Biomedical subjects
Publications and source records attributed to C Suwanwela.
Medical practice and medical education are undergoing revolutionary changes all over the world. Even though the denominators of change are usually viewed at national and institutional levels, global trends also play an important role, and international co-operation is needed now, more than ever. Thailand with its rapid rate of change serves as an interesting example for review.
This paper begins with historical and other reflections on the nature and importance of quality in medical education. It then identifies and discusses missions of a medical school--which include teaching, research, medical service, continuing education, and social advocacy--and notes that these elements should be complementary and indeed synergistic. Components of quality, both of a medical graduate and of a medical school, are then considered. After discussing the use of examinations to assess quality of graduates, the paper concludes by calling for a total quality approach to medical education, with due attention to input, process, and output.
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A case is reported of unilateral proptosis of the left eyeball as a unique clinical presentation of primary angiosarcoma of the skull involving the sphenoid and frontal bones and roof of the orbit on the left side of a 32-year-old man. The intraosseous, extradural non-encapsulated, and friable tumour contained cytoplasmic factor VIII-related antigen. After complete removal of the tumour the patient has been well for 10 months of the follow-up period. This case brings the total number of reported primary angiosarcomas of the cranium to nine. All patients were male and most of them were young. The average age was 24 years. The frontal bone seems to be the site of predilection for cranial angiosarcomas. Surgical extirpation, radiation, or combined surgical removal and radiation have been used for treating angiosarcoma of the skull with variable results. It is suggested that angiosarcoma of the skull has a worse prognosis than angiosarcoma of bones other than the cranium because the patient may die of secondary neoplastic involvement of the brain.
A mixed paraganglioma and glioma occurred in the conus medullaris and cauda equina of a woman. The tumor was subdural, encapsulated, and vascular. It was first manifested with symptoms and signs of compression of the cauda equina when she was 19 years of age and was excised when she was 24. The tumor was attached to the conus medullaris, the dura mater, and a nerve root of the cauda equina. Striking light and dark cells with an organoid arrangement mingled with a few glial fibrillary acidic protein (GFAP)-positive neuroglia forming a combined paraganglioma and glioma. Twenty-three paragangliomas were reported in the literature including the present case. The sex and age of recorded 19 patients demonstrated ten males and nine females with an average age of 46.3 years. Twenty tumors were subdurally situated at the conus medullaris and cauda equina. Three neoplasms were epidural and thoracic in location.
A case is presented of a solitary primary extracerebral mixed glioma occurring in the right suprasellar and parasellar region of a 49-year-old woman who had bilateral temporal hemianopsia for 3 months. At craniotomy, the well demarcated outline and extracerebral location of the tumor suggested that it was a meningioma. However, its gliomatous nature was confirmed by identification of glial fibrillary acidic protein (GFAP) in the tumor cells. Review of nine reported solitary primary intracranial extracerebral gliomas, including the present case, revealed that they tended to occur in the third to fifth decades of life, in patients with an average age of 42 1/2 years, and without sexual predilection. All were supratentorial with a tendency to be situated in the vicinity of the Sylvian fissure. Only the glioma in the present case was at the cranial base. They were diagnosed as three astrocytomas, two glioblastomas, two oligodendrogliomas, one astroblastoma, and one mixed glioma. A suggestion is made that all these gliomas arose primarily from heterotopic neuroglia in the leptomeninges.
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A unique case of congenital osteolipoma of the skull occurred. A 27-year-old woman had multiple hard tumors affecting the frontal and parietal bones, the rim of the orbit, the maxilla, the base of the skull, and the horizontal part of the mandible on the right side. The slowly growing tumor was first noticed in the right parietal bone when she was born. The partially excised right frontoparietal lesion was composed of deformed and sclerotic trabeculae of bone and mature adipose tissue that formed an osteolipoma, which was regarded as hamartomatous. Its pathogenesis was suggested as associated with maldifferentiation of the mesenchyme or its derivatives toward the osseous and adipose tissue at the early development of the cranium.
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138 patients with extradural hematoma have been analyzed in order to assess the factors influencing their mortality. Early diagnosis, based on the development of minimal clinical signs, and prompt treatment will lower the mortality rate. The 16% mortality rate in this series might be reduced to 11%, had there been no errors in management.
Twenty-two patients with chronic atlantoaxial dislocation have been treated. Of 13 patients with a reducible dislocation by skeletal traction, 12 underwent successful posterior infusion of the first, second and third cervical vertebrae. Of nine patients with irreducible dislocation, eight underwent surgical reduction and fusion through the transoral approach. The reduction was successful in all eight, but fusion was accomplished in four.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.