Venous ultrasonography findings and clinical correlations in 104 Thai patients with chronic venous insufficiency of the legs

<p><b>INTRODUCTION</b>The pattern of venous reflux in Thai patients with chronic venous insufficiency (CVI) was studied in correlation with clinical manifestations.</p><p><b>METHODS</b>Ultrasonography findings and clinical data were prospectively collected and retrospectively reviewed.</p><p><b>RESULTS</b>CVI was found in 104 legs of 79 patients (mean age 59.8 ± 12.5 years; C4: 24.1%, C5: 8.9%, C6: 67.1%). 6.7% of the legs had a history of deep vein thrombosis (DVT). The prevalence of superficial vein reflux (SVR), deep vein reflux (DVR), and combined SVR and DVR in 90 legs without previous venous surgery was 82.2%, 63.3% and 57.8%, respectively. In legs with SVR, the prevalence of great saphenous vein reflux (GSVR), small saphenous vein reflux (SSVR), and combined GSVR and SSVR was 91.9%, 33.8% and 25.7%, respectively. 77.0% of SVR involved the calf segment. For medial ulceration, 79.6% had GSVR and 35.2% had SSVR. For lateral ulceration, 46.7% had SSVR and 33.3% had isolated GSVR. Pulsatile venous signal was found in 3.3% of legs. In 17 legs with ulceration after previous surgical treatment, calf vein reflux (residual calf great saphenous vein or small saphenous vein) was found in 13 (76.5%) legs.</p><p><b>CONCLUSION</b>Calf vein reflux plays an important role in CVI and in patients with recurrent ulceration after previous superficial venous surgery. Although GSVR was present in most patients with CVI in the legs, SSVR may present in one-third of patients, especially those with lateral ulceration. The high prevalence of DVR in the absence of DVT and the presence of a pulsatile venous signal in some patients highlight the incomplete understanding of CVI aetiology.</p>

Bacteriology and Antibiotics Usage in Patients with Diabetic Foot Infection

Abstract Bacteriology and Antibiotics Usage in Patients with Diabetic Foot Infection Waigoon               Stapanavatr         MD Burapa                  Karnjanabatr       MD Department of Surgery, BMA Medical College and Vajira Hospital Infection in diabetic foot is usually severe and is the most common cause of admission in diabetic patients. If surgical management is delayed, improper or missed diagnosis, risk of amputation will be high since nearly half of diabetic foot infection patients have peripheral arterial occlusive diseases. Patients with diabetic foot infection who need surgical intervention are usually infected with multiple organisms. Staphylococcus aureus is the common cause of infection in the United States of America, which is different from Asia. In Asia, bacteria in diabetic foot infection are usually response to simple antibiotics e.g. Proteus Mirabilis, Escherichia Coli, Klebsiella Pneumoniae, etc. Proper management for patients with diabetic foot infection consists of appropriate correction of arterial occlusion and combination antibiotics to cover gram positive, gram negative and anaerobic organisms. Erythromycin, Ciprofloxacin and Gentamicin have sensitivity to organisms in diabetic foot infection in South East Asia. Keywords: diabetic foot, organisms, antibiotics Vajira Med J 2010 ; 54 : 199-208  

Urban Medicine

Abstract Urban Medicine Waigoon           Stapanavatr         MD* Anan                 Manomaipiboon   MD, MSc (clinical epidemiology)** *Department of Surgery, BMA Medical College and Vajira Hospital **CEU, BMA Medical College and Vajira Hospital                 Bangkok Metropolitan Administration Medical College and Vajira Hospital had already set the vision and mission to develop the knowledge and research in urban medicine for more than 4 years. Urban medicine is a new medical science that prepared for social changing. However, the definition and specification are not clear. The knowledge and evidence in this topic was reviewed and summarized for further strategic planning.Vajira Med J 2005 ; 49 : 109 - 116

Urban Medicine: Basic Knowledge

Abstract Urban Medicine: Basic Knowledge Waigoon   Stapanavatr    MD Department of Surgery, BMA Medical College and Vajira Hospital Urban Medicine is a new science that initiated for urbanization. In the future, many rural areas in Thailand  will change to urban areas. However, urban medicine had not been described clearly in our country. This article A reviews the health problems and diseases relating to urban development.

Solid Pseudopapillary Tumor of the Pancreas: A Case Report

Abstract Solid Pseudopapillary Tumor of the Pancreas: A Case Report Suphakan         Techapongsatorn            MD, FICS Waigoon           Stapanavatr                     MD, FICS Satit                  Srimantayamas               MD Wisit                  Kasetsermwiriya            MD Department of Surgery, BMA Medical College and Vajira Hospital                 Solid pseudopapillary tumor is an uncommon low-graded malignant tumor of the pancreas. Definite diagnosis usually comes from pathological study of the surgical specimens. The prognosis is good whenever the tumor is completely removed. We herein present a case report of 19-year-old Myanmese woman suffered from intra-abdominal mass for 7 years. The computed tomography showed huge solid and cystic mass at body and tail of pancreas. She underwent enbloc resection included distal pancreatectomy and splenectomy. The pathological finding revealed solid pseudopapillary tumor. The patient was follow-up for 24 months with an uneventful post-operative course. She was free from tumor recurrence. Key words: pseudopapapillary tumor, pancreas Vajira Med J 2006 ; 50 : 193 - 197

Peripheral Arterial Disease of Lower Extremities, PAD

Abstract Peripheral Arterial Disease of Lower Extremities, PAD Burapa                 Kanchanabat                 MD Waigoon               Stapanavatr                  MD Yoothapong         Sangpayup                     MD Pong                     Kanchanasuttirak          MD           Peripheral arterial disease (PAD) commonly affects lower Extremities. The main cause is atherosclerosis. There is no available incidence data in Thai population. It is a major cause of lower limb amputation. PAD could be categorized as chronic arterial occlusion, presenting with chronic ulcer, gangrene or rest pain and acute arterial occlusion which leading to rapid limb loss. PAD is easily diagnosed by history taking, physical examination and measurement of ankle/brachial index (ABI). Treatment options are depends on its severity and the patient's condition. Risk factors modification, antiplatelets, anti-coagulants, thrombolytics and arterial bypass surgery may consider for appropriate patients. Vajira Med J 2007 ; 51 : 217 - 225

Pattern and Prevalence of Venous Reflux in Patients with Lower Extremity Chronic Venous Insufficiency

Abstract Pattern and Prevalence of Venous Reflux in Patients with Lower Extremity Chronic Venous Insufficiency Burapa        Kanchanabat                 MD Yuttapong Wongmahisorn              MD Waigoon     Stapanavatr                  MD Pong           Kanchanasuthiruk         MD Anan           Manomaiphiboon                     MD, MSc (Clinical Epidemiology) Department of surgery, BMA Medical College and Vajira Hospital. Objective: To study the pattern and prevalence of deep and superficial venous reflux in chronic venous insufficiency (CVI) patients. Study design: Prospective descriptive study. Subjects: A total of 30 CVI patients (40 legs) with Clinical Etiological Anatomical Pathological (CEAP) classification of ≥ C4 who attended the vascular clinic at BMA Medical College and Vajira Hospital between October 2006 and December 2007 were prospectively enrolled. Methods: The history and physical examination of the patients were recorded. Reflux of common femoral, superficial femoral, popliteal and greater saphenous veins were examined in all patients with the duplex doppler ultrasonography. The lesser saphenous veins were examined in 17 patients (22 legs). The reflux time more than 500 milliseconds were used for reflux diagnosis. Main outcome measures: Pattern and prevalence of venous reflux in lower extremity CVI patients. Results: In 30 CVI patients, there were 15 male and 15 female patients, with the mean age of 56.2 ± 12.5 years. In 30 legs (22 patients), which had not been operated for greater saphenous venous stripping, the most common pattern of reflux was combined superficial and deep vein reflux which were found in 80.0%. The isolated superficial and deep vein reflux were 6.7% and 10.0% respectively. Overall, deep and superficial vein reflux were found in 90.0% and 86.7% respectively. In 10 legs (8 patients) that had previous greater saphenous venous stripping, the incidence of deep vein reflux was 80.0%. The lesser saphenous veins were examined in 22 legs (17 patients), and reflux was found in 13 legs (59.0%). Conclusion: In patients who had not had greater saphenous venous stripping, the incidence of deep venous reflux was 90.0% and the incidence of superficial venous reflux was 86.7%. The common pattern was combined superficial and deep vein reflux, which were found in 90.0%. The isolated reflux was uncommon and found in only 6.7% and 10.0% for superficial vein and deep vein respectively. Vajira Med J 2008 ; 52 : 119 - 128

Results of Arteriovenous Fistula without Prosthetic Usage for Hemodialysis in BMA Medical College and Vajira Hospital

Abstract Results of Arteriovenous Fistula without Prosthetic Usage for Hemodialysis in BMA Medical College and Vajira Hospital Waigoon     Stapanavatr         MD, FICS, M.Ed (Educational Measurement) Yuthapong  Sangpayup           MD, FICS Burapa        Karnjanabatr       MD, FICS Department of Surgery, BMA Medical College and Vajira Hospital Objectivs: To determine the result of vascular access by autogenous arteriovenous fistula (AVF) for hemodialysis and to evaluate factors that may associate with the success of autogenous AVF. Study design: Descriptive study. Subjects: Chronic renal failure patients who needed hemodialysis and had permanent vascular access creation in our institution during April 2004 and March 2007. Methods: The data were retrospectively collected from medical records, operative records and computer database. Main outcome measures: The success rate of permanent vascular access using autogenous AVF. Results: During the study period; 225 patients were consulted for permanent vascular access for hemodialysis. Twelve cases had tunnel cuffed catheter (TCC) while 22 cases had inadequate medical records and were excluded. 191 cases who were operated for permanent vascular access using autogenous AVF were recruited. Mean age was 57.5 ± 13.9 years (15-91 years). 84 cases were men and 107 cases were women. 114 cases had hypertension and 119 cases had diabetes. Men had successful AVF in 90.5% which was significantly higher than 86.0% in women. Hypertensive patients had success rate of 89.5% which was not significantly different from non-hypertensive patients (94.8%). Diabetic patients had success rate of 90.8% which was not significantly different from non-diabetic patients (93.1%). Conclusion: Most of the chronic renal failure patients had successful autogenous AVF for hemodialysis, a few patients needed TCC and none needed graft. Vajira Med J 2009 ; 53 : 51 - 57