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The Journal of Prapokklao Hospital
Clinical Medical Education Center (J.P.M.C.)
Adviser
Banthit Chaowagul
Editor
Damrong Bhanthumkosol
AssociateEditor
Prayuth Somprakit
Editorial Board
Prakit Kasemsarn
Danai Danvivathana
Prasert Rimchala
Dumrong Wangarnuttara
Suchart Chaimuangraj
Somboon Somlaw
Pramot Chudum
Siriwatt Thiptharadol
Somboon Kietinun
SombatNavarattara
Wilaipan Rimchala
CheocharnViriyaluppa
Prapap Yoothavisuthi
Manager
ChaiyasitBhinyovithayiikul
Assistant Managers
SumapornSealim
Chintana Chingchit
Pimon Chanakot
Sirinarj Limmanonukul
FinancialManager
SudswatLikitwatanakul
Art
SegsomBoonsirichai
Office address
TechnicalDbpartmentof PrapokklaoHospital
Amphur Muang
Chantaburi22OOO
Tel. Chantaburi
3l l6l l-3. 3ll27O
Publication
Quarterly
Owner
PrapokklaoHospital
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DURATION
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VIAL OF 10 C.C.
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COMPOSITION A
SOLUTION OF PURE INSULIN
CHARACTERISTICS
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DURATION 8 hrs.
PRESENTATION
N.P.H. INSULIN
COMPOSITION
VIAL OF 10 C.C.
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OF A COMPLEX OF ISOPHANE INSULIN,
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PROTAMINEAND ZINC
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Yol.2 No. 1-2 Jan.-Mar.,Apr.-Jun. 1985
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Contents
Page
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MEDICAL EDUCATION
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The Study of Community Medicineand
The Attitude of The MedicalStudentsin
MESRAP Program
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Seree Soolaangchaya M.D.
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ORIGINAL ARTICLE
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Current Trend of Breast-feeding
in Prapokklao Hospital
1auurhnunn6{ndn.u.
RmnkaewKanokpongsakdi
M.D,
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Dip In Nurse
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Chintano C'lringchit B. S. (Statistics )
Danai Danvivathana M.D.
1 0 Birth Weightof Newborn Infant in Rela-
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Careat PrapokklaoHospital
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The Patient of Suspected Hereditary Factor
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SangchaiKaewkitichaiM.D.
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DamrongBhanthumkosoI M.D.
VII Deficiency. A casereport
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Yol.2 No. l-2 Jan.-lllar.,Apr.-Jun. 1985
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Contents
Page
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How to Manage
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Apr.-Jun.1985
.l PrapokklaoHosp Clin Med Educat Center
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Abstract
The Study of Community Medicineand The Attitude of The MedicalStudentsin
MESRAP** Program
Seree Sooksangchaya M. D.*
* D e p a r t m e n t o f S o c i a l M e d i c i n e ,P r a p o k k l a o H o s p i t a l , C h a n t a b u r i ,T h a i l a n d .
J Prapokhlao Hosp Clln Med Educot Center 1985i2:1-3.
Community medicine is one of the major subiects that students in MESRAP program have to attend in
order to achieve the KAP (knowledge, attitude & Practice) to s€rve rural communities, especially the good attitude
toward working in the rural communities, so the program extended more credits to community medicine. However
the author observed that MESRAP students get boring with community medicine and think thatthey have wasted
their time too much to this subject. lt is the author's opinion that in order to achieve such attitude, teaching in community medicine should not depend too much on department of community and social medicine alone, other departments should play their roles as well.
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Abstract CurrentTrendof Breast-feeding
in Prapokklao
Hospital
Rtunkaew Kanokpongsakdi M.D.,* Preeya Kramakum Dip ln Nurse,*+ Chintana Chingchit B.S.
(Satistics),* ** Danai Danvivatft162 flil.p. tf* * {t
* D e p a r t m e n t o f P e d i a t r i c s ,* * D e p a r t m e n t o f O u t - P a t i e n t , * * * D i v i s i o n o f M e d i c a l R e c o r d a n d S t a t i s tics, ****pup"rtment of SocialMedicine.
J Prapokkloo Hosp Clin Med Educot Center 1985i2i4-9,
This study presents results of survcy conducted in 1984 to determine thc trend on thc incidcnce of
breast fecding. Mothcrs who had their deliveries at Prapokklao Hospital with their babies attended well baby clinic
were sclected. Data were gathered by interviewing the mothers. Duration of breast feeding and factors which may
influence wer'e analysed. Thc results show that nearly 90 per cent of mothers initiated brcast feeding and dcclincd
rapidly during the first 4 months after delivery.
Teenage, primiparity, high education and official work are thefactors which influenccd thc initiation
and duration of breast feeding.
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Abstract
Birth Weight of Newborn lnfant in Relation BetweenGood and Poor Antenatal Careat
PrapokklaoHospital.
G.N.**
SomboonKietinun
M.D.*,Charune
Sancharvanakit
* , * * D e p a r t m e n t o f O b s t e t r i c s& G y n e c o l o g y , P r a p o k k l a o H o s p i t a l , C h a n t a b u r i ,T h a i l a n d .
J Propokkloo Hosp Clin Med Educot Center 1985;2:1&17.
The study of the birth weight of the newborn infants at Pnpokklao Hospital, Chantaburi, Thailand
'l
from 1 st J anuary 983 to 31 st Decemb€r, 1 983 showed averagebirth weight of male and female newborn infants at
37 weeks or over were 3,079.58 I 439.35 and 3,012.69 ! 4O7.66 grams respcctively with statistically significant difference. ln comparison of the.group male newborn infant whose the mothers had antenatal care 4 times or over
with the average birth weight of 3,'l'1.7.25t 396.48 grams to the group whose the mothers had antenatal care less
than 4 times with the averagebirth weight of 3,075.77 !373.36 grams, there were statistically difference.
ln comparison of the group of female newborn infant whose the mothers had antenatal care 4 times
or more (with the averagebirth weight of 3,058.45 !36/.W
Srams) to the group whose the mothers had antenatal
care less than 4 times (with the averagebirth weight of 2,990.01 t 405.29 grams), there were statistically difference.
(p (0.O5 and 0.0O.t respectively).
The male and female newborn infants in Bangkok were 169.42 grams and 163.31 grams heavier than
the male and female newborn infants at Prapokklao Hospital respectively.
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Vol. 2 No. 1-2 Jan.-Mar.,
Apr.-Jun.1985
HospClin Med EducarCenter
I Prapokklao
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Gestationalase Weicht ir
rlu@er-=-:-=-_lS.D.
grams
weKs
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37 weeksor over
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46
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3,082.14 t 455.91
3,076.09r 464.00
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under4 times
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weeks S.D.
srrms
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HospClin Med EducatCenter
J Prapokklao
Vol. 2 No, 1-2 Jan.-Mar.,
Apr.-Jun.1985
l5
efrrr.ri? ritadai muhsiinn nm n6na arih n aaQ'l
Gestational age Weight in
-
weeks
S.D.
grams
il*krJ5]
ANClno ANC
Overall delivery
37 weeksor over
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r85
38
3,104.49! 402.53
3 , 11 2 . 6 3! 295.36
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141
3 , 1i 1 . 1t
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42
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161
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under4 times
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roner:drld.r
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nydr rnolun{ rufi 1. qn: rfror'itl, ol: rdacirl, qniu-urlur-n6d'lnr,ur6 :hu_
tuet:.
Birth weight
gestational
and
age of the Thai infant.
ilr no:: firr nn'jr a at.:firita rlnrurnn.irn4rufitiild'* r n
nofi !lurfl nnlirnr: rrltm6 zsro; b6:s66-604.
n:: firi odrno:: firiaun.jra n*.: lorufirt'urir d'qvrr.l 2. quru'qnrrJiurai,r-unurrjruro.r.nq6n::lnunr:rriujrrrin
xo ril qtn tfl:: nlla:Han:cylueior.hru"nrr:
nRnon!D til 1' n.
sfi6 s drrnofu<o.osuovo.oor)uor'ldfirlurirfiq
tntulnl: 3l',lt2527
i 8194-tt2,
3. Bjerre l, Varendh G. A study of some biologicaland
nrlnfifi s drrno
socio-economlcfactors in low birth weight. Acta paediatr
z. rlrrarfnd'rrodunr:nu: nrfioufi .lrta1,fi'mafo Scand1975;64:60*12.
Vol. 2 No. 'l-2 lan.-Mar,,Apr.-Jun. 19g5
4, FedrickJ, Adelsteinp. Factorsassociated
wit}l low birth
weight infants deliveredat term. Br, ObstetGynaecol
1978i85:1-7.
5. Papaevangelou
G, Papadatos
C, Alexiou D. The effectof
maternal age, parity and socialclasson the incidenceof
smafhfor-dates
newborns.Acta paediatrScand1973;622
527-30.
6. Urrusti J, Yoshida P, Velasco L, et al. Human fetal
growth retardation: I clinical featuresof samplewith intrauterinegrowth retardation.Pediatrics1972; 50:547.
J PrapokktaoHospCtin Med EducatCenter
L7
7. rJrvn-lilqnriqni, duU:oi rdu:6u"uylli,
t1n:olelrdo,
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Gtt s
df
HereditaryFactorVll Deficiency
Wil?Ullill0yfiJUl:fl
q,
v,t
I J'tu
ilunailu?u
u
oru? ur:hrim:r r^t.u.u
9
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ttolt=u ilfl1fl glTruYl.u.*
n.u.*
rJ:vfinrnurRtufr
a n.u.**
sir:.rdvl"uqulnn
Abstract
The Patient of Suspected Hereditary
factor Vll
deficiency.
A case report.
Sombat Navarattara M.D.*, Sangchal Kaewkitichai M.D.*, Prakit KasemsarnM'D.*,
Damrong Bhanthumkosol M.D.**
* D e p a r t m e n t o f P e d i a t r i c s *, * D e p a r t m e n t o f P a t h o l o g y ,P r a p o k k l a o H o s p i t a l , C h a n t a b u r i ,T h a i l a n d .
"1985;2t'18-21 .
J Prapohklao Hosp CIin Med Educat Center
H e r e d i t a r y f a c t o r V l l d e f i c i e n c y i s a r a r e d i s e a s e . T h e c l i n i c a l m a n i f e s t a t i o n sa r e m u c o u s m e m b r a n e
bteeding and sometimes intracranial hemorrhage. The abnormal laboratory test is prolonSed prothrombin time,
w i t h n o r m a l p a r t i a l t h r o m b o p l a s t i n t i m e . C o n f i r m a t i o n o f t h i s d i a g n o s i si s m a d e b y r u n n i n g a s s a yf o r f a c t o r V l l .
A case of one-month-old boy with suspected hereditary factor Vll dificiency is reported with details
o f h i s t o r y , c l i n i c a l m a n i f e s t a t i o n s l, a b o r a t o r y f i n d i n g s i n c l u d i n g a u t o p s y f i n d i n g s
Unfortunately specific assayof factor Vll was not done due to lack of laboratory facilities.
ullur
-i s ".
PTT (partial thromboplastin time)
frasrJfrr36nr:
plexdeficiency 6 rtfr'Hnnr:vroflouvll.lf'o.:ilfrffi nr:
PTT ttat PT (prothrombintime)
fiqiln66orir
nnr: vlerRoLYl1.lv{o.:rJfl ri6 nr:
s r u nrr : u3o1:ofi tv{r^r
loudrirPTT rtnrqirTT (thromPT fiqilnfiadr+dur
fiorJnfi luil:rrne\vru acquiredcoagulationdefect
bin time) rjn6rlu
fir rlilouturdn6ol:n acquired prothrombin com-
factor VII (proconvertin factor)
R'11rR1:1J10
coagulationfactor rrqifrrufiol ti
Gra!yl't.l
r rr\6':-iau\fi ud 1: o6lufl rdu 6 slf i{ on'r:1no
.
^P.
urol66tfi.1ntlyljlq coagulation
R1?Y?iqpro-
ulrf riarllJI n
convertinf actor rrqirir ifi qrijul: ofi rnr
' il u qun nt nnu h watn arcuil nn it o"u
nui
'. ninrhihilnatiinat b wat u-rnmvilrun{t o"u
nG
ori6nr:ivirnirr qiori:vrrn: 1ofrruaur lesYir'Lil
1:ofifiornr:r[avorRr:r[fi0].:uhi:uri:.:trqifl:isnu'ir
Vol.2 No.'l-2 lan.-Mar.,
Apr.-Jun.1985
HospClin Med EducatCenter
J Prapokklao
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1 rdaufiaridr rnailrlrrfiu [^r
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rurdilr r :Jnrnd1
Hb o.ssniuf, Hct 22"1,WBC 1o,7oo/nu.ilru.,
{'uvrqi rfiotufi 17fi{ulail fl.fl.2b2?
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rn6ordaoarjlurn
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ilnA eircoagulogram
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I
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looked toxic
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firutodrurn (dyspnea)
:toilenrn
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An ru0.:: riruolrryirn1ufi
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zO 1:dr:qudnr:f,nurunvruf,rcn{ndrin
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nary resuscitationvir coagulogr"* ia (err:r.rfi r)
o ld
arrar: vh factor VII assaytd'cirtvirfr'utasnt
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rn
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!r
aa
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nr:rvlilfiIanrnnrrit factorvU losi6 factor VII
J
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ior:sri
rdnorqr-z r6oufiarnr:6qirrfioonrriCi'r
oro
r6os6ofi
.:fin acquired
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assay olrriu'jr{rJrttlsdfi oro",:uwornr: usorhi
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firnqn td:r$,irutfufir
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&ateaq
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ufi'jr hereditary factor VII deficiency rflu
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lurj::rvrqlns
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unr:n'rr {'ulriuyrvr6fi
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uoyfiror^nvfir
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PTT run: uRn[1'l1uu
Vol.2 No. 1-2 f an.-Mar.,
Apr.-lun. 1985
frsrfrn::ilil:vnlfl
J PrapokklaoHospClin Med EducatCenter
3. VanCreveld S.
Congenital hypoproconvertinemia. Ann
P e d i a t r 19 5 8 ; 1 9 0 : 3 1 6 .
4 . R a b i n e r S F , W i n i c k M , S m i t h C H . C o n g e n i t a ld e f i c i e n c y
of factor Vll associated with hemorrhagic diseaseof the
ilaaautryil
ufluvnfruYufin
nn?naiiiruwnn
Ttwatnaynvtln
nffi {un$ frk{er4rytn7#utus,.
flvtu
5.
rt uavntannonfunnflnnhri'rnm
dmunt
N ailEil't
I
u
"
-iq,
-
o
d
n tnduilfluu tun 7J6u a,w 1uu
rondrrdl{6.r
2l
n e w b o r n . P e d i a t r i c s1 9 6 0 : '2 5 : 1 0 1 .
Hilgartner MW, McMillan CW. Coagulation disorders:
S m i t h ' s b l o o d d i s e a s e so f i n f a n c y a n d c h i l d r e n . 4 t h e d .
Saint Louis: CV Mosby, 1978t796-7.
6 . A l b l o o m O T . H e m o s t a s i sa n d t h r o m b o s i s . N e w y o r k :
C h u r c h i l l & L i v i n g s t o n ,19 8 1 : 3 5 3 - 4 .
7. Fair DS.
1. MitrakulC. Fatalbleedingin congenitalhypoproconvertinemia. J Med AssThailand1975i58142-4.
8.
2. VanCreveld
S,VederHA,BlansMM. Congenital
hypoproconvertinemia.
Ann Pediatr1956;187:373.
Quantitation of factor Vll in the plasma of
n o r m a l a n d W a r f a r i n - t r e a t e di n d i v i d u a l s b y r a d i o i m m u -
n o a s s a y .B l o o d 1 9 8 3 ; 6 2 : ' 7 8 4 - 9 1 .
G r e e n e W B , M c M i l l a n C W . S u r g e r y f o r s c o l i o s i si n c o n g e n i t a lf a c t o r V l l d e f i c i e n c y .A m J D i s C h i l d 1 9 8 2 ; 1 3 6 :
411-3.
24
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u\6'H
nlu{rlrur :ru
r uuo;\ritdru
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rurir{'r.lro$nvtrinunrl;uyltndaudlu$r.: rdu in- ?tuRl?v
unr:in :*t ufiat*t oi'.rfr
testinalobstruction, fistula ttnvpostoperative 4ir fiuuin:: ruud.:nr:airdl'ofn
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'loifii{orur
animw nriu
nr:?finr:fnur uffao: as'[ofiaoirs i uo"rrorztonfrunuwn6'lwtta6
au"unnuntanfprostheticsilo TosSchuster6.:ueifln.ff.1969rt Y1't qundaannnf
,nfivtilaananf
nurtfif
lfrd'n:rErrrto.:yr1r
o.: frirnnatuta iaryrytnlfihaamuutilfiurl
nflon.:6o,rurfruo"'::irsluri
s.o du-E
o'r,i
nr:rars1of,ilri6r,{o
rJolfudnr:fnulfildHn6fi
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oa ?DRlttuuuoHunnulYto\:4Rtu
s{vtu?til0sr't1
n1:tfio sepsise{rfiqnunrlilfinir usnto{a{ (sac
dehiscence)
ronarrdr{d.r
1. FonkalsrudEW. Selectiverepairof neonatalgastroschisis basedon degreeof viceroabdominaldisproportion.
Ann Surg1980;191:139-44.
aa
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v
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e
&
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,^
TRlJ1O?U?ttUUUOtlU.llU"lYlO{YlflTllo"o-'" 0m101U
2. Bower RJ, BellMJ,TernberyJL, etal. ventilatorysupport and primary closureof gastroschisls.Surg 1982;
(mortality) d'smrnrrrfioT:n
(morbidity)eir unr
9l :52-5.
rsusr?nlaqjtul:
{rrururn*u d{rfioujiu!rfisurTu 3. Ein SU, Rubin 52. Gastroschisis:Primary closureor
g u s
^aA
,a'
silonpouch. , PediatrSurg1980;15:549-52,
iG6uq ufirld'ujf,uuuu?R?lilAoufnur6"rrlii
rfiuilo
4.
HrabovskyEE, Boyd JB, Savrin RA, et al. Advancesin
L ,u ,& a
I
e.ru{ilu'lma.r1
nTuilillnlu fl1un tunun?lil[01E1lo,3
of gastroschisis.
Ann Surg1980; 192:
the management
244-8.
perinatology
update.,
5 . King DR, Savrin RA, Boks ET. Gastroschisis
PediatrSurg1980; 15:553-7.
R1rr-nl* r 6i?rJi 6 rfiu fl elr{rl,sn rir ri'o.:1 n'*uri u
RaffenspergerlG, JonaJZ. Gastroschisis.Surg Gynerfinnr:nfirsfi'uiGstagereduction rdu rtslulio.l
col Obstet1974; 138:230-4.
Denmark 5M, GeorgesonKE. Primary closureof gasfro$frrurnunsr'ro1516nrtrrlluda{fi'onlrtfr' abdotroschisis:Facilitationwith postoperative
muscleparalyminal tensiondr
abdominaltensionfiHnr4rlfr
sis.Arch Surg1983;1I 8:66.
PhilippartAr, CantyTG, FillerRM. Acutefluid volume
r drurn d.rufi"lrloup"r.nr:fl1slffiJo
nflTrnrflilhJod1
requlrementsin infantswith antcriorabdominalwall deIysistrrw1frmechaniealventilation2luurirsafiurn
fects. I PediatrSurS'1972i7t553-'1.
Filston HC, EdwardsCH lll, Chitwood WR fr, et al.
Yrun$rnrfio\iln'r.rirfinrrs uynRdou d rnfu rnnfin
Estimation of postoperativefluid requirementsin inl ari f rfiuiJoHrll u rir vi'o.lv1n* ulo udorHrll u rir vYo.l
fantsand children.Ann Surg1982; 196:76-81,
I
t
Filler RM, AngelolE, JohnBD, et al. Total intravenous
gH'ir,:nr:r.,itfioo'
1
0
.
g
g
adt.tut.r:
lu fi'l.t?uuyt1,:[6u
of infants
nutrition: An adiunct to the management
o'lt4u 6 uaunt:lf ventilatory assistance
rad'.:nir
eTo2
w i t h a r u p t u r e dc o m p h a l o c c l eA.m I S u r g1 9 7 1 ; 1 2 1 :
454-9.
rijuif filoiHariryrotou nfis o
t1
RubinSZ, MartinDJ, Ein SH. A oitical look at delayed
intestfnafmotility In gastroschisis.
Am I Surg1978;212
414$.
I
1 2 . SchusterSR. A new method for stagedrepairof large
nr:fnurrfisflraslnfrsIqsi616uijomllurirfr'a.r omphalocefes. SurgGynecolObstet1967i "l25: 837-50.
)
e
Xuuo
ruor'r'tq u rorjl 1s.r'tud
rurururnfi urfiuru1fnTr
!
fl:il
Vol.2 No. 1-2 !an.-Mar.,Apr.tun.
t9g5
J Prapokklao
HospCtinMed EducarCenter
25
1 3 . Dewar GA, BeatepG, Chappell
JS. Gastroschisis-the 1 5 . Schwaltzberg
SD, pokorny lVJ,McGill
place of stagedreductionby silastic
silo. S Afr J Surg
I 9 8 1 ;19 , 9 6 - 1
06.
"14. AaronsonlA, Eckstein
HB. The role of the silasticpros_
thesis in the managementof gastroschlsis.
Arch Surg
't971i'1"t2t297
-3O2.
CW,et al. Gas_
troschisis
and omphalocele.Am I Sure"l982;.l44t6SO4.
t 6 . Gierupl, OslenL, LundkvistK. Aspects
on the trearment of omphalocele
and
t"
crinicarexperie
n...z xinoui,l'rjilT*?i;
"'
rlJ;: "
26
2028
I:lnururan:silnrndr ild z qfufi r-z l.n.-i.n., tl.u'-i'tt'
11:d1:qudn1:dnurttnmusrtrnfn6fin
uvtst?'luYltdil
id nr::-nurdon:uonlflu?l1lotdou
<trv
rdutmru
{ iiuvn=nnvYr.u.'
Ab*nct
Couching
CheocharnViriYaluPPaM.D.*
*Departmentof Ophthalmology,PrapokklaoHospital,Chantaburi,Thailand'
J Prapokkloo Hosp Clin Med Educot Center 1985;2:2631'
for many thousandyears B'c''
couching or reclination belongsto the historic past of thc eye suEGry
and Thailand€tc' A lot
Cambodia
Burma,
as
India,
such
and is still practisedtoday by quecksin easterncountries,
couching which was done by
of
complications
serious
the
after
blind
patients
absolutely
became
of Thai c.taract
quacks,suchas infcctions, endophthalmitis,uveitis, retinal detachment,optic atrophy etc'
this papcr, the procedureof
The dctails of procedureof couching have been kept to be a sccrct. In
Thalland.
in
chantaburi,
quack.
lives
who
stepby step by a
couchingwasdemonstrated
quackswill not be a secret
The author hopes that, after this paper,the proceduresof couchingof Thai
any more,
illlu1
Couchingnto reclination6a i6nr:dr6'odo
nl r ontunfiulu: r nr ;d.riurto
$fufi t'{xnuilotdoutYil
'fiutd't6'tir*'r1trijul6nr:fnr*rdon:von
lqstfrr{iu
nirn r I n: vi Rctr(cornea)ufir 6oaan
ui ora.:finr um.:
(probe)fl ao
fi'ufi raf,.:ornfiufitfrrafinuvi.rilnrsilu
f,.lrirurad'l
la'lrJerrrugurunci'ilorufi'ror (lens)onudr\rJ
to{eRo1r
rJ:vT?nlutiluiltlo{n1ldt
couching
1uariulu:r ilfiuranrsfiuflriouois s otr:: v et.:
firJ:r ng a{tuu f,ngrul a .:t r r 6 u q1oufi :J: r I r! 6 o
' ihao"nry1nn
nryi
hunn anvtlnn dt o"u
(SusrutaSambita) 6lrfluri'nour^rvr6\ei
"a-agorv"
rir nr.lif, oti'uun:fn sr 6an:; onTosi6nt: vh couching
lriulrodr rrflufllud'uou
ruw\df,uvrooomruiEiorflo
fir:1ogiu'
rns fi rYCIur
Couchingfiu\oiraruotrJrrfrrlurJ:c
ftrrfirruruvrufi nulu
Iosfinr:hirfio6on:sondfi'un
arfioufr.:nlofruhiros
rJollufi i'nqunvr6arulraqirai
rririiinr:vh couchingtnu rfisluei'loiilu{rlrurafri
ornnr:r4rcouchinglrufir unlo:roilu'irrrfirerrld
a{luc rurafr.rta.lgnol (vitreouschamber)
ernn.:1r.1
riuuiouufir
e{r rafulurj : vt, d ti't fi'ot{cJur ril u oi'u'ir 6u rds
"
nrir ttrn uo;lvrs fi.lfinr:vhcouchinglosilr'arfiou
(quack)fi'uodtrurrldunrfl ilr ;i6nrr rutfluuto':nr:
T
fn Bt d'an: c onlu rJ: vrvra'lvrufi u1eififufi nfi ndr frI
Vof.2 No. 1-2 lan.-Mzr.,
Apr.-Jun.l9g5
J PrapokklaoHospClin Med EducatCenter
27
6.fl .ufo rnd(Dan BeachBradley)3 rflurra aIruT
ri.u
toiurrzus
urqjs1Ru1y{iaufr.ri'n:*rI: onrrfiofl u.fl . 237
I
I
do
tu:-snrnrmv!ryrdN16on?nh rnfirr6,roq'rir uaclsi.
tf l?ftff
'hifl
yirnr::-nurdantconlofl
lTufinnairrd.ridnr::-nur
t'ur'irur*n-tnfiar
'jrorrilunnylr
fnr rnarr,rrdrurirqr?urrirrrrm
couchingdruniokj rnsld.yl.tnr:
firru,lna"rar+imb'
rrtai
fn'rEr
nuriu'lddurfl
un*.ru:nrfiatufi s fi wr nrur^r.
e.
Sn$ihrrtr*:plr
rrf
r;
r*.r*
237B eir n:-ui 6nr::-nBr01'a
n: yonTosi.nu url{yt6uHu
rsuufi$riurrulriinrfrz rir mirrlm tt
rJol:iufru16'fi
rJrrngluriufinso.16
rc6rrilur^{fl
6Airu
sfur,furJ,,fi rcusnrifrruibi$nrnf,d
-,r- l*##l*lnn
:ufi rz il vr.a.z+ssrfiuulosu.yl.l4o?no,Jr?xfllfl0#
tl*n*tl* d
r.u. (o.t 1asq3lil) ndrr.irfinrraouir{.nujnartu f,rafr t'ui'1,
u rlnullnof *rrorr u+ru
finrumuritriin*rriru
rIl,iirurrrrrl#nsrfir r
fiuilfis$oyadrug
to rir riirr rr iir t,rrnlsnnnrirrrhni
ouairun6ufi ail:; rurruso-+ofl riaufiuloi.fi
rrr
sifl rr-il rilEirrui t,r I r$il1$*iilsrft
r^r
ilr urrflon nruui nr:fn ur oi'an: c onIosi fi nr: fi r
h iU lfitirrrrrIntrrt,rr,t,lt,]u,il'Iilfn UUfSU
eouching
r u n r 1u i r r r u i l r n n n o J o n rnol l r v r n r r * rxrrrliailurnulrin
rsfr*di
lorrda'irnlruffi16'ufr
uo,r'leifu
urorn6ur6u
rlopiu
rilqilaliifi
fiifi nr:fnr*r6'an:s
onloanruarfi
oufro.rrrr
rir nrs,[rJ
rru'lnrrrduu
fli t Tuiaaru
firnnnrotorrj:srnalms Iqsfrnr:drunaer
nrrrufdI
siarfio.rfiuadtrfluorr
rudu 6olrtfrnr:fn:*r6an:yon
Iouurua
rfioufiugnafi
ouuiluqraq6dnd'urtru:-:.r6.n\c raorr(refraction)ud'rnu.jrrfialfrs r riu.jurnuduu
'[rJ
q
ruundlosvTr
+ 10.0D (dioptre)ud'rsrrur:oto.:rfiu1d'
alalu
arnaqfi
rj'ilru'lrJfunr:fn
r*rIosnilarfroufrurru :sastnnTouhifl
srflorrdl I (astigmatism)
uo: rda
'ir:"ouor sota r{rJr afru
flnr: dn:*r oirrfi ,j.l$€ifi
u 1ri'sruu'iurau"f
uu * r s.oD rrfiaarrur:neirunrftfi a
rJ:rolflfia fosoyosrflJusrrurrracauuo:figruv
lu:rs;lnfi16'odr.:forru olln1u1Tattfl
ori6nr:dr
riautr.:6unyfaE,ny
oocrur:ndrueirfnr*r
1,000-3,ooo
couchingtri'i{:ro.rru'[oi'rirr:
:Jrurrs uoriru{cirulei.
:rrrqianr:inurilfi.ln*{n uonornfruuuardourirfi
rfluorirrd
nrl*:*r*rEir.i1ul6lrirrfiafrardu nr:rronurufo:
1ouyTr1'[:Jud'rnr: ri r couchingriuvlr riuorru
trfirur{lsurur rarf.rdafirur{
uorfitir6'qfiqofida :ir upi'ri?uu5ofr ul ar coucherTqu'lildorlfli'o iiir fio
nr: fq qljr fi'r:-n
urtrirars'lri
rarr3u *u o0.,od*uu il6ari'o.lacorofi rauayl: rau rfisr $eiunitfli
alfi a1u
" 1{ootd'nX.:{ilru6nd'rs (1rlid r) uannoaadzol uruil::trsx sourfi
rfioua-,r
fi " ulir t3'1
lf'eirJrsuou
1f nr::-nur6'on::onlors
Drua
riaufi{:rs.Jruld u{ra:tuuur6r!.s1{o1{coucherorduarjrirldl.r{.rJra
rJ:vs ul^r! rfiuuas'[d'drl : :Joirr 1 fi rir rur uno.r*[ifr u d'rur,6srfi'uorfiotrir
couchingrouororr.rdq,1
flau
loirurornurrn6rJ:; dr oir unvirurafi rtu o-.:
nr*ofu nui
nrutqi'nl ruitld'grtr dr r^lrn novesinui o ophtacain
6 rriruryiinld'trnrruf drur oorJ1
o1na?il il arfiaufiad ncrul n5tuounuao
mydriaticsrtiu mydriaticum
lun1.:unnr
6nr ooufir qrJ?1ro.lriy{yrdrJ:y
drEirua rudrld'rJr n6u (f orceps)6u cfr 6fi'ilu riJu ri'ou r6n,r
'[6'f
virufiuar fi unr::-n:gr6'an:: onI oao: * uardouu., urosn{ui rrat limbusun: u3iarunrroTrutemporal
ufi'r:J:vrurr*
ro fl
il:rng'lra'.rtrivrut:oun:n"fi'au
vir.:orn
limbusrj:yrurrx+ ruru.
aririjurrnruru:J:villil
ul:-Jrou1
(complication)u0natnfiurf,
orf.lru
lru\6'r{.rn1tio ro urfi l0fllfrfrilfrdr"r6iu"
limbus
{:ranu
1l
28
qfufi r-z ru.n.-i.n', ttt'tl'-i'u' zo2a
flra n€n6fin J: sllururail:cilnrndr ihi z
11:d'l: ludnl: f,nurttvtvtu
e. Arterial clamP
rtfr finr: dnsroso'l
6o'irnr:u'lot4io " ldu" fiun.:vi
a. lufiorjarulutuo{ ts
zondesdrs tt{:rcurrn*{osvlrtfrufirqrslnnrhjlu
s. n::t[n:
lu
e:uufi.:to.rqnorldro$os\rifio'lr1,ro:\:qiatrJ6n
o. tufiniloruilu
1orsfi " triu" o{fiurfio{rlraidntr unvriruorlflrud
nr:rirld arterialclamp6'u1ufioruo{15viln
uu
roi":lfiolfirsl6
ufir (pupildilate)coucherfiovrrvr
qrnilnrufinil:;Mma ruru.
1pJfia; filfirfiaf,rlfrtufio
Hd'ruao.:\rJoio\rJ
finrfiun'jrnl rufiolnr: Ioflfid nrulon arterial
fiu td rrwqnerr
couching
drufutnio.:fiad1f,lunr:vtt
zol uru sourfi uncfirrfio'[fr clamp rilufirnruqru(guarding)
udtiluuannoaod
^slo
ls lid retractor rrfrrldfiqfi tqis il'[{un'la':\rJ
nr:
lrndi4r{rtru'[rifi
raitoi'tvirfiu
r,jrvirfi
a: orodrun
rdrlnrnlimbusrj:rurar + ruru'
6lriluuirrrupars plana(plid a unr s) uinr*fr
rfl u ui rr rudfiu ooo16oofi osn'jr ui rr nr6u 1 virld'fr
uitrsu g.oourfinr
l4oufilornnnvh couching
idnrrrir Couching
r. Lid retractor (lid sPeculum)
nrs
rdaqaanfiaun'jrriru6u6i$urtopiufinr:nird'q
luqneri(intraocularsurgery)ul{xf,q trju nlitor
z. Tooth forcePs
errooR(removeintraocular
fi ,:uilnnrlnorufioqiluqn
(3rjfiz)
tnio.rfiofitftunurlr couching
gild z rn:'aularlx1 ililunnflt
couclans
grtdr rranr?innuntTuinatuit?otpn phw
il
i 1r-" ild' r.
,8.
]i.,r
1Jds uantd;rnnlfa*erialclampo-u\ufinuofrc i:uon
ilnwfiniltvatun uu.
#H'
n:
pars
pbnaoufinfr$Jntu
unfiuftnrtnrl,
lrfds uanrnrr
Vol. 2 No. 1-2 lan,-Mar.,
Apr.-Jun.19g5
grJiio rranua"vn
n aanTdm
Fnilan uuntMaafiFtfi
uwli
I PrapokklaoHospClin Med EducarCenrer
29
1rlfis lanr?rifruil atalarmdntJan xui fi t zwrtin nt
rra anLd
m6nila tauu
6nnit"lilutnni rytlfi o
1ildz rranrn
foreign body) nua.tlleiflritfiofinlr6n ru pars plana
rriutdurfiu(p.lfi + rnr 5)
rad'ror nld'flo r yrr n.i'[il$d'rfioyi u 6.:aonr d'?
116e uannnTttUntumunflnnnurhnt
rn.rd'rfluu6nilorililunril'rorrfiofiufi
(3r1fio unr 7)
uyr.t
ril finil n1uruur.iI u uirl:Jf .:rafrr il r u or (iris)
rusiaddrunfitsiaufiror
ouuiu:Jorgna
6nINrirnf,lu3rrtu
rual 18ooour4uoloonilil6r tun:drtiudocfirlfi'
l t A
Tillual (pupil) (?ilfi 8 uov s)
fr'il'lslo.lriutriforourvirfi
n?:unyntoydnrflLil1RR.i1
r rn5orl'ufi ry'rJra
rafi'.:vi
fio: anrlruo:tn u.junrsmrnud
tf:Jarsna6nnounvilrouri'rErrtrlvrr.reiru,n
frs uuil:;rurru+roD firfliill\{udr
ry'rhafio:rua.rrfiu
forTufirilufil ro1oiln:ru d,:rflu6flimsrfi'nfirnlru
urfrnr'lilf,.ro.oourfinr ou$rirnrnnnl'l:Jlusru afn orlri'uri{r-huuw ryr 6dfisiocoucherq rii $u\r.J
r fr.:tolgn enrs5oud'ri rd { ry 6naanri}rfi (1rJfi r o) 5n roilu:rad ruor'[rirrlufioyfinr: dr.:urErzu
neir.r
1 ur 1
Coucherloi'rrirlri'{:ra
rflu6'u'irra'u:J:vsrrnnrtro uiolrh*u:J:rnruto.t
{rilfl {sialildn6rn: dd
vir couchingud'r:i.rrdq fin1:tt$nr o.: Ienseapsule una.:uriau unvfi\ri6opironraioririnur ueirj:ynr:10
rfis'irrflun:t rurrirsfi.:'[i1ild
6.rvir u{'fr ri aR'j1 " 0.:1ru or " fioy yir nr: oooanoirs riilrara.:fi6o
rurrroirrh
(posterior)rroyn,:eir.l(inferior) ot ilri 1u14
u.J 12.oo
n:vuanderur
(syringe)1oild. Aoilsrrleilurdudosr r,lrsriou
tl
l:{nururail:srJnrndr iJfiz qfufi r-i u.n.-i.n., ru.u.-i.tl.zsz8
11:d1:(udn1:f,ncruilyruaranfndrjn
30
fiira .ttara tfiauto.t n'lrruhi:J:cdnlunt vlruo:nl ui
rdrnfi'u6 a.florI: nnr'tri61{o fi t rradrdvirlfi'rfioT'ln
uvnndounfrlntilr couching\dadrlrurnura niu
nr:6or4ol'ln,endophthalmitis,dafiu (glaucoma),
oonlilqo (retinal detachment), rfioooanluiuerr
(retinal
(vitreoushemorrhage),rfioooantuoonl
hemorrhage)unvil'lvnrflnrrdaru(optic atrophy)
osfiotuaoflfi ilr,5
udrluf4qory'r-lesfi
T
urhntlrin n1il a{ du n ait
Erliiro marn 7fiJat w armdnnnn-u
targnn't
ior:oi
oRlosil
ilarfioufrutflu?6f4
if nr:fnur6'an:Y
q\rirfinWurrilutrnruruvrnrgfiuf
a
5
o
0
tf
onuuv{na$r.rlrlJ
rlsuiourfir
couching
ufi.rorn{rhaldfunr:vh
luu
lrH6aaqi
ilotilluil: srr sfifierurufir rreia'.rn
coucherfio: nduhj rrf orufr.:f .rrtrr:-uil: ; nrut o.r unct6'u
uenreirrl rdu nry fin {'.: rl rfia un:'[:i riludu lurhcrnsfidrfr.:r{eturrdu lvrs 6urdu un;r'{ilr
uvruvlntfio{rfiuufio'lrnr rijrrdu
a1Jufrr{rJrad'o.rlnorur:
ntvrorlo1luiifl l n.:n u{rh ofi
dr ufuturJ:vuvr
ovrilunr:frrru{rJtrl{rf,of,orfi'unr:finxaro'uo
rd'r
to.r fi'rrafi.rrlrnr:fnsrufird:curr*
coucher
z-slu td'funr:fnurlasi6'fiufi'ltfionrrvuvt:ndoutuofn
X
I
etr
^
a
^
rvr6lul:
rilsrurntfluil:tdr,{ilra
rirhutfiofinr: 6ot6oodrquu: r tdu endophthalmitis nr:fnumrn6'nquu
fi {fi\dfi
ur.nrudo
lgnr.irit'oolnrarqnqroan\ilfi
fi rbi'ro.rtilrfiuufir {rJmlrJnu coucherfiovldfu
vr:rnlua1RR1rRri f r duhis ruertt dfi6urith u
nl ruv1
drdr.:'irrrr:rr'lilfuilTvynulro.:ttn
a\:ilr6,rv1r1r{rua
nr1
l
'lilrriu
un:: rruart:rtarfilil fifrvir\ilfi.:nr:ni soilflov611{snunvvrir^r6fiu
{ilrafi6olvrufirroyjrrfl
:*ror{orfirfludan:von
futj'lgnruto.:llfi n.i rdo couche,vlrnrtl-nurtaSo druruunrfialfr''leifunr:fn
ovt6'fi
lrfiuud'lorn
Ionrsrua
rrfirfiosfinnfiu6iuranraio " fior'r1"ro ryiruoror:6 rouiln?'1ru14?.:osr.ru.:yi
6r1*n*ruradr.:srusu'ii
I
({:urmufi'ucoucher
flnnurflufisdfiuronuiafiosl
nrtfnur fi.dr*:lt, a.:t6a
qi':-u
"tn
torviruoror:6fr
rnlo) ilrvirnr:dourkanamycin nr: Is :*rurunsnr: n: vvl oouruotdoufiufifi1
dfrrmfio.rodr
ro3r i'r d'rfilrnr:
tri'funsr-z rfiruqn{u unvlri'chloramphenicolRfimuqilcrnr{rrafir
sflr rta.t6'o
1frnrrdnurvrr
rEiruarrr:arqltdarrYuo:
2 unilXn fuil:rrru s rrnrufi.tarullounru
z lu
qe
vr,
f
"l
o; da.riirrrlfruri
\rJ lqutolnstrrtuunfi
rirur{rJru
fi u6ronnt ln; 1o0-2ooulyr n:von-tr{urirhrtrtur{':1
rufirueiosnnrianrfiurflu:ru1'[r.l
r u d.:Hnrd at at nrr :-nu r 6'a
td':-unr: 6 nrci riasn[ai'm:
nr:uil.rc:::rsldornnr:v1r
urlou
couching
: yra'ir
I
n'lconlouifira ru ruat6ou unv{adra.:nr:fn
U
I
v
c
6
tfi
d
da
a
f
al
c&
"a'r{1:6"fiu "figdraR"tlng"ilf1fir" tfluoYrd 6a
aruurnorriunrfiuorngidrfl
n*.:ns3,ooo4,oooulyl
"fi 1i'1
fil" oy16'soo-r,oooulyr rriurdgrflu" fi u6ron"
srufi rn6orflula { "yi1uo1nr:6"
nlr Iril:ndouniifunu:-nurslon:vonlflufluordou
tdor ornnrrrun: arotriufisorn
uru.:,odu.:fiounv
f
-t
d
,'
nr:airfio6'an::ontor {n qunrndur.ruilo
1l1u :r r,fr.r
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Vol. 2 No. 1.2 Jan.-Mar.,
Apr.-run. 1985
d+fl r*i6fi rrau1yn ilriun: fid'reio\rjti
J PrapokklaoHospClln Med EducatCenter
3l
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. Stallard HB. Eye surgery.5th ed. Bristol: John Wright,
1976:617-8.
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. inrrcion: vonlour lor6ou. unlufl nld 1: 2b24; lo z258-64.
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5. ritqri uriunlin, rldn do:r1fr, 6:rlr nrqourior6. nttv
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nraE nailnau n.u."
Abstract Oral TraumaTo ThePreschool
Child
KalanKlunklin O.D.S.*
*Departmentof Dentistry,PrapokklaoHospital,Chantaburi,Thalland.
l PropohklooHosp Ciln Med Educot Center 19gS;2t32-38.
Oraltraumaoccuringtothepreschoolchlldrenisoneofthemostcompllcetingdcntalp?oblems.
Successfu!treatment needsco-operetionof the child's parent rDd also consultation betweenthc dcnti3ts,maxillo-facial
surgeorisandneurosurgeons.
Conservativetreatmentofthetraumatizedtilethisgtilladvisod.
However,if pre*rvation of the teeth is considcredto giveunsatisfactoryresult, extraction of them shoutd be p*formed,
rfiarfiannuroriuurirdnufirfiodrfityfinrr:
n:vrirfi6o nr:ilsrsrilofursuriiorur:orro
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riouiuri uu 6.ruonrn:fi rfi'urfio
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yrn6lnu rfi01fr'Hntornr::-nurdunyrrqrf
r0{6ud.:
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(maxillo- nr:h{r{l ruvriluifrerrlr:srroi{l
facialsurgeon) trngil:yarndauuyin6
(neurosurfnovflnr:rTo
rd.:rTurn
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geon)
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runr:usnrdnornfiorrur:orraiahi uoifi'r
Vol. 2 No.'l-2 Jan.-Mar.,
Apr.-Jun.1985
HospClin Med EducarCenter
I Prapokklao
33
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J PrapokktaoHospClin Med EducatCenter
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HospClin Med EducatCenter
J Prapokklao
Apr,-Jun.1985
Vol.2 No. 1-2 lan.-Mar.,
37
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l:rnflrurail:cilnrndr ilrdz qdufi r-z r.n.-i.n., ul.u.-i.u. zrzs
rondr:dt{6.1
North Am I 982;26:461-80.
l. Camp JH. Current therapy in dentistry.Vol 7. Saint 4. ClementJH. Oral traumato the preschoolchild. Dent
Louis:The CV Mosby,1976.
Clin North Am 1984;28:177-88.
2. Andresen JO. Traumatic injury of the teeth. lst ed. 5. Sidney BF. ClinicalPedodontics.
4th ed. Philadelphia:
Copenhagen:
Munksgaard,
1972.
W B S a u n d e r1,9 8 3 .
3. Levine N. Iniury to the primary dentition. Dent Clin
Apr,-Jun.1985
Vol.2 No. 1-2 lan.-Mar.,
j Prapokklao Hosp Clin Med Educat Center
39
uiln?'lurilu?{'r
d6l
ilo{Ifion luon tl{l?lu{lttovfll: ttnun ?11
aru#ndfi-u1l:T: Yl.u.*
Abstract
Another Faceof Shock to Look at and How to Manage
M.D. FACSFICS FRCST*
SomsakdiDhanvarachorn
Thailand.
*Departmentof Surgery,ChaoPhrayaApai BhubeiHospital,Praieanburi,
1985i2139-53'
Center
Educat
Med
Clin
J Propo*hloo Hosp
perfusioncausingcellularhypoxiaand anaeroShock has beendefinedas a state of inadequatetissue
as in the caseof septicshock,cellularhypoxia is a resultof dlsorderedcellularmetabo'
bic metabolism.Sometimes,
regulating
event. Takinginto accountthe variousparamcters
tism with increasedtissueperfusionasa compensatory
to maintain adequatetissueperf$ion. Success'
cardiacoutput and blood pressure,one can use different strategies
as well as measures
to maintain
ful treatment dependson prompt recognitionand treatm€ntof underlyingcilus€'
and specific
Detailsin pathophysiology
adequateflow to vital organswhile awaitingthe resultof specifictreatment.
been
discussed'
have
of
shock
various
types
of
treatment
nnvf anfi6a n'r?r
o;rfiul6"irfirla16onluuifl
rir,irfionrtilto{ "64fl" urjfiuuhj rdou6lq1ru
rro'irGru
[tl,iYl6 firrarnr{rlon n'[nto.:60n rroornr:odrtrduut^{fi'ud:roiurqndduro.:
n?1uIo; ryrto.rexlR1T
rilil n6
ilarrur:nqI dorfiao'[6'0
rurnfrurvirfiu 6o'jrf anrfioornrl'r1o\
n.:'[:J
rlr 6rfi'oenrrufrd.:rrjdsurtrj
rurnrvir'['r
firrfr'03.:a
qjfi: : d'urt n6 tir6rfi'onl ru'
p1ufirltyrar
a'irnrrr6oo6o nnvdorrrud'urfiooruei:10
riruirvtt.:nfifinfi
R1:$nval Rlrttffo{la.:tfro ta i6an6+rJ6uu1il ndrr6orrJduu'lilrflu cardiogenic
ot i r r:ti'uar
nt 1Afiti'tei'.r
o 6 oo"',,qr't. u",t',o shockrrnvhypovolemicshockfizuadurdorltorn
rfru{ tfiu.:1'{
rdooir.:1 trifi r6oo'trl
oootfiaouoo*r di.uo rrovnr: d rt nd
ffl r I eir.r1 ru:.:oi'ufiaqjluu
t . nr:rlr s.:aan8tau or nrJao'[:Ju-.la
nrfia.ru',o"'oo'trd* u L\il nti uu
tfiaoaofia0a"l u oaon6roufirfluzu
\rinis.lno raiafi6onr:'[un16uurro.:
lun:do:.:fi'udrilsepticshockfrunudt
ta.:rdorfia'lrisru: ald'oon6tou firurnr
z. rqn6Eir.:'1
oovrurniu rroi
u'[:JorililnGraioar
nr:'[ranrisufi.:rfl
\6'
nrrrf anrfiqornrt o6'[il4r rur:alfo an6rouloi
,ilu taann
u It tuutn adtntYn ofu0tufl,k tdurp
CI.1
t:JduuuU
ur ir riJudo.trtittonr:
Rn?rn$e.lufR
40
?t:ltr:fiu6nr:dnrtunnoflrcn{n6rin
J:snururofl:cilnrndr ild g rfufi r-s u.n.-i.n., ur.u.-i.u.zsza
firfio6u1u:suu'lra
nriuu6rerrur:nuri.:nrlcfonaon6rfi:JfrfiSurera
unfi'ud'rsni:r{
r1frn-r1o
rd'urfa{urfio
rflu s :so-u oi'roiohlii
(1ilidr )
lfrnlrud'urfiaoorfi
:vsr"uI
:yo-uRrrruo-urfioorfl
uHaflBrra.:
rcai'rrfi
s drururfioofi'oonornr{rlousinso*
Z
,-
cardiac output l[ng systemic vascular resistance
iiuoUti'Uventricular preload,
nr r roi'urfiooeir fiufinr rl qrurornrdaofi'aonorntirlo
load un: intrinsic myocardial contractility
ventricular after
snil
non.: (depressionin cardiac output) raSou:r6'ru vrqufllo.: Frank-straling rfioofi'oo nornrfrlo usinv
nruluu ooo16oonru:Jnrsnodl o.l (Iossof systemic t'.rur vrduo: dr or riu6ardoofi'oanornr{r1ounvnrrn
vascular resistance)
d'urfioosir n.:daurfiodulrurd preloadfiudr raioqr
ovfl u: r d'ruyrrutun naorfiaoar url nr ud.''uou..,o1 rurn1
(1Jfiz)lsrdurolfirloB.:6od"lrurnrvirtorfio
$nt'ir.:nru
fiil frfiiurero:Ln
d'urfiolf'nrrruoiurfi
aorilnG : cururlo onrsCi'r
16ilfi fioyBrrirtrfr{rururdaofiaon
loufirdaoaonornrirlorurniu
arulu cardiogenicornrirlolu uoiw 6'rursrduB'.r
lr niu rvirfiu ouorr rio
shockunyhypovolemic
shockfiurdaooontrnfi'rlo 6r eofidrfils rfuro.:ndrrurfrarirlo 6 un: r ndruru
noa.:un:irrnrufirlfifi3urerounfrulounr: rdrtu: r6'ru tdaofioonornrirloovnfiunonr
(1oC) ur:r:q:fru
nruluuooo16oosruilnru
trwd:::ru:-hyaryrd'o1uffi
fi'r preload unt afterload o.:fi rt:,:dotalvtr'looy
6 rur'rr rr 6ovl",oruu'ro6urrn: dr .:nrr u d.:fl 1: cathe- frufiunrttaofirrua{firtolouor.r
6.:rrfi'irut.:dota.rrl'r1o
cholamines
u"'o6t lu{rJrln{r:rad'rdo;nu.jrorri
ovloldeioutr
r6rurnluoruusftuyrr.:nfi
f,ny{oarfr.trnql
rururrn:rrfnrfluirunsrf,udrulun{ru:nnrild'r 16"jr firrirlofinl ru6-urfl
orartonnradi'rqonrd ufir
a
&
4
- q
e
tu
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aiou
rnooovaRiloa0Ril1Rllun1fl?
t0gnnTr
0luo?ug'1
inotvsiuz rdaErfi
aonornr{rtodruruilrRliorJ
tropicdrugs(1oB tilfli1oD)
afterload
nrurn
I
6uoqifi'unlrurirlani'rlo
(heartrate)un:druru fi.ou:.raofi
rirlofr'a.:dralir
r or6'orfirfiosiadrufiuu:.:
tfioofioanornrarloueio: o*.1(stroke
volume)firlo 6'rurrulo.:unoo16o
orro.: rr:r dofror n.:6uvriol rTr.r
q oyvirlfr nrrrud'urfioodrtdryrrly finlrud'uluraoao16oo
fi rduriruiafrrrurn
uoilnqjlrwrirloonrs6'rs
riu
6rururdoofi
oonornfirlofiou
or riryfulun:dlo r t*ano'tofrti'rlofra.r"frra
rixfi orlraqifiurriufr'u fir precardiogenic
shocknrururnuavhypovolemicshock loadunvcontractility
arjnlddrururfioodqan
orn
ur.::u 16oodo
anornri'rlonon,l rynrydrururfiaofi rleloluuoins6'{nr crd'uo; rfl urJ nr ernd'un-urirr a.r
fi
aanornu-rlouoinvn*,lujfiuuuil nrlun r onono i r.:nra afterload rn:rsacfrufirorrld'uluunaor6aouo.l
d'lfiradr$u septic shock
,
,;
,
Blood
Pressure
1{6t
Regulation oJ blood pressure
q
e
Vol. 2 No. 1-2 lan.-Mar.,
Apr.-Jun.1985
HospClin Med EducatCenter
I Prapokklao
lraqjraio afterloadoonI 6rururdoofioanolnu-xto ta.rrirlo (contractility) oonl
lurrsiay6'rHrs rduoyennfru rn:tuilr Jor.:ri'urir
ru6'r u1flflu
4l
u6o afterload rfi't
tfiaodoanornrXrlouoinynr*rnon.: r*ufi6an?1
tunr:fnurnrryf onfiufiarilnlu6tdi'rdcrlr: n
ild'urfioo
qqlnpreloadoofln eionr:uod'x tfit myocardial oxygen consumption (MVO2) \6'
oitnl ernaqlarorfi
il1n cirilfu MVOa orfiuoqjfi'lpreload, afterload,
contractility Inyox1il15?Tolrirto oirro.lMVO'
oyrurndufi'ru:.rEi'u
nrslufirtori'a.:dr
u6ir.J
r:rndu ncir':
a
A
I
u
r't
da
o
0nrltlfiilJnoapreload,
o
unyotl ilri rrrolrXrlord un n6ur*uror eirra.:MVO'
E
:
o
J
afterload,
fl1ur:nehu?ruteinirr1nr{n6f,n
o
(n
lollf'Haonnror
n?lil6'ur6oofi'Ln?1il r5?ro.lti'?10
lSBf x HR : Double product, SBP-systolic blood pressure,HR -
Preload--+
-[utrirur
heart rate) 6.:f,rJ'lr
ntunr: rir u?al{lrI ri1Ta.:
MVO2'lurrxyd rir nr:fn :*r{:-lr l aqj'jr rfi ru6
uut ooo
-io,t
Cuwe I
Increasedcontractility causedby digitalis, betasympathomimeticdrugs,calcium
CurueII Normal heart.
A--->8,
stroke volume increasedwith an increasein preload;
heart overloadcd,further increasein
B---X,
preloadcausesreduction in stroke volume
CurveIII Depressedcontractllity causedby ischaemia,acidosis/hypoxia,myocardialdepressant
factor
;.rlfi z fle
contractility
Frank-Starlingcuroe and contractilit1
nsr,fiiJstql
;^
r.loylrRoRlu14d{ nl ?t6 ofltuL 1.tuvi{ ri un.j.l -t.ia:
6an (shockcycle)6.:fl{uoraufi'
rfioduA.:
oialld 1pl
^'
Y r3 )
n?I il d'ur6oooir or no r rn qlo fiErr ruov riJue.t0ti.t
rou u{rdrad'nto
tfr'rtodeirr 1 l1erooRfi
rrqn66onr:
eaJ
Intravascu
larVolume0 ecreased
Permeability
Increased
Membrane
Metabolic
By- Products:
Lacticacid
Factor
Myocardial
Depresant
Endogenous
Catecholamines
Adenine
Nucleotides
:rJfrg rh" shockcgcle
1:uurrrau:vrjnrndrlJfiz qfufi r-z u.n.-i.n.,tu.u.-i.u.zrza
2r:d1:f,udnr:dnurunnusrasr€nfifin
42
ffftl adenosinetriphosphate (ATP) 6l6rrfludo.l
{nfiflnir ufira
*asqorRr'tYt1
{onnrr orqnl ru6'ut6oo
lun:fifitrifiuiolrqoan6rounr
fioan6rouoqi6'ru
e.r
nr q fi eior1d'
[r.,n
il arq or n r: ovgnril 6uu a'lRR'lrri.,r'r
(nr:r.:fr
r)
lil riluni: tmruni rg
oon6rou(aerobicmetabolism)
iu
'o
nr::-nurr$or duuovnr:6oorruf,ihu
qe
rfiofi6anrfi
oduovoiari lfn l*rdaunrrifioo-s
nfl'ilfrrf,siin'ld w fio.liuilo$'u
ffMIo!rv{:t1t
m?s6o
u.nHnrtyr:.lduuornnriuoulooonlt6flu
1frrumo.:nr:
riruflun;ounn6n(lacticacid)d.:ocriourniulu tillfrfrrjrsnnodturro:6on 6rosr4rbinrr:6antil
srrur:on6'udu\d6un'ir irreversibleshock
irrnru 6nrl:snr:nfi.:fi6onr:finrruqiurfioonodr
nr:fi or: anfi.:crrr1 rrjduuuiln.:lar preload,
aolrtfi: rur.nhvarvrdnlufi66
ilt^{r
m6nvirlruuniu
drrflunravirlf'r11ofi
r6nriouun;rfrr'lsuu afterload, contractility uwnrrrutfulaor[l1oo;
unao16oo
.) nr u: nu an'[6'nd
rr 1 6r er tuqt o.:6on$nsf,.:n r u: n
ranaorrfiaordasflnr: nod'r virbi'nr: rir aan6rou'[:Jf,
ornrn.t
rtn6aofiosn.:Hnfi6on:ouan6nun:n:o6u1
niu 1f6onrrurunnr:fnureira'jrrtrlri{rl':a66uui
rur:onr\qiornnr:{'u6no:
nl ru15mo.:rir1osr
adeninenucleotides
fi rfi rudrurufiua rir r rurnovvir
oir.r
lf'q nraurl6to.:rooordaorJos'[unr:s
orulfr'ar:
1 ntonr:f,.:ntr6'utolfr'rlo preloadoornnlld'u
jugular afterload6anll6'runru
6uniru(capillary
permeability;
rdu'[:Jrlrfiosdl turanaordaoeir
orn:vr uuhnri aulil rirliovi r .::r ra'ir I rsn6firi un'ir oionlltunrisu 6rcirorq'rfilnnaotfiaauoCt'run1
{o6fin rirraft contractility
Third spaceloss{i.rrirlri'firlu: vuu'[uatiail aoaJ lnahor:rurarRr:trfl
o.tvl'l
6aqnr:
r*udapreloadooor uuorroflorruonGnfrfifir*eio
to rnrlofiuotdurnfiqo ueifiri'*nsr'[d.ir0fi
ndr tfludu
nfirrurflari'rtovirlfr'nr: uosi'rnon.: runfi6ar4rtfr'nnv n:cyruro.:firloqiovnr.:onlognr:
r{rrrrrrflu:lo{'trfi1filrrir
6anrarnilrJ6nourflur,ro:drisn'irr.ro:6an
rfia
ovrriutfi'irfi .lrlrundn
cardiac
rfiorr a:{ anufir Hnfiorililrnruud'.J
fi6orsn6row rua.: cardiacoutput fi .rdu 6ni6rafinro.:fl1T1r1
q fioyrdurarirfi\rjfi
d'u\o uoroirnv6u
lraruo
outputfi6o eitnlru unRgirfiJo.roon6
tnulurfioounr
luvrrrEirun6fi
narrur:err:runrryf
sYollnia'lil
nioqorndr
anorirl.iro
1 *avtfiaodroir.rr1urfiu
Iosnr:50oarruo'urfi
rururnlftodusuusirias lO.rn:o$Bnnotutnootto{q{ i6snvlrsoorn{ruru
aod.ra
n*.:rirfi\6'uonoir.rornrir
nrrruoi'udiolqu
o'r.:or
nnrulu rlas trrfi noeirn,l loufirirta r osmolalitv{.r ucificir
a;A
unoordaouor.:
firfirflurn:ry'irlurr*ydrfio6onfiuTorr[grdslilsir
(ertr.:fi z)
unaordaoeir.:
d'r virlfr'nr:rdlrfis.:
Lurruvfifir fi'{u1fl
1tilqro.16onnr:nua{rJruhi'
1 o{lunrrrrao
Korotkoffsounds
fioilnfi'hjtd 6'.:frunr:ifi
odunrry frnrrrud'urfi
ooodr.:rios
zo-eouu.il:avro:6'a.::J
fr136
fi lildo olfa an6 t ou (anaerobic metabolism) o:tl r
qual
aia
IU
t
Ei.
-
c
afl
.l e
sfr:rifi r Essentialcomponmts Jor the diagnosisoJ shock
1.
Quantitativecriteria
falls below90 mmHgsystolicblood pressure
or a fall of 30 - 40 mmHgfrorn previously
Bloodpressure
recordedlevels
2.
Evidenceof low perfusion
Cerebralblood flow decreased
Renalblood flow decreased
Peripheralblood flow decreased
Obtundation/restlessness
Oliguria
Cool mottledperiphery(exceptin SepticShock)
ll
Vof.2 No.'l-2 lan.-Mar.,
Apr.-Jun.1985
HospClin Med EducatCenter
I Prapokklao
43
nffufi z .An indirec't assessment
oJ sEstemicJlou
Measure
Variable
lmprovedCardiacOutput
Decreased
CardiacOutput
Blood pressure
Increased
Decreased
Heart rate
(A-V) 02 content
Decreased
I ncreased
Narrows
Widens
Arterial lactate
Urinesodium
Decreased
I ncreased
Higher
Urine/serum
osmolality ratio
Lower
Lower
Higher
nrirrdonmror: blood gases, SGOT,
Rlrfn:rt
O.lU
1. 6l:su un1g101fr
urilo'ir{rl r a\oi':*u
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Apr.-Jun.1985
J PrapokklaoHospClln Med EducatCenter
45
nlt1.li 4 TechniqueJor monitoring shock
lndex
Method
Comment
BLOODPRESSURE
posturaldrop
Pulsepressure,
Sphygmomanometer,
doppler,
intraarterial
Widepulsepressure
in sepsis;
orthostaticdrop = volume depletion
HEART RATE
Palpation, osciIloscope
Sinustachycardiausually( 150 beats/
min; if > 150 considerprimarytachyarrythmia
F I L L I N GP R E S S U R E
Preload
CVP, PCWP(Swan-Ganzcatheter) Giant V wavein mitral insufficiency;
sequentialchangebetter indication of
effect of therapy
CARDIACOUTPUT
Fick principle,dye dilution,
thermodilu tion, radionuclide
4ngiography
High CO is typical of sepsis
ARTERIAL BLOODGASES Arterial, capillary
Capillarygasmay be misleadingwith
vasoconstrictionor with BP drop
CENTRALVENOUSGASES Via Swan-Ganz,via CVP
Centralvenous02 saturationvaries
directly with CO over short periodsof
observation
U R I N EO U T P U T
urine/serum
Urinesodium,
osmolality
f ndwelling calheter
CO drop = renal blood flow drop
= urinedrop (( 30 ml/hr) = urine
Na drop (< 20 mEq/l); u/s osmolality
ratio ) 2.1)
ARTERIALLACTATE
Biochemistry
Up with poor microcirculatoryperfusion= prognosisindex
DERIVEDINDEX
FORMULA
1. Arterial02 content
2. Venous
02 content
02 contentgradient
3. Arterial-venous
4. Fickprinciple
A. %saturation(Hbx1.39)+g.gg3PaO2(vo1%)
B- %nturation (Hbxl .39)+g.gg3 PvO2(vol.%)
FormulaA-FormulaB
Flow (CO) = oxygenconsumption/arterial-venous
02 content
gradient
+ diastolic(mmHg)
1/3 (putsepressure)
BP CVP x 80 (dynes.sec.cm-s/m2)
5. Meanbloodpressure
resistance
index
vascular
6. Systemic
index
vascular
resistance
7. Pulmonary
cl
PA - PCWPx 80 (dynes.sec.cm-s/m2)
ct
CI
8. Strokevolumeindex
Y-x 1000 hYbeatlm2)
I
tl
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oun'iroyrrr6aot6'firpi:,lrsdoilrn
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orurdaoari:yu'ir,r
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r]ssrryosfiilriilnG ovfinr:rTlilcfl'llrooRUrnouhypovolemicshockorov1r1fr
rfio myocardialdepres-
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or
sion 6.:riluHndurfioI ruto'tfl subendocardial
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riouf,tJfli
n:vfunryfllstiaun.r
+. PaOq,fiudu
2. Intubation with or without ventilation
uot intrapulmonary shunt
nauo$41fi'
PaO2qrn'h osr:t.rJ:oyrd'runr:1fr'aan-
Vol.2 No. 1-2 lan.-Mar.,Apr.-fun. 1985
HospClin Med EducatCenter
I Prapokklao
47
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index)
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nl?; septicshockrfiqiutda.:ornotlrufio:Jnfi
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l. ilqnrriol corticosteroidsfi.:fiaorilei'lri
rurifor
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fr rJol fuii r{ia.irtury'r-h
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Vol.2 No.'l-2 Jan.-Mar.,
Apr.-Jun.1985
vt,i
HospClin Med EducatCenter 49
J Prapokklao
|
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y
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ui o\ri nairrfio
l-
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orofir,r-rlo
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lf pacem
aker cirutuntilfi u'rtordu15rlflfr rrryi o
rudhifinrr y:-luor', ud'rti'' d'snroruor frilr r r,rnrfasov 60
z. fir{rJ'lafin1?yilaou?ild'nrlr:rru6'rl
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pcwp
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fi
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echocardiogram,
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outputI
Cardiac
BloodpresursI
hypoxia
acidosis,
Metabolic
factor
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yii
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afterload,
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t
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PRIIIARY TREATmEITIT l.
2.
3.
4.
5.
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if no pulmonrryodemr;doprmimil odrma
Fluidchallenge
lf shockpenirtr: homodynrnicnonitoring
G R O U2P
= diutrticr,morphiil,nitroglycorin0
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= 6oom'n.U- l5 mcg/kg/min
to incrsmcontrsctitity
nitropruside
afiorlord= phontolEmino.
to raduca
G R O U IP
lf PCVP< 18colloidfluid chrlhngs
to increo prrload:250plumaovcr20 - 30 min
Ii,PfiOVEiIEIIT
I
f
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monitoring I
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@
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I
lerion,
t ntt-t t"*trs'..ily correctoble I
pullstion
balloon
intr.ao.tic
I
I
I
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0t1f1{fi 5 Catses oJ cardiogenic shock
finr:rrl'asuurja.ru6o'[rifirlun:dti'lrifinr:ujduu
a
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2.
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6.
7.
8.
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Tachy-arrhythmiasor brady-arrhythmias
End-stage(severe)congestive-ischemic
cardio"
myopathy
:J3iliillqrduillurJasrrvundu rimar urine/serum
osmolalitvratio oodrnr rirta.:aan6roulur6oqr
t
A
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uo.0q,nu n1nl1il$q
r f,un:gcirg
unvdlno6lnn o'lR'Dn:r?unrtrlnlrion'l
9.
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onn{ uani1ndn1?sil
oerurudrril n?'rasfiosn.rnia
nrg'[rj
I
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: vuu\raorluurfrr'lrjf,.:ua
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srurJnrs rfiald'rro
r uanruri{rjruudrfio.rff
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outputld'loanr:
lndfio'irCVP, n?lilrfmarf'rl0.rfis.ruarrlrlurda rr{rjl,o.Jlun?[u ru?srJulfi nriflil fi,:ufi'ir$'{fl
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Vof.2 No.'l-2 lan,-Mar.,
Apr.-Jun.1985
J PrapokklaoHospClin Med EducatCenter
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sailfu nitlf Ringer'slactateraiannradr Tos1ri1u 16' ueida.rrir oirsn?rr,J:
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qd\ri\d'rfi
fi6nr:f i'ta.sr14
fl1dfi
u MVos ueiorir r1o Tulollo{U'l inotropic drugs a,:'[6'
rvr:rsoyfru6reiaurir.rrjnaofiul^{osunlT
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n6o luu noor6oonr urj nrrLnosir n.:unyfiruarur nn onr: oia
aoi
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on orfis.i nooorhaooirfi rosfirtd'r6oosrurafir'[rj6'r{orioril
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r:J6uuu:.J
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f,.r\ri66u{rlrurudrfi
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rfio.:ornnrrrfi anodu,filnorfiaer
lr niu\rj 6n'[un: rfl
d doon"'r,du cardiaccontractilityfnfi ur.rrfionld'
utndtp-sympathomimetic
agentsurnn'jr
{ooglun{ruunresponsive
shock 6.:oclondrrtor'{rs
flrtl4sFlon
unresponsive
shockA.:d 6o
t. Unrecognized
pneumothorax
z. Sympathomimetic
agents lun{l{rhufi
nrr
v
fi
il aour ru6'rrhi r loirg fnfi suuurrlrlri-lf, dopaminerfia,duolm eehra.rn
firurfror.r''r1o
ryrrry?1
z. Addison'S
disease
pericardialeffusion
3. Unrecognized
q. Shocksecondaryto intestinalischaemia
frr.looiorir
MVO, riaan'jrflrisoproterenoluoRolR
s. "Cold" septicshock
fif,.:fioruarurlGfi
rsudafirlfrlurodrlnju r-otlleno. Shocksecondaryto brainstemdysfuncni u/ nn./ urfi o: 11
rlfr'rfiao\rJrfru.:\er$nyoi0 r t1u tion (i.e. neurogenic)
rio.rri'o.r
urniunfo r q fi'urirlf'ri'rlorao6'16dud':
a fi'r
fl:,il
lri'ruroe-rz tilIn: ni u/ nn./ utfi qvrf t o.rur
o: nfiru
n'l isoproterenol uEifirrarnlfrutournn'jr
rs\runr:fnurntrruoiur6oo
sirui o6onfiu'[ildrrilu
X-o
I
a
-,
a
:
lennfrur/nn./urfi qvrfilo.lur o; nnrutfl u c- agonist
6'0.:td'ol
loi'urfiaonfiulrjryirrin6 rtudonr:oyno1o
Vol. 2 No. 1-2 lan.-Mar.,
Apr.-lun. 1985
ri1nrrrudurvirh
fi'ld'lil6rrflufro.l
rilu po/ aoilil.r.l:ayt 6.
rsruotrJ rfiB{usieiil'tufl
arnrrdunor.jrrfrou6onrl
1
'[6'ftl
rdaorfifl{r'{0fi
rijunrrR
iln?rufi? rtiu :Jaar.:y 7 .
ooR!fifl.r?{a
{rhuffrnordrflufiu nr:fiornsrsrr,r
8.
rdrrnl ruei'urfio
o{uur nq oroortrj rduui rr rund'rn
rdoil-rloqrrslr{fiui rr runir .:6ufirflu'[rj'[d'
1.
2.
.
3.
4.
5.
J PrapokklaoHospClin Med EducatCenter
53
Kuhn LA. "Salvage"with assistedcirculationin acure
myocardialInfarctionand shook.Am I Cardiot1914;
34:.873-4.
Loeb HS, WinswloEB, RahemtoolaSH, RosenKM,
GunnarRM, Acute hemodynamic
effectsof dopamine
in patientswith shock,Circulation1971;44:163-j3.
SambhiMP, WeilMH, Udholi VN. Acurepharmacodynamlc effectsof glucocorticoids:Cardiacoutput and related hemodynamicchangesin normal sublects and
patientsin shock. Circulation1965;31:523-30,
9. ScheidtS, AscheimR, Killip T ltl. Shockafter acute
myocardialinfarction:A clinicaland hemodynamic
profife. Am j Cardiol1970;26:.556-64.
1 0 . SibbaldWJ, PatersonNA, Holliday RL, Baskerville
J.
position: Hemodynamic
The Trendelenbulg
effectsin
ronar:dr.r6.r
hypotensiveand normotensivepatients. Crit CareMed
BarnottJA, SanfordJP. Bacterlalshock.In: WeilMH,
1979t7t218-24.
ed. Crltical care medicine,current principlesand pracI t.
Udhoji VN, Weil MH. Hemodynamicand metabolic
tices Hagerstown:Harper& Row, I 976.
studies on shock associatedwith bacteilmia: Observationson 16 patients.Ann InternMed 1965;62t966-79.
ChattetleeK, Swan HJ, KaushikVS, Jobin G, Magnusson P, ForresterJS. Effectsof vasodilatortherapy for
12. Weil MH, Morisette M, MichaelsS, et al. Routine
plasma colloid osmotic pressuremeasurements.Crit
severepump failure in acute myocardialinfarction on
CareMed 1974; 3:229-34.
short-termand late prognosis.Circulation1976;53:7971 3 . Weil MH, Shubin H. The "VIP" approachto the
802.
bedsidemanagement
of shock.In: WeilMH, ed.Critical
measurements
in shock:MeCohn JN. Bloodpressure
care medicine,current principlesand practices.Hagerschanismsof inaccuracyin auscultatoryand palpatory
town: Harper& Row, 1976.
methods.IAMA 1967; 199t972-6.
1 4 . Weil MH, ShubinH, RosoffL. Fluidrepletionin circuCohn JN. Centralvenouspressureasa guideto volume
latory shock:Centralvenouspressureandother practical
expansion.
Ann InternMed 1967;66t'1283-7.
guides.
4.
classiJAMA'l 965;'l 922668-7
ForresterJS,DiamondGA, SwanHJ. Correlation
WilsonRF, Thal AP, KindlingPH, Grifka T, Ackerman
t).
fication of clinical and hemodynamicfunction after
E. Hemodynamicmeasurements
in septicshock. Arch
acute myocardiallnfarction.Am J Cardiol1977;39:
Surg1965;91t'12'l-9.
13745.
54
I:{il0rurail:c:Jnrndr ilfi z qfufi t-z u.n.-i.n., tl.tt.-i.u. esza
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sign) rfiarir umbilical venographyfio:rriu'hCt'u
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cvl e
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lunr: riranrnf .:f,rloel firrirstioudo; frnl rrirtrj
umrruiuiloo
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&
a
u
,J
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a
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oiruor.tfi sr d.roI frorifi odururnI: naonorn
qnoYutJ
(chylothorax) rir
nrrrrirru6o.:tudo.:16o{'lrlao
(hydrothorax) nrrrrJoqUl.tna.:usi
lurfioriruiloo
SwischukLE. Radiologyof the newbornand younginfant. Ealtimore:Williams& Wilkins,1973.
2. Caffey J, SilvermanFN, Baker DH, et al. Pediatric'
X-ray dlagnosis.6th ed. Chicago:Year Book Medical,
19 7 3 .
l.
Prescribing information
and Description
Composition
U L F A R E T f o r I n j e c t i o n0 . 5 a n d 1 g . a r e p r e p a r a t i o n so t w h i t e
to light yellow crvstals or crystalline powder. each vial containi n g 0 . 5 g . ( p o t e n c y )a n d 1 g . ( p o t e n c y ) o f c e f s u l o d i ns o d i u m ,
respectively.
Actions
1 . U n l i k e c o n v e n t i o n a lc e p h a l o s p o r i n ,U L F A B E T r s m a r k e d l y
a c t i v e a g a r n s tP s e u d o m o n a sa e r u g i n o s a .
2 . T h e a n t i b a c t e r i a al c t i v i t y a g a i n s t P s e u d o m o n a sa e r u g i n o s a
i s n e a r l ye q u i v a l e n tt o t h e a m i n o g l y c o s i d ea n t i b i o t i c s ,s u c h
as, gentamicin.
3. Since its mode of action differsfrom that of the aminoglyc o s i d ea n t i b i o t i c s ,U L F A R E T h a s b e e n p r o v e n t o h a v e p o s i -
In children, usually 100m9/kg daily, divided 3-4 doses. For
, p to
s e v e r e a n d i n t r a c t a b l ei n f e c t i o n s , s u c h a s s e p t i c e m a a u
2 N m g / k g d a i l y , d i v i d e d3 - 4 d o s e s .
F o r p a t i e n t sw i t h i m p a i r e dr e n a l f u n c t i o n , t h e i n i t t a ld o s e i s t h e
s a m e a s l o r t h o s e w i t h s o u n d k i d n e y s .T h e m a i n t e n a n c ed o s e
m u s t b e a d j u s t e d w i t h t h e c r e a t i n i n e - c l e a r a n c eT. h e r e c o m m e n d e d d o s a g e st h e r e b ya r e
dosein %o
Creatinine-clearanceRecommended
of initialdose
Dosageinterval
t i v e a n t i b a c t e r i a la c t r v i t y a g a i n s t a m i n o g l y c o s i d e - r e s i s t a n t
s t r a i n so f P s e u d o m o n a sa e r u g i n o s a .
4 . l t s a c t r o n i s b a c t e r i c i d ael v e n a t m i n i m u m i n h i b i t o r yc o n c e n tration {MlC)
5 . U L F A R E T d i s p l a y s a s t r o n g r e s i s t a n c et o b e t a - l a c t a m a s e
p r o d u c e b y P s e u d o m o n a sa e r u g i n o s a .
l ction of ULFARET against Pseu6 . T h e p o t e n t a n t i b a c t e r i aa
domonas aeruginosaisbelieved attributable to its prominent
e x t r a c e l l u l am
r e m b r a n ep e r m e a b i l i t V .
Indications
Infections due to cefsulodin sensitive Pseudomonas aeruginosa :
- Septicemia
- P n e u m o n i a ,b r o n c h i t i s a n d p r i m a r v i n f e c t i o n w i t h
bronchiectasis
- P y e l o n e p h r i t i su, r o c y s t i t i sa n d p r o s t a t i t i s
- S e c o n d a r yi n f e c t i o n sa f t e r r n j u r yo r b u r n
- Pentonitis
D o s a g ea n d A d m i n i s t r a t i o n
foradults,
0.5to 'l g. dailyinlramusculary,
intravenously
Usually.
o r b y i n t r a v e n o u sd r i p , d i v i d e di n t o 2 t o 4 d o s e s .
The dosage range should be adjusted accordrnglo age and
s e v e r i t yo f i n f e c t i o n . D a i l y d o s e s m a y b e i n c r e a s e du p t o 4 g .
f o r t h e t r e a t m e n to f s e o t r c e m i a .
50
30
20
10
5
8 hrs
l2 hrs
90
80
70
60
55
45
95
90
BO
70
65
60
o ml/min),
ln the case of acute renal failure (creatintne-clearance
7 5 0 l oo f t h e i n i t i a ld o s e i s r e c o m m e n d e do v e r 2 4 h r s .
in theformof
ULFARET
canbeadministered
: 0 . 5 g - o f U L F A R E T d i s s o l v e di n a s o l u t i o no f l o c a l
a n e s t h e t r cs u c h a s 0 . 5 - 2 % l i d o c a r n eo r m e p i v a c a i n e
i.v.
. 0 . 5 a n d I g . o f U L F A R E Td i l u t e di n 2 0 m l o f d i l u e n t
( i s o t o n i cs a l i n es o l u t i o n o r d e x t r o s er n j e c l i o n )
i . v . d r i p : S i n g l ed o s e so f 0 . 5 t o 2 g . o f U L F A R E Td i l u t e di n a
replenishing fluid, such as glucose solution, electrolyte
s o l u t i o no r a m i n o a c i d p r e p a r a t i o n , m a y b e u s e d f o r
i n t r a v e n o u sd r i p i n f u s i o n o v e r 3 0 m i n u t e s t o 2 h r s .
i.m.
Precaution
P l e a s er e f e r t o o a c k a q ei n s e r t
, t d . B a n g k o k ,T h a i l a n d .
T a k e d a( T h a i l a n d l L
Vol.2 No. l-2 lan.-Mar.,
Apr.-Jun.1985
J PrapokklaoHospClin Med EducatCenter
57
I
UA[ARd1:
:ruurt{tio
finrr::or Inn-or-fld,
mhri rqrrorr,nlryr-ua"n6frio"rrfu6,
qnd rdurnouru,
alri6 urr"snifi
lrt, qnr"uqio"un:iorri.
Urinary Tract Infection in Infants and Children
Evaluated by Ultrasound
Kangarloo H, Gold RH, Fine RN, Diament Mf, Boechat MI.
Radiology 1985; 154:367-73.
IVP finrrrud.lrl t.ls ro1y o{riaan.Jrqner:rtrr6
lu{ilrcrn:ulraqj anrfulu:rsfi fl renal scarringu1r
eruto.rlo
rradul uonornfiuIVp kicrrur.rntfr'
rioryn:r un: 16so
a:1: ilrntiln.jronqnrsr?6
rns nily
nr:dnur{:-hu16nfi'fi
nr:6ordaro.t:rul?11.tr6u rl':ru.rru6.r*usrlljro,l:lfoosr:rrrrdrilunr: o: r o
(Urinary
ilnsrrv
tract infection-UTI) drutu
uiuur:nlu{rhurdnfiriJuUTI firqnonrmr6r-Jn6
se:tu filoi':*unt:nr?odxurenal ultrasonography, rufirfi'lrj{rrflu6'o.:vir
IVp 6n
uqi6'a.:dr
voiding
IVP uo: voiding cystourethrogaphy ufirilrzun cystourethrographyfi'rqnonrtrrdrrlorr rufio:Jnfi
nr: n:': oruritnrlv fi ttluff auufr.:(retrospective)
rfio 6lnr:rir IVP unt/Hi"or:rrrn6u 1 r1ArurAil
oil: : fi yrf nrnlun r: n: r ou1n?1ilfio:Jn6d.orfl u er uraq
rinrr::ru Inn"ai'eildilr.u.
-!
lri'rfioUTI riliuurfiuuniilfirs if
r.rnR"tT
sn?oy{udrtudruru se:lu freiil?u30r1u
ihufi linffi h wutn awtvtJnn it o"un$
fi'^uolrrrr.fit s idilnG ray6n2er1uilun?1ilfio Comparisonof Sonographyand Plain-Filmsin
A
o.lr
"'
:lnft fi.:riluarnaqrirlfr'rfiq
UTI horiJufouflr4euo.: Evaluationof TheAcuteAbdomen
frsuruo
nlrilfioiln6rradrfiu\d'rrrivesicoureteralSimeone JF,
Novelline RA, Femrcci J" JT, et al.
AJR 1985; 144149-52.
refl,r*dflrarirdtar'[q:Jn6
s:ru'lorfifiurunrfluuei
\rjfl refluxa:ru
hydronephrosis
di.:'lrifiduplinr:6n:lr:.Jiu! rfisuluri'rJrufi'r,rI:
{ilururnd'ru
cation5 T1u dysplastic
kidneysdfl ."fl* fr.rz rirr ,dr*oou',nlt:Jrori'0.:rduulrfi'utudrJra
d1il?lles:.ra
runy'lilflyn.lrfiuflnnrr:qo6'us:ruhypoplastic 6.:16'funr:or?orhsn1l'{yn$tf,
rio.rvio.runyrhaaEnrkidney1r'ru ttnshydronephrori,
dfi duplication sr?6 urlazuadnsadr.:udrrhfr.r
z orir.rruruiloHn:ru
5 :lu
Voiding cystourethrography fiufirJ:y1usd
lunr:riruuon'irfl vesicoureteral
reflux raia\ri fr.r
frflirulfrrfiu urethra6 to: n: r o\il16'6':s
oao:rtrr6
ItN; IVP
n-u r^ru'jriounvzr nlivlrqoo:rqre6tfr'nr:ifiadsfi
r111
sirf, uan\ri\6' 6.:rflul'l n:ro.::; r.ruyn\:
n'nrirsR'I1
udurird6'u6'liiau uny\erfaunr sonr:vlrqnonrod'ufl'[6'orR
m6srrur: ntfr'nr:6ufiunr:?fi
R1rriluR11,{
':1u
vrr.:f r f,d r rfl un'r nfi
n.lli r 6idfi e u 4 u unr dr 1a'
1:{ilururnfl:cilnrndr ilri z nriufi r-z u.n.-i.n., ttt.u.-i.u. 2528
11:Gl1:fiil6nr:dncrufiyr0mflsrindfin
58
s odrriulil
6.:fi'rnururnn'ir
dnrcu iaua; +r nr:vltonenrtrroi\ri\drfiruforo uny aortic contour
riro;fi aortic rupture
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Apr.-Jun.l9g5
Rt?c:RrRtydlUt.lff?uil;afrlnilo
(partialor completeplacentaprevia)fi.ruoifl
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Vol.2 No.1-2 lzn.-Mar.,
Apr.-Jun.1985
I PrapokklaoHospClln Med EducatCenter
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Apr.-Jun.1985
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D€partment
Medicine
Surgery
Orthopedic
Rehabilitativemedicine
Opthalmology
Otolaryngology
Pediatric
Pediatricpatients
Wellbaby clinic
New born
Jan.
No. of Out-Patient
Feb.
lagl-.
No. of Infatient
Feb.
Mar.
3,441
1,389
569
515
322
332
3,109
1,270
540
554
288
253
3,250
1,349
63
621
303
314
s62
3't2
103
449
310
1't2
460
317
87
19
22
23
25
18
18
792
570
321
59s
496
3',t4
740
577
315
266
178
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321
314
34s
1,101
3U
762
222
582
653
940
380
679
286
439
720
1,054
424
724
267
,,,
148
23
42
3't9
101
31
38
364
126
22
36
10,863
11,680
Obstetric& Gynecology
A.N.C.
Obstetric
Gynecology
Family planning
Psychiatry
Dentistry
Total
11ps5
s00
7s9
2,150
1,goo
2,026
13
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Typesof Opcration
larl'.
Types of Anesthesia
Generalanesthesia
Regionalanesthesia
Brachialplexusnerveblock
Local anesthesia
Miscellaneous
PathologicalExamination
Autopsy
Surgicalpathology
Units
cases
Prapokkho hospital
case5
cases
Other hospital
ca5e5
Cytopathology
Prapokklaohospital
cases
Other hospital
Clinicalhematology
Clinicalchemistry
cases
case5
tests
tests
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tests
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tests
lmmunologyand Serology
ca5e5
lrlar.
3
18
24
22
35
18
72
480
205
15
31
96
1
30
22
14
45
21
fan.
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Feb.
Mer.
282
119
28
197
58
261
103
24
151
67
282
135
17
73
67
fan.
Feb.
}lar.
6
350
285
65
261
255
5
2,935
8,560
3,230
3,856
2,256
21
260
290
70
286
283
3
2,999
6,306
2,492
4,057
2,658
66
486
164
20
46
110
8
30
37
28
39
4
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Generalsurgcry
Neurosurgery
surgery
Urological
surgery
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Thoracicsurgery
Plasticsurgery
Eye
E.N.T.
Obstetric
Gynecology
No. oL _Opcration
Feb.
29
381
319
62
290
28',1
9
3,588
10,555
4,1A9
4,703
2,O19
69
438
134
17
31
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Vol.2 No. 1.2 lan.-Mar.,
Apr.-lun. 1985
I PrapokklaoHospClin Med EducarCenter
Elood Banking Scrvice
Donor
Volunteer
Replacement
Professional
Transfusion
Wholeblood & Packedred cell
Wholeblood
Packedred cell
Lyophilizedplasma
Frozenplasma
Freshfrozen plasma
Plateletrich plasma
Plateletconcentrate
Cryoprecipitate
Leukocytepoor blood
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Emergencycrossmatching
Mobileunit
Units
units
units
units
units
units
units
units
units
units
units
units
units
units
units
units
cases
units
times/month
Typesof X-Ray
Plainstudy
Specialstudy
Upper Gl study
K . U . B .s t u d y
Biliarystudy
Arteriogram
Myelogram
Bronchogram
Miscellaneous
Mar.
665
366
299
615
293
322
686
493
193
s64
501
308
193
649
546
377
"t69
s41
486
338
148
39
8
30
40
4
29
41
16
'1,728
r,ssa
86
4
94
3
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No. of Speciallnvestigation
Types of Special Investigation
E.K.G.record
E.K.G.monitoring
Fetalmonitoring
Feb.
lan.
202
10
111
164
9
80
157
11
68
Jan.
No. of X-Ray
Feb.
Mar.
1,654
115
36
42
15
13
1
8
1,394
91
31
31
15
9
1,197
76
29
23
10
5
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7
75
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ffi
Esophagoscopy
23
3
13
5
9
;
18
1
19
5
8
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1,101
940
1,054
56
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14
2
32
6
9
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Proctoscopy
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257,849.07
u
I
lly
utsflu9r l9l
1J111 175,855.13
{luotinuril:rflo1nrdo
il.R.
4. Ringerlactate
an:
nn:
an:
aa:
5. N.s.s.d'rlrrrua
1. I.V. fluid I I 1|uru
2. Dextrow 50Vo
3. C.P.D.solution
7,080
77,331.27
305,371.46
228,665.02
228,04O."19
162,307.48
R.yt.
U.R.
6,450
66,357.54
6,250
50
s0
50
500
400
aflt
400
"1,450
1,600
1,25O
6. Peritoneal dialysis solution
aq:
450
200
350
7. Tuberculintest l: l0O
8. Tuberculintest 1:1,000
an:
nn:
9. Water for injection
anl
'
{
i
.
us/
tgl
5',rilu1lJ:'1fl
nlnrs0n9{40
aqt
.03
.03
.03
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.13
.'t5
350
9,830.18
330
9.080.16
250
8,550.18
1l
lrrnoruran:silnrndr ili z qfui t-z r.a.-i.n., tu.u.-i.u. zlza
rlidr:fludn1:dnuruflflgf,rcnfndrin
78
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n.yl.
rirlddrolunriilAa
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1l'l1l
Xarirrilorf.rdo
rJ:vnu-o'[d
u11r
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88,770
81,724
76,950
314,560
290,560
273,6@
1111r 225,790
208,890
196,650
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(t?er)
rJ:vnu"qbi druzu rj:cfiu"fll# o l u l u
rn'Xiltu
(1'?9t)
1,000ua.
2. l.V. fluidllUlo
500rJO.
3. l.V. fluid i,ilia
50 Ua.
rll.lutu
(Uln)
8,000
250
5,000
500
10,000
475
7,600
100
1,600
300
4,800
10
220
5. C.P.D.
tIuluMQ: rrliuurilurnrnrfi
rirrilrudouo 1urn1
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1,000lJa.
12
32
500ua.
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50 ua.
N.S.s.drqrnorulo 1,000uo.
10
28
10
32
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20
45
l.V. fluid r,illfl
(1191)
rJ:vnfor'ln"
400
drqrmururo 1,000 ua.
4. N.S.S.
l.V. fluid xU19l
rfl.rlttu
(urn)
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1. l.V.fluidl,u1a
{
U.R.
n.il.
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Adults,including
geriatricpatientsand
children'overtwelveyearsof age
$rndrrd
dosag9
lncreased
doeage
I severcin&ction,
tonly moderutely
s&nslllve
pathogens
l*2 s
2-4's
oncedaily
oncedaily
{in exceptional
casesonly: over 4 g
daily, givenin two
dosesat l2-hour
intcrval9
InhtrtlAnd
youngihildren
2G80 mg per kg bodyweight
Premtture infants
maximum doseof 50 mg per kg
bodyweightoncedaily
In pgtientswith renal insuffrciency:
creatiiine
clearance> l0 ml/min
:
<10 ml/min
standarddosage
nraximumdose:2 g oncedaily
once daily
F, Hoffmann-k Roche& Co., Limited Company,Basle,Switzerland
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TOPICALTHERAPY
FOR
GENITALHERPES
acdve
a Fff..dvelyresolves
Inlectlon.
symptoms.
resolves
a Rapidly
to use.
a convenient
for selfladministration.
a Suitable
TTNITL'A
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Fenac
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ini
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well as
io is as
solution,
parn
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amino
essential
th Vuj-N
In
acros
rly1.
Leukopeniadue to radiation and/or chemotherapy.
It is well known that the activity of cerboxylas in livet homogenate of albino
lComporition
ard Propertier]
nts grown on a VBr deficient regime cm be enhmced by adding VB, (or Thia-
General name
:
lnosine
mine diphosphate, hereimftq abbrwiat€d TDP) to such deficient regime or further
hopdetily
:
Hypoxmthine riboside
incras€d by adding Adenosine triphosphate (heleinafter abbreviated ATP) to VBr
Chemicalname
:
Hypoxanthine9-0-ribofurabinoside
Structural fomula
,
nAt-
mme
(or TDP).
The exploitation of INOSIE-F has orisinated from a repolt by Biochemical
Rmm, Tokyo Agricultunl Univasity, that when INOSIE-F, instead of the above
'
mentioned ATP, is added to VB, (or TDP), the eme results will b? obtaircd.
The study on clrification
of this mode of action is still kept toing on and in
puallel therewith, fundammtal experiments have als
been onducted
frcm
pathohistological and biochemical viewpoints.
There are many reports abady made on metabolism, its activating eflect on
h€ptaic function and its action on the maintenane of ATP level in the cells of the
bone murow md Lcells rnd moreovq, its action on the ciralatir€
system has also
?n
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(1) Incinr permrt$ through th. €llwrll!.!)
{21 Inotin. i.k.r dirc{ P.rt in tuglr mt$olirm.l)'2)
(3)
Inoina $aiytt r rnzymr oxidiring pyruvic *id.3)
{4)
In6im
i5l
Inorinc t.kat pur in 3ynthGiring nwlaotidar
rciiv.t.!
rirengly xrtthinc-oxidm,
otc.?)
lor nwboftlcl
in thr
orgrnirm,2)
treen proved sulficient, thus drawing attraction frcm the medi€l professionby and
llndicationl lrukopenia due to radiation and/or chemotherapy
by in its application to clinics.
IAdmininrctionanddoragpl
Usually administer l,200mt
eirr.riufirJ:r noul: nRnrl;
-
l,8oomg as Inosine oralty in 3
divided dorcs ptr day for adults.
The dosge may be increasd or decreasedsuitably according to
the gatient's agemd symptom.
Modern Manu Go., Ltd.
Cloxin
Cloxin
Mobutol
Ripin
ini,
caps.
Tabs.
caps(Rifampicin)
ol:rcrafLllrnrrns
or}n
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rez arnniredad e 1a{ruris ) nu$a'lan{'n
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Blood
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Cut down
Tube
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t-v
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Intraocular
LensStyle
,BER
SHEETS
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(335 NPI)
#AD-BD-900-G
I UVfiltration
I Designed
for fixationwithinthecapsularbag
I Uniqueclosed-loop
designprovides
secure
four-point
fixation
ineitherstandard
ft.0 .- opticcanbeimplanted
or reverse
opticposition
I Hapticsare5-0polypropylene
sutureblueor clear
I Designed
to allowone-handed
implantations
3H
SRRH
AnginaPectoris
Basic
Therapy
lso
lso
Betardil0mo
(1 capsule contarns20 mg isosorbid"U
dinitratein a sustainedreleaseform)
f"p",!,?til.,{,0mg
dinitratein a sustainedreleaseform)
high galenicprecision
linearrelease
excellenttherapeutic
resulb
Fle{nr.Mackt{achf.
D-7918ILLERTISSEN
Fed.Rep.of @rrwry
i;i
in 1978
thefacts
favoredCebxm'...
now
theystilldo
fii',
liii
F
id:i
*q$
"t
:is;i:i
iiiirx
. broadspectrumof activityespecially B ftagilis
. highlystablein the presenceof p'lactamaseenrymes
i,i'''.''.l'ii
. clinicallyprovenefficacy
. safetycomparableto cephalothin
il
"l
w
Cebxrny^
IMSDJ
[Cefo*tinSodium
MSO
sx r? l ooflxEo{lrurD} rrD.
ffii xncr
,I s""urvrt lo. 3^prrr^tlrt
tlL. 3942141
SftAfiA
DOIIME ^trntrr. or IIERCX& CO..lllC.. r^xuv.
whcto lodty't
thecry it
acilctroe
i J. u.s.l.
r t\cregy.
OrSYRr0utOR
E. L. H. TRADING CO.t LTD.
2 4 2 . 3 W t T H A y U . A O A Og. a N G x o x t . I H A | L A N O
TEL 2q186606l
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