Enoxaparin versus unfractionated heparin in acute ischemic stroke [in-evolution type]. Differential effects of enoxaparin on von willebrand factor release and a possible relation to improved clinical outcomes

The significance of low-molecular-weight heparins [LMWHs] in the management of acute stroke remains controversial. Investigating the effect of early administration of Enoxaparin [ENOX] on risk reduction of early recurrent ischemic strokes compared with Unfractionated Heparin [UFH]. Besides, exploring whether these benefits of ENOX might lead to reduction in death and disability. One hundred patients with acute ischemic stroke in evolution were enrolled [with symptoms of stroke within eight hours randomization]. Patients were randomized to receive UFH or ENOX for ten days. National Institutes of Health Stroke Scale [NIHSS] and Computed Tomography [ct] scan were performed at the time of admission, and after 48 hours of randomization. The mean baseline of [NIHSS] were 9.14 +/- 0.62 and 7.86 +/- 0.54 among patients randomized to UFH and ENOX respectively [P-value 0.2]. At discharge, the mean NIHSS showed a statistically significant difference in favor of the ENOX group [7.9 +/- 0.82 vs 4.96 +/- 0.54 for ENOX and UFH respectively [P-value = 0.002]] The mean NIHSS after therapy in patients who demonstrated neurological improvement was 5.6 +/- 0.46 in the UFH arm compared to 3.65 +/- 0.39 in the ENOX arm [P-valne=0.001]. A deterioration in the clinical neurological condition [progressive stroke symptoms] inspite of treatment with anticoagulant therapy was seen in 20% [n=10] of the patients in the UFH treatment arm compared to none [n=0] in the ENOX treatment arm [P-value=0.005]. ENOX + aspirin was superior to UFH + aspirin in reducing adverse neurological disability after acute ischemic stroke in evolution

Urinary creatinine and serum cystatin C in asthmatic children treated with inhaled corticosteroid and beta 2 agonist

L-arginine, an amino acid involved in the production of urea, creatinine and nitric oxide [NO] that is known to play an important role as an inflammatory mediator in the airways. Inhaled corticosteroids and beta [2] agonists are the most frequently prescribed medications in the management of chronic asthma. Current guidelines emphasis their complementary role. Although many patients use both drugs, there is little information on the effectiveness of their combination. In the present study we investigated the effect of a combination of glucocorticoids and beta [2] -agonists inhaled by asthmatics on the metabolism of L-arginine. Sixty-six children with mild-to moderate asthma were enrolled in this study and treated with different regimens of inhaled drugs but fifty three children only completed the study [Twenty one with inhaled beta [2] agonist [salmeterol], 15 with inhaled corticosteroid [fluticasone propionate], and 17 with a combination of inhaled salmeterol and fluticasone propionate]. Fifteen healthy-matched children served as a control group. Pulmonary function tests [forced expiratory volume in one second [FEV[1]], peak expiratory flow rate [PEFR]], methacholine challenge tests, serum cystatin C, 24 hours urinary measurement of urea, creatinine, nitrates, and urinary osmolality were performed before and after three months of the inhaled drug therapy. The results of this study demonstrated: [1] Non significant differences in serum cystatin C and urinary urea, creatinine, nitrates, osmolality were noted in asthmatic children vs control group. [2] non significant differences in serum cystatin C level and urine osmolality were observed in different groups before and after therapy. [3] compared to that before therapy, children treated by the combination of corticosteroid and beta [2] agonist had a significant higher level of urinary creatinine [p=0.0001] and a higher creatinine/urea ratio [c/u ratio] [p=0.0001] with significantly lower levels of urinary urea [p=0.002], and urinary nitrates [p=0.0001]. [4] in children treated by the combination of corticosteroid and beta [2] -agonist, there were a significant positive correlations between urinary creatinine and both FEV[1] [r= +0.699, p<0.01] and methacholine provocative dose causing a 20% fall in FEV[1] [R= +0.695, P< 0.01]. Also there were significant positive correlations between c/u ratio and both FEV[1] [r= +0.821, p = <0.01] and methacholine provocative dose causing a 20% fall in FEV[1] [r= +0.850, p< 0.01]. [5] in children treated with corticosteroid alone, only urinary nitrates was significantly lower after treatment as compared to that before treatment. [6] in children treated with beta [2] agonist alone, no significant differences in urinary urea, creatinine, nitrates and c/u ratio as compared to that before therapy. In asthmatic children, treatment with a combination of inhaled corticosteroid and beta [2] -agonist had a beneficial augmenting influence on the metabolism of L-arginine with better improvement of lung functions and bronchial hyperreactivity than treatment with either corticosteroid or beta [2] -agonist alone. Also creatininuria and urinary c/u ratio can be used as a simple and noninvasive parameters for assessment of response to treatment in these children. Also our results demonstrated normal serum cystatin C concentrations in asthmatic children in between attacks and remained unaffected by a therapy with inhaled corticosteroid, beta [2] agonist or a combination of both

Plasma adrenomedullin and brain natriuretic peptide in children with chronic congestive heart failure

The goal of this study is to delineate the role of adrenomedullin [ADM] and brain natriuretic peptide in the pathophysiology of chronic heart failure [CHF] and the potential use of their circulating levels for diagnosis and treatment of heart failure. Fifty children [19 males and 31 females] with chronic congestive heart failure [CHF] were enrolled in this study. Plasma ADM and BNP levels were assayed by radioimmunoassay and ELISA respectively. Enrolled children were classified into four classes according to New York association functional class [NYHA]. Their age ranged between one year to fifteen years. Twenty-one children [8 males and 13 females] with age ranging from 3-13 years served as control group. The results showed that the plasma concentrations of adrenomedullin [ADM] in pg/ml increased progressively with advancing class of heart failure by NYHA; 3.45 +/- 0.59 for class I, 5.32 +/- 0.95 for class II, 7.29 +/- 1.18 for class III and 14.65 +/- 2.06 for class IV, that were significantly higher than in controls [1.97 +/- 0.46, P<0.001]. Also, plasma BNP concentrations in ng/l were 42.56 +/- 4.14, 129.4 +/- 18.85, 569.05 +/- 37.76 and 1039 +/- 359.57 respectively in children of NYHA class I, II, III and IV, that were higher than in controls [9.21 +/- 1.433, P<0.001]. there was a significant positive correlation, between ADM and BNP in relation to severity of heart failure. ADM and BNP concentrations were significantly reduced after treatment. Adrenomedullin and natriuetic peptide appears to participate actively in the pathogenesis and perpetuation of chronic heart failure in children. This fact might open a new pathogenesis and perpetuation of chronic heart failure in children. This fact might open a new therapeutic channel for children with heart failure to prevent progression to chronicity and to those with already chronic heart failure through uses of ADM and BNP agonist specific for their receptors

Evaluation of endothelin-1 and Von Willebrand factor as biomarkers of pulmonary hypertension in children with congenital heart disease

This study was done to delineate the role of endothelin-1 [ET-1] and von willebrand factor [vWF] in the pathophysiology of pulmonary hypertension [PHT] secondary to congenital heart disease. Forty-three children [29 males, 14 females] with cyanotic and acyanotic congenital heart diseases were enrolled in this study. Their age ranged between 4 months 5.10 year. Plasma ET-1 levels and vWF:Ag activity were assayed by enzyme linked immunosorbent assay. Enrolled children were divided into three groups according to pulmonary artery pressure [PAP]. Group 1 with normal PAP [/= 50mmHg] [n=14]. Twelve perfectly matched healthy children were enrolled as a control group. The results of the present study showed that plasma ET-1 levels in group I were significantly higher than that in control group [P<0.001], on the other hand no significant differences were noted in vWF: Ag% in both groups. Plasma endothelin-1 and vWF:Ag were significantly elevatd in all groups with PHT Vs controls [P<0.001 and P<0.001]. Plasma endothelin-1 and vWF: Ag% were significantly elevated in group III Vs both group II and I [P<0.001]. plasma endothelin-1 and vWF:Ag% were significantly elevated in group II Vs group I [P<0.001 and P<0.001]. Plasma ET-1 levels and vWF:Ag% positively correlated with pulmonary artery pressure in group II and III [P<0.001 and P0.001]. Elevated ET-1 and vWF may contribute directly to development of pulmonary hypertension in children with congenital heart diseases. ET-1 and vWF estimation could be used as non-invasive early markers of pulmonary hypertension in such children, particularly in post-operative evaluation. Our data are in keeping with evidence of significant coagulation abnormalities in pulmonary hypertension and the need for chronic anticoagulant therapy may increase survival in children with pH. These facts opened the door for exploring therapeutic anti-ET-1 and anti- vWF agents in the treatment of pulmonary hypertension in children

Plasma levels of soluble CD14 and endothelin-1 in infants with respiratory syncytial virus-induced bronchiolitis as predictors of subsequent recurrent wheezing in a two years follow-up study

Respiratory syncytial virus [RSV] infections have been demonstrated to be associated with subsequent recurrent wheezing episodes and the development of childhood asthma. The CD14 receptor responds to the microbial burden in the environment and modulates the development of the allergic phenotype. Endothelin-1 is a potent bronchoconstrictor involved in many diseases including respiratory tract infections. Plasma levels of soluble CD14 [SCD14] and endothelin-1 [ET-1] were measured by a commercially available enzyme-linked immunosorbent assay [ELISA] in 32 infants who were hospitalized with RSV bronchiolitis to investigate their relation to the subsequent development of recurrent wheezing during a two years follow-up period. Thirty healthy infants were served as a control group. The results proved that the mean level of plasma sCD14 was significantly lower in infants with acute RSV bronchiolitis compared to control group [22.01 +/- 6.27 vs 817.50 +/- 247.52 ng/ml, p<0.001]. The mean sCD14 plasma level of 18.52 +/- 5.24 ng/ml in the group of 19 children who exhibited recurrent wheezing was significantly lower than the level of 27.11 +/- 3.57ng/ml in the group of 13 children who did not exhibit recurrent wheezing [P<0.001]. the mean plasma level of ET-1 was significantly increased in infants with RSV bronchiolitis compared to the controls [3.86 +/- 1.44 vs 0.71 +/- 0.18 pg/ml, p<0.001] and the mean plasma ET-1 level of 4.60 +/- 1.17 pg/ml in the group of children who exhibited recurrent wheezing was significantly higher than level of 2.78 +/- 1.11 pg/ml in the group of children who did not exhibit recurrent wheezing [P<0.001]. the risk for subsequent development of recurrent wheezing was not influenced by age at hospitalization, sex, breast-feeding, positive family history of atopy, or passive smoking. The results of this study showed that plasma level of sCD14 was decreased and plasma endothelin-1 was increased in infants during acute RSV bronchiolitis and their levels were significantly different in infants who had experienced subsequent wheezing than in infants who not and that reduced plasma sCD14 and increased ET-1 levels in infants with RSV bronchiolitis are useful in predicting the risk to develop subsequent recurrent wheezing. From the results of this study, it can be recommended that CD14 may be a potential target for preventive measures against atopic diseases. This study also encourage further studies on the value of ET-1 antagonism among alternative therapeutic modalities of childhood asthma

Homocysteine a risk factor for cardiovascular disease in patients with type 2 diabetes mellitus

Diabetes mellitus has been widely recognized as major risk factor for coronary artery disease and, at the present time, diabetics are considered at high risk for coronary events independently of prior evidence of atherosclerotic disease [1]. Hyperhomocysteinemia has emerged as a novel risk factor for myocardial infarction. Diabetes shares many common mechanisms of plaque development with hyperhomocysteinemia, such as those related to endothelial dysfunction, thrombosis and oxidative stress [2]. To study the importance of serum homocysteine [Hcy] level as a predictor of myocardial infarction in patients with type 2 diabetes mellitus and to detect that this level is of an equal importance as other cardiovascular risk factors such as hypertension, hypercholesterolemia and smoking. Forty individuals were divided into three groups: group I [acute myocardial infarction with type 2 diabetes group, n=15], group II [uncomplicated type 2 diabetes group, n=15] and group III [normal control, n=10]. Diagnosis of myocardial infarction was confirmed from ECG criteria together with significant elevations in serum creatine kinase activity and echocardiographic examination. Higher homocysteine levels was found in AMI patients with type 2 diabetes and in uncomplicated type 2 diabetic patients [P< 0.01] than the normal control. Homocysteine was positively associated with total cholesterol, LDL-c, P.PB.S, and negatively associated HDL-c. Higher homocysteinemia was predominantly observed in type 2 diabetic patients with myocardial infarction especially those presenting low HDL-c, high LDL-c. Serum homocysteine is considered to be one of the strong and important predictor of myocardial infarction in type 2 diabetes

Elevated plasma matrix metalloproteinase-9 level in hepatocellular carcinoma: is it induced by hepatocyte growth factor?

Hepatocellular carcinoma [HCC] is one of the most common cancers worldwide affecting one million cases per year. The aim of the present study was to evaluate the diagnostic role of plasma matrix metalloproteinase-9 [MMP-9] in patients with HCC and its relation to hepatocyte growth factor [HGF]. This study was conducted on 30 patients classified into: Group II included 10 patients with chronic active hepatitis. Group III included 10 patients with liver cirrhosis and Group IV included 10 patients with HCC. Ten healthy subjects were also included in the study as a control group [group I]. Alt studied groups were subjected to clinical, laboratory, ultrasonographic examination and estimation of serum alpha-fetoprotein [APP], HGF and plasma MMP-9. There were significant elevations in serum levels of AFP. HGF and plasma levels of MMP-9 in patients with HCC compared to other studied groups. Also serum AFP and HGF levels in group II and III were higher than those of the controls. However, MMP-9 levels in group II and III were not significantly different from those of the controls. Also MMP-9 and HGF levels were significantly higher in HCC patients with lung metastasis. portal invasion and tumour size

Clinicopathological patterns and distribution of schistosomiasis in Asir Region

The objective of this study is to report, for the first time, the histopathologic pattern of Schistosomiasis from the Asir Region and to compare it to patterns reported from other regions of the Kingdom of Saudi Arabia. Several studies have reported the patterns of Schistosomiasis in other regions of the Kingdom of Saudi Arabia and other countries where Schistosomiasis is endemic. Schistosomiasis is endemic in certain areas of Asir region, however no data is available concerning the clinicopathological pattern of Schistosomiasis in the Asir Region. This is a retrospective analysis of 217 cases of Schistosomiasis from surgical and biopsy files of Asir Central Hospital during a period from January 1990 to October 1999. Our study revealed that Schistosomiasis was more common among the expatriate population of Asir Region than Saudi nationals residing in this area. The urinary tract was most commonly involved, and then in descending frequency came the vermiform appendix, liver and large bowel. These findings are somewhat different from those observed in the Riyadh Region where the vermiform appendix was the most commonly affected organ. Based on the histopathologic pattern, our study describes the pattern of Schistosomiasis in the Asir Region and may serve as a base-line for future research work

effect of metformin on the endocrine variables in clomiphene resistant polycystic ovarian disease

To investigate the effect of metformin on the endocrine variables in clomiphene resistant polycystic ovarian disease [PCOD]. Departments of Obstetrics and Gynaecology, Internal Medicine and Clinical Pathology, Faculty of Medicine, Tanta University, Egypt. Thirty-three infertile women due to PCOD were enrolled and divided into 23 cases received oral metformin 850 ma/ twice daily for 8 weeks and 10 cases received placebo for the same period. Basic hormonal parameters, serum glucose and insulin were tested before and after treatment. Metformin led to 65% improvement in acne score, 57% menstrual improvement and significant reduction of serum LH androstenedione, DHEAS, free testosterone, glucose and insulin. Highly significant elevation of SHBG was observed. The mean fasting insulin dropped from 28 uU/ml before to 16 uU/ml after therapy and this drop was significantly correlated to changes in testosterone, free testosterone, SHBG and glucose. Metformin may be suggested as a therapy for women with colomiphene resistant polycystic ovarian disease. It can ameliorate hyperinsulinemia, hyperadrogenemia with their impacton the restoration of regular menses and ovulation; and hence improving the pregnancy capability

Goserelin and oral contraceptive combination versus laparoscopic ovarian cauterization and their effects on the endocrine changes in women with clomiphene citrate resistant polycystic ovary disease

The aim of this study was to compare the effects of combination of long acting GnRH agonist [Goserelin] and oral contraceptive [OC] therapy and laparoscopic ovarian cauterization on the endocrine changes in women with clomiphene citrate [CC] - resistant polycystic ovary disease [PCOD]. Twenty one women with CC- resistant PCOD were included randomly in the study to either laparoscopic ovarian cautery [n = 10] or GnRH-a and OC therapy for 3 months [n = 11]. Serum concentrations of LH, F.S.H, androstenedione [A], testosterone [T] and sex hormone binding globulin [SHBG] were determined in each group and during the follicular phase of first menstrual cycle after cessation of each treatment. Our results showed that the mean serum concentrations and clinical profiles were similar in both groups. Both groups showed significant decrease in LH, A and T and significant increase in FSH compared with pretreatment levels. The SHBG concentration increased in both groups after therapy, however, the increase was significant only in the goserelin and OC group. There were no significant difference in the final concentrations of LH, FSH and A between the two study groups after each treatment, whereas, T was significantly decreased and SHBG significantly increased in the goserelin and OC group. The ovulation rate after the cessation of either therapy was similar [8/10 versus 9/11, p > 0.05]. On the basis of our results, we conclude that despite similar endocrine effects, medical treatment with GnRH-a and OC may be more appropriate and effective in reversing the abnormal cascade in PCOD. Although both regimens have temporary and similar improvement on PCOD, the adhesion forming potential, invasiveness, cost and surgical complications of laparoscopic ovarian cauterization may enable GnRH-a and OC combination to be cost effective option in women with CC-resistant PCOD

Cardiac troponin-T as a diagnostic marker in children with rheumatic carditis

Rheumatic carditis is the most serious major manifestation of acute rheumatic fever in children. Cardiac Troponin-T [cTnT] is established as a new specific marker of myocardial damage or injury. The present work was carried out to study the value of cTnT as a diagnostic marker of myocardial injury in children with rheumatic carditis, and to compare it to established parameters of myocardial injury such as creatine kinase [CK] and its MB isoenzyme. Forty-five children with acute rheumatic fever were enrolled in the study; classified into 3 groups: group [A]: 15 children with rheumatic carditis without cardiomegaly, group [B]: 15 children with rheumatic carditis and cardiomegaly and group [C]: 15 children with other rheumatic presentations. Fifteen normal healthy children were enrolled as a control group. All children included in the study were subjected to diagnostic laboratory and radiological investigations, including serum total CK, CK-MB isoenzyme% [using electrophoresis] and cTnT [by immunoassay test]. Our results showed significant elevation of cTnT, total CK and CK-MB isoenzyme in children with rheumatic carditis [groups A and B], as compared to the control group [P < 0.05]. These values were significantly higher in group [B] children [with cardiomegaly], as compared to group [A] children [P<0.05]. Also, the ideal cut-off point for cTnT was found to be 0.1 micro g/L with a sensitivity 100%, while the sensitivity for CK-MB was 86.7% and that for total CK was 53.3%.we conclude that cardiac troponin-T [cTnT] can be used as a diagnostic marker of myocardial injury in children with rheumatic carditis, with a higher sensitivity than CK and its MB isoenzyme

Serum intercellular adhesion molecule-1 and leukotreine B4 in children with bronchial asthma: correlation with bronchial hyperreactivity

The objective of the present study was to investigate circulating intercellular adhesion molecule-1 [cICAM-1] and serum Leukotreine B[4] [LTB[4]] in asthmatic children. Twenty five asthmatic children and similar number controls were enrolled. Using enzyme immunoassay techniques, serum ICAM-1 and LTB[4] levels were determined on admission in acute attacks, 24 hrs and 2 weeks after remission. Bronchial hyperreactivity was tested in 10 patients with forced expiratory volume in one second [FEV[1]]> 80% using Methacholine inhalation provocation test. The results of the present study showed that cICAM-1 and LTB[4] increased significantly in patients with acute attacks Vs controls [P<0.05]. Both cICAM-1 and LTB[4] levels correlated significantly with severity as well as frequency of acute attacks [P<0.05], but correlated insignificantly with the atopic status of the patients as well as bronchial hyperreactivity represented by the peak concentration of methacholine at which FEV[1] dropped by 20% of post-saline inhalation value[PC20FEV1] [P>0.05]. Serum ICAM-1 and LTB[4] showed insignificant drop 24 hr after remission [P>0.05]. But significantly dropped two weeks later on [P < 0.05]. Those patients with chronic asthma sustained significantly higher levels of cICAM-1 and LTB[4] two weeks after remission [P<0.05 Vs controls]. There was significant drop in LTB[4] 24hr after remission in dexamethazone-treated patients Vs non-dexamethazone treated patients [P<0.05]. cICAM-1 levels showed no such significant drop [P>0.05]. However, dexamethazone administered during acute paroxysm showed insignificant effect on cICAM-1 and LTB[4] levels obtained two weeks after remission [P>0.05]. In conclusions i]. The present data suggested that ICAM-1 and LTB[4] may play a remarkable pathophysiologic role in acute and chronic asthma in children. ii] ICAM-1 and LTB[4] are suggested to have no influence on bronchial hyperreactivity in asthmatic children and both are not influenced by the atopic status of the child, but closely linked to the severity and frequency of acute asthmatic attacks and chronicity of asthma iii] cICAM-1 is under limited steroid control, while LTB[4] levels is suggested to be steroid-sensitive iv] The present data, opens the door in the near future, for possible therapuetic interventions using novel anti-inflammatory agents acting by blocking ICAM-1 molecules and LTB[4] receptors, in acute and chronic asthma in children

Idiopathic granulomatous lobular mastitis

To study the histologic and clinical features of idiopathic granulomatous lobular mastitis among Saudi females in Asir Region and to increase awareness of this disease among pathologists and surgeons practicing in the Kingdom of Saudi Arabia. A review of 312 breast biopsies at the histopathology laboratory of Asir Central Hospital, over an eight and a half year period [January 1987 to June 1995] revealed a total of 8 cases of granulomatous mastitis. Only one case proved to be tuberculous mastitis and is excluded from the current study. The remaining 7 cases fitted the diagnosis of idiopathic granulomatous lobular mastitis. The latter diagnosis was made based on the classic histological features and absence of microorganisms using special stains and cultures. The mean age of the 7 patients was 28.8 years [range 22-23 years]. Right and left sides of the breast were equally affected and all patients gave a history of delivery within 3 years before the biopsy was taken [mean no. of years since last delivery = 1.6 years; range =0.4-3 years]. Malignancy was clinically suspected in 4 patients, chronic inflammation was only suspected in one patient and no prebiopsy clinical impression was given for the two remaining cases. Treatment and follow-up of the 7 cases is not well documented as complete excision was carried out in 4 cases with lesion free follow-up period of only 1.5 years, whereas in the remaining 3 cases an incisional biopsy was carried out and patients were lost to follow-up. The current study showed that histological and clinical feature idiopathic granulomatous lobular mastitis among Saudi female patients is similar to that reported in other countries and that this disease is not uncommon in Saudi Arabia. Therefore, the awareness of this entity should be increased among pathologists and surgeons in Saudi Arabia

Serum uric acid in primary nocturnal enuresis

A case control study was conducted on 41 cases of primary nocturnal enuresis and 20 controls in order to evaluate the implications of serum uric acid in the pathogenesis of primary nocturnal enuresis. Serum uric acid level was significantly lower in cases when compared with controls. No significant difference was detected in serum uric acid level between enuretic children with or without behavioral disturbance. Also, no difference was detected between those considered deep sleepers by their parents or not. This relatively lower level of serum uric acid in children suffering from primary nocturnal enuresis may be a possible factor in the pathogenesis of this problem

Role of helicobacter pylori in the genesis of gastric ulcerations among smokers and non-smokers

H. Pylori infections were investigated by three different methods: Serologically, microbiologically and biochemically, in 210 male patients aged 20-40 years. Gastric ulcers were diagnosed in 126 patients with which H. Pylori infection showed significant high association [X2 = 162.8]. Smoking showed a positive role in magnifying such a problem. Smokers were carrying a higher rate of infection than non-smokers, among patients with gastric ulcers [99% compared to 79%]. The risk of getting H. Pylori infection was computed in different smokers categories. Heavy cigarette smokers were found to be on top of the list, followed by moderate to mild cigarette smokers and common hubble-bubble smokers while, neither private hubble-bubble nor cigar/pipe smokers showed significant risk [odds ratio = 8.2, 4.3, 4.1, 1.1 and 0.8, respectively]

Effect of schistosomiasis on histopathologic pattern of urothelium in 262 bladder biopsies

Schistoscmiasis is a known endemic disease in the Asir region of the Kingdom of Saudi Arabia. Primary urinary carcinoma is the fourth ranked cancer in the Asir region. The current study aims at reviewing the histopathologic pattern of 262 cystoscopic biopsies to evaluate the impact of schistosomiasis on the urothelial lining of the urinary bladder among patients from Asir region. Schistosomiasis was diagnosed in 91 cases [37.7%], non-neoplastic urothelial lesions were seen in 75 cases [29%] and primary bladder cancer was diagnosed in 61 cases [23.3%]. Schistosomiasis was seen in association with 67% of patients with squamous cell carcinoma, 50% of patients with non-neoplastic proliferative urothelial lesions, 20% of patients with adenocarcinoma and only 2.3% of patients with transitional cell carcinoma. Of the 91 patients with schistosomiasis 47 [51.5%] showed associated urothelial lesions of one type or the other while the remaining 44 [48.5%] did not show associated urothelial lesions. The conclusion of the study is that schistosomiasis has an impact on bladder cancer through a series of pre-neoplastic mucosal changes

Gastric cancer in southern Saudi Arabia

A total of 84 cases of primary gastric cancer were diagnosed in the histopathology laboratory of Asir Central Hospital over a five year period [1987 to 1991]. Seventy-two patients [86%] were Saudis and 12 cases [14%] were non-Saudis. The mean age of the patients included in this study was 60 years with a range of 22 to 85 years and a male:female ratio of 4.6:1. Intestinal adenocarcinoma occurred in 63 patients [75%] followed by malignant lymphomas in 12 cases [14%] and diffuse adenocarcinoma in nine cases [11%]. The gastric antrum was the most common site affected [47%], followed by gastric corpus [27%], cardia [14%], and fundus [12%]. Comparisons of our findings to similar reports from other provinces of Saudi Arabia and other countries are discussed