Prognostic significance of cyclooxygenase-2, epidermal growth factor receptor 1, and microvascular density in gastric cancer.

Gastric cancer remains a significant global health burden with poor treatment outcome. New treatment modalities that target inflammation, proliferation, and angiogenesis have been used in various cancers, including gastric cancer. We sought to study the pattern of expression of two important proteins, cyclooxygenase-2 and epidermal growth factor receptor, and their association with microvascular density, clinicopathological features, and survival in Arab Omani patients with gastric cancer. Formalin-fixed, paraffin-embedded tumors were studied by immunohistochemistry using monoclonal antibodies to cyclooxygenase-2, epidermal growth factor receptor, and CD34. The immunohistochemical results were correlated with clinicopathological features and survival. In our study population, we found a male/female ratio of 72:43, a median age of 59 years, stage III and IV incidence of 66.9%, and a median follow-up of 96 months. Positive expression rates of cyclooxygenase-2 and epidermal growth factor receptor were 89.6 and 23.5%, respectively. The median microvascular density value was 52.5. When this value was determined as the cut-off point, 50% of patients were found to have high microvascular density. Epidermal growth factor receptor over-expression correlated with high microvascular density values, advanced lymph node involvement (N3), and TNM stage presentation (III and IV). Similarly, lymph node involvement was associated with cyclooxygenase-2 over-expression and high microvascular density. Univariate analysis showed that epidermal growth factor receptor over-expression, pathological T3 and T4 disease, and overall stage III and IV disease were adverse prognostic factors. On multivariate analysis using a Cox regression model, expression of epidermal growth factor receptor, and advanced TNM stage were significant adverse prognostic factors for overall survival. Expression of epidermal growth factor receptor in Arab Omani patients with gastric cancer correlates with aggressive tumor characteristics and is an independent prognostic factor. Further clinical studies are needed to evaluate the utility of epidermal growth factor receptor immunohistochemistry as a tool for gastric cancer treatment.

Experimental xylazine-ketamine anesthesia in the common carp (Cyprinus carpio).

The potential anesthetic effect of ketamine in combination with xylazine was examined in the common carp (Cyprinus carpio). Anesthesia (indicated by cessation of voluntary swimming and loss of responses to pinching the skin with forceps and pricking the tail with a needle) was induced by mixing 14.4 ml of ketamine (5% solution), or 11.4 ml of xylazine (2% solution), or both, in 10 l of water containing 10 fish/group. Xylazine alone induced sedation and anesthesia in 5-12.3 min with a mean duration of 7.3 min. Ketamine alone induced similar effects in 7.2-9.7 min for an average of 24.2 min. Combined xylazine and ketamine took longer (14-22.8 min) to induce sedation and anesthesia, but the duration was longer (42.7 min). The respiratory rates of anesthetized fish significantly decreased in all treatments when compared to controls. In conclusion, the combination of xylazine-ketamine was found to induce smooth anesthesia in the common carp for a time sufficient for common clinical and surgical interventions.

Cotyledonoid leiomyoma in pregnancy.

BACKGROUND: Benign smooth-muscle tumors (leiomyomata) are the most frequent tumors found in the female genital tract. They are easy to diagnose in pregnancy and usually managed conservatively. Some variant forms with unusual infiltrative growth pattern have been known, but they are rare in pregnancy. The variant forms pose diagnostic and management difficulties. CASE: An unusual type of leiomyoma (cotyledonoid), adhering to the bowels and occupying the whole left broad ligament, was excised completely at 14 weeks of gestation, and the pregnancy continued to term. CONCLUSION: Familiarity with benign uterine smooth-muscle tumors with unusual growth patterns by gynecologists and pathologists is essential in avoiding over-treatment.

Congenital lumbar hernia in association with carpus equina varus.

A rare case of congenital lumbar hernia associated with carpus equina varus is described in a week old baby. The treatment is described with limited review of the literature.

Scorpion venom cardiomyopathy.

Cardiac function was evaluated by serial echocardiography in 30 children affected by scorpion stings. They could be separated into two groups on the basis of the initial echocardiogram. Group 1, consisting of 18 children, had normal left ventricular function, whereas group 2, consisting of 12 children, showed compromised left ventricular function (ejection fraction less than 0.55; fractional shortening less than 27%). In group 2 the left ventricular end-systolic dimension was increased significantly and the interventricular septal thickening fraction was depressed significantly, compared with group 1. Nine children in group 2 showed improvement in all measurements of contractility, usually within 24 to 48 hours. Of the remaining children, one showed no echocardiographic changes and subsequently died. Another child made a slow improvement over several weeks. We conclude that myocardial toxicity is a common and serious complication of scorpion stings in children. Systolic function appears to be affected predominantly. Serial echocardiography is useful to follow changes in left ventricular function, which are generally matched by clinical improvement. Patients who fail to improve within 24 to 48 hours require particularly close observation.