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1.
J Med Assoc Thai ; 84(3): 408-16, 2001 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-11460944

RESUMO

OBJECTIVE: To survey the prevalence of cognitive impairment in the elderly and to estimate the prevalence of dementia in the community dwelling Thai population. To assess the psychometric property of Thai Mental State Examination (TMSE). MATERIAL AND METHOD: We conducted a countrywide survey of 3,177 Thai elderly who were 60 years old and over from 1995 to 1997. Medical history and ability to carry out daily activities were taken by trained medical personnel. Thai Mental State Examination (TMSE) was used for cognitive study. Every elderly person involved in this study was examined by either an internist or a neurologist. Blood was taken for haematological and biochemical analysis. SPSS 6.0 was the main statistical analysis of the data. RESULTS: Three thousand one hundred and seventy seven elderly people were enrolled in this study, thirty eight point eight per cent were male and sixty one point two per cent were female. There was correlation between age, education and TMSE (r=-0.345, r=0.473, p<0.001). We found no correlation between TMSE, mean arterial blood pressure (BP), systolic BP, diastolic BP, haematocrit, cholesterol, triglyceride, blood sugar and syphilitic serology. Multiple cut off points of TMSE was proposed to utilise the twenty fifth percentile in each five yearly age interval. Those who were under the 25th percentile of TMSE and had impaired daily activities were diagnosed as dementia. The prevalence of dementia was 9.88 percentiles in our study. CONCLUSION: Dementia is a common problem in the Thai elderly. As treatment has become available for several etiologies of dementia, early detection and assessment of dementia with a cognitive screening test are essential. Public education to distinguish between dementia and old age needs to be emphasised.


Assuntos
Transtornos Cognitivos/epidemiologia , Demência/epidemiologia , Avaliação Geriátrica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Tailândia/epidemiologia
2.
Artigo em Inglês | MEDLINE | ID: mdl-11414408

RESUMO

Liver necropsy from patients infected with human immunodeficiency virus was analyzed in 117 cases. Wide ranges of opportunistic infections were recorded in 47%. Cryptococcosis (21.4%) was the most outstanding infection, followed by tuberculosis (16.2%), cytomegalovirus (5.1%) and penicillosis (3.4%). Non-specific alterations of the liver tissues included fatty steatosis (49.6%), fibrosis (55.6%), portal inflammation and reactive hepatitis. Cases of chronic active and chronic passive hepatitis and one case of hepatocellular carcinoma were reported. In the infected liver, predominant pathological changes included granuloma and spotty necrosis, which were attributed to tuberculous hepatitis. Infection with Cryptococcus usually showed no associated pathological change. The sensitivity for the clinical diagnosis of Cryptococcus was 88.8% and specificity was 91.7%. For tuberculosis, sensitivity was 20% and specificity was 67.9%.


Assuntos
Infecções Oportunistas Relacionadas com a AIDS/epidemiologia , Hepatopatias/patologia , Infecções Oportunistas Relacionadas com a AIDS/patologia , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Feminino , Humanos , Hepatopatias/classificação , Hepatopatias/etiologia , Masculino , Pessoa de Meia-Idade , Tailândia/epidemiologia
3.
Artigo em Inglês | MEDLINE | ID: mdl-10774689

RESUMO

A case of coinfection of cytomegalovirus (CMV) and Cryptosporidium in an AIDS patient is reported. Chronic diarrhea was the presenting symptom. Etiologic agents were diagnosed only at postmortem evaluation. CMV intranuclear inclusions were seen in the terminal ileum, colon and vermiform appendix. Cryptosporidium oocysts were also present in the intestinal brush border of the colon. Improvement of diagnostic procedures such as colonic biopsy and the use of appropriate staining procedure for AIDS patients with diarrhea can help identify the cause of illness.


Assuntos
Infecções Oportunistas Relacionadas com a AIDS , Criptosporidiose/virologia , Infecções por Citomegalovirus/virologia , Infecções Oportunistas Relacionadas com a AIDS/parasitologia , Infecções Oportunistas Relacionadas com a AIDS/patologia , Infecções Oportunistas Relacionadas com a AIDS/virologia , Adulto , Doença Crônica , Criptosporidiose/patologia , Infecções por Citomegalovirus/patologia , Diarreia/etiologia , Feminino , Humanos , Intestinos/patologia
4.
Artigo em Inglês | MEDLINE | ID: mdl-10695804

RESUMO

A unique case of nosocomial aspergillosis following neurosurgery in a 10 year old girl was documented. She presented with intracerebral hemorrhage after three weeks of operation for evacuation of craniopharyngioma. To our knowledge, this is the first reported case of intracerebral hemorrhage due to nosocomial aspergillosis following neurosurgery.


Assuntos
Encefalopatias/complicações , Hemorragia Cerebral/microbiologia , Craniofaringioma/cirurgia , Craniotomia/efeitos adversos , Infecção Hospitalar/complicações , Neuroaspergilose/complicações , Neoplasias Hipofisárias/cirurgia , Encefalopatias/diagnóstico , Hemorragia Cerebral/diagnóstico por imagem , Criança , Infecção Hospitalar/diagnóstico , Evolução Fatal , Feminino , Humanos , Neuroaspergilose/diagnóstico , Tomografia Computadorizada por Raios X
5.
J Med Assoc Thai ; 81(6): 413-22, 1998 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-9676073

RESUMO

The purpose of this study was to investigate the effects of botulinum A toxin for the treatment of post-stroke spasticity patients. Twenty two post-stroke spasticity patients were recruited in the study. All patients had moderate to severe spasticity of upper and lower extremities. Botulinum toxin was injected intramuscularly according to the spasticity pattern. Injections were performed at either 2, 3, or 6 month intervals as determined by the neurologist. The total dose of each session of injection varied between 50-100 IU. Subjective and objective examinations were conducted by the physiotherapist prior to the first injection and subsequently at 1st week, 2nd week and every month after each injection. All patients were asked subjectively about their satisfaction with the treatment. The objective examinations used in this study were Ashworth scale and Fugl-Meyer Sensorimotor Assessment Form. All patients were satisfied with the treatment. Marked reduction of the spasticity was found after one to two weeks of injection. The duration of effectiveness of botulinum toxin for spasticity is from 3-6 months. The average improvement in Ashworth score was between 1 and 1.5 points. The Fugl-Meyer scores showed significant improvement in most patients for the motor function of upper and lower extremities, and balance. All patients demonstrated increase in passive range of joint motion and decrease in joint pain. This study demonstrates that botulinum toxin therapy is safe and effective in treating chronic upper and lower extremities' spasticity following stroke. The dosage used in this study is about one-half of the recommended dosage in the literature. The only drawback of this therapy is its high cost (300 US dollars for 100 I.U.).


Assuntos
Toxinas Botulínicas Tipo A/uso terapêutico , Transtornos Cerebrovasculares/complicações , Espasticidade Muscular/tratamento farmacológico , Fármacos Neuromusculares/uso terapêutico , Adulto , Idoso , Idoso de 80 Anos ou mais , Esquema de Medicação , Feminino , Humanos , Estudos Longitudinais , Masculino , Análise por Pareamento , Pessoa de Meia-Idade , Espasticidade Muscular/etiologia , Índice de Gravidade de Doença , Tailândia , Resultado do Tratamento
6.
J Med Assoc Thai ; 81(7): 497-505, 1998 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-9676086

RESUMO

Epidemiology of stroke in the elderly in Thailand was conducted from August 1994 to October 1996. The total of 3,036 Thai elderly were included in this study. They represented the elderly population from four regions; Central Region (615 elderly, Nakhon Pathom Province), Northern Region (840 elderly, Lampang Province), North-Eastern Region (706 elderly, Sakon Nakhon Province), and Southern Region (857 elderly, Ranong Province). All elderly in these selected areas received general physical examinations and complete neurological examinations from neurologists. Demographic data concerning each individual was recorded by specially trained nurses. Data included age, sex, occupation, education, drug usage, alcohol, smoking and pre-existing diseases. Blood was taken from each subject for complete blood count, fasting blood sugar, cholesterol, triglyceride, high density lipoprotein cholesterol and VDRL. Data on physical examinations were recorded with particular attention to blood pressure, carotid bruit, cardiac murmurs, cardiac arrhythmia, speech, posture, gait, frontal lobe releasing signs, Babinski sign and focal neurological deficit. Thirty-four stroke patients were identified from 3,036 elderly (prevalence rate of 1.12 per cent). There were 12 stroke patients from Central Region (prevalence rate of 1.99 per cent), 5 from Northern Region (0.6 per cent), 4 from North-Eastern Region (0.6 per cent) and 13 from Southern Region (1.5 per cent). Hypertension was the main risk factor for stroke in this study whereas diabetes mellitus, smoking, alcohol consumption, hyperlipidemia and underlying heart diseases were insignificant risk factors. The prevalence of hypertension in Thai elderly was ranging from 16.7 to 47.2 per cent (criteria over 140/90 mmHg) or 6.1 to 24.8 per cent (criteria over 160/90 mmHg). Prevalence of smoking and alcohol consumption in Thai elderly ranged from 19.5 per cent (Sakon Nakhon) to 62.1 (Lampang) and 16.75 per cent (Nakhon Pathom) to 33.70 per cent (Lampang) respectively. Data from physical examinations revealed that dysarthria, hemiplegic gait and Babinski sign were the significant signs for diagnosis of stroke in the community setting. The prevalence of carotid bruit, cardiac murmur and cardiac arrhythmia were ranging from 1.3 to 1.8 per cent, 3.1-7.1 per cent and 0.8-1.4 per cent respectively. From this study, it can be concluded that stroke prevention is the best policy for stroke management. Stroke prevention measures should thus be aimed at the high risk elderly group. This is best achieved by identifying risk factors among them and then controlling these risk factors properly.


Assuntos
Transtornos Cerebrovasculares/epidemiologia , Idoso , Estudos de Casos e Controles , Estudos Transversais , Feminino , Inquéritos Epidemiológicos , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Tailândia/epidemiologia
7.
J Med Assoc Thai ; 80(1): 1-8, 1997 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-9078810

RESUMO

One hundred patients (9.09 per cent) with blepharospasm from a grand total of 1,100 patients (at the Movement Disorders Clinic at Siriraj Hospital) who had been treated with botulinum A toxin (BTX-A) injection between 1989 and 1996 were analysed. The 100 patients comprised 65 females and 35 males with a female to male ratio of 1.86:1. Their mean age was 53.3 years (S.D. 12.03). Sixty patients had idiopathic blepharospasm, 31 patients were diagnosed with Meige syndrome (blepharospasm plus oromandibular dystonia) and nine patients with segmental dystonia (Meige syndrome plus cervical dystonia). The mean duration of suffering was 39.22 months (S.D. 44.83). Each patient received 30-50 IU of BTX-A injections according to the standard Siriraj injection pattern. Nine patients were lost to follow-up. The results of BTX-A injection were classified as: excellent result (an improvement of more than 75 per cent) in 83.51 per cent; a good response (an improvement of 50-75 per cent) in 13.19 per cent; a moderate response (an improvement of 25-50 per cent) in 2.20 per cent; and minimal or no response in 1.10 per cent. The complications of BTX-A injection were transient minimal ptosis (9.89 per cent), transient double vision (1.10 per cent) and excessive lacrimation (1.10 per cent). The efficacy of BTX-A injection lasted one to two months in 1.10 per cent, two to three months in 23.08 per cent, three to four months in 45.05 per cent, four to five months in 16.48 per cent, five to six months in 4.40 per cent and more than six months in 9.89 per cent. Botulinum A toxin injection is a simple and effective out-patient treatment for patients with blepharospasm, causing no systemic side-effects and minor transient local complications. The only drawback of this treatment is its high cost (100 IU cost 300 US dollars).


Assuntos
Blefarospasmo/tratamento farmacológico , Toxinas Botulínicas Tipo A/uso terapêutico , Síndrome de Meige/tratamento farmacológico , Fármacos Neuromusculares/uso terapêutico , Adolescente , Adulto , Idoso , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
8.
J Med Assoc Thai ; 79(5): 278-84, 1996 May.
Artigo em Inglês | MEDLINE | ID: mdl-8708518

RESUMO

A cross-sectional design study was done at Siriraj Hospital from 1990 to 1994 to determine the prevalence of dementia in Thai patients with Parkinson's disease. There were 81 males and 51 females with a male to female sex ratio of 1.59:1. One hundred and thirty two patients with Parkinson's disease were enrolled in this study. The mean duration of illness was 3.5 (S.D. 3.53) years. All patients were screened for depression by using the Thai Geriatric Depression Scale and patients with Alzheimer's disease or stroke were excluded from the study. The Thai Mental State Examination (TMSE) is a standard test used in this study to identify dementia in Thai patients with Parkinson's disease. Thirty four patients (25.76 per cent) scored TMSE below 23 points (cut-off point for dementia) and were considered as having dementia. Twenty four patients (18.18 per cent) scored below 20 points and were considered as having severe dementia, 12 patients (9.09 per cent) scored between 20-22 points (classified as mild to moderate dementia). Thirty seven patients (28.03 per cent) were in the borderline group as they had TMSE scores between 23-25 points. Fifty nine patients (44.70 per cent) were determined as nondemented as their TMSE scores were over 25 points. The items of cognitive function tests in TMSE which were severely impaired in the demented group were recall, attention and calculation whereas registration was relatively unaffected. Orientation and language were moderately impaired in the demented group. Dementia in Thai patients with Parkinson's disease is a significant problem for long term care of patients because of its high prevalence (one-fourth of all patients) and nearly one-fifth had severe dementia. Prompt recognition and proper management of dementia are required for family members and medical personnel to handle patients with Parkinson's disease.


Assuntos
Demência/complicações , Doença de Parkinson/complicações , Idoso , Estudos Transversais , Demência/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Testes Neuropsicológicos , Prevalência , Tailândia/epidemiologia
9.
J Med Assoc Thai ; 79(4): 205-9, 1996 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-8708504

RESUMO

Fifteen Thai patients with Parkinson's disease (7 females, 8 males) were enrolled in an open label trial of pergolide (a new dopamine agonist) to evaluate its safety and efficacy. Inpatients and outpatients from Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand from 1992 to 1994 were included in the study with a total duration of 18 weeks. Both de novo patients and patients who were being treated with levodopa without dopamine agonist and were obtaining a less than optimal response at both visit 1 and visit 2 were all enrolled in this study. At entry into the study, 3 patients had Hoehn and Yahr stage I, 7 patients at stage II, 3 patients at stage III, and 2 patients at stage IV. Pergolide dosage was gradually built up until an optimal dosage was achieved. The average dose of pergolide during the study was 0.94 mg/day (range 0.075 to 8 mg/day). All patients completed the study and no patients dropped out. Two patients (13.33 per cent) experienced nausea (on 0.4 mg/day and 0.075 mg/day), two patients (13.33 per cent) experienced sleepiness (0.50 mg/day and 0.075 mg/day) and one patient (6.67 per cent) unsteadiness on walking (0.50 mg/day). There was one patient who required pergolide up to 8 mg/day which is higher than the recommended dosage (5 mg/day) but this patient experienced no adverse effects and his disabled dyskinesic was abolished. Our study demonstrated the good toleration and efficacy of pergolide treatment for Thai patients with Parkinson's disease. This new dopamine agonist stimulates both D1 and D2 receptors in comparison to other dopamine agonists (bromocriptine and lisuride) which stimulate only D2 receptors.


Assuntos
Antiparkinsonianos/uso terapêutico , Doença de Parkinson/tratamento farmacológico , Pergolida/uso terapêutico , Idoso , Antiparkinsonianos/administração & dosagem , Relação Dose-Resposta a Droga , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doença de Parkinson/fisiopatologia , Pergolida/administração & dosagem , Tailândia , Resultado do Tratamento
10.
Parkinsonism Relat Disord ; 1(2): 85-8, 1995 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-18591006

RESUMO

The evaluation of the efficacy of botulinum A toxin injection for hemifacial spasm has never previously been done in a double-blind study in spite of its use as a treatment. We thus conducted a double-blind cross-over study of botulinum A toxin use in hemifacial spasm in 55 patients at Siriraj Hospital, Mahidol University, Bangkok, Thailand. Thirteen patients decided to withdraw from the study due to a lack of efficacy, all of them were subsequently found to be in the saline injection group. The remaining 42 patients, in the botulinum A toxin injection (30 mouse units) group, reported the responses as: excellent (34 patients; 80.95%), moderate patients; 2.38%). In contrast, when given the saline injection they reported no excellent outcome, 1 patient (2.38%) with moderate improvement, 5 patients (11.90%) with mild improvement and, 36 patients (85.71%) with no response. Side effects of botulinum toxin injections were found in 14.29% of patients compared with 9.5% of the saline injection group. The side effects of botulinum toxin injection were mild transient facial weakness (7.14%), local pain (4.76%) and excessive lacrimation (2.38%). We concluded that botulinum A toxin injection was a simple and effective out-patient treatment for the management of hemifacial spasm.

11.
J Med Assoc Thai ; 78(7): 337-43, 1995 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-7658177

RESUMO

A cross-sectional designed study was done at Siriraj Hospital from 1990 to 1994 to determine the prevalence of dementia in Thai stroke survivors. Two hundred and twelve Thai stroke (both hemorrhage and infarction) survivors (132 males and 80 females) were enrolled in this study. The mean age of the study group was 62.78 (S.D. 11.12) years with the mean duration of stroke suffering of 2.09 (S.D. 2.74) years. All patients were screened for depression by using Thai Geriatric Depression Scale and patients with Alzheimer disease were excluded from the study. The Thai Mental State Examination (TMSE) is a standard test used in this study to identify stroke patients with dementia. Seventy stroke patients (33.02 per cent) scored below 23 points (cut-off point for dementia) and considered as dementia. Forty patients (18.88 per cent) scored below 20 points and were considered as having severe dementia, 30 patients (14.15 per cent) scored between 20-22 points (classified as mild to moderate dementia). Fifty-eight patients (27.36 per cent) were in the borderline group as they had TMSE scores between 23-25 points. Eighty four patients (39.62 per cent) of stroke survivors were determined as nondemented as their TMSE scores were over 25 points. The items of cognitive function tests in TMSE which were severely impaired in demented group were recall and calculation whereas registration and attention were relatively unaffected. Orientation and language were moderately impaired in the demented group.(ABSTRACT TRUNCATED AT 250 WORDS)


Assuntos
Transtornos Cerebrovasculares/complicações , Demência/etiologia , Estudos Transversais , Demência/diagnóstico , Feminino , Humanos , Masculino , Entrevista Psiquiátrica Padronizada , Pessoa de Meia-Idade , Prevalência , Índice de Gravidade de Doença , Tailândia
12.
J Med Assoc Thai ; 78(6): 281-8, 1995 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-7561552

RESUMO

A prospective open study of botulinum toxin A treatment for patients with various movement disorders at Siriraj Hospital, Mahidol University was analysed to evaluate its efficacy. The grand total of 900 patients comprised of a) 592 patients (65.78 per cent) with hemifacial spasm; b) 92 patients (10.22 per cent) with occupational cramp; c) 79 patients (8.78 per cent) with blepharospasm and Meige syndrome; d) 72 patients (8.00 per cent) with spasmodic torticollis; e) 19 patients (2.11 per cent) with hemidystonia and generalised dystonia; f) 11 patients (1.22 per cent) with spasmodic dysphonia; g) 10 patients (1.11 per cent) with spastic hemiparesis; and h) 25 patients (2.78 per cent) with miscellaneous group (i.e. tics, Gilles de la Tourette, facial myokimia, benign fasciculation, etc.). The results of treatment for hemifacial spasm were classified as excellent in 486 patients (82.09 per cent), moderate improvement in 60 patients (10.14 per cent), mild improvement in 39 patients (6.59 per cent) and no improvement or worse in 7 patients (1.18 per cent). There were complications of mild transient facial weakness in 50 patients (8.45 per cent) and mild ptosis in 12 patients (2.02 per cent). The effect of botulinum toxin treatment lasted 3-6 months. In occupational cramp and spasmodic torticollis the good response rate was around two-thirds of all patients, whereas, blephalospasm, spasmodic dysphonia, spastic hemiparesis and tics responsed in 79-88 per cent of the patients. Botulinum toxin A injection is thus a simple, safe, and effective out-patient treatment for patients with various kinds of movement disorders but it is a costly therapy.


Assuntos
Toxinas Botulínicas/administração & dosagem , Transtornos dos Movimentos/tratamento farmacológico , Seguimentos , Humanos , Injeções Intramusculares , Estudos Prospectivos , Tailândia
13.
J Med Assoc Thai ; 77(12): 627-32, 1994 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-7759972

RESUMO

Twenty patients with primary hemifacial spasm and ten patients with Parkinson's disease were studied by means of paired stimuli blink reflex. The second stimuli were delivered at a varying time interval between 50-900 ms. The R2 response's absolute refractory periods were compared between patients and twenty one age-matched normal controls as well as between hemifacial spasm and Parkinson's disease. In normal subjects, the mean absolute refractory period was found to be 271.42 +/- 64.36 ms, in hemifacial spasm 160.00 +/- 50.62 ms and in Parkinson's disease 157.14 +/- 53.45 ms. The absolute refractory periods obtained from patients were significantly shorter than in normal controls (p < 0.05). However the values between patients with hemifacial spasm and Parkinson's disease were not (p > 0.05). This result strongly supports bilateral facial motoneurons hyperexcitability as the underlying mechanism of hemifacial spasm.


Assuntos
Músculos Faciais/fisiopatologia , Neurônios Motores/fisiologia , Espasmo/fisiopatologia , Adulto , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Período Refratário Eletrofisiológico
14.
J Med Assoc Thai ; 77(9): 464-70, 1994 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-7706965

RESUMO

Botulinum A toxin injection is the most recent and effective treatment of various movement disorders especially focal dystonia. Spasmodic torticollis is one focal dystonia which responds poorly to both medication and surgery. Botulinum A toxin injection has been adopted as a treatment procedure at the Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand since 1989 (before the American Food and Drug Administration approval) as a research protocal for Thai patients. This report is the first ever study of this treatment for Thai patients with spasmodic torticollis. Fifty six spasmodic torticollis patients who had been treated with botulinum A toxin injection at the Movement Disorder Clinic, Siriraj Hospital were analysed. Thirty six patients were male and the male to female ratio was 1.8:1. Most of the patients (76.79 per cent) were aged between 20-49 years and half of them were from Bangkok. Twelve patients (21.43 per cent) were classified as simple torticollis, 35 patients (62.5 per cent) were combined torticollis, 7 patients (12.5 per cent) were retrocollis, and 2 patients (3.57 per cent) were lateral collis. Three patients had generalised dystonia and 2 patients had segmental dystonia. Duration of suffering in each patient ranged from 1 month to 25 years with the mean duration of 3.70 (S.D. 5.09) years. Only four patients (7.14 per cent) refused botulinum A toxin injection due to their mild symptoms. The remaining 52 patients were given botulinum A toxin injection of 30-120 international units into the most overactive group of muscles which were responsible for abnormal neck posture (mainly sternocleidomastoid and splenius capitis). Eight patients (15.38 per cent) were lost to follow-up.(ABSTRACT TRUNCATED AT 250 WORDS)


Assuntos
Toxinas Botulínicas/uso terapêutico , Torcicolo/tratamento farmacológico , Adolescente , Adulto , Idoso , Feminino , Seguimentos , Humanos , Injeções Intramusculares , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
15.
J Med Assoc Thai ; 77(1): 1-6, 1994 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-7798824

RESUMO

The comparative study of the efficacy of coumadin and aspirin in primary cardioembolic stroke prevention of chronic rheumatic heart disease (mitral stenosis) with atrial fibrillation was conducted at Siriraj Hospital, Mahidol University, Bangkok, Thailand. Seventy-nine patients were enrolled in the trial. Allocation of patients into coumadin or aspirin groups depended upon the patients' choice. Nineteen patients were given coumadin at the adjusted dosage to maintain the therapeutic range of International Normalised Ratio between 1.5-3. Sixty patients were given aspirin at the fixed dosage of 75 mg per day. Six patients were lost to follow-up over the 3 yr period; four in the aspirin group and 2 in the coumadin group. There were three patients with nonfatal cardioembolic stroke in the aspirin group but none in the coumadin group after three years of follow-up. Six patients had mitral valve replacement during the study (i.e. three patients in each group). There were complications in 12 patients, 10 in the aspirin (16.6 per cent) and 2 in the coumadin (10.5 per cent) group. The complications in coumadin group were minor bleeding over the thigh in one patient and generalised ecchymosis over the whole body in one other. In the aspirin group, the complication was gastrointestional symptoms, mainly epigastric pain, but no frank bleeding was observed. Primary prevention of cardioembolic stroke in chronic rheumatic heart disease was found to be more effective with coumadin than aspirin. Our study does not support the use of aspirin in primary prevention of cardiac embolism in chronic rheumatic heart disease.


Assuntos
Aspirina/uso terapêutico , Fibrilação Atrial/complicações , Transtornos Cerebrovasculares/prevenção & controle , Estenose da Valva Mitral/complicações , Cardiopatia Reumática/complicações , Tromboembolia/prevenção & controle , Varfarina/uso terapêutico , Adolescente , Adulto , Transtornos Cerebrovasculares/etiologia , Distribuição de Qui-Quadrado , Doença Crônica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cardiopatia Reumática/mortalidade , Taxa de Sobrevida , Tromboembolia/etiologia
16.
Hum Mol Genet ; 3(1): 177-80, 1994 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-8162021

RESUMO

The autosomal dominant cerebellar ataxias have proved particularly difficult to classify due to the lack of phenotypic concordance both within and between families. Genetic heterogeneity has been established, and disease loci for spinal cerebellar ataxia have been assigned to chromosomes 6 (SCA1), 12 (SCA2) and 14 (Machado Joseph disease (MJD)). Genetic analysis performed on a large Thai kindred with autosomal dominant cerebellar ataxia, in which frontal lobe signs and dementia are commonly observed in affected family members, exclude linkage to the SCA1, SCA2 and MJD loci. This demonstrates that mutation in at least one further locus can cause spinal cerebellar ataxia, indicating the need for caution in the use of markers for predictive testing or prenatal diagnosis these disorders.


Assuntos
Cromossomos Humanos Par 12 , Cromossomos Humanos Par 14 , Cromossomos Humanos Par 6 , Demência/genética , Degenerações Espinocerebelares/genética , Mapeamento Cromossômico , DNA/sangue , DNA/genética , DNA Satélite/genética , Demência/complicações , Feminino , Genes Dominantes , Ligação Genética , Marcadores Genéticos , Humanos , Escore Lod , Masculino , Linhagem , Degenerações Espinocerebelares/complicações
17.
J Med Assoc Thai ; 75(4): 199-203, 1992 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-1402442

RESUMO

Two hundred and fifty patients with hemifacial spasm from the Movement Disorder Clinic, at Siriraj Hospital have been treated with botulinum toxin injection since January 1989 as a collaborating research project with Smith-Kettlewell Eye Research Institute in San Francisco. Each patient received 30 units in four injection sites over the hyperkinetic facial muscles. There were 169 female and 81 male patients, the sex ratio of female to male was 2.1:1. The mean age of all patients was 50.2 +/- 12.6 years with the range of 22 to 78 years. The majority of patients had been suffering for 3-10 years. The results of botulinum toxin injection were classified as excellent in 81.2 per cent, moderate improvement 10.0 per cent, mild improvement 6.8 per cent and no improvement or worse in 2.0 per cent. There were complications of mild transient facial weakness in 44 patients (17.6%) mild ptosis in 7 patients (2.8%) and excessive lacrimation in 1 patient (0.4%). The effect of botulinum toxin treatment lasted for 3-6 months duration. Botulinum toxin injection is a simple and effective out-patient treatment for patients with hemifacial spasm with no systemic side effects and minor transient local complications.


Assuntos
Toxinas Botulínicas/uso terapêutico , Músculos Faciais , Espasmo/terapia , Adulto , Idoso , Toxinas Botulínicas/administração & dosagem , Feminino , Humanos , Injeções Intramusculares , Masculino , Pessoa de Meia-Idade
18.
BMJ ; 302(6792): 1565-7, 1991 Jun 29.
Artigo em Inglês | MEDLINE | ID: mdl-1855041

RESUMO

OBJECTIVES: To develop a simple, reliable, and safe diagnostic tool for acute stroke syndromes in a setting where computerised brain scanning was not readily available and to validate its accuracy with regard to pathological types of stroke. DESIGN: 13 clinical variables that potentially might differentiate supratentorial cerebral haemorrhage from infarction were recorded and tested by multivariate analysis in a prospective study of 174 patients with acute stroke. In developing the Siriraj stroke score stepwise discriminant analysis of the variables was followed by a linear discriminant equation to differentiate between supratentorial haemorrhage and infarction. The score obtained was validated against scores in 206 other patients with stroke, computerised brain scans being used for definitive diagnosis. SETTING: Siriraj Hospital Medical School, Mahidol University, Bangkok. SUBJECTS: Prospective study: 174 consecutive patients with acute supratentorial stroke syndrome (not subarachnoid haemorrhage) admitted to Siriraj Hospital during 1984-5; validation study: 206 patients admitted to Siriraj Hospital or another hospital for supratentorial intracerebral haemorrhage or infarction. RESULTS: The Siriraj stroke score was developed and calculated as (2.5 x level of consciousness) + (2 x vomiting) + (2 x headache) + (0.1 x diastolic blood pressure) - (3 x atheroma markers) - 12. A score above 1 indicates supratentorial intracerebral haemorrhage, while a score below -1 indicates infarction. The score between 1 and -1 represents an equivocal result needing a computerised brain scan or probability curve to verify the diagnosis. In the validation study of the Siriraj stroke score the diagnostic sensitivities of the score for cerebral haemorrhage and cerebral infarction were 89.3% and 93.2% respectively, with an overall predictive accuracy of 90.3%. CONCLUSION: The Siriraj stroke score is widely accepted and applied in hospitals throughout Thailand as a simple and reliable bedside method for diagnosing acute stroke.


Assuntos
Hemorragia Cerebral/diagnóstico , Infarto Cerebral/diagnóstico , Transtornos Cerebrovasculares/diagnóstico , Doença Aguda , Arteriosclerose/diagnóstico , Pressão Sanguínea/fisiologia , Estado de Consciência/fisiologia , Diagnóstico Diferencial , Análise Discriminante , Feminino , Cefaleia/diagnóstico , Humanos , Masculino , Métodos , Pessoa de Meia-Idade , Análise Multivariada , Estudos Prospectivos , Reprodutibilidade dos Testes , Vômito/diagnóstico
19.
J Med Assoc Thai ; 74(4): 181-6, 1991 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-1940701

RESUMO

This is the first large scale case series of motor neurone disease (MND) in Thailand. Seventy-seven patients were identified between 1978 and 1984 at Siriraj Hospital Medical School, Bangkok, Thailand. Fifty-five patients were male (71.43%) and the mean age of the patients was 51.55 (SD 14.26) years with the range of 17 to 78 years. Clinical classification of MND was categorized as progressive bulbar palsy (PBP), 26 patients (33.77%); amyotrophic lateral sclerosis (ALS), 42 patients (54.54%); and progressive spinal atrophy (PSA), 9 patients (11.69%). The mean age of PBP, ALS and PSA were in the order of 57.61 (SD 12.09), 52.81 (SD 11.18), and 28.11 (SD 9.44) years. Progressive spinal atrophy group was younger than PBP and ALS groups significantly at the P-value less than 0.05 by analysis of variance and Duncan tests. Fifty-three patients (72.60%) were resident in Bangkok and the central part of Thailand. The main presenting symptoms were wasting of the small muscles of both hands, leg weakness, and speech and/or swallowing difficulties. These symptoms were found in 62 patients (81.58%). Nearly half of the patients (48.68%) came to our care within six months of onset, 22.8 per cent presented with asymmetry of motor wasting, while limb and trunk fasciculation was seen in 73.61 per cent. Dysarthria, dysphagia and tongue fasciculation were recorded as 51.32, 48.68, 60.53 per cent respectively. Exaggerated deep tendon reflexes were noted as 65.79 and 80.26 per cent over the upper and lower limbs, while Babinski sign was elicited in only 23.3 per cent of the patients.(ABSTRACT TRUNCATED AT 250 WORDS)


Assuntos
Doença dos Neurônios Motores/fisiopatologia , Adolescente , Adulto , Fatores Etários , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doença dos Neurônios Motores/epidemiologia , Estudos Retrospectivos , Tailândia/epidemiologia
20.
J Med Assoc Thai ; 74(3): 172-5, 1991 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-1861136

RESUMO

The first report of the rare combination of myotonia congenita, Klinefelter syndrome and primary hypoparathyroidism was reported. The patient was a 21-year-old man who presented with stiffness of the muscles for 12 years and a history of generalised convulsion for 8 years. His school studies declined gradually and his secondary schooling was interrupted. Examination revealed a muscular young man with myotonic percussion over the muscles of the body as well as the myotonic lid lag. Chvostek's sign was positive and his serum calcium level was very low whereas the serum phosphate was high. Symmetrical and extensive calcification of the brain parenchyma was demonstrated in the CT scan. His secondary sexual characteristics were not well developed and his testes were very small. Chromosome study confirmed the diagnosis of Klinefelter syndrome by the identification of 47 XXY chromosome. He was prescribed calcium replacement and the anticonvulsant was withheld with no more episodes of seizure.


Assuntos
Hipoparatireoidismo/complicações , Síndrome de Klinefelter/complicações , Miotonia Congênita/complicações , Adulto , Diagnóstico Diferencial , Humanos , Hipoparatireoidismo/diagnóstico por imagem , Hipoparatireoidismo/tratamento farmacológico , Cariotipagem , Síndrome de Klinefelter/diagnóstico , Síndrome de Klinefelter/genética , Masculino , Miotonia Congênita/diagnóstico , Miotonia Congênita/patologia , Tomografia Computadorizada por Raios X
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