Siriraj Medical Journal

205-212

Authors: Chanon Ngamsombat, M.D.*, Jitsupa Wongsripuemtet, M.D.*, Sriwimon Manochiopinig, Ph.D.**, Siriwan Piyapittayanan, M.D.*, Suvicha Chaovongphanit, B.Sc., Orasa Chawalparit, M.D.

Objective: The arcuate fasciculus (AF) is classically described as white matter connecting Broca’s and Wernicke’s area, which is important for language processing in human. In a previous study, lateralization of the AF to the left in normal healthy people was described. However, using the AF for lateralization of the dominant hemisphere in Thai speakers with Thai mother tongue language has not been studied. The purpose of this study was to demonstrate any feasibility that AF (by diffusion tensor imaging (DTI)) could be used to lateralize the dominant hemisphere in native-Thai speakers. Methods: Ten normal official Thai speakers with Thai mother tongue language (5 males, 5 females, mean age 24.9 years old; range 22-37 years old) were studied with DTI by 3T MRI using deterministic method in post processing software. The fractional anisotropy, relative fiber density index (RFD) and asymmetry index (AI) were analyzed to determine the dominant hemisphere. Comparison to functional hemispheric language lateralization from functional magnetic resonance imaging (fMRI) was done. Results: Slightly higher fractional anisotropy (FA) values for the left AF as compared with the right AF in all subjects were noted. The lateralization of RFD to the right were found in 5 subjects, to the left in 3 subjects and no definite lateralization in 2 subjects. The lateralization of AI to the right was found in 5 subjects, to the left in 3 subjects and no definite lateralization in 2 subjects. The lateralization from the fMRI language paradigm using visual analysis of all subjects were to the left. The anterior end of the AF tract was at par opercularis in 6, par triangularis in 3 and middle frontal gyrus in 5 subjects. The posterior end of the AF was at superior temporal gyrus in 7, middle temporal gurus in 9 and angular gyrus in 4 subjects. The area of termination of the AF was not correlated with activation from fMRI in 6 subjects when fused with word paradigm and in 7 subjects when fused with verb paradigm. Conclusion: The way to reconstruct the AF is feasible with practical method and software. However its clinical value to determine the dominant hemisphere in Thai subjects needs to be explored more with more advanced and promising technique.

219-226

Authors: Pichanee Chaweekulrat, M.D., Chaiyawat Suppasilp, M.D., Bhoom Suktitipat, M.D., Ph.D.

Objective: The relationship between vitamin D and atopic dermatitis remains controversial. Here, we systematically reviewed and meta-analyzed the association between serum 25-hydroxy vitamin D concentration (25(OH) D) and atopic dermatitis (AD), AD severity, and the benefits of oral vitamin D supplementation. Methods: A total of 15 observational studies and 5 RCTs from 12 countries were included in this review. The effects of vitamin D deficiency or vitamin D level on AD and standardized AD severity score were performed using a random-effects model on 3 aspects: 1) serum vitamin D and risk of AD, 2) serum vitamin D level and severity of AD, and 3) the benefits of oral vitamin D supplementation on AD severity. Results: The analysis showed serum 25(OH)D deficiency marginally increased the risk of AD (OR = 1.55, 95%CI = 0.94 - 2.55, p = 0.084). Low serum 25(OH)D was correlated with greater AD severity (r = -0.29, 95%CI = -0.504 to -0.048, p = 0.020), and oral vitamin D supplementation helped reduced AD severity score by 0.963 standard deviation (95%CI = 0.23 to 1.70, p = 0.011). Conclusion: The association between serum 25(OH)D deficiency and risk of AD was still controversial. However, our meta-analysis suggested that higher serum 25(OH)D is associated with lower severity of AD. Moreover, oral vitamin D supplementation also helps to reduce AD severity.

235-240

Authors: Prapun Aanpreung, M.D., Niramol Tantemsapya, M.D., Monawat Ngerncham, M.D., Mongkol Laohapansang, M.D.

Objective: Extrahepatic portal vein obstruction (EHPVO) is a common cause of portal hypertension in children. Informative data about this disease in Thai children is still limited. The objective was to study etiology, clinical presentation, investigation, treatment, result and long-term outcome. Methods: The medical records of patients aged less than 15 years with diagnosis of EHPVO at Siriraj Hospital from 1993 to 2013 were retrospectively analyzed. Results: There were 22 children (13 males and 9 females) with median age at diagnosis 5.1 years. The etiology was idiopathic in more than 50%. The patients had umbilical vein catheterization at least 27.2%. The presenting symptoms were splenomegaly 54.5% and upper gastrointestinal bleeding 45.5%. Doppler ultrasonography showed positive results in 52.6%. Initial endoscopic finding showed esophageal varices (EV) grade I 27.3%, grade II 36.3%, grade III 31.8%, and gastric varices (GV) 4.6%. The indications for endoscopic interventions were primary prophylaxis 30%, secondary prophylaxis 40% and stopping GI bleeding 30%. The interventions included endoscopic sclerotherapy (EST) in 6 cases, esophageal variceal ligation (EVL) in 6 cases, both in 7 cases and glue injection in 1 case. Rebleeding occurred in 50% of secondary prophylaxis and bleeding groups, but none in the primary prophylaxis group. Patients were followed up for a median of 5.3 years. For long term follow-up, massive splenomegaly and hypersplenism were the major concerns. Surgical treatment included splenectomy (3 cases) and distal splenorenal shunt (1 case). None of the patients died from complications. Conclusion: The etiology of EHPVO is unknown in the majority of patients. SCT and EVL had success to control and prevent variceal bleeding and eradicate varices. There is an unsettled issue about management of EHPVO after controlling acute bleeding. Currently, Meso-Rex bypass and distal splenorenal shunt are proposed to be the recommended treatment for suitable cases with reported success in both eradicating varices and controlling hypersplenism, albeit preserving the spleen.

245-247

Authors: Narimon Limprasert, D.D.S.

In Thailand, it is commonly considered that autogenous tooth transplantation can only be performed by oral surgeons. Though the author is an oral surgeon, a general dental practitioner who can carry out simple surgery can also perform autogenous tooth transplantation with good functional results and significant cost savings over other options for carefully selected patients. This report presents a case of a 16 year-old Thai male patient who underwent autogenous tooth transplantation following the surgical technique recommended by Clokie CM, et al. The right mandibular third molar was transplanted to the right mandibular second molar showing successful results with radiographic follow-up for three years.