Misdiagnosis in vertebral osteomyelitis: problems and factors.

One hundred and one cases diagnosed with vertebral osteomyelitis were evaluated for misdiagnosis and both factors and outcomes of misdiagnosis were assessed. There were 67 patients with tuberculous spondylitis and 34 patients with pyogenic vertebral osteomyelitis. Misdiagnosis occurred in 33.7 per cent of the cases. The average delayed diagnosis time was 2.6 months (range, 0.2 to 12). Age between 60 to 70 years was the most frequent group for misdiagnosis, while the most frequent area of misdiagnosis was the lumbar spine. Metastatic carcinoma, spinal stenosis, herniated nucleus palposus and back strain were common initial misdiagnoses. The factors, age group, absence of fever and positive straight leg raising test (SLRT) were associated with misdiagnosis in univariate analysis and multivariate analysis (odds ratio 3.40 (95%CI:1.07-11.94), 3.47 (95%CI:1.20-10.05), and 24.47 (95%CI:2.18-274.28), respectively) Misdiagnosis was statistically significantly associated with the result of treatment. This paper emphasizes that the elderly age group, absence of fever and positive SLRT are the independent factors which increase the risk of misdiagnosis of vertebral osteomyelitis.

Follow up of water use in a tin mining area affected with arsenic poisoning.

Ron Phibun district in southern Thailand has been known as an endemic area for arsenic contamination. The government has been trying to improve the situation by encouraging the use of rainwater and piped water. This study aimed to document the change of water use and to identify factors associated with safe water use in 1997 compared to that in 1994. Home visits and face-to-face questionnaire interviews were undertaken. Information on water use for drinking, cooking, washing food and washing utensils in 1994 and 1997 was obtained. Among 3,849 households from which data could be obtained (estimated 79% of total households), the percentages of using safe water (including water from bottled rain water, piped and artesian well water) for drinking and cooking rose from 72.5 and 57.9 in 1994 to 93.6 and 80.9 in 1997, respectively. The percentages for washing foods and for washing utensils rose from 28.6 and 20.5 to 59.1 and 53.8, respectively. In 1997, percentage of households using piped water for drinking and cooking was still low (3.6 and 12.3) compared to those using piped water for washing food and utensils (39.1 and 43.6). Multivariate analysis shows that independent factors of the household predicting safe water use are: high arsenic area, near main road and having piped water installed. The influence of these factors (as judged by the level of odds ratio) operates more or less equally on water use for all purposes, except that installation of piped water has more influence on washing water than drinking and cooking water. We conclude that safe water supply in the area is still inadequate. Even if piped water is installed, it is often not used for drinking and cooking. The reasons for not using piped water for drinking and cooking need to be identified.

Characteristics of repeat aborters in Vietnam.

Two hundred and sixty married women seeking induced abortion service in Hanoi, Vietnam were interviewed to determine the magnitude of repeat induced abortion and explore selected characteristics of the repeat aborters. Seventy-one percent of the sample reported having had at least one previous induced abortion. After adjustment for age and number of living children, poor attitudes toward contraception, low use of modern contraceptives and failure of contraception were shown to be significantly associated with repeat induced abortion. Woman's age, number of living children, contraceptive knowledge and experience and desire for no more children were positively related to repeat induced abortion. Socio-demographic characteristics were not related to repeat induced abortion. Improvement of attitudes toward contraception, persuasion to use modern contraception and promotion of contraceptive effectiveness are recommended strategies to prevent repeat induced abortion.

A study of 111 cases of globus hystericus.

Videofluorography (VFG) and manometry were used to evaluate 111 patients who were diagnosed with globus hystericus. Most of the globus patients were affected by functional diseases and the underlying pathology could be revealed by VFG in 73.9 per cent of the series and by manometry in 80.2 per cent. There were 10.8 per cent of the series in which VFG and manometry yieled normal findings. The most common abnormality determined by manometry was esophageal aperistalsis. The most common abnormality revealed by VFG was cricopharyngeal bar. VFG was sensitive for morphologic detection while manometry was sensitive for motility study. Functional disorders can result in morphologic abnormality and vice versa. Therefore, VFG and manometry complement each other and are invaluable tools in the investigation of globus patients.

Experience with oesophageal carcinoma in Songklanagarind Hospital.

Clinical data from 175 patients with squamous cell carcinoma of the oesophagus or cardia admitted to Songklanagarind Hospital between 1982 and 1988 were analysed to evaluate the effects on survival of various tumour and treatment variables. Most tumours (greater than = 86%) were in stage III or IV. Forty-seven percent of stage-IV tumours and 99 per cent of those in stages I, II or III were resectable. One-year and 3-year survival rates of resected stage-III patients (57.3% and 27.5%) were significantly higher than those of resected stage-IV patients (33.3% and 0%). Resection conferred no benefit over radiotherapy chemotherapy or no treatment on the survival of stage-IV cases beyond one year. Combined chemotherapy/radiotherapy/resection of stage-III and stage-IV patients gave no statistically significant improvement in survival. Among resected patients, only lymph node involvement was associated with significantly lower survival (relative risk compared to no involvement = 2.3, 95% CL: 1.2, 4.6), while the fungating type of tumour was possibly associated with improved survival (relative risk compared with all other types = 0.24, 95% CL: 0.05, 1.1).

Early detection of oesophageal carcinoma in southern Thailand.

The use of balloon cytology technique for detection of oesophageal carcinoma has been tested in 73 non-symptomatic patients and 53 patients with symptoms of oesophageal carcinoma from the high incidence of Southern Thailand. Cytological findings were compared with findings of esophagoscopy and oesophageal biopsy. Among symptomatic patients, scope/biopsy revealed 29 positive for carcinoma, against which balloon cytology yielded 9 false negatives (sensitivity 69%), but no false positives. All false negatives were of the stenosing type of tumour. One of 3 early cases of carcinoma revealed by the balloon technique among asymptomatic patients could not be detected by oesophagoscopy, biopsy or oesophagogram, but was confirmed by repeated cytological examination. The basic properties of the balloon cytology technique appear to justify its use as a routine diagnostic tool among high-risk patients for oesophageal carcinoma in Southern Thailand.