No abstract

Squamous cell carcinoma (SCC) of the rectum is an extremely rare malignancy, accounting for 0.1-0.2% of rectal malignancies. It is associated with ulcerative colitis, prior radiation, schistosomiasis, ovarian cancer, endometrial cancer, human papilloma virus, colocutaneous fistulas and colonic duplication. Prior reported cases of SCC of the rectum have involved treatment with brachytherapy and external beam radiation. This case is particularly interesting because of the remote exposure of radiation (21 years previously) and the subsequent development of SCC of the rectum. Although extremely rare, SCC of the rectum can occur decades after radiation exposure.

A 77-year-old Hispanic female presented to the emergency department status-post 15 minutes of respiratory arrest in a house fire. Chest X-rays revealed bilateral patchy alveolar airspace opacities in the upper lungs consistent with smoke inhalation injury. The blood bank received a sample for a type and screen. Separation of the plasma revealed an intense red-pink hue (see figure, A). Additional information was obtained from the ordering physician. The patient had been given a 5-gram injection of hydroxocobalamin (see figure, B) for treatment of suspected cyanide poisoning associated with smoke inhalation. The plasma color is secondary to treatment with a large dose of hydroxocobalamin. Cyanide, a toxic by-product of smoke from house fires, is rapidly absorbed through the lungs. 1,2 The inhalation of carbon monoxide together with cyanide results in serious tissue hypoxia from the dissociation of oxygen from heme along with inhibition of cytochrome oxidases. 2 Anoxic damage rapidly ensues, with serious dysfunction particularly to the brain. 2 Hydroxocobalamin, an analog of vitamin B12, is an effective antidote to smoke inhalation-associated cyanide poisoning. 1 The drug is known for an intense red color. Hydroxocobalamin binds to cyanide molecules and converts them to