Dinitrogen pentoxide, N205, may be a significant reservoir for stratospheric nitrogen oxides, esp... more Dinitrogen pentoxide, N205, may be a significant reservoir for stratospheric nitrogen oxides, especially at night and in the polar night. The room-temperature ultraviolet cross sections for N206 were reported between 285 and 380 nm by Jones and Wulf,'between 210 and 290 ...
Chronic hepatitis C infection (HCV) accounts for approximately 50% of the cases of hepatocellular... more Chronic hepatitis C infection (HCV) accounts for approximately 50% of the cases of hepatocellular carcinoma (HCC) in the United States. Cirrhosis or an advanced stage of fibrosis is the major risk factor of HCC; patients with cirrhosis are recommended to undergo surveillance with alpha-fetoprotein and ultrasound. Alpha interferon (IFN-α) is associated with a reduced risk of HCC in patients with chronic infection but insufficient data exist to recommend treatment of patients with cirrhosis and HCV for this reason alone. Resection and liver transplantation are the only ”curative” therapies available. Advanced fibrosis or cirrhosis in patients with HCC limits the number of patients for whom resection is applicable. Moreover, the remaining liver is at high risk of developing a second primary tumor. Partial hepatic resection for hepatocellular carcinoma should be restricted to patients with well-compensated cirrhosis (Child’s A class). Acceptable parameters include a single lesion not exceeding 5 cm, normal levels of bilirubin, and absence of portal hypertension. Liver transplantation is the best definitive treatment for HCV-infected patients who have small, localized HCC (solitary lesion not greater than 5 cm, or no more than 3 lesions, none of which are greater than 3 cm). Limitations of liver transplantation as a therapy for HCC are the scarcity of donor organs and the prolonged waiting time during which continued tumor growth occurs. Living donors can reduce waiting time and increase the number of patients treatable by transplantation. Chemoembolization and local ablation therapies have not been shown to confer survival benefits as primary treatments for HCC. The potential benefit of these procedures in controlling tumor growth to “bridge” patients to liver transplantation must be further investigated. Similarly, systemic chemotherapy and hormonal therapy do not generally produce a survival advantage. However, recent studies that used octreotide and combination doxorubicin/cisplatin/ 5-FU/interferon appear to be promising.
Fibrolamellar hepatocellular carcinoma is an uncommon malignancy seen in young adults without und... more Fibrolamellar hepatocellular carcinoma is an uncommon malignancy seen in young adults without underlying liver disease. Physical signs are minimal and laboratory values are noncontributory. Diagnosis is suggested by clinical history, supported by radiographic studies, and confirmed by histologic examination. Individuals with fibrolamellar carcinoma generally have a greater survival than those with hepatocellular carcinoma. Although most patients with fibrolamellar carcinoma undergo curative surgery, two of the three patients we report had inoperable tumors.
In patients with hepatocellular carcinoma (HCC) exceeding conventional Milan criteria (one lesion... more In patients with hepatocellular carcinoma (HCC) exceeding conventional Milan criteria (one lesion < or = 5 cm or two or three lesions < or = 3 cm) for orthotopic liver transplantation (OLT), down-staging of the tumor before OLT presents an unique and intriguing perspective on tumor biology and expanded criteria for OLT. According to the University of California, San Francisco protocol, the eligibility criteria for down-staging included one lesion < or = 8 cm, two or three lesions each < or = 5 cm with total tumor diameter < or = 8 cm, or four or five lesions each < or = 3 cm with total tumor diameter < or = 8 cm. In the majority of these patients, successful down-staging using well-defined endpoints could be achieved prior to OLT, without resulting in post-transplantation HCC recurrence. The promise of down-staging warrants consideration of a unified policy granting patients with HCC that has been successfully down-staged the same priority listing for OLT as those meeting conventional criteria.
Colonic adenocarcinoma developed in an intravenous drug abuser with the acquired immune deficienc... more Colonic adenocarcinoma developed in an intravenous drug abuser with the acquired immune deficiency syndrome (AIDS) that was diagnosed by the presence of antibodies to the human immunodeficiency virus (HIV), generalized lymphadenopathy, and biopsy proven esophageal candidiasis. The colon cancer presented atypically at a young age with no known risk factors and with a bulky primary tumor and a local fistula. AIDS and AIDS risk factors have been associated with Kaposi's sarcoma, lymphomas, and anal and oropharyngeal carcinoma. This report suggests a possible association between colonic adenocarcinoma and AIDS.
Dinitrogen pentoxide, N205, may be a significant reservoir for stratospheric nitrogen oxides, esp... more Dinitrogen pentoxide, N205, may be a significant reservoir for stratospheric nitrogen oxides, especially at night and in the polar night. The room-temperature ultraviolet cross sections for N206 were reported between 285 and 380 nm by Jones and Wulf,'between 210 and 290 ...
Chronic hepatitis C infection (HCV) accounts for approximately 50% of the cases of hepatocellular... more Chronic hepatitis C infection (HCV) accounts for approximately 50% of the cases of hepatocellular carcinoma (HCC) in the United States. Cirrhosis or an advanced stage of fibrosis is the major risk factor of HCC; patients with cirrhosis are recommended to undergo surveillance with alpha-fetoprotein and ultrasound. Alpha interferon (IFN-α) is associated with a reduced risk of HCC in patients with chronic infection but insufficient data exist to recommend treatment of patients with cirrhosis and HCV for this reason alone. Resection and liver transplantation are the only ”curative” therapies available. Advanced fibrosis or cirrhosis in patients with HCC limits the number of patients for whom resection is applicable. Moreover, the remaining liver is at high risk of developing a second primary tumor. Partial hepatic resection for hepatocellular carcinoma should be restricted to patients with well-compensated cirrhosis (Child’s A class). Acceptable parameters include a single lesion not exceeding 5 cm, normal levels of bilirubin, and absence of portal hypertension. Liver transplantation is the best definitive treatment for HCV-infected patients who have small, localized HCC (solitary lesion not greater than 5 cm, or no more than 3 lesions, none of which are greater than 3 cm). Limitations of liver transplantation as a therapy for HCC are the scarcity of donor organs and the prolonged waiting time during which continued tumor growth occurs. Living donors can reduce waiting time and increase the number of patients treatable by transplantation. Chemoembolization and local ablation therapies have not been shown to confer survival benefits as primary treatments for HCC. The potential benefit of these procedures in controlling tumor growth to “bridge” patients to liver transplantation must be further investigated. Similarly, systemic chemotherapy and hormonal therapy do not generally produce a survival advantage. However, recent studies that used octreotide and combination doxorubicin/cisplatin/ 5-FU/interferon appear to be promising.
Fibrolamellar hepatocellular carcinoma is an uncommon malignancy seen in young adults without und... more Fibrolamellar hepatocellular carcinoma is an uncommon malignancy seen in young adults without underlying liver disease. Physical signs are minimal and laboratory values are noncontributory. Diagnosis is suggested by clinical history, supported by radiographic studies, and confirmed by histologic examination. Individuals with fibrolamellar carcinoma generally have a greater survival than those with hepatocellular carcinoma. Although most patients with fibrolamellar carcinoma undergo curative surgery, two of the three patients we report had inoperable tumors.
In patients with hepatocellular carcinoma (HCC) exceeding conventional Milan criteria (one lesion... more In patients with hepatocellular carcinoma (HCC) exceeding conventional Milan criteria (one lesion < or = 5 cm or two or three lesions < or = 3 cm) for orthotopic liver transplantation (OLT), down-staging of the tumor before OLT presents an unique and intriguing perspective on tumor biology and expanded criteria for OLT. According to the University of California, San Francisco protocol, the eligibility criteria for down-staging included one lesion < or = 8 cm, two or three lesions each < or = 5 cm with total tumor diameter < or = 8 cm, or four or five lesions each < or = 3 cm with total tumor diameter < or = 8 cm. In the majority of these patients, successful down-staging using well-defined endpoints could be achieved prior to OLT, without resulting in post-transplantation HCC recurrence. The promise of down-staging warrants consideration of a unified policy granting patients with HCC that has been successfully down-staged the same priority listing for OLT as those meeting conventional criteria.
Colonic adenocarcinoma developed in an intravenous drug abuser with the acquired immune deficienc... more Colonic adenocarcinoma developed in an intravenous drug abuser with the acquired immune deficiency syndrome (AIDS) that was diagnosed by the presence of antibodies to the human immunodeficiency virus (HIV), generalized lymphadenopathy, and biopsy proven esophageal candidiasis. The colon cancer presented atypically at a young age with no known risk factors and with a bulky primary tumor and a local fistula. AIDS and AIDS risk factors have been associated with Kaposi's sarcoma, lymphomas, and anal and oropharyngeal carcinoma. This report suggests a possible association between colonic adenocarcinoma and AIDS.
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