Biomedical subjects
Publications and source records attributed to W Laupattarakasem.
A method of constructing an aiming device for insertion of distal locking screws is described. The device helps facilitate the free-hand technique, lessens the difficulty of drilling and insertion and allows the surgeon to perform at a distance, away from the radiation beam.
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We describe an alternative fixation for the pure uncomminuted subtrochanteric fracture by using the AO tibial nail. There were no intraoperative complications in 24 fractures with this method. The fractures healed within 4 months postoperatively in 18 non-pathological fractures that could be followed up. There were minor complications, including 10 degrees external malrotation in one case and varus angulation after nail breakage in another. The nails were removed in seven healed fractures without problems. Two pathological fractures which were stabilized by the AO tibial nail, combined with the use of bone cement to fill the bone defect, were able to have early postoperative ambulation without any problems with the fixing device.
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A prospective study of 149 patients suffering from adenocarcinoma of unknown primary site (ACUPS) of bone was carried out. The tumors are classified as 63 extraspinal, 67 spinal and 19 mixed involvement. Upon meticulous physical examination, Virchow's node was detected in 15 cases, rectal shelf in 11 cases and hepatomegaly in 44 cases. Blood chemistry showed elevation of alkaline phosphatase (> 3 sigma units) in 98 cases and chest roentgenogram showed pulmonary lesions in 23 cases. Treatment was surgery and radiotherapy in 64 and two cases respectively. In all of these patients histological findings of the biopsy or resection specimen had confirmed the diagnosis of adenocarcinoma. Among 124 evaluable patients, overall survival was analysed using Kaplan-Meier life table analysis. Survival rates at one, two and four months after diagnosis were 80.7, 60.5 and 25 per cent with a mean and median survival times of 90 and 77 days respectively. Statistical analysis was also performed to ascertain the prognostic importance of the following variables: age, gender, Virchow's node, rectal shelf, hepatomegaly, serum alkaline phosphatase, pulmonary lesion, and multiplicity and site of the osseous lesions. The presence of pulmonary lesion or hepatomegaly significantly produced unfavorable impact on the duration of survival (p = 0.0004 and 0.0150, respectively) while other remaining factors had not.
A new application of operative ultrasound to help assess the fracture alignment for closed reduction and passing the guide wire in closed femoral nailing is described. This method can be used instead of fluoroscopic monitoring in certain important steps which can markedly reduce the exposure time of fluoroscopic monitoring. Nine of ten cases were successful using this technique for closed unlocked nailing with an average ultrasound monitoring time of 8 minutes. The time required for fluoroscopic assessment was reduced to less than 1 minute for each successful case.
We describe the method to simplify the procedure and shorten the operating time during closed femoral nailing. This includes early surgery, using a special reduction device, a marker to help interpretation of fracture alignment, limiting the surgical field to the trochanteric area with the thigh undraped to facilitate mobilization of the undraped C-arm, avoiding unnecessary intermediate reamers, less cortical reaming and a second team for distal locking when required. For 60 simple unlocked nailings and 15 locked nailings, the operation times were 40.4 and 58.7 min, respectively. These are much shorter than in previous reports.
The diagnostic values of the presence of Virchow's node (VN) or rectal shelf (RS) in spinal metastasis from adenocarcinoma of unknown origin were studied prospectively in 60 patients during 1986-1988. These were compared with 14 cases with other malignancies of the spine and 37 controls with nonneoplastic spinal lesions. The diagnosis was confirmed by histologic study in all malignant cases. The results were analyzed by diagnostic test analysis and McNemar chi 2 testing. This yields 18.3-21.6%, 97.2-100%, and 92.8-100% sensitivity, specificity, and predictive value, respectively, for a positive test for VN and RS to differentiate significantly adenocarcinoma from other malignancies and control patients (P less than 0.005). These findings may thus be considered as a simple and economic guide for physicians to determine the proper approach to patients with a spinal lesion suspected to be malignant.
Melioidosis is an infection caused by a gram-negative bacilli, Pseudomonas pseudomallei. This organism can cause fatal infection in domestic animals and are probably transmitted to humans by soil contamination of skin abrasions, ingestion, and inhalation. Melioidosis is being increasingly diagnosed in Western countries in other than its endemic areas of tropical and subtropical zones. In the past, only a few single case reports of articular melioidosis were published in English journals, and almost all were secondary to melioidosis of another organ. Accurate diagnosis of this infection is important because a high mortality rate is usually associated with the septicemic form. Nine cases of isolated articular involvement were diagnosed between 1984 and 1988 in Northeast Thailand. Symptoms were subtle and diagnosis required a high degree of suspicion. Diagnosis depended on bacteriologic methods including Gram's stain, pus and blood cultures, and on an indirect hemagglutination titer of over 1:40. In addition to general measures for septic arthritis, antibiotic therapy using a combination of intravenous cotrimoxazole, doxycycline, and chloramphenicol was generally satisfactory. Second line drugs (i.e., more effective but also more expensive drugs that the authors administered when patients failed to respond to the first line drugs cotrimoxazole, doxycycline, and chloramphenicol) comprising intravenous ceftazidime and cotrimoxazole were administered in cases with an underlying disease. Comparison of the disease course before and during hospitalization as well as the total days of treatment between two small groups of patients with and without underlying disease revealed no statistically significant difference.
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A new model of convenient measuring device, axial rotation gravity goniometer (ARGG), was designed to improve the reliability in measuring rotary motions of the forearm and shoulder. Inter-tester reliability was significantly higher for ARGG than for the standard plastic goniometer.
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Several methods for the correction of cubitus varus have been described, but most reported series are small and show a high rate of complications. We report a six-year personal experience of 77 osteotomies by a new technique which provides rigid fixation and allows correction of both varus and rotation deformities. It also prevents lateral bulging at the level of the osteotomy. In 58 cases followed up for an average of 16 months, there were no serious complications, a satisfactory carrying angle and no significant loss of movement, giving 88% excellent or good results.
Continuous passive motion (CPM) is an established method of preventing joint stiffness and of overcoming it. The optimum duration of treatment, however, is not known, though a period of one to three weeks is usual. This may be unnecessarily long and a programme lasting only three days has been tried in 34 patients: in 22 (Group A) treatment was designed to increase movement in stiff joints which had been operated on or manipulated, and in 12 (Group B) it was to prevent stiffness after an injury. A specially designed CPM device was used. In Group A, the range by the third day of treatment was significantly greater than before manipulation or operation and this increase was maintained until the latest follow-up at an average of 24 weeks. In Group B, the pre-injury range was almost retained and thereafter there was a gradual increase. Patient compliance in the first 12 hours of CPM was relatively poorer than that described in previous reports, and in five patients treatment had to be discontinued.
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