Lampang Medical Journal

Permanent Pacemaker Implantation by Left Bundle Branch Area Pacing Technique

Thu, 20 Feb 2025 00:00:00 +0700

Permanent pacemaker is a device used to treat patients with cardiac conduction abnormalities from the atrium to the ventricle or with malfunctioning cardiac electrical origins, ensuring the heart beats at an appropriate rhythm. Currently, there are two techniques for placing ventricular leads: through the myocardium and at the cardiac conduction system. The latter is divided into two positions: His bundle branch area pacing and left bundle branch area pacing (LBBAP). LBBAP is a simpler, more stable technique requiring lower pacing power, resulting in better synchronization between the right and left ventricles, making it increasingly popular. This article describes the LBBAP procedure in detail.

Epidemiology and Factors Associated with Complications in Patients with Deep Neck Infection at Lampang Hospital

Sasipim Boonpeng — Mon, 16 Dec 2024 00:00:00 +0700

Background: Deep neck infection (DNI) is a critical condition characterized by infection in the potential spaces within the deep layers of the neck. Early diagnosis and treatment are essential to minimize the risk of severe and life-threatening complications.
Objective: To explore the epidemiology, complications, and factors related to complications in patients with DNI treated at Lampang Hospital.
Material and methods: An analytic cross-sectional study was conducted on in-patients diagnosed with DNI at the Otorhinolaryngology Department, Lampang Hospital, between January 1, 2021, and December 31, 2023. Data were extracted from medical records, covering demographic, clinical, and complication-related information. Regression analysis was utilized to identify factors associated with complications.
Results: A total of 267 patients were included, with a male predominance (57.3%) and a mean age of 51.9 ± 17.4 years. Neck or facial swelling (64.1%) was the leading symptom. The submandibular space was the most commonly affected site (39.0%), and dental infections were identified as the primary source (52.8%). Klebsiella pneumoniae was the most frequently isolated pathogen (7.5%). The main treatment method was surgical drainage (80.5%), followed by antimicrobial therapy alone (10.1%) and needle aspiration (9.4%). Complications occurred in 43 patients (16.1%), with septicemia being the most frequent (8.6%). There were seven fatalities (2.6%). Significant factors associated with complications were chronic kidney disease (OR 8.36, 95%CI 2.31–30.29, p=0.001), anemia (OR 3.62, 95% CI 1.05–12.44, p=0.041), dyspnea (OR 6.89, 95%CI 1.71–27.74, p=0.007), multiple space infections (OR 6.14, 95%CI 2.10–17.94, p=0.001), and retropharyngeal space infection (OR 3.77, 95%CI 1.23–11.52, p=0.020).
Conclusion: The study found a complication rate of 16.1% among DNI patients. Chronic kidney disease, anemia, dyspnea, multiple space infections, and retropharyngeal space infections were significantly associated with increased risk of complications.

Clinical Outcomes of Transcatheter Device Closure for Patent Ductus Arteriosus in Adults

Somluck Ninwaranon — Fri, 31 Jan 2025 00:00:00 +0700

Background: Patent ductus arteriosus (PDA) is a congenital heart defect that is rarely found in adults. Transcatheter PDA closure (TC-PDA) is the standard and accepted treatment method due to its lower risk and fewer complications compared to surgery.
Objective: To determine the safety and clinical outcomes of TC-PDA in adults using closure devices at Lampang Hospital.
Material and methods: This retrospective observational study examined patients over 15 years old who underwent TC-PDA using the Cocoon duct occluder between February 2015 and May 2022 at Lampang Hospital. Data on procedural safety and clinical outcomes were analyzed at 1, 6, and 12 months post-procedure.
Results: A total of 14 patients with a mean age of 42.6±16.1 years were included, of whom 9 (64.3%) were female. The average PDA size was 7.0±3.6 mm. The PDA closure success rate was 100%, with no complications observed during or within 24 hours after the procedure. Follow-up transthoracic echocardiography revealed no residual shunt. Significant reductions were observed in the left ventricular systolic and diastolic dimensions (p<0.05) and right ventricular systolic pressure as early as 1 month (p<0.05), while the left ventricular ejection fraction remained unchanged. Patients with dyspnea improved to New York Heart Association class I, except for one patient who remained in class II at 12 months.
Conclusion: TC-PDA in adults at Lampang Hospital demonstrated high safety with no complications. The procedure reduced left ventricular dimensions and right ventricular systolic pressure, leading to improved clinical symptoms.

A Comparative Retrospective Study to Identify the Smallest Primary Cementless Femoral Prosthesis Available in Thailand Using Digital Templating Method

Rukthanin Ruktrakul , Charun Sirimongkol — Thu, 20 Feb 2025 00:00:00 +0700

Background: Cementless femoral stems are commonly used in hip arthroplasty; however, caution is advised for patients with narrow femoral canals. Currently, there is no published study on the smallest cementless stem available in Thailand, and such information would be valuable for preoperative planning.
Objective: To identify the smallest cementless stem that can be implanted in Thai patients with narrow femoral canals, particularly in those with Dorr type A femurs.
Material and methods: A comparative analytic study was conducted on patients who underwent hip arthroplasty using the smallest size (size 1) Avenir cementless stem at Lampang Hospital between January 2015 and March 2023. Preoperative radiographs of the normal contralateral hip were calibrated and magnification adjusted. Digital templating was then performed using 10 different stem templates, and the optimal stem size was recorded. The percentage of patients in whom the fourth smallest stem size, or the third and fourth smallest sizes could be inserted was compared among the 10 stem types using the exact probability test.
Results: The study included hip radiographs from 71 patients, with a mean age of 60.1 ± 10.8 years (range 25–89), of whom 54 (76.1%) were female. Femoral morphology was classified as Dorr type A in 45 cases (63.4%) and type B in 26 cases (36.6%). The Accolade II stem could be inserted as the fourth smallest size in 57 cases (80.3%), a rate significantly higher than that of other stems (p<0.001). No significant differences were found among the Tri-Lock, Synergy, M/L taper, and Polar stems (p>0.05). The third and fourth smallest sizes could be inserted in all cases (100%) using the Accolade II stem and in 69 cases (97.2%) with the Polar stem (p=0.496), both demonstrating significantly higher insertion capabilities than other stems (p<0.05). The Tri-Lock stem could be inserted in 58 cases (81.7%), which was not significantly different from the Synergy stem (56 cases, 78.9%, p=0.833) but was significantly higher than the M/L taper stem (34 cases, 47.9%, p<0.001). Analysis of the 45 patients with Dorr type A femurs yielded similar results.
Conclusion: The Accolade II stem is the smallest cementless stem available in Thailand, followed by the Polar stem. The Tri-Lock and Synergy stems ranked third and were considered equally comparable.