Salvage treatment for sarcomas of the hand.

We report 6 patients (1 male and 5 females; age range, 13-77 years) with hand sarcoma. The lesions were located between the digits and the distal end of the radius. A painless mass was the common manifestation in these patients. An incisional biopsy was performed on every patient, and histology revealed two low-grade malignant sarcomas and four high-grade malignancies. A surgical salvage procedure was performed. The 4 patients with high-grade malignancy underwent adjuvant therapy such as radiotherapy and/or chemotherapy. Four patients are still alive and exhibit acceptable function in the affected hand. Our surgical procedure is presented.

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.

Tuberculous infection of the hand and wrist.

The authors report on 23 patients treated for tuberculosis of the hand and wrist during the past 20 years. Duration of symptoms prior to diagnosis ranged from several months to years. Swelling and pain on motion were common symptoms, as was increased sedimentation rate. Granulomatous inflammation was seen on paraffin section in most of the patients, however tissue cultures were positive for Mycobacterium tuberculosis in only 6 patients in this study. Treatment of these patients were divided into medical and surgical treatments. The incisional biopsy and antituberculous drug were carried out and administered in the medical-treated group for 2 years. The surgical synovectomy as well as debridement and administration of antituberculous drugs were carried out on the surgical group. The results showed no recurrence in this study. Most of the patients showed improved symptoms and an increased range of motion. In conclusion, this treatment resulted in good recovery of function with low morbidity.

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)

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.

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.

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.

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.

An immunofluorescence study of cerebral malaria. A correlation with histopathology.

Histopathologic and immunopathologic features of cerebral malaria have been defined in a study of six autopsy cases with severe Plasmodium falciparum infection. In five cases, immunofluorescent studies demonstrated intense deposition of P falciparum antigen, IgG, and fibrin in cerebral vessels associated with the histopathologic finding of hemorrhage in the white matter of cerebrum and cerebellum regardless of the presence of parasitized erythrocytes in the cerebral vessels. Immunofluorescent study also demonstrated the extravascular deposits of P falciparum granular antigen associated with acute inflammatory lesion in cerebral tissue in one case. These findings suggested that the immunopathogenic mechanism may in some way play a role in the pathogenesis of cerebral malaria.

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.

Sporadic cases of carriers of human T-lymphotropic virus type 1 in Southeast Asia.

Sera obtained from 3,472 persons in Malaysia, Thailand, Philippines and Indonesia were tested for the presence of antibody to adult T-cell leukemia-associated antigen by the gelatin particle agglutination test and indirect immunofluorescence. Among these, only two seropositives were identified. One was a 30-year-old male Malaysian of Indian origin. The other was a 42-year-old female Thai who resided in Bangkok. These results suggested that the infection of human T-lymphotropic virus type 1 might not be endemic in these countries.

Automated cytochemistry in non-Hodgkin's lymphoma: a new method for determination of cells from lymph node biopsy.

Cell suspension prepared from the lymph node biopsy of patients with non-Hodgkin's lymphoma (NHL), metastatic carcinoma (MC) and non-neoplastic lymphadenopathies (NL) were analyzed by the Hemalog D, automated differential counter. The preparation of lymph node cells is described first in this study. The results show that the percentage of large cells (diameter greater than 13.5 micron) stained negatively with peroxidase (LUC, large unstained cells) was remarkably increased in patients with NHL (mean +/- SEM = 18.6 +/- 3.1%) and was particularly increased in the subgroup, diffuse histiocytic type (31.1 +/- 5.3%). Patients with MC had a raised percentage of nonspecific esterase-positive cells (9.2 +/- 1.4%) compared to patients in the NHL and NL groups. Patients in the NL group had low percentages of both LUC (5.3 +/- 0.7%) and nonspecific esterase-positive cells (1.8 +/- 0.2%). Quantitation of cells in the lymph node by using the Hemalog D may assist in the diagnosis of lymph node diseases.

Squamous carcinoma in scars: clinicopathological correlations.

Twelve cases of squamous cell carcinoma arising in scars of the skin are analyzed. Correlation of tumor aggressiveness, tumor differentiation, intensity of small lymphocyte infiltration, and nature of adjacent collagen tissue to tumor stroma was investigated. All tumors were predominantly well differentiated. Nine patients had no metastasis or recurrence after surgical treatment of the primary tumor. Three patients developed widespread metastases and died less than 2 years after operation. The tumors of these latter patients contained areas of pleomorphic and spindle cells and had minimal infiltrates of small lymphocytes. In contrast, the 9 patients who remained free of tumor had moderate infiltrates of small lymphocytes, and in just 1 of 9 was an area of pleomorphic tumor cells found. Prognosis in scar carcinoma, therefore, may be related to tumor differentiation and the degree of host response with small lymphocytes to the tumor, rather than to the universally poor prognosis recorded in the past.