p53 expression related to the aggressive infiltrative histopathological feature of basal cell carcinoma.

AIMS: To determine whether the p53 protein expression which is involved in the genesis and progression of various malignant tumours may relate to age, sites or the aggressive histopathological feature of the basal cell carcinoma. METHODS ADN RESULTS: One hundred and fifty-eight basal cell carcinoma specimens from Songklanakarind Hospital, southern Thailand, collected from January 1992 to December 2000, were examined by immunohistochemistry using polyclonal anti-p53-CM1 (Novocastra Laboratories, Newcastle, UK; dilution 1:700). p53 protein expression was demonstrated in 48.7% of cases. The multivariate analysis showed that the aggressive infiltrative histopathological type was significantly associated with p53 expression (odds ratio 2.95, 95% confidence interval 1.10-7.90), whereas age, sun-exposure site, cellular response and fibrosis were not. CONCLUSIONS: The p53 expression is found to be related to the aggressive histopathological feature, which may be of predictive value for the behaviour of basal cell carcinoma. However, this result does not support the relation between sun exposure inducing basal cell carcinoma and p53 protein expression.

Snoring and obstructive sleep apnea in Thai school-age children: prevalence and predisposing factors.

We studied the prevalence of habitual snoring and its associations with tonsillar size, allergic rhinitis, obesity, and parental smoking, as well as prevalence of obstructive sleep apnea (OSAS) in a sample of 1,142 children aged 6-13 years (mean, 7.25 +/- 0.58) from seven randomly selected schools in Hat yai, Southern Thailand. Eighty-five (8.5%) of the children were habitual snorers; the prevalence was the same in boys and girls. Significant and independent association was present between snoring and allergic rhinitis with an odds ratio of 5.27 (95% CI, 1.57-17.77). The odds ratio was significantly increased to 2.65 (CI, 1.31-5.39), 5.72 (CI, 2.67-12.25), and 11.06 (CI, 1.91-63.84) in children with tonsillar size of 2+, 3+, and 4+, respectively. Of the 85 habitual snorers, 69 could be contacted by telephone call or by hospital visit. Eight of these were reported to have at least one of the following symptoms: difficulty breathing during sleep, stop breathing at night, restless sleeping and frequent awakening, sleeping with the head tipped back, and a tendency to breathe through the mouth rather than the nose. Polysomnographic studies in these 8 children demonstrated an apnea/hypopnea index of 0.6-4.7 per hr. Seven children met the criteria for OSAS. Thus, our estimate of the prevalence of OSAS among Thai schoolchildren was 7/1,008 (0.69%). We have shown that the prevalence of habitual snoring was 8.5%, and the prevalence of OSAS in a sample of Asian school-age children in Southern Thailand was 0.69%, which was similar to that observed in Western populations. An association of snoring with tonsillar size or allergic rhinitis was demonstrated. All but one of the snoring children with sleep-related symptoms had OSAS, but all were mild cases.

Post-operative nausea and vomiting in out-patient gynecologic laparoscopy: a comparison of thiopental-nitrous oxide, propofol-nitrous oxide and total intravenous anesthesia using propofol.

An intravenous anesthetic drug, propofol was considered to pose antiemetic action. A randomized controlled trial was conducted to evaluate whether propofol could effectively reduce post-operative nausea and vomiting (PONV) compared to thiopental-nitrous oxide (N2O). One-hundred and eight patients undergoing outpatient gynecologic laparoscopy were assigned to receive 3 techniques of anesthesia; thiopental-N2O (T/N), propofol-N2O (P/N) and total intravenous anesthesia (TIVA) using propofol (P/P). The results showed that in the early period (0-5 hours), post-operative nausea in T/N, P/N and P/P groups was 72 per cent, 44 per cent and 31 per cent, respectively (P = 0.002), and post-operative vomiting was 58 per cent, 36 per cent and 11 per cent respectively (P = 0.00014). Patients in the P/N and P/P groups experienced nausea less frequently than the T/N group [relative risk (RR) = 0.62, (95% CI 0.41-0.93) and RR = 0.42 (0.25-0.72) respectively]. Patients in the P/N and P/P groups experienced vomiting less frequently than the T/N group [RR = 0.62 (0.37-1.04) and RR = 0.19 (0.07-0.5) respectively]. Two patients in the T/N group were admitted because of severe nausea and vomiting. In conclusion, TIVA using propofol and propofol-N2O anesthesia can significantly reduce the incidence of PONV in the early period. Concerning the economic crisis of the country as well as the quality of care, propofol-N2O would be the most appropriate anesthetic of choice.

Lack of association between p53 expression and betel nut chewing in oral cancers from Thailand.

To elucidate whether betel-associated oral squamous cell carcinoma is associated with p53 protein expression, tumor samples from 156 patients with detailed histories of exposures were investigated immunohistochemically using CM1 antibody. The expression of p53 (>10% positive cells) was found in 38.5% of the cases. The frequency of expression in betel chewers alone and betel chewer with tobacco use were 37.9% (11/29) and 25%(9/36), respectively, whereas that in betel chewers with smoking/drinking it was 47.2%(17/36) and in smokers or drinkers without chewing was 42.0% (21/50). However, the differences were not statistically significant. Multivariate analysis also revealed with the no independent association of betel chewing with p53 expression (odds ratio [OR] 1.81, 95% confidence interval 0.50-6.49), whereas alcohol drinking and smokeless tobacco use were significant (OR 7.58, 2.01-28.53 and 0.39, 0.16-0.98, respectively). These results suggested that betel chewing with or without smokeless tobacco use may not induce oral cancers via a p53-dependent pathway. However, since this is an immunohistochemical study, further molecular analysis is needed.

Delay in breast cancer care: a study in Thai women.

BACKGROUND: Breast cancer is the second most common cause of cancer death in Thai women. Cancer registry data reveal a high prevalence of late-stage disease at diagnosis. The factors resulting in delay in Thailand have not yet been investigated. OBJECTIVES: To determine the extent of, and the factors contributing to, delay in breast cancer care. DESIGN: Women with breast cancer who were first treated at Songklanagarind Hospital between June 1994 and June 1996 were interviewed with retrospective chart audits of care. MEASURES: Dependent variables included patient delay (symptom recognition to first care) and system delay (first care to treatment). Independent variables tested included demographic factors, help-seeking behavior, and cancer knowledge. Nonparametric rank sum tests were used for univariate analysis, and Cox regression was used for multivariate analysis. RESULTS: Ninety-four cases were included in the study. The median patient and system delays were 4 weeks; 26.6% and 24.4% of patients, respectively, experienced patient and system delay >12 weeks. Only marital status (unmarried compared with married women) was significantly associated with patient delay (hazard ratio [HR] 2.78, 95% CI 1.23-6.25). Contacting a provincial hospital instead of a university hospital as first medical care (hazard ratio 2.50, 1.23-5.26), being given a diagnosis rather than being told nothing (HR 2.04, 1.14-3.57) and being given treatment rather than being immediately referred (HR 4.55, 2.22-9.09) were associated with system delay. CONCLUSIONS: Patient delay and system delay in breast cancer care are important weaknesses of disease control in Thailand. Educational programs should target unmarried women, who are at higher risk of delay. System delay in hospitals outside the university needs to be improved by a good referral system.

Histiocytic necrotizing lymphadenitis (Kikuchi's disease): clinicopathologic characteristics of 23 cases and literature review.

Kikuchi's disease or histiocytic necrotizing lymphadenitis is a self limiting disorder which usually affects young women and manifests clinically by cervical lymphadenopathy with or without fever. Though the disease has been described since 1972, many clinicians and pathologists are unaware of its existence. We therefore reviewed 23 cases of Kikuchi's disease in Songklanagarind Hospital from 1987 to 1996. Clinical data, histopathology including immunostaining were presented together with brief literature review. We found 18 women and 5 men with the age range 9-57 years. The sites of nodal enlargement were cervical in 17, axillary in 3 and unknown in 3 cases. Typical histologic features namely patchy paracortical lymphohistiocytic aggregates with variable karyorrhexis and absence of granulocytic infiltration were seen. Immunostaining confirmed that the principle cells were histiocytes and T-lymphocytes. Importance in the recognition of the entity was emphasized for it may be mistaken for other infective lymphadenitis or lymphoma.

Spinal epidural hematoma caused by extradural arteriovenous malformation: a case report and review of the literature.

About 330 cases of spinal epidural hematoma have been reported in the literature but few cases had pathologically proven extradural arteriovenous malformation. The authors report a case of spinal epidural hematoma caused by extradural arteriovenous malformation. The patient presented with a sudden onset of back pain followed by rapidly progressive neurological deficit. MRI was the procedure of choice for diagnosis of this lesion. Treatment was emergency surgical decompression. Prognosis depends on the preoperative neurological deficit, operative interval and localization of the hematoma.

Cancer incidence in Songkhla, southern Thailand, 1990-1994.

A population-based cancer registry of Songkhla was established by the Cancer Unit of Songklanagarind Hospital under the support of the IARC in 1990. The province is in the southern region of Thailand and has a population of 1.2 million. This study presents the average annual incidence rate of the provincial total and of the district level covering 1990-1994. It is aimed at providing a comprehensive picture of descriptive epidemiology of cancer in the province. Data were collected from all hospitals in the provinces. Analysis was done under the program provided by IARC. There were 3,973 invasive cancer cases in the period. The age-standardized rate for all cancers was 116.7 in males and 88.7 in females. Lung, oral cavity, liver, and esophagus were the main leading sites in males while the cervix and breast were outstanding in females. By comparison, the incidence of most cancers were lower than other registries in Thailand except for two cancer sites. The incidence of male oral cavity and esophagus cancers in males (ASR 10.7 and 8.5 respectively) were considerably higher. Na Mom, Hat Yai, Sadao and Muang were districts having a high incidence of cancer.

Development of cancer registry in Phatthalung Hospital.

Evaluation of feasibility is required for development of a hospital-based cancer registry of Phatthalung Hospital. The completeness of case finding from in-hospital sources was evaluated for cancer cases diagnosed from January 1, 1994 to December 31, 1994. Cancer patients were collected from a file of pathological reports and medical records in Phatthalung Hospital. Items in the registration form included identification, demographic data and the data specific to cancer. During the same period of time, all biopsy cases sent from Phatthalung Hospital were selected from the pathological record of the Department of Pathology, Songklanagarind Hospital and from the database of the cancer registry of Songklanagarind Hospital. Ninety cases with histological verification were identified either from Phatthalung or Songklanagarind sources. Twenty seven cases were male and 63 were female. Fifty records were identified from Phatthalung sources and 40 additional records from Songklanagarind sources. Identification of cancer cases only from Phatthalung sources represented only 56% of all histologically verified cases. The two most common primary sites in males were colon and prostate. The percentages were 18.5 and 11.1 respectively. Lung cancer accounted only for 7.4% of all histologically verified cases. The two most common primary sites in females were cervix uteri and breast which accounted for 31.7% and 23.8% respectively. There was too much failure of case identification by in-hospital sources only. Songklanagarind sources were important for case findings. However, it is important that the medical records and filing system in Phatthalung Hospital should be improved.