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Mantle cell lymphoma (MCL) prognosis has significantly improved in recent years; however, the possible survival benefit of new treatment options should be evaluated outside of clinical trials. We investigated 73 consecutive MCL patients managed from 2006 to 2020. For younger patients p = 0.04). Interestingly, there was a trend towards improved OS for patients treated between 2016 and 2020 compared to between 2006 and 2010 and between 2011 and 2015 (5-year OS was 91%, 44%, and 33%). These findings could be due to the introduction of BR as a first-line regimen for elderly patients and to the introduction of ibrutinib as a second-line regimen.

Central nervous system localization of multiple myeloma (CNS-MM) accounts for about 1% of all MM during disease course or even rarer at diagnosis. A difference in the origin, i.e., osteodural or primary dural vs leptomeningeal/intraparenchymal, seems to define two distinct types of intracranial myeloma, with different clinical behavior. CNS-MM may occur also as a presentation of MM. Treatment is still unsatisfactory and many treatments have been reported: chemotherapy, intrathecal therapy, and radiotherapy, with dismal prognosis. Other sites of myeloma localization could be also of interest and deserve description. Because of the rarity and aggressiveness of the disease clinicians are often doubtful on how to treat it since there is no general agreement. Moreover, recent drugs such as the anti CD38 monoclonal antibody, immunomodulatory drugs, and proteasome inhibitors have changed the treatment of patients with MM with a significant improvement in overall response and survival. The role of novel agents in CNS MM management and unusual presentations will be discussed as well as the potential role of other new immunomodulatory drugs and proteasome inhibitors that seem to cross the blood-brain barrier. The purpose of this review is to increase awareness of the clinical unusual presentation and neuroradiological findings, give practical diagnostic advice and treatment options algorithm.

A 24-year old male seen in the trauma bay involved in a motor vehicle accident with rollover landing on its roof. He was partially ejected with his right leg hyperflexed and entrapped. The patient was stable with complaints of right knee pain. There was dimpling of the right distal medial thigh (A, B). After unsuccessful attempts at closed reduction, the patient was taken for open reduction. There was entrapment of the femoral condyle in the extensor mechanism. The soft tissues were released and the condyle reduced back into its normal position. The extensor mechanism was then repaired. The patient had palpable posterior tibial and dorsalis pedis pulses after completion of the procedure. The mechanism for posterolateral knee dislocation is valgus and rotational stress during knee flexion. The medial cruciate ligament, anterior cruciate ligament, and the posterior cruciate ligament are usually injured in posterolateral knee dislocation with incarceration of the capsule and ligamentous structures in the intercondylar notch. Early open reduction is indicated as it is generally considered irreducible by closed reduction. The "pucker sign" is considered pathognomonic. On Radiographs with attention to the patella shows the patella maintaining its in-line attachments to the tibial tuberosity and is reduced with respect to the proximal tibia but dislocated with respect to the distal femur. At the follow up the patient is ambulatory after rehabilitation.

Clostridium sordelli infection is a rare but potentially lethal infection associated with abortions, injury, contaminated wounds, and illicit drug use. It causes a recognizable syndrome with marked leukocytosis. Rapid diagnosis and aggressive sepsis management is required for optimal outcome. We report a case in a trauma patient with delayed presentation after sustaining facial trauma with soil contamination. The critical care management is summarized and a review of the literature.

Retinal morphology serves as an extremely sensitive end point to hypoxic and ischemic conditions manifested by circulatory perturbations. Therefore, the effect of massive transfusion of stroma-free hemoglobin solution (SFHS) on retinal morphology of rats was evaluated. Seventy-three rats were divided into three groups. Two groups were transfused to 75% blood volume replacement--one (n = 30) with 7% SFHS one (n = 26) with 7% albumin solution and the third group (n = 17) was cannulated, not transfused (controls). Animals in each group were killed at 1, 5, 12, and 24 hours and 2 months after the procedure. In the transfused rats, focal and perivascular regions of edema, axonal swelling, and vacuoles were observed by light and transmission electron microscopy in the nerve fiber layer of the central retina. These conditions progressively decreased from 1 to 12 hours in the albumin-treated group. The retinas of SFHS-treated rats killed at 12 and 24 hours had similar but more severe morphologic changes than any of the albumin-treated animals; swelling was more severe in those obtained at 24 than at 12 hours, whereas vacuoles were larger in animals obtained at 12 hours. Abnormalities were observed in the prelaminar portion of the optic disc of the SFHS-treated groups killed at 12 and 24 hours. Subretinal hemorrhaging occurred in about 50% of the SFHS-treated animals killed at both 12 and 24 hours and was associated with swelling, vacuolization, and disruption of the photoreceptor outer segments and retinal pigment epithelium. Below normal levels of glycogen were present in the Müller cells of the retinas of albumin-treated rats killed at 5, 12, and 24 hours. At 12 hours after transfusion the Müller cells in lesions of the retinas obtained from the SFHS-treated rats were devoid of glycogen. High glycogen levels, however, appeared in a zone peripheral to the lesions. The latter effect was not apparent in the specimens obtained at 24 hours. The damage observed was probably due to hypoxic and ischemic effects secondary to urinary hemoglobin excretion and concomitant blood volume loss. No abnormalities were seen in the controls. The retinas of SFHS-treated rats killed at 1 and 5 hours showed normal retinal morphology and glycogen levels. Presumably, SFHS exerted a protective effect during this time period. If the current formulation of SFHS is to be used clinically, it will have to be administered continuously until blood is available for transfusion, and the patient's intravascular volume should be monitored carefully to prevent hypovolemia.

The eyes of 15 rhesus monkeys were evaluated. Various degrees of vitreal syneresis were observed in 28 of the 30 eyes. The observed vitreal structures varied from fine strands randomly spaced throughout the vitreous to thick, intertwining, fibrous networks with some clumping of the collagenous condensate at the fiber junctions. Qualitatively, the degree of syneresis was slightly more extensive in the eight older mature males than in the seven younger animals. In all animals a clear view of the fundus could be obtained with the ophthalmoscope. The vitreous structures may be one cause of variability in ocular dose-response relationships for exposure to laser radiation. The effect on retinal exposure experiments of the finer vitreal structure is considered minimal.

Changes in rhesus spectral sensitivity were induced at low-level (2.1 log td) repetitive exposure to a visible (514 nm) coherent source. Irradiation involved the entire retina. Long-term suppression of intermediate cones was evident in spectral sensitivity functions measured for a very fine photopic (1.85 min-1) acuity criterion. At slightly coarser acuity criteria (1.42 min-1) but still photopic, evidence of rod intrusion was obtained. Recovery from these effects was not obtainable 14 months post-exposure. Possible morphological correlates at photoreceptor ultrastructural levels are discussed. Optical coherency is implicated in these effects.

Intramuscular injections of 2 and 4 mg X 70 kg-1 atropine sulfate were administered to 10 male volunteers. Volunteers performed a pursuit tracking task under two light conditions (daytime and dusk/dawn) at 30 and 150 min after injection. The tracking task consisted of a laboratory-constructed viscous-damped optical simulator of the US Army's Ground Laser Locator Designator system. A scale model Warsaw Pact T-62 tank moved at a constant velocity at a simulated distance of 1 km. Doses of 4 mg X 70 kg-1 of atropine significantly degraded tracking performance at 150 min after injection in daylight and at both 30 and 150 min after injection in dim light. Doses of 2 mg X 70 kg-1 did not degrade performance significantly. The present results suggest that atropine will produce tactically significant performance degradations for up to 3 h after administration.

Using a ruby laser, we induced vitreous hemorrhage in each eye of 12 rabbits. On the following day either 25,000 Ploug units of urokinase or saline were injected into the eyes of each rabbit. Urokinase did not accelerate the absorption of blood from the vitreous but prevented the development of severe vitreous fibrosis which replaced the hemorrhage in seven of the control eyes.

Thresholds for laser chorioretinal injury in the red end of the visible spectrum and the near-infrared (IR-A) spectral regions are presented. An unpredicted wavelength dependence of the injury threshold for single Q-switched pulses is demonstrated. Four lasers were used to determine thresholds at 40 wavelengths between 532 nm and 1064 nm: a ruby laser, a neodymium:YAG-pumped dye laser, an erbium:YLF laser and an alexandrite laser. Despite many careful and repeated efforts to determine a cause for the variation due to possible variations in the lasers or other aspects of the experimental technique and due to biological absorption properties of the eye, there is no complete or obvious explanation for the significant variations of threshold with small changes in wavelength. The implications of these findings for laser safety standards are presented.

A series of experiments was performed to determine the parameters necessary to produce immediate measurable changes in the visual system of nonhuman primates after exposure of the fovea to laser radiation. The parameters investigated were stimulus spatial frequency (1.6 and 2.8 c/deg), size of the visual field stimulated (30 and 3.6 degrees), retinal diameter of the laser exposure (50 and 500 micron), and total intraocular energy. Steady-state visual evoked potentials (VEP's) were recorded from cynomolgus monkeys in response to an oscillating grating. Single 20 ns Q-switched ruby laser pulses (694.3 nm) were directed into the fovea of the experimental eye during the pattern stimulation. No immediate effects on the VEP were noted. Strong delayed effects occurred 45 to 120 s postexposure and were characterized by large phase shifts in the response signal as referenced to the stimulus, magnitude decreases, variance increases, and a loss of waveform correlation with pre-exposure baseline signals. These effects persisted for approximately 30 s before the VEP again became normally re-entrained.

The effect of low levels of coherent radiation on the eye is not fully established, but is generally presumed to be noninjurious. Irradiation of the retina with a Q-switched ruby laser emitting low amounts of energy (0.1 percent probability of creating damage) consistently produces ultrastructural alterations in rods and cones. Outer segments of these cells are broken and disorganized and their lamellae are in disarray 1 day after such irradiation.