Browsing by Author "S. Jaovisidha"

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    Delayed presentation of huge pseudoaneurysm of Profunda femoris artery branch after dynamic hip screw fixation for intertrochanteric fracture: A case report and literature review
    (2020-04-01) N. Pengrung; P. Sa-Ngasoongsong; N. Kulachote; N. Sirisreetreerux; P. Pootracool; S. Jaovisidha; Faculty of Medicine, Ramathibodi Hospital, Mahidol University
    © JOURNAL OF THE MEDICAL ASSOCIATION OF THAILAND | 2020. Pseudoaneurysm is a rare life-threatening condition caused by vascular injury after a proximal femoral fracture fixation. Although the onset of symptoms may be acute or delayed, this condition requires early diagnosis and proper treatment. In cases with delayed presentation as soft tissue mass in the thigh area with or without pain and anemia, the differential diagnoses as soft tissue tumors, deep vein thrombosis, and infection should be considered. The definitive diagnosis can be set using duplex ultrasonography, CT angiography, and MRI. The management includes the conservative method and surgical treatment, depending on the lesion size. In the present report, the authors presented an elderly male who had delayed presentation of a huge pseudoaneurysm from the branch of his profunda femoris artery after proximal femoral fracture fixation, together with a literature review of its etiology, treatment, and outcome. The authors believed this article provide supportive information for an appropriate stepwise approach for diagnosis and an effective strategic management in the patients with pseudoaneurysm and having late presentation.
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    Influence of heterotopic ossification of the hip on bone densitometry: A study in spinal cord injured patients
    (1998-01-01) S. Jaovisidha; D. J. Sartoris; E. M.E. Martin; K. Foldes; S. M. Szollar; L. J. Deftos; University of California, San Diego; Mahidol University;
    Objective: To evaluate (1) the magnitude of falsely elevated bone density results caused by heterotopic ossification (HO) around the hip and (2) effect of age of patients when the measurement was taken, age of patients at injury, and age of injury (time since event) to the prevalence of HO. Subjects and methods: We blindly analyzed plain radiographs of the hip [(obtained within 1 month of dual energy X-ray absorptiometry (DEXA)] in 107 spinal cord injured (SCI) patients for HO and matched the result to the three regions of interest (ROI): the femoral neck, Ward's triangle, and the trochanter. The influence of HO on bone densitometric values was determined by the analysis of variance (ANOVA) and post-hoc analysis. Results: Nineteen (18%) patients had HO; overlying the femoral neck (79%), trochanter (74%) and Ward's triangle (37%), respectively. Significant elevation of densitometric values (P < 0.05 or less) was observed in a various magnitude at each ROI, with the greatest elevation at Ward's triangle. The prevalence of HO was high when the patients were injured at age range of 20-39 years. Conclusions: HO around the hip can cause significantly elevated bone densitometry results at all ROIs, which can obscure underlying osteoporosis, leading to underestimation of fracture risk. Determination of bone density in this region with corresponding plain radiographs would be of help. In SCI patients, prevalence of HO was high when the age of patients at injury was 20-39 years.
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    Influence of spondylopathy on bone densitometry using dual energy X-ray absorptiometry
    (1997-05-01) S. Jaovisidha; D. J. Sartoris; E. M E Martin; M. De Maeseneer; S. M. Szollar; L. J. Deftos; VA Medical Center; Mahidol University
    Spinal cord injury (SCI), as well as other neuromuscular disorders, not only results in osteopenia but also induces various patterns of osseous, articular, and soft tissue alterations. In the spinal column, a variety of abnormalities occur. To evaluate the magnitude of discrepancy of bone densitometry results caused by spondylopathy in SCI patients, we analyzed anteroposterior (AP) radiographs of the lumbar spine [obtained within 1 month of dual energy X-ray absorptiometry (DXA)] in 116 SCI patients for various manifestations of spondylopathy, and matched the result to each vertebral level (L1. 2.3, 4). The dataset was stratified by individual vertebra (totally 463 vertebrae) as valid (no demonstrable other abnormal density on plain radiograph except osteopenia), abnormal without, and abnormal with hardware. The influence of spondylopathy on bone densitometry results was determined by the analysis of variance (ANOVA) and post hoc analysis. Our results showed that 227 (49%) vertebrae were abnormal. Significant elevation (15%, 15%, 18%, 20%; P < 0.001-P < 0.05) of bone mineral density (BMD; g/cm2) was observed at all levels (L1, 2, 3, 4, respectively), particularly at those abnormal vertebrae without hardware compared with valid (no other abnormal density on radiograph except osteopenia (Table 1). The L4 level was most severely affected. We concluded that in SCI patients, owing to various secondary progressive skeletal abnormalities, particularly neuropathic spondylopathy, can have strongly and significantly elevated vertebral bone densitometry results, which can obscure underlying osteoporosis, leading to misinterpretation and underestimation of fracture risk. DXA, although characterized by improving spatial resolution, cannot replace radiography in establishing the magnitude of this skeletal pathology. Therefore, determination of bone density in this region with corresponding plain radiographs is highly recommended.
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    MR imaging of fat-containing tumours: The distinction between lipoma and liposarcoma
    (2010-05-01) S. Jaovisidha; Y. Suvikapakornkul; P. Woratanarat; T. Subhadrabandhu; A. Nartthanarung; P. Siriwongpairat; Mahidol University
    Introduction: This study aimed to retrospectively review the magnetic resonance (MR) imaging features of the lipomatous tumour in order to differentiate between lipoma and liposarcoma. Methods: The MR images of 38 patients (24 female and 14 male with a mean age 48 years) in a consecutive five-year period, who had histologically verified lipoma (n is 29) and liposarcoma (n is 9), were retrospectively reviewed. The images were assessed for the number, site, size and margin of the lesions, as well as the signal intensity (homogenous, bright signal on T1-weighted [T1W] image, bright signal suppressed on T1W with fat-suppression image, bright signal on T2-weighted with fatsuppression image), the internal architecture (thin/thick septum, cystic change), the effect on the surrounding tissue (oedema, neurovascular involvement) and the enhancement pattern. Results: A partially ill-defined margin, neurovascular involvement, enhancing thick/nodular septum and a partially bright signal intensity on T1W images were statistically significant MR imaging features that favoured a diagnosis of liposarcoma (p-value is less than 0.0001). Male gender, an internal cystic change and surrounding soft tissue oedema increased the risk of liposarcoma approximately 2.8, 3.5 and 3.5 times, respectively, compared with the reference group (lipoma), but this was not a statistically significant finding. Thick/nodular septum was signif icantly associated with liposarcoma compared with lipoma (odds ratio 69.3, 95 percent confidence interval 5.2-3184.8, p-value is less than 0.0001). Conclusion: Statistically significant MR imaging features that favour a diagnosis of liposarcoma included a par tially ill-defined margin, neurovascular involvement, enhancing thick/ nodular septum, and a partially bright signal intensity on T1W images. The most statistically significant predictor of liposarcoma was thick/ nodular septum.
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    Ultrasound in patients with equivocal inguinal hernia
    (2020-01-01) S. Jaovisidha; A. Sakulchan; P. Woratanarat; C. Wilasrusmee; N. Chitrapazt; Faculty of Medicine, Ramathibodi Hospital, Mahidol University
    © JOURNAL OF THE MEDICAL ASSOCIATION OF THAILAND | 2020. Objective: To determine the correlation of ultrasound (US) diagnosis and further management in patients with equivocal inguinal hernia. Materials and Methods: The Institutional Review Board approved the present retrospective study of US diagnosis and medical record in patients with equivocal inguinal hernia, who underwent US during a consecutive five-year period. The clinical indications and physical examinations were recorded, and the US diagnosis was evaluated. The correlation of the US diagnosis and further management (operative or non-operative management) was reviewed. Results: One hundred twenty-seven patients, with 143 sides, were included of which 48 of 143 (33.6%) had visualized inguinal hernia by US and 45 of these (93.8%) were planned for surgery. The rest, 95 of 143 (66.4%), showed various findings such as solid lesions in 11 of 95 (11.6%), cystic lesions in 8 (8.4%), lymph nodes in 6 (6.3%), other findings in 22 (23.2%), and normal findings in 48 (50.5%). At step of treatment planning, 45 of 48 (93.8%) of patients with and 20 of 95 (21.1%) of those without visualized hernia were planned for surgery (p<0.001). At step of surgery, 30 of 48 (62.5%) of patients with and 22 of 95 (23.2%) of those without visualized hernia underwent surgery (p<0.001). At step of final diagnosis, the inguinal hernia was diagnosed in 30 of 32 (93.8%) and 8 of 84 (9.5%) in the groups with and without visualized inguinal hernia by US (p<0.001). US has sensitivity of 78.9%, specificity of 97.4%, accuracy of 91.4%, PPV of 93.8%, and NPV of 90.5% in patients with equivocal inguinal hernia. Conclusion: US has an obvious role in diagnosis and guiding further management of patients with clinically equivocal inguinal hernia.
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    Ultrasound in pediatric patients with clinically first joint pain
    (2019-01-01) S. Jaovisidha; R. Chunharas; P. Woratanarat; S. Vilaiyuk; N. Chitrapazt; Faculty of Medicine, Ramathibodi Hospital, Mahidol University
    © JOURNAL OF THE MEDICAL ASSOCIATION OF Thailand | 2019 Background: Joint pain in children is a presentation of important differential diagnoses including juvenile idiopathic arthritis (JIA) and septic arthritis, which can cause permanent joint destruction. In children, un-cooperativeness and thick subcutaneous fat may limit evaluation of joint inflammation. Objective: To evaluate association of physical examination and ultrasound findings in pediatric patients with clinically first joint pain and association of ultrasound findings and final diagnosis. Materials and Methods: Children (16 years old or younger) with clinically first joint pain but equivocal clinical diagnosis were eligible if they were sent for ultrasound of the joint. Images were reviewed by two investigators using consensus agreement. The ultrasound findings were assessed for joint effusion, synovial thickening, synovial hyperemia, peri-articular soft tissue swelling, and bone erosion. Clinical examination and final diagnosis were reviewed from medical record. Patients with incomplete clinical data and those with underlying disease of hemophilia were excluded. Results: The retrospective study consisted of 50 patients (87 joints). Most common ultrasound abnormality was joint effusion in 19 of 87 (21.8%) joints. There was significant association between ultrasound findings and physical examination (p<0.001). Ultrasound detected abnormal findings in two of 30 joints, which were not detected on physical examination. Provisional diagnoses were septic arthritis (44%) and acute inflammatory arthritis (26%). Only eight patients (16%) were sent under clinical suspicion of JIA. Thirty-three patients had diagnoses changed after ultrasound. At the final diagnosis, only one patient (2%) was diagnosed as septic arthritis and 17 patients (34%) as JIA. Most common diagnosis associated with synovial thickening and synovial hyperemia was JIA [in 10 of 15 (66.7%) and six of eight (75%) of cases, respectively]. Negative ultrasound finding was found in cases clinically suspected of neoplasm. Conclusion: Ultrasound in pediatric patients with clinically first joint pain showed significant correlation with physical examination. In some cases, ultrasound can contribute positive findings even when physical sign is not present. Synovial thickening, synovial hyperemia, peri-articular soft tissue swelling, and negative finding by ultrasound showed significant correlation with final diagnoses. The findings of synovial thickening and synovial hyperemia frequently associated with JIA.
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    Unsuspected vertebral fracture in older women undergoing screening bone mineral density assessment: Prevalence, impact, and agreement with lateral spine radiography
    (2016-12-01) C. Utamakul; C. Sritara; M. Bhumiwat; C. Bua-ngam; K. Sriudomporn; S. Promma; A. Thakkinstian; S. Jaovisidha; Mahidol University; Thailand Ministry of Public Health; Sapphasitthiprasong Hospital
    © 2016 Elsevier Masson SAS and European Union Geriatric Medicine Society Objectives To define the prevalence of unsuspected vertebral fracture in older women undergoing screening dual X-ray absorptiometry (DXA) using vertebral fracture assessment (VFA), to assess the impact of VFA on patient management by providing additional information to BMD and FRAX®, and to assess the agreement between VFA and standard lateral spine radiography. Materials and methods The IRB approved the study protocol. Medical records and VFA images of consecutive women aged ≥ 60 years referred for screening DXA during August 2009 to July 2010 were retrospectively reviewed. Those with known conditions potentially affecting bone metabolism or severe scoliosis were excluded. The fracture risk was estimated using FRAX®. An agreement on the presence and type of vertebral fracture was conducted on a subset of 30 subjects. Results Of 634 eligible women, unsuspected vertebral fractures were identified in 153, resulting in an overall prevalence (95% confidence interval [CI]) of 24.1% (20.8–27.6%) and 17.4% (20.8–27.6%) for fractures of any grade and of grade 2–3, respectively. Among non-osteoporotic, low-risk women, the detection of vertebral fracture changed the diagnosis in 17.3% and treatment in 11.1%, demonstrating the impact of VFA. The agreements between VFA and radiography for T11-L4 vertebrae were 0.64–1. Conclusions The prevalence of unsuspected vertebral fracture as defined by VFA was significant in women aged ≥ 60 years referred for screening DXA. By showing vertebral fractures in low-risk non-osteoporotic subjects, VFA appeared to have clinical impact. Its agreement with radiographs for the detection of vertebral fracture was moderate to good.