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Phrae, Thailand

Muttarak M.,Chiang Mai University | Sangchan S.,Phrae Hospital | Kongmebhol P.,Chiang Mai University | Sukhamwang N.,Chiang Mai University | Chaiwun B.,Chiang Mai University
Biomedical Imaging and Intervention Journal | Year: 2010

Objectives: To review the mammographic and ultrasonographic findings of invasive lobular carcinoma (ILC), determine the role of ultrasonography (US) in the detection of ILC, and determine if ILC is frequently missed on mammography. Materials and methods: Approval by Institutional Review Board was granted. Between January 2000 and July 2008, medical records and pathological diagnosis of 1,146 invasive breast carcinomas at the authors' institution were retrospectively reviewed. Only patients with pathologically-proven pure ILC were included. The initial mammographic reports were analysed to determine the true-positive and false-negative rates for the detection of cancer. Results: There were 37 patients diagnosed as pure ILC which accounted for 3% of all invasive breast carcinoma. Of the 37 patients, 16 had imaging studies and constituted the material of this study. The patients ranged in age from 45-76 years (mean age, 56.43 years). Of the 16 patients, one was asymptomatic, one presented with bleeding tendency and was found to have factor VIII abnormality (mammography was performed to search for primary breast carcinoma), one presented with left breast enlargement with left axillary mass, one presented with right axillary mass, and 12 presented with palpable breast mass(es). Mammographic breast density was extremely dense in five, heterogeneously dense in eight, scattered fibroglandular density in three, and fatty in one. Four patients had bilateral breast carcinoma and one had multicentricity. The carcinoma was correctly detected on initial mammographic evaluation in 15 patients (93.75%). The most common mammographic finding was architectural distortion (8/16 = 50%). The most common US finding was irregular hypoechoic mass (15/18 = 83.3%). There were 18 tumours in 16 patients. Mammography detected 16 tumours but US detected 18 tumours. US was not better than mammography in the detection of tumours but was helpful in the detection of multicentricity and guide biopsy. Conclusion: The most common mammographic feature of ILC was architectural distortion and the most common US feature of ILC was irregular or ill-defined hypoechoic mass with acoustic shadowing. These findings were similar to other studies. The rate of missed diagnosis was not high but this is likely because most of our patients were symptomatic. US was not helpful to improve detection of ILC but was helpful to confirm the suspicious abnormalities on mammograms, detect multicentricity and guide biopsy. © 2010 Biomedical Imaging and Intervention Journal. Source


Techasena W.,Nan Hospital | Wongwacharapiboon P.,Nan Hospital | Terawanich S.,Phrae Hospital | Pattamadilok S.,National Health Research Institute
Journal of the Medical Association of Thailand | Year: 2011

The authors have added the second dose of measles vaccine to children aged 18 months since 1997 because of the measles outbreaks in Nan province in 1993-1994. Objective: To compare measles antibody level between two doses vaccination at 9, 18 months and single dose at 9 months in children at the age of 4 to 6 years old. Material and Method: A cross sectional serological study in children 4 to 6 years old was performed between August 2008 and August 2009 at three hospitals in Nan and Phrae provinces. The subjects were divided into two groups, 1) 100 children in Nan provincial hospital received two doses of measles vaccination at the age of 9 and 18 months and 2) 91 children received single dose measles vaccination at the age of 9 months, 41 from Phrae provincial hospital and 50 from Weingsa district hospital. Blood samples were drawn for measles antibody measurement by ELISA assays at Virus Research Institute, National Institute of Health, Thailand. Results: The mean measles antibody level in children 4 to 6 years old in both groups was a satisfactory high level, 1,887.67 and 1,621.02 mIU/ml in single and two doses vaccination respectively, which were not statistically significant (p = 0.431). The higher level in single dose group could be explained by the average age being younger than the two doses group by one year (4 years 2 months vs. 5 years 4 months). Therefore, the waning immunity in younger age group is suspected to be less than the older age group. The rate of protective measles antibody level (≥ 255 mIU/ml) was significantly higher in the two doses group than the single dose, 87% compared to 76% (p = 0.046), which represented primary vaccine failure at the age 4 to 6 years of 13% and 24%, respectively. Conclusion: The authors suggest that a second dose of measles vaccine at the age of 18 months be administered to decrease the number of primary vaccine failure from 24% to 13%. Further studies in the same age group and in different areas are required to confirm these findings. Source


Tungtrongjit Y.,Phrae Hospital
Journal of the Medical Association of Thailand = Chotmaihet thangphaet | Year: 2012

To compare the level of pain scores, range of motion, quadriceps strength and quality of life after TKA patients between preoperative quadriceps exercise group and usual care group. A randomized controlled trial study. From January 2011-January 2012, 60 patients undergoing primary TKA were included. The patients were randomized into two groups with the use of blocking letter in 30 patients for each. The patients assigned to the preoperative quadriceps exercise group were asked to participate in three weeks home quadriceps strengthening exercise program until their TKA. The patients assigned to the usual care group were asked to continue their normal activities until their TKA. Preoperative data were collected within three weeks prior to the TKA. Should be 4 data collection included visual analog scale (VAS), quadriceps strength, knee range of motion and Modified WOMAC score. Both groups were evaluated four times: three weeks before surgery, 1 month, 3 months and 6 months after surgery. 60 patients was divided into 2 groups, the preoperative quadriceps exercise group and the usual care group. Most patients were female, older than 60 years, primary school educated, housekeeper occupation. Body mass index, duration of knee pain, Paracetamal and NSAIDs use were not statistically significant different. The quadriceps exercise group had statistically significant decreased pain in the postoperative 3 months (p = 0.003). The quadriceps exercise group had statistically significant decreased mean Modified WOMAC score in the postoperative 1, 3 months (p < or = 0.001, 0.001) and quadriceps strength better than the usual care group during the follow-up in the postoperative 3 months. Preoperative quadriceps exercise at least three weeks prior total knee replacement result in short-term benefit such as decreased pain, improved quadriceps strength and improved quality of life after elective TKA. Source


Aekplakorn W.,Mahidol University | Tantayotai V.,Walailak University | Numsangkul S.,Khon Buri Hospital | Sripho W.,Nakhon Ratchasima City Municipality | And 14 more authors.
Journal of Diabetes Research | Year: 2015

Aim. To evaluate an agreement in identifying dysglycemia between fasting plasma glucose (FPG) and the 2 hr postprandial glucose tolerance test (OGTT) in a population with high risk of diabetes. Methods. A total of 6,884 individuals aged 35-65 years recruited for a community-based diabetes prevention program were tested for prediabetes including impaired fasting glucose (IFG) or impaired glucose tolerance (IGT), and diabetes. The agreement was assessed by Kappa statistics. Logistic regression was used to examine factors associated with missed prediabetes and diabetes by FPG. Results. A total of 2671 (38.8%) individuals with prediabetes were identified. The prevalence of prediabetes identified by FPG and OGTT was 32.2% and 22.3%, respectively. The proportions of diabetes classified by OGTT were two times higher than those identified by FPG (11.0% versus 5.4%, resp.). The Kappa statistics for agreement of both tests was 0.55. Overall, FPG missed 46.3% of all prediabetes and 54.7% of all diabetes cases. Prediabetes was more likely to be missed by FPG among female, people aged <45 yrs, and those without family history of diabetes. Conclusion. The detection of prediabetes and diabetes using FPG only may miss half of the cases. Benefit of adding OGTT to FPG in some specific groups should be confirmed. © 2015 Wichai Aekplakorn et al. Source


Sengsuk C.,Naresuan University | Tangvarasittichai O.,Naresuan University | Chantanaskulwong P.,Phrae Hospital | Pimanprom A.,Vachira Phuket Hospital | And 3 more authors.
Indian Journal of Clinical Biochemistry | Year: 2014

Blood transfusion can be a life-saving therapy for β-thalassemia major and β-thalassemia/HbE (β-TM) patients with chronic anemia, major caused severe iron overload particularly in β-TM patients received only blood transfusion therapy. We aim to evaluate the association of iron overload with oxidative stress, liver damage, and elevated very low density lipoprotein cholesterol (VLDL-C) in transfusion-dependent β-TM patients. Serum ferritin, malondialdehyde (MDA), liver profiles, triglycerides levels, and VLDL-C were significantly higher while total cholesterol, low-density lipoprotein cholesterol, high density lipoprotein cholesterol and total antioxidant capacity were lower in β-TM than controls. Serum ferritin was significantly correlated with MDA, liver enzymes and lipid profiles (p < 0.05). Multiple forward stepwise linear regression analyses of the significant variables showed that in these β-TM patients, independent predictors of iron overload were MDA (β = 0.410, r 2 = 0.671, p < 0.001), ALT (β = 0.493, r 2 = 0.578, p < 0.001), and VLDL-C (β = 0.253, r 2 = 0.711, p < 0.001). In conclusion, iron overload associated with increased oxidative stress, lipid peroxidation, liver damage, decreased TC, LDL-C, HDL-C and over production of VLDL-C, is significantly problem in transfusion-dependent β-TM patients. These appeared the major cause of future morbidity and mortality in β-TM patients. © 2013 Association of Clinical Biochemists of India. Source

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