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Nakwan N.,Hat Yai Medical Education Center
European Journal of Cardio-thoracic Surgery

Major aortopulmonary collateral artery (MAPCA) is a rare vessel anomaly defect arising from the systemic arteries and supplying flow to the pulmonary capillary circulation, which frequently associates with cyanotic heart disease, particularly pulmonary atresia coexisting with ventricular septal defect and tetralogy of Fallot. The branches of MAPCA usually originate from the descending aorta, while a feeding vessel from a coronary artery directed to the pulmonary vasculature is a rare occurrence. Herein, we present the first case of right side pulmonary atresia with a variant of MAPCA originating from the left circumflex coronary artery to the pulmonary capillary circulation in a patient who presented with acute coronary syndrome. © The Author 2014. Source

Nakwan N.,Hat Yai Medical Education Center
Respiratory care

Obstructive fibrinous tracheal pseudomembrane (OFTP) is an airway complication that occurs after endotracheal intubation. It originates from superficial mucosal abrasion and desquamation of necrotic tracheal epithelium at the site of cuff pressure. This condition is a rare cause of postextubation stridor. We present a case of postextubation stridor secondary to OFTP, resulting in clinical features of upper airway obstruction > 8 h after extubation. The case features complete obstruction at the tip of the endotracheal tube from OFTP. Copyright © 2014 by Daedalus Enterprises. Source

Nakwan N.,Neonatal Intensive Care Unit | Nakwan N.,Hat Yai Medical Education Center | Wannaro J.,Neonatal Intensive Care Unit

Background: Persistent pulmonary hypertension of the newborn (PPHN) is one of the most serious conditions in neonates resulting in a high mortality and morbidity. New alternative therapies for PPHN have been sought to improve survival and reduce morbidity. Objectives: To report an initial experience of using beraprost sodium (BPS) to treat infants with PPHN and to assess its effect on oxygenation and hemodynamic stability over a 72-hour study period. Methods: The clinical data of neonates who received BPS as an adjunctive therapy for PPHN in our hospital between July 2007 and June 2008 were retrospectively reviewed. Results: During the study period, 7 infants with PPHN were successfully treated with BPS. The mean gestational age and birth weight were 39.3 ± 1.5 weeks and 3,365.7 ± 569.8 g, respectively. BPS was initiated at a median age of 42.7 h after birth (range: 2.1-166.5 h) with a baseline mean oxygen index (OI) of 33.9 ± 15.7 and a baseline mean systolic blood pressure (SBP) of 79.4 ± 9.9 mm Hg. The mean difference of OI at 24, 48 and 72 h following the treatment was -15.7 ± 14.8 (p = 0.043), -18.2 ± 12.3 (p = 0.018) and -16.7 ± 17.5 (p = 0.042), respectively. The mean SBP was significantly reduced as early as 6 h after initiation of treatment (-11.1 ± 11.5 mm Hg, p = 0.034) without changes in heart rate. Three cases were complicated with chronic lung disease, and the remaining 4 cases were normal at hospital discharge. No neurodevelopmental and cardiopulmonary disorders were observed in all cases at 1 year of age. Conclusions: BPS may be used as an alternative treatment for infants with PPHN giving a significant improvement in oxygenation. Copyright © 2010 S. Karger AG, Basel. Source

Nakwan N.,Hat Yai Medical Education Center | Lertpichaluk P.,Hat Yai Medical Education Center | Chokephaibulkit K.,Mahidol University | Villani P.,Clinical and Experimental Pharmacokinetics Unit | And 2 more authors.
Pediatric Infectious Disease Journal

The purpose of this study was to evaluate the pulmonary and systemic pharmacokinetics of colistin following a single dose of nebulized colistimethate sodium (CMS) in mechanically ventilated neonates. We administered a single dose of nebulized CMS (approximately 120,000 IU/kg of CMS, equivalent to 4 mg/kg colistin base activity) to 6 ventilated neonates with ventilator-associated pneumonia. The median gestational age was 39 weeks (range, 32-39 weeks). Mean (±SD) tracheal aspirate colistin maximum concentration (Cmax), area under the concentration-time curve (AUC0-24) and t1/2 were 24.0 ± 8.2 μg/mL, 147.6 ± 53.5 μg·hours/mL and 9.8 ± 5.5 hours, respectively. The plasma concentrations of colistin were low. In neonates, a single nebulized dose of CMS (120,000 IU) resulted in high local concentrations for at least 12 hours and low systemic concentrations of colistin. Twice daily nebulization might be more appropriate. Copyright © 2015 Wolters Kluwer Health, Inc. Source

Nakwan N.,Neonatal Intensive Care Unit | Nakwan N.,Hat Yai Medical Education Center | Wannaro J.,Hat Yai Medical Education Center | Dissaneevate P.,Hat Yai Medical Education Center | And 2 more authors.
Southeast Asian Journal of Tropical Medicine and Public Health

An infected cephalhematoma is a rare condition in neonates. We report a case of an 18-day-old neonate who was diagnosed with an infected cephalhematoma caused by an extended spectrum beta-lactamase (ESBL)-producing Escherichia coli complicated with septicemia, meningitis, and skull osteomyelitis.b He was successfully treated with meropenem and surgical incision and drainage. ESBL-producing E. coli may cause infection of a cephalhematoma in neonates. Source

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