Restriction fragment length polymorphism (RFLP) analysis of HLA class II genes in Thais
การวิเคราะห์ความหลากหลายโดยวิธี RFLP ของยีน HLA class II ในคนไทย

Pantip Nantanawoot, Graduate Student, Department of Biomedical Sciences, Faculty of Medicine
Dasnayanee Chandanayingyong, Department of Transfusion Medicine, Faculty of Medicine, Mahidol University
Sa-nga Pattanakitsakul, Department of Microbiology, Faculty of Medicine, Mahidol University
Suvina Ratanachaiyavong, Department of Biomedical Sciences, Faculty of Medicine
Grant : Government Budget
Presented : 13th Annual Academic Meeting, Faculty of Medicine, PSU, Hat Yai, Songkhla, 20-22 August 1997
Key words : restriction fragment length polymorphism (RFLP), DNA-restriction fragment length polymorphism (DNA-RFLP), HLA class II genes polymorphism
The DNA-restriction fragment length polymorphism (DNA-RFLP) analysis was employed to study the HLA class II genes polymorphism in a selected hundred Thais who have been previously serotyped. Based on the HLA class II RFLP assignment in Caucasoid using the TaqI and MspI restriction digests in conjunction with the HLA-DRDQ and DQprobes, almost all of the HLA class II allogenotypes were successfully assigned. Three variants of HLA-DR RFLP patterns were identified namely, DR16b, DR12b and DR13c. The DR16b defined by the 13.0, 1.7 and 1.65 kb fragments was differed from the DR16a by having a smaller upper fragment size (i.e. 13.00 instead of 14.8 kb). The DR12b, the rare variant previously described in Caucasoid as DRx 3 (defined by the 11.1, 4.2 and 4.1 kb fragments) was found to be the common DR12 among Thais. The DR13c, characterized by the 13.0, 6.5 and 4.1 kb fragments was the RFLP pattern firstly described in this study. Though the majority of RFLP patterns found in Thais was similar to those previously reported in Caucasoid, their HLA DR/DQ/DQ linkage association was rather different, particulary for the DR15/DR16b, DR12b, DR14b and DR72 RFLP genotypes. In addition, the DNA-RFLP allogenotyping is not only correlated with the serological typing but also highly correlated with the PCR-SSO/SSP typing results. In conclusion, HLA DNA-RFLP allogenotyping could be used for HLA-DR/DQ allogenotyping in Thais. The method could offer a higher accuracy than the standard method of serological micro-cytotoxicity test.

The quality of drinking water in PSU's Hat Yai Campus : The nitrate/ nitrite level and bacterial counts
คุณภาพน้ำดื่มในวิทยาเขตหาดใหญ่มหาวิทยาลัยสงขลานครินทร์ : ปริมาณไนเตรตไนไตรต์ และจำนวนจุลินทรีย์

Pilaipak Chumak, Department of Biomedical Sciences, Faculty of Medicine
Kusumarn Noipha, Department of Biomedical Sciences, Faculty of Medicine
Yaowalak Pongpitak, Department of Pathology, Faculty of Medicine
Suvina Ratanachaiyavong, Department of Biomedical Sciences, Faculty of Medicine
Grant : Faculty of Medicine, PSU
Presented : 13th Annual Academic Meeting, Faculty of Medicine, PSU, Hat Yai, Songkhla, 20-22 August 1997
Key words : drinking water, water, nitrate/nitrite level, Prince of Songkla University
The changing of agricultural pattern and industrialization have had an impact on the accumulation of nitrate in the environment. It is interest to investigate that how safe is the drinking water in our PSU's Hat Yai campus. Water samples were collected from 6 different sites of cooling drinking water supply. Three samples were collected from each site; 1 from the prior inlet and 2 from the outlet of the water filtering device. Twelve samples of the bottled water from three different local companies including PSU's and Hat Yai municipal's tap water were also investigated. The measurement of nitrate/nitrite level in the water samples was based on the ISO 6635 method. The microbiological contamination was determined by the number of bacterial count (CFU/ml). The results of our study revealed that the lowest nitrate level in the drinking water came from the 3 locally producing bottled water company (ranging from 0.103-1.914 mg/L) followed by the cooling drinking water supply at the gymnesium, cafeteria and dormitories (ranging from 2.372-6.098 mg/L). To our surprize, the filtered drinking water in the hospital canteen which got its supply from the Hat Yai Municipal's Tap water Department contains the highest nitrate/nitrite level (9.553/0.238 mg/L). However, these nitrate/nitrite level are still within the acceptable range for drinking water issued by WHO. On the microbiological aspect, no E. coli was found in any of the samples in our study. However, two strains of pathogenic bacterias were identified in 2 out of eight samples of bottled water from two companies. In addition, many strains of non-pathogenic bacterias were found more than 500 CFU/ml in 50% and 33.3% of sampling from the bottled and the cooling drinking water, respectively. In conclusion, the amount of the nitrate/nitrite in the drinking and the tap water in our campus was under the standard control level. Though our drinking and the tap water supply are free from E. coli, two strains of pathogenic bacterias were identified in the bottled water and significant numbers of non-pathogenic bacterial strains were frequently detected. We suggested that it would be safer for the consumer especially those who have immune deprivation to boil the water before drink.

Analysis of the thyrotropin receptor as a candidate gene in familial Graves' disease
การศึกษาวิเคราะห์ยีน TSH-receptor ในครอบครัวของผู้ป่วย Gravesž disease

Nicholas de-Roux, Hormone and Reproduction Research (INSERM U135), University of Paris, France
Dennis C. Shields, Department of Genetics, Trinity College, Dublins, Ireland
Michale Misrahi, Hormone and Reproduction Research (INSERM U135), University of Paris, France
Suvina Ratanachaiyavong, Department of Biomedical Sciences, Faculty of Medicine
Alan M. McGregor, Department of Medicine, King's Collage Hospital School of Medicine and Dentistry, London, UK
Edwin Milgrom, Hormone and Reproduction Research (INSERM U135), University of Paris, France
Published : J Clin Endocrinol Metab, 1996; 81(10) : 3483-6
Key words : TSH-receptor, Graves' disease, family study
Familial clustering of Graves' disease indicates a genetic etiology. Searches for genetic factors additional to the known human leukocyte antigen (HLA) association have implicated the gene for the TSH receptor (TSHR). We analyzed the linkage and association among three recently described microsatellite markers within the TSHR introns in Graves' disease in large multiple affected Welsh and English families (223 members, 44 affected individuals). Linkage analysis under a dominant model strongly rejected the hypothesis that TSHR is linked to Graves' disease in these families (lod score = -4.53). More detailed analyses also failed to provide evidence for linkage; these included combined segregation and linkage analysis, correction for HLA-DR3 status, allowance for the levels of thyroid autoantibodies in unaffected pedigree members, consideration of a recessive model for the disease, and linkage disequilibrium between disease and marker alleles. We also considered the possibility of a genetic heterogeneity of Graves' disease and thus analyzed separately the different families with a similar result. Although these results cannot eliminate a minor role of the TSHR gene locus in the genetics of Graves' disease, they argue against it being a major genetic determinant in this pathology.

A preliminary analysis of bio-chemotherapy (PIAF regimen) in advanced hepatocellular carcinoma
Teerha Piratvisuth, Asst. Prof., Gastroenterology and Hepatology Unit, Department of Medicine, Faculty of Medicine
Wiwatana Thanomkiat, Department of Radiology, Faculty of Medicine
Presented : International Symposium on Viral Hepatitis and Perspectives from The ASEAN Region, 10-12 September 1997, Bangkok, Thailand
Key words : hepatocellular carcinoma, bio-chemotherapy, PIAF
The majority of hepatocellular carcinoma (HCC) patients have advanced stage of the disease at the time of their presentation who generally survive less than 4 months after diagnosis. We treated 9 patients who had advanced HCC with systemic Bio-chemotherapy (Cisplatinum 80 mg/m2 D1, Adriamycin 40 mg/m2 D1, 5-FU 500 mg/m2 D2-4 and Interferon alpha-2b 5 MU/ m2 D1-4) intravenouly every 4 weeks. All patients received GM-CSF for promoting recovery of suppressed bone morrow. Two patients lost follow-up after receiving only one cycle of Bio-chemotherapy, then only 7 patients were analysed.
Results : There were 7 male patients with median age of 54 year old of ages (range : 33- 68). The median tumor size was 12.5 cm (range : 8.5-19.5). The patients were able to receive Bio-chemotherapy 2 to 7 cycles (median = 3 cycles). 1 of 7 patients (14.3%) had good response with 97.4% decrease in tumor volume after seven cycles of therapy. He is still alive 15 months after diagnosis. 1 of 7 patients (14.3%) had partial response (more than 50% reduction of tumor volume) and another 3 patients (42.9%) had stable disease (tumor volume decreased less than 50% or increased less than 25%). The tumor volume increased more than 25% in two patients (28.6%)which classified as progressive disease. Median survival was 7.5 months when three patients who lost follow-up at 3 month were counted as death. By the time of analysis, two patients are still alive 15 months and 6 months after diagnosis. 3 of treated patients (42.9%) had improved their performance status assessed by Karnofsky's score. The therapy was withdrawn due to drug intolerance in two patients (28.6%).
Conclusion : From our preliminary study, the Bio-chemotherapy may have potential benefit in management of advanced HCC.

Treatment of experimental ischemia/reperfusion injury with S-adenosylmethionine
J. Bruce Dunne, Institute of Liver Studies, King's College Hospital, London
Teerha Piratvisuth, Asst. Prof., Department of Medicine, Faculty of Medicine
Roger Williams, Institute of Liver Studies, King's College Hospital, London
J. Michael Tredger, Institute of Liver Studies, King's College Hospital, London
Published : Transplantation, 1997, 63(4) : 500-6
Key words : Ischemia, reperfusion injury, S-adenosylmethionine
Triple therapy with S-adenosylmethionine (SAM) (given to the donor animal, included in University of Wisconsin solution [UW], and added to the reperfusing medium) has been shown to reduce the sequential cold and warm ischemia/reperfusion injuries characteristic of the liver transplantation procedure. To clarify the actions of SAM during different stages of ischemia/reperfusion, we have compared its benefit in five dosage regimens, using perfused rat livers after sequential periods of 24 hr cold and 20 min rewarming ischemia. When added only to UW, the presence of SAM throughout ischemia improved hepatic blood flow by 26% after 15 min of reperfusion versus no treatment (2.32ฑ0.18 vs. 1.84ฑ0.11 ml/min/g liver, P<0.05). SAM also improved blood flow by 23% during the 3-hr perfusion overall (P<0.05). Oxygen consumption and the release of purine nucleoside phosphorylase (PNP) were decreased (both P<0.05). When added to both UW and the perfusate, SAM additionally increased bile production at 15 min (7.14ฑ1.21 vs. 2.31ฑ0.74 mg/h/g liver, P<0.01). By pretreating the liver donor with SAM in vivo, and including it in the preservation and reperfusing media, it was possible to prolong and amplify the benefits on blood flow (P<0.001) and bile production (P<0.05) and to sustain glucose uptake (P<0.01). An acute exposure to SAM, when used in saline to flush UW from the graft before reperfusion, increased blood flow at 15 min (by 68%) and over a 3-hr period (both P<0.001), but no indices of metabolic activity were improved. Oxygen consumption and PNP release were both decreased (P<0.05). When added to the perfusate (present throughout reperfusion), SAM increased blood flow at 15 min (58%) and over a 3-hr period (P<0.01 in both cases). Net glucose uptake was increased (P<0.05), whereas oxygen consumption (P<0.001) and PNP release fell (P<0.05). Actions of SAM achieved acutely and over the intermediate- and long-term all seem to underlie its benefits in reducing ischemia/reperfusion injuries.

Findings and benefit of liver biopsies in 46 patients infected with human immunodeficiency virus (HIV)
Teerha Piratvisuth, Asst. Prof., Department of Medicine, Faculty of Medicine
Pisud Siripaitoon, Department of Medicine, Faculty of Medicine
Hutcha Sriplung, Asst. Prof., Department of Pathology, Faculty of Medicine
Presented : Annual Scientific Meeting 1996 of The Gastroenterological Association of Thailand, 28-31 January 1997, Bangkok, Thailand
Key words : liver biopsy, human immunodeficiency virus (HIV), histology
Liver biopsies were performed in 46 HIV-positive patients at Songklanagarind Hospital, between May 1995 and November 1996. The liver histology and culture, patient characters, labo- ratory parameters and extra-hepatic histology and culture were analysed. There were 41 males (89.13%) and 5 females (10.87%) age from 21 to 44 year old of ages (median = 31). 78.26% of them were employee, farmers and fishermen whose most common risk factor was sexual contact with prostitute (80.43%) suggesting low education and misunderstanding results to high risk behavior of getting HIV infection. The most common liver involvement was tuberculosis (32.61%) and the rests were AFB-negative granuloma, histoplasmosis, cryptococcosis, penicillosis, viral hepatitis, fatty liver, drug induced hepatitis and nonspecific hepatitis [17.39, 13.04, 13.04, 8.70, 4.35, 4.35, 2.17 and 10.87% respectively (3 of them had dual infection)] . Liver biopsy showed definite diagnosis in 41 cases (89.3%). 8 Granulomas with negative AFB stain, of which 6 were positive AFB stain from lymph nodes and sputum (5 and 1 respectively). So, overall hepatic tuberculosis would be 50%. 11 of 15 cases of hepatic tuberculosis had lymphadenopathy and all of them were positive AFB stain from lymph node aspirations or biopsies. There were 14 patients (30.43%) who had concomitant different opportunistic infections of extra-hepatic sites. There were no statistical significant different of patient characters, laboratory parameters including CBC, LFT, PT/PTT and ultrasonography of abdomen between the group of liver histologies.
Conclusions : Tuberculosis was the most common liver involvement in HIV-positive patient in Southern Thailand. Liver biopsy was very useful in making diagnosis in HIV-positive patient with abnormal LFT. Liver involvement could be different from extra-hepatic disease, particularly in a case of non-tuberculosis. Lymph node aspiration or biopsy was useful in a case of suspicious of tuberculosis who had lymphadenopathy and abnormal LFT.

Validity of patient address in hospital medical records for patient follow-up system : Radiotherapy division, Songklanagarind Hospital
ความถูกต้องของที่อยู่ผู้ป่วยตามเวชระเบียนในการติดตามผู้ป่วยรังสีรักษา โรงพยาบาล สงขลานครินทร์

Temsak Phungrassami, Asst. Prof., Department of Radiology, Faculty of Medicine
Grant : Faculty of Medicine, PSU
Published : Songkla Med J 1997, 15(2) : 53-57
Key words : patient address, medical records, validity, quality control, Songklanagarind Hospital
Objective : To evaluate the validity of patient address in medical records for mail patient follow-up system.
Design : Descriptive study.
Materials and Methods : During April 22 to August 31, 1996, 273 new patients were completely treated. The address they plan to stay after the treatment were asked. These addresses were compared with the addresses in hospital medical records.
Results : 18.3% difference between two sources of patient address was detected. The majority of cases due to changing of patient addresses without updating data.
Conclusions : To improve the data validity in mail follow-up system, the service division should ask additional information about the actual addresses from the patients instead of using only the data in hospital medical records.

Opinions of heads of health center toward health center management in Pattani Province
ความคิดเห็นของหัวหน้าสถานีอนามัยต่อการบริหารจัดการสถานีอนามัยในพื้นที่จังหวัดปัตตานี

Suchart Hatethong, Fourth year medical student, Department of Community Medicine, Faculty of Medicine
Rangsant Ratantpant, Fourth year medical student, Department of Community Medicine, Faculty of Medicine
Prawat Kijtamanulkij, Fourth year medical student, Department of Community Medicine, Faculty of Medicine
Yindi Sae Kow, Fourth year medical student, Department of Community Medicine, Faculty of Medicine
Sarawadee Seekitikul, Fourth year medical student, Department of Community Medicine, Faculty of Medicine
Suchada Sae Heng, Fourth year medical student, Department of Community Medicine, Faculty of Medicine
Atiporn Wasinanukorn, Fourth year medical student, Department of Community Medicine, Faculty of Medicine
Thawan Benjawang, Asst. Prof., Department of Community Medicine, Faculty of Medicine
Presented : 13th Annual Academic Meeting, Faculty of Medicine, PSU, Hat Yai, Songkhla, 20-22 August 1997
Key words : health center, head of health center, health center management
The objectives of this research is to study obstacles and factors which cause problems in health center management in Pattani Province. The study design is cross sectional. 124 heads of health centers are included in the study population. They are asked to express their opinions concerning aspects of health center management. Data collected from questionaire and direct interview are analysed using Epi Info V.5
The result data is 55.7 % obtained from the population. Most are female, married, Muslim and Pattani natives with Certificate in Public Health education. They have been promoted to be heads of health centers in the province for less than 4 years. Each center averagely has 3 personnel which they would prefer more. The health service management problems are curative services which inadequte medicines and vaccines are the main causes. Lack of health personnel is the obstacle of maternal and child health service and dental health care. Insufficient budget is responsible for nutritional program. Problems in family planning service, drug addiction prevention and immuni-zation are usually caused by lack of community participation. Extrinsic factor that affects health center management is economic status of the villagers, although the factors of religion, weather, geographic setting of the centers and traditional therapy do not. Most of the subjects need knowledge development in management, medicine and public health. They also need motivation and salary increase.
Results of laminectomy for the treatment of degenerative lumbar spinal stenosis
ผลการรักษา degenerative lumbar spinal stenosis โดยการผ่าตัด laminectomy

Theerasan Kiriratnikom, Asst. Prof., Department of Orthopaedic Surgery, Faculty of Medicine
Kuntanop Titirungrung, Department of Orthopaedic Surgery, Faculty of Medicine
Published : Songkla Med J 1997, 15(3) : 81-85
Key words : Laminectomy, lumbar spinal stenosis
The results of decompressive laminectomy in degenerative lumbar spinal stenosis and its effects on degeneration of spine and stability of spine in 30 patients in Songklanagarind Hospital were studied. The average age at time of follow up was 63.65 years (range, 45-79 years), the average duration of symptoms to surgery was 22.3 months (range, 1-120 months) the average duration of follow up was 7.07 years (range, 5-11 years). We found that the results of decompressive laminec- tomy were excellent in 44.66%, good in 36.66%, unchange in 13.33% and worse in 3.33%. The most degeneration of spine was L3-4 level and the second most degeneration was L4-5 level; spinal instability was 40%. No correlation was found between stability and result of surgery; and no correlation was found between stability and age of patient.
In conclusion, long term result of decompressive laminectomy in degenerative spinal stenosis was good. However, instability and increase degeneration of spine may occur in the future at the level of surgery.

Knowledge, attitudes and practices in menopause of women in southern Thailand
ความรู้ เจตคติ และการปฏิบัติตนในวัยหมดระดูของสตรีภาคใต้

Thitima Suntharasaj, Asst. Prof., Department of Obstetrics and Gynecology, Faculty of Medicine
Published : Songkla Med J 1996, 14(3) : 101-107
Key words : knowledge, attitudes, practices, menopause
Objective : To survey knowledge, attitudes and practices in menopausal period of women in Southern part of Thailand.
Design : Descriptive study
Materials and methods : The questionnaires were given to women who had visited the gynecological clinic between January and June 1995.
Results : 126 women responded to the questionnaires. The mean age was 35.8 years. Eighty- two percent of them were married and 88.6% were in reproductive age. Most of them (38.9%) were government services. The mean income per month was below 5,000 baht in 44.4%. Only 19.2% were informed about menopause and hormonal replacement therapy (HRT) and 23.8% of them had received this knowledge from doctors and nurses. About 89% knew that menopause was a natural sequence but only 30.2% responded correctly that menopause can be caused by the removal of the uterus and both ovaries. These women (62.7%) knew that instability of mood and insomnia were the menopausal symptoms and 38.1% of knew about hot flash. However, only 15.9% and 7.1%, respectively mentioned about osteoporosis and cardiovascular diseases. Their knowledge about practices and selfcare after menopause was high level; 88.9% showed that they should exercise regularly, 81.7% knew to take more calcium from vegetables, milk or other food, 72.2% and 70.6%, respectively abstained from alcohol and smoking. 90.5% would have on annual check-up and 30.2% would decrease or abstain from sexual activities.
Concerning HRT, 20.6% of them agreed that every menopausal woman should take hormone. Most of them (92.9%) would consult doctors and 79.4% would have a check and blood tests before taking HRT. After menopause, 42.1% intended to receive HRT. Most of them (35.3%) prefered taking pills in somedays, and 23.5% would take HRT by injection every 2-3 months. 54.5% objected to have withdrawal bleeding with HRT. 60.3% to 81% of these women had no or incomplete knowledge about the side effects of HRT.
Conclusions : The knowledge, attitudes and practices in menopausal period of women living in Southern Thailand were unsatisfactory and inadequate, especially their knowledge of HRT and the adverse effects of menopause.

Prevalence of p53 protein expression in squamous cell cervical carcinoma and clinicopathological correlation
ความชุกของโปรตีน p53 ในเซลล์มะเร็งปากมดลูกชนิดสแควมัสและความสัมพันธ์กับ ลักษณะทางพยาธิวิทยาคลินิก

Tippawan Liabsuetrakul, Department of Obstetrics and Gynecology, Faculty of Medicine
Saibua Chichareon, Asst. Prof., Department of Obstetrics and Gynecology, Faculty of Medicine
Supaporn Suwiwat, Asst. Prof., Department of Pathology, Faculty of Medicine
Chavaboon Dechsukhum, Department of Pathology, Faculty of Medicine
Grant : Department of Obstetrics and Gynecology and Songklanagarind Hospital
Published : Songkla Med J 1997, 15(3) : 93-100
Key words : p53 protein, squamous cell cervical carcinoma
Objective : To study the prevalence of p53 protein expression in squamous cell cervical carcinoma by immunohistochemistry, and to correlate p53 protein expression to clinical findings and histological parameters.
Design: Descriptive study
Materials and Methods : One hundred sixty-four paraffin-embedded cervical tissues demon-strating squamous cell carcinoma at the Department of Anatomical Pathology, Songklanagarind Hospital from January 1,1993 to December 31,1994 were stained by a monoclonal antibody, Pab 1801 for p53 protein expression. The samples were evaluated for age at diagnosis, age at marriage, duration of marriage, tumor size, stage, cell type, nuclear polymorphism, and mitoses. Association between p53 protein expression and these factors was analyzed by chi-square test and logistic regression.
Results : The prevalence of p53 protein expression in the samples was 45.7 percent (95% CI = 38-53%). In a logistic model which included age at marriage, duration of marriage and number of mitoses, marriage at age < 20 years was associated with a significantly increased risk of p53 positivity (OR = 4.02, 95%CI = 1.64-9.86) but evidence for association with duration of marriage and number of mitoses was insufficient. Age at diagnosis, tumor size, stage, cell type, and nuclear polymorphism were not shown to be associated with p53 protein expression.
Conclusion : The prevalence of p53 protein expression as revealed by immunohistoche- mistry of squamous cell cervical carcinoma specimens in this study was 46 percent.The p53 protein expression was significantly associated with age at marriage after adjustment for duration of marriage and number of mitoses was made.

An enzyme-linked immunosorbent assay to detect PCR products of the rfbS gene from serogroup D salmonellae : A rapid screening prototype
John M. Luk, Asst. Prof., Department of Surgery, University of Hong Kong, Queen Mary Hospital, Hong Kong
Urairat Kongmuang, Department of Pathology, Faculty of Medicine
Raymond S.W. Tsang, National Laboraty for Enteric Pathogens, Bureace of Microbiology, LCDC, Ottawa, Ontario, Canada
Alf A. Lindberg, Prof., Pasteur Merieux Connaught, 69280 Marcy L' Etoile, France
Grant : Swedish Medical Research Council
Published : J Cli Micro, 1997, 35(3) : 714-718
Key words : DIG, PCR, LPS, salmonella, EIA
We describe a digoxigenin-based enzyme-linked immunosorbent assay (DIG-ELISA) following a PCR to detect the amplified lipopolysaccharide rfbS gene as a means for rapid screening of serogroup D salmonellae in stool specimens. For pure bacterial cultures, the sensitivity of the PCR DIG-ELISA was approximately 10 bacteria. In the presence of stool materials, the salmonellae were first isolated by an immunomagnetic separation technique with an 09-specific monoclonal antibody, MATy-09, followed by PCR and DIG-ELISA. The corresponding sensitivity was about 10 to 100 bacteria. To evaluate the assay performance clinically, 203 stool samples from patients with diarrhea were subjected to the routine culture techniques and the PCR ELISA method with overnight enrichment. The conventional culture method identified 145 salmonellae (31 serogroup B, 27 serogroup C, 82 serogroup D, and 5 serogroup E isolate) and 58 non-salmonella bacteria. The PCR ELISA method correctly identified all 82 serogroup D salmonellae (A405 by ELISA, 2.54ฑ0.74) but was negative for the other Salmonella serogroups (A405 0.26ฑ0.08; n = 63) and non-Salmonella isolates (A405 0.16ฑ 0.04; n = 58). In order to obtain a visible result, the assay takes approximately 6 h (PCR, 4 h; ELISA, 2 h), along with brief enrichment cultivation of the samples (from 4 to 16 h). Thus, the PCR DIG-ELISA offers a fast, accurate, semiquantitative means of detecting infectious agents such as salmonellae, and future robotic automation is possible.

Biocompatibility evaluation of pulsed electro-magnetic field stimulator (PEMFS) for bone-reunion by using cell culture test system
การประเมินอันตรายทางชีวภาพของเครื่องกระตุ้นกระดูกด้วยคลื่นแม่เหล็กไฟฟ้า โดยวิธี ทดสอบกับเซลล์ที่เพาะเลี้ยง

Uraiwan Jinorose, Department of Pathology, Faculty of Medicine
Peerapong Prinyaroj, Asst. Prof., Department of Orthopedic Surgery and Physical Medicine, Faculty of Medicine
Saranetra Waikakul, Assoc. Prof., Faculty of Medicine, Siriraj Hospital, Mahidol University
Kittipat Tantraroongroj, Asst. Prof., Department of Electrical Engineering, Faculty of Engineering
Wattana Varirat, Department of Orthopedic Surgery and Physical Medicine, Faculty of Medicine
Grant : NECTEC
Published : Research Report
Key words : pulsed electromagnetic field, biocompatibility evaluation, cell culture test system
Biocompatibility evaluation of a home-made Pulsed Electro-Magnetic Field Stimulator (PEMFS) for bone-reunion was performed on cell cultures test system during Feb, 1995-May, 1997. Eight cases of normal amniotic cell cultures were used for one month treatment test. Each of duplicated cultures was placed in PEMF at 1.5, 10, and 20 mV/cm (test system) and in no PEMF (control). The observation of cell morphology, cell density, mitotic number and karyotypes were evaluated. No significant difference between the tests and the control was resulted but it was noticeable that the different PEMF strength were shown to have a dose-related effect. To evaluate the effect in a longer treatment, ten cases of lymphoblastoid cell lines (LCL) were used. Two cases were set up the experimental conditions as the previous ones but were placed in PEMF for four months. Other eight cases were set for comparing only between the PEMF at 1.5 mV/cm and the control. Evaluation of PEMF effect in LCL test system was done by using sister chromatid exchange (SCE) technique. SCE is a chromosome evidence or location where sister chromatids were broken and reunion. The SCE figure using for genotoxicity evaluation is the average number of SCE count per mitosis (SCE/cell) (general normal cell has a SCE/cell ~5-10). From 4-month treatment of PEMF at 1.5, 10, and 20 mV/cm in two LCL cases, the SCE/cell values obtained were 8.7, 10.9 and 13.6 respectively comparing to the control, the value was 7.6. Due to various technical and biological variations, the SCE/cell data obtained were unable to test statistically for significance of the difference. However, these SCE/cell values were also shown to be a dose-related effect. The effect at 1.5 mV/cm was acceptable in a normal range. For the test comparing between PEMF at 1.5 mV/cm and the control in eight LCL cases, the SCE/cell values obtained were 10.8 and 9.9, respectively which were also in a normal range. Conclusively, the biocompatibility evaluation of PEMFS by using cell culture test system resulted that the difference between PEMF at 1.5 mV/cm and the control was not significantly detected but the effect of PEMF in a dose-related manner was obvious.

Prenatal chromosome analysis in 1104 cases at Songklanagarind Hospital : during January 1991-1997
การตรวจวินิจฉัยโครโมโซมก่อนคลอดใน 1104 ราย ณ โรงพยาบาลสงขลานครินทร์ : ระหว่าง มกราคม 2534-2540

Uraiwan Jinorose, Department of Pathology, Faculty of Medicine
Somkhae Puangpetchr, Department of Pathology, Faculty of Medicine
Penkhae Kongtong, Department of Pathology, Faculty of Medicine
Jariya Khaimahn, Department of Pathology, Faculty of Medicine
Rawiwan Rattanapreugsachart, Department of Obstetrics and Gynecology, Faculty of Medicine
Roengsak Leetanaporn, Asst. Prof., Department of Obstetrics and Gynecology, Faculty of Medicine
Thitima Suntharasaj, Asst. Prof., Department of Obstetrics and Gynecology, Faculty of Medicine
Oonjai Kor-anantagul, Assoc. Prof., Department of Obstetrics and Gynecology, Faculty of Medicine
Pornprot Limprasert, Department of Pathology, Faculty of Medicine
Vicharn Panich, Prof., Department of Pathology, Faculty of Medicine
Grant : Government Budget
Published : Research Report
Key words : prenatal chromosome analysis, quality and efficiency assessment, laboratory service, Songklanagarind Hospital
Prenatal chromosome analysis is a procedure in the prevention of chromosome defect birth. During January 1991 to May 1997 at Songklanagarind Hospital, we rountinely obtained amniotic fluid samples in a total of 1104 cases. The amniotic cultures and chromosome harvest were performed by using in situ technique. Karyotypes were analysed from GTG-banded chromosomes. This report presented an assessment of chromosome laboratory service. Since 1991 the specimens were referred from two to nine hospitals in six provinces in southern Thailand. Average of annual referral increasing rate was 51%. Most of the indications was advanced maternal age at > 35 years (88.6%), followed by previous child anomaly (7.4%) and fetal anomaly (1.7%). Gestational ages were mostly at 16-18 weeks (67.2%). The earlier age at 14-15 weeks was also obtained (3.4%). Success rate of karyotype analysis was 99.1%. Rate of reporting time in 7-14 days was 80.4%. Chromosome abnormalities were detected in 4.1% (45/1089); autosomal trisomies 26 cases, structural aberrations 10 cases and sex chromosome aberrations 9 cases. Cost-benefit was calculated to be 36,300.- baht for detection of one abnormal case. In conclusion, our service quality and efficiency were assessed to be very reasonable for prenatal chromosome disorder prevention.

Non-0 : 1 Vibrio cholera septicemia in thalassemic patients
การติดเชื้ออหิวาตกโรคชนิด Non-0 : 1 ในกระแสเลือด ในผู้ป่วยธาลัสซีเมีย

Vichai Laosombat, Assoc. Prof., Department of Pediatrics, Faculty of Medicine
Pornpimol Preakprasert, Asst. Prof., Department of Pediatrics, Faculty of Medicine
Malai Wongchanchailert, Asst. Prof., Department of Pediatrics, Faculty of Medicine
Published : Southeast Asian J Trop Med Public Health, 1996, 27 : 411-3
Key words : Non-0 - 1, Vibrio cholera, septicemia, thalassemia major, splenectomy
We reported two cses of Non-0 : 1 Vibrio cholera septicemia in splenectomized beta thalassemia major. The first case was 17 year-old whose spleen was removed at the age of 14 years. He had fever and diarrhea for 1 day and was brought to the hospital with cardiac arrest and did not respond to resuscitation. Hemoculture grew Vibrio cholera Non 0 : 1. The second case was 10 year-old. Splenectomy was done at the age of 5 years due to hypersplenism. He had fever, vomiting abdominal pain and watery diarrhea for 1 day. Physical examination revealed moderate pallor, mild icteric sclerae, mildly distended abdomen, generalized tenderness and guarding at right lower quadrant of abdomen. Rectal examination showed normal sphinctor tone, no abnormal mass and no definite point of tenderness. The diagnosis of peritonitis was made and explore laparotomy was done on that day. The operative findings showed inflammation at the terminal ileum and appendix. Turbid fluid without fowl smell was found in the abdominal cavity showing numerous of white blood cells. Stool and blood culture grew Vibrio cholera Non-0 : 1 and Non-0 : 139. He responded very well with ampicillin, gentamicin and flagyl.

Clinical, hematological and molecular features in Thais with - Malay/ - thalassemia and - Malay/Hb E
ลักษณะทางคลินิก, ค่าทางโลหิตวิทยาและความผิดปกติระดับโมเลกุลในคนไทยที่เป็น เบต้า-มาเลย์/เบต้า-ธาลัสซีเมียและเบต้ามาเลย์และฮีโมโกลบิน อี

Vichai Laosombat, Assoc. Prof., Department of Pediatrics, Faculty of Medicine
Malai Wongchanchailert, Asst. Prof., Department of Pediatrics, Faculty of Medicine
Benjamas Sattayasevana, Department of Pediatrics, Faculty of Medicine
Chamnong Nopparatana, Department of Pathology, Faculty of Medicine
Published : Inter J Hematol, 1996, 64(suppl 1) : S82
Key words : beta thalassemia, clinical, hematological, molecular, - Malay
The clinical, hematological and molecular features of 22 patients with - Malay/ - thalas- semia, 10 patients with - Malay/Hb E and relatives from 26 unrelated families are reported. Patients with - Malay/Hb E had very mild clinical symptoms with normal growth and development and did not require any blood transfusion. Twenty percent of patients have mild hepatosplenomegaly. Patients with homozygous - Malay had mild clinical symptoms and some cases required blood transfusion especially in cases with autoimmune hemolytic anemia. About 62% of patients with homozygous - Malay had mild hepatosplenomegaly. Patients with - Malay/IVS 1 nt 5 (G-C), - Malay/codon 17, - Malay/IVS 1 nt 1, - Malay/41 (-C) and - Malay/3.5 kb del had severe clinical symptoms with classical physical appearance of thalassemic disease.

The prevalence of hepatitis C virus antibodies in thalassemic patients in the south of Thailand
ภูมิต้านทานต่อเชื้อไวรัสตับอักเสบ ซี ในผู้ป่วยธาลัสซีเมียในภาคใต้ของประเทศไทย

Vichai Laosombat, Assoc. Prof., Department of Pediatrics, Faculty of Medicine
Malai Wongchanchailert, Asst. Prof., Department of Pediatrics, Faculty of Medicine
Malida Pornpatkul, Asst. Prof., Department of Pathology, Faculty of Medicine
Kittiphom Worachat, Department of Pathology, Faculty of Medicine
Aranya Wiriyasateinkul, Department of Pediatrics, Faculty of Medicine
Grant : Faculty of Medicine, PSU
Published : Southeast Asian J Trop Med Public Health, 1997, 28(1) : 149-153
Key words : hepatitis C, thalassemia, south of Thailand
One hundred and one thalassemic patients, 37 with homozygous - thalassemia, 60 with -thalassemia Hb E and 4 with hemoglobin H disease with Hb Constant Spring were studied. Twenty-four of 101 (23.8%) tested positive for antibody to hepatitis C virus (anti HCV). Anti-HCV positivity among those with homozygous - thalassemia was significantly higher than anti-HCV positivity among the beta-thalassemia Hb E group. The number of blood transfusions received by anti-HCV positive thalassemic patients was significantly higher than that by anti-HCV negative thalassemic patients. Ninety per cent of anti-HCV positive thalassemic patients had persistently or intermittently raised SGPT levels.

Molecular basis of beta-thalassemia in Thailand
ความผิดปกติระดับโมเลกุลของธาลัสซีเมียชนิดเบต้าในประเทศไทย

Vichai Laosombat, Assoc. Prof., Department of Pediatrics, Faculty of Medicine
Chamnong Nopparatana, Department of Pathology, Faculty of Medicine
Malai Wongchanchailert, Asst. Prof., Department of Pediatrics, Faculty of Medicine
Aranya Wiriyasateinkul, Department of Pediatrics, Faculty of Medicine
Grant : HRH Princess Chulabhorn Research Institute
Published : Singapore Paediatr J, 1995, 37 : 148-152
Key words : beta thalassemia, molecular basis
Twenty four mutations of beta thalassemia have been characterized in Thailand. The five most common mutations are codons 41/42 (-CTTT), codon 17 (A-T), IVS 1 nt 5 (G-C), IVS 2 nt 654 (C-T) and ATA nt-28 (A-G) account for 78%. Each part of the country has a different set of common mutations. In Bangkok, the central part of Thailand, the four most common mutations (codons 41/42, codon 17, IVS 2 nt 654 and ATA nt-28) account for 76%. In Changmai, the northern part of Thailand, the most common mutations are the same as those found in Bangkok except the IVS 2 nt 654 which consist of 83%. In Khonkaen, the northeastern part of Thailand, four common mutations [codons 41/42, codon 17, codons 71/72 (+A), IVS 2 nt 654] account for 90%. In Songkhla, the southern part of Thailand, five common mutations (codons 41/42, IVS1 nt 5, codon 19 (A-G), codon 17, IVS1 nt 1 (G-T) and ATA nt-28 account for 78%. The frequencies of IVS-1 nt 5 (G-C) and codon 19 (A-G) in the south of Thailand are higher than those found in other parts of the country. The mutation that found in Thai Muslims are IVS 1 nt 5, IVS 1 nt 1, codon 19, codons 41/42, ATA nt-28 and 3.5 kb deletion. The five most common mutations in Thai Chinese patients are codons 41/42, ATA nt-28, IVS 2 nt 654, codon 17 and codons 71/72 respectively.

Endometrial cancer in Songklanagarind Hospital
มะเร็งเยื่อบุโพรงมดลูกในโรงพยาบาลสงขลานครินทร์

Virach Wootipoom, Department of Obstetrics and Gynecology, Faculty of Medicine
Published : Songkla Med J 1997, 15(2) : 43-47
Key words : endometrial cancer, cancer, Songklanagarind Hospital
A review of 102 patients with endometrial cancer between 1988-1996 at Songklanagarind Hospital showed that the patients features usually presented with abnormal uterine bleeding, and mainly found at the age between 51-60 years. Only 31.4% were nulliparous and almost half of the patients had a body weight more than 50 kilograms. About 26% of the patients had menopause at the age of 50 years or more. Most of the patients were diagnosed by fractional curettage and the common pathological findings were grade I endometrioid adenocarcinoma. More than half of the patients were in stage I by clinical staging.

Impacts of training of village health volunteers in reduction of morbidity from acute respiratory infections in childhood in southern Thailand
Virasakdi Chongsuvivatwong, Assoc. Prof., Epidemiology Unit, Faculty of Medicine
Ladda Mo-suwan, Assoc. Prof., Department of Pediatrics, Faculty of Medicine
Korpchoot Tayakkanonta, Asst. Prof., Department of Community Medicine, Faculty of Medicine
Kannika Vitsupakorn, Department of Community Medicine, Faculty of Medicine
Rogan McNeil, Clinical Trials Center, Macquarie, Australia
Grant : Ford Foundation
Published : Southeast Asian J Trop Med Public Health, 1996, 27(2) : 333-338
Key words : education, health volunteer, respiratory tract infection, prevention
In 1990, the Ministry of Public Health of Thailand started a five-year education program on management of cases with acute respiratory infection (ARI). The objective of this-study was to test whether such a program could reduce the average number of sick days of the target children. 30 villages in the study district were randomly allocated into 15 study and 15 control villages. A 2-day training workshop for village health volunteers from the study villages was conducted. The cohort of children age below 5 years in the two areas were followed-up for 19 week in the peak season of the disease. Among the 664 and 649 target children with 67,083 and 67,984 child-days observed in the study and the control villages, 71 and 41 children, respectively, were free from any episode. The preventive odds ratio of treatment adjusted for age and village effects = 0.88, 95% (CI 0.4-1.95). The median of the average sick periods in the individuals were 27 and 34 days, respectively. After adjusting for age, episodes/month and locality, the ratio of average sick days between children in the study and control villages was 0.89 (95% CI 0.76-1.05) or 11% shorter duration without statistical significance. The adjusted odds ratios of visiting the health center, private clinics, the community hospital and provincial hospital were 0.95 (95% CI 0.69-1.25), 1.43 (95% CI 0.98-2.11), 2.01 (95% CI 1.06-3.82) and 4.71 (95% CI 1.50-14.8), respectively. The training program thus had rather little impact on morbidity of the disease but tended to promote utilization of higher level of health services by the affected children Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand. PMID-0009279998.

Predictors for the risk of hookworm infection : experience from endemic villages in southern Thailand
Virasakdi Chongsuvivatwong, Assoc. Prof., Epidemiology Unit, Faculty of Medicine
Suparb Pas-Ong, Walailuk University
Don McNeil, Prof., Clinical Trials Center, Macquarie, Australia
Alan Geater, Epidemiology Unit, Faculty of Medicine
Mapaosis Duerawee, Epidemiology Unit, Faculty of Medicine
Grant : WHO Country Budget
Published : Trans R Soc Trop Med Hyg, 1996, 90(6) : 630-633
Key words : hookworm infection, epidemiology, defecation, southern Thailand
To assess the role of defaecation pattern in predicting the level of risk for hookworm infection in southern Thailand, 4 villages in different geographical settings in endemic areas were studied. Close observation and stool examinations for hookworm were carried out. The first village was used for exploring the risk factors for hookworm infection. The resultant statistical model was then tested using the other 3 villages. Only 23-40% of the sample regularly defaecated in a latrine. The pattern of defaecation did not differ between the sexes, but was associated with age and site of residence. In the first village, the following variables were not statistically significant : sex, age, level of past education, household income, having neighbouring houses within 20 m, latrine availability, site of defaecation. The only statistically significant protective factor was shoe wearing, which showed an exposure-outcome severity relationship. Similar results were obtained in the other 3 villages. These results refute the protective effect of latrine use on the individual user, who may still get infection from the faeces of other community members. Promotion of shoe-wearing, which provides individual protection, should be an important supplementary strategy for hookworm control programmes in such areas.

A study on disabled children in a rural community in southern Thailand
Sukajan Pongprapai, Asst. Prof., Department of Orthopedic Surgery and Physical Medicine, Faculty of Medicine
Korpchoot Tayakkanonta, Asst. Prof., Department of Community Medicine, Faculty of Medicine
Virasakdi Chongsuvivatwong, Assoc. Prof., Epidemiology Unit, Faculty of Medicine
Peter Underwood, Assoc. Prof., Department of General Practice, Faculty of Medicine, University of Western Australia, Australia
Grant : AIDAB
Published : Disabil Rehabil, 1996, 18(1) : 42-46
Key words : disabled person, service accessability, health service need and demand, southern Thailand
This study reports the findings of a survey undertaken in 1990/1991 in a poor and predominantly Malay-Muslim community in southern Thailand. The aims were to estimate the prevalence and type of childhood disability and to examine some of the ways in which this disability can be prevented and treated. The result showed that the overall prevalence rate of child disability was 1.2%. Most disabled children were suffering from limb impairment, followed by muteness, deafness, and mental retardation. Nearly half of the children had never been treated or assessed by a modern rehabilitation service, two-thirds would be expected to gain significant improvement from assessment and appropriate referral, and one-third of the disabilities could have been prevented using the application of modern technologies. Cost, inaccessibility and strong cultural beliefs explained the failure of the children's families to bring them to the service. The study indicates several ways in which disability could be better prevented, detected or treated in rural Thailand.

Prolonged standing and physical exertion at work during pregnancy increases the risk of preterm birth for Thai mothers
Skulrat Ritsmithchai, Epidemiology Unit, Faculty of Medicine
Alan Geater, Epidemiology Unit, Faculty of Medicine
Virasakdi Chongsuvivatwong, Assoc. Prof., Epidemiology Unit, Faculty of Medicine
Grant : Prince of Songkla University
Published : J Occup Hlth, 1997, 39 : 217-222
Key words : preterm birth, work activity, prolonged standing, physical exertion, case-control study
Background - Women in Thailand are increasingly engaged in work which requires pro- longed standing and physical exertion. Previous reports are inconclusive regarding the association between prolonged standing during pregnancy and preterm birth. The current study was conducted to test this association.
Study objective - To determine whether prolonged standing and/or physical exertion during pregnancy are associated with preterm birth.
Study design - Matched case-control study.
Setting - Hat Yai Hospital, Songkhla, Thailand, between May 1 and November 30, 1993. Subjects -
Cases : 223 mothers of singleton preterm infant.
Controls : 223 mothers of singleton term infant giving birth following the case and matched with case on age (within 5 years age group) and parity.
Measurement variables - Indicators of work activity and other potential risk factors including socioeconomic status, maternal stress, medical complications, and obstetric problems were ascertained through the medical records and by questionnaire-based interview administered to each eligible subject immediately after delivery. Conditional logistic regression was employed for multivariate analysis.
Results - After adjustment for pregnancy complications, previous preterm birth, physical exertion and physical exercise, a significant association between prolonged standing longer than 3 hours per day throughout gestation and preterm birth was demonstrated, with an odds ratio of 4.10 (95% CI 1.29, 13.10) when compared with no prolonged standing. Physical exertion throughout pregnancy was also an independent risk factor of preterm birth (OR= 2.91 95% CI 1.29, 6.58).
Conclusions - Standing longer than 3 hours per day at work throughout pregnancy, or lifting more than 10 kg weight at work, significantly increased the risk of preterm birth.

Impact of prenatal care on perinatal mortality
Nguyen Trong Hieu, Hung Vnong Hospital, Ho Chi Minh City, Vietnam
Virasakdi Chongsuvivatwong, Assoc. Prof., Epidemiology Unit, Faculty of Medicine
Grant : WHO
Published : Southeast Asian J Trop Med Public Health, 1997, 28(1) : 55-61
Keywords : Vietnam, prenatal care, perinatal mortality
This study aimed to estimate the perinatal mortality rate (PMR) in Ho Chi Minh City, Vietnam, and to assess the association between perinatal death (PD) and prenatal care (PC). During January 1st to December 31st, 1992, among 4,809 births ascertained from 22 communes randomly selected in two areas, urban and rural, of Ho Chi Minh City, 48 still births and 66 early neonatal deaths were recorded, resulting in a weighted PMR of 25 (95% confidence interval : 20-29) per thousand. Major causes of PD were prematurity 33%, congenital malformation 15%, perinatal asphyxia 12%, perinatal infection 11%, birth injury 4%, others 8% and unknown 16%. From the whole sample, a nested case-control study was conducted on 103 cases (all the mothers whose infants died) and 309 controls (selected among the mothers of surviving infants) to assess the relationship between PD and prenatal care (PC). During unconditional logistic regression, starting prenatal care (PC) within the 1st trimester was associated with a lower risk of PD, giving an odds ratio of 0.11 (95% CI : 0.02-0.61), whereas having 4 to 8 visits gave an odds ration of 0.15 (95% CI : 0.03-0.67). It is concluded that early onset of prenatal care and having four to eight visits provide significant protection against perinatal mortality.

Fecundity in Thai and European regions : results based upon waiting time to pregnancy
Pichaya Tuntiseranee, Department of Community Medicine, Faculty of Medicine
Jorn Olsen, Prof., Aarhus University, Aarhus C, Denmark
Virasakdi Chongsuvivatwong, Assoc. Prof., Epidemiology Unit, Faculty of Medicine
Somnuek Limbutara, Hat Yai Hospital, Songkhla
Grant : DANIDA
Published : Human Reproduction (accepted for publication on 2 October 1997)
Key words : fecundity, reproductive health status, time-to-pregnancy
Very little is known about the frequency of subfecundity in different cultures, ethnic groups and regions. In order to fill this gap, the European Study Group on Infertility and Subfecundity established data on the prevalence of infertility and subfecundity in five European regions. In this study, the comparison of fecundity among 4035 Caucasian women from five European countries was expanded to 1496 Asian women from southern Thailand. Fecundity was measured by using "time to pregnancy", the time women took to conceive after stopping contraceptive methods. The Thai primigravida women had shorter time to pregnancy than European women whereas time to pregnancy was found to be longer among Thai multigravida, although not statistically significant. The study illustrated that cross culture comparison of subfecundity is difficult despite the use of a common protocol and questionnaire due to differences in use of contraceptive methods and a different concept of pregnancy planning. The time to pregnancy distribution was not outside the variation found within the European samples.

Granulomatous reaction in peripheral T-cell proliferative disease : A case report
รายงานผู้ป่วยโรคเพอริเฟอรัล ที-เซลล์ โปรลิเฟอเรทิฟ ที่พบปฏิกิริยาการอักเสบ แบบแกรนนูโลม่า

Winyou Mitarnun, Assoc. Prof., Department of Pathology, Faculty of Medicine
Published : J Med Assoc Thai, 1997, 80(12) : 795-798
Key words : metabolic acidosis, T-cell lymphocytes, peripheral T-cell proliferative diseases
A 52-year-old male presented with a prolonged fever, anemia, weight loss, hepatospleno-megaly, 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.

Hepatic peripheral T-cell lymphoma : A spectrum of liver pathology and clinical correlation
เฮปาติค เพอริเฟอรัล ที-เซลล์ ลิมโฟมา : ลักษณะทางจุลพยาธิวิทยาของตับ และอาการทางคลินิก

Winyou Mitarnun, Assoc. Prof., Department of Pathology, Faculty of Medicine
Suparp Kietthubthew, Department of Stomatology, Faculty of Dentistry
Supaporn Suwiwat, Asst. Prof., Department of Pathology, Faculty of Medicine
Published : J Med Assoc Thai, 1997, 18(4) : 219-232
Key words : hepatic peripheral T-cell lymphoma, liver pathology
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 twoof 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.

Nursing incident reports of medication errors in Songklanagarind Hospital
รายงานอุบัติการการให้ยาผิดพลาด ในฝ่ายบริการพยาบาล โรงพยาบาลสงขลานครินทร

Worawan Nuaklong, Nurse, Department of Nursing Service, Faculty of Medicine
Sununta Youngvanichset, Nurse, Department of Nursing Service, Faculty of Medicine
Nitaya Kraiwong, Nurse, Department of Nursing Service, Faculty of Medicine
Nitaya Panchamedithee, Nurse, Department of Nursing Service, Faculty of Medicine
Wallapa Thakan, Nurse, Department of Nursing Service, Faculty of Medicine
Kosom Mookachornpunt, Nurse, Department of Nursing Service, Faculty of Medicine
Lawan Charoenwannapong, Nurse, Department of Nursing Service, Faculty of Medicine
Grant : Songklanagarind Hospital Foundation
Published : Songkla Med J 1997, 15(3) : 75-80
Key words : medication errors, incident reports, nursing medication error, Songklanagarind Hospital
A retrospective study was carried out of nursing medication error incident reports. The objectives of this research were to study causes, severity, management, and prevention of medica- tion errors among nurses. The sample was 61 incident reports of medication errors in nursing service of Songklanagarind Hospital between 1988 to 1994. The instrument used in this study was medication error form which composed of 3 parts.
We found 68.9% of drug errors, 16.4% of blood transfusion errors, and 14.7% of intravenous infusion errors. The majority of incidents (63.9%) were happened in day shift (8.01 am-4.00 pm) in surgical and pediatric wards (19.7%). Most of nurses (61.9%) who performed medication errors had nursing experiences 0-3 years. Causes of medication errors were performance deficiencies (78.7%), knowledge deficiencies (7.8%), and both (11.5 %). The severity of medication errors were moderate (70.5%), severe (21.3%), and mild (8.2%). The management of the impacts were observation, and other optimal care. The suggestion of prevention were improving personnel performance and work system.

Dependent care agency in caretakers of children with thalassemia
ความสามารถของผู้ดูแลในการดูแลเด็กโรคธาลัสซีเมีย

Worawan Nuaklong, Nurse, Department of Nursing Service, Faculty of Medicine
Grant : Faculty of Medicine, PSU
Published : Research Report
Key words : dependent care agency, caretaker, thallasemia
The purposes of this research are (1) to investigate the dependent care agency in caretakers of children with thalassemia; (2) to study the relationship between caretakers' age, the length of caretakers' education, caretakers' income, the number of caretakers' children, and the length of caretaking and dependent care agency in caretakers of children with thalassemia; (3) to identify predictive indications of dependent care agency in caretakers of children with thalassemia. The study has been based on Orem's Nursing Theory. On the basis of certain criteria, eighty-one caretakers of OPD children with thalassemia receiving medical treatment at the Paediatrics- Hematology Clinic, Songklanagarind Hospital were chosen as the subjects of the study. The subjects were asked to respond to a questionnaire designed by Fildey (Fildey, 1986), addressing dependent care agency in caretakers.
The findings of the study suggest that the average dependent care agency in the caretakers under investigation is relatively high. It is worth nothing that the lowest dependent care agency lies in areas where the caretakers are not well informed or unknowledgeable, resulting in inability to properly take care of the children's health. Interestingly, it is found that the caretakers' highest dependent care agency is in areas related to their affection towards the children. Age, the number of the caretakers' children, and the length of caretaking are found to be negatively related to the caretakers' dependent care agency while there is a significantly positive relationship between the length of the caretakers' education and their dependent care agency. Basic conditioning factors which can significantly predict the dependent care agency in caretakers are the length of the caretakers' education and their age, explaining 15.3 percent of the variance of the dependent care agency (P < .05).
The findings of the study support part of Orem's hypothesis, which states that basic conditioning factors affect the dependent care agency incaretakers. In addition to the findings, the researcher has also suggested some applications of the findings to health care practice, nursing education and further research.