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Biomedical subjects

N Phuenpathom

Publications and source records attributed to N Phuenpathom.

16 recordsLinked to original sources
PubMed2001

Traumatic occipitoatlantal dislocation.

BACKGROUND: Traumatic occipitoatlantal dislocation (OAD) is a severe ligamentous injury resulting in instantaneous death or severe neurological deficit. However, survivors of OAD, both short and long term, have been increasingly reported; this may be because of improved prehospital care, more rapid transportation, a high index of suspicion, and new radiological techniques. METHODS: The medical records and film of three patients who had traumatic OAD were retrospectively reviewed. Diagnosis was made by lateral cervical spine radiography, computed tomography (CT), or magnetic resonance imaging (MRI). Treatment consisted of early respiratory support and subsequent posterior surgical fusion. RESULTS: The three survivors of traumatic OAD represent 3.1% of all cervical spine injuries in our service. Two were children and the other was a 64-year-old man, all of whom suffered from severe neurological deficits. Lateral cervical spine radiographs led to the diagnosis of OAD. Two were longitudinal, and one was anterior. Two patients died within 2 weeks after injury. The remaining patient, who had anterior OAD, survived longer, which allowed posterior fusion with a U-shape Steinman pin and wiring to be performed. However, she died 5 months after injury because of septicemia. CONCLUSION: Early recognition and treatment may improve the outcome of this injury. Treatment consists of early respiratory support and subsequent surgical fusion.

Atlanto-Occipital Joint↗
PubMed2000

The changing pattern of head injury in Thailand.

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.

Accidents, Traffic↗
PubMed1999

Nonshaved cranial neurosurgery.

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.

Adolescent↗
PubMed1999

Post-traumatic hydrocephalus: experience in 17 consecutive cases.

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.

Adolescent↗
PubMed1999

Intraoperative intracranial aneurysm rupture.

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.

Aged↗
PubMed1998

Multiple intracranial aneurysms in Songklanagarind Hospital.

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.

Adult↗
PubMed1996

Distribution of azithromycin into brain tissue, cerebrospinal fluid, and aqueous humor of the eye.

To measure the concentrations of azithromycin in the central nervous system, 20 patients with brain tumors (group I) received a single 500-mg oral dose of azithromycin either 24, 48, 72, or 96 h prior to the tumor removal operation and 10 patients with cataracts undergoing surgery (group II) and 7 patients scheduled to undergo lumbar puncture (group III) received the same dose of azithromycin 24 h prior to the operation or procedure. Serum from all patients, brain tissue from group I, aqueous humor from group II, and cerebrospinal fluid from group III were assayed for azithromycin concentration. The mean concentrations of azithromycin in brain tissue 24, 48, 72, and 96 h after administration were 2.63 +/- 2.58, 3.64 +/- 3.81, 0.74 +/- 0.37, and 0.41 micrograms/g, respectively. In contrast, the concentrations of azithromycin in cerebrospinal fluid and aqueous humor of the eye were very low or undetectable. Therefore, these data show that azithromycin appears to be widely distributed into brain tissue but not into cerebrospinal fluid or aqueous humor of the eye.

Adolescent↗
PubMed1993

Outcome and outcome prediction in acute subdural hematoma.

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.

Acute Disease↗
PubMed1992

Results of delayed operations for ruptured supratentorial aneurysms in 22 consecutive patients.

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.

Adult↗
PubMed1992

Treatment of severely head injured patients with absence of basal cisterns on initial CT scans.

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.

Adolescent↗
PubMed1990

Management of head injury patients who talked and deteriorated.

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.

Adolescent↗
PubMed1990

Langerhans cell histiocytosis of the spinal cord: a case report.

A 14-year-old boy with Langerhans cell histiocytosis of the spinal cord who presented with progressive enlarged bilateral inguinal masses, difficulty in urination, walking and paresthesia in the left lower extremity and perineum is reported. Radiographic studies and computerized axial tomography of T12 to L2 spines showed destruction of the vertebral body of L1 and left-sided paravertebral soft tissue mass extending into the vertebral canal with complete block of the dural sac at the level of L1 spine. The operative finding was an extradural mass at the anterolateral aspect of L1 to L2 spines. After surgical removal of the lesion and chemotherapy with vincristine, prednisolone, 6-MP and methotrexate for 15 months, his neurological deficit improved and there has been no evidence of recurrent disease during his two years follow-up. Langerhans cell histiocytosis is a possible cause of spinal cord compression or cauda equina syndrome and should be considered after excluding other more common causes.

Adolescent↗
PubMed1990

TSH secreting pituitary adenoma in children: a case report.

The clinical presentation of TSH-secreting pituitary adenoma in an 11-year-old boy is reported. Hyperthyroidism, signs and symptoms of increased intracranial pressure with the elevation of TSH, T3, T4 were the clues for suspecting this disorder. Bilateral carotid angiogram was performed which disclosed a suprasellar mass, and pituitary surgery was performed. Electron microscopic examination confirmed the diagnosis of TSH secreting pituitary tumor.

Adenoma↗