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Murdani A, Kumar A, Chiu HM, Goh KL, Jang BI, Khor CJL, Lau J, Mostafa I, Ramchandani M, Ratanalert S, Tajiri H, Yuen M, Zhang ST, Duforest-Rey D, Rey JF. WEO position statement on hygiene in digestive endoscopy: Focus on endoscopy units in Asia and the Middle East. Dig Endosc 2017; 29:3-15. [PMID: 27696514 DOI: 10.1111/den.12745] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Accepted: 09/21/2016] [Indexed: 12/14/2022]
Abstract
The aim of this position statement is to reinforce the key points of hygiene in digestive endoscopy. The present article details the minimum hygiene requirements for reprocessing of endoscopes and endoscopic devices, regardless of the reprocessing method (automated washer-disinfector or manual cleaning) and the endoscopy setting (endoscopy suite, operating room, elective or emergency procedures). These minimum requirements are mandatory for patient safety. Both advanced diagnostic and therapeutic endoscopies should be carried out in an environment that is safe for patients and staff. Particular attention is given to contaminants. Procedural errors in decontamination, defective equipment, and failure to follow disinfection guidelines are major factors contributing to transmission of infection during endoscopy. Other important risk factors include inadequate cleaning, use of older endoscopes with surface and working channel irregularities, and contamination of water bottles or irrigating solutions. Infections by multidrug-resistant organisms have become an increasing problem in health-care systems worldwide. Since 2010, outbreaks of multidrug-resistant bacteria associated with endoscopic retrograde cholangiopancreatography have been reported from the USA, France, Germany, and The Netherlands. In many endoscopy units in Asia and the Middle East, reprocessing procedures have lagged behind those of Western countries for cultural reasons or lack of financial resources. This inconsistency in standards is now being addressed, and the World Endoscopy Organization has prepared this position statement to highlight key points for quality assurance in any endoscopy unit in any country.
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Affiliation(s)
- Abdullah Murdani
- Department of Internal Medicine, Universitas Indonesia, Jakarta Timur, Indonesia
| | - Ajay Kumar
- Fortis Escorts Liver and Digestive Diseases Institute, New Delhi, India
| | - Han-Mo Chiu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Khean-Lee Goh
- Department of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Byung Ik Jang
- Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea
| | - Christopher J L Khor
- Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore, Singapore
| | - James Lau
- Endoscopy Center, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong
| | - Ibrahim Mostafa
- Endoscopy Unit, Department of Gastroenterology and Hepatology, Theodor Bilharz Research Institute, Cairo, Egypt
| | | | - Siriporn Ratanalert
- NKC Institute of Gastroenterology, Songklanagarind Hospital, Songkhla, Thailand
| | - Hisao Tajiri
- Department of Internal Medicine, Jikei University School of Medicine, Tokyo, Japan
| | - Minghwa Yuen
- Cantel Medical Asia/Pacific Pte. Ltd, Singapore, Singapore
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Ratanalert S. IN10-MO-02 Normal pressure hydrocephalus. J Neurol Sci 2009. [DOI: 10.1016/s0022-510x(09)70057-7] [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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Abstract
The goal of this study was to evaluate the effect of preoperative education on patient satisfaction and cooperation during an endoscopic retrograde cholangiopancreatography (ERCP) procedure. Risk reduction was also studied in terms of decreased meperidine administration. Subjects were preoperatively educated by the endoscopy nurse regarding the ERCP procedure and how to communicate with the nurse during the procedure. Forty-five patients with a mean age of 58 years participated in the study. Effective patient cooperation was achieved. All subjects were satisfied with the educational process and the ERCP team. These findings suggest preoperative education is a cost-effective intervention in enhance patient cooperation and patient satisfaction for patients undergoing ERCP.
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Affiliation(s)
- Siriporn Ratanalert
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat-Yai, Thailand.
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Abstract
This study of 300 patients with severe head injury evaluated the clinical predictors determined after admission and associated with significant increase of poor outcome. The overall poor outcome was 58%. Logistic regression showed that age, status of basal cisterns on initial CT, Glasgow Coma Scale score (GCS) at 24 h after injury and electrolyte derangement occurring during admission strongly correlated with the outcome. A probability diagram of the outcome determined at 24 h after injury from the combination of the significant predictive factors provides a basis for determining the interventions to the appropriate target population. Intracranial pressure monitors with sophisticated devices may not be suitable for a developing country. Allocation of resources toward development of adequate intensive care beds and well-trained staff combined with serial CT imaging may be an alternative approach for the improvement of the outcome of severe head injury.
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Affiliation(s)
- S Ratanalert
- Department of Surgery, Faculty of Medicine, Prince of Songkla University, Songkhla Thailand.
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Abstract
Unshaved cranial neurological surgery has been successfully performed at Songklanagarind Hospital. However, within the Buddhist community, shaving is one of the traditional procedures for cleanliness and purification, and the unshaved method may have a cultural effect on social beliefs. Knowledge of social attitudes toward shaving or not shaving for cranial neurological surgery has implications for informed consent process prior to cranial operation. The attitudes of shaving were surveyed in the communities of Songkhla Province where Songklanagarind Hospital is situated. Of 1128 respondents, the female to male ratio was 3:2, their age was mostly under 40 years old and 91% were Buddhist. Sixty per cent of the respondents were in favour of shaving. After knowing the equivalent result of surgery either by shaved or unshaved method, the group favouring unshaved cranial surgery increased from 12 to 37%. Statistical analysis, through ordinal and multinomial logit, identified the young age, female and more educated who needed to socialize, and frequently meet many people were the groups who preferred or were ready to change their choice to the unshaved method. The neurosurgeon should give an advice to the patient not only the indications and results of surgery, but also a choice of shaved or unshaved cranial neurological surgery.
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Affiliation(s)
- S Ratanalert
- Department of Surgery, Faculty of Medicine, Prince of Songkla University, Hat-Yai, Songkhla 90112, Thailand.
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Abstract
OBJECTIVE To determine whether patterns of head injury are changing with time. MATERIALS AND METHODS A total of 3194 and 4217 consecutive trauma patients who attended the emergency room in 1985-86 and 1996 respectively were studied with respect to age, sex, cause of injury, injury severity, pathology, and outcome. RESULTS The number of patients with head injury in 1996 nearly doubled (1224/4,217:29.03%) when compared to the 1985-86 study (504/3, 194; 15.78%). This was due to an increase in the outpatient subgroup (1009/1224). The admitted patients with head injury showed a pattern of less severe injury. Severe head injury decreased from 12.4 to 7. 9%. However, acute subdural haematoma and diffuse brain injury increased from 12.2% and 9% to 32% and 16.8% respectively. The mortality rate of admitted patients increased statistically significantly from 14.4% to 21.8% between the 1985-86 and 1996 studies. CONCLUSIONS This comparative study showed attend toward less severe injury. This may be due to multiple factors. The predominant factor may be the compulsory use of motorcycle helmets. The limitation of this study was that it utilised tertiary hospital based data only. Tertiary hospital receive more and serious head injured patients from surrounding provincial hospitals this may be the major cause of the increased the mortality rate.
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Affiliation(s)
- N Phuenpathom
- Division of Neurological Surgery, Department of Surgery, Faculty of Medicine, Prince of Songkla University, Hadyai, Songkla, 90110, Thailand
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Ratanalert S. Frontal ventriculoperitoneal shunt: technical note. J Med Assoc Thai 1999; 82:1056-9. [PMID: 10561973] [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: 02/14/2023]
Abstract
Cerebrospinal fluid shunt placement is one of the most commonly performed procedures in neurological surgery. The author describes a technique to avoid an additional skin incision in the frontal ventriculoperitoneal shunt procedure without the purchase of new instruments or prolongation of surgical time.
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Affiliation(s)
- S Ratanalert
- Department of Surgery, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand
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Phuenpathom N, Ratanalert S, Saeheng S, Sripairojkul B. Intraoperative intracranial aneurysm rupture. J Med Assoc Thai 1999; 82:332-5. [PMID: 10410492] [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: 02/13/2023]
Abstract
119 patients with surgically treated intracranial aneurysm between December 18, 1984 and October 1997 were analyzed resulting in nine patients with intraoperative aneurysm rupture. These nine cases formed the basis of this study. The incidence of intraoperative aneurysm rupture was 7.6 per cent. The mortality was 33.3 per cent. In our institution, maneuvers used to control profuse hemorrhage include induced hypotension, suction dissection, and temporary clips at the parent vessels. Some controversies exist regarding the effect of timing of surgery on intraoperative aneurysm rupture and ischemic consequence from induced hypotension. The argument is whether early surgery, within 72 hours, increases the incidence of intraoperative aneurysm rupture.
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Affiliation(s)
- N Phuenpathom
- Department of Surgery, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
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Abstract
BACKGROUND Preoperative shaving for cranial neurosurgical procedures is still recommended in textbooks. There are reports demonstrating the success of nonshaved surgery. The objective of this study was to compare the surgical infection rate of cranial neurosurgical procedures with two different scalp preparations: shaved or nonshaved. METHODS Clinical trials of nonshaved scalp preparation were performed in non-emergency cranial neurosurgical procedures at Songklanagarind Hospital from August 1994 to December 1996. Patients were entered in the nonshaved group using the following exclusion criteria: immunocompromised host, presence of infectious diseases, surgery with foreign material insertion, multiple operations within 1 month, and presence of traumatic wound around the operative site. Patients who survived less than 1 month after surgery were excluded except in cases where death resulted from intracranial infection. RESULTS During the 29-month period, 225 of 1,244 cranial neurosurgical procedures were selected for study. Ages ranged from 4 to 86 years. Brain tumors were encountered in 57%. In the nonshaved group, there were 89 procedures (80 cases), compared with 136 procedures (123 cases) in the shaved group. Surgical infection rates were 3.37% and 5.88%, respectively (p>0.05). CONCLUSIONS Nonshaved scalp preparation is recommended for nonemergency cranial neurosurgical procedures.
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Affiliation(s)
- S Ratanalert
- Department of Surgery, Faculty of Medicine, Prince of Songkhla University, Hat-Yai, Thailand
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Phuenpathom N, Ratanalert S, Saeheng S, Sripairojkul B. Post-traumatic hydrocephalus: experience in 17 consecutive cases. J Med Assoc Thai 1999; 82:46-53. [PMID: 10087738] [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: 02/11/2023]
Abstract
BACKGROUND Ventriculomegaly after head injury is one of controversial debate. Currently there is no definite way to distinguish post-traumatic hydrocephalus (PTH) from cerebral atrophy. The favourable outcome is only from CSF shunting in patients with true post-traumatic hydrocephalus, not hydrocephalus exvacuo. METHOD 17 patients with post-traumatic hydrocephalus were retrospectively reviewed from January 1993 to February 1996 to determine risk factors and guidelines for the management of this problem. RESULTS These 17 patients represented 1.6 per cent of the 1080 head-injured patients seen at Songklanagarind Hospital during that period. 385 patients were classified as severe head injury in whom 7 were complicated with post-traumatic hydrocephalus. Our study found a high incidence of correlation between PTH and decompressive craniectomy. The late effect of decompressive craniectomy may cause CSF blockage around the convexities and hydrocephalus. The diagnoses were based on clinical manifestations and CT scan appearances. The outcome was related closely to the initial GCS score and the method used for diagnosis. CONCLUSION Post-traumatic hydrocephalus was 1.8 per cent in patients with severe head injury. Late neurological deterioration confirmed by CT scan findings was more useful than CT scan findings alone. CSF shunting was effective in patients with ventriculomegaly who had clinical signs and symptoms of increased intracranial pressure from post-traumatic hydrocephalus.
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Affiliation(s)
- N Phuenpathom
- Department of Surgery, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
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Sripairojkul B, Saeheng S, Ratanalert S, Pheunpathom N, Sriplung H. Traumatic hematomas of the posterior cranial fossa. J Med Assoc Thai 1998; 81:153-9. [PMID: 9623005] [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: 02/07/2023]
Abstract
The objective of this study was to find out the result of treatment and the factors which can predict the outcome of traumatic hematomas of the posterior cranial fossa. Twenty two patients with traumatic hematomas of the posterior cranial fossa from 1,500 patients with traumatic intracranial hematomas were analyzed. There were fourteen male and eight female patients. The most common etiology was a motor vehicle accident. About 90 per cent of the patients had a direct injury to the occipital region. Ninety per cent of the patients had an occipital skull fracture or diastatic fracture of the lambdoid suture. The overall mortality rate was about 38 per cent. Patients having pure epidural hematoma had zero mortality. By contrast, patients suffering epidural hematoma with associated intracranial hematoma had 20 per cent mortality. Intracerebellar hematoma led to 60 per cent mortality. Glasgow Coma Scale (GCS) before operation was used to predict the patients' outcome. Ninety per cent of the patients who had a GCS between 13 and 15 had a good recovery. By contrast, only 30 per cent of the patients who had a GCS below 9 had a good recovery. Statistical analysis showed that the GCS value of below 9 predicted the poor outcome for the patients.
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Affiliation(s)
- B Sripairojkul
- Department of Surgery, Prince of Songkla University, Hat Yai, Thailand
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Phuenpathom N, Ratanalert S, Sripairojkul B. Multiple intracranial aneurysms in Songklanagarind Hospital. J Med Assoc Thai 1998; 81:75-9. [PMID: 9529834] [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: 02/07/2023]
Abstract
We retrospectively reviewed the 107 patients on whom direct surgery was performed for intracranial aneurysms between December 18, 1984 and July 25, 1996. The incidence of multiple intracranial aneurysms in our hospital is 6.5 per cent (7/107 cases). There were 16 aneurysms in 7 cases with multiple aneurysms. There were 2 and 5 patients with 3 and 2 aneurysms respectively. The most common site was at the junction of posterior communicating artery (PCoA) and internal carotid artery (ICA). The preoperative conditions of the patients were closely related to the operative results. We performed direct surgery on bilateral aneurysms by bifrontal approaches. There was no mortality.
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Affiliation(s)
- N Phuenpathom
- Department of Surgery, Faculty of Medicine, Prince of Songkla University, Thailand
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Saeheng S, Ratanalert S, Pheunpathom N, Tangsinmankong K. The further surgical experiences in intracranial meningiomas at Songklanagarind Hospital. J Med Assoc Thai 1998; 81:80-6. [PMID: 9529835] [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: 02/07/2023]
Abstract
Meningioma is a common benign intracranial tumor documented in many reports. We retrospectively reviewed 81 patients with a total of 84 meningiomas. There were 61 females and 20 males. Most patients were in the third to sixth decades of life. The most common presenting symptoms were headache and decreased visual acuity. Focal neurological deficits and signs of increased intracranial pressure were found in most patients. The three most common tumor locations were falx and parasagittal, sphenoid wing and convexity. Of the 84 meningiomas, 67 were completely resected and 17 were partially resected. Operative morbidities were accounted for by hemiparesis, cranial nerve palsy and infection. There was only one operative death in our series. 70 patients had normal and good results, 4 patients had severe disabilities and results were unknown in 6 patients. Recurrences were detected in 8 patients and 5 patients underwent surgery again with good results in 4 patients. Recurrences occurred in 3 patients with total and 5 patients with subtotal resections. The most significant factor for recurrence was the extent of tumor resection.
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Affiliation(s)
- S Saeheng
- Department of Surgery, Prince of Songkla University, Hat Yai, Songkhla, Thailand
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Tussanasunthornwong S, Ratanalert S. Direct approach to a traumatic intracavernous internal carotid artery aneurysm: a case report. J Med Assoc Thai 1995; 78:157-63. [PMID: 7643032] [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: 01/26/2023]
Abstract
A traumatic intracavernous ICA aneurysm is a rare complication of head injury with skull base fracture. The hallmark of this condition is delayed, repeated, progressively worse and eventually fatal epistaxis. Inadequate treatment and delayed diagnosis are the major contributors to the high mortality. After epistaxis is controlled by anterior and posterior nasal packing, the patient should be investigated with carotid angiography and cross-flow study. In general, the acceptable procedure for this lesion is the trapping procedure by internal carotid artery ligation at the neck and clipping just proximal to the origin of the opthalmic artery, or by detachable balloon occlusion. However, Dolenc's technique of direct approach to cavernous sinus lesions makes it feasible to clip directly, as in this reported case.
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MESH Headings
- Adult
- Aneurysm, Ruptured/diagnostic imaging
- Aneurysm, Ruptured/etiology
- Aneurysm, Ruptured/surgery
- Carotid Artery, Internal/diagnostic imaging
- Carotid Artery, Internal/surgery
- Cerebral Angiography
- Craniocerebral Trauma/complications
- Craniocerebral Trauma/physiopathology
- Epistaxis/etiology
- Hematoma, Epidural, Cranial/etiology
- Hematoma, Epidural, Cranial/surgery
- Humans
- Male
- Tomography, X-Ray Computed
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Abstract
This study is based on a series of 109 consecutive head injured patients with the CT scan diagnosis of acute subdural hematoma. The overall outcome was assessed at 6 months after injury using the Glasgow Outcome Scale. By logistic regression analysis a small set of clinical features (the best sum Glasgow Coma Scale score within 24 h after admission, and pupillary inequality) was revealed as significant prognostic features. The method described allows bedside predictions in individual future cases.
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Affiliation(s)
- N Phuenpathom
- Department of Surgery, Prince of Songkla University, Thailand
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Ratanalert S, Phuenpathom N, Chompikul J, Ladpli S. Treatment of severely head injured patients with absence of basal cisterns on initial CT scans. J Med Assoc Thai 1992; 75:644-8. [PMID: 1307388] [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: 12/26/2022]
Abstract
Sixty-four severely head injured patients with absence of basal cisterns on initial CT scan were studied from January 1986 to March 1989. None had good recovery at 6 months follow-up period. The result from logistic regression analysis pointed to the GCS at 24 hours following injury as an independent, significant outcome predictor. Conventional treatment is not suitable for these patients. Earlier and more aggressive therapy should improve their outcome.
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Affiliation(s)
- S Ratanalert
- Department of Surgery, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand
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Phuenpathom N, Ratanalert S. Results of delayed operations for ruptured supratentorial aneurysms in 22 consecutive patients. J Med Assoc Thai 1992; 75:495-501. [PMID: 1304018] [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: 12/26/2022]
Abstract
Twenty-two patients with surgically treated ruptured aneurysms were reviewed retrospectively regarding age, sex, aneurysm site distribution, clinical grading, rebleeding, timing of surgery and long term results. The most common aneurysm site was in the Anterior Communicating artery (44%). The mean time between aneurysmal subarachnoid hemorrhage and surgery was 20 days. There were 4 cases with intraoperative rupture. The outcome was favorable in 63.6 per cent after a mean follow-up of 21 months. The overall mortality rate was 22.7 per cent. The results may be improved by an early, well planned operation.
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Affiliation(s)
- N Phuenpathom
- Department of Surgery, Faculty of Medicine, Prince of Songkla University, Thailand
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Ovartlarnporn B, Ratanalert S, Keowkarnkar W. Liquid meal emptying in non-ulcer dyspepsia: a study in 22 Thai patients. J Med Assoc Thai 1992; 75:236-9. [PMID: 1402448] [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: 12/26/2022]
Abstract
Twenty-four patients with non-ulcer dyspepsia (NUD) were recruited for gastric emptying study of liquid meal before and after 1 week's treatment with domperidone (80 mg in 19, 40 mg in 2, dropout 1 and excluded 2). Delayed gastric emptying was found in 8 of 22 (36.36%). Clinical improvement was found in 11 patients after treatment. Gastric emptying improvement was found in 3 patients (2 without clinical improvement). No correlation was found between the clinical and gastric emptying improvement. (Fisher exact test p greater than 0.25). Impaired liquid emptying is common in NUD and domperidone improved clinical symptoms in 50 per cent of NUD in this study.
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Affiliation(s)
- B Ovartlarnporn
- Department of Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
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Abstract
Of 203 patients with severe head injuries admitted from January 1986 to May 1989 at Songklanagarind Hospital, 32 cases who initially talked prior to deteriorating to a Glasgow Coma Scale score of 7 or less within 48 hours after injury were identified. Many variables were analyzed to ascertain what might be responsible for the differences in outcome. The Glasgow Coma Scale score before neurosurgical intervention was identified, using the logistic regression model, as a significant prognostic predictor. Mortality rate was 40.6%, with two patients left in a vegetative state. Surgically correctable intracranial mass lesions occurred in 29 cases. The most important factors in salvaging these patients are rapid diagnosis and immediate surgical decompression before irreversible brain damage sets in.
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Affiliation(s)
- S Ratanalert
- Department of Surgery, Faculty of Medicine, Prince of Songkla University, Thailand
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Chungpieboonpatana A, Ratanalert S, Ladpli S. Occipital lobe infarction following descending transtentorial herniation. J Med Assoc Thai 1988; 71:553-60. [PMID: 3249162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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