Journal of the Medical Association of Thailand = Chotmaihet thangphaet
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Comparative Study
Comparison of 18F-FDG Pet/CT and CT: diagnosis performance in lymphoma patient after treatment.
Retrospectively comparing 18F-FDG PET/CT and CT findings at the same anatomic locations in patients with lymphoma by using a combined PET/CT scanner and to analyze the lesions on both metabolic and anatomic bases to evaluate their sensitivity specificity positive predictive value (PPV), negative predictive value (NPV), and accuracy. We analyzed all studies, all patients, common cell type in this study such as diffuse large B cell lymphoma (DLBCL) and Hodgkin's lymphoma and indication of the study such as restaging for recurrence post-therapy and evaluate residual disease within two months after chemotherapy. ⋯ The PET/CT is better than CT for post-treatment lymphoma patient particularly for cell type of DLBCL and indication for evaluation of active lymphoma within two months after chemotherapy.
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Recent treatments in hematological malignancies have substantially improved. Unfortunately, once a patient with a hematological malignancy has complications, the prognosis is poor and the in hospital and ICU mortality rates are high. Debates concerning the reluctance to admit patients into ICUs with poor prognoses often emerge. The aim of the present study is to identify the patients who are more likely to benefit from ICU admissions. ⋯ Patients with lymphoma and acute myeloid leukemia admitted into the ICU referral center in the south of Thailand who had mechanical ventilation, use of vasopressors and APACHE II scores greater than 27 were associated with a higher ICU mortality rate. The authors suggest that early identification of the subgroup of patients whose probability of survival is so low that advanced ICU support should not be continued would be a more reasonable goal. This will allow more efficient care to potential survivors not in this group.
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Pragmatic surveys for shock management by Thai physicians are unavailable. The objective of this study is to identify the shock management patterns on both; the incidence of septic shock and hemorrhagic shock here in Thailand. ⋯ Most physicians manage shock with the current protocols. Hemodynamic goals are preferred over tissue perfusion targets. Early antimicrobial therapy and de-escalation are routinely practiced without the use of infective biomarkers. Crystalloids are preferred over colloids for the initial resuscitation. CVPs and fluid challenges are still preferred over the new fluid responsiveness methods for preload assessment. Hydrocortisone is the most common steroid prescribed for septic shock but the threshold of initiation, frequency of use and methods of discontinuation vary.
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There are varieties of clinical practices for intensive care respiratory support. However there has been no published report characterizing its current practice in Thailand. The present study was undertaken to characterize the practice of respiratory support for intensive care patients in Thai tertiary hospitals. ⋯ The VC-CMV was more commonly used as the initial mode of ventilation in both surgical and medical ICUs. Pressure support was the predominant weaning mode in the medical ICUs, while SIMV was more predominant in the surgical ICUs. Individual patients in medical ICU had a greater number of ventilator days and less probability of being ventilator-free.
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Septic shock is a serious condition associated with a high mortality rate. The 'Early goal-directed therapy" has been reported as the effective treatment. Whether or not an intensive care unit (ICU) admission can improve the outcomes of septic shock patients, has not been elucidated. ⋯ Apart from the early goal-directed therapy, early ICU admission substantially improves the outcomes of septic shock patients.