Radical vulvectomy and lymphadenectomy at Srinagarind Hospital.

Vulvar carcinoma, although rare, is difficult to manage. We conducted a study to describe the management in our hospital. From 1978 to 1991, 69 patients with primary carcinoma of the vulva were treated at Srinagarind Hospital, Faculty of Medicine, Khon Kaen University. Forty-two patients underwent radical vulvectomy and lymphadenectomy. The data presented the techniques, surgical events and outcome of the operations. The 5 and 10-yr survival rates for the operable cses were 88.5 per cent and only 22 per cent for those who were non-operable. Surgery is still the recommended primary treatment for this rare malignancy of the female genital tract.

Intervention of inappropriate antibiotic use at a university teaching hospital.

The magnitude of inappropriate antibiotic use is high (52.3%). In the empiric treatment group, 41.1 per cent were inappropriate, mostly due to no indication of use. In the surgical prophylaxis, 79.7 per cent were inappropriate, mostly due to delayed prophylaxis and length more than 3 days. In documented infection, 40.2 per cent were inappropriate, mostly due to wrong choice and too many drugs. Intervention by education decreased the overall inappropriate use, empiric inappropriate use and prophylactic use, while there was no change in inappropriate documented infection use and inappropriate economic use. We propose further interventions by other strategies, repeated education and a wider scale of intervention.

Cass scores as a preoperative prediction for recurrences of cervical cancer after radical hysterectomy and pelvic lymphadenectomy at Srinagarind Hospital.

Risk factors for recurrence after radical hysterectomy and pelvic lymphadenectomy at Srinagarind Hospital was studied from 218 patients operated between 1976 to June 30, 1988. Four preoperative risk factors i.e., cell types, age, stages and size of the lesions were computed and cross-tabulated with the recurrence rate from the data of the whole patients. The correlation was found to be statistical significant. This scoring system should be called from the first letter of the factor as 'CASS' and used for selection of the patients for radical hysterectomy and pelvic lymphadenectomy.

Antibiotic use at a university hospital. Antibiotic Working Group of Srinagarind Hospital.

A prospective survey of antibiotic use in 5 departments (MED, SURG, OB-GYN, PED, ORTHO) in Srinagarind Hospital was done during May 1988. The majority of prescribers were interns and residents, except in the department of OB-GYN. Out of 400 prescriptions, 52.3 per cent were inappropriate and 5 per cent were inappropriate for economic reasons. For empirical use, the inappropriateness was 42.3 per cent mostly due to no indication of use. For surgical prophylaxis, 82.4 per cent were inappropriate mostly due to delayed prophylaxis and excessive length of treatment of more than 72 hours. For the treatment of documented infection, 39.6 per cent were inappropriate, mostly due to wrong choice and too many drugs used. There were no statistical differences in mortality, total hospital stay, hospital stay after treatment between the appropriate and inappropriate use.

Risk factors for survival in patients performed radical hysterectomy for cervical carcinoma.

Risk factors for survival were analyzed for 208 women diagnosed with invasive cervical cancer at Srinagarind hospital, Faculty of Medicine, Khon Kaen University between January 1, 1976 and December 31, 1987. All underwent radical hysterectomy and pelvic lymphadenectomy. The clinical data, operative data, histology, complications and follow-up profiles were analyzed by cross-tabulation and chi-square test. The main significant factors were analyzed for survival functions by the Cutler-Ederer method with Breslow and Mantel-Cox tests. Recurrences of the disease, FIGO stages, sizes and types of the lesions, histology, lengths of the uterus and modes of removal of left ovaries were all significant risk factors. The first five factors have been mentioned in previous literature but the latter two were not and need further investigation.