Chumpon Wilasrusmee

A Systematic Review and Meta-analysis of Randomised Controlled Trials Comparing Endovenous Ablation and Surgical Intervention in Patients with Varicose Vein

OBJECTIVES AND DESIGN A systematic review and meta-analysis was conducted to compare clinical outcomes between endovenous laser ablation (EVLA), radiofrequency ablation (RFA), ultrasound-guided foam sclerotherapy (UGFS) and surgery. METHODS We searched MEDLINE and Scopus from 2000 to August 2011 to identify randomised controlled trials (RCTs) comparing EVLA, RFA, UGFS, and surgery or combinations of these for treatment of varicoses. Differences in clinical outcomes were expressed as pooled risk ratio and unstandardised mean difference for dichotomous and continuous outcomes, respectively. Methodological quality was assessed using Cochrane tools. RESULTS Twenty-eight RCTs were included. The primary failure and clinical recurrences were not significantly different between EVLA and RFA versus surgery with the pooled RR of 1.5 (95%CI:0.7, 3.0) and 1.3 (95%CI:0.7, 2.4) respectively for primary failure, and, 0.6 (95%CI:0.3, 1.1) and 0.9 (95%CI:0.6, 1.4) respectively for clinical recurrences. The endovenous techniques had advantages over surgery in lowering wound infections (RR = 0.3 (95%CI:0.1, 0.8) for EVLA), haematoma (RR = 0.5 (95%CI:0.3, 0.8) and 0.4 (95%CI:0.1, 0.8) for EVLA and RFA), and return to normal activities or work (mean differences = -4.9 days (95%CI:-7.1,-2.7) for RFA). CONCLUSIONS The primary failure and recurrence in EVLA and RFA were non-significantly different compared with surgery. However, they had lower haematoma, less wound infection, less pain and quicker return to normal activities.

Systematic review and meta-analysis of safety of laparoscopic versus open appendicectomy for suspected appendicitis in pregnancy.

Laparoscopic appendicectomy has gained wide acceptance as an alternative to open appendicectomy during pregnancy. However, data regarding the safety and optimal surgical approach to appendicitis in pregnancy are still controversial.

In Vitro Immunomodulatory Effects of Ten Commonly Used Herbs on Murine Lymphocytes

OBJECTIVES Physicians are increasingly encountering patients who use herbal products. Some of these products are known to modulate the immune system but their scientific basic is not well established. Because these products can affect the host immune system, they could be beneficial in the treatment of immune-related diseases, or alternatively, they could cause inadvertent side-effects. The purpose of this study was to determine which of these common herbal products modulate lymphocyte proliferation in vitro. METHODS Lymphocyte proliferation assays using concanavalin A (mitogen stimulation) and mixed lymphocyte culture (alloantigen stimulation) were used as in vitro tests to investigate the immunomodulatory effects of 10 commonly used herbal products. RESULTS Ginger and tea were consistently immunosuppressive while dong quai, milk thistle, and St. Johns wort were consistently immunostimulatory in vitro. Ginseng enhanced lymphocyte proliferation only in the mitogen-stimulation assay. The magnitude of the enhancement or suppression of the individual herbal products was different in the two assays. CONCLUSION Our study provides a uniform survey of the immunomodulatory properties of 10 commonly used herbal products and paves the way for testing these effects in vivo and in clinical setting.

Morphological and biochemical effects of immunosuppressive drugs in a capillary tube assay for endothelial dysfunction

Abstract: Immunosuppressive drugs common in clinical transplantation are known to have untoward effects on the vascular system. The effects of some drugs, notably cyclosporin A (CyA), have been studied on the vascular system, while those of others have not. In the vascular system, endothelial cells are the predominant cell type exposed to intravascular concentrations of immunosuppressive drugs. We therefore studied the effects of drugs common in clinical transplantation on endothelial cells in a capillary tube assay. The endothelial cells in the capillary tubes are morphologically more similar to those in the microvasculature than endothelial cells in monolayers. We studied the kinetics and extent of capillary tube formation and prostacyclin (PGI2) and endothelin‐1 (ET‐1) release from the in vitro capillaries to determine the morphological and biochemical effects of five immunosuppressive agents on endothelial function. We found a significant difference in the morphological and biochemical effects of the two common calcineurin inhibitors, CyA and tacrolimus (FK506) on capillary morphology in vitro. The former had a pronounced injurious effect on the morphology of the in vitro capillaries, while the latter did not. CyA also significantly increased ET‐1 release by the capillaries, but FK506 did not. Mycophenolate mofetil (MMF) was the only other agent that had a moderately injurious effect on the morphology of the in vitro capillaries. Sirolimus (rapamycin) and dexamethasone, similar to FK506, had no effect on the capillary morphology. All these agents, except dexamethasone, increased PGI2 release. Our data suggest that CyA adversely affects the morphology of the microvasculature and that this is mediated, at least partly, by an increased ET‐1 release by endothelial cells exposed to CyA. These findings describe a novel effect of CyA and MMF on endothelial cells that could be relevant to understanding the mechanisms of immunosuppressive drug‐mediated endothelial injury in clinical transplantation.

Deep Venous Thrombosis in Surgical Intensive Care Unit: Prevalence and Risk Factors

BACKGROUND Critically ill patients are at high risk for developing venous thromboembolism. The objective of this study was to determine the prevalence of, and risk factors for, lower extremity deep vein thrombosis (DVT) among critically ill surgical patients in Thailand. MATERIALS AND METHODS Patients older than 15 years who were admitted to a surgical intensive care unit (ICU) of a tertiary care hospital were enrolled. Bilateral lower extremity compression Doppler ultrasonographic examination was performed to detect DVT within 14 days of ICU admission. Demographic data, primary disease, operative intervention, co-morbidities, acute physiology and chronic health evaluation (APACHE) II score and the length of ICU stay were tested for association with the presence of DVT. RESULTS Among the 190 first-time admitted ICU patients with a mean APACHE II score of 9.2 +/- 6.0 (range, 0-29), 20 patients had DVT (prevalence of 10.5%). Thromboprophylaxis was not given to any patient. The only independent and significant risk factor for DVT was a longer ICU stay. Age, sex, APACHE II score, presence of comorbidities and operative intervention were not associated with the presence of DVT. CONCLUSION The prevalence of DVT in critically ill patients in a Thai surgical ICU was approximately 10.5%. Further research is needed to evaluate the risks and benefits of venous thromboprophylaxis in Thai patients.

Hemoglobin Concentration and Pregnancy Outcomes: A Systematic Review and Meta-Analysis

Objective. To conduct a systematic review and meta-analysis of hemoglobin effect on the pregnancy outcomes. Methods. We searched MEDLINE and SCOPUS from January 1, 1990 to April 10, 2011. Observational studies addressing association between hemoglobin and adverse pregnancy outcomes were selected. Two reviewers independently extracted data. A mixed logistic regression was applied to assess the effects of hemoglobin on preterm birth, low birth weight, and small for gestational age. Results. Seventeen studies were included in poolings. Hemoglobin below 11 g/dL was, respectively, 1.10 (95% CI: 1.02–1.19), 1.17 (95% CI: 1.03–1.32), and 1.14 (95% CI: 1.05–1.24) times higher risk of preterm birth, low birth weight, and small for gestational age than normal hemoglobin in the first trimester. In the third trimester, hemoglobin below 11 g/dL was 1.30 (95% CI: 1.08–1.58) times higher risk of low birth weight. Hemoglobin above 14 g/dL in third trimester decreased the risk of preterm term with ORs of 0.50 (95% CI: 0.26–0.97), but it might be affected by publication bias. Conclusions. Our review suggests that hemoglobin below 11 g/dl increases the risk of preterm birth, low birth weight, and small gestational age in the first trimester and the risk of low birth weight in the third trimester.

Prognostic value of ABCG2 in moderately and poorly differentiated intrahepatic cholangiocarcinoma.

Larbcharoensub N, Sornmayura P, Sirachainan E, Wilasrusmee C, Wanmoung H & Janvilisri T 
(2011) Histopathology59, 235–246

Comparative study of tailor-made mesh plug herniorrhaphy versus Lichtenstein herniorrhaphy versus Bassini operation: a prospective clinical trial.

OBJECTIVE Operations to cure inguinal hernia are among the most common surgical procedures. However, the most effective surgical technique for inguinal hernia repair is unknown, and the recurrence at 5 years varies between 1% and 10%. Surgical techniques and implanted materials are crucial to the result of and costs associated with hernia repair. The objective of this study was to determine whether the tailor-made mesh plug for inguinal hernia repair was as effective and safe as other methods of herniorrhaphy. METHODS Of 94 patients who had a primary diagnosis of inguinal hernia prospectively included in the study, 25 were treated with tailor-made mesh plug herniorrhaphy, 26 with Lichtenstein herniorrhaphy and 36 with the Bassini operation. The primary outcome was the recurrence of hernia at 1 year, and secondary outcomes included surgical complications and hospital stay. RESULTS There was no postoperative mortality in this study. Three patients had recurrence after Bassini operation, but there was no recurrent hernia after Lichtenstein or mesh plug herniorrhaphy. Groin swelling and ecchymosis were found in two patients (1 tailor-made mesh plug, 1 Lichtenstein herniorrhaphy). No surgical site infection occurred. Mean operating time was 60 minutes (range, 45-75 minutes) for tailor-made mesh plug herniorrhaphy, 82 minutes (range, 30-120 minutes) for Lichtenstein herniorrhaphy, and 82 minutes (range, 30-135 minutes) for the Bassini operation. CONCLUSION Tailor-made mesh plug herniorrhaphy is a safe operation. The mesh plug material (Mersilene) was cheap. The recurrence rate was lower with tailor-made mesh plug herniorrhaphy than with the Bassini operation, but equal to that with Lichtenstein herniorrhaphy. Postoperative complications did not differ among all operations.

Development of wire-driven laparoscopic surgical robotic system, “MU-LapaRobot”

This paper describes the design and development of a new wire-driven laparoscopic surgical robotic system. The aim of our design is to develop a surgical robotic system to work with traditional surgical tools to reduce the surgeons learning curve in using our robotic system. The overall design is strictly based on surgical requirements which our specific workspace analysis also plays an important role. The motion of laparoscopic tool creates a unique constraint which is a remote-fulcrum point away from the robot at the small incision on abdominal wall. Our robot consists of 3 sections; 1) 2-link passive planar manipulator with level adjuster for locating the fulcrum point in 3D-space, 2) 2-DOF distant-parallel mechanical linkage for generating a cone-shape workspace, and 3) tools quick release for switching tool during the surgery. Our current study and mechanical design is based on our first design of “A Passive Laparoscopic Tool Holder with Electromagnetic Brake System” in full motion constraint. The new design is a wire-driven and motorized system. The design, implementation, experiment and results are discussed here. The ultimate goal of this project is to develop an interchangeable surgical robots which capable of human-robot collaboration and tele-operation.

Network meta-analysis of antibiotic prophylaxis for prevention of surgical-site infection after groin hernia surgery

First‐generation cephalosporins (such as cefazolin) are recommended as antibiotic prophylaxis in groin hernia repair, but other broad‐spectrum antibiotics have also been prescribed in clinical practice. This was a systematic review and network meta‐analysis to compare the efficacy of different antibiotic classes for prevention of surgical‐site infection (SSI) after hernia repair.