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Opartpunyasarn P, Vichitvejpaisal P, Oer-areemitr N. The effect of binaural beat audio on anxiety in patients undergoing fiberoptic bronchoscopy: A prospective randomized controlled trial. Medicine (Baltimore) 2022; 101:e29392. [PMID: 35713444 PMCID: PMC9276398 DOI: 10.1097/md.0000000000029392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 04/13/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Fiberoptic bronchoscopy is an invasive procedure known to induce anxiety in patients. Binaural beat therapy, in which sounds of different frequencies are delivered to the 2 ears to entrain the brainwaves, has been used to reduce anxiety in some operations. This study aimed to determine the anxiolytic effects of binaural beat audio in patients undergoing fiberoptic bronchoscopy. METHODS Eligible subjects were randomly assigned to receive binaural beat music, plain music, or no music. They were asked to wear earphones starting approximately 15 minutes before the bronchoscopy. The level of anxiety was measured using the State-Trait Anxiety Inventory questionnaire. Blood pressure, heart rate, and sedative drug administration were also recorded. RESULTS One hundred and twelve subjects were randomized into binaural beat music (n = 38), plain music (n = 38), and no music (n = 36) groups. The mean change in post-bronchoscopy State-Trait Anxiety Inventory state score in the binaural beat music, plain music, and no music group was -7.26 (P < .001), -3.92 (P = .005), and -1.12 (P = .454), respectively. The mean systolic blood pressure and diastolic blood pressure significantly decreased from baseline by -9.89 (P = .002) and -5.76 (P = .005), respectively, in the binaural group. The mean heart rate increased from baseline by 3.32 (P = .035), 5.21 (P = .038), and 3.64 (P = .149) in the binaural beat music, plain music, and no music groups, respectively. CONCLUSION Binaural beat music appeared to reduce anxiety among patients undergoing fiberoptic bronchoscopy.Trial registration: TCTR, TCTR20200915002. Registered 14 September 2020 - Retrospectively registered.
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Affiliation(s)
- Pornchai Opartpunyasarn
- Pulmonary and Critical Care Division, Department of Medicine, Phramongkutklao Hospital, Bangkok, Thailand
- Department of Medicine, Chulabhorn Hospital, Bangkok, Thailand
| | | | - Nittha Oer-areemitr
- Pulmonary and Critical Care Division, Department of Medicine, Phramongkutklao Hospital, Bangkok, Thailand
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Shields CL, Dalvin LA, Chang M, Mazloumi M, Fortin P, McGarrey M, Martin A, Yaghy A, Yang X, Vichitvejpaisal P, Mashayekhi A, Shields JA. Visual Outcome at 4 Years Following Plaque Radiotherapy and Prophylactic Intravitreal Bevacizumab (Every 4 Months for 2 Years) for Uveal Melanoma: Comparison With Nonrandomized Historical Control Individuals. JAMA Ophthalmol 2020; 138:136-146. [PMID: 31830238 DOI: 10.1001/jamaophthalmol.2019.5132] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Importance Radiation retinopathy following plaque radiotherapy for uveal melanoma can lead to vision loss that might be avoided with prophylactic anti-vascular endothelial growth factor treatment. Objective To determine visual outcome following prophylactic intravitreal bevacizumab in patients with plaque-irradiated uveal melanoma. Design, Setting, and Participants Retrospective, nonrandomized, interventional cohort study at Wills Eye Hospital, Philadelphia, Pennsylvania. Prophylactic bevacizumab was administered between 2008 and 2018 to 1131 eyes with irradiated uveal melanoma (bevacizumab group) and compared with 117 eyes with irradiated uveal melanoma between 2007 and 2009 (no bevacizumab [historical control] group). Interventions Prophylactic intravitreal bevacizumab was provided at the time of plaque removal as well as 6 subsequent injections at 4-month intervals over 2 years. Main Outcomes and Measures Visual acuity. Results The median patient age was 61 years, 1195 of 1248 patients were white (96%), and 632 of 1248 were women (51%). The median tumor thickness was 4.0 mm, and median distance to foveola was 3.0 mm. A difference was not identified (bevacizumab vs control group) in demographic features, clinical features, or radiation parameters. The mean follow-up was 40 months vs 56 months (mean difference, -18; 95% CI, -24 to -13; P < .001). By survival analysis, the bevacizumab group demonstrated less optical coherence tomography evidence of cystoid macular edema at 24 months (28% vs 37%; hazard ratio [HR], 1.5; 95% CI, 1.1-2.2; P = .02) and 36 months (44% vs 54%; HR, 1.5; 95% CI, 1.1-2.1; P = .01), less clinical evidence of radiation maculopathy at 24 months (27% vs 36%; HR, 1.5; 95% CI, 1.0-2.2; P = .03), 36 months (44% vs 55%; HR, 1.50; 95% CI, 1.1-2.0; P = .01), and 48 months (61% vs 66%; HR, 1.4; 95% CI, 1.0-1.9; P = .03), and less clinical evidence of radiation papillopathy at 18 months (6% vs 12%; HR, 2.0; 95% CI, 1.1-3.9; P = .04). Nonparametric analysis documented better visual acuity outcomes in the bevacizumab group at all points, including 12 months (median logMAR visual acuity [Snellen equivalent]: 0.30 [20/40] vs 0.48 [20/60]; mean difference, -0.28; 95% CI, -0.48 to -0.07; P = .02), 24 months (0.40 [20/50] vs 0.70 [20/100]; mean difference, -0.52; 95% CI, -0.75 to -0.29; P < .001), 36 months (0.48 [20/60] vs 1.00 [20/200]; mean difference, -0.49; 95% CI, -0.76 to -0.21; P = .003), and 48 months (0.54 [20/70] vs 2.00 [counting fingers]; mean difference, -0.71; 95% CI, -1.03 to -0.38; P < .001). Conclusions and Relevance These findings from a retrospective cohort of plaque radiotherapy and prophylactic intravitreal bevacizumab in patients with uveal melanoma suggest better visual outcomes when compared with nonrandomized historical control individuals through 4 years.
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Affiliation(s)
- Carol L Shields
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Lauren A Dalvin
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota
| | - Michael Chang
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Mehdi Mazloumi
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Patricia Fortin
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Mark McGarrey
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Andrei Martin
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Antonio Yaghy
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Xiaolu Yang
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Pornpattana Vichitvejpaisal
- Chulabhorn Hospital, HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Arman Mashayekhi
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Jerry A Shields
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania
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Mazloumi M, Vichitvejpaisal P, Dalvin LA, Yaghy A, Ewens KG, Ganguly A, Shields CL. Accuracy of The Cancer Genome Atlas Classification vs American Joint Committee on Cancer Classification for Prediction of Metastasis in Patients With Uveal Melanoma. JAMA Ophthalmol 2020; 138:260-267. [PMID: 31944225 DOI: 10.1001/jamaophthalmol.2019.5710] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Importance The Cancer Genome Atlas (TCGA) classification is a newly emerging method for prediction of uveal melanoma (UM)-related metastasis and death. Limited information is available regarding the accuracy of the TCGA classification for prediction of metastasis in patients with UM. Objective To investigate the accuracy of the TCGA classification for predicting UM-related metastasis compared with the American Joint Committee on Cancer (AJCC) classification. Design, Setting, and Participants In this retrospective cohort study, patients with UM treated with plaque radiotherapy at a tertiary referral center from October 1, 2008, to December 31, 2018, were evaluated. All patients with tumors classified according to the American Joint Committee on Cancer Staging Manual, 8th Edition, and who completed pretreatment fine-needle aspiration biopsy sampling for genetic analysis of chromosomes 3 and 8 for TCGA classification were included. Tumors were classified into 4 categories, 17 subcategories, and 4 stages using AJCC classification and further grouped into 4 classes using TCGA classification. Main Outcomes and Measures Value of TCGA classification vs AJCC classification for predicting UM-related metastasis. Results Of 642 included patients, 331 (51.6%) were women, and the mean (SD) age was 58.0 (13.8) years. There were 642 tumors from 642 patients classified according to both AJCC and TCGA classifications. The mean (range) follow-up time for the entire cohort was 43.7 (1.4-159.2) months. At 5 years, TCGA classification showed higher value for prediction of metastasis (4 TCGA classes: Wald statistic, 94.8; hazard ratio [HR], 2.8; 95% CI, 2.3-3.5; P < .001; 4 AJCC categories: Wald statistic, 67.5; HR, 2.6; 95% CI, 2.1-3.2; P < .001; 17 AJCC subcategories: Wald statistic, 74.3; HR, 1.3; 95% CI, 1.2-1.3; P < .001; 4 AJCC stages: Wald statistic, 67.0; HR, not applicable; P < .001). After entering TCGA and AJCC classifications into a multivariate model, TCGA classification still showed higher value for prediction of metastasis (TCGA classification: Wald statistic, 61.5; HR, 2.4; 95% CI, 1.9-2.9; P < .001; AJCC classification: Wald statistic, 35.5; HR, 1.9; 95% CI, 1.5-2.4; P < .001). Conclusions and Relevance These results suggest that TCGA classification provides accuracy that is superior to AJCC categories, subcategories, and stages for predicting metastasis from UM. When genetic testing is available, TCGA classification can provide a more accurate way to identify patients at high risk of metastasis who might benefit from adjuvant therapy.
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Affiliation(s)
- Mehdi Mazloumi
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Pornpattana Vichitvejpaisal
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania.,Chulabhorn Hospital, HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Lauren A Dalvin
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania.,Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota
| | - Antonio Yaghy
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Kathryn G Ewens
- Perelman School of Medicine, Department of Genetics, University of Pennsylvania, Philadelphia
| | - Arupa Ganguly
- Perelman School of Medicine, Department of Genetics, University of Pennsylvania, Philadelphia
| | - Carol L Shields
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania
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Shields CL, Dalvin LA, Vichitvejpaisal P, Mazloumi M, Ganguly A, Shields JA. Prognostication of uveal melanoma is simple and highly predictive using The Cancer Genome Atlas (TCGA) classification: A review. Indian J Ophthalmol 2019; 67:1959-1963. [PMID: 31755428 PMCID: PMC6896568 DOI: 10.4103/ijo.ijo_1589_19] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 09/26/2019] [Accepted: 10/01/2019] [Indexed: 01/16/2023] Open
Abstract
Purpose The cancer genome atlas (TCGA) is a comprehensive project supported by the National Cancer Institute (NCI) in the United States to explore molecular alterations in cancer, including uveal melanoma (UM). This led to TCGA classification for UM. In this report, we review the American Joint Committee on Cancer (AJCC) classification and TCGA classification for UM from the NCI's Center for Cancer Genomics (NCI CCG) (based on enucleation specimens [n = 80 eyes]) and from Wills Eye Hospital (WEH) (based on fine needle aspiration biopsy [FNAB] specimens [n = 658 eyes]). We then compare accuracy and predictability of AJCC versus (vs.) TCGA. Methods Review of published reports on AJCC and TCGA classification for UM was performed. Outcomes based on AJCC 7th and 8th editions were assessed. For TCGA, UM was classified based on chromosomes 3 and 8 findings including disomy 3 (D3), monosomy 3 (M3), disomy 8 (D8), 8q gain (8qG), or 8q gain multiple (8qGm) and combined into four classes including Class A (D3/D8), Class B (D3/8qG), Class C (M3/8qG), and Class D (M3/8qGm). Outcomes of metastasis and death were explored and a comparison (AJCC vs. TCGA) was performed. Results In the NCI CCG study, there were 80 eyes with UM sampled by enucleation (n = 77), resection (n = 2), or orbitotomy (n = 1) and analysis revealed four distinct genetic classes. Metastasis and death outcomes were subsequently evaluated per class in the WEH study. The WEH study reviewed 658 eyes with UM, sampled by FNAB, and found Class A (n = 342, 52%), B (n = 91, 14%), C (n = 118, 18%), and D (n = 107, 16%). Comparison by increasing class (A vs. B vs. C vs. D) revealed older mean patient age (P < 0.001), worse entering visual acuity (P < 0.001), greater distance from the optic disc (P < 0.001), larger tumor diameter (P < 0.001), and greater tumor thickness (P < 0.001). Regarding outcomes, more advanced TCGA class demonstrated increased 5-year risk for metastasis (4% vs. 20% vs. 33% vs. 63%,P < 0.001) with corresponding increasing hazard ratio (HR) (1.0 vs. 4.1, 10.1, 30.0,P= 0.01 for B vs. A andP < 0.001 for C vs. A and D vs. A) as well as increased 5-year estimated risk for death (1% vs. 0% vs. 9% vs. 23%,P < 0.001) with corresponding increasing HR (1 vs. NA vs. 3.1 vs. 13.7,P= 0.11 for C vs. A andP < 0.001 for D vs. A). Comparison of AJCC to TCGA classification revealed TCGA was superior in prediction of metastasis and death from UM. Conclusion TCGA classification for UM is simple, accurate, and highly predictive of melanoma-related metastasis and death, more so than the AJCC classification.
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Affiliation(s)
- Carol L Shields
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Suite, Philadelphia, PA, United States
| | - Lauren A Dalvin
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Suite, Philadelphia, PA, United States
| | - Pornpattana Vichitvejpaisal
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Suite, Philadelphia, PA, United States
| | - Mehdi Mazloumi
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Suite, Philadelphia, PA, United States
| | - Arupa Ganguly
- Department of Genetics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Jerry A Shields
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Suite, Philadelphia, PA, United States
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Vichitvejpaisal P, Dalvin LA, Mazloumi M, Ewens KG, Ganguly A, Shields CL. Genetic Analysis of Uveal Melanoma in 658 Patients Using the Cancer Genome Atlas Classification of Uveal Melanoma as A, B, C, and D. Ophthalmology 2019; 126:1445-1453. [DOI: 10.1016/j.ophtha.2019.04.027] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 04/12/2019] [Accepted: 04/15/2019] [Indexed: 12/24/2022] Open
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Dalvin LA, Lim LAS, Chang M, Udyaver S, Mazloumi M, Vichitvejpaisal P, Su GL, Florakis E, Mashayekhi A, Shields JA, Shields CL. Circumscribed choroidal hemangioma: Clinical features and outcomes by age category in 458 cases. Saudi J Ophthalmol 2019; 33:219-228. [PMID: 31686962 PMCID: PMC6819721 DOI: 10.1016/j.sjopt.2019.07.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 07/08/2019] [Indexed: 11/17/2022] Open
Abstract
Purpose To investigate features and outcomes of circumscribed choroidal hemangioma by patient age. Methods Retrospective review of circumscribed choroidal hemangioma from 3/29/1967–6/4/2018 based on age at presentation (≤20 vs. >20–50 vs. >50 years). Results There were 458 circumscribed choroidal hemangiomas diagnosed at mean age (13 vs. 41 vs. 64 years, p < 0.001). The youngest age group had worse presenting visual acuity (20/400 vs. 20/150 vs. 20/100, p < 0.001), larger tumor basal diameter (13.5 vs. 6.6 vs. 6.2, p < 0.001), greater tumor thickness (5.8 vs. 3.1 vs. 2.9, p < 0.001), closer distance to foveola (0.5 vs. 1.4 vs. 1.2, p = 0.03), and greater extent of subretinal fluid (4 quadrants, 26% vs. 8% vs. 2%, p < 0.001). The youngest patients were less likely to be treated with primary observation (39% vs. 39% vs. 56%) or photodynamic therapy (10% vs. 27% vs. 22%) and more likely to be treated with plaque radiotherapy (26% vs. 6% vs. 3%) or external beam radiotherapy (13% vs. 1% vs. 0%) (p < 0.001). The youngest patients required greater total number of treatments (mean 4 vs. 2 vs. 1, p < 0.001). At mean follow-up (44 vs. 68 vs. 60 months, p = 0.37), the youngest patients had worse visual acuity (20/400 vs. 20/200 vs. 20/100, p = 0.03), but no difference in visual acuity loss of 3 or more Snellen lines (27% vs. 13% vs. 16%, p = 0.55). Conclusion Younger patients (≤20 years) with circumscribed choroidal hemangioma present with worse visual acuity and larger, more posterior tumors. Future studies are needed to improve early detection and treatment for this subgroup of patients.
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Affiliation(s)
- Lauren A. Dalvin
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, 840 Walnut Street, Suite 1440, Philadelphia, PA 19107, United States
- Department of Ophthalmology, Mayo Clinic, Rochester, MN 55905, United States
| | - Li-Anne S. Lim
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, 840 Walnut Street, Suite 1440, Philadelphia, PA 19107, United States
| | - Michael Chang
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, 840 Walnut Street, Suite 1440, Philadelphia, PA 19107, United States
| | - Sanika Udyaver
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, 840 Walnut Street, Suite 1440, Philadelphia, PA 19107, United States
| | - Mehdi Mazloumi
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, 840 Walnut Street, Suite 1440, Philadelphia, PA 19107, United States
| | - Pornpattana Vichitvejpaisal
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, 840 Walnut Street, Suite 1440, Philadelphia, PA 19107, United States
- Chulabhorn Hospital, HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Grace L. Su
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, 840 Walnut Street, Suite 1440, Philadelphia, PA 19107, United States
| | - Eleni Florakis
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, 840 Walnut Street, Suite 1440, Philadelphia, PA 19107, United States
| | - Arman Mashayekhi
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, 840 Walnut Street, Suite 1440, Philadelphia, PA 19107, United States
| | - Jerry A. Shields
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, 840 Walnut Street, Suite 1440, Philadelphia, PA 19107, United States
| | - Carol L. Shields
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, 840 Walnut Street, Suite 1440, Philadelphia, PA 19107, United States
- Corresponding author.
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Vichitvejpaisal P, Dalvin LA, Lally SE, Shields CL. Delayed implant infection with Cutibacterium acnes ( Propionibacterium acnes) 30 years after silicone sheet orbital floor implant. Orbit 2019; 39:139-142. [PMID: 31021283 DOI: 10.1080/01676830.2019.1605613] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Purpose: To report a case of delayed implant infection with Cutibacterium acnes (C. acnes, previously known as Propionibacterium acnes) 30 years after silicone sheet orbital floor implant.Methods: Case report with orbital imaging.Results: A 61-year-old male with a history of traumatic orbital floor fracture right eye (OD) repaired using a silicone sheet orbital floor implant 30 years prior, presented with 6 months of painless blepharoptosis and diplopia OD. On examination, there was 3 mm right upper eyelid blepharoptosis and hyperglobus. There was no globe proptosis, dysmotility, or compression and no cutaneous erythema, hyperthermia, discharge, or tenderness to palpation. Orbital magnetic resonance imaging (MRI) revealed a cystic mass in the inferior orbit in the region of the floor implant, measuring 25 mm in diameter and 10 mm in thickness. By MRI, T1-weighted images revealed a hypointense signal within the mass and T2-weighted images showed hyperintense signal with a flat hypointensity centrally representing the floor implant. Microbiologic cultures grew C. acnes.Conclusions: C. acnes can manifest several decades after placement of an orbital prosthetic implant, leading to delayed infection.
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Affiliation(s)
- Pornpattana Vichitvejpaisal
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, USA.,Chulabhorn Royal Academy, Chulabhorn Hospital, HRH Princess Chulabhorn College of Medical Science, Bangkok, Thailand
| | - Lauren A Dalvin
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, USA.,Department of Ophthalmology, Mayo Clinic, Rochester, MN, USA
| | - Sara E Lally
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, USA
| | - Carol L Shields
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, USA
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Molek R, Chatthamrak P, Sukket P, Saengtawee N, Chuwongin D, Vichitvejpaisal P. Factors influencing the 3-year recurrence of liver carcinoma after surgery. Eur J Cancer 2017. [DOI: 10.1016/s0959-8049(17)30356-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Wiwatwongwana D, Vichitvejpaisal P, Thaikruea L, Klaphajone J, Tantong A, Wiwatwongwana A. The effect of music with and without binaural beat audio on operative anxiety in patients undergoing cataract surgery: a randomized controlled trial. Eye (Lond) 2016; 30:1407-1414. [PMID: 27740618 DOI: 10.1038/eye.2016.160] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2015] [Accepted: 06/07/2016] [Indexed: 01/11/2023] Open
Abstract
PurposeTo investigate the anxiolytic effects of binaural beat embedded audio in patients undergoing cataract surgery under local anesthesia.MethodsThis prospective RCT included 141 patients undergoing cataract surgery under local anesthesia. The patients were randomized into three groups; the Binaural beat music group (BB), the plain music intervention group (MI), and a control group (ear phones with no music). Blood pressure (BP) and heart rate were measured on admission, at the beginning of and 20 min after the start of the operation. Peri-operative anxiety level was assessed using the State-Trait Anxiety Inventory questionnaire (STAI).ResultsThe BB and MI groups comprised 44 patients each and the control group 47. Patients in the MI group and BB group showed significant reduction of STAI state scores after music intervention compared with the control group (P<0.001) but the difference was not significant between the MI and BB group (STAI-S score MI group -7.0, BB group -9.0, P=0.085). Systolic BP was significantly lower in both MI (P=0.043) and BB (0.040) groups although there was no difference between the two groups (P=1.000). A significant reduction in heart rate was seen only in the BB group (BB vs control P=0.004, BB vs MI P=0.050, MI vs control P=0.303).ConclusionMusic, both with and without binaural beat, was proven to decrease anxiety level and lower systolic BP. Patients who received binaural beat audio showed additional decrease in heart rate. Binaural beat embedded musical intervention may have benefit over musical intervention alone in decreasing operative anxiety.
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Affiliation(s)
- D Wiwatwongwana
- Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - P Vichitvejpaisal
- Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - L Thaikruea
- Department of Community Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - J Klaphajone
- Department of Rehabilitation Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - A Tantong
- Department of Psychology, Faculty of Education, Chiang Mai Rajabhat University, Chiang Mai, Thailand
| | - A Wiwatwongwana
- Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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Tengtrisorn S, Vichitvejpaisal P, Nitirungjaras A, Kritsaneepaiboon S, Kiddee W, Singha P. Ocular Malformations with Presumable Intraocular Calcification. J Med Assoc Thai 2015; 98:719-723. [PMID: 26267997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
This is a case of ocular malformations with presumable intraocular calcification based on computed tomography (CT) imaging, magnetic resonance imaging (MRI) and ocular ultrasound (US) findings. The authors presented the clinical, imaging and pathological findings of this case. Intraocular calcification is the most important finding in retinoblastoma, which requires aggressive management. It is important to distinguish it from other intraocular lesions, especially intraocular calcified hematoma.
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Yen M, Chen J, Ausayakhun S, Kunavisarut P, Vichitvejpaisal P, Ausayakhun S, Jirawison C, Shantha J, Holland GN, Heiden D, Margolis TP, Keenan JD. Retinal detachment associated with AIDS-related cytomegalovirus retinitis: risk factors in a resource-limited setting. Am J Ophthalmol 2015; 159:185-92. [PMID: 25448999 DOI: 10.1016/j.ajo.2014.10.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Revised: 10/10/2014] [Accepted: 10/10/2014] [Indexed: 11/26/2022]
Abstract
PURPOSE To determine risk factors predictive of retinal detachment in patients with cytomegalovirus (CMV) retinitis in a setting with limited access to ophthalmic care. DESIGN Case-control study. METHODS Sixty-four patients with CMV retinitis and retinal detachment were identified from the Ocular Infectious Diseases and Retina Clinics at Chiang Mai University. Three control patients with CMV retinitis but no retinal detachment were selected for each case, matched by calendar date. The medical records of each patient were reviewed, with patient-level and eye-level features recorded for the clinic visit used to match cases and controls, and also for the initial clinic visit at which CMV retinitis was diagnosed. Risk factors for retinal detachment were assessed separately for each of these time points using multivariate conditional logistic regression models that included 1 eye from each patient. RESULTS Patients with a retinal detachment were more likely than controls to have low visual acuity (odds ratio [OR], 1.24 per line of worse vision on the logMAR scale; 95% confidence interval [CI], 1.16-1.33) and bilateral disease (OR, 2.12; 95% CI, 0.92-4.90). Features present at the time of the initial diagnosis of CMV retinitis that predicted subsequent retinal detachment included bilateral disease (OR, 2.68; 95% CI, 1.18-6.08) and lesion size (OR, 2.64 per 10% increase in lesion size; 95% CI, 1.41-4.94). CONCLUSION Bilateral CMV retinitis and larger lesion sizes, each of which is a marker of advanced disease, were associated with subsequent retinal detachment. Earlier detection and treatment may reduce the likelihood that patients with CMV retinitis develop a retinal detachment.
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Vichitvejpaisal P, Reeponmahar S, Tantisiriwat W. Atypical manifestation of progressive outer retinal necrosis in AIDS patient with CD4+ T-cell counts more than 100 cells/microL on highly active antiretroviral therapy. J Med Assoc Thai 2009; 92 Suppl 3:S52-S56. [PMID: 19702067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Typical progressive outer retinal necrosis (PORN) is an acute ocular infectious disease in acquired immunodeficiency syndrome (AIDS) patients with extremely low CD4+ T-cell counts. It is a form of the Varicella- zoster virus (VZV) infection. This destructive infection has an extremely rapid course that may lead to blindness in affected eyes within days or weeks. Attempts at its treatment have had limited success. We describe the case of a bilateral PORN in an AIDS patient with an initial CD4+ T-cell count >100 cells/microL that developed after initiation of highly active antiretroviral therapy (HAART). A 29-year-old Thai female initially diagnosed with human immunodeficiency virus (HIV) in 1998, presented with bilaterally decreased visual acuity after initiating HAART two months earlier. Multiple yellowish spots appeared in the deep retina without evidence of intraocular inflammation or retinal vasculitis. Her CD4+ T-cell count was 127 cells/microL. She was diagnosed as having PORN based on clinical features and positive VZV in the aqueous humor and vitreous by polymerase chain reaction (PCR). Despite combined treatment with intravenous acyclovir and intravitreous ganciclovir, the patient's visual acuity worsened with no light-perception in either eye. This case suggests that PORN should be included in the differential diagnosis of reduced visual acuity in AIDS patients initiating HAART with higher CD4+ T-cell counts. PORN may be a manifestation of the immune reconstitution syndrome.
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Vichitvejpaisal P, Sitthikongsak S, Preechakoon B, Kraiprasit K, Parakkamodom S, Manon C, Petcharatana S. Does computer-assisted instruction really help to improve the learning process? Med Educ 2001; 35:983-989. [PMID: 11564203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
OBJECTIVES We have developed both a computer-assisted instruction (CAI) multimedia program and a textbook on arterial blood gas interpretation with the same content as formal didactic instruction. A prospective, randomized study was designed to compare the outcomes of self-learning using the software and using the textbook. METHODS 80 third-year medical students were randomly allocated to two groups: the CAI (n=40) and text group (n=40). A 30-item, type-K examination was administered as the pre-test. After the pre-test, the volunteers in the CAI group studied the software program, whereas those in the text group spent their time reading the textbook covering the same material. The post-test was held immediately at the end of a full day of study, and 3 weeks later, the final test was performed without prior notice. A P value of <0.05 was considered to be a statistically significant difference. RESULTS Students in the text group seemed to fulfil their assignments and improved their scores post-test better than those in the CAI group. After 3 weeks, the final test scores of both groups demonstrated a significant decrease, but showed an insignificant difference between the two groups. CONCLUSION Text-based learning seems to be a convenient method of education where time is limited. However, with more time available, use of software may be as good as the conventional learning method and can be an alternative tool. The computer-assisted instruction program seems to enhance the learning process.
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Affiliation(s)
- P Vichitvejpaisal
- Department of Anaesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 7, Thailand
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Vichitvejpaisal P, Joshi GP, Liu J, White PF. Effect of severity of pulmonary disease on nitrous oxide washin and washout characteristics. J Med Assoc Thai 1997; 80:378-83. [PMID: 9240012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The influence of chronic obstructive pulmonary disease (COPD) on the nitrous oxide (N2O) washin and washout characteristics was evaluated in 90 (ASA II-III) males undergoing elective peripheral surgery under general anaesthesia with controlled ventilation. Patients were classified by preoperative bedside pulmonary function testing into three groups. Group I (n = 30), patients without COPD (FEV1/FVC > 80% predicted values; control group); Group II (n = 30), patients with mild COPD (FEV1/FVC = 65-79% of predicted values); and Group III (n = 30), patients with moderate COPD (FEV1/FVC = 50-64% of predicted values). The anaesthetic technique was standardized for all patients. The Datex Capnomac Ultima monitor was used to measure the inspired and expired concentrations of nitrous oxide (N2O), carbon dioxide (CO2), and isoflurane. The duration of both N2O washin (time from start of N2O administration to equilibrium of inspired and expired N2O concentrations) and 5 per cent washout (time from discontinuation of N2O to an expired N2O concentration of 5 per cent of the equilibrium value) were recorded. The duration of N2O washin and washout were significantly prolonged in Groups II and III (P < 0.001) as compared to the control group (Group I). The end-tidal CO2 concentration decreased significantly during N2O washout without causing oxygen desaturation (SpO2 < 90%). We conclude that the duration of N2O washin and washout were significantly prolonged in anaesthetized patients with COPD which may delay the induction and recovery from N2O anaesthesia.
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Affiliation(s)
- P Vichitvejpaisal
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center at Dallas, USA
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Vichitvejpaisal P, Joshi GP, Kumar S, White PF. Effects of nebulized beta 2-adrenergic agonists on pulmonary mechanics in anesthetized patients with chronic obstructive pulmonary disease. J Med Assoc Thai 1996; 79:779-84. [PMID: 9071082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
We evaluated the effects of nebulized beta 2-adrenergic agonists on pulmonary mechanics in patients with COPD undergoing peripheral surgery with a standardized general anesthetic technique. Thirty males with COPD were randomized into one of three groups. Group I (control group; n = 10) received nebulized saline 3 ml, Group II (n = 10) received nebulized albuterol (2.5 mg in 3 ml), and Group III (n = 10) received nebulized metaproterenol (15 mg in 3 ml). At 20 min after tracheal intubation, the study drugs were nebulized over 20 min. Datex Capnomac Ultima monitor was used to measure pulmonary mechanics on a breath-by-breath basis. There was no difference between the three groups with respect to demographic data and preoperative respiratory parameters. A similar degree of DPH occurred with the initiation of mechanical ventilation in all three groups. Patients receiving nebulized bronchodilators (Groups II and III) displayed a significant decrease in DPH and an increase in total dynamic compliance. However, there were no differences in DPH and total dynamic compliance between Groups II and III. We conclude that nebulization of either albuterol or metaproterenol can alleviate DPH resulting from mechanical ventilation in anesthetized patients with COPD.
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Affiliation(s)
- P Vichitvejpaisal
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, USA
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Singh H, Vichitvejpaisal P, Gaines GY, White PF. Comparative effects of lidocaine, esmolol, and nitroglycerin in modifying the hemodynamic response to laryngoscopy and intubation. J Clin Anesth 1995; 7:5-8. [PMID: 7772359 DOI: 10.1016/0952-8180(94)00013-t] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
STUDY OBJECTIVE To compare the safety and efficacy of lidocaine, esmolol, and nitroglycerin in modifying the hemodynamic response to laryngoscopy and intubation. DESIGN Randomized, placebo-controlled, double-blind study. SETTING University-affiliated VA medical center. PATIENTS 40 ASA physical status I and II patients undergoing electric surgery with general endotracheal anesthesia. INTERVENTIONS Anesthesia was induced with thiopental sodium 5 mg/kg, and intubation was facilitated with vecuronium 0.15 mg/kg. Isoflurane (0.5% to 1%) and 50% nitrous oxide in oxygen were used for maintenance of anesthesia. In addition, patients received one of the following four study drugs intravenously (i.v.) prior to laryngoscopy: Group 1 (control) = saline 5 ml; Group 2 = lidocaine 1.5 mg/kg; Group 3 = esmolol 1.4 mg/kg; Group 4 = nitroglycerin 2 micrograms/kg. MEASUREMENTS AND MAIN RESULTS Mean arterial pressure (MAP) and heart rate (HR) were recorded every minute for 20 minutes following induction of anesthesia. Following laryngoscopy and intubation, MAP increased significantly in all four treatment groups (control 49% +/- 19%, lidocaine 55% +/- 26%, esmolol 25% +/- 11%, nitroglycerin 45% +/- 21%) compared with preinduction baseline values. In the esmolol-pretreated patients, the increase in HR was significantly lower (20% +/- 3%) compared with the nitroglycerin (37% +/- 8%), lidocaine (52% +/- 8%), and control (29% +/- 4%) groups. CONCLUSIONS Lidocaine 1.5 mg/kg i.v. and nitroglycerin 2 micrograms/kg i.v. were ineffective in controlling the acute hemodynamic response following laryngoscopy and intubation. Esmolol 1.4 mg/kg i.v. was significantly more effective than either lidocaine or nitroglycerin in controlling the HR response to laryngoscopy and intubation (p < 0.05). Esmolol also was significantly more effective than lidocaine in minimizing the increase in MAP (25% vs. 55%).
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Affiliation(s)
- H Singh
- Department of Anesthesiology and Pain Management, University of Texas, Southwestern Medical Center at Dallas 75235-9068, USA
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Vichitvejpaisal P, Chandanayingyong D, Bejrachandra S, Opartkiattikul N, Svastdi-Xuto O, Kraiprasit K, Udompunturux S. Preoperative autologous blood collection and haemodilution with gelatin solution (gelifundol). J Med Assoc Thai 1993; 76:521-5. [PMID: 7964259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Autologous blood collection and haemodilution with gelatin solution had an effect on the decrease in red blood cells, haemoglobin, haemotocrit, fibrinogen and platelets; however, this technique had no effect on coagulograms, platelet function and haemostasis. In conclusion, this technique is suitable and possibly practical in obtaining sufficient blood for elective surgical patients and is without any undesirable side effects.
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Affiliation(s)
- P Vichitvejpaisal
- Department of Anaesthesiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Vichitvejpaisal P, Svastdi-Xuto O, Udompunturux S. A comparative study of isobaric and hyperbaric solution of bupivacaine for spinal anaesthesia in caesarean section. J Med Assoc Thai 1992; 75:278-82. [PMID: 1460407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Though hyperbaric solution of bupivacaine following intrathecal injection had satisfactory spread of analgesia, it regressed rapidly with more side effects. Isobaric bupivacaine seemed to provide a slow regression of analgesia with fewer undesirable effects except for its inadequate spread of analgesia. As a result, if the dosages as well as the time of administration of isobaric solution are well adjusted, we believe that it is safe and reliable with an excellent level of analgesia for caesarean section.
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Affiliation(s)
- P Vichitvejpaisal
- Department of Anaesthesiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Vichitvejpaisal P, Svastdi-Xuto O, Udompunturux S. The use of nebulized salbutamol in patients with bronchospasm during anaesthesia: a clinical trial. J Med Assoc Thai 1991; 74:397-403. [PMID: 1791394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The 2.5 mg salbutamol in 2.5 ml normal saline (Ventolin nebules) was used in 22 patients with unexpected bronchospasm via a nebulizer connected to an inspired limb of an anaesthetic machine. Recording of cardiovascular effects, specific notes of breath sound according to symptom severity (clinical lung score), arterial blood gases and airway pressure, was made every 5 minutes up to 30 minutes. The PaCO2 decreased and a/A ratio appeared to increase (improved shunt effect) significantly. However, the cardiovascular effects showed no statistical significance. The airway pressure as well as the clinical lung score appeared to decrease significantly to normal limits 20 minutes after the therapy. We conclude that the use of nebulized beta 2 selective bronchodilator is suitable in the treatment of unexpected bronchospasm without any cardiovascular disturbances.
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Affiliation(s)
- P Vichitvejpaisal
- Department of Anaesthesiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Vichitvejpaisal P, Navakunvichit T, Stitsupamas U, Svasti-Xuto O. Bedside evaluation of the respiratory function in abdominal surgery with a simplified instrument a controlled study. J Med Assoc Thai 1990; 73:145-51. [PMID: 2380646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Though total prevention of postoperative pulmonary abnormalities after upper abdominal surgery does not seem to be possible, appropriate application of treatment to restore VC and FRC. The pulmonary function test helps the physician to predict postoperative respiratory disorders. Nevertheless, by using a simple respirometer and mini Wright's peak flow meter to evaluate the pulmonary functions perioperatively, it shows close relationship to the conventional test. Both FRC and SVC decreased to approximately 50-55 per cent of the preoperative values one day after surgery and yet, they increased significantly to 70-75 per cent of the preoperative levels on the fifth postoperative day. It is evident from this study that this simple test can serve as a reliable screen of pulmonary function. It can be performed economically and does not require complex equipment.
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Affiliation(s)
- P Vichitvejpaisal
- Department of Anaesthesiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Vichitvejpaisal P, Svastdi-Xuto O. .5 per cent plain bupivacaine for spinal anaesthesia effects of posture. J Med Assoc Thai 1989; 72:687-91. [PMID: 2628536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
0.5 per cent plain bupivacaine following intrathecal injection in the lateral position seems to be lower than that in the sitting position. The dosages of the drug according to the patients' height and the time for injection were shown to yield a desirable spread of analgesia. Provided that strict attention is paid to volume replacement, the technique is safe quick and reliable and provides excellent analgesia. It is satisfactory for use in orthopaedic surgery and abdominal surgery that does not take more than 2 hours.
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