Siriraj Medical Journal

57-61

Authors: Sineenad Chotiwatesilp, M.D., Santi Assawapalangchai, M.D.

Objective: To evaluate the efficacy of a simple customized shoe-insert in decreasing abnormal plantar pressure and in changing the pain score in patients with chronic plantar foot pain. Methods: Ten patients with chronic plantar foot pain were initially recruited from the outpatient unit of the Department of Rehabilitation Medicine, Siriraj Hospital. The simple customized shoe-inserts were fabricated from 2 layers of EVA foam. Some pieces of foam were attached to the specific locations between the two layers by using the subjects’ foot pressure graph as blueprint. The plantar pressures were measured during walking by digital foot scanning (FootscanTM insole system), with and without the customized shoe-inserts in. The average pain scores were altogether reported by the patients in terms of a visual analog scale. The same measurements were repeated again with the shoe-inserts in after 2 weeks of use. Results: Nine participants (3 males, 6 females) were evaluated completely. The diagnoses were plantar fasciitis (all 9 subjects) and matatarsalgia (3 of the 9 subjects). Immediately after applying the shoe-inserts, foot pressures were significantly decreased (p = 0.011) when walking. However after 2 weeks, the pressures were no longer significantly reduced (p = 0.859, p = 0.173) compared to the baseline before fitting. Also, for the pain score change, most subjects initially reported pain relieved (7 in 9 subjects), but the second visit showed no significant difference (p = 0.081) compared to the first day before using. Conclusion: The simple customized shoe-inserts could potentially decrease average plantar pressure as well as the average pain score in most cases. However the pain score reductions were not significantly different after 2 weeks of the device applications. Future investigations with an appropriate sample size are required to precisely conclude the efficacy of the shoe-inserts.

66-70

Authors: Sitthipong Srisajjakul, M.D.*, Saranya Kawin, M.D.*, Piyavadee Leksrisakul, M.D.**, Kobkun Muangsomboon, M.D.*

Objective: To evaluate CT features of adrenal pheochromocytoma with clinical and histopathological correlation. Methods: A retrospective study was approved by the ethics committee. Forty-four patients with proven adrenal pheochromocytoma from January 2002- December 2007 at our institution were included. Only 10 out of the 44 had available preoperative computed tomography (CT). All 10 CT were interpreted independently by two abdominal radiologists, with correlation with clinical and histopathological analysis. Results: All 10 patients had unilateral adrenal pheochromocytoma. Three were men and 7 were women. The mean age of patients was 45.1 years old. Eight out of 10 patients presented with hypertension. Four patients presented with neuroendocrine symptoms such as palpitation and diaphoresis. Other symptoms were palpable abdominal mass, headache and gastrointestinal symptoms (nausea, vomiting or abdominal pain). Pre-operative biochemistry tests for pheochromocytoma were performed in 8 patients. The tumor size varied from 2-15 cm in diameter. CT features of pheochromocytoma of this study showed 1 tumor of pure solid mass (2 cm tumor size) and 9 tumors of complex cystic masses. The range of density values at the solid part of tumors was 25-53 HU on non-contrast phase CT and the mean was about 41.4 HU. All 10 tumors showed enhancement of the solid part. Intratumoral hemorrhage and calcifications were detected. No intratumoral fatty component was detected. Conclusion: CT findings of adrenal pheochromocytoma were typical heterogeneous soft tissue density mass and moderate enhancement. Tumors with cystic component and hemorrhage were common in our study. CT was useful for tumor characterization in patient with nonclassic clinical manifestation of pheochromocytoma and also for pre-operative management.

73-78

Authors: Ravit Ruangtrakool, M.D.

Objective: To identify characteristics associated with suspected child abuse in the setting of blunt abdominal trauma. Methods: Retrospective review. Results: Three cases of blunt abdominal injury caused by suspected abusive force admitted in Siriraj Hospital between May 2001 and July 2006 are reviewed. The first case is a six-year old boy who had liver laceration grade III at segment II and III. The history of trauma was refused by his parents initially. At last, the patient confessed that he was hit by the mother’s boy friend. The second case is a-10-month old girl who was operated for traumatic rupture in the 3rd part of the duodenum (90% circumference) as well as hematoma at the root of mesentery and ligament of Trietz following shopping with her family without history of traumatic event. Chest X-ray showed multiple old fractures at left posterior 6th, 7th, 8th ribs as well as a callus formation at the costochondral junction of the right 7th rib. Bone survey also demonstrated laminated periosteal reaction of the right tibia from previous fracture. The third case is a 3-year-old boy with intramural duodenal hematoma located between the 2nd part of the duodenum and the D-J junction. The patient told that he was stepped upon during lying down by his grandmother who has abused him many times before. Conclusion: Child abuse is suspected in a case of conflict between physical examination findings and history of the accidental events, especially physically damage than the mechanism of injury. The patterns of inflicted injury are also discussed in this publication. Injury to the duodenum is unusual in the pediatric trauma patients but more commonly is the result of child abuse. Diagnosis and treatments of various types of duodenal injury including intramural duodenal hematoma are elucidated in this article.

84-89

Authors: Praphathip Eamsobhana, Ph.D., D.A.P,&E.

No abstract available.

4-8

Authors: Pravit Akarasereenont, M.D., Ph.D., Premrutai Thitilertdecha, B.Sc., Sirikul Chotewuttakorn, M.Sc., Titchaporn Palo, B.Sc.,Patcharamon Seubnooch, B.Sc., Jantanee Wattanarangsan, M.Sc., Rattana Phadungrakwitya, M.Sc., Saipan Klumklomjit, B.Sc.,Phornnapa Chareonkij, M.Sc., Yaowares Sathiyos, B.Sc., Tawee Laohapand, M.D.

Quality assessment of traditional herbal medicines is of benefit not only in research but also in practice. The method of quality assessment of the Thai traditional medicine, Ayurved Siriraj Prasachandaeng, was established by using High Performance Thin Layer Chromatography (HPTLC) and High Performance Liquid Chromatography (HPLC). In HPTLC, the chromatographic fingerprints were developed; the color and the relative retardation factor (rRf) of bands were compared with those of reference markers. Likewise, relative retention time (rRt), and applied information content (φ) were evaluated in HPLC fingerprints. Reference markers, gallic acid, caffeic acid, p-coumaric acid, ferulic acid, vanillic acid and kojic acid were used as qualitative markers in HPTLC whereas gallic acid, caffeic acid and vanillic acid were used as qualitative and quantitative markers in HPLC. Similarity of the chromatographic pattern among batches was determined by the presence of stated mathematic parameters in the range of 80 to 125 percent of the average. The HPTLC and HPLC fingerprints of three batches of Ayurved Siriraj Prasachandaeng showed similar chromatographic patterns. Such similarity showed that the productions of different batches in the recipe were consistent. Moreover, it revealed that some markers found in the recipe certainly came from various medicinal herbal components of their own recipes. In conclusion, the combination of rRf from HPTLC, and rRt and φ from HPLC is the suitable method for identification and quality control of different batches of Ayurved Siriraj Prasachandaeng.

14-17

Authors: Japarath Prechapanich, M.D., Euranong Tongtub, M.D.

Objective: To determine the effect of parity to pregnancy outcomes. Methods: A retrospective study was conducted among 976 singleton pregnant women during July to October 2007 at Siriraj Hospital. Two groups of patients were recruited in this study, the first group was nulliparity (488 patients) and the second group was multiparity (488 patients). The adverse pregnancy outcomes including antepartum hemorrhage (APH), gestational diabetes (GDM), pre-eclampsia, preterm birth, premature rupture of membranes (PROM), mode of delivery, postpartum hemorrhage (PPH) and neonatal morbidity were studied comparatively. Results: The adverse pregnancy outcome in the aspects of pre-eclampsia, PROM, preterm birth, operative obstetrics and neonatal phototherapy in nulliparity were significantly higher than multiparity with odds ratio 2.43 (95%CI 1.05-5.61), 1.79 (95%CI 1.07-2.98), 1.91 (95%CI 1.23-2.96), 11.20 (95%CI 2.60-48.13), and 2.10 (95%CI 1.40-3.14) respectively. APH was increased in the multiparity group but not significant different by statistics, with odds ratio 5.04 (95%CI 0.59-43.31). There were no significant differences for the prevalence of GDM, PPH, low birth weight and macrosomia in these two groups. Conclusion: Increased risk of pre-eclampsia, PROM, preterm birth, operative obstetrics and neonatal phototherapy in nulliparity compared with multiparity.

23-25

Authors: Nattakamon Supanon, M.D.*, Waranya Boonchai, M.D.*, Sitthichoke Taweepraditpol, M.D.**

Benign symmetric lipomatosis (BSL) is characterized by the presentation of numerous symmetric non-tender fatty tumors in the neck, suboccipital region, proximal extremities and upper parts of the trunk, typically noted as a “pseudoathletic” appearance. The etiology of BSL remains unknown but mitochondrial mutations have been found in some patients. The mitochondrial cytopathy was suggested to be studied in all BSL patients especially those with neuropathy. We have presented a case of BSL with reverse fat distribution, which we named the “Pop-eye” appearance in which the fatty tumor was distributed at both the distal part of the upper extremities and the proximal part of the lower extremities. A study of the mitochondrial tRNA lysine gene did not reveal mutation at position 8344.

32-35

Authors: Panom Ketumarn, M.D.

No abstract available.

39-41

Authors: Wanchai wanachiwanawin, M.D.

No abstract available.

47-51

Authors: Irene Ruengkhachorn, M.D., Mongkol Benjapibal, M.D.

Carcinoma of the uterine cervix is one of the most common malignant neoplasms among women and remains the leading female malignancy in Thai women. Cervical cancer diagnosed during pregnancy remains a therapeutic challenge for physicians. Pregnant women should have cervical cytology screening at their first prenatal visit. In cases of cytological abnormality, colposcopy is indicated. Cervical conization is used for the diagnostic role only. The management of invasive cancer depends on the gestational age at diagnosis, stage of disease, patient’s desire of pregnancy, ethics and religious belief s including family and decision making by multidisciplinary teams.