Biomedical subjects

R Rajatanavin

Publications and source records attributed to R Rajatanavin.

At least 55 records · Page 3Linked to original sources

PubMed1997

Preevacuation serum CA 125 in complete hydatidiform mole.

Studies on CA 125 in hydatidiform mole are limited. The objective of this study was to measure the preevacuation serum CA 125 level in patients with complete hydatidiform mole and to determine whether it could predict the later development of persistent trophoblastic disease. Preevacuation serum CA 125 levels were immunoradiometrically measured in 69 patients with histologically confirmed complete hydatidiform mole. The mean (range) serum CA 125 level was 63.7 (10.5-404.7) U/ml. Using 35 U/ml as the cutoff point, the elevated CA 125 levels were observed in 53.6% (37/69) of the patients. The mean serum CA 125 level of patients who later developed persistent trophoblastic disease was not significantly higher than that of those who had benign course (78.9 vs 52.6 U/ml, P > 0.05). In conclusion, the preevacuation serum CA 125 level was elevated in about half of patients with complete hydatidiform mole and it could not be used to predict the subsequent development of persistent trophoblastic disease.

Adult↗

PubMed1997

Vitamin D receptor gene polymorphism is associated with urinary calcium excretion but not with bone mineral density in postmenopausal women.

Polymorphism of vitamin D receptor (VDR) gene has been found to be associated with serum osteocalcin (OC) levels and bone mineral density (BMD) in Caucasian identical twins and unrelated postmenopausal women. Being ethnically different and living in a geographic area with adequate vitamin D status due to abundant sunshine exposure, it is unclear whether VDR gene polymorphism will affect bone mass in Thai population. In the present study, we investigated the association between VDR gene polymorphism and bone metabolism in Thai postmenopausal women. Subjects consisted of 84 postmenopausal women. Bsm I, Taq I and Apa I polymorphisms of VDR gene were determined by PCR-RFLP. B, T and A represent the absence of the corresponding restriction sites while b, t and a indicate the presence of the restriction sites. Data were expressed as mean +/- SE. Sixty-six subjects (78.6%) had bb genotype while 18 (21.4%) had Bb genotype. None of the subjects was found to have BB genotype. Taq I restriction site was in linkage disequilibrium to the Bsm I site. For Apa I polymorphism, 33 (39.3%), 42 (50.0%) and 9 (10.7%) of the subjects had aa, Aa and AA genotypes, respectively. There was no significant difference in serum intact OC levels and BMD at various skeletal sites among subjects with different genotypes. Despite the lack of difference in BMD and intact OC levels, subjects with bb genotype had higher 24-hour urinary calcium excretion than those with Bb genotype (bb, 6.1 +/- 0.3 mmol/day; Bb, 4.4 +/- 0.6 mmol/day; p < 0.05). The effect of Bsm I VDR genotype was still significant (p < 0.05) after dietary calcium intake was controlled using analysis of covariance. Despite the difference in urinary calcium levels, there was no significant difference in fractional excretion of calcium among subjects with different Bsm I-related genotypes, suggesting that the effect of the VDR gene polymorphism on urinary calcium excretion is more likely due to the effect on intestinal calcium absorption rather than renal tubular calcium reabsorption. We conclude that VDR genotype distributions in Thai postmenopausal women are different from those reported in Caucasians. VDR gene polymorphism does not appear to be associated with BMD or bone turnover in Thai postmenopausal women. However, Bsm I VDR polymorphism may have physiologic role in calcium homeostatasis by modulating intestinal calcium absorption.

Adult↗

PubMed1997

Neonatal thyrotropin profile as an index for severity of iodine deficiency and surveillance of iodine prophylactic program.

Neonatal serum thyrotropin (TSH) level has been proposed as an index for the monitoring and surveillance of an iodine prophylactic program. We have determined an effective way to put this idea into practice. During the first phase of our study, neonatal serum TSH levels were obtained from umbilical cord blood of neonates born in Chiangmai and Nan provinces, where several districts were areas of severe iodine deficiency, and were compared with those of neonates born in Bangkok, which was a control area. The median and (95% CI [confidence interval]) of serum TSH level of neonates born in Chiangmai 5.8 (5.7-5.9) microU/mL was significantly higher than in Nan 5.1 (5.0-5.2) microU/mL, and in Bangkok 3.7 (3.7-3.8) microU/mL. Neonatal serum free thyroxine (FT4) concentration in Bangkok was higher than in Nan; while the reciprocal was true for neonatal TSH concentration in randomly selected samples (FT4 1.6 [1.6-1.7] ng/dL vs. 1.5 [1.5-1.6] ng/dL and TSH 3.5 [3.3-3.9] microU/mL vs. 5.5 [5.2-5.9] microU/mL, respectively.) When odds ratio of the likelihood of having neonatal TSH level higher than in Bangkok was calculated using 95th percentile value of neonatal TSH level in Bangkok as a cut-off point, the odds ratio of TSH profile in all districts in Chiangmai and Nan were greater than unity. In the second phase of our study, data were collected from 32 district and 10 provincial hospitals. The optimum number of samples in each hospital derived from the first phase of our study was at least 178. Discrepancy between goiter rate and odds ratio of TSH profile was observed, but there was a significant correlation between the two indices (r = 0.67, p < .001). Our study confirmed the practical utility of neonatal TSH profile as a biological index for assessment and monitoring and surveillance of an iodine prophylactic program at a district hospital in a developing country.

Fetal Blood↗

PubMed1997

Endemic cretinism in Thailand: a multidisciplinary survey.

Endemic cretinism has been classified into neurological and myxedematous types. Profound mental deficiency, deaf-mutism and cerebral diplegia are predominantly found in the former. The latter have been described as less mentally retarded but with severe growth retardation and myxedematous features. The pathogenesis of different clinical types of endemic cretinism is still unclear. Recently, a unifying hypothesis suggested that iodine deficiency, severe enough to cause maternal and fetal hypothyroxinemia, results in neurological defects in all cretins. We conducted the present study in northern Thailand to determine the validity of this hypothesis in another geographical area. The study consisted of a multidisciplinary survey on 112 endemic cretins aged 2-66 years in Nan. They were categorized clinically into three types of endemic cretins, neurological (n = 57), myxedematous (n = 19) and mixed form (n = 36). The subjects were generally short and the majority had severe mental retardation (mean intellectual quotient (I.Q.) 30.8 +/- 8.8), psychomotor defect and profound sensorineural hearing loss. The I.Q. score and proportion of cretins with sensorineural hearing loss and psychomotor defect were similar among the three types of cretins. The most frequent neurological abnormalities were spasticity, hyper-reflexia, the presence of primitive reflexes and gait disturbance. These abnormalities were distributed equally among the three types of endemic cretins. Delayed skeletal maturation and abnormal epiphysis were also present in all types of cretins. However, myxedematous cretins were shorter (P < 0.01), having more myxedematous features (P < 0.05 to P < 0.001) and less sexual maturation (P < 0.05). Thyroid volume was lower in cretins with hypothyroidism (P < 0.01). In conclusion, our findings support the hypothesis that neurological features are present in all types of cretins, and are the consequence of maternal and fetal hypothyroxinemia due to severe iodine deficiency. The clinical manifestations of the cretins were subsequently modified by the length and severity of postnatal iodine deficiency and hypothyroidism.

Adolescent↗

PubMed1997

Prediction of low bone mineral density in postmenopausal women by artificial neural network model compared to logistic regression model.

Measuring bone mineral density (BMD) is currently the best modality to diagnose osteoporosis and predict future fractures. The use of risk factors to predict BMD and fracture risk has been considered to be inadequate for precise diagnostic purpose, but it may be helpful as a screening tool to determine who actually needs BMD assessment. Recently, artificial neural network (ANN), a nonlinear computational model, has been used in clinical diagnosis and classification. In the present study, we evaluated the risk factors associated with low BMD in Thai postmenopausal women and assessed the prediction of low BMD using an ANN model compared to a logistic regression model. The subjects consisted of 129 Thai postmenopausal women divided into 2 groups, 100 subjects in the training set and the remaining 29 subjects in the validation set. The subjects were classified as having either low BMD or normal BMD by using BMD value 1 SD lower than the mean value of young adults as the cutoff point. Decreased body weight, decreased hip circumference and increased years since menopause were found to be associated with low BMD at the lumbar spine by logistic regression. For the femoral neck, increased age and decreased urinary calcium were associated with low BMD. The models had a sensitivity of 85.0 per cent, a specificity of 11.1 per cent and an accuracy of 62.0 per cent for the diagnosis of low BMD at the lumbar spine when tested in the validation group. For the femoral neck, the sensitivity, specificity and accuracy were 90.5 per cent, 12.5 per cent, and 69.0 per cent, respectively. Models based on ANN correctly classified 65.5 per cent of the subjects in the validation group according to BMD at the lumbar spine with a sensitivity of 80.0 per cent and a specificity of 33.3 per cent while it correctly classified 58.6 per cent of the subjects at the femoral neck with a sensitivity of 76.2 per cent and a specificity of 12.5 per cent. There was no significant difference in terms of accuracy, sensitivity and specificity in the prediction of low BMD at the lumbar spine or the femoral neck between ANN model and logistic regression model. We concluded that ANN does not perform better than convention statistical methods in the prediction of low BMD. The less than perfect performance of the prediction rules used in the prediction of low BMD may be due to the lack of adequate association between the commonly used risk factors and BMD rather than the nature of the computational models.

Aged↗

PubMed1996

Serum vitamin D, parathyroid hormone and biochemical markers of bone turnover in normal Thai subjects.

The sera from 158 healthy Thai volunteers (77 males and 81 females), aged 20-80 years, were studied. The vitamin D status, parathyroid gland activity and the magnitude of bone turnover were assessed by measurement of serum 25-hydroxycholecalciferol (25-OH-D), intact parathyroid hormone (N-tact-PTH), osteocalcin and alkaline phosphatase. The mean serum 25-OH-D, N-tact-PTH, osteocalcin and alkaline phosphatase concentrations in men were 67.4 +/- 31.6 (S.D.) [Range (R): 20.6-147.1 ng/ml], 23.3 +/- 10.3 (R: 5.6-56.6 pg/ml) 3.4 +/- 1.5 (R: 1.2-10.5 ng/ml), and 19.9 +/- 6.6 (R: 7.5-35.7 IU/L), respectively, and the mean levels in women were 42.4 +/- 23.9 (R: 13.8-127.8 ng/ml), 26.1 +/- 11.3 (R: 10.5-68.7 pg/ml), 3.7 +/- 2.1 (R: 0.5-11.5 ng/ml), and 19.5 +/- 6.0 (R: 9.1-41.5 IU/L), respectively. There is no evidence of vitamin D deficiency in ambulatory elderly Thais. Serum N-tact PTH increased with advancing age in both men and women whereas increasing serum osteocalcin and alkaline phosphatase with age were observed only in women. In addition, serum alkaline phosphatase correlated to serum osteocalcin only in women suggesting an increase in bone turnover after menopause. These basic data would be useful for the study of metabolic bone diseases in Thai population.

Adult↗

PubMed1996

Effect of TSH-suppressive doses of levothyroxine on bone mineral density in Thai women.

Thyroid hormone stimulates both osteoblast and osteoclast. However, the effect on osteoclast exceeds that of osteoblast resulting in a decrease in bone mass. TSH-suppressive doses of levothyroxine (L-T4) with otherwise normal thyroid function, so-called subclinical hyperthyroidism, has been reported to cause a reduction in bone mass. However, the sites of bone loss vary among studies. Moreover, the effect of menopausal status on thyroid-hormone-induced bone loss is inconclusive. Ethnic and geographical differences may modify the skeletal response to thyroid hormone. In the present study, we looked at the effect of TSH-suppressive doses of L-T4 on bone mineral density (BMD) in Thai pre- and post-menopausal women. Subjects consisted of 27 Thai females aged between 23-79 years. Eighteen were premenopausal and nine were postmenopausal. All were attending the Thyroid Clinic at Ramathibodi Hospital and had been on at least 150 micrograms/day of L-T4 for the treatment of nodular thyroid diseases for more than 2 years with at least one TSH value during the follow-up period in the suppressive range. None of the subjects had a previous history of Graves' disease. BMD was determined by dual-energy X-ray absorptiometry. Data of 54 age-matched healthy controls were used for comparison. BMD values were converted to Z-scores before analyses. Data were expressed as mean +/- SEM. Compared to controls, postmenopausal women on long-term L-T4 had decreased BMD at anteroposterior spine (-0.69 +/- 0.20 vs 0.05 +/- 0.17, P < 0.01), femoral neck (-0.61 +/- 0.35 vs 0.18 +/- 0.24, P < 0.05), femoral trochanter (-0.64 +/- 0.37 vs 0.13 +/- 0.22, P < 0.05) but not at Ward's triangle. In contrast to the findings in postmenopausal women. there was no significant difference of BMD compared to controls in premenopausal women at the lumbar spine, Ward's femoral neck or femoral trochanter. We conclude that Thai postmenopausal women on long-term TSH-suppressive doses of L-T4 have reduced BMD at various skeletal sites which may increase fracture risks. TSH-suppressive doses of thyroid hormone should only be prescribed when appropriate and no longer than necessary to minimize this adverse effect of excessive doses of thyroid hormone on bone.

Absorptiometry, Photon↗

PubMed1996

Evaluation of five commercial kits for free thyroxine estimation by comparison with equilibrium dialysis method in nonthyroidal illness.

Five commercial kits for estimating FT4 in serum of 59 euthyroid control and 38 patients with severe NTI were studied: one non analog method (Gammacoat two step RIA, Clinical Assay) and four different analog methods (Amerlex-M RIA, Amersham; Enzymun test competitive enzyme immunoassay, Boehringer Mannheim; Amerlite chemiluminescence immunoassay, Kodak Clinical Diagnostics; Berilux chemiluminescence immunoassay, Behring) compared with equilibrium dialysis (Eq) method. Serum FT4 estimates in NTI patients measured by all commercial kits in this study yielded results comparable with those by equilibrium dialysis. The proportions of serum FT4 values concordant with FT4 (Eq) in each kit were 76.3, 76.3, 76.3, 68.4 and 78.9 per cent respectively. The percentage of NTI patients who had serum FT4 values lower than the reference levels of the methods used were 21.2, 26.3, 7.9, 15.8, 18.4 and 18.4 per cent respectively. No patient with low serum FT4 (Eq) level had subnormal or high serum TSH value. However, 4 out of 6 patients with high serum FT4 (Eq) values had depressed serum TSH values. All of them also had elevation of serum FT4 estimates measured by all kits. Serum FT4 estimates measured by all methods correlated well with FT4 (Eq) levels within the NTI group.

Adolescent↗

PubMed1995

Virilization associated with choriocarcinoma.

We demonstrate here two autopsy-proven cases of virilization associated with choriocarcinoma. The first patient was a 27-year-old woman with a 7-year history of metastatic choriocarcinoma who presented with left hemiparesis and virilization. Serum testosterone concentration was 18 nmol/l, free testosterone 471 pmol/l, dehydroepiandrosterone sulphate (DHEA-sulphate) 1.7 mumol/l, sex hormone binding globulin 12.3 nmol/l, estradiol (E2) 1,843 pmol/l, and hCG 1.6 x 10(5) IU/l. The second patient was a 21-year-old virilized woman with metastatic choriocarcinoma who presented in semicomatose state. Limited endocrine investigation revealed serum testosterone 27 nmol/l and hCG 2.7 x 10(5) IU/l. Both patients died despite chemotherapy and radiation therapy. Autopsy findings revealed choriocarcinoma with brain and multiple organ metastasis in both. Pathology of the ovaries of both patients demonstrated hyperplasia of luteinized theca cells and lutein cells. We postulate that an association of virilization and choriocarcinoma resulted from long-standing stimulation of ovary by hCG causing theca cell hyperplasia with subsequent hypertestosteronemia and virilization.

Adult↗

PubMed1995

Serum testosterone and its relation to bone mineral density and body composition in normal males.

OBJECTIVE: Bone mineral density (BMD) declines with age in both men and women, predisposing the elderly to osteoporosis and fractures. Although there are extensive data about post-menopausal osteoporosis, there is relatively little information concerning the decrease in BMD with age in normal men, particularly the contribution of declining gonadal function with age to BMD. In the present study, we investigated the effect of age on the pituitary-gonadal axis in normal males and its relation to BMD and body composition. SUBJECTS: Ninety healthy Thai males in the Bangkok Metropolitan area without a history of smoking or significant alcohol consumption were studied. MEASUREMENTS: Serum testosterone (T), free testosterone (FT), LH and FSH were measured by radioimmunoassay in fasting blood samples obtained in the morning between 0600 and 1000 h. BMD at anteroposterior L2-L4, lateral L2-L4, femoral neck, femoral trochanter and Ward's triangle were determined by dual-energy X-ray absorptiometry. RESULTS: There were significant declines with age in BMD at lateral L2-L4 (r = -0.37, P < 0.001), femoral neck (r = -0.49, P < 0.0001), Ward's triangle (r = -0.54, P < 0.0001) but not at anteroposterior L2-L4 or femoral trochanter. Serum FT (r = -0.56, P < 0.0001) but not T (r = -0.19, P = 0.07) decreased with age. Serum LH (r = 0.27, P < 0.001) and FSH (r = 0.4, P < 0.0001) increased with age suggesting a defect in gonadal androgen synthesis or possibly a secretion of bioinactive LH. Serum FT concentrations were significantly correlated to lateral L2-L4 (r = 0.27, P < 0.05), femoral neck (r = 0.48, P < 0.0001) and Ward's triangle (r = 0.50, P < 0.0001) BMD. After controlling for age, declining FT with age was still associated with a decrease in BMD in femoral neck (P < 0.05) and Ward's triangle (P < 0.05) but not in lateral L2-L4. The proportion of body fat increased with age (r = 0.3, P < 0.01). Decreased serum T, but not FT, was associated with increased body fat after age was taken into account (P < 0.0001). CONCLUSIONS: There is a decline in serum free testosterone together with increases in LH and FSH with age in healthy males. The decrease in serum free testosterone is partially associated with the age-related decline in bone mineral density added to the effect of age at the femoral neck and Ward's triangle. Testosterone but not free testosterone is associated with age-related increase in body fat.

Adult↗

PubMed1994

The efficacy of percutaneous tetracycline instillation for sclerosis of recurrent thyroid cysts: a multivariate analysis.

A dichotomy exists in the literature concerning the efficacy of sclerosing agent tetracycline hydrochloride for treatment of thyroid cysts. However, the studies vary in patient selection and none employed a statistical method for simultaneous analysis of multiple factors that might affect the outcome of therapy. We, therefore, studied the efficacy of percutaneous instillation of tetracycline for eradication of recurrent thyroid cysts, using a multivariate analysis. Thirty-seven patients with recurrent, cytologically benign thyroid cysts (not cured after 3 aspirations) were studied. Twenty-three patients were given tetracycline instillations [100 mg/ml, range (R): 1-4 ml]. The remainder underwent only repeated needle aspiration. They were followed for 33 +/- 12 (SD) months, R: 12-58 months. Cure was achieved in 21 out of 23 cases after tetracycline instillation within 2 +/- 1.7 months (R: 1-6 months) and in 12 out of 14 cases after aspiration alone within 9.9 +/- 11.3 months (R: 1-43 months, 4-10 aspirations). Multivariate survival analysis using the Cox proportional-hazards regression model demonstrated significantly shorter time interval before cure in the group with tetracycline instillation (p = 0.001). The volume, color or duration of cysts and levothyroxine (L-T4) treatment did not appear to influence the outcome of therapy. After initial cure by tetracycline instillation, 5 cases had relapse. Three were later cured by reinstillation of tetracycline or by repeated aspirations (R: 1-3 times). Complications of tetracycline instillation included brief episode of neck pain and development of a foreign body granuloma in a single patient. In conclusion, tetracycline instillation is a quick and effective procedure for treating recurrent thyroid cysts.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Cutaneous↗

PubMed1994

A multicenter study on hip fractures in Thailand.

The present study is a multicenter study on hip fractures aimed at estimating the incidence among Thais. It also describes treatment modalities, associated medical care costs, complications, outcome of orthopedic care, length of stay in hospitals and duration of delay in seeking orthopedic care after occurrence of fractures. An extremely low hip fracture incidence of 7.05 per 100,000 population was found. Hip fracture was shown to increase steeply with age. An average of 26.44 days of delay in seeking orthopedic care following occurrence of hip fractures was reported. In contrast to the belief in Western countries that almost all hip fractures will seek orthopedic care, 7.8 per cent of these Thai cases denied orthopedic care during admission to hospitals. Median of charge to patients was 11205.00 baht, over one fourth of the national income per capita (36,563).

Age Distribution↗

PubMed1994

The performances of newer free thyroxine assays vs equilibrium dialysis.

The performances of 5 different commercial kits for the measurement of serum FT4 concentration; Amerlex-M Free T4 RIA, Gammacoat 125I FT4 2 step RIA, Enzymune-test FT4, Amerlite FT4, Berilux FT4 were compared with equilibrium dialysis. All assays demonstrated FT4 values in good correlation with those measured by equilibrium dialysis (r = 0.84-0.89, p < 0.001). The intra-assay coefficients of variation were good and comparable. All methods yielded good separation of uncomplicated hypo/hyperthyroid patients from euthyroid controls. However, only equilibrium dialysis gave consistently normal results of FT4 values throughout pregnancy. All methods other than equilibrium dialysis gave falsely low values in majority of women in the 2nd and 3rd trimester of pregnancy.

Adolescent↗

PubMed1994

Polyglandular autoimmune (PGA) syndromes: report of three cases and review of the literature.

Polyglandular autoimmune (PGA) syndrome is caused by autoimmune process in multiple endocrine glands. This usually results in endocrine gland hypofunction, except for the thyroid gland, in which both hyper or hypofunction may occur. The syndrome can be classified into two types, type I and type II, each with distinct clinical characteristics. We report three cases of PGA syndromes. The first patient had type I PGA syndrome, characterized by hypoparathyrodism, primary adrenal insufficiency and primary ovarian failure. She also had chronic mucocutaneous candidiasis, which is the distinct feature in this syndrome. The second patient had type II PGA syndrome, with primary adrenal insufficiency, Hashimoto's thyroiditis and primary ovarian failure. She also had widespread vitilgo. The last patient also had type II PGA syndrome. She had insulin dependent diabetes mellitus, Graves' disease and alopecia areata.

Adult↗

PubMed1994

Evaluation of a new direct radioimmunoassay for serum thyroid peroxidase and thyroglobulin antibodies.

The measurement of serum TPO Ab and Tg Ab by a new direct sensitive RIA in this study are quantitative and provided a convenient system. When compared to the commonly used PH technique for TM Ab and Tg Ab, this RIA determination appears to be more sensitive than by PH, since it enabled detection of TPO Ab and/or Tg Ab in sera that were negative by PH. Thus, this RIA determination should be more widely used in a clinical laboratory.

Adult↗

PubMed1993

Screening for congenital hypothyroidism in Thailand: has its time come?

The incidence of congenital hypothyroidism at Ramathibodi Hospital was approximately 1:2,486-1:3,843 livebirths, comparable to those found in other industrialized countries. The screening program utilizing TSH measured by a kit manufactured in Thailand was accurate and cost-benefit. It is time to organize TSH screening at least in a university hospital in Thailand to prevent the social burden of raising mentally-handicapped children.

Congenital Hypothyroidism↗

PubMed1993

Immunochemiluminometric assay for measurement of thyrotropin in various thyroid disorders.

The measurement of serum TSH concentration by the new ICMA had good precision and was more efficacious than RIA, IRMA and IEMA in distinguishing hyperthyroid patients from euthyroid subjects. Moreover, the measurement of serum TSH by ICMA was less interfered by high concentrations of hCG in sera of patients with trophoblastic disease. However, the assay needs special equipment and the cost is currently higher than other available methods.

Adult↗

PubMed1993

Graves' disease complicating pregnancy.

During the 12-yr period from 1981 to 1992, over 85,000 deliveries at Ramathibodi Hospital from 114 pregnancies (prevalence 0.1%) in 110 patients were complicated by Graves' disease. The diagnosis was made following conception in 52 per cent. Medical treatment with propylthiouracil was the main regimen. Maternal and perinatal outcome were related with thyroid status at delivery including thyrotoxic crisis, preeclampsia and preterm deliveries. There was no case of fetal goitre, hyperthyroidism, but fetal hypothyroidism occurred in 12.2 per cent which calls for close monitoring of antithyroid drug dosage and close neonatal-infant follow-up.

Female↗