- Detalles de la revista
- Publicado por primera vez
- 01 Jun 2007
- Periodo de publicación
- 6 veces al año
- Acceso abierto
The urge to purge: colonic ‘hydrotherapy’, unproven but widely practiced, potentially dangerous, and unsupported by scientific evidence
Páginas: 731 - 734
The only documented justifications for colon cleansing are preparation for surgery or prior to barium contrast x-rays or colonoscopy.
- Alternative/complementary medicine
- coffee enemas
- colonic irrigation
- gastrointestinal quackery
- high colonic
- Acceso abierto
Páginas: 735 - 746
Background: Several isoforms of voltage-gated sodium channels (VGSCs) found in peripheral nerves is associated in the pathogenesis of neuropathic and inflammatory pain. Until now, there are few studies of the distribution of VGSCs in dental pulp and its relationship to dental pain.
Objective: Perform literature review to provide update information of VGSCs in dental pulp.
Methods: We reviewed and discussed seventy-eight articles listed in MEDLINE (PubMed) database using keywords including “sodium channels” and “dental pain”. They are articles published in English from 1978 to 2010.
Results: Although several VGSCs isoforms are distributed in dental pulp, only NaV1.7, NaV1.8, and NaV1.9 have been found to be upregulated in painful pulpitis.
Conclusion: NaV1.7, NaV1.8, and NaV1.9 seem to have key roles in inflammatory dental pain. As a result, they might be the targets to treat dental pulp inflammation.
- Dental pulp
- sodium channels
- Acceso abierto
Expression of M-ficolin, H-ficolin, and L-ficolin in peripheral blood mononuclear cell of tuberculosis patients
Páginas: 747 - 754
Background: Ficolins are lectins that have been demonstrated to play an important role in innate immune response in a variety of diseases. Mycobacterium tuberculosis (M.tb) infection can trigger a series of changes in the host. However, the role of ficolin in tuberculosis is still unclear.
Objective: We investigated the expression of ficolin in peripheral blood mononuclear cell (PBMC) in TB patients and healthy control.
Methods: Using semi-quantitative RT-PCR, western blotting, and flow cytometry, we compared the expression of M-ficolin, L-ficolin, and H-ficolin in the peripheral blood mononuclear cell (PBMC), purified monocytes, and cultured dendritic cells of TB patients with healthy volunteers as controls.
Results: M-ficolin expression in PBMC was significantly lower at both mRNA and protein levels in TB patients as compared to healthy controls. The lower M-ficolin level in TB patient PBMCs may be attributed to its lower level in monocytes. The expression levels of H-ficolin and L-ficolin in both healthy controls and TB patients were very low and they had no significant differences between the two groups.
Conclusions: Compared to healthy controls, M-ficolin expression is significantly lower in TB patients. Measurement of M-ficolin may be a potential auxiliary tool to diagnose TB infection.
- mycobacterium tuberculosis
- peripheral blood mononuclear cell
- Acceso abierto
Páginas: 755 - 764
Background: Ablizia julibrissin could inhibit the proliferation of cancer cells in vitro and in vivo. However, the effects of the compositions Julibroside J8 and J12 on the angiogenesis are still poorly understood.
Objective: We compared the pharmacodynamics of julibroside J8 and J12 in inhibiting angiogenesis in vitro and in vivo.
Methods: Julibroside J8 and J12 were separated from the crude extract of Ablizia julibrissin. The effects of julibroside J8 and julibroside J12 on growth, migration, and matrigel tube formation of human microvascular endothelial cells (HMEC-1) were explored. In addition, the in vivo anti-angiogenic effect of julibroside J8 and J12 was evaluated on a chorioallantoic membrane (CAM).
Results: HMEC-1 cells showed dose-dependent inhibition of growth, migration, and tube formation, when treated with 0.5-4 μg/ml julibroside J8 or 0.1-0.5 μg/ml julibroside J12 respectively. The formation of microvessels on CAM was also inhibited by julibroside J8 or julibroside J12 at concentrations of 10-100 μg.egg-1 or 5-50 μg.egg-1 respectively.
Conclusion: Julibroside J12 confers more potent inhibitory effect on angiogenesis than julibroside J8 does.
- chicken chorioallantoic membrane
- human microvascular endothelial cells
- julibroside J8
- julibroside J12
- Acceso abierto
The expression of human epididymis protein 4 and cyclindependent kinase inhibitor p27Kip1 in human ovarian carcinoma
Páginas: 765 - 774
Background: Cyclin-dependent kinase inhibitor p27Kip1 is a new class of tumor suppressor in a dosage dependent manner to control cell cycle progression. Human epididymis protein 4 (HE4) is a potentially useful biomarker for ovarian carcinoma, comparable with cancer antigen 125 in identifying women with ovarian cancer, both localized and advanced. However, the prognostic significance of p27Kip1 and HE4 in ovarian cancer is unclear.
Objective: Investigate the expression of p27Kip1 and HE4 in the progression of human ovarian cancer.
Material and method: Immunohistochemical analysis was performed on formalin-fixed paraffin sections of 61 specimens. The association between HE4 and p27Kip1expression and clinicopathological features was analyzed using χ2-test. For analysis of survival data, Kaplan-Meier curves were constructed, and the log-rank test was performed.
Results: The expression of p27Kip1 negatively related with HE4 expression, but it correlated significantly with lymph nodes. On the other hand, HE4 expression correlated significantly with disease stage and lymph nodes. Kaplan-Meier analysis of the survival curves of p27Kip1 and HE4 revealed a highly significant separation between low vs. high expressers in ovarian carcinoma.
Conclusion: Expression of HE4 was up-regulated significantly in human ovarian carcinoma. Overexpression of HE4 might be responsible for oncogenesis and development of ovarian carcinoma. HE4 and p27Kip1 may be of prognostic significance in human ovarian cancer.
- HE4 (WFDC2)
- human ovarian cancer
- Acceso abierto
Inhibition of cell cycle progression and apoptotic activity of resveratrol in human intrahepatic cholangiocarcinoma cell lines
Páginas: 775 - 786
Background: Cholangiocarcinoma (CCA) is a cancer of the bile duct epithelium and is characterized by a poor prognosis and unresponsiveness to conventional treatments. Effective therapeutic agents for CCA are urgently needed. Resveratrol, a phytoalexin found in several fruits, has been reported to inhibit growth of various cancer cell lines.
Objective: We investigated the effect of resveratrol on the intrahepatic CCA-derived KKU-100 and KKU-M156 cell lines.
Materials and methods: The cell lines used were established from Thai CCA patients (KKU-100, a poorlydifferentiated adenocarcinoma and KKU-M156, a moderately-differentiated adenocarcinoma). The mechanisms of an antiproliferative effect of resveratrol on these cell lines were determined using sulforhodamine B assay, flow cytometry, ethidium bromide/acridine orange staining, DNA fragmentation, and Western blotting analysis.
Results: Resveratrol significantly inhibited CCA cell growth in a dose- and time-dependent manner. Resveratrol induced cell cycle arrest at the G0/G1 phase in KKU-100 by decreasing cyclin D1, cyclin E, cyclin-dependent kinase (Cdk)2 and Cdk4 levels and increasing p53, Cdk inhibitors (CDKIs) p21 and p27 levels. By comparison, resveratrol induced cell cycle arrest at the S and G2 phases in KKU-M156 cells by increasing cyclin E, Cdk2, p53, p21 and p27 levels and decreasing cyclin B1 and Cdk1 levels. Subsequently, resveratrol induced apoptosis of both cell lines by increasing the Bax/Bcl-2 ratio and apoptosis-inducing factor, and decreasing survivin and subsequent activation of caspase-9 and -3 and DNA fragmentation.
Conclusion: Our study highlighted for the first time that resveratrol had different effects on cell cycle progression and apoptosis mechanisms in different CCA cell types. Resveratrol inhibits growth of the KKU-100 and KKUM156 cell lines by arresting different phases of the cell cycle and inducing a mitochondrial-dependent apoptosis pathway, through both caspase-dependent and -independent means. These results suggest that resveratrol could be developed as a chemotherapeutic agent against CCA.
- cell cycle arrest
- human cholangiocarcinoma cell lines
- mitochondrial-dependent signaling pathway
- Acceso abierto
Type I collagen extracted from rat-tail and bovine Achilles tendon for dental application: a comparative study
Páginas: 787 - 798
Background: Collagen has attracted great interest as a biomaterial for various dental and medical uses.
Objective: Investigate the characteristics and biocompatibility of type I collagen extracted from rat-tail tendon and bovine Achilles tendon for dental application.
Materials and methods: Type-I collagen was extracted from rat-tail and bovine Achilles tendon using pepsin. The purity of collagen extracts was examined using sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE). The biocompatibility with human gingival fibroblasts (HGFs) and human oral keratinocytes (HOKs) was examined using an MTT (3-(4,5-Dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide) assay. Scanning electron microscope (SEM) illustrations of purified collagen alone and collagen with HGFs and HOKs were presented. A three-dimensional wound-healing model of fibroblast populated collagen lattice (FPCL) was used to determine the capability of both sources of collagen to induce wound healing in vitro. Cellular collagen lattices were fabricated to examine the contraction rate of these collagens.
Results: The average yield of collagen extracted from rat-tail and bovine Achilles tendon were 21.8±14.9% and 5.4±0.4%, respectively. The SDS-PAGE analysis showed that the extracts were composed of alpha 1, alpha 2 and beta chains with little contamination of other small proteins. The MTT assay showed good proliferation of cells cultured with each collagen extract, indicating that collagen extracts were non-toxic to the cells. SEM and the FPCL analysis showed that both types of collagen were biocompatible with both HGFs and HOKs, inducing good contraction in the in vitro model.
Conclusion: Type-I collagen extracted from rat-tail and bovine Achilles tendon appeared to be biocompatible with HGFs and HOKs. Both biomaterials may be of use in dental practice.
- bovine Achilles tendon
- human gingival fibroblasts
- human oral keratinocytes
- rat tail
- Acceso abierto
Páginas: 799 - 806
Background: The Thai government has implemented the first peritoneal dialysis (PD) policy to end-stage renal disease (ESRD) patients under the universal health-care coverage in 2008. However, no data on Thai PD patients’ health-related quality of life (HRQOL) was available.
Objectives: We measured the HRQOL of Thai PD patients, to compare it with those of other PD nations, and to assess the relationships between the HRQOL and socio-demographic and clinical data.
Methods: This is a cross-sectional study. About 100 PD patients were randomly selected from 10 hospitals registered with the National Health Security Office. Face-to-face interviews were conducted between October 2008 and February 2009. The face-to-face interview included WHOQOL-BREF, a generic HRQOL measure including four domains: physical, psychological, social, and environmental domains, and ESRD symptoms. Socio-demographic and clinical data was collected from medical records.
Results: Mean age was 42.2±13.8 years; 53% were male. The four domain scores included 13.05±2.34, 13.40±2.67, 13.30±2.95, and 12.52±2.11 for physical, psychological, social, and environmental domains, respectively. The Thai sample had higher physical and psychological domain scores of WHOQOL-BREF than the Taiwanese sample (both p <0.01) but a lower environmental domain score than the Greek sample (p <0.01). No significant differences in social domain scores between the three nations were found. The multivariate regression analyses showed that ESRD symptoms were significantly and negatively associated with the four domains of WHOQOL-BREF (p <0.01 except the social domain p <0.05). The regression model also found that males were negatively associated with the psychological domain (p <0.05).
Conclusion: This Thai PD sample yielded the highest domain scores on the psychological domain, followed by the social, the physical, and the environmental domains, respectively. The Thai PD had comparable HRQOL to other PD nations. ESRD symptoms and males were negatively associated with HRQOL in Thai PD patients
- End-stage renal disease
- health-related quality of life
- health status
- kidney or renal failure
- peritoneal dialysis
- Acceso abierto
The comparison of 1988 and 2009 FIGO staging system for uterine sarcoma in King Chulalongkorn Memorial Hospital during 1999-2008
Páginas: 807 - 816
Backgrounds: Uterine sarcoma was staged previously according to the 1988 FIGO staging system for endometrial adenocarcinoma. However, in 2009 a new staging system for uterine sarcoma has been developed.
Objectives: The purpose of this study was to compare the survival between traditional and new FIGO staging system.
Materials and methods: The medical records of uterine sarcoma patients who received primary treatment at King Chulalongkorn Memorial Hospital, Thailand between 1999 and 2008 were reviewed. The survival curves were generated by Kaplan-Meier method. A comparison of survival between groups was assessed by the log-rank test.
Results: Thirty-three patients were included. The incidence of uterine sarcoma was 0.8% and 4.4% of all gynecologic cancers and uterine cancer, respectively. A comparison between these two staging systems showed that four patients (12.1%) were down-staged and none was up-staged. The 5-year disease-free survival (DFS) and overall survival (OS) were 40.4% and 56.0%, respectively. Age, parity, histology, tumor size, lymph node dissection, and adjuvant treatments were not significant prognostic factors. Patients with early stage had significantly longer survival than those with advanced stage. Mean DFS in early stage according to 1988 and 2009 FIGO staging system were 80 and 77 months, respectively. Mean OS were 97 months and 91 months, respectively. Mean DFS in advanced stage were 34 months and 15 months, respectively. Median OS were 12 months and 10 months, respectively. There was no difference in survival between these two staging systems.
Conclusions: Stage is the only independent prognostic factor. There was no difference in survival between these two staging systems.
- FIGO staging system
- uterine sarcoma
- Acceso abierto
Páginas: 817 - 824
Background: Knowing aortic arch branches’ variations before surgery of supraaortic arteries is important. Failure to detect critical variation at surgery may cause serious consequences. There is different incidence of variation reported in the literatures, and is possibly due to different race.
Objective:We determined the incidence and pattern of the aortic arch branches’ variation in Asian adults observed in chest computed tomography (CT).
Materials and methods: We retrospectively reviewed 687 chests CT between January 2006 and April 2007. The incidence and pattern of variations of aortic arch branches were analyzed.
Results: Of 687 studies, the variations of aortic arch branches were present in 76 patients. Six of 76 patients had more than one variant. The incidence of each variation was as follows: 5.97% common origin of left common carotid artery and brachiocephalic artery or left common carotid artery arising from brachiocephalic artery, 4.08% left vertebral artery arising from aortic arch, 0.29% right vertebral artery arising from brachiocephalic artery, 0.29% right vertebral artery arising from right common carotid artery, 1.16% aberrant right subclavian artery and 0.15% common origin of left common carotid artery and right common carotid artery with aberrant right subclavian artery.
Conclusion: There are some racial variations of the aortic arch branches. Our data provide information on the incidence of aortic arch branches’ variations in an Asian population. Despite these variations are usually asymptomatic, they may cause symptoms or complication during surgery of the head, neck and thorax in certain conditions.
- Aortic arch branch
- vascular anatomy
- Acceso abierto
Páginas: 825 - 830
Background: The standard preparation of fortified preterm human milk (FHM), 1 to 2 packs of human milk fortifier (HMF) in 50 milliliters of expressed breast milk (EBM), may fail to meet the theoretical requirements of ill preterm infants. The superfortified preparation of preterm human milk (SHM), 3 packs in HMF in 50 milliliters of EBM, however, leads to concerns about the osmolality of the preparation, as the higher the osmolality, the greater the risk of necrotizing enterocolitis.
Objective: We evaluated the effect of the superfortification of HMF on the osmolality of EBM
Material and method: Twelve samples of EBM were collected from mothers of a gestational age of less than 37 weeks. We measured the osmolality of the preterm human milk (PHM), FHM, and SHM. The SHM was kept at room temperature to measure the osmolality at 10 minutes after fortification.
Results: The means (SD) osmolality of the PHM and FHM were 293.9 (12.7), 335.2 (18.7) mOsm/kg H2O, respectively. The means (SD) osmolality of SHM immediately after fortification and 10 minutes after fortification at room temperature are 370.6 (17.4) and 369.8 (17.2) mOsm/kg H2O respectively.
Conclusions: The measured osmolality of SHM was less than 450 mOsm/kg H2O. This is still within the international reference range for the composition of PHM, except Ca, P, Zn, Cu, vitamin A, B1, B2, niacin, and folic acid. Therefore, SHM should be considered for feeding in only high-risk preterm neonates for short-term periods. Adverse effects need to be observed.
- Human milk
Brief communication (Original)
- Acceso abierto
Páginas: 831 - 836
Background: Metastasis of tumor implantation includes a series of processes from detachment from the primary tumor to formation of the implanted metastase. Tumor cells survival in urine is a necessary condition for metastasis. Adaptation to urine is essential for this.
Objective: Establish a urine-resistant cell sub-strain of human bladder cancer cell line (ET cell lines), and study different characteristics compared to parent cells.
Methods: EJ cell lines were cultured in nutrient medium. Urine-resistance cell sub-strain (EJ-U) was harvested after prolonged culture by gradually increasing the concentration of urine. Gen chip was used to detect the genome series of EJ and EJ-U and to analyze the difference of gene expression.
Results: EJ-U in urine had a higher survival rate after 24 hours in urine compared with EJ. The EJ-U had almost the same growth velocity with EJ, and they had the analogous growth curves. The time-duration for EJ-U to survive was longer than EJ in urine. In gene ontology analysis, 272 significant different genes were found.
Conclusion: EJ-U cell sub-strain was more adaptable than its parent cell lines EJ. The different genes may explain the reason why bladder cancer cells could survive for a long time in urine.
- Bladder cancer
- cell sub-strain
- gene chip
- Acceso abierto
Páginas: 837 - 842
Background: Severe clinical hepatitis after imatinib treatment has been reported anecdotally. Hepatic tissue of patients with liver matastasis is often fragile and difficult to handle during liver resection from gastrointestinal stromal tumor (GIST).
Objective: Observe hepatic tissue of these patients and examine the detailed histopathology underlying the change in the texture of non-tumorous hepatic parenchyma of these patients.
Materials and methods:We reviewed six GIST patients with liver metastases who underwent hepatic resection at King Chulalongkorn Memorial Hospital between July 2004 and November 2005. Four patients did not have imatinib and two patients received imatinib for four and eight months before liver resection. Preoperative hepatic biochemistry profiles of all patients were unremarkable. We examined histopathology of non-tumorous hepatic parenchyma of these patients using H-E staining, and additional histochemistry for vascular endothelial growth factor and epidermal growth factor receptor using immunohistochemistry staining.
Results: In all patients, common histopathological changes were swelling of hepatocytes, diffuse parenchymal congestion, dilatation of central vein, and infiltration of portal tract by mononuclear cells. However, there was significant zone 3 hepatocytolysis only in patients who received imatinib treatment. Additionally, moderate degree of hepatic steatosis correlated well with the duration of imatinib exposure. Immunohistochemical study could not demonstrate any difference between these two groups.
Conclusion: In two cases of subclinical hepatotoxicity from exposure to imatinib, histopathologic findings were consistent with drug induced liver injury. Imatinib induced liver injury may be more common than obvious clinical hepatitis.
- Gastrointestinal stromal tumor
- liver injury
- Acceso abierto
Páginas: 843 - 848
Background: Corneal transplantation is the most frequent organ transplantation worldwide. Many indications for corneal transplantation have been proposed and several novel indications have been reported in various studies. Nevertheless, there is no national data from Thailand to date.
Objective: We identified indications and evolving trends of corneal transplantations in Thailand between January 1996 and December 2008
Methods: Corneal graft registry records of the Thai Red Cross Eye Bank during January 1996 and December 2008 were retrospectively reviewed. Diagnosis of the recipient eye is considered as an indication for transplantation. Patients’ demographic data, diagnosis, operating hospitals, and number of collected corneal tissues annually were collected. Analyzed data were shown in scattergram and simple linear regression. A p value of 0.05 was considered significant.
Results: Among 3,582 records, 2,802 (78.2%) had the transplantation done for an optical reason. Others were performed due to either therapeutic or tectonic reasons. None of the cases was operated for a cosmetic concern. Mean age of patients was 51.8 years. Male (56.8%) was slightly predominant over female (43.2%). Corneal scar (20.44%) was the most frequent indicated reasons followed by corneal ulcer (19.15%), pseudophakic and aphakic bullous keratopathy (16.81%), corneal dystrophies (11.08%) and regraft (10.75%). PBK/ABK and regraft showed an increasing trend during the study period.
Conclusion: Common indications for corneal transplantation in Thailand were corneal scar, corneal ulcer, PBK/ ABK, corneal dystrophies and regraft respectively. Due to imbalanced demand and supply of donated corneas, not all of the patients received corneal transplantations in a timely manner. As a result, this study might not truly represent the actual indications for corneal transplantation in Thailand. With continued development in donation awareness, financial support and inter-organizational collaborations and healthcare as a whole, adequate numbers of corneal supply might be possible in the future.
- Corneal transplantation
- penetrating keratoplasty
- Acceso abierto
The efficacy of 4% lidocaine with 3% ephedrine used on nasal packs or as a nasal spray for pain relief in nasal endoscopy
Páginas: 849 - 854
Background: Before nasal endoscopy, topical intranasal anesthetics and decongestant are usually used to relieve patients’ pain and discomfort. Two methods of drug administration are usually performed, nasal packing vs. nasal spray.
Objective: We compared the efficacy of nasal packing vs. nasal spray with 4% lidocaine and 3% ephedrine in patients undergoing rigid nasal endoscopy in terms of pain, discomfort, clarity of view of lateral nasal anatomy and overall patient and examiner preference.
Methods: A single-blinded randomized controlled clinical trial was conducted in 86 adult patients undergoing rigid nasal endoscopy at the Outpatient Department of Otorhinolaryngology, Faculty of Medicine, Khon Kaen University, Thailand. Nasal cavities were randomly selected to receive nasal packing or nasal spraying before nasal endoscopic procedure. Outcomes were assessed for differences in pain, discomfort, clarify of nasal anatomy during nasak endoscopic procedures as well as patient and examiner preference.
Results: There were statistically and clinically significant differences between the nasal spray groups and nasal packing groups during drug administration in the number of patients who had less pain, 46 (56.1%) vs. 17 (20.7%), patients’ pain score 2.36 vs. 3.20 and patient preference, 63.4% vs. 30.5%, respectively. During nasal endoscopic procedure, there were no clinically and statistically significant difference in the number of patients who had less pain, less discomfort, pain score and discomfort score. There was also no statistically and clinically significant difference for the choice of method of drug administrations for nasal endoscopic examination in the future. During nasal endoscopy, the endoscopist could see the middle meatus and superior meatus more clearly when nasal packing group had been performed and the endoscopist expressed a clear preference for nasal packing.
Conclusions: Nasal packing provided a clearer view of lateral nasal wall anatomy. This method of drug administration was preferred by the endoscopist. There were no clinically and statistically significance differences between both methods in terms of patients’ overall preference.
- nasal endoscopy
- nasal packing
- nasal spray
- Acceso abierto
Newborn screening for congenital adrenal hyperplasia in Srinagarind Hospital, Khon Kaen University, Thailand
Páginas: 855 - 860
Background: Salt wasting 21-hydroxylase deficiency congenital adrenal hyperplasia (CAH) is the most common cause of adrenal insufficiency during neonatal periods. Newborn screening for CAH will improve case early detection and decrease associated morbidity and mortality. The previous nationwide incidence of CAH in 1999 was 1:19,521. To date, CAH newborn screening has not been included in national newborn screening program.
Objective: We evaluated the incidence of CAH in newborns delivered at Srinagarind Hospital.
Methods: Between September 2005 and June 2008, the filter paper blood spot 17-hydroxyprogesterone (17-OHP) tests were determined in newborns delivered at Srinagarind Hospital. The tests were concurrently performed with TSH and phenylketonuria screening in national newborn screening program of the Ministry of Public Health of Thailand. Re-evaluation with completed physical examinations, repeated blood test for serum 17-OHP and serum electrolytes were performed in newborns who had 17-OHP levels higher than cut-off values. CAH was indicated in patients who had abnormal high serum 17-OHP concentration with or without hyperpigmentation and/or ambiguous genitalia in affected females and/or electrolyte imbalance.
Results: Five thousand seven hundred seventy one of 7,147 (80.74%) live births were screened for CAH. Fourteen infants (0.24%) were recalled for re-evaluation. Eight of fourteen (57.14% response rate) infants had the repeated blood tests. Abnormal elevated serum 17-OHP concentrations were found in two infants. Only one had clinical and laboratory findings indicative of CAH. The incidence of CAH was therefore 1:5,771.
Conclusion: The incidence of CAH from newborn screening in Srinagarind Hospital was obviously higher than national incidence of Thailand. The implement of CAH screening for all neonates should be reconsidered.
- Congenital adrenal hyperplasia
- newborn screening
- 21-hydroxylase deficiency
- Acceso abierto
Neurodevelopmental outcomes of children with gastroschisis at university hospital in northeast Thailand
Páginas: 861 - 866
Background: Gastroschisis is common among congenital abdominal wall defects. The cause is unknown but it was found to be associated with young maternal age. The association between gastroschisis and delayed development is undetermined.
Objective: We described neurodevelopmental outcomes in patients with gastroschisis at 24±6 months corrected age (CA) and identify factors associated with delayed neurodevelopmental outcomes.
Method: This is a cross sectional descriptive study, in patients with gastroschisis born between July 2007 and December 2008, who were admitted to the neonatal unit at Srinagarind hospital, a university hospital in northeast Thailand. The patients underwent developmental assessment at 24±6 months CA by Bayley Scales of Infant Development III (BSID III) which assesses three domains: cognitive, language and motor development.
Result: Fifteen of 21 patients with gastroschisis were included in the study. The mean age at follow up was 21.8±3.9 months. Four patients (26.7%) had delayed development. One was mildly delayed in all aspects including cognitive, language, and motor development. Three patients (20%) had mild delay in language development only. No significant risk factor associated with delayed neurodevelopmental outcomes was identified. Transient hypothyroidism from iodine excess was found in three out of four patients (75%) who had undergone the silooperation (p=0.01).
Conclusion: Developmental evaluation should be performed in patients with gastroschisis because we found that 26.7% of patients with gastroschisis had delayed development. However, significant risk factors could not be identified due to limited number of subjects. If the patient underwent the silo-operation, thyroid function should be tested and closely followed-up.
- neurodevelopmental outcomes
- transient hypothyroidism
- risk factor
- Acceso abierto
Páginas: 867 - 872
Background: Colostomy formation and closure procedures are common operations, frequently be performed in patients with anorectal malformation. Collected information is lacking concerning the outcome of colostomy closure operations and the major factors influencing the outcome.
Objective: The authors examined the outcome and complications of colostomy closure in patients with anorectal malformation, and the major factors influencing the outcome.
Materials and methods: The study period was January 1997 through December 2007. A review of medical records from this period showed 259 cases of anorectal malformations (ARM). The records of one hundred and one patients from Songklanagarind Hospital were examined. The variables considered were first feeding time following the procedure, length of hospital stay and presence of complications. Influencing factors that might be related with these outcomes were identified.
Results: The data showed 107 colostomy closures. The median first feeding time was two days and median post operative hospital stay was five days. There were 13 cases (12.2%) of acute complications, of which the most common was wound infection (four cases, 3.7%) and 16 cases of late complication, most of which were fecal impaction (eight cases, 7.5%). Acute post-operative complications were more likely in patients with co-morbidity prior to surgery (p-value 0.088) and in transverse-end colostomies (p-value 0.004), and with an interval between colostomy formation and closure less than four months or more than eight months (p-value 0.010). Hospital stay was longer in patients with transverse-end colostomy (p-value 0.051), Down syndrome (p-value 0.009) and acute complications (p-value <0.001).
Conclusion: Many variables influenced the outcome of colostomy closure, most commonly co-morbidity prior to surgery, transverse-end colostomy, Down syndrome, and longer or shorter than normal interval between colostomy formation and closure.
- Anorectal malformation
- colostomy closure
- Acceso abierto
Páginas: 873 - 880
Background: Recently, a competency-based educational system has been recommended for anesthesia residents in Thailand, instead of a structure-and-process-based medical system. Learning portfolios have become popular and reliable in health profession and education to assess competency and performance in clinical practice.
Objectives: Develop a portfolio for learning improvement in first year anesthesia residents in Thailand, and validate this portfolio as a competency evaluation and to identify strength and weakness of implementation.
Methods: A learning portfolio was developed from Thai Medical Council general competencies, academic activities, and performance assessment in several modalities. Twenty-four first year anesthesia residents and eight mentors were enrolled for this study. One staff mentored three residents and rated their competencies in portfolios, twice, four-months apart. Content validity was assessed by six content experts. Concurrent validity of portfolio was determined by agreement with faculty global rating and in-training examination. Inter-rater reliability of portfolio was evaluated by five faculties that rated 24 residents. Practicality was commented upon by all mentors and residents in the questionnaire and semi-structure, open-ended questions.
Results: All content experts accepted that this portfolio could assess general competencies of the first year anesthesia residents. Concurrent validity of portfolio was demonstrated by high overall agreement with faculty global rating and in-training examination. Inter-rater reliability was good. The majority of mentors and residents (>70%) agreed with the benefit of portfolio based on learning development and competency assessment. However, half of residents were not satisfied with the burden from portfolio.
Conclusion: The present learning portfolio provided benefit in learning improvement. It was a valid and reliable tool in competency assessment, but a burden, in the views of the residents.
- Acceso abierto
Páginas: 881 - 888
Background: Repair of facial defects is a unique challenge because it is critical that donor tissues match the tissues in the affected region and provide good functional as well as aesthetic outcomes.
Objective: Summarize the outcomes of the use of expanded forehead flaps to repair extensive facial defects in 13 patients.
Methods: Axial expanded forehead flaps pedicled on the superficial temporal vessels and supraorbital and supratrochlear neurovascular bundles were used to repair defects of the nose, eyelids, and mouth. Seven cases involved damage to the nose and lip and six cases involved the forehead and nose. Among the latter six cases, three had skin surface tumors involving the forehead together with the upper eyelid and the nose, in which one was pigmented nevus, one was neurofibroma, and one was hemangioma.
Results: A total of 34 flaps, ranging in size from 2.5-4 cm to 12-9 cm, were used to repair facial defects in the 13 patients (five males, eight females; median age, 32 years). There were no surgical or postoperative complications, and all flaps survived. In all cases, cosmetic and functional outcomes were considered satisfactory.
Conclusion: The expanded forehead flap provides a large amount of tissue with color and texture similar to that of facial structures, and avoids significant donor sight scars. In addition, the extensive blood supply of the forehead helps to ensure flap survival. Expanded forehead flaps are useful for the repair of large facial defects.
- Axial flap
- expanded forehead flap
- facial defect
- plastic surgery
- Acceso abierto
Páginas: 889 - 892
Background: Congenital adrenal hyperplasia (CAH) classical form comprises salt wasting (SW) and simple virilizing (SV) forms. This group accounts for about 75% of the affected individuals. Variation in mutation of CYP21A2 gene may cause different phenotypes.
Objectives: We reported a case of SV 21-hydroxylase deficiency that was misdiagnosed as a boy due to completely reversed external genitalia.
Methods: Allele-specific PCR for eight common mutations and dosage analysis of the CYP21A2 gene by SALSA multiplex ligation-dependent probe amplification (MLPA) were done.
Results: The molecular analysis revealed a 30 Kb homozygous deletion of CYP21A2 gene.
Conclusion: Genotype-phenotype correlation expected SW form of the disease rather than SV form hence, this discrepancy might be caused by other genes or modifier genes.
- Azeri family
- congenital adrenal hyperplasia
- simple virilizing