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A nized complication of organ transplantation. 1-8
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1 Posttransplantation De Novo Tumors in liver Allograft Recipients Israel Penn De novo cancers occurred after transplantation in 8,008 organ allograft recipients, who developed 8,5 different types of malignancy. Three hundred twenty-four liver recipients developed 9 cancers. There were striking differences in the patterns of neoplasms observed when these were compared with 7,00 tumors that occurred in renal allograft recipients. Lymphomas were much more common in liver allograft recipients (57% v % of all tumors), whereas skin cancers (9% v l5%), carcinomas of the cervix (% v l%), renal tumors (% v %), and vulvar carcinomas (% v 0.6%) were more common in renal allograft recipients. The high incidence of lymphomas is related partly to the more intense immunosuppressive therapy administered to hepatic allograft recipients and partly to the large percentage of pediatric patients among them. The intense immunosuppression also accounts for the much shorter induction times of lymphomas (mean, 5 v 6 months; P <.00) and nonlymphomatous tumors (mean, 7 v 7; P <.00) in liver compared with kidney recipients. The longer follow-up of renal recipients probably accounts for the higher incidence of the other tumors that tend to appear relatively late after transplantation. A remarkable feature was the high incidence of allograft involvement by lymphoma (%). Complete remissions after treatment occurred in of 8 patients in whom the lymphoma was confined to the allograft. A few tumors in liver recipients were related to the underlying disease for which transplantation was performed: hepatomas in patients who underwent transplantation for hepatitis B cirrhosis and colon carcinomas or cholangiocarcinomas in patients who underwent transplantation for chronic ulcerative colitis with sclerosing cholangitis. A surprising finding was the development of four leiomyosarcomas, three occurring in the allograft itself, in pediatric liver recipients. Copyright by the American Association for the Study of Liver Diseases n increased risk of neoplasia is a well-recog- A nized complication of organ transplantation. -8 Because the largest number of transplantations have been performed in renal allograft recipients, some of whom have been observed for periods of up to years, most experience with posttransplantation tumors has been in these patients. In the relatively small number of hepatic allograft recipients collected thus far, a rather different pattern of neoplasia has been observed compared with that in renal recipient~.~.~,~-~~ This report briefly mentions the overall experience, reviews the types of malignancies observed in hepatic allograft recipients, and then examines the differences in tumor incidence and behavior observed in hepatic allograft recipients compared with renal transplant recipients. From the Department of Surgery, University of Cincinnati Medical Center and Cincinnati Veterans Affairs Medical Center, Cincinnati, OH. Supported in part hy a grant from the Department of Veterans Affairs. Address reprint requests to: Israel Penn, MD, Department of Surgety, University of Cincinnati Medical Center, P.O. Box , Cincinnati, OH Copyright by the American Association for the Study of Liver Diseases 07-0/96/ $.00/0 Materials and Methods Data collected by the Cincinnati Transplant Tumor Registry (CTTR) from the fall of 968 through December 99, were analyzed. Statistical analyses included the paired student s t-test. A two-tailed P <.05 was considered significant. Results Overall, 8,5 types of cancer occurred de novo after transplantation in 8,008 organ transplant recipients. The patients included 6,707 who received kidney allografts and 79 heart, liver, 5 bone marrow, pancreas, 8 combined heart and lung transplantations, 6 lung, upper-abdominal organ clusters, and small bowel allograft. The most common neoplasms in the overall series were cancers of the skin and lips (, cases), lymphomas (, cases), carcinomas of the lung (76 cases), Kaposi s sarcoma (5 cases), carcinomas of the uterus (8 cases), colon and rectum (0 cases), kidney (96 cases), breast (67 cases), head and neck ( cases), vulva and perineum (7 cases), urinary bladder (90 cases), unknown primary site (86 cases), leukemias ( 6 cases), hepatobiliary carcinomas (6 cases), carcinomas of the prostate (6 cases), thyroid gland (06 cases), and sarcomas 5 Liver Transplantation and Surgeiy, Vol, No (January), 996: pp 5-59
2 De Novo Tumors After Liver Transplantation 5 (other than Kaposi s sarcoma) (00 cases). The malignancies that occurred in hepatic allograft recipients are listed in Table. Table shows a very different pattern of neoplasms in hepatic compared with renal allograft recipients. Of note is the very high incidence of lymphomas in the former group (57% v %) and the low incidences of carcinomas of the cervix, vulva and perineum, and renal tumors. Lymphomas Lymphomas by far comprised the largest group (57%). The tumors occurred in 9 males and 9 females, and in one instance the gender of the patient was not stated. The patients ages were not stated in 7 instances. In the other 7, they ranged from 5 months to 70 years (average 7, median years) at Table. Common Neoplasms in Renal Versus Hepatic Recipients Renal Hepatic 7,00 9 tumors* % tumorst % Skin cancers, Lymphomas Kaposi s sarcoma 0 Carcinomas of cervix 78 Renal tumors 76 CA vulva/perineum 07 Carcinomas of colon 65 8 *In 6,707 patients. tln patients I Table. 9 Cancers in Hepatic Allograft Recipients Type of Cancer Lymphomas Cancers of skin and lips Carcinomas of colon and rectum Carcinomas of the lung Kaposi s sarcomas Carcinomas of breast Head and neck carcinomas (excluding thyroid, parathyroid, and eye) Sarcomas (excluding Kaposi s) Carcinomas of uterine cervix Carcinomas of the kidney Carcinomas of pancreas Hepatobiliary carcinomas Carcinomas of stomach Carcinomas of testis Carcinomas of vulva, perineum, penis, or scrotum Metastatic carcinomas (primary site unknown) Carcinomas of body of uterus Carcinomas of prostate Carcinomas of ovary Carcinomas of urinary bladder Leukemias Brain neoplasms (excluding lymphomas) No. of Tumors in Hepatic Recipients* *Three recipients each had two separate types of neoplasm and one had three. 7 6 ne time of transplantation. Seventy-four patients (%) were in the pediatric age group (8 years and younger). Of 69 patients with adequate data, 8 (70%) received triple therapy (cyclosporine, azathioprine and prednisone), (6%) received double therapy (cyclosporine and prednisone), 5 (%) received FK506-based regimens, and (%) received azathioprine and prednisone. The corresponding figures in renal transplant recipients were very different-%, 9%, < %, and 5%, respectively. A total of 0 patients in the various subgroups received FK506. Antilymphocytic agents-alg (), Om (5), or both () were used in a total of 98 patients (58%). This compares with 6% usage of antilymphocyte preparations in renal recipients with lymphomas in the CTTR. Lymphomas appeared from weeks to 59.5 months after transplantation (average, 5; median, 6 months). This compared with a period of week to 05.5 months (average 6, median 6 months) in renal transplant recipients. These differences are statistically significant (P <.OOl). Morphologically and immunologically the lymphomas were a heterogenous group, reflecting the diverse classification systems in use since the CTTR started to function. They are listed in Table. The organs affected by lymphoma were listed in 85 cases. Of these, 88 (8%) involved a single organ or site. The most common locations are listed in Table. Extranodal disease occurred in patients (6%). Of note in the 85 patients was the frequent involvement of the allograft that was affected in 8 instances (%). In 5 patients (9%) the intestines, most often the small bowel, were affected. In some patients the presenting feature was generalized peritoni-
3 5 Israel Penn Table. Types of Lymphoma Type of Lymphoma PTLD 8-cell lymphoma Lymphoma (type not specified) Large cell lymphoma Burkitt's lymphoma 8-cell hyperplasia Plasmacytomas T-cell lymphomas Small cell lymphoma Lymphosarcoma Hodakin's disease No. of Patients Abbreviation: PTLD, posttransplantation lymphoproliferative disease. tis caused by perforation of an intestinal lymphoma. The tonsils and/or adenoids were involved in 0 patients (%), mostly in the pediatric age group. The central nervous system was involved in only 8 patients (lo%), mostly in patients with widespread disease. Thirty-two patients received little or no treatment. In 9 instances, the patients died of the lymphoma and/or from other causes and the diagnosis was only made at autopsy examination. In another patients no treatment was attempted, because their condition was terminal. Table. Most Common Sites Affected by Lymphoma Localized Widespread (n = 88) (n = 97) Organ/Site No. of No. of Affected Patients % Patients % Allograft Lymph nodes 60 6 Bowel 5 Tonsils/adenoids/ pharynx Stomach Central nervous system 5 Lung 5 Kidney Spleen Bone marrow Treatment of the lymphomas involved one or more of the following measures: reduction or cessation of immunosuppressive therapy, excision including retransplantation, localized radiation therapy, acyclovir or ganciclovir administration, chemotherapy, immunotherapy with agents including interferonalpha, immune gamma globulin and monoclonal anti-b-cell antibodies. The type of treatment administered was not recorded in 0 patients. Reduction or cessation of immunosuppressive therapy camed a price. Graft failure from acute or chronic rejection occurred in seven patients, five of whom had complete remissions of their lymphomas. One of the seven died of liver failure and sepsis after 5 months. The other six required retransplantation, of whom one died intraoperatively, and a second died of fulminant hepatic failure of the new graft 5 days postoperatively. Of the four remaining patients, one died of failure of the second transplant 6 months after reoperation, and three are alive at 6.5,, and 6 months, respectively, after reoperation. Of particular interest are 8 cases in which the allograft was the only site of disease. In two cases, there was also a mass in the porta hepatis, whereas in two other cases disease was confined to the porta hepatis rather than in the allograft. In two patients the disease was found at autopsy, one patient having died of lymphoma and the other from multiple organ failure. Of the 6 treated patients, 6 died of lymphoma, died of other causes, died of hemorrhage during attempted retransplantation, 6 are still being treated, and complete remissions were accomplished in patients. Two of these are following single modality therapy (chemotherapy in one and retransplantation in another). The other 9 patients received multimodality therapy including reduction or cessation of immunosuppression (8 patients), administration of acyclovir or ganciclovir (5, chemotherapy (, local excision of the liver lesion (), immune globulin administration (), retransplantation (, radiotherapy (l), and monoclonal anti-b-cell antibody administration (). Overall eight patients underwent retransplantation as treatment of allograft lymphoma. One died of hemorrhage during reoperation, a second died shortly after surgery, and a third died of sepsis months later. In two other patients the lymphoma recurred in the second allograft and both died of malignancy at 0.5 and months, respectively, after operation. Three other patients are alive, of whom two are in complete remission from their lymphomas 9 and 56.5 months after reoperation.
4 De Novo Tumors After Liver 7~ransplantation 55 Of all treated patients, 6 had complete remissions (8 of them died later from other causes). The types of treatment used in 6 of the 6 patients are listed in Table 5. Of the 6 complete remissions, 9 (6%) occurred in patients with disease localized to a single organ or site and (7%) occurred in patients with widespread disease. In the former group of 9 (8%) remissions occurred when the allograft was the only site of disease (see above). Overall postdiagnosis follow-up of treated patients ranged from days to 9 months (average, 5; median, 5 months). In 8 of the 6 patients with complete remissions, follow-up after treatment was brief, being less than 8 months, (range, 0.75 to 7.5; average, 8 months). However, in patients the remissions were very durable, being more than 8 months (range, 9 to 9; average, 65 months). At present, 5 of the 89 patients are alive in complete remission, are alive and receiving treatment, 6 died of lymphoma, and 9 died of other causes. Nonlymphomas There were 78 males (including one already mentioned with a lymphoma) and 58 females. Their ages ranged from.5 to 67 years (average, 7; median, 9 years). Only 8 were in the pediatric age group. Of patients with adequate data, (8%) received triple therapy (cyclosporine, azathioprine, and pred- Table 5. Treatments Used in Patients With Complete Remissions Single Multimodality Modality Therapy7 Therapy* (No. of (No. of Treatment* Patients) Patients) Decrease or cessation of immunosuppression Excision (including retransplantation) Acyclovir or ganciclovir Immune globulin C hemotherapy Radiotherapy Interferon Monoclonal anti-b-cell antibodies *The type of treatment used was not recorded in one patient. tused in patients. *Used in 0 patients. nisone), (0%) received double therapy (cyclosporine and prednisone), and 6 (5%) received azathioprine and prednisone. The corresponding figures in renal transplant recipients were very different 7%, 8%, and 6%, respectively. FK506 was used in 8 patients either alone or in the various subgroups described. Antilymphocytic agents antilymphocyte globulin (), Om (7, or both (0) were used in a total of 5 patients (8%). This compared with 6% usage of antilymphocyte preparations in renal recipients with nonlymphomatous tumors in the CTTR. When renal transplant recipients in the CTTR with nonlymphomas were compared with hepatic allograft recipients the time of appearance of the tumors in the latter group was surprisingly short. In the former group the average and median times were 7 and 57 months, respectively, (range, to 98.5 months) whereas in liver transplant recipients the average and median times were 6 and.5 months, respectively (range,.5 to 95.5 months). These differences are statistically significant (P <.OOl>. Surprisingly, only 0.5% tumors in the liver transplant recipients appeared less than months after transplantation compared with.7% in the non-liver transplant recipients. The age of patients at the time the cancer was diagnosed ranged from to 69 years (average, 9; median, 5 years). Follow-up after diagnosis of the cancer ranged from 0 to 58 months (average, ; median, 5 months). Thirty-six patients died of their malignancies including patient described above who died of lymphoma. The other 5 malignancies that caused death were carcinomas of the colon (6, lung (6, pancreas (, liver (, head and neck (, stomach (), cervix (), leiomyosarcoma (, and one each of breast, kidney, ovary, skin (squamous cell carcinoma), unknown primary, brain, and Kaposi s sarcoma. Another patients died of recurrent preexisting cancers for which transplantation had been performed, including two cholangiocarcinomas and one angiosarcoma; the de novo malignancies in these patients played no role in their deaths. Another patients died of causes unrelated to their cancers. Of the 86 patients who are currently alive are well, 5 are being treated for their cancers, and in 50 the malignancies are apparently under control. The following several cancers deserve special comment: Carcinomas of the colon and rectum. Of the 8 patients, 6 had a history of chronic ulcerative colitis and required liver transplantation because of sclerosis cholangitis. Two other patients had sclerosing cholan-
5 S6 Israel Penn gitis with no apparent history of ulcerative colitis. Another patient had a family history (a father and brother) with colonic cancers. In patients, no curative treatment was possible because of the advanced stage of the disease and in another because the tumor was only discovered at autopsy examination. Hepatic neoplasms. One patient underwent partial auxiliary liver transplantation for hepatitis B cirrhosis. Twenty-four months later he died of metastatic hepatocellular carcinoma, which had occurred in his own diseased liver. The second patient underwent transplantation for fulminant hepatic failure due to hepatitis. After transplantation she developed hepatitis B cirrhosis in the allograft, complicated by a hepatoma, 5.5 months after transplantation. She died one day after attempted retransplantation. The third patient underwent transplantation for sclerosing cholangitis complicating chronic ulcerative colitis. Nineteen and a haif months later a choiangiocarcinoma was discovered involving the allograft and causing bone metastases. The patient died of the malignancy 5.5 months later. Sarcomas. Sarcomas comprised four leiomyosarcomas, one mesothelioma, and one fibrosarcoma. All leiomyosarcomas and the fibrosarcoma occurred in children aged.5 to 7.5 years and appeared from 5.5 to 5.5 (average, 7) months after transplantation. Remarkably, four of the five tumors, including the fibrosarcoma, involved the allograft, whereas the remaining leiomyosarcoma involved the mesentery. There was no evidence that the donors, or any recipients of other organs from them, had leiomyosarcoma or fibrosarcoma. In fact HLA-DRl genotyping indicated that the fibrosarcoma was of recipient origin. Two patients are alive 8 and 9.5 months, respectively, after excision of a leiomyosarcoma of the left lateral hepatic segmenti and mesentery, respectively, and the patient with the fibrosarcoma is alive with tumor 0 months after commencement of chemotherapy. Two patients died of metastatic leiomyosarcoma months and 7.5 months respectively after diagnosis of their malignancies. A 56-year-old woman underwent transplantation for a hepatoma. An unknown interval after transplantation she developed a peritoneal mesothelioma and was receiving chemotherapy.5 months after diagnosis. Skin cancers. Twenty-two patients had squamous cell carcinomas (SCCs), 9 had basal cell carcinomas (BCCs), had SCCs and BCCs, and had malignant melanomas, of whom also had squamous cell carcinomas. The lip alone was involved in two patients with SCCs and the lip and skin in one patient with SCCs and BCCs. Thirty-six patients had single lesions, whereas had multiple carcinomas. One patient with malignant melanoma had regional lymph node metastases and is alive 6 months after radical axillary clearance. One patient with multiple SCCs died of spread from a preauricular lesion. Carcinomas of the uterine cewix. Whereas 7% of carcinomas in the overall series were in situ lesions, three of four (75%) of neoplasms in the hepatic allograft recipients were invasive cancers, which caused the deaths of two of the recipients. Kaposi s sarcoma. Eight patients were male and two were female. Five patients had nonvisceral disease limited to the skin, and five had visceral disease involving the internal organs. Most patients were from the Eastern Mediterranean area in keeping with C7TR findings that most transplant recipients with KS are either Arab, black, Jewish, or Mediterranean.-.8 One patient died of widespread visceral disease and two died of other causes. The other seven are alive, with three of them in complete remission after treatments which included reduction of immunosuppression (, excision (, ganciclovir (, and chemotherapy (). The length of follow-up from diagnosis in 9 patients ranged from 0.5 to.5 (average, 8) months. Discussion The most common malignancies in the overall C7TR series are carcinomas of the skin and lips, lymphomas, Kaposi s sarcoma, carcinomas of the uterine cervix, carcinomas of the kidney, carcinomas of the vulva and perineum, hepatobiliary carcinomas, and various sarcomas excluding Kaposi s sarcoma. - A very different pattern of posttransplantation neoplasia is observed when one compares cancers in hepatic allograft recipients with those observed in the largest single group of patients in the CTTR, namely renal recipients. The most striking finding was a disproportionately high incidence of lymphomas in hepatic versus renal patient^.^,^,^ This observation is confirmed by a study of lymphomas from the University of Pittsburgh that showed a % incidence in renal transplant recipients, compared with a.7% incidence in hepatic allograft recipients. l In contrast, renal patients exceeded hepatic recipients in the incidence of skin cancers, carcinomas of the cervix, and carcinomas of the vulva and perineum. Several factors may account for these differences. In
6 De Novo Tumors After Liver Transplantation 57 hepatic recipients, intense immunosuppressive therapy is often needed to prevent death from rejection, whereas severe rejection of kidney allografts can be managed by discontinuing administration of immunosuppressive agents and returning the patients to dialysis the rap^.^,',^ A complication of intense immunosuppressive therapy is a disproportionate increase in the incidence of those malignancies that occur in the early months after transplantation, namely lymphoma^.^,^,^ This is borne out by the much greater use of triple therapy in liver recipients with lymphomas compared with kidney recipients, and the greater use of antilymphocyte preparations in the former group compared with the latter. The intense immunosuppression in the hepatic recipients probably accounts for the short induction time in them as compared with renal allograft recipients. The high incidence of lymphomas in children is striking. 5-7 Children have more lymphoid tissue than adults which, in areas such as the Peyer's patches of the small bowel and the tonsils and adenoids, may become the site of lymphomas, if among other things, the child becomes infected with Epstein-Barr virus (EBV). Primary EBV infection is more common in childhood than in adulthood and in immunosuppressed patients is likely to have more deleterious effects. lh,7 In keeping with previous reports from the CITR,-,9 the great majority of lymphomas in liver allograft recipients were non-hodgkin's lymphomas with occasional cases of pa~rnacytoma'~j~ or Hodgkin's disease. The high percentage of patients in the present study who died of lymphoma is in keeping with a 79-fold increased death rate from this cause among liver transplant recipients reported in one study.'o In contrast, a gratifjmg feature is that % of patients had complete remissions in response to treatment. The most successful treatment was reduction or cessation of immunosuppressive therapy. Although polyclonal lesions are more likely to respond to such treatment than clonal lesions, the distinction is not absolute, and a trial of reduced immunosuppression appears to be indicated regardless of clonal status. However, this carries the risk of acute or chronic rejection, but complete remission with retention of good allograft function can be achieved in many cases.8,, In the present study, liver allografts appear more prone than others to be the site of lymphoma^.^-^,^ Allograft involvement by lymphoma should always be considered in the differential diagnosis of graft dysfunction. It is characterized on computed tomogra- phy scans by single or multiple low-density areas in the allograft or by a hypodense mass in the porta hepatis or by multiple hypoechoic areas on sonograms. The diagnosis is confirmed by percutaneous needle biopsy results, but occasional biopsies are misleading, as necrotic tissue only may be removed, necrotic areas being a common feature of many posttransplant lymphomas. The length of follow-up after transplantation is an important factor in the types of malignancies encountered. Many renal transplant recipients have been observed for a decade or even decades or more, whereas most hepatic transplant recipients were treated in the last 0 to years. Because malignancies such as skin cancers, carcinomas of the cervix, and carcinomas of the vulva and perineum occur late after transplantation, this may explain the discrepancy in the incidences of these tumors in renal and hepatic allograft recipients. The small number of liver allograft patients compared with the large number of renal transplant recipients may have also contributed to the marked differences in the incidence of the various cancers. Hepatic allograft recipients with nonlymphomatous tumors more frequently received triple therapy and antilymphocyte preparations than renal recipients. The heavy immunosuppression administered to hepatic allograft recipients compared with renal recipients may also account for the shorter induction time of nonlymphomatous neoplasms. It may also account for the rather aggressive behavior of some tumors and is in keeping with a more than sevenfold death rate from all cancers in liver allograft recipients reported in one study. lo The pattern of malignancies observed in hepatic allograft recipients closely resembles that observed in cardiac transplant recipients. When the types of neoplasms observed in heart or heart-lung recipients were compared with those observed in renal transplant recipients, lymphomas predominated in the former group (% v % of all malignancies), whereas other tumors were common in the latter group-skin cancers (9% v S0/,), carcinomas of the cervix (% v lo/,), and carcinomas of the vulva and perineum (% v 0.%). The reasons for these differences are similar to those discussed above regarding liver allograft recipients. Leiomyosarcoma is distinctly rare in children. The development of four cases of leiomyosarcoma and one of fibrosarcoma'? in pediatric liver allograft recipients is remarkable, particularly because the allograft was involved in four of the five cases.
7 58 Israel Penn Recently, Epstein-Barr virus in a clonal form, has been isolated form several smooth muscle tumors in organ allograft recipients suggesting that the virus has a role in the development of these malignan- Smooth muscle tumors have also been observed in acquired immunodeficiency syndrome patients, mainly children, with liver involvement in at least five case^.^',^^ Epstein-Barr virus infection has been associated with several of these tumors.9 Although most posttransplant cancers are etiologically related to immunosuppressive therapy, a small number are associated with the underlying disease requiring transplantation or its sequelae. Thus, in kidney transplant recipients, 0% of renal carcinomas may have resulted from the carcinogenic effects of analgesic abuse, and a substantial number of others may have been related to acquired cystic disease of the kidney.0 We have no explanation of why four liver allograft recipients developed carcinomas of the kidney. The altered anatomy after orthotopic liver transplantation may make removal of right-sided renal tumors difficuk In one third of liver allograft recipients with carcinomas of the colon in the present study, transplantation was necessitated by sclerosing cholangitis or other complications of chronic ulcerative colitis, a disease in which colonic carcinoma is a wellrecognized c~mplication.~~ In one study, there was a 6.5% incidence of colorectal cancers among 6 liver allograft recipients who had been treated for sclerosing cholangitis and chronic ulcerative and a second study reported an % incidence of colorectal neoplasms ( cancers and large villous adenoma with severe dysplasia) in 7 patients. In the present study, three liver transplant patients developed malignancies in their allografts or native liver almost certainly related to the underlying liver disease. Two patients developed hepatomas related to hepatitis B infection, a well-recognized precursor of this malignan~y.~~ The third patient, who underwent transplantation for sclerosing cholangitis complicating chronic ulcerative colitis, developed a cholangiocarcinoma that presumably originated in the recipient s residual bile duct and then involved the allograft. Cholangiocarcinoma is known to occur in ducts affected by sclerosing cholangitis,6-8 Acknowledgment I thank numerous colleagues throughout the world for generous contributions to the CTTR of data concerning their patients. References. Penn I. Why do immunosuppressed patients develop cancer? In: Pimentel E, ed. CRC critical reviews in oncogenesis. Vol. Boca Raton: CRC, 989:7-5.. Penn I. The changing patterns of posttransplant malignancies. Transplant Proc 99 ;:0-0.. Penn I. Immunosuppression-A contributory factor in lymphoma formation. Clin Transplant 99;6:-9.. Penn I. Incidence and treatment of neoplasia after transplantation. J Heart Lung Transplant Blohme I, Brynger H. Malignant disease in renal transplant patients. Transplantation 985;9: Kinlen W. Incidence of cancer in rheumatoid arthritis and other disorders after immunosuppressive treatment. Am J Med 985;78:(supl A) Sheil AGR, Disney APS, Mathew TH, Amiss N, Excell N. Cancer development in cadaveric donor renal allograft recipients treated with azathioprine (AZA) or cyclosporine (CYA) oraza/cya. Transplant Proc 99 ;:-. 8. Starzl TE, Nalesnik MA, Porter KA, Ho M, lwatsuki S, Griffith BP, et al. Reversibility of lymphomas and lymphoproliferative lesions developing under cyclosporinesteroid therapy. Lancet 98;: Penn I. Posttransplant de novo malignancies. In: Busutti RW, Klintmalm GB, eds. Transplantation of the liver. Philadelphia: Saunders, in press. 0. Polson RJ, Neuberger J, Forman D, Calne R, Williams R. De novo malignancies after liver transplantation. Transplant Proc 988;0: Levy M, Backman L, Husberg B, Goldstein R, McMillan R, Gibbs J, et al. De novo malignancy following liver transplantation: A single-center study. Transplant Proc 99;5: Nalesnik MA, Locker J, Jaffe R, Reyes J, Cooper M, Fung J, et al. Experience with posttransplant lymphoproliferative disorders in solid organ transplant recipients. Clin Transplant 99;6:9-5.. Danhaive 0, Ninane J, Sokal E, Latinne D, Phillipe M, Gosseye S, et al. Hepatic localization of a fibrosarcoma in a child with a liver transplant. J Ped 99;0:- 7.. Doyle H, Tzakis AG, Yunis E, Starzl TE. Smooth muscle tumor arising de novo in a liver allograft: A case report. Clin Transplant 99 ;5: Penn I. De novo malignancy in pediatric organ transplant recipients. J Pediatr Surg 99;9: Sokal EM, Caragiozoglou T, Lamy M, Reding R, Otte JB. Epstein-Barr virus serology and Epstein-Barr virus associated lymphoproliferative disorders in pediatric liver transplant recipients. Transplantation 996: Renard TH, Andrews WS, Foster ME. Relationship between Om administration, EBV conversion, and the lymphoproliferative syndrome in pediatric liver transplant recipients. Transplant Proc 99 ;: Joseph G, Barker RL, Yuan B, Martin A, Madeiros J, Peiper SC. Posttransplantation plasma cell dyscrasias. Cancer 99;7: Schemankewitz E, Hammami A, Stahl R, Henderson
8 De Novo Tumors After Liver Transplantation 59 JM, Check IJ. Multiple extramedullary plasmacytomas following orthotopic liver transplantation in a patient on cyclosporine therapy. Transplantation 990;9: Nalesnik MA, Randhawa P, Demetris AJ, Casavilla A, Fung JJ, Locker J. Lymphoma resembling Hodgkin disease after posttransplant lymphoproliferative disorder in a liver transplant recipient. Cancer 99;7: Cherqui D, Duvoux C, Plassa F, Gaulard P, Julien M, Fabniez PL, et al. Lymphoproliferative disorder of donor origin in a liver transplant recipient: Complete remission after drastic reduction of immunosuppression without graft loss. Transplantation 996: Honda H, Franken EA Jr, Barloon TJ, Smith JL. Hepatic lymphoma in cyclosporine-treated transplant recipients: Sonographic and CT findings. Amer J Roentgenol 989;5: Spiro IJ, Yandell DW, Li C, Saini S, Ferry J, Powelson J, et al. Brief report: Lymphoma of donor origin occurring in the porta hepatis of a transplanted liver. New Engl J Med 99;9:7-9.. Moody AR, Wilson SR, Greig PD. Non-Hodgkin lymphoma in the porta hepatis after orthotopic liver transplantation: Sonographic findings. Radiology 99;8: Lee ES, Locker J, Nalesnik M, Reyes J, Jaffe R, Alashari M, et al. The association of Epstein-Barr virus with smooth-muscle tumors occurring after organ transplantation. New Engl J Med 995;: Timmons CF, Dawson DB, Richards S, Andrews WA, Katz JA. Epstein-Barr virus associated leiomyosarcomas in liver transplant recipients: Origin from either donor or recipient tissue. Cancer, in press. 7. Van Hoeven KH, Factor SM, Kress Y, Woodruff JM. Visceral myogenic tumors: a manifestation of HIV infection in children. Am J Surg Path 99;7: Mueller BU, Butler KM, Higham MC, Husson RN, Montrella KA, Pizzo PA, et al. Smooth muscle tumors in children with human immunodeficiency virus infection. Pediatrics 99;90: McLain KL, Leach CT, Jenson HB, Joshi W, Pollock BH, Parmley RT, et al. Association of Epstein-Barr virus with leiomyosarcomas in young people with AIDS. New Engl J Med 995;: Penn I. Primary kidney tumors before and after renal transplantation. Transplantation 995;59: Zorn BH, Taylor RJ, Wood RP, Stratta RJ, Shaw BW. Renal cell carcinoma in a liver transplant recipient. Transplant Proc 99 ;: Spiro HM. Clinical Gastroenterology. nd Ed. New York: Macmillan, 977: Bleday R, Lee E, Jesserun J, Heine J, Wong WD. Increased risk of early colorectal neoplasms after hepatic transplant in patients with inflammatory bowel disease. Dis Colon Rectum 99;6: Higashi H, Yanaga K, Marsh JW, Tzakis A, Kakizoe S, Starzl TE. Development of colon cancer after liver transplantation for primary sclerosing cholangitis associated with ulcerative colitis. Hepatology 990;: Schroter GPJ, Weil R, Penn I, Speers WC, Waddell WR. Hepatocellular carcinoma associated with chronic hepatitis B virus infection after kidney transplantation (Letter). Lancet 98;: Wee A, Ludwig J, Coffey RJ, Larusso NF, Weisner RH. Hepatobiliary carcinoma associated with primary sclerosing cholangitis and chronic ulcerative colitis. Hum Pathol 985;6: Koneru B. Liver transplantation for malignant tumors. Surg Rounds 989;: Delcore R, Eisenach JB, Payne KM, Bhatia P, Forster J. Risk of occult carcinomas in patients undergoing orthotopic liver transplantation for end-stage liver disease secondary to primary sclerosing cholangitis. Transplant Proc 99;5: Miros M, Kerlin P, Walker N, Harper J, Lynch S, Strong R. Predicting cholangiocarcinoma in patients with primary sclerosing cholangitis. Gut 99 ;: Herbener T, Zajko AB, Koneru 6, Bron KM, Campbell WL. Recurrent cholangiocarcinoma in the biliary tree after liver transplantation. Radiology 988;69:6-6.
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text:
i really hope tomorrow is a brighter day.
today was gorgeous.
all lovely light and sunshine and clear weather.
it also heralded the death of Steve Jobs.
sometimes when i am driving along and forget that i am supposed to be paying a lot more
attention to what i am doing, my daydreams sort of grab me and take me away.
one of my recurring thought series includes what would
George Washington
think of life in America today?
first of all, the things he fought for so valiantly are taken for granted.
but in really good ways i think, at least most of the time.
i know we could be better as countrymen and women.
when it comes right down to it,
we seem to serve as a moral compass for the rest of the world.
right or wrong, it is so.
this is in spite of the sense that many other places accuse us of untold levels of greed, arrogance and entitlement.
we, however, as americans take care of the rest of the world.
we put our tax dollars, free speech and freely elected leaders where our mouths are .
sometimes we even get it done and done right.
george appreciate how women are these days?
would he see any substantive social changes and not freak out?
would he appreciate that american is the stamp on things such as the invention of :
the light bulb
the internet
just what would he appreciate about how we have taken his world and made it ours?
i wonder all the time, what new breakthroughs can americans claim for our history books and making our lives easier?
i realize this is just the most glossy overview.
i do occasionally remember to drive when i am behind the wheel.
the daydreams need to be put aside for me to survive on the road.
perhaps someday this will be a legitimate study on my part.
i have a dogleg path to perhaps writing a book,
teasing this premise into more fully formed
and cogent prose.
mostly, it is a tentative stepping in and out of a curiousity
that in all likelihood will never be fully formed.
but that is me.
i am not always the most dedicated to following through.
what i do admire though,
is that there has been a crevice in our country's fabric.
one that a drop of water was able to make its way through.
one that may have aided in the formation of a grand canyon sized idea.
i like to think that Steve Jobs was that drop of water.
and my absolutely preferred computerized world is his grand canyon.
every person is better for his having made the effort to channel.
his daydreams into life changing realities.
my gratitude is deep.
what his ideas, enactment of ideas and hiring of thinkers to flesh them out have
created a rich world.
a helpful world.
i love him for making hints so intuitive and friendly to other like-minded,
thick-headed people like me.
the world filled to its brim with admirers.
yet i who love old things more than most...
love all of my apple products.
unreasonably so many days.
and they are all due to the genius
and dedication and discipline that were harnessed
by mr. STEVE "johnny appleseed" JOBS.
he spread ideas like seeds.
or made it possible for the rest of us to do that for ourselves.
i thank him for every single one of them.
even the ones i will never understand or know about.
they are helping someone somewhere.
i am confident of that.
farewell and if i can, i hope to meet you someday amongst the puffy clouds.


text:
The University of Texas basketball player Andrew Jones has been diagnosed with leukemia, the school announced Wednesday morning.
Jones, a sophomore from Irving MacArthur, has begun treatments after going through a number medical tests and evaluations the past week.
"We hope everyone will keep him in your thoughts and prayers," a family statement said. "This is obviously a difficult situation for our family, and we hope everyone will respect our privacy at this time."
Jones was the Longhorns second leading scorer with 13.5 points per game. He missed four games in December after fracturing his right wrist.
"Speaking for our entire team and staff, we love Andrew and will do everything we can to support his family and help him get back to health," Texas coach Shaka Smart said in a statement. "I want to thank everyone for being respectful of the privacy that the Jones family needs at this time."
Leukemia is a cancer of the body's blood-forming tissues, including the bone marrow and the lymphatic system, according to the Mayo Clinic.
"We know Andrew's a fighter with a strong family and our thoughts, prayers and support are fully behind them," Texas athletic director Chris Del Conte said in the release. "At The University of Texas, we will do everything in our power to provide all of the resources we can to assist Andrew and his family."
Stefan Stevenson: 817-390-7760, @StevensonFWST


text:
Tikit's Support Team takes on 3 placement students for 2016/17
As the job market grows more and more competitive for graduates, placement years are quickly becoming a popular option for many students. Having industry experience before graduating from university provides students with real life, practical skills. As a result their chances of swiftly entering full time employment after graduating is greatly increased. Placements also benefit the employer. They may choose to offer a full time role to the student once they have graduated, saving money on recruitment and training fees.
At Tikit, we work closely with Portsmouth University to provide the students with the opportunity to gain vital experience they need for the future. This year we have offered three students the chance to work with us, the most we have ever taken on. Two are working with our Applications team while the other has taken on a role in Business Administration. They will be working with Tikit's software portfolio including Partner for Windows (P4W), Carpe Diem, eMarketing, Template Management System (TMS).
To date we have had a high success rate with our placement schemes, with a majority of our students returning to work with us after graduation. In fact, our very first placement student, Reuben Manning is now an Applications Support Manager after joining Tikit back in 2009.
Meet this year's placement students:
Jonathan Jones currently studies BSc Business Information Systems at Portsmouth University. He is from London and campaigns for free speech all across the country.
Heidi Johansen is currently studying BA (Hons) International Business at Portsmouth University. She is originally from Oslo, Norway and can speak fluent Norwegian.
Yanna Antoniou studies BSc Computing at Portsmouth University. She is from Cyprus and is a member of a Poker Society.
Jonathan, Heidi and Yanna will be with the company for one year. They will be treated the same as any other member of the Tikit support team. We hope they enjoy their time here and gain some hands on experience, as well as valuable knowledge they will need for the future.


text:
A WOMAN who lost nine stone has finally got the body she's always dreamed of after her mum paid for her boob job and excess skin removal.
Laura Rood, 32, from Las Vegas, USA, was told by her doting mum Joan that if she could successfully lose weight she would pay for her to have cosmetic surgery.
At her heaviest, Laura weighed 22st 7lb – piling on pounds during her first marriage and consuming highly calorific food after her father died.
In 2015, after countless failed attempts at dieting, the paralegal student had a vertical sleeve gastrectomy – where surgeons removed part of her stomach.
Laura's restricted appetite, combined with strict dieting and daily exercise, helped her to shift a whopping nine stone.
But, despite her hard work, Laura's transformation was so extreme that she was left with swathes of saggy excess skin that she says made her look like fictional film character E.T.
Laura was also left feeling that her boobs resembled "flattened watermelons".
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But Joan was a woman of her word and fulfilled her vow, forking out £16,500 for her daughter to have 11lb of excess skin removed – as well as her "hanging" H-cup breasts transformed to perky E-cups.
Laura said: "When I was 16 years old, my mother told me that if I got to a healthy weight and needed to have something done cosmetically she would pay for it.
"As a 31-year-old, she did that for me and it was an amazing gift that I'll never be able to fully thank her for.
"It cost over £16,500 I couldn't have ever afforded that, now when I look in the mirror I don't feel bad about how I look which is amazing.
"I had such a bad self-image that when I saw a picture of E.T. with all of his sagging skin it reminded me of my own body.
"I had an apron stomach that went down to my thighs, it was almost impossible to disguise.
"My breasts were like two flattened watermelons stuck to my chest, which limited my confidence and stopped me from being able to work-out and run comfortably.
"Mum was so proud, it meant the world to me that she offered to keep her promise from all those years ago."
From a young age, Laura used food to deal with her problems but became worse after her marriage turned emotionally abusive.
Laura said: "During my marriage, I gained 100lb (seven stone) from depression and poor self-image, you don't realise food is such a comfort to you.
"I remember my ex-husband saying 'no one else would ever love me' because I was so big."
Her overeating then worsened further when her father Norman passed away in 2008.
Breakfast – nothing
Lunch – McDonalds double quarter pounder with cheese, large fries and coke
Snack – crisps, sweets, fizzy drinks
Dinner – one whole large pizza
Dessert – one massive piece of cake
Laura said: "After my father died, I lost a part of me and slipped into a depression where food was my only comfort."
But two years ago, she chose to change her life by having bariatric surgery and within a year had dropped down to a healthy 13st 2lb.
Now Laura isn't letting anything hold her back and has even started blogging about surgery to encourage others to consider the option that changed her life.
She said: "I went from being a shell of a woman who didn't recognise her own face in the mirror to someone who sees a poised, strong, confident and beautiful woman capable of anything."
Mum Joan Rood, from Bradenton, Florida, said: "I remember making the promise to Laura, when she was around 16 or 17 years old.
Breakfast – protein shake with yoghurt
Snack – slice of string cheese
Lunch – green salad with coconut vinegar, avocado oil, hemp seed, black seeds, chia seeds and cheese
Snacks – yoghurt
Dinner – protein drink, soup or yoghurt
"It would have broken my heart to have seen her work so hard towards her goals and dreams only to have the excess skin get in the way of her truly enjoying her new life and wonderful achievements."
"I can see a totally different person has emerged. I think she feels as though now she is capable of doing so much more with her life than she ever thought was possible for herself.
"I believe it is because she has found a confidence in herself that she has never had before."
You can follow Laura on Instagram @Vsg.Vegas or on her website at: www.the-talking-tummy.com


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I'm sure that the owners of these dogs care for, and love, their animals much better than 90% of pet owners out there!! Please learn something about the working dog/ sled culture before you throw out the 'chained dog' comments!!! I have many types of animals......none are chained or bound but all are protected from danger by the appropriate measures!!
In the video below Brian, who lives in Churchill, Manitoba, Canada, has been rescuing and breeding Eskimo dogs since 1974, after he found out that the lovable breed could potentially go extinct. During the 1980s, Churchill residents noticed polar bears were becoming a bit of a nuisance.


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Drug rehab for Orange County residents is often at the top of many concerns of loved ones who have fallen victim to the lure of drugs. However, illegal drugs like cocaine and heroin aren't the only substances that get abused. Alcohol is another source of substance abuse. Thankfully, an addiction, whether for illegal substances or restricted ones, can be traced to the same causes and can be fought in the same way.
Kicking the Habit
The core thing about fighting addiction is recognizing its existence either through the help of concerned loved ones or on your own. Checking into facilities for drug and alcohol rehab in Orange County like Ranch Creek Recovery is the first step into becoming free from your addiction. It starts by clearing out the drugs and alcohol in your system, helping your body to get better.


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I have a command that I want to use with several different menu items, but in each case the command parameter would be different. For example, suppose my command is call SelectCommand and I have three menu items called Select 1, Select 2 and Select 3:
<MenuItem Header="Select 1" InputGestureText="Ctrl+Shift+F1"
Command="{x:Static local:MyClass.SelectCommand}"
<MenuItem Header
View Complete Post
View Complete Post
I want to be able to show the record that was just inserted after add_button_click event. I run the insert from mycommand and then set mycommand2 to run the read to populate a details view.
I have a feeling I am going about this the wrong way.
The insert fires correctly but the details view does not populate.
Dim connectionString As String = ConfigurationManager.ConnectionStrings("ApplicationServices").ConnectionString
Dim insertSql As String = "INSERT INTO Customers(CompanyName, CompanyAddress1, CompanyAddress2, CompanyCity, CompanyCounty, CompanyZip, CompanyState, CompanyPhone, CompanyFax, CompanyWebsite, CompanyEmail, CompanyContactFirst, CompanyContactLast, CompanyActive, CompanyID, CreatorID, CreatorCompanyID, PrivateCustomer)VALUES(@CompanyName, @CompanyAddress1, @CompanyAddress2, @CompanyCity, @CompanyCounty, @CompanyZip, @CompanyState, @CompanyPhone, @CompanyFax, @CompanyWebsite, @CompanyEmail, @CompanyContactFirst, @CompanyContactLast, @CompanyActive, @CompanyID, @CreatorID, @CreatorCompanyID, @PrivateCustomer)"
Dim insertNewSql As String = "IF NOT EXISTS(SELECT * FROM Customers WHERE CompanyName=@CompanyName) INSERT INTO Customers(CompanyName, CompanyAddress1, CompanyAddress2, CompanyCity, CompanyZip, CompanyState, CompanyPhone, CompanyFax, CompanyWebsite, CompanyEmail,
When executing a large .sql file contents, which creates a lot of objects on a database, running the ExecuteNonQuery over a Database object, we're getting a FailedOperationException. Is there a way to find which of the SQL statements passed in
the string is causing the exception, and have some more 'familiar' error message?
Are there other options to run the multiple T-SQL statements created with the SQL Server Management Studio database script generation feature?
We are using the SMO on a .NET Fx 3.5 app running against a SQL Server 2008 instance on a 32 bits computer.
i got some samples and i did autocomplete using jquery , its working well for single input values
but i need to pass multiples values after one by one in the textbox. Is it possible to pass multiple
values in the textbox for autocomplete in jquery in asp.net?
I am developing a multi-company application and want my users to give the functionality like the following to switch companies.
Is this possible? then how?
Please help
I have a user control that I place on a page severl times. When I make a selection on a ddl in one one control the SelectedIndexChanged event fires for all the control on the page for that ddl. So I get duplication of an insert that I do. Is there a way to make sure these events are isolated so this doesn't happen.
I want to add multiple rows of a gridview if the data for multiple fields are same.
Idea for this is that a user may search a record with some parameter e.g. Sector, plot.
For example 15 records being displayed in gridview.
There should be checkbox before every row and if user wants to update Plot and Flat No that is same for 10 rows out of 15 so he will check the rows and update.
For this a dialog box should appear asking for the parameter i.e. Plot and Flat or something else next time may be it will be City or country. Moreover, there is already an Edit button to update records, when user click it another page open for the record to be updated and whatever he wants to update, it updates.
Hope everone understand the scenario.
I don't want to disturb the already provided Edit functionality and want to provide same record to be updated.
Any idea in this regard would be appreciated.
In my web.config I have:
<add name="ADProvider1"
<add name="ADProvider2"
If I just have ADProvider1 it works, when I add ADProvider2, even though for testing I only use ADProvider1 I get an error: "Unable to establish secure connection with the server"
Am I adding the second provider to the membership section incorrectly?
Hi! Can someone tell me how I can troubleshoot the
following error: "Encountered multiple versions of the same assembly
with GUID...try pre-importing one of these assemblies".
The website developed in VS 2010 (.Net 3.5). This error is only received on my
workstation. Another person developing the site does not experience
this issue at all. Also, not sure if this matters, but on my workstation the 'Assembly
Information...' dialog contains no values even though the 'AssemblyInfo.vb' file does specify values for the title, desc, etc.
The GUID being referenced in the error is the main project of the three projects
within the solution.
I tried looking through the GAC, but do not see any references to the projects or DLLs in the VS solution and am not sure what else/where to look.
If I delete the copy of the solution on my local machine and pull down a copy from source control (AnkhSVN) the solution will build with no error. Once I make any changes, such as adding a new aspx file, then the error is received.
I can provide any additional information needed.
I have two database connections that connect to two separate SQL severs. The connection strings are stored in a separate ConnectionStrings.config file I have the following in my Web.config
<connectionStrings configSource="ConnectionStrings.config" />
I use LINQ to SQL and a DBML file is created. I finished dragging and dropping tables from the first db. When switched to the second connection and try to drag and drop tables to the surface, I got a warning "The objects you are adding to the designer use a different data conneciton than the designer is currently using. Do you want to replace the conneciton used by the designer?". Should I add a second DML and drag and drop the tables from the second db so I don't get problems with multiple connections? If say Person is a class in the first DBML and PersonPrivacyContent is on the second DMBL. How could I associate these two classes? If only one DBML is needed, how do I switch between two connections and execute LINQ queries in each db? Thank you.
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- FrankhowellAsked on March 12, 2016 at 10:40 AM
Our from is set up on Facebook once it's filled out and click the submit button nothing happens. Help
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I have just replied to your first thread. Please check and let us know the needed information.


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Sand Spring to host Kingdom Heirs, Common Bond
The Kingdom Heirs from Pigeon Forge, Tenn. (Dollywood) will be in concert at Sand Spring Baptist Church on Feb. 27 at 7 p.m.
Also appearing will be Common Bond from Mt. Sterling, Love offering accepted.
Sand Spring Baptist is located at 1616 Harrodsburg Road in Lawrenceburg.
Lawrenceburg resident begins Lexington ministry
Jacoby named to the Dean's List at Citadel
William Earl Jacoby of Lawrenceburg has been named to the Dean's List at the Citadel, the military college of South Carolina, for academic achievement during the fall semester of the 2013-2014 academic year, according to a release.
Dean's List recognition is given to those students whose grade point average is 3.2 or higher with no grade below a C for the previous semester's work.
A little more than half of Anderson County kindergarteners are prepared for kindergarten, according to a statewide test administered to students for the first time this school year.
The BRIGANCE kindergarten screener tested kindergarteners at the beginning of the year on visual, cognitive and motor skills with tasks like copying basic shapes such as squares or rectangles, standing on one foot for 10 seconds and with their eyes closed, and identifying colors and letters.
Valentine's Day has been celebrated in form or fashion since Pope Gelasius declared Feb. 14 as a special day for honoring Saint Valentine in the late 5th century, but it wasn't until sometime in the 14th century that it became associated with love.
Since then it has turned into the greeting card industry's second most profitable holiday (Christmas being first), with some 150 million cards and gifts sent each exchange each year in the United States alone.
This winter isn't the worst one Anderson County's ever seen, according to meteorological records, but that doesn't mean it hasn't been difficult to clear the roads of ice and snow to get residents to work and school.
Billy Powell Catlett, who's been the road department supervisor in Anderson County for the past three years, said he's keeping his fingers crossed that the extra 200 tons of salt that arrived last Friday will be enough to see the county through the rest of the season.
The Lawrenceburg fire and rescue recently held an awards banquet to honor firefighters and other first responders over the last year.
The city of Lawrenceburg fire and rescue responded to 101 runs in 2013, according to a release from City Fire Chief Bobby Hume. Out of the 101 runs, 25 of those were fire runs.
Awards given out during the banquet included:
Most fire runs attended: Rex Riley
Most fire training hours attended: Allen Davenport
Firefighter of the year: Robbie Hume
Junior firefighter of the year: Dalton Hawkins
Judge Linda Armstrong heard the following cases during Anderson District Court proceedings on December 12, 2013.
Aaron J. Hilbert, arraignment, second-degree criminal abuse – pleaded not guilty, preliminary hearing Dec. 19.
Rachel Barker, review, seven counts of theft by deception (less than $500) – continued to Mar. 6.
Laura M. Blankenship, motion for review, three counts of theft by deception (less than $500) – show cause.
Whitney Brock, review, theft by deception (less than $500) – commonwealth to file motion to revoke.
By Tom Loftus and Jere Downs
The Courier-Journal
Preparing for her 4 p.m.-to-midnight shift at a Louisville convenience store on Friday, 33-year-old Lyn Riley said a hike in minimum wage would have a significant impact on her life — lifting her from welfare.
The $7.25 hourly wage she earns now is just not enough to cover rent and utilities for her one-room basement apartment in Smoketown, and food and diapers for her 18-month-old daughter, Riley said.
The following people were arrested and transported to jail during the past two weeks, according to information released by Anderson County Jailer Joani Clark. According to information from Clark, a total of 68 people were arrested in January 2014.
Jan. 26
Justin Reynolds, fourth-degree assault domestic violence, by the Kentucky state police.
Darla Gravitt, Kenton County warrant, by the Anderson County Sheriff's Office.
Richard Trent, second count DUI, speeding, no license in possession, by Kentucky state police.
Copyright © 2019
The Anderson News is your source for local news, sports, events, and information in Lawrenceburg, KY and the surrounding area.


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James Franco
Super Uncomfortable on 'Late Night'
… Taking about Ally Sheedy
James Franco had some super uncomfortable moments Wednesday night on "Late Night with Seth Meyers" when the host asked the actor about Ally Sheedy.
You'll recall, after Franco won Best Actor during the Golden Globes, Sheedy tweeted, "Why is a man hosting? Why is James Franco allowed in? Said too much." She later deleted the post.
Franco said he didn't know what she was talking about and added he had a good relationship with Sheedy, to which Meyers shot back … wasn't he curious enough to call her and find out what she was talking about? Franco squirmed but said he was satisfied with letting it be.
Franco says the sexual misconduct allegations are not true, but he's willing to take a bullet and stay silent rather than tarnish the #MeToo movement.
The L.A. Times just published a story claiming 5 actresses have accused Franco of misconduct, one of whom says during the filming of a nude orgy scene, Franco "removed protective plastic guards covering the actresses' vaginas while simulating oral sex on them."
The casting director who worked on that movie disputes the claims and says there were no complaints on set and she "personally checked on all the actresses constantly to make sure they were ok and comfortable."


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Hubli (Karnataka): Uttar Pradesh Chief Minister Yogi Adityanath said that the myth regarding the visit to Noida and losing the chair of CM should be thrashed.
"I am visiting Noida on December 23 and 25 to break this myth. Development of Uttar Pradesh and its people is our first priority," said Yogi Adityanath in Hubli.
Adityanath further said that remaining in the position of Chief Minister is not his objective.
"Objective is not to be in the position of a Chief Minister but welfare of the people of Uttar Pradesh," added Yogi Adityanath.
Yogi Adityanath will be visiting Noida on December 25 to receive Prime Minister Narendra Modi for inauguration of the Noida-Kalkaji Metro line.
It is believed that any Chief Minister of Uttar Pradesh visiting Noida during the tenure apparently losses the chair.
Former Chief Minister Akhilesh Yadav never visited Noida in his year tenure and inaugurated projects and roads by remote control sitting in his official residence in Lucknow.
Soon after Chief Minister Veer Bahadur Singh visited Noida in 1988 he was ousted of power. His successor Narayan Dutt Tiwari of the Congress, Mulayam Singh Yadav, Kalyan Singh and Mayawati also faced similar fate. (ANI)


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Zelda has fast become probably one of my 3 most popular ladies! It's easy to see why as she does each clip with such enthusiasm!! And the Loads she puts out nothing short of AWESOME!!! Enjoy another FUNKY Dozen minutes of action! Enjoy some great behind the bowl clips as you can see those logs shoot right out her tight asshole! Then enjoy as she takes the fun to the Tub to get a little naughty before a shower!! Enjoy as she grunts and strains out a painful load into the tub! Then enjoy Two great squatting clips over the floor. Five Great Loads from on of the best doing it!!
(542)All of the following downloads are included when you purchase:
Download #1:
Length: 12:45s Resolution: 1920x1080Download Format: mp4File Size: 466 MB
Download #2:
Length: 12:45s Resolution: 1920x1080Download Format: mp4File Size: 2 GB


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November 06, 2010
Christmas Photo... Take One!
I love this photo of my little monkeys that I took a few weeks ago. I wanted a photo of them that I could use in my Christmas cards, and this was one that I took of them on the couch after we got home from having professional photos taken:) I'm still waiting for those... but in the meantime it made for a great scrapbook page!
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2 comments:
- Sabriena Satchwell An Independent Stampin' Up!® Demonstrator said...
You serioulsy have such cute kids! Look at their little smerks! I love it.
- November 8, 2010 at 9:07 AM
- Kari said...
Oh my gosh - I can't believe how much they are looking like Sean!! Beautiful shot and beautiful kids!
Miss you!
- November 10, 2010 at 11:41 AM
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