Epithelial ovarian cancer in the young in Siriraj Hospital

Objective: To access incidence, risk factors, 5-year progression free survival and overall survival in young patients with epithelial ovarian cancer (EOC) in Siriraj Hospital. Methods: Medical records of patients equal or younger than 40 year of age treated with EOC in Siriraj Hospital from January 1998 to December 2007 were reviewed for clinical characteristics, treatments, and outcomes. Survival curves were generated using Kaplan-Meier method. Cox regression analysis to determine multivariate factor for recurrence and survival was performed. Results: Incidence of patients equal or younger than 40 year old with EOC in Siriraj Hospital was 5.8 % of all EOC. Mean age was 33.4±5.4 years. Sixty five percents of patients had abnormal pretreatment CA-125 level. Majority of the patients were in stage I of EOC. Sixty five percents of patients underwent optimal surgery. Adjuvant chemotherapy was applied in 83.7%. Twenty two patients were dead with a median time to death of 3 months. Five-year progression survival was 84.8% and 5-year overall survival was 76% with the median follow up time of 20.5 months. Abnormal pretreatment CA-125 level and suboptimal surgery were the only two independent prognostic factors for survival. Conclusions: The incidence of EOC in the patients equal or younger than 40 year of age is 5.8% of all EOC. The 5-year overall survival rate was 76%. From multivariate analysis, the independent prognostic factors for overall survival were abnormal pretreatment CA-125 level and suboptimal surgery with the hazard ratio of 6.69 (P<0.001) and 2.79 (P=0.033)

The Normal Reference Values of Carrying Angle from Birth to Adolescence

Objective: The aim of this study was to establish normal carrying angle reference values from birth to adolescence, and to identify variations in carrying angle relative to age, gender, and elbow side. Methods: The prospective cross-sectional study was performed in normal healthy children aged newborn to sixteen years during May 1959 to April 1961. Children were recruited from newborn units, nurseries, and schools located in Bangkok, Thailand. There was a total of 17 groups – one for each year of age from 0 (at birth) to 16. The carrying angles of both arms were measured using a clear plastic full-circle orthopedic goniometer. The data of age, side, and gender of each child were recorded. Results: A total of 921 children with 1,842 measurements were included. There were 407 boys and 514 girls. The mean carrying angle was lowest at birth and highest in the 15- year and 16-year age groups. The increase in the carrying angle was observed to progress to valgus 6 degrees at 6 years of age, and to valgus 11 degrees and stabilization at 15 years of age. There was no statistically significant difference between the mean carrying angle of the left and right side for any of the 17 evaluated age groups. Girls demonstrated a significantly greater carrying angle than boys (p<0.001). The intraclass correlation coefficient (ICC) of inter-observer variation between two observers was 0.848. Conclusion: This study established normal carrying angle reference values from birth to adolescence. Our results revealed that the elbow is slightly varus at birth, then increases in carrying angle until reaching stabilization of skeletal growth and development at 15 years of age. The carrying angle is slightly greater in girls than in boys. This normal reference value data will benefit orthopedists who take care of the pediatric patients with elbow-relate

Prevalence and prognosis of myocardial scar in patients with known or suspected coronary artery disease and normal wall motion

<p>Abstract</p> <p>Background</p> <p>Some patients may have normal wall motion after myocardial infarction. The aim of this study was to determine the prevalence and prognosis of patients with myocardial scar in the absence of abnormal wall motion. We studied patients with suspected or known coronary artery disease (CAD) who were referred for cardiovascular magnetic resonance (CMR) for the assessment of global and regional cardiac function and late gadolinium enhancement (LGE) and had normal left ventricular wall motion. Prognostic value was determined by the occurrence of hard endpoints (cardiac death and nonfatal myocardial infarction) and major adverse cardiac events (MACE) which also included hospitalization due to unstable angina or heart failure or life threatening ventricular arrhythmia.</p> <p>Results</p> <p>A total 1148 patients (70.3%) were studied. LGE was detected in 104 patients (9.1%). Prevalence of LGE increased in patients with increased left ventricular mass. Average follow-up time was 955 ± 542 days. LGE was the strongest predictor for hard endpoints and MACE.</p> <p>Conclusion</p> <p>LGE was detected in 9.1% of patients with suspected or known CAD and normal wall motion. LGE was the strongest predictor of significant cardiac events.</p

Extraperitoneal Laparoscopic Radical Prostatectomy: Early Experience in Thailand

The transperitoneal approach is the conventional technique for laparoscopic radical prostatectomy. There are, however, several disadvantages of the approach, such as damage to intraperitoneal organs and long-term ileus. To prevent these complications, we propose an extraperitoneal approach that has been successfully used for open radical prostatectomy in treating patients with localized prostate cancer. The aim of this study was to evaluate the feasibility of extraperitoneal laparoscopic radical prostatectomy (ELRP). The outcomes of ELRP and open radical prostatectomy were also assessed and compared. METHODS: There were two groups of patients with localized prostate cancer confirmed by transrectal ultrasound biopsy. Patients were included if they had no previous hormonal treatment and no previous transurethral prostatectomy. Group I comprised patients in whom open radical prostatectomy was performed between February 2001 and August 2005 (n = 55). Group II comprised patients in whom ELRP was performed between December 2005 and October 2006 (n = 41). Early postoperative results, clinical outcomes and complications were analysed among the two groups using χ2, t and Mann-Whitney tests. RESULTS: Group I and Group II did not show significant differences regarding age, clinical staging, hospitalization time, or pathological stage. Group II had a longer mean operative time than Group I (t test, p < 0.001). Median blood loss was significantly less in Group I (Mann-Whitney test, p < 0.001). Group II also demonstrated shorter catheter removal time (Mann-Whitney test, p = 0.003). In Group II, there were two rectal complications, including rectal injury and rectal necrosis, which were treated laparoscopically and conservatively without long-term problems. CONCLUSION: With experience, ELRP is feasible with equal oncological outcomes to open radical prostatectomy. Although a certain disadvantage was presented by ELRP, the less invasive surgery and reduction in operative blood loss were major advantages. It is suggested that a large and longitudinal trial be conducted to investigate the effectiveness of such an approach in managing functional outcomes

Comparison of cardiovascular magnetic resonance of late gadolinium enhancement and diastolic wall thickness to predict recovery of left ventricular function after coronary artery bypass surgery

Abstract Background The objective was to compare the value of late gadolinium enhancement (LGE) and end-diastolic wall thickness (EDWT) assessed by cardiovascular magnetic resonance (CMR) in predicting recovery of left ventricular function after coronary artery bypass surgery (CABG). Methods We enrolled patients with coronary artery disease and left ventricular ejection fraction Results We studied 46 men and 4 women with an average age of 61 years. Baseline left ventricular ejection fraction was 37 ± 13%. A total of 2,020 myocardial segments were analyzed. Abnormal wall motion and the LGE area were detected in 1,446 segments (71.6%) and 1,196 segments (59.2%) respectively. Wall motion improvement was demonstrated in 481 of 1,227 segments (39.2%) that initially had wall motion abnormalities at baseline. Logistic regression analysis showed that the LGE area, EDWT and resting wall motion grade predicted wall motion improvement. Comparison of Receiver-Operator-Characteristic (ROC) curves demonstrated that the LGE area was the most important predictor (p Conclusion LGE and EDWT are independent predictors for functional recovery after revascularization. However, LGE appears to be a more important factor and independent of EDWT.</p