Immunohistochemical analysis of expression and allelotype of mismatch repair genes (hMLH1 and hMSH2) in bladder cancer.

Mutation of human homologues of DNA mismatch repair (MMR) genes in tumours has been shown to be associated with the phenomenon of microsatellite instability (MSI). Several studies have reported the occurrence of MSI in bladder cancer, but evidence of involvement of MMR genes in the pathogenesis of this cancer is still unclear. We therefore utilized quantitative immunohistochemical (IHC) image analysis and PCR-based allelotype analysis to determine hMLH1 and hMSH2 genes alteration in a cohort of Egyptian bladder cancer samples. IHC analysis of 24 TCC and 12 SCC revealed marked- intra and intertumour heterogeneity in the levels of expression of the two MMR proteins. One TCC lost MLH1 expression and one lost MSH2, (1/24, 4%), and one SCC lost MSH2 (1/12, 8%). A large proportion of analysed tumours revealed a percentage positivity of less than 50% for MLH1 and MSH2 expression (44% and 69%, respectively). Complete loss of heterozygosity in three dinucleotide repeats lying within, or in close proximity to, hMLH1 and hMSH2 was rare (2/57, (4%) for MLH1; and 1/55, (2%) for MSH2), however allelic imbalance was detected in 11/57 (hMLH1) and 10/55 (hMSH2) at any of the informative microsatellite loci. These alterations in structure and expression of DNA MMR genes suggest their possible involvement in the tumorigenesis and/or progression of bladder cancer.

Esophageal transection by the EEA stapler for bleeding esophageal varices in schistosomal hepatic fibrosis.

Thirty patients with esophageal varices due to schistosomal hepatic fibrosis underwent surgical treatment. They were divided into two groups. The elective group consisted of 20 patients who underwent splenectomy, gastroesophageal devascularization with esophageal transection using the EEA (U.S. Surgical Supply) stapler. The emergency group included ten patients, one of whom had the same procedure as those in the elective group and nine patients who had only esophageal transection with the EEA stapler. The use of the stapler in performing splenectomy and the devascularization operation did not decrease the recurrence of bleeding. Esophageal stapling in the emergency group controlled the bleeding in 90 per cent of the patients. The reappearance of esophageal varices and gastric varices in three patients in the emergency group was managed by distal splenorenal shunt operation.

The distal splenorenal shunt in patients with variceal bleeding due to schistosomal hepatic fibrosis.

Twenty consecutive patients classified as Child's A and B with variceal bleeding from schistosomal hepatic fibrosis were electively managed by the distal splenorenal shunt. Patients were assessed clinically by angiography and were observed for up to 16 months. The over-all survival rate was 85 per cent with an operative mortality rate of 10 per cent. All of the patients had patent shunts as confirmed angiographically and all maintained hepatic perfusion; there was also a 40 per cent immediate reduction in the size of the spleen postoperatively as measured on the angiograms. None of the patients had encephalopathy and only two patients had postoperative ascites.

Schwannoma of the neck.

Sixteen cases of schwannomata of the neck were included in this study. Clinical and pathological features were analysed. Pre-operative diagnosis was always difficult and was achieved in only three cases. The lesion should be suspected whenever examining the neck for a solitary swelling of long standing. Schwannomata of the cervical vagus or sympathetic chain usually bulge into the pharynx and present as parapharyngeal tumours. Neurological deficits were absolutely absent in our cases. Every attempt should be exerted to spare the involved nerve even on the expense of leaving behind a part of the tumour which is definitely benign and having practically no tendency for malignant change.

Colorectal schistosomiasis: clinicopathologic study and management.

Forty patients with colorectal schistosomiasis who failed to respond to medical therapy were studied. They had dysentery with bloody mucus and anemia, polyps, pericolic masses, and schistosomal ulcers. Two patients had cecal masses which appeared to be intussusception and appendicitis. Three patients had chronic intestinal obstruction. Diverting transverse colostomy, followed by other surgical procedures, is the safest method of management.