No abstract

III colon cancer have a 50% chance of cure with surgery. 1 Multiple trials have established the benefit of adjuvant chemotherapy in reducing the recurrence risk. Specifically, leucovorin, fluorouracil, and oxaliplatin (FOLFOX or slightly different method, FLOX) provides significant benefit in both disease-free and overall survival compared with the prior standard of fluorouracil and leucovorin. [2][3][4] In the setting of metastatic colorectal cancer, cetuximab and panitumumab are US Food and Drug Administration approved for targeting the For editorial comment see p 1431.

The incidence of rAAA does not appear to be declining. Although operative rAAA repair continues to be associated with substantial risk and remains an especially lethal condition among the elderly, the operative mortality rate has declined in recent years in Maryland. Lower operative mortality rates and hospital charges are associated with operations performed by high-volume surgeons.

From 1982 to 1986, nine patients with non-Hodgkin's lymphoma primarily involving the pancreas were managed at the Johns Hopkins Medical Institutions. This group of nine patients represents 2.2% of patients with non-Hodgkin's lymphoma (nine of 402) and 4.9% of all patients presenting with pancreatic malignancies (nine of 182) at the Johns Hopkins Medical Institutions during this period. Computed tomography (CT) scan findings of a large pancreatic mass (6 cm) with extrapancreatic extension and significant retroperitoneal lymph node enlargement suggested lymphoma. Diagnosis was established by radiographically-guided needle biopsy in four patients, by laparotomy in four, and by peripheral lymph node biopsy in one. In five jaundiced patients, initial chemotherapy with the nonhepatotoxic agents cyclophosphamide and prednisone resulted in marked tumor regression, allowing for early resolution of jaundice and subsequent addition of more aggressive adriamycin containing combination chemotherapy. Overall, complete remission has occurred in six of nine patients, with a median survival of 24 months (range 4-69 months). It is concluded from this experience that the majority of patients with pancreatic lymphoma can be managed without surgery. Excellent control of symptoms, including jaundice, as well as long-term remission, can be obtained with chemotherapy alone. The only role for surgery in this setting may be to aid in establishing the diagnosis when percutaneous biopsy is nondiagnostic.

Synthesis of l-Phenyl-l,2-propanedione (7). In a 25-mL two-necked round-bottom flask equipped with a magnetic stirring bar, argon inlet, and rubber septa was placed 0.74 g (2.0 mmol) of ethyltriphenylphosphonium bromide in 20 mL of THF followed by addition of 2.2 mL (2.2 mmol) of sodium bis(trimethylsilyl)amide via syringe. After the red solution stirred for 3 h, 1.2 mL (1.0 mmol) of benzoyl chloride was added, immediately discharging the color of the solution and producing a white precipitate. Stirring was continues for an additional 4 h, at which time 0.5 g (2.2 mmol) of oxaziridine 4 was added all at once. The reaction mixture was quenched after 0.5 h by addition of 10 mL of saturated NH4C1 solution and 10 mL of water. The solution was transferred to a 125-mL separatory funnel, extracted with methylene chloride (3 X 10 m), and dried over anhydrous MgS04.After removal of solvent, the product was isolated by preparative TLC eluting with 20% ether-n-pentane to afford 0.8 g (54%) as a yellow oil identical in all respects with an authentic sample of 1 -phenyl-1,2-propanedione (7).19