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Mahidol University Abstract of International Publications 2003

Faculty of Medicine Ramathibody Hospital

No.26 Authors Title Source Keywords Abstract : : : : : Aekplakorn W, Loomis D, Vichit-Vadakan N, Shy C, Wongtim S, Vitayanon P. Acute effect of sulphur dioxide from a power plant on pulmonary function of children, Thailand. International Journal of Epidemiology. 32(5) : 854-61, 2003(Oct). SO2, Particulate air pollution, Pulmonary function, Epidemiology, Thailand. Background Epidemiological studies have shown reversible declines of lung function in response to air pollution, but research on the independent effect of short-term exposure to ambient sulphur dioxide (SO2) on pulmonary function is limited. This study evaluated the association of short-term exposure to increased ambient SO2 and daily pulmonary function changes among children with and without asthma. Methods The associations of daily exposure to SO2 and particulate matter 10 mum in diameter (PM10) with pulmonary function were examined in 175 asthmatic and non-asthmatic children aged 6-14 years who resided near a coal-fired power plant in Thailand. Each child performed daily pulmonary function tests during the 61-day study period. General linear mixed models were used to estimate the association of air pollution and pulmonary function controlling for time, temperature, co-pollutants, and autocorrelation. Results In the asthmatic children, a daily increase in SO2 was associated with negligible declines in pulmonary function, but a small negative association was found between PM10 and pulmonary function. A 10-mug/m(3) increment was associated with changes in the highest forced vital capacity (FVC) (-6.3 ml, 95% CI: -9.8, -2.8), forced expiratory volume at 1 second (FEV1) (-6.0 ml, 95% CI: -9.2, 2.7), peak expiratory flow rate (PEFR) (-18.9 ml.sec (-1), 95% CI: -28.5, -9.3) and forced expiratory flow 25 to 75% of the FVC (FEF25-75%) (-3.7 ml.sec (-1), 95% CI: -10.9, 3.5). No consistent associations between air pollution and pulmonary function were found for non-asthmatic children. Conclusion Declines in pulmonary function among asthmatic children were associated with increases in particulate air pollution, rather than with increases in SO2.

No. 27 Authors Title Source Keywords

: Aekplakorn W, Loomis D, Vichit-Vadakan N, Wongtim S, Vitayanon P, Plungchuchon S. : Heterogeneous response of daily pulmonary function to air pollution among asthmatic children, Thailand. : Epidemiology. 14(5) : S23, 2003. : Pulmonary function, Asthma, Children.

No. 28 Authors Title Source Keywords Abstract

: Aekplakorn W, Stolk R, Neal B, Suriyawongpaisal P, Chongsuvivatwong V, Cheepudomwit S, Woodward M. : The Prevalence and Management of Diabetes in Thai Adults. : Diabetes Care. 26 : 2758-64 (Issue 10), 2003(Oct). : Cardiovascular system, Diseases, Diabetes. : OBJECTIVE -- The aim of this study was to determine in Thai adults aged ?35 years the prevalence and management of diabetes and the associations of diabetes with cardiovascular risk factors. RESEARCH DESIGN AND METHODS -- The International Collaborative Study of Cardiovascular Disease in Asia was a complex sample survey. Data from a structured questionnaire, brief physical examination, and blood sample were collected from 5,105 individuals aged ?35 years (response rate 68%). Population estimates were calculated by applying sampling weights derived from the 2000 Thai census. RESULTS -- The estimated national prevalence of diabetes in Thai adults was 9.6% (2.4 million people), which included 4.8% previously diagnosed and 4.8% newly diagnosed. The prevalence of impaired fasting glucose was 5.4% (1.4 million people). Diagnosed diabetes,

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Mahidol University Abstract of International Publications 2003

undiagnosed diabetes, and impaired fasting glucose were associated with greater age, BMI, waistto-hip ratio, systolic blood pressure, total cholesterol, and serum creatinine levels. The majority of individuals with diagnosed diabetes had received dietary or other behavioral advice, and 82% were taking oral hypoglycemic therapy. Blood pressure-lowering therapy was provided to 67% of diagnosed diabetic patients with concomitant hypertension. CONCLUSIONS -- Diabetes is common in Thailand, but one-half of all cases are undiagnosed. Because diagnosed diabetes is likely to be treated with proven, low-cost, preventive therapies such as glucose lowering and blood pressure lowering, initiatives that increased diagnosis rates would be expected to produce substantial health benefits in Thailand. No. 29 Authors Title Source Keywords Abstract

: Aekplakorn W, Stolk RP, Neal B, Suriyawongpaisal P, Chongsuvivatwong V, Cheepudomwit S, Woodward M. : The prevalence and management of diabetes in Thai adults - The International Collaborative Study of Cardiovascular Disease in Asia. : Diabetes Care. 26(10) : 2758-63, 2003(Oct). : Impaired glucose-tolerance, Risk-factors, Fasting glucose, Global burden, Cholesterol, Mortality, Mellitus, Program, Health. : OBJECTIVE - The aim of this study was to determine in Thai adults aged greater than or equal to35 years the prevalence and management of diabetes and the associations of diabetes with cardiovascular risk factors. RESEARCH DESIGN AND METHODS - The international Collaborative Study of Cardiovascular Disease in Asia was a complex sample survey. Data from a structured questionnaire, brief physical examination, and blood sample were collected from 5,105 individuals aged greater than or equal to35 years (response rate 68%). Population estimates were calculated by applying sampling weights derived from the 2000 Thai census. RESULTS - The estimated national prevalence of diabetes in Thai adults was 9.6% (2.4 million people), which included 4.8% previously diagnosed and 4.8% newly diagnosed. The prevalence of impaired fasting glucose was 5.4% (1.4 million people). Diagnosed diabetes, undiagnosed diabetes, and impaired fasting glucose were associated with greater age, BMI, waist-to-hip ratio, systolic blood pressure, total cholesterol, and serum creatinine levels. The advice, a individuals with diagnosed diabetes had received dietary or other e majority of and 82% were taking oral hypoglycemic therapy. Blood pressure-lowering therapy was provided to 67% of diagnosed diabetic patients with concomitant hypertension. CONCLUSIONS - Diabetes is common in Thailand, but one-half of all cases are undiagnosed. Because diagnosed diabetes is likely to be treated with proven, low-cost, preventive therapies such as glucose lowering and blood pressure lowering, initiatives that increased diagnosis rates would be expected to produce substantial health benefits in Thailand.

No. 30 Authors Title Source Keywords No. 31 Authors Title Source Keywords Abstract

: Aekplakorn W. : Effects of short-term air pollution exposure on respiratory symptoms and lung function in children and adults (Maemoh project panel studies). : Epidemiology. 14(5) : S134 (Suppl. 1), 2003. : Air pollution exposure, Lung, Children, Adults.

: Angsuwarangsee S, Polnikorn N. : Combined Ultrapulse CO2 Laser and Q-Switched Alexandrite Laser Compared with Q-Switched Alexandrite Laser Alone for Refractory Melasma : Split-Face Design. : Dermatologic Surgery. 29(1) : 59, 2003(Jan). : Ultrapulse CO2 Laser, Q-Switched Alexandrite Laser. : Background. Melasma is common and can cause major psychological impact. To date, the mainstay of treatment, including various hypopigmenting agents and chemical peels, is ineffective and can

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Mahidol University Abstract of International Publications 2003

cause adverse effects. Laser is a new approach and is yet to be explored for its efficacy and safety. Objective. To compare combined Ultrapulse CO2 laser and Q-switched alexandrite laser (QSAL) with QSAL alone in the treatment of refractory melasma. Methods. Six Thai females were treated with combined Ultrapulse CO2 laser and QSAL on one side of the face and QSAL alone on the other side. The outcome was evaluated periodically for up to 6 months using the modified Melasma Area and Severity Index score and the modified Melasma Area and Melanin Index score. Results. The side with combination treatment had a statistically significant reduction of both scores. On the QSAL side, the score reduction was not significant. Two cases developed severe postinflammatory hyperpigmentation and were effectively treated with bleaching agents. Transient hypopigmentation and contact dermatitis were observed with the combination treatment side. Conclusions. Combined Ultrapulse CO2 laser and QSAL showed a better result than QSAL alone but was associated with more frequent adverse effects. Long-term follow-up and a larger number of cases are required to determine its efficacy and safety for refractory melasma.

No. 32 Authors Title Source Keywords Abstract

: Ariyapruchya B, Sungkanuparph S, Dumrongkitchaiporn S. : Clinical presentation and medical complication in 59 cases of laboratory-confirmed leptospirosis in Bangkok. : Southeast Asian J Trop Med Public Health. 34(1) : 159-64, 2003(Mar). : Leptospirosis, Bangkok. : We reviewed the laboratory-confirmed cases of leptospirosis in Ramathibodi Hospital, a medicalschool hospital in Bangkok, to assess the documented cases of leptospirosis in Bangkok and the medical complications of severe cases. There were 59 cases from January 1994 to December 2000. More than half of the cases were Bangkok residents and did not travel outside Bangkok in the preceding 2 weeks. The majority of the cases presented in late rainy season. The clinical presentation, laboratory findings, medical complication, treatment and outcome are given. Leptospirosis in the urban area is common and should be recognized, particularly in rainy season.

No. 33 Authors Title Source Keywords Abstract

: Atichartakarn V, Angchaisuksiri P, Aryurachai K, Chuncharunee S, Thakkinstian A. : In vivo platelet activation and hyperaggregation in hemoglobin E/beta-thalassemia: A consequence of splenectomy. : International Journal of Hematology. 77(3) : 299-303, 2003(Apr). : Platelet activation, Beta-thalassemia, Splenectomy. : Patients with hemoglobin E/beta-thalassemia (E/beta-Tbal) who have undergone splenectomy are prone to thrombosis in the small pulmonary arteries. To study the role of platelets in this situation, we assayed plasma beta(2)-thromboglobulin (betaTG) and performed whole blood platelet aggregation analysis of 30 E/beta-Thal patients, half of whom had undergone splenectomy. We compared results with those obtained with 15 healthy control subjects. Plasma betaTG levels in splenectomy patients were significantly higher than in control subjects and patients who had not undergone splenectomy, and platelets in splenectomy patients exhibited hyperaggregation in response to adenosine diphosphate, thrombin, and ristocetin. Levels of plasma thrombin-antithrombin III complex were also significantly higher. Ibis finding is likely due to an increased number of erythrocytes with exposed phosphatidylserines, an effect that has been associated with splenectomy. The increased presence of thrombin in the blood may well be the cause of platelet hyperactivity, which was evident only in the asplenic patients. Platelet hyperactivity very likely plays a pathogenetic role in the thrombosis of small pulmonary arteries that occurs in E/beta-Thal patients who have undergone splenectomy.

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Mahidol University Abstract of International Publications 2003

No. 34 Authors Title Source Keywords Abstract

: Atichartakarn V, Chuncharunee S, Chandanamattha P, Likittanasombat K, Aryurachai K. : Correction of hypercoagulability and amelioration of pulmonary arterial hypertension by chronic transfusion in an asplenic hemoglobin E/{beta}-thalassemia patient. : Blood. 2003 (Nov). : Pulmonary arterial hypertension, Pulmonary vascular resistance, Beta-thalassemia. : Chronic transfusion of packed red blood cells was given to a splenectomized hemoglobin E/betathalassemia female with pulmonary arterial hypertension (PHT), in addition to other ongoing treatment with warfarin, acetyl salicylic acid, desferrioxamine, and other supportive measures. Serial measurements of plasma thrombin-antithrombin III complex (TAT) levels and right sided cardiac catheterization were used to monitor changes after treatment. Reduction of plasma TAT levels from 7.5 to 3.8 micro g/L (normal 3 +/- 2.4), pulmonary vascular resistance (PVR) from 553.8 to 238.6 dyne.sec.cm(-5) (normal 67 +/- 30) and mean pulmonary arterial pressure from 51 to 32 mmHg (normal 9 to 19) occurred in tandem. Normalization of blood hypercoagulability as reflected in plasma TAT level by chronic blood transfusion was the likely basis for improvement of increased PVR, being secondary to thrombotic pulmonary arteriopathy, and subsequently PHT.

No. 35 Authors Title Source Keywords Abstract

: Atichartakarn V, Likittanasombat K, Chuncharunee S, Chandanamattha P, Worapongpaiboon S, Angchaisuksiri P, Aryurachai K. : Pulmonary arterial hypertension in previously splenectomized patients with beta-thalassemic disorders. : International Journal of Hematology. 78(2) : 139-45, 2003(Aug). : Thalassemia, Splenectomy, Pulmonary hypertension. : Our aim was to study the cause and describe the clinical features of pulmonary arterial hypertension (PHT) in splenectomized beta-thalassemia (beta-Thal) patients. Ten splenectomized beta-Thal patients with systolic pulmonary artery (PA) pressure >30 mm Hg were evaluated by echocardiography, right-heart catheterization, and pulmonary angiography. Five of these patients later underwent hemodynamic studies. Echocardiography and pulmonary angiography on the 10 patients showed normal values of left ventricular systolic function and no findings of acute or chronic pulmonary embolism. Hemodynamic evaluation showed very high PA pressures associated with markedly increased pulmonary vascular resistance indices (PVRIs). Hematological evaluation of the 10 patients showed marked anemia, markedly increased numbers of nucleated red blood cells (nRBCs), and serum ferritin. Mean platelet count, plasma beta(2) thromboglobulin, and thrombinantithrombin III complex levels were significantly increased. It was concluded that PHT can be found in splenectomized beta-Thal patients. Features associated with PHT were female sex, hemoglobin E/beta-Thal, status many years postsplenectomy, marked anemia, markedly increased nRBC count, thrombocytosis, and very high serum ferritin levels. PHT was not due to pulmonary emboli. Our findings suggested that severe PHT was due to increased PVRI from thrombotic pulmonary arteriopathy, likely from chronic low-grade hypercoagulability and platelet activation after splenectomy.

No. 36 Authors Title Source Keywords Abstract

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Attia J, Thakkinstian A, D'Este C. Meta-analyses of molecular association studies: Methodologic lessons for genetic epidemiology. Journal of Clinical Epidemiology. 56(4) : 297-303, 2003(Apr). Systematic review, Meta-analysis, Molecular association studies, Genetic models, Hardy-Weinberg equilibrium, Multiple comparisons. : Meta - analyses of population-based molecular association studies have become increasingly common over the last 10 years, but little attention has been paid to methodology. In addition to the traditional considerations pertinent to any meta-analysis, there are genetic issues particular to molecular association studies: checking Hardy-Weinberg equilibrium, handling data from more

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Mahidol University Abstract of International Publications 2003

than two groups while avoiding multiple comparisons, and pooling data in a way that is sensitive to genetic models. We systematically reviewed all meta-analyses of molecular association studies identified via MEDLINE. Of a total of 37 studies, eight (22%) described the search terms. Nineteen (51%) did not state inclusion or exclusion criteria. Heterogeneity was assessed in 28 (76%), but only 7 of 37 (19%) studies checked for publication bias. Nine (24%) studies assessed the goodnessof-fit of Hardy-Weinberg equilibrium, and eight (22%) gave any biological rationale to justify the choice of genetic model used for pooling. There is a need for greater communication between epidemiologists and geneticists to develop methods appropriate to this area.

No. 37 (347) Authors : Title : Source : Keywords :

Ayuthya SKN, Malathum K, Matangkasombut OP. Restriction of vancomycin use at a university hospital in Thailand. American Journal of Health-system Pharmacy. 60(10) : 1053-4, 2003(May). Medical-center, Criteria.

No. 38 Authors Title Source Keywords Abstract

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Bhumisirikul W, Bhumisirikul P, Pongchairerks P. Long-term storage of small surgical instruments in autoclaved packages. Asian Journal of Surgery. 26(4) : 202-4, 2003(Oct). Surgical instruments, Operating. BACKGROUND: In most operating theatres, unused sterile instruments must be re-sterilized according to preset protocols. Protocols differ among institutions and are not based on strong scientific evidence. OBJECTIVE: To determine and compare the duration of sterility of small instruments packaged in double-layered linen versus plastic-paper envelopes after autoclaving. MATERIALS AND METHODS: Two groups of orthopaedic screws were simultaneously sterilized by autoclaving. In Group 1, each screw was packaged in a double-wrapped linen pack. The screws in Group 2 were individually packaged in an inner wrap of paper and an outer plastic-paper envelope that is commercially available. Unwrapped screws in Group 3 served as controls. During the first 48 weeks, five packages were randomly taken from each group, and from 48 weeks to 96 weeks, 20 packages were taken at random and sent for microbial culture. Five screws from Group 3 were also randomly picked with each sample. RESULTS: Up to 96 weeks, no organisms were cultured from any sample from Groups 1 and 2. Almost all samples from Group 3 grew several species of bacteria. CONCLUSION: For small metal instruments, autoclaved packages in double-wrapped linen or doublewrapped plastic-paper combinations can be stored safely for at least 96 weeks.

No. 39 Authors Title Source Keywords Abstract

: Boonlert W. : Comparison of the Performance of Point-of-Care and Device Analyzers to Hospital Laboratory Instruments. : Point of Care. 2 : 172-8 (Issue 3) 2003(Sep). : Critically ill, Blood plasma, Critical care medicine, Point-of-care testing. : SUMMARY: Point-of-care testing plays an important role in critical care medicine. This study evaluated the performance of the OPTI CCA and OMNI 9 critical care analyzers by comparing them to our currently used routine instruments (Stat Profile Ultra C, CRT, Dimension RxL, and Cell Dyn). The authors used least squares linear regression, the correlation coefficient, mean bias, and Student t test for data analysis. Three levels of aqueous control material were used to perform within-run and between-day evaluation of imprecision, as well as recovery studies, and arterial whole-blood and plasma obtained from critically ill patients were used to perform the comparison study. For within-run and between-day imprecision, the coefficients of variation of analyte measurements obtained with the OPTI and OMNI were within acceptable limits, and the recovery of analytes was close to 100%. Most comparison results from the OPTI and OMNI correlated well with results from

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Mahidol University Abstract of International Publications 2003

currently used routine instruments. Most analytes on the OPTI and OMNI showed acceptable agreement with small mean biases, except pO2, Na+, and Cl-. Therefore, users should check these analytes and consider the potential clinical significance of such bias. Otherwise, the OPTI CCA and the OMNI 9 are suitable for analysis of samples from patients in critical care.

No. 40 Authors Title Source Keywords

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Bunyaratavej N, Penkitti P, Kittimanon N, Boonsangsom P. The effect of menatetrenone on biochemical markers in bone remodelling. Bone. 32(5) : S219 (Suppl. S), 2003(May). Menatetrenone, Bone remodelling.

No. 41 Authors Title Source Keywords Abstract

: Chailurkit LO, Jongjaroenprasert W, Rungbunnapun S, Ongphiphadhanakul B, Sae-Tung S, Rajatanavin R. : Effect of alendronate on bone mineral density and bone turnover in Thai postmenopausal osteoporosis. : Journal of Bone and Mineral Metabolism. 21(6) : 421-7, 2003. : Alendronate, Postmenopausal osteoporosis bone, Mineral density, Biochemical markers of bone resorption. : Alendronate has recently been approved for the prevention and treatment of postmenopausal osteoporosis, and its efficacy has been demonstrated in many Western countries. Our present study was performed to evaluate the effect of alendronate on bone mineral density (BMD) and its tolerability in Thais. Eighty postmenopausal women with osteoporosis participated in this study. After giving informed consent, the subjects were randomly allocated either 10 mg alendronate or placebo in a double-blind fashion. All patients received a supplement of 500 mg elemental calcium daily. BMD at the lumbar spine, femoral neck, and distal forearm was measured at baseline and 6 and 12 months after treatment. Biochemical markers of bone resorption were determined at baseline and 6 months after treatment. Baseline characteristics were similar in both alendronate- and placebotreated groups. Ten subjects discontinued the study. Of 70 subjects, 32 received 10 mg alendronate daily and the remaining subjects received placebo. At 1 year, BMD in the alendronate-treated group had increased from baseline by 9.2%, 4.6%, and 3.1% at lumbar spine, femoral neck, and distal forearm, respectively. These percentages were greater than those in controls (4.1%, 0.6%, and 1.0%, respectively). Urinary N-terminal telopeptide (NTx)-I and serum C-terminal telopeptide (CTx)-I levels decreased in both groups after 6 months of treatment. However, more reduction was demonstrated in the alendronate-treated group (71.9% vs. 28.4%, P < 0.01, and 84.7% vs. 33.1%, P < 0.01, respectively). Compliance with treatment and drug tolerability were good in both alendronate and placebo groups. We concluded that treatment with alendronate 10 mg daily for Thai postmenopausal women with osteoporosis significantly increased BMD at all skeletal sites and reduced biochemical markers of bone resorption. It was well tolerated without any serious side effects.

No. 42 Authors Title Source Keywords Abstract

: Chaimuangraj S, Jamavan K, Mokkhavesa C, Timvipak C, Junvimalaung N, Stitchantrakul W, Kochakarn W, Gojaseni P. : Cystine urinary lithiasis in Thailand: a report of five cases. : Journal of the Medical Association of Thailand. 86(6):573-8, 2003(Jun). : Cystine urinary lithiasis. : Cystine urinary stone is an autosomal recessive hereditary disease, frequently recurring and resisting fragmentation by Shockwave lithotripsy. As cases have never been reported before in Thailand, five cases of renal cystine stones at Ramathibodi Hospital were reported. Two were in the same family. In all cases the stones were removed by open surgery or percutaneous nephrolithotomy. Postoperatively, all the stones were analyzed by infrared spectroscopy for cystine. In two cases,

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Mahidol University Abstract of International Publications 2003

cystine stones were also identified by scanning electron microscopy. Urine was analyzed for cystine by sodium cyanide-nitroprusside test, its concentration by spectrophotometry and cystine crystals were identified by the new crystal induction technique under light microscopy. By high-performance liquid chromatography (HPLC) test, urinary dibasic amino acids (ornithine, lysine, arginine) in these cases were also found to be significantly elevated. Clinical findings, diagnosis, treatment and prevention of cystine stones are reviewed.

No. 43 Authors Title Source Keywords Abstract

: Chaimuangraj S. Thamavit W. Tsuda H. Moore MA. : Experimental investigation of opisthorchiasis-associated cholangiocarcinoma induction in the Syrian hamster - pointers for control of the human disease. : Asian Pacific Journal of Cancer Prevention. 4(2) : 87-93, 2003(Apr-Jun). : Cholangiocarcinoma, Human Disease, CCCs. : Appropriate animal models for specific diseases in man can facilitate elucidation of mechanisms underlying tumour development and allow potential interventions and therapeutic regimens to be tested in vivo before consideration for use in the human situation. In the North-east of Thailand exceptionally high levels of cholangiocellular carcinomas (CCCs) are encountered, related to infestation with Opisthorchis viverrini liver flukes. The Syrian hamster can also be infected with metacercariae of the fluke and heavy loads of parasites cause the development of cirrhotic livers. While the presence of flukes alone does not give rise to neoplasms, large yields of cholangiofibrotic lesions and CCCs can be readily induced with additional carcinogenic insult. While removal of the parasite with the antihelminthic drug Praziquantel can protect against carcinogenesis, this is dependent on the timing of the drug administration and the efficacy of application to the human situation remains to be confirmed. The available information would suggest that interest needs to be concentrated on potential chemopreventive agents which could be administered to individuals at high risk. Furthermore, understanding of the genesis of CCCs and the characteristics of preneoplastic lesions, again as assessed in the animal model, might allow novel approaches to identification of early stage cases and effective surgical intervention.

No. 44 Authors Title Source Keywords Abstract

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Chaiworramukkun J, Chandanamattha P, Boonbaichaiyapruck S. Thrombolysis for prosthetic valve malfunction: case report and review. Journal of the Medical Association of Thailand. 86:S110-5 (Suppl 1), 2003(May). Thrombolysis, Prosthetic Valve Malfunction, Old Female. A 40 year old female with severe mitral valve stenosis, underwent mitral valve replacement by single disc valve 4 years ago. She presented at this admission with a new onset of congestive heart failure. The prothrombin time was inadequate with international normalized ratio (INR) 1.43. Transthoracic echocardiography revealed high pressure gradient across the mitral valve. Fluoroscopy demonstrated restrictive opening of single disc motion. Intravenous thrombolysis was given for presumptive diagnosis of prosthetic valve thrombosis. The patient gradually improved and did not have to undergo surgical correction.

No. 45 (370) Authors : Chaiyata P, Puttadechakum S, Komindr S. Title : Effect of chili pepper (Capsicum frutescens) ingestion on plasma glucose response and metabolic rate in Thai women. Source : Journal of the Medical Association of Thailand. 86(9) : 854-60, 2003(Sep). Keywords : Chili Pepper, Capsicum Frutescens, Thai, Women, Metabolic Rate. Abstract : OBJECTIVES: To evaluate the effect of 5 g fresh chili pepper (CAP) on glucose response after a glucose drink and metabolic rate (MR) in Thai women. MATERIAL AND METHOD: The glucose response after a glucose drink was evaluated in 10 healthy women. The plasma glucose levels at 0,

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Mahidol University Abstract of International Publications 2003

15, 30 and 60 min after glucose load with and without 5 g fresh CAP were compared. Evaluation of MR was performed in an additional 12 subjects. MR was measured by the ventilated-hood indirect calorimetry system before and for 60 min after CAP ingestion. RESULTS: The rise of plasma glucose at 30 min after CAP ingestion was significantly lower than the rise of plasma glucose after a plain glucose drink by 20.6 per cent (p < 0.01). On the other hand, the CAP ingestion significantly increased MR above resting MR. Moreover, MR immediately increased by 20 per cent within a few minutes after CAP ingestion and showed a remarkable increase of 7.2-17.4 per cent from baseline for 11 min. The significance of thermogenic change was present up to 30 min (p < 0.05). CONCLUSIONS: Within 30 min after consumption of 5 g of Capsicum frutescens, plasma glucose level during the absorption period was significantly inhibited. The metabolic rate was also immediately increased after ingestion and sustained up to 30 min. No. 46 Authors Title Source Keywords Abstract

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Chanrachakul B, Herabutya Y. Postterm with favorable cervix: is induction necessary? Journal of Obstertrics Gynecology and Reproductive Biology. 106(2) : 154-7, 2003(Feb). Delivery, Favorable cervix, Pregnancy, Prolonged. Objective: To study the cesarean rate between expectant management and immediate induction in the otherwise uncomplicated postterm pregnancy with favorable cervix. Study design: A total of 249 women with uncomplicated pregnancies at 41 weeks plus 3 days (290 days) with favorable cervix (Bishop score greater than or equal to6) were randomized to either expectant management (n = 125) or immediate induction of labor (n = 124). The women in the induction group were sent to labor ward for induction by artificial rupture of membranes (ARM) and/or oxytocin infusion. The women with expectant management had nonstress test (NST) and amniotic fluid index (AFI) performed once a week and twice a week after 43 weeks of gestation until spontaneous labor. Results: The cesarean rate was not different between expectant management and immediate induction (21.6% versus 26.6%; P = 0.36). Ninety-five percent of the expectant group delivered within 1 week after enrollment, and all of them delivered within 9 days after randomization. Maternal and fetal complications in both groups were not different. There was also no difference in the mean birth weight (P = 0.24) and the frequency of macrosomia (birth weight greater than or equal to4000 g) between the two groups (P = 0.23). Conclusion: Cesarean section rate between expectant management and immediate induction in the otherwise uncomplicated postterm pregnancy with favorable cervix was not different. Due to the very low adverse perinatal outcome, both expectant management and immediate induction are acceptable.

No. 47 Authors Title Source Keywords No. 48 Authors Title Source Keywords Abstract

: Chaudhry HR, Kongsakon R, Ignacio JC, Raza SB, Leynes MCR, Hasanah CI, Chan B, Onate P, Brnabic AJM, Lowry AJ, Buenaventura R. : Quality of life and clinical outcomes for Asian outpatients with schizophrenia: A double-blind randomised comparison of olanzapine and haloperidol. : European Neuropsychopharmacology. 13 : S309 (Suppl. 4), 2003(Sep). : Quality of life, Schizophrenia, A double-blind randomised comparison, Olanzapine, Haloperidol.

: Chittacharoen A, Domhardt R, Manonai J, Golbs S. : Efficacy and tolerability of the hormone replacement drug estradiol valerate/levonorgestrel in the treatment of menopausal syndrome in Thai women. : Methods and Findings in Experimental and Clinical Pharmacology. 25(8) : 645-51, 2003(Oct). : Estradiol valerate/levonorgestrel, Hormone replacement therapy, Menopausal syndrome. : A prospective, open, single-center; uncontrolled phase IV study examined the efficacy; and tolerability, of a 6-month oral sequential hormone replacement therapy (estradiol valerate and levonorgestrel; Klimmiorm((R))) in 50 outpatient peri- and postmeaopausal Thai women. The clinical

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Mahidol University Abstract of International Publications 2003

effectiveness of the drug was demonstrated by a rapid alleviation of the classical vasomotor menopausal complaints and a favorable effect on lipid metabolism. A rapid reduction in climacteric

complaints ranging up to the complete absence of symptoms was achieved during the first 3 months

of treatment. The positive effect on lipid metabolism was demonstrated by a clear refuction in total cholesterol and trigylcerides as well as a slight reduction in the LDL fraction and a significant increase in the HDL fraction. The therapy resulted in stabilizaiion of the cvcle length. Cycles with regular withdrawal bleeding periods lasting 3 to 4 days with mostly mild intensiiv were restored in most of the women. The thickness of the endometrium measured sonographically did not change significantly. The drug was safe and well tolerated by most of the women. There were no clinically significant changes in body weight, blood pressure, hematological tests, and other laboratory parameters. Complimice was very good with a dropout rate due to undesirable side effects of only 5%.

No. 49 Authors Title Source Keywords

: Chittacharoen A, Herabutya Y, Punyavachira P. : A randomized trial of oral and vaginal misoprostol to manage delivery in cases of fetal death - In reply. : Obstetrics and Gynecology. 101(6) : 1354, 2003(Jun). : Vaginal Misoprostol, Fetal Death.

No. 50 Authors Title Source Keywords Abstract

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Chittacharoen A, Herabutya Y, Punyavachira P. A randomized trial of oral and vaginal misoprostol to manage delivery in cases of fetal death. Obstetrics and Gynecology. 101(1) : 70-3, 2003(Jan). Abortion, Labor. OBJECTIVE: To compare the effectiveness and side effects of oral and vaginal misoprostol for the termination of second and third trimester pregnancy with intrauterine fetal death. METHODS: Eighty pregnant women at 16-41 weeks' gestation with intrauterine fetal death were randomized in two groups to receive either 400 mug of misoprostol orally every 4 hours (n = 40) or 200 mug of misoprostol vaginally every 12 hours (n = 40) until the termination of pregnancy was completed. The adverse effects, progress, and outcomes of delivery were assessed. RESULTS: The groups were similar in age, weight, height, gestational age, parity, and modified Bishop scores before intervention. The mean induction-to-delivery time in the oral group (13.95 [standard deviation (SD) = 5.63] hours) was significantly shorter than the time in the vaginal group (18.87 [SD = 10.38] hours, P = .001). The number of deliveries within 24 hours after the initial drug administration in the oral group (92.5%) was significantly higher than the number in the vaginal group (67.5%, P < .001), and all delivered within 48 hours after the initial drug administration. However, the gastrointestinal side effects in the oral group was significantly higher than in the vaginal group (P = .005). CONCLUSION: Misoprostol (400 mug given orally every 4 hours) was more effective than misoprostol (200 mug given vaginally every 12 hours) for the termination of second and third trimester pregnancy with intrauterine fetal death, but with more gastrointestinal side effects.

No. 51 Authors Title Source Keywords Abstract

: Chuansumrit A, Suwannuraks M, Sri-Udomporn N, Pongtanakul B, Worapongpaiboon S. : Recombinant activated factor VII combined with local measures in preventing bleeding from invasive dental procedures in patients with Glanzmann thrombasthenia. : Blood Coagulation and Fibrinolysis. 14(2) : 187-90, 2003(Feb). : Glanzmann thrombasthenia, Dental procedure, Recombinant activated factor VII. : Recombinant activated factor VI I (rFVIIa), combined with local measures of fibrin glue and a celluloid splint, preventing bleeding from four invasive dental procedures is reported. A single dose of 180-200 mug/kg was successfully used in three surgical removals of impacted teeth. Four

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Mahidol University Abstract of International Publications 2003

doses of rFVIIa were required in another full mouth treatment of extraction, pulpotomy, filling and the stainless steel crowning of 13 teeth. The repeated dose of rFVIIa was given whenever the bleeding complication was visualized. It is cost-effective for preventing external bleeding. Additionally, an oral rinsing solution of tranexamic acid (25 mg/kg) was given three times a day for 7 days. In conclusion, rFVIIa has been shown to be an effective alternative to platelet concentrate in patients with Glanzmann thrombasthenia.

No. 52 Authors Title Source Keywords Abstract

: : : : :

Chuansumrit A. Treatment of haemophilia in the developing countries. Haemophilia. 9(4) : 387-90, 2003(Jul). Developing countries, Haemophiliac. In developing countries, most of the patients with haemophilia are in the paediatric age group as they seldom reach adulthood because of inadequate treatment. Haemophilia is not given the priority it deserves as there are high numbers of other serious health problem. Haemophilia care should be integrated into the existing healthcare system of a primary care centre, a treatment centre, a comprehensive care centre and a reference centre. It Is considered important to educate the personnel through the curriculum of medical students and all healthcare personnel. Diagnosis should be started at the antenatal stage and subsequently confirmed by laboratory testings. Qualified therapeutic products should be produced locally in combination with imported affordable factor concentrate. In-house preparation of fibrin glue is helpful for dental procedures without the need for any blood component. Home care treatment is essential and can be adopted even by parents with low literacy. Lastly, research for laboratory diagnosis, treatment and prevention should be continuously conducted to serve people with haemophilia specifically in developing countries.

No. 53 Authors Title Source Keywords

: Chuansumrit A. : Confirmation of high dose recombinant factor VIIa in treating patients with Glanzmann thrombasthenia. : Journal of Thrombosis and Haemostasis. 1(2) : 396, 2003(Feb). : Recombinant factor VIIa, Glanzmann thrombasthenia.

No. 54 Authors Title Source Keywords

: Chyun DA, Katten DM, Minicucci DS, Davey JA, Khuwatsamrit K, Inzucchi SE, Melkus GD. : Motivational and psychological factors associated with control of Type 2 diabetes mellitus (T2DM) and cardiac risk factors (CRFs). : Diabetologia. 46 : 1242 (Suppl. 2), 2003(Aug). : Type 2 Diabetes Mellitus, T2DM, Cardiac Risk Factors, CRFs.

No. 55 Authors Title Source Keywords Abstract

: Domrongkitchaiporn S, Sirikulchayanonta V, Angchaisuksiri P, Stitchantrakul W, Kanokkantapong C, Rajatanavin R. : Abnormalities in bone mineral density and bone histology in thalassemia. : Journal of Bone and Mineral Research. 18(9) : 1682-8, 2003(Sep). : Thalassemia, Bone histomorphometry, Bone turnover marker, Bone densitometry, Iron. : Introduction: Bone histomorphometric studies in thalassemia to show alterations in bone histology and their relationship to biochemical parameters are very limited. Therefore, this study was systematically conducted to determine the alterations in thalassemia patients. Methods: Serum biochemical parameters, trans-iliac crest bone biopsy, and determination of bone mineral density of femur and lumbar spine were done in 18 thalassemic patients (10 females and 8 males). Results:

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Mahidol University Abstract of International Publications 2003

Serum osteocalcin, carboxy terminal teleopeptide fragment of type I collagen, and parathyroid hormone levels were within normal limits, but serum 25(OH) vitamin D (19.3 +/- 1.6 ng/ml) and 1,25(OH)2 vitamin D (33.77 +/- 1.51 pg/ml) levels were decreased. Serum insulin-like growth factor I (IGF-I; 145.2 +/- 20 ng/ml) was suppressed, whereas serum ferritin (1366.6 +/- 253.9 ng/ml) was markedly elevated. Reduced bone mineral density was found in all studied areas. Trabecular bone volume was significantly decreased (16.65 +/- 1.12%), whereas bone formation rate, eroded surface, and other bone histomorphometric parameters were within normal limits. The trabecular bone volume varied significantly with bone mineral density of total femur (r = 0.48, p = 0.04). There was an extensive stainable iron surface on the mineral front (9-60%). Significant correlation between serum IGF-I, serum ferritin, stainable iron surface, and bone mineral density, lumbar spine, and total femur were found. Serum IGF-I correlated with trabecular bone volume (r = 0.6, p = 0.03), inversely with both serum ferritin level (r = -0.6, p < 0.01), and inversely with stainable iron surface (r = -0.53, p = 0.02). Multiple regression analysis demonstrated that IGF-I was the only independent variable that determined bone mineral density of lumbar spine and total femur. Conclusion: Low bone mineral density and reduced trabecular bone volume with extensive iron deposition are the predominant

findings in thalassemic patients. There was no evidence of increased bone resorption or mineralization

defect. A reduction in circulatory IGF-I may modulate the reduction of bone mass.

No. 56 Authors Title Source Keywords Abstract

: : : : :

Donsakul K, Dejthevaporn C, Witoonpanich R. Streptococcus suis infection: clinical features and diagnostic pitfalls. Southeast Asian J Trop Med Public Health. 34(1) : 154-8, 2003(Mar). Streptococcus Suis Infection, Diagnostic Pitfalls. Eight cases of Streptococcus suis (S. suis) infection between 1993-1999 were retrospectively studied. There were 6 cases of meningitis and 2 cases of endocarditis. Acute meningitis with early sensorineural hearing loss was the characteristic feature and the most common presentation of S. suis infection. S. suis endocarditis is a rare presentation in Thailand. This organism was often mistaken for Streptococcus pneumoniae or Streptococcus viridans. In this study, this was true in five cases in whom S. suis was identified later. However, the rapid diagnosis of S. suis meningitis may rely on Gram stain of the CSF in the setting of acute meningitis with hearing loss. These cases were treated with intravenous penicillin or ampicillin with a mean duration of 4 weeks. This treatment was very effective and there was no relapse among these patients.

No. 57 Authors Title Source Keywords Abstract

: Fanti P, Stephenson TJ, Kaariainen IM, Rezkalla B, Tsukamoto Y, Morishita T, Nomura M, Kitiyakara C, Custer LJ, Franke AA. : Serum isoflavones and soya food intake in Japanese, Thai and American end-stage renal disease patients on chronic haemodialysis. : Nephrology Dialysis Transplantation. 18(9) : 1862-8, 2003(Sep). : Diet, Genistein, Phytochemicals, Soya, Uraemia. : Background. Soya foods, a staple in several Asian countries, have received increasing attention because of their nutritional properties and their high isoflavone content. We have shown recently abnormal pharmacokinetics of soya isoflavones following acute oral intake, in soya-naive endstage renal disease (ESRD) patients. No information is available, however, about blood levels of soya isoflavones in ESRD patients with habitual soya intake. Additionally, no information is available about the conjugation profile of these compounds in ESRD patients. Methods. To assess the relationship between habitual soya intake on blood isoflavone levels in ESRD patients, we recorded dietary soya food intake and analysed circulating levels of soya isoflavones in randomly selected, clinically stable haemodialysis patients from the United States (n = 20), Thailand (n = 17) and Japan (n = 20). Dietary records and three weekly blood samples were collected from each participant. Combined isoflavones and individual genistein, daidzein, glycitein and O-desmethylangolensin

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Mahidol University Abstract of International Publications 2003

(DMA) were analysed in serum by liquid chromatography/mass spectrometry. Lipid phase micronutrients, including tocopherols, carotenoids and retinol were also measured to compare ethnic differences in isoflavones with those of more common lipid soluble antioxidant micronutrients. Results. Soya intake was higher in Japanese than in Thai patients and it was negligible in the US patients. Blood levels of genistein were very elevated and significantly higher in the Japanese patients (1128 +/- 205 nM), as compared with the Thai and US patients (258 64 and 168 49 nM, respectively; P < 0.001). The other isoflavones followed the same trend. Daidzein was more concentrated than genistein in the dialysis patients. Robust correlation was present between weekly soya intake and blood isoflavone levels (r=0.56, P < 0.001). Despite very high total isoflavone concentrations, the levels of unconjugated and sulphated isoflavones in the Japanese patients were comparable to those described in healthy subjects. Compared with the striking difference in isoflavones, more easily accessible dietary antioxidants, including tocopherols, carotenoids and retinol, differed only minimally or not at all in the three groups. Conclusions. ESRD patients appear to accumulate isoflavones as a function of dietary soya intake, resulting in blood concentrations that are higher than those reported in subjects with preserved kidney function. Even in the presence of very elevated total isoflavone levels, the concentrations of the unconjugated and sulphated fractions are comparable to those of healthy subjects. A discrepancy is noted between accumulation of soya isoflavones and other more common lipid-soluble antioxiant micronutrients.

No. 58 Authors Title Source Keywords Abstract

: Guan Z, Wang Y, Maoleekoonpairoj S, Chen Z, Kim WS, Ratanatharathorn V, Reece WHH, Kim TW, Lehnert M. : Prospective randomised phase II study of gemcitabine at standard or fixed dose rate schedule in unresectable hepatocellular carcinoma. : British Journal of Cancer. 89(10) : 1865-9, 2003(Nov). : Hepatocellular carcinoma, Gemcitabine. : The present randomised phase II study was an effort to evaluate single-agent gemcitabine as a first-line systemic treatment of Asian patients with unresectable hepatocellular carcinoma (HCC). Gemcitabine was given via intravenous infusion at 1250 mg m(-2) on days 1 and 8 of 3-week cycles. Patients were randomised to receive gemcitabine as a 30-min intravenous infusion (standard schedule) or at a fixed dose rate (FDR) of 10 mg m(-2) min(-1). A total of 50 patients were enrolled in the study, of whom 48 received study therapy. One patient on standard schedule had a partial response, for an overall response rate of 2.1% (95% CI: 0.05 - 11.1%). The median time to progression and survival time were 46 and 97 days, respectively. The overall rates of Grade 3 or 4 haematological and nonhaematological toxicities were 39.6 and 64.6%, respectively, with no significant difference between the two treatment arms. There were no drug-related deaths and severe clinical toxicities were rare. Both schedules of gemcitabine were safe and toxicity was well manageable in this patient population. However, gemcitabine seems no more active than other cytotoxic agents when used alone for systemic treatment of advanced HCC.

No. 59 (191) Authors : Hamada T, Wessagowit V, South AP, Ashton GHS, Chan I, Oyama N, Siriwattana A, Jewhasuchin P, Charuwichitratana S, Thappa DM, Lenane P, Krafchik B, Kulthanan K, Shimizu H, Kaya TI, Erdal ME, Paradisi M, Paller AS, Seishima M, Hashimoto T, McGrath AA. Title : Extracellular matrix protein 1 gene (ECM1) mutations in lipoid proteinosis and genotype-phenotype correlation. Source : Journal of Investigative Dermatology. 120(3) : 345-50, 2003(Mar). Keywords : Genodermatosis, Hyalinosis cutis et mucosae, Alternative splicing. Abstract : The autosomal recessive disorder lipoid proteinosis results from mutations in extracellular matrix protein 1 (ECM1), a glycoprotein expressed in several tissues (including skin) and composed of two alternatively spliced isoforms, ECM1a and ECM1b, the latter lacking exon 7 of this 10-exon gene (ECMI). To date, mutations that either affect ECM1a alone or perturb both ECM1 transcripts have

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Mahidol University Abstract of International Publications 2003

been demonstrated in six cases. However, lipoid proteinosis is clinically heterogeneous with affected individuals displaying differing degrees of skin scarring and infiltration, variable signs of hoarseness and respiratory distress, and in some cases neurological abnormalities such as temporal lobe epilepsy. In this study, we sequenced ECM1 in 10 further unrelated patients with lipoid proteinosis to extend genotype-phenotype correlation and to add to the mutation database. We identified seven new homozygous nonsense or frameshift mutations: R53X (exon 3); 243delG (exon 4); 507delT (exon 6); 735delTG (exon 7); 785delA (exon 7); 892delC (exon 7) and 1190insC (exon 8), as well as two new compound heterozygous mutations: W160X/F167I (exon 6) and 542insAA/R243X (exons 6/7), none of which were found in controls. The mutation 507delT occurred in two unrelated subjects on different ECM1 haplotypes and may therefore represent a recurrent mutation in lipoid proteinosis. Taken with the previously documented mutations in ECM1, this study supports the view that exons 6 and 7 are the most common sites for ECM1 mutations in lipoid proteinosis. Clinically, it appears that mutations outside exon 7 are usually associated with a slightly more severe mucocutaneous lipoid proteinosis phenotype, but neurological features do not show any specific genotypephenotype correlation.

No. 60 Authors Title Source Keywords Abstract

: Herabutya Y, Chanarachakul B, Punyavachira P. : Induction of labor with vaginal misoprostol for second trimester termination of pregnancy in the scarred uterus. : International Journal of Gynaecology and Obstetrics. 83(3) : 293-7, (2003 Dec). : Vaginal Misoprostol, Scarred Uterus, Second Trimester Pregnancy. : OBJECTIVES: To assess the safety of vaginal misoprostol for second trimester pregnancy termination in patients with a history of cesarean section. METHODS: A consecutive series of 593 women with pregnancies of 14-26 weeks were studied. A cohort of 56 cases had undergone previous cesarean section delivery. The 528 cases who had no history of prior uterine surgery served as the controls. The termination was carried out according to the regimen used at the time of enrollment, either 600 microg applied at every 6 or every 12 h, or 800 microg applied at every 12 h using the vaginal route. RESULTS: The median induction to abortion time in the previous cesarean section group (15.1 h) was not significantly different from that of the controls (15.8 h). The median total dosage of misoprostol used was the same for both groups (1200 microg). The rates of incomplete abortion and analgesia usage were significantly higher in the previous cesarean section group as compared with the controls. CONCLUSIONS: Vaginal misoprostol was effective for the second trimester pregnancy termination but the safety of misoprostol in the scarred uterus cannot be assumed from this study. A large series is needed to reach the power to see the difference.

No. 61 Authors Title Source Keywords Abstract

: Hirunsatit R, Kongruttanachok N, Shotelersuk K, Supiyaphun P, Voravud N, Sakuntabhai A, Mutirangura A. : Polymeric immunoglobulin receptor polymorphisms and risk of nasopharyngeal cancer. : Bmc Genetics. 4 : Art. No. 3, 2003(Jan). : Epstein-Barr-Virus, To-Cell Contact, Epithelial-Cells, Secretory Component, Carcinoma-Cells, Infection, Diet. : Background: Epstein-Barr virus (EBV) associated nasopharyngeal cancer (NPC) is an important squamous cell cancer endemic in Southeast Asia and the Far East and can be considered a multifactorial genetic disease. This research explores potential associations between nasopharyngeal epithelial EBV receptor and NPC susceptibility. To prove the hypothesis, we evaluated two candidate genes, complement receptor 2 (CR2) and polymeric immunoglobulin receptor (PIGR) by using 4 SNPs, CR2 IVS2-848C --> T, PIGR IVS3-156G --> T, PIGR 1093G --> A and PIGR 1739C -->T, to genotype 175 cases and 317 controls, divided into Thai, Chinese and Thai-Chinese based on their respective ethnic origins. Results: The results obtained indicated that PIGR is an NPC susceptibility

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Mahidol University Abstract of International Publications 2003

gene. The risk association pertaining to each ethnic group was detected for homozygous PIGR 1739C with a significant ethnic group adjusted OR ( 95% CI) of 2.71( 1.72-4.23) and p < 0.00001. Haplotype of the two missense PIGR SNPs, 1093G A and 1739C T, and sequence analyses have confirmed the role of the nucleotide PIGR 1739 and excluded possibility of an additional significant nonsynonymous NPC susceptibility SNP. Conclusions: We present genetic evidence leading to hypothesize a possibility of PIGR to function as the EBV nasopharyngeal epithelium receptor via IgA-EBV complex transcytosis failure. The PIGR 1739C-->T is a missense mutation changing alanine to valine near endoproteolytic cleavage site. This variant could alter the efficiency of PIGR to release IgA-EBV complex and consequently increase the susceptibility of populations in endemic areas to develop NPC.

No. 62 Authors Title Source Keywords Abstract

: Hongeng S, Pakakasama S, Chaisiripoomkere W, Chuansumrit A, Sirachainan N, Ungkanont A, Jootar S. : Outcome of transplantation with unrelated donor bone marrow in children with severe thalassaemia. : Bone Marrow Transplant. 2003(Dec). : Children, Severe Thalassaemia, Bone Marrow Transplantation, BMT, GVHD. : Summary: We conducted a study of unrelated donor bone marrow transplantation (BMT) in 11 children with severe thalassaemia. The conditioning regimen consisted of busulphan, cyclophosphamide and antilymphocyte globulin. All received T-cell nondepleted bone marrow. The median marrow-nucleated cell dose was 4.9 x 10(8) /kg (range; 3.5-8.0 x 10(8) /kg). Median time of granulocyte recovery was 16 days (range; 13-21 days), and of platelet recovery was 39 days (range; 14-196). Grade 2-4 acute graft-versus-host disease (GVHD) developed in six patients (54%), and grade 3-4 in one patient (9%). Three (27%) of 11 evaluable patients had chronic GVHD (limited stage). All 11 patients are alive without thalassaemia after a median follow-up time of 397 days (range; 171-814 days). This study lends support to consideration of unrelated donor BMT as an acceptable therapy to cure severe thalassaemia especially in patients who are young and do not yet show irreversible severe complications of iron overload. Bone Marrow Transplantation advance online publication, 15 December 2003; doi:10.1038/sj.bmt.1704361

No. 63 Authors Title Source Keywords Abstract

: Hongeng S, Petvises S, Worapongpaiboon S, Rerkamnuaychoke B, Pakakasama S, Jootar S. : Generation of CD3(+)CD56(+) cytokine-induced killer cells and their in vitro cytotoxicity against pediatric cancer. : International Journal of Hematology. 77(2) : 175-9, 2003(Feb). : Immunotherapy, CD3(+)CD56(+) cells, Cytotoxicity, Pediatric cancers. : A certain number of pediatric cancer patients still succumb to relapse following conventional treatment of their malignancies. One of the mechanisms of relapse is escape from immunity. Adoptive cellular immunotherapy with effector cells has the potential to overcome this escape. In adults, the CD3(+)CD56(+) cell, a cytokine-induced killer (CI K) cell, appears to be a promising effector cell type with the greatest cytotoxicity. This effector cell type may work in children as well. No similar studies with children have been published. We speculated that expanded CD3(+)CD56(+) cells obtained from pediatric cancer patients during remission would act similarly against various pediatric tumor cell lines; therefore, we undertook the present study to find support for our speculation. This study was undertaken to generate and expand CD3(+)CD56(+) CIK cells from normal peripheral blood mononuclear cells (PBL) obtained from 6 children with cancer (2 with acute lymphoblastic leukemia, 2 with large cell lymphoma, and 2 with osteosarcoma) in remission after intensive chemotherapy and to study the cytotoxic activities of these cells against chronic myeloid leukemia cell line K562 t(9;22), 4 pediatric tumor cell lines [infant acute lymphoblastic leukemia RS4 t(4;1 1), TEL/AML acute lymphoblastic leukemia REH t(12;21), alveolar rhabdomyosarcoma Rh-Cr t(2;1 3), and Ewing sarcoma EW-Le t(11;22)], and 2 pediatric glioblastoma multiforme cultured cell lines (G74 and G77). CIK cells were generated and expanded in culture medium to which interferon gamma,

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Mahidol University Abstract of International Publications 2003

monoclonal antibody against CD3, and interleukin 2 were added at appropriate times. Cells were counted by flow cytometry. Net lactate dehydrogenase release from target cells incubated with CIK cells was used as an index of CIK cell cytotoxicity against various pediatric tumor cell lines. The results show that after 21 days in culture CD3(+)CD56(+) CIK cells derived from the 6 pediatric patients accounted for a median of 28.3 % of the entire culture (range, 10.7%-36.4%). Before expansion no such cells were found in any of the 6 children. Median lytic activity rates of CIK cells were 45.5% to 64.5%, rates that contrasted drastically to the lytic activity rates of PBL, which were only 8% to 12%. The findings of the present study are encouraging. They provide information for developing adoptive immunotherapy for future clinical trials with pediatric cancer patients, particularly those patients with minimal residual disease after intensive chemotherapy or stem cell transplantation (especially nonmyeloablative transplantation procedures).

No. 64 Authors Title Source Keywords Abstract

: Hussain M, Polnikorn N, Goldberg DJ. : Laser-assisted hair removal in Asian skin: Efficacy, complications, and the effect of single versus multiple treatments. : Dermatologic Surgery. 29(3) : 249-54, 2003(Mar). : Pulsed Alexandrite Laser, Ruby-Laser, Selective photothermolysis. : Background. Alexandrite laser hair removal can be quite successful in lighter skin types. Effective hair removal in Asians can be difficult, and multiple treatments are usually required for effective treatment. Objective. To evaluate the safety and efficacy of alexandrite laser hair removal in Asian skin, to determine the benefit of multiple treatments, and to evaluate the value of test patches before laser treatment. Methods. One hundred forty-four Asian subjects with Fitzpatrick skin types III to V were treated with a cooled 40-ms alexandrite laser with fluences of 16 to 24 J/cm(2). Initially, all treated subjects underwent test patch application. After test patch application, 35 subjects with 66 anatomic sites received three treatments. Thirty-five subjects with 66 anatomic sites received two treatments, and 74 subjects with 124 anatomic received a single treatment. All subjects were followed for 9 months after their final treatment. Results. In subjects that were treated three times, a 55% hair reduction was noted at 9 months after the third treatment. In subjects treated two times, a 44% hair reduction was noted at 9 months after the second treatment. In subjects treated only one time, a 32% hair reduction was noted at 9 months after the single treatment. No subjects had scarring or long-term pigmentary changes. There appeared to be no correlation between test patch acute complications and those seen after actual treatments. Conclusion. Although Asian skin can be effectively treated with a cooled, long-pulsed alexandrite laser, complications do occur. Laser hair removal efficacy was increased with multiple treatments. There does not appear to be an exact correlation in Asian skin between complications occurring after test patch treatment and those seen with subsequent treatments.

No. 65 Authors Title Source Keywords

: : : :

Jallu V, Kaplan C. Human platelet antigen Duv genotyping by PCR-SSP. Journal of Thrombosis and Haemostasis. 1(2) : 396-7, 2003(Feb). Alloantigen, Genotyping, Platelet, SSP.

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Mahidol University Abstract of International Publications 2003

No. 66 Authors Title Source Keywords Abstract

: Jirapinyo M, Theppisai U, Manonai J, Suchartwatnachai C, Jorgensen LN. : Effect of combined oral estrogen/progestogen preparation (Kliogest((R))) on bone mineral density, plasma lipids and postmenopausal symptoms in HRT-naive Thai women. : Acta Obstetricia et Gynecologica Scandinavica. 82(9) : 857-66, 2003(Sep). : Kliogest((R)), Thai, Estrone, Bone mineral density. : Background. Kliogest((R)) is commonly prescribed for the relief of acute postmenopausal symptoms and prevention of postmenopausal bone loss. However, there have been few data on its effect in Asian women.Methods. This 1-year, single-center, randomized, double-blind and placebo-controlled study evaluated the efficacy and safety of Kliogest((R)) in hormone replacement therapy (HRT)naive Thai women. The subjects were 120 healthy Thai women aged between 45 and 65 years, with intact uterus, and who had been amenorrheic for at least 1 year. Results. Kliogest((R)) increased spine (+ 6%, p < 0.01) and hip (+2%, p < 0.01) bone mineral density (BMD), and lowered plasma total cholesterol (TC) (-16%, p < 0.05) and low density lipoprotein cholesterol (LDL-C) (-16%, p < 0.05) concentrations. However, Kliogest((R)) also resulted in a decrease in high density lipoprotein cholesterol (HDL-C) concentration (-18%, p < 0.05). Compared to placebo, the reduction in menopausal symptoms by Kliogest((R)) was not statistically significant. The frequency and severity of treatment-related uterine bleeding decreased with the duration of Kliogest((R)) treatment. Furthermore, there was a fairly strong relationship between the change in serum estrone concentration and the average monthly weighted bleeding scores over the first 6 months (Spearman's correlation r = 0.54; p < 0.001), which became weaker over the entire treatment period (Spearman's correlation r = 0.27; p < 0.01). Although there was a small to moderate relationship between baseline estrone concentration and both lumbar (r = 0.23, p < 0.02) and hip (r = 0.20, p < 0.05) BMD, there was no significant relationship between Kliogest((R)) -induced change in estrone concentration and change in lumbar and hip BMD. Conclusions. Continuous treatment with Kliogest((R)) for 1 year reversed the potential postmenopausal bone loss in HRT-naive Thai postmenopausal women. However, its effect on cardiovascular risk is uncertain. Furthermore, Kliogest((R)) is safe but appears to have no significant effect on climacteric symptoms in the patients in the present study.

No. 67 Authors Title Source Keywords

: : : :

Jirasiritham S, Mavichak V, Danviriyasup K, Jirasiritham S. Conversion of C-0 to C-2 monitoring of cyclosporine in stable kidney transplant patients. Transplantation Proceedings. 35(1) : 236-7, 2003(Feb). Acute rejection.

No. 68 Authors Title Source Keywords

: Kawamatawong T, Choothakan S, Chaowanakarnkit L, Sathianpitayakul E. : The comparison of characteristics of recoverd fluid between two aspiration techniques of bronchoalveolar lavage procedures (hand suction versus controlled wall suction). : Chest. 124(4) : 78S, 2003. : Hand Suction, Controlled Wall Suction.

No. 69 Authors Title Source Keywords Abstract

: Kiertiburanakul S, Sungkanuparph S, Malathum K, Pracharktam R. : Concomitant tuberculous and cryptococcal thyroid abscess in a human immunodeficiency virusinfected patient. : Scandinavian Journal of Infectious Diseases. 35(1) : 68-70, 2003. : Fine-needle aspiration, Anterior neck mass, Meningitis, Diagnosis, Gland, Aids. : Suppurative thyroiditis is a rare condition caused mostly by Staphylococcus aureus and streptococci. Both tuberculous and cryptococcal thyroid abscess are even rarer. The incidence of extrapulmonary forms of tuberculosis and cryptococcosis has increased in areas with a high prevalence of human

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Mahidol University Abstract of International Publications 2003

immunodeficiency virus (HIV) infection. A case is reported of dual infection by M. tuberculosis and Cryptococcus neoformans presenting as a thyroid abscess in a 32-y-old woman with symptomatic HIV infection. Atypical presentations of both tuberculosis and cryptococcosis should be considered in areas with a high incidence of these diseases.

No. 70 Authors Title Source Keywords

: : : :

Kitiyakara C, Kopp JB, Eggers P. Trends in the epidemiology of focal segmental glomerulosclerosis. Seminars in Nephrology. 23(2) : 172-82, 2003(Mar). Adult Nephrotic Syndrome, Stage Renal-Disease, Glomerular-Disease, Racial-Differences, African-Americans, National Registry, Kidney-Disease, Biopsy, Children, Glomerulonephritis.

No. 71 Authors Title Source Keywords Abstract

: Kochakarn W, Lertsithichai P. : Unilateral transurethral incision for primary bladder neck obstruction: symptom relief and fertility preservation. : World Journal of Urology. 21(3) : 159-62, 2003(Aug). : Primary bladder neck obstruction, Unilateral transurethral incision, Fertility. : Our aim was to review the results of unilateral transurethral incision (TUI) of the bladder neck for the treatment of primary bladder neck obstruction. A total of 35 patients with the mean age of 40.31 years were included in the study. The international prostate symptom score (I-PSS), quality of life (QoL) score, uroflowmetry and sperm count were determined. The mean preoperative I-PSS was 32.1 points, peak urine flow rate was 7.8 cc/s and sperm count was 59.2 million/cc. There was a 28% reduction of I-PSS at 3 months, 38% at 6 months and 55% at 1 year. The urine peak flow rate increased by 54% at 3 months, 83% at 6 months and 95% at 1 year. The reduction in the sperm count was 63% at 6 months and 69% at 1 year. The QoL score improved significantly after 1 year compared with the preoperative period. Unilateral TUI of the bladder neck is an effective treatment for primary bladder neck obstruction. However, the postoperative sperm count is significantly reduced at 6-12 months (18-21 million/cc) but is probably sufficient for adequate fertility.

No. 72 (210) Authors : Title : Source : Keywords : Abstract

Kositchaiwat C, Ovartlarnporn B, Kachintorn U, Atisook K. Low and high doses of rabeprazole vs. omeprazole for cure of Helicobacter pylori infection. Alimentary Pharmacology and Therapeutics. 18(10) : 1017-21, 2003(Nov). Proton Pump Inhibitor, Triple Therapy, Consensus Report, Clarithromycin, Eradication, Amoxicillin, Management, Efficacy, Metaanalysis, E3810. : Background: Low-dose rabeprazole-based triple therapy was effective for Helicobacter pylori eradication in a few Japanese studies. Aim: To compare the effectiveness of 1-week low-dose and high-dose rabeprazole-based triple therapy with those of omeprazole. Methods: One hundred and sixty-two H. pylori-infected dyspeptic patients were randomized to receive twice daily for 1 week either rabeprazole 10 mg (R-10), rabeprazole 20 mg (R-20) or omeprazole 20 mg (O) in combination with amoxicillin 1000 mg (A) and clarithromycin 500 mg (C). H. pylori status assessment was by the CLO test and histology at entry and by the C-13-urea breath test at 4-6 weeks after cessation of therapy. Results: H. pylori eradication rates in intention-to-treat groups were 85%, 96% and 83% for R(10)AC, R(20)AC and OAC, respectively. Eradication rates in per protocol groups were 86%, 96% and 90% for R(10)AC, R(20)AC and OAC, respectively. On an intention-to-treat analysis, the R(20)AC group had a significantly higher eradication rate than did R(10)AC or OAC (P < 0.05). However, the higher eradication rate with R(20)AC did not reach statistical significance in the per protocol analysis. Drug intolerance was found in three OAC patients. Conclusion: High-dose rabeprazole-based triple therapy is more effective than its low-dose equivalent or omeprazole in eradicating H. pylori infection.

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Mahidol University Abstract of International Publications 2003

No. 73 Authors Title Source Keywords

: : : :

Kulvatunyou N. Internal jugular vein and anatomic relationship at the root of the neck ­ Response. Anesthesia and Analgesia. 96(5) : 1540-1, 2003(May). Vein, Neck.

No. 74 Authors Title Source Keywords Abstract

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Kunavisarut S, Nimvorapan T, Methasiri S. Pythium corneal ulcer in Ramathibodi Hospital. Journal of the Medical Association of Thailand. 86(4) : 338-42, 2003(Apr). Corneal Ulcers, Pythium Insidiosum. This is a retrospective study of corneal ulcers caused by Pythium insidiosum in Ramathibodi Hospital from 1988 to 1998. The clinical data was from the medical records of 10 patients, of which 8 had complete information. Mean age of the patients was 49.8 years old and seven were farmers. Initial visual acuity was mostly below finger counts. All manifested as fungal corneal ulcers, diagnosis of Pythium insidiosum was confirmed by histology. After failed medication, penetrating keratoplasty (PKP) was performed in order to remove the infected tissue. One patient had only anterior lamella keratectomy performed and was completely cured. Seven other patients had to have their eyes removed (evisceration or enucleation) to be cured. The study shows that Pythium corneal ulcer is rare but devastating. Patients with an agricultural occupation are most at risk. Antibiotics and antifungals could not control or cure this disease, so education for people at high risk is advocated.

No. 75 (218) Authors : Kwan ACP, Bao TN, Chakkaphak S, Chang FY, Ke MY, Law NM, Leelakusolvong S, Luo JY, Manan C, Park HJ, Piyaniran W, Qureshi A, Long T, Xu GM, Xu LY, Yuen H. Title : Validation of Rome II criteria for functional gastrointestinal disorders by factor analysis of symptoms in Asian patient sample. Source : Journal of Gastroenterology and Hepatology. 18(7) : 796-802, 2003(Jul). Keywords : Asia, Constipation, Diarrhea, Dyspepsia, Factor analysis, Functional gastrointestinal disorder, Heartburn, Irritable bowel syndrome, Rome II criteria, Validation. Abstract : Background and Aims: It has been unclear as to whether the Rome II criteria could be applied to patients in the Asia region with functional gastrointestinal (GI) diseases. The aim of the present study was to determine if symptoms of Asian patients with functional gastrointestinal disorders formed groups which corresponded to the Rome II diagnostic criteria. Methods: A modified English version of Talley's bowel disease questionnaire was developed in collaboration with various research teams in accordance with the Rome II criteria. This instrument was translated into the local languages of the following nine Asian regions: China, Hong Kong, Indonesia, Korea, Malaysia, Singapore, Taiwan, Thailand and Vietnam. From September to December 2001, newly enrolled outpatients attending 14 GI or medical clinics in these regions were invited to complete the questionnaire. From these respondents, patients with functional gastrointestinal disorders fulfilling the '12 weeks out of 12 months' criteria were separated for further analysis. Principal component factor analysis with varimax rotation was used to identify symptom clusters or factors. These factors were compared with the existing classification of functional GI diseases derived from the Rome II criteria. Results: Factor analysis of symptoms from 1012 functional GI patients supported the Rome II classification of the following groups of functional GI disorders: diarrhea-predominant irritable bowel syndrome, functional constipation, functional dyspepsia, functional abdominal pain syndrome, functional heartburn, and functional vomiting. Functional diarrhea was combined with functional anorectal disorders, and globus merged with functional dysphagia into one factor. Some of the functional dyspepsia, abdominal bloating and belching symptoms were loaded into one factor. Conclusions: Factor analysis of symptoms from a sample of Asian patients with functional GI disorders partially supported the use of the Rome II classification.

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Mahidol University Abstract of International Publications 2003

No. 76 Authors Title Source Keywords Abstract

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Laothamatas J, Hemachudha T, Mitrabhakdi E, Wannakrairot P, Tulayadaechanont S. MR imaging in human rabies. American Journal of Neuroradiology. 24(6) : 1102-9, 2003(Jun-Jul). Paralytic rabies, Nervous-system, Encephalitis, Diagnosis. BACKGROUND AND PURPOSE: Whether human rabies of different forms, encephalitic (furious) and paralytic (dumb), share similar MR imaging patterns is unknown. We assessed the diagnostic value of MR imaging in both forms of the disease and compared the clinical and neuroimaging findings. METHODS: Three patients with paralytic and two with encephalitic rabies were examined during preserved or deteriorated levels of consciousness. Six MR examinations of the brain, three of the spinal cord, and one of the brachial plexus were performed with a 1.5-T superconducting magnet. RESULTS: No difference was noted between the MR findings in both clinical forms of human rabies. Nonenhancing, ill-defined, mild hyperintensity changes in the brain stem, hippocampi, hypothalami, deep and subcortical white matter, and deep and cortical gray matter were demonstrated on T2-weighted images in the noncomatose patients with rabies. Enhancement along the brachial plexus of the bitten arm was noted in one patient with encephalitic rabies who at that time had only local neuropathic pain symptoms. Enhancement with gadolinium-based contrast material was seen at the hypothalami, brain stem nuclei, spinal cord gray matter, and intradural cervical nerve roots only when the patients became comatose. CONCLUSION: Both forms of human rabies share a similar MR imaging pattern. Such pattern and the lack of enhancement in a noncomatose patient with suspected encephalitis may differentiate rabies from other viral encephalitides.

No. 77 Authors Title Source Keywords Abstract

: Leungwattanakij S, Tiewthanom V, Hellstrom WJ. : Evaluation of corporal fibrosis in cadaveric pericardium and vein grafts for tunica albuginea substitution in rats. : Asian J Androl. 5(4): 295-9, 2003(Dec). : Corporal Fibrosis, Cadaveric Pericardium, Vein Grafts. : AIM: To evaluate the degree of corporal fibrosis in rats with cadaveric pericardium or vein as grafting materials for tunica albuginea substitution. MATERIALS AND METHODS: Thirty male Sprague-Dawley rats (300 g approximately 325 g) were divided at random into 3 groups of 10 animals each: group 1 was the sham-operated controls and groups 2 and 3 underwent wedge excision of tunica albuginea and replacement with cadaveric pericardium and vein grafts, respectively. Four months later, rats were sacrificed and the penis removed to assess the degree of fibrosis using RTPCR technique for TGF-bgr1 mRNA expression. The tissues were fixed in 10% formalin, paraffinembedded and stained with Masson's trichrome and Verhoff's van Giesen for collagen and elastic fibers. RESULTS: Four months after grafting, there was minimal fibrosis surrounding the patch in the vein graft rats and moderate fibrosis in the pericardial graft rats. The degree of penile fibrosis in the pericardial graft rats was significantly higher than that in the controls (P<0.01), but in the vein graft rats it was not significantly different from that of the controls (P>0.05). CONCLUSION: The degree of penile fibrosis of cadaveric pericardial graft was significantly higher than that of the control group, while in the vein graft group it was comparable to the latter. The authors believe that the vein graft may be a more ideal substance to be used as the tunica albuginea substitute than the pericardial graft in the surgical treatment of Peyronie'S disease.

No. 78 Authors Title Source Keywords

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Likittonasombut P, Witoonpanich R, Viranuvatti K. Encephalomyeloradiculopathy associated with wasp sting. Journal of Neurology Neurosurgery and Psychiatry. 74(1) : 134-5, 2003(Jan). Hymenoptera stings.

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Mahidol University Abstract of International Publications 2003

No. 79 Authors Title Source Keywords No. 80 Authors Title Source Keywords Abstract

: Lolekha PH, Vanavanan S, Teerakarnjana N, Chaichanajarernkul U, Lolekha S. : Reference ranges of electrolyte and anion gap in venous whole blood and plasma of healthy school children. : Clinica Chimica Acta. 331(1-2) : 167-9, 2003(May). : Laboratory evaluation, Clinical-diagnosis.

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Lolekha PH. Comparative Study of Values of Calculated Bicarbonate and Measured Total Carbon Dioxide Content. Point of Care. 2 : 135-43 (Issue 2), 2003(Jun). Medical technology, Critically ill, Bicarbonate ions. Bicarbonate [HCO<sub>3</sub>-] can be calculated using the Henderson-Hasselbalch equation and direct measurements of pH and pCO<sub>2</sub>. In critically ill patients, studies show discrepancies between calculated [HCO<sub>3</sub>-] and measured total carbon dioxide content (TCO<sub>2</sub>) obtained with different analyzers. These discrepancies are caused by variations in the dissociation constant (pK1') and by other confounding factors. The authors' goal was to determine whether discrepancies between calculated [HCO<sub>3</sub>-] and measured TCO <sub>2</sub> still exist when using modern whole-blood analyzers. They compared calculated [HCO<sub>3</sub>-] obtained with three critical care analyzers with measured TCO<sub>2</sub> from two routine chemistry analyzers. Arterial whole blood from critically ill patients and venous serum from hospitalized patients were studied. They obtained calculated [HCO<sub>3</sub>-] from the OPTI CCA, OMNI 9, and Stat Profile Ultra C. TCO<sub>2</sub> was obtained using the Dimension RxL and the CRT. The authors found that most calculated [HCO<sub>3</sub>-] and measured TCO<sub>2</sub> correlated well using least squares linear regression. However, poor agreement of calculated [HCO<sub>3</sub>-] versus measured TCO<sub>2</sub> was found using Bland-Altman analysis and Story and Poustie's criteria. In conclusion, discrepancies still occur in mean bias for calculated [HCO<sub>3</sub>-] versus measured TCO<sub>2</sub>, and the bias may be clinically important when making decisions about the treatment of acid-base disorders.

No. 81 Authors Title Source Keywords Abstract

: Lolekha S, Pratuangtham S, Punpanich W, Bowonkiratikachorn P, Chimabutra K, Weber F. : Immunogenicity and safety of two doses of a paediatric hepatitis a vaccine in thai children: Comparison of three vaccination schedules. : Journal of Tropical Pediatrics. 49(6) : 333-9, 2003. : Age-specific prevalence, Immunization, Antibody, Virus, Epidemiology, Adults. : As fewer children in Thailand are exposed to hepatitis A virus (HAV) and so do not have seroprotective anti-HAV antibodies, they are becoming an important source of HAV transmission. A flexible HAV vaccination schedule would facilitate incorporation of the vaccine into existing immunization programmes, and we compared the immunogenicity and safety of three HAV immunization schedules. An open, randomized, clinical trial was carried out in which healthy children were given a primary dose of the inactivated hepatitis A vaccine, Avaxim 80 paediatric, with a booster dose 6, 12 or 18 months later. Anti-HAV geometric mean concentrations (GMC), seroconversion rates, and GMC ratios (GMCR) of the three schedules were compared and reactogenicity was evaluated. Seroconversion rates were above 98 per cent (per group) up to the booster. The three schedules were equivalent in terms of GMCRs, each eliciting a large booster effect. Local reactions were reported for fewer than 9 per cent of each group after dose one and less frequently after the booster dose. Injection site pain, gastrointestinal tract disorders and fever were the most commonly reported adverse events. No vaccine-related serious adverse events were reported. It was concluded that the hepatitis A vaccine, Avaxim 80 paediatric, is safe and immunogenic when given as a two-dose schedule to healthy seronegative children aged 5-10 years, with the second dose given at either 6, 12 or 18 months after the first.

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Mahidol University Abstract of International Publications 2003

No. 82 (483) Authors : Lotinun S, Limlomwongse LC, Sirikulchayanonta V, Krishnamra N. Title : Bone calcium turnover, formation, and resorption in bromocriptine- and prolactin-treated lactating rats. Source : Endocrine. 20(1-2) : 163-70, 2003(Feb-Mar). Keywords : Bone formation, Bone resorption, Bromocriptine, Histomorphometry, Lactation, Prolactin. Abstract : To evaluate the effect of endogenous prolactin (PRO on bone metabolism, we studied bone calcium turnover by the Ca-45 kinetic method and bone formation and resorption by bone histomorphometry and biochemical markers in 13-wk-old lactating Wistar rats. For 1 wk, the animals received daily administration of 0.9% NaCl (control) intraperitoneally, 6 mg of bromocriptine/kg of body wt intraperitoneally, or 6 mg of bromocriptine/kg of body wt plus 2.5 mg of ovine PRL/kg of body wt subcutaneously. Bromocriptine, a dopaminergic inhibitor of endogenous PRL secretion, significantly decreased calcium ion deposit rate and calcium resorption rate in femur, tibia, vertebrae 5 and 6, and sternum by 20-42%. By contrast, calcium resorption rate of the vertebrae and the sternum of the PRL-treated group was higher than that of controls, whereas the tibia and sternum exhibited a greater net loss of calcium. The suppression of bone calcium turnover in the bromocriptine-treated group was further supported by a significant decrease in the urinary deoxypyridinoline, a biochemical index of bone resorption, and the histomorphometric data, which showed changes indicative of suppressed bone resorption and formation. The histomorphometric data from the PRL-treated group were not different from those of the control group with the exception of an increase in the longitudinal growth rate. The results suggested a role of endogenous PRL in the stimulation of bone turnover during lactation.

No. 83 Authors Title Source Keywords Abstract

: Mahachoklertwattana P, Chuansumrit A, Sirisriro R, Choubtum L, Sriphrapradang A, Rajatanavin R. : Bone mineral density, biochemical and hormonal profiles in suboptimally treated children and adolescents with beta-thalassaemia disease. : Clinical Endocrinology. 58(3) : 273-9, 2003(Mar). : Growth-factor-I, Thalassemia major, Binding-protein, Puberty, Mass, Men, Osteoporosis, Deferoxamine, Osteocalcin, Intermedia. : OBJECTIVE Thalassaemia/haemoglobinopathy is a hereditary disease causing increased erythropoiesis and expansion of the bone marrow cavity. As a consequence, there is a reduction in trabecular bone tissue resulting in osteopenia/osteoporosis. The present study was performed to assess bone mineral density (BMD) in children and adolescents with beta-thalassaemia disease and to determine biochemical and hormonal changes that may affect BMD. METHODS Forty-eight children and adolescents with beta-thalassaemia were divided into two groups, transfusion-dependent (TD) (n = 16) and transfusion-independent (TI) (n = 32). All patients were treated suboptimally. BMD was determined by dual-energy X-ray absorptiometry. Bone maturation was assessed by radiographic bone age (BA). Blood and urine samples were obtained for the determination of biochemical and hormonal profiles, which included PTH, 25-hydroxyvitamin D (25-OHD), osteocalcin, bone-specific alkaline phosphatase, IGF-1, fT4, TSH and urine deoxypyridinoline. RESULTS Most of the patients were short and underweight, and they had delayed BA with mean Z- scores of -2.77 in the TD and -2.04 in TI groups. The mean Z- scores of BMD in the TD vs. TI groups of total body, radius, femoral neck and lumbar spine were -2.09 vs. -1.49, -0.73 vs. -0.54, -1.93 vs. -1.17 and -3.45 vs. -2.43, respectively. Although the means BMD values in the TD group were lower than those in the TI group, they were not significantly different. Mean serum IGF-1 levels were lower in the TD than the TI groups, 11.6 and 24.9 nmol/l, respectively (P < 0.05). Other biochemical and hormonal profiles did not differ between these two groups. CONCLUSIONS Patients with undertransfused severe beta-thalassaemia had more bone marrow expansion, lower serum IGF-1 levels and more delayed bone age than did patients with untransfused moderately severe beta-thalassaemia. Therefore, the severity of the disease appeared to be a primary factor for low bone mineral density in undertransfused patients in association with bone age delay and low serum IGF-1.

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Mahidol University Abstract of International Publications 2003

No. 84 Authors Title Source Keywords Abstract

: Mahachoklertwattana P, Sirikulchayanonta V, Chuansumrit A, Karnsombat P, Choubtum L, Sriphrapradang A, Domrongkitchaiporn S, Sirisriro R, Rajatanavin R. : Bone histomorphometry in children and adolescents with beta-thalassemia disease: Iron-associated focal osteomalacia. : Journal of Clinical Endocrinology and Metabolism. 88(8) : 3966-72, 2003(Aug). : Mineral Density, Vitamin-D, Igf-I, Growth, Hormone, Metabolism, Puberty, Mass, Osteoporosis, Osteocalcin. : Thalassemia/hemoglobinopathy is a hereditary disease that causes chronic anemia and increased erythropoiesis. Consequently, an expansion of bone marrow spaces may contribute to osteopenia/ osteoporosis. However, the pathogenesis of bone changes is not yet known. We, therefore, carried out the study on bone histomorphometry and biochemical and hormonal profiles in children and adolescents with suboptimally treated beta-thalassemia disease with the hope of gaining some new insight into the cellular and structural alterations of thalassemic bone. Seventeen patients underwent iliac crest bone biopsy for histomorphometric analyses. Bone mineral density (BMD) measurements were performed by dual energy x-ray absorptiometry. Most patients had growth retardation and delayed bone age. BMD was low especially at the lumbar spine. Serum IGF-I levels were almost always low. Bone histomorphometry revealed increased osteoid thickness, osteoid maturation time, and mineralization lag time, which indicate impaired bone matrix maturation and defective mineralization. In addition, iron deposits appeared along mineralization fronts and osteoid surfaces. Moreover, focal thickened osteoid seams were found together with focal iron deposits. Dynamic bone formation study revealed reduced bone formation rate. These findings indicate that delayed bone maturation and focal osteomalacia are the pathogenesis of bone disease in suboptimally blood-transfused thalassemics with iron overload. Iron deposits in bone and low circulating IGF-I levels may partly contribute to the above findings.

No. 85 Authors Title Source Keywords

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Manonai J, Suthutvoravut S, Intaraprasert S. A 5-year experience with Norplant implants in Thai women. International Journal of Gynecology and Obstetrics. 82(1) : 83-4, 2003(Jul). Norplant implants, Continuation rate.

No. 86 Authors Title Source Keywords Abstract

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Manonai J, Theppisai U, Suchartwatnachai C, Jetsawangsri T, Chittacharoen A. Compliance with hormone replacement therapy in Thai women. Maturitas. 44(3) : 201-5, 2003(Mar). Hormone replacement therapy, Compliance, Menopause. A retrospective study was performed to determine the compliance of hormone replacement therapy (HRT), the characteristics of women who continue to use HRT and the reasons for discontinuation. This study comprised of 821 postmenopausal women who attended the menopause clinic between January 1993 and December 1997. A total of 613 women (74.67%) were considered to be good compliant users. They had been on HRT for at least I year. Two hundred and eight women (25.33%) discontinued the treatment, with an average of 5.1 months duration of use. The younger age group at time of consultation and at menopause and those with previous hysterectomy were factors associated with higher degree of compliance. Its compliance decreased with age and the duration of menopause. The common reasons in the women's decision to discontinue HRT were bleeding episodes (23.08%), undesirable side effects (15.05%) and on physicians' advice (13.46%), respectively. Compliance with HRT appears to be similar to that reported in other specialist centres. Factors affecting compliance were age, age at menopause, duration of menopause, and hysterectomy. Irregular vaginal bleeding was the major reason for discontinuation.

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Mahidol University Abstract of International Publications 2003

No. 87 Authors Title Source Keywords Abstract

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Murphey MD, Jaovisidha SW, Temple HT, Gannon FH, Jelinek JS, Malawer MM. Telangiectatic osteosarcoma: Radiologic-pathologic comparison. Radiology. 229(2) : 545-53, 2003(Nov). Bone neoplasms, CT, Bone neoplasms, MR, Osteosarcoma. PURPOSE: To describe the imaging characteristics of a large series of telangiectatic osteosarcomas with pathologic findings for comparison. MATERIALS AND METHODS: The authors retrospectively reviewed 40 pathologically confirmed telangiectatic osteosarcomas. Patient demographics and images from radiography (n = 36), bone scintigraphy (n = 17), angiography (n = 4), computed tomography (CT) (n = 25), and magnetic resonance (MR) imaging (n = 27) were evaluated by three authors in consensus for lesion location, size, and intrinsic characteristics. There were 27 men (68%) and 13 women (32%) in the study, with an age range of 4-83 years (mean age, 24 years). RESULTS: Lesions frequently affected the femur, tibia, and humerus. Radiographs showed geographic bone lysis, a wide zone of transition, and matrix mineralization. CT demonstrated low attenuation, MR demonstrated high signal intensity on T2-weighted images, and both demonstrated hemorrhage, which simulated the appearance of aneurysmal bone cyst. Viable sarcomatous tissue surrounding hemorrhagic and/or necrotic regions was best seen at contrast material-enhanced CT and MR imaging, with thick peripheral, septal, and nodular enhancement in all cases. Subtle matrix mineralization in this viable tissue was best seen at CT. An associated soft-tissue mass was also seen in 19 of 25 cases (76%) at CT and in 24 of 27 cases (89%) at MR imaging. CONCLUSION: CT and MR imaging findings of telangiectatic osteosarcoma often include thick nodular tissue (and matrix mineralization at CT) in a largely hemorrhagic and/or necrotic osseous lesion with an associated soft-tissue mass, which allows distinction from aneurysmal bone cyst.

No. 88 Authors Title Source Keywords Abstract

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Natta R, Somsak T, Wisuttida T, Laor L. Narrowband ultraviolet B radiation therapy for recalcitrant vitiligo in Asians. Journal of the American Academy of Dermatology. 49(3) : 473-6, 2003(Sep). Psoralen, Puva, Psoriasis. Background. Narrowband ultraviolet B (NBUVB) has recently been reported to be effective therapy for vitiligo. However, reports on its efficacy in recalcitrant vitiligo are lacking. Objective: Our objective was to assess the efficacy of NBUVB in patients with vitiligo who did not respond to either topical therapy or oral psoralen plus ultraviolet A (PUVA). Method: This was a retrospective analysis of patients with vitiligo who were treated with NBUVB from February 1998 to January 2001. They received NBUVB treatment 2 times per week, with an initial close of 100 mJ/cm(2). The close was increased by 10% to 20% per treatment for 20 treatments. The close was then increased by 2% to 5% per treatment until 50% repiginentation was observed or persistent erythema developed. The treatment was continued until maximum repigmentation was achieved. The treatment was terminated if the patient showed less than 25% improvement after 40 to 50 exposures. Results: There were 60 patients: 22 men and 38 women, aged 11 to 61 years. The mean duration of vitiligo was 8.2 +/- 7.1 years. There were 53 cases of generalizecl and 7 cases of localized vitiligo. The lesions covered from less than 5% to 50% of body surface. Twenty-five patients were skin type III, 33 patients were skin type IV, and 2 patients were skin type V. Every case had been previously treated with topical steroid with or without topical psoralen with solar light exposure. Thirty-six patients (60%) had been treated with oral PUVA before NBUVB therapy. After NBUVB treatment, 25 of 60 patients (42%) achieved more than 50% repiginentation on face, trunk, arms, and legs. However, hand and foot lesions showed less than 25% repigmentation in all cases. There was no significant difference between the responders and nonresponders in age, sex, duration of diseases, and skin type. The response rate of patients who had not been previously treated with PUVA was significantly higher than that of patients who had been previously treated with PUVA (67% vs 36%, P =.003). Conclusion: This retrospective, open study demonstrated that NBUVB therapy was effective in 42% of Asian patients with recalcitrant vitiligo without serious side effect. The only clinical parameter that could differentiate nonresponders from responders was previous exposure to PUVA.

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Mahidol University Abstract of International Publications 2003

No. 89 Authors Title Source Keywords Abstract

: Okascharoen C, Nuntnarumit P, Sirinavin S. : Neonatal tuberculosis associated with shock, disseminated intravascular coagulation, hemophagocytic syndrome, and hypercalcemia: a case report. : Journal of the Perinatol. 23(1): 79-81, 2003(Jan). : Neonatal Tuberculosis, Disseminated Intravascular Coagulation, Hemophagocytic Syndrome, Hypercalcemia. : We report on a female infant with disseminated tuberculosis who presented with clinical sepsis and disseminated intravascular coagulation starting at 14 days of age. Parenteral ofloxacin combined with streptomycin were used because the enteral route was not possible and intravenous isoniazid and rifampicin were not available. Rare complications including infection-associated hemophagocytic syndrome, hypercalcemia, and adrenal insufficiency were detected and successfully managed.

No. 90 Authors Title Source Keywords Abstract

: Ongphiphadhanakul B, Chanprasertyothin S, Payattikul P, Saetung S, Rajatanavin R. : The implication of assessing a polymorphism in estrogen receptor alpha gene in the risk assessment of osteoporosis using a screening tool for osteoporosis in Asians. : Osteoporosis International. 14(10) : 63-867, 2003(Oct). : Estrogen receptor, Gene-environment interaction, Genetics of osteporosis, Osteoporosis in Asians, Screening of osteoporosis. : Both genetic and environmental factors interact to determine bone mass and the risk for developing postmenopausal osteoporosis. Recently, an Asian-specific tool, the Osteoporosis Self-Assessment Tool for Asians (OSTA), has been developed to assess the risk of osteoporosis in women. An index is calculated by multiplying the difference in body weight in kilograms and age in years by 0.2 and disregarding the decimal digits. The risk of osteoporosis is classified as high, intermediate or low according to the OSTA index less than -4, -4 to -1 and greater than -1. In the present study we examined how a single nucleotide polymorphism (SNP) in exon 8 of the estrogen receptor alpha (ERalpha) gene affected the predictive value of the OSTA index. Subjects consisted of 358 postmenopausal women who were at least 55 years old. BMDs were measured by DXA, and the SNP in the ERalpha gene was assessed by PCR-RFLP. When considering both the OSTA index and ERalpha genotype in a logistic regression model, it was found that both the OSTA index and the ERalpha genotype independently contributed to the risk of osteoporosis. The odds ratios were 1.58 (95% CI 1.26-1.91) and 2.51 (95% CI 1.42-4.44) for one unit decrement in the OSTA index and each copy of the A allele of the ERalpha genotype, respectively. The joint effect conformed more to a multiplicative model of interaction than an additive model. This suggests that persons with the high-risk genotype are at far greater risk of developing osteoporosis with advancing age or decreasing body weight, the two variables from which the OSTA index is derived. Targeting preventive measures for osteoporosis subjects with risk factors and also disease-susceptibility alleles is likely to be more cost effective.

No. 91 Authors Title Source Keywords Abstract

: Ongphiphadhanakul B. : Genetic polymorphisms of estrogen receptor-alpha: possible implications for targeted osteoporosis therapy. : American Journal of Pharmacogenomics. 3(1) : 5-9, 2003. : Osteoporosis Therapy, ERalpha. : Genetic factors play an important role in the determination of bone mass and osteoporosis. A number of candidate genes have been implicated in osteoporosis, including genes encoding type 1 collagen, vitamin D receptor, estrogen receptor-alpha (ERalpha), and others. A number of association studies have been performed with single nucleotide polymorphisms in the ERalpha gene to assess their relation with bone mineral density in pre- and postmenopausal women, as well as the rate of bone loss after menopause and skeletal response to estrogen administration. The polymorphisms studied thus far mostly involved intronic polymorphisms in intron 1. Other less

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Mahidol University Abstract of International Publications 2003

frequently studied polymorphisms include those in exons 1, 4, and 8. Although most studies demonstrated associations with various bone-related parameters, the results are still disputed. Assessing genetic factors including ERalpha polymorphisms, if their significances are confirmed, can be helpful in targeting preventive measures to individuals with higher risk of developing osteoporosis and render the preventive effort more cost-effective. Moreover, pharmacogenetically, it may help identify postmenopausa l women who tend to have better skeletal responses after estrogen replacement. It is not known, however, if patients who possess favorable polymorphisms in terms of skeletal responsiveness will also have an undesirably higher risk of adverse effects. This issue needs to be further investigated before clinical decisions based on the balance between benefits and risks can be made.

No. 92 Authors Title Source Keywords Abstract

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Panaphut T, Domrongkitchaiporn S, Vibhagool A, Thinkamrop B, Susaengrat W. Ceftriaxone compared with sodium penicillin G for treatment of severe leptospirosis. Clinical Infectious Diseases. 36(12) : 1507-13, 2003(Jun). Doxycycline, Therapy. A prospective, open-label, randomized trial at Khon Kaen Hospital (Thailand) was conducted from July 2000 through December 2001 to compare the clinical efficacies of ceftriaxone and sodium penicillin G for the treatment of severe leptospirosis. A total of 173 patients with severe leptospirosis were randomly assigned to be treated with either intravenous ceftriaxone (1 g daily for 7 days; n = 87) or intravenous sodium penicillin G (1.5 million U every 6 h for 7 days; n = 86). The primary outcome was time to fever resolution. Survival analysis demonstrated that the median duration of fever was 3 days for both groups. Ten patients (5 in each group) died of leptospirosis infection. There were no statistically significant differences in the duration of organ dysfunction. Ceftriaxone and sodium penicillin G were equally effective for the treatment of severe leptospirosis. Once-daily administration and the extended spectrum of ceftriaxone against bacteria provide additional benefits over intravenous penicillin.

No. 93 Authors Title Source Keywords Abstract

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Panburana P, Phaupradit W, Tantisirin O, Sriintravanit N, Buamuenvai J. Maternal complications after Caesarean section in HIV-infected pregnant women. Australian and New Zealand Journal of Obstetrics and Gynaecology. 43(2) : 160-3, 2003(Apr). Caesarean section, HIV-infected pregnant women, Lamivudine, Nevirapine, Zidovudine. A study of maternal complications after elective Caesarean section in HIV infected women was carried out from January 1999 to April 2001. The control group consisted of all the seronegative pregnant women who underwent the elective Caesarean section during the study period. The study group was divided into two subgroups. Subgroup 1 patients were given 600 mg zidovudine (ZDV) orally and 300 mg lamivudine (3TC) daily from 34 to 38 weeks' gestation. Subgroup 2 patients were given 600 mg ZDV orally daily from 34 to 38 weeks' gestation and 150 mg nevirapine orally on the morning of the Caesarean section day. In both groups, the elective Caesarean section was carried out at 38 weeks' gestation and ZDV syrup (2 mg/kg) was given orally to the newborn immediately in the operating theatre and then every 6 h for 4 weeks. No statistically significant differences in maternal complications were found between the HIV infected and non HIV infected women.

No. 94 (248) Authors : Pattanapen G. Title : The porcine arachnocyte spectrum: Panzonal polymorphism of hepatic stellate cell population as revealed by extensive reconstruction of confocal optical imaging. Source : Hepatology. 38(4) : 784A (Suppl. 1), 2003. Keywords : Porcine Arachnocyte Spectrum, Hepatic Stellate Cell.

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Mahidol University Abstract of International Publications 2003

No. 95 Authors Title Source Keywords Abstract

: Phusitphoykai N, Tungsiripat T, Siriboonkoom J, Vongthongsri A. : Comparison of conventional versus wavefront-guided laser in situ keratomileusis in the same patient. : Journal of Referactive Surgery. 19(2) : S217-20 (Suppl. S), 2003(Mar-Apr). : Corneal Optical Aberrations, Higher-Order Aberrations, Wave-Front Aberrations, Photorefractive Keratectomy, Ablation, Topography, Surgery. : PURPOSE: To verify whether there is any difference in visual outcome, including higher order aberrations, after performing laser in situ keratomileusis (LASIK) with conventional ablation and wavefront-guided ablation in myopic eyes of the same patient. METHODS: This was a prospective randomized study of 20 myopic eyes (10 patients) who had LASIK using the Nidek NAVEX excimer laser system. Wavefront-guided customized ablation was used in the first eye of the patient (study group) and the other eye of the same patient was operated with conventional ablation (control group). Mean refractive error was similar between left and right eyes of the same patient. Preoperative examination included higher order aberration by Nidek OPD-Scan. Uncorrected and best spectaclecorrected visual acuity and higher order aberrations were recorded postoperatively. RESULTS: Preoperative and postoperative best spectacle-corrected visual acuity was better than 20/40 (100%) after LASIK in both the conventional ablation and wavefront-guided customized ablation groups. Postoperative refraction was within +/-0.50 D of emmetropia: 90% in the conventional group and 100% in the wavefront-guided group. No statistically significant difference in postoperative higher order aberrations was found between groups. CONCLUSION: Postoperative visual outcome with both conventional LASIK and wavefront-guided customized ablation was not significantly different. Higher order aberrations did not significantly increase postoperatively in either group.

No. 96 Authors Title Source Keywords Abstract

: Prariyachatigul C, Chaiprasert A, Geenkajorn K, Kappe R, Chuchottaworn C, Termsetjaroen S, Srimuang S. : Development and evaluation of a one-tube seminested PCR assay for the detection and identification of Penicillium marneffei. : Mycoses. 46(11-12) : 447-54, 2003. : Penicillium marneffei, One-tube seminested polymerase chain reaction assay, Detection, 18S rRNA. : A one-tube seminested polymerase chain reaction (PCR) assay was developed to detect and identify Penicillium marneffei DNA coding for 18S rRNA both from purified DNA and from clinical samples. DNA from 120 strains of organisms and 19 blood samples from AIDS patients was amplified with F3, CPL1 and PM primers. Under optimized conditions, these primers detected 100% specifically amplified products of 251 and 331 bp from all P. marneffei DNA preparations (47 strains) and from two blood samples of AIDS patients suspected to suffer from penicilliosis marneffei. The assay was sensitive to detect as little as 10 pg purified DNA, which is equivalent to 250 cells. This PCR assay might be useful as an alternative test, if a rapid diagnosis of penicilliosis marneffei is needed.

No. 97 (261) Authors : Prariyachatigul C, Chaiprasert A, Geenkajorn K, Kappe R, Chuchottaworn C, Termsetjaroen S, Srimuang S. Title : Original article Development and evaluation of a one-tube seminested PCR assay for the detection and identification of Penicillium marneffei Entwicklung und Evaluierung eines Ein-R?hrchenSeminested- PCR-Assays zum Nachweis und zur... Source : Mycoses. 46 : 447-54 (Issue 11/12), 2003(Dec). Keywords : One-tube seminested polymerase chain reaction assay, Detection, 18s rrna, Penicillium marneffei. Abstract : A one-tube seminested polymerase chain reaction (PCR) assay was developed to detect and identify Penicillium marneffei DNA coding for 18S rRNA both from purified DNA and from clinical samples.

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Mahidol University Abstract of International Publications 2003

DNA from 120 strains of organisms and 19 blood samples from AIDS patients was amplified with F3, CPL1 and PM primers. Under optimized conditions, these primers detected 100% specifically amplified products of 251 and 331?bp from all P. marneffei DNA preparations (47 strains) and from two blood samples of AIDS patients suspected to suffer from penicilliosis marneffei. The assay was sensitive to detect as little as 10?pg purified DNA, which is equivalent to 250 cells. This PCR assay might be useful as an alternative test, if a rapid diagnosis of penicilliosis marneffei is needed.

No. 97 Authors Title Source Keywords Abstract

: Preutthipan S, Linasmita V. : A prospective comparative study between hysterosalpingography and hysteroscopy in the detection of intrauterine pathology in patients with infertility. : Journal of Obstetrics and Gynaecology Research. 29(1) : 33-7, 2003(Feb). : Cervical stenosis, Female infertility, Hysterosalpingography, Hysteroscopy. : Aim: To investigate the accuracy of hysterosalpingography (HSG) in comparison to hysteroscopy in the detection of intrauterine pathology in patients with infertility, where hysteroscopy is the gold standard. Methods: A prospective, comparative study included 336 patients undergoing both HSG and diagnostic hysteroscopy. Main outcome measures were sensitivity, specificity, positive and negative predictive value, and accuracy rate of HSG. Results: Intrauterine abnormalities were shown on HSG in 286 patients and confirmed in 200 at hysteroscopy. Contrarily intrauterine lesions were detected by hysteroscopy in 4 out of 50 patients in whom HSG were normal. The most common intrauterine finding of 336 patients on hysteroscopy were intrauterine adhesions (IUA) (74), followed by endometrial polyps (56), and submucous myoma, 26 patients. Statistical analysis revealed that HSG in the detection of intrauterine pathology had a sensitivity of 98.0%, specificity of 34.9%, positive predictive value of 69.9%, negative predictive value of 92.0%, and accuracy rate of 73.2% with false-positive and false-negative rates of 30.1% and 8.0%, respectively. The common incorrect diagnoses of HSG were misdiagnosing a condition of cervical stenosis as severe IUA in 24 patients, endometrial polyps as submucous myoma in 22 out of 50 patients, and submucous myoma as endometrial polyps in 12 out of 72 patients. Conclusions: Hysterosalpingography is still a useful screening test for the evaluation of the uterine cavity. If a hysterogram demonstrates intrauterine abnormalities, hysteroscopy should be considered to make a definite diagnosis and treatment. Both procedures should be complementary to each other.

No. 98 Authors Title Source Keywords Abstract

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Pulkes T, Liolitsa D, Nelson IP, Hanna MG. Classical mitochondrial phenotypes without mtDNA mutations - The possible role of nuclear genes. Neurology. 61(8) : 1144-7, 2003(Oct). DNA. The authors analyzed the total mitochondrial (mt) genome in 15 patients with classic mitochondrial phenotypes. Novel somatic mtDNA mutations in two patients with chronic progressive external ophthalmoplegia were identified. Total automated mtDNA genome analysis did not reveal other pathogenic mtDNA mutations. The authors conclude that classic mitochondrial phenotypes, including those with adult onset, may occur in the absence of mtDNA mutations. Nuclear gene mutations may be the cause.

No. 99 Authors Title Source Keywords Abstract

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Pulkes T. Episodic ataxia type 2: an uncommon inherited CNS channelopathies. Journal of the Medical Association of Thailand. 86(4): 376-80, 2003(Apr). Episodic ataxia type 2, CNS. The author reports the first Thai patient with a rare inherited ataxic disorder characterized by intermittent episodes of ataxia, headache and vertigo. The patient was well between attacks despite

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Mahidol University Abstract of International Publications 2003

persistent nystagmus on examination. Magnetic resonance imaging of the brain revealed cerebellar atrophy. All symptoms were ameliorated by acetazolamide therapy. This clinical syndrome was previously described as acetazolamide-responsive episodic ataxia which was subsequently shown to be associated with mutations in a alpha1A-subunit of P/Q type voltage-gated calcium channel gene, known as `episodic ataxia type 2'. Clinical and molecular aspects of episodic ataxia type 2 were also reviewed.

No. 100 Authors Title Source Keywords Abstract

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Saipanish R. Stress among medical students in a Thai medical school. Medical Teacher. 25(5) : 502-6, 2003(Sep). Drug-use, Strategies, Alcohol. This study aimed to determine the prevalence and sources of stress among Thai medical students. The questionnaires, which consisted of the Thai Stress Test (TST) and questions asking about sources of stress, were sent to all medical students in the Faculty of Medicine, Ramathibodi Hospital, Thailand. A total of 686 students participated. The results showed that about 61.4% of students had some degree of stress. Seventeen students (2.4%) reported a high level of stress. The prevalence of stress is highest among third-year medical students. Academic problems were found to be a major cause of stress among all students. The most prevalent source of academic stress was the test/exam. Other sources of stress in medical school and their relationships are also discussed. The findings can help medical teachers understand more about stress among their students and guide the way to improvement in an academic context, which is important for student achievement.

No. 101 Authors Title Source Keywords Abstract

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Saksasithon S, Sungkanuparph S, Thanakitcharu S. Pneumocystis carinii pneumonia in patients without HIV infection. Journal of the Medical Association of Thailand. 86(7): 612-6, 2003(Jul). Pneumocystis carinii pneumonia, HIV. BACKGROUND: Pneumocystis carinii pneumonia (PCP) can occur in immunocompromised patients without HIV infection. Risk factors, clinical features, treatment outcomes, and factors related to mortality in these patients may be useful clinical data for physicians who care for these patients. METHOD: A retrospective study of PCP patients without HIV infection at Ramathibodi Hospital, from 1994 to 2001, was conducted. Only cases with microbiological and/or pathological proven were included. RESULTS: There were 19 patients with 42.1 per cent males and a mean age of 44.6 years. All patients had underlying immunocompromised diseases. 94.7 per cent of the cases received immunosuppressive drugs. PCP occurred at a mean duration of 26.4 months after the diagnosis and treatment of underlying diseases. Common clinical presentations of PCP were progressive dyspnea, fever, and non-productive cough. All patients had abnormal chest radiography with a majority of bilateral interstitial infiltration (63.2%). Diagnosis of PCP was confirmed with microbiological examination from bronchoalveolar larvage (84.2%) and pathological diagnosis from transbronchial biopsy (15.8%). Almost all of the cases (94.7%) were treated with co-trimoxazole. Ten patients (52.6%) had concomitant bacterial pneumonia or fungal pneumonitis. Overall mortality rate was 36.8 per cent. Mortality was significantly higher in patients who needed mechanical ventilation (p = 0.006). There was a trend toward a higher mortality rate in patients with concomitant pulmonary diseases (p = 0.09). CONCLUSIONS: PCP may complicate a variety of immunocompromised states especially autoimmune diseases and hematologic malignancy. Patients who receive corticosteroids and/or cytotoxic drugs should receive primary PCP prophylaxis. The mortality rate is high especially in severe cases that need mechanical ventilation. Intensive care and close monitoring are needed for these patients.

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No. 102 Authors Title Source Keywords

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Abstract

Samankatiwat P, Samartzis I, Lertsithichai P, Stefanou D, Punjabi PP, Taylor KM, Gourlay T. Leucocyte depletion in cardiopulmonary bypass: a comparison of four strategies. Perfusion-UK. 18(2) : 95-105, 2003. Cardiac Troponin-I, Systemic Inflammatory Response, Creatine-Kinase-Mb, Perioperative Myocardial-Infarction, Blood Cardioplegia, Surgery, Injury, Specificity, Mechanisms, Diagnosis. : Leucocytes have been shown to play a fundamental role in the pathophysiology of inflammation. This prospective, randomized, controlled study was designed to identify the most advantageous leucocyte depletion technique in terms of reduction in systemic inflammatory response syndrome and myocardial ischaemia reperfusion injury associated with cardiopulmonary bypass (CPB). Forty consecutive patients undergoing elective coronary artery bypass graft (CABG) surgery were randomly allocated to one of four groups. The four groups consisted of a control group, a systemic leucocyte depletion (SLD) group, a cardioplegic leucocyte depletion (CLD) group and a total leucocyte depletion (TLD) group. There were 10 patients in each group. Lactoferrin (marker of neutrophil activation) and troponin-I ( marker of myocardial ischaemia reperfusion injury) were measured at six time points: post induction, 5 min on CPB, 5 min before releasing the aortic crossclamp, 15 min after releasing the clamp and 1 and 24 hours after the discontinuation of CPB. Plasma lactoferrin levels increased rapidly in every group after the commencement of CPB, subsequently reached a peak after releasing the aortic crossclamp and gradually declined after the discontinuation of CPB. The lowest lactoferrin concentration was observed in the TLD ( range 2.15-141.9 ng/mL) and CLD groups (7.469-114.6 ng/mL). Regarding myocardial injury, plasma cardiac troponin-I levels did not differ significantly between groups; but troponin-I concentrations rose dramatically after releasing the aortic crossclamp in all groups. Nevertheless, the CLD group had the lowest troponinI level (1.37-5.55 ng/mL). In conclusion, it is believed that myocardial ischaemia is probably a major contributor to the inflammatory response. Although there is no clear statistical significance shown in this pilot study, the data tend to support the cardioplegic leucocyte depletion strategy as the optimal method for attenuating neutrophil activation and myocardial ischaemia reperfusion injury.

No. 103 Authors Title Source Keywords Abstract

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Simaroj P, Kosalprapai K, Chuckpaiwong V. Effect of laser in situ keratomileusis on the corneal endothelium. Journal of Refract Surgey. 19 : S237-40 (2 Suppl), 2003 Mar-Apr). Corneal endothelium, LASIK. PURPOSE: To assess the effects of laser in situ keratomileusis (LASIK) on the corneal endothelium. METHODS: In a prospective study, preoperative and 12-month postoperative specular microscopy of the central corneal endothelium and corneal thickness assessment was done in 180 eyes of 105 patients (mean age 31.96 +/- 8.88 years; range 16 to 55 yr) who had LASIK to correct myopia. The central endothelium was analyzed for several parameters including cell density, coefficient of variation, and corneal thickness. Preoperative and postoperative data were compared. RESULTS: The mean preoperative endothelial cell density was 2,547.37 +/- 282.00 cells/mm2, mean coefficient of variation of cell size was 58.33 +/- 11.50%, and mean central corneal thickness was 558.90 +/28.42 microm. There was not a statistically significant change in mean endothelial cell density (2,508.24 +/- 289.57 cells/mm2) or mean coefficient of variation (58.61 +/- 9.89%) at 1 year after surgery (P >.05 ). Average endothelial cell loss was 1.54% at 1 year after surgery. Mean central corneal thickness at 12 months postoperatively was 493.24 +/- 52.55 microm (P<.01). CONCLUSION: LASIK did not appear to alter corneal endothelial cell density at 12 months postoperatively.

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Mahidol University Abstract of International Publications 2003

No. 104 Authors Title Source Keywords

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Sirachainan N, Chuansumrit A, Hanutsaha P, Pakakasama S, Hongeng S. Preserving eye function in prematurely born children with severe protein C deficiency. Journal of Thrombosis and Haemostasis. 1(8):1858-1859, 2003(Aug). Management, Diagnosis, Risk.

No. 105 Authors Title Source Keywords Abstract

: Sirinavin S, Thavornnunth J, Sakchainanont B, Bangtrakulnonth A, Chongthawonsatid S, Junumporn S. : Norfloxacin and azithromycin for treatment of nontyphoidal Salmonella carriers. : Clinical Infectous Diseases. 37(5) : 685-91, 2003(Sep). : Trimethoprim-Sulfamethoxazole, Antibiotic Treatment, Fecal Excretion, Typhoid-Fever, Double-Blind, Ciprofloxacin, Children, Enteritis, Placebo, Trial. : There has been inadequate evaluation of an antibiotic for eradication of nontyphoidal salmonellae (NTS) in asymptomatic carriers. In a randomized, placebo-controlled trial, such efficacy was evaluated using 2 five-day regimens (norfloxacin, 400 mg twice per day, and azithromycin, 500 mg once per day) compared with placebo. The study included 265 food workers in an area of Thailand where NTS are endemic who were asymptomatic NTS carriers. The presence of NTS in stool samples was assessed on days 7, 30, 60, and 90 after start of treatment. At each assessment visit, <4% of participants in each of the 3 groups carried an initial Salmonella serotype; 16%-35% had new Salmonella serotypes detected, except on day 7 in the azithromycin group, when the rate was 4%. Sanitation was good at work but not at home. Selection of multidrug-resistant Salmonella enterica serotype Schwarzengrund was demonstrated. The study regimens were not better than placebo for treatment of asymptomatic food workers who carried NTS in an area where these organisms are endemic, and use of the regimens resulted in antimicrobial resistance.

No. 106 Authors Title Source Keywords Abstract

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Sirinavin S, Vorachit M, Thakkinstian A, Hongsanguensri S, Wittayawongsruji P. Pediatric invasive pneumococcal disease in a teaching hospital in Bangkok. International Journal of Infectious Diseases. 7(3) : 183-9, 2003(Sep). Pediatric invasive pneumococcal disease, PNSSP. BACKGROUND: Increased problems with drug-resistant Streptococcus pneumoniae (SP) and the dearth of epidemiologic and clinical information on invasive pneumococcal disease in children in Asia formed the basis for this study. METHODS: A periodic retrospective review of the records of 0-15-year-old patients was conducted at a teaching hospital in Bangkok, during 1971-2000. RESULTS: Infections with penicillin-non-susceptible SP (PNSSP) strains rapidly increased after they first appeared in 1988, and they accounted for 71% (29/41) of the total cases during 1996-2000. Of 137 patients, 74% were <60 months old, and 66% had an underlying condition. Infections included: bacteremia without focus 51; pneumonia 38; meningitis 35; peritonitis 13; and bone/joint infection 2. Two patients had two foci of infection. Eight of 10 episodes in patients with AIDS were bacteremic pneumonia. Median ages (range) in months for patients with and without an underlying condition were 24 (1-174) and 10 (0-160); and for the patients without an underlying condition they were: pneumonia 23 (4-156); bacteremia without focus 12 (0-160); and meningitis 7 (2-156). Case-fatality rates were 18% and 2% for patients with and without an underlying condition. The study also examined factors associated with PNSSP infection and death. During 1991-2000, 74% (43/58) of the total cases occurred from November to April, which are dry months. CONCLUSIONS: This study population contained a high proportion with both an underlying condition and infection with PNSSP, and a moderately low proportion with bacteremia without focus. The disease was two to three times more common in dry months than in rainy months.

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Mahidol University Abstract of International Publications 2003

No. 107 Authors Title Source Keywords Abstract

: Sritara P, Cheepudomwit S, Chapman N, Woodward M, Kositchaiwat C, Tunlayadechanont S, Sura T, Hengprasith B, Tanphaichitr V, Lochaya S, Neal B, Tanomsup S, Yipintsoi T. : Twelve-year changes in vascular risk factors and their associations with mortality in a cohort of 3499 Thais: the Electricity Generating Authority of Thailand Study. : International Journal of Epidemiology. 32(3) : 461-8, 2003(Jun). : Cohort study, Mortality, Risk factors, Thailand, Vascular diseases. : Background Vascular mortality is increasing in economically developing countries such as Thailand but reliable data about the determinants of these changes are few.Methods In 1985, male and female employees of the Electricity Generating Authority of Thailand took part in a cardiovascular risk factor survey. In 1997, a follow-up survey was conducted and causes of death were determined for those subjects known to have died. Changes in levels of vascular risk factors over 12 years, and the associations of baseline risk factors with vascular mortality, were calculated. Results The 1985 survey recruited 3499 volunteers (average age 43 years) of whom 23% were female. In 1997, vital status was determined for 3318 (95%) and 2967 (85%) of the study participants were resurveyed. Mean levels of systolic blood pressure (SBP) and diastolic blood pressure (DBP), body mass index, total cholesterol and high density lipoprotein (HDL) cholesterol, all increased over the 12-year follow-up period. Over the same time, the prevalence of diabetes also rose but the proportion of current smokers decreased. Vascular diseases were the most frequent cause of death during followup (n = 46), were positively associated with baseline age, SBP, DBP, smoking, diabetes, male sex, and total cholesterol, and were negatively associated with HDL cholesterol. Conclusions Levels of most vascular risk factors worsened over the 12-year period between 1985 and 1997. The associations between baseline risk factor levels and vascular mortality were consistent with those observed in other populations. interventions that control vascular risk factors have the potential to avert much premature vascular disease in Thailand.

No. 108 Authors Title Source Keywords

: Stolk RP, Suriyawongpaisal P, Aekplakorn W, Woodward M, Neal B. : Fat distribution is strongly associated with plasma glucose levels and diabetes in Thai adults - The InterASIA study. : Circulation. 107(19) : 3, 2003(May). : Fat, Plasma glucose levels, Diabetes, Thai, Adults.

No. 109 Authors Title Source Keywords Abstract

: Subsin B, Thomas MS, Katzenmeier G, Shaw JG, Tungpradabkul S, Kunakorn M. : Role of the stationary growth phase sigma factor RpoS of Burkholderia pseudomallei in response to physiological stress conditions. : Journal of Bacteriology. 185(23) : 7008-14, 2003(Dec). : Gram-negative bacteria, Escherichia-coli, Pseudomonas-aeruginosa, Expression, Vectors, Yersinia-entercolitica, Salmonella-typhimurium, Virulence factors, RNA-polymerase, Gene. : The Burkholderia pseudomallei rpoS gene was identified, and an rpoS null mutant was constructed. The mutant was shown to have an increased sensitivity to carbon starvation and oxidative stress. By using rpoS-lacZ fusions, transcription of rpoS was shown to be growth phase regulated, reaching a peak upon entry into stationary phase.

No. 110 (566, 787) Authors : Sukying C, Bhokakul V, Udomsubpayakul U. Title : An epidemiological study on insomnia in an elderly Thai population. Source : Journal of the Medical Association of Thailand. 86(4) : 316-24, 2003(Apr). Keywords : Insomnia, Elderly, Thai. Abstract : The authors investigated the one-month prevalence and associations of insomnia in an elderly Thai population. A random sample of 40,111 individuals was selected from those of persons over 60 years of age by multiple stage sampling. The subjects were interviewed using a sleep questionnaire.

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Mahidol University Abstract of International Publications 2003

Prevalence of insomnia of the population was 46.3 per cent. Depression and poor perceived health were factors strongly associated with insomnia. On the basis of these findings, the authors consider the prevalence of insomnia among the Thai elderly to be rather high. The implications of this study are of great importance for the design and development of preventive strategies and communitybased interventions.

No. 111 Authors Title Source Keywords Abstract

: Sungkanuparph S, Sathapatayavongs B, Pracharktam R. : Rapidly growing mycobacterial infections: spectrum of diseases, antimicrobial susceptibility, pathology and treatment outcomes. : Journal of the Medical Association of Thailand. 86(8) : 772-80, 2003(Aug). : Mycobacterial Infections, Treatment Outcomes. : OBJECTIVES: A series of cases infected with rapidly growing mycobacteria were studied to reveal the spectrum of disease, antimicrobial susceptibility, pathology, and treatment outcomes. METHOD: The cases identified as rapidly growing mycobacterial infections in Ramathibodi Hospital from January 1993 to June 1999 were retrospectively studied. RESULTS: There were 20 patients and most of the cases had no underlying disease. Only two cases were HIV-infected patients. The presenting clinical features were lymphadenitis (7), skin and subcutaneous abscess (7), eye infection (4), pulmonary infection (1), and chronic otitis media (1). Four of the seven cases with lymphadenitis had Sweet's syndrome. The organisms were Mycobacterium chelonae/abscessus group (17 cases) and Mycobacteriumfortuitum group (3 cases). The organisms were susceptible to amikacin, netilmicin and imipenem. The M. fortuitum group was susceptible to more antibiotics than the M. chelonaelabscessus group. Pathology of the infected tissue varied from non-specific findings to suppurative or caseous granuloma. The clinical responses corresponded to the antimicrobial susceptibility. Most of the patients had a good clinical outcome. A combination of two or more drugs was used for the medical treatment. Surgical resection was performed where possible to reduce the load of the organism, especially in cases with very resistant organisms. CONCLUSIONS: Rapidly growing mycobacterial infections can occur in apparently normal hosts. Clinical syndrome is variable. The pathology is non-specific and culture is needed for definite diagnosis. Clinical responses varied but seemed to correlate with the in vitro susceptibility result. More studies are needed before one can deal with these infections more effectively.

No. 112 Authors Title Source Keywords Abstract

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Sungkanuparph S, Sathapatayavongs B, Pracharktam R. Infections with rapidly growing mycobacteria: report of 20 cases. International Journal of Infectious Diseases. 7(3) : 198-205, 2003(Sep). Infections, Mycobacteria. OBJECTIVES: A series of cases infected with rapidly growing mycobacteria was studied to determine the spectrum of disease, antimicrobial susceptibility, treatment, and outcome. METHODS: The cases identified as infections with rapidly growing mycobacteria in Ramathibodi Hospital from January 1993 to December 1999 were retrospectively studied. RESULTS: Most of the cases had no underlying disease. Only two cases were HIV-infected patients. The presenting clinical features were lymphadenitis (seven cases), skin and/or subcutaneous abscess (seven cases), localized eye infection (four cases), pulmonary infection (one case), and chronic otitis media (one case). Four of seven cases with lymphadenitis had Sweet's syndrome, and one had psoriasis as an associated skin manifestation. Anemia was present in five cases, and improved with treatment of the primary disease. The organisms were Mycobacterium chelonae/abscessus group (17 cases) and Mycobacterium fortuitum group (three cases). Susceptibility patterns of the organisms showed susceptibility to amikacin, netilmicin, and imipenem. M. fortuitum group was susceptible to more antibiotics than M. chelonae/abscessus group. The clinical responses corresponded to the antimicrobial susceptibility. Combinations of two or more drugs were used for the medical treatment. Surgical

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Mahidol University Abstract of International Publications 2003

resection was performed where possible, to reduce the load of the organism, especially in cases with very resistant organisms. CONCLUSIONS: Infections with rapidly growing mycobacteria can occur in apparently normal hosts. The clinical syndrome is variable. The pathology is nonspecific. Clinical responses varied, but seemed to correlate with the in vitro susceptibility result. More studies are needed to enable us to deal with this infection effectively.

No. 113 Authors Title Source Keywords Abstract

: Sungkanuparph S, Tanphaichitra D, Pracharktam R. : Chronic diarrhoea caused by cryptococcus neoformans in a non-human immunodeficiency virusinfected patient. : Scandinavian Journal of Infectious Diseases. 35(3) : 211-2, 2003. : Aids. : A 43-y-old woman with underlying cervix carcinoma stage IIIB, status postirradiation, and diabetes mellitus with tripathy suffered from chronic diarrhoea for more than 6 months. Stool examination showed few white blood cells and red blood cells. Rectal swab cultures disclosed Cryptococcus neoformans in 2 samples obtained 2 weeks apart. The diarrhoea responded to treatment with oral fluconazole for 4 weeks. Repeated rectal swabs revealed no yeast growth. During follow-up for 4 y, she had no problems with diarrhoea. Chronic diarrhoea caused by C. neoformans; is rare and clinical suspicion is needed.

No. 114 Authors Title Source Keywords

: Sungkanuparph S, Vibhagool A, Mootsikapun J, Chetchotisakd P, Tansuphaswaswadikul S, Bowonwatanuwong C, Chantratita W. : Efavirenz-based regimen as treatment of advanced AIDS with cryptococcal meningitis. : Jaids-Journal of Acquired Immune Deficiency Syndromes. 33(1) : 118-9, 2003(May). : HIV-1-Infected patients, HIV-Infection, Therapy.

No. 115 Authors Title Source Keywords Abstract

: Sungkanuparph S, Vibhagool A, Mootsikapun P, Chetchotisakd P, Tansuphaswaswadikul S, Bowonwatanuwong C. : Opportunistic infections after the initiation of highly active antiretroviral therapy in advanced AIDS patients in an area with a high prevalence of tuberculosis. : Aids. 17(14) : 2129-31, 2003(Sep). : Advanced Hiv-1 Disease, Reconstitution, Era. : A prospective multicentre study was conducted to investigate the incidence and spectrum of opportunistic infections after the initiation of highly active antiretroviral therapy (HAART) in advanced AIDS patients with very low CD4 cell counts. Sixty patients with successful HAART treatment, which raised the median CD4 cell count from 9 to 168 cells/mul at 48 weeks, were studied. Fourteen patients developed 20 episodes of opportunistic infections, including tuberculosis, Mycobacterium avium complex infection, relapsed cryptococcal meningitis, herpes zoster, toxoplasmosis, and herpes genitalis.

No. 116 Authors Title Source Keywords Abstract

: Sungpet A, Suphachatwong C, Kawinwonggowit V. : Transfer of one fascicle of ulnar nerve to functioning free gracilis muscle transplantation for elbow flexion. : Anz Journal of Surgery. 73(3) : 133-5, 2003(Mar). : Brachial plexus injury, Elbow flexion, Functioning free gracilis muscle transplantation, Ulnar nerve. : Background: In brachial plexus injury, elbow flexion is the first priority in reconstruction. Neglected

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Mahidol University Abstract of International Publications 2003

cases need functioning free muscle transplantation that requires the donor nerve to supply the transplanted muscle. The purpose of this study was to investigate the effects and results of transferring one fascicle of the ulnar nerve to the transplanted gracilis muscle. Methods: One woman and two men with neglected avulsions of the C5,C6 roots of the brachial plexus underwent free gracilis muscle transfer for elbow flexion. One fascicle of the ulnar nerve was used as the donor nerve. Results: The mean period of follow-up was 33.3 months. The average reinnervation time of gracilis muscle was 3.7 months. At the final examination, the mean strength of elbow flexion was 4.3 kgf. The grip strength, moving two-point discrimination and the strength of the wrist volar flexion on the affected side was not worse than before surgery in any patient at the last follow-up examination. Conclusions: A fascicle of the ulnar nerve can be one of the most effective options for functioning free muscle transplantation for elbow flexion.

No. 117 Authors Title Source Keywords Abstract

: Sungpet A, Suphachatwong C, Kawinwonggowit V. : One-fascicle median nerve transfer to biceps muscle in C5 and C6 root avulsions of brachial plexus injury. : Microsurgery. 23(1) : 10-3, 2003. : Biceps muscle, Brachial plexus injury. : Five male patients with avulsions of the C5 and C6 roots of the brachial plexus underwent transfer of one fascicle of the median nerve to the motor branch of the biceps muscle. The mean period of follow-up was 32 months. The average reinnervation time of the biceps was 3.4 months. Four patients achieved biceps strength of Medical Research Council (MRC) grade 4, and one patient had strength of the biceps of MRC grade 3. The mean period of time from surgery to MRC grade 3 was 9 months. At the last follow-up examination, grip strength, pinch strength, moving two-point discrimination, and strength of wrist volar flexion on the affected side were not worse than before the operation in any patient.

No. 118 (568) Authors : Title : Source : Keywords : Abstract :

Suriyawongpaisal P, Kanchanasut S. Road traffic injuries in Thailand: trends, selected underlying determinants and status of intervention. Inj Control Saf Promot. 10(1-2) : 95-104, 2003(Mar-Jun). Road traffic injuries, Thailand. Injuries and deaths from traffic crashes have become a major public health and socio-economic problem in Thailand. Injuries, fatalities and economic losses due to traffic crashes have increased with the rising level of motorization. This study analyzes hospital-based data compiled by the Ministry of Public Health, data compiled by the National Police Office and data compiled by the traffic engineering division of the Department of Highways, Ministry of Transport and Communications. Analysis reveals that 70% of the people injured or killed in traffic crashes are aged 10-39. Men are at four to five times higher risk of death and injury due to traffic crashes than women. The number and rate of traffic injury in Thailand swung from a record low during the economic recovery in the 1980's to record a high during the bubble economy, then declined with the economic crisis in 1997. The economic costs were estimated at U.S.$1.6 billion in 1995. An urban-rural difference in traffic injuries has been recorded with a higher rural case-fatality rate. A number of known behavioral risk factors have been identified, i.e., drunk driving, speeding, substance abuse and failure to use helmets and seat belts. However, determinants of behavior need further investigation. Hazardous road locations have also been mapped. Trends of traffic injuries seem to follow trends of economic growth. Without effective policy and implementation programs to control the determinants, it is expected that traffic injuries will increase as the country recovers from economic crisis. A major pitfall to many current government programs is that they incorporate no systematic evaluation. The fragmented structure of road safety authorities further complicates collaboration and coordination. A broad coalition of stakeholders is needed to catalyze policy action.

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Mahidol University Abstract of International Publications 2003

No. 119 Authors Title Source Keywords Abstract

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Suriyawongpaisal P. Chariyalertsak S. Wanvarie S. Quality of life and functional status of patients with hip fractures in Thailand. Southeast Asian Journal of Tropical Medicine and Public Health. 34(2) : 427-32, 2003(Jun). Hip fractures, Thailand, HRQOL, ADL. Measurement of quality of life and functional status provides important additional information for priority setting in health policy formulation and resource allocation. Hip fracture has been a concern in health planning in developing countries due to an increasing trend, as reported in several studies. Ironically, in developing countries, studies of the impacts of hip fracture on quality of life and functional status are rare. This prompted our team to seek evidence of the impacts using a longitudinal follow-up approach in a Thai setting. In this study, health-related quality of life (HRQOL) before and after hip fractures was evaluated in 250 Thai patients. Measurement of HRQOL was based on a modified SF-12 questionnaire, which was developed with a realization of the following demands: 1) cultural sensitivity of measurement tools; 2) disease-specific HRQOL measurement and 3) feasibility of conducting field work. Functional status was measured using an adapted version of the Index of Activity of Daily Living (ADL), which was previously developed in another setting in Thailand. Mild, moderate and severe deficits in quality of life were found in 36%, 60%, and 4% respectively, of surviving patients. The number of patients with physical functioning dependency, as measured by the ADL, also increased significantly in all 10 activities assessed. Comorbidities were associated with deficits in health-related quality of life but age, sex, income, education level, and surgery were not. Our findings indicate that hip fracture could lead to crippling consequences, with a pronounced effect on the quality of life of Thai patients. Further studies using control groups and longitudinal design are needed to validate the results of this study.

No. 120 Authors Title Source Keywords

: Tanvetyanon T, Tapaneeyakorn J. : Octreotide for bleeding as a result of hepatocellular carcinoma invasion of the gastrointestinal tract. : Journal of Gastroenterology and Hepatology. 18(2) : 231-2, 2003(Feb). : Hepatocellular carcinoma.

No. 121 Authors Title Source Keywords Abstract

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Teeraratkul S. Transanal one-stage endorectal pull-through for Hirschsprung's disease in infants and children. Journal of Pediatric Surgery. 38(2) : 184-7, 2003(Feb). Hirschsprung's disease, Transanal endorectal pull-through. Purpose: This report presents the technique and results of transanal one-stage endorectal pullthrough procedure in children with rectosigmoid lesions from Hirschsprung's disease. Methods: Eight children aged one month to 6 years with frozen section biopsy-proven Hirschsprung's disease underwent transanal one-stage endorectal pull-through procedures during a 12-month period. A rectosigmoid transitional zone was suggested by contrast enema in 7 patients; rectal manometry was done to confirm the diagnosis in one patient. Preoperative colonic irrigation to evacuate feces out of the dilated colon was done in the hospital. Bowel preparation was the same as conventional colorectal surgery. Full-thickness rectal biopsy at 1 to 2 cm above the dentate line was submitted for pathologic diagnosis. A rectal mucosectomy dissection was started 0.5 cm proximal to the dentate lines and was extended into the intraperitoneal rectum. The muscular sleeve was divided circumferentialy at 3 to 4 cm proximal to the dentate line, exposing the intraperitoneal rectum and allowing full-thickness mobilization of the rectosigmoid colon out of the anus. Aganglionic colon segment was resected, and the normal colon was pull down to anastomose with the distal end of anorectal mucosa. Results: Operating time, including taking frozen sections, ranged from 110 to 180 minutes. The length of bowel resections ranged from 9 to 25 cm. The length of hospital stay depended on the

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amount of fecal impaction in the colon. Older children with substantial fecal impaction required 2 weeks of preoperative saline enema. One infant needed 3 days for bowel preparation, the same as for conventional colorectal surgery. The hospital stay ranged from 6 to 7 days in children younger than 2 years and 10 to 28 days in older children. There were no intraoperative or postoperative complications related to the pull-through procedure. One case of colitis occurred in the 6-year-old child, which required rectal tube decompression one week after the operation. Seven patients passed stool within 24 hours after surgery. All patients had normal bowel movements within 3 weeks. There was no rectal cuff stricture or enterocolitis during one year of follow-up. Conclusions: Transanal one-stage endorectal pull-through operations for rectosigmoid lesions from Hirschsprung's disease can be performed successfully in all ages of children with good results, avoiding transabdominal exploration. The early postoperative enterocolitis in the older children might occur and should be treated urgently. The partial coloanal anastomosis obstruction found in older children could be treated by placing a rectal tube into the anus to decompress the dilated pull-through colon. The limitation of this approach is that retroperitoneal fixation of the descending colon could not be dissected by the transanal route.

No. 122 Authors Title Source Keywords

: Thakkinstian A, D'Este C, Eisman J, Nguyen T, Attia J. : Meta-analysis of molecular association studies: The vitamin D receptor gene polymorphisms and bone mineral density as a case study. : Journal of Bone and Mineral Research. 18 : S324 (Suppl. 2), 2003(Sep). : Vitamin D Receptor Gene Polymorphisms, Bone Mineral Density.

No. 123 Authors Title Source Keywords Abstract

: Trachoo O, Sura T, Sakuntabhai A, Singhasivanon P, Krudsood S, Phimpraphi W, Krasaesub S, Chanjarunee S, Looareesuwan S. : Molecular characterization of hereditary persistence of fetal hemoglobin in the Karen people of Thailand. : Hemoglobin. 27(2) : 97-104, 2003. : Hereditary persistence of fetal hemoglobin (HPFH), Deletional thalassemias, bBta-globin gene cluster, Karen, Thailand. : Hereditary persistence of fetal hemoglobin (HPFH) is the condition whereby a continuously active gamma-globin gene expression leads to elevated fetal hemoglobin (Hb F) levels in adult life [Stamatoyannopoulos G, Grosveld F. Hemoglobin switching. In: Stamatoyannopoulos G, Majerus PW, Perlmutter RM, Varmus H, eds. The Molecular Basis of Blood Diseases. Philadelphia: WB. Saunders, 2001:135-182; Wood WG. Hereditary persistence of fetal hemoglobin and deltabeta thalassemia. In: Steinberg MH, Forget BG, Higgs DR, Nagel RL, eds. Disorders of Hemoglobin: Generics, Pathophysiology, and Clinical Management. Cambridge: Cambridge University Press, 2001:356-388; and Weatherall DJ, Clegg JB. Hereditary persistence of fetal hemoglobin. In: Weatherall DJ, Clegg JB, eds. The Thalassaemia Syndromes. Oxford: Blackwell Scientific Publishers, 1981:450507]. The condition is caused either by mutation of the beta- and gamma-globin genes, or the gamma-gene controlled region on other chromosomes. Several families with this condition have been reported from Vietnam, Cambodia and China, and the Southeast Asian mutation (or HPFH-6), a 27 kb deletion, was demonstrated. Here we report on a mother and her daughter of the Karen ethnic group with high levels of Hb F, living in the Suan Pueng District on the border of Thailand and Myanmar. Genotyping showed a heterozygosity for the 27 kb deletion of the beta-globin gene. Their conditions have been confirmed by gap polymerase chain reaction (PCR) with three oligonucleotide primers recently developed by Xu et at. [Xu X-M, Li Z-Q, Liu Z-Y, Zhong X-L, Zhao Y-Z, Mo Q-H. Molecular characterization and PCR detection of a deletional HPFH: application to rapid prenatal diagnosis for compound heterozygotes of this defect with beta-thalassemia in a Chinese family. Am J Hematol 2000; 65:183-188.], and a DNA sequencing method. Thus far there has

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been no official report of the HPFH-6 anomaly from Thailand. The compound heterozygosity of beta-thalassemia (thal) and hereditary persistence of Hb F causes the phenotype of thalassemia intermedia; in contrast, homozygotes for this anomaly show only mild microcytic anemia. Hence, genetic counseling for hereditary persistence of Hb F carriers is needed for family planning.

No. 124 (734) Authors : Vibhagool A, Sungkanuparph S, Mootsikapun P, Chetchotisakd P, Tansuphaswaswadikul S, Bowonwatanuwong C, Ingsathit A. Title : Discontinuation of secondary prophylaxis for cryptococcal meningitis in human immunodeficiency virus-infected patients treated with highly active antiretroviral therapy: A prospective, multicenter, randomized study. Source : Clinical Infectious Diseases. 36(10) : 1329-31, 2003(May). Keywords : Maintenance therapy, Aids, Fluconazole. Abstract : A prospective, multicenter, randomized study was conducted with human immunodeficiency virus (HIV)-infected patients who were successfully treated for acute cryptococcal meningitis, were receiving secondary prophylaxis, and were naive for antiretroviral therapy. Patients were randomized to continue or discontinue secondary prophylaxis when the CD4 cell count had increased to >100 cells/muL and an undetectable HIV RNA level had been sustained for 3 months. At a median of 48 weeks after randomization, there were no episodes of cryptococcal meningitis in either group.

No. 125 Authors Title Source Keywords Abstract

: Vilaichone RK, Mahachai V, Kositchaiwat C, Graham DY, Yamaoka Y. : Relation between seroreactivity to low-molecular-weight Helicobacter pyloti-specific antigens and disease presentation. : Clinical and Diagnostic Laboratory Immunology. 10(6) : 1025-8, 2003(Nov). : Atrophic Gastritis, Virulence Factors, Caga Status, Infection, Cancer, Prevalence, Biopsies, Assay, Risk. : The identification of Helicobacter pylori-strain specific factors that correlate with clinical outcome has remained elusive. We investigated possible relationships between a group of H. pylori antigens and clinical outcome and compared an immunoblot assay kit (HelicoBlot, version 2.1 [HB 2.1]; Genelabs Diagnostics) with an established serological test, the high- molecular- weight cellassociated protein test (HM-CAP). We used sera from 156 Thai patients with different disease presentations, including 43 patients with gastric cancer, 64 patients with gastric ulcer, and 49 patients with nonulcer dyspepsia (NUD). HB 2.1 was compared to HM-CAP as a diagnostic test for H. pylori infection. The seroprevalence of H. pylori was significantly higher among gastric cancer patients than among patients with NUD (93 and 67%, respectively; P < 0.01). Among the H. pyloriseropositive patients, the presence of the antibody to the 37,000-molecular-weight antigen (37K antigen) was inversely related to the presence of gastric cancer (e.g., for gastric cancer patients compared with NUD patients, odds ratio [OR] = 0.28 and 95% confidence interval [CI] = 0.1 to 0.8). The presence of antibody to the 35K antigen was higher in gastric ulcer patients than in NUD patients (OR = 11.5; 95% Cl = 2.4 to 54.3). The disease associations of antibodies to the 35K and 37K antigens are consistent with the possibility that these antigens are either indirect markers for H. pytori-related diseases or have specific active or protective roles in H. pylori-related diseases.

No. 126 Authors Title Source Keywords Abstract

: Viseshsindh W, Kochakarn W, Waikakul W, Roongruangsilp U, Siripornpinyo N, Viseshsindh V. : A randomized controlled trial of pubovaginal sling versus vaginal wall sling for stress urinary incontinence. : Journal of the Medical Association ot Thailand. 86(4) : 308-15, 2003(Apr). : Pubovaginal Sling, Vaginal Wall Sling, Stress Urinary Incontinence. : PURPOSE: To compare the results of Pubovaginal sling and Vaginal wall sling for the treatment of stress urinary incontinence in females. MATERIAL AND METHOD: Between February 2001 and

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Mahidol University Abstract of International Publications 2003

December 2001, a randomized controlled trial was done to compare safety and efficacy of pubovaginal sling versus vaginal wall sling in the management of women with urinary incontinence. Fifteen women 42-68 years old (mean age 51.3 years) were treated with fascial sling (group A) and 11 women 45-60 years old (mean age 50.4 years) with vaginal wall sling (group B). Twenty-one patients had type II SUI and 5 patients had type III SUI (ISD); none had pre-operative detrusor instability. Measures of outcome included efficacy based on SEAPI-QMN, post-operative presence of stress or urge incontinence, frequency of complications, operative time, post-operative pain, length of hospitalization, length of clean intermittent catheterization (CIC) time and mean global evaluation. RESULTS: All patients were followed for at least 3 months after surgery (median 7 months). A total of 20 and 6 women received spinal and general anesthesia, respectively. SEAPI-QMN decreased from a median of 6.3 to 0.8 for group A and from 6.1 to 0.9 for group B. No patient in either group had persistent stress incontinence. Urge incontinence was present in 2 of group A patients and 1 of group B patients. No serious post-operative complications were encountered in both groups. Postoperative pain and operative times for group B patients were significantly lower than for group A patients. Length of hospitalization, length of CIC time and mean global evaluation were not significantly different between the two groups. CONCLUSION: In the short-term, both pubovaginal sling and vaginal wall slings were effective in the treatment of women with SUI. However, the use of vaginal wall sling resulted in significantly shorter operative times and lower post-operative pain compared with pubovaginal sling. Therefore, the vaginal wall sling should be the prefered treatment for SUI.

No. 127 Authors Title Source Keywords

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Visudtibhan A, Lusawat A, Chiemchanya S, Visudhiphan P. Migraine prophylaxis with flunarizine in children. Cephalalgia. 23(7) : 616, 2003(Sep). Migraine prophylaxis, Flunarizine, Children.

No. 128 Authors Title Source Keywords Abstract

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Volrathongchai K, Delaney CW, Phuphaibul R. Nursing minimum data set development and implementation in Thailand. Journal of Advanced Nursing. 43(6) : 588-94, 2003(Sep). Nursing minimum data set, Thailand, National health information system, Development, Implementation. : Background. In 1997, the Thai Ministry of Public Health began planning to implement a national health information system. Development of the nursing component of this system is an ongoing process. The first step in developing a nursing information system is to identify an essential Nursing Minimum Data Set (NMDS). Aim. To describe the development of a NMDS in Thailand and explore the challenges of implementing it, including the issue of the comparability with data sets in other countries, primarily the United States of America. Methods. The process of developing a NMDS specific to Thailand is reviewed. Strategies for implementing this data set and important issues related to it are then discussed. Findings. Although a preliminary Thai NMDS has been identified, challenges associated with its development and implementation within the Thai National health information system remain. Conclusion. A Thai NMDS and its elements have been identified. The International Classification of Nursing Practice was translated and is to be used to implement the data set describing the nursing care of patients and their families. However, many issues, such as the need for conceptual translation and increasing nurses' involvement in the process, still need to be addressed in order to implement the data set successfully.

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No. 129 Authors Title Source Keywords Abstract

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Waikakul S, Waikakul W, Pausawasdi S. Management of pain after brachial plexus injury: a parallel study. Pain Clinic. 15(2) : 125-32, 2003. Elbow flexion, Spinal cord, Deafferentation, Avilsion, Lesions, Restoration, Neurons. Introduction: The study was carried out to find out the effects of surgical management on pain after brachial plexus injury. Method: A prospective with control trial was performed in 279 patients (236 males and 43 females) who had isolated total root avulsion for brachial plexus injury accompanied by pain. The patients were allocated into 5 groups according to the time between the injury and the first visit: within 2 months in group 1 (66 patients), 2 to 4 months in group 2 (80 patients), 4 to 8 months in group 3 (51 patients) and more than 8 months in group 4 (60 patients). The patients in group 5 (22 patients) all came to us within 2 months, but did not accept any kind of surgical management. So these patients received only conservative treatment and were defined as the control group. Total root avulsion was confirmed by physical examination, electrodiagnosis and cervical myelogram in all patients. Furthermore, surgical exploration was performed in all patients of groups 1, 2, 3 and 4. Neurotization with 3 ipsilateral intercostal nerves was carried out in groups 1, 2 and 3. Free gracilis transfer was carried out in group 4. Pain evaluation was carried out in every patient with a descriptive method and visual analogue scale. Improvement in motor and sensory function was also evaluated periodically. All patients were followed up for at least 2 years. Results: Better pain improvement was found in the groups 1 and 2. Improvement of neurological function was correlated to improvement of pain. Correlation with improvement of sensory function was better than with improvement of motor function.

No. 130 (333) Authors : Wanitkun S, Khowsathit P, Khositset A, Pongpanich B. Title : Echocardiographic videodensity index of the coronary arteries in Kawasaki disease: A predictor for subsequent coronary artery abnormality. Source : Pediatric Research. 53(1) : 156, 2003(Jan). Keywords : Echocardiographic videodensity index, Coronary arteries, Kawasaki disease, Coronary artery. No. 131 Authors Title Source Keywords Abstract

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Warrasak S. Suvaranamani C. Euswas A. Sumetpimolchai V. Laothamatas J. Choroidal osteoma in Oriental patients. Journal of the Medical Association of Thailand. 86(6):562-72, 2003 Jun. Choroidal osteoma, Choroid. BACKGROUND: Choroidal osteoma is a rare tumour of the choroid. This is the first report of cases of choroidal osteoma in Thai patients. OBJECTIVE: To report the clinical characteristics, imaging findings and long-term follow-up of choroidal osteoma in four Oriental patients. METHOD: Four cases of choroidal osteoma were observed for 5 years or more. RESULTS: All patients were young female patients whose ages ranged from 24 to 37 years. Three were unilateral and one was bilateral. The tumors were located at the juxtapapillary and macular area with overlying serous retinal detachment. Two patients had previous thyroid diseases and one was pregnant when the tumors were diagnosed. Osteoma did not develop in the vicinity of posterior staphyloma of high myopic eyes. Echography showed acoustic features of a plano-convex sonically dense lesion with high reflectivity echoes which persisted despite lower system sensitivity. None had subretinal neovascularization. Subretinal fluid disappeared spontaneously within one to 14 months in three patients. Gradual growth of the tumor in a pseudopodium manner developed from two to six years after initial examination. Decalcification occurred spontaneously or after laser ablation. CONCLUSIONS: The authors presented four Oriental patients with choroidal osteoma who were observed for at least 5 years. Echography is the best method for identifying this lesion and has unique acoustic features. Subretinal fluid can be seen in the absence of subretinal neovascularization and resorbs spontaneously. Decalcification occurred as a natural process or after laser ablative treatment. Hormonal changes may implicate the development of this tumor.

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No. 132 Authors Title Source Keywords Abstract

: Wattanasirichaigoon D, Prasad C, Schneider G, Evans JA, Korf BR. : Rib defects in patterns of multiple malformations: A retrospective review and phenotypic analysis of 47 cases. : American Journal of Medical Genetics Part A. 122A(1) : 63-9, 2003(Sep). : Spondylocostal dysostosis, Spondylothoracic dysostosis, VACTERL association, MURCS association. : Rib anomalies may occur in isolation, as well as in association with abnormalities of vertebral segmentation and multi-system malformations. Specific entities include the VACTERL and MURCS associations, spondylocostal dysostosis, and spondylothoracic dysostosis. The relative significance of rib anomalies in other lesser known syndromes and associations remains unclear. To document the diagnoses and related defects in patients with rib anomalies as part of broader pattern of anomalies, we retrospectively identified 47 cases from a hospital population, and evaluated specific costal findings and associated birth defects. In our study, fusion was the most common pattern of rib anomaly (72%), followed by bifid (28%) and hypoplastic ribs (26%). Unrecognized patterns of multiple congenital anomalies (MCA) and VACTERL association were the commonest specific diagnoses with a frequency of 30 and 28%, respectively. An associated vertebral defect was found in 72% of the patients. Of those with no vertebral anomaly, the combinations of "rib and cardiac defects alone" and "rib and renal defects alone" were seen in one-third of the patients (4/13). Both the occurrence and type of rib anomaly were helpful in defining certain syndromes and enhanced the likelihood of identifying related malformations.

No. 133 Authors Title Source Keywords Abstract

: Wattanasirichaigoon D, Visudtibhan A, Phudhichareonrat S, Chiemchanya S, Leelahagul P, Suwan K, Supapannachart S. : Nonketotic hyperglycinemia in two siblings with neonatal seizures. : Southeast Asian Journal of Tropical Medicine and Public Health. 34(1) : 202-7, 2003(Mar). : Neonatal Seizures, Nonketotic Hyperglycinemia, NKH. : Seizures are a common problem in neonates. Differential diagnoses include infection, trauma, hypoxia and congenital metabolic disorders. Among these, congenital metabolic disorder is less familiar to general pediatricians. We report two patients with nonketotic hyperglycinemia (NKH), a rare and lethal congenital metabolic disease. Transient hyperammonemia and transient hypouricemia, uncommon features found in NKH, were detected in one patient. High doses of sodium benzoate and dextromethorphan failed to modify the clinical course. Neuropathology denoted characteristic diffuse vacuolization and changes in reactive and gliotic astrocytes. The clinical course, biochemical findings, diagnostic approaches and diagnostic tests are discussed in detail. Recent modalities of treatment are reviewed. Because of its rarity and rapidly progressive course, it maybe underdiagnosed resulting in death before being recognized. Awareness of the possibility of congenital metabolic disorder in early neonatal catastrophe will increase the diagnostic rate.

No. 134 Authors Title Source Keywords Abstract

: Wilailak S, Dangprasert S, Srisupundit S. : Phase I clinical trial of chemoimmunotherapy in combination with radiotherapy in stage IIIB cervical cancer patients. : International Journal of Gynecological Cancer. 13(5) : 652-6, 2003(Sep-Oct). : Chemoimmunotherapy, Radiotherapy, Cervical cancer, Stage IIIB. : To determine the feasibility and toxicity of a chemoimmunotherapy regimen in combination with radiotherapy in stage IIIB cervical cancer patients, cisplatin 10-20 mg/m(2) intravenous (iv) weekly, 5-fluorouracil (5FU) 500 mg/m(2) (24-h infusion) weekly, interferon alpha-2a 3 MU subcutaneously 3 days a week, and 13-cis-retinoic acid 0.5 mg/kg/day orally were given in concurrence with 8-week period of radiotherapy and continued for another 4 weeks after finishing radiotherapy. The dose of

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Mahidol University Abstract of International Publications 2003

cisplatin was escalated from 10 mg/m(2) in the first group of three patients (level 1) to 15 mg/m(2) in the second group of three patients (level 2) and to 20 mg/m(2) in the third group of two patients (level 3) if the former groups could tolerate the drugs well. Patients in levels 1 and 2 had tolerable toxicities. Two patients in level 3 experienced grade 4 leukopenia, so chemoimmunotherapy was discontinued after 2 and 3 cycles orderly. After recovery from toxicities, they continued with radiotherapy. In conclusion, cisplatin 15 mg/m(2), 5-FU 500 mg/m(2) weekly, interferon alpha-2a 3 MU subcutaneously 3 days a week, and 13-cis-retinoic acid 0.5 mg/kg/day orally in combination with radiotherapy in stage IIIB cervical cancer patients is tolerable. Leukopenia is the dose-limiting toxicity.

No. 135 Authors Title Source Keywords Abstract

: Wilasrusmee C, Botash R, Da Silva M, Shah G, Siddiqui J, Bruch D, Kittur S, Wilasrusmee S, Kittur DS. : Initial angiogenic response in reduced renal mass after transplantation. : Journal of Surgical Research. 115(1) : 63-8, 2003(Nov). : Pig aortic endothelial cells, Matrigel, Glomerular capillary density, VEGF, Kidney transplantation, Angiogenesis. : Introduction. Shortage of organs is a major problem in kidney transplantation and requires novel strategies to increase the number of kidney transplants. To reduce the shortage of kidneys, we have proposed transplantation of two halves of one kidney into two recipients (hemirenal transplantation, HRT) and have shown its feasibility in pig and human kidneys. However, reduced renal mass can lead to progressive renal failure in rodents and can reduce the longevity of kidney transplants in humans. Recent studies suggest that derangement of angiogenesis plays a role in the progressive renal failure after reduction in renal mass in rodents. However, since the renal physiology of rats is different from that of large animals, we studied angiogenesis in reduced renal mass transplants in pigs and determined if the reduction in renal mass has the same effect in large animals as that in rodents. Materials and methods. Kidney autotransplantation was performed in domestic outbred swine. Heminephrectomy of the autotransplanted kidney and nephrectomy of the contralateral kidney were performed 1 week after transplantation to reduce the renal mass. Four weeks after transplantation, the pigs were sacrificed and the hemirenal and control nephrectomy specimens were processed for morphometric analysis of glomerular capillary density and immunohistochemical analysis of VEGF expression. Soluble extracts from the kidneys were tested in an in vitro angiogenesis assay to determine their activity to influence angiogenesis. Statistical analysis with ANOVA was performed on the glomerular capillary density in kidney specimens. Results. All these parameters of angiogenesis were increased in the reduced renal mass autotransplants as compared to normal kidneys or whole kidney autotransplants. Glomerular capillary density was increased significantly after reduction in renal mass. VEGF expression also was increased progressively by the third week after reduction in renal mass. Soluble extract from the reduced renal mass transplants significantly increased the in vitro angiogenesis. Conclusion. This is the first study to demonstrate that angiogenesis is increased in the initial stages of reduction in renal mass after transplantation in a large animal model. Increased angiogenesis was found in this model earlier than reported in small animal models (2 weeks in pigs versus 6 weeks in rats). Taken together with other studies, our data suggest that derangement in angiogenesis could play an important role in long-term graft function after hemirenal transplantation.

No. 136 Authors Title Source Keywords

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Wilasrusmee C, Da Silva M, Siddiqui J, Bruch D, Kittur S, Wilasrusmee S, Kittur DS. Role of endothelin-1 in microvascular dysfunction caused by cyclosporin A. Journal of the American College of Surgeons. 196(4) : 584, 2003(Apr). Endothelin-1, Cyclosporin A.

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No. 137 Authors Title Source Keywords Abstract

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Wilasrusmee C, Ondocin P, Bruch D, Shah G, Kittur S, Wilasrusmee S, Kittur DS. Amelioration of cyclosporin A effect on microvasculature by endothelin inhibitor. Surgery. 134(2) : 384-9, 2003(Aug). Embryo Chorioallantoic Membrane, Remnant Kidney Model, Growth-Factor, Impaired Angiogenesis. Background. We have previously shown that endothelial injury by cyclosporin A (CyA) is associated with an increased endothelin-1 (ET-1) release. We now sought to determine, in an animal model of angiogenesis, if inhibiting the effect of ET-1 on endothelial cells (ECs) would reverse the CyAmediated endothelial injury in an animal model of angiogenesis.Methods. An angiogenic mixture of Matrigel (0.5 ml), fibroblast growth factor (1 ng/ml), vascular endothelial growth factor (100 ng/ml), and heparin (64 unit/ml) was injected as a subcutaneous plug in the flank of C3H mice (n = 5). In experimental groups CyA (20 mg/ml), CyA, and BQ 123 (ETA receptor antagonist), CyA and PD 142893 (ETA and ET-B receptor antagonist), or CyA and ET-1 antibody were added to the angiogenic mixture. Angiogenesis in the mixture was quantified by modified planimetric point counting method in skin/Matrigel cross-sections stained with factor VIII to highlight endothelial neocapillaries. Mean +/- SD of angiogenic area was analyzed with analysis of variance and Bonferroni test. The survival curves obtained by Kaplan-Meier analysis were compared between the groups, and the statistical significance of survival and mortality rates was computed by log rank's and Fisher's exact test, respectively. Results. The mean +/- SD of angiogenic area in control animals (without CyA in the angiogenic mixture) was 56.76 +/- 4.2. CyA inhibited angiogenesis in the subcutaneous angiogenic plug. Adding CyA to the angiogenic mixture significantly reduced angiogenic area (5.33 +/- 1.4, P < .001) while vehicle for CyA had no such effect (56.33 +/- 3.8, P = 10). Polyclonal ET1 antibody or PD 142893 ameliorated the effect of CyA, whereas BQ 123 did not. The mean angiogenic areas in animals with ET-1 antibody, PD 142893, or BQ 123 in the angiogenic mixture were 57.20 +/7.5 (P 06), 46.00 +/- 11.5 (P = 1.0), 8.60 +/- 2.9 (P < .001), respectively. Conclusions. Our data show that blocking ET-B receptors specifically ameliorates the microvascular injury to the neocapillaries in angiogenesis caused by CyA. Antiendothelin-1 antibody and ETR antagonist (PD 142893) could, therefore, reduce the ill effects of CyA on microvascular endothelium.

No. 138 Authors Title Source Keywords Abstract

: Wongphaet P, Butrach W, Sangkrai S, Jitpraphai C. : Improved function of hemiplegic upper extremity after cognitive sensory motor training therapy in chronic stroke patients: preliminary report of a case series. : Journal of the Medical Association of Thailand. 86(6) : 579-84, 2003(Jun). : Traumatic brain injuries, TBI. : BACKGROUND: Recovery of upper extremity functions after a severe stroke and traumatic brain injuries (TBI) have generally been less than satisfactory. The "cognitive sensory motor training therapy" is a relatively new method claimed to improve motor control using a specific type of repetitive sensory and motor re-learning protocol. There has been no previous study demonstrating the effectiveness of this method. OBJECTIVE: To investigate the value of the cognitive sensory motor training therapy to improve upper extremity motor function in chronic stroke and TBI patients. MATERIAL AND METHOD: Seven patients with persistent impaired upper extremity functions for over 6 months after a stroke or TBI were trained with the cognitive sensory motor training therapy program. Hand and arm functions were measured with Action Research Arm (ARA) test before the beginning of the study and once a month thereafter. Data were analyzed retrospectively. RESULTS: There was improvement of ARA scores in all of the trained patients. On average there was an increase of the ARA score of 7.7 points during the average training time of 2.5 months. CONCLUSION: The cognitive sensory motor training therapy may be an effective method for motor rehabilitation of chronic stroke or traumatic brain injured patients. Further prospective randomized control trials are justified and required.

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No. 139 Authors Title Source Keywords Abstract

: Murayama N, Matsunaga A, Tangbanluekal L, Tantawiwat S, Ohtsuka R. : Effects of oral contraceptive use on body mass index and blood pressure among female villagers in North-East Thailand. : Journal of Biosocial Science. 35(2) : 243-261, 2003. : Oral contraceptive, Body mass index, Blood pressure, Female, Thailand, BMI. : The use of contraceptives has become prevalent among females in Thailand in the past 20 years, and oral contraceptive use has been suggested to trigger changes in fat intake, energy expenditure, fat metabolism and blood pressure. Based on field investigations of 391 married women aged 20 years or over in Yasothon Province, North-east Thailand, this study aims to elucidate the effects of oral contraceptive use on body mass index (BMI: kg/m2 ) and blood pressure, taking into account reproductive histories and socioeconomic conditions. The proportion of obese (BMI> 25) subjects was high in the age groups 30-39, 40-49 and 50-59, accounting for, respectively, 39.4%, 51.1% and 48.5% of these populations. The proportion of women with hypertension (90/140 mmHg) was 23.7%, 18.5% and 26.2% in the 40-49, 50-59 and 60-69 age groups. Current contraceptive practices in the studied population included sterilization by operation, oral contraception and injection. These methods accounted for 43.0%, 12.8% and 8.2% of the population, respectively. Sociodemographic factors such as reproductive history, years of education and household income were not significantly related to BMI or to blood pressure (ANOVA with age adjustment). In contrast, oral contraceptive users had significantly higher BMIs and diastolic blood pressures (p<0.01, ANOVA with age adjustment). Multiple regression analysis also revealed that oral contraceptive use was a weak but significant contributing factor to both high BMI and blood pressure when sociodemographic factors were taken into account and controlled for statistically. It can thus be concluded that the use of contraceptive pills, which contain oestrogen and progestin and are provided free of charge to Thai women, tend to increase BMI and to elevate blood pressure.

No. 140 Authors Title Source Keywords Abstract

: Futrakul N, Siriviriyakul P, Panichakul T, Butthep P, Patumraj S, Futrakul P. : Glomerular endothelial cytotoxity and dysfunction in nephrosis with focal segmental glomerulosclerosis. : Clinical Hemorheology. 29( 3,4): 469-473, 2003. : Glomerular Endothelial Dysfunction, Cytokine, Endothelial Cell Cytotoxicity, Nephrosis, Focal Segmental Glomerulo- Sclerosis. : Glomerular endothelial cell dysfunction (GED) with defective release of vasodilator has been delineated in nephrosis (NS) in vivo and in vitro studies. In NS with focal segmental glomerulosclerosis (FSGS), an immunocirculatory balance may be impaired due to defective anti-inflammatory cytokine. This study aimed at simultaneous determination of both proinflammatory cytokine (tumor necrosis factor alpha) and an anti-inflammatory cytokine (interleukin-10) in NS with FSGS. An endothelial cell cytotoxicity (ECC) was also examined using nephrotic serum. It was shown that (1) the initial endothelial cell cytotoxicity was significantly different from the control, (2) ratio between tumor necrosis alpha and interleukin-10 was significantly elevated, and (3) intrarenal hemodynamics was changed significantly.

No. 141 Authors Title Source Keywords Abstract

: Jatuporn S, Sangwatanaroj S, Saengsiri A, Rattanapruks S, Srimahachota S, Uthayachalerm W, Kuanoon W, Panpakdee O, Tangkijvanich P, Tosukhowong P. : Short-term effects of an intensive lifestyle modification program on lipid peroxidation and antioxidant systems in patients with coronary artery disease. : Clinical Hemorheology. 29(3,4): 429-436, 2003. : Lipid Peroxidation, Antioxidants, Lifestyle, Diet, Coronary Artery Disease. : The purpose of this study was to compare the short-term effects of an intensive lifestyle modification (ILM) program on lipid peroxidation and antioxidant systems in patients with coronary artery

54

Mahidol University Abstract of International Publications 2003

disease (CAD). Twenty-two patients in the control group continued to receive their conventional treatment with lipid-lowering drugs, whereas 22 patients in the experimental group were assigned to intensive lifestyle modification (ILM) without taking any lipid-lowering agent. The ILM program comprised dietary advice on low-fat diets, high antioxidants and high fiber intakes, yoga exercise, stress management and smoking cessation. After 4 months of intervention, patients in the experimental group revealed a statistically significant increase in plasma total antioxidants, plasma vitamin E and erythrocyte glutathione (GSH) compared to patients in the control group. There was no significant change in plasma malondialdehyde (MDA), a circulating product of lipid peroxidation, in either group. We concluded that the ILM program increased circulating antioxidants and reduced oxidative stress in patients with CAD.

No. 142 Authors Title Source Keywords

: : : :

Hussain M, Suwanchinda A, Charuwichtratana S, Goldberg D. A new long pulsed 940 nm diode laser used for hair removal in Asian skin types. Journal of Cosmetic and Laser Therapy. 5(2): 97-100, 2003. Hair removal, Asian, Skin types.

No. 143 Authors

Title Source Keywords Abstract

: Gu DF, Duan XF, Huang GY, Wu XG, Ma YF, Yu FJL, Chen GXYN, Wang HBLG, Yao JSCL, Xu JLLH, Wang QHP, Chen SDFQ, Mo SXJJ, Wu SCXP, Suriyawongpaisal P, Cheepudomwit S, Loelekla P, Srithara P, Sariyaporn P, Pongchoke P, Jaiyavat S, Nantawan C, Kasikoson V, Thamthitiwat S, Siviroj P, Suwanteerangkul J, Tasanavivat P, Kessomboon P, Horas S, Chongsuvivatwong V, Yipintsoi T, Apakupakul N, Jirathamopas W, Jintapakorn W, Kosulwat V, Boonpraderm A, Wongchanapai A, Wanijjakul C, He J, Whelton P, Bazzano L, Chen J, Muntner P, Reynolds K, Xin X, Chappman N, Colman S, MacMahon S, Neal B, Woodward M, Zhang XH, He J, Whelton P, Glasser D, Gu DF, MacMahon S, Neal B, Patni R, Reynolds R, Suriyawongpaisal P, Wu XG, Xin X, Zhang XH. : Cardiovascular risk factor levels in urban and rural Thailand - The International Collaborative Study of Cardiovascular Disease in Asia (InterASIA). : European Journal of Cardiovascular Prevention & Rehabilitation. 10(4): 249-257, 2003(Aug). : Coronary-Heart-Disease, Monica Project Populations, Total Cholesterol, Global Burden, United-States, Event Rates, Trends, Health, Hypertension, Prevention. : Background Vascular mortality is increasing in economically developing countries but reliable data about the determinants of cardiovascular disease are few. The International Collaborative Study of Cardiovascular Disease in Asia (InterASIA) was designed to obtain,precise estimates of cardiovascular risk factor levels in the adult population of Thailand. Design A complex sample survey. Methods Data from a structured questionnaire, brief physical examination and a blood sample were collected from 5305 individuals aged 35 years or older (response rate 68%). Mean risk factor levels were calculated for eight groups defined by age and sex in 18 representative urban and rural areas of Thailand. Population risk factor levels were calculated by applying sampling weights derived from the 2000 Thai Census and allowing for the complex sampling design. Results The estimated mean (standard error) population blood pressure was 120/76 (0.7/0.5) mmHg, mean serum total cholesterol was 5.2 (0.06) mmol/l, mean body mass index was 24 (0.2) kg /m(2), mean fasting plasma glucose was 5.6 (0.06) mmol/l, the proportion with diabetes 9.6 (1)% and the proportion of current smokers was 25 (3)%. There were estimated to be 5.1 (0.5) million individuals with high blood pressure, 4.4 (0.4) million with high total cholesterol, 8.9 (0.8) million overweight or obese, 2.4 (0.2) million with diabetes and 6.2 (0.9) million current smokers. Mean levels of all major risk factors, except smoking, were worse in urban compared with rural areas. However, except for total cholesterol, the absolute numbers of individuals with abnormal risk factor levels were highest in rural areas. Conclusion Absolute levels of cardiovascular risk factors in Thailand are high. Effective risk factor control strategies that target both rural and urban areas of Thailand have the potential to avert much premature cardiovascular disease.

55

Mahidol University Abstract of International Publications 2003

No. 144 (190) Authors : Fucharoen S, Winichagoon P, Sripichai C, Mankongdee T, Vichittumaros K, Sirankapracha P, Sura T, Chuansumrit A, Nuchprayoon I, Suwansings S, Intarasiripong S. Title : Thalassemia: Genotype-phenotype interaction. Source : Blood. 102 (11): 3838(Part 2), 2003(Nov 16). Keywords : Thalassemia.

No. 145 (824) Authors : Buntup D, Petmitr S, Wongkhajornsilp A, Chanyavanich V, Sangruji T, Theerapuncharoen V, Jutapakdeegul N, Hayashi K, Thangnipon W. Title : Mutations in the p53 tumor suppressor gene mutations in primary gliomas and short-term cultures of malignant gliomas. Source : Journal of Neurochemistry. 87: 59-59 (Suppl.1), 2003(Dec). Keywords : Glioma, Mutation, p53, PCR-SSCP.

56

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