Large gastric perforation in carmi syndrome: a morbid complication in a rare association.

The association between epidermolysis bullosa (EB) and congenital pyloric atresia (CPA) named Carmi Syndrome is rare. We report unusual and morbid complication of gastric perforation resulting in peritonitis in a preterm neonate born with Carmi Syndrome.

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.

Pathological prognostic factors in breast carcinoma.

OBJECTIVE: Pathological prognostic factors in breast cancer are now widely used to predict biological behavior of cancer and to plan its effective management. In this paper, we attempt to evaluate the reports from our histopathology laboratory spanning over a period of 4 years, to assess completeness in recording these factors. It will enable us to improve and standardize reporting on breast cancer. METHODS: The pathology reports of primary carcinoma of the breast diagnosed in our laboratory from 1st January 1994 to 31st December 1997 (4 year period) were reviewed for details on tumor size, histological type and grade, presence or absence of tumor emboli in vascular channels, proximity of the tumor to resection margins and lymph node status. RESULTS: Tumor size was not recorded in 1 case each in 1994, 1995 and 1996 and 2 cases in 1997. Histological type was mentioned in all cases in 1995 and 1997. It was not mentioned in 1 case in 1994 and 3 cases in 1996. Out of 77 cases with axillary clearance, the total number of lymph nodes was recorded in 83% of cases. The number of lymph nodes with metastasis was recorded in 71% of cases. CONCLUSION: Our histopathology laboratory receives the majority of surgical biopsies carried out in the Sultanate of Oman. During our study period we received a total of 45354 biopsies. From 1993 onwards, pathological prognostic factors of breast carcinoma were incorporated in our pathology reports following the publication of major and leading articles regarding the same. This study shows an improvement in the quality of reports after introducing this concept in 1994. This study clearly reveals the necessity for written protocols to be established, to standardize and improve the quality of reporting.

Pattern of breast neoplasms in Oman.

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Random plasma glucose and the glucose challenge test in pregnancy.

BACKGROUND: The oral glucose tolerance test for detecting women with gestational diabetes is too complicated and prolonged for routine use. Similar and less time consuming screening tests have been proposed including random plasma glucose estimation and the glucose challenge test (blood glucose estimation one hour after a 50 g glucose load). However, in practice, correct timing of the blood sample, which is of critical importance in the interpretation of the results of these tests, is difficult to ensure. This study was designed to evaluate these two screening tests in identifying women with abnormal glucose tolerance in pregnancy. METHODS: One hundred and eleven consecutive pregnant women at risk for gestational diabetes and 121 consecutive pregnant women with no risk factors had random plasma glucose estimation followed by the 50 g glucose challenge test at 26 to 30 weeks of gestation. A 100 g 3 hour oral glucose tolerance test was done within two weeks of the screening tests. The sensitivity and specificity of screening tests in predicting abnormal glucose tolerance were calculated. RESULTS: Seven (6.3%) women in the high risk group and four (3.3%) in the low risk group had gestational diabetes, while 11 (9.9%) and 8 (6.6%) had impaired glucose tolerance. Random plasma glucose level of 90 mg/dl or greater had a sensitivity of 63% and specificity of 66% in predicting abnormal glucose tolerance, while a threshold level of 115 mg/dl for the glucose challenge test yielded a sensitivity of 63% and a specificity of 55%. CONCLUSIONS: Neither random plasma glucose estimation nor the glucose challenge test is a useful screening procedure for abnormal glucose tolerance in pregnancy.

A randomized controlled trial of valethamate bromide in acceleration of labor.

A randomized controlled study of valethamate bromide administered by intramuscular injection in acceleration of labor was done in 60 consecutive primigravidae and 60 consecutive multigravidae admitted in labor at 2-4 cm cervical dilatation. There was no difference observed in the rate of cervical dilatation between those who received valethamate bromide and those who received normal saline. However, maternal tachycardia was observed in significantly more women primigravida RR 1.97, 95% CI 1.3-3.0; multigravida RR 2.16, 95% CI 1.3-3.6) who had received valethamate bromide.