Survival and prognostic factors of patients with primary fallopian tube cancer receiving adjuvant paclitaxel and carboplatin chemotherapy.

AIM: To determine the survival and prognostic factors of patients with primary fallopian tube cancer (PFTC) who had been treated with paclitaxel and carboplatin chemotherapy. METHODS: The records of patients with PFTC who had been treated between 2002 and 2010, identified through the report of Chiang Mai University Hospital, were reviewed. All patients had pathological materials initially reported or reviewed by a gynecologic pathologist before initiation of treatment. RESULTS: Thirty patients met the inclusion criteria. Median age was 51 years. Serous adenocarcinoma was observed in the majority of patients (76.7%). Approximately 46% of patients were in stage I­II. The 5-year progression-free survival (PFS) for all patients was 37.2%. The 5-year PFS was 75.0% for stage I, 51.4% for stage II and 18.5% for stage III. Median PFS of the entire cohort was 26.0 months with a 95% confidence interval (CI) of 18.7­33.3 months. This rate was 18.5 months (95% CI, 6.7­35.6) for stage III whereas it was not reached for patients of stage I­II. Serous histology and stage were noted to be significant independent predictors of PFS with an adjusted hazards ratio of 7.54 (95% CI, 1.34­42.4) and 6.19 (95% CI, 1.59­24.08), respectively. CONCLUSION: The 5-year PFS of the whole cohort was 37.2% with a median survival of 26 months. International Federation of Gynecology and Obstetrics stage and histological subtype were a significant independent factor for predicting PFS.

Predictive value of negative cone margin status for risk of residual disease among women with cervical adenocarcinoma in situ.

OBJECTIVE: To determine the value of negative cone margins in predicting residual disease in women with adenocarcinoma in situ (ACIS). METHODS: Data were retrospectively analyzed from 60 women with ACIS who underwent conization at Chiang Mai University Hospital between March, 1998, and December, 2010. Negative margin status was defined as absence of neoplastic epithelium at all margins, coupled with presence of normal cervical epithelium. The association between the incidence of residual lesions and cone margin status was analyzed via χ(2) or Fisher exact test. RESULTS: When adjusted for age and completeness of visualization of the cervical squamocolumnar junction during colposcopy, women who underwent loop electrosurgical excision procedure were 4 times more likely to have positive cone margins than those who underwent cold-knife conization (95% CI, 1.13-16.43). Residual disease was not found among 26 women who had negative cone margins, but was observed in 17 (65.4%) of 26 women with positive cone margins (P<0.001). CONCLUSION: Women with ACIS who had negative cone margins were found to have a notably low risk of residual disease. Adherence to the standard method of cone sampling and criteria for negative margin status might contribute to a high predictive value of negative cone margins.

Preceding cervical cytology in women with high-grade squamous intraepithelial lesion.

OBJECTIVE: To evaluate the preceding cervical cytology and factors leading to cytohistologic discrepancy in women with high-grade squamous intraepithelial lesion (HSIL) histology. METHODS: The records of women who were found to have histologically confirmed HSIL without any associated invasive and glandular lesions, at Chiang Mai University Hospital between January 2005 and May 2009, were reviewed. Cytohistological discrepancy was defined as HSIL histology preceded by low-grade squamous intraepithelial lesion (LSIL) and atypical squamous cells of undetermined significance (ASC-US) smears. RESULTS: The records of 436 HSIL cases were reviewed. The mean age of the women was 45.0 ± 9.3 years. The preceding smear abnormalities were as follows: 275 (63.1%) with HSIL; 50 (11.5%) with atypical squamous cells cannot exclude high-grade squamous intraepithelial lesion (ASC-H); 40 (9.2%) with squamous cell carcinoma; 35 (8.0%) with LSIL; 32 (7.3%) with ASC-US; and 4 (0.9) with glandular abnormality smears. Overall, the rate of cytohistological discrepancy was 15.4% (95% CI 12.1-19.1%). The small size of HSIL and presence of coexisting LSIL are significant independent predictors for cytohistologic discrepancy. CONCLUSION: Approximately 15% of HSIL cases are under-diagnosed by cytology. Significant factors leading to cytohistologic discrepancy are lesion size and the presence of coexisting LSIL.

Patient satisfaction with the service at Menopause Clinic, Maharaj Nakorn Chiang Mai Hospital.

OBJECTIVE: To evaluate patient satisfaction of service at the Menopause Clinic and to identify factors affecting patient satisfaction. MATERIAL AND METHOD: Cross sectional descriptive study was conducted at the Menopause Clinic, Maharaj Nakorn Chiang Mai hospital. Three hundred twenty six subjects were included. The questionnaire consists of two parts, demographic and patient satisfaction. The patient satisfaction was evaluated in five aspects. RESULTS: The overall patient satisfaction level was good (mean 4.2 +/- 0.71). The satisfactions about service behavior quality of care and health information were in excellent level (mean 4.29 +/- 0.69, 4.25 +/- 0.65, and 4.26 +/- 0.69, respectively). The satisfaction about clinic facilities/conveniences and medical expense were in good level (mean 3.83 +/- 0.79 and 3.87 +/- 0.75). There are three variables that could affect patient satisfaction: Occupation and level of education affected satisfaction in medical expense aspect (p < 0.001 and p < 0.05) and number of visits affected the clinic facilities/convenience aspect (p < 0.05). CONCLUSION: Some patient characteristics affected the patient satisfaction. However, system and structure of service in different setting hospitals are of concerned.

Symptoms of estrogen deficiency in nursing personnel in Maharaj Nakorn Chiang Mai Hospital.

OBJECTIVE: To determine the self-reported prevalence and severity of climacteric symptoms of estrogen deficiency in nursing personnel working in Maharaj Nakorn Chiang Mai Hospital during the year 2002. DESIGN: Cross-sectional descriptive study. SETTING: Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University. SUBJECT: Six-hundred and eight nursing personnel, including professional nurses and practical nurses, aged 40-60 years, working in Maharaj Nakorn Chiang Mai Hospital. MATERIAL AND METHOD: The same sets of questionnaires were provided and distributed to each subject. Subjects had self assessment under individual decision with written consent and data was prospectively collected. The data were analyzed using software SPSS version 10 and presented in frequencies and percentage. MAIN OUTCOME MEASURE: The prevalence and severity of each climacteric symptoms. RESULTS: Five-hundred and seventy five of 608 subjects (94.6%) responded to the questionnaires, 62.6% of them were in normal reproductive period, while the remainder (37.4%) were in the menopausal period. The latter group was divided into 4 subgroups of pre/peri-menopause, post menopause, surgical menopause and premature ovarian failure. The prevalence of climacteric symptoms was systematically classified as follows, vasomotor instability 40.7% (severe cases, 5.4%), psychosomatic symptoms 50.9% (severe cases, 3.9%), lower urinary tract symptoms 29.1% (severe cases, 2.4%), lower genital tract symptoms 34.0% (severe cases, 2.7%), and other symptoms 50.7% (severe cases, 4.3%). The first five most common symptoms were as follows, forgetful 84.1% (severe cases, 7.9%), myalgia 74.3% (severe cases, 10.6%), anxious 71.0% (severe cases, 5.3%), tired 70.0% (severe cases, 4.1%), headache 68.3% (severe cases, 8.3%). The least common symptom was needle pain, the prevalence was 19.7% (severe cases, 1.3%). The overall prevalence of women using hormone replacement therapy was 13.1%, only 8.9% were current users. CONCLUSION: Focusing on each symptom of climacteric symptoms, the authors found high prevalence in psychosomatic symptoms and other symptoms such as forgetful, myalgia, anxious, tired and headache. While the classic symptom (vasomotor instability) was found to be low in the present study which was different from the previous reports. This may be due to the racial or cultural and educational factors among different populations.

Mammographic change in hysterectomized women on 0.625 mg/day of conjugated equine estrogen.

OBJECTIVE: To compare the mammographic change before and after conjugated equine estrogen (CEE) 0.625 mg/day in hysterectomized women. DESIGN: A retrospective descriptive study. SETTING: Menopause clinic, Maharaj Nakorn Chiang Mai Hospital. MATERIAL AND METHOD: Dedicated mammograms and demographic data of 66 women who had been hysterectomized were reviewed. Post surgical menopausal women were recruited for the study. CEE 0.625 mg/day was given just after the operation. The baseline mammography was done before the initiation of HRT and they were compared with the follow-up mammography performed 12-18 months after therapy. The degree of increase in mammographic density was classified as follows: minimal changes (10-25% increased density), moderated change (26-50% increased density), and marked change (> 50% increased density). RESULTS: The mean age +/- SD was 47 +/- 4.3 years old. The mean duration +/- SD of hormone used was 13.5 +/- 2.4 months. The most common indication for operation was myoma uteri (43.9%). On the baseline mammogram, 5 cases had cystic change and one case had a small circumscribed solid mass suspected to be fibroadenoma. On the follow-up mammograms, there were 2 cases (3.0%) detected to have significantly increased breast density. One was moderately increased and the other was markedly increased, but cystic changes and one fibroadenoma were not changed. CONCLUSION: CEE has little effect on increased mammographic density.