Helicobacter pylori versus platelet-to-spleen ratio as a risk factor for variceal bleeding in patients with liver-cirrhosis-related portal hypertension.

Background Acute upper gastrointestinal (GIT) bleeding is a common medical emergency clinically manifested by hematemesis and/or melena. This study aimed to elucidate the roles of Helicobacter pylori and the platelet-spleen ratio as risk factors for variceal bleeding in patients with portal hypertension secondary to liver cirrhosis. Methods The study was conducted on 200 patients with liver cirrhosis of various etiologies who were divided into two groups: group 1 included 100 patients with liver cirrhosis and portal hypertension with or without a history of upper GIT bleeding, and group 2 included 100 patients with liver cirrhosis without portal hypertension. Upper GIT endoscopy was performed, and biopsy samples were taken from the gastric antral mucosa for rapid urease testing. The platelet-spleen diameter ratio was calculated for all patients. Results In group 1, most patients who had a history of variceal bleeding were H. pylori-negative whereas most patients without a history of variceal bleeding were H. pylori-positive, implying that H. pylori may play a significant role as a protective factor against variceal bleeding. The calculated odds ratio for the rapid urease test was low (0.851), whereas the calculated odds ratio for the platelet-spleen diameter ratio was higher (9.766) than that for the rapid urease test. Thus, the rapid urease test plays a significantly higher role than the platelet-spleen ratio as a risk factor for bleeding (p-value = 0.001). Conclusions H. pylori has a more significant relationship with upper GIT bleeding than the platelet-spleen diameter ratio.

Predictors of non-sentinel lymph node metastasis in breast cancer patients with positive sentinel lymph node (Pilot study).

BACKGROUND: Sentinel Lymph Node Biopsy (SLNB) procedure was found to be an accurate method of staging the axilla in patients with early stage breast cancer. The standard of care for breast cancer patients with positive SLN metastasis includes complete Axillary Lymph Node Dissection (ALND). However, in 40-70% of patients, the SLN is the only involved axillary node. Factors predicting non SLN metastasis should be identified in order to define subgroups of patients with positive SLN in whom the axilla may be staged by SLNB alone. OBJECTIVES: To identify the factors predicting metastatic involvement of the non-SLNs in breast cancer patients having SLN metastasis. PATIENTS AND METHODS: Data were collected and analyzed from 80 patients with early stage invasive breast cancer (T1, T2, N0, M0) who underwent SLNB at the Surgical Oncology Department, Kuwait Cancer Control Center (KCCC) between November 2004 and February 2009. SLNB was performed using a combined technique (radioactive colloid, and blue dye) in the majority of cases. In some cases, only one technique was used. Complete ALND was performed in the case of failure of SLN identification and in patients with positive SLN. Multiple variables (patient, tumor, and SLN characteristics) were tested as possible predictors of nonsentinel lymph node metastasis. RESULTS: The mean age of patients at diagnosis was 46.6years. The median tumor size was 2cm. The SLN identification rate was 96.2% (77 out of 80 patients). The SLN was positive in 24 patients (31%), and half of these showed evidence of capsular invasion. The median number of SLNs removed was two. The median number of positive SLNs was one. The incidence of non-SLN metastasis associated with positive SLN was 50% (12 out of 24 patients). Lymphovascular invasion was found to be the only factor associated with non-SLN metastases. In addition, two trends were observed, though they did not reach the statistical significance: the first is that the majority of patients having capsular invasion of the SLN (8 out of 12 patients, 67%) had positive non-SLN metastasis, and the second is that the patients having more than one SLN metastasis were more likely to have non-SLN metastasis (4 out of 5, 80%). CONCLUSION: In the current pilot study, only the lymphovascular invasion in the area of the primary tumor was found to be significantly related to the nonsentinel lymph node metastasis. There was a tendency toward higher incidence of nonsentinel lymph node metastasis associated with the number of positive SLN and capsular invasion of SLN, though this did not reach the statistical significance. This could be attributed to the small number of patients recruited. Further evaluation of the predictors of nonsentinel lymph node metastasis on a larger number of patients is required. The validation of these predictors in prospective studies may enable approximately half of early stage breast cancer patients with positive SLN to be staged with SLNB alone while avoiding the morbidity of unnecessary ALND.

Hepatocyte growth factor as a tumor marker in the serum of patients with prostate cancer.

BACKGROUND AND AIM: Prostate cancer is a leading cause of death among men worldwide; it is invasive and metastasizes to different organs. Metastatic spread of this type of cancer is the greatest barrier to achieve cure. The present study is carried out to study the serum levels of hepatocyte growth factor (HGF) in patients with prostate cancer in relation to stage and grade and to evaluate its diagnostic and prognostic clinical validity as a tumor marker. PATIENTS AND METHODS: The study included 47 patients with prostate cancer and 15 apparently healthy men as a control group. The patients were divided into two groups, including 27 patients with localized prostate cancer (group I) and 20 patients with metastatic prostate cancer (group II). Detection of serum levels of HGF and prostate specific antigen (PSA) was carried out by an enzyme immunoassay. RESULTS: The serum levels of HGF and PSA were significantly increased in groups I and II as compared to the control group and were highest in group II. The best cut-off value for HGF was 663.8 pg/ml with 83% and 93.3% sensitivity and specificity, and was 4.4 ng/ml for PSA with a sensitivity and specificity of 85.1% and 100%; respectively; with positive and negative predictive values of 97.5%, 63.6% and 100%, 68.2%; respectively. Combining PSA and HGF was more accurate in distinguishing between patients with metastatic disease and those with localized disease than either marker alone with a sensitivity of 98.1% (p<0.05). CONCLUSIONS: HGF is elevated in the serum of patients with carcinoma of the prostate and this elevation is related to the stage of malignancy and is independent of age. These results imply that HGF may be an important serum marker for prostate cancer.