Impact of venous thromboembolism on the natural history of pancreatic adenocarcinoma

Few studies have analyzed the effect of ve- nous thromboembolism （VTE） events on the prognosis of pancreatic cancer, but their results were conflicting. The pres- ent study was undertaken to determine the effect of VTE on pancreatic adenocarcinoma （PA） outcomes. METHODS： All consecutive patients diagnosed with PA from May 2004 to January 2012 in a single oncology center were retrospectively studied. Clinical, radiological and histologi- cal data at time of diagnosis or within the first 3 months after surgery, including the presence （＋） or absence （-） of VTE were collected. VTE was defined as radiological evidence of either pulmonary embolism （PE）, deep venous thrombosis without infection or catheter-related thrombosis. PA with and without PE was compared for survival using the Kaplan-Meier method to estimate overall survival. RESULTS： Among 162 PA patients with a median follow-up of 15 （3-92） months after diagnosis, 28 demonstratedVTE （＋）. PA patients with and without PE were similar for age, American Society of Anesthesiologist score, body mass index, and histo- ry of treatment. The distribution of cancer stages was similarbetween the two groups VTE （＋） and VTE （-）. The median du- ration of survival was significantly worse in the VTE （＋） group vs VTE （-） （12 vs 18 months, P=0.010）. In multivariate analysis, the presence of VTE and surgical treatment were independent prognostic factors for overall survival. CONCLUSION： VTE （＋） at time of diagnosis or within the first 3 months after surgery during treatment is an indepen- dent factor of poor prognosis in PA.

Standardized quantitative measurements of wrist cartilage in healthy humans using 3T magnetic resonance imaging

AIM: To quantify the wrist cartilage cross-sectional area in humans from a 3D magnetic resonance imaging(MRI) dataset and to assess the corresponding reproducibility. METHODS: The study was conducted in 14 healthy volunteers(6 females and 8 males) between 30 and 58 years old and devoid of articular pain. Subjectswere asked to lie down in the supine position with the right hand positioned above the pelvic region on top of a home-built rigid platform attached to the scanner bed. The wrist was wrapped with a flexible surface coil. MRI investigations were performed at 3T(Verio-Siemens) using volume interpolated breath hold examination(VIBE) and dual echo steady state(DESS) MRI sequences. Cartilage cross sectional area(CSA) was measured on a slice of interest selected from a 3D dataset of the entire carpus and metacarpalphalangeal areas on the basis of anatomical criteria using conventional image processing radiology software. Cartilage cross-sectional areas between opposite bones in the carpal region were manually selected and quantified using a thresholding method.RESULTS: Cartilage CSA measurements performed on a selected predefined slice were 292.4 ± 39 mm2 using the VIBE sequence and slightly lower, 270.4 ± 50.6 mm2, with the DESS sequence. The inter(14.1%) and intra(2.4%) subject variability was similar for both MRI methods. The coefficients of variation computed for the repeated measurements were also comparable for the VIBE(2.4%) and the DESS(4.8%) sequences. The carpus length averaged over the group was 37.5 ± 2.8 mm with a 7.45% between-subjects coefficient of variation. Of note, wrist cartilage CSA measured with either the VIBE or the DESS sequences was linearly related to the carpal bone length. The variability between subjects was significantly reduced to 8.4% when the CSA was normalized with respect to the carpal bone length.CONCLUSION: The ratio between wrist cartilage CSA and carpal bone length is a highly reproducible standardized measurement which normalizes the natural diversity between individuals.