Weerachai Kosuwon

Ultrasonography of pulled elbow

We used ultrasonography in ten children with pulled elbow to compare measurements of the radiocapitellar distance (RCD) on the affected and the unaffected sides. Similar measurements were made in a group of ten age-matched normal children. The mean RCD in pronation of the affected and normal sides in the patients with pulled elbows was 7.2 mm +/- 0.7 and 3.8 mm +/- 0.5, respectively (p < 0.0001). In the normal children the mean RCD in pronation was 4.5 mm +/- 0.5. We conclude that ultrasonography is of value for documenting pulled elbow in children.

Melioidotic septic arthritis and its risk factors.

Background: Melioidotic septic arthritis is an infection caused by the gram-negative bacillus Burkholderia pseudomallei . It is commonly found in Northeast Thailand. The goal of our study was to identify specific characteristics of patients with melioidotic septic arthritis by comparing them with patients with non-melioidotic septic arthritis and to describe the results of treatment of melioidotic septic arthritis.Methods: We conducted a retrospective study of seventy-seven patients with septic arthritis who were treated in our hospital over a period of four years. Twenty-five of the patients had melioidotic septic arthritis, and fifty-two had non-melioidotic septic arthritis. Univariate and multivariate analyses were conducted to identify the risk factors for melioidotic septic arthritis, and the clinical course of the twenty-five patients with melioidotic septic arthritis was followed until the infection resolved.Results: Patients with melioidotic septic arthritis differed significantly (p = 0.002 ) from those with non-melioidotic septic arthritis with regard to the frequency of diabetes mellitus and of involvement of an upper-extremity joint. The odds ratio that melioidosis was the cause of the infection was 15.7 (95% confidence interval, 4.5 to 55.6) in a patient with diabetes mellitus and 4.51 (95% confidence interval, 1.04 to 19.65) in a patient with involvement of an upper-extremity joint. Twenty-two of the twenty-five patients with melioidotic septic arthritis responded to treatment, which consisted of six months of antibiotic therapy combined with needle aspiration, as well as surgical drainage of the affected joint when necessary (sixteen patients).Conclusions: A diagnosis of melioidotic septic arthritis should be considered when septic arthritis is seen in an individual who is indigenous to or has recently visited Southeast Asia. The infection is more likely to be melioidotic septic arthritis if it involves an upper-extremity joint and if the patient has diabetes mellitus.Level of Evidence: Prognostic study, Level II-1 (retrospective study). See Instructions to Authors for a complete description of levels of evidence.

Prediction of idiopathic respiratory distress syndrome by the stable microbubble test on gastric aspirate

We evaluated the usefulness and accuracy of the stable microbubble test (SMT) performed on gastric aspirates of neonates to predict idiopathic respiratory distress syndrome (IRDS) and compared the results with those of the shake test, using the clinical characteristics of IRDS as the gold standard for the diagnosis of IRDS. One hundred forty paired samples of gastric aspirates, obtained within 1 hour of delivery from neonates with gestational ages between 27 and 42 weeks (mean, 36.6 ± 3.5 weeks) and birth weights between 800 and 4,090 grams (mean 2,571 ± 826 grams) were evaluated.

Prevalence of Known and Unknown Primary Tumor Sites In Spinal Metastasis Patients

Study Design: A retrospective study. Objectives: Three objectives have been designated for this study: (1) to determine the prevalence of identifiable and non-identifiable primary tumor sites in patients with spinal metastasis, (2) to identify the most common site of the known primary tumor sites, and (3) to identify the factors associated with survival time. Summary of Background Data: The spine is the third most common metastatic site for several primary visceral carcinomas. The primary tumor site could not be identified in 15% to 20% of patients who had been diagnosed of with a skeletal metastasis. Most of the previous studies on skeletal metastasis have not been limited to spinal metastasis alone. Methods: Between January 2007 and July 2011 reviews were done for 82 patients with spinal metastasis who had not received a previous diagnosis of carcinoma. The assessment parameters included the following: general demographic data, Karnofsky score, Frankel score, number of spinal vertebra affected, region of the spine affected by metastasis, other skeletal metastasis site, visceral metastasis, known or unknown primary sites of metastasis, histological cell type of metastasis, and the survival period. The log-rank test and Cox proportional hazard model were used to study the survival analysis. Results: Of the 82 patients included in the study, 56 were male. The mean age was 57 years. 86.6% had a known primary carcinoma site while the remaining 13.4% had none. The two most common known carcinoma sites were the lung and biliary systems. Among the 11 unknown primary sites, the most common histological finding was adenocarcinoma. The mean survival period was 8.7 ± 11.7 months. The survival analysis revealed two statistically significant factors: the primary tumor site’s aggressiveness (P<0.005) and the presence of visceral metastasis (P<0.05). Conclusion: The prevalence of identifiable primary site was 86.6% and the most common site was the lungs followed by the biliary system. The primary carcinoma site’s aggressiveness and the presence of visceral metastasis were the factors associated with patient survival.

An aiming device for distal locking in closed locked femoral nailing

A method of constructing an aiming device for insertion of distal locking screws is described. The device helps facilitate the free-hand technique, lessens the difficulty of drilling and insertion and allows the surgeon to perform at a distance, away from the radiation beam.

Clinical results of primary malignant musculoskeletal tumor treated by wide resection and recycling autograft reconstruction using liquid nitrogen.

To evaluate the clinical results of primary malignant musculoskeletal tumors treated with wide resection and recycling autograft reconstruction using liquid nitrogen.

Prognostic factors and clinical outcomes in synovial sarcoma of the extremities

To evaluate the clinical outcomes and identify which prognostic factors influence the clinical outcomes of synovial sarcoma patients at a tertiary university hospital in Thailand.

Cholangiocarcinoma with spinal metastasis: Single center survival analysis.

The aim of this study was to perform a survival analysis of Cholangiocarcinoma (CCA) with spinal metastases. 55 cases of CCA with spinal metastases were retrospectively reviewed. We recorded age, sex, Kanofsky performance score, Frankel scale, number and region of affected vertebrae, presence of appendicular bone metastases, treatment received, and survival time; then performed a survival analysis. Overall median survival was 4months (95%CI, 2.89-5.11). Frankel A had the poorest survival (2months-95%CI, 1.15-2.85) compared to Frankel C and D (P=0.004 and <0.001, respectively). One-level spinal metastasis had the longest survival (8months-95%CI, 5.98-10.02) compared to two-level and more than two-level involvement (P=0.036 and 0.001, respectively). The higher Kanofsky score had the longer survival (11months-95%CI, 9.61-12.39) compared with the low and moderate score groups (P<0.001 and 0.012, respectively). Radiation therapy had a survival of 6months (95%CI, 3.41-8.59), significantly longer than the 3months for palliative spine surgery and 2months for palliative treatment alone. CCA resection and palliative spine surgery-when performed together and/or combined with other adjuvant treatment(s)-had a survival time of longer than 9months. In conclusion, CCA with spinal metastases had a poor median survival. A single level of affected spine, a Frankel scale of C or better, a moderate to high Kanofsky score, and radiation therapy were associated with significantly longer median survival. CCA resection and spinal surgery may play an important role in prolonging survival when used in conjunction with other adjuvant treatment modalities.

Morphological Study of Subaxial Cervical Pedicles by Using Three-Dimensional Computed Tomography Reconstruction Image

Malpositioning of cervical screws risks neurovascular injury. A cervical screw fixation system can provide proper rigidity, alignment correction, and high rates of fusion afforded by high pullout biomechanical strength. The objective is to assess the dimensions and axis of the C3–C7 cervical pedicles. A 1-mm slice thickness computed tomography (CT) scan of the cervical spine of 30 patients (15 males, 15 females) were analyzed and reconstructed in three-dimensions using Mimics® 10.01 software. We measured pedicle axis length (PAL), pedicle and lateral mass length (PL-LM), pedicle length (PL), outer pedicle width (OPW), and pedicle transverse angle (PTA) from the axial image and outer pedicle height (OPH) and pedicle sagittal angle (PSA) from the sagittal image. The OPH and OPW at all subaxial cervical spines were suitable for insertion of 3.5 mm cervical pedicle screws. PSA was directed cranially at C3 to C5 (13.84, 7.09, and 2.71) and directed caudally at C6 and C7 (–4.55, –6.94). PTA was greatest at C5 and smallest at C7. The respective difference between the left and right side for nearly all parameters was not statistically significant (except for C6 PL and C7 OPH). Females had a significantly smaller OPH and OPW than males at nearly all levels. The PTA was not significantly different between the sexes. Cervical pedicle screw fixation in the Thai population can be safely performed and guidelines for insertion at each vertebra documented. Appropriate preoperative planning is necessary to achieve safe and accurate placement of the screws.

Determination of Cartilage Volume Using MRI in Patients with KneeOsteoarthritis: Efficacy Study of 25 Milligrams of Sodium Hyaluronate(2.5 Ml) Versus Placebo

Background: Osteoarthritis (OA) of the knee is prevalent and associated with both pain and functional disability. Visco-supplementation is an intra-articular therapeutic modality for the treatment of knee OA, based on the physiologic importance of hyaluronan in synovial joints. The therapeutic goal is to restore the viscoelasticity of synovial hyaluronan, decrease pain, improve mobility and restore the natural protective functions of hyaluronan in the joint radiography is currently the most widely used modality for assessing damage in OA: this technique allows the measurement of joint space width (JSW) the appropriate primary endpoint for demonstration of efficacy. There are, however, questions regarding its validity and reliability. Magnetic resonance imaging (MRI) with its superior soft tissue contrast is the best technique available for assessment of normal articular cartilage and cartilage volume. Therefore, this study aimed to evaluate the short-term benefit of intra-articular injection of hyaluronic acid (GoOn®) for protecting the articular by using MRI in patient with OA knee. Patients and Methods: This was a phase III double-blinded (i.e., both the patients and MRI examiners), randomized, controlled trial of 60 patients with mild to moderate knee OA, diagnosed according to both clinical signs and X-ray. All of the patients received MRIs (1.5 T) of the affected knee(s) at visit 0 and 6 months after the first injection. The patients received either an intra-articular injection into the affected knee weekly for 5 weeks of HA (GoOn®) or a placebo. Blinded examiners used the visual analog scale (VAS) and the WOMAC score to do weekly and monthly assessments for 6 months. The engineer used Mimics 10.01 to transform the MRI scanner data into 3D images of the articular cartilage for measuring CV, which was also blinded to the treatments. Results: Subjects averaged 59.5 years of age (range, 46 to 84). During the enrollment phase, only female farmers attended came. Four patients in the placebo group and one in the GoOn® group refused to undergo the second MRI. The mean body weight and height was 64.20 ± 10.25 kg and 1.53 ± 0.057 m, respectively. The respective baseline VAS and WOMAC score was 6.40 ± 1.64 and 51.65 ± 13.3. Forty-four patients were KL grade 2 and 16 were grade 3. The mean total CV at baseline in the GoOn® and placebo groups was 14.7 ± 3.5 ml and 15.5 ± 3.9 ml, respectively. There was no significant difference in the mean total CV after 6 months in either group (p>0.05) except at the femorotibial junction of the GoOn® group was increase CV more than the placebo group (p<0.05). The mean difference in the total WOMAC score and all three subscales in the GoOn® vs. the placebo groups were statistically significant (p<0.05). The difference in mean VAS between both groups was not statistically significant. No adverse events were reported. Conclusion: GoOn® was an effective symptomatic treatment in mild to moderately painful OA knees according to the WOMAC score. In the short-term six-month period, there was not any change in the total cartilage volume except at the femoro-tibial junction.