Vajira Medical Journal: Journal of Urban Medicine

95-106

Authors: Pasistha Termworasin, Dissajee Lumbiganon, Chattip Prueksapraopong

Background: Road traffic accident is one of the leading causes of death in children. Appropriate car seat use can reduce the severity of injuries. Objective: The aims of this study were to collect information on car seat use and to compare the knowledge of parents of preschoolers in Bangkok regarding road traffic safety for children including car seat use before and after receiving car seat brochure by using pretest and posttest questionnaires. Methods: The pretest questionnaires were sent out to parents of preschoolers in 3 randomly selected schools and were collected 3 days later. Thereafter, the car seat brochures and the posttest questionnaires were sent to the parents and the questionnaires was collected back after 2 weeks. Results: Of the 309 parents, 254 (82.2%) completed the pretests and 135 (43.7%) of them also completed the posttest questionnaires. Among 254 parents, most of them were female. All of them knew about car seat, mostly from the internet (73.2%) and relatives (40.6%). Among 233 parents who used car to take their children to school, 82.0% had ever used car seat but only 21.5% of them always used it. The most important reason for not using car seat was children’s refusal. The overall score of knowledge about car seat increased after receiving car seat brochure. Conclusions: This study demonstrated that very few parents used car seat for every ride of their young children. Car seat brochure may increase knowledge but more strategies are needed to improve car seat use for child passenger safety.

117-126

Authors: Natthapong Hongku, Pruk Chaiyakrit, Chaipipath Senwiruch

Objective: To demonstrate the varus correction angle after performing the medial tibial reduction osteotomy and tibia component undersizing and lateralization techniques for correcting varus deformity in computer-assisted and cruciate-retaining total knee arthroplasty. Methods: Cadaveric study included 5 bodies (10 knee joints) using total knee arthroplasty surgery assessing the varus correction angle, degree, medial and lateral gap measurement of knee joint during the different angles. Then, medial tibial reduction osteotomy and tibia component undersizing and lateralization were performed by 3 and 6 mm and all parameters were measured. Results: The varus correction angles after 3 and 6 mm medial tibial reduction osteotomy were 2.00 and 2.93 degrees respectively. The medial gap increased 1.5 mm after 3 mm medial tibial reduction osteotomy tibia component undersizing and lateralization in full extension knee position. Conclusions: Medial tibial reduction osteotomy and tibia component undersizing and lateralization were used to correct the varus deformity in total knee arthroplasty. The average of the varus correction angle was only 0.6 degrees per 1 mm of bone cut, therefore, this technique should not recommend to be used alone for severe varus deformity knee.

135-142

Authors: Wanthanachai Rotchomphu, Wisit Kasetsermwiriya

Background: Advances in surgical techniques and appropriate perioperative management has decreased the mortality rate of pancreaticoduodenectomy less than 5 percent. However, postoperative pancreatic fistula is the most serious and life-threatening condition with the incidence rate at 27% for conventional reconstruction. A newly modified technique in Japan Kakita pancreaticojejunostomy has been reported that it reduces postoperative pancreatic fistula; however there were only few reports of this technique outside Japan. This study aimed to compare rate of pancreatic leakage between the new technique and conventional pancreaticojejunostomy after pancreaticoduodenectomy in Thai patients. Methods: Data of 25 consecutive patients with periampullary cancer and benign conditions (e.g. chronic pancreatitis) who underwent pancreaticoduodenectomy at Vajira hospital from 2005 to 2015 were reviewed. Postoperative results of fifteen patients who underwent conventional pancreaticojejunostomy (group A) were compared with ten patients who underwent modified Kakita pancreaticojejunostomy (group B). The primary outcome measure was the rate of postoperative pancreatic fistula (POPF) and secondary outcomes included; operative data, postoperative morbidity, mortality and evaluation of the risk factors of pancreatic leakage. Results: There were no differences in clinicopathological characteristics and postoperative morbidity between two groups. Overall, the leakage rate was 32% (8/25). The pancreatic leakage in group A was 50 % (5/10) while the leakage rate in group B was 20% (3/15), p=0.194. Duration of hospital stay in group A was 39 days (17-66 days) and in group B was 28 days (21.5-46.5 days); p = 0.824. All of the complications could be managed by conservative measures. Intraoperative blood loss was a risk factor for leakage (1500 ml vs. 750 ml, p = 0.038). The leakage caused delayed gastric emptying (3 vs. 0, p = 0.24) and prolonged hospital stay (72.5 days vs. 25.5 days, p< 0.0001). Conclusion : This retrospective single-center study showed that duct-to-mucosa anastomosis by modified Kakita technique was a safe procedure.

153-164

Authors: Nitaya Srichamnong, Anchalee Jantapo

Objectives: The objectives of this research aim at comparing the way of life and potential of the older person in a community, Nonthaburi Province. Methods: This study was a descriptive research. The samples were 98 elders in the community using Krejcie and Morgan sample size table and simple random sampling method. The statistics used for data analysis were percentage, arithmetic mean, standard deviation, and one - way ANOVA. Results: The finding revealed that overall of health behaviors was in a moderate level (x̄ = 2.30, SD = 0.20), consisting of having food (x̄ = 2.30, SD = 0.20), no alcohol drinking (x̄ = 1.55, SD = 0.71), and visiting doctor regularly (x̄ = 2.35, SD = 0.22). Sleep and exercise were in a good level (x̄ = 2.56, SD = 0.51 and x̄ = 2.53, SD = 0.53, respectively). Lifestyle in moderate level were relationships with family and community. As for spiritual growth, it was in a good level (x̄ = 2.63, SD = 0.36). The potential of the older person was a moderate level (x̄ =1.84, SD = 0.35). where as the ability to using computers was in a low level (x̄ =1.38, SD = 0.53). When compared health behaviors and potentials of the older person, their basic learning skills, work, income, and health condition were not significantly different. (P> .05). Conclusion: The lifestyle of health behavior and potential of the older person were a moderate level. Older person with different potentials found that health behaviors were not significantly different.