Biomedical subjects

S Limthongkul

Publications and source records attributed to S Limthongkul.

34 records · Page 2Linked to original sources

PubMed1989

Fiberoptic bronchoscopy in diagnosis of patients with suspected active pulmonary tuberculosis.

Patients suspected of having active pulmonary tuberculosis, in whom acid-fast bacilli (AFB) are not demonstrated on sputum direct smear, present a difficult diagnostic and therapeutic problem. Flexible fiberoptic bronchoscopy is a useful procedure in evaluating these patients. Within five years, during the period of January 1983 to December 1987, 112 patients who were suspected of having active pulmonary tuberculosis underwent fiberoptic bronchoscopy. The diagnosis of pulmonary tuberculosis was established by using this procedure in 76 per cent of cases. Immediate diagnosis were made from microscopic specimens obtained from bronchoscopy in 38 of 65 patients (58%). It is concluded that fiberoptic bronchoscopy should be performed in evaluating patients with negative smears for AFB who are clinically suspected of having tuberculosis before initiating a trial of antituberculous drugs. The technique is safe and markedly efficacious in making an immediate diagnosis and uncovering other diseases that present themselves like tuberculosis.

Adolescent↗

PubMed1989

Emergency room assessment and adrenaline treatment of patients with acute asthma of different severity.

The adequacy of emergency room assessment and treatment of patients with acute severe asthmatic attacks was evaluated by analyzing the course of 451 visits of 348 patients to Chulalongkorn hospital's Emergency Room. Eighty-five per cent of the patients had an initial index score of greater than or equal to 4 and an average peak expiratory flow rate of 92.16 +/- 46.3 L/min. The discharge index score was 85 per cent with a score of less than or equal to 3 and an average peak expiratory flow rate of 192 +/- 40.3 L/min. Our study indicated that the predictive index proposed by Fischl et al correlated with the severity of airway obstruction; however, the initial index did not help with emergency room decision-making in predicting which patients might be hospitalized, have a relapse or be discharged. In fact, in our emergency room department, the index score to determine airway obstruction and the pattern of response to treatment were better predictors of the outcome, which was classified into three categories: non-responsive or minimally responsive, responsive, and partially responsive. By using conventional clinical criteria (i.e. recumbent position with elimination of laboured breathing, disappearance of dyspnea and reduction of wheezing), there was a 93 per cent accurate determination in the episodes of patients who responded sufficiently to the emergency room treatment to allow their discharge. The remaining 7 per cent of those seeking emergency treatment were hospitalized, which is a lower incidence than that of others series.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗

PubMed1989

The pathogenesis of low pleural fluid glucose in acidotic malignant pleural effusions.

To clarify the pathogenesis of low glucose concentrations in acidotic pleural fluid of malignant effusion, simultaneous studies of 1) serial plasma-pleural fluid glucose, pH, PCO2, gentamicin, tobramycin and netilmicin in vivo, and 2) serial in vitro incubation of pleural fluid pH and PCO2 were conducted in 19 cases. In all effusion samples, the pleural fluid pH and PO2 levels were lower and the CO2 levels were higher than those of arterial blood, respectively. The pleural fluid aminoglycoside levels increased gradually, reaching the maximum values after about four to seven hours, thereafter, it gradually decreased. There were three types of serial pleural fluid-plasma glucose concentrations, of which types 2 and 3 showed either a delayed rise or no rise in pleural fluid glucose concentrations, respectively. Serial pleural fluid pH and PCO2 levels remained stable during the in vitro incubation study, especially during the first three hours. The pleural fluid kinetics of the three aminoglycosides followed a large reservoir model without any relationships to pleural fluid pH, PCO2, fluid-volume and no significant differences of the kinetics among the three aminoglycosides. This indicated that the diffusion block of the antibiotics did not depend on molecular weight nor pH, PCO2 dependent. Since the molecular weight of three aminoglycosides is greater than that of glucose, lactic acid, CO2 and O2, it may be concluded, therefore, that an over utilization of glucose and O2 with an over production of lactic acid and CO2 by the pleura, rather than glucose transport defect, results in a low glucose concentration in malignant effusions.

Adult↗

PubMed1988