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Abstract Vajira Surgical Nutritional Screening Tool Compared with Subjective Global Assessment Test (SGA) Kamonrut Pibul MD, FRCST, FICS Anan Manomaipiboon MD, MSc, FRCST, FICS Suphakarn Techapongsatorn MD, MSc, FRCST, FICS Surasee Boonyavanich MD Thanaporn Tosanguanrungruang RN Sunanta Vitayaudom RN Department of Surgery, BMA Medical College and Vajira Hospital Objective: To evaluate the diagnostic performances of the Vajira surgical nutritional screening tool compared with subjective global assessment (SGA) test. Study design: Descriptive study (diagnostic test). Subjects: A total of 200 patients admitted in the general surgical units, BMA Medical College and Vajira Hospital between January and June 2008. Methods: The nutritional status was evaluated by the Vajira surgical nutritional screening tool in terms of score ranging from 0-11 and SGA test. Age, sex and diseases were also recorded. Main outcome measures: sensitivity, specificity, positive predictive value, negative predictive value and 95% confidence interval (95% CI). Results: The mean age of the patients was 50.5 + 11.5 years. About 36.0% of them were male while 64.0% were female. Hepatobiliary diseases were found in 20.0% while large bowel malignancy was found in 16.0%. Prevalence of malnutrition diagnosed from SGA test was 44.5% including 35.0% of mild-moderate malnutrition and 9.5% of severe malnutrition. The score from Vajira surgical nutritional screening tool at cutoff point \> 4 had a sensitivity of 83.2% (95% CI, 78.0-88.3%), specificity of 87.4% (95% CI, 82.8-92.0%), positive predictive value and negative predictive value of 84.1% (95% CI, 79.0-89.2%) and 86.6% (95% CI, 81.9-91.3%) respectively to diagnose malnutrition compared to SGA test. Conclusion: The Vajira surgical nutritional screening tool is an effective tool with high sensitivity and specificity for identifying malnutrition in surgical patients. Key words: Vajira Surgical Nutritional Screening test, Subjective Global Assessment, SGA, malnutrition, surgical patients Vajira Med J 2009 ; 54 : 25 - 32
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Abstract Off-pump Coronary Artery Bypass Grafting in BMA Medical College and Vajira Hospital Suksan Kanoksin MD, FICST* Suphakarn Techapongsatorn MD, FICST* Petchsree Charoensombatamorn BS (nursing)** Siriwan Tankittiwat BN, MSc (nursing administration)** * Department of Surgery, BMA Medical College and Vajira Hospital ** Nursing Department, BMA Medical College and Vajira Hospital Objective: To compare the results between off-pump and on-pump coronary artery bypass grafting. Study design: Cross-sectional study. Subjects: A total of sixty-two patients with coronary heart disease underwent coronary bypass at the Department of Surgery, Bangkok Metropolitan Administrtion Medical College and Vajira Hospital during November 2003 to April 2005 were enrolled. Methods: Hospital records and operative note records were collected and analyzed. Main outcome measures: Preoperative risk factors, intra-operative clinical markers and postoperative outcomes. Results: From the study, the differences between both groups in terms of age, sex, blood pressure, hyperlipidemia and diabetic mellitus were not significant. But there were statistically significant differences between both groups in terms of chronic obstructive pulmonary disease, renal disease, heart failure and number of vessel disease. According to result from intraoperative clinical markers, there was statistically significant differences between both groups in terms of numbers of bypass grafts. From the result of postoperative outcomes, on-pump coronary artery bypass group had more mortality rate, stroke incidence, wound infection rate, reoperation rate for stop bleeding, blood transfusion, drainage volume, rising of cardiac enzyme, longer period of ICU stay, longer ventilator dependence period, and longer hospital admission period. Conclusion: The outcomes of off-pump coronary artery bypass grafting was better than on-pump coronary artery bypass grafting for treatment of coronary heart disease patients. This procedure can reduce the post-operative blood transfusion, post-operative ventilation usage, post-operative ICU stay, and hospital stay. Vajira Med J 2007 ; 51 : 171 - 177
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Abstract Fungal Peptic Ulcer Perforation: a Case Report Yuthapong Wongmahisorn MD, FICS Arkom Suesawatee MD Suphakarn Techapongsatorn MD, FICS, MSc Department of Surgery, BMA Medical College and Vajira Hospital Peptic ulcer perforation is the most common complication of peptic ulcer disease. Surgical management is the standard treatment. The mortality and mobidity depend on age, underlying disease, delay of operation, pre-operative status. The Helicobacter pylori is the common organism that related to and should be treated with peptic ulcer perforation. In this report, we present the patient who had peptic ulcer perforation and septicemia from Candida albicans. This is an uncommon organism in peptic ulcer disease. In spite of the surgical management, appropriate antibiotics and anti-fungal agents, the patient died during post-operative period. Vajira Med J 2009 ; 53 : 299-304
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Abstract Knowledge, Attitude and Behavior of Women towards Breast Cancer Screening Cherdchai Kittipovanon MD* Suphakarn Techapongsatorn MD, MSc (Health Development), FICS** * Somdej Prayuparaj Kranuan Hospital, Khon Kaen ** Department of Surgery, BMA Medical College and Vajira hospital Objective: To study the knowledge, attitude and behavior of Thai women towards breast cancer screening. Study design: Descriptive study. Subjects: Two hundred women attending out-patient clinic of the Department of Surgery or visitors of in-patients in the surgical wards at BMA Medical College and Vajira hospital or Somdej Prayuparaj Kranuan Hospital, Khon Kaen during August - December 2007 were enrolled into the study. Methods: Self-administered questionnaires about knowledge, attitude and behavior towards breast cancer screening were distributed to the subjects. Data were collected and analysed. Main outcome measures: Knowledge, attitude, and behavior towards breast cancer screening. Results: Seventy-five percent of subjects had knowledge towards breast cancer screening by self examination and 70% had knowledge towards breast cancer screening by the physicians. Regarding the attitude towards breast cancer screening, 93% had good attitude to self-breast examination, 70% to the physicians' breast examination, and 95% to mammography. However, only 70% had ever performed the breast-self examination and only 30% ever sought for medical consultation for breast examination and mammography. Conclusion: Majority of subjects had good knowledge and attitude towards breast cancer screening, but only 30% went for medical breast examination and mammography. Vajira Med J 2009 ; 53 : 261-266
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Abstract Endovascular Abdominal Aortic Aneurysm Repair: the First Experience in BMA Medical College and Vajira Hospital Suksan Kanoksin MD, FRCST, FICS* Navin Suraphakdee MD.** Suphakarn Techapongsatorn MD, FRCST, FICS* Worawong Slisatkorn MD, FRCST, FICS*** * Department of Surgery, BMA Medical College and Vajira Hospital ** Department of Emergency Medicine, BMA Medical College and Vajira Hospital *** Department of Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University This report presents the first experience of endovascular aortic aneurysm repair (EVAR) in the patient with infrarenal abdominal aortic aneurysm at BMA Medical College and Vajira Hospital. The patient was a 73-year-old male, who had abdominal pain which referred to perineal area for 1 year. The physical examination showed pulsatile abdominal mass and the computer tomography revealed infrarenal abdominal aortic aneurysm with a dimension of 6 cm. The patient underwent the EVAR with an uneventful postoperative outcome. At 3-month follow up, neither major complications nor endoleak was observed. Vajira Med J 2008 ; 52 : 265-273