Thammasat Medical Journal - ธรรมศาสตร์เวชสาร
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Item จดหมายถึงบรรณาธิการ(Thammasat University, Rangsit Campus, 2010-03-10) Saroj WanapruksItem Pathognomonic facies(Thammasat University, Rangsit Campus, 2010-03-10) Kongkiat KulkantrakornItem Pain control in cancer patients in tertiary care setting(Thammasat University, Rangsit Campus, 2010-03-10) Naiyana Patcharapisarn; Penkae Ketumarn; Tawanchai JirapramukpitakObjective: To investigate the prevalence of significant pain and the appropriateness of analgesics treatment prescribed among cancer patients with pain in tertiary care hospitals. Material and Method: A cross-sectional study was conducted between October 2007 and June 2008 on 228 cancer patients with pain in the outpatient pain clinic of a university hospital and the inpatient ward of a regional cancer center in Bangkok Metropolitan Region. The Brief Pain Inventory (BPI) was used to assess pain severity and pain interference. Significant pain or inadequate pain control was defined as pain of worst intensity during 24 hours, rated by the patient as 4 or higher out of 10 on the BPI. Pain Management Index (PMI) was calculated to measure the appropriateness of analgesic prescription based on the World Health Organization guidelines. Results: Only 21 patients (9.2%, 95%CI: 5.4-13.0) had negative PMI, which was indicative of inappropriate analgesic prescription. The prevalence of significant pain in the cancer patients with pain in the two tertiary care settings was 61.4% (95%CI: 55.1-67.7). Pain was reported to severely interfere with their work (34.2%), ability to walk (25.0%), and enjoyment of life (22.4%). Multivariate regression analysis revealed that inadequately treated pain was associated with being treated in the cancer center (Adjusted odds ratio 2.2, 95% confidence interval 1.2-4.1, p = 0.009). Conclusion: Despite the relaxation of opioid analgesic regulation since 2006, pain has remained under-treated in the majority of cancer pain patients even in the tertiary care services. Awareness of pain undertreatment should be raised among policy makers (such as Thai FDA) and health professionals involved. A more comprehensive and intensive approach to pain assessment and management is needed. Regular assessment of the patients’ compliance and preference to analgesic regimens prescribed and of pain-related cancer comorbidities (e.g., depression) should be emphasized. A policy on provision of a wider variety of opioids type and preparation forms may help improve the patients’ compliance and in turn reduce the pain symptoms.Item Surgical Landmark of Optic Foramen: Evaluation by 3D-CT(Thammasat University, Rangsit Campus, 2010-03-11) Pornthep Pungrasmi; Pisit Wattanaruangkowit; Wichit TharanonObjective: The aim of this study was to determine the distance and direction of the optic foramen and inferior orbital rim at the reference point above infraorbital foramen. Materials and methods: Among the patients who had undergone CT scan by CT I-CAT, we evaluated the results of 150 orbits (75 male and 75 female). We measured distances and angles of optic foramen from inferior orbital rim by Simplant Master version 11 and Simplant CMF Module. Using the mean, standard deviation and 95% CI, all were analyzed by SPSS 11.5 for Window. Statistical differences were calculated between males and females using unpaired t-test. Results: The distances from optic foramen to inferior orbital rim above infraorbital foramen in males and females were 49.15+/-3.09 and 46.74+/-2.87 mm respectively (p=.000) and 95% CI were 48.44›49.87 and 46.08-47.40 mm respectively. The angle between the imaginary line drawing from optic foramen to that point on the inferior orbital rim and the saggital plane in males and females were 18.55+/-3.40 and 20.23+/-3.80 degree respectively (p=.005) and 95% CI were 17.76-19.33 and 17.37-18.97 degree respectively. Conclusion: In males, the optic foramen were located at 49.15+/-3.09 mm away from inferior orbital rim above infraorbital foramen and their directions were 18.55+/-3.40 degree medially to saggital plane. In females, the optic foramens were located at 46.74+/-2.87 mm away from inferior orbital rim above infraorbital foramen and their directions were 20.23+/-3.80 degree medially to saggital plane. From statistical data, l andmark of optic foramen were significantly difference in males and females.Item บรรณาธิการแถลง(Thammasat University, Rangsit Campus, 2010-03-10) ก้องเกียรติ กูณฑ์กันทรากรItem Structure(Thammasat University, Rangsit Campus, 2010-03-10) Sompol Pongthai; Somchai BovornkittiItem Transplantation(Thammasat University, Rangsit Campus, 2010-03-10) Kongkiat Kulkantrakorn; Somchai BovornkittiItem Down syndrome facies(Thammasat University, Rangsit Campus, 2010-03-10) Somjit KraisiItem Ultrasound Findings in Musculoskeletal Infection(Thammasat University, Rangsit Campus, 2010-03-05) Korkiat VivitmongkolchaiUltrasound is a good imaging modality for superficial soft tissue evaluation hence it is useful in patient with clinical suspicious of musculoskeletal infection. It can demonstrate various kinds of musculoskeletal infection e.g. cellulites, pyomyositis, abscess, necrotizing fasciitis, septic bursitis, infectious tenosynovitis. It is also helpful in screening septic arthritis and osteomyelitis. Although ultrasound can not differentiate infectious from non-infectious inflammation, it can guide fluid aspiration for further examination. This article presents ultrasound findings in musculoskeletal infection.Item Synonym(Thammasat University, Rangsit Campus, 2010-03-10) Athasit Vejjajiva; Somchai BovornkittiItem Pathognomonic facies : Hemangioma(Thammasat University, Rangsit Campus, 2010-03-10) Surajit AwskulsutthiItem Buy Thai(Thammasat University, Rangsit Campus, 2010-03-10) Kongkiat Kulkantrakorn; Somchai BovornkittiItem Synovium vs. synovial fluid(Thammasat University, Rangsit Campus, 2010-03-10) Somchai Bovornkitti; Athasit VejjajivaItem English-Thai Medical Dictionary : the letter D(Thammasat University, Rangsit Campus, 2010-03-10) สมชัย บวรกิตติItem The Factors Related to Mortality of Patients with Necrotizing Fasciitis at Uthaithani Hospital(Thammasat University, Rangsit Campus, 2010-03-10) Chaw Suradom; Panee Wiruchagool; Kwanta KrakannaBackground: Necrotizing fasciitis (NF) is a fatal condition which commonly occurs in patients who have some immunodeficient conditions. The incidence of disease increases in several tropical epidemic areas in Thailand. Main etiology was external punctured wounds. It is frequently found in farmers as reported in this study. Objective: To study risk factors which related to mortality rate of NF. Material and method: A retrospective study was conducted by collecting data from all medical records of the patients undergone surgery for NF in Uthaithani Hospital during October 2002 to September 2008. The data was analyzed by using the statistics of mean, standard deviation, percentage, Chi-square test and independent T-test. Result: There were 137 cases of NF, 67 males, 70 females, mean age 60.7 ± 15.5 years (range 39-96 years) Thirty two cases (23.4%) died, mainly in elderly patients, mean age 67.5 ± 12.2 years. Over all duration of symptoms were 1 to 8 days (3.3 ± 1.8) and length of hospital stays were 2 to 48 days (15.2 ± 12.6). The proportion of each risk factors in dead cases when compared with all cases were diabetes mellitus 19.4% (6/31), cirrhosis 33.3% (2/6), heart diseases 72.7% (8/11), steroid intake 44.4% (8/18), white blood cell count over 20,000 cell/mm³ 42.4% (14/33), blood creatinine over 2 mg/dL 46.1% (12/26), duration of admission times to operation over 12 hours 20.9% (10/43), unsuitable antibiotics usage 25% (3/12), polymicrobial infections 31.8% (14/44), infections to muscular layer 50% (6/12), initially missed diagnosis 40.7% (11/27), shock at initial admission 64.7% (11/17) and limb amputation 33.3% (4/12). Conclusion: The statistic risk factors which were related to mortality of NF were initially missed diagnosis, old age, heart disease and steroid intake. Some factors were found in severe cases upon admission such as or shock, renal and pulmonary insufficiency. Concerning bacterial effects, risk factors were polymicrobial and muscular layer infections. It also revealed that limb amputations and infection to muscular layer were related to diabetic cases. But other factors had no significant relationship to mortality.Item Vehicular fuel(Thammasat University, Rangsit Campus, 2010-03-10) Kongkiat Kulkantrakorn; Somchai BovornkittiItem Thai term for “peer review”(Thammasat University, Rangsit Campus, 2010-03-10) Somchai BovornkittiItem Eye care in primary care unit(Thammasat University, Rangsit Campus, 2010-03-10) Luksanaporn KrungkraipetchAbstract not availableItem บรรณาธิการแถลง(Thammasat University, Rangsit Campus, 2010-03-10) ก้องเกียรติ กูณฑ์กันทรากรItem Occupational health policy and implementation in enterprises in Thailand(Thammasat University, Rangsit Campus, 2010-03-10) Surasak BuranatrevedhObjective: Objective of this study was to study the occupational health policy and implementation in enterprises in Thailand. Methods: This was a documentary descriptive study. Frameworks of the study included a national policy, governmental organization, and occupational health services in enterprises in Thailand. Results: There was no specific law regarding occupational health in Thailand. It was mainly implemented as stipulated by the Labor Protection Act 1998 and the Factory Act 1992. The Ministry of Industry, the Ministry of Labor, and the Ministry of Public Health were playing various roles in occupational health with limited co-operation. Occupational health services required by law covered requirements suggestion by International Labor Organization Convention 161 concerning occupational health services, 1985. However, an implementation in enterprises was not well enforced. Also, nurses and physicians worked in enterprises were not required by law to have knowledge about occupational health. Recommendations: There should be a specific occupational health law. The governmental organizations which enforce occupational health law should have only 1-2 organization to enforce and monitor enterprises to provide appropriate occupational health services. Also, nurses and physicians who work in enterprises should be required by law to have knowledge about occupational health.