visitor # 1 since May 2003
JN : Annu Rev Med. 2007;58:89-106.
TI : Acute ischemic stroke: overview of recent therapeutic developments.
AU : Suwanwela N, Koroshetz WJ.
EN-AB: Stroke, a disorder encompassing all cerebrovascular accidents, is a public health problem of immense proportions across the globe. Therapeutic efforts are directed at three aspects: prevention, acute treatment, and rehabilitation. Preventative measures, which in many instances mirror those for cardiovascular disease, can achieve the greatest public health impact. Measures that enhance the recovery of neurologic function and reduce neurologic disability after stroke can also affect a large population of handicapped stroke survivors. In the past 10 years, the greatest changes have occurred in the field of acute stroke treatment. Ultra-early-stage therapies with the potential to dramatically reverse severe neurologic deficits, or halt their progression, have caused a restructuring of the emergency care of neurologic patients. The parallels with the evolution of emergency treatment of acute coronary syndromes after 1970 are striking. This review focuses on aspects of stroke therapy that are either just entering, or soon to enter, current practice. (NO 17217327)
JN : Lancet. 2005 Feb 5-11;365(9458):501-6.
TI : Early supported discharge services for stroke patients: a meta-analysis of individual patients' data.
AU : Langhorne P, Taylor G, Murray G, Dennis M, Anderson C, Bautz-Holter E, Dey P, Indredavik B, Mayo N, Power M, Rodgers H, Ronning OM, Rudd A, Suwanwela N, Widen-Holmqvist L, Wolfe C.
EN-AB: BACKGROUND: Stroke patients conventionally undergo a substantial part of their rehabilitation in hospital. Services have been developed that offer patients early discharge from hospital with rehabilitation at home (early supported discharge [ESD]). We have assessed the effects and costs of such services. METHODS: We did a meta-analysis of data from individual patients who took part in randomised trials that recruited patients with stroke in hospital to receive either conventional care or any ESD service intervention that provided rehabilitation and support in a community setting with the aim of shortening the duration of hospital care. The primary outcome was death or dependency at the end of scheduled follow-up. FINDINGS: Outcome data were available for 11 trials (1597 patients). ESD services were mostly provided by specialist multidisciplinary teams to a selected group (median 41%) of stroke patients admitted to hospital. There was a reduced risk of death or dependency equivalent to six (95% CI one to ten) fewer adverse outcomes for every 100 patients receiving an ESD service (p=0.02). The hospital stay was 8 days shorter for patients assigned ESD services than for those assigned conventional care (p<0.0001). There were also significant improvements in scores on the extended activities of daily living scale and in the odds of living at home and reporting satisfaction with services. The greatest benefits were seen in the trials evaluating a coordinated multidisciplinary ESD team and in stroke patients with mild to moderate disability. INTERPRETATION: Appropriately resourced ESD services provided for a selected group of stroke patients can reduce long-term dependency and admission to institutional care as well as shortening hospital stays. (NO 15705460)
JN : J Pediatr Endocrinol Metab. 2004 May;17(5):801-3.
TI : Pallister-Hall syndrome with hypoparathyroidism.
AU : Wacharasindhu S, Shotelersuk V, Srivuthana S, Yodvisitsak W, Suwanwela N, Savage MO.
EN-AB: We report on a 5 2/12 year-old boy who presented with convulsions, precocious puberty due to a 1.9 x 1.9 x 1.6 hypothalamic hamartoma of the tuber cinereum, and some dysmorphic features including polysyndactyly of hands and feet, suggesting the diagnosis of Pallister-Hall syndrome. Hypocalcemia due to hypoparathyroidism was demonstrated, and this combination has not been reported previously. Therefore, we can add hypoparathyroidism as another feature of Pallister-Hall syndrome. (NO 15237717)
JN : J Med Assoc Thai. 2003 Jun;86 Suppl 2:S490-5.
TI : Straight artery sign in extracranial carotid artery dissection.
AU : Suwanwela NC, Phanthumchinda K, Suwanwela N.
EN-AB: BACKGROUND AND PURPOSE: Magnetic resonance imaging (MRI) has become generally accepted as a non-invasive method to provide the definitive diagnosis of cervicocerebral vessel dissection. The finding of an intramural hematoma on axial MR images is the characteristic sign of the disease. However, there has been no previous report of the characteristic magnetic resonance angiographic (MRA) findings. METHOD: The authors retrospectively reviewed MRI and MRA findings of patients with spontaneous extracranial carotid dissection. The most striking finding on MRA was the straightness of the affected artery when compared to the non-affected side of the same patient. For quantitative measurement, "Carotid Straightness Index (CSI)" was developed to measure the straightness of the arteries and compared the indices of both extracranial internal carotid arteries in the same patient. RESULTS: The patients' age range was from 21-55 years (mean 38 years). There were 6 males and 3 females. All patients had the classical "Straight artery sign" on the MRA. The carotid straightness index was significantly higher in the affected artery when compared to the normal side of the same patient. CONCLUSION: The straight artery sign and the carotid straightness index can be very useful for early detection of the extracranial carotid dissection. It can be found in early stage disease or in less severe forms of carotid dissection where significant narrowing is not demonstrated. (NO 12930030)
JN : J Med Assoc Thai. 2003 Feb;86(2):178-82.
TI : Mutation of the Notch 3 gene in a Thai cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy family.
AU : Suwanwela N, Srikiatkhachorn A, Tangwongchai S, Phanthumchina K, Suwanwela N.
EN-AB: The authors report the first Thai family with cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) in which the family members had a classical history of progressive vascular dementia. The proband was a 31-year old Thai male who presented with an acute stroke in the subcortical region. His past history revealed mental disturbance, including poor judgement and regressive behavior as well as mood changes for 1 year. He did not have a history of migraine or any other vascular risk factors except for a strong family history of ischemic stroke and progressive dementia. Magnetic resonance imaging demonstrated multiple small infarctions in the subcortical white matter of the bilateral frontal, parietal and occipital lobes with another small lesion in the pons. Genetic study demonstrated a Notch 3 mutation consisting of the substitution of a nucleotide at position 406 in exon 3 leading to the replacement of an Arginine by Cysteine at position 110 in the 2nd EGF motif, which is compatable with CADASIL. (NO 12678157)
JN : Am J Med Genet A. 2003 Jan 15;116A(2):164-9.
TI : Postnatal growth failure, microcephaly, mental retardation, cataracts, large joint contractures, osteoporosis, cortical dysplasia, and cerebellar atrophy.
AU : Shotelersuk V, Desudchit T, Suwanwela N.
EN-AB: We describe two sibs with postnatal-onset growth deficiency, microcephaly, cataract, prominent supraorbital ridge, large joint contractures, severe osteoporosis, cortical dysplasia, cerebellar atrophy, and mental retardation. The combination appears to constitute a previously undescribed syndrome inherited in an autosomal recessive pattern. Copyright 2003 Wiley-Liss, Inc. (NO 12494436)
AU : Sueblinvong T, Noophun P, Pataradool K, Suwanwela N, Phanthumchinda K, Tresukosol D.
TI : Posterior leukoencephalopathy following cisplatin, bleomycin and vinblastine therapy for germ cell tumor of the ovary.
JN : J Obstet Gynaecol Res 2002 Apr ; 28 (2) : 99-103 (NO 07782)
AU : Suwanwela NC, Phanthumchinda K, Suwanwela N.
TI : Transcranial doppler sonography and CT angiography in patients with atherothrombotic middle cerebral artery stroke.
JN : AJNR Am J Neuroradiol 2002 Sep ; 23 (8) : 1352-1355 (NO 08138)
AU : Suwanwela NC, Phanthumchinda K, Suwanwela N, Tantivatana J, Janchai A.
TI : Thrombolytic treatment for acute ischemic stroke: a 2 year-experience at King Chulalongkorn Memorial Hospital.
JN : J Med Assoc Thai 2001 Jun ; 84 (Suppl 1) : S428-436 (NO 06878)
AU : Suwanwela N, Tantanatrakool B, Suwanwela NC.
TI : Intracranial lymphoma: CT and MR findings.
JN : J Med Assoc Thai 2001 Jun ; 84 (Suppl 1) : S228-243 (NO 06907)
AU : Suwanwela N, Phanuphak P, Phanthumchinda K, Suwanwela NC, Tantivatana J, Ruxrungtham K, Suttipan J, Wangsuphachart S, Hanvanich M.
TI : Magnetic resonance spectroscopy of the brain in neurologically asymptomatic HIV-infected patients.
JN : Magn Reson Imaging 2000 Sep ; 18 (7) : 859-865 (NO 07010)
AU : Suwanwela NC, Suwanwela N, Phanthumchinda K.
TI : Comparison of transcranial Doppler ultrasound and computed tomography angiography in symptomatic middle cerebral artery stenosis.
JN : Australas Radiol 2000 May ; 44 (2) : 174-177 (NO 07046)
AU : Intragumtornchai T, Prayoonwiwat P, Swasdikul D, Suwanwela N, Chaimongkol B, Sangsuree J, Chancharunee S, Chansung K, Leelasiri A, Yoshida Y.
TI : Myelodysplastic syndromes in Thailand : a retrospective pathologic and clinical analysis in 117 cases.
JN : Leukemia Res 1998 ; 22 : 453-60 (NO 03753)
AU : Intragumtornchai T, Prayoonwiwat W, Swasdikul D, Suwanwela N, Chaimongkol B, Jootar S, Chansung K, Chancharunee S, Leelasiri A, Yoshida Y.
TI : Myelodysplastic syndromes in Thailand: a retrospective pathologic and clinical analysis of 117 cases.
JN : Leukemia Research 1998 May ; 22 (5) : 453-60
EN-AB: To gain more insight into the understanding of myelodysplastic syndromes (MDS) as they occur in Thailand, a retrospective clinicopathologic analysis was conducted in patients (age 15 years) diagnosed as MDS from January 1992 to December 1996 at the five major medical centers in various geographic regions of the country. The central reviewers independently examined the bone marrow and peripheral blood smears of all the patients and classify the disease according to the French-British-American (FAB) classification. There were a total of 117 eligible patients. The median age of the patients was 56 years (range 16-86). The male:female ratio was 1:1. Thirty-two percent of the patients were younger than 40 years. The frequency of the FAB subtypes was RA/RARS, 54.7; RAEB, 23.1; CMML, 9.4; and RAEB-T, 12.8%. Anemia was the most common symptom presenting in 84.6% of the patients. In the 34 patients in whom the cytogenetics in the bone marrow were analysed, 44.1% revealed abnormalities. Of these, monosomy 7 and trisomy 8 were the most common aberration, each being detected in 26.7% of the patients. Transfusions were the main therapeutic modality in 80% of the patients. Kaplan-Meier analysis revealed a 5 year survival rate of 29% for the whole group with a median survival of 24 months. Twenty-five percent of the patients had progressed to acute myelogenous leukemia (AML) with a median time to disease-progression of 23 months. The median survival for RA/RARS, RAEB, CMML and RAEB-T were 58.4, 19.9, 10.7 and 8.7 months, respectively (P 0.001). The stepwise Cox regression analysis revealed the percentage of blasts in the bone marrow as the only parameter significantly associated with survival and disease progression. On comparison with data from other countries, the age of Thai patients with MDS is considerably lower than the western population but is comparable to other asian countries. The distribution of the FAB subtypes and the survival of the patients are similar. The major prognostic features, however, lie in the percentage of blasts in the bone marrow rather than the degree of the observed cytopenia. (NO 05395)
AU : Suwanwela NC, Suwanwela N.
TI : Takayasu arteritis : ultrasonographic evaluation of the cervico-cerebral arteries.
JN : Int J cardiol = International Journal of Cardiology 1998 ; 66 ((Suppl)) : 163-173 (NO 05615)
AU : Intragumtornchai T, Prayoonwiwat P, Swasdikul D, Suwanwela N, Chaimongkol B, Sangsuree J, Chancharunee S, Chansung K, Leelasiri A, Yoshida Y.
TI : The clinicopathologic features of myelodysplastic syndromes in patients younger than 40 years.
JN : Br J Haematol 1998 ; 102 : 342
EN-AB: Myelodysplastic syndromes (MDS) are a group of clonal hemopathy affected mainly the elderly population. The median age of the patients reported from most studies conducted among the Western population is 70 years. Recently a nationwide study had been conducted on patients newly diagnosed as MDS during 1992-1996 in the five major medical centers in various geographic region of Thailand. All specimens of the patients were independently examined by the central reviewers (WP, DS, NS and YY) and were classified according to the FAB criteria. There were a total of 117 patients. The median age of the patients was 56 years (range, 16-86). Interestingly, 32 of the patients were younger than 40 years. The clinicopathologic features of these younger patients, as compared to the older patients, were as the followings:The clinical feature as well as the outcome of MDS in the young patients are therefore generally similar to the older cases. The major difference is CMML which is predominantly a disease of the elderly and is very rare among those who are younger than 40 years old. (NO 05929)
AU : Suwanwela N, Piyachon C.
TI : Takayasu arteritis in Thailand. clinical and imaging features.
JN : International Journal of Cardiology 1997 ; 54 (Suppl) : S117-34
EN-AB: PURPOSE: To present and evaluate the clinical and imaging features of patients with Takyasu arteritis in Thailand. MATERIALS AND METHODS: Clinical and angiographic findings were studied in 63 patients with Takayasu arteritis collected at Chulalongkorn Hospital Medical School, Bangkok. Imaging features including CT scan in 15 patients, magnetic resonance imaging in 14 patients and magnetic resonance angiography in ten patients were evaluated and compared to angiography. RESULTS: Among 63 patients there were 43 females and 20 males with the ratio female to male 2.15:1. The most common age groups were in the third and fourth decades of life. The most common clinical findings were hypertension and absence or weakness of pulses. Elevated erythrocyte sedimentation rate was found in 50. For angiography, the most common vessel affected was the abdominal aorta (20). The second and third most common sites were renal arteries (18.7) and the subclavian arteries (14.3). Coronary artery involvement was found in two out of eight patients. No pulmonary involvement was found in eight cases studied by pulmonary angiography. For classification of angiogram, the most common type of involvement (66.7) was extensive involvement of the aorta and branches (type V of new classification established from International Conferences on Takayasu arteritis in Tokyo 1994). No patient was found to have only involvement of brachiocephalic branches or ascending aorta and brachiocephalic branches. CT scan showed calcification in the vessel walls (8/15 cases) which helped in diagnosis of the disease. Wall thickness, surrounding tissue, appearance of the vessel and intraluminal thrombus could be well seen. Magnetic resonance imaging added more detail in multiple planes and could demonstrate vascular flow. High detection rate of the lesions (94.8) was found for the aorta. The study was less sensitive for smaller vessels. Magnetic resonance angiography showed better correlation of the findings of brachiocephalic arteries compared to angiography. Subclavian steal syndrome could be diagnosed. For renal arteries, MR angiography could correctly demonstrate occlusion of renal artery in six out of eight cases. In the other two cases only stenoses of the vessels were found on angiograms. One renal arterial stenosis on MR angiography was confirmed by angiography. CONCLUSION: Takayasu arteritis could be found in Thailand. Clinical features were almost the same as in reports from other countries. Various forms of arterial involvement were demonstrated by imaging modalities. Angiography remained the best method for detection and diagnosis of Takayasu arteritis in correlation with clinical and laboratory findings. Although CT scan, magnetic resonance imaging and magnetic resonance angiography were limited and less sensitive for detection of the lesions, they were useful as noninvasive modalities showing more details of intraluminal clot, vascular wall and surrounding tissue which could be correlated with pathological findings and pathogenesis of the disease. Our study suggests that MR imaging and MR angiography can be screening and diagnostic techniques for patients with suspected Takayasu arteritis. (NO 02211)
AU : Suwanwela N.
TI : Imaging of the craniovertebral junction (Abstract).
JN : จุลสารสมาคมประสาทศัลยศาสตร์ แห่งประเทศไทย = Bulletin of the Neurosurgical Association of Thailand 1997 May-Jun ; 6 (5) : 11
EN-AB: The term craniovertebral junction refers to the occipital bone surrounding foramen magnum, the atlas and axis. Cramovertebral abnormalities can be classified into congenital and acquired in origin. There is some overlapping within these classifications. Congenital anomalies include malformations of the occipital bone such as clivus segmentations, basilar invagination and condylar hypoplasia. Malformations of atlas can be assimilation of atlas, atlantoaxial fusion and aplasia of atlas arches. Malformations of axis can be irregular tlantoaxial segmentation, dens dysplasia and segmentation failure of C2-C3. Neural dysgenesis can also occur. Acquired abnormalities of craniovertebral junction include abnormalities at the foramen magnum such as secondary basilar invagination in Paget's disease, osteomalacia, rheumatoid cranial settling and foraminal stenosis such as achondroplasia. The second group in acquired abnormalities is atlantoaxial instability. These are found in errors of metabolism, Down's syndrome, infections, inflammatory conditions, trauma, tumors and miscellaneous. Many neuroradiologic investigations are used to diagnose these abnormalities such as plain x-ray with special views, tomography, CT scan and angiography. Because of the direct sagittal and coronal imaging capabilities, MRI is very useful for evaluating the lesions. 3D-spiral CT scan is another new technique that is very helpful. Many craniometric lines and angles have been described for assessment of craniovertebral junction relationships. However, it should be aware that the anatomic structures and planes vary within a normal range. Some of the normal values in Thai people are different from what have been described in the western world. In these cases all measurements in Thai people should be compared to the Thai standards. Apart from diagnosis of the craniovertebral abnormalities by various diagnostic imaging procedures, special imaging techniques may be needed for proper pre-operative planning of the craniovertebral junction abnormalities. Post operative result can also be determined by different modalities of diagnostic imaging. (NO 03148)
AU : Intragumtornchai T, Prayoonwiwat P, Swasdikul D, Suwanwela N, Yoshida Y.
TI : Myelodysplastic syndromes in Thailand : a retrospective pathologic and clinical analysis in 117 cases.
BK : Accepted for publication in Leukemia Res 1997 (NO 03750)
AU : Chaitachawong C, Tosukhowong P, Tungsanga K, Supaprom T, Suwanwela N, Kongwattanakul K, Pansin P, Khurekhum K, Jinayon J, Sitprija V.
TI : Effect of potassium citrate intake on acid-base and electrolytes balance in high risk groups of sudden unexplained death syndrome (SUDS).
CONF : Chulalongkorn University 80th Anniversary Research Conference 1997 : 629-640 (NO 03850)
AU : Suwanwela N.
TI : Vasculitis of the nervous system. Taiwan
CONF : Scientific proceeding 2nd congress of Asian and Oceanian Society of Neuroradiology and Head & Neck Radiology 1997 : 57-58 (NO 03917)
AU : ปิยะรัตน์ โตสุโขวงศ์, เกรียง ตั้งสง่า, นิตยา สุวรรณเวลา, ถาวร สุภาพรม, กัลยา ก้องวัฒนากุล.
TI : โรคใหลตายและโรคที่มีกลุ่มอาการของโรคที่เหมือนกับโรคใหลตาย : จากประสบการณ์การศึกษาโรคใหลตายในภาคตะวันออกเฉียงเหนือ
JN : จุฬาวิจัย 1997 Oct ; 16 (10) : 18-23 (NO 04750)
AU : Suwanwela N.
TI : Radiology in ischemic disease.
JN : Bull Neurosurg Assoc Thai 1997 ; 6 (3) : 16 (NO 05613)
AU : Intragumtornchai T, Wannakrairot P, Chaimongkol B, Bhoopat L, Lekhakula A, Thamprasit T, Suwanwela N, Suthipinthawong C., Prayoonwiwat W, Meekungwal P, Sirijerachai C, Pairojkul C.
TI : Non-Hodgkin's lymphomas in Thailand. A retrospective pathologic and clinical analysis of 1391 cases.
JN : Cancer 1996 ; 78 (8) : 1813-9
EN-AB: BACKGROUND: Geographic variations in the histopathologic pattern of non-Hodgkin's lymphoma (NHL) are well documented. Insight into this epidemiologic data might shed light on the underlying etiology. Currently, there is a paucity of information regarding the pattern of NHL occurring in Thailand and Southeast Asia. The current nationwide study was undertaken to obtain a clearer definition of the disease among Thais and to compare this information with data from other Asian and Western countries. METHODS: A retrospective analysis of histopathologic subtypes and clinical features was conducted in 1391 patients (age or = 15 years) with NHL, who were treated at 6 major medical centers in 4 representative areas of Thailand. One hundred and thirty unselected cases were immunohistochemically studied. The reports from other countries used for comparison were identified through a computerized search on MEDLINE. RESULTS: Of the total cases studied, follicular lymphomas constituted 3.8 and diffuse lymphomas 91.4. The frequency of low and intermediate grade (including large cell immunoblastic, using the Working Formulation) were 12.8 and 72.9, respectively. The most common histologic subtype was the diffuse large cell and large cell immunoblastic entity, which constituted 39.9 of the cases studied. The rate of small lymphocytic and diffuse small cleaved subtypes were higher than in the United States. Of the 130 cases studied, T-cell lymphoma comprised 16.1, which was much less than in Japan, China, or Taiwan. CONCLUSIONS: The histopathologic pattern of NHL in Thailand was characterized by the features noted for Asia, i.e., a low rate of the follicular entity and a preponderance of the diffuse aggressive subtypes. In addition, the frequency of the small lymphocytic and diffuse small cleaved subtypes were increased compared with the Western population and the rate of T-cell lymphoma appeared to be less than in Far East Asia. (NO 02241)
AU : Suwanwela N, Piyachon C.
TI : Takayasu arteritis in Thailand. clinical and imaging features.
JN : International Journal of Cardiology 1996 ; 54 (Suppl) : S117-134
EN-AB: PURPOSE: To present and evaluate the clinical and imaging features of patients with Takyasu arteritis in Thailand. MATERIALS AND METHODS: Clinical and angiographic findings were studied in 63 patients with Takayasu arteritis collected at Chulalongkorn Hospital Medical School, Bangkok. Imaging features including CT scan in 15 patients, magnetic resonance imaging in 14 patients and magnetic resonance angiography in ten patients were evaluated and compared to angiography. RESULTS: Among 63 patients there were 43 females and 20 males with the ratio female to male 2.15:1. The most common age groups were in the third and fourth decades of life. The most common clinical findings were hypertension and absence or weakness of pulses. Elevated erythrocyte sedimentation rate was found in 50. For angiography, the most common vessel affected was the abdominal aorta (20). The second and third most common sites were renal arteries (18.7) and the subclavian arteries (14.3). Coronary artery involvement was found in two out of eight patients. No pulmonary involvement was found in eight cases studied by pulmonary angiography. For classification of angiogram, the most common type of involvement (66.7) was extensive involvement of the aorta and branches (type V of new classification established from International Conferences on Takayasu arteritis in Tokyo 1994). No patient was found to have only involvement of brachiocephalic branches or ascending aorta and brachiocephalic branches. CT scan showed calcification in the vessel walls (8/15 cases) which helped in diagnosis of the disease. Wall thickness, surrounding tissue, appearance of the vessel and intraluminal thrombus could be well seen. Magnetic resonance imaging added more detail in multiple planes and could demonstrate vascular flow. High detection rate of the lesions (94.8) was found for the aorta. The study was less sensitive for smaller vessels. Magnetic resonance angiography showed better correlation of the findings of brachiocephalic arteries compared to angiography. Subclavian steal syndrome could be diagnosed. For renal arteries, MR angiography could correctly demonstrate occlusion of renal artery in six out of eight cases. In the other two cases only stenoses of the vessels were found on angiograms. One renal arterial stenosis on MR angiography was confirmed by angiography. CONCLUSION: Takayasu arteritis could be found in Thailand. Clinical features were almost the same as in reports from other countries. Various forms of arterial involvement were demonstrated by imaging modalities. Angiography remained the best method for detection and diagnosis of Takayasu arteritis in correlation with clinical and laboratory findings. Although CT scan, magnetic resonance imaging and magnetic resonance angiography were limited and less sensitive for detection of the lesions, they were useful as noninvasive modalities showing more details of intraluminal clot, vascular wall and surrounding tissue which could be correlated with pathological findings and pathogenesis of the disease. Our study suggests that MR imaging and MR angiography can be screening and diagnostic techniques for patients with suspected Takayasu arteritis. (NO 02809)
AU : Watana D, Suwanwela N, Phancharoen S.
TI : Transient severe visual loss complicating acute glomerulonephritis . case report.
JN : Chulalongkorn Medical Journal 1995 ; 39 (5) : 373-380
EN-AB: Blindness is a rare complication of acute glomerulonephritis. During 12 year (1982-1993) there were 3 children with acute glomerulonephritis presented with complete cortical blindness. All of them had hypertensive encephalopathy all developed complete blindness before the onset of convulsion or coma. The mechanism of cortical blindness is focal edema in the occipital lobes which results from breakthrough of autoregulation with passive overdistention of cerebral arterioles. Carnical CT scan findings are compatible with focal edema in the occipital lobes. All patients began to perceive light within 30 hours of using the antihypertensive drugs, Furosemide, Dexamethasone and Mannitol. All made full recovery. Any child with sudden blindess should be examined for acute glomerulo-nephritis and hypertension. (NO 02136)
AU : Suwanwela N, Suwanwela C.
TI : Surgical management of frontoethmoidal encephalomeningoceles.
BK : Operative neurosurgical techniques : indications, methods and resultsโดย: Schmidek HH, Sweet WH (edited) 3rd edition ed. : WB Saunders, 1995 : 159-166 (NO 03596)
AU : Shuangshoti S, Siriaungkul S, Suwanwela N.
TI : Primary meningioma intimately related to skull. case report and review of the literature.
JN : Surgical Neurology 1994 Dec ; 42 (6) : 476-80
EN-AB: A report is made of a primary meningioma intimately associated with the left sphenoid ridge and temporal bone of a 41-year-old woman. The lesion produced hyperostosis of the involved bones, ipsilateral proptosis, and reduced vision for 4.5 years. The radiotherapy yielded little improvement of the exophthalmos and vision. Review of 125 reported meningiomas intimately related to the skull and presenting primarily with hyperostosis and minimal soft tissue component, including the current case, disclosed that all but one affected the cranium proper, particularly the middle ear, temporal bone, frontal bone, and parietal bone. The exceptional one was in the mandible. They tended to occur between the fifth and seventh decades of life with the peak occurrence between the fifth and sixth decades. The average age was 46 years for overall. The female-to-male ratio was 2:1. Six of 125 primary meningiomas closely associated with the skull were malignant and two of these spread to the lungs. The pulmonary metastasis was spontaneous in one case. (NO 02873)
AU : Suwanwela N, Phanthumchinda K, Kaoropthum S.
TI : Headache in brain tumor : a corss-sectional study.
JN : Headache 1994 Jul-Aug ; 37 (7) : 435-8
EN-AB: Headache is one of the cardinal features of intracranial neoplasm. However, there is little published information on the prevalence and clinical profiles of headache in patients with brain tumor. This cross-sectional study recruited 171 cases of brain tumor. The average age was 39 years (range from 4 to 75 years). The female to male ratio was 1.2:1. The prevalence of headache was 71. The duration of headache ranged from 3 days to 10 years with an average of 15.7 months. Most prominent headache profiles in this series were intermittent, nocturnal and early morning headache as well as headache upon arising. Most of the patients had mild to moderately severe headache. Headache is more common with tumors below the tentorium cerebelli. It is more prevalent in primary and intracerebral tumor than in metastatic and extracerebral tumor. Headache has lateralizing value, especially in patients with supratentorial lesions who have no obvious increased intracranial pressure. (NO 04584)
AU : Pantongrag-Brown L, Suwanwela N.
TI : Case report. chronic spinal cord compression from extramedullary haematopoiesis in thalassaemia--MRI findings.
JN : Clinical Radiology 1992 Oct ; 46 (4) : 281-3
EN-AB: A 27-year-old-man with beta-thalassaemia/HbE presented with signs and symptoms of spinal cord compression due to epidural extramedullary haematopoiesis. Magnetic resonance images demonstrated spinal cord constriction and atrophy suggesting that the disease process was long-standing. On transverse T2-weighted images, high signal intensity was observed within the spinal cord suggestive of post-compressive spinal cord myelomalacia or gliosis. (NO 02279)
AU : Pantongrag-Brown L, Suwanwela N.
TI : CT findings in tuberculous spondylitis.
JN : Australasian Radiology 1992 Feb ; 36 (1) : 4-7
EN-AB: The computed tomographic (CT) features of ten documented cases of spinal tuberculosis were analyzed. All cases showed evidence of vertebral body destruction, with paravertebral soft tissue masses. Four cases revealed extension of involvement into the neural arches. Calcification within the paraspinal soft tissue was found in only two cases. Two of four cases who received intravenous contrast medium demonstrated evidence of rim enhancement around multilocuated fluid collections. Compared to conventional roentgenography, CT better delineated the extent of bony destruction, involvement of the spinal canal and existence of paraspinal soft tissue masses. (NO 02280)
AU : Kasantikul V, Lerdlum S, Suwanwela N.
TI : Cerebral abscesses due to pseudomonas pseudomallei.
JN : J Med Assoc Thai 1992 ; 75 (9) : 536-541
EN-AB: Two cases of cerebral abscesses caused by Pseudomonas pseudomallei are reported. The first case, a 51-year-old women had a sudden onset of progressive right hemiparesis and right facial palsy and died within 7 days. Postmortem examination disclosed brain abscess in association with disseminated infection outside the central nervous system. The second case, a 9-year-old boy displayed cerebral abscesses as an isolated manifestation. Recovery occurred after treatment with ceftazidime. Review of the ten case reports of cerebral melioidosis revealed that the lesion occurred in patients of all ages and was more common in men than in women. The frontoparietal lobe was the most common location. Fever, headache, and hemiparesis were frequent clinical manifestations while seizures, ataxia were uncommon. CT scanning, serum antibody titer along with hemoculture were useful investigative tools. The importance of early diagnosis and prompt treatment is emphasized for this fatal but treatable disease. (NO 02531)
AU : Piyachon C, Suwanwela N.
TI : Takayasu arteritis in Thailand.
JN : Heart Vessels 1992 ; 7 (Suppl) : 60-67 (NO 04933)
AU : Kasantikul V, Suwanwela N, Pongsabutr S.
TI : Magnetic resonance images of brain stem infarct in periarteritis nodosa.
JN : Surgical Neurology 1991 Aug ; 36 (2) : 133-6
EN-AB: A 35-year-old woman displayed unusual symptoms of progressive bulbar dysfunction. At necropsy, systemic necrotizing vasculitis and small pontine infarcts were demonstrated. The angiographic and magnetic resonance imaging findings are described. The latter investigation is a sensitive method for detecting such pontine lesions. To our knowledge, this case is the first report of magnetic resonance imaging findings of brain stem infarct in a patient with periarteritis nodosa. (NO 02906)
AU : Charoenlap P, Lertlum S, Viratchai C, Suwanwela N, Suwangool P.
TI : An elderly female patient with pneumonia and abnormal cardiac shadow.
JN : จุฬาลงกรณ์เวชสาร = Chulalongkorn Medical Journal 1991 Mar ; 35 (3) : 169-176
EN-AB: An 87-year-old female patient had problems of fever, cough, dyspnea and alternation of conciousness for 4 days. Physical examination revealed consolidation of right lung. Sputum examination and culture revealed gram positive diplococci. She had history of left hemiplegia, three years previous to this admission. Carcinoma of cervix was diagnosed one year prior to this admission without treatment. Chest roentgenogram revealed consolidation of right lung with abnormal right cardiac shadow with curvilinear ring calcification. Clinical diagnosis was pneumococcal pneumonia, cerebral thrombosis, aneurysm of aortic root. Post-mortem diagnosis was sacular aneurysm of ascending aorta. Underlying disease was most likely atherosclerosis. There was carcinoma of cervix with invasion of vagina and bladder and cerebral infarction of left parietal lobe. (NO 03179)
AU : Shuangshoti S, Kasantikul V, Suwanwela N, Vehehagarun S.
TI : Primary osteosarcoma of skull with phagocytosis of tumour cells : case report and review .
CONF : World Health Organization Biregional training course on electron microscopy and diagnosis of human disease, Mukherjee TM, Swift JG (eds) 1991 : 380-389 (NO 03865)
AU : Pantongrag-Brown L, Suwanwela N, Arjhansiri K, Chetpukdeechit V, Kitisin P.
TI : Demonstration on computed tomography of two pseudoaneurysms complicatingchronic pancreatitis.
JN : Br J Radiol 1991 Aug ; 64 (764) : 754-757 (NO 04237)
AU : Suwanwela N, Lerdlum S, Bhoopat W, Kosolbhand P, Suwanwela C, Pungrassami P.
TI : Ossification of posterior longitudinal ligament : imaging study in Thailand.
JN : Thai J Radiol = รังสีวิทยาสารThai Journal of Radiology 1991 Jan-Apr ; 28 (1) : 37-52
TH-AB: Ossification of posterior longitudinal ligament (OPLL) ซึ่งเป็นสภาวะ ที่พบได้มากในคนญี่ปุ่นนั้น พบได้ในคนไทยเช่นกัน และเป็นสาเหตุทำให้เกิดอาการจากการ กดต่อไขสันหลัง (spinal cord) และเส้นประสาท (nerve root) ได้ หากไม่คำนึง ถึงอาจให้การวินิจฉัยไม่ถูกต้องและเป็นผลเสียต่อการรักษาได้ การถ่ายภาพรังสีธรรมดา จะวินิจฉัยโรคนี้ได้ยาก และการทำ myelography จะช่วยในการวินิจฉัยโรคนี้ได้ดี ช่วยบอกรายละเอียดของ calcification ตำแหน่งและความรุนแรงโดยเฉพาะการยื่น เข้าไปกดในช่องไขสันหลังว่ามากน้อยเพียงใด การที่จะวินิจฉัยได้จำเป็นต้องทราบลักษณะ การเปลี่ยนแปลงที่เกิดขึ้นในโรคนี้ MRI เป็นการตรวจวิธีใหม่ที่แสดงให้เห็นไขสันหลัง (spinal cord) ได้ชัดเจนขึ้น โดยไม่จำเป็นต้องฉายสารทึบแสงเข้าสู่ช่องน้ำไขสันหลัง (subarachnoid space) และสามารถตรวจใน sagittal plane ได้ชัดเจน. (NO 04928)
AU : Pantongrag-Brown L, Suwanwela N.
TI : Emergency CT scans in Chulalongkorn Hospital.
JN : Thai J Radiol = รังสีวิทยาสารThai Journal of Radiology 1990 May-Dec ; 27 (2) : 29-33 (NO 04932)
AU : Suwanwela N, Lerdlum S, Ukachoke J, Shuangshoti S, Kasantikul V.
TI : Computed tomography of intracranial fungal infections.
JN : Chula Med J 1988 Apr ; 32 (4) : 327-337
EN-AB: Fungal infections of the central nervous system are rare and usually occur in debilitated patients with an underlying pathologic condition. Lesion in the central nervous system are almost always secondary to a focus elsewhere in the body. Computed tomographic scans of twenty patients with intracranial fungal infections at Chulalongkorn Hospital were reviewed. Twelve cases of cryptococcosis, three cases of aspergillosis, two cases each of nocardiosis, mucormycosis and a case of chromoblastomycosis were included. In cryptococcosis, three patients had normal scans. Three patients had communicating or non-communicating hydrocephalus. Additional findings included four cases of meningeal and gyral opacification, two cases of multiple enhanced nodules, and two cases of rim enhancing masses. In nocardiosis, gyral enhancement from meningoencephalitis, enhancement of ependyma from ependymitis and communicating hydrocephalus were found in one case, while abscess and noncommunicating hydrocephalus were found in another case. In phycomycosis, one patient had edema and abscess in the basal ganglia; the other patient had unilateral hydrocephalus from a small mass obstructing the foramen of Monro. Extensive subarachnoid hemorrhage was a unique finding in a case of aspergillosis. In another two cases with, enhanced masses, a granuloma and an abscess were found. CT scan was normal in a patient with chromoblastomycosis although at autopsy a mass was found in the medulla oblongata. Correlation of CT and pathological findings were also made in other cases. Computed tomography, (NO 01530)
AU : Suwanwela N, Lertlum S, Phanuphak P, Hanvanich M, Jimarkorn P, Vajarapongse K, Chomdej S, Vajaragupta L, Hemachudha T, Locharernkul C.
TI : Radiologic aspects of AIDS in Thailand.
JN : Chula Med J 1988 Jan ; 32 (1) : 43-58
EN-AB: An increasing number of patients with acquired immunodeficiency syndrome (AIDS) has been reported in Thailand. Radiologic findings including CT scan and ultrasonographic findings were studied in 7 out of a total of 11 AIDS patients from November 1984 to August 1987. Chest x-ray films were abnormal in all cases of which 4 were proven to be pneumocystis carinii pneumonia, 2 to be tuberculosis and one of no definite diagnosis. Radiologic features of pneumocystis carinii pneumonia were bilateral perihilar, basilar, diffuse reticulonodular infiltration, consolidation and atypical upper lobe infiltration. In tuberculosis, upper lobe infiltration and mediastinal node enlargement were seen. Diffuse mucosal plaques, irregular enlarged folds and ulceration were demonstrated in upper gastro-intertinal tract studies in three patients with Candida esophagitis. Evidences of cholecystitis in both CT scan and ultrasonography were seen in a patient with jaundice. He also had hypoechoice lesions in the liver, spleen and kidneys which later disappeared. On CT scan, two patients had evidences of mild degrees of cerebral atrophy. Another patient with AIDS-related complex (ARC) showed evidences of retroperitoneal node enlargements on CT scan and ultrasonography. Inhomogeneous density of cervical spinal cord and evidences of brain atrophy in this patient were also demonstrated on CT scan. (NO 01551)
AU : Shuangshoti S, Chayapum P, Suwanwela N, Suwanwela C.
TI : Unilateral proptosis as a clinical presentation in primary angiosarcoma of skull.
JN : Br J Ophthalmol 1988 ; 72 (9) : 713-719
EN-AB: A case is reported of unilateral proptosis of the left eyeball as a unique clinical presentation of primary angiosarcoma of the skull involving the sphenoid and frontal bones and roof of the orbit on the left side of a 32-year-old man. The intraosseous, extradural non-encapsulated, and friable tumour contained cytoplasmic factor VIII-related antigen. After complete removal of the tumour the patient has been well for 10 months of the follow-up period. This case brings the total number of reported primary angiosarcomas of the cranium to nine. All patients were male and most of them were young. The average age was 24 years. The frontal bone seems to be the site of predilection for cranial angiosarcomas. Surgical extirpation, radiation, or combined surgical removal and radiation have been used for treating angiosarcoma of the skull with variable results. It is suggested that angiosarcoma of the skull has a worse prognosis than angiosarcoma of bones other than the cranium because the patient may die of secondary neoplastic involvement of the brain. (NO 01940)
AU : Shuangshoti S, Kasantikul V, Suwanwela N.
TI : Spontaneous penetration of dura mater and bone by glioblastoma multiforme.
JN : J Surg Oncol 1987 Sep ; 36 (1) : 36-44
EN-AB: Three patients are reported whose cranial dura mater and bones were penetrated by intracranial glioblastomas in the absence of previous craniotomy or radiotherapy. The gliomatous nature of the tumors was confirmed by localization of cytoplasmic glial fibrillary acidic protein (GFAP) of the neoplastic cells. Review of the literature disclosed only 15 glioblastomas, including the three cases, spontaneously penetrating the cranial dura mater and bones. These patients ranged in age from 3.5 to 70 years with an average age of 40 years. The male/female ratio was 5/8. Five glioblastomas were in the temporal lobes, three were in the frontal lobes, three were in the frontotemporal regions, two were in the occipital lobes, one was in the frontoparietal region, and one was in the temporoparieto-occipital region. Six glioblastomas also had spontaneous distant metastases. In the absence of previous craniotomy and radiotherapy, rapid growth of the glioblastomas may promote such spontaneous penetration into the cranial dura mater and bones (NO 01314)
AU : Phancharoen S, Limudomporn S, Mitrakul C, Suwanwela N.
TI : Spontaneous intracranial hemorrhage in infancy : natural history and outcome.
JN : Chula Med J 1986 Jan ; 30 (1) : 15-25
EN-AB: This is a study of eighteen infants with spontaneous intracranial hemorrhage admitted to the Pediatric Department, Chulalongkorn Hospital between January 1980 and December 1984,in which the cause of hemorrhage was idiopathic vitamin K deficiency. The age range were two to eight weeks, 88.89 per cent of the patients' birth weight were more than 2,500 grams and 83.33 per cent were breast-fed. Acute onset of drowsiness, pallor and tensed anterior fontanel were the major clinical manifestations. All patients had hematocrit level below 30 per cent and prolonged prothrombin time which returned to normal level after vitamin K1 and fresh frozen plasma administrations. Computerized axial tomography studied in eleven patients revealed the incidence of subdural, subarachnoid and intracerebral hemorrhage as 63.63, 27.27 and 54.54 per cent respectively. Craniectomy were performed in two patients due to their clinical deterioration from brain herniation and one died from brainstem dysfunction caused by the herniation. Convulsive disorders, microcephaly, delayed growth and development with motor deficit were common sequelae, especially in the intracerebral bleeding group (5 out of 7). The role of early surgical intervention in this group is still controversial. (NO 00122)
AU : Shuangshoti S, Menakanit W, Changwaivit W, Suwanwela N.
TI : Primary intraorbital extraocular primitive neuroectodermal (neuroepithelial) tumor.
JN : Br J Ophthalmol 1986 Jul ; 70 (7) : 543-548
EN-AB: A case is reported of primary primitive neuroectodermal (neuroepithelial) tumour occurring in the right orbit of a 52-year-old man. The intraorbital extraocular location is unique for this kind of neoplasm. The malignant tumour was differentiated into primitive neuroepithelial, ependymal, and oligodendroglial cells. The neuroglia was identified by localisation of cytoplasmic glial fibrillary acidic protein. It is suggested that this primary intraorbital, extraocular, primitive neuroectodermal tumour with neuroglial differentiation is akin to the primitive neuroectodermal tumours of the neuraxis, including the cerebellar medulloblastomas, and to some peripheral nerve tumours known as malignant neuroepitheliomas, malignant ependymomas, and neuroblastomas. The ectomesenchymal remnant of the neural crest or ectopic neuroepithelium or both may have been the origin of the present tumour. Differentiation of the neuroectodermal component of the neural crest or heterotopic neuroepithelium or both would create a primitive neuroectodermal tumour with diverse neuroglial elements. (NO 01063)
AU : Suwanwela N, Lerdlum S, Ukachoke J, Wangsuphachart S, Khaoroptham S.
TI : Computed tomography of spinal cord arteriovenous malformations.
JN : Chula Med J 1985 Dec ; 29 (12) : 1291-1304
EN-AB: Computed tomography of the spine has been used in the evaluation of five patients with surgically proved arteriovenous malformation of the spinal cord. In plain CT scans, focal hyperdense areas were found in all cases. In one case, an area of higher attenuation value was demonstrated and proved to be a hematoma at operation. In all four enhanced scans, enhanced patches and dots were visualized which corresponded to enlarged vessels. Metrizamide CT scans performed in three preoperative cases showed widened cords with irregular or tortuous filling defects. One post first operative metrizamide CT scan also demonstrated a filling defect which disappeared in the following scan after the second operation. CT scan especially with intravenous contrast enhancement and post intrathecal metrizamide should be a useful screening and follow-up method for AVM of the spinal cord, and a safe procedure for assessing therapeutic results. (NO 00221)
AU : Shuangshoti S, Suwanwela N, Suwanwela C.
TI : Combined paraganglioma and glioma of conus medullaris and cauda equina.
JN : J Surg Oncol 1984 Mar ; 25 (3) : 162-167
EN-AB: A mixed paraganglioma and glioma occurred in the conus medullaris and cauda equina of a woman. The tumor was subdural, encapsulated, and vascular. It was first manifested with symptoms and signs of compression of the cauda equina when she was 19 years of age and was excised when she was 24. The tumor was attached to the conus medullaris, the dura mater, and a nerve root of the cauda equina. Striking light and dark cells with an organoid arrangement mingled with a few glial fibrillary acidic protein (GFAP)-positive neuroglia forming a combined paraganglioma and glioma. Twenty-three paragangliomas were reported in the literature including the present case. The sex and age of recorded 19 patients demonstrated ten males and nine females with an average age of 46.3 years. Twenty tumors were subdurally situated at the conus medullaris and cauda equina. Three neoplasms were epidural and thoracic in location. (NO 00184)
AU : Suwanwela N, Wangsuphachart S, Tanpairoj S.
TI : Computed tomography of the eye and orbit : experiences with 70 cases.
JN : Chula Med J 1984 Sep ; 28 (9) : 1001-1030
EN-AB: Seventy patients who had orbital abnormalities in late-generation CT examination of the eye and orbit were analyzed. CT scan could demonstrate location, extension of the orbital lesions as well as their relationships to globe, optic nerve, extraocular muscles, vascular structures, intraorbital fat or periorbital structures. Of the 70 patients, 30 cases had tumors (31 tumors), 16 cases were primary and 14 cases extended from periorbital tumors and metastasis. Other categories were frontoethmoidal encephalomeningocele 9, inflammation (abscess, mucocele, pseudotumor, optic neuritis, old eye infection) 8, thyroid ophthalmopathy 6, fibrous dysplasia 7, carotid-cavernous fistula 3, orbital fracture 2, organized hematoma 1, chronic glaucoma 1, chronic retinal detachment 1, artificial eye 1 and amyloidosis 1. Some specific diseases could be verified by CT scan such as thyroid ophthalmopathy, carotid-cavernous fistula, fracture, frontoethmoidal encephalomeningocele, fibrous dysplasia and mucocele. Axial CT scan with direct coronal scan or coronal and sagittal reformations are the present most non-invasive useful procedures in diagnosis of orbital lesions. Details of CT finding in different diseases were discussed. (NO 00875)
AU : Shuangshoti S, Kasantikul V, Suwanwela N, Suwanwela C.
TI : Solitary primary intracranial extracerebral glioma.
JN : J Neurosurg 1984 Oct ; 61 (10) : 777-781
EN-AB: A case is presented of a solitary primary extracerebral mixed glioma occurring in the right suprasellar and parasellar region of a 49-year-old woman who had bilateral temporal hemianopsia for 3 months. At craniotomy, the well demarcated outline and extracerebral location of the tumor suggested that it was a meningioma. However, its gliomatous nature was confirmed by identification of glial fibrillary acidic protein (GFAP) in the tumor cells. Review of nine reported solitary primary intracranial extracerebral gliomas, including the present case, revealed that they tended to occur in the third to fifth decades of life, in patients with an average age of 42 1/2 years, and without sexual predilection. All were supratentorial with a tendency to be situated in the vicinity of the Sylvian fissure. Only the glioma in the present case was at the cranial base. They were diagnosed as three astrocytomas, two glioblastomas, two oligodendrogliomas, one astroblastoma, and one mixed glioma. A suggestion is made that all these gliomas arose primarily from heterotopic neuroglia in the leptomeninges. (NO 01060)
AU : Suwanwela N, Wangsuphachart S, Suwanwela C.
TI : Clivus chordoma.
JN : Thai J Radiol 1980 ; 17 (1) : 13-25
TH-AB: Chordoma เป็นเนื้องอกที่พบได้น้อย การศึกษาทางรังสีวิทยาอาจช่วยในการวินิจฉัย โดยพบการเปลี่ยนแปลงต่างๆ กันในภาพรังสีธรรมดา, tomogram, angiogram, pneumoencephalogram, ventriculogram, cisternogram, การศึกษาโดยสารราดิโอไอโซโทปและเครื่องเอกซเรย์คอมพิวเตอร์ ได้รายงานลักษณะการเปลี่ยนแปลงทางภาพรังสีของผู้ป่วยโรคเนื้องอก chordoma ที่พบในโรงพยาบาลจุฬาลงกรณ์ จำนวน 3 ราย และได้วิเคราะห์วารสารที่มีรายงานโรคนี้ (NO 00005)
AU : Suwanwela N, Suwanwela C, O'Charoen S, Charoenkupt L.
TI : Gas myelography.
JN : Thai J Radiol 1980 Oct ; 17 (2) : 109-125
EN-AB: Gas myelography, using polytomographic techniques is a useful method in the evaluation of certain diseases and conditions of the spinal cord and spinal canal. These include syringomyelia,diseases in the craniovertebral junction, spinal cord atrophy,spinal cord injury and spinal dysraphism. During the past 4 years, gas myelography was performed in 17 patients with 6 cases of syringomyelia (one associated with astrocytoma of the spinal cord, one with Arnold Chiari malformation), 2 cases of spinal cord atrophy, 1 case of motor neurone disease, 1 case of cervical reticulopathy, 2 cases of tumor in the spinal cord and spinal canal, 3 cases of spinal cord injury and 2 cases of myelomeningocele (one associated with Arnold Chiari malformation). The techniques of performing gas myelography and myelographic findings are demonstrated and discussed. (NO 00018)
AU : Shuangshoti S, Phonprasert C, Suwanwela N, Netsky MG.
TI : Combined neuroepithelial (colloid) cyst and xanthogranuloma (xanthoma) in the third ventricle.
JN : Neurology (Minneap) 1975 Jun ; 25 (6) : 547-552
EN-AB: A case is reported of a combined neuroepithelial cyst and xanthogranuloma of the choroid plexus in the third ventricle of a 22-year-old woman. It is suggested that proliferated neuroepithelial cells lining the cyst enter the fibrous wall through the disrupted basal lamina, and then become xanthomatous cells. Disintegration of these foamy epithelial cells releases lipids and other materials into the cyst wall, provoking a response of macrophages and multinucleated giant cells of foreign-body type. A xanthogranuloma is then formed. The origin of "colloid" cysts is from neuroepithelium; these cysts arise from both ependyma and choroid plexus. Those cysts arising in or near the floor of the third ventricle may originate in stomodeal epithelium, but a distinction cannot be made from neuroepithelial cysts by presently available methods. (NO 00973)
AU : Suwanwela C, Suwanwela N.
TI : Intracranial arterial narrowing and spasm in acute head injury.
JN : J Neurosurg 1972 Mar ; 36 (3) : 314-323
EN-AB: Arteriography in 350 patients with a moderate to severe head injury, including repeated studies in 40 patients, revealed narrowing of one or more of the intracranial arteries in 65 patients (18.6 per cent). Narrowing of the intracranial portion of the internal carotid artery and the first part of the anterior and middle cerebral arteries was found in 18 patients and was believed to be responsible for the clinical symptoms in some. Narrowing of the branches of the cerebral arteries at the site of the cerebral contusion was seen in 33 patients and diffuse narrowing of the intracranial arteries in 12. In two additional patients with gunshot wounds of the brain, there was narrowing of the cerebral artery adjoining a torn vessel. The evidence suggests that vascular spasm is responsible for the narrowing in some patients, while contusion and hemorrhage in the arterial wall is the cause in others. Whatever the mechanism, the occurrence and significance of cerebral arterial narrowing in association with acute head injury needs to be emphasized. (NO 01354)
AU : Suwanwela C, Suwanwela N, Charuchinda S, Hongsaprabhas C.
TI : Intracranial mycotic aneurysms of extravascular origin.
JN : J Neurosurg 1972 May ; 36 (5) : 552-559
EN-AB: Six patients with intracranial mycotic aneurysms of extravascular origin are reported. Four had aneurysms of the intracavernous portion of the internal carotid artery associated with thrombophlebitis of the cavernous sinus, and two had aneurysms of the cerebral arteries associated with meningitis. An aneurysm of this type may rupture, producing subarachnoid hemorrhage, or it may become thrombosed and decrease in size or spontaneously disappear. In some patients it may persist and develop calcification in the wall. (NO 01355)
AU : Suwanwela C, Suwanwela N.
TI : Air study in infants and children with frontoethmoidal encephalomeningocele.
JN : Neuroradiology 1972 ; 4 : 190-194
EN-AB: In the past eight years, we have seen 105 patients with encephalomeningocele in the front part of the head which is exceptionally common in Southeast Asia. Air study was done in 52 patients. In seven patients air entered the herniation, in six from the subarachonoid space and in one from the lateral ventricle, proving the intracranial communication of the mass. In four patients air was seen to outline the neck of the herniation. Air study was most useful in detecting the associated abnormalities of the brain, such as hydrocephalus, obstruction of the foramen of Monro, ventricular dilatation, cortical atrophy, porencephalic cyst and agenesis of corpus callosum. The ventricular system and the subarachnoid space was found to be normal in only 18 patients in this group. Air study proves to be a fruitful method for the evaluation of frontoethmoidal encephalomeningocele, and no serious complication was encountered. (NO 01386)
AU : Suwanwela C, Suwanwela N.
TI : A morphological classification of sincipital encephalomeningoceles.
JN : J Neurosurg 1972 Feb ; 36 (2) : 201-211
EN-AB: Cranial defects and cerebral abnormalities as revealed by postmortem dissection in 12 patients with sincipital encephalomeningocele are reported. The various methods of classifying this lesion are discussed. A classification based on the location of the defect in cranium is outlined. The clinical application of such a classification and its usefulness in the surgical management are emphasized. (NO 01434)
AU : Suwanwela C, Sukabote C, Suwanwela N.
TI : Fronto-ethmoidal encephalomeningocele.
JN : Surgery 1971 Apr ; 69 (4) : 617-625
EN-AB: In eight years, we have studied 100 patients with encephalomeningocele in the anterior part of the head. Operation is advised to correct deformity, prevent progression of the lesion, and to anticipate erosion and infection. Neglected hydrocephalus, active infection, or possible brain damage constitute contraindications to operation. We have had one operative death among 72 patients treated by operation. (NO 01368)
AU : Suwanwela N, Suwanwela C.
TI : คุณค่าของเอกซเรย์ของศีรษะในการวินิจฉัยโรคเนื้องอกภายในช่องกะโหลกศีรษะ
JN : Chula Med J 1970 Jul ; 15 (3) : 184-200
TH-AB: ในคนไข้ที่เป็นเนื้องอกภายในช่องกะโหลกศีรษะ ประมาณหนึ่งในสามภาพเอกซเรย์ของศีรษะมีการเปลี่ยนแปลงเฉพาะที่ช่วยบอกตำแหน่งของเนื้องอกได้อีกหนึ่ง ในสาม มีลักษณะของความดันเพิ่มขึ้นภายในศีรษะและอีกราวหนึ่งในสามเอกซเรย์ของกะโหลกศีรษะไม่พบการเปลี่ยนแป ลง สำหรับ benign tumors อัตราการผิดปกติเห็นได้สูงกว่านี้ ในผู้ป่วยที่อาการทางคลีนิคสงสัยว่ามีเนื้องอกในสมอง การถ่ายภาพเอกซเรย์ของกะโหลกศีรษะจึงเป็นการตรวจที่มีประโยชน์มากในการช่วยบ่งชี้ให้ทำการตรวจค้นต่อ ไปได้ถูกทาง (NO 01154)
AU : Suwanwela C, Hongsaprabhas C, Srikasikul S, Sukabote C, Suwanwela N, Chienpradit K.
TI : Fronto-ethmoidal encephalomeningocele.
JN : Chula Med J 1969 Oct ; 14 (4) : 179-196
EN-AB: We have studied 82 patients with encephalomeningocele in the anterior part of the head. The geographical variations in the incidence of this disease have been discussed. Pathological, clinical and therapeutic aspects have also been considered. (NO 01356)
AU : Suwanwela C, Poshyachinda V, Poshyachinda M, Suwanwela N.
TI : Radioisotope scanning of the brain.
JN : J Med Assoc Thai 1969 Oct ; 52 (10) : 812-831
EN-AB: Radioisotope scanning of the brain was first introduced at the Chulalongkorn Hospital Medical School, Bangkok, on June 1, 1967. More than 600 scans have been done since. 203Hg-Chlormerodrin was used. The first 300 patients were studied and reported. To facilitate the evaluation of the test, two authors (V.P. and M.P.) reread the scans without knowing the histories or final diagnoses. Among 102 cases with proven diagnoses, there were 67 abnormal, 12 probably abnormal, 11 probably normal and 12 normal scans. Scanning was abnormal in 29 of 32 patients with primary brain tumors. Eight meningiomas, 5 glioblastomas multiforme, 4 medulloblastomas, 4 craniopharyngiomas, 2 astrocytomas and 2 pinealomas all gave abnormal scans. One case each of neurinoma of the facial nerve, pituitary adenoma and ependymoma of the fourth ventricle showed no abnormality in the scans. Localization of tumor was correct in 28 of the 29 abnormal scans. The ability to tell the type of tumor was limited to a small number of meningioma and glioblastoma multiforme. All 8 metastatic brain tumors gave abnormal scans. Among 53 cases of non-neoplastic lesions of the brain, 40 showed abnormal scans. They were abnormal in 12 of the 16 cerebral infarctions which showed wide ranges of isotopic uptake. One patient who had encephalomalacia from cerebral in farction gave so high an uptake that it was misdiagnosed as a meningioma. All 8 brain abscesses and cerebritis showed abnormal scans. Cerebral scars, intracranial hematoma, aneurysm and arterio-venous malformation were also seen with abnormal scans. Differentiation between (NO 01366)
AU : Suwanwela C, Suwanwela N, Hongladarom T, Hongsaprabhas C.
TI : Subarachnoid hemorrhage, aneurysms และ arterio-venous malformation ของสมอง
JN : Chula Med J 1969 Apr ; 14 (2) : 55-72
TH-AB: ในการศึกษาผู้ป่วยที่เจาะน้ำไขสันหลังได้เลือด (ไม่ใช่จากบาดเจ็บ) ผู้ป่วย aneurysm และ arteriovenous malformation รวม 105 ราย พบว่า การมีเลือดออกในน้ำไขส้นหลัง เกิดจาก aneurysm ร้อยละ 21 arteriovenous malformation ร้อยละ 15, และแตกออกมาจากก้อนเลือดในเนื้อสมอง ร้อยละ 29, นอกจากนี้เกิดจากโรคอื่น ๆ ในสมอง ร้อยละ 14, ตรวจหาสาเหตุของเลือดออกไม่พบ ร้อยละ 21 aneurysm พบทั้งหมด 23 ราย นับว่าน้อยกว่าในประเทศญี่ปุ่นในยุโรป และในสหรัฐอเมริกา ได้วิจารณ์ถึงเหตุที่ทำให้พบน้อย (NO 01393)
AU : Suwanwela C, Boonyunwetwat D, Suwanwela N, Intakorn E, Kongmebhol V, Boonruxa U, Loharnchun Y.
TI : ประสบการณ์ทางการแพทย์ที่ตำบลหนองรี จังหวัดกาญจนบุรี
JN : Chula Med J 1969 Jan ; 14 (1) : 22-34
TH-AB: การส่งแพทย์เคลื่อนที่ออกไปปฏิบัติงานในท้องถิ่นทุรกันดารนั้น, นอกจากจะได้ประโยชน์ตามวัตถุประสงค์ในการบำบัดโรคให้แก่ประชาชนแล้ว ยังมีผลพลอยได้คือประสบการณ์ของแพทย์ที่ออกปฏิบัติการด้วย ทำให้ทราบถึงความต้องการด้านการแพทย์ของประชาชนในท้องถิ่นนั้น ๆ. ทั้งนี้ย่อมเป็นประโยชน์ในการพิจารณาการพัฒนา การพัฒนาการแพทย์และการศึกษาแพทย์ให้เหมาะสมกับความต้องการของประเทศ คณะแพทย์ที่ออกปฏิบัติงานในหน่วยของคณะกรรมการกลางรักษาความปลอดภัยแห่งชาติชุดที่ 30 มีความเห็นว่า. น่าจะบันทึกประสบการณ์ไว้ เพราะอาจจะเกิดประโยชน์ได้บ้างแม้จะเป็นการสำรวจทางการแพทย์อย่างตื้น ๆ ก็ตาม (NO 01395)
AU : Suwanwela N, Suwanwela C, Charuchinda S, Hongladarom T, Bunnag TS.
TI : Angiography in tuberculous meningitis.
JN : Thai J Radiol 1967 ; 5 (2) : 104-115
EN-AB: Tuberculous meningitis is a fairly common disease in Thailand, the incidence being 0.7-0.9 per cent of hospitalized pediatric cases. Mortality from this disease is over 30 per cent. Clinical diagnosis is not always easy, recovery of tubercle bacilli from cerebrospinal fluid is not always successful, curability is not always prompt and cause problems in diagnosis and treatment. Cerebral angiography may provide additional hints in diagnosis, prognosis and treatment. The report consists of 15 cases of tuberculous meningitis in which cerebral angiography was performed for purpose of differential diagnosis, mainly to exclude a space occupying lesion. The findings have been interesting and to a certain extent coincide with those reported in the literature, although few studies have been reported. The angiographic findings in tuberculous meningitis observed in our series are: narrowing of the intracranial part of the internal carotid artery and narrowing of the proximal parts of the anterior and middle cerebral arteries; occlusion of the intracranial part of the interanl carotid artery and occlusion of the proximal parts of the anterior and middle cerebral arteries; calcification and fusiform aneurysms in the anterior cerebral artery. This last features have not been reported previously. The sites of the changes in the arteries are summarized in the diagram, figure 8. (NO 01369)
AU : Suwanwela N, Arthachinta S, Tangchai P, Suwanwela C, Bunnag TS.
TI : Angiographic study in intracranial abscess.
CONF : Annual Meeting of the College of Radiologists of Australasia. 16th, 1965 Oct 18-22, Australia
JN : Australas Radiol 1966 Nov ; 10 (4) : 324-329
EN-AB: The subject of "Angiographic" Study of in Intracranial Abscess" presented here is the result of a joint work of the Departments of Neurosurgery, Radiology and Pathology of the Chulalongkorn Hospital and Medical School, University of Medical Sciences, Bangkok, Thailand. The purpose of this paper is an attempt to demonstrate the different angiographic features that may be encountered in a brain abscess. Wickbom, in 1953, Lindgren in 1957, Greitz and Lindgren in 1961, and Weber in 1962, all agree that the angiographic appearance of brain abscess does not differ from that seen in avascular lesions such as a haematoma ; but in some instances a hypervascular zone or ring may be seen surrounding the avascular area in the early venous or a little earlier phase. We have gathered 16 brain abscesses and two subdural abscesses between July, 1962, and October, 1965. Carotid angiography was performed in 12 cases, in the remaining six cases ventriculography was performed. We have grouped the radiological findings into three categories ; the most illustrative seven cases are presented in this article. (NO 01317)
AU : Arthachinta S, Suptharasamai P, Suwanwela N, Harinasuta C.
TI : Lymphangiographic study in lymphedema of lower extremities with special attention to cases of filariasis : a preliminary report.
JN : Thai J Radiol 1964 ; 2 (2) : 67-81
EN-AB: 1. Early individual lymph vessel obstruction was demonstrated in our study of filarial cases which have no clinical evidence of lymphedema. 2. Such individual obstruction was also found in non-filarial lymphedema. 3. Further changes such as dilatation, varicosity fine reticulate superficial lymphatic network, loss of normal beeding of lymphatic valves, intradermal backflow and communication between superficial and deep lymphatics of the leg were found in more advanced cases, the changes being proportional to the severity of the condition. 4. Obstruction of the inguinal nodes or nodes at higher levels may be present which contribute to the cause of lymphedema. 5. The lymphatic changes described are permanent and irreversible. Stagnation of lymph drainage is the major factor producing recurrent lymphedema. Infection may be an early cause of these permanent changes or may later aggravate the situation in an already edematous leg. 6. It is not possible, with our small series of cases studied, to differentiate filarial from non-filarial lymphedema by lymphangiography. (NO 01367)
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