ABSTRACT
Abstract A Study of Serum Magnesium Levels Attained in Intravenous Magnesium Sulfate Therapy for Severs Preeclsmpsia: A Comparison between 4 and 6 Grams Loading Dose Regimens* Surawute Leelahakorn BSc (Med), MD, Dip Thai Board of Obstetrics and Gynecology, Dip Thai Board of Gynecologic Oncology Mala Trewatcharegon BSc (Med Tech), MSc (Biochemistry) *** *This work was supported by the Vajira Research Fund (annual research fund 1999 **Department of Obstetrics and Gynecology, BMA Medical College and Vajira Hospital ***Department of Central Laboratory, BMA Medical College and Vajira Hosspital Objective: To compare the serum magnesium levels obtained from severe preeclamptic patients between the 4 grams and the 6 grams loading dose regimens and to compare the power of two regimens that can made the serum magnesium level to reach the therapeutic level. Study design: A prospective double blinded randomized controlled trial. Setting: Department of Obstetrics and Gynecology and Department of Central Laboratory, BMA Medical College and Vajira Hospital Subjects: Thirty-five severe preeclamptic women of 28 weeks of gestational age. Methods: The subjects were divided by weight to be 70 Kg and less than 70 Kg. Then the subjects in each stratum were allocated by randomized to receive the 4 grams or the 6 grams loading dose of magnesium sulfate, followed immediately by the same maintenance dose of 2 grams per hour. Maternal blood samples were taken for measuring serum magnesium levels before therapy 1, 4 8 hours after therapy before delivery and 6 hours after delivery including cord blood sample and they were compared between the two regimens. Other patient's characteristics and outcomes were collected and compared between the two regimens also. Main outcome measures: Serum magnesium levels. Results: The serum magnesium levels at the first hour after therapy of the 6 grams loading dose group were higher than the 4 grams loading dose group with statistical significant difference (4.400.26 mg/dl vs 3.73 0.38 mg/dl, p-value = 0.011) but the serum magnesium levels at the 4th and the 8th hours after therapy before delivery and at the 6th hours after delivery were no statistical significant difference. In the comparison of the power of achieving the therapeutic level, the 6 grams loading dose group was higher than the 4 grams loading dose group in achievement of the therapeutic level at the first hour after therapy with statistical significant difference (26.3% vs 0%, p-value = 0.049 ). Even though at the 4th and 8th hours after therapy before delivery and at the 6th hours after delivery the power of achieving the therapeutic level of the 6 grams loading dose group was higher than the 4 grams loading dose group with no statistical significant difference, but when compared all samplings after therapy the power of the 6 grams loading dose group in achievement of the therapeutic level was higher than the 4 grams loading lose group with statistical significant difference (43.3% vs 10.4%, p-value = 0.0002). The characteristics and outcomes of the patients and fetuses of two groups were no statistical significant difference. Conclusion: The 6 grams loading dose regimen was more effectively in rising serum magnesium level and in rising serum magnesium level and in achieving the therapeutic level than the 4 grams loading dose regimen, especially in the first hours after treatment. Both regimens were safe for treatment and no serious complication was found in mothers and newborns. Key word: severe preeclampsia, magnesium sulfate, serum magnesium levelVajira Med J 2003 ; 47 : 103 - 112
ABSTRACT
Abstract Endometrial Cancer: Incidence of Retroperitoneal Lymph Node Metastasis and Clinico-pathological Factors Predicting Retroperitoneal Lymph Node Metastasis Surawute Leelahakorn MD* Siriwan Tangjitgamol MD* Sumonmal Manusirivithaya MD, MSc (Clinical Epidemiology)* Jakkapan Khunnarong MD* * Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, BMA Medical College and Vajira Hospital Objectives: To evaluate the incidence of retroperitoneal lymph node (RLN) metastasis in endometrial carcinoma (EMC) and to assess the clinico-pathological factors predicting RLN metastasis. Study design: Retrospective study. Subjects: Two hundred and twenty five patients with clinical stage I-II EMC who underwent surgical staging at our institute during January 1993 and December 2007. Methods: Medical and pathological records of all EMC patients were reviewed. Clinico-pathological characteristics and other data were extracted and analyzed. Main outcome measures: Retroperitoneal lymph node metastasis. Results: Mean age of the patients was 55.0 ± 9.8 years (30-84 years). All patients had total abdominal hysterectomy, bilateral salpingo-oophorectomy and pelvic lymph node resection. One hundred and seventy seven patients (78.7%) also had para-aortic lymph node resection. The most common histopathologic type was endometrioid adenocarcinoma (90.7%). Mean number of lymph nodes obtained was 23.2 ± 10.6 nodes. Retroperitoneal lymph node metastasis was found in 28 patients (12.4%): pelvic lymph node metastasis in 25 patients (11.1%) and para-aortic lymph node metastasis in 10 patients (4.4%). By univariable analysis, clear cell or papillary serous adenocarcinoma type, high grade (II-III) tumor, tumor size \> 2 cm, tumor located in lower uterine segment, cervical involvement, gross intra-abdominal metastasis, myometrial invasion more than inner half, lymph vascular space invasion and positive peritoneal cytology were significantly associated with RLN metastases. By multivariable analysis, only myometrial invasion more than inner half and lymph vascular space invasion were independently associated with RLN metastasis. Conclusion: RLN metastases were found in 12.4% of patients with clinical stage I and II EMC. Presence of myometrial invasion more than inner half and lymph vascular space invasion were significantly associated with RLN metastasis by multivariable analysis. Vajira Med J 2008 ; 52 : 129 - 138