Siriraj Medical Journal

65-71

Authors: Saipin Muangman, M.D., Somkhuan Dechasilaruk, M.D., Walaiporn Punkla, M.D., Manee Raksakietisak, M.D., Pranee Rushatamukayanunt, M.D., Saowapark Chumpathong, M.D., Kamheang Vacharaksa, M.D., Suvit Soontarinka, M.D.

Background: The purpose of awake craniotomy is to test neurological functions to ensure accurate lesion surgery and lessen postoperative neurological complications. There are several methods to provide anesthesia during awake craniotomy including local anesthesia infiltration, local anesthesia plus conscious sedation, general anesthesia and wake-up during surgery and sleep again (asleep-awake-asleep or AAA). Each method has its pro and con with different complications. In Siriraj Hospital, there was no prior study of anesthetic techniques and complications of awake craniotomy. Methods: The retrospective descriptive study of awake craniotomy was carried out with 60 patients in Siriraj Hospital 2007-2011. Results: There were 35 males (58.3%) with average age 40.7±12.6 years and weight 64.2±12 kilograms undergoing awake craniotomy. Twenty patients (33.3%) presented with seizure before surgery. Most diagnosis was oligodendroglioma in 25 patients (41.7%), mostly at the frontal lobe (44 patients or 73.3%). The most common position was supine (46 patients or 76.7%). ICU length of stay was 1.4±0.9 (0,6) days. Hospital stay was 11.1± 9 (4, 55) days. Total intravenous anesthesia (TIVA) was mostly used (52 patients or 90%) while 18 patients (30%) received scalp block. Most patients (85%) did not require nasal airways while 8 patients (13.3%) did, and only 1 patient (1.7%) required laryngeal mask airway (LMA) to help open up air passage. The drugs used during asleep1 and asleep2 were propofol together with dexmedetomidine and fentanyl in 34 patients (56.7%) and 23 patients (38.3%), respectively. While being awake (15 patients or 20%), dexmedetomidine and/or fentanyl were administered. Complications during anesthesia were hypertension (33.3%), hypotension (26.7%), upper airway obstruction (23.3%), bradycardia (15%), tachycardia (10%), seizure (1.7%) and nausea (1.7%). Conclusion: The most common anesthesia method in Siriraj Hospital for awake craniotomy was TIVA (90%), using propofol together with dexmedetomidine and fentanyl. Only one patient (1.7%) received anesthesia via inhalation with LMA. Complications during anesthesia were mostly hypertension, hypotension and upper airway obstruction, respectively.

79-83

Authors: Pudit Suraprasit, M.D., Sumanas Bunyaratavej, M.D., Penvadee Pattanaprichakul, M.D., Waritch Kobwanthanakun, M.D., Nuntida Prasertworonun, M.D., Charussri Leeyaphan, M.D.

Background: Wood’s lamp examination is a useful diagnostic test in many dermatological disorders. However, there was limited data on knowledge of physicians about this tool. Objective: To evaluate basic knowledge of physicians on Wood’s lamp and its applications. Methods: The study used questionnaires in Thai general physicians who attended the 2013 Dermatology Annual Meeting. The questionnaire composed of a picture of a Wood’s lamp instrument and two open-end questions including 1) What is the name of this device? 2) Which diseases can this device help to make the diagnosis? Results: Eighty-two physicians enrolled in this study. Only 55 physicians (67.1%) answered the name of a Wood’s lamp correctly. There were 29 out of 55 physicians (52.7%) knew at least one application of Wood’s lamp. About half did not know any applications. Tinea versicolor, followed by melasma, tinea captitis, erythrasma, acne, porphyria, and vitiligo, respectively were the common applications that most physicians answered. Conclusion: This study showed around two-third of physicians know Wood’s lamp, but only half of them were knowledgeable about its’ application in dermatoses. Education regarding Wood’s lamp and application should be emphasized more in physicians to assist in dermatologic diagnoses.

90-96

Authors: Phornnapa Charoenkij, Titchaporn Palo, Sirikul Chotewuttakorn, Suveerawan Limsuwan, Tawee Laohapand, M.D., Pravit Akarasereenont, M.D.

Objective: To investigate the anti-inflammatory effects of AVS073 via the expression of COX-2 in human peripheral blood mononuclear cells (PBMC) induced by LPS. Methods: PBMC from healthy volunteers were treated with LPS alone, AVS073 alone (0.1-10 μg/ml) and LPS plus AVS073 for 18 hours. Cell proliferation was measured using MTT assay, while COX-2 mRNA, COX-2 protein and PGE2 production were assessed using real time RT-PCR, western blot and enzyme immunoassay (EIA), respectively. Results: It was found that neither LPS nor AVS073 has effects on cell proliferation. The optimum time of LPS- induced COX-2 expression was 18 hours. Even the expression of COX-2 mRNA showed trends toward decrease in all concentrations of AVS073 treatment, it was not significantly different. However, the expression of COX-2 protein was significantly decreased by 10 μg/ml AVS073. Surprisingly, endogenous PGE2 was significantly increased, whereas exogenous PGE2 was not significantly changed. Conclusion: AVS073 has some anti-inflammatory effects, probably at the level of post translational modification. Increase in endogenous PGE2 production, in spite of the decrease in the expression of COX-2 protein, may be due to the other factors or isoforms of COX.

104-108

Authors: Atthaphorn Trakarnsanga, M.D., Thawatchai Akaraviputh, M.D., Chotirot Angkurawaranon, M.D., Chanin Pandee, M.D., Natthawut Photong, M.D., Voraboot Taweeruchana, M.D., Thammawat Parakonthun, M.D., Chainarong Phalanusitthepa, M.D., Jirawat Swangsri, M.D., Asada Methasate, M.D., Thanyadej Nimmanwudipong, M.D., Vitoon Chinswangwatanakul, M.D.

Background: Single-incision laparoscopic colectomy (SILC) is an evolving technique with potential advantages by reducing number of incisions that can reduce port-related complications and improve cosmetic results. The purpose of this study was to compare the short-term outcomes between SILC, hand-assisted laparoscopic colectomy (HALC) and standard multi-port laparoscopic colectomy (MLC). Methods: Retrospective analyses of a total of 90 patients between May 2010 and December 2011, who underwent SILC for colon cancer surgery, were performed in 30 patients. Clinicopathological parameters were matched 1:1 with patients who underwent HALC (n=30) and MLC (n=30). Short-term outcomes were collected and analyzed. Results: Operative time was significantly shorter in SILC compared to HALC and MLC (p< 0.001), as well as less estimated blood loss (p = 0.02). There were no significant differences in conversion rate and number of harvested lymph nodes. SILC had the advantage of less 24-hr postoperative pain score compared to HALC and MLC (p< 0.001), whereas length of stay and time to full diet were not different. Conclusion: In selected patients, SILC can be successfully and safely performed with shorter operative time, less estimated blood loss and less postoperative pain score.

114-116

Authors: Sakunee Niranvichaiya, M.D., Manasmon Chairatchaneeboon, M.D.

Gnathostomiasis is transmitted to humans via ingestion of third-stage larva of genus Gnathostoma. Thailand is considered an endemic area for the disease. We reported a 65-year-old Thai male patient with clinical presentation of a small number of nodular migratory swellings on the face and neck. The histopathology of skin biopsy revealed parasitic material surrounded by eosinophil infiltration and fibrosis in deep dermis. Therefore, we were able to confirm diagnosis of cutaneous gnathostomiasis. After treatment with ivermectin followed by albendazole, the lesions still persisted; thus, surgical excision of lesions may be the necessary curative treatment.

119-124

Authors: Piyanant Chonmaitree, M.D.

Hepatitis B infection is a serious global health problem. Chronic kidney disease patients with hepatitis B infections are associated with high rates of mortality and morbidity. The problems with vaccinating hemodialysis patients are that they have been shown to have lower seroconversion rates, lower peak antibodies, and antibody decline faster than in healthy persons. Patients with chronic kidney disease should be vaccinated as early as possible. Four double doses of vaccination are recommended. Anti-HBs should be monitored every 12 months in vaccinated hemodialysis patients. Additional strategies to improve seroconversion rates are third generation hepatitis B vaccine, combined hepatitis B and hepatitis A vaccine, intradermal injection, and adjuvants.