Protein Expression of bax, bcl-2, and p53 in Patients with Non-Hodgkin's Gastric Lymphoma: Prognostic Significance

The biologic significance of bcl-2, bax, and p53 gene expression in patients with non-Hodgkin's gastric lymphoma is unknown. We examined the prognostic value of these genes in 36 patients with gastric lymphoma treated in our clinic between 1990 and 1995. Paraffin-embedded specimens from 36 patients who underwent primary resection of the stomach for gastric lymphoma were analyzed immunohistochemically for p53, bax, and bcl-2 gene expression. Expression of bax was seen in 24 of 36 patients (66.7%), p53 expression was found in 8 of 36 tumors (22.2%), and bcl-2 cytoplasmic staining was detected in 6 of 36 patients (16.7%). We performed a univariate analysis to examine the possible correlation between the expression of these genes and the survival of our patients. Expression of bax protein proved to be a statistically significant prognostic factor (p= 0.049). Protein expression of p53 and bcl-2 did not statistically correlate with survival. In the bcl-2-negative (−) patient group (30 patients), those who were bax-positive had a statistically significant better survival than those who were bax-negative (63.3% vs. 36.7%, p= 0.03). There was also a statistically significant correlation between p53 expression and the grade of the tumor (p= 0.0014). P53 protein expression increased along with the grade. Expression of bax is a significant prognostic factor in patients with gastric lymphoma. Its prognostic value increases significantly when studied in bcl-2-negative patients; but expression of bax failed to be an independent prognostic factor. Expression of bcl-2 and p53 has no prognostic significance. Expression of p53 seems to represent a marker for loss of differentiation.     

Western body mass indices need not compromise outcomes after modified D2 gastrectomy for carcinoma

BACKGROUND: To determine the role of body mass index (BMI) in a Western population on outcomes after modified D2 gastrectomy (preserving pancreas and spleen where possible) for gastric cancer. METHODS: Eighty-four consecutive patients undergoing an R0 modified D2 gastrectomy for gastric cancer were studied prospectively. Male patients with a BMI of greater than 24.7 kgm(-2) and female patients with a BMI of greater than 22.6 kgm(-2) were classified as overweight and compared with control patients with BMIs below these reference values. RESULTS: Thirty-eight of the patients (45%) were classified as overweight. The median BMI of the overweight patients was 27.0 kgm(-2) (range, 22.7-34.7 kgm(-2); 27 males) compared with 21.2 kgm(-2) (range, 15.2-24.7 kgm(-2), 31 males) for control patients. Operative morbidity and mortality were 26% and 7.9% in overweight patients compared with 22% and 6.5% in control patients (morbidity, chi(2) = 0.240; df = 1; P = 0.624; mortality, chi(2) = 0.059; df = 1; P = 0.808). Cumulative survival at 5 years was 52% for overweight patients compared with 55% for control patients (chi(2) = 0.15; df = 1; P = 0.7002). In a multivariate analysis, the number of lymph node metastases (hazard ratio, 1.441; 95% confidence interval [CI], 1.159-1.723; P = 0.009) and splenectomy (hazard ratio, 12.111; 95% CI, 9.645-14.577; P = 0.043) were independently associated with the duration of survival. CONCLUSION: High BMIs were not associated with increased operative risk, and longterm outcomes were similar in the two groups after modified D2 gastrectomy.     

Validation study of the accuracy of a postoperative nomogram for recurrence after radical prostatectomy for localized prostate cancer.

PURPOSE: A postoperative nomogram for prostate cancer was developed at Baylor College of Medicine. This nomogram uses readily available clinical and pathologic variables to predict 7-year freedom from recurrence after radical prostatectomy. We evaluated the predictive accuracy of the nomogram when applied to patients of four international institutions. PATIENTS AND METHODS: Clinical and pathologic data of 2,908 patients were supplied for validation, and 2,465 complete records were used. Nomogram-predicted probabilities of 7-year freedom from recurrence were compared with actual follow-up in two ways. First, the area under the receiver operating characteristic curve (AUC) was calculated for all patients and stratified by the time period of surgery. Second, calibration of the nomogram was achieved by comparing the predicted freedom from recurrence with that of an ideal nomogram. For patients in whom the pathologic report does not distinguish between focal and established extracapsular extension (an input variable of the nomogram), two separate calculations were performed assuming one or the other. RESULTS: The overall AUC was 0.80 when applied to the validation data set, with individual institution AUCs ranging from 0.77 to 0.82. The predictive accuracy of the nomogram was apparently higher in patients who were operated on between 1997 and 2000 (AUC, 0.83) compared with those treated between 1987 and 1996 (AUC, 0.78). Nomogram predictions of 7-year freedom from recurrence were within 10% of an ideal nomogram. CONCLUSION: The postoperative Baylor nomogram was accurate when applied at international treatment institutions. Our results suggest that accurate predictions may be expected when using this nomogram across different patient populations.     

Analysis of clinical stage T2 prostate cancer: do current subclassifications represent an improvement?

PURPOSE: The purpose of this study was to determine whether the extent of palpable cancer within the prostate predicts outcome after radical prostatectomy. PATIENTS AND METHODS: We combined prospectively collected data on 1,755 consecutive clinical stage T2 patients treated with radical prostatectomy alone at four institutions. According to the 1992 American Joint Committee on Cancer tumor-node-metastasis system, 645 (37%) were T2a, 758 (43%) were T2b, and 352 (20%) were T2c. Kaplan-Meier and proportional hazards regression analyses were performed on the 1992 and 1997 T2 subclassifications. After controlling for the effects of prostate-specific antigen (PSA) and biopsy Gleason sum, the two staging systems were compared for their ability to predict recurrence-free survival (RFS). Adjusted RFS curves were constructed using the corrected group prognosis method. RESULTS: Follow-up ranged from 1 to 166 months (median, 26 months). Cancer recurred in 417 (24%) of the T2 patients. The 1992 (P =.005) but not the 1997 (P =.100) T2 subclassification predicted outcome after controlling for PSA and Gleason sum. After covariate adjustment, RFS was 7% higher at 5 years in the 1992 T2a subcategory relative to the T2b subcategory. CONCLUSION: The 1992 American Joint Committee on Cancer system is superior to the 1997 system, and the former adds prognostic information to a model containing pretreatment PSA and Gleason sum. These results suggest that 1992 T2 subclassification derived from palpable findings improves prognostication over the 1997 subclassification.     

Synchronous diagnosis of multiple tumours in a postmenopausal woman

We report an unusual case of a postmenopausal woman that was diagnosed with multiple tumours derived from different embryogenic tissues. She presented with postmenopausal vaginal bleeding. Clinical examination revealed a large pelvic mass, tender on palpation. Serum CA-125 level was elevated at 8,985 kU/l (normal range 0–35). A CT scan showed a malignant-appearing right ovarian mass with a peritoneal nodule, small amount of free fluid in the pelvis and evidence of a colonic intussusception. The patient underwent total abdominal hysterectomy, bilateral salpingo-ophorectomy, partial omentectomy and right hemicolectomy with side-to-side anastomosis. Histopathology showed a Grade 3 endometrial adenocarcinoma. Both ovaries were completely replaced by partially necrotic poorly differentiated endometrioid adenocarcinoma. Small deposits of metastatic adenocarcinoma were seen within the omentum. Sections from the retroperitoneal mass showed a low-grade liposarcoma. A large polypoid tumour within the right colon was a tubulo-villous adenoma.     

Can thromboelastography predict which patients with heparin-induced thrombocytopenia may suffer thrombotic complications of type II?

Despite the existence of several sensitive functional and antigen assays used for the diagnosis of heparin-induced thrombocytopenia (HIT), an additional assessment of the patient's hemostatic status, in order to predict the thrombotic complications of the malevolent HIT type II, has become necessary. Herein below, we present the findings of thromboelastography (TEG) in a post-cardiac-surgery patient with the clinical diagnosis of HIT type II and false negative tests for heparin antibodies. We have reached the conclusion that TEG may prove to be a useful supplementary method to predict those HIT patients who may suffer complications of HIT type II.     

Deep Hypothermia and Circulatory Arrest in the Surgical Management of Renal Tumors with Cavoatrial Extension

Abstract   Background: The inferior vena cava (IVC) is involved in almost 5% to 10% of renal tumors. Their intraluminar extension to the cardiac cavities occurs with a tumor-thrombus formation at a percentage of 1%. The aim of this study is to present the principles of "radical" management that should be targeted to excision of the kidney together with the cavoatrial tumor-thrombus. Material: From 2003 through 2008, we treated six patients with renal-cell carcinoma involving the IVC and/or the right cardiac chambers. The main symptoms leading to the diagnosis were hematuria, dyspnea, or lower limb edema. The extension of the tumor was type IV in three cases, type III in two, and type II in one case. Method: Extracorporeal circulation combined with a short period of hypothermic circulatory arrest was the method used. Radical nephrectomy combined with cavotomy and atriotomy was performed to an "en-block" extirpation of the tumor-thrombus and allowed oncologic surgical clearance of the disease. Results: There was no operative death. The mean postoperative course duration was 11 days, apart from one obese patient who presented postoperative pancreatitis and died on the 44th postoperative day due to respiratory failure. During the cumulative postoperative follow-up of 171 months the patients remain free of recurrence. Conclusions: The use of extracorporeal circulation and deep hypothermic circulatory arrest provides a good method for radical excision of renal carcinomas involving the IVC with satisfactory morbidity and long-term survival results. Cooperation of urologists and cardiac surgeons is necessary for this type of operation .     

A comparative study of anxiety and depression in patients with bronchial asthma,chronic obstructive pulmonary disease and tuberculosis in a general hospital of chest diseases

Background  

Depression necessitating assistance from health professionals has a lifetime prevalence of 10%. Chronic disease increases comorbidity with mood and/or anxiety disorders. Patients with chronic pulmonary disease present with severely impaired functionality, chronic somatic and psychogenic pain, require frequent hospitalizations and have a dependency upon medical and nursing personnel. In the present study we assessed anxiety and depression in patients hospitalized for pulmonary disease in a pulmonary disease hospital.