Siriraj Medical Journal

202-209

Authors: Arunotai Siriussawakul, M.D., Aungsumat Wangdee, R.N., Anan Chatsiriphatthana, M.D., Chulaluk Komoltri, Ph.D. (Biostatistics), Sukanya Dejarkom, M.D., Sukanya Jirachaipitak, M.D., Anchala Jirakulsawat, RN, Somsak Areewatana, M.D.

Background: Several alternative airway tools have now become primary devices for endotracheal intubation in obese patients. Since there were no guidelines to suggest which patient characteristics may be best suited for alternative techniques, we conducted this study to identify which airway bedside tests could predict the occur- rence of troublesome intubation while performing conventional endotracheal intubation in obese Thai patients. Methods: This cohort study was conducted in 200 obese patients who were expected to not use alternative tools for rst-line management in a tertiary care university hospital. Troublesome intubation was de ned using an intubation dif culty scale (IDS) score > 0. An IDS value of 0 means ideal intubation, i.e., one performed without effort, on the rst attempt, practiced by one operator, using one technique, with no impediment of the tube passage. Eleven types of preoperative airway assessment – including malformation of central teeth in the upper jaw, a modi ed Mallampati test, an upper-lip bite test, the range of motion of the neck ( exion and extension), the inter-incisor gap, the hyomental distance, the thyromental distance, the sternomental distance, the neck circumference, and the length of the neck – were examined in all patients. Results: The inter-observer reliability of raters was > 0.7 before initiation of the study. Overall, 52.5% of patients experienced troublesome intubation during conventional endotracheal intubation. According to a multivariate analysis, the independent risk factors were a modi ed Mallampati test, the neck circumference, and the inter- incisor gap. Conclusion: Based on our ndings, alternative airway tools should be the rst line of airway management in the case of patients with a high modi ed Mallampati test, a large neck circumference, and a short inter-incisor gap.

332-338

Authors: Walailak Chaiyasoot, Thana Pongpanumaspaisan, Trongtum Tongdee, Somrach Thamtorawat, Satit Rojwatcharapibarn

Objective: The purpose of this study was to report our experience with 35 patients, presenting with primary or secondary bone tumors, who underwent pre-operative transarterial embolization in our institution. Methods: Pre-operative transarterial embolizations between 2009 and 2013 were retrospectively reviewed in 35 patients (20 men and 15 women), with a mean age of 49.29 years, range 15-79 years. Medical records were reviewed to obtained patient’s data, histological diagnosis, anatomical site, post embolization complication, interval between embolization and surgery, operative procedure and operation time. Estimated blood losses (EBL) were obtained from operative notes or anesthetic notes. Results: Thirty- ve patients had a total of 43 procedures in 5 years period, in which ve patients underwent twice and one patient underwent four pre-operative embolizations. All 43 pre-operative embolization procedures were technically successful and underwent surgery after embolization, with a mean of 2.7 days, range 0-15 days. No patient experienced embolization associated major complication. The mean estimated blood loss was 2,915 mL (range 20-14,000 mL). Conclusion: Pre-operative transarterial embolization of both primary and secondary bone tumors was safe, effective and tended to reduce intra-operative blood loss particularly when superselective embolization was performed. Blood loss during surgery increased if the operation was not performed within 3 days after emboliza- tion due to re-canalization and angiogenesis.

350-357

Authors: Peamruetai Butdapan, Khuannara Narajeenarone, Angkana Apichartvorakit, Sukree Kade, Suton Jansomsarit, Premsuda Jamjuntra, Kunlatorn Debmongkon, Pradit Pratepavanit, Tawee Laohapand, Pravit Akarasereenont.

Objective: To explore the ability of the posture of the “Hermit Doing Body Contortion” (HDBC) to relieve shoulder and scapular pain in patients with chronic myofascial pain syndrome (MPS). Methods: One hundred and thirty-six out-patients with chronic MPS were randomly assigned to one of two groups. The experimental group was advised to perform a posture of the HDBC named “posture for relieving abdominal pain, pain of the scapular blade” (PRASP) every day for two months. Both groups received Thai traditional massage treatment and hot herbal compresses once a week for four weeks. Using a numeric rating scale and dolorimeter, outcomes were assessed prior to commencing the intervention (M0), and one and two months after commencing the intervention (M1 and M2). Results: The mean change in pain intensity between M1 and M2 differed signi cantly between the groups (1.32±1.45 in the experimental group and 0.47±2.26 in the control group; p = 0.039). Similarly, the mean change in pressure pain threshold between M0 and M2 also differed signi cantly between the groups (1.39±1.76 in the experimental group and 0.53±1.90 in the control group; p =0.027). In both cases, the experimental group achieved greater pain relief. Conclusion: In patients with chronic MPS, the posture of the HDBC combined with standard Thai traditional medicine treatments provided better ongoing relief of shoulder and scapular pain than did standard Thai traditional medicine treatments alone.

363-368

Authors: Achra Sumboonnanonda, Khounelaphet Touphaythoune, Wipa Mongkonsuk.

Objective: To study longterm renal outcome of Thai children with idiopathic nephrotic syndrome (INS). Methods: We retrospectively reviewed 75 followed-up in a tertiary care, university hospital. Male to female ratio was 2:1. Mean age at diagnosis was 6.2 years, and 56.0% were less than 5 years old. 57.3% previously received prednisolone from other hospitals and 32 patients (42.7%) were steroid resistant nephrotic syndrome (SRNS). Initial short stature was found in 1.3%. Hypertension and hematuria was found in 34.7% and 14.7%, respectively. Renal biopsy performed in 40 patients (53.3%) revealed minimal changes disease in 17 (42.5%), focal and segmental glomerulosclerosis (FSGS) in 12 (30.0%), mesangial proliferative glomerulonephritis in 5 (12.5%), IgM nephropathy in 4 (10%), and IgA nephropathy in 2 (5%) patients. Immunosuppressive medications included Cyclophosphamide in 64.5%, Tacrolimus in 14.7%, Cyclosporin in 8.0% and Mycophenolate mofetil in 4.0%. Enalapril was given in 48.0%. Results: Mean follow-up time was 7.4 years. Complete remission was achieved in 77.3%. One patients (1.3%) had Chronic Kidney Disease stage 3 and 5 patients (6.7%) had End Stage Renal Disease (ESRD). One patient with ESRD died of severe respiratory tract infection. The factor associated with poor renal outcome was FSGS (p=0.032). Renal survival at 5,10, and 15 years were 95.3%, 85.7% and 57.2%, respectively. At last follow-up, short stature was found in 4.0% and hypertension in 20.0%. Other complications included cataract (29.3%), glaucoma (9.3%), diabetes mellitus (2.6%), septicemia (9.3%), other infections (10.6%). Conclusion: We suggest that although renal outcome in Thai children may be better than in caucasian, longterm follow up is still needed, especially in children with FSGS.

377-380

Authors: Piyakorn Poonyam, Asawin Sudcharoen, Therdkiat Trongwongsa, Piyanant Chonmaitree.

Iron is one of the common causes of pill-induced esophagitis with a proposed mechanism involving direct esophageal injury. Diagnostic endoscopic nding includes nding an intact pill or its residue on endoscopy, but they are rarely found. Pathology typically reveals luminal brown-black crystalline materials adjacent to the injured surface epithelium or in combination with luminal broin ammatory exudate. Brown crystalline material on Perl’s staining is the typical nding of iron-induced esophagitis. Crucial treatment is cessation of medication. We report an elderly woman diagnosed with iron-induced esophageal ulcer whose ulcers improved while iron medication was maintained.

386-394

Authors: Monton Wongwandee

Seizures in pregnant women cause several maternal and fetal consequences. Eclampsia is usually diagnosed to be the etiology. However, seizures during pregnancy or puerperium could be caused by pre-existing epilepsy, the initial presentation of a non-pregnancy-related disorder or the new-onset pregnancy-related disorder. Therefore, thorough diagnostic evaluation is essential. Although the pathogenesis of new-onset pregnancy-related neurological disorders remains unknown, physiological changes during pregnancy and puerperium are believed to have a major role. Advanced neuroimaging of the brain and cerebral vessels can help in differentiating the speci c causes of seizures in these patients.