The most common presenting symptom for someone with pancreatic head cancer is painless progressive jaundice. The prognosis for inoperable pancreatic cancer is grave. Surgical resection is the only curative options. For those jaundiced patients with operable pancreatic cancer, some clinicians will insist on relieving the jaundice before surgery. This is achieved by placing a plastic stent into the common bile duct to re-establish bile flow into the duodenum. Usually this means a delay of 4 to 6 weeks before surgery can be performed. (The rationale for relieving the jaundice is to reduce the risk of developing hepato-renal syndrome.)  However, some surgeons will operate immediately without relieving the jaundice, believing that stenting before surgery increases the post-operative complications rate. The argument of ‘to drain or not to drain’ before surgery has been raging for more than 2 decades.

A multi-centre, randomised study on 202 patients with pancreatic head cancer was recently completed in the Netherlands (N Engl J Med 2010; 362: 129 – 137). The researchers compared pre-operative biliary drainage (for 4 – 6 weeks) with subsequent surgery against surgery alone in order to determine the rate of serious complications within 120 days after randomization in these 2 groups of patients. The rate of serious complications in the early surgery group was 39% while that in the biliary drainage group was 74%. The surgery-related complications rate was 37% in the early surgery group compared to 47% in the biliary drainage group. This study thus showed that routine pre-operative biliary drainage increases the rate of complications in patients with jaundice secondary to pancreatic head cancer.

Despite this study, there will still be clinicians who routinely perform pre-operative biliary drainage for these patients because they believe this will reduce the risks associated with surgery in the presence of jaundice. As it is very difficult to complete a study with very large number of patients with pancreatic head cancer, the controversy of ‘drainage’ versus ‘no drainage’ will unfortunately continue.

As a result of the recent event in US, many Western countries are contemplating the use of full-body scanners on passengers to improve airport security. These machines are used to see under clothes and to identify unusual objects. Many people have objected to their use because of privacy issues. For some there is the worry of health implications if one is scanned too often.

There are 2 types of machines being used: the millimetre wavelength imaging scanner which beams radio waves over the body to create a 3-dimensional image and the backscatter X-ray scanner which uses low dose radiation to create a 2-sided image. The backscatter scanner will expose individuals to ionizing radiation, similar to that found in medical X-rays. While the average chest X-ray delivers 100 microseverts of radiation, the typical backscatter scanner delivers 0.1 microsevert of radiation. Thus, it is logical to conclude that such low level of radiation exposure would not be of great concern.

Would repeated, regular low dose radiation exposure over a prolonged period of time have health implications? This may be relevant to frequent travellers in the course of their work. What about the security staff who are manning the machine on a regular basis? No one has an answer to this.

Some have advocated that all passengers should be scanned while others have suggested using the scanner on selected passengers. We will have to wait and see which policy will finally be adopted. I have no doubt that the use of scanners will be implemented.

Personally, I have adopted the policy of travelling only when necessary and I choose my destination with more care than before. This helps to give me peace of mind and the feeling of staying safe or safer.

Happy 2010! Time for the traditional new year resolution. So what will it be for you? Losing some weight is a popular one. However, many fail to achieve this as the year wears on. Perhaps the following research finding might give you more impetus to try harder this year.

Researchers from Boston University studied the incidence of type 2 diabetes in relation to restaurant meal consumption among 44.072 African American women who were not diabetic at entry to the study (Am J Clin Nutr 2009 Dec 16, epub). These women completed a questionnaire every 2 years, from 1995, for 10 years. Compared to women who never eat fast food burgers and fried chicken, women who eat 2 or more burgers meals per week has a 40% increased risk of developing diabetes. Similarly for women who eat 2 or more fried chicken meals per week, the increased risk was 68%. The increased risk of type 2 diabetes is associated with weight gain and obesity.

Yes, it is the fault of the dreaded condition – getting fat- again! Getting fat has a lot to answer for in our society and in our world. Perhaps you should really stick to your new year resolution this year and constructively lose some weight.

Happy New Year!