Siriraj Medical Journal

1-7

Authors: Aphinya Charoensak, M.D., Thana Pongpanumaspaisan, M.D., Kobkun Muangsomboon, M.D.

Objective: To distinguish between non-surgical and surgical adult bowel intussusceptions by using CT characteristics. Methods: By searching from CT reports between January 2005 to December 2011, there were 76 patients with 82 lesions of adult bowel intussusceptions. CT scans were independently reviewed by two radiologists who were aware that all patients had an intussusception, but not given other clinical and pathological information. Accuracy of each CT characteristic to distinguish between non-surgical and surgical intussusception were calculated. Results: There were 43 enteroenteric lesions (52.4%) and 39 colonic involving lesions (47.6%). Surgery was performed in 38 lesions (46.3%) and the remaining 44 lesions (53.7%) did not undergo surgery. Five of 43 (11.6%) enteroenteric and 33 of 39 (84.6%) colonic involving intussusceptions received surgery. Lead points were identied in all of the surgical intussusceptions. The mean sensitivity, specicity, positive predictive value, and negative predictive value to diagnose surgical enteroenteric intussusceptions using diameter thickness of > 4 cm, length > 4 cm, proximal bowel diameter > 3 cm, interposed fat thickness > 0.5 cm, and lead points were (100%, 92.1%, 62.5%, 100%); (100%, 47.4%, 20%, 100%); (40%, 94.7%, 50%, 92.3%); (80%, 73.7%, 28.6%, 96.6%) and (100%, 76.3%, 35.7%, 100%), respectively. Conclusion: The majority of colonic involving intussusceptions undergo surgery. No CT feature is useful to diagnose surgical colonic involving intussusceptions. In contrast, most enteroenteric intussusceptions did not require surgery. Using diameter thickness > 4 cm, could be helpful to diagnose surgical enteroenteric lesions.

14-19

Authors: Rugee Sriondee, R.N., MNS., Kanokporn Nateetanasombat, R.N., Ph.D., Rachanee Namjuntra, R.N., D.N.S.,Winai Ratanasuwan, M.D., MPH.

Background: Regularity and continuity of medication is important in HIV/AIDS treatment. Late adolescents and early adults tend to have more problems of regularity and continuity of medication taking. Methods: This quasi-experimental study has objectives to study outcomes of a Cognitive and Behavioral program in improving the regularity and continuity of medication taking and CD4 and AIDS knowledge in late adolescent and early adult HIV/AIDS patients. Sixteen study patients were specifically selected from Immunodeficiency and infectious diseases Clinic at Siriraj Hospital. Study equipment include Cognitive and Behavioral program, Drug Diary card, and questionnaire evaluating AIDS knowledge. The regularity and continuity of medication taking by patients was evaluated at enrollment and 3rd, 5th, 9th, 13th and 17th weeks after enrollment. Plasma HIV-RNA and CD4 were measured at enrollment and 17th weeks after enrollment. AIDS knowledge was evaluated at enrollment and at the 3rd weeks after enrollment. Data was analyzed by Wilcoxon Signed Rank Test and Friedman Test. Results: The regularity and continuity of medication taking by patients was improved from 88.5% to 100% (p < 0 .001) from the 3rd weeks after enrollment. The number of plasma HIV-RNA was decreased from 171, 369 to 2,439 copies/ml (p = 0.022) at the 17th weeks after enrollment. The number of CD4 was increased 328 to 366 cells/mm3 (p = 0.005) at 17th weeks after enrollment. AIDS knowledge was increased significantly (p < 0.001) at the 3rd weeks after enrollment. Conclusion: This study elaborated that Cognitive and Behavioral Program can significantly improve the regularity and continuity of medication taking by patients’ AIDS knowledge leading to the ultimate outcome of controlling plasma HIV-RNA and CD4 elevation. This Cognitive and Behavioral Program can be applied to solve the problems of patients’ irregularity and in-continuity of medication taking.

27-32

Authors: Preechaya Wongkrajang, M.D., Chaicharoen Tantanate, M.D.

Objective: Leukocyte differential count (LDC), a component of complete blood count (CBC), is important in the diagnosis and follow-up of various diseases. Inter-instrument comparison of LDC is important in the laboratory using multiple analyzers to ensure the precision and reliability of test results. Methods: One hundred and twenty EDTA blood samples were collected and analyzed using the DxH, LH, and XE. Regression and correlation analysis, intraclass correlation coefficients (ICC), and difference plots between the LDC findings from each analyzer and the means of all methods were analyzed. Results: Neutrophil, lymphocyte, monocyte, and eosinophil counts from 3 automated hematology analyzers were strongly correlated (r2 > 0.97, p-value < 0.001, and intraclass correlation coefficient (ICC) 0.89-0.99). However, a negative bias was observed when comparing the monocyte count from the Sysmex analyzer and the mean of all 3 analyzers. Conclusion: Leukocyte differential counts between or among different models and/or brands of hematology analyzers may be different. From this study, the correlations of leukocyte differential counts between analyzers were excellent, except for basophil count. Monocyte counts from the Sysmex analyzer showed a negative trend. Laboratories should evaluate this significance, in terms of both quality management and clinical aspects

37-40

Authors: Raviwon Atisook, M.D.*, Pattrapun Wongsripuemtet, M.D.*, Saowapark Chumpathong, M.D.*, Suwanit Therasakvichya, M.D.**

Gestational trophoblastic disease originates from abnormal proliferation of molar tissue and most of them are not complicated. However, life threatening complications such as hyperthyroidism and severe pre-eclampsia can occur. We report the successful anesthetic management with general anesthesia technique in the molar pregnancy with pre-eclampsia and hyperthyroidism scheduled for trans-abdominal hysterectomy without any complications.