Chiang Mai Medical Journal

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CONFOCAL MICROSCOPY OF THE HUMAN CORNEA
(Chiang Mai Medical Journal, 2007-11-30) Winai Chaidaroon
Confocal microscope is an ophthalmic instrument that provides real-time and non-invasive serial imaging of cornea. With the principle of both projecting of light to the tissue and focusing lens have the same focal point, it has a high magnification of 40X to visualize many layers of cornea, in sequence, the epithelial layer, subepithelial nerve plexus (which has not demonstrated by any instrument before), stroma (the most thickness layer that comprised of keratocytes and matrix), and endothelium. Therefore, this instrument can apply for a clinical use in the studies of cornea.
POTENCY OF EXTEMPORANEOUS CEFAZOLIN SODIUM EYE DROPS USED IN MAHARAJ NAKORN CHIANG MAI HOSPITAL
(Chiang Mai Medical Journal, 2007-11-30) Anutra Khangtragool; Banyong Khantawa; Phuriwat Leesawat
To assess the potency of extemporaneous cefazolin sodium (33 mg/mL) eye drops stored at 2-8 OC and 28 OC and used in Maharaj Nakorn Chiang Mai Hospital. This prospective study of the potency of extemporaneous cefazolin sodium (33 mg/mL) eye drops, used in Maharaj Nakorn Chiang Mai Hospital, was divided into 2 groups. Group I comprised eye drops stored at 2-8 OC and group II thus stored at 28 OC. The minimum inhibitory concentration (MIC) was assessed on the day of preparation and then day 3, 7, 14, 21 and 28. The MIC was examined by the broth dilution techniques. Cefazolin sodium (33 mg/mL) eye drops stored at 2-8 OC were stable for 28 days, but eye drops stored at 28 OC were stable for 14 days. The potency of extemporaneous cefazolin sodium (33 mg/mL) eye drops was less stable at 28 OC and they therefore should be stored in a refrigerator.
CT FINDINGS OF ACUTE PANCREATITIS IN MAHARAJ NAKORN CHIANG MAI HOSPITAL
(Chiang Mai Medical Journal, 2007-11-30) Anchalee Wongnai; Wittanee Na-Chiang Mai
Purpose: To retrospectively review etiologies, CT findings, complications and correlation between the CT severity index (CTSI) and length of hospital stay (LOS) in the patients with acute pancreatitis in Maharaj Nakorn Chiang Mai Hospital. Materials and methods: Ninety one patients with a diagnosis of acute pancreatitis were recruited from the Maharaj Nakorn Chiang Mai Hospital database from October 2003 to June 2005. The etiologies of acute pancreatitis were collected from medical records. Fifty patients underwent CT scans in the hospital. The CT findings were analyzed. All patients were grouped into mild, moderate and severe pancreatitis using the currently accepted CTSI, developed by Bathazar et al. Correlation between CTSI and LOS was calculated by ANOVA and Sheffe methods using the SPSS program. Result: The most common etiology of acute pancreatitis was alcohol ingestion, which presented in 30 patients (60%). By using the currently accepted CTSI, we graded the severity of acute pancreatitis as mild in 30 (60%), moderate in 16 (32%) and severe in 4 (8%) of the 50 patients. The most common extrapancreatic abnormality was pleural effusion; which accounted for 29 (58%) of the 50 patients. Complications of pancreatitis were as follows; pancreatic abscess in 6 patients (12%), infected pancreatic necrosis in 2 (4%), pancreatic pseudocyst in 4 (8%), venous thrombosis in 8 (16%) and splenic infarction in 1 patient (2%). When comparing LOS between groups, there was a significant difference in LOS between the mild and moderate pancreatitis groups (p=0.04) and between the mild and severe pancreatitis groups (p=0.001), but there was no significant difference in LOS between the moderate and severe pancreatitis groups (p=0.078). Conclusion: The most common etiology of acute pancreatitis in Maharaj Nakorn Chiang Mai Hospital is alcohol ingestion. Most of the patients with acute ancreatitis are in the mild group. The most common complication is venous thrombosis. The grading of pancreatitis could be graded in mild and severe acute pancreatitis groups, which correlated well with patient outcome.
ANTIPROLIFERATIVE EFFECT ON COLON CANCER CELL LINES BY AQUEOUS EXTRACT FROM THE BARK OF MILLINGTONIA HORTENSIS
(Chiang Mai Medical Journal, 2007-11-30) Siwapong Tansuwanwong; Hiroyuki Yamamoto; Kohzoh Imai; Usanee Vinitketkumnuen
Millingtonia hortensis is a traditional medicinal plant widely used in South-East Asia. This study focused on the antiproliferative effect when comparing between aqueous extract and ethanol extract from the bark of M. hortensis using human colon cancer cell lines, DLD-1, HCT15, SW48 and SW480. In in vitro experiments, the MTT method was used to determine the antiproliferative effect of M. hortensis extract on colon cancer cells. An aqueous extract of M. hortensis significantly reduced the proliferation rate of colon cancer cell lines in a dose-dependent manner. However, no antiproliferative effect was observed by ethanol extract of M. hortensis. This finding indicated that only aqueous extract from the bark of M. hortensis is able to inhibit colon cancer cell proliferation, and its mechanism is now under investigation.
OUTCOMES OF DIFFERENTIATED THYROID CARCINOMA (DTC) PATIENTS AT MAHARAJ NAKORN CHIANG MAI HOSPITAL (MNCM)
(Chiang Mai Medical Journal, 2007-11-30) Supawan Buranapin; Laddawan Limpijarnkit; Natapong Kosachunhanun; Jongkol Vachiranakorn; Ampica Mangklabruks
Objective: To compare the outcome of DTC patients treated at MNCM with various types of therapy. End point measurements were cancer recurrence and cancer death. Materials and methods: A retrospective review of all available medical records of DTC patients from January 1988 to December 1998 was performed. Some patients, who were diagnosed DTC long before 1988 and had continued to follow-up, were included in this study. There were 292 patients (225 female and 67 male) comprising 54.5% papillary cell carcinoma, 39.7% follicular cell carcinoma and 5.8% mixed papillary and follicular cell carcinoma. Results: The mean age at diagnosis was 43.6±0.86 years. The female to male ratio was 3:1 and mean tumor size 3.8 cm. The outcomes among 4 types of therapy were compared: surgery alone, surgery combined with thyroid hormone suppression (THS), surgery combined with THS and I131 remnant ablation started within 1 year after surgery, and surgery combined with THS and I131 remnant ablation started more than 1 year after surgery. There were no significant differences among the groups of therapy regarding sex, tumor size, cell type, local tumor invasion and cervical node metastasis, but age at diagnosis and distant metastasis were significantly different. The mean survival time for each treatment group was 8.04, 10.67, 23.97 and 12.11 years, respectively (p=0.03). Disease free interval in each treatment groups was 6.72, 8.72, 19.94 and 9.53 years, respectively, (p=0.003). Factors that influenced cancer death were cervical node metastasis, distant metastasis and thyroid remnant ablation. Factors that influenced cancer recurrence were age at diagnosis, cervical node metastasis, distant metastasis and thyroid remnant ablation. Conclusion: This study suggested that thyroid remnant ablation is effective in decreasing cancer recurrence and cancer death in DTC patients.
COMPOSITION OF METALS ON DIFFERENT TYPES OF FIRED BULLETS
(Chiang Mai Medical Journal, 2007-11-30) Piya Durongkadech; Karnda Vichairat; Pongruk Sribandidmongkol; Klintean Wunnapuk
To ascertain how metals on the surface of shot bullets refer to the type of bullets, 12 lead bullets, 13 full metal jacket bullets and 18 semi-jacketed bullets were drawn from gunshot victims. Lead, copper, zinc and nickel, including the proportion of lead and copper were measured from the retained bullets to determine the relationship between these metals and types of bullets by using atomic absorption spectrophotometer to determine. There was not much zinc and nickel detected on all three bullet types, whereas a lot of lead and copper was evident. Though lead and copper levels were significantly different among the three types of bullets, and only their proportion might be useful for distinguishing them from each other.
TRANSURETHRAL DEHYDRATED ETHANOL INJECTION OF THE PROSTATE FOR THE TREATMENT OF BENIGN PROSTATIC HYPERPLASIA (BPH): A PRELIMINARY REPORT
(Chiang Mai Medical Journal, 2007-11-30) Supon Sriplakich; Pises Insuan
Purpose: To evaluate the efficacy and safety of a minimally invasive treatment for benign prostatic hyperplasia (BPH) by transurethral dehydrated ethanol injection. Patients and method: Eight patients with clinical symptoms of benign prostatic hyperplasia were evaluated by urodynamic study, cystoscope and transrectal ultrasound preoperatively. Under regional anesthesia, transurethral injection was performed at 6-10 sites into median and bilateral prostatic lobes, and 12-20 mL of dehydrated ethanol was used depending on the prostatic size in each patient. At 3 months after treatment, International prostatic symptom score (IPSS), quality of life score and parameter of benign prostatic obstruction (BPO) were re-evaluated and compared with the baseline. Result: Average operative time was 19.29 minutes (range 15-30). There were no intra operative complications, but the postoperative treatment required catheterization for a mean of 11 days (range 7 to 39). Gross hematuria and blood clot obstruction had caused irrigate bladder to occur in 1 patient. Only 1 patient could not remove the urethral catheter in 4 weeks, so he was offered transurethral resection of the prostate. Seven patients completed the study. The median IPSS was 23 (range 16 to 31) preoperatively, and it significantly improved to 5 (range 2 to 17) at 3 months postoperatively (p=0.018). The median quality of life score also improved significantly from 5 (range 4 to 6) to 1 (range 0 to 2) (p=0.016). The mean residual urine volume significantly decreased from 103.71±70.88 to 21.29±18.36 mL (p=0.016). However, the mean peak urinary flow rate increased, but not significantly, and there was no significant change in mean prostate volume from 39.30±28.11 to 28.44±12.90 mL (p=0.241). Conclusion: Our preliminary data proved that this technique is an effective alternative treatment with minimal adverse effects, and it is safe for patients with benign prostatic hyperplasia, especially when there is a high operative risk.
CORDOCENTESIS; INDICATIONS, TECHNIQUES, COMPLICATIONS AND A TRAINING COURSE
(Chiang Mai Medical Journal, 2007-11-30) Fuanglada Tongprasert
Cordocentesis is a procedure to sample fetal blood from the umbilical cord by a needle that is inserted through the maternal abdominal wall under continuous ultrasonographic monitoring. Typical indications for cordecentesis are the fetal risk of thalassemia and rapid daryotyping. Fetal intravascular accessibility allows the possibility of proceeding to more difficult invasive procedures of performing intrauterine blood transfusions or other intrauterine fetal therapies. At least cordocentesis should be performed at 18 weeks of gestation, with no more fetal loss rate. The procedure-related fetal loss risk is 1.4% which is mainly associated with the surgeon’s skill and experience. Therefore, it is necessary for the surgeon to practice increasingly to develop their skill and lower associated complications. The author here also presents a cordocentesis training course for early practitioners to develop their skill in cordocentesis, without any fetal and maternal jeopardy.
DISTAL FEMORAL FRACTURE DURING LOWER LIMB DRESSING TRAINING IN A PARAPLEGIC PATIENT: A CASE REPORT
(Chiang Mai Medical Journal, 2007-11-30) Siam Tongprasert; Apichana Kovindha; Tuenchai Attawong
Distal femoral fracture could occur during lower limb dressing training in a paraplegic patient. We report a 64-year-old man presenting with a fracture T10-T11 and complete T8 paraplegia after a fall. After posterior spinal fusion was carried out, a Jewett brace was applied to help stabilize the spine and then the patient was transferred to a rehabilitation ward for intensive rehabilitation. During lower limb dressing training, there was a sudden fracture of his right thigh. Plain films revealed a spiral fracture at the distal one third of the right femur. After surgical treatment with a plate and screws, the fracture was healed without any complications. By presenting a paraplegic patient with femoral fracture during lower limb dressing training, we here by present a dressing training guideline to prevent such a complication.
AMNIOCENTESIS IN TWIN PREGNANCIES
(Chiang Mai Medical Journal, 2007-11-30) Fuanglada Tongprasert
Amniocentesis has been recognized as a relatively safe and accurate method for prenatal diagnosis in singletons. In twin pregnancies, amniocentesis requires a technique that can reliably sample each fetus and provide accurate results. In addition, it must be acceptably safe. Genetic amniocentesis is traditionally performed between 16 and 18 weeks of gestation. The different techniques were described by many centers. Here, the author presents four widely-performed methods; double needles-dye as a marker technique, dyefree single needle technique, dye-free dual needle technique and dye-free double needle technique. The efficacy of twin amniocentesis approaches 100% in all techniques performed with continuous ultrasound guidance. The risk of fetal loss in twin pregnancies after amniocentesis varies widely among available literature. This is probably due to the difference in experience of the operators in each center, the availability of a high resolution ultrasound machine and the experience gained throughout the years. In conclusion, the procedure-related fetal loss risk of twin amniocentesis may be slightly higher than that of singleton amniocentesis by approximately 1 to 2%, which is superimposed on an increased background loss rate.
RUPTURED VASA PREVIA: REPORT OF FOUR CASES
(Chiang Mai Medical Journal, 2007-11-30) Vorapin Gomutbutra
The author reported 4 cases of ruptured Previa with a fatal perinatal outcome of two dead fetus in utero, two still births and a neonatal death. No definite prenatal diagnosis could be made in any of them. After experiencing two cases, every risk case needed awareness especially in unexplainable severe fetal distress after small bloody aminotic fluid. However, two more fetal deaths occurred with Ruptured Vasa Previa. Antenatal diagnosis and elective cesarean section may reduce mortality and morbidity. The purpose of this report was to postulate whether some special devices may soon be able to detect this abnormality in a high index of suspicious cases.
LOCALIZATION OF DENGUE VIRUS CAPSID PROTEIN WITH HOST CELL CHROMOSOME DURING MITOSIS
(Chiang Mai Medical Journal, 2009-09-21) Sunpetchuda Supasa; Sutha Sangiambut; Poonsook Keelapang; Thongkham Taya; Chunya Puttikhunt; John Aaskov; Watchara Kasinrerk; Sirijitt Vasanawathana; Wannee Limpitikul; Prida Malasit; Nopporn Sittisombut
Rationale: The capsid (C) protein of dengue virus functions primarily as a building block of the nucleocapsid. During virus replication, C localizes in the cytoplasm as well as nuclei of infected cells. The function of C nuclear localization remains unknown. This study aimed to investigate the localization of C in infected cells undergoing mitosis. Methods: Indirect immunofluorescence analysis was employed. Vero and PS clone D cell lines were infected with dengue viruses for 24-48 hours, fixed, permeabilized and reacted successively with antibodies specific for C and NS1, and fluorochrome-conjugated secondary antibodies. Stained cells were visualized under a fluorescence microscope. Results: During the infection with dengue serotype 2 viruses, C was detected in the cytoplasm and/or nuclei of interphase cells. In the majority of infected mitotic cells, C localized to the cytoplasm with no staining of chromosomes. In the remainder, C was found to associate with the periphery of mitotic chromosomes with less intense staining in the cytoplasm. Association of C with chromosomes, which was observed with recent clinical isolates and laboratory adapted strains, was not restricted to any specific phase of mitosis. Conclusions: Differential localization to the cytoplasm or chromosome in mitotic cells suggests the highly dynamic nature of the C protein.
COLON CANCER REGISTRY AT SAWANPRACHARAK HOSPITAL, NAKHON SAWAN
(Chiang Mai Medical Journal, 2009-09-21) Choosak Hongladaromp
Background: The Department of Surgery, Sawanpracharak Hospital, introduced the colon cancer registry in 2000 because colon cancer became the second most common cancer in surgical service. Objective: To evaluate the outcome of colon cancer treatment and the colon cancer registry program. Materials and methods: The database of colon cancer registry at the Department of Surgery, Sawanpracharak Hospital, was analyzed. Results: There were 238 patients with colon cancer, 125 men and 113 women, with a mean age of 62.3 years (range 24-98 years). Sigmoid colon was the most frequent primary site of cancer (39.9%). Am emergency operation was performed in 121 patients (50.8%) with bowel obstruction or bowel perforation. The stage of cancer was stage I: 1.2%, stage II: 36.9%, stage III: 39.1%, stage IV: 20.3% and unknown: 8.4%. Local recurrence and/or metastasis occurred in stage II and stage III at 4.5% and 19.4% respectively. Mean survival time was stage 1: 32.2 months (range 20-49 months), stage II: 15.8 months (range 2-54 months), stage III: 14.5 months (range 2-55 months) and stage IV: 6.9 months (range 0-42 months). Postoperative chemotherapy showed benefit vy prolonging mean survival time in patients with high-risk stage II (25.4 months vs 7.3 months), stage III (19.6 months vs 6.4 months) and stage IV (14.9 months vs 1.5 months), p \< 0.05. Conclusion: Advanced stage disease, and inaccurate staging from inadequate lymph node sampling had an impact on poor patient outcome. Inaccurate staging and postoperative surveillance are the major problems when evaluating cancer prognosis. Cancer registry and active follow-up are the important factors in evaluating the quality of treatment.
ZINGIBER CASSUMUNAR ROXB. INHIBITS HYALURONAN PRODUCTION IN HUMAN ORAL FIBROBLASTS
(Chiang Mai Medical Journal, 2009-09-21) Siriwan Ong-chai; Pareena Chotjumlong; Prachya Kongtawelert; Suttichai Krisanaprakornkit
Zingiber cassumunar Roxb. was previously shown to possess potent anti-inflammatory activity. We investigated the effect of its ethanol extract on hyaluronan (HA), an extracellular matrix compound with proinflammatory activity synthesis in human oral fibroblasts. Cultured ﬁ broblasts were treated at various times with different concentrations of the extract (0.1-50 μg/mL) with or without retinoic acid (RA; 10 μM), or left untreated as a control. Culture medium was analyzed for HA quantities by the ELISA-based assay. Total RNA was harvested and RT-PCR analyses were performed to determine mRNA expression of hyaluronan synthase (HAS) -1, -2, and –3. Z. cassumunar extract, at 25 and 50 μg/mL, with or without 10 μM of RA, significantly decreased HA levels (p \< 0.05). Consistent with decreased HA levels, mRNA expression of HAS-2, but not HAS-1 or HAS-3, was selectively down-regulated by the extract. Collectively, these data indicate that the ethanol extract of Z. cassumunar inhibits HA synthesis in human oral fibroblasts, which may be involved in chronic inflammatory disorders, particularly in the oral cavity.
UNUSUAL RADIOGRAPHIC PRESENTATION OF TUBERCULOUS SPONDYLITIS : 3 CASES OF MIMIC SPINAL METASTASIS
(Chiang Mai Medical Journal, 2009-09-21) Torphong Bunmaprasert
Background: Spinal infection and tumor are common diseases that cause back pain with collapsed vertebrae. Radiographic findings of spinal tuberculosis are similar to those of spinal metastasis. Objective: To radiographically demonstrate that spinal tuberculosis is able to mimic spinal metastasis. Patients and methods: Three cases were collected during January to June 2008. All presented with nonmechanical back pain with or without neurological deficit. Plain radiographs, myelography, technetium bone scan, computed tomography (CT) scan and magnetic resonance (MR) imaging of the spine were done. All patients were treated surgically. Tissue specimens were sent for analysis. Results and discussion: Study subjects comprised 2 men and 1 woman, with an average age of 51 years. Plain radiographs of two cases showed destruction of the vertebral bodies, pedicles and posterior elements of the spine. Disc spaces and vertebral endplates were preserved. The other case had disc space and endplate destruction, but a CT scan strongly suggested spinal metastasis. All specimens showed chronic caseating granulomatous inflammation without malignancy. Generally, the radiographic findings suggested spinal metastasis destructive of the vertebral body, but they did not include the vertebral endplates or intervertebral discs. The earliest sign was pedicle erosion. Spinal tuberculosis destroyed the body. It might also spare the disc and the posterior neural arch in early phases. Finally, a biopsy should be done. Conclusion: Radiographic presentation of spinal tuberculosis is able to mimic spinal metastasis. Tissue diagnosis before treatment is mandatory.
STRABISMUS SURGERY IN THYROID-RELATED ORBITOPATHY
(Chiang Mai Medical Journal, 2009-09-21) Prapatsorn Patikulsila; Chompoonoot Kunaviktikul
Objective: To study the outcome of strabismus surgery in patients with thyroid-related orbitopathy (TRO). Design: Consecutive case series. Patients and methods: Sixteen patients with strabismus associated thyroid-related orbitopathy, who underwent strabismus surgery in Chiang Mai University Hospital during August 1997 and September 2004, were reviewed. Results: With a mean follow-up period of 31.2 months (range, 6-84), all patients (100%) achieved successful surgical alignment, although 4 of 16 patients (25%) required more than one operation. Orthophoria resulted more in the adjustable suture technique than in the non-adjustable suture technique. Conclusion: Muscle surgery resulted in the successful correction of strabismus in TRO without serious complications.
BRACHIAL PLEXUS BLOCK IN MAHARAJ NAKORN CHIANG MAI HOSPITAL: A RETROSPECTIVE STUDY OF 794 CASES
(Chiang Mai Medical Journal, 2009-09-21) Ananchanok Saringcarinkul; Benjapun Boonma
Objective: To study the success rate and complication of brachial plexus block in Maharaj Nakorn Chiang Mai Hospital, Thailand. Methods: The anesthetic data of brachial plexus block performed for operations on the upper extremity in the Department of Anesthesiology, Faculty of Medicine, Chiang Mai University, from January 2004 to December 2005, were reviewed and analyzed for success rate and complication. Results: The number of supraclavicular brachial plexus blocks performed in this study was 767 from 794 of all cases between 2004 and 2005. The age ranged from 13 to 86 years and hypertension was the most common underlying disease found. Of the 767 patients, 666 (86.83%) were classified as successful, while 101 were failures (13.17%) requiring unplanned general anesthesia. The supraclavicular approach with a nerve stimulator guide, and interscalene and axillary approaches were used in only 27 patients, and the success rate was 77.8 percent (21/27). Supplementary blocks were needed in 74 patients (9.32%); 41 ulnar, 2 median, 4 radial, 13 digital, 9 surgical field and 5 ulnar and median nerve blocks were performed. There was no significant difference of success rate among the groups of different local anesthetics used. The most serious complication was found in only one pneumothorax case (0.13%). Conclusion: Classic supraclavicular plexus block has usually been the anesthesia of choice in Maharaj Nakorn Chiang Mai Hospital for operations on the upper limb. Although the success rate was higher, there was no significant difference to that among different brachial plexus block techniques. The data from anesthetic records were incomplete and did not conclude the factors of success in brachial plexus block.
PROLONGED EFFECT OF CHILDREN AND FAMILY BASED INTERVENTION ON TREATING CHILDHOOD OBESITY
(Chiang Mai Medical Journal, 2009-09-21) Sainatee Pratanaphon; Nittaya Pun-Ai; Samatchai Chamnongkich
The effects of modest lifestyle modifications in growing obese children using a children and family based intervention were interesting. This study was aimed to investigate the long term effect of intervention on the BMI percentile change and anthropometric measure change in obese/overweight children, compared with normal weight children. Three hundred and twelve children aged 6-7 years participated in this study. They were defined as normal weight, overweight, and obese, based on the BMI criterion from the International Obesity Task Force (IOTF). The obese/overweight children and their parents enrolled in a 1-day seminar including education and behavioral modification, and group discussion. In addition, an interview and suggestions were made for each family 4 times a year via the telephone. The anthropometric data such as BMI and WC value as well as the changes in BMI percentile of all children were examined at pre- and post- 1 year intervention. The results showed that, at follow-up, the BMI percentile change of the obese/overweight children had not altered, which compared with normal weight children (odds ratio, 1.69 : 95% CI, 0.71-4.02; p = 0.17). Similarly, the mean change in BMI and WC values of obese/overweight children remained significantly higher than that of normal weight children (p \< 0.001). Thus, long-term intervention that focused on dietary education and behavioral modification, including a follow-up 3 times a year, did not provide any advantages on the BMI percentile change, or BMI and WC values of the obese/overweight children.
THE CLINICAL APPLICATIONS OF SINGLE-PHOTON EMISSION COMPUTED TOMOGRAPHY AND COMPUTED TOMOGRAPHY (SPECT/CT) IN ONCOLOGY
(Chiang Mai Medical Journal, 2009-09-21) Sirianong Namwongprom
The accurate evaluation of a tumor’s stage is one of the most important steps for successful treatment. Radionuclide imaging, now widely used, is useful because it may reflect not only morphological characteristics but also metabolic activities. Conventional imaging techniques can provide anatomical information, necessary for the accurate detection and localization of structural and morphological abnormalities. However, it does not reflect the functional or metabolic status of a tumor. By contrast, the high sensitivity of the Nuclear Medicine techniques lack the necessary anatomic information. Therefore, both techniques will complement each other. In evaluation of disease, fusion of the anatomical and functional imaging presented by single-photon emission computed tomography (SPECT) and computed tomography (CT) has been shown to improve diagnostic accuracy by enabling better localization and definition of organs and lesions. Technical developments have led to the development of better software techniques for image fusion and to the development of SPECT/CT systems. The advantages of combining SPECT with CT are numerous and are primarily due to the anatomic referencing and the attenuation correction capabilities of CT. This article describes recent advanced and clinical applications of SPECT/CT imaging in tumor imaging.
INCREASE IN EPITHELIAL BUCCAL CELL MICRONUCLEI IN STUDENTS EXPOSED TO EMBALMING SOLUTION VAPOR
(Chiang Mai Medical Journal, 2009-09-21) Klintean Wunnapuk; Werawan Ruangyuttikarn; Yingpan Anusri; Tippawan Prapamontol
The micronuclei were evaluated in epithelial buccal cells of 47 dentistry students, who were taking a human gross anatomy course at the Faculty of Medicine, Chiang Mai University. Buccal cells were collected and stained to investigate micronucleus induction in order to study genotoxicity before, during and after exposure to embalming solution, which contains formaldehyde, methanol and phenol. The buccal cells were collected at 0, 10 and 15 weeks, with exposure periods of 4 hours per week. The cells were separated using cytocentrifuge before staining with Feulgen plus Fast Green. The results showed a significant increase in the total number of micronuclei in mononucleated buccal cells, from 1.57±1.51 to 5.26±3.91 and 2.53±1.72 micronuclei per 1,500 mononucleated buccal cells at 0-, 10- and 15-week exposure periods, respectively. Formaldehyde, methanol and phenol levels in the air of the dissection room were collected and quantified using high performance liquid chromatography, gas chromatography-flame ionization detection, and gas chromatography-mass spectrometry. Their measurable levels were 0.19±0.06, 39.72 ±49.10 and 0.08±0.05 μg/mL, respectively, meaning the level of formaldehyde was higher than the recommended NIOSH exposure limit of 0.0016 μg/mL. It was concluded that increasing micronuclei in the dentistry student’s epithelial buccal cells may have resulted from co-exposure of compounds contained in the embalming solution.

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