Metastatic follicular carcinoma of thyroid to pericardium.

A 62 year-old man presented with massive pericardial effusion and a thyroid nodule. One thousand ml of serosanguinous pericardial effusion was tapped and the cytology consistent with metastatic papillary carcinoma. Total thyroidectomy was done. The pathological report of the thyroid gland was follicular carcinoma, poorly differentiated with capsular and vascular invasion. The patient received a treatment of 150 mci I-131 without complications. The total body scan after I-131 treatment showed only residual thyroid tissue. There was no demonstrable abnormal uptake in other parts of the body. No significant reaccumulation of pericardial fluid occurred. The diagnosis was follicular carcinoma of the thyroid with pericardial metastasis. The patient was discharged from the hospital with an improved clinical status.

Thyroid scintigraphy in children with hypothyroidism: a five-year experience.

The presence or absence of thyroid glandular tissue demonstrated by thyroid scintigraphy is important for genetic and prognostic counseling and for acceleration of diagnosis in other affected siblings. Technetium-99m-pertechnetate thyroid scintigraphy was performed on 27 children with cretinism at the Division of Nuclear Medicine, Faculty of Medicine Siriraj Hospital during the 5-year period from June 1991. Based on scintigraphic findings, three main groups of thyroid localization were seen. Thirteen (48.1%) were athyrotic while 3 (11.1%) had an ectopic thyroid and 11 (40.8%) had gland in normal position. Perchlorate discharge test was performed in 8 children of the last group and the results were positive indicating an organification defect. Thyroid scintigraphy and perchlorate discharge test provided the useful information for diagnosis, follow-up, and prognosis in children with cretinism.

Carbon Monoxide Exposure in Metropolitan Mass-transit Air-conditioned Buses.

A survey was done to determine the probability of health risk due to carbon monoxide exposure while travelling in twenty mass-transit air-conditions buses i.e., from the route number 8, serving between Rajaworadit pier and Paknam. Carbon monoxide concentrations were assessed inside the recorded as soon as the bus starting out of the station until arriving at the terminal. The patterns of carbon monoxide distributions inside each bus were similar, in dome shape, both morning and afternoon trips. The finding suggested no toxic gas accumulation throughout traveling. The evidence corresponded to polluted gases exchange being taken place while opening of the door at each bus-stop. After 40 and 70 minutes for out-bound travelling respectively, carbon monoxide concentrations rose up to the peak while the buses passing through the heart of the city. The highest peak found in an in-bound morning trip after one hour of travelling was 34 parts per millon. This level was still not exceeding the National Environmental Board standard of 35 parts per million for one hour exposure. The conclusion was therefore no health hazard for general population due to carbon monoxide existing during travelling by mass-transit air-conditioned buses except group of population with underling coronary artery disease who may take high risk of recurrent attack. Recommendation was made to prevent and minimize health risk by installing the air-curtain at the door which automatically switch on while the door is opening and regular inspecting the exhaust system to be always in good condition.

The experience of rabies prophylaxis in Siriraj Hospital 1980-1987.

Twenty two hundreds and thirty five records of patients receiving rabies vaccine prophylaxis between February 1980 and October 1987 were analyzed retrospectively in order to find out the epidemiological backgrounds of animals bite victims. These patients were 1,130 males and 1097 females with the ages raged from 9 months to 87 years. Most of the patients (1,486 case, 66.40%) were under the age of 25 while the most commonly found were between 5-9 years. The injuries occurred mostly around their residential areas. The rabies vaccine prophylaxis using the suckling mouse brain vaccine (SMV), Sample vaccine and human diploid cell vaccine (HDCV) were 1,626, 266 and 343 cases respectively. Primary suture of wounds and wound cleansing were carried out in 123 patients. No serious side effect was observed subsequent to the injection of rabies vaccine. However, skin rash was observed among patients receiving SMV and Sample vaccine in 14 and 7 cases respectively.

Experiences from a one-year supervision of pulmonary tuberculosis patient and Their associates.

Monthly scheduled follow-ups of 28 sputum-smear-culture-positive tuberculosis patients and 110 members of their families revealed 14 suspected cases of pulmonary tuberculosis and several interesting findings: (1) the incidence of tuberculosis was mostly among poor families with unsuitable shelter; (2) assessing family members and close associates of patients proved to be a fruitful approach for case-finding; (3) several BCG-vaccinated persons were found to have developed tuberculosis; (4) despite enthusiastic supervision of patients undergoing treatment, the defaulter rate was high (19.5%); and (5) all the antituberculotic regimens prescribed in this paper proved effective, as indicated by negative sputum examination from the fourth month of therapy onwards and a relapse rate of only 3.0 percent. Suggestions are made for improving the control of tuberculosis among the general public.

Paracetamol induced hepatotoxic: Report of a case.

Paracetamol poisoning by ingestion was reported in one attempted suicide case. The amount of tablets taken was equal to 70 gm. Signs of liver damage were detected on the third day of poisoning. The bilirubin level raised to 10.5 mg per 100 ml. Treatment started with 40 mg of prednisolone and 6 tablets of hepatofolk daily. Toxic symptoms rapidly subsided while liver functions gradually returned to normal in one month. The patient had been well since then. On reviewing the literature, the normal therapeutic dose of 3 gm per day could induce hepatotoxic when comsumed for one year. With higher doses, shorter periods were observed. The evidence evoked. There should be precautions made by both hpysicians and laymen when prescribing or consuming the drug without any indication. Normal defence mechanisms of the body for paracetamol, including the roles of intoxication were described. Those who ingest the chemical more than 10 gm must be considered high risk to poisoning. Treatment with a specific antidote should begin within 10 hours to prevent seriously adverse effects.

Study on relationship between urine borax and various diseases.

A survey was done to determine the possibility of borax being an aetiology of disease inducer. Various groups of patients, 50 each, attending special clinics at the Out-Patient Department were selected for this study. Urine was collected for borax assessing. Positive urine borax was found higher among dermatologic, rheumatologic, gastroenterologic and nephrologic patients (50, 42, 38 and 30% respectively), while cardiologic, hypertensive and diabetic were lower (14, 14 and 12% respectively), using compared with 28.3%, the average positive urine borax in general population as the base-line. The results were relavant to a previous study on organ distribution of borax at high concentration particularly in skin, gastro-intestinal tract and kidneys. The evidence strongly suggests borax is a health threatening hazard. Urgent need for prevention and control is recommended.

Bangkokian at risk to borax.

The sutdy was done in 1986 to assess borax excretion in urine among Bangkokians. The population included 589 vegetarians and 1,767 non-vegetarians. Screening test for borax in urine was performed by dropping one microdrop on readily prepared tumeric paper and then reading the results by means of colour change. The findings showed 27.3% and 28.6% positive for borax in vegetarians and non-vegetarians respectively. Eating habits did not play any importance. This study was performed one year after the use of borax was strictly prohibited in all foodstaffs. The evidence reflected the ignorance of food dealers on relevant laws. More than one quarter of Bangkokians are still at risk to borax nowadays.

Study on health hazard due to methyl bromide among librarians.

Fumigation of Book and document for pest control was firstly applied in Thailand ten years ago. Methyl bromide, one of the fumigants, has been used for such purpose, but this process provided a potential health hazard from inhalation exposure of readily vapourized poisonous gas. There were 60 librarians included in the study. In spite of no methyl bromide being detected in the air in the working environment, all of librarians possessed the toxic material in the blood at a level of 1.02-8.13 mg./100 ml. It was probably due to inhalation of toxic gas that formerly penetrated the books and instantly vapourized when the books were opened or rearranged. 91.7% of the workers reported abnormal feelings. The rate of spontaneous recovery was 70.9% in mild category. The remainder needed self-medication or physician consultation. Special investigations were made to evaluate health status. The results showed 13.3% with dangerous methyl bromide blood levels, 28 with mild degree impairment of pulmonary functions, 6.7% with abnormal EEG, slightly elevated enzymes SGPT (ALT) in 13.3%, alkaline phosphatase in 1.7% and slightly decreased leucocyte counts in 10.0%. Recommendations were introduced to carry out annual medical examinations and relevant investigations to all concerned. For those who previously had abnormalities needed periodic check-ups at 6 month intervals. Whenever abnormal feelings occur, methyl bromide in the blood must be considered.

Acute abdominal pain from methyl bromide poisoning.

An unusual chief complaint of methyl bromide poisoning was reported. The patient, a single 32 years-old Thai female, working as a librarian for nine years was the victim. She kept on inhaling vapourized toxic gas from the books and documents previously fumigated for insecticidal purpose during the process of her daily work. She had experienced sniffing and felt weak since starting her career. Serious abnormal feeling occurred three days before admission. Nausea and abrupt abdominal pain around the right iliac fossa were manifested. Acute appendicitis was first diagnosed by a surgeon. The clue that lead to a correct diagnosis was about her occupation. The blood was sent to the toxicology center assessing for toxic materials. The result showed 32.2 mg./100 ml. of methyl bromide contained in the blood. She fortunately escaped from open laparotomy. After six days of hospitalization, she returned to work in a new position as recommended. A follow-up was carried out two months later. The methyl bromide blood level had fallen to 3.21 mg./100 ml. and her health had returned to normal. This was the first reported case of methyl bromide poisoning in Thailand.

Perchlorate discharge test.

A variety of perchlorate discharge techniques was performed and the criteria for interpretation varied according to the techniques employed. The modified technique, 10 microcurrie of Na131 I was injected into the patient with a 10 minute serial recording for 1 hour ; KC 104 300 mg/25 ml was given orally and continued with 10 minute serial recording for 30 minutes. This technique can identify the iodide transport defect and organic binding defect of the thyroid gland, and trapping function of the gland. In 25 mormal subjects, the thyroid131 I- content increased during a 60 minute serial recording and after KC 104 was given. The discharge observed during 90 minutes ranged from 1% to (- 55.7%). The range at the 20 – minute uptake is from 4.70% to 11.66% (X ฑ 2 SD). In 15 patients, 3 patients had iodide transport defect, 9 patients organic binding detect, while such defects could not be found for the remaining patients. However, it is possible that the remaining three may have other kinds of defects such as iodotyrosine coupling defect, iodotyrosine dehalogenase defect or abnormal secretion of iodoprotein.

99mTechnetium - retention.

99mTc-retention is a new index for thyroid function studies. The residual 99mTcO4 content in the thyroid was determined 1 hour after KCIO4 administration. The ratio between the residual and uptake by oral administration, called "99mTechnetium retention," in the hyperthyroid is less than 19.5%. A comparision of diagnostic accuracy between 99mTechnetium retention and other techniques, 99mTechnetium-uptake, RIA serum T3 and T4 was carried out in 200 patients, This yielded overall sensitivity of 93.0%, 91.2%, 82.7%; specificity of 99.3%, 89.1%, 99.2% and 100.0% and accuracy of 97.4%, 89.7%, 94.5%, and 92.3% respectivity. This index is very effective for identifying (1) hyperthyroid and iodine deficiency goiter witout suppression test, (2) relapse and remission of Grave's disease after medical therapy. However such index is not applicable to iodine thyrotoxicosis, thyrotoxicosis factitia, ectopic thyroid production and hyperthyroiditis. Perchlorate (CIO4) ions are not only a competitive inhibitor of TcO4 from the gland. Therefore this technique exposes the least radiation hazard to the gland.

99mTc-pertechnetate for thyroid function studies by oral administration.

99mTc-pertechnetate for thyroid function studies is given oral, need not be sterile or pyrogen-free. The patients need be fasting only 3 hours and no food should be ingested for at least two hours following the oral administrations. The optimum time for uptake measurement is 2 hours after dose. The euthyroid range is from 2.5-11.2%. The suppression test can be carried out with 60 microgram of T3 daily for 5 days. A normal uptake response to T3 is a suppression to < 80% of initial uptake. Poor suppression is characteristic of grave’s disease. The comparison between 99mTc-uptake and RIA, serum T4 and T3 in 50 patients results in similar findings in both euthyroidism and hyperthyroidism, except for one subject with heart disease. The uptake and suppression test can give more information about iodine deficiency goiter. Using 131I and 99mTcO4, we compared 240–iodine uptake and 20-technetium uptake in the same subjects. The diagnosis of 33 patients was made on clinical grounds and confirmed by RIA-technique. The indications were the same, but the iodine uptake was more sensitive, for 6 patients with iodine deficiency disease whereas technetium found only 3. The suppression studies, 131I is satisfied in all cases. Technetium is reasonable in hyperthyroidism and iodine deficiency goiter. If 20-uptake is in normal range, some of them are a suppression and some fail to suppress. Because the normal rang of technetium is lower than iodine and the thigh correction for extrathyroid activity is inadequate. In patients with low 99mTc-uptake, the suppression test is not needed neither are there cases of thyrotoxicosis with false low 99mTc-uptake such might occur with early iodine avidity and wash out at 24 hours.

New method for measuring blood volume.

Patients without nausea received a capsule of 200 mg of Sn Cl2 orally and waited for 1 hour or patients with nausea were injected intravenously with a dose of MDP-Sn (II) and waited for 10 minutes. After the waiting time, 10 ml of blood was withdrawn. Whole blood was incubated with 99mTc 200 ตCi for 30 minutes and 1 wash with normal saline was sufficient. This procedure of labeling RBC with 99mTc is much more convenient than the conventional one. We have used this method since 1979 until 1984 with 52 patients without any adverse reaction occurring. The results are satisfactory not only in accuracy and cost but also in reducing the radiation dosage to patients and operators. This report offers 3 main benefits for this procedure. First of all it can help doctors to make decisions about the priority of examination. Secondly, it can be useful for those who are looking for a good method of measuring blood volume. Finally it can be most helpful in a teaching programme.