Cortical blindness after motorcycle accident: a case report.

A 47 year-old Thai man presented with acute bilateral blindness after suffering head trauma in a motorcycle accident. No neurological deficit was found. The visual acuity was light perception with poor light projection on both eyes. Other ocular examinations were normal except ecchymosis on both lower eyelids and mild subconjunctival hemorrhage on the left eye. Emergency computerized tomography showed normal appearance of optic nerves, optic canals and multiple contusional intracerebral hemorrhages at both occipital lobes. This case demonstrated a rare condition of permanent cortical blindness without other neurological deficits resulting from a head trauma.

Contraceptive vaccine: new hope for the overcrowded world?

The overall rate of fertilization in humans has contributed to sustained increases in the world population and the added urgency of the need to develop new, effective contraceptive strategies. One potential approach to preventing fertility is to disrupt sperm-egg interaction or embryonic-maternal communication during early pregnancy with immunological reagents. This has lead to the principal concept of "contraceptive vaccine" which may become available in the near future.

Detection of endometrial cancer in asymptomatic postmenopausal breast cancer patient treated with tamoxifen: a case report.

Breast cancer is among the commonest malignancies in women and tamoxifen has been widely used for more than two decades for treatment of breast cancer. It has been known that long term use of tamoxifen significantly increases the risk of endometrial cancer but there is no generally accepted recommendation regarding the surveillance of endometrial pathologies in breast cancer patients taking tamoxifen. Although the incidence of endometrial cancer associated with tamoxifen use is not high, the risk is true and these patients could be helped by screening methods such as transvaginal ultrasonogrphy. We report here a case of endometrial cancer detected by transvaginal 2D scan in an asymptomatic postmenopausal woman taking tamoxifen.

Fetal exencephaly arising as a result of preimplantation exposure to ammonium chloride.

OBJECTIVES: To investigate the effect of preimplantation exposure to 0.6 mM ammonium chloride on both preimplantation and postimplantation development of (F1 x F1) strain mouse embryos. METHOD: Two-cell stage mouse embryos were randomly allocated to culture in either M16 medium or M16 added with 0.6 mM ammonium chloride for 2 days before being transferred to 2.5 day pseudopregnant recipients. Embryo morphology was assessed after 1 and 2 days of culture. The recipient females were sacrificed on day 15.5 of gestation. The number of implantation sites, fetuses, moles and any gross abnormalities found were noted. RESULTS: There was no significant difference in the number of embryos reaching morula stage after two days of culture between the two groups (chi2=0.86, P>0.05). Implantation and pregnancy loss rates between the two groups were within comparable ranges. Crown-rump length was significantly higher in the group of embryos exposed to ammonium chloride (t=2.46, P<0.05). There was one gross abnormality, exencephaly, detected in the experimental group (4.35% per fetus obtained). CONCLUSIONS: Besides the abnormal increase in fetal size, preimplantation exposure to ammonium chloride also resulted in gross abnormality, exencephaly. If such effects occurred in the course of human in vitro fertilization, it could be devastating. Further study in this aspect is, therefore, clinically very important in preventing unwanted abnormalities that could arise from human in vitro fertilization.

Economic evaluation of water iodization program in Thailand.

In Thailand, iodine deficiency disorders (IDD) are endemic in 57 out of 75 provinces with an estimated 15 million people at risk of IDD. A three pronged control program with iodized salt, iodized water and iodized oil capsules is being implemented. The water iodization program is both school based and household based. In the household, the residents are given iodine solution, two drops of which is to be added to 10 l of drinking water. In the schools, in addition to this method, an iodinator is used. This releases a fixed amount of iodine into the drinking water. This study examines the cost of the water iodization program in Thailand for the year 1996 in terms of cost per beneficiary, cost per microg iodine consumed daily and cost per goiter person years averted. We used a discount rate of 5%. Field visit and interviews of health personnel from Ministry to village level were conducted to gather primary data. Review of existing papers and reports of the Department of Health, Government of Thailand was done for secondary data. The costs included the capital cost of equipments, initial training and the recurrent costs of potassium iodate, proportional salaries of personnel involved, monitoring and communication activities. The cost per beneficiary of school based iodinator method (US$ 0.72) and school based drop method (US$ 0.64) were similar and much higher than the household based approach (US$ 0.12). The cost per microg of iodine consumed daily was ten times higher in the school based approach (US$ 0.01) compared to the household approach (US$ 0.001). The cost per goiter case averted for the whole strategy of water iodization was US$ 194.50. Water iodization appears to be a low cost intervention. However, the need for behavioral modification raises the issue of long term sustainability.

The environmental impact on male fertility.

There have been several reports indicating that the quality and quantity of human spermatozoa are facing a serious decline. This leads some scientists and environmentalists to believe that the human species is approaching a fertility crisis. Several factors have been claimed to be the attributable causes of the decline in male fertility potentials. These include heavy metals and various chemical agents widely used in agriculture and industry. Moreover, other physical factors such as the increased global temperature and radiation exposure as well as the biologic factors such as the contamination of phyto- and xeno-estrogen in the environment could detrimentally affect male reproductive function. These effects can result in, not only a reduction in sperm concentration, but also alterations in sexual behavior, mood disorders and the presence of genital cancers. The knowledge in male gonadal toxicity, therefore, is very useful in understanding the impact of environment to the male reproductive system. This will lead us to protective strategies to avoid the adverse effects of environmental factors on the male fertility.

The prevalence of inadequate vitamin A nutriture in preschool children of north and northeast Thailand.

Previous surveys have suggested that preschool children in the North and Northeast of Thailand are at risk of inadequate vitamin A nutriture. Therefore, vitamin A status was assessed in 996 children aged 2-6 years in the North and Northeast Thailand during the dry (Feb.-April) and rainy (Sept.-Nov.) seasons. Approximately 1 per cent of samples during both periods exhibited serum retinol concentrations below 10 mcg/dl with means (+/-SD) concentration of 29 +/- 9.8 mcg/dl in the dry season and 37 +/- 15.4 mcg/dl in the rainy season. About one fifth of the studied children showed abnormal CIC and depleted liver stores (RDR > 20%). High risk areas were ranked and corresponded well by these 2 indicators. Therefore, it is concluded that the magnitude of the problem estimated by RDR and CIC are a more precise measurement of marginal vitamin A status than serum vitamin A level alone and about one-fifth of preschool children in the North and Northeast regions of Thailand experience subclinical vitamin A deficiency.