First trimester serum inhibin A in normal pregnant women

Objectives To establish reference ranges for maternal serum inhibin A in normal first trimester pregnant women. Materials and methods This was a cross-sectional study. We measured maternal serum inhibin A in normal pregnant women gestation age between 6⁺⁰ and 14⁺⁶ weeks using the enzyme-linked immunosorbent assay (ELISA) method. Maternal serum inhibin A was analyzed according to gestational ages (GA). Results Serum of 300 pregnancies was analyzed and the outcome demonstrated the median of maternal serum inhibin A according to gestational age. The levels of maternal serum inhibin A during the 6⁰–6⁺⁶ week of gestations are lowest when compared with other gestational age. The levels of maternal serum inhibin A during 9⁰–9⁺⁶ week of gestations are maximal. Maternal serum inhibin A then declined until 14 weeks of gestation. Conclusion Serum inhibin A can be measured during the first trimester of pregnancy by using the recent ELISA technique. Our reference ranges might be useful for further studies, such as prediction of adverse pregnancy outcome in threatened abortion.     

A head-mounted visual stimulator for neurotological examination

OBJECTIVES: Presently, the neurotological tests, using visual stimulation, such as optokinetic nystagmus test (OKN), eye-tracking test (ETT) is being widely used for the diagnosis of vertigo or disequilibrium. The problems of these tests are the large size of the visual stimulator and therefore a wide space requirement. Even if a small apparatus is developed, the apparatus itself would be very expensive. In this study, we developed a small visual stimulation test system comprising the virtual visor, which receives an image for visual stimulation from an on-line computer. METHODS: Using smooth pursuit and optokinetic stimulation onto a virtual visor we assessed the ENG recording in 20 normal subjects. RESULT: We found the 30 degrees /s OKN, horizontal eye tracking were adequately stimulated by this technique with reliable results. CONCLUSION: This new method of smooth pursuit and optokinetic stimulating by a virtual visor is capable of producing reliable results and may be used in the clinical laboratory of vertigo. However, this stimulator also has some limitations, mainly because of the visual angle of the virtual visor stimulator.     

Primary non-Hodgkin,s Lymphoma of the Uterine Cervix

Primary malignant lymphoma of the cervix is a rare disease. Because the number of reports of this cancer is limited, there is no consensus on its management, prognosis or the efficacy of various treatments. Primary malignant lymphoma of the cervix stage Ib was diagnosed in a woman aged 25 years. The patient was treated with 6 courses of CHOP chemotherapy (cyclophosphamide, doxorubicin, vincristine, and prednisone). Clinical and pathological responses were complete. This case supports current thinking in that, in selected young patients with primary malignant lymphoma of the cervix who desire to preserve fertility and ovarian functions, combination chemotherapy regimens such as CHOP are the treatment of choice.     

Three-dimensional sonographic features of a fetus with Wolf-Hirschhorn syndrome

We present a case of fetal Wolf-Hirschhorn syndrome diagnosed by conventional two-dimensional and three-dimensional ultrasonography. Conventional two-dimensional ultrasonography revealed a diaphragmatic hernia, nuchal edema, and suspected hypospadias. Three-dimensional ultrasonography clearly showed a flattening of the face, a high forehead, a broad nasal bridge continuing to the forehead, exophthalmos, and micrognathia (resembling the appearance of a Greek warrior helmet), but conventional two-dimensional ultrasonography did not depict these findings. Prenatal chromosomal analysis confirmed the diagnosis of Wolf-Hirschhorn syndrome [46XY, del(4)(p15.2)]. Here we demonstrate how three-dimensional ultrasonography provided a novel visual depiction of the facial dysmorphism, which helped substantially in prenatal counseling.     

Longer waiting times for early stage cervical cancer patients undergoing radical hysterectomy are associated with diminished long-term overall survival

Objective

The aim of this study was to evaluate the impact of surgical waiting time on clinical outcome in early stage cervical cancer.

Methods

The cohort consisted of 441 patients diagnosed with stages IA2-IB1cervical cancer who underwent radical hysterectomy and pelvic node dissection. The patients were divided into two groups based on surgical waiting time. The associations between waiting time and other potential prognostic factors with clinical outcome were evaluated.

Results

The median surgical waiting time was 43 days. Deep stromal invasion (hazard ratio [HR], 2.5; 95% confidence interval [CI], 1.4 to 4.6; p=0.003) and lymph node metastasis (HR, 2.9; 95% CI, 1.3 to 6.7; p=0.026) were identified as independent prognostic factors for recurrence-free survival while no prognostic significance of surgical waiting time was found (p=0.677). On multivariate analysis of overall survival (OS), only deep stromal invasion (HR, 2.6; 95% CI, 1.3 to 5.0; p=0.009) and lymph node metastasis (HR, 3.6; 95% CI, 1.5 to 8.6; p=0.009) were identified as independent prognostic factors for OS. Although OS showed no significant difference between short (≤8 weeks) and long (>8 weeks) waiting times, multivariate analysis of OS with time-varying effects revealed that a waiting time longer than 8 weeks was associated with poorer long-term survival (after 5 years; HR, 3.4; 95% CI, 1.3 to 9.2; p=0.021).

Conclusion

A longer surgical waiting time was associated with diminished long-term OS of early stage cervical cancer patients.     

First trimester embryonic/fetal heart rate in normal pregnant women

Objective: To establish reference ranges for first trimester embryonic/fetal heart rate in normal pregnant women. Materials and methods: This was a cross-sectional study. We performed ultrasonogram in 319 normal pregnant women, gestation age between 6⁺⁰ and 14⁺⁶ weeks and measured embryonic/fetal heart rates using M-mode. The embryonic/fetal heart rates were analyzed according to gestational ages (GA). Results: Data of 319 pregnancies were analyzed and the outcome revealed the mean of fetal heart rate according to gestational age. The mean embryonic heart rates during the 6th–7th week of gestation are lower when compared with the other gestational ages. At the 8th week of gestation, the embryonic heart rate is maximum. Then the embryonic/fetal heart rate gradually decreased to 161 beats/min at the 14th week of gestation. The regression equation for embryonic/fetal heart rate (beat/min) [y] according to GA (day) [x] was y = −53.124 + 6.1333x + (−0.0407)x ² (r ² = 0.525; P < 0.001). Conclusion: Embryonic/fetal heart rates during the 6⁺⁰ and 14⁺⁶ week of gestation are related to GA. Our reference ranges may be useful for further studies such as for prediction of adverse pregnancy outcome in threatened abortion.     

Endometrial Cancer in Thai Women aged 45 years or Younger.

The aim of this retrospective study was to clarify the clinopathologic profile of endometrial cancers in women aged 45 years or younger. All patients with histopathologically confirmed endometrial cancer treated at Songklanagarind Hospital from 1996-2005 were included. Of the 51 identified, 40 (78.4%) were in stage I, 7 (13.7%) in stage II, and 4 (7.8%) in stage III. The age range was 25-45 years (median 41) with a body mass index ranging from 17.6-44.2 (median 27.2). Eighty one percent reported abnormal vaginal bleeding, and twenty four percent polycystic ovaries. Prevalences of diabetes mellitus, hypertension and thyroid disease were 17.7%, 15.7%, and 3.9%, respectively. Seven cases (13.7%) had synchronous ovarian cancer with endometriod adenocarcinoma as the most common histopathological form. Forty patients had well differentiated, 8 moderately differentiated and 2 poorly differentiated tumors. The 5-year disease-free survival (and 95% CI) and 5-year overall survival rates were 88.0% (75.1-94.4%) and 87.5% (74.1-94.2%), respectively. Univariate analysis revealed that patients who had a history of hypertension or lymph node metastasis had a poor prognosis. We conclude that the majority of women aged 45 years or younger with endometrial cancer were obese and the tumors were most commonly in an early stage and were well differentiated.     

Causes and time-course of vertigo in an ear, nose, and throat clinic

The purpose of this study is to review etiologies and identify the time-course of vertigo presenting in an ear, nose, and throat clinic, and serve as a reference guide for other clinics. The study includes retrospective chart review in a tertiary care, university hospital. The patient data with reported ICD-10 codes as causes of vertigo between April 2005 and December 2007 were extracted from the database. At each visit, the main diagnosis as to etiology, characteristics of the vertigo, its time-course, and patient demographic data were recorded. Of 547 cases, 17 diagnoses were made in 73.9%. Diagnostic categories included peripheral vertigo 72.9%, central vertigo 0.8%, psychogenic cause 0.2%, and unknown 26.1%. Common causes of vertigo were benign paroxysmal positional vertigo (BPPV) 52.5%, Meniere’s disease 14.6%, and sudden idiopathic hearing loss 2.9%. Less common diagnoses were benign paroxysmal vertigo of childhood 0.7%, labyrinthitis 0.7%, and vestibular schwannoma 0.3%. Rare conditions were delayed endolymphatic hydrops, Ramsey Hunt syndrome, otosyphilis, vestibular neuritis, temporal bone fracture, post-concussion syndrome, cerebellar infarction, epilepsy, cervical vertigo, Streptococcus suis meningitis, and psychogenic vertigo. Ninety-nine cases who reported remission of vertigo during the study period had median onset of the remission at 4 weeks. In the ear, nose, and throat clinic at Chiang Mai University, a tertiary university hospital, peripheral vestibular disorders were the main etiology of vertigo. The three most common causes were BPPV, Meniere’s disease, and sudden idiopathic hearing loss. Half of the cases who returned for follow up had remitted symptoms within 4 weeks.