcinoma (n = 224). Median DSS for patients aged ≥ 70y vs. < 70y were 15 months (SE: 1.6) vs. 20 months (SE: 3.4), respectively (p = 0.05). One, two, and 5-Y DSS rates for the cohort of elderly patients were 58%, 36% and 23%, respectively.</p> <p>Conclusions</p> <p>Properly selected elderly patients can undergo pancreatic resection with acceptable post-operative morbidity and mortality rates. Long term survival is achievable even in the presence of adenocarcinoma and therefore surgery should be seriously considered in these patients.</p

Josef Klausner Collection 1936-1941

The collection consists of photocopies of letters (typed and handwritten) from Josef Klausner, in Berlin, to his son Julius, in the United States.processed for digitizationSent for digitizationdigitize

What should be Done?--The Crisis in Hebrew Literature (1907)

This work is also available on Amazon's Kindle. It is derived from a copy originally in the library of Beth Am ("House of the People") which was formerly at 58th and Burleigh Streets, Milwaukee.This is a translation from Hebrew of a 25-page work published in Krakow, Poland in 1907. Dr. J. Klausner begs support for Hebrew literature at a time when the disturbed political situation in Eastern Europe made any publication whatever very difficult. He discusses the status of Hebrew as the language of the Jewish People, and his opposition to the use of Yiddish or other European languages to express Jewish culture

The Knowledge Mining Center

. Interviewing experts in order to elicit the knowledge they use in solving problems is a very common task in the knowledge acquisition phase. In practice, interviewing experts is a very tedious and costly task. Surprisingly, up to now there is very little technological support for performing interviews widely available. Recent developments in new hardware and software now provides a significantly better technological base to fill this gap. The Knowledge Mining Center is an easy-to-use, yet very flexible tool for interviewing. It allows for better presentation of information during interviews by using multimedia technology and online access to information such as design documents or protocols of earlier interviews. Its main advantage, however, is its capability to semiautomatically capture, segment, and annotate information verbally communicated during interviews. The paper motivates the need for technological support for interviewing, discusses design considerations for interviewing t..

Non-hip fracture-associated trauma in the elderly population

BACKGROUNDThe rate of trauma in the elderly is growing.OBJECTIVESTo evaluate the characteristics of non-hip fracture-associated trauma in elderly patients at a level I trauma center.METHODSThe study database of this retrospective cohort study was the trauma registry of a level I trauma center. Trauma patients admitted from January 2001 to December 2003 were stratified into different age groups. Patients with the diagnosis of hip fracture were excluded.RESULTSThe study group comprised 7629 patients. The non-hip fracture elderly group consisted of 1067 patients, 63.3% women and 36.7% men. The predominant mechanism of injury was falls (70.5%) and most of the injuries were blunt (94.1%). Injury Severity Score was found to increase significantly with age. The average mortality rate among the elderly was 6.1%. Age, ISS, Glasgow Coma Score on admission, and systolic blood pressure on admission were found to be independent predictors of mortality.CONCLUSIONSFalls remain the predominant cause of injury in the elderly. Since risk factors for mortality can be identified, an effective community prevention program can help combat the future expected increase in morbidity and mortality associated with trauma in the elderly

Ultrasonography for the evaluation of abdominal trauma in multiple casualty incidents

Objective: Ultrasound (US) is commonly used for the diagnosis of hemoperitoneum in trauma patients. The use of US in the evaluation of abdominal injury during multiple casualty incidents (MCIs) has been described, but never evaluated. The purpose of this study was to determine the accuracy of US for evaluation of the unique injury patterns associated with MICs. Patients and methods: We conducted a retrospective study of patients admitted to a Level 1 trauma center during MCIs resulting from terrorist attacks in the Tel-Aviv area. Results: During the 4-year study period there were 43 patients who had an US examination as part of their initial assessment. The overall accuracy of the US examination was 77%, with a sensitivity of 40%, and a specificity of 88%. The positive predictive value (PPV) was 50%, and the negative predictive value (NPV) was 83%. Conclusions: Although US examination lacks the sensitivity to be used alone in determining operative intervention in the evaluation of patients admitted in an MCI, a reasonable specificity might justify its use as a screening tool in MCIs