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Biomedical subjects

S Chiemchanya

Publications and source records attributed to S Chiemchanya.

At least 19 recordsLinked to original sources
PubMed2001

West syndrome in Thailand: a hospital-based survey.

The prevalence of West syndrome in Thailand had not been studied. During January 1997 to December 1999, at the Department of Pediatrics, Ramathibodi Hospital, Bangkok, Thailand, of the total 628 first seen epileptic patients, aged 0-15 years, 31 patients (4.9%) with West syndrome were encountered. Sixteen were males. The mean age at presentation was 9.7 months (range 4-32 months) and at seizure onset was 5.7 months (range 2-11 months). Twenty-two patients had typical spasms, four each had generalized tonic seizures and focal seizures prior to the onset of infantile spasms, and another patient had myoclonic seizures. Nineteen patients were classified as symptomatic. Electroencephalogram revealed hypsarrhythmia in six patients, multifocal independent epileptiform discharges in 24 patients, and focal epileptiform discharges in four patients. Abnormal brain-imaging findings were demonstrated in six of the 11 patients investigated. Vigabatrin was given to 17 patients whereas one patient was given valproate. Others who had been severely retarded were given phenobarbital in combination with benzodiazepine. Six patients were lost to follow-up. Of the remaining patients, the duration of follow-up ranged from 7 to 44 months (mean 28 months). Infantile spasms disappeared in 11 patients, persisted in six patients, and changed to other form in eight patients. The developmental outcome was apparently normal in five, slightly delayed in four, moderately delayed in ten, and severely delayed in eight patients.

Adolescent↗
PubMed2001

Cavernous sinus thrombophlebitis in children.

Eight Thai patients less than 15 years of age who were diagnosed with cavernous sinus thrombophlebitis at Ramathibodi Hospital, Bangkok, Thailand over the past 30 years were reviewed retrospectively. The predisposing infections and causative microorganisms were similar to previous reports in children and adults. Despite severe neurologic dysfunction during admission, including blindness, there was neither death nor severe permanent deficit found in the majority of the patients. Only one patient experienced mild hemiparesis caused by cerebral infarction, which was secondary to this condition. Early recognition of this condition, the appropriate selection of empirical antibiotic therapy, and the awareness of associated complication were the key factors leading to excellent outcome.

Adolescent↗
PubMed2001

Systemic nontyphoidal Salmonella infection in normal infants in Thailand.

BACKGROUND: The relative paucity of information about systemic nontyphoidal Salmonella (NTS) infection in infants without an underlying disease prompted this study. METHODS: Infants without an underlying disease, who had positive cultures for NTS from their normally sterile sites during 1978 through 1998, were included. Their medical records were reviewed. RESULTS: The study included 75 eligible infants; 68 (91%) had positive blood cultures. The spectrum of disease included transient bacteremia (5), bacteremia without localized infection (37), bone and joint infection (5) and meningitis (28); 53 and 88% of infants were < or =3 and < or =6 months old, respectively. All infants with localized infection were < or =7 months old, and infants with meningitis were 3.35+/-1.87 (mean +/- SD) months old. In bacteremic infants risks for localized infection and meningitis were 30 and 24%, respectively. Abnormal neurologic findings were the only predictor for meningitis. Relapse of meningitis occurred in two infants despite treatment with cefotaxime for 4 and 6 weeks. Severe neurologic deficit occurred in 21% of infants with meningitis. Of 11 infants with meningitis who received early treatment at this tertiary care center, 1 died but none had severe neurologic deficits; whereas of 17 referred cases, 2 died and 6 had severe neurologic abnormalities. No death occurred in infants without meningitis. CONCLUSION: Systemic NTS infection in normal infants has a variable disease spectrum. Infants 0 to 6 months of age are at high risk for localized infection, especially meningitis.

Age Distribution↗
PubMed2001

Adverse cutaneous reactions to phenobarbital in epileptic children.

INTRODUCTION: Cutaneous adverse reaction to phenobarbital is not uncommon. According to previous studies, around 3 per cent of children taking phenobarbital have reactions. However, there has been no report in Thai children. OBJECTIVE: To study adverse cutaneous reactions to phenobarbital in children with epilepsy. PATIENTS AND METHOD: A retrospective study from medical records of epileptic children aged under 15 years diagnosed at the Department of Pediatrics, Ramathibodi Hospital, Bangkok, Thailand from January 1989 to December 1993 was done. Adverse cutaneous reactions were categorized into 3 groups according to severity. Duration from the initiation of phenobarbital to the onset of reactions and the clinical course were collected for analysis. RESULT: There were 18 children from the total of 572-retrievable medical records of children with epilepsy who had adverse cutaneous reactions. The prevalence was 3.2%. There were 5, 10 and 3 patients categorized into mild-form, moderate-form, and severe form respectively. All except one patient had the onset of cuteneous reactions within 3 weeks. No morbidity or mortality was observed in these patients. Recovery of the cutaneous reactions was obtained between 5 and 14 days in those with mild or moderate form. CONCLUSION: Adverse cutaneous reactions to phenobarbital observed in Thai epileptic children were similar to those found in previous reports. Physicians who prescribe phenobarbital must be aware of the serious adverse reactions which might occur. Early recognition of the adverse reactions and prompt intervention including discontinuation of the drug must be exercised to prevent any serious complications.

Anticonvulsants↗
PubMed2001

Thromboembolic complications in Thai pediatric patients.

Sixty patients with thromboembolic complications from 1987 to 1997 at the Department of Pediatrics, Ramathibodi Hospital were retrospectively studied. Twenty patients were infants and 40 patients were children and adolescents with a mean age of 18 days and 8 years, respectively. The sites of thromboembolic complications were in the central nervous system, 27.5 per cent; skin as purpura fulminans or necrotic lesions, 24.5 per cent; gangrene of the toe, finger or colon, 19 per cent; deep vein thrombosis, 16 per cent; and other sites such as heart and lungs, 13 per cent. Most of them had triggering conditions (80%) and underlying diseases (76.7%) causing thromboembolism. The low levels of either antithrombin III, protein C or protein S were found in 42 per cent (15/36). The management included administration of standard or low molecular weight heparin if not contraindicated, replacement of fresh frozen plasma 10 ml/kg twice a day and treatment of underlying and triggering conditions. The fatality rate was 15 per cent (9/60). Subsequent episodes of thromboembolism occurred in 6 patients including: pulmonary emboli in one patient with protein C deficiency who refused warfarin administration, deep vein thrombosis in 2 patients with unidentified etiology, and necrotic skin lesions in 3 patients with vasculitis who did not respond to treatment. In conclusion, a comprehensive investigation and specific treatment for patients with thromboembolic complications are emphasized in order to prevent recurring episodes.

Adolescent↗
PubMed1999

Stroke and seizures as the presenting signs of pediatric HIV infection.

The authors report two pediatric patients with definite human immunodeficiency virus infection whose initial presentation was stroke and seizure. The first patient was a 3-year-old female who developed acute hemiparesis as the first manifestation. The other, a 2-month-old infant, had focal seizures secondary to cerebral infarction. Investigations revealed ischemic infarction of the thalamus, hypothalamus, and internal capsule in the first patient and cerebral cortex in the second. Further investigations failed to demonstrate any other causes of these cerebral infarctions. Opportunistic infection of the central nervous system was not documented. The authors emphasize that cerebrovascular accident may be the initial presentation in human immunodeficiency virus infection in children. Human immunodeficiency virus infection must be included in the differential diagnosis, and testing for the disease is mandatory in the investigation of stroke in any child who is at risk of having this infection.

Cerebrovascular Disorders↗
PubMed1999

Temporal lobectomy for intractable complex partial seizures in pediatric patients.

Fourteen children, 7 boys and 7 girls, who failed conventional medical treatment for complex partial seizures underwent anterior temporal lobectomy at Ramathibodi Hospital, Bangkok, Thailand, from July 1993 to June 1998. The mean age at onset of patients was 6.7 years old and the mean duration of seizures before surgery was 6.4 years. The age of patients at surgery ranged from 8 to 22 years old. These patients had had limited presurgical evaluation which included video-electroencephalography (EEG), magnetic resonance imaging (MRI) and single photon emission computed tomography (SPECT). All patients demonstrated concordant among clinical symptoms, EEG, MRI and SPECT on the same side of the temporal lobe. Ten and 4 patients had unilateral and bilateral temporal lobe lesions respectively. The operations were done on the left in 10 patients and on the right in 4 patients. Seizure free after 1/2-5 years of follow-up was obtained in 70 per cent of patients which included 9 of 10 patients with unilateral temporal lesion and 1 of 4 patients with bilateral temporal lesions. The rest of the patients showed marked reduction of seizures except for one patient with bilateral lesions in whom only 50-70 per cent reduction was obtained. Marked improvement of behaviour was also observed in 70 per cent of patients. Resected brain specimens revealed mesial temporal sclerosis, gliosis, tumors and cavernoma in 6, 5, 2 and 1 patients respectively.

Child↗
PubMed1999

Vigabatrin in infantile spasms: preliminary result.

PURPOSE: To evaluate the efficacy of vigabatrin in the treatment of infantile spasms in Thai children. PATIENTS & METHOD: From March 1996 to May 1998, patients aged under 2 years presenting with infantile spasms at Ramathibodi Hospital were initiated with vigabatrin 35-50 mg/kg/day in two-divided doses. The dosage was escalated by 25 mg/kg weekly until spasms ceased or the maximum dose of 130 mg/kg was reached. RESULTS: There were 20 patients enrolled. The ages ranged from 3 to 23 months (mean 7.6 months). They were categorized as 4 cryptogenic and 16 symptomatic. Infantile spasms were completely controlled in 12 patients (60%). Six patients (30%) had at least 50 per cent reduction of seizure frequency. There were 2 patients whose seizure frequencies and severity were not altered. Only one patient whose infantile spasms partially responded to vigabatrin developed orofacial dyskinesis which disappeared after discontinuation of vigabatrin. Five patients had their vision evaluated which was unremarkable. Based on parental global evaluation, there was an increase in alertness, cheerfulness and interaction to the environment and stimulation in 8 out of 15 patients who were still taking vigabatrin and responded to treatment. CONCLUSION: Vigabatrin is effective for infantile spasms. A long-term follow-up of these patients is necessary to evaluate its efficacy and side-effects.

Anticonvulsants↗
PubMed1999

Seizures after intracranial surgery in pediatric patients.

We retrospectively reviewed the occurrence of seizure after performing intracranial operations in children aged less than 15 years. During a 5-year period, there were 18 patients out of a total of 155 who developed one or more seizures within 1 year after operation. The majority of patients (55.6%) had the onset of seizures within 24 hours. Seventy-two per cent of the patients had partial seizures. Two patients who developed immediate postoperative seizures had sodium derangement. Eight of 10 patients who had early onset seizures had had an operation for supratentorial lesions. Among the 6 patients who developed seizures after infratentorial tumor removal, the cause of seizure was not known in 4 patients. We emphasize that prompt investigations to exclude any structural lesions and other possible causes of seizure, especially electrolyte disturbance along with appropriate antiepileptic drug administration, are important in patients who develop seizures after the operation. The recommendation for routine administration of antiepileptic drug prior to the operation has yet to be concluded.

Adolescent↗
PubMed1998

Triple diagnosis in carcinoma of the breast: a replacement for open biopsy.

Using the combination of clinical diagnosis, mammography and fine-needle aspiration cytology (FNA) as a "triple diagnosis" to guide management of carcinoma of the breast, we retrospectively reviewed 46 patients with FNA diagnosis of carcinoma of the breast in Ramathibodi Hospital from 1993 to 1995. Pathological diagnosis was available in 36 cases and used as a gold standard. Clinical diagnosis alone was accurate in 28 of 36 cases. Mammography was available in 24 cases of which the diagnosis was accurate in 22 cases. Triple diagnosis was available in 19 cases and all were accurate. Using this approach and review of the literature, we suggest that triple diagnosis could replace an open biopsy in diagnosis of carcinoma of the breast.

Algorithms↗
PubMed1998

Guillain-Barre syndrome in Thai children: retrospective analysis of the clinical and outcome prior to intravenous immune globulin era.

The authors retrospectively reviewed Guillain-Barre syndrome (GBS) in 48 Thai children over a period of 20 years from 1970 to 1989. The clinical presentations of this syndrome were compared to those reported in previous studies of children in Western and Asian countries. Antecedent infection, including respiratory tract infection and nonspecific viral infection, in this group of patients is similar to previous studies in children. Cranial nerve involvement found in this study (45.8%) was higher than that in other studies. The outcome of GBS in Thai children in this study was not different from other reports even without IVIG administration. The authors emphasize that respiratory and supportive care are important in managing patients suffering from this syndrome.

Adolescent↗
PubMed1998

Recurrent acute cerebellar ataxia of childhood following nonspecific respiratory tract infection.

Acute cerebellar ataxia in childhood following viral infection is a self-limited disease. The disease with recurrent course has rarely been reported. At the Department of Pediatrics, Ramathibodi Hospital, three children with recurrent episodes of acute cerebellar ataxia following nonspecific viral infection were encountered. The age at onset of each patient was 2 years, 18 months and 2 years old. The clinical symptoms were similar and improved rapidly after gluco-corticoid was given. All patients recovered without residual deficit. Six, 5 and 3 recurrent attacks of similar illness were noted in each patient respectively after the first episode. However, no further attack occurred after the age of 5 years and the age of last follow-up was 17, 16 and 14 years old respectively. The pathogenesis of the recurrent episodes is uncertain. The abnormal immunological response is postulated.

Acute Disease↗
PubMed1997

Acute cysticercal meningitis in children: response to praziquantel.

Acute purulent meningitis as a manifestation of cerebral cysticercosis is uncommon. We report two children aged 12 months and 3 years who presented with clinical signs of acute meningitis and whose initial cerebrospinal fluid (CSF), except for negative culture, was typical of purulent meningitis. However, eosinophils were present in subsequent examinations of the CSF and the haemagglutination titre for cysticercus rose. Praziquantel was given to both children with dramatic improvement in clinical and CSF findings.

Acute Disease↗
PubMed1997

Accuracy of fine needle aspiration cytology in the evaluation of peripheral lymphadenopathy.

We conducted an audit of the lymph node aspirates received from January 1996 to December 1996 of 541 patients sent to the Cytology Division, Department of Pathology, Ramathibodi Hospital by their clinicians. The aim of this retrospective study was to determine the pattern of diseases that commonly present with peripheral lymphadenopathy and to evaluate the accuracy of Fine Needle Aspiration Cytology (FNAC) in the diagnosis of lymph node diseases. An excisional biopsy sample of lymph node was available in 233 (43%) cases for comparison to the histopathology. The predominant lesion was benign which included necrotizing granulomatous lymphadenitis (NGL), reactive changes (RC) and suppurative lymphadenitis (SL). The predominant malignant lesion was metastatic squamous cell carcinoma. The accuracy for NGL, SL and RC were 69 per cent, 75 per cent and 95 per cent, respectively. The accuracy for metastatic disease was 97 per cent. The specificity and sensitivity of FNAC were 99 per cent and 94 per cent, respectively. An excisional biopsy should be done in case of doubt to clarify the pattern of RC.

Adolescent↗
PubMed1996

Strokes in Thai children : etiology and outcome.

In Asian countries, specific etiology and outcome of stroke in children are rarely reported. During January 1979 to December 1997, 68 children with stroke, admitted to the Department of Pediatrics, Ramathibodi Hospital, Bangkok were reviewed for etiology and outcome; 38 patients (22 males) had ischemic stroke and 30 (20 males) had hemorrhagic stroke. Severe headache, vomiting, disturbance of consciousness and papilledema were prominent presentations of hemorrhagic stroke. Bleeding from vascular anomalies of the brain (AVM) was the most common etiology of hemorrhagic stroke while septic and non-septic emboli from congenital and acquired heart diseases were the most common cause of ischemic stroke. The mortality rate was 7% and 9% in hemorrhagic and ischemic strokes, respectively. Complete recovery was observed in 52% of cases of hemorrhagic stroke but in only 26% of ischemic stroke. Hemiparesis was the most common residual neurological deficit with higher occurrence in ischemic stroke.

Adolescent↗
PubMed1995

Optic neuritis in children: recurrence and subsequent development of multiple sclerosis.

Recurrent optic neuritis and the subsequent development of multiple sclerosis in children, particularly in Asian countries, are not well known. We report on recurrent optic neuritis and subsequent multiple sclerosis in 22 Thai children who were younger than 15 years of age at the onset of optic neuritis, had no previous neurologic illness, and were monitored for 6-20 years. Improvement of vision was observed in 8, 10, and 2 patients after the first, second, and third week of onset, respectively. Two patients had recurrent optic neuritis and the other 2 patients subsequently developed clinical definite multiple sclerosis characterized by hemiparesis at 6 months and myelopathy at 2 years later in 1 patient and myelopathy and brainstem dysfunction in the other at 4 and 6 years later. The frequency of subsequent development of multiple sclerosis after optic neuritis may be similar to that reported from the United States and European countries.

Age of Onset↗
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↗