Chadin Tharavej - Academia.edu (original) (raw)

Papers by Chadin Tharavej

$Research paper thumbnail of Pelvic fractures: experience in management of 170 cases at a university hospital in Thailand$

PubMed, Feb 1, 2002

BACKGROUND, OBJECTIVE AND METHOD: Management of patients with pelvic fractures requires a multidi... more BACKGROUND, OBJECTIVE AND METHOD: Management of patients with pelvic fractures requires a multidisciplinary team approach. Currently, survival has been dramatically improved but some controversies still remain. The purpose of this study was to examine management and results of treatment of patients with pelvic fractures who were admitted to the Trauma Unit, King Chulalongkorn Memorial Hospital, Bangkok, Thailand from January 1991 to December 2000. Results: There were 170 patients in the study. The age ranged from 15 to 91 years (mean 33.89 +/- 16.14). The most common cause of injuries was motorcycle accidents (50.0%). There were 27 (15.9%), 47 (27.6%), 80 (47.1%) and 16 (9.4%) patients with Type I, II, III and IV pelvic fractures, respectively. Forty per cent of patients were in shock when they first arrived at the emergency room. Seventy two patients (42.4%) had 274 associated injuries. Sixteen patients (9.4%) had open pelvic fractures. The Injury Severity Score (ISS) ranged from 4 to 75 (mean 17.55 +/- 12.86). Eighty two patients (48.2%) received blood transfusion from 1 to 40 units (mean 10.04 +/- 8.47). Sixteen patients (9.4%) underwent pelvic angiography, 10 bleeding points were demonstrated and successfully treated by transcatheter embolization. One hundred and thirty two patients (77.6%) received no specific treatment for the pelvic fractures. The remainder (22.4%) were treated with pelvic sling in 6 patients (3.5%), skeletal traction in 21 patients (12.4%), external fixation in 6 patients (3.5%), internal fixation in 4 patients (2.4%), and right hemipelvectomy in 1 patient (0.6%). Fifteen patients (8.8%) died. Causes of death were exsanguination in 6 patients (40% of death), severe head injuries in 6 patients (40% of death) and sepsis with multisystem organ failure in 3 patients (20% of death). Nonsurvivors had a significantly higher ISS and units of blood transfusion than survivors (P < 0.001). The hospital stay ranged from 1 to 300 days (mean 24.7 +/- 34.19). Conclusion: Approximately 75 per cent of patients in our study had major pelvic fractures (Type II and Type III pelvic fractures). The majority of bleeding from pelvic fractures could be treated conservatively. Angiography with transcatheter embolization was extremely helpful when conservative treatment failed to stop pelvic bleeding. External fixation for early control of bleeding pelvic fractures was infrequently employed.

PubMed, Mar 29, 2002

Selective management was offered in 57 patients who had penetrating injury to the anterior neck. ... more Selective management was offered in 57 patients who had penetrating injury to the anterior neck. During the study period, decision making in patient management at our institution depended largely on clinical presentations. Indications for neck explorations were unstable hemodynamics, airway obstruction, active bleeding from the wound, and evidence of aerodigestive tract injuries. Some patients with deep wounds of zone II also underwent neck explorations. Investigations were performed in selected cases. With this selective policy, there were two unnecessary operations among 40 patients (70.2%) who underwent neck exploration. Both of them were operated because of deep wounds of zone II. The remaining 17 patients (29.8%) had uneventful conservative treatment. There was no mortality in this study. The authors concluded that selective management of penetrating neck injuries based on clinical presentations is safe and practical.

Archives of Gynecology and Obstetrics, Jun 18, 2004

Pheochromocytoma is a rare disease of the chromaffin cells that secrete catecholamines. It may oc... more Pheochromocytoma is a rare disease of the chromaffin cells that secrete catecholamines. It may occur during pregnancy. Bilateral pheochromocytoma in pregnancy is even rarer. A 26-year-old woman, gravida 2, para 0-0-1-0, 18 weeks&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; pregnancy, was initially seen with elevated blood pressure (170/100 mmHg) and mild headache. The cause of hypertension was conventionally investigated and bilateral pheochromocytoma was finally searched for and found. Bilateral adrenalectomy was undertaken at 23 weeks&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; gestation and Cesarean section was performed at 31 weeks&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; gestation due to intrauterine growth retardation (IUGR) and compromised fetal well-being. The maternal outcome was uneventful and the baby was physiologically complicated only by neonatal jaundice. Pheochromocytoma should be searched for in the conventionally differential diagnosis in hypertension during pregnancy, especially in the young. Early diagnosis and proper management with medical treatment followed by surgical removal of the tumor usually result in good maternal and fetal outcomes.

International surgery

ABSTRACT

Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2006

The treatment of severe acute pancreatitis (SAP) varies among several institutes. It has been evo... more The treatment of severe acute pancreatitis (SAP) varies among several institutes. It has been evolving from routine surgical management to conservative management in the early stages. The surgical management has a role in the later stages of the disease. The purpose of the present study was to review the management and outcome of the patients with SAP at King Chulalongkorn Memorial Hospital, Bangkok, Thailand. Two hundred and ten patients with a diagnosis of acute pancreatitis at King Chulalongkorn Memorial Hospital, Bangkok, Thailand from December 2001 to April 2005 were studied by retrospective chart review. Forty patients were diagnosed with SAP, 27 men and 13 women. SAP was most commonly caused by alcohol abuse (47.5%) and biliary tract disease (37.5%). Eighteen patients (45%) had pancreatic necrosis. Among them, seven patients (38.9%) had infected necrosis, and the rest had sterile necrosis. All patients with infected pancreatic necrosis underwent open pancreatic necrosectomy, ...

$Research paper thumbnail of Pelvic fractures: experience in management of 170 cases at a university hospital in Thailand$

Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2002

Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2001

One hundred and thirty two patients who underwent aortic surgery at King Chulalongkorn Memorial H... more One hundred and thirty two patients who underwent aortic surgery at King Chulalongkorn Memorial Hospital, Bangkok, Thailand from January 1991 to December 2000 were studied. Twenty three patients (17.4%) were aged less than 60 years, 102 (77.3%) aged 60-80 years, and 7 (5.3%) were older than 80 years. Ninety eight patients (74.2%) underwent elective operations and 34 (25.8%) underwent emergency operations. Elective abdominal aortic aneurysms (AAA) repair was the most common indication for abdominal aortic surgery (56.0%). Eighteen patients (13.6%) underwent surgery for infected AAA. The incidence of infected AAA was 16.1 per cent among patients with AAA. Fifteen patients (11.4%) had ruptured AAA and 19 patients (14.4%) had aortoiliac occlusive disease. The overall mortality rate was 15.2 per cent. The mortality of elective aortic surgery was 5.1 per cent and of emergency aortic surgery was 44.1 per cent. The mortality of elective AAA repair was 4 per cent. Multiple system organ failu...

Surgical Endoscopy, 2006

Background: The Bravo catheter-free pH monitoring system uses a capsule attached to the esophagea... more Background: The Bravo catheter-free pH monitoring system uses a capsule attached to the esophageal mucosa to detect acid exposure. Placement of the Bravo capsule is associated with intermittent chest pain in 50% of normal volunteers. The authors hypothesized that chest pain in this setting may be attributable to hypertensive esophageal contractions induced by the Bravo capsule. Methods: The study population consisted of 40 consecutive patients with reflux symptoms who had stationary esophageal manometry within 1 h after Bravo capsule placement. The control group consisted of 40 patients with symptomatic gastroesophageal reflux disease (GERD) from a population of patients with foregut symptoms who were computer matched to the study group for age, sex, lower esophageal sphincter (LES) pressure, LES length, and 24-h pH composite score. The patients in the control group had manometry before Bravo capsule placement. The occurrence of chest pain was assessed before and during the monitoring period by interview and review of the patientÕs diary. Mean contraction amplitudes in the distal third of the esophagus after 10 wet swallows were averaged. The prevalence of patients with esophageal contraction amplitudes in the distal third that exceeded the 95th percentile of normal (180 mmHg) and the mean amplitude of distal third esophageal contractions in the study and control populations were compared. In the study group, the incidence of chest pain among the patients with hypercontractility of the esophagus was compared with the incidence among those without hypercontractility. Results: The mean contraction amplitude was higher in the study group (144.7 vs 105.5 mmHg; p = 0.002). The number of patients with a mean distal esophageal contraction amplitude exceeding the 95th percentile of normal also was significantly higher in the study group (13/40 vs 5/40; p = 0.03). A total of 10 patients experienced new onset of chest pain with the Bravo capsule in place, and 6 patients experienced hypertensive esophageal contractions. Conclusions: The intraesophageal Bravo capsule can cause hypertensive esophageal contractions, which may lead to chest pain.

Injury, 2002

We reviewed 87 patients with hepatic injuries who were admitted to King

Archives of Gynecology and Obstetrics, 2004

South Asian journal of cancer, Apr 22, 2024

Background Definitive chemoradiation therapy is an alternative curative treatment for esophageal ... more Background Definitive chemoradiation therapy is an alternative curative treatment for esophageal squamous cell carcinoma (ESCC). The prevalence of anastomotic leakage (AL) after salvage esophagectomy is significantly higher than planned esophagectomy after chemoradiation, which increases operative mortality. Minimizing ALrelated mortality requires early detection. Several investigators have demonstrated the role of serum C-reactive protein (CRP) in early AL detection after esophagectomy for decades. However, its value in early AL detection after salvage esophagectomy is unknown. This study aims to evaluate the value of serial serum CRP levels for early AL detection in ESCC patients after salvage esophagectomy. Methods We retrospectively reviewed the medical record of 36 patients diagnosed with thoracic squamous cell esophageal carcinoma who underwent salvage esophagectomy at our hospital between December 2016 and May 2022. The CRP level was measured daily from postoperative day (POD) 1 to 5. Sensitivity, specificity, and receiver operating characteristic (ROC) curves were calculated to determine the optimal cutoff value. Results A total of 36 patients underwent salvage esophagectomy. Of these 36 patients, 3 patients (8.3%) were diagnosed with AL. The CRP level on POD 2 to 5 had been significantly associated with the presence of AL. The ROC curve showed the excellent diagnostic accuracy of CRP level on POD 2 to 5, with an area under the curve of 0.98, 0.98, 0.93, and 0.87, respectively. The optimal cutoff value of CRP on POD2 to 5 was 270, 250, 200, and 150 mg/L, respectively, with high sensitivity, specificity, and negative predictive value. Conclusion Postoperative serial CRP level after salvage esophagectomy is a reliable useful tool for early AL detection, similar to other settings of esophagectomy.

$Research paper thumbnail of 159. New Endoscopic Treatment Technique to Prevent Refractory Corrosive Esophageal Strictures$

Diseases of the Esophagus

Refractory esophageal stricture is an undesired complication after caustic ingestion associated w... more Refractory esophageal stricture is an undesired complication after caustic ingestion associated with increased morbidity and mortality. Prevention rather than treatment of the stricture is a desirable goal. The objective of this study was to report the safety and outcome of our novel endoscopic technique using Repeated endoscopy with Intraluminal Fibrinous adhesioLysis of the Esophagus (RIFLE) during the first 2 weeks of caustic ingestion aiming to prevent the development of refractory esophageal stricture and bypass surgery. Patients with Zagar’s grade IIb-IIIa corrosive esophageal injury were included. Patients undergoing emergent surgery were excluded. Since 2018, upper endoscopy with lysis of intraluminal fibrinous adhesion by advancing endoscopic tip through the lesions has been gently performed initially at the third day and then repeated twice a week during the first 2 weeks of the ingestion in 15 patients of the study group. Before 2018, a standard ‘wait and see’ treatment w...

Gastroenterology & Hepatology: Open Access, 2018

Esophageal metastatic lesions are rare particularly of hepatocellular carcinoma (HCC). The majori... more Esophageal metastatic lesions are rare particularly of hepatocellular carcinoma (HCC). The majority of reported cases were diagnosed pot-mortem, only a few cases were identified by upper endoscopy. Endoscopic ultrasound (EUS) has never been reported as a diagnostic tool for esophageal metastasis from HCC, nor has EUS-FNA ever been used for this purpose. We reported a 59-year-old male who was under surveillance post liver transplant from HCC 4years ago, had elevated alpha fetoprotein (AFP) at 258.3ng/ml and a positron emission tomography-computed tomography (PET-CT) showing an increased uptake lesion of standardized uptake value (SUV) 7.5 at gastro-esophageal junction. EUS showed a homogeneous hypoechoic mass measuring 35x20mm from the 3rd layer of the distal esophageal wall and EUS-FNA was performed. Cytopathology was consistent with metastatic HCC. The patient expired 20months later from progressive disease with systematic bacterial infection despite multidisciplinary treatments.

Journal of Gastrointestinal Oncology, 2019

Background: Nowadays, preoperative radio-chemotherapy is a standard treatment for locally advance... more Background: Nowadays, preoperative radio-chemotherapy is a standard treatment for locally advanced esophageal squamous cell carcinoma (ESCC). Tumor regression grade (TRG), referring to a classification of cancer response to preoperative treatment, can predict a prognosis of survival. Many TRG systems are proposed for use in esophageal cancer, but none of them has become standard grading system. This research compared five TRG systems, including Mandard system, Chirieac system, Schneider system, Hermann system, and Japan Esophageal Society (JES) system, to find the most accurately predictive system. Methods: We recruited 37 participants with locally advanced ESCC from 2006 to 2014. All of them were treated with radio-chemotherapy followed by esophagectomy. The resection specimens were evaluated microscopically for percentage of viable residual tumor comparing with tumor bed, number of positive lymph nodes and, consequently, assigned TRG grade according to each TRG system. Kaplan-Meier (KM) graphs were used to describe the median survival time. Log-rank tests and cox proportional hazard regression models were used in assessing associations between TRG systems and survival. Proportional hazard assumptions were evaluated on the basis of Schoenfeld and log-log plot. Akaike information criterion (AIC) values and pseudo R-squared values assessed model fit. All statistical tests were two-sided. Results: The KM graphs displayed overlapped curves in all TRG systems. The log-rank tests revealed that Schneider, JES and Mandard systems were statistically associated with overall-survival (P<0.05). Only the multivariate cox regression analysis of Schneider system showed the statistically significant hazard ratio (P=0.037). Schneider system also had the best AIC and pseudo R-squared values. Conclusions: Schneider system might be the best predictive system. However, the overlapped KM curve opposed. This study had limitation due to small number of participants. More participants were needed to confirm our findings.

Surgical Endoscopy, 2018

Background Early postoperative jejunal limb obstruction is a rare complication following gastric ... more Background Early postoperative jejunal limb obstruction is a rare complication following gastric surgery with jejunal reconstruction. The condition is mainly attributed to kinking of the jejunal limbs, gastrojejunal or jejunojejunal anastomosis. There has been currently limited information regarding the safety and efficacy of endoscopic treatment in patients with early postoperative jejunal obstruction. We aimed to investigate outcome of endoscopic small-bore naso-jejunal (N-J) tube stenting across the obstructed segment in patients with uncomplicated early postoperative partial jejunal limb obstruction. Methods All patients diagnosed of jejunal limb obstruction within 8 weeks after gastric-related surgery were reviewed. Patients with malignant obstruction, complete closed loop obstruction, sepsis, instability, intestinal strangulation, or perforation were excluded. All patients underwent endoscopic dekinking and stenting for 2 weeks with an N-J tube using 16-French single lumen plastic nasogastric tube across the obstruction segment after failed conservative therapy. Successful N-J tube placement across the obstruction point was confirmed by contrast study. Complications, technical, and clinical success were evaluated. Results Twenty-one patients met the criteria. The primary operations were 7 partial gastrectomies with Billroth-II reconstruction, 7 total or partial gastrectomies with Roux-en-Y reconstruction and 4 Whipple's operations, 2 bypass procedures, and 1 proximal gastrectomy. Most common site of obstruction was jejunojejunal anastomosis and gastrojejunal anastomosis following Roux-en-Y and Billroth-II reconstruction, respectively. Endoscopic N-J tube placement was technically successful in 20 out of 21 patients (95%). One patient had aspirated pneumonia. There was no procedure-related mortality. After N-J tube removal, clinical success was demonstrated in 19 out of 20 patients (95%) at the median duration of 6 months. One patient underwent reoperation due to repeated tube dislodgement. Conclusions Endoscopic stenting with a 16-F naso-jejunal tube across the angulated segment is safe and effective for treatment of patients with uncomplicated early postoperative partial jejunal limb obstruction following gastric surgery with jejunal reconstruction.

Surgical Endoscopy, 2017

Outcome of endoscopic dilatation in acid-induced corrosive esophageal stricture is less known. Th... more Outcome of endoscopic dilatation in acid-induced corrosive esophageal stricture is less known. This study aims to determine the outcome of dilatation and predictors of failed dilatation in patients with acid-induced corrosive esophageal stricture. Patients diagnosed of corrosive esophageal strictures were included. Endoscopic dilatation with graded Savary-Gilliard dilator was performed as the first line treatment. Outcome of dilatation was considered favorable when patients were able to swallow solid without intervention at least six months after successful dilatation. Failure of dilatation was defined as one of the following; complete luminal stenosis, inability to perform safe dilatation, perforation, and inability to maintain adequate luminal patency. Surgery or repeated dilatation was indicated in failed dilatations. There were 55 patients with corrosive esophageal strictures. Of 55 patients, 41 (75%) had failed dilatation (38 having esophageal replacement procedure, two continue repeated dilatation and one unfit for surgery). Of 323 sessions of dilatations, eight out of 55 patients (14.5%) had perforations. There was no dilatation-related mortality. Patients with concomitant pharyngeal stricture (p = 0.0001), long (C 10 cm) stricture length (p \ 0.0001), number of dilatation [6 sessions per year (p = 0.01) and refractory stricture (inability to pass a larger than 11 mm dilator within three sessions) (p = 0.01) were more likely to have failed dilatation. Thirty-two of 38 patients with surgery had good swallow outcome with one operative mortality (2.6%). At the median follow-up of 61 months, overall favorable outcome was 84% after surgery and 25% for dilatation (p \ 0.0001). Majority of patients with acid-induced corrosive esophageal stricture were refractory to dilatation. Esophageal dilatations were ultimately failed in three-fourth of the patients. Concomitant cricopharyngeal stricture, long stricture length, requiring frequent dilatation, and refractory to [11 mm dilatation were factors associated with failed dilatation.

Thoracic Cancer, 2017

Background: Locoregional failure is a major problem associated with chemoradiation treatment for ... more Background: Locoregional failure is a major problem associated with chemoradiation treatment for squamous cell esophageal carcinoma. The aim of this study was to assess the feasibility, efficacy, and toxicity of preoperative radiation (dose > 50 Gy) with platinum-based chemotherapy followed by esophagectomy in locally advanced squamous cell carcinoma. Methods: Data of patients with cT2-cT4 or node positive squamous cell carcinoma of the esophagus who received trimodality treatment between February 2006 and June 2015 were reviewed. Results: Forty-four patients were treated with intensity-modulated radiation therapy, volumetric-modulated arc therapy or three-dimensional radiation therapy. The median radiation dose was 60 Gy. The average volume of the lungs receiving 10 Gy was 48.1%, 20 Gy was 24.5%, and the average mean lung dose was 14 Gy. After chemoradiation, R0 resection was achieved in 31 patients (71%). Patients who received >60 Gy had a higher pathologic complete remission rate than those in the lower dose group (59.1% vs. 36.4%). R0 resection and radiation dose >60 Gy were associated with better overall survival in Cox proportional hazards regression analysis. The median follow-up duration was 22.4 months and median survival was 25.6 months. Two-year overall, progression-free survival and locoregional control rates were 55.9%, 28.6%, and 56%, respectively. The most common grade 3-4 toxicities were esophagitis (63.6%) and neutropenia (25%). Grade 3-4 postoperative morbidities included surgical wound infection (2.3%), acute renal failure (2.3%), and anastomosis stricture (2.3%). Conclusion: Trimodality treatment with a high preoperative radiation dose and chemotherapy yielded a good pathologic complete response rate, and long-term survival with low toxicities.

Asian Biomed, Nov 11, 2013

Chawalit Lertbutsayanukula, Panit Chiewaratanapongb, Naruemon Klaikeawc, Supatporn Tepmongkold, N... more Chawalit Lertbutsayanukula, Panit Chiewaratanapongb, Naruemon Klaikeawc, Supatporn Tepmongkold, Nitra Piyavisetpate, Virote Sriuranpongf, Chadin Tharavejg aDivision of Radiation Oncology, Department of Radiology, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand, bLopburi Cancer Center, Thailand, cDepartment of Pathology, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand, dDivision of Nuclear Medicine, Department of Radiology, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand, eDivision of Diagnostic Radiology, Department of Radiology, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand, fDivision of Medical Oncology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand, gDivision of General Surgery, Department of Surgery, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand

$Research paper thumbnail of Pelvic fractures: experience in management of 170 cases at a university hospital in Thailand$

PubMed, Feb 1, 2002

PubMed, Mar 29, 2002

Archives of Gynecology and Obstetrics, Jun 18, 2004

International surgery

ABSTRACT

Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2006

$Research paper thumbnail of Pelvic fractures: experience in management of 170 cases at a university hospital in Thailand$

Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2002

Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2001

Surgical Endoscopy, 2006

Injury, 2002

We reviewed 87 patients with hepatic injuries who were admitted to King

Archives of Gynecology and Obstetrics, 2004

South Asian journal of cancer, Apr 22, 2024

$Research paper thumbnail of 159. New Endoscopic Treatment Technique to Prevent Refractory Corrosive Esophageal Strictures$

Diseases of the Esophagus

Gastroenterology & Hepatology: Open Access, 2018

Journal of Gastrointestinal Oncology, 2019

Surgical Endoscopy, 2018

Surgical Endoscopy, 2017

Thoracic Cancer, 2017

Asian Biomed, Nov 11, 2013