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Year 2008

JN : Neuropathol Appl Neurobiol. 2008 Apr;34(2):245-7. Epub 2007 Nov 5.
TI : Primary central nervous system plasmablastic lymphoma in AIDS.
AU : Shuangshoti S, Assanasen T, Lerdlum S, Srikijvilaikul T, Intragumtornchai T, Thorner PS. (NO 17983424)

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Year 2007

JN : J Med Assoc Thai. 2007 Feb;90(2):307-12.
TI : Normal measurements of extraocular muscle using computed tomography.
AU : Lerdlum S, Boonsirikamchai P, Setsakol E.
EN-AB: OBJECTIVE: Establish criteria for the diameters of normal extraocular muscles using computerized tomography in a Thai population. MATERIAL AND METHOD: Diameters of extraocular muscles (medial, lateral, superior complex, and inferior rectus) were calculated for 200 patients on coronal direction of screening paranasal sinuses. The effects of age and sex were also analyzed. RESULT: Normal ranges for the diameters (mean +/- 2 SDs) of extraocular muscles were 3.7 +/- 0.9 mm for medial rectus, 3.6 +/- 1.2 mm for lateral rectus, 4.0 +/- 1.4 mm for inferior rectus and 3.8 +/- 1.4 mm for the superior group. The mean diameter of the extraocular muscles in male patients was not significantly larger than in female patients (p > 0.05). There was also no statistically significant correlation between age, diameter of each extramuscular muscle and the sum of all four muscles. CONCLUSION: The present result may help radiologists and ophthalmologists to accurately assess enlargement of the extraocular muscles, particularly in Oriental populations. (NO 17375636)

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Year 2006

JN : J Infect Dis. 2006 Sep 1;194(5):642-50. Epub 2006 Jul 18.
TI : Changes in body composition and mitochondrial nucleic acid content in patients switched from failed nucleoside analogue therapy to ritonavir-boosted indinavir and efavirenz.
AU : Boyd MA, Carr A, Ruxrungtham K, Srasuebkul P, Bien D, Law M, Wangsuphachart S, Krisanachinda A, Lerdlum S, Lange JM, Phanuphak P, Cooper DA, Reiss P.
EN-AB: BACKGROUND: Body composition changes complicate antiretroviral therapy. Improvements in lipoatrophy after a switch in nucleoside reverse-transcriptase inhibitors (NRTIs) have been demonstrated. We investigated 60 patients switching from failed NRTIs to ritonavir-boosted indinavir and efavirenz. METHODS: Body composition (assessed by dual-energy x-ray absorptiometry scan and by single-slice computed tomography of the abdomen through the level of the fourth lumbar vertebra [L4] and the mid-right thigh) and fasted metabolics were measured at the baseline time-point at switch and at weeks 48 and 96 thereafter. Mitochondrial DNA and RNA were extracted from right-thigh subcutaneous fat and peripheral-blood mononuclear cells (PBMCs) at weeks 0 and 48. The primary end point was the change in mean limb fat over 48 weeks. RESULTS: At week 96, we observed increases in mean (standard deviation [SD]) limb fat (+620 [974] g; P=.003), L4 subcutaneous adipose tissue (+20 [35] cm(2); P<.001), mid-thigh subcutaneous adipose tissue (+5 [10] cm(2); P<.001), and L4 visceral adipose tissue (+11 [34] cm(2); P=.01), but we also observed reduced lean limb mass (-831 [1,100] g; P=.3). Mean (SD) mtDNA content in subcutaneous fat and in PBMCs increased (+109 [274] and +45 [100] copies/cell, respectively). Improved virological control or immune recovery did not explain the results. Triglyceride, total cholesterol, estimated low-density lipoprotein cholesterol, ratio of total cholesterol to high-density lipoprotein cholesterol, and blood glucose levels deteriorated (i.e., had increased by 206%, 67%, 58%, 19%, and 6%, respectively, at week 96). CONCLUSIONS: This regimen was associated with statistically significant but clinically modest increases in peripheral fat, visceral fat, and mitochondrial nucleic acid content. A predominantly adverse metabolic profile developed. (NO 16897663)

JN : J Med Assoc Thai. 2006 Aug;89(8):1269-76.
TI : Successful resection of Hypothalamic Hamartoma with intractable gelastic seizures--by transcallosal subchoroidal approach.
AU : Bunyaratavej K, Locharernkul C, Tepmongkol S, Lerdlum S, Shuangshoti S, Khaoroptham S.
EN-AB: A 19-year old female with intractable gelastic seizures was found to have 0.7 x 1.8 x 1.8 cm elliptical mass on the floor of the third ventricle. The signal intensity on the Magnetic Resonance Imaging (MRI) was consistent with the Hypothalamic Hamartoma (HH). Ictal EEG demonstrated rhythmic 7 Hz waves over Fp2, F4, and C4 with spreading to the right temporal region and then bilaterally. Ictal Single Photon Emission Computerized Tomography (SPECT) showed hyperperfusion at hypothalamic and medial frontopolar regions. The patient underwent surgical resection using Trans Callosal Subchoroidal Approach (TCSA) to the third ventricle. Pathological finding confirmed the diagnosis of hypothalamic hamartoma. Following the operation, she has been seizure free up to 12 months. Thereafter, provoked seizures seldom occurred and there has been improvement in her memory, emotional control and independence. This appears to be the first report of this surgical approach for HH, which is less likely to disturb memory function compared to previously described interfoniceal approach. (NO 17048440)

JN : J Med Assoc Thai. 2006 Apr;89(4):527-32.
TI : The first invasive EEG monitoring for surgical treatment of epilepsy in Thailand.
AU : Srikijvilaikul T, Locharernkul C, Deesudchit T, Tuchinda L, Lerdlum S, Tepmongkol S, Shoungshotti S.
EN-AB: The authors report the first invasive electroencephalography (EEG) monitoring in Thailand in a patient who had intractable left temporal lobe epilepsy. The seizure origin and functioning cortices were identified The corresponding epileptogenic zone was resected without functional deficit. The patient has become seizure free 1 year since surgery. Subdural EEG monitoring with cortical stimulation have been developed at this tertiary epilepsy center The technique provides essential evidence for the surgical decision so that the best post operative outcome can be achieved. (NO 16696401)

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Year 2005

JN : J Med Assoc Thai. 2005 Sep;88 Suppl 4:S110-5.
TI : Prevalence of anatomic variation demonstrated on screening sinus computed tomography and clinical correlation.
AU : Lerdlum S, Vachiranubhap B.
EN-AB: Screening sinus computed tomography (SCCT) of 133 patients performed from March 2003 to February 2004, were retrospectively reviewed, concerning anatomic variation at ostiomeatal unit (OMU) and nasal septal deviation. Six patterns of inflammatory sinus disease were designated: maxillary infundibulum, nasofrontal duct, OMU, sphenoethmoidal recess, polyposis and sporadic. The most common anatomic variation was concha bullosa (14.3%), followed by Haller cell (9.4%), large Agger nasi cell (7.9%) and paradoxical middle turbinate (5.3%). Nasal septal deviation was presented in 75 patients (56.4%). Inflammatory sinus disease was presented in 181 lateral nasal walls (68%) and maxillary infundibular pattern was the most common (33.1%). There was significant correlation between large Agger nasi cell and nasofrontal duct pattern (p < 0.05). The remaining anatomic variations and nasal septal deviation had no significant correlation to the inflammatory sinus disease. Overall, the anatomic variation which can compromise the mucociliary drainage was frequently observed, however, only the large Agger nasi cell had significant correlation to the inflammatory sinus disease. (NO 16623013)

JN : Clin Infect Dis. 2005 May 15;40(10):1521-8. Epub 2005 Apr 12.
TI : Epstein-Barr virus infection-associated smooth-muscle tumors in patients with AIDS.
AU : Suankratay C, Shuangshoti S, Mutirangura A, Prasanthai V, Lerdlum S, Shuangshoti S, Pintong J, Wilde H.
EN-AB: BACKGROUND: The aim of our study is to describe the unusual clinical manifestations of smooth-muscle tumors (SMTs) in patients with acquired immunodeficiency virus (AIDS) and to demonstrate the association between Epstein-Barr virus (EBV) infection and SMTs. METHODS: Nine patients with AIDS and SMTs were characterized at Chulalongkorn Hospital (Bangkok, Thailand) from 2001 through 2003. Tumor tissues suitable for immunohistochemical analysis and in situ hybridization were assayed for SMTs and EBV, respectively. Plasma and serum samples were tested for EBV by real-time quantitative polymerase chain reaction and serologic analysis. RESULTS: The study included 8 adults and 1 child (3 males and 6 females). All patients had CD4 cell counts of <200 cells/microL. By the end of the study, 3 patients had died, and 6 patients had survived. The sites of SMTs were the epidura (5 intracranial and 4 intraspinal SMTs), vocal cords (2), adrenal glands (2), abdominal wall (2), iris (1), liver (1), lung (1), orbit (1), and thigh (1). Seven patients had multicentric SMTs involving intracranial sites only (4 SMTs), extra- and intracranial sites (3), or extracranial sites only (2), which occurred either concurrently or sequentially. We found evidence of EBV infection, as determined by in situ hybridization, in all SMTs. Furthermore, EBV DNA was detectable in plasma samples from 2 patients. The results of serologic analysis were consistent with past EBV infection. CONCLUSIONS: SMTs in patients with AIDS typically arise in multiple and very unusual sites that are not often observed in SMTs among immunocompetent individuals. Our series also suggests association between EBV infection and SMTs in patients with AIDS. The exact role of EBV in smooth-muscle oncogenesis awaits further study. (NO 15844077)

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Year 2004

JN : J Med Assoc Thai. 2004 Sep;87 Suppl 2:S152-60.
TI : MR imaging of CNS leiomyosarcoma in AIDS patients.
AU : Lerdlum S, Lalitanantpong S, Numkarunarunrote N, Chaowanapanja P, Suankratay C, Shuangshoti S.
EN-AB: Leiomyosarcomas of the central nervous system are extremely rare; however they are becoming more prevalent in immunocompromised patients. The authors present MRI (Magnetic Resonance Imaging) of six cases of pathological proved leiomyosarcomas of the central nervous system in patients infected with human immunodeficiency virus. MR images of 4 cases of intraspinal leiomyosarcoma showed lobulated masses expanding multilevel of neural foramina with extradural and intradural extension, giving dumbbell appearance which mimic neurofibroma. Two cases of intracranial leiomyosarcoma revealed a mass at the left cavernous sinus involving prepontine cistern in one case and two lesions in the other case showing masses with dural based appearance at the region of the planum sphenoidale and the posterior aspect of the falx cerebri which mimiced a meningioma. The leiomyosarcoma should be included in the differential diagnosis of extra-axial CNS lesions in HIV-infected patients. (NO 16083180)

JN : J Med Assoc Thai. 2004 Jul;87(7):850-3.
TI : Idiopathic superficial siderosis: a case report.
AU : Phanthumchinda K, Likitcharoen Y, Lerdlum S.
EN-AB: Superficial siderosis of the central nervous system (SSCN) is a very rare disorder. The clinical syndrome of SSNC consists of sensorineural hearing loss, cerebellar ataxia and myelopathy. The clinical syndrome together with the typical appearance on magnetic resonance imaging (MRI) of hyposignal intensity along the leptomeninges in T2 sequence permit the diagnosis of SSCN. A 58 year-old man who has a history of chronic progressive hearing loss and gait instability for 5 years is presented. The neurological examination revealed bilateral sensorineural hearing loss, cerebellar ataxia and mild spasticity of the lower extremities. MRI showed classical superficial siderosis in the form of hyposignal intensity along the leptomeninges in T2 sequence. The prominent sites of hemosiderin deposition in this case were cerebellar vermis, trigeminal nerves, vestibulocochlear nerves, around the brain stem and spinal cord surface. Cerebrospinal fluid findings confirmed chronic subarachnoid hemorrhage but bleeding site could not be demonstrated. There is no specific treatment available for idiopathic SSCN. (NO 15521245)

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Year 2002

AU : Shotelersuk V, Ittiwut C, Srivuthana S, Mahatumarat C, Lerdlum S, Wacharasindhu S.
TI : Distinct Craniofacial-skeletal-dermatological Dysplasia in a Patient With W290C Mutation in FGFR2.
JN : Am J Med Genet 2002 Nov ; 113 (1) : 4-8 (NO 07893)

AU : Tepmongkol S, Wangsuphachart S, Lerdlum S, Sittipunt C, Udayachalerm W.
TI : Comparison of TC-99m apcitide scintigraphy with CT angiography in intermediate probability of pulmonary emboli by pioped criteria using pulmonary angiography as a gold standard.
JN : ASEAN J Radiol 2002 Sep-Dec ; 8 (3) : 185-192 (NO 08154)

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Year 1999

AU : Tiraratchailert A, Lerdlum S.
TI : Clinical manifestations and radiologic findings of Romberg syndrome.
JN : Chulalongkorn Medical Journal = จุฬาลงกรณ์เวชสาร 1999 Jan ; 43 (1) : 39-44
EN-AB: Progressive hemifacial atrophy (Romberg syndrome) is a rare disease of unknown etiology manifested variable involvement of the skin, soft tissue and underlying cranio-facial skeleton with sharply delimited by the midline. Atrophy is typically affecting the subcutaneous tissue and skin with later involvement of the muscles and bones. Few studies have been reported in the literatures. A typical case of Romberg syndrome with complete radiologic examination including three dimensional computed tomography was presented. (NO 05493)

AU : Tiraratchailert A, Lerdlum S.
TI : Clinical manifestations and radiologic findings of Romberg syndrome.
JN : Chulalongkorn Medical Journal = จุฬาลงกรณ์เวชสาร 1999 Jan ; 43 (1) : 39-44
EN-AB: Progressive hemifacial atrophy (Romberg syndrome) is a rare disease of unknown etiology manifested variable involvement of the skin, soft tissue and underlying cranio-facial skeleton with sharply delimited by the midline. Atrophy is typically affecting the subcutaneous tissue and skin with later involvement of the muscle and bones. Few studies have been reported in the literatures. A typical case of Romberg syndrome with complete radiologic examination including three dimensional computed tomography was presented. (NO 05579)

AU : Tiraratchailert A, Lerdlum S.
TI : Clinical manifestations and radiologic findings of romberg syndrome.
JN : Chula Med J 1999 ม.ค. ; 43 (1) : 39-44
EN-AB: Progressive hemifacial atrophy (Romberg syndrome) is a rare disease of unknown etiology manifested variable involvement of the skin, soft tissue and underlying cranio-facial skeleton with sharply delimited by the midline. Atrophy is typically affecting the subcutaneous tissue and skin with later involvement of the muscles and bones. Few studies have been reported in the literatures. A typical case of Romberg syndrome with complete radiologic examination including three dimensional computed tomography was presented., Progressive hemifacial atrophy (Romberg syndrome)
TH-AB: เป็นกลุ่มอาการที่ประกอบด้วยความผิดปกติในลักษณะ atrophy ของผิวหนังเนื้อเยื่อ และกระดูกบริเวณใบหน้า โดยจำกัดบริเวณเพียงครึ่งซีกของใบหน้าอย่างชัดเจน เป็นกลุ่มอาการที่พบได้น้อยและยังไม่พบสาเหตุของโรคที่แน่นอน รายงานนี้ได้นำเสนอผู้ป่วย 1 ราย โดยแสดงให้เห็นความผิดปกติอย่างชัดเจนจากการตรวจด้วยเอกซเรย์คอมพิวเตอร์. (NO 06432)

AU : Laoprasopwattana P, Lerdlum S, Aeumjaturapat S.
TI : MRI evaluation of spontaneous CSF rhinorrhea.
JN : Chula Med J 1999 ก.ย. ; 43 (9) : 665-671
EN-AB: Spontaneous cerebrospinal fluid (CSF) rhinorrhea is rare when compared with traumatic CSF rhinorrhea. Accurate localization of the site of leakage is essential for planning surgical treatment. We report a patient with spontaneous CSF rhinorrhea through a defect at the sphenoid sinus region detected by magnetic resonance imaging (MRI) and plain computed tomography. T2 weighted MR images are useful for the detection and localization of CSF leakage. MRI provides an accurate and noninvasive method for preoperative investigation of CSF rhinorrhea.,
TH-AB: การรั่วซึมของน้ำหล่อเลี้ยงสมอง และไขสันหลัง (Cerebrospinal fluid leakage) จากบริเวณฐานกะโหลกศีรษะ มักมีการอักเสบติดเชื้อของระบบประสาทตามมา ทำให้เกิดอัตราการเจ็บป่วย และการเสียชีวิตสูงขึ้น การวินิจฉัยภาวะนี้ให้ได้รวดเร็ว และถูกต้องแม่นยำจะทำให้การรักษาเป็นไปได้ทันท่วงที และมีประสิทธิภาพ ในอดีตวิธีการวินิจฉัยภาวะ CSF leakage โดย Computerized tomographic cisternography และ Radionuclide cisternography เป็นวิธีการตรวจที่ยุ่งยาก อาจเกิดผลแทรกซ้อนจากการตรวจ ผู้ป่วยได้รับรังสี ในปัจจุบัน Magnetic resonance imaging (MRI) เป็นการตรวจที่สามารถแสดงให้เห็นตำแหน่งความผิดปกติของโรคได้แม่นยำ ทั้งยังไม่เกิดผลแทรกซ้อนจากการตรวจ ทำให้ได้ข้อมูลในการวินิจฉัย ภาวะ Cerebrospinal fluid leakage ที่สะดวก รวดเร็ว แม่นยำ และปราศจากรังสี ซึ่งช่วยให้การรักษาเป็นไปได้ดียิ่งขึ้น. (NO 06485)

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Year 1997

AU : Israsena N, Phanthumchinda K, Sinsawaiwong S, Lerdlum S.
TI : Spontaneous carotid dissection.
JN : จดหมายเหตุทางแพทย์Journal of the Medical Association of Thailand 1997 Jun ; 80 (6) : 406-410
EN-AB: Spontaneous internal carotid dissection typically occurs in young or middle-aged patients. It is associated with a high rate of recovery and low mortality. Anticoagulant and antiplatelet drugs fail to demonstrate a significant improvement when compared with placebo. A 38-year-old woman with spontaneous dissection of the internal carotid artery diagnosed by MRI is reported. She had an excellent recovery without treatment and no recurrent attack occurred after one year of follow-up. The clinical manifestations, diagnostic tests and treatment of spontaneous internal carotid disection are briefly reviewed in this communication.
TH-AB: รายงานผู้ป่วยหญิงไทย อายุ 38 ปี มาด้วยอาการปวดศีรษะ และตามองไม่เห็นชั่วคราวด้านขวา 3 วันต่อมา ผู้ป่วยเกิดอาการสมองขาดเลือดจากการอุดตันของหลอดเลือดมิลเดิลซีรีบรั ลด้านขวา การตรวจด้วยคอมพิวเตอร์สมองพบสมองขาดเลือดในบริเวณที่เลี้ยงด้วยหลอดเ ลือดมิดเดิลซีรีด้านขวา การตรวจหลอดเลือดที่ไปเลี้ยงสมองสี่หลอดโดยทางรังสีวิทยา พบการอุดตันของอินเตอร์นัลคาโรติดด้านขวาบริเวณ 1 เซ็นติเมตรเหนือแขนงแยกของหลอดเลือดคาโรติดการตรวจด้วยเอ็มอาร์ไอ พบลักษณะของลิ่มเลือดในผนังหลอดเลือดและรูของหลอดเลือดบริเวณดังกล่าว บางส่วนยังไม่อุดตัน ซึ่งเข้าได้กับลักษณะของการเซาะของหลอดเลือดอินเตอร์นัลคาโรติด ผู้ป่วยรายนี้ไม่มีประวัติอุบัติเหตุ และไม่มีประวัติโรคหลอดเลือดมาก่อน ผู้ป่วยได้รับการวินิจฉัยว่ามีการเซาะของหลอดเลือดคาโรติดชนิดเกิดขึ้ นเอง และได้รับการรักษาด้วยแอสไพริน 300 มิลลิกรัมต่อวัน ร่วมกับการทำกายภาพบำบัด ผู้ป่วยฟื้นตัวได้ดี และไม่มีอาการเกิดขึ้นซ้ำอีกหลังติดตามการรักษาครบ 1 ปี. (NO 03151)

AU : Shuangshoti S, Lerdlum S.
TI : Concurrent occurrence of solitary spinal epidural osteochondroma and angiolipoma.
JN : Clin NeuropatholClinical Neuropathology 1997 Mar-Apr ; 16 (2) : 107-10
EN-AB: A unique concurrent occurrence of spinal epidural osteochondroma and angiolipoma was found in the first thoracic level of a 21-year-old man. The combined lesions produced longstanding motor and sensory disturbances because of compression of the corresponding segment of the spinal cord, and abrupt paraparesis presumably due to spontaneous hemorrhage from the angiomatous component of the angiolipoma. The neurological deficits were satisfactorily improved after surgical removal of the hematoma as well as of both lesions which were regarded as mesenchymal hamartomas. (NO 05142)

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Year 1995

AU : Kasantikul V, Maneesri S, Panichabhong V, Lerdlum S.
TI : Adenosquamous carcinoma of the thyroid. a case report and review of the literature.
JN : Journal of the Medical Association of Thailand 1995 ; 78 (4) : 197-203
EN-AB: A case of mixed squamous cell carcinoma and papillary adenocarcinoma of the thyroid in a 75-year-old woman is described. Review of 19 reported adensquamous carcinoma including the present case revealed that they tended to occur in the sixth and seventh decades of life with an average age of 63.84 years and without sexual predilection. Local invasion and meta-stases of this highly fatal neoplasm are common. (NO 02106)

AU : Kasantikul V, Maneesri S, Lerdlum S.
TI : Lipoblastic meningioma. a light and electron microscopic study.
JN : Journal of the Medical Association of Thailand 1995 ; 78 (5) : 276-280
EN-AB: A patient with intracranial lipoblastic meningioma in the right frontal lobe is reported. The tumor was entirely made up of vacuolated cells. The nature of this rare neoplasm has been verified by light and electron microscopic studies. (NO 02108)

AU : Kasantikul V, Maneesri S, Lerdlum S, Panichabhongse V.
TI : Calcified cystic pituitary prolactinoma.
JN : J Med Assoc Thai 1995 ; 78 (9) : 497-501
EN-AB: An unusual cystic pituitary prolactinoma in a 20-year-old man in described. The tumor was roentgenographically calcified. Ultrastructurally, the calcium deposits were found within the cytoplasm of tumor cells, extracellular spaces and blood vessels. The mechanism of intratumoral calcification is discussed in relation to degeneration of neoplastic cells and reparative process. (NO 02578)

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Year 1994

AU : Shuangshoti S, Kasantikul V, Lerdlum S.
TI : Subacute necrotizing encephalomyelopathy (Leigh's disease) in adults clinically diagnosed as multiple sclerosis.
JN : Chulalongkorn Medical Journal 1994 ; 38 (3) : 145-163
EN-AB: A report is made on two women, aged 32 and 40 years respectively who died with subacute necrotizing encephalomyelopathy (adult form of Leigh's disease). These two patients were incorrectly diagnosed clinically to have multiple sclerosis because of diversified neurologic manifestations affecting the visual, motor, sensory, and autonomic systems. The course of ailment lasted about 10 years in case 1, and 1 year and 10 months in case 2. A review of 15 cases of the adult form of Leigh's disease, including these two patients, disclosed that clinically the malady showed psychomotor regression and brainstem dysfunction. The clinical diagnosis is confirmed by demonstrating symmetrical abnormalities in the basal ganglions, computed tomographic brain scan or magnetic resonance imaging. Pathologically, subacute necotizing encepthal omyelopathy is manifested by irregularly defined lesions in the basal ganglions, thalmus, brainstem, and spinal cord. These lesions are often bilateral and symmetrical, and contain proliferating small blood vessels with endothelial hyperplasia as well as relatively intact neurons. The etiology, pathogenesis, and appropriate treatment of Leigh's disease remain to be elucidated. (NO 02626)

AU : Sriussadaporn S, Lerdlum S.
TI : Abdominal tuberculosis presented with obstructive jaundice : a case report.
JN : Chulalongkorn Medical Journal 1994 ; 38 (8) : 479-484
EN-AB: A case of abdominal tuberculosis presented with obstructive jaundice is reported. The tuberculous tubercles involved the liver, gall bladder, mesentery, peritoneum and lymph nodes. Obstructive jaundice was caused by external compression of the common bile duct from the surrounding enlarged lymph nodes. Surgical management included cholecystectomy and exploration with T-tube drainage of the common bile duct. Antituberculous therapy included isoniazid 300 mg/day and rifampicin 450 mg/day for 12 months, and pyrazinamide 1.5 gm/day during the first 2 months. The T-tube was removed after completion of the antituberculous therapy and when the T-tube cholangiography demonstrated free flow of contrast material into the duodenum. (NO 02646)

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Year 1993

AU : Sangwatanaroj S, Sriussadaporn S, Tangchai W, Rojanasakul A, Jindaruk S, Dhitavat V, Lerdlum S, Chitmaitree B, Maungmingsuk V, Migasena R, Niruthisard S, Leelanukrom R, Choedamphai E, Pramuan P, Hanvanich M, Bunyaratavej S.
TI : Gastrointestinal fistulae associated with a large abdominal wall defect : the usefulness of synthetic meshes. a case report.
JN : จุฬาลงกรณ์เวชสาร = Chulalongkorn Medical Journal 1993 ; 37 (7) : 469-476
EN-AB: A case of gastrointestinal fistulae associated with a large abdominal wall defect was reported. The abdominal wall integrity was temporarily maintained by the use of synthetic meshes. Both absorbable (Dexon) mesh and non-absorbable (Mersilene) mesh were used in this case. Recurrent fistulae developed after placement of the meshes but was surgically closed successfully. The patient recovered and was discharged home after 8 months and 4 days of hospitalization. Synthetic mesh is an invaluable conduit for maintaining abdominal wall integ ity in a patient with a large abdominal wall defect when autogenous tissues are not available. (NO 02206)

AU : Intragumtornchai T, Phanthumchinda K, Lerdlum S, Sumpathanukul P, Sakulramrung R.
TI : POEMS Syndrome : a case with proliferative vasculopathy and a review of cases in Thailand.
JN : Journal of the Medical Association of Thailand 1993 Oct ; 76 (10) : 585-590
EN-AB: A Thai male, aged 36 yrs, presented with chronic progressive sensorimotor polyneuropathy and mixed osteosclerotic and lytic lesions at the lumbar vertebrae (L). Generalized hyperpigmentation, bilateral gynecomastia, small testes, hepatomegaly, lymphadenopathy and ascites were observed. Computerized tomography of the lumbosacral spines revealed osteosclerotic changes at L3,4,5 with spiculated bony proliferation at the transverse processes and posterior components of the spines. Histopathological examination of the lesion was compatible with plasmacytoma. Proliferative vasculopathy was demonstrated in plasmacytoma. Serum immunofixation showed an IgM monoclonal gammopathy. Further investigation demonstrated secondary adrenal insufficiency with low level of plasma testosterone. The patient responded well to local radiotherapy and intermittent chemotherapy with melphalan and prednisolone. The histopathological findings of proliferative vasculopathy suggested the important role of capillary leakage as a factor responsible for systemic manifestations in the POEMS syndrome. The reported cases of this syndrome among Thais are summarized. (NO 02534)

AU : Lerdlum S, Vasuratna B, Sriratanapong S.
TI : Magnetic resonance imaging of the brain in Wilson's disease.
JN : Chulalongkorn Medical Journal 1993 ; 37 (10) : 639-643
EN-AB: Wilson's disease is an autosomal recessive disorder of copper metabolism with increased deposition of copper in the brain and liver. A case of Wilson's disease in a 22-year-old woman was examined by Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) at 1.5 Tesla. MRI demonstrated lesions with hypointense signal on Tl weighted images and mixed hypointense and hyperintense signal on T2 weighted images in both lenticular nuclei. These abnormal signal intensity areas may be caused partly by gliosis, edema or cavitation as well as by copper and iron deposits. (NO 02797)

AU : Sriussadaporn S, Tangchai W, Rojanasakul A, Jindarak S, Lerdlum S, Chitmaitree B, Maungmingsuk V, Migasena R, Niruthisard SP, Leelanukrom R, Choedamphai E, Hanvanich M, Bunyaratavej S, Sangwatanaroj S, Pramuan P, Dhitavat V.
TI : Gastrointestinal fistulas associated with a large abdominal wall defect : the usefulness of synthetic meshes : a case report.
JN : จุฬาลงกรณ์เวชสาร = Chula Med JChulalongkorn Medical Journal 1993 Jul ; 37 (7) : 469-76
EN-AB: A case of gastrointestinal fistulae associated with a large abdominalwall defect was reported. The abdominal wall integrity was temporarilymaintained by the use of syntheticc meshes. Both absorbable (Dexon)mesh and non-absorbable (Mersilene) mesh were used in this case.Recurrent fistulae developed after placement of the mesches but wassurgically closed successfully. The patient recovered and wasdischarged home after 8 months and 4 days of hospitalizatiion.Synthetic mesh is an invaluable conduit for maintaining abdominal wallintegrity in a patient with a large abdominal wall defect whenautogenous tissues are not available. (NO 04196)

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Year 1992

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 : Kasantikul V, Raiyawa S, Rantanavijarn C, Lerdlum S.
TI : Human sparganosis presenting as exophthalmos and ocular mass.
JN : Chulalongkorn Medical Journal 1992 ; 36 (1) : 47-51
EN-AB: A 51-year-old woman presented with swelling of the right upper eyelid, and exophthalmos. Computed tomography (CT) scanning disclosed a high density mass of the right orbit which obliterated the medial rectus muscle causing exophthalmos. The larva of sparganum was removed from the lesion. In Thailand, only ten cases of ocular sparganosis have been described. The lesion occurred in patients of all ages and was more common in women than in men. Swelling of the eyelids were frequent clinical manifestations while subconjunctival mass and exophthalmos were uncommon. CT scan along with tissue examination are necessary for a definite diagnosis. (NO 02751)

AU : Intragumtornchai T, Israsena S, Benjacholamas V, Lerdlum S, Benjavongkulchai S.
TI : Esophageal tuberculosis presenting as intramural esophagogastric hematoma in a hemophiliac patient.
JN : Journal of Clinical Gastroenterology 1992 Mar ; 14 (2) : 152-6
EN-AB: A spontaneous intramural esophagogastric hematoma developed in a patient with hemophilia A. The hematoma did not resolve after antihemophiliac factor replacement but ruptured into the stomach causing massive gastrointestinal bleeding. The associated enlarged right tracheobronchial gland and the histopathological finding of fibrocaseating granuloma at the esophagogastric junction indicated that the primary disorder was esophageal tuberculosis. The whole process responded rapidly to antituberculous treatment. (NO 02897)

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Year 1991

AU : Shuangshoti S, Lerdlum S, O'Charoen S.
TI : Significant spontaneous hemorrhage associated with primary meningioma of the central nervous system. report of a case and review of the literature.
JN : Chulalongkorn Medical Journal 1991 ; 35 (12) : 839-851
EN-AB: Sixty reported cases of spontaneous bleeding primary neuraxial meningiomas (PNMs) including our case are analysed. They were distributed according to the known age of 51 patients in the second to eighth decades of life respectively with the peak occurrence being in 15 patients (or 29.4 per cent of the total) in the fifth decade of life. The average ages were 46, 49, and 48 years for males, females, and both sexes, respectively. The female-to-male ratio was almost equal (i.e. 9:8) for 50 patients in whom the sex was known but was 3:I at the peak occurrence. The average age of patients with bleeding PNMs was about 6.5 years older than the average age of 290 patients with non-bleeding PNMs who exhibited a female-to-male ratio of 3:2 for the entire series, and 2:1 at the peak occurrence (70 per cent) in patients between the fourth and sixth decades of life. Both bleeding and non-bleeding PNMs frequently occurred on the cerebral convexity (38 per cent each), but the frequency of occurrence in the cerebral ventricle in the former was strikingly higher than in the latter (15.6 per cent VS. 3.5 per cent). Intraspinal meningioma rarely bled. Endotheliomatous meningioma was the histologic type that bled most frequently (40 per cent), followed by the angioblastic type (22 per cent), fibroblastic type (18 per cent), transitional type (14 per cent), and others (6 per cent). Subarachnoid hemorrhage was the most frequent type of bleeding (40 per cent) followed by combined types of hemorrhage (32 per cent) and intracerebral (peritumoral) hemorrhage ( 17 per cent). The prognosis of patients with bleeding PNMs was worse than those with non-bleeding PNMs. (NO 02700)

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 : 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)

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Year 1988

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)

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Year 1985

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)

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Year 1984

AU : Vajarapongse K, Wetchsetnont D, Vajragupta L, Buachum V, Lerdlum S.
TI : Ultrasonography of amoebic liver abscess.
JN : Chula Med J 1984 Sep ; 28 (9) : 973-983
TH-AB: การศึกษาลักษณะภาพอุลตราซาวด์ของฝีในตับที่เกิดจากเชื้อบิดอมีบา ในผู้ป่วย 52 ราย ซึ่งมีจำนวนฝีทั้งหมด 60 แห่ง ในโรงพยาบาลจุฬาลงกรณ์ ระหว่างปี ค.ศ. 1980-1983 ได้ทำการวิเคราะห์ลักษณะภาพอุลตราซาวด์ของฝีในตับในแง่ของ จำนวน ขนาด รูปร่าง ตำแหน่ง ลักษณะการสะท้อนของคลื่นเสียง (echogenic pattern) และความเข้มของเสียง ที่ผ่านขอบหลังของฝี (through transmission) จากการศึกษาพบว่า ฝีในตับที่เกิดจาก เชื้อบิดอบีมามีจำนวนหนึ่งแห่ง มี 46 ราย และมากกว่าหนึ่งแห่ง มี 6 ราย ฝีส่วนใหญ่ มีรูปร่างกลมหรือรูปไข่ อยู่ในกลีบขวาของตับ และชิดกับผิว คลื่นเสียงสะท้อนภายในฝี (internal echo) มีน้อยหรือไม่มี 50 เปอร์เซนต์ การสะท้อนของคลื่นเสียงที่ขอบฝีมีน้อย (echogenic echo) 73 เปอร์เซนต์ และมีการเพิ่มขึ้นของความเข้มของเสียงหลังจากผ่าฝีไปแล้ว (through transmission) 70 เปอร์เซนต์ ลักษณะดังกล่าวอาจจะเป็นแนวทางในการวินิจฉัยแยกโรคระหว่างฝีในตับที่เกิดจากเชื้ออมีบาและฝีในตับที่ เกิดจากเชื้อชนิดอื่น (NO 00152)

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