Gemcitabine and radiotherapy in the treatment of uterine cervical cancer patients at Phramongkutklao Hospital.

OBJECTIVES: To determine response, complication and survival of uterine cervical cancer patients treated with concurrent gemcitabine radiotherapy. MATERIAL AND METHOD: A retrospective review of medical records of 41 patients with uterine cervical cancer patients, stage IIB and above treated with concurrent gemcitabine radiotherapy from August 2000 to August 2003. RESULTS: At 6 and 12 months of follow up, the complete response rate was 75.6% and 65.9%. The cumulative probability of survival at 6 and 12 months after treatment was 0.93 and 0.85. The main complications were mild hematologic and nonhematologic toxicities. CONCLUSION: Concurrent gemcitabine radiotherapy provided a satisfactory response in patients with uterine cervical cancer with mild toxicity. Long term follow up data is necessary to determine the recurrent rate of this regimen.

Prevalence and risk factors of urinary incontinence in Thai menopausal women at Phramongkutklao Hospital.

OBJECTIVE: To determine the prevalence and risk factors of urinary incontinence in menopausal women at Phramongkutklao Hospital. MATERIAL AND METHOD: The present cross sectional study was conducted in healthy women, with intact uterus and at least one ovary, attending the university hospital menopausal clinic. They had no history of pelvic mass, paralysis or using any diuretic. They completed the self-administered questionnaire regarding urinary incontinence symptoms and risks. RESULTS: Four hundred patients were enrolled. The prevalence of urinary incontinence was 75.3%. The prevalence of stress, urge and mixed urinary incontinence were 18.3%, 17.5% and 39.5%, respectively. Obesity was statistically significant in association with all types of urinary incontinence (OR 1.65, 95% CI 1.10-2.64) and mixed incontinence (OR 2.65, 95% CI 1.50-3.14). Previous vaginal delivery was only significantly related with mixed type (OR 2.11, 95% CI 1.17-3.55). But only 3.6% of the menopausal women had ever been treated for symptoms of urinary incontinence. CONCLUSION: While the prevalence of urinary incontinence is high, the percentage of the suffering patients, seeking medical services, is low. Therefore, more attention should be paid to these treatable problems. Obesity might be the risk factor for all types of urinary incontinence, while previous vaginal delivery was suggested to be a risk factor for the mixed type.

Colposcopic directed biopsy in the management of abnormal pap smear at Phramongkutklao Hospital.

OBJECTIVE: To evaluate agreement in pathologic diagnosis of tissue obtained by colposcopic directed biopsy (CDB) and conization or total abdominal hysterectomy (TAH) in the diagnosis of cervical intraepithelial neoplasia (CIN). MATERIAL AND METHOD: Medical records of women with abnormal cervical cytology referred for colposcopic examination from January 1, 1999 to December 31, 2003 were reviewed. Agreement in diagnosis of CIN in tissue obtained by CDB and tissue obtained by conization or TAH is defined as not more than one level of CIN disparity. RESULTS: Agreement between pathologic diagnosis of tissue from CDB and tissue from conization or TAH is 67.1% with a 95% confidence interval of 57-77%. Six cases of invasive cancer were not diagnosed from CDB but subsequently diagnosed from conization. CONCLUSION: Agreement between pathologic diagnosis of tissue obtained from CDB and tissue from conization or TAH in the present study was too low to accept CDB as a diagnostic modality for CIN in selected cases. Conization should be performed in these cases after diagnosis of CIN is made by CDB.