Changes in oral cytokeratin expression in HIV-infected subjects with long-term use of HAART.

OBJECTIVES: The objectives of this study were to determine (i) the expression of oral cytokeratins (CKs) among human immunodeficiency virus (HIV)-infected subjects compared with non-HIV controls, (ii) the oral CK expression in the subjects with highly active antiretroviral therapy (HAART) compared with those without HAART, and (iii) factors associated with the expression of oral CKs. MATERIALS AND METHODS: Oral tissues from buccal mucosa were obtained by punched biopsy in HIV-infected subjects with and without HAART, and non-HIV individuals. The samples were processed for immunohistochemical studies of CK1, CK13, CK14, CK16, and involucrin. The staining intensity was scored and recorded. Logistic regression analysis and multi-way ANOVA test were performed. RESULTS: The expression of CK13, CK14, and CK16 was found to be significantly different between HIV-infected subjects and non-HIV individuals (P < 0.05). The expression of those CKs was also significantly different between those who were and were not on HAART (P < 0.05). No significant difference between the groups was observed regarding CK1 and involucrin. CONCLUSIONS: Oral epithelial cell differentiation as marked by the CK expression is affected by HIV infection and use of HAART. CKs may be the useful biomarkers to identify HIV-infected subjects who are at risk of malignant transformation of the oral mucosa because of HIV infection and HAART.

Absence of Epstein-Barr virus in esophageal squamous cell carcinoma.

It is strongly suspected that the Epstein-Barr virus (EBV) plays a role in the genesis of nasopharyngeal and gastric carcinoma. The aim of this study was to search for such a connection between esophageal squamous cell carcinoma (ESCC) and EBV. We investigated 104 surgically resected esophageal cancers using in situ hybridization (ISH) for EBV-encoded RNA (EBER). We found no EBER-positive cancer cells in any tests, although there were five samples in which EBER-positive tumor-infiltrating lymphocytes (TILs) were found. We conclude from this study that EBV is not associated with ESCC.

Assessment of the physical properties of laparoscopic myoma-fixation devices.

BACKGROUND: The physical properties of three commercial 5-mm myoma-fixation devices available for clinical use (short-pitch corkscrew, long-pitch corkscrew, buttress-thread screw) and a standard wood screw were examined. METHODS: Fresh specimens of uterine leiomyoma masses were used to test the maximum traction force obtained from each device on 31 occasions. The myoma tissue at each traction site was evaluated histologically to determine its density. The maximal traction forces in each myoma density group were compared using a generalized estimating equations approach to linear regression based on repeated measures within each myoma. The bending strength also was determined for each device. RESULTS: A wide range of maximum traction forces with a mean of 130.8 +/- 71.5 N (range, 21.6-341.6 N) over all devices and tissue densities was recorded. The mean maximum traction force provided by the short-pitch corkscrew (159.2 +/- 12.2 N) was significantly higher (p < 0.01) than that of the other devices in medium-density myomas, and not significantly lower than that of other devices in low-density myomas. The mean maximum traction force provided by the buttress-thread screw was significantly lower than that of the short-pitch corkscrew only in medium density myomas, and did not differ significantly from that of the wood screw in any density group. The wood screw provided the highest bending strength (6.73 x 10(4) N/m) (whereas the short- and long-pitch corkscrew provided the lowest (9.70 x 10(2) N/m and 1.95 x 10(3) N/m, respectively) and the buttress-thread screw an intermediate (2.24 x 10(4) N/m) strength (p < 0.0005 for all comparisons except for the two corkscrews). CONCLUSIONS: Screw-type myoma-fixation devices can provide comparable traction force with high bending strength. A long-pitch corkscrew should not be used for laparoscopic myomectomy because of its low traction force and bending strength. When a commercial screw is not available, a standard wood screw can be used with acceptable traction force and very high strength for bending.

Cowden's syndrome with Lhermitte-Duclos disease.

Cowden's syndrome (CS) is a rare autosomal dominant condition featuring multiple hamartomas, often with mucocutaneous lesions, goitre, breast cancer, gastrointestinal polyps or even Lhermitte-Duclos disease (LDD). In this article we report the case of a 34-year-old man who was diagnosed with LDD. Subsequent examinations also revealed manifestations of CS, i.e. macrocephaly, thyroid nodules and gastrointestinal polyps.

Prenatal diagnosis of fetal bladder outlet obstruction at Songklanagarind Hospital: report of 5 cases.

Five cases of fetal bladder outlet obstruction prenatally diagnosed in the Perinatology Unit, Department of Obstetrics and Gynaecology, Songklanagarind Hospital, Songkhla, from January 1990 to September 1999 were reported. Ultrasound findings demonstrated megacystis, various degrees of hydroureter and hydronephrosis and oligohydramnios. Sex could be determined in only four cases and all were male. Chromosome abnormality (trisomy 18) was documented in one case. Postmortem results in three cases established that posterior urethral valves were the cause of obstruction. All cases in our series had poor outcome based on gestational age at first diagnosis, sonographic findings, fetal urinalysis, and chromosome abnormality. Four cases underwent termination of pregnancy and the other resulted in a dead fetus in utero. The outcome of some cases may be improved by using the vesicoamniotic shunt placement procedure that increases the likelihood of fetal survival. Therefore, the recommendation is to establish this procedure at Songklanagarind Hospital in the future.

Tubulointerstitial renal failure in childhood leptospirosis.

We report three children with tubulointerstitial renal failure following leptospirosis. All had acute nonoliguric renal failure with mild hypocalemia and mild metabolic acidosis. Maximum blood urea nitrogen (BUN) and creatinine were 217 and 7.1 mg/dl, respectively, on the 6th day of disease, and no patient required dialysis. They presented with acute febrile illness and dehydration, and required intravenous fluid supplements. Myalgia, vomiting, and bleeding were found in two children. Abdominal pain, arthralgia, diarrhea, and conjunctival suffusion were found in one child. Only one child, who had an underlying disease of beta-thalassemia/Hb E, had jaundice, hepatosplenomegaly, anemia, and thrombocytopenia. Penicillin treatment was given in one case. All recovered, with normal renal function. The leptospirosis complement fixation test was used to confirm diagnosis. L. batavia was considered the etiologic agent in two of the children.

Hepatic peripheral T-cell lymphoma: a spectrum of liver pathology and clinical correlation.

Thirty-two patients with fever of unknown origin, weight loss, anemia, elevated serum levels of alkaline phosphatase and/or lactate dehydrogenase were evaluated. Histopathologic findings of the liver showed T-cell infiltration in the hepatic sinusoids and portal tracts. The cellular morphology varied from mature lymphocyte to malignant lymphoid cells. We divided the cases into four groups on the basis of cellular atypia. Group A and group B showed mature lymphoid cell infiltration, however, only group B had multiple large areas of hepatocellular necrosis. Group C showed atypical lymphoid cell infiltration. In group D, definite malignant lymphoid cell infiltrates were demonstrated. Groups B, C, and D patients had a very poor prognosis. All of them died despite chemotherapy. Group A patients had a better prognosis. Those who had chemotherapy achieved a complete remission. Progression to a higher group occurred in two of six patients with group B lesions and one of seven patients with group C lesions. The EBV-RNA genomes were found increasingly in the higher groups. This study supports the concept that these groups of disease represent a spectrum of peripheral T-cell proliferations.

Non-fatal acute renal failure due to wasp stings in children.

We report two children who developed acute renal failure after multiple wasp stings. Each case involved intravascular hemolysis which caused acute renal failure, volume overload, hypertension, anemia, hyponatremia, hyperkalemia, and metabolic acidosis. Peritoneal dialysis was required for short periods. The children recovered completely with blood urea nitrogen and creatinine returning to normal within 3 months. One child had a renal biopsy which showed mild tubulointerstitial nephritis. Although there is no specific treatment or antivenom, dialysis and supportive care have proved to be successful.

Granulomatous reaction in peripheral T-cell proliferative disease: a case report.

A 52-year-old male presented with a prolonged fever, anemia, weight loss, hepatosplenomegaly, and elevated serum level of alkaline phosphatase. The patient developed septicemia, metabolic acidosis, and died 3 days after admission. Liver necropsy, tissue showed group C, peripheral T-cell proliferative disease. Epstein-Barr virus genomes were demonstrated in the nuclei of these abnormal T-cell lymphocytes. Granulomatous reaction was observed in the liver and bone marrow. Stains and cultures for mycobacteria and fungi gave negative results. Granulomatous reaction is believed to be induced by cytokines which were released from the T-cell lymphocytes that infiltrated in the liver and bone marrow.

AIDS-related non-Hodgkin's lymphoma presenting as delayed healing of an extraction wound.

Non-Hodgkin's lymphoma (NHL) of the oral cavity frequently occurs in patients infected with human immunodeficiency virus (HIV). This report describes a lesion presenting as delayed healing of an extraction wound with hyperaemic swollen gingivae and ulceration in an apparently healthy 34-year-old Thai fisherman. The lesion was the first evidence of his HIV-positivity. It is, therefore, imperative that clinicians should consider a diagnosis of HIV infection in cases of non-healing extraction wounds in patients in high risk categories.

Liver involvement in murine typhus.

Liver involvement was retrospectively evaluated in 137 patients with murine typhus. Fifteen (10.9%) were jaundiced. One patient had been subjected to cholecystectomy after misdiagnosis of acute cholecystitis. Serum aminotransferase levels were abnormal in 48/52 measurements, and there were elevations of > 5-fold in 14 patients. Liver biopsies and/or necropsies from four jaundiced patients showed portal tract and sinusoidal infiltrates, cloudy swelling/and necrosis of the hepatocytes and occasional pseudogranuloma formation. There were striking mitoses even in the early stage, suggesting rapid hepatocellular regeneration. Haemolytic diseases (G6PD deficiency or haemoglobinopathies), alcoholism, and a second infection probably also contributed to the pathogenesis of jaundice in murine typhus. This rickettsiosis should be included among differential diagnoses of acute hepatitis in patients exposed to areas endemic for Rickettsia typhi.

Zellweger syndrome: first reported case in Thailand and literature review.

We describe an infant boy with facial dysmorphism, profound hypotonia, psychomotor retardation, seizure and hepatomegaly. Biochemical study revealed elevation of very long chain fatty acids and pipecolic acid, consistent with peroxisomal disorder. He died at the age of 4 months. Electron microscopic study demonstrated decreased amounts of peroxisomes in liver and kidneys. The clinical characteristic, accompanied the biochemical and microscopic findings led to the diagnosis of Zellweger syndrome. The recognition of this syndrome is important since it is a fatal disease. The pattern of inheritance is autosomal recessive, hence genetic counseling is necessary. We emphasize that peroxisomal disorder should be included in the differential diagnosis in patients with infantile hypotonia. This patient is the first reported case of Zellweger syndrome in Thailand.

Precancerous lesion and early carcinoma of the pyriform sinus.

Thirty-five specimens from total laryngopharyngectomy clinically diagnosed as squamous cell carcinoma of the pyriform sinus were studied. Patients receiving chemotherapy or radiotherapy were excluded. Pathological examinations revealed 26 (74.3%) precancerous lesions and early carcinoma of the pyriform sinus. Eight out of 26 cases were detected by gross examination. Most pathological findings were carcinoma in situ (CIS). Epithelial changes of the pyriform sinus were not similar to those of the uterine cervix. They usually showed abrupt change, frequently from normal to CIS, mild dysplasia to invasive carcinoma and these lesions can be detected early by physical examination. Because of multifoci of carcinoma, the concept of "multicentric origin" is proposed.

A clinico-pathologic study of ovarian tumors.

A series of 286 patients receiving surgical treatment for ovarian tumors at Song-klanagarind Hospital between January 1987 and June 1990 were reviewed. The most frequent diagnoses by age group were: cancer in 53 per cent of women > or = 50 yrs of age, endometrioma in 63 per cent of women 31-49 yrs of age and benign cystic teratoma in 49 per cent of women < or = 30 yrs of age. Mucinous ovarian tumors were the most common type of epithelial neoplasms. Abdominal pain was the symptom most frequently experienced in patients with benign ovarian tumors. The 95 per cent confidence interval for finding malignancy in women > or = 50 yrs, ascites > 500 ml and size of ovarian tumor > 10 cm was 47-99 per cent.

Lung cavities from Pneumocystis carinii in a patient with systemic lupus erythematosus.

A patient with SLE developed pneumonia due to Pneumocystis carinii. The unusual presentation was the multiple lung cavities. There appeared to be a temporal relationship between the lung infection and reducing steroid intake in this patient.

Fulminant hepatitis, possible virus origin: a report of seventeen cases in southern Thailand.

This report described seventeen patients suffering from fulminant hepatitis and had a rapid fatal course. They were all residents of Southern Thailand. Fourteen cases were recognized between April and August which is the beginning of the rainy season in this part of the country. All age groups were found with males slightly predominant. Clinical manifestation presented with fever and later developed jaundice, convulsion and other central nervous system symptoms, liver failure and acute renal failure. Four cases had pneumonia and another three cases had pleural effusion. Laboratory investigations revealed hyperbilirubinemia, marked increase in serum transaminases, a variable alkaline phosphatase level and electrolytes derangement. HBsAg was positive in only two of fourteen cases. Blood cultures and serological examination for infections were unfruitful. Histopathological changes of the liver were classified into three types; type 1 massive hepatocellular coagulation necrosis; type 2 massive scattered hepatocellular necrosis and type 3 massive bridging hepatocellular necrosis. Electron microscopy of five cases revealed spherical viral-like particles ranging in size 70 to 90 nm in diameter, in the cytoplasm of liver cells. This is believed to be a unique type of fulminant hepatitis, possibly viral in origin, and were clinically and pathologically different from the previously described fulminant viral hepatitis.

Ovarian neoplasms in childhood and adolescents in Songklanagarind Hospital, February 1983-March 1989.

Ovarian tumors in young females under the age of 20 years in Songklanagarind Hospital from February 1983 to March 1989 were evaluated. The total number of patients was 47, with a 4.0 per cent incidence of ovarian tumors in all age groups. Germ cell tumor was the most common tumor (59.6%) and 60.7 per cent were malignant. The chief presenting symptom was abdominal distention or mass, with 17.0 per cent of torsion. Ascites and solid consistency of tumors suggested its malignant potential. Surgery was the treatment for all patients with a conservative approach in the majority of cases and supplemented with chemotherapy and/or radiotherapy in malignant cases.

Intrahepatocellular erythrocyte inclusions with hepatic sinusoidal infiltrates and splenomegaly.

We describe two patients suffering from a prolonged fever, pancytopenia, and splenomegaly. The spleen of both patients was grossly enlarged and the liver was moderately enlarged. The blood pictures were characterized by anemia and leukopenia to a severe degree, with moderate thrombocytopenia and moderate reticulocytosis. The serum transaminases were in the normal range, but the alkaline phosphatase was greatly increased. Splenectomy and wedge liver biopsies were performed on both patients. Histological findings of the spleen were variable. The histopathologic findings of the liver showed infiltration of lymphocytes, plasma cells, monocytes, and neutrophils into the dilated hepatic sinusoids. The sinusoidal infiltrate was more prominent in zones 1 and 2 and less prominent in zone 3 of the acinus. Erythrocyte inclusions that were confirmed by immunohistochemical methods were seen in the cytoplasm of hepatocytes. Electron microscopy revealed a penetration of erythrocytes into the cytoplasm of hepatocytes and caused leakage of cytoplasmic contents into Disse's spaces and sinusoids.

Intracranial tuberculoma in Thailand: report of a case and review of the literature.

A case of cerebellar tuberculoma in an adult treat at Songkhlanagarind hospital is presented. The total number of well-documented cases in Thailand is 14. The exact incidence is unknown. The epidemiology, clinical and diagnostic features are reviewed.