Necrotizing enterocolitis: a comparison between full-term and pre-term neonates.

A retrospective study comparing 16 full-term and 18 pre-term neonates with NEC operated on at Siriraj Hospital between 1987 and 1999 is presented. Major risk factors leading to NEC in full-term neonates included sepsis, SGA, birth asphyxia, severe jaundice requiring exchange transfusion and chorioamnionitis. Although full-term neonates developed NEC earlier than pre-term neonates (8.56 days vs 12.78 days), the average ages of operation in both groups were the same. There was no difference in CBC and bacteriological culture's results between term and pre-term patients. The decision to conduct operative treatments for full-term neonates with NEC was mostly based on only clinical signs of peritonitis (56.25%) before the pneumoperitoneum developed (31.25%). Ileo-caecal region was the most common site of bowel necrosis in both premature and full-term infants. Although term infants had a better 3-month survival rate than pre-term neonates (75% and 61% respectively), both groups had the same surgical complication rates.

Sacrococcygeal teratoma: 25 year experience.

We retrospectively studied all thirty-five children (M 6, F 29) with sacrococcygeal teratomas admitted to Siriraj Hospital between 1974 and 1999. Although an abdominal delivery is recommended for lesions greater than 5 cm to avoid dystocia, the average diameter of masses which required interventions from dystocia (n = 3) was not different from vaginal delivery (n = 27). All except two first presented with sacral masses recognized at birth. One patient presented with an abdominal mass and the last one was diagnosed after suffering from difficulty in urination. Ninety-seven per cent of cases were completely excised initially (32 sacral, 2 abdomino-sacral approaches), however, six patients required other treatment for recurrent diseases. One mature teratoma recurrence was resected. Two patients who had malignant recurrences following complete benign excisions, died from advanced malignancy. Four presented with malignancy initially. Wound infection, bladder atony and UTI were the most common complications postoperatively. Advanced malignancy was the major cause of death. No patient died directly from the procedure.

Thai national reference preparation in blood coagulation. IV. Home made reference plasma for von Willebrand's factor assay.

Two lots of home made reference plasma: FVIII R:Ag 30/8/88 and FVIII R:Ag 18/10/88 were prepared by lyophilization of pooled normal human plasma. Modification of J. Cejka's technique was used to determine FVIII R:Ag. This technique was tested for reliability i.e. precision, reproducibility and sensitivity. The concentration of FVIII R:Ag, determined by calibration against the 1st British Standard for FVIII R:Ag, human 66/355, which was established by National Institute for Biological Standard and Control (NIBS & C), London, the WHO International Laboratory for Biological Standard, were respectively 1.058 and 1.023 Ag units/ml for FVIII R:Ag 30/8/88 and FVIII R:Ag 18/10/88, respectively. The precision of the procedure and the accuracy of FVIII R:Ag concentration of both lots were verified by using them as standard curve to determine FVIII R:Ag in 4 unknown plasma samples, supplied by the UK Reference Laboratory for Anticoagulant Reagent & Control; WHO Collaborating Center for Quality Assessment, in Blood Coagulation Testing for International Quality Control Survey in Blood Coagulation. The results were very satisfactory. The coefficient of variation was between 2.22-5.47 per cent when compared with other 29 laboratories around the world. These home made reference preparation are stable at least up to 30 months at -70 degrees C, and can be applied for calibration of unknown sample instead of the 1st British Standard for FVIII R:Ag, human 66/355.

Laboratory assessment of thrombolytic therapy in acute myocardial infarction.

Hemostatic profiles and cardiac enzymes were studied in 55 acute myocardial infarct (AMI) patients to assess SK and rt-PA therapy. Hypofibrinogenemia occurred 85% in SK group and 55% in rt-PA group with high FDP and D-Dimer, indicating systemic fibrinogenolysis and local crosslinked fibrin clot lysis. The incidence of bleeding in SK and rt-PA groups combined with anticoagulants were the same but lower in rt-PA with antiplatelet. The mean FDP was significantly higher in the bleeding group (p < 0.01). Cardiac enzymes: CK, CK-MB peak values indicated reperfusion were 26.6%, 60% and 90% in conventional, SK and rt-PA therapy, respectively. Early and late occlusion did not occur either in SK or rt-PA followed by anticoagulants. Late occlusion was found in patients treated with rt-PA and antiplatelet. Mortality rate was 20% in conventional therapy.

Development of a new method for detection of platelet factor 3 like activity.

We asked the question, "Can thalassemic erythrocytes play some role in alteration of the hemostatic system?", because clinical examination of thalassemic patients shows symptoms and signs related to alterations in hemostatic and circulatory systems, and thalassemic erythrocytes are different from normal erythrocytes. We obtained one of the answers to the question: The erythrocytes of postsplenectomized patients of beta-thalassemia/HbE disease could stimulate their own platelets to aggregate spontaneously. To know the role of erythrocytes in platelet aggregation, we wanted to examine the effect of thalassemic erythrocytes on the coagulation system by focusing of PF3-like activity of erythrocytes, because PF3-like activity of the ghosts of erythrocytes had been reported. For the study, we tried to develop a technique that was accurate and sensitive enough to detect PF3-like activity of blood. The system we developed was the following: 1) We activated the intrinsic coagulation pathway of commercial standard plasma by ellagic acid. 2) CaCl2, a fixed amount of PF 3 and synthetic thrombin inhibitor MD 805 were added to the reaction mixture. 3) At a fixed time, thrombin activity in the mixture was measured by using S-2238 as a substrate. At full activation of the contact system by ellagic acid, the amount of thrombin formed in a certain time depended on the amount of PF3-like substances such as cephalin, freeze-thawed platelets or ghosts of erythrocytes added to the test system, indicating that PF3-like activity of those substances can be measured by the activity of thrombin generated in a fixed time.(ABSTRACT TRUNCATED AT 250 WORDS)

Increase in spontaneous platelet aggregation in beta-thalassemia/hemoglobin E disease: a consequence of splenectomy.

Clinical symptoms related with disturbances of the circulatory system are often observed in beta-thalassemia/hemoglobin E (beta-thal/HbE) patients after splenectomy. Pulmonary thrombosis is one of the important contributing factors. However, the pathogenesis of this phenomenon was not known. Previous studies on platelet functions were controversial as platelet-rich plasma (PRP) was employed for all of the studies. By centrifugation, most of the hyperactive platelets were excluded before platelet aggregation tests were performed. Besides, the role of red cells related to platelet aggregation was not investigated. In this study, a platelet function test was designed to avoid these two handicaps of previous work as mentioned, by using whole blood from 15 normal and 40 beta-thal/HbE patients (15 nonsplenectomized and 25 splenectomized) to study spontaneous platelet aggregation. The principle of the test was to evaluate platelet number in whole blood by electronic platelet counter at time 0 (45 minutes after blood collection) and this number was used as 100% of free unaggregated platelets. Then the same specimen of whole blood was incubated at 37 degrees C with continuous stirring by magnetic stirrer in an aggregometer for 8 minutes; at 1 minute intervals free unaggregated platelets were evaluated and calculated as a percentage of the initial control value. The results indicated increased spontaneous platelet aggregation in whole blood of post-splenectomized beta-thal/HbE patients. The residual free platelet number were 24% at 8 minutes after incubation. Effects of red blood cells on spontaneous platelet aggregation were studied by mixing autologous beta-thal/HbE red cells obtained from splenectomized and non-splenectomized patients with platelet rich plasma.(ABSTRACT TRUNCATED AT 250 WORDS)

Detection of PF3 availability in whole blood from volunteers and beta-thalassemia/HbE patients: a promising method for prediction of thrombotic tendency.

The platelet factor 3 (PF 3) plays a very important role in activation of coagulation factors and is regarded to be available during activation of platelets. However, membrane fraction of erythrocytes is also shown to have PF 3-like activity, suggesting that the abnormal erythrocytes may accelerate the activation of platelet by forming thrombin on their abnormal membrane or by way of other factors of the abnormal erythrocytes, and may increase the availability of PF 3 in whole blood (WB). To examine this hypothesis, we developed a method for determination of PF 3 activity, because the method now available for the PF3 determination could not detect changes in PF 3 activity with time. The principles of our method were as follows: 1) The reaction system was adjusted so that the amount of thrombin generated in a fixed reaction time correlates with the amount of PF 3. 2) To avoid inhibition of thrombin activity by antithrombin III, a synthetic thrombin inhibitor, MD 805, was added to the system and the activity of thrombin generated was measured by synthetic thrombin substrate S-2238 using A405 as an indicator of the availability of PF3. The results obtained by the method were the following: WB taken from volunteers showed A405 of 0.12 +/- 0.02 at 30 minutes after blood collection and then the A405 increased to 0.27 +/- 0.03 at 90 minutes. However, one volunteer showed the value of 0.59 at 90 minutes, though the value at 30 minutes was 0.16. The platelet number in his WB did not change during the study.(ABSTRACT TRUNCATED AT 250 WORDS)

Long term oral anticoagulant therapy after heart valve prostheses at Siriraj Hospital.

One hundred and forty-six cases of cardiac valvular prostheses in the Department of Surgery, Siriraj hospital, were studied retrospectively for the effect of long-term oral anticoagulant therapy. Warfarin sodium was given to 119 patients after operation, 5 cases discontinued therapy and 27 cases received no anticoagulant at all due to loss of follow-up. One stage prothrombin time was used as laboratory control. The advocated therapeutic range for commercial rabbit brain thromboplastin was 1.35-2.2 P.T. ratio. The incidence of thromboembolism was 8.9 per 100 patients - year in the nontherapeutic group, and was 0.6 per 100 patients - year in the therapeutic group (p less than 0.05). Bleeding complications was 26.9 per cent. These were 34 minor-, 11 major-and 2 fatal bleeding episodes. One bleeding manifestation was found in the nontherapeutic group, the etiology was not recorded. The mean dose of warfarin sodium in the thromboembolic group was 2.5 mg/day, this gave a therapeutic ratio of less than 1.4. In the bleeding group that had P.T. ratio not exceeding 2.2, the mean dose was 3.37 mg/day; and 5.23 mg/day when P.T. ratio was higher than 2.2 (p less than 0.01). Therefore, it seems justifiable to conclude that the appropriate mean dose should be over 2.5 mg/day and less than 3.37 mg/day. However, regular blood test to determine the appropriate daily dose for each individual patient is obligatory, as patients might be more or less sensitive to the drug than the average and drug requirement varies from time to time even in the same individual owing to many factors.(ABSTRACT TRUNCATED AT 250 WORDS)

Treatment of tetanus in children.

Analysis of 678 cases of tetanus in children for a period of 28 years has been performed with particular stress paid to the conservative, uncomplicated treatment. The combination of diazepam, chlorpromazine, methocarbamol, antitetanus serum, heavy dose of penicillin and intensive nursing care are simple, uncomplicated and give quite a good result. The mortality rate decreased from 30% to 4.4%. Paralysis was cared and there was a need for artificial respiration. This method can be used everywhere with case.

Papulonecrotic tuberculid in childhood.

A case of papulonecrotic tuberculids of anterior abdominal wall with active tuberculous cervical lymph gland in a 12-year-old girl was demonstrated. This case illustrated the fact that although the papulonecrotic tuberculid is a rare entity, physicians should be aware of its existance to be considered in the differential diagnosis of dermatological lesions. Lesions, which appear in crops resembling chickenpox, with a longer duration and a strongly positive tuberculin test should lead to the diagnosis of papulonecrotic tuberculid. The investigations should include biopsy and demonstration of an active tuberculous foci. The lesions will regress if the patient receive antituberculosis therapy. Misdiagnosis and postponement of treatment with specific drugs may give rise to unsatisfactory consequences.