Trends in incidences of stomach and colorectal cancer in Khon Kaen, Thailand 1985-2004.

BACKGROUND: The life styles of Thai people are changing with westernization and this would be expected to have an impact on the prevalence of cancer and other non-communicable diseases. For planning control programmes it is necessary to monitor change over time and the present study was conducted to provide information on stomach and colorectal cancer incidence rates in Khon Kaen Cancer Registry (KKCR), established in 1984 at the Faculty of Medicine, Srinagarind Hospital, Khon Kaen University. OBJECTIVE: To assess trends in urban and rural areas of Khon Kaen province during 1985 - 2004. METHODS: Data for stomach and colorectal cancer with an ICD-O diagnosis (coding C16 , C18 - C20) from the population-based cases of the KKCR, registered between 1985 and 2004, were retrieved and incidence trends were calculated using the Generalized Linear Model method (GLM), which generates incidence-rate-based logarithms. RESULTS: The study population comprised 2,530 cases, 721 of stomach (males 449, females 272) and 1809 of colorectal (males 976, females 833) cancer. Most cases were aged 35-75 years. According to the histopathological diagnosis, the most common was adenocarcinoma with over 90 percent. The overall age-standardized incidence rates (ASR) for stomach cancer were 4.5 and 1.4 per 100 000 in males and females, respectively, during 1985-1989, 3.7 and 2.0 during 1990-1994, 3.0 and 2.2 during 1995-1999 and 3.6 and 1.8 during 2000-2004 . The respective figures for colorectal cancer were 3.3 and 2.6, 4.6 and 3.1, 5.4 and 3.5 and finally 5.8 and 5.3. In both urban and rural areas males were affected more frequently than females, although a shift was evident towards decrease in the se ratio was evident for colorectal cancers over time. DISCUSSION: The results of this study showed slight increase in the incidence of colorectal cancer in Khon Kaen province, while rates for stomach cancer remained quite stable. The findings indicate a need for continuing research in stomach and colorectal cancer epidemiology, with subdivision into particular sites within these two sections of the gut.

Outcome of in-patient trauma cases: Accident and Emergency Unit, Khon Kaen University.

OBJECTIVES: To study and report the outcome of in-patient trauma cases based on the Trauma and Injury Severity Scoring (TRISS) method and compare the outcome with the registry data from the Major Trauma Outcome Study (MTOS). MATERIAL AND METHOD: A descriptive study was performed by retrospective data collection. From 1 January 2002 to 31 December 2002, all admitted trauma patients in the Accident and Emergency Unit, Department of Surgery, Faculty of Medicine, Khon Kaen University were included in the present study. Survival analysis was completed for all of the patients. STATISTICAL ANALYSIS: TRISS method and W, M and Z-statistics (Z-score) on the basis of definitive outcome-based evaluation (DEF) method for comparing with MTOS data. RESULTS: The majorities of patients were men (76.85%) and mean age was 30.81 years. One hundred and ninety five patients (96.06%) sustained blunt trauma, the vast majority resulting from motor vehicle crashes. The observed survivors were 182, whereas the expected survivors were 183.582. The W, M and Z-statistics were -0.779, 0.843 and -0.493 respectively. CONCLUSION: Z-score -0.493 indicated no statistical difference between observed and expected survivors.

A comparison of letrozole and anastrozole followed by letrozole in breast cancer patients.

BACKGROUND: We previously studied the noninferiority of anastrozole (ANZ) versus ANZ followed by letrozole (A-LTZ) due to reimbursement policy. We found that patients with A-LTZ had better overall survival (OS) than did patients with ANZ alone. This study aimed to prove that patients with A-LTZ also had better OS than patients with letrozole (LTZ) alone. METHODS: All medical records of the breast cancer patients taking LTZ with or without ANZ between 2004 and 2013 were reviewed. All patients were divided into two groups: the LTZ group included patients treated with LTZ alone, and the A-LTZ group included patients treated with ANZ who were automatically changed to LTZ due to change of the reimbursement policy. RESULTS: From 359 cases, there were 179 cases in the LTZ group and 180 cases in the A-LTZ group. The mean age of patients in the LTZ group was 53.7 years and in the A-LTZ group was 54.2 years. The distribution of clinical stages among the LTZ group versus the A-LTZ group was 21 versus 4 (stage 1), 86 versus 116 (stage 2), 55 versus 46 (stage 3), and 17 versus 14 (stage 4), respectively. Among the LTZ patients, 63.7% took aromatase inhibitor monotherapy and 36.3% had a switching strategy, while in the A-LTZ group, 53.9% took AI monotherapy and 46.1% had a switching strategy. OS of the A-LTZ group was longer than that of the LTZ group. CONCLUSION: The patients in A-LTZ, taking ANZ followed by LTZ had better OS than those in LTZ, taking LTZ alone.

Intramural duodenal hematoma: a case report and review of the literature.

One case of intramural duodenal hematoma following blunt abdominal injury is presented. The radiographic examinations included plain abdominal films, ultrasonography, upper gastrointestinal series, computerized tomographic (CT) scan and magnetic resonance imaging (MRI). The patient was examined by gastroscopy and treated conservatively as an in-patient for 1 month. He was symptom free at the 3-month follow-up.

Effects of switching from anastrozole to letrozole, due to reimbursement policy, on the outcome of breast cancer therapy.

BACKGROUND: Endocrine therapy is one of the standard treatments for estrogen-receptor-positive breast cancer patients. Letrozole is the only aromatase inhibitor (AI) included in Thailand's essential drug list since the change of reimbursement policy in 2008, when patients had to change their AIs (other than letrozole) to letrozole. This study aimed to prove that the efficacy of anastrozole plus letrozole is not less than anastrozole alone. METHODS: All medical records of breast cancer patients taking anastrozole between 2004 and 2013 were reviewed. Some patients were initially treated with anastrozole and then changed to letrozole (A-LTZ group), whereas the other patients were continuously treated with anastrozole until completion of therapy (ANZ group). RESULTS: In a total of 180 (55.9%) out of the 322 cases, anastrozole was replaced with letrozole. The mean age of patients in the ANZ group was 54.9 years and that of those in the A-LTZ group was 54.2 years. Clinical stages (1-4) of the ANZ versus A-LTZ patients were four versus four, 76 versus 116, 46 versus 46, and 16 versus 14, respectively. ANZ patients took AI monotherapy (46.5%) and switching strategy (53.5%), while A-LTZ patients took AI monotherapy (53.9%) and switching strategy (46.1%). The overall survival (OS) of A-LTZ patients was longer than that of ANZ patients. Stage 2 and 4 patients in the A-LTZ group also had better OS than those in the ANZ group, but stage 3 patients had similar OS in both groups. CONCLUSION: Anastrozole can be replaced by letrozole any time during endocrine therapy. The patients taking anastrozole plus letrozole surprisingly seemed to have better OS than patients taking anastrozole alone.

Clinical factors predictive of PCR positive in pandemic H1N1 2009 influenza virus infection.

OBJECTIVE: Pandemic H1N1 2009 influenza virus (H1N1) has been spreading globally. Clinical features might be predictive and may be different among countries. Even though the PCR test is a confirmatory test for this viral infection, it is expensive and limited in most Thai health care facilities. We studied predictive factors of PCR positive in H1N1 suspected patients. METHODS: Consecutive patients who had influenza-like illness less than seven days and had been tested for H1N1 by the real-time PCR method between May and July 2009 were enrolled. Clinical data was collected and compared between those who had positive and negative PCR tests. RESULTS: There were 6494 patients had flu-like symptoms. Of those, 166 patients were done PCR test and 75 patients (45·18%) had positive PCR test. There were four predictors for positive PCR test including history of contact with confirmed H1N1 patients, headache, body temperature, and coryza with the adjusted odds ratio (95% confidence interval) of 2·84 (1·09-7·40), 6·25 (1·42-27·49), 1·69 (1·08-2·66), and 0·31 (0·12-0·79), respectively. CONCLUSIONS: Clinical factors can be both suggestive and protective factors for H1N1 infection. These factors may be helpful in clinical practice to assess the possibility of the H1N1 infection in people who are at risk; particularly in resource-limited health care facilities.

Lifestyle-related risk factors for stomach cancer in northeast Thailand.

BACKGROUND: Stomach cancer is not common in Thailand but the life styles of the Thai population are changing to become more Western so that information for planning control programme of stomach cancer is necessary. The highest incidence rates of this neoplasm are found in Eastern Asia, ranging from age-standardized rates of 95.5/105 (men) and 40.1/105 (women) in Yamagata, Japan to 4.1/105 (men) and 2.1/105 (women) in Khon Kaen, Northeast of Thailand. In Thailand, the estimated age-standardized incidence rates in 1993, 1996 were 4.9/105, 4.1/105 in men and 3.0/105 , 2.6/105 in women. Risk factors for stomach cancer in Thai population are unclear, but possibly include low intake of vegetables and fruits, alcohol drinking, tobacco smoking and high intake of salt. OBJECTIVE: To investigate various aspects of dietary factors, smoking, and alcohol drinking in determining risk of stomach cancer in Thai population. METHODS: A case-control study was conducted in Khon Kaen, Thailand during 2002-2006, to study the role of these factors in stomach cancer. 101 stomach cancer cases and 202 matched controls (case : control = 1:2) by sex, age (? 3 years) and region were recruited from Srinagarind Hospital and Khon Kaen Regional Hospital, in Khon Kaen Province. All of cases were histologically confirmed. Controls had a variety of diseases, the main ones being disease of the eye. Information on dietary habits, alcohol drinking and smoking were collected by a structured questionnaire, blood samples were collected for further study. RESULTS: The distribution of the general characteristics by case-control status, the distribution of age and sex were similar in cases and controls. In the final analysis, the factors that found to be higher risk but not statistically significant were long-term filter cigarette smoking (OR=1.9, 95%CI: 0.85-4.50), long-term alcohol consumption (OR=1.2, 95%CI: 0.51-2.60) and low intake of vegetables and fruits (OR=1.2, 95%CI: 0.74-1.96). A high intake of vegetable oil (OR=4.5, 95%CI: 1.00.-20.17) was found to be associated with increased risk, and similar tendencies were noted for pork oil (OR=1.4, 95%CI: 0.63-3.01) and jeaw prik (mainly chilly with plara broth) (OR=1.2, 95%CI: 0 .76- 2.01). CONCLUSION: Our study confirmed protective effects of a high intake of fruits and vegetables against stomach cancer development and showed a high intake of sauces to increase risk of stomach cancer as in other countries in Asia.