Exchange transfusion in severe falciparum malaria: a simple method modified from hemodialysis circuit.

We set up a simple extracorporeal circuit, modified from the extracorporeal method generally used in conventional hemodialysis, for exchange transfusion. Temporary vascular access was used in exchange transfusion for both draining the infected blood and infusion of the freshly non-infected blood. This method of exchange transfusion was performed in 3 severe complicated falciparum malaria patients who had a percentage of parasitemia of 80, 40, and 35. The magnitude of parasitemia decreased immediately to less than one per cent and this value persisted twenty-four hours after the procedure. No complications of exchange transfusion were detected in all patients. Erythrocyte morphology determined by scanning electron microscopy was unaltered by exchange transfusion. Because of the simplicity, the effectiveness, and the safety of the procedure, this extracorporeal circuit modified from hemodialysis circuit would be a more beneficial exchange transfusion method in the treatment of severe complicated falciparum malaria than the manually-performed one.

Modification of the acetylcholinesterase (AchE) staining method in Hirschsprung's disease.

Demonstration of the increasing activity of acetylcholinesterase (AChE) in a segment of the colon has proved to be the most accurate diagnostic tool to diagnose Hirschsprung's disease. Two methods of histochemical assessment were tried to establish the most appropriate and effective method for this study within the limitation of available equipment. Lake's method was chosen and was modified as the standard histochemical examination.

Homicide: a report of 4,122 cases from Bangkok and provinces.

A retrospective review of 4,122 homicides was carried out between 1991 and 1995. About 47 per cent of cases occurred in the Bangkok Metropolitan area (BKK) and 53 per cent in the nearby provinces. A steady increase in the murder rate was noted in the latter. BKK was the place where most killings occurred, but was probably related to the high number of extrajudicial executions. Of the victims, 86 per cent were men and 14 per cent were women. The incidence peaked in the 3rd decade of life but there was also a rising trend among teenagers. Three major causes of death were firearms, sharp-force, and blunt-force in combination accounting for 92 per cent of the deaths. Firearms alone were used in about half of all murder cases. An analysis of organ injuries in relation to the types of weapons used was also presented. The data indicate the necessity to limit access to firearms.

Epithelial-myoepithelial carcinoma of parotid gland: a case report with immunohistochemical and ultrastructural studies.

A 66-year-old man presented with a painless mass of the parotid gland. Light and electron microscopic studies verified the basic nature of the tumor as epithelial-myoepithelial carcinoma, a low-grade malignant neoplasm of the salivary gland. Pathologically, there were two types of cells; the inner eosinophilic epithelial cells lining the ducts and the outer clear cells. The former cells displayed immunoreactivity for cytokeratin and ultrastructural features of apical microvilli and desmosome. The latter cells were positive for actin, S-100 protein, vimentin and the cytoplasm contained actin microfilaments. Such pathological findings were characteristic features of this rare tumor. To our knowledge, this is the first reported case of EMC in Thailand.

Clinicopathological features predicting recurrence of intracranial meningiomas.

A series of 11 recurrent meningiomas was studied. Most lesions occurred in women. The youngest patient was 17 years old and the oldest was 73 years. The mean age was 44 years. Multifactorial risk factors were involved in the tumor regrowth including age of patients, location of tumors, adequacy of initial surgery, certain histopathological features and subtypes of tumors. Tumors in young adults tended to have a rapid interval of regrowth as well as a tendency of multiple recurrences. Brain invasion, extensive bone and muscle involvement, foci of necrosis and hemorrhage, high mitotic index, angioblastic and papillary patterns were common pathological risk factors. Additionally, recurrent tumors may retain their original pathological appearance or become more aggressive by showing marked cellular pleomorphism. Area of liposarcomatous component was encountered in one recurrent lesion.

Moderately differentiated neuroendocrine carcinoma (atypical carcinoid) of the larynx.

A moderately differentiated neuroendocrine carcinoma or atypical carcinoid of the larynx occurred in a 68-year-old woman who developed rapidly progressive dysphagia, hoarseness and a neck mass. Immunohistochemical and electron microscopic studies verified the nature of this tumor. Local invasion and distant metastases are common. It is suggested that cigarette smoking could increase the risk of developing this neoplasm.

Castleman's disease: a clinicopathologic study of 12 cases.

Castleman's disease observed in 12 Thai patients was investigated. The male to female ratio was 1:3. Peak prevalence was in the third and fourth decades. It is suggested that the disease in Orientals tends to have extrathoracic mass more often than in Caucasians. Solitary non-tender slow growing mass was the most common symptom. Generalized lymphadenopathy in association with cutaneous plasmocytoma was noted in one example while asymptmatic pelvic lesion in a patient was discovered incidentally. Histologically, the hyaline-vascular type was found in 8 instances, the remainders were plasma-cell type. Surgery was effective for localized lesions while systemic form could benefit from chemotherapy.

Bullet embolus to the right pulmonary artery after abdominal gunshot wound with "piggyback bullet".

This report describes a 17-year-old man with piggyback bullets to the abdomen followed by bullet embolization to the right pulmonary artery. The first bullet was removed from the abdomen while the second missile in the lung was left intact. We believe this is the first case in Thailand of a bullet embolus resulting from piggyback bullets.

Primary ovarian carcinoid: a mixture of insular, trabecular and mucinous components.

A case of primary ovarian carcinoid in a 53-year-old woman is described. The tumor which replaced the left ovary showed a mixture of insular, trabecular and mucinous cell types in the same mass. The nature of the neoplastic cells has been verified by light and electron microscopic studies. The latter investigation demonstrated bundles of tonofilament and apical villi of the trabecular cells in addition to the morphologic difference of neurosecretory granules among these various cells.

Mucin-producing malignant meningioma with papillary and glandular patterns.

An exceedingly rare intracranial malignant meningioma with papillary and glandular patterns in a 45-year-old man is described. Intracellular mucin production was demonstrated. The nature of the neoplastic cells was verified by immunohistochemical and electron microscopic studies.

Effects of law promulgation for compulsory use of protective helmets on death following motorcycle accidents.

This study revealed a significant decrease in mortality from injuries sustained by motorcycle accidents following the decree promulgated in 1992 for compulsory use of safety helmets by motorcyclists and pillion riders. The helmets can help only in protection of head injury but do not affect the number of accidents. This safety device can not protect any serious injuries of the neck, chest or internal organs which could result in death or permanent disability. To gain maximum benefit from the law, the helmets should be of standard specification and worn properly. Education to drivers and pillion riders particularly male adolescents is essential in reducing the incidence of motorcycle accidents.

Calcified cystic pituitary prolactinoma.

An unusual cystic pituitary prolactinoma in a 20-year-old man is described. The tumor was roentgenographically calcified. Ultrastructurally, the calcium deposits were found within the cytoplasm of tumor cells, extracellular spaces and blood vessels. The mechanism of intratumoral calcification is discussed in relation to degeneration of neoplastic cells and reparative process.

Lipoblastic meningioma: a light and electron microscopic study.

A patient with intracranial lipoblastic meningioma in the right frontal lobe is reported. The tumor was entirely made up of vacuolated cells. The nature of this rare neoplasm has been verified by light and electron microscopic studies.

Adenosquamous carcinoma of the thyroid: a case report and review of the literature.

A case of mixed squamous cell carcinoma and papillary adenocarcinoma of the thyroid in a 75-year-old woman is described. Review of 19 reported adenosquamous carcinoma including the present case revealed that they tended to occur in the sixth and seventh decades of life with an average age of 63.84 years and without sexual predilection. Local invasion and metastases of this highly fatal neoplasm are common.

Intrathoracic lymphangiohemangioma associated with hemothorax: a cause of intrauterine fetal death.

A case is presented of a large intrathoracic lymphangiohemangioma in association with spontaneous hemothorax. The lesion was found in a macerated stillborn infant. The precise nature of the tumor was documented histologically.

Congenital hemihypertrophy with adrenocortical adenoma.

A rare case of adrenocortical adenoma in a 7-month-old female infant with congenital hemihypertrophy of left leg is described. Only 7 similar cases including the present one, are on record. The patients ranged in age from 7 weeks to 45 years. The male:female ratio was 3:4. The adrenal tumors were often detected after CH had become evident. Large functional tumors often produced symptoms of hirsutism, virilization, and precocious puberty. CT and ultrasound are necessary for early detection and prompt treatment.

Prolactin cell carcinoma of the pituitary.

Two patients with malignant prolactinoma are reported. The diagnosis of malignancy depends on the demonstration of invasion of brainstem and subarachnoid space and on the presence of marked cellular pleomorphism and mitotic activity. Review of the literature revealed that such malignant tumors were more common in men than in women. The most frequency intracranial sites of metastases were frontal and occipital lobes, and cerebellum. The possibility of radiation-induced carcinomatous transformation is discussed.

Cerebral abscesses due to Pseudomonas pseudomallei.

Two cases of cerebral abscesses caused by Pseudomonas pseudomallei are reported. The first case, a 51-year-old women had a sudden onset of progressive right hemiparesis and right facial palsy and died within 7 days. Postmortem examination disclosed brain abscess in association with disseminated infection outside the central nervous system. The second case, a 9-year-old boy displayed cerebral abscesses as an isolated manifestation. Recovery occurred after treatment with ceftazidime. Review of the ten case reports of cerebral melioidosis revealed that the lesion occurred in patients of all ages and was more common in men than in women. The frontoparietal lobe was the most common location. Fever, headache, and hemiparesis were frequent clinical manifestations while seizures, ataxia were uncommon. CT scanning, serum antibody titer along with hemoculture were useful investigate tools. The importance of early diagnosis and prompt treatment is emphasized for this fatal but treatable disease.

Granulomatous mastitis: case report and review of literature.

A 38-year-old woman presented with a 5-month history of a right breast mass after delivery of her second child. The lesion simulated the picture of a carcinoma on clinical grounds. Fine-needle aspiration also reported an erroneous diagnosis of malignancy. At surgery, a discrete granuloma with microabscesses was seen without any causative organisms being identified. Open biopsy or Tru-Cut needle biopsy is recommended to prevent such an error which may result in unnecessary radical surgery.