The efficacy and safety of lyophilized cryoprecipitate in hemophilia A.

This prospective study of assessing the efficacy and safety of lyophilized cryoprecipitate (LC), which was heat-treated at 60 degrees C for 25 hours, was conducted in 23 patients with hemophilia A (severe 13, moderate 9, mild 1) at the International Hemophilia Training Center, Bangkok from 1997 to 1998. A total of 223 infusions of LC were given. The status of the patients could be classified into 4 groups: group I, non-bleeding (n = 13); group II, severe bleeding requiring hospitalization (n = 9); group III, appendectomy (n = 1) and group IV, early bleeding controlled by modified home treatment (n = 200). Pharmacokinetic studies were conducted in groups I and II. The mean in vivo half-life of factor VIII clotting activity (F VIII:C) was 12.6 hours and the mean in vivo incremental recovery at baseline was 2.1 per cent/unit/kg. The mean clearance was 3.22 ml/kg/h. There was no statistically significant difference in these parameters between groups I and II (p > 0.05). The hemostasis was successfully achieved and 1 to 2 small urticarial wheals were observed in only 2 infusions. In addition, 9 out of 23 patients received LC exclusively for 1 year. None of them developed inhibitor to F VIII:C nor did any contract additional transfusion-transmitted infection except one who developed anti-hepatitis C virus seroconversion after receiving 16 bottles of LC in 4 months. Therefore, the more efficient virus-inactivation in the preparation of LC should be established.

Rehabilitation in uncomplicated myocardial infarction at Ramathibodi Hospital: 5 years follow-up.

Prospective study: 44 cases of post acute uncomplicated myocardial infarction were divided into 2 groups: control and exercise groups. The control group consisted of 22 patients, 35-74 years (mean 63.25) and exercise group consisted of 22 patients, 33-71 years (mean 54). The exercise test was performed at 5 METS predischarge then an exercise program conducted by a physiatrist (physician specialized in physical medicine and rehabilitation) but was not given in control group. The exercise test was repeated 12-weeks post discharge with results showing a remarkable difference between the 2 groups statistically. Also, after a 5 year follow-up, the exercise group were living, normally, 77 per cent versus only 30 per cent in the control group. Death in the exercise group and the control group was 5 per cent and 45 per cent respectively.

Subclinical carpal tunnel syndrome in hospital staff.

An electrodiagnostic study was performed on 50 subjects (one hundred hands) of asymptomatic hospital staff (pharmacists, secretaries, typists, nurses, cleaners, and cooks) by using an MS-92 electrodiagnostic instrument at Ramathibodi Hospital, Bangkok, Thailand. It was found to be 64 per cent. The longer the duration of the worker's experience on the job, the greater the incidence of carpal tunnel syndrome. Based on the result of this paper: cleaners, pharmacists and nurses face a higher risk of developing carpal tunnel syndrome 5.67, 3.92 and 2.24 times greater, respectively, than others.

Surgical orthopedic correction of hemophilic hemarthrosis at Ramathibodi Hospital.

During 1982-1992, 15 major surgical orthopedic correction (SOC) were performed in 12 hemophiliacs. There were 11 synovectomy, 2 osteotomy, 1 currettage and suture wound, 1 release of multiple joint contracture and 1 removal of pseudotumour. During 1982-1989, frozen cryoprecipitate was entirely used for replacement therapy in 5 cases who had 7 SOC. During 1990-1992, 7 cases received SOC by using factor VIII concentrate (Emoclot or Profilate) alone or combined with cryoprecipitate in 8 SOC. Multiple surgical procedures could be performed by using factor VIII concentrates. The orthopedist could operate 3 joints in one setting ie right knee, left knee and right middle finger. There are many advantages of factor VIII concentrates over those of cryoprecipitate, especially in the aspect of HIV transmission by HIV seronegative blood products. The disadvantage is the extremely high cost of factor concentrates.

Conservative management of degenerative knee: an experience with 508 cases at Ramathibodi Hospital.

An analysis of the physical management of degenerative joint disease (1,016 knees) conducted at Ramathibodi Hospital, Bangkok, during the period 1985-1989 indicates that degenerative knee occurs mostly among those in the middle and older age groups (41-70 years, mostly among those 51-60 years of age). Physical therapy is suitable for treatment because of its ease, low cost and safety. Long-term follow-up showed that only 7.66 per cent required surgery.