Vajira Medical Journal
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Item Use of Immunohistochemical Study in Pathology(Vajira Medical Journal, 2009-12-30) Unaporn Trongsakul; Sujitra Tanvanich; Siriwan TangjitgamolAbstract Use of Immunohistochemical Study in Pathology Unaporn Trongsakul BSc (Biology) Sujitra Tanvanich MSc (Pathobiology) Siriwan Tangjitgamol MD Department of Anatomical Pathology BMA Medical College and Vajira Hospital Immunohistochemistry is the application of immunologic technique used to determine types of antigen in cells or tissue structure. The staining is based on the principle of antigen-antibody binding compound. This compound could be detected by a catalytic chemical reaction of chromogen, producing specific color at specific cellular location. Used of immunohistochemical stain are: to detect the cancer cell origins, to classify the tumors, to demonstrate micrometastatic cancer cells, as a prognostic indicator and to identify microorganisms. Although the physicians who submit a tissue for histologic diagnosis do not require extensive knowledge on immunohistochemistry, basic information of the technique would help them understand the complicated pathological work. Furthermore, the knowledge or familiarity on this special technique would certainly assist them to collaborate with pathologists in making use out of these various immunohistochemistry stainings to facilitate the diagnosis and optimal care for the patients. Vajira Med J 2008 ; 52 : 285-291Item The Causes of Unreceipted Unnatural Death Report in BMA Medical College and Vajira Hospital(Vajira Medical Journal, 2009-12-30) Charoonsak NualchaemAbstract The Causes of Unreceipted Unnatural Death Report in BMA Medical College and Vajira Hospital Charoonsak Nualchaem MD Department of Forensic Medicine, BMA Medical College and Vajira Hospital Objectives: To study the prevalence and causes of unnatural death reports being unreceipted in BMA Medical College and Vajira Hospital. Study design: Descriptive study. Subjects: The death reports from unnatural causes in BMA Medical College and Vajira Hospital and the inquiry officials at Samsen police station. Methods: Data from the unnatural death reports during January 1996 - December 2005 and the records in which the inquiry officials had signed upon the receipt of death reports were searched for the unreceipted reports. Qualitative data to evaluate the knowledge and recognition of the importance of a death report was obtained from 12 inquiry officers from Samsen police station by an in-depth interview. Results: From 1,935 unnatural deaths of the five causes, the most common cause was unknown (48.5 %). The rate of unreceipted death reports was 74.4%. The most common type of unnatural causes with the highest prevalence of unreceipted death reports was also the unknown cause (98.5%). From the interview with the inquiry officials, most of them had good knowledge in forensic medicine, but 83.3% had insufficient time. The recognition of the inquiry officials regarding the importance of death reports was fair. The problems in the receiving of the death reports was marked. The main problem was the working process of the inquiry officials themselves especially their insufficient working hours. Conclusion: The rate of unreceipted death reports was 74.4%. The most important cause of unreceipted death reports was insufficient working hours of the inquiry officials. Vajira Med J 2008 ; 52 : 209-218Item Expression of Estrogen Receptor and Progesterone Receptor in Epithelial Ovarian Tumors(Vajira Medical Journal, 2009-12-30) Sujitra Tanvanich; Siriwan Tangjitgamol; Sumonmal ManusirivithayaAbstract Expression of Estrogen Receptor and Progesterone Receptor in Epithelial Ovarian Tumors Sujitra Tanvanich MSc (Pathobiology)* Siriwan Tangjitgamol MD*,** Sumonmal Manusirivithaya MD, MSc (Clinical Epidemiology)** Somneuk Jesadapatarakul MD* * Department of Anatomical Pathology, BMA Medical College and Vajira Hospital ** Department of Obstetrics and Gynecology, BMA Medical College and Vajira Hospital Objectives: To examine the expression of estrogen receptor (ER) and progesterone receptor (PR) in epithelial ovarian tumors and their associations with status of malignancy, histopathologic subtypes and grading. Study design: descriptive study. Subjects: Tissue of epithelial ovarian tumors resected at the BMA Medical College and Vajira Hospital between 1996-2005. Methods: The patients with epithelial ovarian tumors who were operated in our institution were identified. Samples of formalin-fixed, paraffin-embedded ovarian tumor tissue of patients were retrieved and processed for ER and PR immunohistochemical study. Data collected were: age, status of malignancy, tumor histologic subtype, and grade of malignant tumor. Expression of ER, PR and their associations with these pathological data were studied. Main outcome measures: Immunohistochemical expression of estrogen and progesterone receptors. Results: During the study period, 191 patients with epithelial ovarian tumors who were operated in our institution were identified. Mean age of the patients was 47.7 ± 14.6 years. Positive immunohistochemical expression of ER and PR were found in 29.8% and 34.0% respectively. ER expression was higher in malignant tumors than borderline and benign tumors, 39.6% versus 25.9% and 13.8% respectively while the expression of PR showed no different expression, 33.0% versus 33.3% and 36.2% respectively. Endometrioid tumors showed highest ER and PR expression 57.1% and 66.7% respectively, while clear cell tumors showed lowest expression of ER (5.9%) and mucinous for PR expression (9.6%). Focusing only on the malignant tumors, we found that the expression of ER and PR in mucinous and clear cell carcinomas were significantly lower than other cell types, 6.8% versus 62.9% for ER and 9.1% versus 50.0% for PR expression. Positive ER expression was significantly lower in well differentiated than moderately and poorly differentiated carcinomas, 11.8% versus 48.6% and 42.6% whereas there was no significant association between PR and grade of tumor. Conclusions: We demonstrated 29.8% of ER and 34.0% of PR expression in epithelial ovarian tumors. Expression of ER in malignant tumors was higher than benign and borderline tumors, whereas the expressions of PR of these tumors were nearly the same. Both receptors were lowly expressed in clear cell and mucinous tumors. ER expression was lower in well differentiated than moderately and poorly differentiated tumors while there was no significant association between PR and grade of tumors. Vajira Med J 2008 ; 52 : 249-256Item India Ink Stain in Incisional Wound of Soft Tissue Tumor(Vajira Medical Journal, 2009-12-30) Damrong Thapanakulsak; Chiroj SoorapanthAbstract India Ink Stain in Incisional Wound of Soft Tissue Tumor Damrong Thapanakulsak MD Chiroj Soorapanth MD, FACS, MMedEd Department of Orthopedics, BMA Medical College and Vajira Hospital Objective: To study the India ink staining characteristics by gross and microscopic pathology in incisional biopsied wound of soft tissue tumor. Study design: Descriptive study. Subjects: Ten patients with soft tissue tumor sized \> 5 cm., who underwent incisional biopsy for histopathologic examination and had subsequent tumor masses excision at our institute. Methods: After incisional biopsy and hemostasis of bleeding sites of the tumor, 3-5 ml. of sterilized India ink was installed into the surgical wound up to the skin surface level for one minute. After the ink had stained along the whole width, length, and depth of the wound, the wound was gauzed dried before suturing closure. When the whole tumor mass was excised as surgical treatment, it was submitted for gross and histologic examination, characteristic staining pattern of India ink over incisional biopsied wound, degree of staining, local tissue reaction, and tumor cells contamination over surgical wound were examined. Main outcome measures: Gross and microscopic pathology of India ink staining. Results: India ink stains were clearly seen in all incisional biopsy wounds by gross and microscopic pathologic examination. Chronic inflammation with foreign-body granulomatous reaction and tumor cells contamination were evidenced in all cases. Conclusion: The staining with India ink in incisional biopsy wound of all soft tissue tumors were clearly seen by gross and microscopic pathologic examinations. Vajira Med J 2008 ; 52 : 243-248Item Accidents during Transportation to School of Students in Bangkok Metropolitan Area(Vajira Medical Journal, 2009-12-30) Busaba Suppawattanabodee; Anan Manomaipiboon; Monawat Ngerncham; Premwadee KaruhadejAbstract Accidents during Transportation to School of Students in Bangkok Metropolitan Area Busaba Suppawattanabodee MSc (Biostatistic)* Anan Manomaipiboon MD, MSc (Clinical epidemiology)** Monawat Ngerncham MD, MPH (epidemiology)*** Premwadee Karuhadej Ed D**** * Clinical Epidemiology Unit, BMA Medical College and Vajira Hospital ** Department of Surgery, BMA Medical College and Vajira Hospital *** Department of Surgery, Siriraj Hospital **** Kuakarun Nursing College Objectives: To evaluate the incidence and types of accidents occurring to students in Bangkok Metropolitan area during their daily transportation back and forth to school. Study design: Descriptive study. Subjects: 17,499 students in kindergarten to Mattayom levels from 134 schools in Bangkok Metropolitan area were selected by multi-stage stratified random sampling. Methods: Data concerning the students' transportation including the accidents, occurring during the school year 2002 were collected by self-administered questionnaires which were answered by the students themselves or their parents. Main outcome measures: The number and percentage of accidents and the types of accidents during daily transportation of the students back and forth to schools. Results: 647 students (3.7%) experienced some accidents during their transportation while 388 students (2.2%) got injuries from the accidents. Most of the accidents occurred with the transportation by bus (23.3 %), public motorcycle (22.6%), and personal car (17.3 %). Types of accidents depended mainly on the types of transportation. The most common type of accident among all types of transportations was the collision between the vehicles. The second common type of accident was: falling off the cars among the students who traveled by public transportation of buses, cars or tricycles; falling over of the motorcycles among the students using motorcycles; and falling down or striking with the hard objects among the pedestrians. Conclusion: Though the number of accidents and injuries in the students' transportation were small, this problem created tremendous effects to the students, parents, school authorities, other people, and society. The majority of these accidents were from the drivers' behavior, lack of service mind of the personnel and partly from the suboptimal condition of the public transportation vehicles. Vajira Med J 2008 ; 52 : 257-264Item Management of Non-deflating Balloon of Foley Catheter(Vajira Medical Journal, 2009-12-30) Wiroj RuksakulAbstract Management of Non-deflating Balloon of Foley Catheter Wiroj Ruksakul MD Department of Surgery, BMA Medical College and Vajira Hospital Foley catheter is the most common tool for urinary catheterization in medical practice. Its removal is easily achieved after the fluid in the retention balloon is evacuated. However, when the catheter fails to collapse, unexpected sequele may occur upon an attempt to remove it. This article reviewed literatures involving the management of patients whose urinary catheter could not be removed due to balloon problems. The advantages and disadvantages of each technique including the practicability were described. Management algorithm was also constructed to demonstrate an information or guideline for medical personnel with different degree of experiences and in various situations. Vajira Med J 2008 ; 52 : 275-283Item Endovascular Abdominal Aortic Aneurysm Repair: the First Experience in BMA Medical College and Vajira Hospital(Vajira Medical Journal, 2009-12-30) Suksan Kanoksin; Navin Suraphakdee; Suphakarn Techapongsatorn; Worawong SlisatkornAbstract Endovascular Abdominal Aortic Aneurysm Repair: the First Experience in BMA Medical College and Vajira Hospital Suksan Kanoksin MD, FRCST, FICS* Navin Suraphakdee MD.** Suphakarn Techapongsatorn MD, FRCST, FICS* Worawong Slisatkorn MD, FRCST, FICS*** * Department of Surgery, BMA Medical College and Vajira Hospital ** Department of Emergency Medicine, BMA Medical College and Vajira Hospital *** Department of Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University This report presents the first experience of endovascular aortic aneurysm repair (EVAR) in the patient with infrarenal abdominal aortic aneurysm at BMA Medical College and Vajira Hospital. The patient was a 73-year-old male, who had abdominal pain which referred to perineal area for 1 year. The physical examination showed pulsatile abdominal mass and the computer tomography revealed infrarenal abdominal aortic aneurysm with a dimension of 6 cm. The patient underwent the EVAR with an uneventful postoperative outcome. At 3-month follow up, neither major complications nor endoleak was observed. Vajira Med J 2008 ; 52 : 265-273Item Efficacy of Sterile Water Compared with Normal Saline Solution for Nasal Irrigation on the Sinonasal Symptoms in Chronic Sinusitis Patients(Vajira Medical Journal, 2009-12-30) Girapong Ungkhara; Thanyunuch AthakrisAbstract Efficacy of Sterile Water Compared with Normal Saline Solution for Nasal Irrigation on the Sinonasal Symptoms in Chronic Sinusitis Patients Girapong Ungkhara MD, MPA* Thanyunuch Athakris MD** * Department of Otolaryngology, BMA Medical College and Vajira Hospital ** Department of Defensive Medicine, Police General Hospital Objective: To compare the efficacy of nasal irrigation using sterile water versus normal saline solution to relieve sinonasal symptoms of chronic sinusitis patients. Study design: Randomized double-blind controlled trial. Subjects: A total of 42 chronic sinusitis patients who were treated at the Department of Otolaryngology, BMA Medical College and Vajira Hospital during December 2004 were enrolled. The inclusion criteria were those who were older than 15 years old, had symptoms of chronic sinusitis for more than 3 months and had been treated with conventional therapy. Methods: The enrolled patients were randomized into 2 groups; 21 patients in normal saline solution group and 21 patients in sterile water group. The investigators and the patients were blinded to the solution each patient received. The patients were asked to answer the questionnaire to evaluate the sinonasal symptoms before irrigation. After being educated about the correct technique of nasal irrigation, the patients had self nasal irrigation at home for 1 week. Then, they were asked to follow up and answered the questionaires to reassess their sinonasal symptoms. Main outcome measures: Sinonasal symptoms score including cough, presence and characteristics of nasal discharge. The highest score was 7. Results: After nasal irrigation for 1 week, sinonasal symptoms were significantly improved in both groups. The median sinonasal symptom score decrease from 6 to 3 in patients of normal saline group and from 5 to 3 in sterile water group. The improvement of sinonasal symptoms score was not significant different between the two groups. Conclusion: In chronic sinusitis patients, nasal irrigation with either normal saline or sterile water was effective and significantly improved the sinonasal symptoms. The improvement of sinonasal symptoms was not significant different between the two solutions.Vajira Med J 2008 ; 52 : 193-199Item Cardiac Function of Preterm Infants whose Mothers Received Dexamethasone(Vajira Medical Journal, 2009-12-30) Thanakrit TarunotaiAbstract Cardiac Function of Preterm Infants whose Mothers Received Dexamethasone Thanakrit Tarunotai MD Department of Pediatrics, BMA Medical College and Vajira Hospital Objective: To evaluate the cardiac function of preterm infants, whose mothers received dexamethasone during antenatal period. Study design: Prospective descriptive study. Subjects: 95 preterm infants gestational age equal to or less than 34 weeks, who were delivered from mothers, who received 4 doses of dexamethasone, at BMA Medical College and Vajira Hospital during December 2006 and November 2007. Methods: Cardiac function was evaluated by echocardiogram in all subjects for the first time at 7 days of age. The cardiac dysfunction infants were re-evaluated by second echocardiography before discharge from the hospital, when the body weight were about 2,000 grams. All the cardiac dysfunction infants from the second echocardiography underwent third echocardiography at the age of 6 months. Factors that might interfere the cardiac function such as maternal gestational diabetes mellitus, gestational age at birth, birth weight, birth asphyxia, fetal intubation, hypothermia, hypoglycemia and sepsis were recorded. Main outcome measures: Poor cardiac function defined as low ejection fraction and low fractional shortening. Results: 51 subjects were females while 44 were males. The subjects were born at the gestational age of 25-34 weeks with the birth weight of 900 - 2,150 grams. 25 infants (26.3%) had poor cardiac function diagnosed by the first echocardiography at 7 days of age. These infants were treated in the hospital until body weight were about 2,000 grams and underwent second echocardiography evaluations before discharge. The second echocardiography revealed 6 infants (6.3%) with poor cardiac functions. Cardiac functions of all these 6 infants turned to normal from the third echocardiography at 6 months of age. Factors associated with poor cardiac functions in these subjects included less gestational age, low birth weight, birth asphyxia and fetal intubation. Conclusion: The incidence of cardiac dysfunctions in preterm infants whose mother received antenatal dexamethasone was 26.3%. The abnormal cardiac function was transient and turned to normal before 6 months. Vajira Med J 2008 ; 52 : 201-208Item Measurement Form Development by Delphi Technique for Measuring Family Protective Behavior against Drug Abuse Problem in Children aged 10-15 years old(Vajira Medical Journal, 2009-12-30) Kovit Yongvanitjit; Kotchakorn Supakanjana; Prapai SupakanjanaAbstract Measurement Form Development by Delphi Technique for Measuring Family Protective Behavior against Drug Abuse Problem in Children aged 10-15 years old Kovit Yongvanitjit MD Kotchakorn Supakanjana ME (Foundations Education) Prapai Supakanjana MSc (Developmental Psychology) Drug Abuse Prevention and Treatment Division, Health Department, BMA Objective: To develop a behavior measurement form to determine family protective behaviors against drug abuse problems among children aged 10-15 years. Study design: Qualitative research using Delphi technique. Subjects: Twenty selected informants including 10 university experts on family issues, four parents with social recognition on child-raising, four parents, who successed in helping their children quit the drugs, and 2 leaders from Bangkok Metropolitan Youth Council. Methods: The family protective behaviors against drug abuse problem which were identified with concensus among key informants were used to develop the measurement form. The Delphi technique was used in the process of data collection and analysis. The form was tested and adjusted in 30 children aged 10-15 years. Main outcome measures: Coefficient of family protection behavioral form. Results: There were 10 main topics involving 120 behaviors that the families should apply to prevent drug abuse problem among their children aged 10-15 years old. Five topics were behaviors that the family should do to prevent drug abuse problem in their children. Among these behavior topics, the highest average score was the topic concerning other behaviors to prevent drug abuse problems in that parents should be the role model not to use any drugs. Another 5 main topics were behaviors that the family should do to help their children to cope with drug problems. Among these, behaviors of relationship development and communication among the family members was the topic that had highest average score, such as parents admit the drug problem and concerned about the feelings of their children in drug problems. These features were used to develop the measurement form of family protective behaviors against drug abuse problem among children aged 10-15 years. This form was then tested and modified. The modified behavior form yielded the Cronbach alpha coefficient of 0.863. Conclusion: The measurement form of family protective behaviors against drug abuse problem among children aged 10-15 years, consisting of 10 main topics involving 120 behaviors, is reliable. The family members should apply these protective behaviors to prevent drug abuse problems among their children. Vajira Med J 2008 ; 52 : 229-235Item Prevalence of Obesity in Private Primary School Students in Dusit District(Vajira Medical Journal, 2009-12-30) Panutcha Phanruk; Supapan TantracheewathornAbstract Prevalence of Obesity in Private Primary School Students in Dusit District Panutcha Phanruk MD Supapan Tantracheewathorn MD Department of Pediatrics, BMA Medical College and Vajira Hospital Objective: To evaluate the prevalence of childhood obesity in private primary schools in Dusit District. Study design: Descriptive study. Subjects: Primary school students from 4 private schools in Dusit District, Bangkok, comprising Ratchawat wittaya School, Kantabutra School, Sridarun School and Kongtapbok Ouppatam Suesansongkror School. Methods: Demographic data including gender, age, and level of class were recorded. Weight and heightwere measured twice for each subject and the mean values were recorded. Main outcome measures: Prevalence of childhood obesity. Results: Of the 1,173 enrolled students, 598 (51.0%) were male and 575 (49.0%) were female. Their mean age was 9.2 ± 2.1 years (range 5-12 years). The prevalence of obesity, preobesity, overweight, normal, preunderweight and underweight were 10.0%, 1.4%, 27.7%, 58.1%, 0.8% and 2.0%, respectively. The prevalence of obesity was significantly higher in male than female. The prevalence of obesity and overweight in 11-year old students or older were significantly higher than the younger students. Conclusion: The prevalence of obesity of private primary school students in Dusit District was 10.0%. The prevalence of obesity and overweight were significantly increased with increasing age. Vajira Med J 2008 ; 52 : 237-242Item The Association between the Interval of Sexual Assault to Collection of Specimen and Detection of Spermatozoa in the Vagina(Vajira Medical Journal, 2009-12-30) Rangsima TaepaiboonAbstract The Association between the Interval of Sexual Assault to Collection of Specimen and Detection of Spermatozoa in the Vagina Rangsima Taepaiboon MD, LLB Unit of Forensic Medicine , BMA General Hospital Objective: To determine the association between the interval of sexual assault to collection of specimen and the detection of spermatozoa in the vagina. Study design: Cross sectional study. Subjects: 97 sexually assaulted women who were sent by the police officers for a forensic medical investigation of sexual assault at BMA General Hospital during January 2002 and May 2008. Methods: Medical records and forensic evidence reports of the sexually assaulted women in BMA General Hospital during the study period were reviewed. Data collections from these records as well as the results from the Serology Laboratory for forensic evidence, Siriraj Hospital were taken. Main outcome measures: Interval between sexual assault to vagina specimen collection, detection of spermatozoa in the vagina. Results: From 97 sexually assaulted victims, sperms were found in the vagina of 66 women (68%). Women who had the examination within 24 hours had the highest positive test for sperm, 29/31 women (93.5%). The positive findings declined as the intervals between sexual assault and vagina specimen collections were longer. Sperms were found in 21/37 women (56.8%), 9/16 (56.3%) women and 7/13 women (53.8%), who were examined within 1-3 days, 3-7 days and after 7 days respectively. Statistical significant association between the interval of sexual assault to collection of specimen and detection of spermatozoa in the vagina was found. Conclusion: The appropriate time that the sexually assaulted victims should consult for the forensic evidence is within 24 hours to yield the highest detection rate of spermatozoa. Vajira Med J 2008 ; 52 : 219-227Item Emerging Viral Respiratory Tract Infection: Human Metapneumovirus (hMPV)(Vajira Medical Journal, 2010-01-06) Suree JirapaiboonsukAbstract Emerging Viral Respiratory Tract Infection: Human Metapneumovirus (hMPV) Suree Jirapaiboonsuk MD Section of Pediatrics, Sirindhorn Hospital Human Metapneumovirus (hMPV) was a newly discovered virus, which was first reported in Netherlands in 2001. This new RNA virus was classified as the Metapneumovirus genus of the Pneumovirinae sub-family of the Paramyxoviridae family. HMPV had been shown to be associated with upper and lower respiratory tract infection in children. The incidence of hMPV infection varies from 1.5-40 %. In Thailand, the incidence was 3.5-5.4 %. Co-infection of hMPV with other organisms was found in 5-30 %, mostly with Respiratory Syncytial Virus (RSV). Clinical manifestations and chest X-ray were indistinguishable from other viral infections. Molecular methods such as reverse transcriptase polymerase chain reaction (RT-PCR) were the preferred diagnostic modality and new more rapid and sensitive hMPV assays, while real-time PCR allowed amplification and detection of hMPV within 2 hours. No specific treatment was recommended. Specific vaccines are currently in progress in experimental animals. Vajira Med J 2009 ; 53 : 101 - 108Item Survival Rate and Outcomes of Very Low Birth Weight Infants in Taksin Hospital, Bangkok Metropolitan Administration(Vajira Medical Journal, 2010-01-06) Taneenat Treratvirapong; Mariam Boonma; Atjana Thummaluxamee; Somchua Atinapan; Wanpen SoodkratokAbstract Survival Rate and Outcomes of Very Low Birth Weight Infants in Taksin Hospital, Bangkok Metropolitan Administration Taneenat Treratvirapong MD* Mariam Boonma MD* Atjana Thummaluxamee MD* Somchua Atinapan BN** Wanpen Soodkratok BN** * Department of Pediatrics, Taksin Hospital, BMA ** Nursing Department, Taksin Hospital, BMA Objectives: To determine survival rate, outcomes and risk factors associated with mortality of very low birth weight infants in Taksin Hospital. Study design: Retrospective descriptive study. Subjects: A total of 185 infants weighing between 500 and 1,499 grams, born during October 2003 and September 2007 in Taksin Hospital, were enrolled. Methods: Hospital records and labor reports were retrospectively reviewed and analysed. Main outcome measures: Survival rate, outcomes and risk factors associated with neonatal mortality. Results: Of the 185 very low birth weight infants, 149 (80.5%) infants survived till discharge while 23 out of 46 (50%) extremely low birth weight infants survived till discharge. Among the survival infants, 30 (20.1%), 4 (2.7%), 46 (30.9%) and 12 (8.1%) had chronic lung disease, stage III-IV retinopathy of prematurity, abnormal hearing screening and neurological deficit respectively. Major causes of neonatal death were respiratory distress and associated complications. In multivariable analysis, gestational age \< 28 weeks (odds ratio (OR) = 2.7, 95% CI: 1.0-3.6), birth weight \< 1,000 g (OR = 1.004, 95% CI: 1.001-1.006), APGAR score at 5 minutes ≤ 5 (OR = 8.7, 95% CI: 2.1-36.2), and sepsis (OR = 5.2, 95% CI: 1.62-16.5) were significant factors associated with very low birth weight infant's mortality. Conclusion: The survival rate of very low birth weight infants in this study was close to some other reports in Thailand. The morbidity of these infants remained high especially in those extremely low birth weight infants. Vajira Med J 2009 ; 53 : 41 - 50Item Comparison of Total Laparoscopic Hysterectomy and Total Abdominal Hysterectomy for Benign Diseases in BMA Medical College and Vajira Hospital(Vajira Medical Journal, 2010-01-06) Budsaba Wiriyasirivaj; Sarwinee Ratchanon; Anusorn TriwitayakornAbstract Comparison of Total Laparoscopic Hysterectomy and Total Abdominal Hysterectomy for Benign Diseases in BMA Medical College and Vajira Hospital Budsaba Wiriyasirivaj MD, MSc (Epidemiology), MSc (Clinical Embryology) Sarwinee Ratchanon MD, MSc (Reproductive Biology) Anusorn Triwitayakorn MD Department of Obstetrics and Gynecology, BMA Medical College and Vajira Hospital Objective: To compare the duration of postoperative hospital stay, operative time, operative blood loss, and surgical complications between patients undergoing total laparoscopic hysterectomy (TLH) and total abdominal hysterectomy (TAH). Study design: Retrospective cohort. Subjects: A total of 150 gynecologic patients, who underwent TLH (n=75) or TAH (n=75) for benign diseases at BMA Medical College and Vajira Hospital between May 2006 and June 2008 were enrolled. Methods: Data of all patients who underwent TLH during the study period were retrospectively collected from the medical records. Then, data of the patients undergoing TAH consecutively to each TLH case, who had similar preoperative diagnosis and comparable uterine size (i.e. difference of uterine size less than4 weeks of gestation), were obtained. Main outcome measures: Postoperative hospital stay, operative time, operative blood loss, and surgical complications. Results: Baseline characteristics of both groups including age, body mass index, uterine size, diagnosis, history of previous abdominal surgery, concurrent gynecologic surgery were not significantly different. Mean postoperative hospital stay of TLH group was significantly shorter than TAH group (3.1 ± 1.0 days vs 4.3 ± 1.0 days, p-value \< 0.001). Mean operative time of TLH group was significantly longer than TAH group (299.6 ± 31.8 minutes vs 117.3 ± 30.4 minutes, p-value \< 0.001). Mean operative blood loss in TLH group was significantly less than TAH group (270.1 ± 27.1 ml vs 351.1 ± 30.5 ml, p-value = 0.049). Proportion of postoperative meperidine requirement and mean meperidine use in TLH group were significantly less than those in TAH group (78.7 % vs 93.3 %, p-value = 0.010 and 60.0 ± 44.8 mg vs 104.0 ± 55.6 mg, p-value \< 0.001). For major surgical complications, there was one case of urinary bladder injury in TLH group but none in TAH group. Blood transfusion and minor surgical complications i.e. postoperative fever, abdominal wound infection, and vaginal cuff infection were not significantly different in both groups. Conclusion: In comparison to TAH, TLH had shorter postoperative hospital stay, less operative blood loss, and less postoperative meperidine requirement but had longer operative time. Major surgical complication was few and should be further evaluated. Minor surgical complications of TLH were not significantly different from TAH. Vajira Med J 2009 ; 53 : 7 - 16Item The Results of Physical Fitness Test of Personnel in BMA Medical College and Vajira Hospital(Vajira Medical Journal, 2010-01-06) Chonlada Klinsukont; Yupadee FusakulAbstract The Results of Physical Fitness Test of Personnel in BMA Medical College and Vajira Hospital Chonlada Klinsukont BSc (Physical therapy) Yupadee Fusakul MD Department of Physical Medicine and Rehabilitation, BMA Medical College and Vajira Hospital Objectives: To study the physical fitness of 21-60-year old female and male personnel in BMA Medical College and Vajira Hospital. Study design: Descriptive study. Subjects: 906 personnel aged 21-60 years in BMA Medical College and Vajira Hospital. Methods: Physical fitness tests including height, weight, percent of body fat, resting heart rate, blood pressure, vital capacity, hand grip strength, leg strength, flexibility of back and maximum oxygen uptake (VO2 max) were measured in all subjects. Main outcome measures: Results of physical fitness tests. Results: Most of the female and male personnel in nearly all age groups had normal or good resting heart rate, normal blood pressure, normal or good vital capacity, fair hand grip strength, fair leg strength, and fair maximum oxygen uptake (VO2max), while most had percent of body fat higher than standard value. In terms of flexibility of back; most female aged 21-40 years had very low or low flexibility while most of the female aged 41-60 years and male in all age groups had normal or good flexibility. Most of the female and male aged of 21-30 years had normal weight, while most of the female aged 31-40 years had normal weight and overweight in nearly the same proportion but most of the male aged 31-40 years had overweight. With the age of 41-60 years most of both female and male had overweight. Conclusion: The physical fitness of most of the female and male personnel in the age of 21-60 years in BMA Medical College and Vajira Hospital showed normal or good values of resting heart rate, blood pressure and vital capacity, fair hand grip strength, fair leg strength and fair maximum oxygen uptake (VO2 max), but percent of body fat was higher than standard value. Most of the female aged 41-60 and male aged 31-60 years had overweight. Most of the female aged 21-40 years had very low or low back flexibility. Vajira Med J 2009 ; 53 : 77 - 87Item Prevalence and Association between Androgen Deficiency and Metabolic Syndrome in Aging Thai Male with Type 2 Diabetes Mellitus(Vajira Medical Journal, 2010-01-06) Swangjit Sura-amornkul; Thantip Jongboonyanupap; Petch RawdareeAbstract Prevalence and Association between Androgen Deficiency and Metabolic Syndrome in Aging Thai Male with Type 2 Diabetes Mellitus Swangjit Sura-amornkul MD, FRCP (T),MSc (Chinical Investigation) Thantip Jongboonyanupap MD, FRCP (T) Petch Rawdaree MD, FRCP (T),MSc Endocrinology unit, Department of Medicine, BMA Medical College and Vajira Hospital. Objective: To determine the prevalence and association between androgen deficiency (AD) and metabolic syndrome in aging Thai male with type 2 diabetes mellitus. Study design: Cross-sectional study. Subjects: 246 males aged ≥ 55 years old with type 2 diabetes who attended Diabetic Clinic, Department of Medicine, BMA Medical College and Vajira Hospital from June 2007 to October 2008. Methods: Waist circumference and blood pressure were measured. Blood was drawn for fasting plasma glucose, glycated hemoglobin (),lipid and total testosterone levels in all participants. Main outcome measures: total testosterone level, metabolic syndrome according to American Heart Association (AHA) criteria. Results: Prevalence of androgen deficiency (AD) in aging Thai male with type 2 diabetes was 35.8%. The total testosterone level of type 2 diabetes aging male with and without AD was 2.55 ± 0.74 and 4.95 ± 1.44 ng/ml respectively. Body weight, body mass index (BMI) and waist circumference were significantly negatively correlated with total testosterone levels. Prevalence of metabolic syndrome in type 2 diabetes aging male with and without AD was not significantly different (87.5% vs 83.5%). Conclusion: AD was frequently found in aging Thai male with type 2 diabetes. However, there was no association between AD and metabolic syndrome in this group. Vajira Med J 2009 ; 53 : 33 - 39Item Use of Intravenous Immunoglobulin (IVIg)(Vajira Medical Journal, 2010-01-06) Panadda SuwanAbstract Use of Intravenous Immunoglobulin (IVIg) Panadda Suwan MD Department of Pediatrics, BMA Medical College and Vajira Hospital Initially used as a replacement therapy for immunodeficiency diseases, intravenous immunoglobulin (IVIg) is now widely used for a number of autoimmune and inflammatory diseases. The mechanisms of action of IVIg are several, it can modulate an immune reaction at the level of T cells, B cells, macrophages, the complement cascade and the cytokine network. Given the potential risks and cost-effectiveness of IVIg, careful consideration of the indications and administration of IVIg is warranted. Vajira Med J 2009 ; 53 : 89 - 100Item Pregnancy Characteristics of Macrosomic Birth(Vajira Medical Journal, 2010-01-06) Waralak YamasmitAbstract Pregnancy Characteristics of Macrosomic Birth Waralak Yamasmit MD Department of Obstetrics and Gynecology, BMA Medical College and Vajira Hospital Objective: To determine the pregnancy characteristics of macrosomic birth. Study design: Descriptive study. Subjects: Two hundred and sixty one pregnant women who delivered infant birth weight of ≥ 4,000 g. at BMA Medical College and Vajira Hospital between January 2005 and December 2007. Methods: Mothers' demographic data, mode of delivery, maternal and fetal complications were collected from medical records and computer data base. Main outcome measures: Maternal age, parity, gestational age, body mass index, overt or gestational diabetes, mode of delivery, maternal and fetal complications. Results: The rate of macrosomic birth during the study period was 2.1%. The mean maternal age was 29.6 ± 6.0 years and 63.2% of the subjects were multiparity. Overt or gestational diabetes was found in 17.6%. Ninety-seven percent of pregnant women were obese at the time of delivery or last prenatal care. Thirty-seven percent of macrosomic deliveries occurred after 40 weeks of gestation. The cesarean section rate was 53.3%. Postpartum hemorrhage in cases with cesarean section was documented 23 times higher than those in women with vaginal delivery. Shoulder dystocia and Erb's palsy were found in 2.7% and 0.8% respectively. Conclusion: Gestational diabetes and maternal obesity were the main pregnancy characteristics of macrosomic birth. Mode of delivery in fetuses with estimated weight ≥ 4,000 g should be carefully evaluated. Vajira Med J 2009 ; 53 : 25 - 32Item Diagnosis of Impacted Maxillary Canine in Children(Vajira Medical Journal, 2010-01-06) Sutad TreesoonratAbstract Diagnosis of Impacted Maxillary Canine in Children Sutad Treesoonrat DDS Dental section, Ladkrabangkrugtep Hospital Maxillary permanent canine is the second most common tooth having problem of impaction after the mandibular third permanent molar. The etiology is uncertain. Two hypotheses have been proposed: the guidance and the genetic theories. At present, the dentist can early predict the impaction of the maxillary canine by various radiographic imagings. This could be achieved as early as 8 years of age leading to a timely treatment planning which would consequently decrease a complicated treatment, side effects, treatment time, and expected cost of treatment. Vajira Med J 2009 ; 53 : 109 - 113