Vajira Medical Journal
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Item Abnormal Pap Smear of the Uterine Cervix at BMA General Hospital(Vajira Medical Journal, 2010-03-29) Karmonphun Chomsevi; Nithas JatuparisuthAbstract Abnormal Pap Smear of the Uterine Cervix at BMA General Hospital Karmonphun Chomsevi MD Nithas Jatuparisuth MD Department of Obstetrics and Gynecology, BMA General Hospital Objective: To determine the prevalence of abnormal uterine cervical Pap Smear of women attending out-patient gynecologic unit, BMA General Hospital. Study design: Descriptive study. Setting: Out-patient gynecologic unit, Department of Obstetrics and Gynecology, BMA General Hospital. Subjects: A total of 7,540 women who were checked for uterine cervical Pap smear during July 1, 2000 - December 31, 2001. Methods: Women who had Pap smear of uterine cervix were interviewed for personal data and reported the result of Pap smear by The Bethesda System (TBS). Those with abnormal Pap smear were contacted for investigations, follow-up and treatment. The result of Pap smear and histologic findings of uterine cervical biopsy under colposcopy were recorded. Main outcome measure: Prevalence of abnormal Pap smear of uterine cervix. Results: The prevalence of abnormal Pap smear of uterine cervix was 2.98% (95% CI 2.60-3.36). There were ASCUS 84 cases (1.11%), AGUS 2 cases (0.03%), LSIL 83 cases (1.10%), HSIL 47 cases (0.62%), and carcinoma 9 cases (0.12%). Concerning those who had abnormal Pap smear, the mean age was 39.92 + 12.13 years and the mean parity was 2 + 1.0. There was a strong relation between cytologic and histologic diagnoses. Conclusion: The prevalence of abnormal Pap smear at BMA General Hospital was 2.98%. There was a strong relation between cytologic and histologic diagnoses. Key words: abnormal Pap smear, prevalence, uterine cervixVajira Med J 2002 ; 46 : 97 - 104Item Abstract Endoscopic Finding in Corrosive Ingestion(Vajira Medical Journal, 2010-03-24) Suphakan Techapongsatorn; Pong Kanjanasuthirak; Satit SrimantayamasAbstract Endoscopic Finding in Corrosive Ingestion Suphakan Techapongsatorn MD Pong Kanjanasuthirak MD Satit Srimantayamas MD Objective: To review the endoscopic finding within 48 hours after corrosive agent ingestion. Study design: Descriptive study. Subjects: One hundred and seventy-one patients were admitted in Department of Surgery, Bangkok Metropolitan Administration Medical College and Vajira Hospital during January 2001 to December 2005, from corrosive ingestion. Methods: Hospital records and endoscopic records were collected and analyzed. Main outcome measure: Endoscopic finding which were classified into 4 groups: no injury, 1st degree injury, 2nd degree injury and 3rd degree injury. The sites of injuries were divided into proximal esophagus, distal esophagus, proximal stomach (cardia, fundus and body), distal stomach (antrum and pylorus) and 1st part duodenum. Results: Demographic data showed that 124 patients (72.5%) were female and the average age was 26.2 years. Intentional ingestion was the cause in 166 patients (97.1%). Hydrochloric acid existing in hard surfaces Cleaner especially toilet and bowl cleaners was the most common corrosive agent in 126 patients (73.7%). The prevalence of injury in upper esophagus, lower esophagus, proximal stomach, distal stomach A and duodenum were 35.0%, 69.4%, 64.9%, 33.1% and 17.2% consecutively. Conclusion: These findings were different from the developed countries. In those countries, the most common corrosive agents were sodium hydroxide and potassium hydroxide that were strong bases in drain or pipe cleaner. Furthermore, lower esophagus especially esophagogastric junction and proximal stomach were the most susceptible sites of injuries. Then, management and teaching should be conversely from the developed countries as mentioned in many textbooks and journals. Key Words: endoscopic finding, corrosive ingestion Vajira Med J 2006 ; 50 : 33 - 38Item Abstract Success Rate of Nocturnal Neutral Wrist Splint in Treatment of Carpal Tunnel Syndrome(Vajira Medical Journal, 2010-01-07) Yupadee Fusakul; Phongphitch SaensriAbstract Success Rate of Nocturnal Neutral Wrist Splint in Treatment of Carpal Tunnel Syndrome Yupadee Fusakul MD Phongphitch Saensri BSc (Occupational therapy) Department of Physical Medicine and Rehabilitation, BMA Medical College and Vajira Hospital Objective: To determine the success rate of nocturnal neutral wrist splint in the treatment of carpal tunnel syndrome in Thai patients. Study design: Prospective descriptive study. Subjects: A total of 40 patients with mild and moderate degree of carpal tunnel syndrome, confirmed by standard electrodiagnosis, who were treated by nocturnal neutral wrist splint in the Department of Physical Medicine and Rehabilitation, BMA Medical College and Vajira Hospital during February to August 2008. Methods: All subjects were treated with custom-molded neutral wrist splint and were instructed to wear the splint every night for 12 weeks. They were followed up and assessed by Symptom Severity Scale (SSS) and Functional Status Scale (FSS) at 2, 6 and 12 weeks. They also reported overall treatment results. Electrodiagnosis were reperformed at 12 weeks after treatment. Main outcome measures: Success rate of splint treatment which was determined from percentage of patients who rated the overall treatment results as "much improved" or "completely recovered". Results: The success rate of nocturnal neutral wrist splint in the treatment of mild and moderate degree of carpal tunnel syndrome was 65.0% at 12 weeks. The means of SSS and FSS improved significantly from baseline compared with SSS and FSS at 2, 6 and 12 weeks after treatment. However, the electrodiagnosis parameters at 12 weeks after treatment were not significantly different from the parameters before treatment. Conclusion: Treatment of mild to moderate degree of carpal tunnel syndrome in Thai patients with nocturnal neutral wrist splint was effective with success rate of 65.0%. Vajira Med J 2009 ; 53 : 131-142Item 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 Accuracy of Frozen Section in Diagnosis of Ovarian Mass(Vajira Medical Journal, 2010-03-26) Siriwan Tangjitgamol; Somneuk Jesadapatrakul; Sumonmal ManusirivithayaAbstract Accuracy of Frozen Section in Diagnosis of Ovarian Mass Siriwan Tangjitgamol MD* Somneuk Jesadapatrakul MD** Sumonmal Manusirivithaya MD* *Department of Obstetrics and Gynecology, BMA Medical College and Vajira Hospital **Department of Pathology, BMA Medical College and Vajira Hospital Objective: To determine the accuracy of frozen section compared to permanent section according to status of malignancy and histologic cell type. Study design: Diagnostic study. Subjects: Frozen and permanent pathological reports of 212 ovarian masses from 212 women who underwent ovarian resection at BMA Medical College and Vajira Hospital from January 1, 1992 to December 31, 2002 were studied. Methods: All frozen and subsequent permanent pathological reports of ovarian masses from the studied group were reviewed. The data of age, tumor size, number of frozen and permanent sections of the ovarian masses, the results of frozen and permanent section were taken from the pathological report. The pathological slides were reviewed when there was discrepancy of frozen and permanent section diagnosis, in deferred diagnosis for status of malignancy and/ or histologic cell type. Main outcome measures: Accuracy, sensitivity, specificity, positive predictive value, negative predictive value of frozen section. Results: From 212 ovarian masses, there were 13 deferred cases which frozen section diagnosis for status of malignancy could not be given. Statistical analysis was then performed in 199 cases.. The overall accuracy was 90.9%. Sensitivity of frozen section diagnosis was highest in the benign group at 99.1%, next was in the malignant group at 86.1% and lowest in borderline group at 50%. The specificity were 90.7, 94.6 and 100.0% in the benign, borderline and malignant groups respectively. Positive and negative predictive values of benign, borderline and malignant groups were 93.3, 41.2, 100.0% and 98.7, 96.2, 92.7%, respectively. All inaccurate diagnosis were in the common epithelial group. When the statistical data were analyzed according to histology subgroup of common epithelial tumor, sensitivity in diagnosis malignant and borderline mucinous were lower than non-mucinous tumor, 62.5% and 41.7% compared to 96.9% and 50.0% respectively. For diagnosis of the histologic cell type, frozen section had 91.9% accuracy. Thirteen out or 16 incorrect histologic diagnosis cases (81.3%) were in the common epithelial group while only three cases were germ cell tumor. Conclusion: The accuracy of frozen section in diagnosis of frozen section in diagnosis of ovarian mass was generally high according to both status of malignancy and histologic cell type. There were exception in tumors with large size, mucinous or borderline tumor which yielded lower accuracy, sensitivity, specificity and positive predictive value than the other groups. The surgeon should recognize these limitations and appraise the test result together with other clinical data. This is to achieve for the correct final diagnosis and the proper management for the patient. Key word: frozen section, ovarian mass, accuracy, malignancy, histologic cell type Vajira Med J 2003 ; 47 : 17 - 28Item The Accuracy of High Resolution Ultrasonography in the Diangnosis of Thyroid Carcinoma in Solitary Thyroid Nodule(Vajira Medical Journal, 2010-03-29) Linda Chandrachamnong; Praween KanchanapitakAbstract The Accuracy of High Resolution Ultrasonography in the Diangnosis of Thyroid Carcinoma in Solitary Thyroid Nodule Linda Chandrachamnong MD* Praween Kanchanapitak MD** *Department of Radiology, BMA Medical College and Vajira Hospital **Department of Pathology, Faculty of Medicine, Srinakharinwirot University. Objective: To study the accuracy of high resolution ultrasonogtaphy in the diagnosis of thyroid carcionoma in solitary thyroid nodule. Study design: Diagnostic test. Setting: Department of Radiology, BMA Medical College and Vajira Hospital. Subjects: One hundred and fifteen patients with solitary thyroid nodule confirmed by high resolution ultrasonography treated at Bangkok Metropolitan Administration Medical College And Vajira Hospital from January 1998 to December 2001. Methods: All patients were investigated by high resolution ultrasonography before surgery. Ultrasonographic diagnoses using echo pattern of thyroid nodules were compared with pathology. Main outcome measures: Prevalence, sensitivity, specificity accuracy, positive predictive value, negative predictive value, posttest likelihood if test negative and likelihood ratio. Results: The prevalence of malignancy in solitary thyroid module was 24/115 or 20.9%. All of the patients with malignancy were female. Sensitivity. Specificity accuracy, positive predictive value and negative predictive value were 79.2%, 52.7%, 58.3%, 30.6% and 90.6% respectively. Posttest likelihood if test negative was 9.4% and likelihood ratio was 1.7/1. Conclusion: Using echo pattern by high resolution sonography in solitary thyroid nodule does not have high specificity and accuracy enough for diagnosis of thyroid carcinoma. Key words: thyroid, solitary nodule, carcinoma, ultrasonographyVajira Med J 2002 ; 46 : 105 - 113Item The Accuracy of Pathological Evaluation for Tumor Necrosis in Post-chemotherapeutic Osteosarcoma by Using the Computer-designed Models(Vajira Medical Journal, 2010-03-24) Damrong Thapamakulsad; Pongsak Kagnarong; Nualsawat Hiransakolwong; Thawepong PhithakmongkolAbstract The Accuracy of Pathological Evaluation for Tumor Necrosis in Post-chemotherapeutic Osteosarcoma by Using the Computer-designed Models Damrong Thapamakulsad MD* Pongsak Kagnarong MD* Nualsawat Hiransakolwong MD (Computer Science) ** Thawepong Phithakmongkol BS (Computer Science) ** *Department of Orthopaedic Surgery, BMA Medical College and vajira Hospital ** Department of Mathematics and Computer Science, Faculty of Science, King Mongkut's Institute of Technology Ladkrabang Objective: To study the accuracy of pathological evaluation for tumor necrosis in post-chemotherapeutic osteosarcoma by using the computer-designed models. Study design: Experimental study by using the computer-designed models. Setting: Department of Orthopaedic Suthery and Department of Pathology, BMA Medical College and Vajira Hospital and Department Of Mathematics and Computer Science, Faculty of Science, King Mongkut's Institute of Technology Ladkrabang. Subjects: 100 graphic models of osteosarcoma about 1066 cm. by size were classified to 4 groups. Each group consisted of 25 graphic models represented 0-50%,50-90%, 90% to 100% and 100% of necrotic volume. Methods: The imitations of pathological serial cross sections for 1, 1.5, 2, 3, 4, 5 cm intervals were created in all 100 graphic models. The average areas of necrosis in each group were calculated and compared with the true necrotic volume Main outcome measure: The difference between average percentage of necrotic areas and necrotic volume. Results: For 1 cm section, the differences between average necrotic areas and volumes in group 1-4 were 26.9%,4.2%, 0.4% and 0% respectively. The errors in clinical assessment were found in group 1, 2. For 1.5-5 cm section, the differences increased gradually especially in group 1, 2. The errors in clinical assessment were 2%, 2%, 4%, 8% and 8% in group 1, 2. and 2%, 0%, 2%, 0% and 0% in group 2, 4. Conclusion: The regular using of 1 cm, section for pathological evaluation of tumor necrosis in post-chemotherapeutic osteosarcoma revealed the estimation errors especially in poor response group. On contrary, in good response group, these errors were less and the thickness of section from 1.5-5 cm did not affect the clinical assessment. Key words: osteosarcoma, tumor necrosis, post-chemotherapyVajira Med J 2006 ; 50 : 27 - 32Item Acquired Hemophilia A (Factor VIII inhibitor) associated with Bullous Pemphigoid: A Case Report(Vajira Medical Journal, 2010-01-13) Wiwat Rodprasert; Rachanid PornvipaveeAbstract Acquired Hemophilia A (Factor VIII inhibitor) associated with Bullous Pemphigoid: A Case Report Wiwat Rodprasert MD Rachanid Pornvipavee MD Department of Medicine, BMA Medical College and Vajira Hospital Acquired hemophilia A or factor VIII inhibitor is an autoimmune disease resulting from the presence of autoantibody to factor VIII. The prevalence is less than hereditary forms. It can be found in all races and ages but it is more common in middle age and older. Male and female are equally affected. It can be found alone or associated with other autoimmune diseases, malignancy, some medications and pregnancy. This is a case of Thai male patient presenting with bullous pemphigoid and ecchymosis. The diagnasis is acquired hemophilia A. Its managements consist of investigation and treatment the associated diseases, immunosuppressive agents and control bleeding disorder. Vajira Med J 2007 ; 51 : 55 - 59Item Adverse effects of GPO-VIR to Blood Cells of the PLHA in the BMA General Hospital(Vajira Medical Journal, 2010-03-24) Supaporn Karalak; Lertlak LeelaruangsangAbstract Adverse effects of GPO-VIR to Blood Cells of the PLHA in the BMA General Hospital Supaporn Karalak MD* Lertlak Leelaruangsang MD** *Blood Bank Department, BMA General Hospital **Out-patient Department, BMA General Hospital Objective: To determine the adverse effects of GPO-VIR (Drug combination of Stavudine, Lamivudine and Nevirapine) to blood cells of the patients living with HIV antigens (PLHA) in the BMA General Hospital. Study design: Descriptive study. Subjects: Fifty PLHA enrolled the Access To Care (ATC) project during May 2003-January 2004 , were treated with GPO-VIR in the out- patient clinic, Department of Medicine, BMA General Hospital. Methods: Sex, age, body weight, CD4 cell count and CBC (complete blood count) in the record of ATC project were collected and analyzed. Main outcome measures: Hematocrit, absolute neutrophil count (ANC), platelet count and CD4 cell count Results: After continuous treatment with GPO-VIR for one year, adverse effects to blood cells were not occurred in all subjects. Hematocrit, absolute neutrophil count and CD4 cell count were increased significantly. Conclusion: The adverse effects of GPO-VIR to blood cells (red blood cells, white blood cells and platelets) were not found in this study. The GPO-VIR was less bone marrow suppression. Hematocrit and absolute neutrophil count were increased significantly. Key words: GPO-VIR, Stavudine, Lamivudine, Nevirapine, bone marrow suppression. Vajira Med J 2005 ; 49 : 69 - 75Item Air Pollution from the Small Foundry Industries to Nearby Communities(Vajira Medical Journal, 2010-01-07) Somkid BuntataoAbstract Air Pollution from the Small Foundry Industries to Nearby Communities Somkid Buntatao MSc, (Environmental Engineering) Department of Environmental Engineering, Faculty of Engineering, Kasetsart University, Bangkok, Thailand Objective: To study air pollution condition of foundry factories and nearby communities. Study design: Descriptive study. Subjects: Five foundry factories in the community, two housess and one school in the vicinity, and the environmental ambient air on the street after office-hours in ten areas. Methods: From 2004-2006, primary survey for the environment in the factories and community were conducted together with the determination of air pollution level in the factories, and air quality in the complaining houses and one public school. Secondary survey was conducted in 2008 for the level of air pollution in the factories, ambient air along the street after office-hour. All the results were compared to the standard levels. Main outcome measures: Levels of carbon monoxide (CO), nitrogen dioxide (NO2), sulfur dioxide (SO2), large (total suspended particulate (TSP) and small (particulate matter with aerodynamic diameter \< a nominal of 10 micron; PM10) dust. Results: The primary survey from 2004-2006 showed that levels of CO in the two foundry factories were above upper standard control while NO2 and SO2 levels in all factories and in the complaining houses and school were within normal limits. Both small and large dust in the complaining houses and school were abnormally higher than the standard values. From the second survey in 2008, levels of CO, NO2, and SO2 in the five factories were all normal while the ambient air on the street after office-hour had abnormally high SO2 in 6 out of ten areas. Conclusion: The air pollution in the communities is due to the dust emitted from the nearby foundry factories. Vajira Med J 2009 ; 53 : 197-202Item Alveolar Osteitis(Vajira Medical Journal, 2010-01-13) Netnapis ChanasongkramAbstract Alveolar Osteitis Netnapis Chanasongkram DDM Dental Section, BMA Medical College and Vajira Hospital Alveolar osteitis, condition known as a "dry socket" is the most common complication following dental extraction. Its precise etiology and effective prevention remain unclear. There are many risk factors that contribute to the development of alveolar osteitis such as trauma, coagulopathies, smoking, preexisting oral infection, female, oral contraceptive pills, oral bacteria etc. Some preventions suggested to be the guideline in reducing its incidence consist of using systemic antibiotic orally after extraction or surgery (metronidazole, clindamycin) and perioperative antiseptic mouth rinsing. Concerning about its management, pain relieving and wound healing stimulation are the main purposes. Vajira Med J 2007 ; 51 : 67 - 71Item The Anti-staphylococcal Property of Mold-made Kanamycin-impregnated Polymethylmethacrylate Beads Compared with Septopal®(Vajira Medical Journal, 2010-03-29) Damrong Thapanakulsak; Chiroj SoorapanthAbstract The Anti-staphylococcal Property of Mold-made Kanamycin-impregnated Polymethylmethacrylate Beads Compared with Septopal® Damrong Thapanakulsak MD Chiroj Soorapanth MD Department of Orthopaedic Surgery, BMA Medical College and Vajira Hospital Objective : To Compare the anti-staphylococcal property by agar diffusion method of mold-made kanamycinimpregnated polymethylmethacrylate beads and Septopal® Study design : Experimental study. Setting : The Department of Orthopaedic Surgery and Department of Pathology, BMA Medical College and Vajira Hospital, during September 1999 - February 2000. Subjects : Thirty beads of Septopal® and 30 beads of mold-made kanamycin-impregnated polymethylmethacrylate (PMMA). Methods: The thirty beads of kanamycin - impregnated PMMA were mold -made in operating suite with aseptic technique and studied for anti- staphylococcal property by agar diffusion method comparing to so beads of Septopal® for 7 days. Main outcome measures : The zones of inhibition of Septopal® and mold-made kanamycin-impregnated PMMA. Results : The zones of inhibition of both groups were significantly more than the zone diameter interpretive standards (Z \> 3.08, 0.002). The zones of inhibition of Septopal® were significantly more than mold-made kanamycin-impregnated PMMA (Z \> 3.08, 0.002). Conclusion: Both Septopal® and kanamycin-impregnated PMMA beads significantly inhibited the growth of S aureus. The antimicrobial activity of Septopal® was higher with statistically significant difference. The kanamycin-impregnated bead was an alternative when Septopal® and gentamicin powder were not available. Key words : antibacterial property, mold-made kanamycin-impregnated PMMA bead, Septopal®Vajira Med J 2001 ; 45 : 217 - 222Item Antimicrobial Susceptibility of Gentamicin-impregnated Polymethylmethacrylate Beads after Resterilization(Vajira Medical Journal, 2010-01-13) Mason Porramatikul; Damrong Tapanakulsak; Siri SirimanapongAbstract Antimicrobial Susceptibility of Gentamicin-impregnated Polymethylmethacrylate Beads after Resterilization Mason Porramatikul MD* Damrong Tapanakulsak MD* Siri Sirimanapong MD* *Department of Orthopaedics Surgery, BMA Medical College and Vajira Hospital Objective: To compare the antimicrobial susceptibility to Staphylococcus aureus of Gentamicin-impregnated polymethylmethacrylate beads (GPMMA beads) before and after resterilization with ethylene oxide gas. Study design: Experimental study (laboratory research). Materials: A total of twenty four pieces of GPMMA bead were selected in this study. This study was conducted at Department of Orthopaedics Surgery, BMA Medical College and Vajira Hospital. Methods: All GPMMA beads were equally divided into two groups: control and experimental groups. The experimental group was sterilized again with ethylene oxide gas before testing. The antimicrobial susceptibility was identified by diffusion method of Kirby-Bauer for both groups. Diameter of zone of inhibition was recorded and compared. Results: In control group, the diameters of zone of inhibition at 24, 72 and 168 hrs were 27.3 ± 1.5, 29.2 ± 1.2, and 29.5 ± 1.2 mm respectively. In experimental group, the diameters of zone of inhibition at 24, 72 and 168 hrs were 29.5 ± 1.2, 30.3 ± 1.4 and 30.8 ± 1.0 mm respectively. Statistical analysis demonstrated significant differences between two groups. Conclusion: The antimicrobial susceptibility to Staphylococcus aureus of GPMMA beads after resterilization with ethylene oxide gas was not less than the new GPMMA beads. Vajira Med J 2007 ; 51 : 103 - 109Item The Anxiety and Information need of the Pregnant Women before Having the Cesarean Section(Vajira Medical Journal, 2010-03-29) Orathai Boonlert; Sangtien ThamlikitkulAbstract The Anxiety and Information need of the Pregnant Women before Having the Cesarean Section Orathai Boonlert BN, MED (Health Education)* Sangtien Thamlikitkul MED (Developing Psychology)** *Department of Obstetrics and Gynecology Nursing, Kuakarun College of Nursing **Department of Psychiatric Nursing, Kuakarun College of Nursing Objective: To study the anxiety, information need and the relationship between the anxiety and the information need of pregnant women before having the cesarean section. Study design: Descriptive study by survey. Subjects: One hundred and twenty four pregnant women who admitted in BMA Medical College and Vajira Hospital for cesarean section from January - November 2000. Methods: Questionnaires consisted of three parts; demographic form, Speilberger's STAI Form X-I and STAI Form X-II inventory and information need questionnaire were filled out and collected. The obtained data were analyzed by using SPSS for Windows program. Main outcome measures: Mean scores of the state anxiety and trait anxiety, and the information need. Results: Mean scores of pregnant women's state anxiety and trait anxiety were in low level (87.9 and 56.5%) and the information need was in high level (88.7%). State anxiety was significantly and positively related to trait anxiety at p \< 0.001 level (r = 0.720), while the anxiety was not significantly related to information need. There was a significant difference of state anxiety and trait anxiety among patients who had different education, income and marital starts at p \< 0.05 level. There was a significant difference of state anxiety among patients who had different cesarean section experience ant p \< 0.05 level. There was also a significant difference of information need among patients who had different education level and cesarean section experience at p \< 0.05 level. The most of information needs was about cesarean section, the second was ambulation and the third was hospital discipltne. Conclusion: Pregnant women had state anxiety and trait anxiety in low level but information need before cesarean section in high level. State anxiety was significantly and positively related to trait anxiety, while state anxiety and trait anxiety were not significant related to information need.Key words: anxiety, information need, cesarean sectionVajira Med J 2002 ; 46 : 135 - 143Item ARTERIAL BLOOD GAS ANALYSIS: Part 1: Pitfalls and interpretation(Vajira Medical Journal, 2010-03-25) Suthat RungruanghiranyaAbstract ARTERIAL BLOOD GAS ANALYSIS: Part 1: Pitfalls and interpretation Suthat Rungruanghiranya, MD (Hon)* *Department of Internal Medicine, Faculty of Medicine, Srinakharuinwirot University The arterial blood gas (ABG) analysis is one of the most commonly used clinical test in assessing a patient's oxygenation, ventilation, as well as acid-base status. However, ABG analysis appears to be a complicated and confusing matter to many physicians. Very often, this procedure was performed incorrectly, compromising its clinical usefulness and accuracy. To maximize its yield, one must understand its technical details, including the techniques, sample collection, handling and common pitfalls. Type of syringes can also influence the ABG measurement. Knowing the limitation of the ABG analysis and its alternatives is also important. The clinical usefulness of venous blood gas was also discussed. Most importantly, to correctly interpret ABG analysis, a practical, stepwise approach is required. That stepwise approach should begin with the assessment of oxygenation, ventilation, and acid-base disturbances. Once one utilizes this test with care and knowledge, I believe it will soon become a simple and straightforward test for everyone.Vajira Med J 2004 ; 48 : 41 - 46Item ARTERIAL BLOOD GAS ANALYSIS: Part 2: Interpretation of acid-base balance(Vajira Medical Journal, 2010-03-25) Suthat RungruanghiranyaAbstract ARTERIAL BLOOD GAS ANALYSIS: Part 2: Interpretation of acid-base balance Suthat Rungruanghiranya M.D.(Hon)* Department of Internal Medicine,Faculty of Medicine, Srinakharinwirot University The arterial blood gas (ABG) analysis is one of the most commonly used clinical test in assessing a patient's oxygenation, ventilation, as well as acid-base status. However, ABG analysis appears to be a complicated and confusing matter to many physicians. Very often, this procedure was performed incorrectly, compromising its clinical usefulness and accuracy. To maximize its yield, one must understand its technical details, including the techniques, sample collection, handling, and common pitfalls. More important, to correctly interpret the ABG analysis, a practical, stepwise approach is required. That stepwise approach should begin with the assessment of oxygenation, ventilation, and acid-base disturbances. This article will focus only on the interpretation of acid-base balance. Once one utilizes this test with care and knowledge, I believe it will soon a simple and straightforward test for everyone.Vajira Med J 2004 ; 48 : 117 - 123Item Assessment of Dermographism at Different Anatomical Body Regions by Dermographometer(Vajira Medical Journal, 2010-03-24) Vilaval TermlinchanAbstract Assessment of Dermographism at Different Anatomical Body Regions by Dermographometer Vilaval Termlinchan MD Sainoi Hospital Nonthaburi Background: Dermographism is a form of physical urticaria. Classic dermographism refers to the ability of the skin to produce a linear wheal with a scratch pressure of 4,900 gm/cm2 . Generally, diagnosis of dermographism involves a simple stroking of the skin with moderate pressure. There are a variety of apparatus for the standardized production of dermographism. However, these are most commercial available. Objective: A dermographometer was devised in order to have a precise and consistent measurement, and calibrated it with moderate pressure from the blunt penhead. The instrument was tested at different body regions. Material and Methods: Twelve patients with symptomatic dermographism and ten patients with chronic idiopathic urticaria and dermographism, attending skin clinic of the Bangkok Metropolitan Administration Medical College and Vajira Hospital, during August-October 2004 were enrolled. The pressure was applied to the volar aspect of left forearm using dermographometer, and to the right forearm by the penhead. Then the pressure was applied to the upper back, abdomen, and shin using dermographometer. The time onset and size of wheal, erythema, flare were recorded. Results: Of the 22 cases, 19 were female. The mean age war 32 years (range 14-52 years). Positive dermographism was defined by wheal with or without flare response. The positive yield at left forearm by the dermographometer was 72.7%. The positive yield of back, abdomen and skin were 68.2%, 68.2% and 13.6% respectively. The abdominal region gave the shortest onset time of wheal produced by dermographometer (median 130 seconds) and the widest wheal size (median 5 mm). Fifteen patients gave positive results at both forearms. Conclusions: The dermographometer had comparable sensitivity to diagnose dermographism with the penhead. The onset and size of wheal and flare varied considerably from site to site. Volar forearm, back and abdomen were the sensitive area to produce dermographism. Shin was the least sensitive area. Keywords: dermographism, wheal, dermographometer, urticaria, strokeVajira Med J 2005 ; 49 : 133 - 138Item 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 Bacterial Profile in Burn Patients in BMA Medical College and Vajira Hospital(Vajira Medical Journal, 2010-01-07) Boonchai Taweerattanasil; Poth ThirakhuptAbstract Bacterial Profile in Burn Patients in BMA Medical College and Vajira Hospital Boonchai Taweerattanasil MD Poth Thirakhupt MD Plastic and Reconstructive Surgery Unit, Department of Surgery, BMA Medical College and Vajira Hospital Objective: To study predominant bacterial profile in burn patients and time-related changes of this profile. Study design: Descriptive study. Subjects: All 82 patients, who were directly admitted after injury in BMA Medical College and Vajira Hospital Burn Unit, during August 2006 to December 2007. Methods: Medical records of enrolled subjects were reviewed. Main outcome measures: Types and incidences of bacteria from subjects' culture specimens. Results: The mean age of the subjects was 26.9 ± 20.8 years. Average total burn surface area was 20.2 ± 22.3 % and average hospital stay was 21.2 ± 24.4 days. There were totally 346 culture specimens, mostly was from burn wound swab culture (203 specimens; 58.7%). The rate of positive cultures among all specimens was 63.9% (221 specimens). Our results showed that the gram-negative bacteria were isolated more frequently (282 times; 64.5%) than gram-positive bacteria (147 times; 33.7%). Most common microorganisms that were isolated from burn wounds were Pseudomonas aeruginosa (18.9%), Staphylococcus coagulase negative (14.2%), Acinetobacter baumannii (10.2%), Enterobacter spp. (9.5%), Enterococcus spp. (9.0%), respectively. Concerning the time-related changes gram-negative bacteria were predominance since admission (51%), and become more predominate in day 7 (60.0%) and day 14 (82.1%) after admission. Conclusion: In burn patients, the most frequent isolate organisms were gram-negative bacteria and this predominance of gram-negative bacteria began since admission, and were more prominence afterwards. Vajira Med J 2009 ; 53 : 253-260Item Bacteriology and Antibiotics Usage in Patients with Diabetic Foot Infection(Vajira Medical Journal, 2010-10-05) Waigoon Stapanavatr; Burapa KarnjanabatrAbstract Bacteriology and Antibiotics Usage in Patients with Diabetic Foot Infection Waigoon Stapanavatr MD Burapa Karnjanabatr MD Department of Surgery, BMA Medical College and Vajira Hospital Infection in diabetic foot is usually severe and is the most common cause of admission in diabetic patients. If surgical management is delayed, improper or missed diagnosis, risk of amputation will be high since nearly half of diabetic foot infection patients have peripheral arterial occlusive diseases. Patients with diabetic foot infection who need surgical intervention are usually infected with multiple organisms. Staphylococcus aureus is the common cause of infection in the United States of America, which is different from Asia. In Asia, bacteria in diabetic foot infection are usually response to simple antibiotics e.g. Proteus Mirabilis, Escherichia Coli, Klebsiella Pneumoniae, etc. Proper management for patients with diabetic foot infection consists of appropriate correction of arterial occlusion and combination antibiotics to cover gram positive, gram negative and anaerobic organisms. Erythromycin, Ciprofloxacin and Gentamicin have sensitivity to organisms in diabetic foot infection in South East Asia. Keywords: diabetic foot, organisms, antibiotics Vajira Med J 2010 ; 54 : 199-208