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Chulabhorn, Thailand

Swangsilpa T.,Mahidol University | Kraiphibul P.,Maha Vajiralongkorn Cancer Center | Tangboonduangjit P.,Mahidol University | Tannanonta C.,Chulabhorn Hospital | And 2 more authors.
Journal of the Medical Association of Thailand | Year: 2011

Objective: The main problem of total body irradiation (TBI) is how to maintain radiation dose homogeneity throughout the body during a treatment course. The simple set up treatment with non-complicated in vivo dosimetry measurement technique is the ideal method to solve this problem. For this reason, the authors have reported the results of in vivo dosimetry measurement method to prove the reliability of dose distribution from the authors' TBI technique. Material and Method: The authors reviewed the data of dose measurement record from 53 patients' treatment files to report the uniformity of absorbed in vivo dose distribution throughout the whole body from TBI with semiconductor detectors and ionization chamber with the accepted homogeneity within + 10% of the prescribed dose. The result was reported in the term of mean and standard deviation of absorbed dose difference from the prescribed dose. Results: The uniformity of radiation dose distribution throughout the whole body of all patients calculated from semiconductors was accepted with mean difference value of -3.2 + 2.5% from the prescribed dose and the difference of mean absorbed dose value at midline point between semiconductor and ionization chamber was 4 + 3.3%. Conclusion: This TBI dosimetry measurement technique has been proved to exhibit the reliability of dose homogeneity throughout the whole body within the accepted value. This could be applied for use at any institute that has some limitation in resources and small treatment room.

Lueangarun S.,Chulabhorn Hospital | Leelarasamee A.,Mahidol University
Interdisciplinary Perspectives on Infectious Diseases | Year: 2012

Background. Inappropriate empiric antimicrobials could be a major cause of unfavorable mortality rates in co-morbid patients. This study aimed to assess the prevalence and impact of first-dose and 24-hour inappropriate antimicrobials on mortality rates of bacteremic septic patients. Methods. A retrospective cohort study was employed. Case record forms of patients diagnosed as sepsis, severe sepsis, or septic shock with positive hemoculture during 2009 were retrieved from the medical wards, Siriraj Hospital. Demographic data, antimicrobial use, types of bacteria isolated from blood and susceptibilities, patients' comorbidities, 28-day and overall mortality rates were collected and analyzed. Results. There were 229 cases, mean age (SD) of 63.5 (17.2) years and mean (SD) APACHE II score of 24.7 (6.8). The prevalence of first-dose and 24-hour inappropriate antimicrobials was 29.7 and 25.3, respectively. The 28-day and overall mortality rates between first-dose inappropriate and appropriate antimicrobial were 67.6 versus 60.2 (P = 0.301) and 75.0 versus 68.3 (P = 0.345), consequently. Patients with septic shock and inappropriate first-dose antimicrobials significantly had higher 28-day mortality rate (61.6 versus 41.9; P = 0.017). Conclusion. Higher mortality rates in bacteremic septic patients were substantially associated with inappropriate first-dose antimicrobials and 3-hour delayed antimicrobial administration after sepsis diagnosis. © 2012 Saoraya Lueangarun and Amorn Leelarasamee.

Tempark T.,Chulalongkorn University | Lueangarun S.,Chulabhorn Hospital | Chatproedprai S.,Chulalongkorn University | Wananukul S.,Chulalongkorn University
International Journal of Dermatology | Year: 2013

Flood is one of the most common natural disasters, which commonly occurs in all parts of the world. The effects of the disasters considerably become enormous problems to overall public health systems. Flood-related skin diseases are a portion of these consequences presenting with cutaneous manifestations and/or signs of systemic illnesses. We conducted a systematic literature review of research publications relating to flooding and skin diseases. The purpose of this review was to provide dermatologists as well as general practitioners with comprehensive conditions of flood-related skin diseases and suggested treatments. Moreover, we categorized these flood-related diseases into four groups comprising inflammatory skin diseases, skin infections, traumatic skin diseases, and other miscellaneous skin diseases in a bid to implement early interventions and educate, prevent, and efficaciously handle those skin diseases under such a catastrophic situation so that better treatment outcomes and prevention of further complications could be ultimately achieved and accomplished. © 2013 The International Society of Dermatology.

Sathitkarnmanee T.,Khon Kaen University | Tribuddharat S.,Khon Kaen University | Noiphitak K.,Chulabhorn Hospital | Theerapongpakdee S.,Khon Kaen University | And 3 more authors.
Journal of Pain Research | Year: 2014

Purpose: To assess the efficacy of a transdermal fentanyl patch (TFP) (50 μg/hour) applied 10-12 hours before surgery versus placebo for postoperative pain control of total knee arthroplasty (TKA). Materials and methods: We enrolled 40 patients undergoing elective TKA under spinal anesthesia using isobaric or hyperbaric bupivacaine. Subjects were randomized to receive a TFP (Duragesic ® 50 μg/hour) or placebo patch applied with a self-adhesive to the anterior chest wall 10-12 hours before spinal anesthesia. Every patient was given patient-controlled morphine for postoperative pain control. Patients were evaluated every 4 hours until 48 hours. Results: Morphine consumption at 24 and 48 hours in the TFP group versus the placebo group was15.40±12.65 and 24.90±20.11 mg versus 33.60±19.06 and 57.80±12.65 mg (P≤0.001). Numeric rating scale scores at rest and during movement over 48 hours were lower in the TFP group. Ambulation and nausea/vomiting scores were statistically greater, but not clinically significant in the TFP group. Sedation scores were low and not statistically significantly different between groups. There was no severe respiratory depression. Conclusion: TFP (50 μg/hour) applied10-12 hours before surgery can effectively and safely decrease morphine consumption and pain scores during the first 48 hours after TKA surgery. © 2014 Sathitkarnmanee et al.

Thamtorawat S.,University of California at Los Angeles | Thamtorawat S.,Mahidol University | Hicks R.M.,Yeshiva University | Yu J.,University of California at Los Angeles | And 8 more authors.
Journal of Vascular and Interventional Radiology | Year: 2016

Purpose To evaluate preliminary outcomes after microwave ablation (MWA) of hepatocellular carcinoma (HCC) up to 5 cm and to determine the influence of tumor size. Materials and Methods Electronic records were searched for HCC and MWA. Between January 2011 and September 2014, 173 HCCs up to 5 cm were treated by MWA in 129 consecutive patients (89 men, 40 women; mean age, 66.9 y ± 9.5). Tumor characteristics related to local tumor progression and primary and secondary treatment efficacy were evaluated by univariate analysis. Outcomes were compared between tumors ≤ 3 cm and tumors > 3 cm. Results Technical success, primary efficacy, and secondary efficacy were 96.5%, 99.4%, and 94.2% at a mean follow-up period of 11.8 months ± 9.8 (range, 0.8-40.6 mo). Analysis of tumor characteristics showed no significant risk factor for local tumor progression, including subcapsular location (P =.176), tumor size (P =.402), and perivascular tumor location (P =.323). The 1-year and 2-year secondary or overall treatment efficacy rates for tumors measuring ≤ 3 cm were 91.2% and 82.1% and for tumors 3.1-5 cm were 92.3% and 83.9% (P =.773). The number of sessions to achieve secondary efficacy was higher in the larger tumor group (1.13 vs 1.06, P =.005). There were three major complications in 134 procedures (2.2%). Conclusions With use of current-generation MWA devices, percutaneous ablation of HCCs up to 5 cm can be achieved with high efficacy. © 2016 SIR.

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