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Rongthongaram W, Plumworasawat S, Charakorn C, Lertkhachonsuk A, Satitniramai S. Overtreatment in the see-and-treat approach for high-grade squamous cervical cytology. Eur J Obstet Gynecol Reprod Biol X 2023; 19:100205. [PMID: 37753518 PMCID: PMC10518508 DOI: 10.1016/j.eurox.2023.100205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 05/05/2023] [Accepted: 06/06/2023] [Indexed: 09/28/2023] Open
Abstract
Objectives To evaluate overtreatment with the 'see-and-treat' approach in patients with high-grade squamous cervical cytology, and identify the clinical factors associated with overtreatment. Study design Patients with high-grade squamous intra-epithelial lesion (HSIL) cytology undergoing colposcopy and loop electrosurgical excision procedure (LEEP) in a single visit or the 'see-and-treat' approach from January 2005 to December 2019 were reviewed retrospectively. The overtreatment rate and complications following LEEP were explored. Results In total, 220 cases were identified. The overtreatment rate was 11.4%, and surgical complications were haemorrhage (n = 3, 1.36%) and infection (n = 9, 4.09%). On univariable analysis, factors associated with overtreatment were current cytological result and colposcopic impression. On multi-variable analysis, current cytological result of non-HSIL compared with HSIL/cancer, and colposcopic diagnosis of low-grade lesion or normal compared with high-grade lesion or cancer had adjusted odds ratios of 13.81 [95% confidence interval (CI) 1.23-155.20; p = 0.033] and 3.58 (95% CI 1.32-9.74; p = 0.013), respectively. Conclusions The overtreatment rate with the 'see-and-treat' approach was 11.4%. Independent factors associated with overtreatment were current cervical cytological result of non-HSIL, and low-grade or normal colposcopic diagnosis.
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Affiliation(s)
- W. Rongthongaram
- Department of Obstetrics and Gynaecology, Division of Gynaecologic Oncology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - S. Plumworasawat
- Department of Pathology, Division of Anatomical Pathology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - C. Charakorn
- Department of Obstetrics and Gynaecology, Division of Gynaecologic Oncology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - A.A. Lertkhachonsuk
- Department of Obstetrics and Gynaecology, Division of Gynaecologic Oncology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - S. Satitniramai
- Department of Obstetrics and Gynaecology, Division of Gynaecologic Oncology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Chantasartrassamee P, Kongsawatvorakul C, Rermluk N, Charakorn C, Wattanayingcharoencha R, Lertkhachonsuk AA. Preoperative clinical characteristics between uterine sarcoma and leiomyoma in patients with uterine mass, a case-control study. Eur J Obstet Gynecol Reprod Biol 2022; 270:176-180. [DOI: 10.1016/j.ejogrb.2022.01.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 01/10/2022] [Accepted: 01/12/2022] [Indexed: 12/12/2022]
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Mathaveechotikul P, Charakorn C, Lertkhachonsuk AA, Lekskul N, Wilailak S, Nagaviroj K. Perspective and conception of Thai gynecologic oncologists in palliative care. Ann Palliat Med 2021; 10:10293-10312. [PMID: 34412494 DOI: 10.21037/apm-21-1418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 08/06/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Palliative care evidently increases the quality of life among the patients with advanced cancer. However, there are very few studies on the aspects of the physicians' ideas, conceptions, or the effects of their ideas in palliative care quality, especially in Asian countries. This study aimed to evaluate the conception and perspective on palliative care in Thai gynecologic oncologists. METHODS The online survey was distributed to all certificated Thai gynecologic oncologists. The survey could be accessed via working email address, hyperlink, or QR code during May 2020 and January 2021. A 5-point Likert scale captured the perspectives and concepts of palliative care. The association between respondents' characteristics and their choices of content in palliative care, together with their decision making in specified clinical scenarios was analyzed. RESULTS A total of 207 completed surveys from 320 Thai gynecologic oncologists were received (64.69% participation rate). They prospected a willingness to give the advices to both patients and their families (85.50%), and strongly agreed to introduce palliative care in any stage of cancer at the time of diagnosis (75.80%). The numbers of their palliative cases per year were 5-20 (57.97%) and the palliative care teams were available in their hospitals. They decided to offer early palliative care and do-not-resuscitate, especially for the elders, or patients with advance stages, or recurrent disease. We found that gynecologic oncologists who previously experienced a palliative care training did not show any difference in decision making in specified clinical scenarios, compared with who did not. CONCLUSIONS Thai gynecologic oncologists responded to the conceptions and perspectives in palliative care. Their concepts of early and willingness to offer a palliative care especially in the elders, advanced stage, or recurrent patients were proven, regardless of the experience in palliative care training.
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Affiliation(s)
- Panida Mathaveechotikul
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Chuenkamon Charakorn
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Arb-Aroon Lertkhachonsuk
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Navamol Lekskul
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Sarikapan Wilailak
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Kittiphon Nagaviroj
- Department of Family Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Insin P, Vitoopinyoparb K, Thadanipon K, Charakorn C, Attia J, McKay GJ, Thakkinstian A. Prevention of venous thromboembolism in gynecological cancer patients undergoing major abdominopelvic surgery: A systematic review and network meta-analysis. Gynecol Oncol 2021; 161:304-313. [PMID: 33563489 DOI: 10.1016/j.ygyno.2021.01.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 01/20/2021] [Indexed: 01/10/2023]
Abstract
OBJECTIVE Although thromboprophylaxis is recommended to reduce death and disability from venous thromboembolism (VTE), it remains underused due to a perceived risk of bleeding, especially in major abdominopelvic surgical patients. METHODS We conducted a systematic literature review to identify all eligible randomized controlled trials (RCTs), searching MEDLINE and Scopus databases through November 25, 2020. RCTs published in any language were eligible if they studied in gynecological cancer patients undergoing major abdominopelvic surgery and assessed efficacy of mechanical and pharmacological interventions. Studies with insufficient data for pooling or those comparing different doses/schedules of interventions were excluded. Outcomes of interest were composite VTE (ie, deep vein thrombosis or pulmonary embolism) and major bleeding. Relevant data were extracted for direct and network meta-analyses. Risk ratios (RR) and 95% confidence interval (CI) were estimated and the best intervention probability calculated for each outcome. This study was registered with PROSPERO (CRD42019145508). RESULTS We identified 1990 studies; 20 RCTs (4970 patients) were eligible. The overall risk of bias was of some concern. In direct meta-analyses, antithrombins were superior to unfractionated heparin in preventing composite VTE (RR 0.69; 95% CI 0.48-0.99), with no difference detected in the rate of major bleeding for any pairwise comparison. In network meta-analyses, graduated compression stockings plus low-molecular-weight heparin (LMWH) was top-ranked for prevention of composite VTE, whereas sequential compression devices (SCD) ranked second, after no treatment, for major bleeding. In a clustered ranking plot, SCD plus LMWH provided optimal balance between efficacy and safety. CONCLUSIONS SCD plus LMWH might be safe and effective in VTE prevention following gynecological cancer surgery. However, the patient's bleeding risk should be considered to balance the risk and benefit of treatment.
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Affiliation(s)
- Putsarat Insin
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI road, Thung Phaya Thai, Ratchathewi District, Bangkok 10400, Thailand; Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Rajavithi Hospital, 2 Phayathai Road, Ratchathewi Districts, Bangkok 10400, Thailand
| | - Kasidin Vitoopinyoparb
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI road, Thung Phaya Thai, Ratchathewi District, Bangkok 10400, Thailand; Department of Surgery, Rajavithi Hospital, 2 Phayathai Road, Ratchathewi Districts, Bangkok, 10400, Thailand
| | - Kunlawat Thadanipon
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI road, Thung Phaya Thai, Ratchathewi District, Bangkok 10400, Thailand
| | - Chuenkamon Charakorn
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI road, Thung Phaya Thai, Ratchathewi District, Bangkok 10400, Thailand; Department of Clinical Epidemiology and Biostatistics, and Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Thung Phaya Thai, Khet Ratchathewi, Bangkok, 10400, Thailand.
| | - John Attia
- Centre for Clinical Epidemiology and Biostatistics, School of Medicine and Public Health, University of Newcastle, Newcastle, University Dr, Callaghan, NSW 2308, Australia
| | - Gareth J McKay
- Centre for Public Health, Queen's University Belfast, Institute of Clinical Science, Block A, Royal Victoria Hospital, Belfast BT12 6BA, United Kingdom
| | - Ammarin Thakkinstian
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI road, Thung Phaya Thai, Ratchathewi District, Bangkok 10400, Thailand
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Wattanayingcharoenchai R, Rattanasiri S, Charakorn C, Attia J, Thakkinstian A. Postoperative hormonal treatment for prevention of endometrioma recurrence after ovarian cystectomy: a systematic review and network meta-analysis. BJOG 2021; 128:25-35. [PMID: 32558987 PMCID: PMC7754428 DOI: 10.1111/1471-0528.16366] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2020] [Indexed: 01/17/2023]
Abstract
BACKGROUND The efficacy of hormonal regimens for the prevention of endometrioma recurrence in women who have undergone conservative surgery is still controversial. OBJECTIVE To compare the efficacy of different hormonal regimens in this context and to rank them. SEARCH STRATEGY MEDLINE and Scopus databases were searched through January 2020. SELECTION CRITERIA Randomised controlled trials (RCTs) or cohorts, comparing the effect of any pair of interventions (i.e. cyclic oral contraceptives [OC], continuous OC, gonadotropin-releasing hormone agonist [GnRHa], dienogest [DNG], levonorgestrel-releasing intrauterine system [LNG-IUS] and expectant management) on endometrioma recurrence were selected. DATA COLLECTION AND ANALYSIS Data were independently extracted by two reviewers. Relative treatment effects were estimated using network meta-analysis (NMA) and ranked in descending order. MAIN RESULTS Six RCTs (675 patients) and 16 cohorts (3089 patients) were included. NMA of the RCTs involving expectant management, cyclic OC, continuous OC, GnRHa and GnRHa + LNG-IUS, showed that all hormonal regimens had a nonsignificant lower risk of endometrioma recurrence compared with expectant management. NMA of the cohorts involving expectant, cyclic OC, continuous OC, GnRHa, DNG, LNG-IUS, GnRHa + OC, and GnRHa + LNG-IUS indicated that LNG-IUS, DNG, continuous OC, GnRHa + OC and cyclic OC had a significantly lower risk of endometrioma recurrence than expectant management. LNG-IUS was ranked highest, followed by DNG and GnRHa + LNG-IUS. Long-term use of hormonal treatment either OC or progestin had a significantly lower risk of endometrioma recurrence than expectant treatment. CONCLUSION In the NMA of RCTs, there was no evidence supporting hormonal treatment for postoperative prevention of endometrioma recurrence. This was at odds with the cohort evidence, which found the protective effect of OC and progestin regimens, especially long-term treatment. Large-scale RCTs of these agents are still required. TWEETABLE ABSTRACT Hormonal regimens given as long-term treatment tend to reduce risk of endometrioma recurrence after conservative surgery.
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Affiliation(s)
- R Wattanayingcharoenchai
- Department of Clinical Epidemiology and BiostatisticsFaculty of Medicine Ramathibodi HospitalMahidol UniversityBangkokThailand,Department of Obstetrics and GynaecologyFaculty of Medicine Ramathibodi HospitalMahidol UniversityBangkokThailand
| | - S Rattanasiri
- Department of Clinical Epidemiology and BiostatisticsFaculty of Medicine Ramathibodi HospitalMahidol UniversityBangkokThailand
| | - C Charakorn
- Department of Clinical Epidemiology and BiostatisticsFaculty of Medicine Ramathibodi HospitalMahidol UniversityBangkokThailand,Department of Obstetrics and GynaecologyFaculty of Medicine Ramathibodi HospitalMahidol UniversityBangkokThailand
| | - J Attia
- Centre for Clinical Epidemiology and BiostatisticsSchool of Medicine and Public HealthFaculty of Health and MedicineUniversity of NewcastleNew LambtonAustralia
| | - A Thakkinstian
- Department of Clinical Epidemiology and BiostatisticsFaculty of Medicine Ramathibodi HospitalMahidol UniversityBangkokThailand
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Lertkhachonsuk AA, Buranawongtrakoon S, Lekskul N, Rermluk N, Wee-Stekly WW, Charakorn C. Serum CA19-9, CA-125 and CEA as tumor markers for mucinous ovarian tumors. J Obstet Gynaecol Res 2020; 46:2287-2291. [PMID: 32830422 PMCID: PMC7693209 DOI: 10.1111/jog.14427] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 04/03/2020] [Accepted: 07/25/2020] [Indexed: 01/19/2023]
Abstract
Abstract Aim To analyze the use of serum cancer antigen 19‐9 (CA19‐9), cancer antigen 125 (CA‐125) and carcinoembryogenic antigen (CEA) in predicting the malignant potential of mucinous ovarian tumor, and to assess the clinical factors associated with these tumors. Methods This retrospective study collected the data from 314 patients who were diagnosed with mucinous ovarian tumor. These patients had preoperative serum CA19‐9, CA‐125, CEA available and underwent surgery at Ramathibodi Hospital between January 2010 and December 2016. The diagnostic performance of CA19‐9, CA‐125 and CEA was analyzed using the receiver operator characteristic curve. The associations between clinicopathological factors and serum CA19‐9, CA‐125 and CEA level were also analyzed. Results A total of 314 patients were recruited in this study. They consisted of 221 patients with benign mucinous ovarian tumor (70.38%), 65 patients with borderline mucinous ovarian tumor (20.70%) and 28 patients with mucinous ovarian carcinoma (8.92%). Multivariate analysis revealed that the tumor size, elevated serum CA19‐9, CA‐125 and CEA influenced the tumor pathology. The mucinous ovarian tumor with large tumor size, elevated serum CA19‐9, CA‐125 and CEA more than the cut off values showed a positive correlation with the risk ratio of 1.60 (95% CI = 1.13–2.28; P = 0.005), 1.74 (95% CI = 1.22–2.47; P = 0.002), 1.90 (95% CI = 1.34–2.70; P < 0.001), 1.58 (95% CI = 1.10–2.29; P = 0.020), respectively. CA‐125 provided the highest diagnostic performance, with an area under receiver operator characteristic curve of 0.745, to differentiate between borderline, malignant or benign mucinous ovarian tumor. Conclusion Preoperative elevation of the serum CA19‐9, CA‐125, CEA and tumor size are useful predictors to differentiate between benign, borderline and malignant mucinous ovarian tumor. The best predictor is CA‐125, followed by CA19‐9 and CEA.
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Affiliation(s)
- Arb-Aroon Lertkhachonsuk
- Division of Gynaecologic Oncology, Department of Obstetrics & Gynaecology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Supree Buranawongtrakoon
- Division of Gynaecologic Oncology, Department of Obstetrics & Gynaecology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Navamol Lekskul
- Division of Gynaecologic Oncology, Department of Obstetrics & Gynaecology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Naparat Rermluk
- Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Wei-Wei Wee-Stekly
- Minimally Invasive Surgery Unit, Department of Obstetrics and Gynecology, KK Women's and Children's Hospital, Singapore
| | - Chuenkamon Charakorn
- Division of Gynaecologic Oncology, Department of Obstetrics & Gynaecology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Charakorn C, Thadanipon K, Chaijindaratana S, Rattanasiri S, Numthavaj P, Thakkinstian A. The association between serum squamous cell carcinoma antigen and recurrence and survival of patients with cervical squamous cell carcinoma: A systematic review and meta-analysis. Gynecol Oncol 2018; 150:190-200. [DOI: 10.1016/j.ygyno.2018.03.056] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 03/19/2018] [Accepted: 03/20/2018] [Indexed: 11/28/2022]
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Lekskul N, Charakorn C, Lertkhachonsuk AA, Rattanasiri S, Israngura Na Ayudhya N. The Level of Squamous Cell Carcinoma Antigen and Lymph Node Metastasis in Locally Advanced Cervical Cancer. Asian Pac J Cancer Prev 2016; 16:4719-22. [PMID: 26107230 DOI: 10.7314/apjcp.2015.16.11.4719] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study aimed to determine the utility and a cut-off level of serum squamous cell carcinoma antigen (SCC-Ag) to predict lymph node metastasis in locally advanced cervical cancer cases. We also investigated the correlation between SCC-Ag level and lymph node status. MATERIALS AND METHODS From June 2009 to June 2014, 232 patients with cervical cancer stage IB2-IVA, who were treated at Ramathibodi Hospital, were recruited. Receiver operating characteristic (ROC) curves were used to identify the best cut-off point of SCC-Ag level to predict lymph node metastasis. Quantile regression was performed to evaluate the correlation between SCC-Ag levels and pelvic lymph node metastasis, paraaortic lymph node metastasis, and parametrial involvement as well as tumor size. RESULTS Pelvic lymph node metastasis and paraaortic lymph node metastasis were diagnosed in 46.6% and 20.1% of the patients, respectively. The median SCC-Ag level was 6 ng/mL (range, 0.5 to 464.6 ng/ mL). The areas under ROC curves between SCC-Ag level and pelvic lymph node metastasis, paraaotic lymph node metastasis, parametrial involvements were low. SCC-Ag level was significantly correlated with paraaortic lymph node status (p=0.045) but not with pelvic lymph node status and parametrial involvement. SCC-Ag level was also related to the tumor diameter (p<0.05). CONCLUSIONS SCC-Ag level is not a good predictor for pelvic and paraaortic lymph node metastasis. However, it is still beneficial to assess the tumor burden of squamous cell carcinoma of the cervix.
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Affiliation(s)
- Navamol Lekskul
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand E-mail :
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Kongsawatvorakul C, Charakorn C, Paiwattananupant K, Lekskul N, Rattanasiri S, Lertkhachonsuk AA. Limited Impact of Music Therapy on Patient Anxiety with the Large Loop Excision of Transformation Zone Procedure - a Randomized Controlled Trial. Asian Pac J Cancer Prev 2016; 17:2853-2856. [PMID: 27356701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023] Open
Abstract
BACKGROUND Many studies have pointed to strategies to cope with patient anxiety in colposcopy. Evidence shows that patients experienced considerable distress with the large loop excision of transformation zone (LLETZ) procedure and suitable interventions should be introduced to reduce anxiety. This study aimed to investigate the effects of music therapy in patients undergoing LLETZ. MATERIALS AND METHODS A randomized controlled trial was conducted with patients undergoing LLETZ performed under local anesthesia in an out patient setting at Ramathibodi Hospital, Bangkok, Thailand, from February 2015 to January 2016. After informed consent and demographic data were obtained, we assessed the anxiety level using State Anxiety Inventory pre and post procedures. Music group patients listened to classical songs through headphones, while the control group received the standard care. Pain score was evaluated with a visual analog scale (VAS). Statistical analysis was conducted using Pearson Chi-square, Fisher's Exact test and T-Test and p-values less than 0.05 were considered statistically significant. RESULTS A total of 73 patients were enrolled and randomized, resulting in 36 women in the music group and 37 women in the non-music control group. The preoperative mean anxiety score was higher in the music group (46.8 VS 45.8 points). The postoperative mean anxiety scores in the music and the non-music groups were 38.7 and 41.3 points, respectively. VAS was lower in music group (2.55 VS 3.33). The percent change of anxiety was greater in the music group, although there was no significant difference between two groups. CONCLUSIONS Music therapy did not significantly reduce anxiety in patients undergoing the LLETZ procedure. However, different interventions should be developed to ease the patients' apprehension during this procedure.
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Affiliation(s)
- Chompunoot Kongsawatvorakul
- Department of Obstetrics and Gynecology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand E-mail :
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Wilailak S, Chan KKL, Chen CA, Nam JH, Ochiai K, Aw TC, Sabaratnam S, Hebbar S, Sickan J, Schodin BA, Charakorn C, Sumpaico WW. Distinguishing benign from malignant pelvic mass utilizing an algorithm with HE4, menopausal status, and ultrasound findings. J Gynecol Oncol 2014; 26:46-53. [PMID: 25310857 PMCID: PMC4302285 DOI: 10.3802/jgo.2015.26.1.46] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Revised: 09/24/2014] [Accepted: 10/06/2014] [Indexed: 12/03/2022] Open
Abstract
Objective The purpose of this study was to develop a risk prediction score for distinguishing benign ovarian mass from malignant tumors using CA-125, human epididymis protein 4 (HE4), ultrasound findings, and menopausal status. The risk prediction score was compared to the risk of malignancy index and risk of ovarian malignancy algorithm (ROMA). Methods This was a prospective, multicenter (n=6) study with patients from six Asian countries. Patients had a pelvic mass upon imaging and were scheduled to undergo surgery. Serum CA-125 and HE4 were measured on preoperative samples, and ultrasound findings were recorded. Regression analysis was performed and a risk prediction model was developed based on the significant factors. A bootstrap technique was applied to assess the validity of the HE4 model. Results A total of 414 women with a pelvic mass were enrolled in the study, of which 328 had documented ultrasound findings. The risk prediction model that contained HE4, menopausal status, and ultrasound findings exhibited the best performance compared to models with CA-125 alone, or a combination of CA-125 and HE4. This model classified 77.2% of women with ovarian cancer as medium or high risk, and 86% of women with benign disease as very-low, low, or medium-low risk. This model exhibited better sensitivity than ROMA, but ROMA exhibited better specificity. Both models performed better than CA-125 alone. Conclusion Combining ultrasound with HE4 can improve the sensitivity for detecting ovarian cancer compared to other algorithms.
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Affiliation(s)
- Sarikapan Wilailak
- Department of Obstetrics and Gynecology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
| | - Karen K L Chan
- Department of Obstetrics and Gynecology, University of Hong Kong, Hong Kong
| | - Chi An Chen
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei, Taiwan
| | - Joo Hyun Nam
- Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kazunori Ochiai
- Department of Obstetrics and Gynecology, The Jikei University, Tokyo, Japan
| | - Tar Choon Aw
- Department of Laboratory Medicine, Changi General Hospital, Singapore
| | - Subathra Sabaratnam
- Department of Pathology, Hospital Sultanah Aminah, Johor Bahru, Johor, Malaysia
| | | | | | | | - Chuenkamon Charakorn
- Department of Obstetrics and Gynecology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Walfrido W Sumpaico
- Department of Obstetrics and Gynecology, MCU-FDT Medical Foundation, Caloocan, Philippines
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Aroonroch R, Visetsiri Y, Wongwaisayawan S, Charakorn C, Kanchanapanjapol S, Rochanawutanon M. Coexisting vulvar Paget's disease and mucinous carcinoma of the breast: a case report and review of the literature. J Med Assoc Thai 2012; 95:847-852. [PMID: 22774633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Vulvar Paget 'disease is the most common site of extramammary Paget's disease (EMPD). The disease frequently associated with the underlying invasive skin adnexal carcinoma or representing the migration of underlying internal malignancy, especially anorectal and genitourinary cancer, but the coexisting with primary breast cancer is rare. Herein, the authors report a case of a 46-year-old Thai woman who had vulvar Paget's disease with subsequent development of mucinous carcinoma of the breast. Interestingly, the overexpression of HER-2/neu in vulvar Paget's disease raises the additional option of anti-HER-2/neu antibody therapy in highly aggressive or recurrent disease. In conclusion, primary breast cancer should be of concern in patients with vulva Paget's disease, even though it is an uncommon association.
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Affiliation(s)
- Rangsima Aroonroch
- Department of Pathology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
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Thanapprapasr D, Nartthanarung A, Likittanasombut P, Na Ayudhya NI, Charakorn C, Udomsubpayakul U, Subhadarbandhu T, Wilailak S. Bone metastasis in cervical cancer patients over a 10-year period. Int J Gynecol Cancer 2010; 20:373-8. [PMID: 20375800 DOI: 10.1111/igc.0b013e3181d4a0a1] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Cervical cancer is the major cancer burden in developing countries. Bone is the third most common site of distant metastasis after the lungs and liver. Therefore, the aims of this study were to find the incidence and clinical characteristics of bone metastasis in our hospital. PATIENTS AND METHODS Fifty-one cervical cancer patients with bone metastasis during the period from January 1998 to December 2007 were recruited. All patients' medical records were reviewed and analyzed. RESULTS Among 4620 cervical cancer patients, there were 51 patients (1.1%) who had bone metastases. Ten patients' medical records were not found; thus, 41 patients were available for evaluation. The median age of the patients was 49 years. International Federation of Gynecology and Obstetrics stage IIB was the most common stage (43.9%). Most patients had squamous cell carcinoma (80.48%) and received radiation therapy alone as their primary treatment (58.53%). The most common presenting symptom was pain (78.04%). Most of the patients had multiple bone lesions and extrapelvic bone metastases. The lumbar spine was the most common site (36.36%). Sixteen patients (39.02%) were treated by palliative radiation therapy. The median overall survival was 23 months. CONCLUSIONS Bone metastases could be found at all stages. Common sites were the bone beyond the radiation field of their primary treatment. It was found at a median of 16 months after cervical cancer diagnosis. Currently, there are many varieties of treatment that result only in palliation. This group of patients has a poor prognosis.
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Affiliation(s)
- Duangmani Thanapprapasr
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine, Ramathibodi Hospital, Rama VI Rd, Bangkok 10400, Thailand.
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Thanapprapasr D, Wilailak S, Ayudhya NIN, Lertkhachonsuk AA, Likittanasombut P, Chittithaworn S, Charakorn C, Weerakiet S. Can vaginal misoprostol effectively increase rate of a satisfactory colposcopy? A randomized double-blind placebo-controlled trial. Jpn J Clin Oncol 2009; 40:203-7. [PMID: 19875508 DOI: 10.1093/jjco/hyp140] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To evaluate the effectiveness of vaginal misoprostol in overcoming an unsatisfactory colposcopy in the patients who had abnormal cervical cytology and to evaluate side effects of vaginal misoprostol. METHODS Sixty patients with an unsatisfactory colposcopy during the period of September 2007-November 2008 were recruited and randomly allocated to receive either two tablets of 200 microg misoprostol (400 microg) or two tablets of similar-looking placebo vaginally. Colposcopic re-examination was performed approximately 6 h later. The results and side effects before and 2 weeks after the colposcopic re-examination were recorded. RESULTS Six out of 30 patients in the misoprostol group (20.0%) had a satisfactory colposcopic re-examination compared with 2 out of 27 patients (7.4%) in the placebo group without statistically significant difference (P = 0.172). Three patients in the placebo group dropped out due to not present at the appointment time. Six out of 30 patients (20.0%) and 1 out of 30 patients (3.3%) in the misoprostol group had side effects before and 2 weeks after the colposcopic re-examination orderly. Twenty-seven patients in the placebo group did not have any side effects before and 2 weeks after the colposcopic re-examination. All side effects occurred were minimal and well tolerated. CONCLUSIONS Four hundred micrograms of vaginal misoprostol were not proved to be effective in converting an unsatisfactory to a satisfactory colposcopy.
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Affiliation(s)
- Duangmani Thanapprapasr
- Gynecologic Oncology Unit, Department of Obstetrics and Gynecology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
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Phupong V, Charakorn C, Charoenvidhya D. Oral salbutamol for treatment of preterm labor. J Med Assoc Thai 2004; 87:1012-6. [PMID: 15515999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
OBJECTIVE The aim of this study was to assess the value of oral salbutamol for the inhibition of preterm labor. MATERIAL AND METHOD Medical records of the department from January 1, 1991 to December 31, 1999 were reviewed for all idiopathic preterm labors that were inhibited by oral salbutamol and statistically analyzed. RESULTS Of 132 pregnancies, 81.1% (95%CI, 74.4, 87.7) were prolonged for more than 24 hours, 59.8% (95%CI, 51.5, 68.2) for more than 2 days, 32.6% (95%CI, 24.6, 40.6) for more than 1 week, and 8.3% (95%CI, 4.2, 14.4) for more than 4 weeks. Tachycardia (pulse rate > 100 beats/min) occurred in 85.6% of the patients, but those with a pulse rate higher than 140 beats/min occurred in only 3%. Hypotension occurred in only 0.8%. Neonatal complications occurred in 28%, while respiratory distress syndrome occurred in 22.7% of the babies. Perinatal mortality in the present study was 7.6 per 1,000 births. When comparing the pregnancy outcome between groups regarding the prolongation time, the pregnancy outcome was significantly better in the group that had a prolongation time of at least 48 hours. CONCLUSION Oral salbutamol proved to be another effective method that inhibits preterm labor and consequently prolongs pregnancy. Because it requires no intensive medical nursing care and observations, and no discomfort of an intravenous line, oral salbutamol may be an alternative drug in the management of preterm labor.
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Affiliation(s)
- Vorapong Phupong
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Thailand.
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Phupong V, Ultchaswadi P, Charakorn C, Prammanee K, Prasertsri S, Charuluxananan S. Fatal maternal outcome of a parturient with Eisenmenger's syndrome and severe preeclampsia. Arch Gynecol Obstet 2003; 267:163-6. [PMID: 12552329 DOI: 10.1007/s00404-001-0284-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Eisenmenger's syndrome in pregnancy is associated with a high maternal and fetal morbidity and mortality. When it occurs with severe preeclampsia, the morbidity and mortality are higher. We report the case of a 30 weeks' pregnant woman with Eisenmenger's syndrome and severe preeclampsia. Cesarean section was performed due to severe preeclampsia and an unfavorable cervix under general anesthesia. The intraoperative period was uneventful and a healthy 1300 g male infant was delivered, but the patient died on the second postoperative day due to a pulmonary embolism. This case confirms the frequently fatal maternal outcome of Eisenmenger's syndrome in pregnancy. Early termination of pregnancy is the treatment of choice.
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Affiliation(s)
- Vorapong Phupong
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Rama IV Road, Pathumwan, Bangkok 10330, Thailand.
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Charakorn C, Wongphichetchai S. Wooden foreign body in the orbital cavity: a case report. J Med Assoc Thai 1998; 81:812-6. [PMID: 9803076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Orbital foreign bodies in Thailand are uncommon. The diagnosis depends on history taking, physical examination and complete investigations. A case of orbital foreign body was reported with satisfactory result of treatment by transethmoidal approach: ethmoidectomy with antrostomy.
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Affiliation(s)
- C Charakorn
- Department of Otorhinolaryngology, Pramonkutklao General Hospital, Bangkok, Thailand
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Charakorn C. The scarless rhytidectomy incision in superficial parotidectomy. J Med Assoc Thai 1998; 81:705-7. [PMID: 9737129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Post-operative scars usually occur at the incision sites following various procedures of the parotid gland surgery. From 1982 to 1996, 201 cases of scarless rhytidectomy incisions were analysed and reported, with satisfactory results.
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Affiliation(s)
- C Charakorn
- Department of Otorhinolaryngology, Pramongkutklao General Hospital, Bangkok, Thailand
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Charakorn C. A comparison of the incidence of post operative bleeding between electric cauterization and suture ligation tonsillectomies. J Med Assoc Thai 1998; 81:536-40. [PMID: 9676092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Two-thousand one-hundred tonsillectomies performed from January 1980 to December 1995 by otolaryngologists at Pramongkutklao General Hospital were reviewed. The Dissection-Tyding snare technique was used and hemostasis completed by electric cautery in 690 cases, by suture ligature in 720 cases, by gauze packing alone as a control in 600 cases respectively. It can be concluded that the use of suture ligature offers an efficient and practical method to reduce the incidence of primary tonsillectomies bleeding.
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Affiliation(s)
- C Charakorn
- Pramongkutklao Hospital, Royal Thai Army, Bangkok, Thailand
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Charakorn C, Amatyakul P. Hearing impairment in Thais due to sport shooting: a preliminary report. J Med Assoc Thai 1998; 81:344-51. [PMID: 9623034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Ninety one sportshooters from several sportshooting clubs ranging in age from 20-49 and 85 control subjects were carefully examined for hearing ability. The male and female ratio was 10.37:1. It was found that 9.34 per cent of the subjects were suffering from hearing impairment at the level of 3,000-8,000 Hertz. At most frequencies the mean decibel between the groups of shooters (1-5 years, 5-10 years, more than 10 years) was significantly different, with the right ear being significantly more impaired than the left ear (alpha = 0.1). At all frequencies the mean decibel level for the control group was significantly different from that for the sportshooters (alpha = 0.1). In conclusion, it is the responsibility of the National Environmental Board on Noise Pollution, the Royal College of Otolaryngologists of Thailand and other related organizations should be much more aggressive in educating sportshooters with regard to protecting their ears against acoustic trauma.
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Affiliation(s)
- C Charakorn
- Pramongkutklao Hospital, Royal Thai Army, Bangkok, Thailand
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