Intranasal leprosy granuloma: The first case report in Thailand.

One male patients presenting with symptoms and signs of atrophic rhinitis and chronic sinusitis for one year, there was also a small red mass at anterior end of right middle turbinate. Histopathological section showed that the mass was covered by stratified squamous mucosa with diffuse cellular infiltration of mostly macrophages with clear vacuolated cytoplasm (= foam cells) with few lymphocytes in submucosa. Acid fast stain (modified Fite Feraco stain) showed numerous acid fast bacilli in scatter and in clumps, known as globi pattern mucosa. This is the first case reported in Thailand. Multidrug therapy was given to the patient which conprised of rifampicin 450-600 mg. Once a month, lamprene 300 mg start and then 100 mg. in alternate day with dapsone 100 mg. OD. The aim of this report is to remind the otolaryngologists of the existence of leprosy in the nose and they should be aware of the highly contagious nasal secretion from these patients.

Detection of Epstein-Barr virus DNA and HHV-6 DNA in tissue biopsies from patients with nasopharyngeal carcinoma by polymerase chain reaction.

A total of 34 tissue biopsies were collected from nasopharyngeal carcinoma (NPC) patients and 5 controls with non-NPC. Extracted DNA from tissue biopsies were analyzed for presence of specific gene sequences to EBV type A and type B, and HHV-6 by polymerase chain reaction (PCR). The different sequences of EBV type A and B were parts from the highly divergent forms of the EBV nuclear antigen 2 (EBNA 2). The PCR amplified products for EBNA 2A and EBNA 2B were 115 and 119 base pairs respectively whereas that of HHV-6 DNA was 776 base pairs. The results demonstrated that EBV DNA was detected in 32 of 34 cases (94.1%): 28 (82.3%) with type A, 2 (5.9%) with type B, and 2 (5.9%) with both types. EBV DNA of type A could be detected 1 (20%) of 5 controls. HHV-6 DNA was in 5 of 34 samples (14.7%) whereas HHV-6 DNA was not detectable in biopsy tissues from controls. The results show that in the NPC patient group, A type of EBV is predominant. Detection of HHV-6 DNA in patients group only might be resulted from reactivation of a latent infection or association with EBV-induction of NPC.

Prevalence of IgA specific antibodies to Epstein-Barr virus capsid and early antigens in nasopharyngeal carcinoma.

Ninety-one patients with nasopharyngeal carcinoma (NPC), and 164 age-matched healthy controls were tested for presence of IgA antibodies to Epstein-Barr virus capsid antigen (VCA) and early antigen (EA) in their sera by indirect ELISA using "EBViral DETECT" commercial test kit. IgA anti-VCA was found in 76 (83.5%) of NPC patients and 16 (9.8%) of the controls. Meanwhile, IgA anti-EA was found in 72 (79.1%) of NPC patients and 21 (12.8%) of the controls. In a parallel study by indirect immunofluorescence test (IIF), IgA anti-VCA was found in 77 of 91 (84.6%) NPC patients and 22 of 142 (15.5%) controls. The prevalence rates of anti-VCA as screened by ELISA and IIF were very similar suggesting that neither one of the two tests can be used alternatively depending on the purpose and facilities in each individual laboratory. IgA antibodies to VCA and EA were more prevalence in NPC patients than those in the controls, the finding which again supported the association between EBV and NPC as was suggested in many other reports.

Epstein-Barr virus serological markers for nasopharyngeal carcinoma in Thailand.

The present study reports on the prevalence of specific IgA and IgG antibodies to EBV viral capsid antigen in nasopharyngeal carcinoma (NPC) patients with different histological types of carcinoma and their age-matched controls by the indirect immunofluorescence test, using the B-95-8 lymphoblastoid cell line as source of viral capsid antigen. EBV specific IgG was found in almost all the study cases, and antibody titers were significantly higher in the NPC patients than in non-cancer controls. GMT of anti-EBV IgG in NPC patients, patients with other malignant diseases, and those with non-malignant diseases were 371.5, 97.7 and 35.5, respectively. Anti-EBV specific IgA was more specific to NPC than was IgG, and was present in 86.5% (83 of 96) cases of NPC patients, 6.6% (2 of 30) of patients with other cancers, and 3.1% (3 of 97) cases of non-malignant diseases. A weak correlation between level of anti-EBV IgA in NPC patients was observed (r = 0.3). EBV IgA was found in all histological types of NPC, ie, WHO types 1, 2 and 3, but WHO type 1 was rare among NPC patients in Thailand. Use of anti-EBV IgA for monitoring cancer therapy is to be further investigated.

Mitoxantrone as single agent in the treatment of advanced breast cancer: clinical experience at Siriraj Hospital.

A total of 35 patients with advanced breast cancer were treated with mitoxantrone, 14 mg/m2 I.V. every 3 weeks. Of these, 27 patients or 78 lesions could be evaluated for response and all 35 patients for toxicity. The overall response rate (CR + PR) was 35 per cent (or CR + PR + SD = 82%), ten lesions achieved a complete response and 17 lesions a partial response. The duration of response varied from a minimum of 2 months to more than 11 months (median = 4 months). Myelosuppression was the dose-limiting toxicity with moderate to severe degree in 19 patients. The most frequent severe degree in 19 patients. The most frequent non-hematologic toxicity was mild grade of nausea and vomiting (67%). No cardiotoxicity was noted in this study after the maximum cumulative dose of mitoxantrone 157.5 mg.

Mitoxantrone as single agent in the treatment of advanced breast cancer: Clinical study at Siriraj Hospital.

During August 1986 – August 1988, a total of 35 patients with advanced breast cancer were treated with Mitoxantrone (Novantrone), 14 mg/M3 intravenously every 3 weeks. Of these, 27 patients with total 78 lesions could be evaluated for response and 30 patients for toxicity. The mean follow-up period was 18 months (2-24 months). The median time to achieve response was 9 weeks after treatment. Eleven patients (41%) achieved an objection tumor response (CR+PR) including four (7%) complete response. In another way of evaluation, a total of 78 evaluable lesions were assessed of which 29 (37%) achieved response (CR+PR), including 10 (13%) complete response. The duration of response varied from minimum 2 months to more than 19 months (median=5 months). The median time to treatment failure was 5.9 months. Myelosuppression was the dose-limiting toxicity and was observed with moderate to severe degree in 19 patients (63%). The most frequent non-haematological toxicities were mild grade of nausea and vomiting occurred in 137 cycles from the total number of 195 evaluable cycles (70%). No cardiotoxicity was noted in this study after the maximum cumulative dose of Mitoxantrone 157.5 mg. This agent is well tolerated and offers comparable efficacy with less tolerable toxicity than other effective agents currently used as single agent in the treatment of advanced breast cancer.

Visceral leishmaniasis: a case report.

Visceral leishmaniasis is diagnosed in a Thai worker returning home from the Middle East. A 39-year-old Thai male who had abdominal swelling, weight loss, hepatosplenomegaly and hyperglobulinemia, was diagnosed by demonstration of organism in liver biopsy and bone marrow aspiration specimen. Amphotericin B was administered in this case.

Lymphangioma cutis. A report of a childhood case.

A case of lymphangioma in a 6-year-old Thai girl was reported. She had verrucous plaque and cystic appearing vesicles on her right lateral chest. A reddish patch on this area had been noticed since was born. At the age of 8 months, vesicles occurred on top of the patch, which enlarged without any further symptoms. She was referred to Siriraj Hospital because of fever following infection of ruptured vesicles. On admission, the verrucous plaque was found from the right axilla to the right subcostal region with vesicular lesions 2-15 millimeters in diameter. After the infection subsided and the diagnosis of lymphangioma cutis was verified by histo pathological section, radiotherapy was started. After 4 consecutive days of 200 rads deep radiation, the lesion remained the same but her father refused further treatment and hospitalization.