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Lojindarat S.,Charoenkrung Pracharak Hospital | Suwikrom S.,Charoenkrung Pracharak Hospital | Puangsa-Art S.,Mahidol University
Journal of the Medical Association of Thailand | Year: 2011

patient who had undergone laparoscopic hysterectomy. Material and Method: A prospective study was performed on 170 patients scheduled for laparoscopic hysterectomy. The operations were performed for benign gynecologic disease. All patients had pre-and post-operative color Doppler sonography of the ureteral jets to determine ureteral patency. Transabdominal color Doppler sonography was used to evaluate the presence or absence of the ureteral jets from both ureteric orifices. The time for detection of the first jet and the number of jets in five minutes were recorded separately for each side. Preoperative assessment was used as control. Statistical analysis was performed by using Wilcoxon signed ranks test, considering p < 0.05 as significant. If there was absence of the ureteral jet on one or both sides, the patient was sent to repeat color Doppler sonography on the next day. Intravenous pyelography was performed to confirm ureteral injuries when the repeat examination was still found abnormal. Results: Bilateral ureteral jets were demonstrated by color Doppler sonography in 168 of the 170 patients. In two patients, postoperative examination demonstrated the absence of the ureteral jet on the left side. Intravenous pyelography was performed and confirmed left ureteral obstruction. They underwent left ureteroneocystostomy. In 168 patients, bilateral ureteral jets were demonstrated in either preoperative or postoperative examination. The time for detection of the first jet was not significantly different between preoperative and postoperative examination of either the right side (p = 0.189) or the left side (p = 0.694). The number of jets in five minutes was not significantly different between preoperative and postoperative examination of either the right side (p = 0.854) or the left side (p = 0.675). Conclusion: Color Doppler sonography is a simple and reliable technique that may be used to evaluate ureteral jets into the bladder in patients who underwent laparoscopic hysterectomy. The time for detection of the first jet and the number of jets in five minutes are not affected by the postoperative status. The presented test may be a good screening test to detect ureteral injuries following laparoscopic hysterectomy.

Suwattanaphim S.,Charoenkrung Pracharak Hospital | Yodavuhd S.,Charoenkrung Pracharak Hospital | Puangsa-Art S.,Mahidol University
Journal of the Medical Association of Thailand | Year: 2015

Background: Oxygen Saturation is one of the important data to determine patient status and worldwide applied in several situations. Evaluation about status of immediate perinatal period of the infant usually uses clinical assessment, Apgar scoring, which had been used for a long time without other scientific measurement. Pulse oximeter, the non-invasive measurement of oxygen saturation, may play role for oxygen saturation evaluation in newborn that immediately change from intra to extra uterine environment. Objective: Monitoring the time duration that immediately born infants by normal labor or Cesarean section modes, used to archived target oxygen saturation (SpO2) and looking for the other factors that influence oxygen saturation adaptation. Material and Method: The data of the 553 infants born in Charoenkrung Pracharak Hospital, Bangkok, Thailand between October 2012 and April 2013 were collected. The 204 healthy newborns that met all criteria were studied. All infants were recorded pulse oximeter from the second to the tenth minute after birth. They were grouped by several factors such as maternal gravidity, gestational age, mode of delivery, Apgar score, birth weight, and sex. Time interval to achieve target oxygen saturation (SpO2 ≥90%) was collected for analysis. Results: The oxygen saturation of infants immediately after birth showed an increase. Median time interval was 6.5 (2-10) minutes for 90% saturation and 7 (2-10) minutes for 95% saturation, respectively. Only mode of delivery showed statistical significant time difference (p<0.001). A Cox proportional hazards analysis of the Kaplan-Meier curves demonstrated that infants born by cesarean delivery took significantly longer time to reach a stable SpO2 ≥90% than infants born by vaginal delivery (95% CI = 1.28 to 2.74; p<0.01). Conclusion: A newly born infant has to take 6.5 minutes (2-10) after birth to adjust their oxygen saturation to reach normal higher level of extra uterine life, median SpO2 of 90%. Furthermore, mode of delivery makes a significant difference of oxygen saturation status; the cesarean route takes significantly longer time than the vaginal route to achieve SpO2 ≥90%. © 2015, Medical Association of Thailand. All rights reserved.

Thaharavanich R.,Charoenkrung Pracharak Hospital | Sintavanuruk K.,Charoenkrung Pracharak Hospital | Laosuwan S.,Charoenkrung Pracharak Hospital | Pongruekdee S.,Charoenkrung Pracharak Hospital
Journal of the Medical Association of Thailand | Year: 2011

Objective: To determine the propofol effect site target concentration at which 50% of patients did not respond to stimulation for colonoscopy (EC50colonoscopy) using a target controlled infusion (Schnider model) and to investigate whether fentanyl reduces these required concentrations. Material and Method: Subsequent to an approval from the institute medical ethics committee, 40 unpremedicated patients, ASA physical status 1-2, aged 18-70 years, BMI less than 30 kg/m2 and scheduled for elective colonoscopy were randomly assigned to a saline-propofol group (control group) or a 1 mcg/kg fentanyl-propofol group (fentanyl group). Propofol was initiated using a target controlled infusion. Initial effect site target concentration (EC) administered to the first patient in each group were 2.5 mcg/ml. For each subsequent patient, EC was determined by the response of the previous patient by the Dixon's up-and-down method (with 0.5 mcg/ml as a step size). Individual patient response to colonoscopy was described as 'no movement' or 'movement'. EC50colonoscopy values were obtained by calculating the mean of 20 patients in each group. Results: The patient demographic data were not significantly different between the two groups. Total propofol dose in the control group was also significantly higher than that in the fentanyl group. The values for EC50colonoscopy were 3.25 ± 0.47 mcg/ml in the control group and 2.65 ± 0.40 mcg/ml in the fentanyl group (p = 0.00). Conclusion: The propofol EC50 for colonoscopy was decreased by supplemental 1 mcg/kg fentanyl with no significant difference in hemodynamic values between the two groups.

Lojindarat S.,Charoenkrung Pracharak Hospital | Luengmettakul J.,Charoenkrung Pracharak Hospital | Puangsa-art S.,Mahidol University
Journal of the Medical Association of Thailand | Year: 2012

Objective: To determine the prevalence and the rate of clinically significant lesions in women with atypical glandular cells in cervical Papanicolaou smears. Material and Method: A retrospective study was performed from the cytologic database of Charoenkrung Pracharak Hospital. All cervical cytologic examinations with a diagnosis of atypical glandular cells (AGC) between January 2002 and December 2009 were identified. Medical records were reviewed to determine the clinical data. Cytologic and histologic follow-up was obtained to establish the presence of clinically significant lesions. Results: One hundred eleven AGC Pap smears were identified from 47,347 Pap smears. The prevalence of AGC was 0.23% over the eight years of the period studied. Clinically significant lesions were diagnosed in 32.4% of the women, including invasive cancer in 18.3%. Women with AGC favor neoplasia were more likely to have clinically significant lesions (53.8%) than women with AGC not otherwise specified (20%, p = 0.003). The rate of clinically significant lesions in women aged 35 years or older (35.7%) was not statistically significant different from women younger than 35 years of age (20%, p = 0.356). All cases of invasive cancer were found in women aged 35 years or older. Cervical adenocarcinoma was the most common invasive cancer found in the present study. Conclusion: Women with atypical glandular cells on Papanicolaou smears were correlated with significant risk for clinically significant lesions, including invasive cancer. Initial evaluation should include colposcopy, directed biopsy, and endocervical curettage. Women with risk factors for endometrial cancer should have an endometrial sampling.

Pungjitprapai A.,Charoenkrung Pracharak Hospital | Tantawichien T.,Chulalongkorn University
Southeast Asian Journal of Tropical Medicine and Public Health | Year: 2011

The purpose of this study was to evaluate the appropriate of restricted antibiotics at a tertiary care hospital in Bangkok, Thailand. Data from patient charts during September-November, 2009 were obtained regarding appropriate use of antibiotics following hospital antibiotic guidelines. Of 307 prescriptions reviewed, the prevalence of appropriate antibiotic use was 74.6% (229/307). Most patients were male (185/307) with a mean age of 64.2±18.0 years. There was a significant association between appropriate antibiotic use and patients having underlying disease, a previous history of recent antibiotic use, a recent hospitalization, admission to a medical unit and having a recent health-care institution acquired infection (p<0.001). The diagnosis of pneumonia was associated with proper use of antibiotics compared with other diagnoses (OR 1.8). Admission to a medical ward was more likely to be associated with correct antibiotic use than having surgery (OR 7.8 and 0.07). Having a health-care institution acquired infection more likely to be associated with appropriate antibiotic use than having a community acquired infection (OR 5.5 and 0.13). Meropenem was more likely to be used appropriately than cefoperazone/sulbactam (OR 1.9 and 0.2). After multivariate analysis, controlling confounding factors, admission to a medical unit and having a health-care institution acquired infection were factors associated with proper use of restricted antibiotics (adjusted OR 9.0 and 7.1; 95% CI 2.27-35.73 and 2.38-20.95; p=0.002 and p<0.001, respectively). The prevalence of appropriate use of restricted antibiotics was high; physicians followed local hospital antibiotic guidelines. Future studies of compliance with hospital antibiotic guidelines and its impact on bacterial resistance and infection related mortality should be carried out to determine if appropriate antimicrobial use leads to improve outcomes.

Cheerranichanunth P.,Charoenkrung Pracharak Hospital | Poolnoi P.,Charoenkrung Pracharak Hospital
Journal of the Medical Association of Thailand | Year: 2012

Objective: To determine whether using pictogram can improve visual estimation of blood loss in a mock cesarean setting and whether profession and clinical experience influence the accuracy of blood loss estimation. Material and Method: Photographs of measured blood volume absorbed in different percentage of surface area of common surgical materials were taken and arranged in the table of pictogram. Pictures of seven cesarean scenarios were set with known blood volumes (20, 35, 60, 100, 350, 400, and 1200 ml) in different surgical materials. Forty-nine participants from four professions had to view all seven pictures and quantitatively estimate blood volume pre-post using the pictogram. Percent error of estimated blood loss was analyzed. Results: Before using the pictogram, tendency of underestimation, overestimation and accurate assessment in lower and higher blood loss volumes were 43.4%, 25.7%, and 30.9% respectively. There was a trend in overestimating blood loss at the lower volumes and underestimating or accurate estimating blood loss at higher volumes. Profession affected the accuracy in estimation of some small blood loss volumes but clinical experience had no influence. After using the pictogram, accurate estimation increased significantly from 30.9% to 61.8%. No difference in ability to determine blood loss in all professions and clinical experience. Conclusion: Estimated blood loss pictogram is a simple tool, easy to use for initial evaluation of blood loss in cesareans and can improve the accuracy of visual blood loss assessment significantly.

Dhippayom T.,Naresuan University | Chaiyakunapruk N.,Naresuan University | Chaiyakunapruk N.,University of Queensland | Chaiyakunapruk N.,University of Wisconsin - Madison | Jongchansittho T.,Charoenkrung Pracharak Hospital
Drug Safety | Year: 2011

Background: The limited use of nortriptyline for smoking cessation is likely due to concerns about its serious adverse effects. Objective: To examine the safety of nortriptyline at doses equivalent to those used in aiding smoking cessation. Data Sources: A systematic search of relevant articles inMEDLINE, EMBASE, the Cochrane Database of Systematic Reviews, CINAHL, PsychINFO,WHO publications and the Clinical Trials database (through November 2008). Study Selection: All studies of nortriptyline at doses between 75 and 100mg in any indication were reviewed. Data Extraction: The quality of included studies was assessed based on the Jadad score. Data were extracted using a data extraction form. Data Synthesis: From 442 potentially relevant articles identified, 17 studies met our selection criteria and were included for data analysis. Indications for nortriptyline in these studies were smoking cessation (eight studies), depression (five studies), neuropathic pain (three studies) and schizophrenia (one study). 2885 individuals participated in these studies, with exposure time ranging between 4 and 12 weeks. The major comparator used in these trials was placebo. Overall, no life-threatening events occurred in these studies. Orthostatic hypotension was significantly higher in nortriptyline users than in comparator groups (relative risk 2.8; 95% CI 1.4, 5.3). Other adverse events significantly associated with nortriptyline were anticholinergic-related effects including drowsiness, dizziness, gastrointestinal disturbance and dysgeusia. Conclusions: Current evidence suggests that nortriptyline, at doses between 75 and 100 mg, is not significantly associated with serious adverse events when administered in patients without underlying cardiovascular disease. © 2011 Adis Data Information BV. All rights reserved.

Sripahol P.,Charoenkrung Pracharak Hospital | Niyomnaitham S.,Mahidol University | Huang K.-G.,Chang Gung University
Journal of Gynecologic Surgery | Year: 2015

Background: Abnormal findings of intra-abdominal organs can be examined during a laparoscopic surgery. Studies show that 4.7% of patients who underwent laparoscopic surgery for benign gynecologic conditions had liver abnormalities, such as perihepatic adhesion (Fitz-Hugh-Curtis syndrome), adenoma, hemangioma, and hepatic cirrhosis. Case: A 44-year-old woman, para3, presented with abnormal Pap smears and classified as cervical intraepithelial neoplasia (CIN) III. She was scheduled for laparoscopic-assisted vaginal hysterectomy. Her preoperative laboratory tests were within normal limit except for the reactive result of HBsAg. Intraoperative findings revealed a normal-sized liver with a nodular surface (Fig. 1a). Liver cirrhosis was suspected and subsequently diagnosed by the gastroenterologist. Conclusion: Abnormality of intra-abdominal organs can be detected during a laparoscopic surgery for a gynecologic condition, especially in the upper abdomen. © Copyright 2015, Mary Ann Liebert, Inc. 2015.

Chantrapitak W.,Charoenkrung Pracharak Hospital | Srijuntuek K.,Charoenkrung Pracharak Hospital | Wattanaluangarun R.,Charoenkrung Pracharak Hospital
Journal of the Medical Association of Thailand | Year: 2011

Objective: To determine the efficacy and amount of blood loss of the maneuver utilizing lower uterine segment compression (LUSC) for the prevention of early postpartum hemorrhage. Material and Method: The present study enrolled 686 mothers with singleton pregnancy, gestational ages between 28 and 42 weeks, at the Department of Obstetrics and Gynecology, Charoenkrung Pracharak Hospital, Bangkok between July 2009 and March 2010. All subjects had no past medical history and delivered by vaginal route. They were divided into two groups, the experimental group and the control group. Mothers in both experimental and control groups were treated with the same methods, oxytocin administration before and after delivery, clamping and cutting umbilical cords within three minutes after birth of the newborns, and placental delivery done by controlled cord traction together with uterine massage at the fundus through the abdominal wall immediately. In addition, in the experimental group, the subjects were assisted by LUSC for 10 minutes. The amount of blood loss was measured and recorded two hours after delivery of the placentas in both experimental and control groups. Results: Among 686 cases, nine cases were excluded from the present study. They were composed of five cases in the control group, with retained placenta, and four cases in the experimental group because of retained placenta, retained placental fragments, severe perineum tear, and vaginal hematoma. Subjects in the experimental group who were additionally assisted by LUSC were found to have lesser incidence of PPH with statistical significance in comparison to those in the control group (2.9% vs. 6.8%; relative risk 0.43, 95% confidence interval 0.21-0.90, p = 0.02). The amount of blood loss reduced by 29.26 ml (289.70 ± 179.53 ml vs. 260.44 ± 116.30 ml), p = 0.012). Conclusion: Lower uterine segment compression (LUSC) significantly reduced the rate of PPH and amount of blood loss after vaginal delivery. The efficacy of this technique was over the conventional method in labor room care. Besides, LUSC was easy and safe. Neither anesthesia nor extra-expense was needed. LUSC was considered the innovation for management of postpartum hemorrhage. The maneuver was able to reduce the risk of maternal morbidity and mortality after the delivery of newborns.

Inthraburan K.,Charoenkrung Pracharak Hospital
Southeast Asian Journal of Tropical Medicine and Public Health | Year: 2013

Macrolide resistant Streptococcus pneumoniae has been increasing rapidly in Southeast Asia. A review from 2000 through 2011 at Charoenkrung Pracharak Hospital that evaluated drug resistance to erythromycin found S. pneumoniae from 158 of the 390 (40.5%) patients: 3.6% intermediate, 36.9% highly resistant. A significant correlation was found between macrolide resistant S. pneumoniae and penicillin resistance (p<0.001), macrolide susceptible pneumococci and penicillin susceptibility (p<0.001). Trends of macrolide resistant S. pneumoniae at Charoenkrung Pracharak Hospital were found to have increased. Therefore, macrolide monotherapy should be avoided or care should be taken for prophylaxis or treatment in the patient suspected of S. pneumoniae infection.

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