Volume 11 (2017): Issue 2 (April 2017)

Korean radish (Raphanus sativus L.) is used in kimchi, a staple of Korean cuisine. A taffy, mu yeot, that includes mainly radish together with other herbs (Bulbus Allii Sativi, Fructus Zizyphi, Semen Zizyphi, Rhizoma Zingberis, and Radix Glycyrrihizae) is used traditionally in Korea to improve pulmonary symptoms. However, to our knowledge, these effects of the taffy have not yet been studied systematically.

To elucidate the anti-inflammatory effects of radish taffy on macrophages and a murine model of pulmonary inflammation, and to suggest the most likely candidate for the effects.

A macrophage cell line, RAW264.7, was used to examine effects of the radish taffy in vitro. Pulmonary inflammation was assessed 24 h after oral instillation of lipopolysaccharide in mice treated with radish taffy for 10 days. We determined the chemical components of radish taffy quantitatively using tandem HPLC mass spectroscopy.

Radish taffy had no apparent effect on the RAW264.7 cells. Treatment of the mice with radish taffy significantly reduced the recruitment of neutrophils to the lung, and the level of myeloperoxidase in bronchoalveolar lavage fluid (BALF). ELISAs showed that the treatment significantly decreased the level of IL 6 in BALF induced by LPS, but not the levels of IFNγ, TNFα, IL 10, or IL 12. Nor did the taffy change the levels of those cytokines or NF-κB activation in lung homogenates. HPLC-MS suggested glycyrrhizin as the most likely candidate for the anti-inflammatory effects.

Radish taffy suppresses neutrophil recruitment to lungs of mice, possibly by reducing IL 6 levels, which may lead to reduced pulmonary inflammation.

Thailand has made progress in reducing perinatal HIV transmission rates to levels that meet the World Health Organization targets for so-called “elimination” (<2%) of mother-to-child transmission (MTCT).

To highlight the Thailand National Guidelines on HIV/AIDS Treatment Prevention Working Group issued a new version of its National Prevention of MTCT guidelines in March 2017 aimed to reduce MTCT rate to <1% by 2020.

The guidelines include recommending initiation of antepartum antiretroviral therapy (ART) containing tenofovir disoproxil fumarate (TDF) plus lamivudine (3TC)/emtricitabine (FTC) plus efavirenz regardless of CD4 cell count as soon as HIV is diagnosed for ART naïve HIV-infected pregnant women. An alternative regimen is TDF or zidovudine (AZT) plus 3TC/FTC plus lopinavir/ritonavir (LPV/r) for HIV-infected pregnant women suspected resistant to non-nucleoside reverse transcriptase inhibitors. Treatment should be started immediately irrespective of gestational age and continued after delivery for life. Raltegravir is recommended in addition to the ART regimen for HIV-infected pregnant women who present late (gestational age (GA) ≥32 weeks) or those who have a viral load (VL) >1000 copies/mL at GA ≥32 weeks. HIV-infected pregnant women who conceive while receiving ART should continue their treatment regimen during pregnancy. HIV-infected pregnant women who present in labor and are not receiving ART should receive single-dose nevirapine immediately along with oral AZT, and continue ART for life. Infants born to HIV-infected mothers are categorized as high or standard risk for MTCT. High MTCT risk is defined as an infant whose mother has a viral load (VL) > 50 copies/mL at GA > 36 weeks or has received ART <12 weeks before delivery, or has poor ART adherence. These infants should be started on AZT plus 3TC plus NVP for 6 weeks after delivery. Infants with standard MTCT risk should receive AZT for 4 weeks. Formula feeding exclusively is recommended for all HIV-exposed infants.

Laparoscopic adrenalectomy remains a challenging operation for pheochromocytoma (PCC) because of excessive secretion of catecholamines causing hemodynamic instability.

To evaluate the use of the LigaSure vessel sealing system (Covidien-Medtronic) to secure hemostasis during laparoscopic adrenalectomy for PCC.

In this observational study we retrospectively reviewed a case series of 19 patients with preoperatively diagnosed PCC, who underwent laparoscopic adrenalectomy who underwent laparoscopic adrenalectomy using the LigaSure vessel sealing instead of using vascular clips or suturing. We report intraoperative findings, conversion rates, blood loss, operative time, morbidity, and postoperative outcomes.

Surgery was performed successfully for 18 patients. Surgery for the remaining 1 patient of the present case series was converted to open adrenalectomy because of surrounding tissue invasion. No mortality or major morbidity was observed. Estimated blood loss was a mean (range 20–300) 153 mL (excluding the loss in the patient whose surgery was converted to open adrenalectomy). The pathology showed 6 patients with potentially malignant PCC (Pheochromocytoma of the Adrenal Scaled Score (PASS) ≥ 4).

The LigaSure device appears to be safe and effective in laparoscopic adrenalectomy for PCC. This clipless approach can be used with acceptable outcomes.

Growth hormone insensitivity (GHI) or Laron syndrome can result from GH receptor (GHR) or postreceptor defects, such as in GH binding or transduction, or insulin-like growth factor 1 (IGF-1) synthesis. Multiple defects in GHI have been reported in cohorts from the Middle East, Ecuador, and the Mediterranean, but rarely reported from Southeast Asia.

Genomic DNA was isolated from peripheral blood leukocytes of young Thai sisters with severe short stature. Coding exons, including the intronic boundaries of the GHR were amplified from genomic DNA by PCR, and products were purified and sequenced. Serum GH, IGF-1, and IGF binding protein-3 were assayed immunometrically.

We found an extreme GHI phenotype and a homozygous mutation in exon 7 of GHR.

This mutation can cause a new donor splice site and interfere with mRNA splicing. To our knowledge, these are first cases of Laron syndrome in Thais confirmed by genotyping.

Congenital abdominal aortic aneurysm (AAA) is a rare condition in neonates. To our knowledge, the natural course of the disease in a Thai neonate has not yet been reported.

To report the characteristics and clinical course of congenital AAA in a Thai neonate.

A female Thai infant was born spontaneously at term (3,990 g) having a large, pulsatile, abdominal mass. Computed tomographic angiography (CTA) of the abdominal aorta showed a large infrarenal AAA, and a fusiform aneurysm at the left common iliac artery. Two small right renal arterial aneurysms were also noted. The large aneurysm was partially resected and a Gore-Tex vascular graft was placed at 15 days old. Histopathology of the aneurysmal wall revealed no specific etiology. Ultrasonography revealed thrombosis of the graft on the 13th day after surgery.

Repeated CTA of the abdominal aorta at age 13 mo showed complete thrombosis of the graft with reconstitution of collateral circulation. The infrarenal AAA and left common iliac aneurysm and 2 small right renal artery aneurysms were completely thrombosed. The patient grew and developed normally to the most recent follow up at age 36 mo.

Congenital AAA with failure of graft replacement may regress spontaneously.