A descriptive study of 36 cases of solitary soft tissue cysticercosis at Ramathibodi Hospital from surgical specimens during 1990-2006

We present a study of 36 cases of solitary soft tissue cysticercosis retrieved from pathological reports and medical records during 1990-2006. The soft tissue was the most common organ affected by cysticercosis in our study accounting for 75% of all affected cases. The brain was the second most common, and accounted for 15%. The most common location for the soft tissue lesions was upper extremities which accounted for 33% of cases, and the least common sites were the back, eyelid, buttock and cheek, which accounted for 3% each. Preoperative diagnoses of the lesions were as follows: lipoma, masses of undetermined nature, cysts, abscesses, fat necrosis and lymphadenitis. The mean size of lesions was 1.5 cm; the minimum and maximum sizes were 0.3 and 3 cm, respectively. The mean age of the patients was 33.5 years and the range was 9 to 68 years. The ratio of males to females was 1 to 5, which may reflect differences in eating habits and social life between males and females in our society. Our findings indicated that none of the cases in our study were diagnosed as cysticercosis preoperatively. Therefore, clinicians should include cysticercosis in the differential diagnosis of soft tissue cystic nodules or masses. Data regarding the sizes of lesions should be helpful in differentiating this entity from other soft tissue lesions in clinical practice and on magnetic resonance imaging.     

Self discipline and obesity in Bangkok school children

Background

In 2004, the Ministry of Health issued the policy of decentralising microscopy services (MCs) to one third of all township hospitals in China. The study was conducted in Gansu Province, a poor western one in China. Ganzhou was one county in Gansu Province. Ganzhou County was identified as a unique case of further decentralisation of tuberculosis (TB) treatment services in township hospitals. The study evaluated the impact of the MC policy on providers and patients in Gansu Province. The second objective was to assess the unique case of Ganzhou County compared with other counties in the province.

Methods

Both quantitative and qualitative methods were used. All 523 MCs in the province completed an institutional survey regarding their performance. Four counties were selected for in-depth investigation, where 169 TB suspects were randomly selected from the MC and county TB dispensary registers for questionnaire surveys. Informant interviews were conducted with 38 health staff at the township and county levels in the four counties.

Results

Gansu established MCs in 39% of its township hospitals. From January 2006 to June 2007, 8% of MCs identified more than 10 TB sputum smear positive patients while 54% did not find any. MCs identified 1546 TB sputum smear positive patients, accounting for 9% of the total in the province. The throughputs of MCs in Ganzhou County were eight times of those in other counties. Interviews identified several barriers to implement the MC policy, such as inadequate health financing, low laboratory capacity, lack of human resources, poor treatment and management capacities, and lack of supervisions from county TB dispensaries.

Conclusion

Microscopy centre throughputs were generally low in Gansu Province, and the contribution of MCs to TB case detection was insignificant taking account the number of MCs established. As a unique case of full decentralisation of TB service, Ganzhou County presented better results. However, standards and quality of TB care needed to be improved. The MC policy needs to be reviewed in light of evidence from this study.     

Self discipline and obesity in Bangkok school children

Background  

Childhood obesity has become an important public health problem in Thailand. This study aimed to determine the relationship between self discipline and obesity in Bangkok school children.     

Echocardiographic predictors of successful versus unsuccessful mitral valve repair in ischemic mitral regurgitation

Mitral valve (MV) annuloplasty is the standard surgical technique for the management of ischemic mitral regurgitation (MR). However, < or = 1/3 of patients develop recurrent MR after annuloplasty. Therefore, we sought to identify the preoperative echocardiographic parameters that predict annuloplasty failure in patients with ischemic MR. Intraoperative transesophageal echocardiograms from 365 patients who underwent MV repair for ischemic MR were reviewed. Of the 365 patients, 297 (81%) had satisfactory outcomes with < 2+ MR, and 68 (19%) had recurrent MR (> or = 2+) during a mean follow-up of 269 days. The mitral annular parameters, including mitral annular diameter, tethering height, and tethering area of the mitral leaflets, were determined in 3 different echocardiographic views. On multiple logistic stepwise regression analysis, a higher mitral annular diameter, higher tethering area, and higher MR severity were identified as independent predictors for failure of MV repair (p < 0.0001). In conclusion, these results demonstrated that preoperative echocardiographic findings can be used to identify patients with ischemic MR at increased risk of repair failure. These echocardiographic measurements should be used to guide the cardiologist and cardiac surgeon in the choice of MV repair versus replacement in patients with ischemic MR.     

Q-Switched Ruby Laser Therapy of Acquired Bilateral Nevus of Ota-like Macules

BACKGROUND: Acquired bilateral nevus of Ota-like macules (ABNLM), also called nevus fuscoceruleus zygomaticus or nevus of Hori, is a relatively common disease in Asia. It is refractory to all medical treatment. OBJECTIVE: To present the first report on the use of Q-switched ruby laser to treat ABNLM. METHODS: One hundred and forty female patients, ages 19-62 years (mean 39 years), were included in the study. The laser fluence employed was 7-10 J/cm2, at a repetition rate of 1 Hz, and with a spot size of 2-4 mm. The number of treatment sessions ranged from 1 to 6 (mean 2.3). RESULTS: Nine patients were lost to follow-up before complete clearance of the lesions, while in the remaining 131 patients complete clearance was obtained. The only complication was a long-term hypopigmentation, observed in three patients. There was no recurrence at 6 months- 4.3 years (mean 2.5 years) of follow-up. CONCLUSION: Q-switched ruby laser is an effective and less invasive tool to eradicate ABNLM.     

Gnathostomiasis, a possible etiologic agent of eosinophilic granuloma of the gastrointestinal tract.

A 42-year-old Thai man from central Thailand came to Ramathibodi Hospital with the complaint of abdominal pain. Physical examination revealed localized tenderness in the right lower quadrant. The clinical impression was acute appendicitis and an operation was performed, revealing a large mass in the cecum. A right hemicolectomy was done for what was thought to be a carcinoma of the colon. The resected colon showed subserosal thickening on the antimesenteric side of the ascending colon with a constricted area at the middle portion. An immature adult Gnathostoma spinigerum was identified in the thickened subserosa of the cecum. Microscopic examination of the involved bowel showed a heavy infiltration of eosinophils, fibroblasts and histiocytes, and mild to moderate edema. The findings were consistent with eosinophilic granuloma of the gastrointestinal tract, and the presence of the parasite in the affected bowel suggested that it was the etiologic agent.     

Various morphologic features of Gnathostoma spinigerum in histologic sections: report of 3 cases with reference to topographic study of the reference worm

Gnathostomiasis is common in Southeast Asian countries and can be found sporadically in other parts of the world mainly due to human migration. The definitive diagnosis can be given either by identification of the parasite isolated from the patient or through histologic section of the lesion. It is therefore important for pathologists to be familiar with the morphology of parasitic larvae which varies according to the levels of section-cutting so that the diagnosis will not be misled. We present three cases of gnathostomiasis with different features of parasitic morphology and compare these with the reference adult worm.     

Ultrastructure of chordoma. A case report

A 50-year-old male developed a sacro-coccygeal chordoma. Prior to the surgery, he had experienced back-pain, numbness of the right thigh and difficulty in voiding and defecation. Total excision of the mass was done and all symptoms were relieved. The light microscopic examination revealed a chordoma. The ultrastructural study was performed with particular interest in physaliferous cells. The fine structure disclosed the prominent associations of mitochondria and rough endoplasmic reticulum. The mitochondria showed irregularities in sizes and shapes but did not attenuate as much as previously reported. The vacuoles that were observed by light microscopy in physaliferous cells were both extra-cellular and intra-cellular and contained finely granular material of acid mucopolysaccharides probably of chondroitin type. The presence of both subplasmalemmal linear densities (SLD) and pinocytic vesicles was consistent with the histogenetic conviction that the tumor arose from mesodermal derivatives.