c-MET positivity and its relationship with histopathological findings in gastric carcinomas exhibiting HER2 gene expression

Context: Co-expressions of receptor tyrosine kinases such as c-MET and HER2 were reported in many studies. The concomitant expression is associated with more aggressive clinical course. Aims: In this study, it was intended to investigate the correlation of the positivity of c-MET and HER2 with histopathologic findings and their impacts on prognosis. Subjects and Methods: After the decision of the ethics committee, a total of 64 cases, whose HER 2 status was studied by dual silver in situ hybridization/immunohistochemistry method, were included in the study. Immunohistochemical staining for c-MET was performed to all cases and the evaluation was performed similarly to the criteria for HER2 evaluation, but cytoplasmic staining was also considered significant. Statistical Analysis Used: The data were analyzed using SPSS 20 for Windows. Results: c-MET positivity which is considered by the score of 2+ and 3+ was found only in 34.4% of HER2 positive cases while it was 59.3% in HER2 negative cases (P = 0.045). The sole histopathological feature associated with c-MET positivity was distal gastric localization (P = 0.016). Conclusions: Even though higher rates of c-MET positivity in HER2 positive cases were stated in the literature, contrary results were obtained in this study. Comparing the HER2+/c-MET + co-expression group with the other groups, no difference was found about age, sex, macroscopic and microscopic characteristics. The presence of c-MET positivity in cases with HER2 expression suggests that c-MET expression might be associated with the resistance to Trastuzumab.

Ease of Intubation with the McGRATH® MAC, C-MAC® or Macintosh Laryngoscopes by Novice Operators in Simulated Difficult Airways – A Manikin Study.

A variety of video laryngoscopes have been introduced to facilitate endotracheal intubations as failed intubations can result in morbidity and mortality. We aimed to compare the use of the conventional Macintosh laryngoscope, McGRATH® MAC and C- MAC® video laryngoscopes among novice operators. 37 medical students were recruited to perform oro-tracheal intubations in a human patient stimulator with simulated ‘difficult airway’ scenario using 3 devices: The Macintosh laryngoscope, McGRATH® MAC and C- MAC® video laryngoscopes. The success rate of tracheal intubation using the C-MAC® video laryngoscope (84%) was higher than both the McGRATH® MAC (59%) and the Macintosh laryngoscope (57%) (p=0.005). The use of video laryngoscopes were associated with lower incidence of oesophageal intubation (p<0.001) and deemed easier to use (p<0.001). Overall, the C-MAC® yielded a higher rate of successful tracheal intubation, a shorter time to glottic visualisation and was deemed to provide the greatest ease of intubation with novice practitioners.

Hypopituitarism in a Dengue Shock Syndrome Survivor without known Pituitary Adenoma

Dengue infection is endemic in South East Asia and parts of the Americas. Dengue hemorrhagic fever is characterized by vascular permeability, coagulation-disorders and thrombocytopenia, which can culminate in hypotension i.e. dengue shock syndrome. Hypopituitarism arising as a complication of dengue is extremely rare. Hemorrhagic pituitary apoplexy of pre-existing pituitary adenomas has been rarely reported in dengue. We describe an uncommon case of hypopituitarism in a dengue shock syndrome survivor without known pituitary adenoma. A 49 years old nulliparous lady (from Kuala Lumpur, Malaysia) presented with typical symptoms of hypocortisolism. Postural hypotension was evident with normal secondary sexual characteristics. Further history revealed that she survived an episode of dengue shock syndrome 6 years ago where premature menopause developed immediately after discharge, and subsequently insidious onset of multiple hormonal deficiencies indicative of panhypopituitarism. There were no neuro-ophthalmological symptoms suggestive of pituitary apoplexy during hospitalization for severe dengue. Magnetic resonance imaging of the pituitary 6 years later revealed an empty sella. Autoimmune screen and anti-thyroid peroxidase antibodies were negative. We describe a rare possible causative association of severe dengue with panhypopituitarism without known pituitary adenoma, postulating pituitary infarction secondary to hypotension (mimicking Sheehan’s syndrome), or a direct viral cytopathic effect. Subclinical pituitary apoplexy secondary to asymptomatic pituitary hemorrhage however cannot be excluded. Future research is required to determine the need for and timing of pituitary axis assessment among dengue shock syndrome survivors.

Optimal protein extraction methods from diverse sample types for protein profiling by using Two-Dimensional Electrophoresis (2DE)

There is a great diversity of protein samples types and origins, therefore the optimal procedure for each sample type must be determined empirically. In order to obtain a reproducible and complete sample presentation which view as many proteins as possible on the desired 2DE gel, it is critical to perform additional sample preparation steps to improve the quality of the final results, yet without selectively losing the proteins. To address this, we developed a general method that is suitable for diverse sample types based on phenolchloroform extraction method (represented by TRI reagent). This method was found to yield good results when used to analyze human breast cancer cell line (MCF-7), Vibrio cholerae, Cryptocaryon irritans cyst and liver abscess fat tissue. These types represent cell line, bacteria, parasite cyst and pus respectively. For each type of samples, several attempts were made to methodically compare protein isolation methods using TRI-reagent Kit, EasyBlue Kit, PRO-PREPTM Protein Extraction Solution and lysis buffer. The most useful protocol allows the extraction and separation of a wide diversity of protein samples that is reproducible among repeated experiments. Our results demonstrated that the modified TRI-reagent Kit had the highest protein yield as well as the greatest number of total proteins spots count for all type of samples. Distinctive differences in spot patterns were also observed in the 2DE gel of different extraction methods used for each type of sample.

Amebic cerebral abscess mimicking bacterial meningitis.

We report a case of an amebic brain abscess in a 2-year-old girl, with symptoms mimicking bacterial meningitis with no evidence of disease elsewhere. Histological evaluation of the abscess revealed the organisms, and the abscess regressed in response to specific medical treatment. This article reviews the rarity of these abscesses and difficulty in the diagnosis.

Endoscopic cut to light management of posterior urethral strictures

Seven patients with impassable traumatic, iatrogenic and infective posterior urethral strictures were managed by this technique. The results of endoscopic CUT TO LIGHT" technique compare favourably with other more invasive open procedures. This procedure is easy to do and carries very low morbidity

Endoscopic management of posterior urethral disruption associated with fracture pelvis

We managed 4 cases of posterior urethral disruption following fracture pelvis, by endoscopic realignment, 11 to 14 days after injury. We used rigid endoscopes through suprapubic tract and distal urethra, for the procedure. A guide wire was passed through suprapubic cystoscope into the urinary bladder and across the disrupted posterior urethra into the distal urethra. Silicone Foleys type catheter was passed per urethra over guide wire into the bladder for 4 weeks. Intermittent self catheterisation was advised for 6 months after removal of urethral and suprapubic catheters. Good results were achieved in 3 cases, who are stricture free, continent and potent. One patient is stricture free, potent but is incontinent of urine. This technique has reduced morbidity rate and does not adversely affect subsequent ureqthroplasty, if so required

Balloon dilatation for prostatic obstruction

Retrograde balloon dilatation of prostatic urethra was performed for prostatic obstruction under cystoscopic visual Control, reusing the balloon dilatation catheter. All 31 patients were treated as in patients. Old, high surgical risk cases, because of their underlying medical problems, Were selected for the procedure. General or epidural anaesthesia was used. All patients had urethral catheter for acute retention of urine. Successful results were noted in 26 cases [84%] for upto 3-18 months follow up. In 5 cases [16%], the procedure was unsuccessful, requiring trans-urethral resection of prostate in 3 cases [10%], and conservative management in 2 cases [6%]

Benign prostatic hypertrophy [Patients profile and management]

A retrospective review of 235 patients of Benign Prostatic Hypertrophy [BPH] who were managed surgically in the Department of Urology, Sheikh Zayed Hospital, Lahore from June, 1987 to June, 1989 is presented. Out of these patients, 192 cases [81.7%] were treated by trans-urethral resection of prostate, 32 patients [13.6%] treated by open protectomy and 11 cases [4.6%] had bladder neck incision. Majority of the patients [70.21%] had significant preexisting medical problems. The mean age of the patients was 68.1 years and 89.37% were more than 55 year of age. The overall mortality rate of surgical management of B.P.H. was 1.2% with a morbidity rate of 15.6%. The mean age was 68.1 years. The common modes of presentation were prostration [43.41%], acute urinary retension [35.33%], chronic retension [17.44%] and other like vesical calculi [3.82%]. The overall morbidity was 15.79% and included intra-operative bleeding [3.41%], TUR syndrome [1.70%], cardiac arrythmias [0.85%], extravasation [1.70%], failure to void [3.41%], post-operative bleeding [1.28%], UTI [2.12%] and epididymitis [1.28%]. Increased morbidity was noticed in patients, presenting with pre-operative acute urinary retention, those who have had prolonged indwelling bladder catheterization, those aged more than 70 years, urban population, when T.U.R.P. time was more than 75 minutes, prostate gland size was more than 45 grams, patients who had pre-existing urinary tract infection and those who had associated vesical calculi. The overall mortality was 1.28%. Morbidity and hospital stay was comparable to previously reported international studies

Role of double pigtail stent in ureteric stone retrieval following unsuccessful ureteroscopy

We analyzed the role of indwelling pigtail stent in successful uretic stone retrieval by second ureterosocopy when first ureterscopy failed. Over a period of 44 months, initial ureteroscopy failed in 41 patients. out of them, 32 patients had gigtail stent inserted and 9 were left without any stent. The group with stent, passed stone spontaneously or had stone retrieval on second ureteroscopy in 84% cases compared with 22% unstented cases, Uretero-lithotomy was done in 5 patients [16%] with stent and 7 cases [78%] without stent, It is concluded that following failed ureteroscopy, insertion of double pigtail stent results in higher subsequent successful ureteroscopic stone removal or spontaneous passage with a lower rate of consequent ureterolithotomy