Siriraj Medical Journal

167-174

Authors: Patsharaporn Techasintana Sarasombath, M.D., Ph.D., Kosol Roongruanchai, M.D., Bunguorn Sermsart, M.Sc., Nuntiya Monkong,M.Sc.,SumatLoymek,B.Sc.,RungratDulyaporn,B.Sc.,OranuchNararak,B.Sc.,SirichitWongkamchai,Ph.D.

Objective: Intestinal parasitic infection is a major health problem in the southern region of ailand. Despite an established annual deworming program, many school age children still su er from parasitic infection. e aim of this study was to investigate the prevalence and health e ects of intestinal parasitic infection in school children in Satun Province, ailand. Methods: is cross-sectional study was conducted in children aged of 3 to 15 years during the period December 2014 to January 2015. Body mass index and hematocrit measurements were performed. Stool samples were collected for parasite detection by direct examination and concentration technique. Results: e prevalence of intestinal parasitic infection was 18.42%. B.hominis (29%), Giardia lamblia (13.3%), Trichuris trichiura (13.3%), and hookworm (13.3%) were the most commonly isolated parasites. School KY had the highest rate of intestinal parasitic infection, followed by schools RC, YT, and SD. Rate of soil-transmitted helminthic (STH) infection was highest at school RC, while the highest rate of protozoa infection was found at school KY. Only STH infection was signi cantly associated with anemia. No signi cant association was observed between weight status and parasitic infection. Conclusion: Intestinal parasitic infection continues to be a problem in school children in Satun Province, ailand. STH infection was found to be signi cantly associated with anemia. e majority of parasite types detected at each school varied substantially, which may indicate distinctly di erent sanitation-related problems at each school. erefore, improvement in personal sanitation and health education should be emphasized at every school in the area to prevent parasitic infection.

181-184

Authors: Apirom Laocharoenkeat, B.Sc.(Pharm), M.S., BCOP, Phurita ongkijpreecha B.Sc.(Pharm), M.S., Pakawan Promroung, B.NS.

Objective: e objective of this study was to determine incidence and severity of vascular pain following modi ed dilulent for gemcitabine solution. Gemcitabine (1,000-1,250 mg/m2) was diluted in 250 ml of normal saline for cancer patients. Methods: e observational study design was conducted in cancer care unit at our University based hospital. Cancer patients who were treated with gemcitabine based regimen during June to November 2015 were enrolled in the study. Gemcitabine was diluted in 250 ml of normal saline and infused over 30 minutes peripherally. Vascular pain incidence and severity were assessed during and at the end of drug administration by using standard pain assessment tools including pain numeric rating scale, or visual analogue scale (VAS). Incidences of vascular pain were collected and analyzed by descriptive statistics. Results: One hundred cancer patients receiving pre-speci ed gemcitabine based regimen were enrolled in the study. e vascular pain incidence was reported in 36 of patients (36%). Among patients with vascular pain, 28 patients (78%) and 8 patients (22%) reported mild and moderate pain severity, respectively. Severe pain was not found in this study. Mean vascular pain score was 1.3±0.56. Conclusion: is study demonstrated that using 250 ml of normal saline as diluent for gemcitabine chemotherapy, the vascular pain incidence was 36% and the pain score appeared to be minimal. Mean±SD of pain score was 1.3±0.56 and there was no incidence of severe pain.

190-193

Authors: Supawadee Pakdeenukoolkijja, M.Sc., Raveewan Klintip, M.Sc., Tippanate Keawvijit, M.Sc., Rasda Boonprasert, M.Sc., Teera Kolladarungkri, M.D.

Objective: e critical values of the drug level are de ned as the drug concentrations which are greater or lower than therapeutic values. ese greater values can cause drug toxicity while the lower values lead to inadequate treatment, and both require immediate attention from physician. Critical values are reported to physician by telephone, but the utilization of critical values and physician’s intervention has not been recognized. e present study was to determine the utilization rate of the critical values (vancomycin) reporting system and to identify the incidence of false positive result of critical values of vancomycin blood level. Methods: e nurses who worked in 8 medicine wards, Siriraj Hospital were interviewed by telephone questionnaires including two main questions for 3 months. Results: e results showed that the utilization rate of the critical values reporting system was 88.81%. A er critical values were reported, the physician adjusted dosage of vancomycin 60.63%, drug discontinuation 23.62% and adjusted nothing 15.75%. e incidences of false positive result of critical values (vancomycin) were 1.38%. Conclusion: e critical values reporting system remains important to help physicians in dose adjustment in critically ill patients or problematic patients such as abnormal drug clearance (liver and kidney diseases) or drug interactions. However, the therapeutic drug monitoring should be used carefully and correlated with clinical signs and symptoms due to the presentation of false positive of the critical values of vancomycin blood level.

198-210

Authors: Chanon Ngamsombat, M.D., Anassaya Jaiyasawadi, M.D., eerapol Witthiwej, M.D., Panida Charnchaowanish, B.Sc., Orasa Chawalparit, M.D.

Objective: Patient evaluation for the treatment of idiopathic normal pressure hydrocephalus (iNPH) with noninvasive investigation is helpful. Di usion tensor imaging (DTI) can evaluate the microstructural change in brain parenchyma. e aim of this study was to compare di usion tensor parameters in the brain before treatment in shunt responsive and shunt non-responsive iNPH patient groups to identify any di erence between groups. Methods: Total 16 subjects with iNPH, 13 overall shunt responsive patients, and three overall shunt non-responsive patients were recruited and underwent MRI study (3-Tesla), including DTI with 32 gradient directions. Patients were scanned before cerebrospinal uid tap test (CSF-TT) and shunt surgery. Fractional anisotropy (FA) and apparent di usion coe cient (ADC) between 2 groups were assessed by manual region of interest (ROI) method with FA color support. DTI parameters were correlated with the surgical outcome by clinical assessment. Results: No statistically signi cant di erence between overall outcome with FA and ADC in all ROIs was found. However, among the overall shunt responsive group, FA was higher, and ADC was lower than the overall shunt non-responsive group in almost all ROIs, except splenium of the corpus callosum (SPL). e di erence was seen predominately at the body of the corpus callosum (CCbo) and genu of corpus callosum (GENU), but less at corticospinal tract pathway (CST), including corona radiata, posterior limb of internal capsule, and corticospinal tract at pons level (CR, PLIC, and Po). Subgroup analysis also showed the same tendency in the gait shunt responsive group, urinary symptom shunt responsive group, and cognitive shunt responsive group. Conclusion: DTI can investigate white matter microstructural change in the iNPH patient. e overall shunt responsive group tends to have higher FA and lower ADC than the overall shunt non-responsive group in almost all ROIs, except SPL. However, no statistically signi cant di erence was found. Further study and comparison between pre and post shunt placement surgery in iNPH patients will be helpful.

214-216

Authors: Singpetch Suksompong, M.D., Pavit Sutchritpongsa, M.D.

Monozygotic triplets are a rare condition to occur naturally or even in assisted reproductive technologies. In this report, we present a case of monozygotic triplets with a singleton pregnancy following embryo transfer of 2 embryos. To our knowledge, this is the rst published case of one singleton and monozygotic triplets a er ICSI and transfer of two day 3 embyos in ailand.

220-222

Authors: anjira Jiranantakan, M.D., M.P.H.*, **, Summon Chomchai, M.D., M.P.H.*, **, Teera Kolladarungkri, M.D.*, **

Fish allergy is well recognized, however scombroid poisoning or histamine sh poisoning, which exhibits identical clinical manifestations, is rarely diagnosed. We report the case of a 28-year-old female who, a er eating tuna spaghetti, experienced a ushed face, generalized erythema, angioedema, shock and tachypnea requiring adrenaline, chlorpheniramine, ranitidine, and hydrocortisone injections. Her symptoms completely resolved within 3 hours. Her condition was diagnosed as scombroid poisoning based on temporality, normal serum tryptase levels (2.7 ng/mL) at 2.5 hours and at her baseline (2.5 ng/mL, 60 hours), as well as negative results on skin-prick test and re-challenging one can of the same branded-tuna orally. e revelant public health authorities were noti ed and a restaurant-visit was made, although the tuna can from which the patient’s dish was prepared had been discarded, hence a histamine analysis of the tuna was unavailable. is case underscores the need for awareness of scombroid poisoning and public interventions regarding food safety.

114-121

Authors: atsanee Soontrapirom,Suriyadeo Tripathi,M.D.,Pattarawalai Talungchit,M.D.,Ph.D., Suporn Apinuntavech,M.D.

Background: Teenage pregnancy is an evolving global public health problem. Level of life assets could predict behaviors and take e ect to less sexual risk behaviors in teenagers. Objective: To compare life assets between pregnant and non-pregnant teenagers and to evaluate the relationship between basic factors and teenage pregnancy. Methods: A total of 172 female teenagers aged 12-19 years were included. e control group was matched with the case group by age with mean age of 17.07 years old. e case group consisted of 86 pregnant teenagers who attended the Teenage Antenatal Care Unit at Siriraj Hospital. e control group consisted of 86 teenagers who were not pregnant and who had never been pregnant. e research instruments were general information and life assets inventory questionnaires developed by Suriyadeo Tripathi with Cronbach’s Alpha coe cient at 0.890. Results: Mean life assets scores were signi cantly higher in the control group than in the case group (T-test analysis: Mean = 94.70/87.65, SD = 17.45/22.68, p-value =.024, respectively). e control group scored more favorably than the case group on 16 items. In addition, the case group could not meet the minimum assessment criteria on 21 items, which indicated their status as an at risk group. A total of 12 factors were found to be statistically signi cantly associated with teenage pregnancy. Conclusion: Overall life assets were signi cantly higher among teenagers who had not experienced pregnancy. e risk factors included level of education, GPA, family income, mothers or family members of teenagers having experience of teenage pregnancy, main guardians, father education, mother occupation, parental relationship, family warmth and smoking were found to be signi cantly associated with risk of teenage pregnancy in this study. ese results will help to facilitate preventive interventions and the development of policies and guidelines to control and perhaps reverse current trends in teenage pregnancy.

128-136

Authors: Jantima Roongruangchai, D.D.S., Ph.D.*, Yadaridee Viravud, D.D.S.,M.Sc.*, Vasana Plakornkul, D.V.M., M.Sc., Kesorn Sripaoraya, M.Sc., Sakultra Muangwatana, M.Sc., Kosol Roongruangchai, M.Sc., M.D.

Background: Anti-epileptic drugs are known to be the risk of teratogenicity. Topiramate (TPM) is a new kind of such drug, for which no research has con rmed the incidence of producing congenital abnormalities. Objective: is study was conducted to study the teratogenic e ects of TPM by using chick embryos as an animal model and the results can be compared to the human embryo of the same stage. Methods: Fertilized Leghorn hen eggs were injected in ovo with two concentrations of TPM, which were 10mg, and 20mg, in NSS at a volume of 0.1 ml into the yolk sac at 21 hrs of incubation and repeated injections at 72 hrs at a volume of 0.05 ml. e chick embryos on day 3, 6 and 11 of incubation were sacri ced and all living embryos were processed for total mount and serial section. Results: e mortality rate increased corresponding to the concentrations of TPM, and the embryonic stage. e total mount of day 3 showed major abnormalities of the eye and heart, such as microphthalmia and looser of heart looping. e serial section of day 3 showed opening of the anterior neuropore, ectopia viscerae and multiple malformations of the eye and heart. Day 6 chick embryos showed ectopia cordis and ectopia viscerae. Moreover, there were retardation and abnormalities of several organs such as eye, heart, liver, mesonephros and gonads. Day 11 chick embryos showed ectopia viscerae and several growth retardations, retardation of ossi cation of both limb bones and skull bones. Conclusion: is study showed that TPM might cause embryonic death, growth retardation and abnormalities of the eye, heart, an opening of the anterior neuropore and ectopia viscerae. is might indicate abnormalities to the baby born from mother with gestational epilepsy who was taking this drug continuously, and it might lead to spontaneous abortion or congenital anomalies of the fetus.

143-146

Authors: Warissara Rongthong, M.D.

Data supporting the role of radiotherapy in secondary trigeminal nerve lymphoma is scarce. Here, I report the case of 64-year-old ai male diagnosed as gastric di use large B cell lymphoma with secondary trigeminal nerve lymphoma. He had previously received one cycle of cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP), followed by ve cycles of rituximab plus CHOP (R-CHOP) with intrathecal methotrexate (MTX) and cytarabine (Ara-C). One month a er the last cycle of R-CHOP, he developed a headache and numbness on the le side of his face. MRI revealed thickening of the le trigeminal nerve. He received one intrathecal injection of MTX and Ara-C, followed by systemic chemotherapy. A er receiving intrathecal chemotherapy, his symptoms disappeared. Clinical response and MRI studies suggested secondary trigeminal nerve lymphoma. Two months later, our patient’s secondary trigeminal nerve lymphoma had progressed. Salvage whole brain irradiation (36 Gy) with boost dose (50 Gy) along the le trigeminal nerve was given. Unfortunately, our patient developed heart failure and expired during the radiotherapy session. In conclusion and speci c to secondary central nervous system lymphoma (SCNSL), radiotherapy may bene t patients who fail to respond to systemic chemotherapy and palliative treatment. e results this report fail to support the role of radiotherapy in secondary trigeminal nerve lymphoma.

151-155

Authors: Asawin Sudcharoen, M.D., Panitpong Marungroj, M.D., Wanaporn Burivong, M.D., Piyakorn Poonyam, M.D., Piyanant Chonmaitree, M.D.

e authors report a case of colorectal liver metastasis which is one of the uncommon causes of liver tumor with central scar in a young female. Our patient presented with right upper abdominal discomfort and palpable liver mass for about 2 months. She did not have underlying disease. She had used oral contraceptive pills for 14 years. Physical examination revealed only liver span 16 centimeters (cm). Multidetector-row computed tomography demonstrated 3 masses and the largest one measured 10.7x 8.3x 7 cm in diameter with lobulated contour, hypodensity enhancing pattern, and a central scar at segment II and IVa of liver. Magnetic resonance imaging (MRI) of the largest mass showed hyposignal intensity on T1-weighted and slightly hypersignal intensity in T2-weighted MRI. is mass also had a large central scar which was hyposignal intensity on T1-weighted and hypersignal intensity in T2-weighted MRI. Liver biopsy showed scattered in ltration of atypical epithelium with glandular formation. Immunohistochemical analysis was compatible with colorectal cancer. Colonoscopy was performed and revealed large mass at distal part of sigmoid colon. e patient was scheduled to undergo surgical operation and receive chemotherapy. To our knowledge, colorectal metastasis of liver should be considered as a cause of liver tumor with central scar.

57-64

Authors: Vitoon Chinswangwatanakul, M.D.,Ph.D.*, Chotirot Angkurawaranon, M.D.**, Asada Metasate, M.D, Ph.D.*, Atthaphorn Trakarnsanga, M.D., Jirawat Swangsri, M.D., Ph.D., Chainarong Phalanusithepha, M.D., awatchai Akaraviputh, M.D.

Background: Self-expanding metallic stents (SEMS) have been acknowledged in management of acute colorectal obstruction. e surgical approach a er SEMS insertion varies from open approach to laparoscopic-assisted approach. e primary objective of this study was to compare the outcomes of laparoscopic approach and open approach a er SEMS insertion. Methods: From January 2007 to December 2010, cross-sectional medical records reviewed a total of 76 patients who underwent colorectal stenting with SEMS. Patients and tumor characteristics, complications, morbidity and mortality were obtained. Results: Forty-three patients underwent SEMS placement as a bridge to surgery. Laparoscopic-assisted surgery (LS) was performed in 24 patients (55.8%), and open surgery (OS) was performed in 19 patients (44.2%). All clinicopathological parameters were matched. e technical success of SEMS was found in 42 patients (97.7%), and the clinical stent success was 100%. LS had a higher chance of primary anastomosis than OS (p=0.012; Odd ratio 2.717; 95%CI: 1.79-4.012). LS had a lower permanent ostomy rate (p=0.031; Odd ratio 0.385; 95%CI: 0.259-0.572) and lower estimated blood loss (p=0.024; Odd ratio 0.23; 95%CI: 0.006-0.086). e post-operative complications, mortality rate, recurrence rate, disease free status, and overall survival rates between the two groups were non-signi cant. Conclusion: Colonic stent is an e ective treatment of acute malignant colonic obstruction. e authors suggest the advantage of laparoscopic approach resection a er colonic stenting results in a higher primary anastomosis rate, and lower blood loss than open surgery.

70-74

Authors: Sakaorat Petchyim, M.D., Naris Kitnarong, M.D., Chutima Wongsiwaroj, M.D.

Objective: To compare the e cacy of selective laser trabeculoplasty (SLT) in terms of intraocular pressure (IOP) reduction between phakic and pseudophakic patients with open-angle glaucoma (OAG). Methods: Phakic and pseudophakic patients with OAG who had IOP ≥15 mmHg treated with ≥2 topical anti- glaucoma medications were enrolled. Pseudophakic eyes with history of complicated phacoemulsi cation were excluded. SLT was performed 270 degrees by one surgeon under the same protocol. IOP was measured with applanation preoperatively and at 1 hour, 1 week, 3 weeks and 3 months postoperatively. Results: ere were 59 eyes (38 phakia and 21 pseudophakia) from 38 patients enrolled between September 2011 and August 2012. e mean IOP signi cantly decreased from 19.5±2.5 and 20.2±3.2 mm Hg preoperatively to 15.6±3.4 and 15.3±3.1 mm Hg postoperatively at 3 months in phakic and pseudophakic group respectively. Mean IOP reduction was not signi cantly di erent between phakic (3.9± 3.1 mmHg) and pseudophakic group (5.0±3.06 mmHg, p=0.197). e non-inferiority test indicated that mean IOP reduction in pseudophakic group was non- inferior to phakic group (p=0.012). Conclusion: SLT was e ective for IOP reduction in both phakic and pseudophakic eyes with OAG. e e cacy of SLT in pseudophakic eyes was not inferior to phakic eyes.

80-84

Authors: Ei Pye Phyo Aung, M.B., B.S.*, Shin Hnaung Lwin, M.B., B.S, M.Med.Sc. (Pharmacology), Ph.D. (Pharmacology), Dip.Med.Ed.*, Nu Nu Aye, M.B., B.S, Ph.D. (Med.Sc.), Dip.Med.Ed.*, Khin Phyu Phyu, M.D.**

Objective: To evaluate the hypoglycemic e ect of ethanolic extract of terminalia chebula Retz. fruits on alloxan- induced diabetic rats compared with standard oral hypoglycemic drug, metformin. Methods: A randomized controlled experimental animal study was done. 30 Wistar albino rats were induced diabetes by alloxan (100 mg/kg). 80%-ethanolic extraction of fruits of terminalia chebula Retz. was performed by using Soxhlet extraction method. Group 1 was normal control. Group 2 was alloxan-induced diabetic control, group 3 was metformin 100 mg/kg standard group, groups 4, 5 and 6 were extracts 100, 200 and 400 mg/kg orally administered fruit extract for 28-days, respectively. Fasting blood glucose (FBG) levels were measured at the end of the rst, second, third and fourth weeks by using standardized glucometer. Results: At the end of rst, second, third and fourth weeks, the FBG levels of diabetic control were 325.7±28.2, 308.5±69.8, 322.7±65.8 and 369.2±57.4 mg/dL, those of metformin (100 mg/kg) were 76.2±9.5, 92.5±14.9, 94.5±17.9 and 90.8±9.9 mg/dL, those of the terminalia chebula Retz. extract 100 mg/kg were 232.5±78.6, 122.8±41.4, 109.2±33.6 and 132.3±41.1 mg/dL, extract 200 mg/kg were 82.7±8.2, 82.7±8.2, 89.7±9.8 and 89±15.2 mg/dL, and extract 400 mg/kg were 80.2±9, 83.5±7.1, 91±11.5 and 82.7±5.9 mg/dL, respectively. When all treatment groups were compared with diabetic control, the FBG levels were signi cantly reduced (p<0.001). ere was no signi cant di erence in FBG levels between standard group and extract (200 and 400 mg/kg) groups. Conclusion: e 80%-ethanolic extract of terminalia chebula Retz. has signi cant hypoglycemic e ect on alloxan- induced diabetic rats and it was comparable with standard drug, metformin. e e ective dose was 200 to 400 mg/kg.

94-96

Authors: Vannipa Vathanophas, M.D., Archwin Tanphaichitr, M.D., Kitirat Ungkanont, M.D.

Brain heterotopia is a benign tumor composed of di erentiated neural tissue that is located outside the cranial vault. is condition is uncommon and presents as a congenital pharyngeal mass. Here, we report a case of neuroepithelial heterotopia in the nasopharyngeal area of a six-month-old boy who presented with cle palate and stridor. e tumor demonstrated aggressive growth with oropharyngeal involvement. Radiologic nding revealed a large heterogeneous enhancement on the le side of the nasopharynx, involving the uvula, le lateral pharyngeal wall, and le tonsil. No connection to the brain or spinal cord was apparent on imaging. Histologic features included presence of neuroglial heterotopias, composed predominately of glial cells in a surrounding neuro brillary matrix. Surgery was the selected intervention, with wide excision performed via cle palate. Previously published literature relevant to this case were reviewed and discussed. Recurrence is common in incomplete resection, although there was no evidence of recurrence at the two-year follow-up in this patient.

102-106

Authors: Anuchit Lerstsirithong, M.D., awatchai Akaraviputh, M.D., Anusak Yiengpruksawan, M.D.

Objective: Duodenal diverticulum is not uncommon but most are asymptomatic. Surgery is recommended only for the patients with symptoms. Although laparoscopic diverticulectomy can be done, it is o en with signi cant di culties due to inherent limitations of the laparoscopic technique and posterior location of the lesion. e advent of the robotic surgical technology with superior imaging and instrumentation may provide an alternative minimally invasive approach for this situation. We herein report our case series utilizing the daVinci Surgical System (dVSS) for duodenal diverticulectomy. Methods: We retrospectively reviewed our robotic database for all duodenal procedures performed at a single institution (the Valley Hospital: VH). Only patients who underwent laparobotic duodenal diverticulectomy (LRDD) were included and their recorded videos reviewed. Data analyzed were patients’ demographic, perioperative outcomes, and technical details. We used the daVinci Si (Intuitive Surgical Inc. Sunny Vale, Calif.) for all cases. Results: 4 female patients underwent LRDD. All presented with abdominal pain. Diagnosis was made by CT scans or MRI with or without EGD. 3 patients had diverticula located in the second part of the duodenum (75%). Concomitant procedures (choledochoduodenostomy and CBD exploration) were performed in two patients. Mean operative time was 142.5 min. ere was one complication but no mortality. Average length of stay was 4 days. Conclusion: LRDD is feasible, e cient, and safe. e dVSS provides the surgeon improved visualization and enhanced dexterity to perform complex procedure.

5-10

Authors: Jarurin Pitanupong, M.D., Chonnakarn Jatchavala, M.D., M.Sc.

Objective: To determine the prevalence, and associated factors of atypical eating attitudes and behaviors in ai medical students. Methods: A cross-sectional survey examined the eating abnormalities in ai medical students, conducted in 2014. Research assistants collected data by using; self-reported questionnaires using e Eating Attitudes Test-26 (EAT-26 ai Version). e statistical analysis used R-program for qualitative variables and logistic regression was applied to determine the correlation and P-value. Results: 141 ai, medical students (15.9%) were reported to have atypical attitudes towards eating, and displayed abnormal eating behaviors. ere was no statistically signi cant correlation of attitude towards eating, and their current eating behaviors according to the medical students’ gender, year of studying and Grade Point Average. However, their eating attitudes and behaviors were, associated with Body Mass index. Normal weight (BMI 18.5- 23.49) and overweight (BMI 23.5-39.9) groups could increase by 2.2 (95% CI =1.2, 4.3) and 2.3 (95% CI=1.1, 4.8) times risk depending on atypical eating attitudes and abnormal eating behaviors respectively, when compared with the underweight group (BMI<18.5). Conclusion: ere was no correlated di erence in concerns to the ai medical student’s abnormal eating habits, with gender, years of their study and Grade Point Average. Only normal to over-weight BMI were associated. Overweight male, medical students signi cantly represented more atypical attitudes towards eating and behaviors than other groups in this population. ese results may reveal the changing trends of eating attitudes and behaviors due to the current ideal body image of being more muscular. However, prospective studies are still needed.

18-23

Authors: Kanthong ongyai, M.D., Sarun Prakairungthong, M.D., Samut Chongvisal, M.D., Siriporn Limviriyakul, M.D., Prasit Srisomboon, M.D., Kanokrat Suvarnsit, M.D.

Objective: To study audiometric changes a er total stapedectomy with tailor-made polyethylene strut. Methods: A retrospective analysis of preoperative and postoperative hearing results. One hundred and ninety- eight patients underwent total stapedectomy during 2009-2014. Stapedectomy was performed with tailor-made polyethylene strut prosthesis on vein or perichondrium gra over oval window. Changes of preoperative and postoperative pure tone average (PTA) were calculated from 4 frequencies a er stapedectomy. Results: Ninety percent success rate in the air-bone gap closure within 10 dB a er stapedectomy. Conclusion: Tailor-made polyethylene strut prosthesis is a cheap and cost-e ective prosthesis, which is an alternative option for surgeons instead of the commercial prosthesis.

32-34

Authors: Sutasinee Phaitoonwattanakij, M.D., Waranya Boonchai, M.D.

Background: ere are several factors which have an impact on patch test results. In the past, comparing the populations between di erent institutes, without appropriate indicators was di cult. us, the MOAHLFA index (Male, Occupational, Atopic dermatitis, Hand dermatitis, Leg dermatitis, Face dermatitis and Age above 40 years) was developed. However, the study of this index in ailand is limited. Objective: ToinvestigatetheMOAHLFAindexinpatchtestingpopulationintheContactDermatitisClinicatSirirajHospital. Methods: e clinical parameters of patients who underwent patch testing at Contact Dermatitis Clinic, Siriraj Hospital during 10 years were studied. Results: Our patch test population showed a statistically signi cant increase in the proportion of male and patients aged above 40 years while a statistical decrease was found in those with occupational skin diseases with a history of atopic dermatitis, and lesions on the hands during a decade. Conclusion: is study revealed patch-test population attending Siriraj contact dermatitis clinic changed in 10-years period. According to MOAHLFA index, the changes were increasing of male, aged >40 years but decreasing of atopic, occupational-related contact allergy patients.

40-43

Authors: in in, M.D., Warot Tanyakitpisal, M.D., Pramote Euasobhon, M.D., Pranee Rushatamukayanunt, M.D., Wanna Srirojanakul, M.D.

Caudal epidural steroid injection (CESI) is one of the most common interventions in management of lumbar radicular pain of the patients who fail to respond to conservative treatment. Complications related to caudal epidural injections are rare. However, occasional complications may become worrisome. is report presents the inadvertent dural puncture during caudal epidural injections in two patients who were su ering from spinal-related radicular pain.

47-50

Authors: Dasnayanee Chandanayingyong, M.D.

e International Histocompatibility Workshops and Conferences (IHWC)1 date back to 1964, when D.B. Amos organized the rst workshop. e following workshops were held in 1965, 1967, 1970, 1972, 1975, 1977, 1980, 1984, 1987, 1991 and 1996. ese workshops have become a central and unifying forum for research and development in the eld of human histocompatibility testing and immunogenetics. e IHWC was a unique example of international collaborative research. e endless polymorphisms of Human Leukocyte Antigen (HLA) forces all of us to cooperate. No single investigator could a ord to go it alone. e high level of collaboration between the laboratories existed because it was necessary. For serological technique, every laboratory who participates will use the same technique and same HLA antisera set. e results will be analyzed and reported to the meeting by appropriate ones, assigned by the organizer. (Siriraj Med J 2017;69:47-50)