Siriraj Medical Journal

76-80

Authors: Tanongsak Homsapaya, M.D., Pakasith Anahanlipaiboon, M.D., Witoon Lairungruang, M.D.

Objective: Patients who receive total knee arthroplasty, which is a procedure that typically results in large amount of blood loss, have a higher probability of experiencing hypovolemic shock which can result in life threatening complications for the patient. Based on study and practice, the amount of blood loss can vary significantly. Currently, there are no other studies related to hypovolemic shock after total knee arthroplasty. The objective of this research is to study protective measures against hypovolemic shock after severe loss of blood which can occur after total knee artrhoplasty surgery and to ensure the safety of the patient post total knee arthroplasty surgery. Methods: This is a retrospective study. Study subjects were patients who received total knee arthroplasty surgery at Jainad Narendra Hospital from October 1, 2007 through March 31, 2010. The total number of study subjects enrolled was 124 patients and 139 subjects. The study focused on the occurrence of hypovolemic shock after knee artrhoplasty surgery. Hypovolemic shock is a state of decreased blood volume characterized by a blood pressure lower than 80/60 mmHg and heart rate of over 100 beats per minute. Results: Out of the 139 subjects, 20 subjects experienced hypovolemic shock after total knee arthroplasty surgery and 119 subjects did not. Differences in the amount of blood given to patients who experienced hypovolemic shock and those who did not experience hypovolemic shock did not indicate any statistical significance with a p-value <0.05. Differences in hematocrit levels pre-operation and two hours post-operation, surgical time, and amount of blood loss post-operation did not indicate any statistical significance with p-value < 0.05 when comparing patients who expe-rienced hypovolemic shock and those that did not after total knee arthroplasty surgery. Conclusion: Total knee arthroplasty surgery can cause severe blood loss that can lead to hypovolemic shock, which can cause life threatening complications for the patient. Therefore, it is critical to maintain proper care and close observation for postsurgical patients who received the procedure 4 hours prior.

85-88

Authors: Arunee Hematulin, Dr.rer.nat, Kornkanok Ingkaninan, Ph.D., Nanteetip Limpeanchob, Ph.D., Daniel Sagan, Dr.rer.nat.

Objective: To evaluate the radiosensitizing potential of Derris scandens extract in a human colon cancer cell model. Methods: The radiosensitizing effect of D., scandens extract on human colon cancer cells (HT-29) and non-cancerous human retinal epithelial cells (RPE) was determined by cell survival and micronuclei analysis after irradiation. Cell cycle distribution was analyzed by a flow cytometer. Results: D. scandens extract powerfully increases the radiosensitivity of HT-29 cells, but is less toxic and does not affect the radiosensitivity of RPE cells. Furthermore, the extract was found to reduce radiation-induced G2/M phase arrest in HT-29 cells, but not in RPE cells. Conclusion: D., scandens extract may have potential as a radiosensitizer for cancer treatment.

92-93

Authors: Theerawoot Tharmviboonsri, M.D., Kongkhet Riansuwan, M.D., Rapin Phimolsarnti, M.D., Banchong Mahaisavariya, M.D.

A surgical technique to drain the medullary content during closed femoral nailing by using a Frazier suction tip as a vent is demonstrated. This method is simple, safe and reproducible. The medullary content can be drained outside without surrounding soft tissue contamination and the intramedullary pressure is possibly minimized when femoral canal reaming and nail insertion is performed.

97-100

Authors: Tuangsit Wataganara, M.D., Namtip Triyasunant, M.D., SOmmai Viboonchart, B.N.

No abstract available.

106-110

Authors: Chumpol Anamnart, M.D., Niphon Poungvarin, M.D., FRCP, FRI(T).

Stroke is a common cause of morbidity and mortality. Approximate 40% of strokes are cryptogenic, because patent foramen ovale (PFO) is commonly found in the normal population. They are conflicting data from studies examining the association between PFO and stroke. Various factors need to be considered such as atrial anatomic variations (PFO size, atrial septal aneurysm, eustachian valve anatomy), the presence of venous thrombosis, and the presence of hypercoagulable state. The presence of any of these findings increases the chance of PFO contributing to a stroke. Limited information suggests no advantage of warfarin over aspirin in preventing recurrent strokes. Both surgical and transcatheter devices have been shown to decrease the rate of subsequent embolic events substantially. Surgical and percutaneous PFO closures have not been directly compared. However, the percutaneous approach appears to be less invasive and so successful that it seems to be a reasonable consideration for first choice treatment of PFO.