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Détails du magazine
Format
Magazine
eISSN
1875-855X
Première publication
01 Jun 2007
Période de publication
6 fois par an
Langues
Anglais

Chercher

Volume 5 (2011): Edition 1 (February 2011)

Détails du magazine
Format
Magazine
eISSN
1875-855X
Première publication
01 Jun 2007
Période de publication
6 fois par an
Langues
Anglais

Chercher

21 Articles

Review article

Accès libre

Tissue engineering of bone and cartilage: a view through the patent literature

Publié en ligne: 04 Feb 2017
Pages: 1 - 12

Résumé

Abstract

Background: Tissue engineering takes on many approaches. It is mostly followed by those in the field through scientific literature. However, there is a virtually untapped resource in patent literature.

Objective: This review focuses on patents through the United States Patent and Trademark Office (USPTO). This source is used only because the author is most familiar with this resource. This article is not intended to be instructional regarding patents, patent law, or how to apply for patents, nor is it intended to be all inclusive of the patent literature. However, the reader might see the value of following the patent literature as a source of ideas, technologies, methodologies, and knowledge with respect to tissue engineering.

Mots clés

  • Bioreactors
  • bone
  • cartilage
  • patent literature
  • tissue engineering
Accès libre

Radiation dose from CT scanning: can it be reduced?

Publié en ligne: 04 Feb 2017
Pages: 13 - 21

Résumé

Abstract

CT has been used to save many patients’ lives and the demand for CT is still increasing. At the same time, there has been increasing concern of the probability of cancer induction by CT radiation. It is necessary for everyone involved in CT scanning, particularly physicians who have to communicate with patients when planning a CT scan, to have a basic knowledge of the CT radiation dose and its potential adverse effects. We have undertaken a systematic review of the literatures to document the radiation dose from CT, the lifetime cancer risk from CT exposure, CT dose parameters, the internationnal CT diagnostic reference levels, and the use and limitation of the CT effective dose. In addition, we conducted a brief survey of the use of CT scan in some university hospitals in Thailand and estimated current CT doses at these hospitals. Our review and survey suggests that CT scanning provides a great benefit in medicine but it also becomes the major source of X-ray exposure. Radiation doses from a CT scan are much higher than most conventional radiographic procedures. This raises concerns about the carcinogenic potentials. We encourage every CT unit to adhere to the International Guidelines of CT dose parameter references. Our preliminary survey from some university hospitals in Thailand revealed that CT radiation doses are within acceptable standard ranges. However, the justification for utilization of CT scans should also be required and monitored. The importance of adequate communication between attending physician and consulting radiologist is stressed.

Mots clés

  • Computer Scanning
  • dose calculation
  • radiation risk
  • state of the art in Thai university hospitals
Accès libre

The genetics behind osteoarthritis: Asian focus

Publié en ligne: 04 Feb 2017
Pages: 23 - 36

Résumé

Abstract

Osteoarthritis (OA), a degenerative joint disease, is the most common form of arthritis in the elderly. Problems arising from the condition are not only health, physical, and psychological, but also economical and social. OA is a complex disease causes by environmental factors (obesity, female gender, advancing age) and genetics. A strong genetic contribution to primary OA has been observed in several studies. Asian population is undoubtedly genetically different from European, whom most studies have been performed. This review systematically compares results of molecules involved with OA from studies performed on Asian and Caucasian populations. The clear differences between Asian and Caucasian populations may be from the sex- and ethnic-specific nature of the disease, as well as from the inclusion criteria of the studies. Global collaboration is highly significant in understanding genetic underlying OA. Knowledge gained from genetic study is important to the development of prevention and therapeutic intervention, and to identify individuals at risk of developing severe or progressive OA.

Mots clés

  • Asian
  • genetics
  • osteoarthritis

Original article

Accès libre

Tuberculous arthritis in Cambodia

Publié en ligne: 04 Feb 2017
Pages: 37 - 43

Résumé

Abstract

Background: Cambodia boasts one of the highest incidences of TB in the world. As such, healthcare providers are experienced with types of extrapulmonary TB such as septic Mycobacterium tuberculosis arthritic infections, not seen in developed countries.

Objective: Examine the incidence and distribution of TB arthritis cases at a Cambodian surgical center, explore the problems of diagnosis and current methods of treatment for this disease.

Methods: The written charts, operation records, and electronic database of patients with clinically diagnosed extrapulmonary TB, confirmed with a positive biopsy between January 2001 and July 2010 were searched. While medical treatment for the TB was given at other facilities, the operations performed and the result for patients with follow-up was reviewed.

Results: Between January 2001 and July 2010, 38 cases of TB arthritis at the CSC in Cambodia were histologically confirmed. Twenty-eight cases affected the lower extremity with the majority affecting the knee and ankle. All 13 patients receiving arthrodesis reported positive surgical outcomes.

Discussion/Conclusion: TB arthritis persists as an ongoing problem at CSC with a significant level of incidence. Arthrodesis is a viable and cost effective mean of treating TB arthritis in Cambodia.

Mots clés

  • Arthritis
  • arthrodesis
  • cambodia
  • fusion
  • incidence
  • tuberculosis
Accès libre

Human IgG inhibits IgA1 protease-dependent adherence of Haemophilus influenza strains to human lung epithelial cells

Publié en ligne: 04 Feb 2017
Pages: 45 - 56

Résumé

Abstract

Background: IgA1 protease may enhance the bacterial infection in human beings. However, the molecular mechanism of bacterial adherence to eukaryotic cells is unclear.

Objective: Reveal the mechanisms of IgA1 protease-dependent and non-protease bacterial adherence to eukaryotic cells.

Method: Type I and type II IgA1 proteases from iga genes (GenBank DQ683355 for NTHi465, DQ683356 for NTHi500 and DQ683357 for Nm430) were cloned, expressed, and purified. Cellular assays for adherence of IgA1 protease-producing and -non-producing and typable and nontypable strains of H. influenzae to human lung carcinoma cells (A549) were carried out in the presence of human antibodies.

Results: Adherence of protease-producing strains and non-producing strains to human epithelial cells was significantly dependent on the enzyme activity. In addition, human IgG was an inhibitor to IgA1 proteasedependent adherence of H. influenzae strains to human cells. However, IgA1 antibodies were irrelevant to IgA1 protease-dependent adherence.

Conclusion: IgA1 protease was required for adherence of pathogenic bacteria to human epithelial cells in IgA1 protease-producing bacteria, and human IgG inhibits the adherence, but not for IgA1 protease non-producing bacteria.

Mots clés

  • Cellular adherence
  • iga gene
  • IgA1 protease subtypes
  • IgG inhibition
  • Neisseria meningitides
  • typable and nontypable Haemophilus influenzae (THi and NTHi)
Accès libre

Clinical and laboratory diagnosis of spinocerebellar ataxia type 3 in a large Chinese family

Publié en ligne: 04 Feb 2017
Pages: 57 - 62

Résumé

Abstract

Background: Hereditary ataxia is a group of hereditary diseases that are characterized by chronic progressive uncoordinated gait and are frequently associated with cerebellar atrophy.

Objectives: To investigate evidence-based diagnosis of hereditary ataxia by retrospective analysis of the diagnostic process in one Chinese family.

Methods: Clinical records of 15 ataxia patients from one Chinese family with 46 family members were retrospectively reviewed and a tentative diagnosis was made based on clinical manifestations, signs and symptoms, mode of inheritance, and progression. Since hereditary ataxia is a group of heterogeneous diseases having various subtypes and overlapping symptoms, we adopted a stepwise evaluation to achieve a tentative diagnosis. To confirm the diagnosis, we performed polymerase chain reaction (PCR) specific for the suspected causative gene of spinocerebellar ataxia (SCA) subtype 3 (SCA3).

Results: Through analysis of hereditary and clinical characteristics of family histories of the patients, we suspected that the family might suffer from SCA, especially, SCA3. The PCR assay for SCA3 showed that, five of the ten samples analyzed had a CAG trinucleotide expansion of the SCA3 gene, and four of the five members developed ataxia. The remaining one, a seven-year-old girl, showed no symptoms or signs except for uvula deviation. No clinical symptoms were found in five other members with negative PCR results. Thus, based on both clinical findings and laboratory results, we further confirmed that the family suffered from SCA3.

Conclusion: Hereditary ataxias are disorders sharing overlapping symptoms. Comprehensive analysis of medical and family records together with genetic diagnosis improves diagnostic efficiency of hereditary ataxia and aides in family counseling.

Mots clés

  • Cerebellar ataxia
  • diagnosis
  • heredity
  • PCR
Accès libre

Antiviral activities of aerial subsets of Artemisia species against Herpes Simplex virus type 1 (HSV1) in vitro

Publié en ligne: 04 Feb 2017
Pages: 63 - 68

Résumé

Abstract

Background: Drug resistance to current anti-herpetic drugs has been increasingly reported. Therefore, there is a need for finding new antiviral agents, in particular from natural sources.

Objective: In the present study, antiviral activity of subset extracts obtained from aerial parts of Artemisia including A. incana, A. chamaemelifolia, A. campesteris, A. fragrans, A. annua, A. vulgaris, and A. persica were investigated against Herpes Simplex type I (HSV1).

Methods: Different concentrations of extracts (400, 200, 100, 50, 25, 12.5, 6.25, and 3.125 μg/mL) were obtained from subset of each plant separately, and used against KOS strain of HSV1 in HeLa cells. After 24 hours incubation, tetrazolium dye (MTT), was added. The dye absorption by viable cells was measured and compared to the positive control (extract-untreated cells) and acyclovir (as anti-viral agent).

Results: The extracts obtained from A. annua had the highest antiviral activity while those of A. chamaemelifolia showed the lowest activity.

Conclusion: Subset extracts of A. annua may be an appropriate candidate for further development of anti HSV1 infection.

Mots clés

  • Antivirals
  • Artemisia
  • asteraceae
  • herpes simplex
Accès libre

Chemokine receptor 9 high-expression involved in the migration and invasion of the non-small-cell lung cancer cells

Publié en ligne: 04 Feb 2017
Pages: 69 - 76

Résumé

Abstract

Background: Metastasis is responsible for most cancer-related death, and the metastatic spread of neoplastic cells may be related to the ability of migration and invasion. Chemokine receptor 9 (CCR9) plays an important role in cutaneous melanoma and prostate cancer cells migration and invasion.

Objective: Investigate the specific role of the chemokine-ligand (CCR9-CCL25) axis in the development of nonsmall cell lung cancer (NSCLC) metastasis.

Methods: Semi-quantitative reverse transcriptase-PCR, western-blot, flow cytometry, migration, and invasion assays were used to examine the function of CCR9 in the NSCLC cells.

Results: CCR9 was highly expressed in NSCLC patient cancer tissue. In addition, in vitro migration and invasion studies on human bronchial epithelial cells of the BEAS-2B and human squamous lung cancer cell lines NCI-H157 showed that migration in response to the CCL25 was inhibited by CCR9 antibody.

Conclusion: CCR9 might play an important role in the migration and invasion of the NSCLC cells.

Mots clés

  • CCR9
  • CCL25
  • non-small cell lung cancer
  • migration
  • invasion
Accès libre

The efficacy and safety of 0.5% Levofloxacin versus fortified Cefazolin and Amikacin ophthalmic solution for the treatment of suspected and culture-proven cases of infectious bacterial keratitis: a comparative study

Publié en ligne: 04 Feb 2017
Pages: 77 - 83

Résumé

Abstract

Background: Bacterial keratitis is a major devastating ocular condition that quickly deteriorates the patient’s vision. Vigorous and prompt treatment of bacterial keratitis with broad-spectrum antibiotic eye-drops is preferred.

Objective: Evaluate the efficacy and safety of 0.5% Levofloxacin for the treatment of suspected and cultureproven cases of infectious bacterial keratitis in comparison to fortified Cefazolin and Amikacin ophthalmic solution.

Materials and methods: Seventy-one eyes from 69 patients suspected of having infectious bacterial keratitis were enrolled in the study. The patients were randomized into two arms, 0.5% Levofloxacin eye drops (34 eyes) or fortified Cefazolin and Amikacin (37 eyes). Sixty-eight eyes were included in the efficacy analysis. During treatment, on days 2, 7, 14, and 21, the patient’s symptoms and signs were scored from grade 0-3 (absent to severe).

Results: At the end of the treatment, 61 out of 71 eyes completely healed. The resolution of the keratitis was not significantly different between both groups. There were no significant differences in the mean time-duration for the ulcer to heal or for the symptoms and clinical signs to disappear between the two groups. No serious adverse events or side effects from the disease were found. The patients compliance was 80% based on the self-reported diaries.

Conclusion: The efficacy and safety of 0.5% topical Levofloxacin was comparable to fortified Cefazolin and Amikacin for the treatment of mild-to-moderate bacterial keratitis. Topical Levofloxacin is far superior because of its availability and patient compliance when used as monotherapy for the treatment of infectious bacterial keratitis.

Mots clés

  • Bacterial keratitis
  • fluoroquinolone
  • fortified topical antibiotics
  • Levofloxacin
Accès libre

RhBMP-2 and -7 combined with absorbable collagen sponge carrier enhance ectopic bone formation: An in vivo bioassay

Publié en ligne: 04 Feb 2017
Pages: 85 - 92

Résumé

Abstract

Background: Recombinant human bone morphogenetic proteins (rhBMPs) have been characterized especially chondrogenic and osteogenic activity both in vitro and in vivo studies. However, delivery of more than one growth factor by sustained release carrier to orthopedic site has yet been questionable in terms of efficacy and synergism.

Objective: Evaluate osteoinductivity and synergistic effect of rhBMP-2 and -7 using absorbable collagen sponge (ACS) carrier system in vivo.

Methods: cDNA of BMP-2 and -7 active domains were cloned and expressed in Escherichia coli BL21 StarTM (DE3) using pRSETc expression system. Then, the purified rhBMPs were loaded onto ACS and evaluated by in vivo rat subcutaneous bioassay. Two and eight weeks postoperatively, all treated groups were histologically verified for evidence of new bone formation and neovascularization by hematoxylin-eosin staining and light microscopy.

Results: The Wistar rat treated with rhBMP-2 or -7/ACS exhibited new bone formation, compared to ACS control. The group treated with ACS supplemented with both rhBMP-2 and -7 significantly showed the osteoid matrix very well-organized into trabeculae-like structure with significant blood vessel invasion.

Conclusion: The osteogenic induction of rhBMPs was combined with ACS carrier in the in vivo bioassay. In addition, the combination of both two potent recombinant osteoinductive cytokines, rhBMP-2 and -7, with ACS carrier demonstrated synergistic effect and might be a more promising and effective choice for therapeutic applications.

Mots clés

  • Absorbable collagen sponge
  • bone morphogenetic protein
  • ectopic bone formation
  • rat subcutaneous model
Accès libre

Caudal block with 3 mg/Kg Bupivacaine for intraabdominal surgery in pediatric patients: a randomized study

Publié en ligne: 04 Feb 2017
Pages: 93 - 99

Résumé

Abstract

Background: Caudal block with the use of an adequate dose of bupivacaine, and combined with a general anesthesia (GA) provides intra-operative anesthesia and postoperative analgesia. No study has examined the use of 3 mg/Kg bupivacaine for intra-abdominal surgery in pediatric patients in clinical practice.

Objective: Compare the effectiveness of three mg/Kg bupivacaine administered as 1.2 mL/Kg 0.25% bupivacaine and 1.5 mL/Kg 0.2% bupivacaine for caudal block in pediatric patients undergoing intra-abdominal surgery.

Methods: In a randomized, double-blinded clinical trial, patients (age: 6 months -7 years) were randomly assigned into one of two groups (n= 40) to receive a caudal block with either 1.2 mL/Kg 0.25% bupivacaine (group A) or 1.5 mL/Kg 0.2% bupivacaine (group B), with morphine 50 μg/Kg. The effectiveness of intra-operative anesthesia, complications, and requirements for post-operative analgesia were evaluated.

Results: Data were available for 74 pediatric patients. There were no significant differences between the two groups in baseline characteristics. Intra-operatively, the numbers of patients who required a rescue analgesic were comparable between the groups (67% in group A and 63% in group B). The numbers of patients who required a muscle relaxant were also comparable between groups (49% in group A and 57% in group B). The time from discontinuation of the volatile anesthetic to extubation was significantly shorter in group B (9.5±1.1 minutes) than group A (14.3±0.9 minutes), p < 0.01. The time from initial caudal block to the first analgesic required in the recovery room was significantly longer in group B (202±45 minutes) than in group A (149±27 minutes). The time from the caudal block to the first analgesic required in the ward was significantly longer in group B (10.4±3.1 hours) than in group A (8.2±2.0 hours). Overall fentanyl requirements were comparable between groups, 52.5±2.0 μg in group A and 49.5±3.0 μg in group B.

Conclusion: Caudal block by either 1.2 mL/Kg 0.25% bupivacaine plus morphine 50 μg/Kg or 1.5 mL/Kg 0.2% bupivacaine plus morphine 50 μg/Kg provided effectively equivalent intra-operative analgesia and surgical relaxation. However, a caudal block with 1.5 mL/Kg 0.2% bupivacaine plus morphine 50 μg/Kg provided superior prolonged analgesic advantages compared with 1.2 mL/Kg 0.25% bupivacaine plus morphine 50 μg/Kg in pediatric patients undergoing intra-abdominal surgery.

Mots clés

  • Bupivacaine
  • caudal block
  • effectiveness
  • intra-abdominal surgery
  • pediatric patients
  • postoperative analgesia
Accès libre

Combination of gabapentin and celecoxib for analgesia after major orthopedic surgery: a randomized, controlled trial

Publié en ligne: 04 Feb 2017
Pages: 101 - 110

Résumé

Abstract

Background: The use of analgesics with different mechanism of action enhances post-operative pain relief by opioids. Both celecoxib and gabapentin have opioid-sparing effect, but it is unclear whether combination of the two drugs accentuates postoperative analgesia and further reduced opioid requirement.

Objective: Determine whether the perioperative use of celecoxib in combination with gabapentin reduces the amount of post-operative opioid consumption in comparison to celecoxib alone or gabapentin alone in patients that have major orthopedic surgery.

Materials and methods: Randomized double-blinded placebo controlled trial was done in 99 patients underwent major orthopedic surgery. They were randomly allocated into four groups. One to two hours before anesthesia, they received midazolam 7.5 mg plus study drugs. Group P received placebo plus placebo at 12 and 24 hours later. Group C received celecoxib 400 mg plus celecoxib 200 mg at 12 and 24 hour later. Group G received gabapentin 400 mg plus gabapentin 300 mg at 12 and 24 hour later. Finally, group CG received celecoxib 400 mg + gabapentin 400 mg plus celecoxib 200 mg + gabapentin 300 mg at 12 and 24 hour later. The patients underwent surgery under general anesthesia. Post-operative pain was treated by intravenous morphine patient-controlled analgesia.

Results: Median morphine consumption (minimum-maximum) in twenty-four hours was 18.0, 15.0, 15.5, and 8.0 mg, in group P, C, G, and CG, respectively. The group CG significantly consumed less morphine (41%) in 24 hour than group G, but not significantly less (38%) than group C. Pain score, sedation score, and nausea/vomiting at postoperative hour 1, 4, 8, 12, 16, 20, and 24 was not significantly different.

Conclusion: Combination of celecoxib and gabapentin further accentuated post-operative analgesia by morphine comparing to celecoxib or gabapentin alone without change in pain score and other side effects of the medications.

Mots clés

  • Analgesia
  • celecoxib
  • gabapentin
  • multimodal analgesia
  • opioid-sparing
  • orthopedic surgery
  • postoperative
  • pain
Accès libre

Speech camp for children with cleft lip and/or palate in Thailand

Publié en ligne: 04 Feb 2017
Pages: 111 - 118

Résumé

Abstract

Background: There is a critical need for speech therapy services for people born with cleft lip and/or palate in developing countries.

Objective: Assess the effectiveness of a speech camp and follow-up session for children with cleft lip and/or palate.

Methods: A Community-Based Model for Speech therapy was implemented at Suwanaphum Hospital District, Roiet, Thailand. Thirteen children with cleft lip and/or palate (3; 6-13 years) attended a four-day speech camp and a one-day follow-up session (six months later) for remediation of their articulation disorders. Paraprofessional training was also provided. Pre- and post-tests were administered to the participants, caregivers, and paraprofessionals to determine the effectiveness of the program. A pre- and post-articulation test, as well as an audiological evaluation were administered. Five speech and language pathologists provided speech therapy, both individual and group, for a total of 18 hours during the four-day speech camp and six hours in the one-day follow-up session. The median difference of the number of articulation errors was determined by results of the Wilcoxon Signed-Rank Test.

Results: There was a significant decrease in articulation errors following both the main speech camp and the follow-up session (z = 3.11, p < 0.01; z = 2.87, p<0.01, respectively). Caregivers’ and health care providers’ satisfaction ratings for participation in the speech camps ranged from good to excellent.

Conclusion: A Community-Based Model of both a speech camp and follow-up session provided an effective speech therapy treatment for children with cleft lip and/or palate.

Keyword

  • Cleft palate
  • community-base model
  • developing country
  • speech camp

Clinical report

Accès libre

Total femur replacement for Ewing’s sarcoma after wide resection of the proximal femur: a long-term follow-up case study

Publié en ligne: 04 Feb 2017
Pages: 119 - 122

Résumé

Abstract

Background: Total femur replacement is a relatively rarely performed procedure for the reconstruction of an affected limb after resection of a malignant bone tumor.

Objective: Report total femur replacement in a 17-year-old male patient after wide resection of the right femur for involvement of the proximal segment of the bone by Ewing’s sarcoma.

Results: The complications that often arose from the use of the tumor prostheses after the tumor resection, e.g., infection and migration/dislocation of the artificial bonehead, were overcome successfully. The patient has been under follow-up for a relatively long period of time (16 years) since the surgery. The operated limb function is now rated at 70% according to the rating system by Musculo-Skeletal Tumor Society (MSTS). The patient has almost completely regained his ability to walk and carries on with activities of daily living.

Conclusion: If appropriate measures are taken to deal with the complications, favorable function of the operated limb can be expected to be maintained for long periods after reconstruction using this technique.

Mots clés

  • Total femur replacement
  • Ewing’s sarcoma
  • complications
Accès libre

Mediastinal teratoma in a neonate with acute respiratory failure

Publié en ligne: 04 Feb 2017
Pages: 123 - 127

Résumé

Abstract

Background: While teratomas account for the leading cause of germ cell tumors, the mediastinal teratomas represent one of the infrequent types of congenital germ cell tumors. Neonates with large mediastinal teratomas generally show severe respiratory distress, and the immediate surgical treatment is needed to alleviate their problems.

Objectives: Report clinical symptoms, diagnostic procedures, treatment option, and outcomes after the treatment for a neonate with a large mediastinal teratoma.

Methods: A 2-day-old female infant presented with acute respiratory failure diagnosed as mediastinal teratoma. It was followed with surgical treatment. The removed tissues were examined pathologically.

Results: The girl suffered an acute respiratory failure two days after birth. The chest radiography, echocardiography, and chest computerized tomography results showed the considerable size of the mediastinal teratoma. A median sternotomy was performed on the third day of infant life to remove the tumor without rupturing the capsule. Pathological diagnosis was germ cell tumor. Clinical follow-ups reported no complication.

Conclusion: The successful management of a neonate with large mediastinal teratomas was presented. Immediate detection and proper treatment of the large mediastinal teratoma in a neonate was most important to decrease the morbidity and mortality of the infant.

Mots clés

  • Acute respiratory failure
  • germ cell tumor
  • mediastinal teratoma
  • median sternotomy
  • neonate
Accès libre

Risk factors of extended-spectrum beta-lactamaseproducing Enterobacteriaceae bacteremia in Thai emergency department: a retrospective case-control study

Publié en ligne: 04 Feb 2017
Pages: 129 - 138

Résumé

Abstract

Background: Infections caused by resistant extended-spectrum beta-lactamase (ESBL)-producing enteric bacteria and their risk factors are globally recognized. However, such risk factors have not been explored in emergency department (ED) where the first choice of empirical antimicrobials is crucial.

Objective: Determine risk factors of ESBL bacteremia in ED, especially in our geographic area.

Methods: A retrospective case-double-control study was conducted at King Chulalongkorn Memorial Hospital. All adult ED patients with ESBL-producing E. coli and K. pneumoniae in blood cultures between October 2007 and October 2008 were recruited for this study. The potential risk factors were analyzed and compared with non- ESBL-producing bacteremic patients (control group 1) and matched general ED patients (control group 2). Nonbeta- lactam susceptibility testing among the cohort was also evaluated.

Results: Thirty ESBL (cases), 103 group 1 controls, and 100 group 2 controls were assessed. Based on the univariate analysis, age, chronic kidney diseases, malignancy, poor functional status, previous hospitalization within 90 days, and previous antimicrobial exposure especially to cephalosporins, quinolones, and carbapenems within 30 days were the risk factors for ESBL bacteremia compared with both types of control patients. Age > 60 and previous cephalosporin use were consistently identified as the risk factors by multivariate models using both control groups. The susceptibility to non-beta-lactam agents in the ESBL group was significantly lower than the non-ESBL. No carbapenem resistance was found.

Conclusion: Elderly ED patients, especially those who had previous cephalosporin exposure within 30 days, were at higher risk of ESBL-producing bacteremic infections. ESBLs tended to have less susceptibility to the non-β-lactam agents.

Mots clés

  • Bacteremia
  • emergency department
  • extended-spectrum beta-lactamase
  • risk factors
Accès libre

Carpal tunnel release by mini palmar incision

Publié en ligne: 04 Feb 2017
Pages: 139 - 142

Résumé

Abstract

Background: Open carpal tunnel release is the gold standard treatment for carpal tunnel syndrome. However, there are complications related to the long incision.

Method: We report the results from a mini-incision open carpal tunnel release with simple instruments.

Results: There were no complications in our small series, improvement of scores was shown at four-week follow-up, and cosmetic results were satisfactory.

Conclusions: Mini-incision carpal tunnel release is one option to treat carpal tunnel syndrome.

Mots clés

  • Boston carpal tunnel questionnaire
  • carpal tunnel syndrome
  • conventional open carpal tunnel release
  • mini-incision carpal tunnel release

Technical report

Accès libre

Re-exploration of the rectus femoris tendon to sartorius transfer in children with spastic cerebral palsy

Publié en ligne: 04 Feb 2017
Pages: 143 - 149

Résumé

Abstract

Background: The rational of rectus femoris tendon transfer is to use a spastic rectus femoris tendon as a knee flexor during swing phase of gait cycle. However, the concept of the rectus femoris tendon transfer has been challenged by the evidence of scar tissue formation along the transferred tendon route.

Objective: Examine the surgical technique for rectus femoris tendon transfer to the sartorius at the index procedure and report the findings at the anchoring site during the re-exploration.

Methods: Three knees were examined in two patients with spastic cerebral palsy who developed recurrent flexion contracture at 18 months after the rectus femoris tendon to sartorius surgery. They underwent femoral shortening procedures and re-exploration at the rectus femoris tendon to sartorius transfer site simultaneously to correct flexion contracture. The transferred tendon route was examined. The anchoring site at the sartorius was manually tested. The follow-up period after the re-exploration procedure ranged from 7-60 months (mean: 37 months).

Results: All three rectus femoris tendons were in a straight line, and glided smoothly on the new route with minimal scar tissue formation. The anchoring site at the sartorius was well healed, and the knee flexion was observed upon manual testing. Degree of knee flexion contracture ranged from 15 to 35 degrees (mean: 27 degrees) before re-exploration procedure. It was 5 to -5 degrees (mean: 0 degree) at the recent follow-up. All patients maintained their ambulatory status.

Conclusion: The present technique for rectus femoris tendon to sartorius transfer gave a straight-line transfer over smooth gliding path and provided a secure anchoring site. It converted the function of the transferred tendon from a knee extensor to a knee flexor and created minimal scar formation with smooth gliding path.

Mots clés

  • Cerebral palsy
  • crouching gait
  • rectus femoris tendon transfer
  • re-exploration
  • spastic diplegia
  • stiffedleg gait

Brief communication (Original)

Accès libre

Accessory brachial artery: a case report, embryological background and clinical relevance

Publié en ligne: 04 Feb 2017
Pages: 151 - 155

Résumé

Abstract

Background: The accessory brachial artery (arteria brachialis accessoria) is a rare upper limb vascular abnormality, reported in less than one percent of cases. It is the artery originating from the axillary artery or the brachial artery, which rejoins the brachial artery further along its distal course within the arm or cubital fossa. Its detailed knowledge is necessary in transradial transulnar catheterization during coronary procedures, mainly due to its narrow caliber, which is responsible for the failure of the intervention performance.

Objectives: Present a case of uncharacteristic branching pattern of the accessory brachial artery.

Method: The case was observed during a routine dissection in the left axilla of a female cadaver at the Department of Anatomy at the Third Faculty of Medicine, Charles University in Prague.

Results: The infrapectoral part of the axillary artery gave rise to a branch that descended distally along the medial side of the arm. This artery accompanied firstly the ulnar nerve, then it diverted laterally towards the median nerve and coursed hidden behind it to re-enter the brachial artery within the distal part of the arm, next to the biceps brachii muscle. The calibre of the accessory brachial artery was two mm only.

Conclusion: The accessory brachial artery is a rare variant of the upper limb vascular system and its prevailingly narrow lumen can cause a failure of the transradial/transulnar catheterization intervention.

Mots clés

  • Accessory brachial artery
  • anatomical variation
  • axillary artery
  • brachial artery
  • variant
  • variation
Accès libre

Ventilatory function among healthy young Saudi adults: a comparison with Caucasian reference values

Publié en ligne: 04 Feb 2017
Pages: 157 - 161

Résumé

Abstract

Background: Ethnic differences in lung function are recognized. However, most of the modern lung function equipments are pre-programmed with Caucasian reference values.

Objective: Measure spirometric values among healthy Saudi male and female adults and compare with the Caucasian reference values in a standard spirometer.

Methods: Thirty healthy Saudi young adults (15 males and 15 females; mean age 25 years) participated in this study. Forced vital capacity (FVC), forced expiratory volume in one second (FEV1), FEV1/FVC (%), and maximal voluntary ventilation (MVV) were recorded using a portable digital spirometer.

Results: Mean values of FVC, FEV1, FEV1/FVC (%) and MVV for the Saudi subjects were significantly lower than the Caucasians predicted values.

Conclusion: Interpretation of lung function tests of Saudi subjects based on the Caucasian prediction equations is generally not valid, as the parameters of lung function tests in Saudi subjects are lower than the Caucasian reference values. The present results underline an urgent need for larger studies to develop prediction equations based on normative spirometric values for Saudi population involving subjects of all ages and both genders living in different climates of the country.

Mots clés

  • Caucasian
  • pulmonary function test
  • Saudi healthy adults
  • ventilatory function
Accès libre

Correlation between mast cell density and histological parameters in Helicobacter pylori-associated gastritis

Publié en ligne: 04 Feb 2017
Pages: 163 - 167

Résumé

Abstract

Background: Helicobacter pylori (H. pylori) are a major cause of chronic gastritis and peptic ulcer. This organism plays a role in gastric carcinoma and B-cell lymphoma. However, the exact pathogenesis of gastric inflammation is still unclear. Mast cells, the important inflammatory cells for allergic process, may participate in the pathogenesis of gastritis related to H. pylori infection.

Objective: Analyze the relationship between mast cell density, H. pylori intensity, histological alterations, and their severity of biopsy proven gastritis.

Methods: One hundred eleven biopsied specimens were collected from Thai patients who were diagnosed H. pylori-associated gastritis of the antrum at King Chulalongkorn Memorial Hospital between 2002 and 2005. All biopsied specimens were examined according to the Updated Sydney System. Mast cell density was evaluated by 0.1% toluidine-stained sections.

Results: The higher mast cell density was correlated with increased neutrophilic infiltration (r = 0.220, p = 0.020), chronic inflammatory cell infiltration (r = 0.381, p <0.001), and lymphoid aggregation (r = 0.271, p = 0.004). No relationship was found between mast cell density and intensity of H. pylori, glandular atrophy, or intestinal metaplasia.

Conclusion: Mast cells might take part in the pathogenesis of H. pylori gastritis.

Mots clés

  • Chronic gastritis
  • Helicobacter pylori
  • mast cell
21 Articles

Review article

Accès libre

Tissue engineering of bone and cartilage: a view through the patent literature

Publié en ligne: 04 Feb 2017
Pages: 1 - 12

Résumé

Abstract

Background: Tissue engineering takes on many approaches. It is mostly followed by those in the field through scientific literature. However, there is a virtually untapped resource in patent literature.

Objective: This review focuses on patents through the United States Patent and Trademark Office (USPTO). This source is used only because the author is most familiar with this resource. This article is not intended to be instructional regarding patents, patent law, or how to apply for patents, nor is it intended to be all inclusive of the patent literature. However, the reader might see the value of following the patent literature as a source of ideas, technologies, methodologies, and knowledge with respect to tissue engineering.

Mots clés

  • Bioreactors
  • bone
  • cartilage
  • patent literature
  • tissue engineering
Accès libre

Radiation dose from CT scanning: can it be reduced?

Publié en ligne: 04 Feb 2017
Pages: 13 - 21

Résumé

Abstract

CT has been used to save many patients’ lives and the demand for CT is still increasing. At the same time, there has been increasing concern of the probability of cancer induction by CT radiation. It is necessary for everyone involved in CT scanning, particularly physicians who have to communicate with patients when planning a CT scan, to have a basic knowledge of the CT radiation dose and its potential adverse effects. We have undertaken a systematic review of the literatures to document the radiation dose from CT, the lifetime cancer risk from CT exposure, CT dose parameters, the internationnal CT diagnostic reference levels, and the use and limitation of the CT effective dose. In addition, we conducted a brief survey of the use of CT scan in some university hospitals in Thailand and estimated current CT doses at these hospitals. Our review and survey suggests that CT scanning provides a great benefit in medicine but it also becomes the major source of X-ray exposure. Radiation doses from a CT scan are much higher than most conventional radiographic procedures. This raises concerns about the carcinogenic potentials. We encourage every CT unit to adhere to the International Guidelines of CT dose parameter references. Our preliminary survey from some university hospitals in Thailand revealed that CT radiation doses are within acceptable standard ranges. However, the justification for utilization of CT scans should also be required and monitored. The importance of adequate communication between attending physician and consulting radiologist is stressed.

Mots clés

  • Computer Scanning
  • dose calculation
  • radiation risk
  • state of the art in Thai university hospitals
Accès libre

The genetics behind osteoarthritis: Asian focus

Publié en ligne: 04 Feb 2017
Pages: 23 - 36

Résumé

Abstract

Osteoarthritis (OA), a degenerative joint disease, is the most common form of arthritis in the elderly. Problems arising from the condition are not only health, physical, and psychological, but also economical and social. OA is a complex disease causes by environmental factors (obesity, female gender, advancing age) and genetics. A strong genetic contribution to primary OA has been observed in several studies. Asian population is undoubtedly genetically different from European, whom most studies have been performed. This review systematically compares results of molecules involved with OA from studies performed on Asian and Caucasian populations. The clear differences between Asian and Caucasian populations may be from the sex- and ethnic-specific nature of the disease, as well as from the inclusion criteria of the studies. Global collaboration is highly significant in understanding genetic underlying OA. Knowledge gained from genetic study is important to the development of prevention and therapeutic intervention, and to identify individuals at risk of developing severe or progressive OA.

Mots clés

  • Asian
  • genetics
  • osteoarthritis

Original article

Accès libre

Tuberculous arthritis in Cambodia

Publié en ligne: 04 Feb 2017
Pages: 37 - 43

Résumé

Abstract

Background: Cambodia boasts one of the highest incidences of TB in the world. As such, healthcare providers are experienced with types of extrapulmonary TB such as septic Mycobacterium tuberculosis arthritic infections, not seen in developed countries.

Objective: Examine the incidence and distribution of TB arthritis cases at a Cambodian surgical center, explore the problems of diagnosis and current methods of treatment for this disease.

Methods: The written charts, operation records, and electronic database of patients with clinically diagnosed extrapulmonary TB, confirmed with a positive biopsy between January 2001 and July 2010 were searched. While medical treatment for the TB was given at other facilities, the operations performed and the result for patients with follow-up was reviewed.

Results: Between January 2001 and July 2010, 38 cases of TB arthritis at the CSC in Cambodia were histologically confirmed. Twenty-eight cases affected the lower extremity with the majority affecting the knee and ankle. All 13 patients receiving arthrodesis reported positive surgical outcomes.

Discussion/Conclusion: TB arthritis persists as an ongoing problem at CSC with a significant level of incidence. Arthrodesis is a viable and cost effective mean of treating TB arthritis in Cambodia.

Mots clés

  • Arthritis
  • arthrodesis
  • cambodia
  • fusion
  • incidence
  • tuberculosis
Accès libre

Human IgG inhibits IgA1 protease-dependent adherence of Haemophilus influenza strains to human lung epithelial cells

Publié en ligne: 04 Feb 2017
Pages: 45 - 56

Résumé

Abstract

Background: IgA1 protease may enhance the bacterial infection in human beings. However, the molecular mechanism of bacterial adherence to eukaryotic cells is unclear.

Objective: Reveal the mechanisms of IgA1 protease-dependent and non-protease bacterial adherence to eukaryotic cells.

Method: Type I and type II IgA1 proteases from iga genes (GenBank DQ683355 for NTHi465, DQ683356 for NTHi500 and DQ683357 for Nm430) were cloned, expressed, and purified. Cellular assays for adherence of IgA1 protease-producing and -non-producing and typable and nontypable strains of H. influenzae to human lung carcinoma cells (A549) were carried out in the presence of human antibodies.

Results: Adherence of protease-producing strains and non-producing strains to human epithelial cells was significantly dependent on the enzyme activity. In addition, human IgG was an inhibitor to IgA1 proteasedependent adherence of H. influenzae strains to human cells. However, IgA1 antibodies were irrelevant to IgA1 protease-dependent adherence.

Conclusion: IgA1 protease was required for adherence of pathogenic bacteria to human epithelial cells in IgA1 protease-producing bacteria, and human IgG inhibits the adherence, but not for IgA1 protease non-producing bacteria.

Mots clés

  • Cellular adherence
  • iga gene
  • IgA1 protease subtypes
  • IgG inhibition
  • Neisseria meningitides
  • typable and nontypable Haemophilus influenzae (THi and NTHi)
Accès libre

Clinical and laboratory diagnosis of spinocerebellar ataxia type 3 in a large Chinese family

Publié en ligne: 04 Feb 2017
Pages: 57 - 62

Résumé

Abstract

Background: Hereditary ataxia is a group of hereditary diseases that are characterized by chronic progressive uncoordinated gait and are frequently associated with cerebellar atrophy.

Objectives: To investigate evidence-based diagnosis of hereditary ataxia by retrospective analysis of the diagnostic process in one Chinese family.

Methods: Clinical records of 15 ataxia patients from one Chinese family with 46 family members were retrospectively reviewed and a tentative diagnosis was made based on clinical manifestations, signs and symptoms, mode of inheritance, and progression. Since hereditary ataxia is a group of heterogeneous diseases having various subtypes and overlapping symptoms, we adopted a stepwise evaluation to achieve a tentative diagnosis. To confirm the diagnosis, we performed polymerase chain reaction (PCR) specific for the suspected causative gene of spinocerebellar ataxia (SCA) subtype 3 (SCA3).

Results: Through analysis of hereditary and clinical characteristics of family histories of the patients, we suspected that the family might suffer from SCA, especially, SCA3. The PCR assay for SCA3 showed that, five of the ten samples analyzed had a CAG trinucleotide expansion of the SCA3 gene, and four of the five members developed ataxia. The remaining one, a seven-year-old girl, showed no symptoms or signs except for uvula deviation. No clinical symptoms were found in five other members with negative PCR results. Thus, based on both clinical findings and laboratory results, we further confirmed that the family suffered from SCA3.

Conclusion: Hereditary ataxias are disorders sharing overlapping symptoms. Comprehensive analysis of medical and family records together with genetic diagnosis improves diagnostic efficiency of hereditary ataxia and aides in family counseling.

Mots clés

  • Cerebellar ataxia
  • diagnosis
  • heredity
  • PCR
Accès libre

Antiviral activities of aerial subsets of Artemisia species against Herpes Simplex virus type 1 (HSV1) in vitro

Publié en ligne: 04 Feb 2017
Pages: 63 - 68

Résumé

Abstract

Background: Drug resistance to current anti-herpetic drugs has been increasingly reported. Therefore, there is a need for finding new antiviral agents, in particular from natural sources.

Objective: In the present study, antiviral activity of subset extracts obtained from aerial parts of Artemisia including A. incana, A. chamaemelifolia, A. campesteris, A. fragrans, A. annua, A. vulgaris, and A. persica were investigated against Herpes Simplex type I (HSV1).

Methods: Different concentrations of extracts (400, 200, 100, 50, 25, 12.5, 6.25, and 3.125 μg/mL) were obtained from subset of each plant separately, and used against KOS strain of HSV1 in HeLa cells. After 24 hours incubation, tetrazolium dye (MTT), was added. The dye absorption by viable cells was measured and compared to the positive control (extract-untreated cells) and acyclovir (as anti-viral agent).

Results: The extracts obtained from A. annua had the highest antiviral activity while those of A. chamaemelifolia showed the lowest activity.

Conclusion: Subset extracts of A. annua may be an appropriate candidate for further development of anti HSV1 infection.

Mots clés

  • Antivirals
  • Artemisia
  • asteraceae
  • herpes simplex
Accès libre

Chemokine receptor 9 high-expression involved in the migration and invasion of the non-small-cell lung cancer cells

Publié en ligne: 04 Feb 2017
Pages: 69 - 76

Résumé

Abstract

Background: Metastasis is responsible for most cancer-related death, and the metastatic spread of neoplastic cells may be related to the ability of migration and invasion. Chemokine receptor 9 (CCR9) plays an important role in cutaneous melanoma and prostate cancer cells migration and invasion.

Objective: Investigate the specific role of the chemokine-ligand (CCR9-CCL25) axis in the development of nonsmall cell lung cancer (NSCLC) metastasis.

Methods: Semi-quantitative reverse transcriptase-PCR, western-blot, flow cytometry, migration, and invasion assays were used to examine the function of CCR9 in the NSCLC cells.

Results: CCR9 was highly expressed in NSCLC patient cancer tissue. In addition, in vitro migration and invasion studies on human bronchial epithelial cells of the BEAS-2B and human squamous lung cancer cell lines NCI-H157 showed that migration in response to the CCL25 was inhibited by CCR9 antibody.

Conclusion: CCR9 might play an important role in the migration and invasion of the NSCLC cells.

Mots clés

  • CCR9
  • CCL25
  • non-small cell lung cancer
  • migration
  • invasion
Accès libre

The efficacy and safety of 0.5% Levofloxacin versus fortified Cefazolin and Amikacin ophthalmic solution for the treatment of suspected and culture-proven cases of infectious bacterial keratitis: a comparative study

Publié en ligne: 04 Feb 2017
Pages: 77 - 83

Résumé

Abstract

Background: Bacterial keratitis is a major devastating ocular condition that quickly deteriorates the patient’s vision. Vigorous and prompt treatment of bacterial keratitis with broad-spectrum antibiotic eye-drops is preferred.

Objective: Evaluate the efficacy and safety of 0.5% Levofloxacin for the treatment of suspected and cultureproven cases of infectious bacterial keratitis in comparison to fortified Cefazolin and Amikacin ophthalmic solution.

Materials and methods: Seventy-one eyes from 69 patients suspected of having infectious bacterial keratitis were enrolled in the study. The patients were randomized into two arms, 0.5% Levofloxacin eye drops (34 eyes) or fortified Cefazolin and Amikacin (37 eyes). Sixty-eight eyes were included in the efficacy analysis. During treatment, on days 2, 7, 14, and 21, the patient’s symptoms and signs were scored from grade 0-3 (absent to severe).

Results: At the end of the treatment, 61 out of 71 eyes completely healed. The resolution of the keratitis was not significantly different between both groups. There were no significant differences in the mean time-duration for the ulcer to heal or for the symptoms and clinical signs to disappear between the two groups. No serious adverse events or side effects from the disease were found. The patients compliance was 80% based on the self-reported diaries.

Conclusion: The efficacy and safety of 0.5% topical Levofloxacin was comparable to fortified Cefazolin and Amikacin for the treatment of mild-to-moderate bacterial keratitis. Topical Levofloxacin is far superior because of its availability and patient compliance when used as monotherapy for the treatment of infectious bacterial keratitis.

Mots clés

  • Bacterial keratitis
  • fluoroquinolone
  • fortified topical antibiotics
  • Levofloxacin
Accès libre

RhBMP-2 and -7 combined with absorbable collagen sponge carrier enhance ectopic bone formation: An in vivo bioassay

Publié en ligne: 04 Feb 2017
Pages: 85 - 92

Résumé

Abstract

Background: Recombinant human bone morphogenetic proteins (rhBMPs) have been characterized especially chondrogenic and osteogenic activity both in vitro and in vivo studies. However, delivery of more than one growth factor by sustained release carrier to orthopedic site has yet been questionable in terms of efficacy and synergism.

Objective: Evaluate osteoinductivity and synergistic effect of rhBMP-2 and -7 using absorbable collagen sponge (ACS) carrier system in vivo.

Methods: cDNA of BMP-2 and -7 active domains were cloned and expressed in Escherichia coli BL21 StarTM (DE3) using pRSETc expression system. Then, the purified rhBMPs were loaded onto ACS and evaluated by in vivo rat subcutaneous bioassay. Two and eight weeks postoperatively, all treated groups were histologically verified for evidence of new bone formation and neovascularization by hematoxylin-eosin staining and light microscopy.

Results: The Wistar rat treated with rhBMP-2 or -7/ACS exhibited new bone formation, compared to ACS control. The group treated with ACS supplemented with both rhBMP-2 and -7 significantly showed the osteoid matrix very well-organized into trabeculae-like structure with significant blood vessel invasion.

Conclusion: The osteogenic induction of rhBMPs was combined with ACS carrier in the in vivo bioassay. In addition, the combination of both two potent recombinant osteoinductive cytokines, rhBMP-2 and -7, with ACS carrier demonstrated synergistic effect and might be a more promising and effective choice for therapeutic applications.

Mots clés

  • Absorbable collagen sponge
  • bone morphogenetic protein
  • ectopic bone formation
  • rat subcutaneous model
Accès libre

Caudal block with 3 mg/Kg Bupivacaine for intraabdominal surgery in pediatric patients: a randomized study

Publié en ligne: 04 Feb 2017
Pages: 93 - 99

Résumé

Abstract

Background: Caudal block with the use of an adequate dose of bupivacaine, and combined with a general anesthesia (GA) provides intra-operative anesthesia and postoperative analgesia. No study has examined the use of 3 mg/Kg bupivacaine for intra-abdominal surgery in pediatric patients in clinical practice.

Objective: Compare the effectiveness of three mg/Kg bupivacaine administered as 1.2 mL/Kg 0.25% bupivacaine and 1.5 mL/Kg 0.2% bupivacaine for caudal block in pediatric patients undergoing intra-abdominal surgery.

Methods: In a randomized, double-blinded clinical trial, patients (age: 6 months -7 years) were randomly assigned into one of two groups (n= 40) to receive a caudal block with either 1.2 mL/Kg 0.25% bupivacaine (group A) or 1.5 mL/Kg 0.2% bupivacaine (group B), with morphine 50 μg/Kg. The effectiveness of intra-operative anesthesia, complications, and requirements for post-operative analgesia were evaluated.

Results: Data were available for 74 pediatric patients. There were no significant differences between the two groups in baseline characteristics. Intra-operatively, the numbers of patients who required a rescue analgesic were comparable between the groups (67% in group A and 63% in group B). The numbers of patients who required a muscle relaxant were also comparable between groups (49% in group A and 57% in group B). The time from discontinuation of the volatile anesthetic to extubation was significantly shorter in group B (9.5±1.1 minutes) than group A (14.3±0.9 minutes), p < 0.01. The time from initial caudal block to the first analgesic required in the recovery room was significantly longer in group B (202±45 minutes) than in group A (149±27 minutes). The time from the caudal block to the first analgesic required in the ward was significantly longer in group B (10.4±3.1 hours) than in group A (8.2±2.0 hours). Overall fentanyl requirements were comparable between groups, 52.5±2.0 μg in group A and 49.5±3.0 μg in group B.

Conclusion: Caudal block by either 1.2 mL/Kg 0.25% bupivacaine plus morphine 50 μg/Kg or 1.5 mL/Kg 0.2% bupivacaine plus morphine 50 μg/Kg provided effectively equivalent intra-operative analgesia and surgical relaxation. However, a caudal block with 1.5 mL/Kg 0.2% bupivacaine plus morphine 50 μg/Kg provided superior prolonged analgesic advantages compared with 1.2 mL/Kg 0.25% bupivacaine plus morphine 50 μg/Kg in pediatric patients undergoing intra-abdominal surgery.

Mots clés

  • Bupivacaine
  • caudal block
  • effectiveness
  • intra-abdominal surgery
  • pediatric patients
  • postoperative analgesia
Accès libre

Combination of gabapentin and celecoxib for analgesia after major orthopedic surgery: a randomized, controlled trial

Publié en ligne: 04 Feb 2017
Pages: 101 - 110

Résumé

Abstract

Background: The use of analgesics with different mechanism of action enhances post-operative pain relief by opioids. Both celecoxib and gabapentin have opioid-sparing effect, but it is unclear whether combination of the two drugs accentuates postoperative analgesia and further reduced opioid requirement.

Objective: Determine whether the perioperative use of celecoxib in combination with gabapentin reduces the amount of post-operative opioid consumption in comparison to celecoxib alone or gabapentin alone in patients that have major orthopedic surgery.

Materials and methods: Randomized double-blinded placebo controlled trial was done in 99 patients underwent major orthopedic surgery. They were randomly allocated into four groups. One to two hours before anesthesia, they received midazolam 7.5 mg plus study drugs. Group P received placebo plus placebo at 12 and 24 hours later. Group C received celecoxib 400 mg plus celecoxib 200 mg at 12 and 24 hour later. Group G received gabapentin 400 mg plus gabapentin 300 mg at 12 and 24 hour later. Finally, group CG received celecoxib 400 mg + gabapentin 400 mg plus celecoxib 200 mg + gabapentin 300 mg at 12 and 24 hour later. The patients underwent surgery under general anesthesia. Post-operative pain was treated by intravenous morphine patient-controlled analgesia.

Results: Median morphine consumption (minimum-maximum) in twenty-four hours was 18.0, 15.0, 15.5, and 8.0 mg, in group P, C, G, and CG, respectively. The group CG significantly consumed less morphine (41%) in 24 hour than group G, but not significantly less (38%) than group C. Pain score, sedation score, and nausea/vomiting at postoperative hour 1, 4, 8, 12, 16, 20, and 24 was not significantly different.

Conclusion: Combination of celecoxib and gabapentin further accentuated post-operative analgesia by morphine comparing to celecoxib or gabapentin alone without change in pain score and other side effects of the medications.

Mots clés

  • Analgesia
  • celecoxib
  • gabapentin
  • multimodal analgesia
  • opioid-sparing
  • orthopedic surgery
  • postoperative
  • pain
Accès libre

Speech camp for children with cleft lip and/or palate in Thailand

Publié en ligne: 04 Feb 2017
Pages: 111 - 118

Résumé

Abstract

Background: There is a critical need for speech therapy services for people born with cleft lip and/or palate in developing countries.

Objective: Assess the effectiveness of a speech camp and follow-up session for children with cleft lip and/or palate.

Methods: A Community-Based Model for Speech therapy was implemented at Suwanaphum Hospital District, Roiet, Thailand. Thirteen children with cleft lip and/or palate (3; 6-13 years) attended a four-day speech camp and a one-day follow-up session (six months later) for remediation of their articulation disorders. Paraprofessional training was also provided. Pre- and post-tests were administered to the participants, caregivers, and paraprofessionals to determine the effectiveness of the program. A pre- and post-articulation test, as well as an audiological evaluation were administered. Five speech and language pathologists provided speech therapy, both individual and group, for a total of 18 hours during the four-day speech camp and six hours in the one-day follow-up session. The median difference of the number of articulation errors was determined by results of the Wilcoxon Signed-Rank Test.

Results: There was a significant decrease in articulation errors following both the main speech camp and the follow-up session (z = 3.11, p < 0.01; z = 2.87, p<0.01, respectively). Caregivers’ and health care providers’ satisfaction ratings for participation in the speech camps ranged from good to excellent.

Conclusion: A Community-Based Model of both a speech camp and follow-up session provided an effective speech therapy treatment for children with cleft lip and/or palate.

Keyword

  • Cleft palate
  • community-base model
  • developing country
  • speech camp

Clinical report

Accès libre

Total femur replacement for Ewing’s sarcoma after wide resection of the proximal femur: a long-term follow-up case study

Publié en ligne: 04 Feb 2017
Pages: 119 - 122

Résumé

Abstract

Background: Total femur replacement is a relatively rarely performed procedure for the reconstruction of an affected limb after resection of a malignant bone tumor.

Objective: Report total femur replacement in a 17-year-old male patient after wide resection of the right femur for involvement of the proximal segment of the bone by Ewing’s sarcoma.

Results: The complications that often arose from the use of the tumor prostheses after the tumor resection, e.g., infection and migration/dislocation of the artificial bonehead, were overcome successfully. The patient has been under follow-up for a relatively long period of time (16 years) since the surgery. The operated limb function is now rated at 70% according to the rating system by Musculo-Skeletal Tumor Society (MSTS). The patient has almost completely regained his ability to walk and carries on with activities of daily living.

Conclusion: If appropriate measures are taken to deal with the complications, favorable function of the operated limb can be expected to be maintained for long periods after reconstruction using this technique.

Mots clés

  • Total femur replacement
  • Ewing’s sarcoma
  • complications
Accès libre

Mediastinal teratoma in a neonate with acute respiratory failure

Publié en ligne: 04 Feb 2017
Pages: 123 - 127

Résumé

Abstract

Background: While teratomas account for the leading cause of germ cell tumors, the mediastinal teratomas represent one of the infrequent types of congenital germ cell tumors. Neonates with large mediastinal teratomas generally show severe respiratory distress, and the immediate surgical treatment is needed to alleviate their problems.

Objectives: Report clinical symptoms, diagnostic procedures, treatment option, and outcomes after the treatment for a neonate with a large mediastinal teratoma.

Methods: A 2-day-old female infant presented with acute respiratory failure diagnosed as mediastinal teratoma. It was followed with surgical treatment. The removed tissues were examined pathologically.

Results: The girl suffered an acute respiratory failure two days after birth. The chest radiography, echocardiography, and chest computerized tomography results showed the considerable size of the mediastinal teratoma. A median sternotomy was performed on the third day of infant life to remove the tumor without rupturing the capsule. Pathological diagnosis was germ cell tumor. Clinical follow-ups reported no complication.

Conclusion: The successful management of a neonate with large mediastinal teratomas was presented. Immediate detection and proper treatment of the large mediastinal teratoma in a neonate was most important to decrease the morbidity and mortality of the infant.

Mots clés

  • Acute respiratory failure
  • germ cell tumor
  • mediastinal teratoma
  • median sternotomy
  • neonate
Accès libre

Risk factors of extended-spectrum beta-lactamaseproducing Enterobacteriaceae bacteremia in Thai emergency department: a retrospective case-control study

Publié en ligne: 04 Feb 2017
Pages: 129 - 138

Résumé

Abstract

Background: Infections caused by resistant extended-spectrum beta-lactamase (ESBL)-producing enteric bacteria and their risk factors are globally recognized. However, such risk factors have not been explored in emergency department (ED) where the first choice of empirical antimicrobials is crucial.

Objective: Determine risk factors of ESBL bacteremia in ED, especially in our geographic area.

Methods: A retrospective case-double-control study was conducted at King Chulalongkorn Memorial Hospital. All adult ED patients with ESBL-producing E. coli and K. pneumoniae in blood cultures between October 2007 and October 2008 were recruited for this study. The potential risk factors were analyzed and compared with non- ESBL-producing bacteremic patients (control group 1) and matched general ED patients (control group 2). Nonbeta- lactam susceptibility testing among the cohort was also evaluated.

Results: Thirty ESBL (cases), 103 group 1 controls, and 100 group 2 controls were assessed. Based on the univariate analysis, age, chronic kidney diseases, malignancy, poor functional status, previous hospitalization within 90 days, and previous antimicrobial exposure especially to cephalosporins, quinolones, and carbapenems within 30 days were the risk factors for ESBL bacteremia compared with both types of control patients. Age > 60 and previous cephalosporin use were consistently identified as the risk factors by multivariate models using both control groups. The susceptibility to non-beta-lactam agents in the ESBL group was significantly lower than the non-ESBL. No carbapenem resistance was found.

Conclusion: Elderly ED patients, especially those who had previous cephalosporin exposure within 30 days, were at higher risk of ESBL-producing bacteremic infections. ESBLs tended to have less susceptibility to the non-β-lactam agents.

Mots clés

  • Bacteremia
  • emergency department
  • extended-spectrum beta-lactamase
  • risk factors
Accès libre

Carpal tunnel release by mini palmar incision

Publié en ligne: 04 Feb 2017
Pages: 139 - 142

Résumé

Abstract

Background: Open carpal tunnel release is the gold standard treatment for carpal tunnel syndrome. However, there are complications related to the long incision.

Method: We report the results from a mini-incision open carpal tunnel release with simple instruments.

Results: There were no complications in our small series, improvement of scores was shown at four-week follow-up, and cosmetic results were satisfactory.

Conclusions: Mini-incision carpal tunnel release is one option to treat carpal tunnel syndrome.

Mots clés

  • Boston carpal tunnel questionnaire
  • carpal tunnel syndrome
  • conventional open carpal tunnel release
  • mini-incision carpal tunnel release

Technical report

Accès libre

Re-exploration of the rectus femoris tendon to sartorius transfer in children with spastic cerebral palsy

Publié en ligne: 04 Feb 2017
Pages: 143 - 149

Résumé

Abstract

Background: The rational of rectus femoris tendon transfer is to use a spastic rectus femoris tendon as a knee flexor during swing phase of gait cycle. However, the concept of the rectus femoris tendon transfer has been challenged by the evidence of scar tissue formation along the transferred tendon route.

Objective: Examine the surgical technique for rectus femoris tendon transfer to the sartorius at the index procedure and report the findings at the anchoring site during the re-exploration.

Methods: Three knees were examined in two patients with spastic cerebral palsy who developed recurrent flexion contracture at 18 months after the rectus femoris tendon to sartorius surgery. They underwent femoral shortening procedures and re-exploration at the rectus femoris tendon to sartorius transfer site simultaneously to correct flexion contracture. The transferred tendon route was examined. The anchoring site at the sartorius was manually tested. The follow-up period after the re-exploration procedure ranged from 7-60 months (mean: 37 months).

Results: All three rectus femoris tendons were in a straight line, and glided smoothly on the new route with minimal scar tissue formation. The anchoring site at the sartorius was well healed, and the knee flexion was observed upon manual testing. Degree of knee flexion contracture ranged from 15 to 35 degrees (mean: 27 degrees) before re-exploration procedure. It was 5 to -5 degrees (mean: 0 degree) at the recent follow-up. All patients maintained their ambulatory status.

Conclusion: The present technique for rectus femoris tendon to sartorius transfer gave a straight-line transfer over smooth gliding path and provided a secure anchoring site. It converted the function of the transferred tendon from a knee extensor to a knee flexor and created minimal scar formation with smooth gliding path.

Mots clés

  • Cerebral palsy
  • crouching gait
  • rectus femoris tendon transfer
  • re-exploration
  • spastic diplegia
  • stiffedleg gait

Brief communication (Original)

Accès libre

Accessory brachial artery: a case report, embryological background and clinical relevance

Publié en ligne: 04 Feb 2017
Pages: 151 - 155

Résumé

Abstract

Background: The accessory brachial artery (arteria brachialis accessoria) is a rare upper limb vascular abnormality, reported in less than one percent of cases. It is the artery originating from the axillary artery or the brachial artery, which rejoins the brachial artery further along its distal course within the arm or cubital fossa. Its detailed knowledge is necessary in transradial transulnar catheterization during coronary procedures, mainly due to its narrow caliber, which is responsible for the failure of the intervention performance.

Objectives: Present a case of uncharacteristic branching pattern of the accessory brachial artery.

Method: The case was observed during a routine dissection in the left axilla of a female cadaver at the Department of Anatomy at the Third Faculty of Medicine, Charles University in Prague.

Results: The infrapectoral part of the axillary artery gave rise to a branch that descended distally along the medial side of the arm. This artery accompanied firstly the ulnar nerve, then it diverted laterally towards the median nerve and coursed hidden behind it to re-enter the brachial artery within the distal part of the arm, next to the biceps brachii muscle. The calibre of the accessory brachial artery was two mm only.

Conclusion: The accessory brachial artery is a rare variant of the upper limb vascular system and its prevailingly narrow lumen can cause a failure of the transradial/transulnar catheterization intervention.

Mots clés

  • Accessory brachial artery
  • anatomical variation
  • axillary artery
  • brachial artery
  • variant
  • variation
Accès libre

Ventilatory function among healthy young Saudi adults: a comparison with Caucasian reference values

Publié en ligne: 04 Feb 2017
Pages: 157 - 161

Résumé

Abstract

Background: Ethnic differences in lung function are recognized. However, most of the modern lung function equipments are pre-programmed with Caucasian reference values.

Objective: Measure spirometric values among healthy Saudi male and female adults and compare with the Caucasian reference values in a standard spirometer.

Methods: Thirty healthy Saudi young adults (15 males and 15 females; mean age 25 years) participated in this study. Forced vital capacity (FVC), forced expiratory volume in one second (FEV1), FEV1/FVC (%), and maximal voluntary ventilation (MVV) were recorded using a portable digital spirometer.

Results: Mean values of FVC, FEV1, FEV1/FVC (%) and MVV for the Saudi subjects were significantly lower than the Caucasians predicted values.

Conclusion: Interpretation of lung function tests of Saudi subjects based on the Caucasian prediction equations is generally not valid, as the parameters of lung function tests in Saudi subjects are lower than the Caucasian reference values. The present results underline an urgent need for larger studies to develop prediction equations based on normative spirometric values for Saudi population involving subjects of all ages and both genders living in different climates of the country.

Mots clés

  • Caucasian
  • pulmonary function test
  • Saudi healthy adults
  • ventilatory function
Accès libre

Correlation between mast cell density and histological parameters in Helicobacter pylori-associated gastritis

Publié en ligne: 04 Feb 2017
Pages: 163 - 167

Résumé

Abstract

Background: Helicobacter pylori (H. pylori) are a major cause of chronic gastritis and peptic ulcer. This organism plays a role in gastric carcinoma and B-cell lymphoma. However, the exact pathogenesis of gastric inflammation is still unclear. Mast cells, the important inflammatory cells for allergic process, may participate in the pathogenesis of gastritis related to H. pylori infection.

Objective: Analyze the relationship between mast cell density, H. pylori intensity, histological alterations, and their severity of biopsy proven gastritis.

Methods: One hundred eleven biopsied specimens were collected from Thai patients who were diagnosed H. pylori-associated gastritis of the antrum at King Chulalongkorn Memorial Hospital between 2002 and 2005. All biopsied specimens were examined according to the Updated Sydney System. Mast cell density was evaluated by 0.1% toluidine-stained sections.

Results: The higher mast cell density was correlated with increased neutrophilic infiltration (r = 0.220, p = 0.020), chronic inflammatory cell infiltration (r = 0.381, p <0.001), and lymphoid aggregation (r = 0.271, p = 0.004). No relationship was found between mast cell density and intensity of H. pylori, glandular atrophy, or intestinal metaplasia.

Conclusion: Mast cells might take part in the pathogenesis of H. pylori gastritis.

Mots clés

  • Chronic gastritis
  • Helicobacter pylori
  • mast cell

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