Journal of the Medical Association of Thailand = Chotmaihet thangphaet
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Comparative Study Clinical Trial Controlled Clinical Trial
Combined thoracic epidural with light general anesthesia for thymectomy in myasthenia gravis.
Forty-seven myasthenia gravis patients undergoing transsternal thymectomy were allocated into 2 groups. Group 1 which consisted of 27 patients was anesthetized using the balanced technique, while 20 patients in group 2 received the combination of thoracic and balanced anethesia. The ventilation was controlled through the endotracheal tube in both groups. ⋯ Adequacy of respiration was observed postoperatively in the intensive care unit (ICU). Group 1 patients required 76.9 per cent of further ventilatory support for the period of 37.11 +/- 39.54 hours and duration of the ICU stay was 65.52 +/- 85.84 hours, whereas, the patients in group 2 showed significantly different results, which were 15.8 per cent of ventilatory support (P = 0.002) for 10.33 +/- 6.03 hours (P = 0.014) and 22.8 +/- 8.06 hours for staying in ICU (P = 0.021). This study demonstrated that the combined thoracic epidural with light general anesthesia provides excellent intraoperative anesthesia together with postoperative analgesia, which reduces the need for postoperative respiratory support, as well as decreases the hospital cost.
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Randomized Controlled Trial Comparative Study Clinical Trial
Patient-controlled analgesia in Thai patients.
We conclude that the intravenous PCA method is acceptable, easy to use, does not depend on the patients' level of education, and is safe for Thai patients. The average pain scores at 48 hours postoperation of the PCA group was significantly lower than for the conventional and the I. ⋯ Thai culture might influence how much pain is accepted and the patients had not experienced other techniques, so they could not make a comparison. The amount of morphine used by the PCA group was intermediate between that used by the other two groups.
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A unique occurrence is presented of additional primary epidermoid carcinoma of the esophagus with fatal bleeding into the upper digestive tract after 3 years of diagnosis of primary bronchogenic adenocarcinoma of an 81-year-old Thai man. The primary bronchogenic adenocarcinoma was surgically removed and followed by radiotherapy and chemotherapy without evidence of tumor recurrence at autopsy. ⋯ Outward extension through the esophageal wall rather than intraluminal protrusion of the squamous cell carcinoma was thought to result in the absence of dysphagia. Although it is uncommon physicians should be aware of the occurrence of multiple neoplasms.
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Three out of 42 patients who had isolated blunt chest injury requiring closed tube thoracostomy developed post-traumatic empyema thoracis. All of them were treated by thoracotomy and evacuation of the infected fluid with multiple chest tube drainage. Cultures of the pleural fluid grew Staphylococcus aureus in these 3 patients. ⋯ Multivariate analysis was performed by using Logistic Regression. Although no statistical significance was observed, the analysis revealed that the risk of empyema thoracis increased in elderly patients and in patients who had prolonged placement of thoracostomy tube. Intensive pulmonary care in elderly patients who sustained chest injury and early removal of thoracostomy tube is recommended in order to prevent the development of empyema thoracis.
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Comparative Study
Comparison of costs for reusable and disposable syringes.
The cost for reusable and disposable syringes was studied in Maharaj Nakorn Chiang Mai Hospital, a university hospital in the northern part of Thailand. The cost for operating reusable syringes includes that for cleaning and sterilization. This consists of labour, replacement for defective syringes, tap water, electricity, depreciation of instruments. ⋯ The cost for reusable syringes was 84,714 baht in comparison with 81,874 baht for disposable items. The latter was cheaper by 2,840 baht per month. It is concluded that disposable syringes are cheaper, at least in this university hospital.