The clinicopathological features, treatment and survival of gastric adenocarcinoma in Omani Arab patients

Background: Gastric carcinoma (GC) is the second most frequent cancer worldwide and the most common cancer in the Sultanate of Oman. The surgical and medical management of GC varies worldwide, and variable ethnic differences in clinicopathological features and survival have been observed. The aim of this work was to study clinicopathological features, management and survival trends of GC in Oman and to assess the impact of aggressive management trends on survival. Methods: A retrospective study of gastric adenocarcinoma cases, treated at three main hospitals in Oman over a 12‐year period, was undertaken. The study was divided into period I (1993–1998) and period II (1999–2004), based on the evolution of cancer services. Results: A population of 339 patients was included in the study (M : F ratio 1.9 : 1). GC was mainly a disease of elderly males with mean ages of 60.3 and 59.3 years for periods I and II, respectively. The most prevalent types of GC observed during periods I and II were distal (60.7% vs. 57.7%), ulcerating (64.3% vs. 63.7%) and intestinal (80.9% vs. 78.4%), with no significant differences between them. The main histopathology was adenocarcinoma with an increase in the signet cell variant (4% to 12.1%, P, 0.03) during period II. Advanced stages III and IV constituted 71.1% and 76.5% of all patients in periods I and II, respectively (P, 0.9). More D2 lymph node dissections and increased use of adjuvant chemo‐radiotherapy and palliative chemotherapy were noted during period II. Median survival time for the entire cohort was 12.3 months (95% CI 9.7–14.4) with a 5‐year overall survival rate of 16.5%. The 5‐year overall survival for periods I and II was 14% and 19% (P, 0.27), respectively. Conclusion: GC in Oman is seen predominantly in elderly males who display predominately distal, ulcerative lesions with an intestinal‐type histology. GC continues to present in advanced stages, with poor prognosis. This fact underscores the need for early diagnosis to achieve a better outcome. There is a need to employ early detection policies of gastric cancer in developing countires as aggressive treatment does not alter the outcome of advanced presentaion.     

Alanine scan and N-methyl amide derivatives of Ac-bombesin[7-14]. Development of a proposed binding conformation at the neuromedin B (NMB) and gastrin releasing peptide (GRP) receptors

Alanine and N-methylation scans together with molecular modelling were implemented in order to propose a binding conformation of the minimum active fragment of bombesin (BB), Ac-BB[7-14], to the gastrin releasing peptide (GRP) and neuromedin B (NMB) receptors. These data are also used to critically evaluate the previously proposed binding conformations such as x-helix and antiparallel β-sheets. This shows that the previously reported conformations do not satisfy the experimental data. A new binding conformation of Ac-BB[7-14] is proposed consisting of three consecutive y-turns followed by a bend and finishing with two y-turns. This low energy conformation (analogous to a fragment of thymidylate synthase, 2TSC) of bombesin stabilized by five internal hydrogen bonds, and with the side chains of residues Trp⁸ and Leu¹³ held on the same side of the peptide, is in agreement with the experimentally observed data. This and the results of molecular modelling may aid in the synthesis of conformationally restricted high affinity bombesin analogues and/or high affinity template-based GRP or NMB receptor agonists and antagonists.     

Efficacy of palatal block for analgesia following palatoplasty in children with cleft palate

Background: This prospective randomized controlled study was undertaken to evaluate the efficacy of palatal block i.e. blocking of naso palatine, greater and also lesser palatine nerves in children with cleft palate undergoing palatoplasty by evaluating its effects on intraoperative anesthetic requirement, postoperative analgesia and parental satisfaction. Methods: Forty‐five pediatric patients aged below five undergoing cleft palate repair were randomly allocated to three groups of 15 each. After tracheal intubation, Group NB received no block for control, group S received 0.5 ml of normal saline and group B received 0.5 ml of 0.25% bupivacaine for palatal block. Postoperative pain score, the time to first demand of analgesia and number of rescue analgesic demands were noted. Finally, the parental satisfaction was graded. Results: The block had no anesthetic sparing effect. The mean pain scores were significantly lower in patients who received block than in the group NB. The mean area under curve for FLACC score in group NB was 29 with 95% CI of 25–32, group S was 15 with 95% CI of 8.9–22.3 and in group B, it was 10 with 95% CI of 6–14. The time to first demand of analgesia was 6 [4.5–6] h in group NB, 18 [6–18] h in group S and 18 [18–18] h in group B (P‐0.000). The number of demands of rescue analgesia was significantly less in group B 0 [0–0.25], 0 [0–2] in S group compared to group NB 3 [3–3] (P‐0.000). The parental satisfaction was good in patients who received block and poor in group NB. Conclusion: Palatal block is technically simple, safe and effectively provides postoperative analgesia with good parental satisfaction. Injection of saline also produced palatal nerve block; however, the effect was not consistent.     

Immunohistochemical Studies of the Adult Human Ovary: Possible Contribution of Immune and Epithelial Factors to Folliculogenesis

PROBLEM : Formation of primordial follicles in adult ovaries could be a cryptic process limited to relatively small areas of the ovarian cortex and occurring during a certain stage of the menstrual cycle. Such an event may require a specific milieu provided by factors involved in developmental processes, i.e., morphoregulatory molecules and macrophages. METHOD : Adult human ovaries were investigated by immunohistochemistry for surface epithelium and granulosa cell markers (cytokeratin 18 and MHC class I), immune system-related morphoregulatory molecules (Thy-1 glycoprotein and N-CAM), and macrophage phenotypes (CD14, CD68, and MHC class II). RESULTS : In some ovaries 300–500 μm areas of surface epithelium were overgrown by tunica albuginea, descended into the stroma, and apparently fragmented into individual small (20–40 μm) follicle-like cell nests. Differentiation of the surface epithelium was accompanied by macrophages and Thy-1 glycoprotein. Small segments of surface epithelium showed N-CAM and a lacked MHC class I expression. In such segments, clear spherical germ-like cells migrated into the deeper stroma, associated with the microvasculature, and eventually aggregated with follicle-like cell nests. CONCLUSIONS : Our data suggest that surface epithelium may be involved in the formation of some primordial follicles in adult ovaries. This process, and further follicular fate, may require a precise interplay of immune system related morphoregulatory molecules and macrophages.