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Vulvar carcinoma, although rare, is difficult to manage. We conducted a study to describe the management in our hospital. From 1978 to 1991, 69 patients with primary carcinoma of the vulva were treated at Srinagarind Hospital, Faculty of Medicine, Khon Kaen University. Forty-two patients underwent radical vulvectomy and lymphadenectomy. The data presented the techniques, surgical events and outcome of the operations. The 5 and 10-yr survival rates for the operable cses were 88.5 per cent and only 22 per cent for those who were non-operable. Surgery is still the recommended primary treatment for this rare malignancy of the female genital tract.

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From 1978 to 1991, 69 cases of primary carcinoma of the vulva were diagnosed and treated at Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Thailand. The average age was 56 years at the time of diagnosis. Five patients (7.2%) were in FIGO Stage I, 25 (36.2%) Stage II, 28 (40.6%) Stage III and 11 (15.9%) Stage IV. Histologically, 60 cases were squamous cell carcinoma, large cell non-keratinizing type, 2 (2.9%) of squamous cell carcinoma, large cell keratinizing type, 2 (2.9%) of adenocarcinoma, 1 (1.4%) of basal cell carcinoma and 1 (1.4%) of malignant melanoma. Radical vulvectomy with inguino-femoral lymphadenectomy were performed in 42 patients. The rest were rejected or unsuitable for surgery. The actuarial 5 and 10-year survival rate for 61 patients followed up 1 to 14 years was 66.0%. The 5-year survival rate for operable cases was 88.5% but for unoperable cases it was only 22.0%. The authors still confirm surgery as the primary treatment of choice for this rare malignancy.

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We found that the incidence of post-cesarean puerperal morbidity at Srinagarind Hospital, Khon Kaen University was 5.5 per cent, which is very low compared to other reports. Statistically significant risk factors for post-cesarean puerperal morbidity included having less than 4 antenatal care visits, duration of labour longer than 12 hours and absence of prophylactic antibiotics.

PIP: All patients who delivered by Cesarean section at Srinagarind Hospital, Khon Kaen University, from June 1, 1988 to May 31, 1989 were studied to determine the incidence and risk factors of puerperal morbidity. Variables included age, parity, gestational age at delivery, blood concentration before delivery, number of antenatal care visits, duration of labor, duration of rupture of membranes before delivery, number of vaginal examinations, history of previous Cesarean section, type of Cesarean section, type of anesthesia, estimated blood loss, operative time, fetal birth weight, and the use of antibiotics. Puerperal morbidity was defined as a temperature of 38 degrees Celsius or higher, occurring on any 2 of the first 10 days post partum exclusive of the first 24 hours. Univariate and multiple logistic regression analyses were used for the assessment of the risk factors. There were 548 Cesarean sections, but 42 patients were excluded, leaving 506 patients. There were 132 elective and 374 emergency Cesarean sections. The incidence of post-Cesarean puerperal morbidity was 5.5%, which is very low compared to other reports, and it was 6.5% in patients who did not receive antibiotics. The causes of puerperal morbidity included endomyometritis (35.7%), wound infection (25.0%), urinary tract infection (10.7%) and unknown cause (28.6%). Only duration of labor for more than 12 hours was found to be a statistically significant risk factor. Other factors including parity, number of antenatal care visits, history of previous Cesarean section, estimated blood loss during operation, and the use of antibiotics were found to be almost statistically significant. Further analysis by multiple logistic regression with all statistically significant and almost statistically significant variables found that statistically significant risk factors for post-Cesarean puerperal morbidity included having less than 4 antenatal care visits, duration of labor longer than 12 hours, and absence of prophylactic antibiotics.

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Two hundred and fifty-seven patients who had undergone total abdominal hysterectomy (TAH) in a rural University Hospital in Thailand between September, 1989 and May, 1990 were found to have an incidence of postoperative febrile and infectious morbidity of 35.4 per cent and 10.1 per cent respectively. The risk factors for febrile morbidity are administration of prophylactic antibiotics, a resident being the surgeon and duration of operation time of more than 120 minutes. The risk factors for infectious morbidity included history of previous surgery, performing TAH alone without adnexectomy and omentectomy and also operation time longer than 120 minutes.

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A community-based case-control study was conducted to characterize pregnant women who did not receive antenatal care. 1,274 deliveries over a 1-year period were documented by weekly visits to 120 study villages. Eighty five women (6.7%) received no antenatal care. By univariate analysis, factors found to be associated with failure to receive antenatal care included maternal age, paternal age, paternal education, home ownership, availability of toilet, annual income, housing condition, gravidity, parity, history of infant death and birth intervals. After logistic regression analysis, only paternal age, paternal education, parity and lack of toilet in the household were found to be associated with failure to receive antenatal care.

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The accuracy of perinatal and infant mortality rates in most developing countries is questionable. We measured perinatal and infant mortality rates in a rural district of Thailand and compared them with the official statistics to assess accuracy. All births and infant deaths in a rural district of Thailand over a one-year period were surveyed. The corresponding official statistics were also collected. The mothers or the relatives of all stillbirths and infant deaths were interviewed about the registration of the stillbirths or infant deaths. The surveyed perinatal and infant mortality rates were 22.0 and 23.1 respectively. The under-registration of stillbirths was 100% and for infant deaths 45%. All the non-registered infant deaths were in situations in which the infant died before the registration of birth. These results document the degree and nature of under-reporting of perinatal and infant mortality in rural Thailand.

PIP: The accuracy of perinatal and infant mortality rates in most developing countries is questionable. The authors measured perinatal and infant mortality rates in a rural district of Thailand and compared them with official statistics to assess accuracy. All births and infant deaths in this area over a 1-year period were surveyed. The corresponding official statistics were also collected. The mothers or relatives of all stillbirths and infant deaths were interviewed about the registration of these occurrences. The surveyed perinatal and infant mortality rates were 22.0 and 23.1, respectively. The underregistration of stillbirths was 100% and for infant deaths 45%. All the nonregistered infant deaths were in situations in which the infant died before the registration of birth took place. These results document the degree and nature of underreporting of perinatal and infant mortality in rural Thailand.

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Risk factors for recurrence after radical hysterectomy and pelvic lymphadenectomy at Srinagarind Hospital was studied from 218 patients operated between 1976 to June 30, 1988. Four preoperative risk factors i.e., cell types, age, stages and size of the lesions were computed and cross-tabulated with the recurrence rate from the data of the whole patients. The correlation was found to be statistical significant. This scoring system should be called from the first letter of the factor as 'CASS' and used for selection of the patients for radical hysterectomy and pelvic lymphadenectomy.

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Risk factors for survival were analyzed for 208 women diagnosed with invasive cervical cancer at Srinagarind hospital, Faculty of Medicine, Khon Kaen University between January 1, 1976 and December 31, 1987. All underwent radical hysterectomy and pelvic lymphadenectomy. The clinical data, operative data, histology, complications and follow-up profiles were analyzed by cross-tabulation and chi-square test. The main significant factors were analyzed for survival functions by the Cutler-Ederer method with Breslow and Mantel-Cox tests. Recurrences of the disease, FIGO stages, sizes and types of the lesions, histology, lengths of the uterus and modes of removal of left ovaries were all significant risk factors. The first five factors have been mentioned in previous literature but the latter two were not and need further investigation.

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Herpes simplex virus (HSV) was detected by the enzyme-linked immunosorbent assay (ELISA). The assay system employed rabbit anti-HSV-2-coated microplates to detect HSV in clinical specimens and the same reagent labelled with peroxidase as a conjugate. The HSV type 2 obtained from vero cell culture and normal cell lysate (NCL) were used as positive and negative reference antigens respectively. HSV was detected in 40 (9.93%) of vaginal swabs obtained from 403 pregnant women just before the deliveries and in 39 (9.68%) fluid samples collected immediately after birth from the mouths of 403 newborns. HSV was detected in five pairs of mother-newborn under investigation. There was no correlation between the incidence of HSV in mothers and newborns (p greater than 0.05).

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