Neoplastic meningitis.

Neoplastic meningitis appears to be increasing in frequency with improvements in the treatment of many cancers. It is most often recognized in patients with leukemia, breast cancer, lymphomas, and small-cell cancer of the lung, although it may be seen with virtually any malignancy. Treatment should include intrathecal chemotherapy, radiation therapy to symptomatic areas of the CNS, and optimal therapy of the systemic cancer. New efforts are underway to decrease the toxicity and improve the efficacy of antineoplastic therapy for this devastating complication of cancer.     

Effect of cyclosporin therapy in controlling the rejection of ileal versus jejunal allografts*

Abstract. Experimental evidence suggests that jejunal allografts are rejected as rapidly as are ileal grafts, despite their lesser content of lymphoid tissue as an immunologic stimulus. However, it may be possible to postpone the rejection of jejunal grafts more readily than that of ileal grafts by means of immunosuppressive therapy with cyclosporin (CyA). To test this, we used the rat model (BN-LEW) of orthotopic small-bowel transplantation. The proximal third of the small-bowel with one-third of the mesenteric lymph nodes (n= 20), or the distal ileal third with all of the mesenteric lymph nodes (n= 22), or the entire small-bowel (n= 23) was interposed after resection of an equivalent type and length of recipient bowel. CyA (15 mg/kg) was given to all of these rats for 5 days. Three additional control groups were not given CyA. The difference in graft/recipient survival among the groups receiving CyA and among those not on CyA therapy was not statistically significant. Antidonor hemagglutinin titers, the mixed lymphocyte culture (MLC) assay, and histologic examination of the allograft failed to show a mitigated rejection reaction for the recipients of jejunal grafts. The data show that short-term treatment with CyA prolongs graft survival. Equal doses of CyA, however, did not lead to prolonged survival of jejunal grafts or alter the course of rejection in comparison with that for ileal or whole-bowel transplants.     

Case Report: Giant choledochal cyst

We report an adult female with a rare giant choledochal cyst. The patient presented following a normal pregnancy with the classical triad of an abdominal mass associated with jaundice and right upper quadrant abdominal pain. The cyst was excised using an intramural technique and biliary reconstruction achieved with a Roux-en-Y hepaticojejunostomy. Our patient has remained well with no evidence of malignancy over a 12 year review period. The aetiology and current management of this condition are discussed.