Lampang Medical Journal

Failure Rate of Methotrexate for Treatment of Ectopic Pregnancy at Lampang Hospital

2023-06-13T19:39:09+07:00

Background: Ectopic pregnancy can be treated non-operatively with methotrexate (MTX) medication. The failure rate of MTX treatment for ectopic pregnancy has not been investigated at Lampang Hospital.
Objectives: To determine the failure rate and factors associated with treatment failure in ectopic pregnancy with MTX at Lampang Hospital.
Material and methods: A descriptive study was conducted on 52 women diagnosed with ectopic pregnancy and treated with MTX at Lampang Hospital between June 2012 and June 2022. Patients were categorized into the failure group and the success group. The data was analyzed using descriptive statistics and compared between the two groups.
Results: There were 44 cases in the success group (84.6%) and 8 cases in the failure group (15.4%). The median value of the initial serum B-hCG level in the failure group was significantly higher than that of the success group (4,892 [IQR 1,946−12,713] vs.1,433 [IQR 638−4,091] mIU/ml, p<0.001). The median duration of treatment until resolution in the success group was 27 days (IQR 20−38.5, range 13−137 days).
Conclusion: The overall failure rate of MTX treatment for ectopic pregnancy was 15.4%. The failure group had a significantly higher initial serum B-hCG level than the success group.

Locked versus Nonlocked Percutaneous K-wire Fixation in Distal Radius Fractures Treatment: a Comparative Study for Maintenance of Postoperative Alignment

2023-09-18T13:44:36+07:00

Background: Distal radius fractures (DRF) are typically treated with percutaneous K-wire fixation and a short-arm slab. Linking all K-wires that were fixed to a fracture site in one system (locked K-wire system) could withstand an immediate physiologic load more than the non-locking system. Whether this system could maintain the fracture alignment until union without immobilization is questionable.
Objectives: To compare the maintenance of radiographic wrist parameters in percutaneous K-wire fixation for closed extra-articular and simple partial intraarticular DRF between locked and nonlocked K-wire systems.
Material and methods: A prospective non-randomized controlled trial was conducted in patients with DRF who underwent percutaneous K-wire fixation at Kamphaengphet Hospital between January and June 2023. Patients were allocated into two groups according to surgeon preference. The study group underwent a locked K-wire system without immobilization, while the control group underwent a nonlocked K-wire system and a short-arm slab. Postoperative wrist radiographs were taken immediately, at 2, 6, and 10 weeks. Wrist parameters (radial height, radial inclination, ulnar variance, and volar tilt) were measured and their differences were calculated with those of the immediate postoperative films. The data were statistically compared between the two groups.
Results: The mean radial height difference, radial inclination difference, and ulnar variance difference of the study group (n=26) were not different from those of the control group (n=31) at 2, 6, and 10 weeks (p<0.05). The mean volar tilt difference of the study group was significantly lower than the control group at 2, 6, and 10 weeks. One patient in the control group had revision surgery.
Conclusion: Using a locked K-wire system without immobilization for percutaneous K-wire fixation in DRF can maintain radial height, radial inclination, and ulnar variance similarly to the nonlocked K-wire system and short arm slab. It also significantly better maintains volar tilt throughout the 10-week follow-up period.

Clinical Features and Visual Outcomes of Eye Injuries among Hospitalized Patients at Chiang Rai Prachanukroh Hospital

2023-07-31T14:12:25+07:00

Background: Eye injury is a leading cause of visual impairment. There are several studies about eye injuries, reporting varied causes and results dependent on levels and areas of the hospital.
Objectives: To determine the epidemiology, causes, clinical features, and visual outcomes of eye injuries in Chiang Rai province.
Material and methods: A retrospective cohort study was conducted among hospitalized patients with eye injuries at Chiang Rai Prachanukroh Hospital between April 2020 and March 2021. Medical records were reviewed at 6 months, or the last follow-up visit. The data were statistically compared between the closed globe injury group and the open globe injury group. Factors associated with legal blindness were analyzed using multivariable logistic regression.
Results: There were 111 patients (111 eyes) enrolled in the study, and 84 cases were male (75.7%). The mean age was 46.4 years (SD 19.4,
range 4−84). Most of the injuries were work-related (69 cases, 62.2%). Among these, 27 cases were caused by flying wood chips (39.1%) and 23 cases by motorized grass trimming (33.3%). Only 2 patients (2.9%) used protective eyewear. There were 74 patients with closed globe injuries (66.7%). Legal blindness was found in 18 cases with open globe injuries (48.7%) and 19 patients with closed globe injuries (25.7%, p=0.020). Factors associated with legal blindness were initial visual acuity < 10/200 (OR 14.80, 95%CI 4.02−80.50, p=0.010) and open globe injury (OR 2.74, 95%CI1.10−6.81, p=0.020).
Conclusion: Three-fourths of hospitalized patients with eye injuries at Chiang Rai Prachanukroh Hospital were male, and two-thirds had close globe injuries. About three-fifths of injuries were work-related, and only 2.9% of the patients used protective eyewear. Factors associated with legal blindness were initial visual acuity < 10/200 and open globe injury.

Effectiveness of Utilizing Local Bone Graft plus Hydroxyapatite with or without Bone Marrow Aspiration from Vertebral Body in Posterolateral Lumbar Fusion: a Randomized-Controlled Trial

2023-10-09T23:10:52+07:00

Background: Decompression laminectomy and instrumented fusion are common surgical treatments for degenerative lumbar spinal stenosis. Long-term results depend on a successful fusion. Autologous iliac bone grafting (AIBG) is the gold standard for posterolateral fusion, but AIBG harvesting can cause complications. Local bone graft (LBG) and hydroxyapatite (HA) are implemented as substitutes for AIBG. However, the osteoprogenitor cells and osteoinductive properties are still deficient in these procedures. The addition of intraoperative bone marrow aspiration (BMA) from the vertebral body to mix with LBG and HA may solve this problem.
Objectives: To compare the fusion rate of lumbar laminectomy with PLF and instrumentation between those using LBG+HA+BMA and those using LBG+HA.
Material and methods: A randomized-controlled trial was conducted among 95 patients with degenerative lumbar spinal stenosis who underwent laminectomy with PLF and instrumentation in Lampang Hospital between
April 2019 and September 2022. LBG, HA, and BMA were added to the fusion sites in the study group (n=48), whereas LBG and HA were utilized in the control group (n=47). Successful fusion was determined at 6 and 12 months postoperatively by the computerized tomography using Christiansen’s classification criteria. Intraoperative blood loss, operative time, length of stay, and surgical site infection were compared between the two groups.
Results: The study group achieved a significantly higher fusion rate than the control group at 6 months (39.6% vs. 12.8%, p=0.005). This higher fusion rate remained at 12 months but was marginally significant (75.0% vs. 55.3%, p=0.054). Subgroup analysis found the significantly higher fusion rate of the study group in the patients with 2–3 fusion levels (85.2% vs. 58.1%, p=0.042). Both groups demonstrated similar outcomes in terms of perioperative blood loss, operative time, length of hospital stay, and surgical site infection.
Conclusion: Adding BMA from the vertebral body could improve the fusion rate in lumbar laminectomy with PLF and instrumentation that used a combination of LBG and HA at 6 months and 2–3 fusion levels at 12 months

Results of Hip Hemiarthroplasty for Femoral Neck Fracture using High-viscosity Bone Cement Injected with Invented Cement Gun

2023-11-21T01:26:15+07:00

Background: The standard cementing technique for cemented hip arthroplasty requires an injection gun, with high-viscosity bone cement being preferred over low-viscosity cement. A novel gun, the Lampang Cement Gun for High-Viscosity Cement (LCG-HV), was invented based on a caulking gun to accomplish this task, serving as an alternative to the commercial cement gun
Objectives: To investigate the efficacy of the LCG-HV and analyze the unit cost, as well as determine the clinical results of cemented bipolar hip hemiarthroplasty using the LCG-HV in terms of quality of cementation and functional outcome.
Material and methods: The first part of the research involved an experimental study using the LCG-HV to inject Palacos R high-viscosity cement. The injection speed and maximum trigger force were measured, and the unit cost per single usage was calculated. The second part of the research was a retrospective cohort study among 52 patients with femoral neck fractures who underwent cemented bipolar hip hemiarthroplasty at Lampang Hospital from January 2019 to April 2023. This procedure used high-viscosity cement and the LCG-HV. Cementation quality was assessed through radiographic evaluation using the Barrack grading system, and the Harris Hip Score (HHS)was assessed at 6 to 12 months postoperatively.
Results: The mean injection speed of the LCG-HV was 4.1±0.4 g/sec (range 3.5–4.5), and the maximum trigger force was 135±10 kg-force (range 124–145). The unit cost of the LCG-HV was 250 Baht for one-time usage (comprising a direct cost of 225 Baht and an indirect cost of 25 Baht). The mean age of the patients was 81.4±7.9 years (range 63–97), with 47 cases being female (90.4%). The types of femoral prostheses used were the Avenir stem in 38 cases (73.1%), the CPT stem in 11 cases (21.1%), and the Excia stem in 3 cases (5.8%). The cementation quality was mostly
categorized as Barrack grade B (53.8%) and grade A (40.4%). Postoperatively, the mean HHS was 76.8±6.9, with 23 cases (44.2%) classified as having excellent or good levels.
Conclusion: LCG-HV features an injection speed suitable for high-viscosity bone cement and a maximum trigger force at the standard level. Its unit cost is lower than that of a commercial gun. Clinical utilization in bipolar hip hemiarthroplasty has provided satisfactory postoperative results and has been able to achieve optimal quality of cementation.