Can an appointment-letter intervention increase pap smear screening in Samliem, Khon Kaen, Thailand?

Our objective was to assess the efficiency of an appointment-letter intervention aimed to increase uptake of cervical cancer screening in women between 35 and 65 years of age. From January, 2007, we randomly recruited 320 women, not screened for at least 5 years, from the Samliem inner-city community, Khon Kaen, Northeast Thailand. A total of 150 women 35, 40, 45, 50, 55, 60 and 65 years of age were assigned to the intervention group according to Thai National Cancer Institute's ( TNCI) strategy. A further 170 women between 36-39, 41-44, 46-49, 51-54, 56-59 and 61-64 years of age were assigned to the control group. Baseline interviews were conducted for all women in both groups by one of the researchers in January, who also provided culturally-sensitive health education emphasizing the need for screening. Then appointment letters were sent only to women in the intervention group in February, with the last date for an appointment being March 31st. In April of 2007, immediately post-intervention, screening-coverage interviews were performed in both groups for comparison. There was a significant increase in the Pap smear screening-coverage rate in the intervention group compared with the control group (44.67% vs. 25.88%, p=0.001). Therefore, the appointment-letter intervention produced a significant effect on increasing Pap smear coverage in this group of women.

Srinagarind Hospital experience in concurrent chemoradiation for 100 patients with stage IB2 to IVA uterine cervical cancer.

PURPOSE: The aim of this study was to determine responses, acute adverse effects, and survival outcomes of women with stage IB2 to IVA treated with weekly cisplatin concurrent with pelvic irradiation at Srinagarind Hospital. MATERIALS AND METHODS: The medical records of 100 women with cervical cancer stage IB2 to IVA who were treated with weekly cisplatin 40 mg/m(2) concurrent with pelvic radiotherapy at Srinagarind Hospital between January 2003 and June 2006 were reviewed and analyzed. RESULTS: During the study period, 100 women were eligible for analysis, with a mean age of 46 years (range 24-60 years). Distribution according to International Federation of Gynecology and Obstetrics (FIGO) staging was IB2 1.0%, IIB 47.0%, IIIB 51.0%, and IVA 1.0%, respectively. A total of 86 patients received five or more cycles of weekly cisplatin. Grade 3 and 4 hematologic toxicities were found in 6.0%. The overall response rate was 97.0%. Complete response was achieved in 86 patients (86.0%) and partial response in 11 patients (11.0%). Stable disease was found in 1 patient (1.0%) but no progressive disease was found. Progression-free survival and overall survival rate were 69.6% and 96.1%, respectively. CONCLUSION: Weekly cisplatin (40 mg/m(2)) concurrent with pelvic irradiation for locally advanced cervical cancer was effective with acceptable toxicity in Thai women.

Weekly gemcitabine and cisplatin concurrent with pelvic irradiation for primary therapy of cervical cancer: report of the first seven cases in Thai women.

PURPOSE: The aim of this study was to evaluate the compliance, response, and side effects of weekly gemcitabine (125 mg/m(2)) given concomitantly with standard weekly cisplatin (40 mg/m(2)) and pelvic radiotherapy for primary treatment of cervical cancer stage IB2-IVA in the first seven Thai cases. MATERIALS AND METHODS: Weekly gemcitabine at a dose of 125 mg/m(2) was given concomitantly with cisplatin at 40 mg/m(2) for six cycles with concurrent radiotherapy in primary therapy of stage IB2-IVA cervical cancer. Radiation consisted of 5000 cGy in 25 daily fractions combined with brachytherapy to take point A to about 8600 cGy. RESULTS: Using weekly gemcitabine at a dose of 125 mg/m(2) with cisplatin at a dose of 40 mg/m(2), five of seven patients demonstrated a dose-limiting toxicity (DLT). DLTs consisted of nephrotoxicity in three cases and bone marrow suppression in two cases. Only one of seven patients could go through six cycles. All 5 living patients had a clinically complete response. CONCLUSIONS: Weekly gemcitabine at a dose of 125 mg/m(2) with cisplatin at a dose of 40 mg/m(2) given concurrently with primary pelvic radiotherapy resulted in an excellent response but unacceptable toxicities for Thai women. The trial protocol was changed by reducing the cisplatin dosage to 20 mg/m(2).

The outcomes of midline versus medio-lateral episiotomy.

BACKGROUND: Episiotomy is the surgical enlargement of the vaginal orifice by an incision of the perineum during the second stage of labor or just before delivery of the baby. During the 1970s, it was common to perform an episiotomy for almost all women having their first delivery, ostensibly for prevention of severe perineum tears and easier subsequent repair. However, there are no data available to indicate if an episiotomy should be midline or medio-lateral. We compared midline versus medio-lateral episiotomy for complication such as extended perineal tears, pain scores, wound infection rates and other complications. METHODS: We conducted a prospective cohort including 1,302 women, who gave birth vaginally between April 2005 and February 2006 at Srinagarind Hospital - a tertiary care center in Northeast Thailand. All women included had low risk pregnancies and delivered at term. The outcome measures included deep perineal tears (including perineal tears with anal sphincter and/or rectum tears), other complications, and women's satisfaction at 48 hours and 6-weeks postpartum. RESULTS: In women with midline episiotomy, deep perineal tears occurred in 14.8%, which is statistically significantly higher compared to 7% in women who underwent a medio-lateral episiotomy (p-value < 0.05). There was no difference between the groups for other outcomes (such as blood loss, vaginal hematoma, infection, pain, dyspareunia, and women's satisfaction with the method). The risk factors for deep perineal tears were: midline episiotomy, primiparity, maternal height < 145 cm, fetal birth weight > 3,500 g and forceps extraction. CONCLUSION: Midline compared to medio-lateral episiotomy resulted in more deep perineal tears. It is more likely deep perineal tears would occur in cases with additional risk factors.

Tubal abnormalities in Thai infertile females.

OBJECTIVE: To determine the prevalence of tubal abnormalities among infertile patients attending the clinic at Srinagarind Hospital. DESIGN: A descriptive study SETTING: Infertility clinic, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Thailand. SUBJECT: A total of 740 female patients presented at the infertility clinic, Srinagarind Hospital between 1 January 1998 and 31 December 2002. MATERIAL AND METHOD: A retrospective review of demographic data, baseline infertility information and the results of tubal assesments (including both hysterosalpingography and laparoscopy) were conducted. MAIN OUTCOME MEASURE: Prevalence of tubal abnormalities in infertile females being treated in the infertility clinic during the study period. RESULTS: Among the 740 patients being recruited to the present study, 533 cases (72.03%) were diagnosed with primary infertility while the rest (207 or 27.97%) came to the clinic due to secondary infertility. The mean infertile period of all study subjects was 4.68 years. Regarding the methods used for tubal assessments, hysterosalpingography (HSG), laparoscopy and combination of the two methods were conducted in 556 cases (75.14%), 30 cases (4.05%) and 154 cases (20.81%), respectively. The prevalence of tubal abnormalities demonstrated in the present study was 27.30% (202 from 740 cases). Among the 202 patients with tubal abnormalities, the pathologies detected were cornual occlusion (46.04%), combined tubal abnormalities (30.20%), distal tubal occlusion (8.42%), hydrosalpinx (3.47%), peritubal adhesion (3.96%), and other abnormalities (7.91%). Other pelvic pathologies detected from laparoscopy were endometriosis (61.49%), pelvic adhesion (24.22%), leiomyoma (12.42%), and ovarian cyst (1.87%). CONCLUSION: Tubal abnormalities were detected in over one-fourth of all infertile females being treated at Srinagarind Hospital. Further study investigating the etiologies of these abnormalities is needed since it could be the measure to bring down the occurrence of such conditions.