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Bangkok, Thailand

Viseshsindh W.,Ramathibodi Hospital
Journal of the Medical Association of Thailand | Year: 2014

Objective: To review our experience of using the tubularized incised plate (TIP) urethroplasty to treat all type of hypospadias and identify factors that affect the results and complications. Material and Method: A retrospective medical records review of 90 patients with hypospadias treated with TIP urethroplasty between November 2007 and March 2012 was performed. The operation was done by TIP technique in eighty patients. The entire length of the urethral plate was incised along the midline and the neourethra was tubularized over a 6 or 8 Fr feeding tube with Maxon or Vicryl 6-0 suture. The urethral stent was removed on the third to seventh post-operative day. All operations were done by the same surgeon. Postoperative follow-up was at least one year in all patients. Presence of complications requiring reoperation and overall general appearance were recorded. Results: TIP was performed in 80 boys, age ranged from 11 months to 15 years (mean age 2.5 years). Distal hypospadias was found in 15, midshaft in 18, proximal in 16, and penoscrotal in 31 patients. Overall success rate was 76.25%. Re-operation was required in 19 patients (23.75%): for urethrocutaneous fistula in 12 (15%), complete disruption of the repair in three (3.75%) and meatal stenosis in four (5%). The meatal stenosis was managed by simple dilatation in all patients. All fistulas, except for one, were successfully repaired in a single operation. Complications increased in penoscrotal hypospadias and repaired at early period. Age at surgery did not increase complications rate. Conclusion: TIP repair is a reliable method for treating all types of hypospadias. Complications rate may depend on type of hypospadias and increase in proximal and penoscrotal location. Our data indicate age at surgery does not increase urological complications. A better outcome is achieved with good experience.

Mente A.,Hamilton Health Sciences | Mente A.,McMaster University | Yusuf S.,Hamilton Health Sciences | Yusuf S.,McMaster University | And 10 more authors.
Journal of the American College of Cardiology | Year: 2010

Objectives: This study examines the risk of acute myocardial infarction (MI) conferred by the metabolic syndrome (MS) and its individual factors in multiple ethnic populations. Background: The risk of the MS on MI has not been well characterized, especially in multiple ethnic groups. Methods: Participants in the INTERHEART study (n = 26,903) involving 52 countries were classified using the World Health Organization (WHO) and International Diabetes Federation (IDF) criteria for MS, and their odds ratios (ORs) for MI were compared with the individual MS component factors. Results: The MS is associated with an increased risk of MI, both using the WHO (OR: 2.69; 95% confidence interval [CI]: 2.45 to 2.95) and IDF (OR: 2.20; 95% CI: 2.03 to 2.38) definitions, with corresponding population attributable risks of 14.5% (95% CI: 12.7% to 16.3%) and 16.8% (95% CI: 14.8% to 18.8%), respectively. The associations are directionally similar across all regions and ethnic groups. Using the WHO definition, the association with MI by the MS is similar to that of diabetes mellitus (OR: 2.72; 95% CI: 2.53 to 2.92) and hypertension (OR: 2.60; 95% CI: 2.46 to 2.76), and significantly stronger than that of the other component risk factors. The clustering of ≥3 risk factors with subthreshold values is associated with an increased risk of MI (OR: 1.50; 95% CI: 1.24 to 1.81) compared with having component factors with "normal" values. The IDF definition showed similar results. Conclusions: In this large-scale, multi-ethnic, international investigation, the risk of MS on MI is generally comparable to that conferred by some, but not all, of its component risk factors. The characterization of risk factors, especially continuous variables, as dichotomous will underestimate risk and decrease the magnitude of association between MS and MI. © 2010 American College of Cardiology Foundation.

Reungwetwattana T.,Ramathibodi Hospital | Reungwetwattana T.,Roswell Park Cancer Institute | Dy G.,Roswell Park Cancer Institute
Journal of Carcinogenesis | Year: 2013

The iterative discovery in various malignancies during the past decades that a number of aberrant tumorigenic processes and signal transduction pathways are mediated by "druggable" protein kinases has led to a revolutionary change in drug development. In non-small cell lung cancer (NSCLC), the ErbB family of receptors (e.g., EGFR [epidermal growth factor receptor], HER2 [human epidermal growth factor receptor 2]), RAS (rat sarcoma gene), BRAF (v-raf murine sarcoma viral oncogene homolog B1), MAPK (mitogen-activated protein kinase) c-MET (c-mesenchymal-epithelial transition), FGFR (fibroblast growth factor receptor), DDR2 (discoidin domain receptor 2), PIK3CA (phosphatidylinositol-4,5-bisphosphate3-kinase, catalytic subunit alpha)), PTEN (phosphatase and tensin homolog), AKT (protein kinase B), ALK (anaplastic lym phoma kinase), RET (rearranged during transfection), ROS1 (reactive oxygen species 1) and EPH (erythropoietin-producing hepatoma) are key targets of various agents currently in clinical development. These oncogenic targets exert their selective growth advantage through various intercommunicating pathways, such as through RAS/RAF/MEK, phosphoinositide 3-kinase/AKT/mammalian target of rapamycin and SRC-signal transduction and transcription signaling. The recent clinical studies, EGFR tyrosine kinase inhibitors and crizotinib were considered as strongly effective targeted therapies in metastatic NSCLC. Currently, five molecular targeted agents were approved for treatment of advanced NSCLC: Gefitinib, erlotinib and afatinib for positive EGFR mutation, crizotinib for positive echinoderm microtubule-associated protein-like 4 (EML4)-ALK translocation and bevacizumab. Moreover, oncogenic mutant proteins are subject to regulation by protein trafficking pathways, specifically through the heat shock protein 90 system. Drug combinations affecting various nodes in these signaling and intracellular processes are predicted and demonstrated to be synergistic and advantageous in overcoming treatment resistance compared with monotherapy approaches. Understanding the role of the tumor microenvironment in the development and maintenance of the malignant phenotype provided additional therapeutic approaches as well. More recently, improved knowledge on tumor immunology has set the stage for promising immunotherapies in NSCLC. This review will focus on the rationale for the development of targeted therapies in NSCLC and the various strategies employed in preventing or overcoming the inevitable occurrence of treatment resistance.

Aims: Tamsulosin, a superselective subtype alpha 1a and 1d blocker, is used for the treatment of male lower urinary tract symptoms (LUTS) commonly caused by benign prostatic hyperplasia (BPH). This prospective study evaluated the efficacy and safety of a new formulation, Tamsulosin OCAS® (Oral Controlled Absorption System), for LUTS associated with BPH in Thai patients. Materials and Methods: Fifty one patients over 40 years old with complaints of LUTS associated with BPH were recruited. Patients received an 8 week course of once daily 0.4 mg tamsulosin OCAS®, and were followed up at 2 (visit 3), 4 (visit 4) and 8 (visit 5) weeks post-treatment. At each visit, patients were assessed using the International Prostate Symptom Score (IPSS), Nocturia Quality of Life (N-QoL) Questionnaire, QoL Assessment Index (IPSS-QoL), and International Index of Erectile Function (IIEF). The primary outcome was efficacy of Tamsulosin. The secondary outcomes included change in the mean number of nocturia episodes, hours of undisturbed sleep (HUS) and uroflowmetry measurements. Results: Total IPSS significantly decreased at week 8 from baseline (from 19.52 to 6.08; p < 0.001). Similarly, the voiding and storage subscores of IPSS also continued to improve significantly starting from the second and third visits, respectively (p < 0.001 versus baseline). The IPSS-QoL and N-QoL scores significantly improved at visit 3 through end of study. In addition, we observed significant nocturia and HUS improvement in their last clinic visit. Uroflowmetry parameters, Q max and Q ave, improved significantly at 3 rd clinic visit. Three patients experienced mild dizziness. Conclusion: Tamsulosin OCAS® treatment led to significant improvements in LUTS, HUS and QoL in Thai patients with bladder outlet obstruction from BPH with few side effects.

Rattarasarn C.,Ramathibodi Hospital | Leelawattana R.,Songklanagarind Hospital | Soonthornpun S.,Songklanagarind Hospital
Metabolism: Clinical and Experimental | Year: 2010

Women have higher 2-hour plasma glucose levels after oral glucose challenge than men. The smaller skeletal muscle mass in women may contribute to the higher postload glucose levels. The objective of this study was to test the hypothesis that the different amount of skeletal muscle mass between men and women contributed to sex difference in postload plasma glucose levels in subjects with normal glucose tolerance. Forty-seven Thai subjects with normal glucose tolerance, 23 women and 24 age- and body mass index-matched men, were studied. Body fat, abdominal fat, and appendages lean mass were measured by dual-energy x-ray absorptiometry. Skeletal muscle insulin sensitivity was determined by euglycemic-hyperinsulinemic clamp. First-phase insulin secretion and hepatic insulin sensitivity were determined from oral glucose tolerance data. β-Cell function was estimated from the homeostasis model assessment of %B by the homeostasis model assessment 2 model. Correlation and linear regression analysis were performed to identify factors contributing to variances of postload 2-hour plasma glucose levels. This study showed that women had significantly higher 2-hour plasma glucose levels and smaller skeletal muscle mass than men. Measures of insulin secretion and insulin sensitivity were not different between men and women. Male sex (r = -0.360, P = .013) and appendages lean mass (r = -0.411, P = .004) were negatively correlated with 2-hour plasma glucose, whereas log 2-hour insulin (r = 0.571, P < .0001), total body fat (r = 0.348, P = .016), and log abdominal fat (r = 0.298, P = .042) were positively correlated with 2-hour plasma glucose. The correlation of 2-hour plasma glucose and sex disappeared after adjustment for appendages lean mass. By multivariate linear regression analysis, log 2-hour insulin (β = 18.9, P < .0001), log 30-minute insulin (β = -36.3, P = .001), appendages lean mass (β = -1.0 × 10-3, P = .018), and hepatic insulin sensitivity index (β = -17.3, P = .041) explained 54.2% of the variance of 2-hour plasma glucose. In conclusion, the higher postload 2-hour plasma glucose levels in women was not sex specific but was in part a result of the smaller skeletal muscle mass. The early insulin secretion, hepatic insulin sensitivity, and skeletal muscle mass were the significant factors negatively predicting 2-hour postload plasma glucose levels in Thai subjects with normal glucose tolerance. © 2010 Elsevier Inc. All rights reserved.

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