Flap analysis: critical point in laser in situ keratomileusis.

A prospective study of 151 eyes, which underwent laser in situ keratomileusis, was done. Corneal flap creation was performed by using Moria LSK- One microkeratome (160 micrometers thickness) (distributed by Microtech, Inc., Moria, France). Flap thickness (measured by high frequency ultrasound), flap diameter (both horizontal and vertical), hinge size and pupillary hinge distance were recorded. The actual values from the measurement were compared to the predicted values from the microkeratome. The mean flap thickness was 161 +/- 38 micrometers compare to 160 micrometers predicted value. The mean diameter of the flap was 9.00 +/- 0.64 mm vertical and 8.94 +/- 0.54 mm horizontal compare to 9.00 mm predicted value. The hinge size was 4.75 +/- 0.84 mm. The pupillary-hinge distance was 3.35 +/- 0.61 mm. There was very high variable of the flap thickness, which can lead to miscalculation of the residual stroma. This miscalculation will be very critical if the residual stroma is left too thin. Caution should be made in higher level of myopia to avoid the serious complication such as keratectasia.

Topical ketorolac tromethamine in the reduction of adverse effects of laser in situ keratomileusist.

PURPOSE : To evaluate whether topical ketorolac tromethamine can reduce the adverse effect of laser in situ keratomileusis (LASIK). DESIGN: A prospective randomized controlled clinical study. PARTICIPANTS: Nineteen patients who underwent bilateral simultaneous LASIK performed at Siriraj Hospital. INTERVENTION: Patients received two drops of ketorolac tromethamine in one eye immediately after surgery. MAIN OUTCOME MEASURES: Symptoms of tearing, photophobia, foreign body sensation and pain were evaluated at 30 minutes, 6 hours and 24 hours. RESULTS: There was no statistically significant difference in symptoms at 30 minutes. At 6 and 24 hours, ketorolac-treated eyes had significantly fewer symptoms compared to non-treated eyes. CONCLUSIONS: Ketorolac tromethamine reduces some unfavorable symptoms within the first 24 hours after LASIK.

Accuracy of cytological findings in abnormal cervical smears by cytohistologic comparison.

To investigate the accuracy rates of cytology in abnormal cervical smears and the factors contributing to a discrepant diagnosis between cytology and histology repots of cervical intraepithelial and invasive neoplasm. During the four-year period 1993 to 1996, abnormal cervical smear findings, which were followed by cervical biopsy, were available in 709 patients. The cytology and histology slides were reviewed in each case. The accuracy rates of cytology before and after review were investigated. The accuracy rate of cytology was 48%. Following review it became 56%, mainly due to a reduction in the number of cases in which the smear showed a lesser degree of CIN than did the biopsy. The proportion of cases in which the cytological impression of CIN was more severe than the histology was minimally altered. The results suggest that difficulty in the interpretation of cervical smear as well as sampling errors are responsible for reduced accuracy even in smears which are considered representative of the pathological process.

Malignant ascites in female patients: a seven-year review.

Malignant ascites is common in various types of advanced cancer. Our objective was to determine the primary site and the clinical characteristics of female patients presenting with malignant ascites as well as evaluating the outcome. The authors carried out a retrospective study of 118 cases of malignant ascites diagnosed from January 1986 to December 1992 in female patients. Of the 118 cases, the primary site of the neoplasms was gynecologic in 65 cases (cervix 4, endometrium 6, ovary 52, fallopian tube 3) = 55.1 per cent, non-gynecologic 29 cases (GI 18, lymphoma 8, breast 2, kidney 1) = 24.6 per cent, and unknown 24 cases = 20.3 per cent. The mean age of patients in the gynecologic, non-gynecologic and unknown primary site was 50.4, 45.5 and 59.3 years respectively. Surgery combined with chemotherapy was the main treatment in the gynecologic group, whereas, supportive and symptomatic management was the main treatment in the unknown primary group. Treatments in non-gynecologic group were supportive and symptomatic, surgery and chemotherapy. Survival was longer in gynecologic than in the nongynecologic and the unknown primary groups. The most common primary site of malignant ascites in females was ovarian cancer. In malignant ascites in females caused by gynecologic neoplasms, the prognosis as measured by survival was better than in the non-gynecologic and the unknown primary groups.

Accuracy of fine needle aspiration cytology in the evaluation of peripheral lymphadenopathy.

We conducted an audit of the lymph node aspirates received from January 1996 to December 1996 of 541 patients sent to the Cytology Division, Department of Pathology, Ramathibodi Hospital by their clinicians. The aim of this retrospective study was to determine the pattern of diseases that commonly present with peripheral lymphadenopathy and to evaluate the accuracy of Fine Needle Aspiration Cytology (FNAC) in the diagnosis of lymph node diseases. An excisional biopsy sample of lymph node was available in 233 (43%) cases for comparison to the histopathology. The predominant lesion was benign which included necrotizing granulomatous lymphadenitis (NGL), reactive changes (RC) and suppurative lymphadenitis (SL). The predominant malignant lesion was metastatic squamous cell carcinoma. The accuracy for NGL, SL and RC were 69 per cent, 75 per cent and 95 per cent, respectively. The accuracy for metastatic disease was 97 per cent. The specificity and sensitivity of FNAC were 99 per cent and 94 per cent, respectively. An excisional biopsy should be done in case of doubt to clarify the pattern of RC.

Cell analysis of bronchoalveolar lavage.

Ninety bronchoalveolar lavage (BAL) of Thai cancerous cases (28), tuberculous cases (24); non-tuberculous cases (17) and miscellaneous diseases cases (13) was performed for total and differential BAL cell count. This technique could be initially used as a guideline for suggestive diagnosis in some suspicious cases particularly cancer from tuberculous BAL. The combination in the ratio of macrophages to dusty and foamy macrophages below 1.25 and total BAL cell count lower than 0.85 x 10(3)/mm3 could suggest a diagnostic indication of cancerous BAL rather than tuberculous BAL or other diseases. Tuberculous BAL revealed a high percentage of macrophages, low level of dusty and foamy macrophages. Non-tuberculous BAL could be distinguished from other diseases by the higher percentage of neutrophil over 55% and lower percentage in every type of macrophages, whereas, a high level in every type of macrophages was found in miscellaneous BAL.

Chromosome analysis of unfertilized oocytes after in vitro fertilization program: a preliminary report.

To assess the contribution of chromosome anomalies to high failure of in vitro fertilization (IVF), a total of sixty three eggs from 37 women participating in the IVF program were cytogenetically investigated. The mean age of the oocytes donors was 36.8 years. Chromosome karyotype was obtained in 30 of unfertilized oocytes: 16 oocytes (53.3%) had a normal haploid chromosome complement; 5 (16.7%) were hypohaploid; 3 (10.0%) were hyperhaploid; 3 (10.0%) were diploid, 3 (10.0%) were polyploid. It may explain for early pregnancy loss, low pregnancy rate after in vitro fertilization.

Cytologic evaluation of smears obtained by self-collection vaginal tampon.

Papanicolaou (Pap) smear test is an established method of cervical cancer screening. However, most women in Thailand are still reluctant to undergo pelvic examination. A prospective study was carried out on the use of self inserted vaginal tampon to collect specimens for Pap test in 126 patients at Ramathibodi Hospital from September to October 1990. The tampons which were inserted overnight and removed by the patients themselves were smeared across a glass slide and immediately fixed in 95 per cent ethyl alcohol. Ninety-six point two per cent of the slides had adequate cells of good quality to be interpreted. The remaining 3.98 per cent could not be interpreted due to the lack of cells and poor cell fixation. It is concluded that the smears obtained by this method are satisfactory for cytologic evaluation.

The application of toluidine blue staining in non-gynecologic cytology.

The diagnostic accuracy of the toluidine blue stain approximates that of the Papanicolaou stain in non-gynecologic cytology. In this study a sensitivity of 95.3 and 96.9 per cent was achieved by used of the toluidine blue and Papanicolaou stains respectively. The specificity for both stains was identical at 96.3 per cent. Given the high degree of accuracy achieved with the toluidine blue stain in this study, and given its numerous advantages over the Papanicolaou stain, it is suggested that consideration be given to using the toluidine blue stain routinely in non-gynecologic cytology to differentiate malignancy from benignancy.

Changing terminology and screening recommendations in cervical cytology screening programs.

In summary, we have presented proposed new diagnostic terminology and screening frequencies for cervical cytology with some of the surrounding debate. As Thailand develops its own cervical screening program for squamous cell carcinoma, an awareness of these new recommendations may help in the design of a local program in the most cost effective manner.

Diagnostic laparoscopy of subfertile women of non demonstrable causes.

From 1983 to 1987, seventy-five subfertile women of non demonstrable causes in the Infertility Unit, Department of Obstetrics & Gynaecology at the Siriraj Hospital, Mahidol University had diagnostic laparoscopy. Thirty-five of seventy-five subfertile women (46.66%) had pelvic pathologies which were not suspected by clinical examination. The two common pathologies of subfertile women of non demonstrable causes were pelvic inflammatory diseases (18.6%: pelvic and peritubal adhesion) and mild endometriosis (16%). Pathophysiology of subfertile women with chronic pelvic inflammatory disease was mainly due to disturbances of tubal ovarian anatomy and function. The possible mechanism of mild endometriosis which may interfere with pregnancy was discussed in the text. The results of this study indicated that diagnostic laparoscopy should be performed in all subfertile women of non demonstrable causes to find out the pelvic pathology in order to correct the causes of infertility.

Prenatal diagnosis of genetic disorder by aminotic fluid cell culture.

Eighty one samples of prenatal diagnosis for genetic disorder by amniotic fluid cell culture were studied. The study period was from January 1984 to 28 February 1987. Amniotic fluid cell culture were analyzed from 18 women who had previous child with Down’s Syndrome, a cases in which the family and congenital anomalies, 53 cased of advanced maternal age (> 35 years old) and 2 cases of miscellaneous (habitual abortion, X-ray) 2 cases. The success rate of the culture was 96.2 per cent. This study found the abnormality of amniotic Fluid cell culture in 3 cases. Two cases were Down’s Syndrome and one case was Klinefelter’s Syndrome. These three cases were proved by chromosome analysis of skin and lung culture.