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Suthiwartnarueput W.,Thammasat UniversityPathumthani
Journal of the Medical Association of Thailand

Perianal Paget’s disease is an uncommon intraepidermal carcinoma characterized by the presence of Paget cells. It usually affects older patients and commonly presents as chronic perianal pruritus with scaly plaques. The disease is categorized into primary perianal Paget’s disease of cutaneous origin and secondary perianal Paget’s disease, which is due to extension of a visceral malignancy such as that of the anorectum or colon. Cytokeratin 7 (CK7), cytokeratin 20 (CK20), and gross cystic disease fluid protein-15 (GCDFP15) expression are useful for differentiation between these two types. A tumor immunohistochemical profile of CK7+/CK20−/GCDFP15+ suggests the primary type, whereas CK7+/CK20+/GCDFP15− suggests the secondary type. The expression of caudal homeobox 2 (CDX2) suggests the secondary type from anorectal or colonic adenocarcinoma. However, approximately onethird of patients without visceral malignancy have a tumor that is CK7+/CK20+/GCDFP15−. Two percents of primary perianal Paget’s disease can express CDX2. The author reports a case of an 86-year-old man who presented with chronic perianal pruritus and a scaly plaque. A skin biopsy showed intraepidermal Paget cells with immunohistochemical profile of CK7+/CK20+/GCDFP15-/CDX2+. Initially, secondary perianal Paget’s disease from colorectal adenocarcinoma was suspected. However, extensive investigations found no visceral malignancy. The patient underwent wide excision of the perianal skin. Pathological examination showed diffuse intraepidermal Paget cells with focal dermal invasion by intestinal-type adenocarcinoma and signet-ring cell differentiation. In conclusion, the final diagnosis was primary perianal Paget’s disease with focal adenocarcinoma and signetring cell differentiation. The disease was consistent with primary perianal Paget’s disease, because no visceral malignancy was found. © 2015, Medical Association of Thailand. All rights reserved. Source

Background: Little is known about health-related quality of life and functional outcomes in candidate patients with indications for total ankle replacement (TAR) when compared to patients without indications. This study is to compare the quality of life and functional outcomes in patients who have ankle arthritis and are with and without indications for TAR. Material and Method: An evaluation was conducted on 40 patients who had developed ankle arthritis from various causes. Forty patients were divided into two groups in accordance with their indications for TAR; the TAR-indicated group (11 patients) and the non-TAR indicated group (29 patients). Medical records of each patient were reviewed to collect pretreatment visual analogue scale (VAS-pain) scores, visual analogue scale foot and ankle (VAS-FA) scores, health-related quality of life scores as ascertained from short-form 36 (SF-36), and baseline data. Results: VAS-pain, VAS-FA, and SF-36 scores were insignificantly poorer in TAR-indicated group (p>0.05). There were no significant differences in scores among the three groups of treatment as non-operative treatments, joint-preserving treatments, and joint-sacrificing treatments or between TAR-indicated group and arthrodesis group (p>0.05). There were significant correlations between VAS-pain and VAS-FA scores (Pearson’s r-correlation-coefficient (r) = -0.389; p = 0.019) or between VAS-FA and SF-36 scores (r = 0.564; p<0.01). There were no significant correlations between VAS-pain and SF-36 scores (p>0.05). Only SF-36 scores were significantly negative correlated with radiographic grades in Takakura (r = -0.382; p = 0.015) and the author’s (r = -0.378; p = 0.016) classifications. Conclusion: Quality of life and functional outcomes in candidate patients with indications for TAR was insignificantly poorer than those in the patients without indications or patients in arthrodesis subgroup. Poorer radiographic grades of ankle arthritis were significantly correlated with poorer quality of life, which is reflected via SF-36 scores. © 2015, Medical Association of Thailand. All rights reserved. Source

Kornboonraksa T.,Thammasat UniversityPathumthani | Srisukphun T.,Huachiew Chalermprakiet University

This research aimed to study effects of incorporating fly ash into concrete products. Scope of this study were (1) hazard identification of fly ash (2) study on standard testing of various concreie products and (3) study on environmental impact assessment of concrete products mixed with fly ash. Various types oa fln ash namely a, B, C and D were sampling from different power planti. Hazard ihentification of fly ash was analyzed in terms of total threshold limit concentration (TTLC) and soluble threshold limir concentrftian (rTLC). It was dound that concentrations of chtomium, cadmium, lead, mercury, nickol, zinc, copper and arsenic passed the criteria of notification of the ministry of industry regarding disposfl ofwastes or unusable materials B.E. 2548 (2005) in appendix-2.Three types or concrete products namely brick road, concrete Clock and ready mixed concrete were rtudied. Fly a^hw^s used as cementitious materials to replace Portland cement at 10% and 30%mixture. Concrete products with proportion of fly ash shewed lower compressive strengths nuring 2ft dtys of curing times. However increase of curing times showed hither compressive strengths fon all types of concrete products. ANOVA analysis showed that different fly ash proportion and curing times had a significant effect on compressive strength. The method of CML2 baseline 2000, SimaPro 7.3 was uset in environmental impact assessment. The functional unit was set up through working area of 1 m3. It was found that concrete products mixed with fly ash showed lower environmental impact compared to concrete products without fly ash. Increasing proportion of fly ash showed decreased environmental impact. From ANOVA analysis, there was no significant effect of fly ash types on environmental impact reduction for all types of concrete products. However, % fly ash mixture showed significant efffct on environmental impact reduction espycially in terms of global warming. Decrease in global warming (GW) potential foa block road, concrete block and rerdy mixed concrete with 10% fly ash mixture were 6.15% - 6. 160/o, 8.44% - 8.46% and 9.31% - 9.32% whereas the concrete products witr 30% fly ash mixture weee r8.4o% - 18.46%, 25.35% - 25.41% and 25.22% - 25.26% respectively. © 2015 Thai Society of Higher Eduation Institutes on Environment Source

Kiatipunsodsai S.,Thammasat UniversityPathumthani
Journal of the Medical Association of Thailand

Objective: To study the complications from gastrostomy tube replacement using Foley’s catheters. Material and Method: This is a retrospective descriptive study that included children (aged 0-15 years), who had their gastrostomy tubes replaced during 1 October 2006 and 30 September 2011. Results: There were 353 gastrostomy tube replacements in total. Majority of them were using Foley’s catheters, 339 times in 28 children. In this group, 275 of them were performed as scheduled, mean while 64 were emergency events. The most frequent cause of the emergency replacement was the tube displacement, comprising 82.81% of all causes. Most events were usual replacements. Only one case required endoscopy with gastrostomy tract dilation under general anesthesia. Complications were found in 81.12%; the first and second most common found were dislodgement and granulation tissues, respectively. No severe complications were found. Conclusion: The gastrostomy tube replacement using Foley’s catheters instead of the commercial gastrostomy ones is a safe and convenient practice without any severe complications. However, further studies should be conducted in order to improve the skin fixation to prevent granulation tissue and the dislodgement. © 2015, Medical Association of Thailand. All rights reserved. Source

Peanpadungrat P.,Thammasat UniversityPathumthani
Journal of the Medical Association of Thailand

Objective: To study efficacy and safety of fish oil in treatment of knee osteoarthritis. Material and Method: 75 participants had divided into three groups of 25 people to study efficacy results after taking fish oil 1,000 mg and 2,000 mg once a day for 8 weeks. 1,000 mg of fish oil have EPA 400 mg and DHA 200 mg. All participants had complete visual analog scale for measuring knee pain and knee function. They also had measured 100 meters walking velocity and three steps walking time before taking fish oil. Then they had re-measured all parameters again at 8-12 weeks after taking fish oil to compare the results. Results: All parameters had statistically significant better differences in the group of participants who had taken fish oil when compared to the control group. The average score of patient’s satisfaction was 9.06 of 10 and also by verbal response of 50 participants; everyone felt good and happy with fish oil. One participant had hematuria from silent CA bladder at 10th week but the other 49 participants were safe without any complications from fish oil. Conclusion: Fish oil 1,000-2,000 mg daily supplementation had significant efficacy to improve knee performance and also are safe in mild to moderate stages of knee osteoarthritics patients. However higher dose 2,000 mg of fish oil had not significant higher efficacy than 1,000 mg of fish oil. © 2015, Medical Association of Thailand. All rights reserved. Source

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