Fever, skin rash, jaundice and lymphadenopathy after trichloroethylene exposure: a case report.

Trichloroethylene, a chlorinated hydrocarbon has been reported to cause many adverse health effects. This paper describes a female patient presenting with rather unusual manifestation secondary to trichloroethylene (TCE) exposure, i.e. hepatitis and generalized dermatitis. The diagnosis was confirmed by positive skin patch testing with 50 per cent TCE solution. After withdrawal from the exposure site, her symptoms improved and liver function test returned to baseline level after a three-months period of follow-up. TCE induced immunologic reaction has been postulated as the pathological process of this illness.

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.

Pseudocyst mass at neck: complication after tracheostomy.

Neck mass after the tracheostomy is a rare complication. A case report of pseudocyst at the left paratracheal area was presented and this has not yet been reported in the English literature. We proposed the pathophysiology of this condition and prevention methods.

Histiocytoses in children: analysis of 120 cases and the bone marrow findings in infection-induced hemophagocytic syndrome vs malignant histiocytosis.

Retrospective analysis of childhood histiocytoses treated at the Department of Pediatrics, Ramathibodi Hospital from May 1970 till June 30, 1992 to verify the prevalence according to the recent classification, course and prognosis was conducted. Among 120 cases, 54 were Class I or Langerhan Cell Histiocytosis (LCH, previously called Histiocytosis-X). Nineteen cases were Class II: Infection-Associated Hemophagocytic Syndrome (IAHS) and Sinus Histiocytosis. Forty-seven cases were class III which included acute monocytic leukemia, juvenile CML; malignant histiocytosis, HMR, and histiocytic lymphoma. Excellent prognosis (cure) was seen in all cases of Hand-Schuller Christian Disease, eosinophilic granuloma, sinus histiocytosis with massive lymphadenopathy and many cases of Class II (except IAHS). The worse prognosis (100% mortality rate) was seen in HMR and juvenile CML. The intermediate prognosis (50%, 54%, 58.8% and 66.7% mortality rate) was seen in MH, HL, LSD and IAHS respectively. To differentiate between IAHS and MH/HMR, the prominent bone marrow findings in 12 cases of IAHS revealed that every case showed prominent hemophagocytosis by the promono-histiocytes/histiocytes, the maximal total erythroblasts (TE) were only 7.5 per cent except for 3 cases; in which one case with agranulocytosis from co-trimoxazole had 84 per cent erythroid cells, one case with prior co-trimoxazole treatment had 37 per cent TE, the last one had 40 per cent TE with massive GI bleeding while in the recovery stage of DHF. All 5 cases of HMR had prominent hemophagocytosis and increased TE (> 22%).(ABSTRACT TRUNCATED AT 250 WORDS)

Cytochemical reactions of homozygous beta-thalassemic spleens.

Splenic cells from 10 homozygous beta-thalassemic patients were stained using cytochemical reactions: non specific esterase and acid phosphatase. Spleens from nonthalassemic subjects: a normal case who underwent gastric surgery and 5 idiopathic thrombocytopenic purpura, were also studied to serve as the control. In thalassemic spleens, no positive dot cell was shown in periarteriolar lymphocyte sheaths (PALS) when they were stained with both nonspecific esterase and acid phosphatase. In contrast, dot positive reaction was demonstrated in 92 per cent of cells from a normal spleen. These cells were presumably T lymphocytes. There were two possibilities to explain our study 1) the absence of T lymphocytes in the PALS of white pulps in homozygous thalassemia may have an impact on the immune system related to infection complication in thalassemia 2) T lymphocytes in the thalassemic spleen may be present but they do not give a positive ANAE dot reaction.

Immunophenotype and cytochemical reactions of acute lymphoblastic leukemia in Thai children.

The immunophenotypes of acute lymphoblastic leukemia (ALL) in 28 Thai children were studied by the APAAP technique using a panel of eight specific monoclonal antibodies: HLA-DR, CD 19, CALLA (CD 10), IgM, CD 7, CD 3, CD 4, and CD 8. Sixty-eight, 18, 3.5, 3.5, and 7 per cent were respectively shown to be common, null, pre-B, B, and mature thymocyte T subtypes. Cytochemical reactions (beta-glucuronidase, alpha naphthyl acetate esterase, and acid phosphatase) in this study could identify null, common, and T ALLs with confidence, and could be used in the process of ALL subtyping to reduce cost.

The preparation of lyophylised of fetal membrane for biological dressing.

The preparation of lyophylised fetal membrane was performed between November 1982 and May 1984, and the membrane was applied to a variety of wounds. The result of the study was impressive, the biologic dressing property did fairly well, and the utilization of this fetal membrane was convenient in time and place.

Tuberculous infection of the hand and the wrist.

Twenty cases of tuberculous infection of the hand and the wrist from the division of plastic reconstructive surgery over the past 17 years. There were fourteen males, and six females. The ages of the patients ranged from 10 years to 80 years, with an average age of 50.1 years. The follow-up time was not less than 3 years. The characteristic manifestation of this diseases was insidious onset, and run chronicity. Painful swelling of the wrist and fingers as well as increased sedimentation rate were frequent findings. However, confirmed histopathological diagnosis is essential. Surgical debridement together with triple anti-tuberculous drugs are recommended. Triple drugs therapy should be given for not less than two years to prevent drug resistance and recurrence of the disease.

Lethal midline granuloma and lymphoproliferative disorders.

Seventeen patients, who presented with unhealing ulcers or destructive lesions of the upper aero-digestive tract at Ramathibodi hospital from 1977 to 1985 were reported. Lesions caused by infection, Wegener's granulomatosis or non-hematopoietic malignancy were excluded. A spectrum of histopathologic findings were evident in our patients, ranging from acute and chronic inflammatory changes with or without necrosis, polymorphic reticulosis or lymphamatoid granulomatosis, and malignant lymphoma of the non-Hodgkin's type (NHL). Although some initial histopathologic findings were non-specific, evidence of lymphoproliferative disorders finally emerged. These malignant lymphoid cells had a predilection for the GI tract and skin. Lymphoma staging should thus be done. Bleeding from the lesion, treatment-induced leucopenia, and sepsis were common in these patients. Early aggressive treatment including adequate antibiotic coverage for superimposed infection, improved nutritional status, and early radiation to the primary lesion are suggested for those diseases.

Autopsy proven cases of pulmonary thromboembolism: 18-year study at Ramathibodi Hospital.

Twelve cases of pulmonary embolism were found among 4,896 autopsies during 18 years in Ramathibodi hospital. This gives an incidence of 0.24 per 100 necropsies. Deep vein thrombosis occurred in two of the twelve cases and was not the main cause of pulmonary embolism in this series.

Angioimmunoblastic lymphadenopathy with dysproteinemia in Thailand.

Angioimmunoblastic lymphadenopathy with dysproteinemia (AILD) is a disease of unknown etiology and pathogenesis. It has the features of hyperimmunity and immune deficiency, and its behavior resembles malignant lymphoma. We report a review of 16 patients with AILD seen at Ramathibodi Hospital from 1982 to 1986. Thirteen patients had fever and seven had pruritus and rashes. Lymphadenopathy was found in all 16 cases; generalized in 14 and localized in 2. Hepatomegaly was present in 14 patients while only 7 had splenomegaly. Laboratory findings included autoimmune hemolytic anemia, lymphocytosis and polyclonal hypergammaglobulinemia. Pulmonary involvement was seen in 5 cases, and bone marrow showed the characteristic features of the disease in 9 cases. Two patients went on to develop diffuse lymphocytic, poorly differentiated lymphoma. Fourteen patients were treated with prednisolone initially. Five responded with complete recovery, eight responded with partial recovery, and one died with extensive involvement of the disease. Six of the patients that recovered partially were later treated with cyclophosphamide, vincristine and prednisolone. One patient recovered completely and two partially. Three died from extensive involvement. Two patients with malignant lymphoma were treated by combination chemotherapy. One case went to complete remission while the other died from infection. One patient was lost to follow up before any treatment was started.

Rhabdomyosarcoma in Thai children.

Twenty-six cases of rhabdomyosarcoma diagnosed from a total of 845 Thai children with childhood malignancy who had been treated at the Department of Pediatrics Ramathibodi Hospital, from May 1970 to December 1982 were analyzed retrospectively. There were 16 boys and 10 girls, aged 3 months to 13 years old (mean age was 5.6 +/- 4.1 years old). The common type was the embryonal cell sarcoma (19 cases), 3 cases were undetermined, 2 cases of alveolar cell type and one each of the pleomorphic and undifferentiated cell type. Only 2 cases had stage II disease, 10 and 14 cases were stage III and IV respectively. The common locations were head and neck (10 cases), abdomen (8 cases including one in the uterus, scrotum and 3 in the urinary bladder), and in 7 cases in the extremities. One patient had small lesion at the buttock. The treatment consisted of surgery, radiation therapy, actinomycin, vincristine and cyclophosphamide. Eight cases were lost to follow-up, 10 cases were discharged in advanced stage after been treated for 6.2 +/- 4 months, 4 cases had no evidence of disease for 2 to 7.5 years, 4 cases died after 4 to 27 months of treatment. The poor result obtained was probably due to the late stages of the disease at diagnosis, and limitations in the use of effective medications.

Therapy related acute non-lymphocytic leukemia: report of 4 cases.

Four cases of acute myelodysplastic-non-lymphocytic leukemia secondary to cytotoxic agents were reported. Primary diseases were breast cancer (1 patient), ovarian cancer (2 patients) and multiple myeloma (1 patient). All except one (with multiple myeloma) were in clinical remission of their primary diseases. Common cytotoxic agent used was melphalan. Median total drug dose and median latent period from diagnosis of primary diseases were 1299 mg and 63 months respectively. None with the exception of one received specific treatment. All died except one who is in a very poor condition. Survival from the diagnosis of hematologic diseases ranged from 3-9 months. Clinical features, cytogenetic findings, pathogenetic mechanism and risk of the disease were briefly discussed.