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Bangkok, Thailand

Anannamcharoen S.,Phramongkutklao Hospital
Journal of the Medical Association of Thailand = Chotmaihet thangphaet | Year: 2012

The presence of distant metastases from colorectal cancer (CRC) does not preclude curative treatment. Early detection of pulmonary metastases at a potentially curable stage could improve survival. The aim of the present study was to assess the prognostic significance of commonly reported clinicopathologic features to identify high-risk patients who would likely benefit from more intensive chest surveillance for pulmonary metastases. A total of 351 consecutive patients, with surgical stages I-III colorectal cancer, who underwent curative resection at Phramongkutklao hospital from 1999 to 2005, were followed regularly according to the established guidelines with routine physical examination, serum carcinoembryonic antigen (CEA) and colonoscopic surveillance. Imaging studies for detecting metastases were computed tomography (CT), plain film radiography, and ultrasonograpy. Clinical and pathologic features were analyzed for their association with pulmonary metastasis. There were 145 patients who had been operated for longer than five years after curative intent surgery. Of these, nineteen patients were lost to follow-up or died from other causes that were unrelated to colorectal cancer. Pulmonary metastases were detected in 26 patients by either CXR or CT scan. Median time to pulmonary metastasis was 19 months (95 percent CI, 12-35). According to an univariate analysis, with log-rank test, identified four factors associated with pulmonary metastasis: Tumor stage T4, Nodal stage N2, elevation of serum CEA > 3.4 ng/ml and presence of lymphovascular invasion(LVI). According to a multivariate analysis, with Cox regression, found an elevation of serum CEA > 3.4 ng/ml which was an independent factor that was significantly associated with pulmonary metastasis (Hazard ratio (HR), 8.9; 95 percent CI, 3.6-22; p < 0.01). The present study revealed that 50 percent of patients who had more than one of these risk factors would eventually develop pulmonary metastases. An elevation of serum CEA > or = 3.4 ng/ml was found as an independent factor that was significantly associated with pulmonary metastasis whereas tumor stage T4, nodal stage N2 and presence of lymphovascular invasion (LVI) were not independent clinicopathologic features associated with subsequent pulmonary metastases. Chest CT scan has greater sensitivity than chest radiography in detection of pulmonary metastasis and should be considered as an imaging study of choice for intensive chest surveillance for patients who had more than one of these risk factors.


Anannamcharoen S.,Phramongkutklao Hospital
Journal of the Medical Association of Thailand = Chotmaihet thangphaet | Year: 2012

Determine the relationship between vascular endothelial growth factor (VEGF) expression and microvascular density (MVD) in primary colorectal cancer specimens including the prognostic value by evaluating the correlation between various common reported prognostic histopathologic indictors and these two angiogenic parameters. The Inter-observer reliability on VEGF and MVD measurement was also determined. Anti-VEGF and anti-factor CD34 monoclonal antibodies immunohistochemical staining was performed in 40 randomly selected formalin-fixed paraffin-embedded colorectal cancer specimens of non-stage-IV patients who underwent curative resection using. Immunoreactive in 25% or more carcinoma cells was categorized as positive. The intensity of VEGF expression was graded in a semiquantitative fashion, ranging from 0 to 2 Tumor MVD was determined by counting any endothelial cells stained with CD34 per two randomly selected fields at x200 magnification in each slide. The correlation between VEGF expression and MVD was evaluated. Inter-observer agreement was assessed by comparing the results of VEGF and MVD measurements made by two pathologists. A moderate correlation was found between the percentage of positive immunoreactive cells and the intensity of VEGF immunoreactive staining (correlation value of 0.436, p < 0.05). MVD was found having no correlation with both the percentage of positive immunoreactive cells and intensity of VEGF immunoreactive staining (the correlation value of -0.056, p = 0.732 and 0.108, p = 0.506, respectively). Neither MVD nor VEGF expression in primary colorectal cancer tissue was found having a significant correlation with any common reported prognostic histopathologic indictors. In counting CD34-stained endothelial cells, this study revealed a high intra-observer correlation coefficient of 0.886 (95% CI: 0.715-0.955) for the first pathologist and 0.913 (95% CI: 0.782-0.965) for the second. High inter-observer reliability was found in both MVD and VEGF measurement with a substantial agreement (agreement: 95%, kappa = 0.643) between the two pathologists. In primary colorectal cancer tissues, there was no significant relationship between MVD and VEGF expression. This study revealed a high intra and inter-observer reliability on VEGF and MVD measurement. Neither MVD nor VEGF expression provided predictive value of advanced or aggressiveness of disease. Further studies on larger sample size would help validate these results.


Phavichitr N.,Phramongkutklao Hospital
Journal of the Medical Association of Thailand = Chotmaihet thangphaet | Year: 2012

Dyspepsia is a common form of chronic abdominal pain in children and adolescents. Although it is usually functional or non-organic in origin, it disturbs daily activities, school attendance and the child's wellbeing. The authors evaluated prevalence and factors associated with dyspepsia among schoolchildren by comparing life-style of dyspeptic children with their asymptomatic peers. Total 1181 schoolchildren (mean age 14.7 +/- 1.8 years) were recruited from three schools in Bangkok. Data on dyspeptic symptoms were collected by using a questionnaire based on Rome III classification system. Potential precipitating factors for dyspepsia and life-style related to dyspepsia were also explored in the questionnaire. Dyspepsia was reported in 24.0% of the subjects. Prevalence was significantly higher in girls than in boys (27.0% vs. 20.0% p = 0.006). There was no difference between the comparison groups in terms of school test scores, past medical illness, parental marital status, parental income, number of siblings,frequency of stool and spicy food, carbonated beverage or dairy product consumption. The dyspepsia group had higher percentage of family history of peptic ulcer (odds ratio [OR] = 2.5 [95% CI = 1.7 to 3.7]), history of taking medicine (OR 1.7 [1 .0 to 2.9]), alcohol consumption (OR 2.4 [1.0 to 5.7]), severe stress (OR = 3.4 [1.2 to 9.9]) and extreme stress (OR = 3.9 [1.3 to 12.0]). Prevalence of self-reported dyspepsia among schoolchildren in this survey was similar to those previously reported; with family history of peptic ulcer, history of taking medicine, alcohol consumption, stresses in life as potential risk factors.


Boonya-Ussadorn T.,Phramongkutklao Hospital
Journal of the Medical Association of Thailand = Chotmaihet thangphaet | Year: 2010

To compare bone mineral density (BMD) of the lumbar spine (L1-L4), total hip (TH), and femoral neck (FN) analyzed by Dual Energy X-ray Absorptiometry (DXA) in premenopausal women with hyperthyroidism and in healthy premenopausal women. Cross-sectional study included 49 premenopausal women with hyperthyroidism and 49 healthy premenopausal women. Age, weight and body mass index (BMI) were comparable in both groups. All subjects had a BMD measurement by DXA in the region of L1-L4, TH and FN and the unpaired t-test was used to analyze. The mean BMD of premenopausal women with hyperthyroidism at L1-L4, TH and FN was 0.928, 0.838 and 0.774 g/cm2, which were lower than those of healthy premenopausal women; 0.991, 0.917 and 0.832 g/cm2 respectively (p-value is less than 0.05). Time interval that had elapsed for active hyperthyroidism was not associated with the decrease of BMD at L1-L4, TH and FN in hyperthyroid women. The BMD of L1-L4, TH and FN in premenopausal women with hyperthyroidism were significantly lower than those of healthy premenopausal women. Therefore, overt hyperthyroidism could be associated with bone loss and may be a risk factor for the development of osteoporosis. However, time interval of active hyperthyroidism was not related to the decrease of BMD in hyperthyroid women.


Chuengchitraks S.,Phramongkutklao Hospital
Journal of the Medical Association of Thailand = Chotmaihet thangphaet | Year: 2010

To demonstrate the incidence of catheter-related blood stream infection (CRBSI) of patients in the pediatric intensive care unit (PICU) after implementing the new guideline to prevent CRBSI. All patients who were admitted to PICU at Phramongkutklao Hospital between January and December 2006 and had central venous catheter (CVC) inserted from the operation room before admission or CVC placed in the PICU were included in a cohort study with longitudinal assessment of an overall catheter care policy targeted at the reduction of vascular access infection. The guideline included five key components (hand hygiene, maximal barrier precautions, povidine skin antiseptic, optimal catheter site selection, daily review of line necessity with prompt removal of unnecessary lines) called "central line bundle". All nursing staffs in the PICU were asked to attend an educational meeting in order to review the scientific data on vascular access insertion, device use and care. Data regarding age, underlying disease, location of insertion, duration, and complication were recorded. A total of 61 patients were recruited. Average duration of catheterization was 8.7 days. Complications were found in 8 cases (13.1%). Hematoma was the most common complication (6.6%) followed by infection (3.3%). Rate of CRBSI was reduced from 2.6 per 1000 catheter days to 2.4 per 1000 catheter days after implementing the new practice guideline. Rate of CRBSI was reduced after implementing the new "central line bundle" guideline to prevent CRBSI.

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