Hematologic markers of distant metastases and poor prognosis in gynecological cancers.

BACKGROUND: Despite the recent progress in the development of anti-cancer drugs, the treatment of metastatic tumors is usually ineffective. The systemic inflammatory response performs key roles in different stages of the carcinogenesis process including metastasis. The high neutrophil-lymphocyte ratio (NLR), monocyte-lymphocyte ratio (MLR), and platelet-lymphocyte ratio (PLR) were found to be associated with poor survival rates in the majority of solid tumors. However, only a few studies were conducted to further investigate this association in patients with advanced gynecological cancers. METHODS: Clinical data from 264 patients with FIGO stage III and IV gynecological (endometrial, ovarian and cervical) cancers treated at King Hussein Cancer Center (Amman-Jordan) from 2006 to 2012 were retrospectively reviewed. We examined the association between absolute neutrophil count (ANC), absolute monocyte count (AMC), MLR, PLR, and NLR with distant metastases, overall survival and event-free survival in gynecological cancers. For survival analysis, Receiver Operating Characteristic (ROC) curve analysis was operated to determine the optimal cutoff values. RESULTS: Patients with high baseline NLR (≥4.1) had more baseline distant metastases than patients with low baseline NLR (< 4.1), (p-value 0.045). Patients with high baseline AMC (≥560) had more distant metastases in comparison to patients with low baseline AMC (< 560), (p-value 0.040). Furthermore, Patients with high baseline PLR (≥0.3) had more distant metastases in comparison to patients with low baseline PLR (< 0.3), (p-value 0.025). Additionally, patients with high baseline ANC (≥5700) had worse overall survival compared to the patients with low baseline ANC (< 5700), (p-value 0.015). Also, patients with high baseline AMC (≥490) had worse overall survival compared to the patients with low baseline AMC (< 490), (p-value 0.044). CONCLUSION: Different hematologic markers obtained from a cheap test (CBC) could potentially be used to predict the presence of distant metastases thus used as prognostic indices in gynecological cancers.

Novel approach of treating Gorham-Stout disease in the humerus--Case report and review of literature.

Gorham-Stout disease or the so-called vanishing bone syndrome is a rare disorder characterized by intra-osseous proliferation of vascular channels resulting in destruction and resorption of the osseous matrix. The exact pathology of this disease showed no evidence of malignant, neuropathic, or infectious components involved in the causation of this disorder except for the culprit of lympho-vascular malformations in the bone. The mechanism of bone resorption is yet to be clarified. The clinical presentation of Gorham's disease varies according to the organ of involvement. Patients diagnosed with Gorham's disease in the bone may initially present with insidious onset of dull aching pain, progressive weakness, or pathologic fractures as the initial presentation. Gorham's disease is progressive in most patients; yet it can be self-limiting in a few reported cases. The axes of treating this disease as reported in the literature include the use of medical treatment, surgical intervention, radiotherapy and/or the combination of any them. However, there is no consensus about the most effective approach for treating this rare disease. The challenge in this disease lies in both: how to diagnose and how to treat. Our novel approach combined surgical intervention, medication and radiotherapy as a treatment of Graham-Stout disease in the humerus, and showed no progression of the disease our case.

Use of human surplus biospecimens in research: a survey from a cancer centre.

Little is known about the public's views on the use of human biospecimens for research in the Eastern Mediterranean Region. A study at a cancer centre in Amman, Jordan, assessed patients' perceptions about the use of blood and tissue samples obtained during clinical care and the use of these in research. A self-administered questionnaire was distributed to a sample of 205 adult cancer patients. Almost all patients (98.0%) accepted the use of their surplus blood samples and archived tissue in research if they consented, with about one-third requesting a specific opt-in consent. Most patients (82.9%) also agreed to donate a blood sample for research purposes only, 84.9% were interested to know the results of that research, but with a specific opt-in consent, and 81.0% accepted sending their samples to research laboratories abroad, even without specific consent. Patients' views on the potential use of the surplus biospecimens in research were largely concordant with the international literature.

Use of human surplus biospecimens in research: a survey from a cancer centre

قليلة هي معارفنا حول آراء الناس عن استخدام العينات البيولوجية البشرية في البحوث في إقليم شرق المتوسط. وقد أجريت هذه الدراسة في مركز للسرطان في عمان، الأردن، لتقييم إدراك المرضى لاستخدام الدم والعينات النسيجية التي يتم الحصول عليها خال الرعاية السريرية واستخدام ذلك في البحوث، وذلك من خال استبيان ذاتي تم توزيعه على عينة تضم 205 من مرضى السرطان البالغين. وافق جميع المرضى تقريبا [98.0 % منهم]على استخدام ما يفيض عن الحاجة من عينات الدم والنماذج النسجية المحفوظة، في البحوث إذا ما طلب الباحثون موافقتهم على ذلك، كما أن ما يقرب من الثلث طلبوا نمطا نوعيا من الموافقة المقيدة. كما وافق معظم المرضى [82.9 % منهم]على التبرع بعينات الدم لأغراض البحوث فقط، وكان 84.9 % منهم مهتمين بمعرفة نتائج تلك البحوث، ولكن مع موافقة مقيدة، بينا وافق 81.0 % منهم على إرسال العينات المأخوذة منهم إلى مختبرات خارج البلاد، حتى بدون موافقة خاصة منهم. وقد تبين أن وجهات نظر المرضى حول الاستخدام المحتمل للعينات البيولوجية الفائضة عن الحاجة في البحوث تتوافق مع ما هو منشور على الصعيد الدولي

ABSTRACT Little is known about the public’s views on the use of human biospecimens for research in the Eastern Mediterranean Region. A study at a cancer centre in Amman, Jordan, assessed patients’ perceptions about the use of blood and tissue samples obtained during clinical care and the use of these in research. A self-administered questionnaire was distributed to a sample of 205 adult cancer patients. Almost all patients (98.0%) accepted the use of their surplus blood samples and archived tissue in research if they consented, with about one-third requesting a specific opt-in consent. Most patients (82.9%) also agreed to donate a blood sample for research purposes only, 84.9% were interested to know the results of that research, but with a specific opt-in consent, and 81.0% accepted sending their samples to research laboratories abroad, even without specific consent. Patients’ views on the potential use of the surplus biospecimens in research were largely concordant with the international literature.

RÉSUMÉ Il existe peu d'informations sur l'opinion du public quant à l'utilisation d'échantillons biologiques humains pour la recherche dans la Région de la Méditerranée orientale. Une étude menée dans un centre anticancer à Amman (Jordanie) a évalué les perceptions des patients concernant l'utilisation des échantillons de sang et de tissu recueillis pendant des soins cliniques et leur utilisation pour la recherche. Un autoquestionnaire a été distribué à un échantillon de 205 patients adultes atteints de cancer. Presque tous les patients (98,0 %) acceptaient l'utilisation des échantillons de sang et de tissus excédentaires conservés pour la recherche, après leur consentement, et environ un tiers exigeait une demande de consentement spécifique. La plupart des patients (82,9 %) consentaient également à faire un don de sang à des fins de recherche uniquement, tandis que 84,9 % souhaitaient connaître les résultats de cette recherche après un consentement spécifique, et 81,0 % acceptaient que leurs échantillons soient envoyés à des laboratoires de recherche à l'étranger, même sans consentement spécifique. Le point de vue des patients sur l'utilisation potentielle des échantillons biologiques excédentaires pour la recherche concordait en grande partie avec les points de vue présentés dans la littérature internationale.

Choroidal metastases as the sole initial presentation of metastatic lung cancer: case report and review of literature.

BACKGROUND: Choroidal metastasis as an initial presenting feature of metastatic lung cancer is exceedingly rare. External beam radiotherapy (EBRT) is an effective and widely accepted therapeutic modality. However, data addressing the effectiveness of other treatment strategies is limited. Herein, we present a patient with choroidal metastases secondary to lung cancer and review the relevant literature. CASE REPORT: A 25-year-old male presented with deterioration of vision. His evaluation revealed bilateral choroidal metastasis secondary to adenocarcinoma of the lung. Unfortunately, his vision continued to deteriorate despite treatment with EBRT and chemotherapy. CONCLUSION: Metastatic lung cancer can manifest with choroidal metastasis as an initial presentation.

Choroidal metastasis as the sole initial presentation of metastatic lung cancer.

Choroidal metastasis as an initial presenting feature of metastatic lung cancer is exceedingly rare. External beam radiotherapy (EBRT) is an effective and widely accepted therapeutic modality. However, data addressing the effectiveness of other treatment strategies is limited. We present a patient with choroidal metastases secondary to lung cancer and review the relevant literature. A 25-year-old male presented with deterioration of vision. His evaluation revealed bilateral choroidal metastasis secondary to adeno- carcinoma of the lung. Unfortunately, his vision continued to deteriorate despite treatment with EBRT and chemotherapy. Choroidal metastasis as an initial presentation of metastatic lung cancer is exceedingly rare, as only 30 cases have been reported. EBRT and systemic chemotherapy are effective therapeutic modalities. This case report could prove helpful to clinicians faced with a similar exceedingly rare scenario.

Snake bite envenomation: experience at King Abdulaziz Medical City, Riyadh.

We surveyed the records of 21 of the 28 snakebite victims seen at King Fahad National Guard Hospital in Riyadh over the 20-year period 1986-2005. The most common symptoms were local pain and swelling and the most common signs oedema and tenderness. Neurotoxicity was not noted in any case. Coagulopathy was recorded for 14/21 patients (66.7%) and 5/19 (26.4%) had leukocytosis. All patients were given tetanus toxoid (100%) and 20 (95.2%) received antivenom. Blood products were administered in 2 cases and prophylactic antibiotics in 10 (47.6%). No allergic reaction to antivenom was reported.

Seasonal effect on heat shock proteins in fish from Kuwait bay.

Heat shock proteins (HSP70) play a significant role in adaptation to temperature and have been proposed as an indicator of cellular stress. Since the water temperature in Kuwait's marine area varies from 13 to 35 degrees C from winter to summer, HSP70 could be a valuable tool in aquaculture in Kuwait. HSP70 levels were quantified by Western blotting in liver, muscle and gill tissues of two varieties of native fish species captured during the winter and summer months from both inside and outside the highly stressed Kuwait Bay area. The HSP70 levels did not differ statistically between fish captured from the two sampling areas. The most common response in both species was higher median levels of HSP70 in winter months. This inverse relation between HSP70 levels in the fish and the water temperature may be due to either genetic adaptation in the fish to the hot climatic conditions of the region or other stressors, such as changes in pollutant levels in the surrounding water.

Snake bite envenomation: experience at King Abdulaziz Medical City, Riyadh

We surveyed the records of 21 of the 28 snakebite victims seen at King Fahad National Guard Hospital in Riyadh over the 20-year period 1986-2005. The most common symptoms were local pain and swelling and the most common signs oedema and tenderness. Neurotoxicity was not noted in any case. Coagulopathy was recorded for 14/21 patients [66.7%] and 5/19 [26.4%] had leukocytosis. All patients were given tetanus toxoid [100%] and 20 [95.2%] received antivenom. Blood products were administered in 2 cases and prophylactic antibiotics in 10 (47.6%). No allergic reaction to antivenom was reported

Endometrial stromal neoplasms are immunoreactive with WT-1 antibody.

WT-1 positivity has previously been noted in nonneoplastic endometrial stroma. In this study we examined WT-1 expression in endometrial stromal neoplasms to ascertain whether these tumors are immunoreactive and whether this antibody might be of value in the diagnosis of these lesions. We also stained cases of cellular and highly cellular leiomyomas to investigate whether WT-1 might be of value in distinguishing these from an endometrial stromal neoplasm. We compared WT-1 staining with CD10, desmin, alpha smooth muscle actin, h-caldesmon, and AE1/3, many of these antibodies being commonly used to distinguish between an endometrial stromal and a smooth muscle phenotype. Cases of ESN (n = 5), low grade ESS (n = 14), and cellular or highly cellular leiomyoma (n = 14) were stained with the aforementioned antibodies. Cases were scored on a scale of 0 to 4+, with 4+ cases exhibiting positivity of >50% of cells. Sixteen of 19 endometrial stromal neoplasms were positive with WT-1, most (14 of 16) with 4+ positivity. Staining was nuclear (5 cases), cytoplasmic (5 cases), or combined nuclear and cytoplasmic (6 cases). All endometrial stromal neoplasms exhibited 4+ staining with CD10. Staining for alpha smooth muscle actin was present in most cases (14 of 19) and desmin and h-caldesmon were positive in a smaller number of cases (8 and 2 respectively). There was 4+ positivity with desmin in only 1 case. The 2 cases that were h-caldesmon positive both exhibited 1+ staining (<5% cells positive). Six cases were positive with AE1/3, 1 with 4+ staining. Leiomyomatous neoplasms always exhibited 4+ staining with desmin and alpha smooth muscle actin and in most cases (12 of 14) with h-caldesmon. The other 2 cases exhibited 2+ positivity. Most cases (12 of 14) were positive with WT-1 (7 of 14 with 4+ staining) and CD10 (5 of 14 with 4+ positivity). One case was positive with AE1/3. We conclude that diffuse WT-1 positivity is characteristic of endometrial stromal neoplasms and that this may be of value in diagnosis. However, WT-1 is of limited use in the distinction between an endometrial stromal and a cellular leiomyomatous neoplasm because many of the latter are also positive. This study confirms the value of h-caldesmon in the distinction between an endometrial stromal neoplasm (almost always h-caldesmon negative) and a cellular leiomyomatous neoplasm (h-caldesmon positive). Although CD10 is positive in endometrial stromal neoplasms, the commonly observed immunoreactivity of cellular and highly cellular leiomyomas with this antibody limits its diagnostic usefulness. Desmin is useful as all leiomyomatous neoplasms exhibited diffuse positivity, whereas only a small number of endometrial stromal neoplasms were focally positive and only 1 case exhibited 4+ positivity. Smooth muscle actin is of limited value since most neoplasms studied were positive. The overlapping immunophenotype of endometrial stromal and leiomyomatous neoplasms may reflect the origin of both cell types from a common progenitor within the uterus.

WT-1 assists in distinguishing ovarian from uterine serous carcinoma and in distinguishing between serous and endometrioid ovarian carcinoma.

AIMS: It has been suggested that WT-1 is helpful in distinguishing a primary ovarian serous carcinoma (OSC) from a primary uterine serous carcinoma (USC). Since both neoplasms are often disseminated at diagnosis and since USC often spreads to the ovary and vice versa, it may be difficult to ascertain the primary site. This is important, since adjuvant therapies for OSC and USC may differ. WT-1 staining patterns also differ between OSC and ovarian endometrioid carcinoma and so it is possible that WT-1 may assist in the distinction of these two neoplasms, which is sometimes problematic, especially with poorly differentiated tumours. This study aims to document the value of WT-1 in these settings. Cases of ovarian borderline serous tumour, primary peritoneal serous carcinoma (PPSC) and uterine endometrioid carcinoma were also studied. METHODS AND RESULTS: Cases of OSC (n = 38), USC (n = 25) (in five of these cases there was also a component of endometrioid adenocarcinoma), ovarian endometrioid carcinoma (n = 13), uterine endometrioid carcinoma (n = 7), ovarian borderline serous tumour (n = 16) and PPSC (n = 6) were stained with WT-1. Cases were scored on a scale of 0-3, depending on the percentage of positive cells. The intensity of staining was scored as weak, moderate or strong. There was positive nuclear staining of 36 of 38 (94.7%) OSC with WT-1. In most OSC (68.4%), >50% of cells stained positively and staining was usually strong. Five of 25 (20%) USC were positive with only two cases exhibiting staining of >50% of cells. All primary ovarian and uterine endometrioid carcinomas were negative. All PPSC were positive, usually with diffuse strong immunoreactivity. Fourteen of 16 borderline serous tumours exhibited positivity with WT-1. CONCLUSIONS: WT-1 is useful in distinguishing OSC (characteristically diffuse strong nuclear positivity) from USC (characteristically negative). However, rarely OSC is negative and occasional cases of USC are positive. WT-1 may also be helpful in differentiating poorly differentiated OSC from poorly differentiated ovarian endometrioid carcinoma.

Mechanical restitution in atrial muscle from human and rat hearts: effects of agents that modify sarcoplasmic reticulum function.

Force of contraction (Fc) of isolated human and rat atrial myocardium shows characteristic patterns of mechanical restitution when single test intervals are interposed in regular stimulation. With several pharmacological agents that modify the function of the sarcoplasmic reticulum we have investigated the role of the sarcoplasmic reticulum in mechanical restitution in these two species. Caffeine, thapsigargin and 2,5-di-(tert-butyl)-1,4-benzohydroquinone (BHQ) were used to reduce Ca2+ uptake, ryanodine to open Ca2+ release channels, and forskolin to stimulate Ca2+ uptake. Under control conditions, Fc recovered rapidly with test intervals shorter than steady-state, and was potentiated with longer than steady-state intervals. In human atrial tissue the maximum potentiation factor was 1.26 +/- 0.03 after a mean test interval of 9.70 +/- 1.55 s (n = 43) as compared to 3.07 +/- 0.45 after 30 sec. in rat atria (n = 48). Caffeine (3 mM) did not significantly affect steady-state Fc but abolished post-rest potentiation in human and rat preparations. Forskolin (1 microM) enhanced and accentuated the mechanical restitution curve in particular for short test intervals. In the presence of thapsigargin (10 microM), steady-state Fc and mechanical restitution could not be distinguished from time-matched controls exposed to solvent only, indicating that this agent is ineffective in human and rat atrial tissue. In contrast, the putative Ca2+ uptake inhibitor BHQ (100 microM) strongly reduced steady-state Fc and decreased potentiation at all intervals in human muscle, but shifted the mechanical restitution curve in parallel to lower values in rat atria. Ryanodine (10 nM) induced post-rest decay in human and depressed both steady-state Fc and post-rest potentiation in rat atrial muscle. From these results it is concluded that human and rat atrial muscle differ in the Ca2+ handling by the sarcoplasmic reticulum during mechanical restitution.

Phlyctenular eye disease in association with Hymenolepis nana in Egypt.

It had been previously noticed that infection with parasites was common in children suffering from phlyctenulosis. In the present study the stools of 471 patients suffering from phlyctenular disease were examined and it was found that 62.6% of them had Hymenolepis nana ova in their stools as compared with 10.8% of the controls. All patients had Hymenolipis nana immune sera. Many of these patients had abdominal symptoms. Hymenolepis nana is a cestode parasite discovered by Bilharz in Cairo in 1851. Infections with it have the same age incidence and geographical distribution as phlyctenular eye disease. It has a tissue stage responsible for a state of hypersensitivity which is thought to be responsible for the phlyctenules.