Vajira Medical Journal: Journal of Urban Medicine

171-180

Authors: Chanyoot Bandidwattanawong, Siwakorn Pipatcharoenkij

Objectives: Advanced non-small cell lung cancer (NSCLC) is one of the world-wide most common newly diagnosed cancer and cause of cancer deaths. Platinum-based chemotherapy was the backbone of management until an immune checkpoint inhibitor (ICI) as monotherapy or combination with chemotherapy is demonstrated survival benefits over chemotherapy. Program cell death ligand -1 (PD-L1) expression is still the best, even though not perfect biomarker of response to an ICI. This study was intended to determine the prevalence of PD-L1 expression among Thai advanced NSCLC patients. Methods: The investigators performed a descriptive study of patients with advanced NSCLC who had formalin-fixed paraffin-embedded (FFPE) tissue specimens available, in January 1, 2016 to December 31, 2018, in the Department of Anatomical Pathology, Faculty of Medicine Vajira Hospital, Navamindradhiraj University. The baseline patients’ demographics were collected. The PD-L1 expression was determined by the PD-L1 IHC 22C3 pharmDx qualitative immunohistochemical assay. The primary endpoint was to assess the prevalence of PD-L1 expression (TPS >1%) among patients with advanced NSCLC. The secondary endpoints were to find out its correlation with demographics and independent factors of 1-year survival. Results: There were 79 NSCLC patients who had FFPE tissue specimens available. However, only specimens from 35 patients had adequate quality for PD-L1 analysis. Only three of them (8.6%) had PD-L1 expression. No baseline demographics was associated with its expression. ECOG performance status was the only independent determining factor of 1-year survival. (SR 75.42, p-value < 0.001) Conclusion: Unexpected low prevalence of PD-L1 expression was demonstrated. The inadequacy of tissue specimen would be the obstacle of PD-L1 analysis. The investigators remind the clinicians that the proper amounts of tumor samplings are suggested for further biomarker analysis.

189-198

Authors: Premwadee Karuhadej, Prapaiwan Danpradit

Objectives: To study family problems and the association of family problems of adolescent students in the sex-risk group and the non sex-risk group in Bangkok. Methods: Research design was descriptive correlation study.There were 2 groups of samples, the sex-risk group and the non sex-risk group. The sex-risk group consisted of 325 female adolescent students who were selected by purposive sampling with the social dimension form constructed by the researchers. The social dimension form contained 6 risk behaviors and 8 general data. The female adolescent students who had one of the six risks and were confirmed by the classroom teacher would be listed in the sex-risk group. The non sex-risk group consisted of 319 female adolescent students who were not listed in the sex-risk group. The research tools were the questionnaires consisted of family problems, risk behaviors of the parents, parental control, family break-ups and family economic status. There were 21 questions of true-false answers with 1 score for the true answer and 0 score for the false answer. The data were collected from the samples and were analyzed by percent and χ2-test. Results: Overall, the sex-risk group and the non sex-risk group had very low levels of family problems (35.4% and 20.1% respectively). However, the sex-risk group had more problems than the non sex-risk group with statistical significance (p<0.01). When considering items of family problems, it was found that the sex-risk group had more problems in 19 of 21 items than the non sex-risk group. The two most common problems, which were at average level (>50%), were item 17: father and mother did not allow the children to go out with friends (χ2 =21.0) and item 1: father worked outside with little time to talk to the children (χ2 =18.3). Conclusion: The family problems were found in the sex-risk group more than the non-sex risk group with statistical significance.

211-220

Authors: Jirawee Jantaranukul, Thitawat Wongampornpat

Objectives: Percutaneous Nephrolithotomy (PCNL) is considered to be the principal treatment for large kidney stones. Nephrolithotripsy approaches—namely the Lower Pole Approach and the Non-Lower Pole Approach—are widely referred to and utilized today. Currently, there is no consensus as to which approach yields the best treatment outcome or results in lowest level of complication. This study reports both treatment outcome and complications from information acquired from patients, with all sizes of kidney stones, who received PCNL treatment under both techniques at Vajira Hospital. Methods: According to the information collected in the past 5 years, there were 72 patients who had been treated with PCNL. The information was collected in terms of stone sizes, treatment techniques, and methods. In order to compare the treatment outcome between the Lower Pole Approach and Non-Lower Pole Approach, operative time and information gathered during follow-up sessions, including complications and hospital length of stay were analyzed. Results: According to the results, 37 out of 72 patients (51.4%) underwent the Lower Pole Approach, and 35 out of 72 patients (48.6%) underwent the Non-Lower Pole Approach. The results revealed that the stone-free rate in the Lower Pole Approach group was indifferent to that in the Non-Lower Pole Approach group (56.8% vs. 54.3% respectively, level of confidence p=0.776), and so was the average operative time in minutes (151.62±40.43 in the Lower Pole Approach group vs. 148.00±60.34 in the Non-Lower Pole Approach group, p=0.765). There were more but milder complications in the Lower Pole Approach group compared to the Non-Lower Pole Approach group (16.2% vs. 5.7% respectively, p=0.033), latter of which resulted in one case of intrathoracic complication. Moreover, it was discovered that the average length of stay in days of the Lower Pole Approach group was significantly shorter than that of the Non-Lower Pole Approach group (6.38±3.09 vs 8.06±4.14 respectively, p=0.048). Conclusion: The kidney stone treatment of the Lower Pole Approach has equal stone-free rate as the Non-Lower Pole Approach but has a higher rate of mild complications.

229-236

Authors: Peerawitch Petchmak, Punnawat Chandrachamnong

Incidental appendiceal neuroendocrine tumors (NETs) are rare and mostly asymptomatic or come with clinically suspected appendicitis. Although, there is a various review of literatures and consensus guidelines, there has been controversy in the management of tumor size 1-2 cm or grading G2 – G3 according to mitotic count (mitoses/10 HPF) or Ki-67. A 20-year-old female presented to the emergency department with acute right lower quadrant abdominal pain with an onset of 2 hours. The presumed clinical diagnosis was acute appendicitis. She underwent an open appendectomy and the histopathologic result of the specimen showed a neuroendocrine tumor of the appendix. It was a controversial decision since it was a well-differentiated tumor of <1 cm as well as G2 at the distal half of the appendix, which made it a challenging surgery. The patient was informed and computer tomography (CT) scan and colonoscopy was done for further evaluation. Discussion of whether a right-hemicolectomy or single appendectomy was proposed to the patient, finally a right hemicolectomy was performed. However, more studies should be conducted to determine the optimal management and follow-up strategy for situations like this.