Predicting Factors for Failure of Percutaneous Drainage of Postoperative Intra-Abdominal Collection.

Objective: To determine the predictive factors for failure of percutaneous drainage (PD) of postoperative intra-abdominal collection, to better select the patients who might benefit from PD. Material and Method: From September 2011 to February 2013, the authors reviewed 42 patients with symptomatic postoperative intra-abdominal collection who had received PD at Ramathibodi Hospital. The PD was considered as failure when clinical sepsis persisted or subsequent surgery was needed. Univariate analysis was used to examine the relationships between failure of PD and the collection and drainage-related variables. Results: The success rate of PD in the present study was 80%. No major complication was detected. The overall mortality was 12%. Univariate analysis showed that the presence of biliary fistula (p = 0.012), subhepatic location (p = 0.040) and the drainage catheter size of 12F (p = 0.002) were significant predictive variables for failure of PD. Conclusion: Image-guided PD of postoperative intra-abdominal collection was found to be a safe and effective procedure with few complications. Initial recognition of biliary fistula in the collection at subhepatic region or in patients underwent hepatobiliary surgery was the important prognostic factor for unsuccessful PD. These patients may be more beneficial for initial surgical drainage.

Effect of Obesity on Left Ventricular Mass: Results from 320 Multi-Slices Computed Tomography.

Objective: To determine effects of obesity and gender on left ventricular mass in normotensive and hypertensive Thai patients using 320-slice cardiac computed tomography (CT). Material and Method: Left ventricular mass (LVM) obtained from 320-slice coronary CT angiogram was compared in 597 normotensive subjects (175 men [65 obese] and 422 women [133 obese], aged 55±7 years) and 483 hypertensive patients (180 men [104 obese] and 303 women [170 obese], aged 60±7 years). Obesity in Asian population was defined by body mass index (BMI) ≥ 25 kg/m2 in both genders. LV mass was normalized for body surface area (BSA)and height2.7. Results: The upper normal limit of LVM/ height2.7 developed from 244 (197 women, 47 men) low risk subjects (non-smoking normal-weight adults free from hypertension, diabetes, coronary artery disease & dyslipidemia) was lower than the established criteria for left ventricular hypertrophy (LVH) (31 versus 44 g/m2.7 in women; 36 versus 48 g/m2.7 in men). There is statistical difference between men and women in all groups of analysis. Among both hypertensive and normotensive subjects, the prevalence of LVH and LVM/height2.7 are higher in the obese group than normal-weight group in both genders (LVM/height2.7p<0.001; prevalence of LVH ­ obese versus normal-weight hypertension: 58% versus 34% in women, 43% versus 14% in men; obese versus normal-weight normotension: 35% versus 16% in women, 40% versus 15% in men). The same differences between obese and normal-weight groups were also present when normalizing LVM for height but not with LVM/BSA. Logistic regression analysis revealed that systolic blood pressure and BMI were the main predictors of LVH in the entire population (p<0.001 in both genders). Equations for predicting LVH in men and women were: Risk of LVH = 1/(l+e-w) where w is as follows: w (men) = 0.02* systolic pressure + 0.25*BMI ­ 9.86, w (women) = 0.03* systolic pressure + 0.17*BMI ­ 8.82. Conclusion: Obesity is an independent stimulus to increase LVM in normo-tensive subjects, and its effect is additive in hypertensive patients. Gender and obesity affect LVM and prevalence of LVH.

Normal data of left ventricular parameters in non-hypertensive patients using 320-slice cardiac CT: a study on intra- and interobserver variability.

OBJECTIVE: Delineate normal data in a Thai population for global left ventricular function, left ventricular mass (LVM), and LV mass index (LVMI) by gated volumetric CT angiography (CTA). MATERIAL AND METHOD: Two hundred twenty seven patients with intermediate risk factors for CAD were referred for CT coronary angiography. The non-hypertensive and non-diabetic asymptomatic group was selected with negative coronary CTA. Pre-condition of mild stenosis or less than 50% area stenosis was consistently met for inclusion in the present study. One hundred fifteen patients were included (31 males, 84 females, age range 38-76 years, mean 54.6 +/- 7.2 for males and 54.0 +/- 6.8 for females respectively). RESULTS: Mean EDV, ESV, SV, CO, and EF in male and females were EDV 122.6 +/- 17.3 vs. 94.9 +/- 16.6ml, ESV 48.2 +/- 9.9 vs. 34.1 +/- 9.1 ml, SV 74.5 +/- 14.2 vs. 60.8 +/- 10.6 ml, CO 4.2 +/- 0.8vs. 3.6 +/- 0.7 Land EF 60.6 +/- 6.6 vs. 64.3 +/- 5.6% respectively The mean LVM and LVMI were higher in males than females (LVM 134.6 +/- 21.4 vs. 96 9 +/- 20.3 g, and LVMI 76.8 +/- 12.4 vs. 61.1 +/- 11.56 g/m2). Altman and Bland plot for each of them showed that the mean and standard deviation of the differences was constant throughout the range of measurements. Each histogram of differences showed that these differences correspond to approximately normal distribution, indicating that the required assumptions held for the use of 95% limits of agreement are valid. CONCLUSION: Data from this group represents healthy volunteers and this may serve as an important source of information representing normal reference values to be used for Thai patients.