Siriraj Medical Journal

135-141

Authors: Cherdsak Duangchan, M.N.S., Tipa Toskulkao, Ph.D., Suporn Danaidutsadeekul, D.N.S., Cherdsak Iramaneerat, M.D., Ph.D.

Background: Postoperative ileus (POI) usually delays the postoperative recovery after open colectomy. Gum chewing may facilitate bowel motility through cephalic-vagal stimulation. Bowel sounds, the time to first postoperative flatus and defecation, the common nursing outcomes of bowel motility, has not been investigated in Thai patients. This study examines the effect of gum chewing on bowel motility in colorectal cancer patients after open colectomy. Methods: A single blind randomized controlled trial was conducted with 32 patients in experimental and 32 patients in control groups. The experimental group chewed a piece of sugar-free gum with a fruity flavor for 20 minutes each time, three times a day starting from the first postoperative day till the date of first oral liquid received, while the control group receive routine care. OriginalArticle Results: The bowel sounds of the experimental group after chewing gum significantly increased more than those of the control group (p = 0.00). The time to the first postoperative flatus in the experimental group was significantly shorter than that in the control group; likewise the first postoperative defecation was also shorter (p = 0.04, p = 0.02, respectively). Conclusion: Gum chewing is helpful in stimulating bowel motility measured by an increase in bowel sounds and in reduced times to first postoperative flatus and defecation. This nursing intervention may be used for stimulating bowel motility in patients with colorectal cancer after an open colectomy.

148-154

Authors: Nithida Na Songkhla, M.D., Mettaya Niamnarong, M.D., Kobkun Muangsomboon, M.D.

Objective: To differentiate clear cell and non-clear cell renal cell carcinoma (RCC) using enhancement pattern, relative enhancement ratio and associated findings on CT scan. Methods: This retrospective study reviewed CT scan in the unenhanced, corticomedullary and nephrographic phase in clear cell and non-clear cell RCC. A total of 49 patients with surgically proven RCC, consisting of 42 clear cell RCCs, and 7 non-clear cell RCCs (6 papillary, 1 chromophobe). Two radiologists compared degree of enhancement, enhancement pattern, the presence or absence of calcification, perinephric change, pelvocalyceal involvement, neovascularization, venous invasion, lymphadenopathy and distant metastasis. Results: Both the attenuation value and degree of enhancement in the corticomedullary phase were higher in clear cell RCC than non-clear cell RCC. The relative enhancement ratio in the corticomedullary phase was significantly higher in clear cell than non-clear cell RCC. The cutoff value of the relative enhancement ratio higher than 1.629 was used to differentiate clear cell RCC from non-clear cell RCC and had the sensitivity, specificity, PPV, NPV and accuracy of 76.2%, 85.7%, 97%, 37.5% and 77.6%, respectively. Heterogeneous enhancement, perinephric change and neovascularization were found significantly more common in clear cell than non-clear cell RCC. Conclusion: The most useful parameter to differentiate clear cell from non-clear cell RCC is relative enhance- ment ratio in the corticomedullary phase.

160-170

Authors: Chetta Ngamjarus, M.Sc., Virasakdi Chongsuvivatwong, Ph.D., Edward McNeil, M.Sc.

Objective: This study was to develop a sample size application (called “n4Studies”) for free use on iPhone and Android devices and to compare sample size functions between n4Studies with other applications and software. Methods: Objective-C programming language was used to create the application for the iPhone OS (operating system) while javaScript, jquery mobile, PhoneGap and jstat were used to develop it for Android phones. Other sample size applications were searched from the Apple app and Google play stores. The applications’ characteristics and sample size functions were collected. Spearman’s rank correlation was used to investigate the relationship between number of sample size functions and price. Results: “n4Studies” provides several functions for sample size and power calculations for various epidemiological study designs. It can be downloaded from the Apple App and Google play store. Comparing n4Studies with other applications, it covers several more types of epidemiological study designs, gives similar results for estimation of infinite/finite population mean and infinite/finite proportion from GRANMO, for comparing two independent means from BioStats, for comparing two independent proportions from EpiCal application. When using the same parameters, n4Studies gives similar results to STATA, epicalc package in R, PS, G*Power, and OpenEpi. Conclusion: “n4Studies” can be an alternative tool for calculating the sample size. It may be useful to students, lecturers and researchers in conducting their research projects.

177-182

Authors: Pramook Mutirangura, M.D., Khamin Chinsakchai, M.D., Supaporn Tunpornpituk, M.Sc., Chumpol Wongwanit, M.D., Chanean Ruangsetakit, M.D.

Background: In general, many patients with acute proximal deep vein thrombosis (DVT) are treated with heparin and oral anticoagulant. Many physicians have been taught to admit these patients to absolute bed rest for the first 24-48 hours due to the fear of dislodging clots that may lead to fatal pulmonary embolism (PE). Objective: The aim of this study is to compare the differences among the changing circumference of affected limb, the severity of pain, and the incidence of symptomatic PE in 3 groups of acute proximal DVT, including absolute bed rest with compression bandages (group 1), ambulation with compression bandages (group 2), and ambulation without compression bandages (group 3). Methods: Between January 2006 and March 2011, 60 patients were enrolled in this study. In this analysis, the clinical characteristics, the changes of affected limb circumference and pain score during the first week of admis- sion and the incidence of symptomatic PE among 3 groups of this study were analyzed. Results: There were no statistical differences in the characteristics among 3 groups of patients. The most gender was female and the mean age for 3 groups ranged from 55.1 to 63.7 years. Comparing among 3 groups, it showed a significant difference of calf circumferences between group 1 and group 3. None of pain score differences were statistically significant among 3 groups. In addition, there was no incidence of symptomatic PE in the three groups of the present study. Conclusion: Our findings confirm that acute proximal DVT treatment with ambulation does not increase the incidence of symptomatic PE, compared with absolute bed rest. Although there is no statistical decrease of the severity of pain between those 3 groups, the group of absolute bed rest and compression can promote the resolution of calf swelling, compared with the group of ambulation without compression bandages.

187-190

Authors: Jarungjit Kraiwattanapong, M.D., Poonsuk Prachukthum, M.D., Taksa Luasiripanthu, M.D.

There have been several reports of Hymenoptera sting around the world, but only a few have been reported being stung at the oropharynx which is considered uncommon and can cause life threatening condition. The authors reported a case of a 41-year-old healthy man who had a bee sting at his uvula 4 hours before coming to the hospital. He felt a lump in his throat and had some degrees of difficult swallowing and breathing and had muffled voice. The uvula was swollen and there was a pinpoint penetrating lesion at the anterior surface of the uvula. No stinger was identified. Vital signs were stable with no stridor nor wheezing. Intraoperative examination to identify stinger was conducted and tissue at the stinging area was excised to confirm complete removal of the possible embedded foreign body.