Clinical Significance of Surgical Margin from Loop Electrosurgical Excision Procedure

Abstract Clinical Significance of Surgical Margin from Loop Electrosurgical Excision Procedure Chantawat       Sheanakul              MD* Sumonmal       Manusirivithaya    MD* Siriwan             Tangjetgamol        MD* Nantana           Kaewpila                 MD** Sura                  Chomxhalaem       MD* *Department of Obstetrics and Gynecology, BMA Medical College and Vajira Hospital **Department of Pathology, Srinakharinwirot University Objective: To determine the prevalence and the correlated factors of unfree surgical margin from LEEP (loop electrosurgical excision Procedure) together with the relationship between surgical margin and residual disease. Study design: Retrospective descriptive study. Subiects: One hundred and six women who underwent LEEP and were diagnosed as cervical intraepithelial neoplasia to microinvasive cervical cancer at BMA Medical College and Vajira Hospital between June 1, 1996 and May 31, 2001. Methods: Medical records and follow up information of the target population were retrospectively reviewed concerning the personal history, surgical margin from LEEP, pathological reports from LEEP and hysterectomy specimens. Main outcome measures: Prevalence of unfree surgical margin from LEEP, residual disease from hysterectomy specimens. Results: During the period of study, unfree surgical margin was found in 43 cases (40.6%). Unfree surgical margin was found in 71.4% of microinvasine, 38.2% and 25.0% in patients with HSIL (high grade squamous intraepithelial lesion) and LSIL (low grade squamous intraepithelial lesion) respectively. From 58 cases who underwent hysterectomy, residual disease was found in 40.6% of unfree surgical margin which was significantly higher than 11.5% in those with free surgical margin (p=0.014). Conclusion: The prevalence of unfree surgical margin from LEEP in this study was 40.6%. Severity of disease was the significant prognostic factor for unfree surgical margin and this positive margin was significantly correlated with the higher incidence of residual disease. Key words: surgical margin, residual disease, LEEP Vajira Med J 2002 ; 46 : 179 - 186

The Relationship of One Abnormal 100 Grams OGTT Value and Large for Gestational Age Newborn

Abstract The Relationship of One Abnormal 100 Grams OGTT Value and Large for Gestational Age Newborn Chantawat      Sheanakul,     MD Department of Obstetrics and Gynecology, BMA Medical College and Vajira Hospital Objective:  To study the incidence of large for gestational age newborn of mothers with abnormal one value 100 grams oral glucose tolerance test (100 grams OGTT) compared to those of mothers with normal value 100 grams OGTT Study design:  Historical cohort study. Subjects:  Ninety six pregnant women attending at antenatal care unit in BMA Medical College and Vajira Hospital from April 1996 - March 1999 with certain gestational age and risk for gestational diabetes mellitus, who underwent 100 grams OGTT test at 24-28 weeks gestational age. Methods:  The medical records of pregnant women at risk for gestational diabetes mellitus who came for antenatal care and underwent OGTT between April 1996 to March 1999 were reviewed.  The subjects were divided into 2 groups, 48 women in each group.  The study group was pregnant women with abnormal one value 100 grams OGTT. The control group was ones with normal 100 grams OGTT.  The incidence rates of large for gestational age newborn between two groups were compared. Main outcome measures:  Incidence of large for gestational age newborn. Results: Incidence of large for gestational age newborn born from mothers in the study group (24.44%) was significantly higher than in the control group (6.66%). Conclusion:  Pregnant women who had one abnormal value of 100 grams OGTT had higher risk of having large for gestational age newborn than those with all normal values of 100 grams OGTT. The obstetrician should be careful in taking care of these particular group of patients and repeat the test again. Key word:  diabetes mellitus, OGTT, pregnancyVajira Med J 2003 ; 47 : 1 - 8

Results of Invasive Cervical Cancer Treatment at BMA Medical College and Vajira Hospital

Abstract Results of Invasive Cervical Cancer Treatment at BMA Medical College and Vajira Hospital Chantawat     Sheanakul               MD* Sumonmal     Manusirivithaya     MD* Thanathip      Tantiwattana           MD** Laddawan      Nakwong                  MD**   *Gynecologic Oncology Section, Department of Obstetrics and Gynecology, BMA Medical College and Vajira Hospital **Radiologic Oncology Section, Department of Radiology, BMA Medical College and Vajira Hospital Objective:  To study the clinical and pathological characteristics of invasive cervical cancer patients together with the prognostic factors and results of treatment in terms of overall 5- year survival rate. Study design:  Descriptive study. Subjects:  All 573 patients with pathological confirmation of invasive cervical cancer primarily were treated at BMA Medical College and Vajira Hospital between 1993-1998. Methods:  Medical records including out-patient records, in-patient records, gynecologic oncology registration records, radiation oncology records and pathological reports were retrospectively reviewed.  Patients' age, stage, histologic type, treatment and follow up information were recorded. Main outcome measures:  Overall 5-year survival rate. Results:  There were altogether 573 new cases of invasive cervical cancer treated at BMA Medical College and Vajira Hospital during the study period.  The mean age of the patients was 50.5+11.8 years.  Nearly 80% were squamous cell carcinoma, while the rest were adenocarcinoma of adenosquamous cell carcinoma.  Most of the patients (74.2%) were diagnosed in stage II or III, while stage I was diagnosed in only 16.6%  The overall 5-year survival rate for all stages was 61.5% (95% confidence interval of 57.0%, 66.1%).  The most important factor that correlated with survival rate was tumor stage.  Patients in stage I had higher survival rate than stage II, III and IV with the 5-year survival rate of 91.1%, 71.6%, 47.6%, and 20.6% respectively.  Adenocarcinoma tended to have lower survival rate comparing to squamous cell carcinoma, stag by stage but did not reach statistical significance. Conclusion:  Most cases of invasive cervical cancer were diagnosed in stage I or II and the frequent histologic cell type was squamous cell carcinoma.  The overall 5-year survival rate was 61.5%.  Tumor stage was the most significant prognostic factor. Key word:  cervical carcinoma, invasive, prognostic factors, 5- year survival rate Vajira Med J 2003 ; 47 : 93 - 102