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The Journal of Prapokklao Hospital
Clinical Medical Education Center (JPMC)
Editor Consultent Woothi
Osathanond
Editor
Prapap
Yuthavisuthi
Associate Editor
Ghatchawan Sompeewong
Editoriel Board
Saluey
Phongpanich
Seree
Sooksangchaya
Prasong
Teerakidpisan
Somchai
Poonawagul
Pornsak
Nimvattanakul
Chanya
Sathitwiriyawong
Vithayut
Namsiripongpun
Chatchai
Sawasdichai
Cheocharn
Viriyaluppa
Jitti
Kositchaiwat
Predee
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Pipat
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Prapassorn Kosakhan
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Pacharin
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Cesarean Section Rate at Prapokklao
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324A6 1
AN
ATYPICAL APPROACH
TO SCHIZOPHRENIA
ncLozAR"lH
CLOZARIL
Antipsychoticagent
Presentation Glozapine
Tablets(scored):25 and 100 mg;
Indication Schizophreniairi patients who are nonresponsive
to or intolerantof classical neuroleptics.See full oroduct
information.
Dosage 12.5 mg. (1/2 tablet 25 mg.) once or twice on the first
day, 25 or 50 mg. on the second day, followed by stepwise
dosage increases up to 300 to 450 mg. (in some patients
600 mg) per day in divided doses. Maximumdaily dose: 900
mg. For maintenance treatment lower doses may sutfice.
See full productinformation.
Contraindications Hypersensitivityto the drug; history of
drug-induced granulocytopenia/agranulocytosis;
impaired
bone marrow function; alcoholic and other toxic psychoses,
drug intoxication, comatose conditions; circulatory collapse;
CNS depression;severehepatic,renal,or cardiacdisease.
Precautions Clozaril can cause agranulocytosis.lts use
should be limitedto treatment-resistant
schizophrenicpatients
who have normal leucocytefindings,and in whom the mandatory white blood cell counts (weekly during the first 18
weeds, at least monthly thereafter)can be performed.Concomitant use of drugs with a substantialpotentialto depress
bone marrow function and of long-actingdepot antipsychopleasecontact
ForFurtherinformation,
Novartis(Thailand)
Ltd.
159/30Vibhavadi
Rangsit
Rd.Donmuang,
Bangkok
10120
ror tnemeorcal
orolesstons
onlv
ldrrn',rncrrrnr',urn
LASAD 1:0596
tics should be avoided.For instructionson how to proceed in
the event of inlection and/or granulocytopenia,see full
product information.
Caution when patienls drive a vehicle or operate machinery;
with patients with a history of seizures; in the presence of
cardiovascular,renal or hepatic disorders,prostatic enrargement, narrow-angleglaucoma; in children and in elderlv
patients;duringpregnancyand lactation.
Interactions Alcohol, MAO inhibitors, CNS depressants,
narcotics,sedativeantihypertensive
agents, adrenaline,drugs
with respiratory depressant effects, warfarin, lithium or other
CNS-activeagents.See full productinformation.
Side effects Granulocytopenia,
agranulocytosis;eosinophilia,
unexplainedleucocytosis;drowsiness,fatigue, dizziness,
headache,EEG changes,seizures,rigidity,tremor, akathisia,
very rarely neuroleptic malignant syndrome; dry mouth or
hypersalivation,blurred vision, disturbancesin sweating and
temperature regulation; tachycardia, postural hypotension,
hypertension,in rare cases circulatorycollapse accompanied
by respiratorydepressionor arrest, ECG changes, isolated
cases of cardiac arrhythmias, pericarditis, or myocarditis;
nausea, vomiting, constipation, w€ight gain, hepatic dysfunction, rarely cholestiasis;
urinary incontinenceor retention,in a
few cases priapism;benign hyperthermia,skin reaclions:
isolatedreportsof unexplainedsuddendeath.
Packs 50 tablets
tlt NovARrrs
O frnpro-,2es absorpttion
ond.
corrseqluently high bi oa.va'i la.bi liry
O Convenient for ozlce a' dny d.osa.gre
[email protected]
Cerebral metabolism activator
Presentation
Co-dergocrine mesylate
Tablcts : 1.0 mg
FAS tablet : 4.5 mg
Ampoule (l ml) : 0.3 mg/ml
Pack size I mg : T250, T500
FAS: T30
Ampoulc:5A
Indications
Symptoms and signsofmental deterioration, notably thosc rclatcd
to ageing (see full product infbrmation)
Acutc ccrebrovascularconditions
Pcripheral vasculardisorders
Subjecrivc symptoms associatedwith arterial hypertcnsion
For Further information,please contact
Novartis (Thailand)Ltd.
159/30VibhavadiR-angsit
Rd. Donmuang,Bangkok10120
FOrtne medtcalprolessionsonly.
ltrart:antunrrrra
L A SA D 1 : 0 5 9 6
Dosage and administration
Orally : 3 to 6 mg per day, in dividcd doses beforc meals.
For once-a-daydosage, IFAS tablet.
In mental detcrioration and in migraine, alleviation of symptoms is gradual and may take severalweeks; prolonged therapy
(3 months or more ) is indicated; treatment may be repeated.
Parenterally l Initial treatment ofacutc cerebrovascular conditions and severeperipheral vasculardisorders. Seefull product
information.
Contraindications
known hyperscnsitiviry
Precautions
Caution in severe bradycardia; check blood pressure after
parcntcral administration.
Side effects
Nasal stuffiness; initially nausea and gastric upsets (may be
avoided by taking the drug with fbod)
Ct NovARrts
Vol. tt Nct.s Iul. - Sept. toor
J Prapokkla<t H<tsp Clin Med Educat Center
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$n:fioril'rnrr16n::urunr: Hospital
udoun::6'uqiln1lillin1Tu?nr:
accreditation
ru1urn.(roner:ti'errhrur).
To.t1r.Jl
Vol, u No. s lul. - Sept.rcoz
I Pnpokklao Hosp Clin Med Educat Center
.t
9,
1t
t23
Ol
an 51n'13fl 1na anil't{il u.lil a.t[u
Imnglillailivrfnrn#r flil.d. 2s30-2s39
ongroi aurda il.u. *
Abstract:
cesarean section rate in prapokklao Hospital, 19a7-1996
Somboon Somlaw M.D. *
* Department
of Obstetricsand Gynecology,PrapokklaoHospital,Chanthabun,Thailand.
J PrapokklaoHosp Clin Md Educat Centenss7;14:t2s_tso-
Cesarean section rate in Prapokldao Hospital rose from 16.45 per rco detiveries
in 1987
to 22'ss [r 19s6. The most common indcation was cephalopeMc disproportion
(cro), nre
second common was previotrs oesarleian seclion, lollowed by breectr presentauon,
fetal
distress, lailed induction and otfrers respeclively.
o
lrltul
durflu zo.zrionr:Rnoo1oo:ru luflrr.e.2ss3"
d'sr:rnr:i,irnnoonrlnfirri'o,l
(cesareanI:urururnaiuniuni rouuriu fi6'o:rnrrdror'o
section
) lu:ix zoild d-rur ld'rfiug.rduo
rjr.d'nrcu rvirriu rs.szlufll{.f,.2s3or$irdlrflu rz.sr cio
sfi6:rotI:.rnurur nfii:rt fid'o:rnr :drri'orvirri'u n1:Rnaoroo r1u luiln.a. zssz.d.rrdo.irrfluHn
o.zluf,n.n zszstfiu{twflura.srionrrRnoo
roo rrnfrurn{rl?s!1nflao rflunrreion::riur:nfi
:ru lufln.q.2s37'T:orururnlxrnrn:ni fi6'o:r frndrug.rdufinr :ci{n::rilueoriqror qr.rndu finr
:
nr:rird'oryirfiu
rz.elufln.a.zszsrfirdurfluzo.r li*n*oo Fetarmonnonng
r-,ndl fir|:rird'onnoo
cionr:nnoo'roo:ru lufln.s. 2s36,I:onururn nr.rrruirria
iun ::rivi rriur..'nd* nr :rirri'finnr :
:rmGu6fid'cr:rnr:rirci'o
rz.z lufln.a. zszerfi! rirunnoon'l.tdarnnoorioun.r
nr:d'ofruhr,ir6'onnoo
* niu,nug6-uintu an x u auanuniz
lt,tnatutanrrtJntnit
t24
tln u fluun s n.fl. - n.u. 2540
44ud
;rr.tlrfluinl#lnaunnunaninifin lxnarunnrilnmdt
la
oX
rTl1U nlTH"reloflnAn$lll
-
X
4. Fetat distress riludo:j.:d[unr:virs.i16'o
n1|U rufl:R1'l:rflTU6n0
AaX -.
q
-4
v
(a
t
a
lua{1 1 nUn']TrSlUfi1 tofl 0'lYl'lTntilo:TR Houna e1n
un:fl.tnilYto1J1{-"
nrrril.r6lu stethoscoperrn:umiorndo.:Fetal
monitoringnionr:n:rowudrmrrdurfu (tnicx
inqrJ:ve.rrf
r
AerV9
.q
f
e
I
y
:
,.1
:
meconium)ul{tUU']nT1
1 . f l n : J ' 1 0 6 lT 1 n 1 : H 1 n f l O 6 r Y l ' l{ 1 4 1 { ' 1 101i
,
a
A
,
s. Failed induction tflufori.:ddrfiorrnnr:
(cesarean
section)lul:'lyt utu r nr'{T:rJntnfrt sl'tt[CI
oxytocin
tn$rtl{rnonlTnnoo[oun1:h4s1Tn:A'1U
fl .:urj::rurruv{.fl.zs3o-zsse
e
a
olv
l-C-
3
a
o
a
v
a
a
o
,XC
glo
tunlTYll 9.1'l
2. flnu1'rlun: t0uo1J0.l1J0u.lT
'lv
t
vtuorlj']un0o rfl0oo'1ttn:/vtTotl']:q {il1n:1 tl{T:U:
Latent phase lJo'lnlrnnoo usi'[ilfin?1ilr{..|.)Urir
Iouuil{nr:dnu1{ounoonuilu
z r:u: 60 r:u:fl
s
rfiunlTnnoo1u:: u: txnld rnil1: flu
nu:Jr:u1nr v{.fl. 2530-2s34ttasfl fl.f,. 2s3s-2s39 rto,Jn 1Tci1
la,da
6. fl1[uqdilj triu Placentaprevia,Abruptio
TflA TUilN.lTT].JTUU
IYIUU
placenta, Prolapsedcord, Elderly primigravida,
Ad
Herpes simplex genitalis, T w i n s , P r o l o n g e d
?fin1:flnt1
A
infertilityltn:ou9
11u{0ilnilr: i6 {rJr ufim nnoo
X':ru,r'rulei:ru
::u
dneiunus6-uitr"sn
Iouidriranaon'l{uli1fia{
ttl
9{An1:flnU'l
drusif,rurl::!1ru 2s3o-2s3eun:\oi'uri.:nejru
u
'&
firria{'luflr r.s. zsso
r . d'ot:rnr:ri1nnoovt"t.Jfi
n rflu
rior-i.r61unr:
drd'onadoao
t . C e p h a l o p e l v i cd i s p r o p o r t i o n( C p O )
rvirnl
;X<rtdr
16.4s ry{ulJutull
17.94 tllu}|.fl.2s34
,Jqa
16.82 910
n:r u un:
1M u6.:n1: fiofrorirut or d:u: r6nri'u{.:16.:
orrotiu tu:lv{.fl. 2s30-2s34 tYllnu
T'ru1il6.tn1'l: Anested tlfl:
n'lTfifloo 1oo Tru 6',o:lnr:drnflooYl,l{nfi'lfrsn1u
Protracted disorder
2. Previouscesareansection
flr,r.s.zsss tvirriu 2o.ss rfiudurflu 22.selu
2s3s-2s3ervirri'u
flrr.s.zsss rirroduluflr^r.rI.
3. Breechpresentation
21.6700n1:nfl00 100 T'lu
Activelabor 6ru
lu::u:
)-,uu9,a
nlt.Nl'f
1 AflJlnltHlAfrOnn'l,ttlU1n8,t Cl,tUAUW.fl. 2530-2539
ilourJr;urnr
mnfl1fflma0i
2530
Totatdetivery(rru)
Cesarean
section(:ru)
253'.t
2532
2533
2534
'lN
2535
2
4,104 4,388 4,824 5,236 5,53924,091 5,5'1
6?5
657
818
909
994 4,053
2s36
2537
2538
2539
l?N
5,280 5,075 5,264 4,928 26,059
1,133 1,132 1,152 1,116 1,113 5,646
0nl1n1tHmn
16.45 14.97 1 6 . 9 6 1 7 . 3 6 '17.94 16.E2 20.55 21.43 22.10 21.20 22.59 21.67
fi{.fftuRT[Yt1't0uunu
15.87 14.94 15.26 16.34 1 1 . 1 1 1 5 . 9 2 17.81 16.83 1 7 . 3 1
A^<t
-
il.f,iT1i
a
1l{.3ll1n{nlIU
I E.3
15.6
26.1
Vol. tt No. S Iul. - Sept issz
I Prapokklao Hosp Clin Med Educat Center
L25
qrroii 2 uflo,t#nd?uuflJ;arlnltti.tilootnilatitfci't,r,1
i,tucifl w.fl. 2s3o-2s3s
iourhrrnn
x0u.t!
2530
Totaldelivery
2531
2532
2533
253d-
t',llt
2535
4,140 4,388 4,824 5,236 5,539 24,091 5,512
Cesarean
section
6i5
657
818
909
994 4,053
CPD
215
261
303
368
384 1,531
2536
2537
2538
2539
5,280 5,075 5,264 4,928 26,0s9
1,133 1,132 1 , 1 5 2 1 , 1 1 6 1,113 5,646
411
346
350
35s
350 1,818
(sr.as)
(rs.rz)
(sr.or)(ao.ce)
(ro.o:)
(ar.zz)(so.eo)
(so.so)
(so.sa)
(sr.er)
(sr.as)
(sz.zo)
o'nnnrrdr6'o
5.24
s.95
6.28
i.03
6.93
6.35
Previous
C.section
138
173
208
225
249
993
7q?
2s9
ARq
266
6.89
6.74
215
355
7.10
6.97
341 1,502
(zo.m)(zo.ss)
(zs.+s)
(2r.ls)(zs.os)
(zr.so)(zz.so)
(erso)(zs.s7)
(sr.ar)(:r.re)(ze.oo)
o'nrrnr:rird'o
3.36
3.94
4.31
4.30
4.50
4.12
4.70
5.04
5.42
6.74
7.04
5.76
presentation
Breech
104
88
103
115
111
527
123
123
101
108
119
5t4
(rs.ar)
(ri.so)(rz.so)
(rz.o$(rr.n)(ra.oo)
(ro.eo)
(ro.gil (a.ril (s.04(ro.oo)
(ro.rz)
6'cr:rnteird'e
2.54
2.00
2.14
2.15
Fetal
distress
98
62
56
62
2.11 2.19
74
352
2.23
2.33
105
81
1.99 2.0s
19
77
2.42 2.20
68
410
(ra.sz)
(s.n) (o.as)(o.sz)(r.u) (e.ee)(s.n) (r.ro) (o.so)(o.so)(o.rr) (z.ze)
d'n:rnr:rird'n
2.39
Failedinduction
32
1.41 1 . 1 6
28
(+..lq) (+.zo)
0ntlnTHlRe
)
mrl4nBlrq
t,
1.18
1.33
1.46
?A
56
183
?I
1.91
1.53
48N
1.56
1.17
64
34
1.38 1.57
a2M
(s.is) (s.so)(s.os)
(r,sz) (c.zr)(z.so)(s.so)(s.os)(z.or)
(s.sr)
0.78
0.64
0.64
0.69
1.01
0.76
0.87
0.55
88
45
117
103
114
467
181
28-l
1.26 0.6s
0.59
283
200 1,138
187
0.78
(rr.os)(0.e7)
(rr.sa)
(ra.ro)
(rr.ae)
(rr.ss)(rs.si)(zs.ss)
(za.so)
(r0.ru)
(u.m)(zo.re)
0nflnTil1n0
214
1.03
2.43
1.97
2.06
1.94
3.28
5.43
qca
?(E
4.06
4,37
?ru1n
riln ilenyluN 6u uat u6t{o aituiaaa:
u
z. :run:rduoro,:frodruu
n:d'o:rnr:rird'a nr : eir 6'orflu6'ud'uso,l I oufi frodrul un r : rir 6'o
q
, X I
r r n{o:-i.l6oirlg lun r : rirnnooyrr or.rrir#0.:
rrJiuu
rfiuumlilr{.q. 2s3o-2s34
undn.s. zsss-zsss
l,{u'ir
ryirriuiaun: z4.so ufl: zo.oo[n:d'o:rnr:rir6'o
ryirfi'ua.rz rfirdurilu s.zosionr:nnao100:-ru
- Cephalopelvic disproportion (CeO)
- Breech presentationrflurTa:_i.r4'1unr:
j
e
I
.s,r-.-":--r.{.'l
t
ae
'
a
ruurlou.lT
tun'trrtsloil1n?iEoIoufrsosirulunr: ri16'orflud'ud'u
srru Tosfi frnctrulunr: rir 6'oryir riu
rird'oioun: ez.zz un:ioun: sz.zo *n:d'o.r-rn1:t iaua: rs.ooun: 10.17uo:fid'n:rn.t:dr6'orrirri'u
tu;N
rirsroryirrTu
o.ssrffilfiurfluo.szdonr:flnoo1oo:-lu 2.l9 ttn: z.zosionr:naoo1oo.t'tu
- Previouscesarean
- Fetatdistressrflurior-ildlunr:rir6'orflu
sectionrfluriori.rdlu
Ln
-
-
A
a-
r
I
I
e
fld u aiud s n.n.- n.a.2b4o
lxnrnunn:,;ilntnit
ntnt1uinnflnawnnunminifin
e
rrjiuuufiuularilrrt.a.zsso-2s34un:f, il.fl. 2s3s1.46 lln! 1.s7 Cro 2s3e r ru'ir nr rd.rn:rliri rfiuii f,ndrulunr: drd'o
7.26 UOO:t',]n1Tn1TH1nO[n1nu
nnonil''r.:xlilfiortvirriuioun: 64.s0 rfildurflu
nlTnfloo 1001']u
- Faited induction rfluriori.rdlunr:ri16'o foun: oz.zso.:nr:r{frs
ol{oufl lJflofl?utun'lT3-tlnnrn'rnu:oun: 8.68 ltn:
a e t e l
9eA
e
Aeffevav
lJflOfl?UtYllRU:0Un! 4.52 [[fl;
0.76ra: o.zggionr:Rsoo1oor1u
riT6'orvirri'u
y
.l
I
X
A;
|
.,---^e
v
a. dodrufrrfrtfr ulslnr:l.i.lnnooYl'lnfili1fo'l
yrndsri.rd Electivecesareansection d.rrflunr:
3.61 N00:1n1:
'u)t,av'X)Ara
ircrofr'triliioUnifitxul:flumlnqnnr:$ 1{lJ11u
i i.s3 un: 20.16un:fi6n:rnr:rir6'orvi'rri'u1.94 f,odlrnr:drd'omnisun: o.rz tuf,il.a. 2s32tfil.l
;X6rea
a.reluil
Sf,od?urvirri'uioua:
tilUillltljl{
4.37 O0nl:fiflO0 100 T1U O.!T']UA:LOUO rrduu4ou q
)
A
e
I
9
A
a|
I
- fllrvtnouq
ilflofl?lltun1:lllclo[Yl1nuT0u8:
1^1.fl.2539 n.tgl1T1.:Yl4
6l"llJgl''l:1.tYl 2
q
aa
!
c)
t
e
3. flOffllllJO.t?!,RnOOtun 1tO.tR:TRlOUlYl']nU
n.nr,lii g iathuaoJnltn-tnf,aonl,tnf,lfraluaznl.infloontnia,tnaaoluntti,tanrtitf,u
isuJr;mn
!
tt
y
nltnncrrnlnnt|
(ns)
2530
25s1
2533
2ss2
lll
2534
253s
2538
2537
2536
25:19
Totalbreech
151
125
176
190
175
817
187
189
147
164
166
853
section
Cesarean
104
88
103
115
117
527
123
123
101
108
119
571
(ir.oi)(sz.zs)
(os.tr)(os.ss)
(oo.eo)
(oo.ss)
(er.so)(os.n)(os.oe)
(oe.rc)
(zo.&)(sa.sz)
Vaginal
delivery
47
37
46
65
253
58
64
66
46
56
17
279
(ez.zt)
(sa.rs)(ze.ss)
(g+.sz)
(3r.2e)
(sq.ez)
(ss.u)
(es.so)
(ss.17)
(sr.zo)(zs.6o)
(nr.ce)
ilr1srilc1 it 'r,:llrnduuatadtiadzufaaaz
-,
)
n-n-lofr 4 iad?uto,rnril
Etective cesarean section
iwJ:nnn
nTSnni
(nu)
Cesareansection
Electivecase
2537
2531
675
657
o
0
(o)
818
1349
909
994
1,133
1,132
46
(o) (o.rz) (o.ss) (o.ao) (o.zs) (a.oo)
ilr"nnile! itntiuuduuutadtiadzuioua:
1,15.2
79
1,116
83
1,113
91
(o.ee) (z.aa) (e.te)
Vol. ta No. s Jul. - Sept. tooz
I Prapokkla<> H<>spCIin Med Educat Center
t27
25
20
15 . 0 9
15
14 . 7 5
10
2534
2535
dq:rnr: drnnanrnrrufirfrao
dn:rorerm:ntj3rirtfio
-_t-
-€-
n1Yt111 n21u {uyfuft y u itt {a t 1n lr th naa nn}Jriti1fia,J;udatl enunt snil? it 6a
5. onrr n1: 9.r
1odoo?1''r.1fi
rirfi'o.lrrJ3uurfi ur 20.s5 $n: zz.sg luiln.fl. 2s3e cirrodu"lu1ir.]fl
riudo:r or uyrr :nrjirir rfio ::ra'ir.lflr r.s. 25s0-2s3e v{.fl.zs3s-zsssryirfiu zr.or sionr:oooor1oor-ru
4
,'q
l\U ? 1 tUlJy{.fl . 2s30 0 0 T1n 1:t,t-10n00?1"t.tvtu"t?l
0.1
rn'lnu 16.4s nan'15nflEo 100 :.tu 00T'tst1ul'l'tTn
A,i
6rsrnirsfi6?o.tlx1^{u'ruraf,3:rr
luflx.s. zssz
fid'$:rnr:hird'orrir
fri rs.s' Lrc:sfi6roil:,lnurur n
siunSunirouuriufl zsss, 2s36, zsszryirfi'u
rjirirrfiorvirfruro.sr sio r.ooonr:rfiorf,:uruo
lu
fln.s. zsssfi6'or:rnr:rircrnoonr,lufirfr'o.r
ryirriuzz.ss 17.81,16.33ufl: 17.3.tnrusirriu' uoior"rn-irsf6rro.l
siont:nnoo10o :'tu d'o:rflr uy1
r:n:Jirir rfforyirri'u I:.rnururnrwra.:n:r[luiln.s.zs:o fid'Er:rnr:
s.oasior,ooonr:rfforiorur oi,:nrrrdr
rir6'olyirriu
zo.reionr:onoo
100r.ru'
Cephalopetvicdisproportion(CpO) r[lu
Ad
?o1:6u
dori.:dlun r : rir 6'ogrrfluo'u6'r.r
ud.: I oufif,osiru
d'o:rnr :il ronoorrluriryTor tuI:,rnururn
nr:rirfioluflil-fl. 2sso-2s34ua:fln.s. 2s3s-2b3s
n::rjnrnfr'r ::u'ir,rfln.s. 2s3o-2s34rilg.:du
rvi'rfi'uioua:
s7.77ufl: sz.zoorrueird'u
d,runnor,J
U
fin:riou lqulufl il.fl. 2530fi6'o:rnr:r"irsr'oryirfiulrnnfiGrorl:lnururnf,S:rt tufln.s. 2s23-2s31
q
dr
'
Aq
16.4s tuUl^t.fl.2534
6'1unr : rir d'oril u6'ud'rso.r fi fforfrulun r :
[n1nu fi.49 €llr0nUtUT?.!d.rrTori.r
16.82Eionr:onoo 1oo air6'qryirfiuioufl : 28' d'o:r nr :d 16'orfi ruduo
rn o.ss
:'ru sfi6lo,rI:.rr^rururafi5:rt' urn:l:lflururn
riiu o.sz eionr:nnao100 T.ru dlriluzunlrorn
flrry.n.zsso-zss+ rvirrir
siuoiunf touuriu' ryirril 1s.6un: is.e2 oan.t:
nooo 1oorru 0ril6iroiu
Y
e
,yle
X
|
tar
qr,t
rrorilrrr.
s. zsss d'0:r n,t)-r.i
u
16'o'[
oig.:{rufl
ifruru{n noorilun:rriu :n fifrodrurfirudu finr :d.r
o:rflussrisorluu.ndr* nr:tf Active managementtutsu:onoon'trlf Friedman
curve lunr:
fld u flilun 3 n.fl. - n.0. 2540
2nffitguinltflnwrmnafrianin1frn lxwaunnrtlnnit
tB
qdJ.vl
0 n n 1TT?u
otl $ fl t uT: u: fi fl 0n n 1tu on rn u,tn 1Tyl')14
2' 6'o:tnt:
r{u1u1ae?:1tfifrodrurvirfi'uioun:
't'ru
rir6'orvirri'u0.76ufl: 0.78don'l:nnoo 100
rilu6'u''.'
nnsnodlnulnrriu n1Tyi1Midforceps
Previous
sectiontijudorildlunr:
cesarean
sor fif,nrhulun r : rir 6'o1uflv{.fl. 2s3orir 6'orflud'u6'u
tyirri'uioun:11.s3tuiln.fl. 2ssstufl n.q. 2s30-25s4
ryirfi'uioufl:24.s0un:
zssaun:fln.fl. 2s35-2s3s
2s39 11{tJliUrilU5oUA:20.16 flnfl t:{v{u1u1nflTT1T
^^
)
a^
f
v
'X
26.6001iln']ou fi .lflnnl'o.l tT{l^lu1u 1nfl TTla 10u'la
v
v
a)
,
r
Xot
a
v
ilfl ofl 1u:0 un :
iuJflo ff ':1{tun't :il 1 grotuu0uouvtl{'l
,
;X
€,
29' 001't1n1Tfl'toolwlJlJulln 4.12 tuu 5.76 0a
I
fl 'rruqoui
*,
u
, X)a-
'
' 1,
t:.Jl{llau.35mufloff?l{tunlrtt.)oo
;X6v--f
finr:
rvirri'uioun:s' rdof;nurlurrua:t6uor^{u'ir
dr Electivecesareansectiong'ldumnf,odru
vq4
roun: 0.12 [uun.Fr. 2532 lfiildurflUiasn: e.re
A
lufl r,r.s. zsss d.:riluslranlfid'o:r nr : lir6'enr ndo
1oot1u
1.e4rflu alszsionlrnnao
:j.rddrsiud*.rn
uill]il8nNU1n1U
firunsionr:nodn:r
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I Prap<tkkla<>Hr>sp CIin Med Educat Center
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ronar:dt16.r
accreta"
t. RuangvutiledP, Titapant V, SuvonnakoteT.
2.-n1:nnooytrlrio,lnnaolunr:eiln::ridrrYu Trends in
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rn rf arttn ?tlrj naonu
qioyll:nutnn'jr ornnr:dnu-nlo,JWisestanakom
f-.......1
caesarean sectionratein Siriraj
Hospital(roeo-rooa).
ThaiJ ObstetGynaecor
1996:8:211-8.
r. Eti'"tinafirlniuri'. nr:rirri'aldrnaoo.
lu: rfi
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ru tTnl T9,t1gtonaa0n.t,Jl{[1rion
Jiamsochon K.
ChaturachindaK. Operative Obstetrics at
RamathibodiHospital, 1970-199o. J Med
AssocThai 1e93;76(Suppt
r):ao-s.
qyrrx.Jdi::ioluornn. g6arrerf-uirrrinur
Rnl:uy{ylufrlsorf
uarinurd'tlouurix louttriu
: I:lrfur{unriyru.rd'uraurrriu2s38: 34s-81.
dril
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fi1tYo.J (Cesarean
section) 1uI:,lr^rtrurafl ::iln tn frr "luflr,r.s. zsso2s39S,JtuQln16.4srflu zz.sscionr:nnoo100:.tu
Cephalopetvicdisproportion (Cpo) riludori.rd
'l
3. O-Prasertsawat p.
.)
tUnl:yl'U{10olJ1nnryOPrevious cesarean Section,
t
Breech presentation,Fetal distress. Failed
-, w
4
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rUilt0ti.lfrl1$tULiou
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Baker ER, D'alton ME. Cesareansection
birth and cesarean hysterectomy. Clin Obstet
Gynecol 1994;37:806-1
5.
o. fimj::lr
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tt.r:
Efin rdrsia6, gnioni t6r.:d, oir:.r
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ri'rurirncirulrug6-uirrrn::u
un:?1,tuflun:ou rr:m:gurinr:6n:*runnuqrsoiofifin I:,r_
oir I:,lnururnyr::ilnrnfir doururnlfi'rrusJuili 1'{U1U'tny{t:iln[n#.]
2s40;
14:4-14.
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9.
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K, FoleyM. Conelation
O'Driscoll
of decrease
Chazotte C, Cohen WR. Catastrophic com-
on perinatalmortalityand increasein cesarean
plications of previous cesarean section. Am J
sectionrates.ObstetGynecol1983;61:1-s.
Obstet Gynecol 1990;163:738-42.
MillerDA, DiazFG, PaulRH.Vaginalbirthafter
WisestanakornW, HerabutyaY, O-Prasertsawat
cesarean : a 1o-year experience. Obstet
P, ThanantasethC. Fetal outcome in term frank
Gynecol1994;84:2ss-8.
breech primipara delivered vaginally and by
elective cesarean section. J Med Assoc Thai
AsakuraH, MyersSA. Morethan one previous
1990;73(supp
t )l: a z - s t .
cesareandelivery:as-year experiencewith 435
patients.ObstetGynecol199s;8s:924-9.
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ta!
Enaril 5, 20 mg Tab.
Glurenor 30 mg tab.
55 arnm1uaanrdfiu 7 azuirr 39 naasm]unrfla
(ta
nfiastniJ
f]?\:tnl,J'1 10110
Vol. u No. s Jul. - Sept. tooz
131
I Prapokkla<t Hosp CIin Med Educat Center
a
Crt
v
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.rt
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*
qlt Su2qa n.il. * *
m[n1 reiryo:ru rl.ns., dd.r.
Abstract : Tuberculous Infection Among Health Care Workers of Prapokklao Hospital, 1996.
Norawee Chuachamsai M.D. *
Urai Poonawagul M.D. **
Ngamta Charoentum Dip.N.S.,B.PH.**
* Departmentof IntemalMedicine,** Department
of Social Medicine,
Thailand.
PrapokklaoHospital,Chanthaburi,
J PrapokklaoHosp Clin Med Educat Center 1997;14:131-141.
A cross-sectional st.rdy was conducted during October 1995 and Febnrary tes6 in order
to determine the prevalence and risk factors of tuberculous infection among health care workers
of Prapokklao Hospital. eoo out ot 1,426 (ss. t t percent) personnets were eligiHe for ttre stgdy,
wift 24s males and 65s females.The mean age was sa.z(rs-e r)years. Possibb risk factors and
relevant informations were collected.by using a self- administrated questonaires. All of tfre 9oo
personnels were tested with PPD-TRC (Thai Red Cross Sodety) 10 lU. by Mantoux technique
and had chest roentgenogram done. 71.4 percen(ece/soo) had positive tuberculin test (an in
duration of rc mm. or more within nc,-72 hours). 39.3 percent(asa/soo) had ls mm. or more
indurations. Working deparEnent older age and sex were associated with higher rate of positive
tuberculin test while history of trberculosis, household tuberculosis case contact BCG scar and
longer period of working history were not The health care workers of the departnent of lntemal
Medicine carried the greatest risk of having positive tuberculin test with g6.a percent positive
rate or z.s Umes tfte other departrnents. Men had greater risk tftan women. There were z
pulmonary tuberculosis cases. Al of them had abnormal ctrest films, positive tuberculin tests (6 had
> 1s mm. and t had 12 mm. induration), clinical manifestations compatible with active disease
and one of them actually had positive acil-fast stained sputum smear. All improved clinically after
treatnent with short course antituberculosis regimens. Subiects with induration of ls mm. or
more significanty had a chance of having abnormal chest roentgenogram than those wath smaller
indurations.
The prevalence of tuberculous infecton among heatth care workers of Prapokklao Hospital
is high, probably associated with the increasing numbers of AIDS and tuberculosis cases in the
hospital. Therefore, health care workers should be alerted and appropriate trberculosis infection
control programe promptly implemented.
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*,1 r rucir#Lnj::f,rn6'mafrirr{uf
"
(conelationcoefficient)uyirri'u.sss Haoirl::n'jr.r
ealoc
cir rodrrvir riu .r ooun: runoir.:::ra-ir,rrir drr*rduo,ru
mo:oruryirfiu .zor
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rurofildu i2x 1s uio ra, .rrd, nru1ur f,rjo.rf
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induration
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un:irul:o r ou
rvirri'uio ru. nrxilfin:xonrjn6un:hifiornr:
a.'[6'iunr:o:roir.Jnrulorunnri
rrdori'ofruT:n o:ldiunr:6onrilriruntrirdn:r.ron
ua:
n:a,rqnn1n:d firJ:: i6 r6urh ud'ruriolorYa
er:rretnrnil::irfl
nd.rsiaLJd
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- eiourrryfiu
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no
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vJu v'
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t
u T0ilfi nn6 1ilu,tT2 -10-10[ilul nr I Tn
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Chi- square test
'[un
efanlrf;nul
r:ra ro:rrLilri'uf,
X-s
::ui r,lnr :fro16o
iruL:crri'l
6'ruil:r6.lqnrnrn 6o
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eoo nu 6orfluiouo:
n{ru.r'rudrtfrri6,rTu
r}lfl urunrfluete rJ::i6 63.i (ooott,aza) rlo,lundrn:dilfrriG.rruoirlu
nr : r5r rJr sor nirul :n uo:rJ:: i6 nr : frurie{rJr u I:{ilururofl::ilnrnfir rY.rrur i'n:r6irunrqzru
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r: 3.7solurqdu34.7fl (1e-61fl)
dv
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(characteristics)
"
riru'tu
(eu)
deurj:
finrf,u
(iauar)
t2il
900
rTtfl
t'ru
24s
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6ss
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900
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t
91
1 0 . 11
J
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809
89.89
uHnrflugce
900
608
67.56
292
32.44
16
1.78
884
98.22
IJ
56
6.22
tUU
844
93.78
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rd
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IJ
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rpuo5qfiur^rud'n:rnr:6orr#oiul:nluqnnrnmo.ilr.lttu'lu1nvl::rln
r.,rnl1nn1rytorourJfrfi3uT
nr:vrosoulfi6"lo.r.od,
soo)ir uun:run:t6uo'tto.l
un: zr.e (oaoz
rvirri'uio
nr:rofi z uot/fifiilutq,luaiqfiu
ilfrfriar4ruaiqh*(ut.)
iirneu
tounr
<10
254
28.2
292
32.5
354
39.3
.^.uJt
10 - 14.9
>15
t?u
VoI. u No. 3 "IuI. - Sept. rcor
ehuuiur: irrnrr rfluoiuiaua: oo.z(zzouar+)
rdodlrund'cr
:r nr :6ordan.roo'''tdil5ti6
t
vA
r^-^
ae
r
f
135
I hapokklao Hosp CIin Med Educat Center
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lutun nu.J1uo'tqTnTtuuooT'l
?.
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a
v),a*
-
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86.8
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77.8
203/282
72.O
276/ 4',t4
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er
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I
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u flJu??ilnflny1
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ullUnfrnU'l
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rrra
Crude OR
P-Value
1.6
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X
ruoorT0
(r.rr-z.ar)
J,^*
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2.81
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79
12
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2.79
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2
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(o.oor z.s)
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40
16
606
238
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.13
136
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rJr{ur6.rqnrn
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regression
drjr:ifi nr:riurhurfl liorl:n1lo6o rJ::i6f,lfir
{rhuirulrnluRrouRi'run;uHnrflu Bcc lilfi
nll f,ir{uf, un:rdon"rur
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IonTe6nrdor.nndrrrr'*{or.o rrir
druiunrrufrrr{uf,::u'ir,lfoXn
rilrJ?rrru
r
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Exptul P-value
ulllutf,uil
n{Urru
.1043
3.3048
rltfl
.0696
1.6423 .0073*
.0634
1.0418 .0'120*
o1f{
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Tiu:[1n1nunun.t1u
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1.0000 .9994
I
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Indurationrorudrri.rz fhiufiomlfir{uf,ri'unrt
ilsnlrdlunlxilfinnlon"o.tuas'rn#.t
I
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,
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z
nu nufidinrnirdn:r.ronfiorjn6s.rfrsiilI:n
U
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rlfirii.nu r$rfi 0'rr{ rn:r:u;r?ordrJ5rj6,l',ulr nnflsu?r
ruofnfiu Ioui:our.tu(induration
) lrnn'ir
irn:r:rdurnnuf,ir{1f, lou1f, Muniptetogistic 15 lJU. 6 nU Un:8n 1 nUUtOUSUrnlnU 12 UU.
lyoq-Jaeec!a)
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Y
X ltv|
r
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r,t u.drJ5rifu
rubjiin'nufrur{uf,riu
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nrnioilnreron
tos{n
(rr.)
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rf,rlf,riuirrTra
rJnfi
348
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545
t?ll
893
odds ratio
(ssz cl)
9.40
(t.tz-zoz.e)'
P-value
VoI. 14 No. s IuI. - Sept. toot
J Praplcklao Hosp CIin Med Educat Center
L37
A4
?o1:ol
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ruu.ryirriuiaun:71.8 riu-irq.:n.i-ul::trn:lnu nlrnoflou nr:uil:Hn un:r66d1f1unr:iunrr:f
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X
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technique,donr booster phenomenon"'"nt:'t:
6oudO Hlvr-,3',8'20'2r.23
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inr:6or#o xv druift{rrnruuan6onr:rlfrj6.lru
rrn:rfilduioun: 4.0 rrnnr:6inuriu::u:oior.rr drdu.nio.rri'u{rJruinrl:n
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r{rufur]r{ldfin'rrrufruriufri'unr:6orda (concentration
of infectious
droptetnuctei)un:
irul:n rrnnr:f,n:r'''dfitfo*udoaoRfio.run:
,rurr.urdf,rrlnlounr:gafiru1.(durationof
uon0ir'1fi'unr:dnurluddui
nr:6inurdl:iv{u1u1o exposure)d'nrnr::ra,r{rJ-ruiilI:ndilun.rournl
n::rlnrnfrr nu'irrnr#rJfrri6.:ru a1q rflfl fi rdog.r6o
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n..,rh
uHnrflu BcG rn:r:u:r?nrdrt5ri6rrulul:.rz. iiarnr:loniomu
nururaLifinmuf,uri'uf,
drudl:.rilururnun:fi.:6
s.L,iiloilrnrn:rqnrnclolu
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o. nrr.*r,#rirul:a1uurun:
::u:,.nrd:Jfr:i6,rrurvi.''ritdfior-.,rf,lr{uf,ri'u
s. ri.:Ljlfiiunr:inurirul:nuiorfilrilinsr
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n116oudoirulrn
r.riainurufr.ilrjldrun6
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z. qnn::{,ul*lu ,riu rdorfiurslra:nr:da.r
rflu BcG riunr:6ordorriurdurri'un-r:dnr*rd
nfrrlnrr.o.uluunoonr nr:lttvio:iru
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run
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,;;dr?nr:uunorn
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:rorilqurrdoniuuou
rn:nr:Jalrinun;n?uq!d
rum:srudo1il
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s. GoldmanKP. Tuberculosis
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lrotduortl{y
r. nr:finr;6inurrfil r6lrdurfiunr:uinrr
ionr:oror:m1ud::uur:uluornranrruun{rhu
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dorstrnr:6o,#ri*Iro rdorfluuurn..,Jflndut,
z. nr:iinr:600rJyrof,ouyrruoiniunnf,
1u
Tubercle 1988;69:237-40.
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Nosocomial transmission of tuberculosis
qnnro#iHnnossurfl
unurdmun.,gai,r#*.ulnrj
rdolfiurrlo.r
riul:nnisinur I orrroxr:odr.rii.ilu g.
'Jrt)
associated with a draining abscess. J Infect
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Kantor HS, PobleteR, pusateriSL Nosocomiat
transmissionof tuberculosisfrom unsuspected
n{r,lrufril tonr erfru.rgo un:fir r :rur6nnrtytosou
nqil{1urr4fl
1uu0unI 1nnrl.truOufrnnrru rdu{riau
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n'jr rriu 4n o r6aurflufiu
9. LundgrenR, Nonman E, Asberg l. Tuberculous
s. nrriinr:yroeaurpuaiq6u
infection transmitted at autopsy. Tubercle
luqnnrn#
rdrrJfr
rjh.rrulnrjn
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iinrrrir two-step techniquerdolfr1d:iaXnd 10. TempletonGL, llling LA, young L, et al. The
uduoulunr :6'ofru'ir il oi Hnu?n rdolf,lunr :d'nfru
risk for transmissionof M. tuberculosisat the
recentconverterlufldotj uonrrndr:ldlfrflu
bedsideand during autopsy.Ann Intem Med
foXnrlr:nou'jrntryrhtwo-steptechnique
4nni.r
uioLi
ronrt:drtd^r
1.
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BrennenC, Muder RR, Muraca pW. Occult
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12. Dolley SW, Villarino ME, Lawrence M, et at.
Nosocomial transmission of tuberculosis in a
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14O rrffitquinlrflnwunnunaninifin lxnnunnrilnnit
1 3 . Edlin BR, Tokars Jl, Grieco MH, et al. An
2 1 . Pearson ML, Jereb JA, Frieden TR, et al.
outbreak of multidrug-resistanttuberculosis
transmission
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14.
Fischl MA, Uttamchandani
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al. An outbreakof tuberculosiscaused by
tuberculosisoutbreak in a renal transplant
multidrug-resistanttubercle bacilli among
p r o g r a m . T r a n s p l a n t a t i o nP r o c e e d i n g s
patients with H|V-infection.Ann lntern Med
1991;23:3091-2.
1992;117:177-83.
16.
23. Zaza S, BlumbergHM, Beck-Sague' C, et
M.
Frampton MW. An outbreakof tuberculosis
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17.
fld u atiuds n.n.- n.u. 2b4o
24. Hiroshi Nakaiina. Tuberculosis: a global
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25. Centers for Disease
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outcomes.JAMA 1996;276]t229-3s.
lor preventing the
Prevention:guidelines
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Tuberculosisoutbreak among health care
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Crit CareMed 199s;1s2:808-11.
GT, et
18. lkeda RM, BirkheadGS, DiFerdinando
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al. Nosocomialtuberculosis:an
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27. Centersfor Disease Controland Prevention:
in a renal
Nosocomialoutbreakof tuberculosis
screening for tuberculosisand tuberculous
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use of preventivetherapy for tuberculous
techniquefor restriction fragment length
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19. Jereb JA, Burwen DR, Dooley SW, et al.
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20. Jereb JA, Klevens RM, Privett TD, et al.
Tuberculosisin health care workers at a
-cA
28. rJlifl l'!fllflTurJ, nivrsl
naariucrqn. uulyl1\t
r1orfi'unr :6n rdsirul rnluq nnrn :n 1.tn''t:
M. tuberculosis.Arch Intem Med 1995:15s:
unn 6:lolI :{}l u 1u1fl u s : fln luuin 'tTYl1.!
n1rul,rvttiti'il il. ?'ltm rirBl tn Bn:I:nYl11{ on
845-59.
7:131-5.
2s39:1
hospitalwith an outbreakof multidrug-resistant
Vol. 14 No. s lul. - Sept. toor
iour
t4t
J PrapokHa<t H<tsp CIin Med Educat Center
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{.:raio r6uil nri. ?'rrfl 1rinrl :n ufl:I :nfl :1.ran
2538;16:25-34.
as. MaloneySA, pearsonML, Gordon MT. et al.
Efficacyof control measures in preventing
nosocomialtransmission
of multidrug_resistant
tuberculosis
to patientsandhealthcareworkers.
ButhpongsapanS, Pitaksiripan
S. prevalence
Ann IntemMed 1995;122:90-sof tuberculous infection among hospital ao. Stroud h, Tokars Jt, Grieco MH,
et at.
personnel,Lampang Hospital. Tenth
Evaluationof infection control measures in
workshopon NosocomialInfection Control.
preventing the nosocomialtransmission of
July 24-26, 1996, RayongResort,Rayong,
multidrug-resistant
M. tuberculosisin a New_
Organizedby the Nosocomial Infection
YorkCityHospital.tnfectControtHospEpidemiol
'|995;1
ControlGroup of Thailand(nbstract).
6: 141- 7.
sr. liieni ur:ialq'1.:d.Tubercutosis
in heatth at. WengerPN, OttenJ, BreedenA, et al. Control
care workers in Chonburi Hospital.n1:
of nosocomial transmission of multidrug_
ilr:rruimnr:rj::.frfl oiod rr. flrJ1nd:n6n
resistantM. tuberculosisamong health care
Xu
rT8u14.31Jr:rytfftnu.
y{.s.
iud z-a rTuuruu
wort(ers and HIV-infected patients.
Lancet
2s38.ru l:.lu:drnniu ntrnof n:rrnyrg.
32. :1un1uil::.frfl. I:.:nururnrr::rjnrnfr'r n.s.
2s39.
33. no.:nruoruirul:o.T'ru,J1ur:uloinur?o.l
inrl :olurj:: rnqlnud'n:rnr:6o rdsicul:n lu
rJ::trn:nnrau?oo1tJ
tlfl . 2s20.
19954;345:235_40.
42. Fidkin SK, Manangan L, Bolyard E, et al.
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infection control program at member hospitats,
1992. Infect Control Hosp Epidemiol j99s;16:
't3s-40.
sa. orn:ni quafl:a1o, l.]T-rrTil u1nnixry. 43. RileyRL, WeltsWF, Milts CC, et
at. Air hygrene
.
nr:6o 16oSnrT:nluq
oar n :I :.lrruru rnraqi.
in tuberculosis:quantitative studies of
m:sr:I:.lnsrurntout rsgz;zz(r
infectivity and control in a pilot ward.
):zg-sg.
3s. flu6'u u?:fio6. irul:n:Joo. nT,lry,tne:uifyl
American Review of Tuberculosis 19s7:75:
or:rifl1: rirri'6r,zsso.
420-3.t.
so. rJ::ruru Eurnr. irul:nlurdn. firur{nfid s. 44. Rutala WA, Jones SM, Worthington
JM, et at.
nl,lrnru:uifnd'lrf r:rfi'o,zsss.
32. Crofton
J, HomeN,MillerF.Clinical
Tuberculosis.
London:The Mac Millan press Ltd., .t992.
se. iri nriruuqn, trgr nrafiena, innn
rJru:riuvrrl,
liq
quurtgn, fiorAorsrruft.
nr;f; n:srriliru rfiuurJfr
fi?urnfi'lr rfiunrn
rpuoiqfiu3Tfio.1^lrfl1riilI:nunrlrnflr.t{on
2s37i15:223-32.
Efficacy of portable filtration units in reducing
aerolized particles in the size range of
M.
tubercolosis. lnfect Control Hosp Epidermiol
1995;1
6:391-8.
L42
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Abstract : Cardiovascukar drugs interaction prescribed from heart clinic, Prapokklao Hospital
Samnao Sindhurat B.Sc. in Pharm. *
* Departmentof Pharmacy,PrapokklaoHospital,Chanthaburi,Thailand.
J PrapokklaoHosp Clin Med Educat Center 1997;14:142-147.
Cardiovascular disease have become a maior health problem in Thailand. Recent
development in cardiovascular pharmacology has introduced several new drugs and helps the
patients to live longer and to spend more enjoyable life. According to knosm harmful disease'
cardiologists usually prescribe many drugs altogether, with different effects and sites of
actions s'hich increase the potential of drug interacfons.
Prescriptions from heart clinic, Prapokklao Hosptial from January 1" to June 3o'n, 1997
were reviewed and calculated for potential adverse effects. Adverse effects have been
classified into mild, moderate and severe. I found 12.18 percent of potentially severe adverse
reactions, mosty interactons of antiarrhtrthmics, anticoagulants and others with digoxin'
13.23 peroent of moderate and t./r4 percent of mild side effects. The result of this study
should alert cardiologists and pharmacists alike to be aware of potential deleterious side
effects between cardiac drugs.
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Rizack MA, Hillman CDM. The medicat letter
handbook of adverse drug interactions. New
YorkThe Medical Letter. 1989.
Tatro DS. Drug Interaction Facts. 4th eo.
Missouri:Facts and comparisons, 1994.
TIMS annual seventh edition. 199s.
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Abstract : Early GT Findings in Cerebral Infarction : A Case Report
Chalit Chitcheochun. M.D.x
* Departmentof Radiology,PrapokklaoHospital,Chanthaburi,Thailand.
J PrapokklaoHosp Clin Med Educat Center 1997;14:r48-1s2.
Early computed tomographic(CT) findings (scan obtained within 6 hours of the onset of
cerebral infarction) were retrospectvely analyzed in a case report of thrombotic cerebral infarction
of the midclle cerebral artery distribution. CT scan was analyzed for the fottowings:(a) a slight
decrease in tissue density, (O) an obscuration ot the lentiform nucleus, (c) hypodensity of the insular
ribbon, (a) toss of the cortical sulci or gyri anA (e) hyperdensity of the middle cerebral artery sign.
The pulpose of lhis case report is to familiarize tfie clinician and the radiologist with the subde
brain parenchymalchanges seen wathin6 hours after symptom onset in order to improve detection
of early ischemic infarction, and to improve patient care.
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Vol. 14 N<>.s Jul. - Sept. toor
J PrapokHao Hosp CIin Med Educat Center
3rJf4s lnsular ribbon utaltl
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echocardiography
ufr'rhinunrrufiorJn6 ueilou
n. Effacementof the cortical sulci or gyri firlrJufr'rrru'jrer naqdrfiol 1n embotusr rul6':Jou
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u,fr'rr
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J. Loss of differentiation between graywhite matter
MCA' nrofinn1:el:1i1*lfnmtnurrolei1[flJ 3_s
finfirun: st:,Juirril suprasellar
cisternsn:rirlri'rru
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thrombus HMcAS rinc: f,ilr{uf,riurdosruordfi u nor
2. Hyperdensity
of themiddlecerebral
adery n,:r5': r6aooan'[urdoflilono1u
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r
A
;
X Ya
frufiu rfiururndurT,rj
fi'lil'16'dosr:fir
usr rrJiuu
t52
2lftnrluinltdnarunnuf,1aninifin lxwrnutan*ilnndr
von KummerR, NoltePN, SchnittgerH, Thron
d:il
t
A, RingelsteinEB. Detectabilityof cerebral
hemisphereischemicinfarcts by CT within 6
r tnaf fiorudr6'qrurntunr:
rontr:tjnoufi
rtufr'rrdrh
ifio {u sr o.:rro r6oo::u : uir u:n si'.r
d'nunr:d
drd'q6'.rd\6'ncimm urfir o:virl fiific {ul6'
-
X
r 5lijil
v.
llulul:
1l
vtve
-
A
X
1996;38:31-3.
hoursof stroke. Neuroradiology
Rieth KG, Fujiwa K, Di Chiro G, et al. Serial
)
to TU n.lTf ntjlYl lvtil 1:fltJ t1{0fluo.]Yl
of CT attenuationand specific
measurements
r r orn'ooun: ur urfl u6'r:-i{ uonil u1n: r,[T: ndttr d'q
gravity in experimental cerebral edema.
uXa
n 1ruoflu0itllro t nootfl uu 3rr rarur n n'i r io un: ss
10.:Tourtslila.rMcA o:rirlfrufior6oooonturd,
luririrudl6'iunrrfn:grdru
sruorrro16oosr'rilil1t16'
1l
35:343-8.
Radiology1980;1
6' Torack RM, Alcala H, Gado M. Correlative
assay of computerizedcranial tomography
(CCf) water content and specific gravity in
Thrombolyticagent
normal pathological postmortem brain- J
toner:dr{6s
NeuropatholExp Neurol 1976;3s:38s.
1. von Kummer R, Bozzao L, Manelfe C. Early
CT diagnosis of hemispheric brain infarction.
vol t.
New York:Springer Verlag Berlin,
- 101.
Heidelberg,1996:1
2. Horowitz SH, Zito JL, DonnarummaR, Patel M,
Alvir J. Computed tomographic angiographic
findings within the first five hours of cerebral
infarction. Stroke 1991;22:'t24s-5s.
3. Tomura N, Uemura K, lnugami A, Fuiita H,
Higano S, Shishido F.
fld u atiufi.s n.n. - n.a. 2b4o
Early CT findings in
cerebral infarction:obscurationof the lentiform
nucleus. Radiology 1988;168:463-7.
7.
BozzaoL, AngeloniU, BastianelloS, Fantozzi
LM, PieralliniA, FieschiC. Earlyangiographic
and CT findingsin patientswith hemorrhagic
infarction in the distribution of the middle
2i1't15-21cerebralartery.A.JNR1991;1
of cerebralemboli8. Yock DH. CT demonstration
J ComputAssistTomogr1981;5:190-6.
9. RauchFlA,Bazanlll C, LarssonEM' JinkinsJR.
Hyperdensemiddle cerebralarteriesidentified
on CT as a false sign of vascularocclusionAJNR 1993;14:669-73.
0ex0ph
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EIE Fo. the |reatmenl of Acute o. Ch.onic non
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(n1utu
30-60?u'tyt)flnununrt[1]adrenaline
flrudrunr:d1 cpR 1o :ou l:hun'irriluHndrrSo
ril uori'x du rar nhil dHnlfr'nor
uio ndub^lv{rri'r1c
lurir.rd
r{uol'rurarit paddles(anterior-posterior)
Retumof
Supportbreathing
1 mg
Epinephrine
lV push+ repeat
Providemedicationsappropriatefor
bloodpressure,heartrate,and rhythm
every3-5 mrn
360J
o Defibrillate
within30-60sll
frori frriruna6oodr.:riou
o ou,doo,,nnrrr6uurulo
medications
O Administer
o{ probablebenefit(Classlla)
rn persistentor recumentVF/W
rir ecc rir oetibrittation
un:tfiurduuur:su n:rfl
hildnnotfimrruru'rduuanrmiramnadrenatine'
'[u
s. Bradyasystole'-a'nu16
r
a (ioun:
o Defibrillate
360J, so-60s aftereachdose of medicationll
tll
Patternshouldbe drug-shock,drug-shock
zs-ss)T0.rcardiacanest1ul:l$ru1u1n5
rfio'tdri.:
ventricularasystole uio
bradycardiafi#t
uri1l16' 6o
r) ratse asystole?.lnmufrqry1ol
mnrurfiourflu asystotesrrufiodulousn.rusi ndu!^h{rraqolounr:rilduug leads dt uio
rt6!
fl?uruqunruunnqcrnruciorrnvF n:tfld:iru
dAg'6
.
<
^
A
X
e
rirue{runriodefibrillatorpaddles trnr6n'lrJ oo' e)
.
510turu1{Hflfl1r:1 ruornoll{trn1 n"rTflu1nT{u Fine VF uiauurunutal vF xu'lufiu electrooes
d oqe l:nfn'hj6 unr5u r) trifascicutar
btock z) rrJFuu y{oo nltu$Rn1u asystole lfrno.rrir defibrillation
f
eU
ra
e
r
r,1ttn extremebradycardia s) rfilufieteialrn riou'riucrouoiolil
0oor un:ld z) hiiu fiunrarruq
I
e
n't::nu'l
v
^
,
oX
lg
fftduHorJnnii o-tlht transcutanouspacing al&l
defibrillation
e
d
iy
A
na.::u Lytn't:lulo,tjuunn11:y1011 riruur adrenaline$n:/uia atropine
V<tl.ta No. s Iul. - Sept. tooz
155
J PrapokHa<t Hosp CIin Med Educat Center
lnarun:nd 2 nlrufflrn ??r asystote
(organized electrical activities) uonrufialrn
vF/w udlilsrur:nodr6r,rc
:lfi r6u1fcir.i
r rrvo
a ContrnueCPR
(Electromechanical
dissociation) ueitrlfi.l
a Intubate at once
evro (ri'rl r rTlrfiu ureinsfr6nr :hi16), idioventncuIar
rhythms, ventricularescape rhythms, postdefi-
a Obtarn lV access
O Confirm asystole in more than one leact
Consider possible causes
a Hypoxia
O Hyperkalemra
O Hypokalemra
O Preexistrngacidosrs
a Drug overdose
a Hypothermia
pseudo-
brillationidioventricular
rhythmsun: bradyasytole
fl1ryrcrrto,Jnmru
fieriln6'rfierlrnn#rurdafr'.:tr
uiarrnnr:dob,ffhfiorJn6yirlfrrfiofi
grurfru'l:J
preloadufo afterloadnon.: uiofi inflow uio
outflowobstruction Hado'',lrl.ryirlri'fi hypoxra,
acidosisun: vagat tone rfiuduTouri'rtJrdo'jr
,
'x
mruqeirlg rndrfi ri.rnoriruiio{rhuld' n.rn
sr:'rlsrunfl: uri1rlueirfiuj ueinrnrffoornI:ori'rlo
Iouhjyr:rufl1n4q Ion.rs:aodifltri6.rioua:s
.J"
,
uw
,
fl''r[uqmfflnutoun
a.1 Severe respiratory insufficiency
uia respiratory arrest Hulsir-iorJ
(omnu16'6.rioua:
ss')
4.2Acutewt ra6oischemia
frrirlfirfio
rOEpinephrine t mg lV push,'"'
repeate every 3-5 mtn
"stunningmyocardium,,
4.3Mechanical:tension
pneumothorax,
auto-pEEp,cardiactamponade
a Atropine 1 mg lV,
4.4 Hypovolemia, hyperkalemia,
repeat every 3-5 mtn up to a
hypothermia,
hypoxia,pre_existing
total of o.o3-0.04mg/kg''-
acidosis,drowning
4.5 Drug overdoses: tricyclic anti_
depressants,p-btocfer, calcium
channelblockers,digitalisetc.
0fi,: nr:inurdruur atropineuionr:yir
electric shock 6'o,l::il'[r-Jn::6u::uurJ::fl'lr
parasympathetic
r fi orior 11.1n I T€ldunfr'urflu
4.6 Postdefibrillation
nr:inur ([oorun:rd s) d'o,rdud'urrrraq
ilmr:rlnGta.rodtIntfl. (nosc)'[6' riruiunr:ld
pacemaker ri,r'[rirfl
uduauiu'irrilunr:fnur
d'.rndrr1fi adrenatine
uSour vasoactive,r*.*dn
#rfi oraoycaroia
lfr' atropine
orono.ilfr's-,rrllnrunr*
mor:g'ruturlonr-Tu
[iltottnt1nl?: hypovolemia
a. Pulseless Electricat Activity (efn)'-'
14
u''ru6n n1rnr ?ny{unduh^tv{rri'rloodr.rtoori'xrad.l
Atn
156
flfr u atiufr s n.fl. - n.il. 2540
Tfllfluinltfrnwuwnuataninifrn lxwatnanttJnnit
'lna.urnrfi
pulseless
electrical
activity(PEA)
s n'nuflIwrz;
PEA includes . Electromecthanical
dissociation(EMD)
o Pseudo-EMD
o ldioventncularrhythms
a Ventncularescape rhythms
o Bradyasystolicrhythms
o Postdefibrillationidioventricularrhvthms
. ContinueCPR
a Intubateat once
o Obtain lV access
o Assess blood flow using Doppler ultrasound
Consider possible causes
(Parentheses=possible
therapiesand treatments)
o Hypovolemia(volume infusion)
o Cardiac tampornade(pencardiocentesis)
o Tensronpneumothorax(needle decompression)
. Hypothermra(see hypothermiaalgorithm,Section lV)
o Masstvepulmonaryembolism (surgery,thrombolyttcs)
o Drug overdosessuch as tricyclics,digitalis, p-blockers, calcium channel blockers
o Hyperkalemta
o Acidosis
o Massive acute myocardial infarction
o Epinephrrne1 mg lV push, : repeat every 3-5 mln
o lf absolute bradycardia(<oo beats/min) or relativebradycardia,give atropine t mg lV
. Repeat every 3-5 min up to a total of 0.04 mg/kg
q
(r fiIanil) nr:fionoiatdo.t
udut^to
uonr,lnu unaltv{ufi'{l tfiufiorJn6tf,euu.l tdu:rnodnrin
(' sooXnf;)
driun Torsadesde Pointesuio Potymorphousunlun{.l un:iliurrulrtr{rdgtno
X
ea
a
I rufifioufiqo
od'xl:fi 6 n1rvtu''rurutfiur owd'.1
w drfi QRS comptexciouj rrJduuu:Jn':'lrJnfr'ru
rtn:nrtfl
finr:fio:ournuluruluou n?rilsi16'qra{nr1il doro'irn:ld'ru0tdononfrufl:ruaiori'rlo
^'^^Xa-Xeror
r.tounnsuoufisunqa6ionr:fnurci'ruurilniir[01 fi vr #', uu:lirlfr1filfi'.r'rrurirqordrirrrfr':'[frHo
uSonr: d1r5xn-'n
a'rdd';ur{ndl5rmnnr:1# defibrittation
lf ugso."
n-t:rit Defibrillation'-'''
lnttit
cPR aixdutltistatsnnldau
vr
Ifrn{ufiutl n616 tflutfru,tnttdtatJtiuiltna,t
1frsuat uavvialofi t daal il t {u t ztuz rtaIouqo6u
rirufirfi tflursfiou transformer I w zu i't,t n n 1'iu wfa eJr 0,,n 1r i1 defibriIIation
Defibrillator
oi,tiu vr dfinIu ccu nio witnessed
rfiuldflrn;:nflsr:,ilflu capacitor vrfoldru'tv{ tiliu
duunn.o etectrodeslt.hirnfrrr rdori'rtr mtrtfittn6 cardiac arrest 1taaunualdciantsn\ aeriorittation
Lnr1Jfr1u'trni'il6ti4
ri'rhrfio depolarization
fid'ifi
rnnfinnr:rir Electrocardioversion''''"
nr:dr:bi defibrilation16'Hn6fr0.:wururru
- 'r !'r'-i
virlnrnrlr
1 . 1 O t 1 4 { U ? Uoriludrjnooi'u
lfii impeoance
cir louarf,utu'roudu etectrodes
!
dluojrranr: (rffur.irgudnntrfiua tr.) oiu nr: uiof,ifisri'ulnu: ilno NTGpatch6.loro::rfio\d
Vol. tl N<t. s lul. - Sept. lssz
J PrapokHao Hosp Clin Med Educat Center
157
(frrfi)
oonlrnd'r{rJru
ufiril::nrg "flo.)....oilnou,' dr:rloura.:6nof,t
e
',
es
Y
-,-!-!Y< |
1..
a
e. rdanld paddtesturod,rau'''rnufiu{deu ?'r
ruflxr.tflHU
?uu n: rstu,l:rln.lorjnrrurirurndo
3. noqurilerrnSor
(ulluraa r) nr.:r6uuruh ufirrJ::nrff ..fl.ru....qnfl
oenbriuator
unou,,
a. rarlur{rud'.:nd'.r.rru'trlf,r
(raururnt z) d.r
norlurJdou\ytflrdfirilira{paddtesnialfi'u
u A
!u",
.
o'tTont?nlJr4u'111
200 1nflrffuo
s. no{il
tead setect lfidun"r'j'r "paddle"
(nSordanteadII fi'rfiorir etectrodes
drufi:riufin
o6u'[rlflti'rlo aqiufi'r)
6. rdanrlru"synchronized"
lun:rfl6'olnr:
dr synchronized
cardioversron
7. noqu "charge"'lr,iflr (rrurrrnt s) ?:
\4!..-.4-.,
A
r6tu llr fl u.l fl ,t0 1 n r FlT0.J
A
ff .Jr n o ? 1 9t? r n 1 il n.l.t-tuyl
virsasdr.r rdorjdour^ra'r.rrub^lf,r{{rhu e.rnyr..r,r
'[rlflrl:virh{frdrtlrn5.rn:rgndu
r nf,r lfirr,r
paddtes uuu6'e{rJrueiohJ
rds6onrrugndulr.|frr
uul0n''l1l
Precordial thump (Thumpversion)r's
nr :rluuriran6'rufrufiodrirliu drundug.r
20-3oslJ.riou4un,16'.:ru:rnaor:rirldjrud'.:ur.:or
#uj rfiur z-s iurfi orcri-rurJiuuJduu{.rur:1fr
8. ?1n paddles dnr etectroOe
get uffr n.t ri'rlcnfr'u
rdur-l
n61d1u:rrw 16'6.:
iorn! 40ua: vF
.srERNUM,,
uu6'rirJr u d'ufiuduu.jr
1ifildn :;gn
ioun: z
'[urj
n'rirzrr ufl: .ApEX,"l idtd'in uidruri.:.r
adril:fi6 i6darodrtfr'nr:yirrruro.rf'rto
::d'u:mul (u3rrruVa-vs) ::i.rorjrhl' ger lraa nfr'urnrn.:Iounr:ri,rhl' w firi'Er:rrfrdu
uio
'16'
u"rf,rufis::rn'jllpaddtes#o*ro noruuytr?Jan"lfi' uJfiuu'lrJrilu
vr raio asystote 6rursrirlfiiir
,,)
uriunoil::rur* (;ilfi z-#n)
rfiurnir r6sr' -' ronr::rsf'rtlnqorirtrurirr,tri.
A
*
X
a
-
)!
, y-
uuleo rytuljl{n,J
T:oUytoJo1t.)
v
vh
'
I
a
s. n:rl fiuriun-r:ifi odunduldflrfi'd cuu?o
#JAfA (witnessedcardiacarest) fi w n'niir
uofirooi'irn.rfiorln6o{uSo\rir
6no:hi16' un: defibrilatorri.rrurkid,r6'0.:nrfio
r o. u{.rlv{4nnurrluua:nauoonr.tnrdunrluufironnrutu 30 iurfi Tou{rJrufrhiri'urfio
niorilr:nrs'ir "o:6onrdoriundr..6.rs-ril,,..nd.l hypoxia
drun:rddnn"r6nr:ld
r:6'0,rfi
defibrilator
....u:u 6lou" fl:r01fr'Kd1q
rdsuirrufiruvi1nl1nr6u.1tuo: pacemakerstand oy liriau
Antcrlor-Poltorlor
11
ot!
paddles twan't defibrillation
aun 2 Uf,OJffiut4UJn1J?1J
158
ild u atiud s n.n. - n.a. 2b4o
21rfl1ifluin itdn w uwnuf,tanin6fin I x wan n n r ilnn it
Anterior/Pogt€rior
Recornntended
Pbcernent
Opig|al Antorior/ rr.fti Ptgncnt
6F
#\M
s ehuuthn'tta?.tetectrode
:rjfi
U
nr:n:v{ufr'e'lo(Pacemaker
Orerapy)''"-"
rndor n ::{ufi rh or fruu6'nn r :dr.r rudr u
'[
finr:rlol m':vrr.:16ub^hilrtriu Hri.:
riruur :su raSo
Br
-
)
t
v
v'l
,
ll{t}lTitUAqUn? tl uanl1n
Yr:1{0nfiu1 14-Ofl1T1{.l
o11fiorn1:t{urhorrnnr:
rirun1.tfl1u etectrode'til drarnfrrJruff;n6'16
n r:d.rfrqq r rub^h^Ir
9t
veX
n::{ulfrrfio depotarizationdudnfi'ur{0fr'r1a n :: ounn1il ruou:r1 tuYlT?.:on
xf tt
rua:ri, lfifi nufi u 6"rto.:ri'rho1NrJ1
o
svJ
l?nn'luvl]ril
1. no
nO electrode
electrocle 1lU1o 8 'DU. t?nn,luvtll\l
Iouvi'rhlorf,'und'nnr: standby pacrng
,,Are'y.
-1' -:'-.-e,A
(;tJfr
s) un?oofl'luflqqliltnauuYln$nnu
nsir16o :'''udfibnrsrfionr:rilduuuiln,:nr.: orillt
'tl
'tduri
u 'iq Yt
d'lrir5'cr:rr5rlo.:nr:n::6u
nrrud'ulafisl t1^11^l1fi1tlYl'ln1an1fl 0{R'lonT'rt:')ljoilIl'l-)l
luouroqo'ulnfr
hemodynamic
I
,,^!.v.u)Y'
oir (systolic< so ur,l.!l:ovr)nuo.:f,usunfirrur{o (unon.t t.)Yl80 n:Jclouln,
n:rlri'zif 6a
z. nr:si.trirn::uslrhilr
edema'tilnr::oou
fr'rlotrorfioo $n: putmonary
finr'::u'rhraqord'unrr:(full cardiacarrest)6'to:
uq
A
e
--
\
/
2.1 nftf, severe bradyasystolicarrest
i
A
t
-.'t
:
n
rmfi asystoteuio rvo dod'j.finr':: hypoper- r5iloirun::$ffluru1off{qo(200 mA) ruafiltctu
capture)ufrr6ociaugno
fusion rfiorrururfiunrr un:nfrrurdofr'rtorinhi n::us'[r.h{r (ventricular
r u
q,
-
Uv
A
n.lTtfl temporary pacemaker ilntot{flo
.t w
v
X
!t!'
'
i
vi
-
a
|
1
conduction tUlltu:flnn1U[1{0fi']ttUJO0H n{tfitJ'l:
r
l|
ts
X
a
v
tvrr$tuftlnT:ttfltfllt4l.)?uan:aun:10
2.2 nlfr bradycardiadbjiudtu
formation
n6o
u'rnlurrudfinrrl fiorJn6so.rimpulse
J
A-
nrtttffn{rJ'l?un{xo6ilqafiu.tcaptureax lo |tn?
tytl^l"lYtu
1n T: Eu
o0u fl1{0.1sl0
c
i
a
I
,s
v
';aed'
riouq tviun::$fffin:*ou
lll
capture $n:lflil
orl
n0
'[rJ
::l'r tu 50-10o
6n:rrfoun: ro lour]'rbh:oqidrl
dtaiun:rflfr'r"hrdudrtfiopu:.tuto heart block
finfiuorurjj
1J1{6r.J
rou.rfinrsxr:rri nr:n::fiurirhi z ii 6o
Y
'v
o
a
n
ill
2. Temporary transyenous pacemaker
r. Transcutaneouspacing riJurn':o.rdi
^
a
vl
a.
.J
v
*',
etectrode6oaqjdfierariouSr
rrum:r.:on 1f'[ ds:o':n rIJwn5oln::Eur4?tlalnT11ailosl1[nron0gn.luuon
ri ur ir.:nru fl''tu electrodeflooli1u subclavianv.
6orilumrr r6ond6 Iou rowr:ritdri.:Lifi ur^rvr
ri'lurla6o nionr:riru6inilanl:'rilurura ruu'r; uia intemaljugularv. dru n.atriumrd,liltdu')
rirraiu n: rfldi.r rflounoor6ooeirL116'raiolu: r ud
ltw-
.J
odri'utraoecut
ae d Hril6'ru1ula.:rt.ventricle
l,,
a
drntursldrihrfrohi'icapturefi6nr:riou
lo':uursnrunx
rnoo(thrombolytic
drug)
{orfiu 60fr0.:iliu1fri captureda rinhi n'ir r.o-r.smn ufird.rcirl{slduz-s ryirlunrr:
rl::eu HadrrTrlu:rudrrieiruuill etectrodescardiac arrest arldo.rlfcirq.rn'irf,rfia'r11nlil
!-,
Vol. 14 No. s Jul. - Sept. issz
J Prapokkla<, Hrrsp CIin Med Educat Center
fl'rulroo:1r{un:: unb^h^h
irl.:uldfro.r::iln :: us
b{r.lrdrfiolr nnr:yir ECC6'ru (mechanicatactivity
)
rJn 61ilfiuultilunrr:qn rdudrx:r: dunJfioorr nr
ua:riorrrtnr:vri cpR
ota
2. 9llll?luilnltu:l{1tU-l (Route of Drug
159
rarulorfinfiourro:riunurriliohriruyio, .$o
6oeiofiurfialfiur1d'rrir6runooard.ruilnru
liofiunttGand z,drur-rrr.rroofiaadti
ttriyau dantn{r-ltao-tofintt:
atletectasis,
pulmonary edema, uay adrenaline_induced
vasoconstrrctionl
2.3 nrofir'tofnso:o (tntracardiac)
Iou
r:l
dlfriaurir
rfio u uonor nfio,rHrJonou?o
2.1?l'roilaoorfiaorir
Xriufi
nr:lfruruilroon'ldz
u'rlo
u
d'r
rirfi
Io nr s rdulEionr : rfioraaoorfiooIoI :_
yrr.l6o
uri
dntrq
cardiactamponade
un; pneumothorax
r.) ranaorfiaoeirdrunar,:
(Central
vein)
6rdor orri'unrru rirur q rflufi rqu or :yir rd o,[rj
6.:eioaqiri'ufr'rhfr'oluurrr
lduri suucravian
v.nia
ine rdrstir,lnrud'ruii6u't 6,
intemaljugutaru. Iou'lfnr:naolt*firusru Cavafix sr I I :n do adrenat
raio lntroducerf<it(6'rui6 modifiedSetdinge/s
technique)nr:tfrrrif;dura:rdrfil'[d:rorir usifi 3. nl:il??t]:u-l
YA
Tucl0uflu,Ju'tndo,:nqo
CpR{'rn:rr ua:ororfio (Drug Administration)2-'' 8'0'r'r-rd
Administration)2'6
r6oooonir
un:dd'ld';uursorufir
rdoo ilor:
r. Adrenatine(Epinephrine
HCt)" rflu
tfsiordoriloun.l'[So
qjriouufrr
catecholamined,lfiqni'nr:q'u ct,-adrenergic
z.)unoorfioooirdtwjnru
(peripheralreceptor 1unr :rir u6i or rn r urafi',m'.:ton qord,u
X'rh
vein) rfluofrunri.:do
r :r 6onlf rilud'uoi'u
u:n rdor Teurfi unr :'ln nu6uuu6oo
rtri'rtou n: srio.r orjr,:'l:
t'rnfllll'rroriloumr'[d:ror5r finnun:ndauriau fieruilu-ir r yHadl6'1ri61rJn.jr
BLS irrurir
Ioulf'r{rdrisn Medicutrdonr#urdoociru3rrru
defibrilation rdolor nhj ufiI nr :rir.tru$'.:l0un:
antecubitalv. raio extematjugular v.(rfionrfru nonr:'lnnriuud subendocardium
z)'hj'[6riru
)-
fruiu.fr'o
) rn: r ; f,rnr finr :'lranr1uu'[d'ri.r.r
r ru yirnr : iriruqnf defibriuationlquq:ilfiu.ruqiufir am_
nourori'rloifddrn'jridurn (lfrrnruroonqnf;' ptitude yrr.l'[r4r{.r 6.:nrltdril uduEiu
tiour raiar6on
r z utfi) orourill 6'.rrJnr : flfltlfl.r:n: nr u zo-sod6. 1f([uluron.r) rilu rescuetherapyrdonr:inur
alu,"
*
uffidorTufiiuri'unr:unrSourourunrrufirnr: -?5',OUuJfl'lr:0
rduur
zurouacif;l#
lq
[afr,tluntt u n,ttilauaaatdaaoi.tn
n ntfr
IourTdrJlrilfzuror rn.(Hsruludn:reru
6atlitnnfrnfla,triunnuwit{auuu universat 1:10,000
rflu ro 66) rrirunoordooel"rrin
s urff
qeA
precaution Iti a'm t tu tJty i6 mt aau i alil fi nt u1
lurog,ltrl 1, 3 un: s run.siorfio.lfiunns urfi
{tJ
2.2 yt'louGtaonil(tntratrachear)
6.:kivia (escatatigoose) H5o o.r iln./nn.nn s-s urfi
nror6uurul c'[i rurury dru iu I ru r,rrfiodsru.]:n lun:rfltfrflu vasopressoragent ruflu
1 iln.olo
6ur.iruyrr.:rdorufi.1u
noonl (tracheat
mucosa)'[d'u
ri soo dd hilururo r-ro 'lruTnr:niu,rurfi
ri'urlri,
adrenaline,
lidocaineun: atropin"r,urodldc,rt irruri'usr:n:aruTrr6uil'lun
rfuoruor
r6orr.:6'rusrr.r..'urL,n6orfllu
10 dd. Ioutfi
2. Lidocaine HCt rfluur
qv
antidysrhythmic
r"irun r r sr uur I fi soo 6n unugirBr il.rrJnr uviori r u
rirurfiru threshotdoionr:rfio ectopic activity d
ild u atiuds n.n.- n.u.2b4o
'nriltrfluinltflnuunnunmin|fin lNnnunnrilnndt
160
-
yi
X
p6un il finzt urhilryriunt il rIat drdaufl'ht
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Vol. tt No. s Jul. - Sept. tooz
nr:rofi s nllJunsn&aua'tnnttit
I Prapokkla<t Hosp Clin Med Educat Center
163
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2. EmergencayCardiac care Committee and
N1n tsu arterial blood gas, pulse oximeter,
Subcommittee.American Heart Association
end tidal CO, rflufru uaidorrdonli;-'[urrnrfi
Adult AdvancedLift Support. Guidelinesfor
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cardiaccare.JAMA 1992;268:2199-241.
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White RD. AcuteTherapy in Patients with
Cardiac Arrythmias CriticalCareMedicine.
ln:MurryMJ, CoursinDB, eds. Perioperative
Management. Philadelphia:Lippincott-Raven,
1997:327-340.
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resuscitation.
NeimannJT. Cardiopulmonary
Eng J Med 1992;327:107s-92.
Paradis NA, Halperin HR, Norvale RM.
Bringing lt All Together:State-of-the-Art
10.qoyi'lu:ABc,..ABC,..ABcfinl5rmo!
therapy for cardiac arest. ln:Paradis NA,
Hafperin HR, Norvale RM, eds. Cardiac
CT:
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Arrest.TheScienceof Practiceof Resuscitation
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& Wilkins,199s:
Medicine.Baltimore:William
Kirby RR,
Melker
RS.
Fundamentals
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CardiopulmonaryResuscitation.In:Civetta
JM, TaylorRN,KirlcyRR,eds.GriticalCare. srd
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1s. Little CM. VasopressorTherapy DuringCardiac
flllqr t0u0oflnu. fil{Jfloqilon1rTluT'rsml{gJ.
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n :.: t Ytfl 9: fl lJ1 fi lJrtr{ Ylu t Tfi fi ? t 1 $ fi ,JtJ:: [ il f, t il u
un:nT:Yl:1.1fl''t!''tTtufllj. 2538.
Arrest. B. Nonadrenergic Vasopressor. In:
Otto CW. Cunent Concepts in Cardiopulmonary
Cardiac Anest, The Science Of practice Of
Resuscitation.In:CoursinDB, PeaelRG, Pragh
ResuscitationMedicine. Baltimore: William &
Wilkins, 'r995:s23-7.
Paradis NA, Halperin HR, Noruale RM, eds.
I
DS.
Critical Care Medicine (Perioperative
management). Philadelphia:Lippincott-
t6. WileyTM, PlatiaE, O DonohueS. Antidysrhythmic
Raven,l 997:387-98.
Therapy During Cardiac Anest and Resuscitation.
In:Paradis NA, Halperin HR, Norvale RM, eds.
1 0 . Kerber RE, Robertson CE. Transthoracic
Defibrillation.In:Paradis NA, Halperin HR,
Cardiac Arrest, The Science of practice of
Norvale RM, eds. Cardiac Anest.The Science
Resuscitation Medicine. Baltimore:William&
of
Wilkins,199s:s2B-44.
Practice of
Resuscitation Medicine.
Baltimore:William
& Wilkins, l99s:370-81.
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17. Erb D, NorualeRM. Resuscitationin the lnHospital Setting. In:paradis NA, Halperin HR,
I:nfr'rtoun:unoor6oo. 'i'unqi:I:.rrruru'rfl
n::ilnrn#t, zsgz.
12. ManningJE, Zoll PM. Therapyof Bradyasystolic
Norvale RM, eds. Cardiac Arest:The Science
of
Practice of
Resuscitation Medicine.
Baltimore:William & Wilkins, 199s-s97-606.
Arrest. In:Paradis NA, HalperinHR, Norvale
18. SafarP, Bircher NG, Yealy D. Basic ano
RM, eds. Cardiac Anest. The Science of
Advanced Life Support. In Schwartz GR,
Practice of ResuscitationMedicine. Baltimore:
CaytenCG, MangelsonMA, et al. eds. principle
William & Wilkins,l99s:621-40.
& practice of Emergency Medicine. 3rd ed.
1 3 . Davis WR. Temporary Cardiac Pacemakers.
In:Civetta JM,Taylor RN,KirbyRR,eds.
14.
165
New YorkLea & Febiges, 1992:89-2.t3.
19. Gullahom GM. Intrahospital Transport. In:
CriticalCare.3rd ed. Philadelphia:Lippincott-
Civetta JM, Taylor RW, Kirby RR, eds. Critical
Raven, 1997:s45-52.
Care 3rd ed. Philadelphia:Lippincott-Raven,
ParadisNA, RoscaveE, LindexRH, Caims CB.
1997:787-808.
Vasopressor Therapy During Cardiac Arrest.
20. Goetting MG, Charsh MD. Complications of
In:ParadisNA, HalperinHR, NorvaleRM, eds.
CardiopulmonaryResuuscitation.In:paradisNA,
Cardiac Arrest, The Science of Practice of
HalperinHR, Norvale RM. eds. Cardiac arrest.
Resuscitation Medicine. Baltimore:William&
The Science of
Wilkins.199s:497-s23.
Medicine. Baltimore:William& Wilkins. 199s:
641-52.
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Fragyrru,
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Composltton
Each tablet of Myonal contains 50mg of eperisone hydrochloride
Indlcations
Muscle relaxant
For improvementof myotonicsymptomssuch as in cervicalsyndrome,periarthritisof the shoulder,tumbago,
etc.
Dosage and Administmtion
Usuallytor adults,orallyadminister3 tabletsper diy in three divideddosesafter each meal.
The dosage should be adjusted depending on the patient age and severity of symptoms.
Avallability
Bottleof 250 Tablets;
Precautions
(1) General
Weakness, dizziness, or drowsiness may occur with the use of this drug. Discontinueuse or
decrease
dosage at the fi.st sign of such symptoms.Patientstaking this drug should not drive or operate machinery.
(2) The followingpatients requirecarefuladministration
Patient$with hepaticdisorders.
(3) Adversereactionsthat may less hequentlyoccur:(1) Hepaticdysfunction,renaldysfunction,or abnormalof R.B.C.count or hemoglobinvalue.Those
functions
should be monilored or hematologicaltests should be performed. Discontinuethe medication
if any
abnormalityis observed.
(2) Other adverse reactions:-rashes; psychoneuroticsymptoms such as insomnia,headache,
drowsiness,
stifiness or numbness, hembling in the extremities; gastrointestinalsymptoms such as nausea
and
vomiting, anorexia, dry mouth, constipation,diarrhea, abdominal pain or other gashointestinal
upset;
symptomsof urinarydisorders.
(4) The drug should be used during pregnancyor tactationonly when the anticipatedbenefits
of its use outweigh
the possiblerisks and discontinuebreast-feeding.
(5) Drug interactions
There is a report that disturbances in ocular accommodation occurred after the concomitant
use of
methocarbamoland tolperisonehydrochloride(a compoundstructurallysimilarto Myonal).
L.P.3.75
Leuprorelin ocelote
Abbreviatedprescribinginformation
EnantoneL.P.3.75 mg Composition : Each vial contains
3.75 mg leuprorelinacetateas lyophilizedmicrocapsules'
at genitaland
lndications: Treatmentof endometriosis
(fromstageI to stagelV), treatmentof
localization
extragenital
prostaticcancer.Dosageand administration:Endometriosis;
or
monthlyas a singlesubcutaneous
one vial administered
injection.Treatmentshouldbe startedduringthe
intramuscular
first live days of the menstrualcycle. The recommended
durationof treatmentis six months.Prostaticcancer;one vial
a d m i n i s t e r e dm o n t h l y a s a s i n g l e s u b c u t a n e o u so r
intramusculariniection.Storage: Store at room temperature
avoidingheat.Protectfromfreezing.Package:Boxof 1 vial.One
2 ml ampulesterilediluentis attached.
a.aa.tu n€ FullPr€*nb,ngInfomt.on. Takeda[rhaila^d).Lld
?ltE[L*
2. Datafi nto.TakedaOharland).Lld
Furtherinformationis availableon requesl.
Takeda(Thailand),Ltd. Tel.+66-2-2480994Fax. +66-2-2480998
t
loloarrriro
lopamidol
THE NON-IONIC WATER SOLUBLECONTRASTMEDIUM
minimizes therisk attendant to myelography,
arteriography and venography.
UrFcDrr-cteo
@
Sodium and meglumine diatrizoate
contrast medium for urographies and Angiographies
--r
t.Ubr
Funtherintormationis availableon request
sa/z
sukumvit
63banskok
10r10
il:"}|:l|;'rff'::Ti::?harmaceuticars
@
lfrl[psn"fiaf4oo
improvescerebralperfusionand mentalfunction
Patientssufferingfrom
diseaseare
cerebrovascular
the victimsof inadequateblood
flow due to obstructivearterial
processesas well as Platelet
adhesionand aggregation.
An acute reductionof cerebral
bloodflow may resultin
transientischaemicattacksor
even in strokeleadingto
reversibleor irreversible
neurologicaldeficits.
A chronicdecreasein cerebral
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manifestedby disordersof
mentalfunction.behavioural
changesand somaticdisorders.
and
Haemorheolooical
antiplateletm6dicationhas the
objectiveto preventrecurrent
ischaemicattacksand to
improvecognitiveand mental
function.
Tbental4QQ
effectsand
exertsneuropharmacological
improves the nutritive microcirculation by
o restoring red celt deformability
o decreasingblood viscosity
o inhibiting platelet a$$re$ation
andantiplatelet
the haemorheological
Tfentat4fi)
disease
approachin the treatmentof cerebrovascular
8nd
ol cdcmlt'tioo
prrErahb.!r.Oq$
Conditions associated with cerebrovascular insulliciscy, srh as impai.Mt
P€oroxiMrine a{n n{- LrdotbiS:
A.tb
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hy9olens'vs agsts
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Ctzzine, uaain6 (e9 skin. MG,
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