Synchronous rectal adenocarcinoma and splenic marginal zone lymphoma.

Synchronous cancers of different primary origin are rare. Here, we describe the case of a patient with concomitant diagnoses of rectal adenocarcinoma and splenic marginal zone lymphoma (smzl). A 57-year-old woman initially presented with abdominal pain. Physical examination and computed tomography demonstrated massive splenomegaly, and a complete blood count revealed microcytic anemia and lymphopenia. During the subsequent evaluation, she presented with hematochezia, melena, and constipation, which prompted gastroenterology referral. Subsequent endoscopic rectal ultrasonography revealed a T3N1 moderately differentiated rectal adenocarcinoma, with computed tomography imaging of chest, abdomen, and pelvis confirming no metastasis. Thus, the cancer was classified as clinical stage T3N1M0, stage iii. Bone marrow biopsy confirmed co-existing marginal zone lymphoma, and with the clinical presentation of massive splenomegaly, a diagnosis of smzl was made. The patient's management was individually tailored for simultaneous optimal treatment of both conditions. Concurrent treatment with neoadjuvant rituximab and 5-fluorouracil chemotherapy, with external-beam radiation therapy to the pelvis, was administered, followed by surgery consisting of en bloc splenectomy and distal pancreatectomy, and low anterior resection. The patient completed a standard course of adjuvant folfox (fluorouracil-leucovorin-oxaliplatin) chemotherapy and has remained disease-free for 7 years. To our knowledge, this report is the first to specifically describe simultaneous diagnoses of locally advanced rectal cancer and smzl. We also describe the successful combined neoadjuvant treatment combination of 5-fluorouracil, rituximab, and pelvic radiation.

Hepatitis C in liver transplantation: preliminary study of prognostic factors.

At the University of Miami liver transplantation for chronic liver disease in HCV-positive patients has shown good results, with a 92% patients survival rate (follow up 8 to 57 months, median 21). None the less, we found that a large number of patients are expected to develop serious histological graft damage and may need retransplantation, which may place a further strain on the already scarce donor resources. We have conducted a preliminary investigation on the importance of parameters which may correlate with the prognosis of HCV grafts. We found no impact of HLA match or typing. An interesting hypothesis, which deserves further investigation, is that some HCV strains could be more virulent than others and play a role as an independent risk factor. We have identified six strains among our patients and the BK serotype shows a trend to be associated with a worse outcome. We have found that patients developing and maintaining higher liver enzyme levels (ALT and GGT) after transplant and those with higher levels of viremia may be at risk to develop serious damage to their grafts.

Reflectance as an indirect measurement of the extent of laser-induced coagulation.

Two-dimensional reflectance images and surface thermal distributions were recorded during argon laser induced coagulation. During laser irradiation, coagulated egg yolk formed a white lesion. The whiteness, or reflectance caused by backscattering of light from the forming lesion, would be measured after a short delay from the onset of laser irradiation. In the experiments which covered exposure time from 4.5 to 17.0 s, we found that it started slowly, the reflectance increased rapidly once the surface temperature of the lesion reached approximately 90 degrees C. After this rapid rise, the reflectance began to taper off until no change in reflectance was recorded. There was a 0.98 correlation between lesion diameter measured from a two dimensional reflectance image and the lesion diameter that was measured microscopically. There was a 0.92 correlation between reflectance at the center of the lesion and microscopically measured depth of coagulation at the same point. However, the correlation between microscopically measured coagulation depth and width was only 0.88.

An automated laser system for eye surgery.

The use of lasers in ophthalmology is discussed, and the procedure and requirements of ophthalmic laser surgery are described. An overview of a proposed laser system for eye surgery is given, and its operation is described. Progress and research to date are reviewed.