Faculty Bibliography

BACKGROUND: A polymethylmethacrylate-collagen filler is generally believed to give long-term benefits, but the risk of granuloma formation over time remains unclear. OBJECTIVE: To determine the incidence of granuloma formation and response to treatment and assess the degree of patient satisfaction over 5 years. MATERIALS AND METHODS: Adults seeking correction of nasolabial folds underwent up to 3 injection sessions over 2 months. Subjects were then queried regularly for the development of signs and symptoms of a granuloma. Any positive responses were evaluated, and lesions suspicious for granulomas were confirmed by biopsy. Granulomas were treated at the discretion of the investigator. Subjects also completed regular satisfaction questionnaires. RESULTS: A total of 1,008 subjects were enrolled and 871 completed the full 5 years of the study. A biopsy-confirmed granuloma developed in 1.7% of subjects. Almost all granulomas responded to treatment. At study exit, 0.9% of subjects had an unresolved granuloma. Patient satisfaction remained high throughout the duration of the study. CONCLUSION: The incidence of granuloma formation with a polymethylmethacrylate-collagen dermal filler is low, and almost all lesions are manageable with simple therapeutic measures. Patient satisfaction remains durable over 5 years. Polymethylmethacrylate-collagen offers a well-characterized and very favorable risk/benefit profile.

BACKGROUND: Increasing evidence suggests that the ratio of number of nodes harboring metastatic cancer to the total number of lymph nodes examined (lymph node ratio, LNR) may affect survival after esophagogastric resection for cancer. We analyzed the impact of LNR in overall survival in patients undergoing esophagogastric resection for cancer. METHODS: Patients who underwent gastroesophageal resection for cancer (1998 to 2008) were categorized into 4 groups according to their LNR: 113 patients had negative nodes (N0), 86 LNR less than .3, 40 LNR .31 to .6, and 47 LNR greater than .6. Study endpoint was overall median survival. RESULTS: Higher LNR was associated (P < .001) with more advanced stage and adverse pathologic features (eg, grading, venous/perineural invasion). Multivariate analysis demonstrated that LNR is an independent predictor of survival. CONCLUSION: In our experience, LNR correlates with adverse pathologic features and is a negative prognostic factor in patients undergoing radical resection for gastroesophageal cancer.

Introduction: Gallstone pancreatitis (GP) is an inflammatory process resulting from gallstone obstruction of the common bile duct. Methods: We conducted a retrospective chart review of 200 consecutively- admitted GP patients who presented to the ED between 1/1/2007 and 6/7/2010d100 at Bellevue Hospital Center (BHC), 100 at New York University Langone Medical Center (NYU). Statistical analyses were performed using Student's t test, chi-square test, and/or log-rank test. Results: Ethnic minority patients comprised 87% BHC patients and 28% NYU patients. Sex distribution was 59% female at BHC and 40% female at NYU. BHC patients were aged 42 years on average, as compared to 62 years at NYU. Median household income was $32,600 at BHC and $53,000 at NYU. BHC patients were uninsured or governmentally insured, while NYU patients were governmentally or commercially insured. The difference in number of non-English-speaking patientswas not significant. BHC patients waited 3 days longer from symptoms to presentation (2.7, 95%CI=1.0-4.4, p<0.01). NYUpatients presented with a median lipase of 3,532dmore than double the 1,490 median lipase of BHC patients. The differences between centers in likelihood of experiencing multiple attacks prior to presentation and in Charlson Co-morbidity Index scores were not significant. BHC patients waited 1 hour longer from presentation to first labs (0.6, 95%CI=0.3- 0.9, p<0.0001), 4 hours longer from presentation to admission (3.6, 95% CI=1.8-5.4, p<0.001), and 4 hours longer from presentation to abdominal CT (4.2, 95%CI=2.5-5.9, p<0.0001). BHC performed 1.6 imaging studies per patient; NYU performed 1.9. NYU GP patients were 12 times more likely to undergo MRCP (OR=11.6, p<0.0001), but the difference in total bilirubin levels between the two populations was not significant. Among surgical patients, those at BHC were 4 times more likely to undergo operation on the same admission (OR=3.7, p<0.001). Among same-admission patients, those at BHC waited 3 days longer for surgery (2!

Introduction: Portal/mesenteric vein resection (PVR) is technically challenging and adds potential morbidity to a pancreaticoduodenectomy (PD). We reviewed our experience with PD for pancreatic adenocarcinoma to evaluate both short and long term outcomes following PVR. Methods: From our institutional pancreatic adenocarcinoma database, we identified 223 patients who underwent pancreaticoduodenectomy (PD) with (Group I n= 20) or without (Group II n= 203) PVR during the period 1990-2011. The study end-points were overall morbidity, 30-day mortality, length of post-operative stay (LOS), overall survival (OS). Differences between groups were evaluated using t-test or chi-squared test. OS for each group was estimated with Kaplan-Meier method and compared using the log-rank statistics. Results: The two groups were similar in terms of gender, age, ethnicity, underlying comorbidities and performance status (see table 1). One patient in Group I and 8 in Group II were deemed borderline resectable (5.0% vs. 3.9%, p = 0.8) and underwent neo-adjuvant treatment. Duration of surgery was longer in Group I (532 vs. 456 min, p = 0.04), but there were no differences in operative blood losses (1047 vs. 991 ml, p = 0.8), length of stay (13.9 vs. 14.4 days, p = 0.8), overall morbidity (55% vs. 38%, p = 0.14). There were only 2 post-operative deaths, both in the Group II (p = 0.7). Pathology revealed similar TNM stage and rates of resections with negative margins (85% vs. 75%, p = 0.8). At median follow-up of 14 months there was no significant difference in OS (20.5 vs. 15.8 months, p = 0.6) Conclusions: In our experience, post-operative and long-term outcomes were not adversely affected by PVR. PVR should be offered to patients with pancreatic cancer involving portal or mesenteric veins. (Table Presented)

Introduction: Increasing evidence suggests that the ratio of number of nodes harboring metastatic cancer to the total number of lymph node examined (lymph node ratio, LNR) affects survival after pancreatic resection for adenocarcinoma. We reviewed impact of lymph node status and LNR in our population of patients undergoing pancreatic resection for adenocarcinomMa.e thods: From our institutional pancreatic adenocarcinoma database, we identified 273 patients who underwent pancreatectomy during the period 1990-2011. of those, 51 had no nodes harvested in the specimen (No LN) and 86 had negative nodes (N0). Among those with positive nodes LNR wa<=s 0.1 in 27, <= 0.2 in 30, <= 0.3 in 21, <= 0.4 in 18 and > 0.4 in 40. Overall median survival was the study end point. Results: The 7 groups were similar in terms of gender, age, ECOG, primary procedure, and status of resection margins (see Table 1). T stage was higher in patients with elevated LNR (p=0.02). Survival was lower for patients with positive nodes (p < 0.01). This difference remained significant when excluding from analysis patients without harvested nodes (p = 0.005). Patient with LNR <= 0.1 had survival similar to N0 patients (20.1 vs. 20.0, p = 0.09). We observed a trend toward a worse survival in patients with higher LNR, which did not reach statistical significanCcoen. clusions: In our experience patients with LNR < 0.1 appeared to have survival similar to those with negative nodes. However LNR did not improve survival prognostication across patients with positive nodes. (Table Presented)