Splenic metastases from caecal carcinoma: Diagnostic considerations and therapeutic strategy.

INTRODUCTION: The spleen is a highly vascular organ and is in close proximity to many potential primary sites such as the stomach, breast, pancreas and colon. It is however an unusual site for metastatic disease. The reasons for this are not fully understood at the present time. A number of hypotheses have been postulated. Definitive diagnosis and subsequent treatment of metastatic disease to the spleen presents a number of challenges for the surgeon and the wider multi disciplinary team. PRESENTATION OF CASE: A 60 year old male presented with a three week history of lower abdominal pain, distension, nausea and a palpable mass in the right iliac fossa. Imaging revealed a large circumferential caecal mass consistent with malignancy with secondary small bowel obstruction. The patient underwent an emergency right hemicolectomy and was subsequently treated with systemic chemotherapy for lymph node positive caecal adenocarcinoma. Two years following initial presentation, two suspicious lesions were noted within the spleen during routine surveillance imaging with computerised tomography of the thorax, abdomen and pelvis. Of note, one month prior to this the patient had a normal surveillance colonoscopy performed with multiple interval carcinoembryonic antigen (CEA) levels recorded within the normal range. Image guided splenic biopsy and subsequent histology confirmed metastatic caecal adenocarcinoma. DISCUSSION: Splenic metastases from any source including the colon are a rare phenomenon. CONCLUSION: This case questions the value of routine post operative CEA monitoring, underlines the importance of multimodal pathways of surveillance and highlights recent advances in image guided splenic biopsy techniques.

How firm size and industry affect employee benefits.

Smaller establishments and service-producing industries typically provide fewer benefits than larger establishments and goods-producing industries, but the extent of benefit coverage varies widely within industrial and establishment-size groupings.

Influence of the spatial periodicity of moving gratings on motion response.

The present experiments examine the suprathreshold response of the motion or direction-selective portion of the human visual system by means of the motion aftereffect (MAE). The MAE was measured as a function of the contrast and spatial frequency of moving sinusoidal gratings. For spatial frequencies less than 1 cy/deg, the MAE speed was found to increase linearly with log contrast up to 80%. For spatial frequencies greater than 1 cy/deg, the rate of increase of the MAE speed with log contrast was not found to be linear over the entire range of contrast. The nonlinearity was greatest for the 8 and 10 cy/deg gratings, which showed very little increase in MAE speed with contrast above 25%. We conclude that the direction-specific mechanisms in human vision show a more limited contrast response to the high spatial frequencies than does the visual system as a whole.