Propulsion causes ballistic-type injuries that must be recognised and distinguished from those caused by firearm projectiles. Differentiating between these lesions is very difficult when using conventional criteria (size, shape, number and distribution on the body) with only external examination of corpses. This is why the particularities of these lesions must be further illustrated and then confirmed by complete autopsies and radiological and anatomopathological examinations.Key pointsWhen occurring simultaneously in terrorist attacks, injuries caused by secondary blasts appear as cutaneous wound patterns that can be macroscopically very similar to those caused by firearm projectiles.The criteria usually found in the literature for distinguishing these two types of projectiles may be difficult to use.It is important in these difficult situations to benefit from systematic postmortem imaging.Systematic autopsy and then anatomopathological analyses of the orifices also help determine the cause of the wounds.On the evening of November 13, 2015, the city of Paris and its surroundings was hit by a series of attacks committed by terrorist groups, using firearms and explosives. The final toll was 140 people deceased (130 victims and 10 terrorists or their relatives) and more than 413 injured, making these attacks the worst mass killings ever recorded in Paris in peacetime. This article presents the forensic operations carried out at the Medicolegal Institute of Paris (MLIP) following these attacks. A total of 68 autopsies of bodies or body fragments and 83 external examinations were performed within 7 days, and the overall forensic operations (including formal identification of the latest victims) were completed 10 days after the attacks. Over this period, 156 body presentations (some bodies were presented several times) were provided to families or relatives. Regarding the 130 civilian casualties, 129 died from firearm wounds and one died from blast injuries after an explosion. Of the 10 terrorists or their relativeolve a very large number of victims in a constrained time.Solid pseudopapillary neoplasms (SPN) of the pancreas are rare neoplasms accounting for 1-2% of all pancreatic tumors and have a general female predominance. We report a case and intraoperative videos of SPN involving the whole pancreatic tail. A 19-year-old female patient initially presented to another healthcare facility complaining of abdominal pain, which was started 6 years ago. A contrast-enhanced Computed Tomography (CT) scan of the abdomen showed a large mass measuring 15.6 cm × 11.6 cm × 11 cm, arising from the pancreas with an enhancing cystic component. The patient underwent exploratory laparotomy, which revealed a huge mass occupying most of the abdominal cavity. Thus, we proceeded with a distal pancreatectomy and splenectomy. Intraoperatively, the frozen section showed that the mass had features of a solid pseudopapillary tumor of the pancreas with negative resection margins. The SPN diagnosis was confirmed by histopathology and immunohistochemistry. The pathophysiology behind the development of SPN and its cellular origin is still a matter of debate with multiple proposed hypotheses. SPNs are asymptomatic in almost 70% of all cases and usually discovered incidentally. The pre-operative diagnosis of SPNs remains a clinical challenge despite all the current advances in the diagnostic modalities. Surgical management with negative resection margins is the mainstay of treatment, even with metastasis and vascular invasion, surgical excision should be performed whenever feasible. The recurrence rate after surgical resection has been reported to be 3-9%. The prognosis of SPN limited to the pancreas is generally excellent with over 95% cure rate following complete surgical resection. SPN is a rare entity of a controversial origin but is considered as a low-grade malignancy. Surgical resection to achieve complete excision constitutes the mainstay of treatment, which mostly results in an excellent prognosis.

Contrast-enhanced ultrasonography (CE-US) brings a higher signal-to-noise ratio and a higher sensitivity for slow flow than traditional B-mode ultrasonography (US). NSC16168 chemical structure However, it remains unclear whether CE-US is also superior to B-mode US in detecting early-stage pancreatic cancer (PC).

This was a retrospective study enrolling patients suspected of pancreatic insufficiency between June 2015 and December 2019. Enrolled patients successively received B-mode US and CE-US examinations, and some their demographic and clinical data were collected. The diagnostic capacity of the two examinations was calculated and receiver operating characteristic (ROC) curves was used to compare the area under the curve (AUC). A subgroup analysis was performed to explore the effects of tumor size on the diagnostic accuracy of B-mode US and CE-US.

There were 128 patients enrolled in this study; 74 patients were diagnosed as early-stage PC patients and the remaining 54 were diagnosed with benign pancreatic lesions. The mean size of the PC was 17.8±4.9 mm. The results revealed that 68 of the 74 PC patients were correctly diagnosed by CE-US, and all 54 patients with benign pancreatic lesions were also correctly diagnosed. Meanwhile, only 55 of the 74 PC patients and 50 of the 54 patients with benign pancreatic lesions were diagnosed correctly using B-mode US. The ROC curve showed that the AUCs of CE-US and B-mode US were 0.959 and 0.835, respectively. According to the subgroup analysis, CE-US exhibited better accuracy than B-mode US for smaller tumors (size <20 mm, P=0.002; size <10 mm, P=0.043; size <5 mm, P=0.025).

CE-US was clearly superior to the conventional B-mode US in detecting early-stage PC, especially smaller sized PC.

CE-US was clearly superior to the conventional B-mode US in detecting early-stage PC, especially smaller sized PC.

We sought to examine the impact of neoadjuvant chemotherapy (NCT), single agent (SA) or multi-agent (MA) chemotherapy, and chemoradiation (NCRT) on response and survival in pancreatic cancer.

Utilizing the National Cancer Database, we identified patients who underwent resection of the pancreatic head for adenocarcinoma [2006-2013]. Overall survival (OS) analysis was performed using the Kaplan-Meier method. Multivariable cox proportional hazard models (MVA) and propensity score matching (PSM) were developed to identify predictors of survival. For upfront surgery (UFS), OS was limited to receipt of adjuvant treatment.

We identified 26,563 patients who underwent pancreatic head resection UFS =23,877, NCRT =1,482, and NCT =1,204. MA-NCT was utilized in 77% and after PSM, 52%. There was improved R0 resections and 30-day mortality associated with neoadjuvant therapy compared to UFS. Overall response rate to neoadjuvant therapy was 24%. The highest response rate seen with MA-NCRT. Response rates for SA-NCT, MA-NCT, SA-NCRT, and MA-NCRT were 11.