Case report: Increased viral receptor expression associated with high viral load and severe pneumonia in a young patient infected with 2009 H1N1 influenza a with no pre-existing conditions.

A case of unusually high severity of influenza pneumonia leading to acute respiratory distress syndrome and death was investigated. This was a previously a healthy 28-year-old man with no underlying conditions, admitted to a hospital during the first wave of influenza pandemic in Thailand in July 2009. He had experienced high fever and influenza-like illness for 5 days before coming to the hospital. He developed acute respiratory distress syndrome and expired on day 7 after admission. In comparison to three other cases of influenza pneumonia in the same outbreak with known risk factors for severe influenza, such as pregnancy and diabetes mellitus, a much higher viral load was detected in the lungs of this patient despite antiviral treatment. In agreement with the high viral load, the lung specimens from this patient, but not the other three patients, showed a high expression of α-2,6-linked sialic acid by lectin staining. The gene responsible for the synthesis of this sialic acid was also found to be upregulated. The data indicated overexpression of the viral receptor as a potential mechanism for severe disease in some patients.

Topical steroid is effective for the treatment of phimosis in young children.

BACKGROUND AND OBJECTIVE: The purpose of the present study was to evaluate the effects of non-operative treatment using topical steroids on phimosis in infants and young children. MATERIAL AND METHOD: Between June 2003 and May 2005, the parents of the children with phimosis were instructed to apply and massage the phimotic skin with 0.05% betamethasone valerate cream twice daily for 2 months. During non-operative treatment, the patients whose parents were not satisfied with the results would undergo circumcision. RESULTS: Ninety-two phimotic boys with an average age of 32.62 months (range, 1 to 144 months) were enrolled for steroid application. Of the 92 patients, 79 (85.9%) were satisfied with their results. The other 13 patients whose outcomes clinically improved but did not satisfy their parents finally underwent circumcision. Histologically, circumcised skins of patients initially receiving steroid therapy revealed markedly interstitial edema and slightly increased vasculature. There were no systemic side effects or significant dermal atrophy in the present study. CONCLUSION: Topical steroid treatment for phimosis is successful in young children. This therapeutic approach is a safe, easy, and inexpensive alternative to circumcision.

Anorectal malignant melanoma: report of two cases from Buddhachinnaraj Hospital.

Anorectal malignant melanoma is a rare disease and has a uniformly poor prognosis. The following are two reported cases from Buddhachinaraj Hospital. A 55-year-old and a 65-year-old female patients presented with rectal bleeding. Large anorectal masses with regional lymph node involvement were detected initially. They exhibited different histological features which were atypical round cell resembling lymphocytes or were small cell appearance and spindle cell appearance similar to sarcoma. The diagnosis was confirmed by expression of S100 protein and HMB45. Abdominoperineal resection (APR) was the treatment of choice in both patients. The former case died in the fourth month after diagnosis because of distance metastasis and congestive heart failure. The latter case is receiving postoperative adjuvant therapy.

Primary peritoneal adenosarcoma with stromal overgrowth and fetal type cartilage: a case report and literature review.

Primary peritoneal adenosarcoma with sarcomatous overgrowth and fetal-type cartilage presented in a 48-year-old female patient is described. The tumor seems likely to have derived from the pelvic peritoneum, wheareas the uterus, ovaries and tubes were uninvolved. It was composed of benign-appearing glands and a sarcomatous component showing cartilaginous differentiation. The extrauterine adenosarcomas were reported in other sites, e.g. cervix, ovary, fallopian tube, bladder, and peritoneum. This case was the ninth case of the primary peritoneal adenosarcoma in the English literature and the first report in Thailand.