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sPe300 mgASPIRIN ENTERI COATED TABTETS* Enteric coated aspirin causes less blood loss,...but absorption is delayed for 6 or more hours, sothat this preparation is unsuitable for occasionalanalgesia, though well suited for long-term medication, as in rheumatoid arthritis'AIIIUNICHEM DISTRIBUTORS L.P.}fr 2711 Rangnam Rd. Bangkok, Thailand Te\.2450274,2452382

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The Journal of Prapokklao HospitalClinical Medical Education Center (J.P.M.C.)AdviserEditorAssociate EditorEditorial BoardManagerAssistant ManagersArtBanthit ChaowagulDamrong BhanthumkosolPrayuth SomprakitPrakit KasemsarnPrasert RimchalaSuchart ChaimuangrajPramot ChudumSomboon KietinunSombat NavarattaraPrapap YoothavisuthiDanai DanvivathanaSomboon SomlawSiriwatt ThiptharadolChaiyasit BhinyovithayakulSumaporn SealimChintana ChingchitMorakot MakkamalSirinarj LimmanonukulPimon ChanakotSegsom BoonsirichaiWilaipan RimchalaCheocharn ViriYaluPPaNipawan KosalwatSurachart HarithaithawornSomsin ChaiwijitJitti KositchaiwatBonlert BhuriyagornSuchat JeampochamanVipun VuttanacheePOffice addresshrblication0wnerTechnical Department of Prapokklao HospitalAmphur MuangChantaburi 22000Tel. Chantaburi 3l l6l l-3, 311270QuarterlyPrapokklao Hospital*r.rld,***liunliur|au kuhfiufrn7wnotdl, a/a guin as (nanatt) wvhtu't n7',m'l,un'tuln lfi. zsercsai;d giirtrinn reefzo nanqnnlaao nri.tulthrniinatt nltnnunluffi Iw. zanzses.

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d?]t dlt fl uuRlr fl n U] I tyrTlufl lfl gtr fiou RtlI:uururoruvilnrndlThe tournal of Prapokklrro Hospital Clinicsl Medical Education Center{ri - {ull S fluull2 tlt.u.-lt.u. 2529 Vol. 3 No. 2 Apr.- Jun. 1986a15u?UI?lil'lPageContentsfldrrJinurintntw Intafwf n.u.atlI?TN''TUilNNIStOnorVil 2'tit?t noo laoo llo { llay?t non raoorit Superior mesenteric rri o lur ornn: v outl t uintntu Tndafntfi n.u.r 00 FILM QUrZr03Nipawan Kosalwot M.D.MEDICAL RECORDTraumatic AV Fistula of Superior Mesente.ric Artery and VeinNipawon Kosalwvt M.D.orqtflrflnirJin"nris{9uI: nr0 or(ua uo ro"nuj run"uful: nrJ o nunnfrihaautnnu107MEDICAL REVIEWMeningitis and Pulmonary TuberculosisMedicine Stafft'tu.t'tunltut:ulufitfl uuaynl:rJ:vru I I Iri.rrlfr uhnrr'Rrr rduur lu{ru{ihu uovn'u rh Ro ilfr trno{ ilrldn"uirlu nr: y rsuuiunrl oiudpn u.u. (adh)ind lartnflufwri w.u.Record of Special l,ecture and Workshop"Writing a Case Report and Uses of Computerin Medical RecordChintana Chingchit B.S. (St.)Jitti Kositchaiwat M-D.uuvriruu"ldoI 13 BOOK REVIEWIuotondl:II5ABSTRACT OF JOURNALdrrtrurnudAfinr:rlfr ri6.rrur ou s rdou122 NEWS130 QUARTERLY STATISTICAL REPORT

Thanxendi s An x io s ele c tivUrelieves anxiety, restores alertnessBeforeThanxene(N = 20)alow beta wave activityo High level of anxietyBlue/violet range of spectrumSignifies low beta wave activityAftert--r-t 'Ifanxene(N = 9)*o Beta wave activity dramatically increasedo Anxiety markedly reducedRed/orange signifies high betawave activitvAnxioselective effect demonstrated in new clinical studylo Dramatic increase in beta wave activity shown with Tranxene.O Beta wave activity is associated with concentration, attention, mentalfocusingl'2*Anxioselective refers to a drug whose most prominentaction is anxiety reduction and which has lbss prominentother behavioral consequences.+Of the 20 sublects enrolled in the study. 10 were placedon placebo and showed no significant change. I patientdropped out due to an unrelated back injury.Thanxend(clorazepate dip ota s sium) CFor your anxious patients who must remain alertFor further details of this study, contact your Sanofi representativePlease see Brief Summary

For Your Anxious Patients Vlho Must Remai n AlertTWEI{E(lorazepate dip ota s siunr) 0r Calms rapidly and effectivelyr Helps restore alertnessr Little likelihood ofproblem sedationxr Time-proven safety profile-adversereactions such as withdrawal seizures andamnesia are unlikely to occurA New Perspective on Anxioselective Effiect:Computer-generated Spectral Analysis of EEGrSUPERIOR FRONIALGYRUSMIOOLEFRONTAL GYFUS ---INF€AIOA FRONIAL GYAUS,, ri8ill'2? ^",LATfRA! fISSUffT-' --''{-POSI CTNTNAIGYFUSINFERIOF ITMPONAL GYRUS - -\-1 rlllLllSUPTNIOR PAFI€TALLOSULEINTRAPAR IATSULCUSPAAIE TOOCC IPITAL--SULC USINF€ RIORPARIETAL !OBUL€SUPAAMARGINAIGYRUS16515514 51351251r51O5958 5 75 65 55 4 5 35 2 5Frgure AGray scale computer EEG ana ysrs,''.,,.,,,...riii|lilwith p acement oi 165 EEG leads 9.0 10,9 12.9 t4.9 16.9 18.9 20.9 22.9 24.9ind cated Low acl vrty rs n the I ghlershades. h gher actlvity n lhe dar^16 EEG lcads werc placcd on the left hcrnisphcre ( Fig. A ) andmidline ( l2 according t() thc lO-20 syste m, \ 'ith .1 additi()nalinterpolated postcri(rr locations ).The resulting data wcre digitized, and comput:rti()ns s'erc made toanalyze delta wavc and be ta wave activity. Tirpographic nlrps \\'crccomputed by linear intcrpretation from the ,1 nearcst elcctrodcs.For cach of the .l,OOO pixe ls (picture clements ) in tlrc map ( I'ig. A. ),four corre sponding wcights we rc multiplie d by thc appropriett:four spectral powcr values. LJsing a dot dcnsitl represcntation,interpolated valucs were displayed on an approximatcly equal arcamap of the lateral surface of the human c()rtex.The magnitude of wave activity ( in microvolts ) \ 'as translatcd (r()nra gray scalc ( Fig. A ) inrc a cokrr scale. Low activity is seen in thegenerally blue /vi()lct range. IModerate activity is shown in ve llon'/grcen. High activity is expresscd in red/()rangc. The col

Vol.3 No.2 Apr.- Jun. 1986 J Prapokklao Hosp Clin Med Educat Center 65nr: rf : v rfru nrt ildt ut: 6f Yn.l ndfr nsa ds I dlfO.lildgltlflYlu lnt{n1t'l :U?l 39t1 lf lR tu cn 1|l n: fi lut tilt il u cI Rtcofrra ruvnr 2Yr.u. l6nurnrco#y'ttru:vqnf dilurvn0 Yt.u."rt?rytuFhOor*6nurAbrtract Evaluation on Clinical Performance of 3rd Group MESRAP*** Students by General PractitionerStandard Criteria of Thai Medical CouncilPimon Chanakot B.S. (Ed.)*, Prayuth Somprakit M.D.+**Department of Education, **Department of Obstetrics & Gynecology, Prapokklao Hospital, Chantaburi,Thailand.J Propokhloo Hosp Clin Med Educot Center 1986;3:65-73.Evaluetion on clinical performance of 3rd group MESRAP*t* students according to Gencral practitlonstStandard crlteria set by Thai Medicat Councit in 1984, was donc by using questionnaire. There were ll res.pondents from 15 medical studcnts, Thc results indicated that most of MESRAP students reached the criterla. Howcver,but therc w.re some crit€ria which our stud€nts' pcrformance did not reach. Those criterla were presented inthis report with some comments for improvements.-gruealJllutl,[UEr.:uql tqilRlT [udar+$rj o{u6'naq: Liy{?1ufl 1fl o{ilnufi'nqo'r s tJrfluufi'neEr: o fl rnyflnr:onrfinnr:ou:ilrt1rnfif,lnfio (intern) luil rnr.e.zszz rlrurard^ Z a 6t tqrRolJU nO O?1il [ilUU[0i10?1tJff1il1TnVn.:n6fi110r' iluinnn bwatn am"ilnn ffi o1unqi.' ilu a6-ui nrlnfi u Ir wa tut atnvil n {t oit n ui"'MESMP-Medical Edtrcatbn for Sfitdents in Rural ArewProiectUfi fr q ur'{ n 6 rrrrJ fl nT ( extern; r fi u u t ei'fi'l ri}r vr 6fi1 n ralor4 vl , -&H5o"[ri 6'.:fiuauf nr:6nr*rur^rmaeraerS erdfi n 1:.1-yrul ur dil:yri n rn fir 6'un r.16.rtdri r ullj R a L a1 il{urfi a il'i I r fi u o? 1 ru fl 1 rJ I : n r 1 .l o Afi nu a .:fi fi o trl ] m [Jrrtrl fl riGri'l rn rudlr o:o rulo.:uynrsnriunr"aorravidnr:n eiiler-lodr rrfl ufi fi q uilnd r?rilAfA lufi s tuTo:.:nr: n.:rci run r: 6 n ur ul rvrfi d rufutr.:tuln,iruru1b ou,{i.:ovolnr:6nurlufl y{.fl.2s28 uo:fird'mo

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Vol.3 No.2 Apr.- Jun.1986 J Prapokklao Hosp Clin Med Educat Center 67incompatible blood trarsftxion,hyperventilationsyndrome, cardiac arrest, hypertensive crises,heart failure, bleeding, hemothoraxi pyothorax;hydrothorax, pneumothorax, pulmon ary edema,respiratory arrest, respiratory failure, respiratoryobstruction, status asthmaticus, acute abdomen,urinary retention, asphyxra of the newborn, fetaldistress, coma, convulsion, shock : anaphylactic- fifi nut^ril6vir'lqirfi s.:ur.:6iru oY.:uno.:dq;:'luoytofl 9t !uo1:1,:Yt 1z. crrrr: oc["nrj:vi6 n: 2oi r{nru llnvillr"tonr:eu ?onr{rfo{ilfr ri6nr: dOr riJuur urJ oH a'lsi vrioufr .rti'nr: riuisrfn urd ru ur v a un1 ilifqn1- fifi orinvrdrir'loi'fi r 1 nuotR,i1l{?ilfifi o-lt1'{11ufifl.1$1JLjfloUfi1tl 11 nu 60 '[r7, raou rarglodo.foqvrr.-'-Zuafi]flt0nluln iltBt0 t3,,8ti, €roiuR ulun tfin tRaofittoraan "i oril, rfioolfilr erdu'lfr a1r6su arr6uulflurfioo ndu'lilnn rro sv6n fr'ol6o ur.iuri'a.r vi'orrynv10.:i6u a o orrv rijuilnilurfioo, 6'r uafi a.l et1 r$60.r,60, rfiaooanfiorlnfi, urrufi.:d'r rllilrnv{rrd, il:r-6rr6oufiqiln6 rdoooonvn,:riornnoo nnrrr? film:firiun::fi n::fifiorjnfi, dnn:von d'urqt{rrfi fl'ufirsi'r, 6ru yilqRA, u1or6uoi1.r"l, 16!oo, rJrorfiarrhor{r fioduoa rlrovlar ilrqud'{ :Jrouru ilrorrilrorrouno rJror{u ilroil'ivdru6ou il?oli ilreror16o.:or, ilrislu rarirfio rfluor:, loa*u irafiouirsqnto.iru, ur^rdu tilfir:.1- fifr qultyrdrirld'rfiarurle':u 6r-.trff o.n1aaqa'ngrauo tu0t1;1.3?1 2chiectasis; empyema, acute necrotising entero-B. drttr: ojfi oa"u l#nr::"nurfl om"unrrvl: noix 1 colitis, cholecystitis; cholelithiasis, hemorrhroid;oJufistula in ano; anal fissure, intestinal obstruction,3.1 n6iilo1nr:raionrrvfi do rf,riluarirrduw liver cirrhosis, pancreatitis, acute and chronicfiolrunrrur:nfnr*rI:o ncilornrruioRl?uR1?vEio renal failure, nephrotic syndrome, urinary tractu ,iu osLUU tOCtlUOUta{- fifiouilm6rir\ei'fir rr nuorn,$rurufifiq[nyrififlnuu!flountil") '1t nu fio amebiasis,chicken pox, cholera, dengue hemorrhage fever,gastroenteritis, intestinal parasitesi herpes, leptospirosis,localized infection and abscesses, malaria,measles, meningitis; encephalitis, mumps,pertussis, salmonellosis, sexuallytransmitteddiseases, shigellosis, tetanus, tuberculosis, diabaesmellitus, iron deficiency anemia, otitis (externaand media), heart failure,hypertension, rheumaticfever,asthma, bronchitis; bronchiolitis,@ryaa, infl uenza, pharyngotonsilitis,pneumonia,acute appendicitis, acute hepatitis, liver abscess,peptic ulcer, acute glomerulonephritis,urinarytract infection, cervical polyp, pelvic inflammatorydisease, abortion, hyperemesis gravidarum,toxemia of pregnancy, normal labour, puerperalinfection, retainedplacenta, rupturedectopicpregnancy, common skin disease, normal newborn,infant feeding- fifi ottwyririr'ld'rfi u.]urrairu d'.:uso.::tsdrt6solufl't'r1{fi 3s.z fi orr uid nlunr:ifi o o-rr rrov:-ufi oro urufi'brJqrar roy{r 141i11: nrai a n { uor nr ciolilfi 60rirunr::Jfr f-ereiohJ ororJf n ur{6urfi a 6r rfl u- fifi0$iln6rir'l6'ft11 nu {1uxufifiorrrrrrfifiai.:uuufloun1ili1 nu 6o scrub typhus,malignancy, enlargement of thyroid; thyroidnodules, hypo- and hyperthyroidism, aplasticanemia, idiopathic thrombocytopenic purpura,cerebrovascular disease, pleural effusion; bron-calculi, prolapse of uterus, prolapse of vaginalwall and stress incontinence, tubo-ovarian abscess,endometriosis, ectopic pregnancy, hydatidiformmole, obstructed labour, plac€nta previa;

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Vof.3 No.2 Apr.- Jun. 1986I Prapokklao Hosp Clin Med Educat Center 69abruptio placentae, severe hypertensive disorderin pregnancy, jaundice in the newborn, hepatomegaly,splenomegaly, foreign body enteringthrough orifice, snake bite- fifinunnirirld'rfiu.ruriflru dluaorrluottdsotunlrl.:d 4suturing of wounds, dilatation and curettage,a.s fi nrrruirfi urrTul: nria n {ruarnr:fi urn endotracheal intubation, episiotomy and repair,uri nr:ifi o dst ni afn r*r ui o fi a r ofn urbiur s'[ei rai a exchange blood transfusion, excision of benignfildrlqur fi r'r u ri a u rdo rufr .:il'o fi uloT'jr n: dlo nmlfr tumor and cyst of skin and subcutaneous tissue.ni:ilrfoinulg'nu:Jrufi i raian'na.rrJinstuilm6{ gastric intubation and lavage, regional anesthesiadrurolnr:including spinal; epidural; and peripheral nerve- fifiqrul,{yrfirirldfrr r r nu i1R{"rurufifinttl{nfifiEilulluffountil 11 nu 6a infertility- fifrnul{yt6rlrt6'rfislurrflru d'.:uso.:rrsnvrdsoluonl.Jfi s4. drrJ'rrodr'lddzunura.r fiilrsfi.ril-nnnr:drlr ro.r16'ei'rg nl lriulo u'il.:rn ru{a a R rfl u 4 orir.o 6af rldra.:Iorrlulo rnrvirfi nunil rnfl ufi u unrtrirnuiu- fifisruflyrdrirtd'rorloariulofr.t r r ou o1ndrurufifiqruurndfis.:rrlunounltJ r r nu 6o amniotomy,amputation of finger and toe, artificialrespiration, blood transfusion, debridement andblock, incision and drainage- fi fi qriln6vir'leioi'ruouroo-lrrs o.nrr nr r6uotunr:r.:fi' oior:nlr rfi u rur.:a rufi fi fi unm6'[ilriaulf'nl ilir ru fi olunr: Ero u $uunrtNd s udnfiun'Enfirhvfiuaannuatunnlunn)ioa-an(uatnnnianufiriariifluarind tnvdtutror-flHtTtniiuatnnniontwdnl Tilh*wnunttlunltdrldtiurilo riilri\dtirurufrfrsruuvrtidci.r Hilruuieltrruildouo'lll1. Diphtheria2. Herpangina3. German measles4. Rabies5. Malnutrition6. Vitamin deficiency disease7. Anxiety neurosis8. Depfessive neurosis9. Acute confusional stage10. Sinusitis11. Chroniconstipation12. Yesical oalculi13. Drug reaction14. Osteoarthritis15. Pterygium16. lmperforate hymen17. Melioidosis101010101010101010't010101010998I't 'l11111l1',|11111l1^l1111.11't111111111tltrlrnunu r nu

70 2r:.11:fl udnl:dnurrrnnunran{n6rin I: rnururan:;rJnrndr ilfi s oriufi z r!.u.-i.r,. zszs*ltlod n uanfilan'rrnrthufiuaannuffrnlunniioa-uuacifufinnaun"ldlryn'tnntvnfitlunl:drldriruruiiintiuillo rlrlrild urnnridci.r ilururnq!lluucouo'lu1. Leprosy2. Poliomyelitis3. Reye's syndrome4. Benign tumor5. Leukemia6. Lymphoma7. Disorder of fluid and electrolyte8. Disorder of blood coagulation9. Hemolytic anemia10. Increased intracranial pressure and intracranialspace-taking lesions11. lschemic heart diseases12. Congenital heart diseases13. Cor pulmonale14. Hernia15. Systemic lupus erythematosus16. Arthritis17. Spinal disc syndrome18. Foreign body in respiratory tract19. Hemangioma; lymphangioma20. Tumor of genital organ21. Psychosis22. Mastoiditis23. Valvular heart diseases24. Disturbance of menstruation25. Narcotic withdrawal syndrome26. Psychosomatic disorder27. lnversion of uterus28. Adreno-genital syndrome29. Common behavioral disorders in children(school phobia; enuresis, etc)30. Yaws31. Diabetes insipidus10101010101010101010101010101010101099999998866551111 ,|I111111111111222222233)566111111111111111111111111111111't'l1111111111111111111111l1111111nounrilorndlu?uf,fiouy{r6 rs nu'leiiuuuunounrridurfiur ro-r erurvirfiudrufurn nrdilrn:tlurrilylu n nrfifi ottilyt6yi r'[d'riaa u nr ilr o r da r fl n r: rJ:-u:J: .: ufitroiotrj lqs ai fl'gra fi'n r n rud'i r fi fi o un n 6 vi r'[d'rio u n'irfa a n y 7 o Aar . fi .:fi do.:f uni fl 1 ilrr 6ryi'r'[qid'ru nura.r tunr:rj r riof n u r {:Jr s a f A tTu $ n r q n r 6 ulcia rj 1 .r I u u'l s fr r,rrnvr'fuvixfi 6o disseminated intravascular clotting,acute glaucnma, cardiac tamponade, pnzumonia-mediastinumueidrnfurirdo DfC fiuhi$fr fi nut rvr6oou'irrt rhil6'rns rr4s {udliluu1o rvidud.:rir{a rda ntriurilotiTosrT? 1 lrJ fin evrial#rfi nrJqur

Vol. 3 No.2 Apr.- Jun. 1986I Prapokklao Hosp Clin Med Educat Center7ttunr:ufionoourflilodtodr.:\:fi6fifi0'jrfirrrr{rfi{r rfl udo lufi'lt ri'rdafi rfl u:Jtyn1 il1 nd fl.o 6o pneumoniamediastinum ttoi cardiac tamponade 6ttildreriu2. fl I il1T ndn:h yl6 qtT't oi 1.:R1u rrordtr^t anl:sr:? oyn {fra.0rl fl ffi nlr fi { r rfl urur urJ nru nt6' r {fa ilfi .t!{nr:rir:lofnurduouryn r,olilflru$1 6o radr 116orinulR, rfru{ut4u rlodrlrn r1olild'o qolilld' r1olilnhlo r{.r'hirrirlo, Huirr, fignurn fiqnrrn, nlrroi qrfiuTerrrosRr:r{flurlo.rit.:nrs R ila { lrn;Aolotilrfluhlsrrilfrl, nrrruf,dnvrrtrilflnon.:, ejru'[ri\6'rduutritoi drutuhild u-rdofi rflur}y*",u'rofi'qtaAeA6 o ri a.rn':r ruifr n mr uu R no n I d.rn-rfa rfi s r i'u ilru il rnl*r*sdfin",rFuunr:eourfi r.: r nrurvirfiu il::nounluvrr rqu6 n r: 6 n r*r un fl s e r n o{ n 6fi o 1: .rr{ u r ur oyuciln rn fir {uvrqi hil6-1fr'uinr: rfl arfi'unfif, orJqrarvrl.trvrfl 6 {rir oc'[d'ufr'tgeia'[rj Iou nr: rd runr, *.r]tuA Xqv Zt:o{1ltnil1RlJltoirsouro.: fifi q[r'{yt6fr\sirurnn"irioloy eo unriumelioidosis .ii.:fir{'tilurilo'jrtvrir\d' 3 Truo'rR 11 nug.z fi nrrilfdntunr.iifi oii's uoyfufi orourxl q o I 4 rA ,iU o$n t1u qfi r rf, y{1r fi u]? 0.J tT n ur 0 n n il 0't n r: sl 0'tilfr'[o'ri runli il fr ffi n r: qio'[rJ or orJi n ur{6urfi o dr rilu 6oadreno-genital syndrome,disorders in children (school phobia;common behavioralenuresis,etc), yaws, diabetes irsipidus 6.:rflu1:ofinlt6'rioss n riu behavioral disord"r, lu 16 nd lrir o ytd'ufi'-lsqia\r.l adrr't:fi6irruacirfi'ld'finr:souodurfir cru6or behavioral disorders fiu\d'riqor or.i"6r1'rdururtyn roi'ruiEr rrt rdn uru:: urs o qj udrs.s fi n?r Nirdlrfi'ul: nrai an {ruor nr:durnruri n r:ifi o ii'u ui ofn :* r ui o fi o r ofn r* rlfr'ra r g'[oi' ui ofihirlqu r fi n u :.j o u r rf o ru fr ,r 6'e fi u'[oi.j r n: fi10 or:tf'nr: drfofn ur orr urlqur ra6 o nr: a.:ilin ur rrvrvrdrid'rutqnr: 6o small pox, yaws, inborn error ofmetabolism, yellowfeverl:nfi\rjfief6nr:1u3. fl rilr:oifi odu b{nr:fnr*rfl o.:niunrrvl:n il'r:ryrs\vru '[6'uri small pox, yellow f*", ,rnt, -X- iu, a t,4utlO'l\:q O{Uyaws (r1o 1iufi 'liln u 6 n u d'r ) 6 l'lililr o I rfl urJqrar fis. r n rilarnr:r.r5'"nrasfi da{frfl uadr {6unc 6'a.urfi''[r nru inborn error of metabolism nuleYfi nl ra ru: oin urT: n n {ruar nr:ui o nrrs qio'lrJfi'ld' fiou rurn uor fl Rr: fl o1{u::iJru aEi $firatrrrd s udnnnnnnnthvduenntryiiuzn-ubanian(uanrinnrffinn)fioa-uniafnvtuiafioto{nyt\u"nw'lniniafiTitlrynti,nnuuaatluRltfrlddrurufidsllriuillo rirtild urrnridii.r nrlulneltlluuflolJolll1. Plague2. Cerebral palsy3. Mental retardation4. Disturbance of sexual function5. Congenital malformation6. Mental disorders7. Epidemic typhus8. Smallpox9. Yaws10. lnborn error of metabolismI 1. Yellow fever101010l01098766311111254547111111't111l11111111111

72'r r : d r : f, ud n 1 : f, n urrrvrnu ara o{n6rin I: ruu ru r nu : srJnrn drilfi g ouiufi z r!.u.-!.u. zozenrrrrs o udn un nn r iltv fiua ann uatutr oTunnrhnhonnlriiltunu nt11Unl1ilgroflltrh'lotro.r lfluilrInuu-ulo inuqurnunlu. aaolu2iludt| | g lJ rtr|lnuntu tlTflluil3t{lluunouolll1. Appendectomy2. Biopsy of skin; superficial mass; cervix3. Caesarean section4. Cardiopulmonary-cerebral resuscitation5. Debridement of open fracture6. lnsertion and semoval of intrauterinedevice7. lntercostal drainage8. Low forceps extraction9. Lumbar puncture10. Oxygen therapy11. Paracentesis (abdominal; thoracic;pericardial; joint)12. Parenteral fluid infusion13. Tubal ligation.l 4. Urethral catheterizationI 5. Breech assisting and extraction16. Circumcision17. Closed reduction of simple fractures'l 8. General anesthesia for uncomolicatedpatient19. Culdocentesis20. Manual removal of placenta21 . Vacuum extraction22. Yasectomy23. Venepuncture24. Yenesection and measurement ofcentral venous pressure25. Postural drainage26. External splinting and plaster ofParis technique27. Tracheostomy28. Nasal packing29. Reduction of simple dislocations(shou lder; e lbow; temporomandibu lar;hip; knee)30. Herniorrhaphy31. Marsupialization of Bartholin cyst32. Skin and skeletal traction33. Suprapubic cystostomy34. Vesicolithotomy1010101010101010101010101010999999999998887665)2111I112222111 ,|1122125311356111t1111111111010101010101010101111111111101010101010111010101110101110

Vof.3 No.2 Apr.- lun.1986J Prapokklao Hosp Clin Med Educat Center 734. d1rnrayi1l6'6'rufl uua r ilil.ludnfioonr:fi rirra.ileidronarruriuto r't-ariofi riJurJryui fi fi fi fl rnfl dodr.lriaa r nutrirnorfiurmetaooufinqqn 6a externalsplinting and plaster of Paris technic. marsupializationof Bartholin cyst, vesicolithotomy 6.:d'a{ufittTos6iru firdrirocfinr:fufinnrvr (videorecord) li rfi a n r: a au r fl o nr aslri'fi fi n uvr vrdlrirr u -m?u6'?s01{[o{rf r ra:*ra'n n 1 r d fi A CI $ il yr 6 r n u ri r ria I n.i r f o l -nv eo ro.:tinau t6'rrri marcupialization, suprapubiccystostomy ltnc vesicolithotomyd r rafun'oan'l: marsupia lization fr ur it ufi .rfi11 rld.irfl rfi fl .lusirns rfi un*.lrafi lfi rir or r4 r'[6' uoififi o -ruyryr6'hild'vlrfiurr r.rrrhi'leiyru:-iourln ur rnu6rtil'[d'v1ro'r n ru ufi o u n r ilfi o s r fi utd'.j r m r ulra nir o rfi fi qr -unnfilnr rnr: "r fi nl rus r rur: nln drdr rfi'r rR ild ur sn -tluuyryrsff nradrll:fi 6fr fi .:fi 6'olufi1llrlil:ynr:6.rldrlrrsuo'lr.Judr nr:dnurdf,.rrir'[d'[riar:rp nirn:ryfifi ounm6tri'nlrnr lfi otunrooriuuud oun1ilrloo d lar o ov rfl unr:ry rijuni::J:s rfi uru nnrsu fi.ro r-l r. rnhcln:ulrnuaran{riorfr n. norsunnufi rdn{ lrrnrn:olrrrinatda,zszz.nfinan: d'ur,fluri':,1fififi nry{ndr6riur:d'reou?mtrt ar a n{vTrt:ha r n eur ur^r m! a r n 0i 1 wr n.: n: niiluriyrsrfi'guncur,lnufindl'lilfru dnil::nr.iyfi.lA a 2.,6a nr:finuriirijunr:6ntcrlouarri'udoilorllr sub_!jective 6o rfl ufi lfi fi ft Erun vrd uoi nl ou6q.jr ?irloi'ui ohi qn ru rn rud uEi o d r.:'[: fi srr u16'fi n r.i r-J: y r f, ur.r o fr tvt r.:nr nn qu $ un: nr orJ fr 116 o{ udrtunr nim oir.: 1 : r rufi .:nr: il: ; r f, uH ad i'rL o o',, * o rirr rrrs r o oi yT?'lilT o.ln 6try uyr?tu fl Ic o{ oxr n.:n.l nhrariyrur d'fld:ilq\d'ri r nr: 6 n rsr nr1 ilR 1 u1: aro.:fi fi q $il yl 6In: .:-nr: r Too ar s'u rn rud rur on g ru ur^r yr s nr rfl urn rud zu nfild'uao.:'jr fl rulra qjfi fi or ur^rrd fi enruo r r:r: n rfi u rtoi'fi'u rn nrci ilr6r:o ru usi fi fi rr.:u-:rio d d'a.lufi'[t: r rfr .rr r r u-rriotu r n rx"ri ru r er: g r u6 .: o r o o r fi .r'[ iq .: rfi u'[ r.Jrriu rfi u r rTrl'l nd n utd'fio u rai a\rir^r r i nrlurj: r,, '[yru u5ofi'qonr:Lr.:odr.:"triu nr:dr6'ofrrtun:, urn.,yflsnr':s rilud'uronar:dr{d.l2. Ruror{n:: rtnr:d'nrfi rnordrnn:lrudrJ::nouirrinrrrn: : r.rnorrllrn: ;rudrJ:cnouilriilrrln: : u r{.fl 2b2?. nl'wlufl n1-C{17 25282 14:09-105.

74 '11: d1:qudn1: dnururrnuaran{ndrin I: wtururan::rJnrndr ilrt s rliuti z ru.u.-i.u. zozeRl ?vvti o.r6uqfr'u S c- 6-pD lu#if ruilt nt li uouri6 uu-snirr:r tt.u.*Abstlact G-GPD Deficiency in MalariaSombat Navarattara M.D.r*Department of Pediatrics' Prapokklao Hospital, Chantaburi, Thailand.J Propokkloo Hosp Clin Med Educot Center 1986;3:7479.G-6PD dcficiency is a gcnctic defcct transmifted by X-linked rcccssivc modc. Incldcncc ls about 12pcr c€nt in Thai malc. This report is a prospcctive study in malarial paticnt agc 5-l 5 ycars old ln Prepokklao Horpl'tal, Chantaburi from 15 fuly 1985 to 17 ,anury 1986. The incidence islOperc.nt. DarkurincflndlnSlremanifestation of both mataria alone and malaria with G-GPD dcficicncy. Wc found 24 cz|*s In 129 urlns cxemln*tion. Five of twcnty-four c:urcs arc G6-PD dcficicncy.unrirnrrvnio.:r6udufi c-o-po rfl unrr:ddrsnoonrrfiuqn::ruulu X-linked recessive nuunlunu)a Z af a r.l a 6 afiflrfiosrufl[n: uSooqjluruouvtstotilfiuoo{t'ltf,uu$o:or rduarnru6 lurj:r rvrslvrur,{uil::ilr nrios nv 12qs^' -[u{rrufin:*ryrr yruafl6nr:oirrj::ilrrufosn; zultr,[ fl r yr1.J R1 o r14fl o r t u o f6 n r: q srJ: r rurufa g os 16r, 2r6udui c-6-PD flrnrflrfio'[uil:vrflslmsviuG-6-PD Mahidol urnfis.qf ,*uo.lnflf,onu C-GPDCanton, G-6-PD Siriraj, C-6-PD Bangkok tto:6nnorurfioa,5' iltaqunnntr u hfinn arnctJnrnffi o"un$lrnrriur^rutd*rtrjlurj::rnatnu r'luulntut'ruioi'uvrujunsnlqouql il1nt60fiun1r:vdo.tr6uduf c-6-PD dfi nrrruflr{uf, rYuvrr.rnf,fin fiolr nr ri s yi rlfinufi rd o { r6uds i c-o-po rfi n r$o rianuo.:unnrdaur rfiutd' $ncurfnurrtrnltlunnlut$orriu'h^r:rurnlu nifiu uncdnrl'l vlrbirfinrfinrfiaaro.lrnn rds uyr frulunurria ordutrn li G-6-PD ltiuan orndu-lrrirlnniu'jr rur nrttu tfluar t"qfi*"'ttfdtc-&PD deficiency uvr:oqjoufi.rrJol:tu rrrr:r:{ni!.rdrfl ura rnal:{ulnolo rdufi o:Jn6tirfl orfl urr srttslr fl ar nr::.uu:.:tio g n'ir nutt: rJo'l $nt fi nr: n1g n1nurnr6sfiaun'if,"t',0.r"'t dld6ourorxanr:ro{nr?vr r:o{r6udsSc-6-PD luriilrslrnrr?u $ncnrr:ilrnrrvdrlu{rl'la

Vof.3 No.2 Apr.-.lun. 1986 J Prapokklao Hosp Clin Med Educat Center 75Mnlriu fi.:lunufiuiolr6udrrfi G-6-pD rnsnudhirr:a.:r6ud'u{firuot SGOT rfi odnurdlqffi nr:ro lnrrtni o.:rduda{rG-GPD lufiiltu ur or 6u uot qfGnr:ro.:01 R1r ilff fl 11rvq

76 ?'l:d1:qudnl:dnuruniluf,'rtn{ndrln 1:{nururailtsilnrnd'lili g qfufi z tu.u.-i.t. zoesuann adufu hv n h wfi rnnrti a n at Gan-untzc 6ulhfi c- epo"',r',ld,{{iloltra'lttuMixed formP. falciparum P. vinxnrrvrSu{ui G-G-PD(P.F+P.v)nl?vilCo{r6ud'ot1 c-6-PDR1?!r6uq-uf c-e-po rjn6r1il101031132111313413117r30nnvrdudu$ G-6-PDnr rsvr do.116 u.l-u fi G-6-PDnrrrrduq'r,ri G-6-PD rJn6:'lu"',rlod n udntnnuduxit h v niuah vuc dtaillaancn'funnv 6u{afi c-tpoo"nsilvilsro'rifaallvifanrrvihir ifaarrvtirjnfi tilCn:roilaanv51924I9710511rfiodnnriruunorrl4irdrrur vru'jrtu{'lrato rJ srr;::n'ir rnrr:r6udurirjnfi un: nrrctt{iort6ududuvrqt{rJruurorndr rno rusrrrururnfi qo : a lolrn6odrrnaliloiriau virluri rfiol aqr unruranufil$ i c-epp fiuunn eirfi'uotir lfirlud r fi q (p < o.os)ornH nnr: 6 n urfi ul rolei: ru: t il: ra nc t6rnsrrNdr6'u uanornfiuffrfi{rJruorni'.:ralorJ:16uui cir 1 a a.r{rh s t6 nI: n ur nr rt s f i fi nr r s ili o.r6udqr fiu w n: r o 6'r s lu t'.r n ln i'uvr qt vr u {rJ r a fi fi n r r s t'ti o.trdudu fi c-6-PD r"' o fl qofi d "' rn olJ rririouf o s nsro.oz (nr:rrfi z)nr:6n urdr rrunr risnra.rr{o rur nr riur tu'irG-&PD n-.rttso.rl0 o; rdoo cir.: 1 lunlr.t od uiorroirJ:crilalvrBrfluund.r{4iborrnrrtoqnql lns!rflurio P. falciparanr iagns ao.sz P, oioax iaaoi'toronrsfii'ruioi'uvrqt un:rfluuradrfiinr, cfitoruns mixed form (P.Jalciparan+P.oioax) r6udsf c-&pD rfludru'lurrn ldrnufinr:dnnrd.rfaanr s.oa (err:r.:d s) 6nurntuflir{uf:vn'jrl nr r I fu r{uf ro.: nr r ; ni o.r5 udu { G- 6-PD rlulr nrda ur nr 6s uei nctGorYu nrrc r6uds d G-6-PD x u'ir lrnr 6ulurhcrnslmaP,0 ueihil6'rhnndnr*rluftnfnhifi nl ruunncir.rnr rsfi 6odrrflrlu rirCfqduvrqi lunr:f,nr*rdvru'irqrlhnr:'tto{nrrcwia.rnr:cEroilsnr?c 16'v1rnr:mrorJnerrv{rhu r6uds fi c-6-PD lu{ilra 16 nlr n ur nr ri s rilr ftufas -frrnlo rzs:rsrnclrilcienroJsnrrs 1 t1u nu'ir{:J'ru zn:rsdra:Jaarrcfrohfiorflufasns 18.6 lu{rursdrru'jlilu{rJeufi inrr;nia u6udsfi c-o-pps :rsuoc rfl u{rhui4fi r6uturlrJn6 r g :ru (nr:r.:fi +)trlnnr:nnsoulnrrlf, Chi-square vru'jrfrn u rusdla.tnv r o tdrlnfirds.rrTu:rs{ruf4rngilrliufiir,r lostilufiilrsrdntru rr :rsfinrflufosas rs.zl uosrflufrrjrsr6nraQt z ls6orfluiosns 3.33 {rJurflnn{.rrnrirdor o rfl uld'fr .ra rnol:daI nili olaTldaIn ra rbii:c6'ur6uduf dr errrn4 Lyon's hypothesis?'s

Vol.3 No.2 Apr,- Jun. 1985 J Prapokklao Hosp Clin Med Educat Center 77€€9'A!eq{I-a-A-a+i+g!33+! €9g-eF9!F9.-e-s.F-es$$irxEii$Es a!TrElt!E F3'OErtE cccccEcEcsEccLEEEEEE9"EE"EE.E 3666566i66666 *zzzzzz9zzzzz 6F

78 ?1r.t1:fiil6n1:inurunnudrtn{ndr?n 1:$r0rurail:cilnrndrilfi g qfufi z ru.u.-i.u. zszsi t - :i rsuniltnRtua.t01 n g1uu0 g [Rn o'ln1T toy{1 3 lilo lnT ug1{drafi6nurlrorndrrnalyuurlrnflqo ro{&cnrrrdadrnalj.:rlriou fio'irhirn.rrYunrurfl uo?.1 uu luulirRT'l?" ornnrtFn urfinu'irfrjru 16nI: nutrur c d r mo u:u m g1n dlr.:fl sr ur nilr c il n rn f,r {uvr qt lr nrrisfifi nrrsr^ri o r 16udu $ c-o-po fi Ia nr s druunyt:,:nurur n!rtturlsirllrSi ufl odr rfiunr: unsori rhnn;fr tirrrnn'jrfirJrsfi fr nrrvududufiilnft!vir.:lnndrrno nudoqjdrrnancu16rfisillrfnurfi frn u nrsnr.:Infi nivrsrlurirhsfi v{i o rrduds ri1:{ilsrurnffic:Jnrnfir {uvrqt mudlnolrJ.nirfou G-GPD fiu r ru'ir fi rir5 ulnoivr unc rir dlilIn nfi ucir,ii.rfl u ui rr rud fi lt o u "' u'r,i o q nq l n'i r fi u o qj d r rl n n n'irilnfi to rirhafi'rhU nr: 6 n Erdlilor o un o.:1firriul6'oantJ rrnsfiI:rxurulnrulo so rds.r vhbioufioqj f,nreu rillcfinrrc6uq rurrfi'urfa{cirs rdu R'rrlr'rnd r rnalj,:rirfaur{r urfunr:fn r*rluI:.ryrs'ru'r ny{r y - fl'r1o1n1t nrrunrlq!ilf,n $nvvrar6:JrntoludrlfrJ n rn f,r i'uvrqi rlasn'jr {rJrul: nlr nrriafi oqj dr rno rhlfi{rJru n rulra qj fi ar nrt6 o o{ ri ouur6'r ua o o r n fi uaJrqrlrfi a.rfiunru'ln qjaqi: ouua noantJ rdu clr unnlur.: nr:fiu drurrln 6n rdanxu'jr{:-hu1: n rur or ri u fl ru) a" c alrfln.0 nflanur:rani r^rfrunnr virf,rr un;ul{nyov r4r{.tu o 1u?urno r naocir fl .: 6 lor o rfl urioil.:6'ir1: olflud'u fi{:-horflo.r r :roa{ddruni'uvrfiin uoifi ur nr ri u fi n r: n n r: fi r.:rur o rb n: v o n 6.rfl u ii a,: fiUrj:;{6'irtj rfi sr r?,rfiau dr mol nl rfi a z f,rjnrrid ou ilrocfinr:6nr*rcio'lilurRn rr6onlr1 rn:Rorso (n.a.zsos) lei:rsouli'irnrr v r {i o.c r6ud0 { G-o-PD lurd nlvrrrldtrTd:iltilo.rYunr:fio fia P. latcfpcrurn [niflu'jr infection lrirh nr: 6n r*rnrrs yri o.: r,5udg ri G-6-PD 1uvn c f a at & t- )rate Ta { P. oioas, 1unufi inrrc nr a.r6uda d G-SPD r.{u?groRtTnMmnuolq 5-15 u n{ttn2uYr 15 n:n0]Rilel unn'irRuf{fi nrr; r6udrl {iln6 11!l.nudr'ruilnr vt.?t.2s28 6.:fufi 17 ilflTrnN r'{.fl.2s29 6ruru i30 llu6at4a P. Jalcipdrum $ns P. oioar frua'nrr6udari d'ui6 methylene blue reduction test r^ru'jrfi{rJrurlnfi uwnllvr rio.rr6ud0{ G-GPD hiioruunncir,r drrio.:rduds{ c-o-pp rs :rrriorflufogfl: 1o ungrTunrusfif,orir.rfirladrfiq d.:rflunr:srlunqu'h leivl r nr: nr r of n s r r: d ru?u 12e : r u rq u'ir rJn n r r vnr r s xi o r r 6 u.f,a i c- o- po hileifl a .r n-un r: 6 er 14 o sir za :rs6otflufouoc ra.o 1udrurufififirjruf4!P. Jalciparumrria.rr6udsf G-O-PD s :ruornnr:cnrerlnfr 1rs r zs : rsJr {u'jr{r.hurh nrrvtrleir za:ra (Coombs' test lfHnou4nrru) 6orflunnnn:tilu:vnrflfoun; ra.o lutru, u'ifi{rhu{iilro.:rdudai c-epo g'tu t twa w uq w t it n u\ fi 6n q nt nt z ry n ri rui,

Vol.3 No.2 Apr.- |un.1986 I Prapokklao Hosp Clin Med Educat Center 792.3.Flatz G, Srlngam S. Malaria and glucose'6'phosphatedchydrogcnase deflclcncy in Thalland. Lancet 1963i14t124&56.Panlch V, Sungnate T, Wasi P, Na-Nakorn S. G-6-PD Mahldolthc mort common glucose-6-phosphate dehydrogenascvariant in Thailand. J Med Assoc Thal 1972;55:576-85.Panich V, Sungnatc T, Na-Nakorn S. Acute intravascularhemolysis and renal failure In a new glucose-6'phosphate dehydrogenase varlant: G-5-PD Sirirai. J McdAssoc Thai 1972; 55:721'31.irrr sl n1iil. nllrnior6udt Snqlnn - o-llorr rvln 6 a"ulo : -irualuil:srnalns. ?u: lunur iiuriu, rrinr {iunr,ur:srinlt. l2!r{uqrtrdt{unvrlqltrl:nrluqn:: u1uil:lrnnIilu. n: lrrr.,r : riouurirnrrfllt{, 2szlrss-lo.6.7.Kruatrachue M, Charoenlarp P, Chongsuphaiaisiddhi T,Harinasuta C. Erythrocyte glucose-6-phosphate dehydrogenaseand malaira in Thailand. Lancet 1962; 8:r 183-85.Lyon MF. Sex chromatin and gene action in the mammafianX - chromosome Am J Hum Genet 1962;14':'t35.8. Kattamis CA. Glucose-5-phosphate dehydrogenase deficiencyin female heterozygotes and the X-inactivationhypothesis. Acta Paediatr Scand 1967dsuppl. 172):103-9.9. in: oi ynrll, il: cnn rcd. nr: tlnuril:'lrornnlnc-o-r,lor -rvln df,olar iruttluriorionun l. cr: ii : u reio; ze: szo-az.10. Panich V, Na-Nakorn S. Hematologic values in G-6-pDdeficiency. J Med Assoc Thai 1981;64:269-72.

80 2r: tl'r:fl udnl:f, nurrrnnudrcctin6iln l: wururan:cilnrndr ilfi s ofufi z rr.o.-i.u. zozef: nn"sr'lul: { yr u -r ur o y'r: y rJ n rn dr o-uYIU'v { sv e:TU 119IUnA il.U.*Iriouurir nunnrdn-nd *.u..firuffuor}rrAbstract Measles in Prapokktao HospitalRaianee Vivatkul M.D.*, Raunkaew Kanokpongsakdl M.D.*tDepartment of Pediatrics, prapokklao Hospital, Chantaburi, Thailand.J Propokhloo Hosp Clln Med Educot Center 19g6;3:E0'g4.A pro3pcctivc study of 105 cases of measlesadmitted to Pnpokklao Hospital from octobcr lst,1gg3to septcmbor 3oth, 1984 was roportcd. Thcrc was no scx diffcrcnce. Fifty onc clsGs (4g.s7Iil wer rdmlttod durlngwintcr. Twcnty five paticnts (23.E961 egcd undcr l yeer, Fifty thrtc paticnts (so4796) agGd undcr 2 yoars, andeighty patlcnts l76.19yol wcrc undcr 5 years.The ove r all measles with complications wcre 65.71 pcr cent. These included dl.rrhca (42.E5g61, pnoumonia(33.33%), otitis md,iz(6.66%1, febrilc convulsion 16.66%). The incldcnccof comptic.tion mrhigh Inchlldrenunder one year ol age (8896). The mortality ritc in th€ prcsent study was 0.95 pcr cant (l ln 105). Nono hadrecievcd mcasles vaccination prior to this cpisode of iilncss.unrilqfhnr:lor1:oriofi'uure qgnrn orq nrrrlnrurnrdenrnru Invil'o:rrfionrrcttn:ndou :rufi.rrJo{rlI: o u-o r fl uI: er fi o rd olr;a fi r^r uteir,frln rq utd' si.:rni lnnrfi onrrc ttntndoulo rlrnunilo sturJ: r rvre rr niau lou rqilr:ilr : r,nq dr fi'.rr{zuurrriu il:;rfla'lils rfludu dald'rfionrrvun:n"fi'ou r"aoruaviCnrrd'orrilra un:6'rnrerruqtlurdnrdn drraiuluil:crme teYdn ur{rhu rd nfi fulfludrr 4 trr runtr iltfl u fr riyi r n r: 6 n ur rfi fl r ri:r I: o riolu fi ei r r 1 u a r u un,r 1:.sr,{ururnlr::rJnrnfir i'uvrqi'loiarS.ructfuf4 1 qn1nilo fr'r a n 6.: niut -uvr.fl.2s26 6$ufi go ir-uursu yr.fl.2527 dru.lufi,:du1 o s :'rrr 6 s{'rJra r1n: rs iornr: nr ro6fi nri.ri6 r1: nfior!'rJr utd'rurer: r ofi 6nrirJrsuo n ro r unc fi ur rs ruri lur"noil:vo{6'lo'rRfl n'rur'{rI'rurndurfi o lornnrrsl:ntril:ndou{rlrlrfia6n rcr fi.rou-6nr:ro,l1: nu-otut:.:rrsr ur n yrnrrst6'funndnrJ:c16rfi'srfi'uarnr: riurJrulurllllur r: c :J n r n d'r 6'uvlr.1i To 0 f, n u r fi I n r r ru f u r^Iu f I o,l nr:r{urJrsluo6nur{arq nudot*du il.rrlGnr:rfl uI: nrintuo 6 er u ny nrr fi oI: nrinluen ouorf.nai o' ilnnunntnfi u bwarut nmvtlntnffi o-unG or n rfi aufiu firJrs yrnlu'ld'funr:ii.:rirn{nfir *sr

Vol.3 No.2 Apr.- Jun. .l986 I Prapokklao Hosp Clin Med Educat Center 8lioa':un.rufiart:nfurfiaonr?ylnrurnrr Iosrrjitu faan; aa.sz (g:Jfi r)rfi aufluor:r.:rirartn uny e ?uR.J6ia a1s?o Jr6 n'lmu ?-a af6nr:m.il:nrior^rulu{:Jraorqrioadqn 4 t6auriou15gu$o;irJrSaur,s ntror?orlJRluagnryfilIn druru I :ra(iaan: o.es) fluunfiqolu{rJrad.lt:cuuuns?'lRiu ToaranryR.lrsl??or4 lu:rgdnufi.l otafiasndr z fldruru ss:ra (iaony 50.47) roila.,fiorrJnfioyrJfn:*runndranrynl{t fla oilR,firnl: unulufirJraara:su.ir.: z-q fl druru zz :ia (foan:sr:ro?iioa-r,fi'uuuauR r? err ? o yl1 \ni'o lrJ fr ri6 n rt rd o nlfl o uun r:ifi oarJI: nulo oy rir oi'rd 6o fiilr0 u: nfum n?rsr oyvl6'funr:o::o CBC un:nr:o:rofloarry fi'rdruqoor:vrra nrfi oil n 6 o: r fi r a o or: y a.lo: r o u ns nn.'t y rda, o, rsttr -t ,ry U ?u fi str ? 0i I \r R I u n u rl?.1 rufi o il n 6t o.lil a o o y a.l ri rsn r nilfi rJ a o lu: rs fi '16':-l n tr err ? oafi o ii'r,.i r rilu rJ o oo-n rs u oy a,:En.: otrurfi o ifi a olr: rfi aq ol run'rur{uf:r n'ir l,irururfl o rfi aotrrfi'larnr: un: ndoum.l.rr; uuilrfl10 6uflufi oduut.irrfluilaoa-nrauornr6o'hfsraiou!nfi 15fl e ri ru:-:lrfl uuulyrr.:lunr:fn ur0{anuflnulornnr: 6n :*rri:-hr 16 nfi fi ornr:nr on6iiori 06fi .rJ:nti'odrurufrrd* .,or r.,o xu'irfirjruri,uryrfleru5s'nr rloy [14fl H{.: so :rl- a 1.1Tou fi d'q}Trnrurfl qgrs: il6.tr fi o d n r* r fi .:ri, ot v o r,.l u., d {:J': l rfirr*u n r:fn urlul:.rna r ur o yr u.jrfir-hu fl rulH qj a r uirfunr:fn urq-. I ' ar1{T?,tqouu1?& | an ntxna6.:rrqlt6ouooroil yt.fl . zs26AAn.:rooutJRttniln.ff.2527 :,trufi.:fiusr.iu6orijudru'luflrl'ru24201612I44i,i,{*,iieiddi;6iFid'jf,=rjc6iu.f,.2526il.fl.2527fli t ua n tifrn naa fir nnhnt ailnrru" n a tiitJ tutdtr-an nt-n y tlu b w a t u t a w* il n it o"u n uizs.tt) neirr6onu'lurirJraarqrloani.r t, 2 uns s fl6ru'lu 2s, 53 ud; 80 ?1u horflufaanv 2g.8, s0.47,r'ruru{ihuzili z uan tq u6n nw fit anh duu n nvalE"",tloi r nnvumnf,autnfit an-nlu dnnrrvun:ndouon0lrvd?{n: ?non01:3'trinur{oAn5 ?ionnl:vlIU[10Shigella group BE. ColiSalmonellaVibrio parahemolyticusodn1r 6fl rio: cuu111{rdufi 'luloilaonauo-ntduLaryngotracheitisBronchiolitisMeasles pneumoniaPost measles pneumoniailtunal{onldu#huiomrn'hia.r{otnonn'lr91100nz-+ il sg il ror+ ildilutiruru iounv4s 42.8537 35.243 2.863 2.861 0.951 0.9s40 38.093 2.861 0.951 0.9513 12.3822 20.9s7 6.667 6.662 1.9

82 ?1: d r : {il d n 1 : in urt tnnu f, rc n J n drl n 1: {il u ru r nil : ;rJ n rn dr ilfi s ofufi z tu.u.-i.u. zszsrnc 76.1e nudrfru (grJfi z)ei.:rts o.::r g nv tduotunr: t.:fi znr: 6n ur6.: nr ?!Intur n 1: n u'jr{d':l fi nrr v nr: rillu u tfi suqf6nrrto.:nr: tfi oI: n uvr: ndouInturnr:ilnfidruru oB lltl (faunr oa.zo) nl?: fiunrr:Inturnr:to.r{:-hu nu'jr{':Jrufi fr n1?!Ylv{-nrrlnturnr:r:rl'ufi t druru sz:ro (faon: so.ae) lnturnr: fi10 nrn rfi nh orrvr: ndoutdln firfi ! {fuun:nrr:4ttlnlurnr::sdufi z {ruru s:ru (foun: {:-hufifl nrr;Insumr:ilnfi (nr:r'rfi e)c.zo)ornnr: 6n urfl fi rlrha rf, udirr I :rsririrl: nil o o{rJ r o fi nlrtu n rfi-n !t rlulr l rT o r u r n r^r u'i r fi I: n ur il rncfn'i r rurYu filfrq.:nvrrndourfi o{u looti{:-houeinv:ru fiI: nrYnndouior:nl16'rrnn'jr r rfin I:nuvr:ndoufinuiloufiqo 6oqoor:r:xdru?u 45:ru (fouw cz.es) To.lnnil'l H nnrtdnurxu'jtl:nriolurdn rfi o\d-1u{rhafr IfiorJaod'nrsudrutu ss:rt founr ss.se) uonoln 2 rv{ff loufrdo:rnr:rfiolrirrqrnqirlrYu l:nfir^ru'[6'tiilrtnrrq*t onrrdntsu fnirln-ufitdq.: rrnr6ul :J:::h tun naofl rroin u rur n uw riou{xo;1urn'rluqg(nrrrrfi r) rdadnur6.:nrrrudtr{uf,t:n'jrlnr:tfio uurr fi .:rrsirdouqnrnlfi .:r6auuR?1nu il: v Nr nriauncnrrs un: ndoufi'uorq vrl'lr 16narqrlou fi nrrv uYt: n - 48.57 rnivluld'filrreiotqdrqo a t6au dr{rJru:rofidauun lnuroxrr{'ilrotdnarqdrn'jr r fl ocrfionrrs oo nriot^rfo rufi'ufi arr 1r ndrfi o t'ioulurdn arqiir n'irun: ndauq ln'lr:ir.:orr1 6u 1 o d r'r fi rls si r 6'q (p 4 o.o s) s fl rn'l6'rioun: 76.1erdnfi rfl uI: nrioflIonra lfi oTr oum: ndauq lrurn"',r',ld, nnudufu hsnixoryriuntutmrnfau fi .ryo s oc os. z r'{i I ua o.:!irriu'ir I: nrio fi n?1 illult: .1ilrun nr r rrcifi d'ufi:rsfiunluurn tfi o ornl: nrtvnn'frouolu. {ilru ftnunrndouunsur.:tfi oor o rfi 061 etloi'to rf rraful: nuvr: n"fi'oudtilr (:ru) 6ruru iouovrrrurios 6o nnfiordarrvnn"fraulu::uumr.:t6uarnr:

Vol.3 No.2 Apr.- Jun. 1986 J Prapokklao Hosp Clln Med Educat Center 83n'jrrflurhraSoiln160o arutraqlornr:doy66uro.rn I utu 2- 3 fulo ut ri d'o.llri'n r::-n u r d'? u fl r il Ad ? uy firrfiu ruqi'[d'nr:fn rgrrJ: y 6'rrj.r no.:urinhnl?y1J1o;1runrrn6ornrvirfiu uonolnrruddrurfluilnrdooIorturrud rilrs rda\6'n ournoylf'nr:fnur6'ru to-trimo-ioun: aa crunrrvlr'rlnrulRr:o..rnnr:dnr*rhirrunrr rufi:r{ufi::Ir n unr ndouuciadr.:1:6'.:fruhoriod.:rfl uI:erdarrurr nilo.:fi'utd a1nxazole:rs.:rud6.: rriu.ir nr:1frloduI: nra-o uri 15 nnr: n1u1:nuvnndauro r.iruunrttdufi ru'[o nr:rfi oiloo muflu:n niuu6urrYu:ru.:rurolsilfind In{r{,un.,dn ra rlrtl\6'r-io u fi .:fou ay 33.33 ttorrirjru ss : rud fi r! o y fl ruy I I fi uu y ri rlrid o r-n6 ufl o .: ryul: o u-nhiu dornr:ilao6'nrnl flrfiur zs :rsfi'ldfunr:fnurdrg r6norq6lrei s r6oufiu1ilur 6'ru1 odvi . lororfrlt d'nn1;fi tr: rul.jrilaodnra ufrurfi o ornnli 6o 16o urofi 6r uvnnfouiu 6,:rJ:vnaudtiloiru'[d'tri oo ra d'r or nfi udur6 r:d'r u6'r nrr r druf.]dro r n r: 6 n u r 1: n ra-olu rd n .' o u t.r n fi',ti.rfu n lTfn u1ynl.:oR troynrto:ro,truruuiotfiootrrflurnruc{ luT:.:ilurur ou: r:Jn rn d'r i'uvruj fi*rdfufitunr: d'o fi unr::-n sr6irsur 6'ruo nfi n n1 nmnily1.fl.2s26 fi.:lufi so n-usrsu.?r,zs27 dn:rnrrrfiolu:is fi 1d'sr 6'ru e n6il {:ra,rrutd'rfi o nlf peni T: n1u16 nris unv 16 nn {.r'[riunn cir.:r1u {:.huiou o:cillin ufaampicillin n'lu:rsd16nrdnoradrn"jr aa. s z rfirfunr:fn urluri:,rqqnil1? rdn arqch n.jr r ilr il uny fl ornrr?utrr {orfi ar: nrrlri gentamicin :Iruniu ampicillinil n'hiq { rn; q ry rfr uii ern fr.,: or nfulilulrlnur ur nz lu rlsds,:.oril\lcuufi.ryru'jr:JnOrlo 6'rr fi f r1 fi rfi o n r r y u n: nda u't eiri a glul: n r{nornr.{onr:6nl*rnunilunr:narqehn.jr r flfifirlru16'fosn: zs.e orqcirn.ir z iflruld'founs s0.47un;orqdrn'jr s flrrulfifo!,ny 76.1e drnfulrazuonr:fnur nu'jrcrulraqjornr:66u T{oon.r um:ndouro.:lrnrinnu'[6'fo0ny 6s.71 61f, qcrrr:q - abtlu s-+ iu fi{rJru r ltnrlrrirsflfin:llonvru pneumotocele'loi'fior: anlfrnr:fnurd'ru cloxacillin aqjir.trilududu rI:ltrururnrflunnlulu zs iu rnrfi r :rsrfiorirvirrufrsrdn::ililrvnlfllu rfi o r1'rurJ a o 6,: fl o u a uo I ei o n r:fn ur 6'.1 u penicillin ltawuryat uuunnfrft,fin M1?na {dtuwnnorir16bwnnantyilnnit o-un$ fiaryrytn}fiauanur1un rr dn rc uno rn6t*n or o,i u'[qi'fa s n: o. oo 6.:rtu ffiof utaunnfithva'tu ruwn{n.tu,ufi iianzoyfilu'ir eioudr.:rurn fr rdor o rilurntr'[6'0:r oilfiilr0nn: rs unnilnQnunn qnilniry uavawiunu, fidn Id o dtul: or u r u r n 16bi'n r:fn u'r 6'rn 0., 4..,r*i uini r ru rizulunnimtwfrriayafi'uuau66 n Err fi u ldr.rodrln:ru nrfltu s-a iua ruo r nr:fn: r ru f,u fi hiq.rr r uloifo u ni 6. 66rfinturdnors:sn'jr.: a rdaufir sfl uw4n:rurflufebrile convulsionrorn d'.:fnfdn oTrd lilnunr:fn{icfioornsruaro''nrauranar:drrOrfirl:Jrlrdadio r :rufiorflufaua! o.es rflurdn 1. mi. Iriiilnsduuf, our rilfornr, Cuii rllcruu{, rnntuarq a r6au finrrtyrnTnsurnrr:yolu r rfiol:nruri!qr::ot._ 1:nrinlul:{rrurlj,|atdn. rr:dr:drnnr4lrtunndrrrilil: crilahu 2626i 2rt 6r- 62.un:ndou ilaor':tunrnr:Hrulofiilruar ornr:f,n 2: qqi r#adnilair, frlrq rrsinurroa. Irnrfnlul:uorurnii:rr.rnfllrdxrn!qrlrrunndurhil:srnrtlnu eozr; r:98,irnuro6 nlfqnfdnar, nrqruf,nd Hnr,;:oi, nqror qqlil1.

84 ?ltdrtiudnlrdlnultnnsmcr{nir?n Iruururanrcilnlndrilri s ciluli e r!.u.-i.u. zszs4.5.6.Irnrindbuorurorlr,rlr1tlrtrttlrillr I {o1anrfl surninur.21rff'r: fi !m!Drr: ttrrndrtriltJ:ulr|lno zrzz; 2s:lE?-13.imrrad ndqt idnar, nrgrufnd mrpol, nqror u1qtil1.knrindb usrula!ilrt1'tun: ! lrilur z. nrrctlnrndoulilIr arla. rrr I rr ( !1riuQul! ttnndrnilrh crniln t 2627 i 2s.144-9.i l{rJr sln ruriNi. lrarfail: {rtulrrlod {nt rf 1nt. ?'rr{l 1rnrlnuurrnd 9626; ?:906-0l.rlno uo;r;r{, ltno i:;irr, quril linu:, unr li:nr-- : ' -rrrrrcl:nltnrndsulul:cilururonl:or, n1lt uEqqill. ttn?lfrrrrtu:rq:. i'rttt1:{f rrlnuq!r:rtnndurilrJ:ctnilntl zszz;23:13O-0.7. KanlanasthltlP, Supachaturas P, Mckananda P, et al.Growth of infants end preschool children. I Mcd AssocThal 1973;56:t8.8. Chavalittamrong B, Vathakanon R Helght and wclghtof Bangkok chitdrcn. I Mcd Assoc Thai I 978;61 (suppl.2l:1-29.9. or:or rrlroil, qnirlr:toryra, dulJtll iiuriu, irun:rrqa. 1:nrlono'nrcuinulul:aria. tt:rltt{tltlRltqur:ttnn6rrrlril:vrnalnu z5z1i zot6r-61.10. Barkln RM. Mcaslcs mortality. Am J Dis Chlld 1975;I 29:307-9.t 1. rlrtnd tir{rnu, uqrn i:ld, rrri6 6t:srJ:rn1df, uquadnrirrriir, iuq6 lrorq, tritr lriuruur{. nr:dnr-odurlorriul:nr-nlurdnlnu. : rlriu6 n'tct 1i zrl25; 5i245- b2.

URFAMrcIN'TO GONORRHEA !fi,lauaflNrilourr|?$Jtf|'fr a:narihrnrtlrfrn b?rrffi Ne6 - rnlrurm-'rdrffitdraar*r rnrilu za rlailuuraadnr5firrrndnvr6u ea-ee xrcfin Fost-gonococcal urcilfiritls tfrta t-z zr dloarrrnsrrn*Fnrrf,surtrasrnn o.s zI rjaanrYa lririrlrdrnn aplastic anemia

Vol.3 No.2 Apr.- lun. 1986 I Prapokkfao Hosp Clln Med Educat Cxnter 85il ut r'lu'lfiJ o sr fi o du on rJ o srttuttutitJn 6 i'tuv.4vs9l'l:ltfl ylutulnfl o yt.u..rjdlisrd frurqd u.u.':urn"$hoAbstrrct Extrapulmonary Paragonimiasis in Chantaburi. Report of Six Cases.Damrong Bhandrumkosol M. O. *, Plucmch it Chlnawongse M.D.*+Departmcnt of Pathology, Prapokklao Hospital, Chantaburi, Thailand.J Propokhlao Hosp Clln Med Educot Center 1986; 3:85-91.Thc first case of paragonimiasis in Thailend was rcportcd in 1928.1 Extensive epldemiologlcel survcysrcvcaled that the endemic arcas arc in thc Saraburi and Nekon Neyok Provinccs. Latcr on spondic carcc hed bccnrcportcd from othcr provinccs, e.g. Chiangmai, Chiangrai,-,"," and Ubonrejrthenec.toThis is the first rcport of peragonimirsls in Chanteburl Provincc. Slx paticntr, eged 12 to 5E ycr6,wcrc dirgnoscd as cxtrepulmonary paragonimlrsis by tisruc cxaminations during 19El to 19E5. All pttlcntscllnlcallyprcscntcd with soft cystic subcutancous milssgs, loctting in thc heed end uppcr ncck wlthout cllnlcal cvldcnccof lung involvemcnt lt is intrrcstint to not€ that .lmort rll patirnts came from thc samc dletrict which conalncmountains and srnall rivcrs, These finding suggestcd that thir rcglon may posslbly bc a ncw endcmlc erea of perego.nimiasis in Chantaburi. Fufther epldcmiological irucatigtion3 arc nccdcd to confirm thcsc findlngs.unulT: nfl sr Glu'[ frj ao rfl uI: n d rfi n o r n r rsr Glul fxrrilnfifs d.rfirfis.r zrfra 6a xi:rlnfifa r:rreraiurulu(Paragonimus westermani) uovnr:r-Infi fn ra rnol:rni fn (Paragonimus heterotrimus)fi inrr,.tru'irrhlfirfi ni:nr rar61u1firJoo1uRu Insroxr;lurj:vrnslns'-.' thanni)nn b wnul an vtJnn dt o\nGT: ofl r,r G1ulf:J o o nu.ir fi n1:nrs r1u*?InnrInsronislurrnvriilrardsny{uoan d.rl,fi'uri 4jrlu6u rnrufi 16'Hlu flfirjflud urot60 lna rlsouriluncAurdu rfludu rJ:crmaluiltrtdult4nubndld'uri rfi niin r?rugraoor luvrtrJau6nr uocludrtalunirjarrl?nr rfludurirrafulurj:rryrfllyrg roiru filfif ru linru.nu{rJ r n I : r 06.: fi 4 fi rir rur o { fi ii l n a ra ri I f,n {lu lorrrr:q:ni lufl r,r.n.zctrr rflu:rsu:n nrsilfilornfiutrirJ:rn g'jrfi{lolruI:nddn,uoouor;ri.rtuil r r.a.

86'11:d1:fi udnl:inuruytnufl ren{ndrln 1: lnururon:vrjnrndriJfi g qu'ufi z tr.tt.-i.u. zszszqsa n:cvlfnin m:3uqor $fl;nor:5 6l\rYlrlun: r :ruir4fidlura{fi6runuan.: drtnor"uol fflrllo:rusru{rl, u6n 1 :1u d.rfr4fidrturrduoqifidrrno i'uvruj d r fi nrn6o eio tiud r t no u:tr rl i'.:uio i'unuinuad$R dsyr{ner:qi ornnrtdr:toqiorrnuir c{ rrafu'lrirnrdtro$os{ilrutoi': ru:rtlliluqrr:r's;iirrnouuarury {'.:uloa::uj riluurad.rfinu{r"lra Yl 1rnRo d ryfudr rno6ulut'.:raio s: v qi fi r^ru'ir fi {r1':uI: nyr u r Glulftl o o rur n 6 a d r r n o uri {no u' {":ra io fi n rolnl: rravnl: 9ll 10?lull'l.rnfrr?n'i r fi {rJ r u x u r G h.r hTrJ a o ru r n 6 n u vi .: u fi r 6 a o-.: r.r io ar nr: fi rir{rhu ilrl:.tt {sr ur nrq'l r il n tn fir {uvrqiunrulsR8-rr siaNrinru.rrunr:tt!nsr61u1firJaofi 6o ornr:so'rri'oufi l3 rr ru6:ur un; droasruuui'{ufo rdu.l:rsrz 6'.:rlo tig 1[q ri*- r s rrnr^rulupiilru{rJrl a:rofiornr:d'nunl 6a :Jro urruun.: raiofihl!1?nlrovrut'{fi 6'ualoqu o:rgrrfitudr1 {:Jra6n s:rutilfiornr:6u1 ry':Jratrufi s r{r:rarudlfl u:rurru{rha o :rulo{1:.:ytulurn funr:fn r*rluI:.:r tsr ur ar {:;il n tn fir {'uvrqi rrT : r;vus :J n rn fir t'uvr qi 6.:'[6fu nr:fn :*t1o0 nr:nit Ci'o rnv :J: v a uqfh ua qfl ud'n fo{ fiuqn ui tr rutt ttttn6 n:r oleifunrrifi oii'anr.rt {urf ivtst'ir tijuvunfi tu'[fi:Joofi vr u fioudnodrudrulol rh ri qaqjuonrJao (extrapulmonary paragonimiasis) fi :vuvtrnrdtflufi'au filrrei s rdououfi.lfl 1:;u:I:.:t^rsrur nt n cil n rn fir i'uvr u! : v n'ir.rfl u.et. 2s24- naruan\ri\d'urifo)2528d'n u ruv fi oud o: r on llou un n6 tilun-oud s fi(cystic masses) s:ru dn r :rufi'auoqi6oRrlqnil1flnau 6 rnv il tl f, n t ii'n t s ut o { nr 3 q R Nl ff oou 6i r il6'r urJ:vi6n"'l'hj:ru.rrupt{lu{rJrrdrurufrod* u r",o tflutflstr$ 3 rluttograflr s:ru arq::u'i'r.r 1z-58 il {rJru s'lrufinfidrrur6no{fi drunoir.: 1 rordrrnoru:srru i'.:vrioi'unqi ual9 ta 6nl: nr ?oil'Nrilo{lJ0unnrt{ilru1n: rl fr tfi o tdootrltfiodlo6luSl o (eosinophils)qtfilueitouaY 4-18 fr{r.l'rurfiuour6or(:iufi r ) dtuiiuolt ot1 a tfl ilu: uR: a o o'l'x s usitill^{ u'lrirurilutrTlu:Jaor*l,l.d, u a n vh u zfr u ae a n n n m ndi nlu g'il n w a filu 1 fiJ a n i a ri u o n il a n*ffflscx occrtredon Rcsldcnce12 Fcmalc Employee Takientong,(not spccificdi Makam districtPrcsantlng SynrptomrPainful, swollenmassLocation of lrrionsLeft zygomaCllnlcd Di.lnoslrI nfccbd subcutancou3 cy3gl€ft zytomq with otEitisof lcft zygomaMaleGardcncrWantxam, Makam Nonjainful, swollendigtrictmassLeft postauricularrcgion (mastoid arca)3 months.Chronic mastolditis, leftFernaleFarmcrPluent, MakamdistrictPainful, swollen mrs(with history ofdischarge)Right post aurielilrcglon (uppcr neck)yarr(not speclfled)Infccted cysvabscrstEmployeChamu, Makam Nongainful, swollendlgtrictmassLeft zygoma6 months.CystGardcncrPatavcG, MakamdilrictNontalnful massLeft side of neckyarSebac€oui cyst18 Female Employ4Salang MuurgdistrictPain left ear,followed bynon+ainful massLGft temporal(prcauricular)8 months.Cystic mds

Vol. 3 No. 2 Apr.-fun. 1986J Prapokklao Hosp Clin Med Educat Center 87nnr{i 2 nli ni ? oilun1tn"artlfiffin n fid nniltfn uo"ir ri tilrtr lu{tlwxu $Tulfil a nfi alu a ntl anX-R.ytcrr]scsi--66]iWBC- 10900 Hoo&wormovaNcgativc Negatlvc Curettag€ & Caldwcll-Luc_ N6s%_ E5%Ruptured cyst 1.5x 1.8x0.8 cm.wBc - 7500_ N3996_ E8%w8c - 7900_ N5396_ E7%Nogativ!(culturc)- Chronicmastoid itis,leftNegativeSimpl€ mstoidectomySurglcal RemdalSmall fraghcnts of cyst wall and boneFragmcnts of cysr wall (l-4 cm.) x (0.2{.4 cm.)wBc - 7500_ N 5096_ E4%NegativeNogativcNcgativePartial RemovalRuprurcd cyst, 5 x 3 x (0.3{.8 cm.)wBc - 5400_ N45%_ E18%ExcisionMas, 3 crn. diameter wift slit like spaswBc - s900_ N58%- E6yo- NegativeExcisionRupturcd cyst, 3.5 x 3 x (0.5-0.7 cm.)Rrrnr?onr{r"lilinurrfia.:ern{rJrsfio :rshjfi ornr:ra u r uuyr1.r16uvrrs1e rns 6.rhildfunr: cnr I:JooIoaf.:fi 4n:rln nnr: cn? irjaoloaf.:f, lurirj rrl s r ls n1u fl S.rdn: 1 uHfl fl 'l:rn?1yl1.ry{s1Giytg1ud.: hir^rufi .:fi nrJn6ld'a1Jo'rn'r:unyn'rrnrtoyruyrlnnAfiolusrr:r.r,fiznlrnr20nl{turi'inurn. nrrfi?ogfluoltJdl ,it rda s:rsfi'nln:rorom s il'j1.r?i'l nr: ii1 fi'n unyhild'fi .rfi ad nr!,tull$.t:ra+6ril (eontent),iurdo 3 r1srflunrl.:1a.r6sv1fi unnudr lorfudrqudnnrild 1.s, 3.s u,nv ssr. Hrl$darlilurfi.ousi5-B lJlJ. fidrirnrn fi.16'tulura.lnrfdsrlut:yfidtrirornrjuryrfio.r e:?ohiyrtlCfrilsrGroaX 2-frur$adn 2 i1u (rlufi 2 uny s) rflurnur.rrlviariiurfin1 ilnrsiu ilurfi,rud 2-s rJrJ. firsun:yon:Julu:rsfi z6urdo lr n r[:J x rrr 1 s fi' s rfl ur{ouri our'r { ud.rtrtli r ?tin u $7u7 ti tJ a n ih fl u uu rhu1u u a w u-r i a frn.H&E 33x1t. H&.8 t32x

88 2'l : d 1 : fl u d n r : d n ur r ru n u ara n { n drl n I: ln u ru r nn : cd n r n dr iJfi s ofufi z tr.u.-i.u. zsuollu1o 36il. t{finnurn'ir t tu. nrutufiio.:r6n1(slitlikespace)'[rjuiurflu}T't{ratqr?otrivrI6:nurG1. nr:sr:roei'rundo.rlnn::nrl ludnfrfiflb,r:.:lra qi u o: r^rrl.r eia urir.tlr rfr u n u'i r fi fi r zu rI': 6'r uluqofi eosinophilic granular debris orlori fildr r u r i,i r ur u ru r n rtr a ql ru o r rri u r fl ur o u a qi o"'r ulul o tHrl.rdsvl (p.1fi r ) fioru:outrinsrf 6o urun1n:r',lrdo. f,au(macrophages) s{urqloilarsdilrurn (pJfi z) ldnarSfilJ:rri fidrrflo (operculum) d:Jorud'rurafi.l,d n r a, & ,iruJdon'luaurqtflu 2 fiu (3:Jfi 2 uav 3) a':ururntflu grld r lriraii?z \filan ol*annn ith loperortu*1 iilatu'[tfi or u ttfir (non-viable) ru0.:tri rfi uln:.:nit.: nt ulu iltunfu Ttifiulanat\ntu1u, H&.8 tszxrurom i\dytur G1uc1o68urfi oTo\d6.r 03 x 38'Iru n: o u\rjr^rur i ur.rtuaqjnr uluurun1n: r4r d olur os-n rid lirrnrufirtndun (multinucleated giant cells) (1rJfi +)t*uoo",od$ornrrfi o16oorrt6r:Irl"tru 6 (lymphocytes)royv{n1fl il1tto6 (plasma cells) un:naqj H*+iavllrl$ r ?rlrari-1a7fiJann otalunulu n a1ahfln atafi tndua'H&E t32xn. It&E 33 x1ild o lrrn#n 7 inna-nnwfinduuna-un1uluuavfi granularlt. H&.E I82x debrb, H&.E 18.2x

Vof.3 No.2 Apr.- Jun.1986 I Prapokklao Hosp Clin Med Educat Center 89trr!fi e ?vrari-? uI fil a n u a ufi ulm nfi n nlu u au tl fi rti n n na"nrtwrtntdaundu, H&E rs2 x1ildorf n:iamna-nmwintiuunn-uclalinu$TuhftJant. II&E 3Jxx. H&.8 rl2xr^ruflrfiordaotnflrlyr:flndrurururn (plfi s $n! 6)rfi o r6aq$rrrfi o6lofi IuSl nilul o,rn {u.r rJ fi fiiurtfiotrnTuuloill (granulomatous reaction) r,rururn tfl uurioru1 rnyfirsn6uorufirrfl6uaturolra{ (multinucleatedgiant cells) frau:autrjnurfaqj (1ilf{ zrns 4) rfiorfioourrfioilnraMrqndunvdlo6lu$lnr^ruldriosunvoqi:auuon lriflsriuriluflitrinrs(viable) unr ru o I rfi uln: r nfi.: nrululoi' (pI{4 a)ludcv1v1n:ruo:rokixufl ruro.:r rsriCl'rud yruttoi eosinophilic granular debris oruoqj:ou1 fi.1to +i c vl6'ruluun;aqi nralubu.:rdn1 tu:rsfi stu{rJru'rrafi z vru'lrifl urG ad nrslura uRryonrura qou 6fi r.ir fio oa n ilr6'ruiorroir^rrnfi lulfiilooar rur: nnutd-lualar:6u1 uonfl66f,rz ofur;eir.:1 drnsinrunu.jrcnrey{ul{urG.grfi z ?zrari lul fil a n ulu $ a 6u-n fi n o tu fi t n 6 alutfirjao 6afi nraruo,: firrart: fiu rirru rurlrdrlfr tlfuahnwinduun niu agft au 1, H& E 132 xlorruudi'l r6or4iowio.: Cl'ueiou nxsuonnl Bnnlnfirnr eiarunau6n riior{lri'rlo r{r1o rdruu nsfinld'ruuo n fin rfl uri o r{1fi or (f ibrous tissues) 6 16orY:t Hrhnryrr{rcornr: ciouiluia.:di.ttuonuri.*.llf,. Xqndrrurfioluur.nro :rufi 3 r[n; s oqifiorTudolrhnra 1o siouuilrnnlo trn:cnn ldfi.r f.rhiun:viof.rhicirufudefrfifiHrl'luuruay}^r:.rr6n ilu'irfiil fr fi3ur nr: o-n ra urfio rdu uvrfiu (acute infl ammation)ei o\dr^u r G u o y u3 rr om a utura.:H rfsd n vl ur niloqn nrrtytryilssrr; oialnnnrurn untgndwlnurilu'lfil aofi o{ldArnrtrfiu fi:rs.rru.jrfl 'rulr nnl?ovruCl'?fl srGlrirJr:rr nlf, ,.ro{ood.u o

90 ?r:drtqudnr:dnururnufi ran{n6rin l: luorurnt:cilnrn.ir ilfi s qfufi z t!.u.-i.u. eszsfiauda{fi q:1efr .rrllnr?, r8 dtafufioudsfi fi t o mslu:ra lruf,r[:rI muo:rohivruitT nsri fi rlsfiiinaqirflrl riio'ird, uufilr{ioserrds{ s't1t $nfiT:t 'ir*irfindrrtdqunrutrJ ntuu d.rfi sirj r utrifu nr:fn u rcirgur bithionolMiyazaki un: Vajrathirat fildrng:1oil1ltfl '11r{rhi\isun: acnrofi .rfi oqinrululil't $is fiki fl n:rnnueTrwsritfinilr:rInBrIs ta lnolrnl fs nrsifi o dst: nil u r ilutrirj o n 6 { o t q"s n r: n: t oyr utrivw ri 1ufiou1dfi rrarlslur6ntrstvrsluil vt.f, . 2so?diSfinuorcus;rnnorqilli nsooourJ$ffisrnradntsu : rs srudrflu:ln {lunuo1?crrrunsritutfiilorsfincirs "t {i u,ru\6-1ufiou6s{fiorqunneirlfi'u\rjd.ro{luofuTcdu$onilonn* su: nlu{lufo{uvrqld'{f4rn$inr::rsuulftilRRr:rn'rnn ou{i61tu1'uo vJrlrulru'ir{rhsfi I o :'tud r ufulurj: : tvralytu lu:rs lru6 o.rr^tur Gtu\firJoouorHon'nfnu#s{r1'r*.ufrofit 1ooi1u Benjapong $a! fl or:' toin: r ar t ui s vlla .lt ru r fi lu\fiil oofitdfilarlluirlnrg$uuncilrironlu{rJT u rrra $otorofidn r :rrldiluluwilol fi6 fnrlfionrn$tfitt lsin::rruoqjlu o drundm{fiodofiu i4lrJrlrvrarflu4 nr uw fi uririr{i +iludturiua r uririr {urqf ln ariru(1.1d s) r4rlfirirdio'jrultrnrCi'lndr?o1ri3dJtr$ildit: : uroln riaa lh nrnrsriluld'rjoo d rnler iodhinururiurtn ril:rcv{utf,ti{ o :r01u:;s3t?81 4 ifiehuu; ru nufi lnr: enrot^rufi oufl fin r* ilclrrun dru$1n 2 x 3 un;fi .:trirnuyru{rJruxurilutft Jan{'iiornr:vtruJon" u. fi16fi.*tlrui n nrurlran{r unrtu{rlrrnlrrn''d rffrr odril:fi6nr:f,nurnrosurnlnuradrloct6uolu{rJru fi .:n ritl : r lfi rnr: f, nnrunl d r:tlt'ttlrm -rto{ arrlulu{lrri a{rlr6nluui tr $dru ndl'm dlltrirfiu 6ro:nru:oiuf,uld'irriluuud.rlrcnuumlnrioi.ruiohirflul:arrurGlutrirjao fiaufi'rn. tonaDdr$lt1. rqirr r{rfi{rer. lrnnorldu rloe rrolrrqlrrli. tiltttl 3t?l;U36?..FMlyazakl l, Hartnasuta T. Thc flrt crsc of humen prn'6ogonlmlasls causcd by paragonlmus Chctt ct Hcla. AnnTrop Med Perasltol 1964; 60:50914.3. Mlyazaki l, Vrlrasthlra 5. Occurrcnsc of tho lunSflubcparagonlmus hotcrotrcmus Chcn ot Hrle In Thellend. IParasltof 1964; 5322O7.12.5.norllutlrJor 3 tro$udiho r t'ro. ttttftt sooo; 4or2rt-!!.e riqdlornuursg- - r,uil5. qfr: 'frrtldot,floor n;loqr, rmri lrir{1. hrnorl- 'rirmo" _riualubiJoalurJr:rndno. utn zsou 4r !6?-.{rb._:>- | --7. Bcnlapong W, Nacypatlmanond S, Bcnfapong K, Thum+%zruksa C, Ruttarasarn S, laroonvssana N. Sudlcs on prragonlmlarls:Tr.atmcnt wlth mcband3olc, cmctlnctrilfl e wufi uan $u auav grtkv m ai{tl zdnnGlu\fil an a t {u wlth mcbondazolc and prazlguantcl. Southc.st Aelan ,atiluo"'tuthfun6Trop Mcd Pubf lc Hoalth 19&4;1523514.U'Faust EC, Ruscll PF, f ury RC. Cr.lf and Frult'r cllnlcalparasltolo0. Eth cd. Phlladclphlt Lca & FoblScr,1970:47&83.rr:nlnh wlorqrn rtlno taloerrl, qunr rlotlfunrl.

Vo].3 No.2 Apr.- fun.1986 J Prapokklao Hosp Clin Med Educat Center 918. n: {u ii rfurlui. un ri.rdnulrl riro ll: nnuriluhiiloaluil :;-rilnho : :ru{1u{i120 1rlu. nildfl 2b00; 40:201-11.9. ro!1 fl ifi u ;. I: nlruriluhilurJoqlul: lfl r,ru1 nun r u tu n.?lttlltntunltalflnE 2526: 8: 573-8.10. Vajrasthlra S, Paragonlmiasis In Thailand. In: Proceedingsof 4th Southeast Aslan Semlnar on Parasit andTrop. Med, Schistosomiasis and other snail transmittedhelminthlasis. Manila: SEAMEO-TROPMED, | 969:299.IL rnlr aicui. 1:nnuriluhiluiloo16nl: lrurulouRrulun.'11:d't:atulnufltlr:unYt6uillrl:vrilfilnu2526; 2z: r6s-6.12. i:dn6 drrlolio{ uosRor!. 1:nruriluhirJon : :1ur.ruriorduto.rnr:nurrn ri{: curnlfl rilunrnrriotorrjr uilfi 1ilu.n'lrrtrrulunrrtJr:lrllu{nxilrnr:druninrn nilrj zo toruilnddxlRxuil{rlt:rmRhu RoprrnnurtrenS lrrimurriucrrnruRlun{, zszo.13. rJ:vr.rd riluuug. Pulmonary paragonimiasis (the lungfluke). Hosp Med 2524t 10':229-36.14. r.l:;rtt6 rfiuuuq, rlflul::or rrriunld, rlno rr:rJ:vo-u.l:nnurilubiluilon, : ruuuriihur6n r : ruruhilrurilutolrn or rrnriordorfuJon. rio lln rirrrfl r: 2525; zr:rEz - aa.15. fr6 :-or56onyrril6. l:nnurilubirJoo , r"rulruriil2u l r.lu.riuilt4rjruar: 2b2s; t9:14?-bt.16. fi xxlu t: 0lrtoryr:. : ruludihul:nnuriluhlrjon: ruu: nlu1: orururnil:ldrrillnlnc: :rtfu irj: ca 16. a r : r'rd nirud r:2625:3:21-8.17. Chung CH. Human paragonimiasis (pulmonary distonla.sis, endemlc hemoptysis. In: Marcial-Roias RA. pathologyof protozoal and helminthlc diseascs with ctinlcalcorrelatlon. Balrimore: Wllliams & Witkins, 1971:SO4-32.18. Inaba N, et al. On a case of cutaneous paragonimlasisand discussion of this disease In Japan. Hifuka noRinsho 1960; 2:447.

92 ?'l:.r'l:fl udnl:dnurunuuaranSndrln l:.:ilururail:cilnrndriJfi s sfufi e tr.u.-i.u. zozgIe., A s | < e-r.- { -C{-.n 1 : on rfl ul, o { nu o u 1 .l l0 u u il a u 0'l Rj'tunar,ftha I i'ttJnur il:varuttrrit u.u."riourrrir nunuldn-nd o.u.':1ihnL6ho.yI uo I t u fi Ylr uAbstraet Acute Bacterial Glossitis. A Case ReportThanong Prasarnphenich M. D. *, Raunkaew Kanotpontsakd i M.D.{'*Department of Pediatrics, Prapokklao Hospital, chantaburl, Thailand.J Prapokkloo Hosp Clin ll|ed Educot Center 1986i 3:92-94.Acute bacterial glossitis is a rare discasc which has drc abrupt onsct of tymptoms and rapld cnlrryc'ment of the tongu€. Pseudomonas sp., hemolytic streptococci and Hemophilug Influonze typc b havc bcen rcgortcdas causative agonts. Wc report the other case of glossitis causing by c{trcptococci.unrilnr:dnrsuta rduodr ordgur rfiuornrdonunfi ris(acute bacterial glossitis) riJul: afi ri obirfi o cellulitisuioiluuuoii6u srrnnrfi nornnr:fiot{o ps--dornonas sp., hemolytic )t rpto"o"a'ula Hemophilusinfluenzaz,sfinl*us:ra.:T:ntfioarnr::ru.:rudrflu{r-hu!6n1rt, fiornr:uuunsdnrsuroi6uodrquu:.t ct:1afiufr1tl,rqtfinrrnnrr6o ri o c -streptococci d rfi rtri rnu Srru'rrulurtr ; -rilalyrs r,onornfiu,iilof4rfluarrnqdrunndr,rrrtog:rfl.truilrtiourru{ludiJ2url'ufift'ulo tqgfrnr:u'ruunr16udduedrmrnrirr-l rdntrulnarq afl ni{rruro{fidtnorcurnl rudrfiro rnr:ifi o duni onr:fn t*ror trhbirfi ne | 3 u r qsn'l?; rry|:Rsou [Tu rtronT3 019 nJlfl n:3 tlff lnooRa tili'.:rlo i'uvrr.6 fulifn r*rlub,rv{ulu1 n?uiilnrnf,r6'unqt rfi oluf4 r s r^r qainlsil r{.fl . 2s2a cirsornrrceai.rfiod'uer:rnloi'fl'tnfu na nuu?lJttn3rturlrvr?ifoqrlu n furiaulrl:{ns1u1ndd?d. il u q u n n nn u Tt ua t n ara v il n ffi o'fu ntf61fi1{ ta rdrno uo:irmls tdfusrernrorf,

Vol.3 No.2 Apr,- Jun, 1986I Prapokklao Hosp Clin Med Educat Center 93o1r1fiu ilrfuil:i?t'narrqiolntrtri66u Eio urdn z iufl.:4r4-.e?-., u E 4 ! u,u. 2il tlqn rQUflll RnUO1141:UOyU"ln1U1rJ1d nUU?ildA$ilnrouil1RauInt:9n10:1itfl1uaonornilrn 6uurr:6'urlrn r3rrrudurr:rfluroyrwarurarir6'ruuufrTourrqd'o r01{$nrnqiloi?u rr.iu exudatedurrufio.:unyflnduuafiu (:rJfi r) sn?o\rjnuio.noulrqrr^rouirrilfru ndurlrnru\ritd {oI 'Lrifo - t-sunreioruilrru6otfieralillqr:vll6u1 arilu6taIRilflUR6I- I l< 6ru onl: 9F lOYl'tlt?to{ilauflnt:dhlnnflu z nfru/on. rfiordaour 13,200 rsn6/nu.r:t. firlvr:fln zol 6ruh^l"t'u6 zsZ 61o6uluf,larl:ilir.:ra.:rfiqrdaorio.:fifinu.xsmildhypochromia frorudun:ruornuniu exudate fi6u16'ruu ofi ri u yr'r .1 n n ru 6 o fi un: r: rr n o qj: r ru rYu rfl uc r s uo ytfi o 16oolrrtf,ofirlvr:fiI n{ru?l{rl'tRnr:ifioq"url u:Jr n'lrisfi vr uoy fi rir orsnh oo o n ornil1 n n oaq rr nr ornnnorrrir.:R.lu rnvR..tl o.r?oyt1.tlio {ilAffAntrrJ:vr?odsr {rJruu{.:ru:.rdursroao'[rirnu16r bi'n r:i ii o ii'rri r rfl u n r: dn r s ur a r 6ua d 1 { r d s u il frurJr gfiu r,r,:.til6 o fl 1: eni: r 6r d'r un;\rifi rj'r ri6 fi uro orn16ouunfi6sRl:t"nuttd1finr:fnureYru penicillin :ruro r unugfietnu'jriflurdnxrl?iljr{Hari rirrlrln6'1 1 e.5 RR. /nn./iu dorfrrnnoordaoeir nraufi{nr:fnur +aailrnfii1.ln1il 38.s's. o''q:rnr:r6'utorfirlo rro frh:.:{'ilruf,rfi arnr: rufi ou16ru ernor: r*.,rrioornn*.:/urfi oqrrnr'rurato za n*,:/urfi n?rruoiurdaoexudatefi 6urn u,6u o -streptococci d r utulr nd.:tto/soilil.il:om drilrnflnoorrnrunyfifirorstnndoeiosrpenicillin uurrdu Neiseriosp. fi'u Staphyl.ococansaura$irururfintios nrnnsr6oilflrdoolfr'ar anu6 luJ duuarrJ frirut rfl u ampicillin auro r ooun./nn./1u dtrun'u gentamicin ltrrlet s un./nn./iu ornrma.:{rJrs66u \fiGilnon.:nrs1u zc drlurolRlr!? illJo laurioun.t uoruriu exudate uqnnanaonnrsufi.0nr:fnr*r a iu (1Jfi z) fiilrunrsrflurln66.:td'{ilru n d'ufrunura d'lornleifunr:fn uro$lul:.rrrururorflurrnr o luior:oiRr:dn rfl u1Jo.:6uodr.:rdsun fiuorn r{o rrunfl rtsrfl uI: n fi r'r u'[d'rio u in r s.:r ud r r ilr: n fiuyr ukih.i rfi u1 o :1u fl 1 n4 Etcrulra drfi o o'ntda pseudornonos sp.,hemolytic sneptococcir ua: Hemophilus influ-:rJS r

94 r 1 t d 1: qu dnr : i n ur unr uar c n J ndrln l: {il u ru r ar't : cil n r n dr ilfi s qtiufi z r!.u.-i.u. zrsssr rnqfiuda eia penicillin oin firarir{rhu:1ud$nr? ru.nu6u 1 ua o llrirriu'j r uu nfi rl u fi rfl un r rn qto.:Ir nd$il nrotfi cr 6 *fl unr:sr nd o: tdanlfurrJ fi 6rurlfiololunr: rfu dufnsr nr:florf, un:uo1Ruhiu exudateororfluut.v'"'0fi61t*nr:rirsfiofiu1o ucirfioenKt,tVWb2,' ei:-hs fn fi :J: vl6nioo:r or^ruuro - ol ilil ooo fis uwfl a rn-uduo: rudar o rfi niuornl: nUurunfifiurflusruaqrlrun:ndau {:ru.rru6orarsuahilftrrilfr6, wlfioarnr:ro.:I:ndrlnorlt otoun::rotir filnqo broad spectrum rfi on:ounqluunfi tluunrurfio6uu'rruuncr6uiuadrrurn fir1frnr:fnurdrfiarofioun'iro: n:ru^ uo'.tr,n"'t rdufl r:nrun10lo.:riol:nr.irnrs us 16oorncttq*ru6u 1d:illaor.rnrsld niu rfior{rurlo.:unvrwqn rfludu'u'r $r'rs.r'rufi u fi nr: qnfi uvrr *6uuru1osruuuir ueTru :"'rl.lrudt6i,su.4rtrorao r rrs fi ornr: o n ra ur{io rorniuin'ndn rs r un: uururn,{i r6o ilri'nr:fn ur lo.rfi uodr.:rdu ur,{ fru c r tn q tfi n or n nr: fi o rio a -strepdrgnrrritiRor'2tococci 1fr'nr:fnur1fiHn66'ru ampicillin rni genronar:dudl:ru{1udlfirfl uafirjrufi finmdRrfr ulo.rfiuarirr tamicinUrdsul {fruorn ria uunfi 6a{i rfi ar tuqorn tdo c -streptococri{:Jru fi ornrrnfrrslfril{of r urriouuo: cnr ohiilur o .l:asu"'o u^ ufi 6t d{al o rfl ufr 1 tnnd'rnr:fnur{rhs:1udG xd'ueirunr:lri' penicillinrn:r; arn'iruunfi 6rrfi rfl uatnqdro; tfl ur4ofiara'uaqjlurJ r n di.rin o cfn ur ci'ru srdld'H o6 usi 6'0.: r:J duutflu ampicillin iufiu gentamiein lunrsilfi{ lvnlcnr:fn ur\ri'[6'H nrfi o.: or n,ia o -rtr"ptococci d tfl ul. Chandra T, Prakash A. Suppurative parenchymatous glossitis.Br I Surg 1965; 521234'5.2. Edwards M5, Rcynolds GE5. Acute glossitis due to Hemophifusinfluenza type b, J Pediatr'1978;93:532-3.San Joaquin VH, Granum M, Surpure JS, Srouii E5.Acute Slossitis and septicemia owing to Haemophilus influenzatype B. Am I Dis Child 1980; I 34:91 .

Vol.3 No.2 Apr. -.lun. 1986 J Praookklao Hosp Clln Med Educat Center 95UilN?1ufiutd'l- c"r6l- -i d 4 I ern]: 9F ?0?t ? l0TUn nctu tdu.ldyytoltft olj :_ 9A I c snn ? 1 u7 w u F I a u av n E 117 y ti n n n t,t n au nisrfr I'uisrry?r"slrl n.u.'Abstrect Echocar di ography : Basic Knowledge ud Clinical Appt ications,itri Kosirchaiwat M.D.**Department of Medicine, Prapokklao Hospital, Chantaburi, Thailand,J Propokkloo Hosp Clin Med Educot Center 19E6i 3:95-99.During tlic past dccadc scvoral diagnostic tools havc bccn Introduccd in the flcld ofcerdlology. Echocardlography has gained incrcasing populrrlty due to thc fact that lt is cntircty nonlnvaslvc, can bo rcedlly pcrformcdat thc bcdsidc, and providcs accurrte and rcproduciblc Information rcgerdlng crdlac pathology. lt dlrplayrcardiac atucttres by mdifying thc basic pfinciglc ot ultatonogr.phy wlth movlng ptcturc, Twedlmcndonel lma3:ing has overcomc the disadvrntagcs of M-mode cchocardlography. Thc lrttcr ls limltcd In lts spefial orlcnatlon ofcardiac morphology. Clinical appllc.tion of two"dlmonglond ochocerdiogrephy ls In tho dlrtnods of vetvulrrlcslonq congenatzl delccts and slrunt lcsions, intncardlu mas, vag'tat on, my0r;ardlzl and garlandlal dbcero andccrtain cardiac functions. Despite all thcsc informdlorc it can provldc. Echocardlogrephy c.nnot rubrtltut forcatdiac cathctcrlzatlon and coronary anglography. In thc nc.r futurc, appllcetlon of contnjt.chocerdlofephy endpulsc dopplcr might cxtend its dlagnostic capabilitlca. In thls rcvlcw brslc prlnclplc and cllnlcet appllcatlonof twodimensional cchocardlography are givcn in dctails.1u: s fl : r o fl rurdiforul R1? yr1.rR llrl: nri'rtornsil noo 16oold'rirrurirtrJodr lnir.:tl.:fr .rlueiruR1: CI:t ou-?1erfinnfiurfi s {s c rYaun fru rfl ufiiaa illufiufirtrj'irfi rJ::lsrrlun1unr:rn.rol8rdsl:nnr:lflodsl:n nr:fnurd'raorltril ttnrtnofiflytl.] rirlo Inserur:nilo.lriunurn drundl unsnnf,na n:: il Ci'radr.rz a.lr ni a.J cn ? oifi o dl m r.rI: nri'rlo rnfi oulnx rudr.: 1 ra.rrfrleld Ins firr e rr nn.rurraflru drdld'sui 116 o lo:r ori'rlotfi o a 6urds { ff st[aun fiu ir.rnr uncliln:c yr u nr ; rfi oufio idunrlsdosid.lsRr:dRHryrl{ai:inarly{fl 1 n1rfufi nodub{fl rri'rlo (noninvasive technique) iliordsffionfild'funntfi o 6o el'r{'rhu (Holter monitor) un: nr: or I ot{ile flf, o1 o1f,n: ? o.ri1 {tds{ $ns m 1 o{rlruornr:nrlnurlTouldt{d1o1$}nil rfludu:rut6'eira rfr ouua luvr nrr ldn r{rr 6.rn.rufdu5ru' ihu a rp mt u b wa t at amv tln tn ffi o1 n $rsyn1'iltsqn6vrr.rnfif,n

96 2r:d1:fludn1:frnuruvtvtuflrasrSndrln l:lnururan:;rJnrndrilfi s'qfufi z tl.o.-i.u. zozefin ru unv nr: n vri'aun d'ustr ln grn nrd t6u':tYu nduy& . d-- -3^3n11illilU g1U t rAUn-ll ut u qn nn1 { fiou fi rfi$.sn cylbhrnfiuq:rfi o{urfr ardBltiln:sYruui rr nrfiinfi a 16 o;j .: fi q nrr l ffi n ; vi'aut fi u r ( acoustic impe'qold.ilunnl{tnnriflr nd a .: o: r o n-?t o r fi o n'n u r fi s .: fl v Yio u n du o r s-uudnnr:.itu 6llo.tRlToi? od'rfl rn4 o.:tirfio nfiurfiu.:atfraunfiutfiern, rrudql (ultrasonography) ndudance) t6'uerncir{fi'u rhlfivnrutulo tto31303n'}trnfi oulur.tta ld ruoir.: q ta lrirlolurrur rf,un:.rfidrrfiu$.iru'[:Jloi'rfi u rnl udq rurnf, tfi qornnr:fuCluoler:Hdndi'otlu6tJtttJltu 3,5oo,ooo'lou/iurfi ndrr6ofi (piezo-electric crystals) ar:f,u::loqinrulurf'll^ 'i 'lltffiun?1 il n rRuR ?11111 ill+ltU i nduo\'.:ndrrflocrhu enro (transducer) turorfin dluonornriludfrd.:vrr.:rfl urd'uqn r fr finu ors rfl udr rdfl {6.:R:r o'luooR dr rfi u raonlil ufirfl.rrltarirfifundurf, u ra lfaud.t6'ru{rrfioumn un;fi oaratf-ondrudrus.01ouflnrflaunfru rdrurluroio.l rrns rrj duuil fil.lrutf, s {oon ltrijunrr,{ (iljfi r)r-3uflorrrfrrsnrofi u3 n ililfirono316nlfl nr: tn6outra'na.:r[rlod rueir.: 1 arjr rfl noo t? m fin u ru:,u oo",r*6r*uqirYunr:6'orr {dr ruri.:ttoc1yJfi uurllt o.:r{r o: r o d vi r rdr qri'il0 ri ruta.:rir1o fi o{ioHrI.:a n or r.lt r n gddruuuta.: nrx r rudu 1 orari,6n eilrJorildrciu flo13unr:n:rodrstniosgfiofid z uuu6o uuuurR M-mode ntrfi16'o;rJ:rn3rflurfiuf4,oduudl6'1t fi 6rdarorlnrrl6n uncrfinloltiadaeirrl ntlurirlo 1pl{4 zy rruudnoldo z-D modegrfi r n. u d n n n t msh ttu i nt a w1m n niu da t,a ria u n a-u" dtuni vhufuta rmlsgn an Inannilfuiutnw"tn to\n"a$vnhqrufuuanrhlo,t. n t n nh t't t,t n m a ri ru u I fi d t riryl u n n o"n1 tin"t nt t orh q u n"u w u"t m m a n1 u fr a n m rl x n'u,i,i < i < vtrn z udnn nu nNfl v n au n aiufialfi ni a w t ouil ofi n u-m o de In a n n ah 7 fni rn z o rh q u ri t t 1 nn n"u a f't m t t a novln-ntw t uuumfiaulunJfi r tn\uftulatmvgnan .n. u f, n o u t y tt u uii da vfnd tu tlzl o"t. n a ti d n t nt a $rtl oi crn hv uu tin. ndudurfioantn

Vof. 3 No. 2 Apr.-fun. 1986I Prapokklao Hosp Clln Med Educat Center 97trilif rrranm'mduduavrfaun{u7un-rwwsununtuntvitu lrld o rr ao r a'rn i u d u a fa u n a-u" 1 u ah a w u fi d t d a r il fl riart t nn u 6u lacn"a t i a n w"tcy t o rt n u iltu fwr a tm c n o n n\auifruriaw-t1o rttTfatun nuar$unirlofu a n arrda u n*u I n a n w-t n n 7 id a n v-tl olrJii r r an r n'm i u d w a " ria,u n a-u ? u a-n a w v u n u n t u tt z t r ti t u n',tnf4'[ddo'rur:adrlilrilisutfi sufrn :e r*yil-rtouinwdunaa{rta danvhn nrtnwrhuftuilantvnn ar {nlsi nlnkidr oc rfl urlurqrlo {fl''rlo n?r ilfi 1{11Jo.1anu X tu tqno'rrurfro ql{ruu"rlo dnurwfioiln6oir.:1 rolri'rloono oulfenfirfi nr: vir tuto in-?10 r:iu nr:fl o rfl o6uri'rta uar Rr: no d?ro rn fir rurdo rfl uEi'u *u n..lodttu!flfllru1Tnfufinnrnrflu z fi6 rrafiounlgiR1mo.: fr.:rirrurlfdrur nrurdEnrnr:fl udt'rto nXrlo d.:riludsfiri,rlolufrn u nr: d'e or r$l lui o6t'l NU11 uoy fl nr rn'aou fi uon nr: rir lruro uirtot6'6\ra#.r rfi oduEr no or? o'r en ruorr urfl uo3.n rur fiu (reallirqtime) r ni o.:iuln ri r r .:i un 1 Nlr nt-u n 1 ytlfr'rJ: r n I uurJ:vluurinr.rnfrrino o fr .r z rfi o r^6o u rYu Io 01ff'r o: r o rfi u.rd'urd u': nr:enrofrrtorfion6urdsrratfrounfirfirj:sTurftfi a lorn nr: o:r ooi'ru rni 0.lrfi ot z f, fi a r ilr'r nlfi' lunr: n:r oifi o ds nrry unyl: nrarlod'reiatrjfiu,urlunrrdrrousyr{rto'[oi6n.jr 6lrflufifiuuilrndulurlogilrnio{flmotfio z fifitifloiruudrnr:llfiro:rofi d rfiil a udl6'.:flt,rr . 6'rudru1a {n: u qn a n fr {q.r ilu1? uny o.r.r1l?.r.:(3rJfi e, + uor s)'z. soorl'tto ue ourvrrarto a f'or (3ilid o)'e. rrafian:rqnan uioou3rrrugru$'rlounyHnoor6aolraqjrdn+. l6rraln:,r duulrycirnfunr:o:raurlo

98 ?'l:rtr:rfudnr:dnurttrnuaran{ndrin I:ltorurart:cilntndrilri e nfi,d e rr.u.-i.u. eozeUv ItoBnL nunrrournrrufiorJnfirordrrrdul rorl"rlo1:nrirlorlqtrfijoiutt nztufintlnhwdun-tlo loon:reqnr:ilnrflnlordufirlo :rrufrmrrililulrnsnrud$frsur oa a I i u o f tr[: nfirlo1u6n n {uarnr: 6u1ilfifn [rJ runu (mitralindrn"sr'lunlrn:106.:uri'j'rnr:n:T rr{rletfiondurf, u le ItToun fruov fi rJ: vTstdtunr:ld.rruodr {ilr n ilru fi nr r r#0.rfi ovalveprolapsesyndrome) n"'rtfrurooa{6ntfintifi ilofido t"' fi'odar:vr:ru6'rd','bicuspid unciufi'rlorfisu rfludut.z hnnllofnrrlnarfrru'wineix1 fl'r:cr: r ld:iT ulunr:if, o dstriarir run lou rqr n cnr: do f,(indocyanine gr€en) ut orir rn fi o{i lfi da lor nra r6n 1rtrrananrfioodr us;1#lunr:fiuurdruurinnr shuntr. rhcfinimrryuo.rrnio.rio nrvrfitcinrnnuonT oi6doctrif,nrvirfiunr:snmndfif, firoriurdunrrrordo (resolution)l#oodltiu.'urinu,n1nz 1ofio{lnfifi'ulrirfiu a-s u. vtr':ciru'frr.r $fl! 1 ur.vrrdrufi n n: d{rJrur6norrufi1t1fi6lou1f,firn:renrutufrlofi ufiodrutrJtl un:trr\rJdru'lfi tf,cr s dru:o t: /1u'$ aroldnrlrdoun'urfio.rernir.s rfawfinrittl nulunllo rdil fiaur{o druta.rri'rl0fi o{rnumutorf, rtfr ul (off-axis) avrlauron (atrial myxoma) fiaurfioo un:nm6ot6oaolrfirlr uanorndolaxfi aqjluuurturufi'ufirrfiarfn6ufir1o rflufius c rt'o u r fi u iltfihi 611rbin r r,t:t r o vr slil (drop oilt)t.a ltaran ituti an1lo l:oaorqo{rura*r1o d'rfiunr: n:roiifl trilriar ilu nylouyrunr:ot?es?uIou ror,{r c m:rlrludo.r q.rr{lrirlot.s nntduT rdu unoerrfioori'rlodu ntnfi o:Jn6ta ru noo 16oo uoiluqidru6'u rfl uduri'rlorfi onuifi odabnuianrrcuriodr't r*r 6u*r1efr nr:rfio shunt tfluduz. {enro {rnrofia.riaruf,rfiorfrunru?arnz. nrrrjrvriut^torj:vfr ninrnnrrrlxru,uotr"rlouocet:irurto.ncuufi'rlottncvrnont6onrrllrjll,rUvtotlRonuarscrfm.rrfian (hemodynamic) riluorjr$ 6.r-jzt nnnnniishuniwi'n7 rorrufi.:ndrru or:6nr*r:ru w r6uora.r{rJ'radaurlrnr:nlrrrlnnt.rrfi a ri'rlo u ns H rl:fi uri'o rrirto I: n dr ru rdo r{':tou o s. {iltl {:J'ruurorufiinrrmnuurloutovrrvrfi oo unrT:nn fi'rrrriorirtofil*.int'rro",,"o I:n:J oo r{of.: {:J,lufi hirrufi o rdu {rJrurflnurv:roz.z nnrhvfiunrhfitornuorttia lorqorn {1:Jrafiuau:rulrjld un:{rhuion rflufiu nr:tnren r: vl r r r ut o .r n 6'ru rdo r-r1 o s r u oi r .: q tu: r rJ s u o dr lu{rJr u ru drtio r o 11 rlridr ur nunv n oru fir'iril r lruil: v nrufi'udui ahi ttns fl 'r rnr nf r mdru': rulrd'tfi nr:yir uuta.rrirl+indru (cardiacindex) un; f,o s runr: fi uCl'r (eiection f raction) leig. nr:nurn:ollrn nr:6onrruarnnrsun-,rRr:in urui a nrs n frleir Ci'o loaq or n nr: r:J dsuuil nfl uroro,rriorrirto nr rofi aulurao{6uuncr{fi.rnfiruudarirlo Torr{rnr:er:rodr riju:sus druo n nrnfrnialo: r ora'rlorfiondurf, u srt'aun fru ur,:1ua r ur: n fufi n rd u.lu*T 1o rfl unr n (phonocardiography)un:enroSodsnrnrttu nrtguro *'ao6l(Doppler echocardiography) rirlfrnr: sn r oifi o futonar:dr16l1. Seward JB, Taiik Af . Twodlmensional cchocardlogra.phy. Med Cfin North Am 1980; 64(2lt'177-2O3.2. Feigenbaum H. Instrum€ntation. ln: Felgenbaum H, cd.Echocardiography. 3rd ed, Phlladelphia: Lea & Fcblgcr,1981:1-50.

Vof. 3 No. 2 Apr.-Jun. 1986J Prapokklao Hosp Clin Med Educat Center 99Feigenbaum H. Echocardiography. In: Braunwald W, ed.Heart disease: A Textbook of cardiovascular medicine.Philadelphia: WB Saunders, 1984:88-145.4. Tajik AJ, Seward JB, Hagler DL, Mair DD, Lie JT. Two-7.dimensional real-time ultrasonic imaging of the heart andgreat vessef s. Mayo Clin Proc 1978; 53:271-303.u rqil ! n il-d Q a. nr: o: r rrirlndr u n Au rd u.r o ; riou n du. 1 r : rT 1 :oru:ardq{ 2b241 I (2):8?-90.6. rn:"u,rdnd oiuruuri. nrrn: ?rnAurdu rccriounorl,r-r1r. ?ri.{:o::$dm; rlr!rix, u::u1;n1r. ilqrruolrio.rr.lr{vrrlorq:-flrdoJ r. frlr{ntlfi r. n:.,rrilil.r , lnuiorurnrrlr. zaio:roo-ss.Gibson DG. Echocardiography. ln: Weatherall DJ,Ledingham JGG, Warrell DA, eds. Oxford textbook ofmedicirre. Vol 2. New York: Oxford Universlty Press,'l 983:13.34-13.41 .

1 O0 ?r:d1: qil6n1: dnurttnnuarasrinirln l:.:ntlrurnn: vrJnrndriJfi g nubfi z t!.u.-i.u. zszgfldrurjirlu-lfr nrr::or Ins"oiflri il.u.-ffi^&ri:Jrutrulyru oru r z ii nfidrrurorifidrrnolJTt?ruuuu'tR0u!tlDIrira nrufi rfr i'.:raie {'uvr uj ilrl:,rilarur nn: r il n rn dr nlrer: ro:"r{n1u nu'irflri'ouuurr6lfiui rr ruUt'uvr lJ oir u o r nr: ri r fi'q'lr.lror nirrrr ur s fl fi fr'our1utibial tuberele 6o uriufi'rn: r o n ria.: rir.: n o r 6 I r 6 n!*d sfi niicnr 1ilfi rJ: y i6'ir\6'fu nr: n: r n r n':- r rur n fi fiau ruro 2 x 2 x 2 nu.str il. \6'[fr'nr:ifi oo'rr rfl a rfru- t lztldinat'jrtflu b wil tu t nw s il n n {t oYu n uiexostosis of right upper tibia1Jfi z

Vol.3 No.2 Apr.- Jun. 1986J Prapokklao Hosp Clin Med Educat Center 101lflouOsteochondrosis of tibial tuberosity (Osgood-Schletter disease)t 1 n nt il d1sf.r f, lo.r:n n'lu r{r.r{r otl o c niu.i r fiut rr nr tibial tubercle fi ra r*6udrura.:n: I g nn qnoanurfludurf;n1 (fragmentation) uncrdarfiadoufi rl n o qrut n nrdr': liun'irrJ nGo-nuorvnr.rvrurfrlnurTibial tubercle rfl ua:ufifi uurrcia n.rrur ornepiphysis druuulaln:lon tibia arofi ossificationcenter r -z d'urfiod tubercle d,to;6on':.r epiphysisla.l tibia rfioorqil:rurru ro fl untfioryun?sgn tibia fio{rfiolr{r.:rfioarqrJ:yilrru rg fl riaurarhfi un r: fi n riu n: : q n fi o qi{r oldo y a r q's*ur o .r nr u o Reioufi ri r fi.r6u1n fiufi 6a n: v q n ei ouaa I epiphysealgrowth plate 6.roc fiorTuododr lu nr uiorrni1 rlrhifi nr:raqoaonlrfrrdutd uiaoroo:uqerrfiu.:urrsru rroiOsgood-Schlatter disease rfl uI: nfi rfi oluftriu lrnn ofi oyrl r1fr rfi a ohj rds.: tibial tubercle'lriyr aAIns fi arnr: r6urJrnr.:eiruurlrto I uir yruludr"larq 6lv1rtr{rfro coaseptic necrosis n.lilrl1 n:confiodtnfiil:sunr 10-16 fl {rrarflulrnn.fi{u.Ql un:uflu.ilrl rda.:oy fi rdan r",,dou.ro rtrtfifi ort*po"Jri, ra'oaotdurilrnn'ir z rir.:il:tlrru z: r orefiil:sl6ro.lnr: rfioodouun: phagocyte o: nn nr il nir'[:J ?rror n: : o nkifunr: n: s vr u m ! rn n {iui n nrfr ururiou rrufi'nruaonlil finr* nrs6,nJ:rn4oonrurrfl u fragr-.1Osgood rfl udflrno'jr fi nr:Induro,r tibial mentation luflqo n::o nln rj ot nn cfi.rdurur 6o njuapophysis lufl n.a. rgosnt;?n tibia fr.rleiHughes rfl u{r udrluarn drafif, o; fi nr:Indu1ol ligamentum patellae uosarofifiu:Judua{nrnolntrnr{RafrnludrsI:odursldroo rror,.u.ldrfl uororfl urhsil.r2-3 ildllilEfiornr:riuilroronryfi urru unynor6uddruyru,rtibial tubercl" Iosfililriouf,ornr:usonto.:nrd,Rrfl ufn or fi ornrr rurn rfi o fi nr: rndauttlr ni o o o n u:.:firutulcionfirrurfioquadriceps niu nr:i.l n::Ioo du:Iulorfludu firurnnqon:vvirornr:fi otn6|n{ uanornfiuria'irornnrrfinrr roi q16u1nlud.xfa{uadr r nr:qn nirov rlrbirdurur n $ny nr1firr6solrdruu:.r:'rnrf rfiun::qne: in?lilu.r.,duit*r..'n rlr1fifi n.:rr eTurc16u rfiasnroir.:nrsosr{u.jrfinr:urruduinnrdoo.ndodoeiau rfiorflustless fifiorJnficia aporphpistibial tubercle ndrovr{u lilfinr:urrulufro rny'uostibia stressCi'lndr}iruunr.:ligamentum hj fi n r: dla 6ua.:n dr ru rdo quadriceps uo n or n.j r o rpatellae rlrlfinrulo.r tendon f46o6olTun:con tibia rilrhoun nrtdrrfiul:no:cioudr.:riof.r rfrouufiuuur{uuncaiotrfi ossification dhiuri.llouu ld'f, r$ro no ltuurllerurl rhfr patellar tendon *uuir fi o sn unr: ril fi suuil n luuurdar{uldrufirn fiu rfl uha il6nlcTlurr or rilurd ouui ofl ar o or rfl url:r m nr z- s fl rfrrfi nsol:J'leYro.: nrutu qj fn o; raqorfioarqrJ::rurnr ra flniafiosndr fiurro*.:ur.:nlrruancrnfiunr:16'fuuror6uuian:snun:rrfi au rvirfr ufi ar nr:f,oofi ori ou6.riafln qjd u: n ru,fiy.r a r o r fl url o f,a n fi o d *..,1 ri, fi o I: a dd uunvororfl uqffi rnqn*l6r.dr*n o raioo*rnrrloan"nuuvntlt"ld1utitioo 1 olitflunr rnofix-rilnirdrurTuu: Tibial tubercle oyflnr:uonrflu8urfinq uoitllO quadriceps.:,nrtuor o or odrir.r or n n: yo nrir rtd ur rn* r uoi o;6ud

LO2 rrttll:{udn'l:dnurttnnofircrnJnifin I:lntlrurart::rJnrndriJfi s ofufi z tu.u.-i.u. zszsu0nyirraanurdoroinrrlrflfi :tlunrrT rirsfif, urniun:lqn tibia orourlo.t (osteoporotic) rfiorfiociouf4:Jnnqluirr*fiu.riu arofifiurJu{'uf4 patellar R1:tendon kiIourJnfi ufir tibial tubercle oroo;l11:c16ius3 ossification center fii16'lrnn'ir r d'u 6lrijuo''ro'rodor*nnrr;f4rilul:nfi'unrr:iln61oi uotrfi aB n1r ui rtrro n ria ri o ci au:Jt : n a :l n-u o rn r: t 6 u il r etroil1!d$sitiruqrrJlaurfiulfil6ndr lufi ifi o;dT Ulunr:if,ednlci ueifirrflufi.r z {r.lnr:if,odtrovdssrniutl6n ni aur rn*.rfi nu'ir i{n u nr: nrr ril dsuuil n Iruuu 16srfiulufir':fi 1il fi or nr: fi teid rnfunr:nirCl'o lilrrusrirlultlfi n: ;qnri r fr'lro3 q r6ulo tx:rs ar o ti ilti epiphysis fl o ri ouftrd-uIstottwncuouul.:t1u tubercle \il r r rur: n rfi a u-ero riun: ; qntibia tfi vhlfifiornnlroudrtrilrniu {i.:firrflurdufinr: o;ilrfio ro''otqoit*fikisoil16ouGofiuaontrJ rd sHnuvr:ndoududr lutio$n'ir*eidrfiq 6o eiruqfrto.t epiphysis duuuta I tibia o rill o rlr n'iirJ n 6firhde[rJrufi genu recurvatum uonornfrufirrn dautrarhilei'uru 1 nt 3 qn patell a o : o ql q t n'jr rJ n 6fi rlri'fi ufi r6'ru1u'[d'fu nr: rf, uo d riau unv os fi ornr:nlt:"RUldo a-n tc u or n n rt rf, o r, (osteoarthritis) or ru rur'lei'r{io.rornl:ndfnrarutoi'rom{rrfir nr:fnur6.tnrcilrt6'[o!,nrrlfrdruucrlr{rJru lfiarufirlroun:h{r{nfifnocldrun fi'rarnr:quu:unnorolfir{unirciT 0 uFiuil nra rno{ rnf,srnia r:irilan!irhu16' (cylinderwalking cast) nnr{nlrir.rfiuo?:1firnril:sr.nnro t6oufir rrrr n fi nr: dn tn u rds uv{ fruf{ u3 rr rur:ir nr: dohydrocortone rir'[rlur-6 rr *dtJ.out u fi rirst{rt}qaZ Yootutnronor:dr16lfir::u:r'lsllolh ntfl uuruunchinrurr nldtr 1. Jacobs P. AvascularMiscellaneous bone lesions.insf,uldflorr{rriludo*irfio lerunrrtmrlorfl tubercler:irlrflun: :q n tibia rfi o sfr.r riluvrr $fr 16o r.n Livlngstone, 1980: 54'6€.of radiology and imaglng. 3rd ed. Edlnburgh:2. Edeiken i, Hodes PJ. Gotden'sris,ttdrtriu d.rrru'irnvursotnornr:tiuuscttlred. Tokyo: lgaku Shoin, 1973:1124.tn.nluldms1u!? m 2- 3 frrJorr{ rvirfi u ui a or o1f n: ; qn 3.hood.4th ed. Tokyo: lgaku Shoin,f4 r o r c ilr o r n fl r u1n fi 1 l rld n.r1u1 fi r o r c fi urir s fi lri'1975:.143-5.4. Turek SL. Orthopeedics: Principlesrfiorflu immobilizing bone graft3rd ed. Phffadelphla: J B Lipplncott, 197711534-5'necrosis of bone; Osteochondritis;In: Sutton D, ed. A TextbookChurchilldlaSnosticradiology.2ndFerguson AB, Orthopaedic surgery in lnfancy and child-and their application.

Prescribing informationComposition and DescriPtionULFARET for Iniection 0.5 and 1 g. are preparations cf whitetd light yellow crystals or crystalline powder, each vial containing0.5 g. lpotency) and 1 g. (potency) of cefsulodin sodium,respeclverv.Actions'1. Unlike conventional cephalosporin, ULFARET is markedlyactive against Pseudomonas aeruginosa.2. The antibaclerial activity against Pseudomonas aeruginosais nearly equivalent to the aminoglycoside antibiotics, sucha5, gentamlcln.3. Since r1s mode of actron differs Jrom that of the aminoglycosideantibiotics, ULFARET has been proven to have positiveantibacterial activity against aminoglycoside-resistantstrains of Pseudomonas aeruginosa.4. lts action is bactericidal even at minimum inhibitory concentration(MlC)5. ULFARET displavs a strong resistance to beta-lactamaseproduce bV Pseudomonas aeruginosa.6. The potent antibacterial action of ULFARET against Pseudomonasaeruginosa is believed attributable to its prominentextracellular membrane permeability.lndicationslnfections due to ce{sulodin sensitive Pseudomonas aeruginosa :- Septicemia- Pneumonia, bronchitis and primary infection withbronchiectasis- Pyelonephritis, urocystitis and prostatitis- Secondary infectionsafter inlury or burn- PeritonitisDosage and AdministrationUsually, for adults, 0.5 to 1 g. dailv intramusculary, intravenouslvor by intravenous drip, divided into 2 to 4 doses.The dosage range should be adjusted according to age andseverity ol in{ection. Daily doses may be increased up to 4 g{or the treatment of sePticemia.In children, usually 100mg/kg. daily, divided 3-4 doses. Forsevere and intractable infections, such as septicemla, up to200 mg./kg. dailV, divided 3-4doses.For patients wrth impaired renal function, the initial dose is thesame as for those with sound kidneys. The maintenance dosemust be adiusted with the creatinine-clearance. The recommendeddosages therebY areCreatinine-clearance Recommende dose inof initialdoseDosage interval(ml/min)8 hrs5030201052.5In the case of acute renal failure (creatinine-clearance o ml/min),75olof the initial dose is recommended over 24 hrsULFARET can be administeredthe form ofi.m. :0.5 g. of ULFARET dissolved in a solution of localanesthetic such as 0.5-2olo lidocaine or mepivacaine.i.v. : 0.5 and 1 g. of ULFARET diluted in 20 ml of diluent(isotonic saline solution or dextrose injectio.n)i.v.drip : Single doses of 0.5 to 2 g. of ULFARET diluted in areptenishing fluid, such as glucose solution, electrolytesolution or amino acid preparation, may be used forintra venous drip inf usion over 30 minutes to 2 hrsPrecautionqnBO7Q605545Please refer to package insert959080706560o/o

Vol.3 No. 2 Apr.- Jun, 1986 J Prapokklao Hosp Clin Med Educat Center 103u?dn::uu-ufinL gr9r 9r o : y ?t?1{ ?t a o n t o o gt tl o .l u ctu ?t a o n t ct o 9l 9i lt,Superior Mesenteric rrlo.rmolnn:vautf ufi nrr::ru Ins-oirud il.u..tpiilrrsrutvru ou :o il nflrdrrurodfioirunvirTau nr: n: ronr.trilo.rrJfru?nr: H anr:orr o udoodrrnoirnsfi.: 6'.misronro ardnrj:rri.l aini:cir6'aruoyilaorryilnfi BUN z.g run./on. $oy Cr o.8Biror'nJrn.nrrl'ul'ro oa onirilu16'6ufl ur:J:rurru s r6au run./on.rJ: v r?rlfolu-u r fi a o rd o uri ourl'rJ r r g nB.:oir r nr: sr: 1onr{:".rd tiro nr nf.: fi rio.:vi'o l\rin riJururo e ilrJ. 1 ofl rrirdvia.:oirutrl"rou',qodri'u. r.:r fi'oufi q il n 6ui oi a.:: or fi urjud'llurio.rvi'o.: t.n n uq o U e ! ^ , ,^'drudril'[6':*r n r: il r 6'o fi'lr rnol u', u r: r o rn m6 ro n rr rudl rfluno (?uYl 1)a r4e )o r [ fl 11 y o f, ? u o ? u'] y o 1* run yr 6t ri'[d'l a n'j r ril uo y'[: 6 nrir.r un yr$p.i roi'oror n:: oua onld' nrara d'lrir6'offr nI q u a a \ q '[uv5a.:trooooe ud 'ld"LrJfnuron uuuLuvr'0.: firfir.:ri 1qrilofifioilrr oru uvi.:ul rr6firon'irfluI: oRTy [1\r;t 'oZ:*1il: vvrruur'1il6fl u riilru6.lrurT: ll'rurur on: ;:,J n rn firauvlu:!r"^

104 rr:dr:qudn1:dnurrrnmuflrasr*ndfin l:rutlruran:cilnrnd'lilfi s au-ufi z r!.u.-i.o. zszcnl:er:-loeilundurdu.rnrrrdq.r x!'ir aortafl1ureiln6 utui celiac axis ttdr superior mesentericartery rJn6d rrqi superior mesenteric vein fiq | &q t ru.no [u ru ilt nyl.] tuuulEl9llj?1.1 $dr $ulu'l??o [fl ut ll* r*6 o ^.t r"'[6'ur n n'ir t .s q il.'[uur.:: vur t-l ufi u'irrurertraqjn'ir aorta fouou (3ilfi z ua: s) aiurrdulo ) ueA trflilnolrrlnfl { ie uunr:if,qdu'irr.irort{Ju AV fistula:yu'jrl!aorta flit-.t superior mesenteric veinuio:vuit.: superior mesenteric artery fi't-l vein 6.:ruuvrir'lfr'fir n1r o: ? od'?ui 6 do e r: fil uc.r ttirra oocli6oor uo.: (angiography)nr:doar: filucrtrirnoosttdoot tto.t lfs rgfl ?u?r iaqid abdominal aorta il:v rur nrn: v qn d'uu fi ':; - d . e'-. vsruonriofi r2 ttdlflq angiografin 50 uB. Ei.)ud'q|Tr40iln./i1*1firirunrl,'{f.:deirudolt 1 nrn/iurfiil: r n g'jr ru0.: rfi unr rma.: aorta uov lttu.loix 1 trifo r ouciruf:..r ulu.: superior mesenteric artery ua l\ilrrluuriu fir \q unv6'L€iourln66 olRnr:Etr'to6'?uodu rat ulil'jr or riJu:vu v 6'u (early phase) u5 o; rurra d't(late phase)ttoi superior mesenteric vein l'lu'lotraqjrurn ie'ld'il:rilru 3 {il. txiltTu splenic veinrufirrvrrtrn portal vein ifiu'l6'lu:vavrdsrfi'u (p]fi +)nr sv d'.:vi r n r: d o sr: fi I uo.: trir n aa q tda o ltcl.t ld1finr:ifiod'u'irtflu traumatic AV fistula :Yu'il.1superior mesenteric artery ltflY veinn1:&i'lsr"fi nu AV fistula:vu'jr.: superior'[oi'rfiutlolirfiumesenteric artery tin: vein 2 :nruu d'rnr:r.ir6'o{'ilrurarl rilurJn66 ovrtoYir n1r do

Vol.3 No.2 Apr.- jun. 1986.f Prapokklao Hosp Clin Med Educat Center 105a r: fi u rrn.: rdrn nao [6oo $o l6 n n*.1 ruoieirjrslilsail lurir-hsJrrrJdnr: o:ro6irundurds.:nlildgon ut6'ufinfruriru'[rjdou'ir aorta frgurorjnfi'[rifinruloT:J,Jilro.looR ucir{u'jr superior mesentericior:nivein figurolnilrn 6ujroyrirfi.:fi1AV fistula il1nn.jt false aneurysm fi.:ufiornrl: yffifi rnu nn0lfi'vi'o.:[[fls R.lr sn? o.ir.:nru 'i'tr o v'[ il a r ru rr n r fl o {ld'rfi u oi r ura ri.r d rfl u; 6 o ei o riun yir fi nr a'ue y rfi auunr fi rd tr lfi'o.:fi ri'o.:fru nr:lfi salranao16ootto{$nvunoor6aodrfioru rurorfun r: i fi o o,-l r d o .: 6'u fi n o o y u o n t6'.i r ri r o r fi n l ru fi o rJ n 6 ei r qud n n r nJ n 6r o o.r a o o rd a o ei r u a a or tihi n 41o toto.lunaor6aot 6ur",.or,flu traumatic AV fistula urotiuriuou usilouft'rlilufirfininnnoTqrn.j.r superiorH5o traumatic false aneurysm 10.:uooor6oouo.l mesenteric artery rfinriouttnvudnn.jr aorta uoRZuly' 'asfild' fidaordaofi'finlrufiorJnfio-.:ncirroroosrfluor nfid,tlriiirltollrI.rltrnt:ro:? o6i?undurds.]nrril6s.:aorta, inferior vena cava, superior mesenteric tu traumatic AV fistula r:iurdsrniuartery tl0; vein, splenic artery ttni vein, renal nr:?fi oa-aduriuaufi uld'o1 n nr?dq fl t:fi uus.rartery ror vein rai ou na o rdo o du 1 i4 aqj ui n ruria.r rfit aorta logrliu superior mesenteric vein tu::agvi'or6'rudruLuduuoyrurolerurn:J:rrurru g sLr. drlon.ir aorta unvnr: o:r ooiru n6urfi s rol rufi n.rfi rijui f n..,r,do rnrdr portal vein tu:vsrrdurfi'u rraoyjror6,alfl,

06?ltd1:qu6n1:f,nurttnrudranfndrln 1:lnorurnn::ilnrndrilfi s nfufi z tl.u.-i.u. zszsdo.rlfgru grur{r\rJlu superior mesenteric artery tula :ru'jr.: superior mesenteric artery uflE veinIoucnr ufirdonr:fiurfl{ [tavn?:ovdrunrnf.:filu fir z uvit'ldrfiuilouiuuiou nralfirilrfio{il':orarud:ruv duun; d'iu 6'eE rfi ri r n'ird6 I ol ru0.:rfi u\d uqilu riJurJn6 unr6{r^irfio6o lnr:rirnr:m'roloudoar:{il':u:rudt owrirnr: n:'lofiriadoria lrfi ulrYurni o I fi uus .rtriru noq 16oq uo sd n n* lrd I rfi oq'ir o: fi nvdosr':fi uus.r 6 iloiuqohlfistula *vi.:fi s o{6nratatri uei{r.lrofi nrruurronfi'lodrsl: fi nruornnr.t n:rofi smrqdsrur: nif, odu lunr: vhnr: snroi6durn tu:rlt nr: dosr: fi urra.tld'irfi traumaUc AV fistula :vra'jrt superior mesentericartery ttni vein trfi'ir ev u a ncir uuul ttnl {ruru fiortdfrnr:emrodrfdnfauluvio.tuRvil?ou fr.iurn 6lrafi n d'u:irul:Jriou!1il16' ornnltil1Ctofilfifi q.of'ir f, traumatic AV fis-

g.2 Cinopol* 9.3 NoproxenAr EntryAt 6 months

Vol.3 No.2 Apr.- Jun. 1986J Prapokklao Hosp Clin Med Educat Center 107o I q r6 -t 6t sr ir.Eyr-et rir: n ru o?t rf Gr ilo { on ld ud I un"ufarl: nrj o srsdgta-,rrnnrirllruoru:n::r*t{rhu r :rs HN eeoT-2e iufi z uriuruu y{.fl. o ru:J: yrGnr:fnluo6o$n rirlfr'r.irhs fi ar nr:25296rufir.irdrfrl6.: 6o subarachnoid h".rr"orrh"ge, flrldnunndnmJfrn6, pirJrumu\nu ara +o iJnfidrrurodfidrrnoi.rrirrfiu 6'.luiqil:r6u!i ordl^rvirk oounrruil:yffir]ooriu\6'ornm:ulir z iurioulua ru0.: rai o ufi ueinur 6 c nrru ln ruui ur rx corticalarea uliu rdari'ruar:ord''nrn!rlufiu-.:a.tilts.i16i Tour^rilruril6otfr'rflu6a.:rdu':fi'utiriou fr.iluiloqrnsfr'[ifn r*rluI: rilrlr Lr oil: ; rl n rn d'r 6'uvr r.15 ri ru fllfr e uo.:6onr:6r,duru r* uurj:y nrnn^r:ry rflunray.' rn ur,dr'[orfinriou'[rirjre6:uy II iuqiorurilu:Jro sn rf, un.:or u: n:'l ru u n riuror y ra fi.r ufir\drir\s#uu fi.:6:urrurnunyldq.: fi.:nrtorfinriau roruwfirrr1 6n iltn00uur.J: v l r runf .:frh.: Ei o rur fi o r 16 u uv'i.r riJ u r e :c o r u r: 6.1 rldsrurnrndrrtrJfruG : RlrEr:?oirtnru{rJru'[6'rirrurl:.:l rurrr n : yu'ir.:yrr rfl arnrl rr{ano'[rii6 a.: nu'jrfitri, comatose, disoriented flnr:'[d!urdu.:rayavhulu ri:tr:fiadqrotriluarud'nrur:-J:vrurru uttoaoo.:fi'left lower lung field, hifi crepitation,zo ii rs u uny rnr rijuinrl: nil oo udau orstl riou\6'fu ri'rlorj n 6, vi'a.::-J n 6, di'un dr'[ri'[d', nr u : uurj: ; s rr,rnr:fn urtrioooo n::sr {r'[ri\6'ur.iuourfl o r orn rfi .:rurrql.:.:ru fi'utriurur^rl'jr{ilrt coma :rrurTlfi stiffneck '[rifl lateralizingsigns [tng muscle power:JnGu.r'r.u:ii #ruiiulo, firJru:rufiruroiruornr: u.rt.R"vt:tue ooil:vu: : fl1.Ior?Q muscleZ" uurduulduro.:'[ri rjro6:ur \or6nriou uoroiorurfi poweri':J': u: r u fi ri rt6'a rj r.:'[: tur{il ra fi \ riid n o1'r n,:fin t* ilrto.: nl rld'u'lun rlra on 6: ur q.: fl o r r6luvi.: o: r o\d'ro nr y tone ltnr R 1T rndoutra rta.r$1mr] r? n1uar: ; oil ntr ruidn 6'r uJ duuliln: r o1'ury'rjro uqila n rfl u grading system'hjloi'' *o'vl 'Leiri ,:J:; T6fr oudr.:fio a ei r rfu n r ru fl1lo.lot R-tr u.r,r.u:ii #rrdrlo : nr-ru[6rq{r^roqr?o-n{RrB'[olur,i'r-l':r1:nrJ a o orr: ffi n'ir or nttul: n:J a o fi fn ur fio $frn: rtundrfi erirbi'r{.:urfir{oi'u niu fiilru comaouo: rui otiln: ud ruuo rai o nr uaqduluiloo fi6'o.: u o n'ir fl disorientation ui o sensation fi \ riilrer:rotd' rilu6'u* It wutttl dtn v il n n ffi du n G u,il.n-n:lue ooJ:vu: lupYrjrs:rofror:rrro

108 ?1:rr1t{I6n1:dnurutnonran{nirin 1:{nururan:cJnrndrilri s qfuri z ur.u.-i.u. zszsil{rf, g.tfi n:Jn6 (bruit) u?tr nr6: uvunvoad'rs uninr: nuduJ::thnr:14 rfl ur6aoir il6'r0 tr'{: r sluur.: id ')n: rfidrho d fi ar nr: td u uil fiuta'l unconsciousnessmediastinum (r{r1o) rfi u.l ruulil n r.:d'rudr u d'r u (1:Ju.r't.n"n:rqc oorJ:vu: o'lotflununvil:crduuacfiil:;l6fnudou ororfl ul:Jld'irnarGsnrv{orfllr,tninnrviluaruorfi\d louronr;{:-hu:rufifiil::iAtilu vascular niu AV malformation $drtfio[nn nr:fn urinrl: orl ao'[ri rriluoutilu subarachnoid hemorrhage fioorr6l $otolq fr fr sruilnd rrtrJ fr u6, firJ'rirl rud6o'ir firio :,i stnufi nl rufi oil n6ra rn nao rdaoluil o oir ruoirarirlfr' 6 r'leir o r v qD r o ri r'[t c*u u d'r'[6'rl rlt n'u ra d'.: rfl ufi ri u 1larflur6oo16'u.x.ur1{ o-ruiilla :fl'ri nu,irurutflordoornrrflufirTvr:fln ezl, }J:6un?:[!ffo.:,ioR1rEl't?o z.se nfi, uovrlroro o tdfroudrrR:ilvtu few gramnr.rria uJ fi f6n r: ri oufi u fir flu'fi tu{:-h u: r u d o s il i6 negative diplococci 611,fi'1fi PGS za firugf,er/iulrjvrr wirulo or o tfl unr: 6o ria rn:r v fitda.: rtEi subarachnoidhemorrhage fi fibTtd'ruoun'uttot chloramphenicol iuor s n:-ilethambutol ttnr pyrazinamideirrurTt-t INH,ifinunndrurlfru? : HnRl:otronr.:fio.t u.rr. isrfr l.rfrnt-uiorri:Jfirlhnr:r,ru'jr tfiotdaoarr ts,aoo tto6/ou.utl.'[6'nr:ifiosi'ul: oufir nn: o: raljrda{run ruo ldn ta ufirlvr:fln sol rJssrrvrJn6 uordrfrnlo'rfilvtJnfisfiofiuuo.:fiufllorirrf,ourorntrauniu u*unor.:nrnriruf.:f,ynr.:an (pJfi r) r'rufi fibrotic infiltration dntfll, mastoiditis, sinusitis ilioadlurjaqLUL unru?tr nr LLL fi frnu nrlrdori'rurlaoHurdi'r u.n.u:i5 dluiirla r odrdrfin6.:r6o{'tri'rtonio iar:rirlubu.rrfi arirurJao rdoilaouS lr rudro I dn ra u6'ru virlr.rfi .r1fs ru nrs drlurdo ulilo'ir rfl urdofin$rirjnG orotflufrnpnsiloonnrlroruiril6run'{:r: diplococci unv ut 6'ruf ilT: nfilfr'rfi o o vl: ?rjfr sruilndrmrJfr u6, rfi afn:srirul:orJooru.fl.n-il:rue ooil:vu: : \ilor:lv{nr:fnurtnrl:nrJooEraufrrfiorornnntr{rJru\ri6 nr:lfrur14 o'lulll{ru log rql^{rvarin r*rinrT: nr.J a o or o tfl ufi usio 6'u\6' vi rtfr arnr:lo.r{ilru r or n.: uovinrl'i otJ o ofi hi'loirfl u nrr ri uoi r u r fi o tfi s r tYl n r: 6o t4 r, u o * u u oat L t6u.vt.u:ii o"rudula : rfiud'rurTu u.tnt.fr'r:rqn: n:fifrodrrfiir61odaorJ:rg'i'jrirul'rnrJootrior:iu-nur firrtrilo'jrt ritri rfi a r1'r: a ru o .r o-n r fl u o r n r-nrl: o il o o o u r n tri'fi rio:.i.:irurnn'irfr riou rriu o:?o tR tJlrv uo: nr: uor:iloorfi orirrirlurio.:rJootn:rrf qd'tru.r'r. inqvr urufrinrdvr"u #.1aton6r'{gua) ,pirjru:rudorouu'l nrirrir\ts*ura dl\ilfio rtufir decolorizetridr,{ofroillniludrrairdotrirru,fiuq^uoltirn:rvdfroun d.:ufir[riurilo'jr rfl urd o{ru4 ruo ro-n tfl !aa a A e01RUUnn[TUl4TOrUOfi Nfl NO.:dntnUOtnfuhn r.:fi,trfi o .: o r n {rh s r n u:-n u t l-ilIr n rJ a o ru r ri o u u Ei'[ il n: IdruuoolRolRrr$nvnrndrgf.rdvn'llanilrovrflu

Vol.3 No.2 Apr.- Jun. l98dI Prapokklao Hosp Ctin Med Educat Center 109fnrl: o:Joo:sa y 6o gia r{ ff nt: or? olir'lr f,uH d.rd,lo rfi polymorphonuclear cells rfluaru'lHai uotRl:n rr; ria ulnfi 6s1frH n nu lun: rfrdnr:ino *a rfi o ri,rufl ila{dn tfl uarnlarl:ou',:'[rifl rrul: 0dfooo n16' unsl:nda r o u a o r ^ u ri r lt n-u ra fi .: u u u ril riu dhihi n n u ar: fi?r u ila 0 nr: 6n rdar o.r: u urj: y n r n rfl u6 o.:fii u ei r u: o1il16' 6ilfrfn :*riuryutj ua: rda ntndr^irurdr srirtt f,un fi'.rld'6 fir ur n pi:-h s rfl urd o ri'u c ru o.: t o, u ulrn{rul: nfi s r rur: n:-n urloid'rs fi'rj rs: rudo.,:,0.,,u fi#r rfi oq nr: r:J duu$:J n,r,flti.lnn*ura 6'.s r:J duuru:Jn.r'l:Jtumr,rfi 66u:ro rf rlu r fijorri rriu I:J:6uuny rqn6no no ti'.tr', uq udu fi dr oy rfi o orn rdofirua mtdn rn I orn uuofi rir uei fi'rnr: uJ dauurj n tf'r filri'ri rfi .rfi .:6ar{uaruara-nreuorniul:orurnn.jr nru chloramphenicol1un r:fn r*r rd o ri'u n ru o rd'n rs r d rfi o o r nztfio gram positive cocci lilfiorrudrrflu ryr:ry'lrjfisynergistic effect n"l penicillin n.nbi'pCs odr.lrds?firflsi1'raudrs iueioilrfirtra*urad'.:ta{u'[ri\oiq.rro*Lrqad uqi'[oiq:ro*Luunsfiorsndfir1m:fln+ol, druIrtd,u6oo7, flLJ:6u eoo run./ofl., pandy 2+ uurfr-,rlu+a run./oo.u.r,r.iod l.ufr srr"u isrli : n: rfl rE a r1'l o I o.l o-n -ta:rornuunfi r5ufiorfl rlfrrfi o adhesive arachnoiditisoutfi o hydrocephalus ru fl ouirul: orat 01il?lr.il.dr::ilr or:uvniqo: dlilr:nrfiold unynr: rfi o arachnoiditis riufi or: nnld'ornr . nrr ud'uflrn{fl .:oou[[: R ufirn d'uoo n.rz. 6'n:cilrfirtrra'und'.: fi'rrir.:u:ndoonla1run o.:'jrLJ'i 6uor 0f,.:kj rur n iroi fi'rfi r\ii.:duts corr"rshp'lio;nnerynaurfl unrullfi ria n.jr Cob web (n.l tfl)u16 ar1'run uo rdn ra u or n fnrT: n ) uiarirbd'uu d'.:ud.rdt'rri'ufia a n or n r{ rur or I u fi ifi ri u n Froin, s syndromerus o vir fi nr: rfi lta,:LJ: duturir'lta*un fir rur n ur o ;rfl uH norn arachnoiditisnr:fnurfi'rrfionrrydn.::lfr'steroids uEid'0.:rurilo'jr'[6-1fr'urrJfr6ruv n: o ueror:nr:Go riald'ufiru.u.in6 l.uini'uioni : eueckerstedt-Stookeytest n?rdril1lfiriahi?u.n. rifu:ruo ooil:yu: : fifiounnf,rrr:Jfrf6ev i o u 'oT0nn1To:?0u14'tO [U 1?r.ry.d1::ilr or:uvninn : eueckenstedt_Stookey test rfl uRt'r yro e o uo.jr fl n r: o o d'utunr r6uu.rnr.no.ro{ no.lrfrnor: Rrrro.lrarrorir'ltfrurfi.nfi o6onr ilH nnnin ur nr: ror: rior n*.: rrsi'[r.ru? 'jr nl ru6'uq.:o qj ufir lou fii 6 nr: vi rd'.:fi 6o n o f i.rgulu,rl r'[t fuu 6',: ut o'[ ri rt r ra:*ulun: tflii'l il nr.i yi r r r,i: r :yt.ru.drrrill orruvn*lo: RlTro,lrud'.:#rluveins('lilki carotid artery ) lrin o fi n trir r n d'l ryun: ddrfl ufr .:nr: 6o srr uH nn r:fn ur u ny rijunr:fn ur o'jr fi n r: qo 6'ulunr rGurir'[t oura d'nai o'[ri tunr r :drs n: rfifiifi oii'so* ru:n.ir rfl uuuo urfirl:-hdun.: :J n 6 r fl a n o u fi'r o r r ru oiuri r'[r fura d'.r o r iu 6 n il : ; ru r rxrn R o r o rfi o n u q o Ci'ul o ryr I rd urir'lt sura fr-.: or n nr: .to-ro uu.rir nrutu ro iurfi rfiorjciorJufiroynfir)^ a Idnrsu firnrnrfluoriridor:rorcnfi.:riaudu rdu yrn fi 16rurai oo.:n'ir rdnriou'lurrr o iurfi firrar nrir.rloz-s Iu u6orfi-r6u luur$rurfiararTrjr6ufirfiorlu fiun,rfrlorr.J nra rdruariluoir rnad.rdd uso.:.irfi nr:nr:dn rc uoan rijunr:fn tcr nrrylil: 6ulurt.r'[to'uu 6'.: q o dur a.:nr.: r6urir\t s'ura d'.:ro rdr.:fr u n r: n: : ri rq ohhi'n r:tu n 16 s ut o rrirb fura d'.:6fi u ur n y ci r u:*unrfra rufi un: ro 6ruluuuofi 6sd no a.roi'r n cir fr'ru ri'rtu:', u d fl o r', ru si'ulir'h fl'uu fi .: a .: rvr: r vflouq:ruilrn oroovvirtf'pariial block rflucom-fifrstur{ndrrnJfruG, piilru:rufi,a.,vd.rluplete block'16'y{.n.crl::iur or:uvnlnn : n1:ooLfluo,:Eion r::-n u r riiua ri r.:'h ?rl fr srryrnti r rtrl fr uG' {rJ -: u 6du n r u fi .t n r:fnBr +e drh:ru6'tnd'u6rua.r6n ratfr'oror:flriruuo n n1: ilur n: r[1: cr'lufirjrs: rsfiy{.or.crr:ttu1 or:uvnino : R.rr1,{urR: nil:oA--ulo.rrEofi'ris uo rdn ra uorn rrlofi riufiuri'Lilo i'uu nru

I 1O lrrttl:(udnr:inurunnudrcn{ndrln 1:otururan:silnrndrilri s qfuli e rr.u.-i.u. zszeadr { nr:vrsrn: nlI:noc uorlunrr:eiolrjfl 6or. Host Inuroln:lu{rhur6nrfinuwq.rarqz. Underlying disease fiuiolil ttiu turralrutrog collagen disease3. Source rirdnkilnl 6n sourc,e"d.ruuoolof{ u.r,r.infi l$Snf,trfonl nr{rrlrjudr6o sinus tractfifiTnrf.r q'iri dimple niohic. rcscnnrdraoun:s?T.r16'funrrfnurs. cl'rla dab n fi'rr^r u rio ri o1: ogfi ofi u u: {n r't?rarn: n11:necldrioudo. {ilruf4ornr:rarlnniaf,n nrrt{srn: nil:nfnlririagddrilldrtr rsua{rl'ls r :ra fi il: cl?lo.riilI: nil oo1uo6n rntuuyrnf draornr: tdsufi fiuro,:liunsnrrvnrrud'ulun:1rnndrurqr finr:lfin1ruuiurfi srrTui e" frlruqtufruoin|o.:{u?rJ ,lod siaut6'firnrrot.oti",-lrtunfiruwlfinr:ifi odu'Jr rfl u16o{re rua ro n ta uI il6'f, n r rl ntlqu r n r:ifi o ii'tl r,ul nlt o: ; u'j r .: ri a {rusrordnreuornttunfi6sunsfrul:n nr:6onruHnnr:fnurornrirhn-urafi': nmsrtn:ndoudrfioornadhesive arachnoiditis :rru6.:nr:ngrn: nil:n {rJrutloddtlttqufi nrruriulfrnr:fn urnrl: rdari'ln rua Idn rn ufi .r z n r rnqhl rioulu:uv r: n oun'jr o:ifi o du'[6'uriuou un:nr:nrra d'noruornil0rG s nttrluiloo:rldrofrn6nr:uil:vnlflwltauqil uwninflwimw iumhvtaip thnritiltuarytmtu h wutn arnvrlnm it o:un$ fi oryrytnTtirtnunurfrleua6fiufruttm4n:I1. Bakar AB, Baker LH Clinical Neurology. Hagerstown:Harper & Row,1980.2. rilriud riutliuor. nr: ioriolu:vuuil: larn. tonct rr il: :noun1: irouRorrlrnnurrr nJ lnraln: ollxrinuriiu.

Vol. 3 No. 2 Apr. - Jun. 1986 J Prapokklao Hosp C[n Med Educat Center I I I: 1 U .l 1 U n I : U: : U 1 U fr r n u r av n r : rf : v ry u rfr rJ fr u?nr:" n r til u a i n n a {tl n t n v n'tJ rt 1 n a u fi t m o{ u fl fn-u f 't rJ t ? rri v t fi s tt',s s I -a0unur 0titogtt 2il.u. (dCIgt)isaSlvvdo9t9t tluugtTufglu yt.u..'1:.:r,rururnl^nrilnunfir i'uvruj ld'i'otfifinr:u::srsfireurnvnr::-J::srurfi.:rJfr:i6nr: 6o.onrrrfl u u: r u I r uril.l r s $ n : n r: d r n o ru fi r r q a J ru rlf riu.l r ung:;rfiuu :yrn'irriud rz-re r*urrnru yr.fl.2528 nrfi'o r:J:vtruto r1: o,{fl 1ur or nyrJn ln fir 6'unql:ruuruinurn:unvrfirfi.:srur'r: ronfnrl :a.:{drurunr:qufiilflffi nr:norufiloo{ fl or:uytytrlfllfl n{63:ut^tsr:JraruuriflsJrfruilfionr"noil:vn{6Irfio:J:-rrJ1,r rrurrr: s rfiuurd ur fiu n r: rfiuu:rr .:ru{rha ucsnr:dr na rufi r rero{ lrtfiiu.Jlur?f -::rflsu uo:rfiolf'uyrvrd fifiEur'{yr6 qnnrn:6u1nnoouriryrirfi'rrr: I rfi uutd'funrrruf un: fl rJ: r n r:-6; t dnr: r*rfi urfr'unr: rfruu:ru.:ru{:-hgttn:nr:f r no ufi r rsla{rurtt'fi'r lru rrq: r rfl s u1t.:r^r sr u r nr'{: r il n rn fir i'uyru1,t9r{rrird'ru0unnl:lf,.rn tr : u: : u r u fr rfl u u a v n r : rJ: v q l r fr .ril:ynoudrurrrni ilsrurn r{rnrirdn fifinutnfi' ilnittnn bwutrtamvilnnffi d\nqi" iha attp nt u h unut aw v iln n ffi du n qiuasri'rrarhdrrr:srflsu drurufr rdu eo nuoradnrorirov\d:-u{runtty rflguuncnfi Aro.tl:.nrg.lulBilt grlnrnf,r{'uvrqi o.:ovfirr:orrlrtJd'ra6 d.rfi .rrudrtit-rrflu6'o ior#un?ryirrufi oorn r6'rnrlri4drfi orfa rrln 1 rirunr: il: vqrri.rrlfr ri6nr:1 oifi n r: i'n urj.r {r:irfu n r: :J:; q I ri.r rJ fi :Ifi n r:oanrflu a n{roo:fi'ul:J loalfiucincn{liinurunvi rn: r ; ri ra rh il r u 4'rJ r u 1 r'l s n1 u ii'.rfirrto dotJtin. n?1ilHilH:nilolurlrilrut. rJqurfi r^rurriurfi'urfiu{turrl:;rf,uun. rj:ylsrf?arnarflrrna{lungnl:cr0aunrr rd u1r afu a onrhfl ru u avilrynrdnuulurdurn"ulrunv:vtiuunl ua ruq: nira.rurlrilrs uornr:{rro rrlqil1.r1urrt: v rfi suro.:I: rxurur on: rrJn rn fir {uvrrr6 r'roqrJ16'6'.ifi 60r. ilrynrnrrrfi uuavriunr1.r una1fl1rtyryrf- nlrJuwrir6uf,r

Ll2?1:dr:qu6nl:f,nurttrnnuaranSndin 1:lnururan:;ilnrndrilfi s nfui z t!.u.'i.u. zszsr{rqrirfi- rfi fl urmdrln: a[r-lrufut{:"n r*r1uI:{ilururn (admission number) fiottnro un:tfiaur1ennfru6o{rJru- finr:aanlurnuilourfi onr:J::ifiruirlilrru1.2 w u un n 6 n ?ln 1 uu av n fi rt t nlf- ntAnmxrJ:vffirrirri*nn un;tfionr:ff$Y'lll- hiinvrunrrdrfi6- fi nr: i'nrfi uiaqnnrrfl .:utJ:;lr ru- nr:vh nro ufl l:J::16{rJrslutTouil d.rs fl rdororn:lqnranrudrfiuz. ifqtrnrr rfurinallunm v riuu2J nrfiauc,Iil OPD card- '|iln.:un:nililn:ufirua. nr:vlrli'uRl'U:'UlUfrIflUor nH nn1:ha'r{r'rild r lrJ: :1 ru rfi lrJ fl fGnr:r1arynfiloinrulra qiafirun-u$n: n'l ln-ul-erq:J:: a ':6d rnfu riararo"'r urr o",rd,i r fiq 6ar. nua{summary shet oia.:otg'uo?rilirilfi aorn utrni un lou tal'{rvlus rufi z (disease data)*n:srud 3 (cause of death) rt{:rsrflsrdosfiunrrd,::rsiruyrr rcfi 6hJfrln: rYtr?{Rttr: nrqr ttn; nr${{errs ritafund'ntn nrdnr:ifi of,g1fifi or: rurornurl:fi o{fl46o International classification of diseasesgth revision unr uur66'o.::rqlfr'foroulou tovtrvi*r:a,:xaiquflr$qz. nr:rirnorfr rrnoilrldlulrutrt: c tiuurJolfiuoalfi rrrra{ fl uvrlrr4rrnlurnr't urT v'6 d lvrr I2.2 nfitIufinnfiiltun ors r[ fi 11 u fl 'r s n{ fi ?: r g r^r u r u r n'[ ui'd r r{iu n r :'l''o fi .:- tiln:ufiru rriu rj::ifinrtenroirlnru qudrlfrri6nr:nolfirrno{iu Insfituqau:J:3no!flufinnnuJft u$:Jo.i uncfufinilrv{rlutolnsrurn drsnr:irfiTrsdunvnr:rr.:turudr tfiu.nu nrooRltuu- orufra€iruliloontv'tJU.l'lu nrttoiullru$ngunnlRT nr:eirtfiunuz.s n16duu xnnrnary chortuo:nr:il::rfiuHn- urrvrdr{'rigurrulll qililn:ruu frn nr: riT ufufi on:: uta.:I:.:rrsrur nfi arrur: otl"l noilfirrno{rnldtd$drisu$d: nr: {on {lI: nfi gndo.:fl q n r il"r n r{ r':rir .: 6'urt rtr{fi H n n: v n u eY.o ei ohl fi r. nuuinr:{ihu ld'uri rrtrrrfiuufr.:r.irhuAnauonruor{ilruh n'onruqrunfior ucvnufio.nJfiffinnr.nrrriuu't n::r{rteifruw{ruin,fiuoolo z. nrruiurr lduri ri'aqn.:od.r qfinrd nu: c uu n r: i'o n { rb nlri en .: riu unr / ui odo ry ufi \,fi'f o ririrarnr:cia r::Jr1.s qonrn: :iq6lu:J:l ur ru :J:vrrd'ur{uftila'rufiruunvnr:tiuz. nr:t"nur fiHnsionr:inr*r{r-lroodr.:eia rfia.: g. nr:io"urJ: vlunito.rRo ufr 1rsroilu.tru rrt: v riuua. nr:6nurX e '^.t nr: fi rnrqu6r.l fl :i6nr: oo ilfi r rqoi rl Iu: rtvlYlu -{r{rirlrJ: rqurfi fr ri6nr: nro'jr n r a Eri fi 3'i rt v{u r r.J'r o r u ri n s r d'a ru fi o n'[Ei6 ru nulr .:uwnur: nrlrno ufi r uno{ rrrlfhiriluil: cl$slilunu odr 16 ltj'i : a unrr rud r t{ ausr\6'flnj: v s I nti nltr nrrt::riaudi.rdfl ofl iln1r arjr.:h fi 6nlrud r ri oua drfiduaqjfi'uuhrurar. nr:t'orfi uioryneir.:1ro.:fr ui rr:b {v{urrt noi?tlz. nr:irR:rvfrfroqnvrrrcfi6s. nr: n1ilrio rynfi d r 6'rgaa.r{:-hu uci nr: ru

Vol.3 No.2 Apr.- |un.1986I Prapokklao Hosp Clin Med Educat Center I l3uusri'rlrri'rrfiaHarvey AM, Johns RJ, McKusick VA, et al. firrurirfi srn'uur'leiadr.:nir.nrr.0 ..,t u.,, fr fii6 0.,,The Principles and Practice of Medicine. zl st $ts "iu0 rT a.n a (abstract) riJurruu nr urlyts ilu6.,Jn o ued., Connecticut : Appleton-Century-Crofts, lor{6'ovird'r rrraoH n.jrfiot{'onrr ru{ro..,o do oo., o..,r9E4:1590 pp.uo;rrnrlunr:duurrrrnr:rorfieiru u.oa.,odfiofiurlrdardrd{o lfl udr:rlrsn grudrniufifi or?ryt6 n a fr il rl r fi u r n"u fi r^r u f fi d r n ut o u n v u yr n r r ru d ui s ru,Nyuy{ytIr?1ilA:]A rfianndnvrunyfiun{rnrlirr rfisrfiugrtuil6'ru ooufirsr6iilocfiorfifiosrunr6oI:n) eals?fl1flnf 6uurls{Iounil1otrfio1Rilt4rivrsrfirl rruulfrfiafltornlunr:6'unir rfufuu:rnnfnr:ruililsfrrfi n{oariuaoilfi ud lfne Johns Hopkins i orr niro rrr: s"':dfi o'rt*rrei rfl u{vr:.r nr1 6lunnnUniversity School of Medicine) 6.r6arilue orrJu eii.r 1 ru livrf Infuunndrofl tcyl1.: rrrvrdrrrilfr f6m1 nnr: tt]rry]6 fi r d r uri uyi.rufiunrrna-rn:fiaulo adr.r't:fiErrll:er:drflurfis.rxrfiorarn.r1il uu! rA ilfi !retnoir lorn dr:r rrirudu f, onnrsiuvroonhranrviniu{eiruaro6o.rlfr orrilqnnr)-a6o riuutlidrurfiloirrr filoocun:ilil:cno!drflu rnu't R"uil nR1: frn ur uny nrr u rfiuro.:r,ir6suiinufronfinu niri.::Jfl r)hnrr lou{riuuriluiur d'nnrr ufilr duq furr: a r: o rlufru 1 oiru run:fnurfirJrari.ludrfiq drnfunlu6grulorI:nisrd lilisrr"uffld n.u.eir I 1 fi fi n drrtirir r o:Iudnr: i'opl rdiluot i'o?1 {uyl il u a ut nr u b wn ut ant v tJn n dt o-u n Grl r\6'n: :fu ucihi rfl su: r ufo ourfi ul:J : r rufr .r fi fii r ruriaufirfiududn ss yiru r*00..'n,daulnltuiltol*v'ius liu ufi?luuneir,l *1 f,lteTrfi ruuurrrnr: ufilrrJruur{rlru unvi 6 nr:fn urtr ilu nru odr.rerduur (The Thai Medical Letter). nrriunil.t !isrd lqiflt"uisuri n.u. efru"nfrrr{ orf.6.fi.il w aryt nn u It wutut awv tJn {-t o-u mli arduarrfl uqRfl lr?.rs z rdaudr{rreuot7a rnnrr l rn6aulu: udurTuur u ny nr:in urI: n oir.r1 6 norlurafi .rfi oo n ilr'lu: : s s rr or'[dr'nu riu ADT rdor.,Advances in Drug Therapy-ADT. nr..rrytn"r: a r ul u qj r fl u u vr n r r ru d uis r r d u r fl'' u r u n r n r: :h v rruSnrruqel 6urqo{ ru*uuuo cunuorin. I:noir.:1 fidrd'raulooqjtu:Jolriu :rufr.:rsuarirrADT rflutr:ar::ruilnf fiilrrcuan.:rruiuclnl rrnfioutu?To.:?,rR1T unvr6lud'n u nry n::J uoyorufi'rrufirfl urfi'unr:lfisrtuvr ncnnirr Io u d'o 16o n i o r: nio d r .: fl r u o ru nlor u n rus ril yr 6 r n r r n trr n : {vr : .rf, nuf d'uorlu o'lR?11 fl 1T eir.:il: ; rr n rfi o u r oo rn n rl er'l 6 ra n n r: dr.:6.:6.:nrulr qj riJudr:r unr rr: c r:rfi oh{rrrvrd unrun or RT yrr rnr: uuyr6'toi'Oq nr unrr ri mr.: rnf,giyrur unymr.:n6fi nfi rtr er: g ru ru rur ci rtiu

I 14 11:.t1:fiudnr:dnurrtntuarcninirin 1:srturtlroil:vrlnrndr{|fi s qfufi z tr.u.-i.u. zszg{e!iufiuZo'1141{aulo': 1u.i114fl i,il ttff v o':r xfir'lnrirnr litrnr:$orsri r 6'o ur.ra lfildlunir ti ou : r ru6 lti o lnr: n: r oircnr;fi sr:fi uua:tJqrarnr.rf, fi trqcrs q6 luusiol6srd l.ufr srt"u isuri r^r.u. uvrl6'us nn drr6.: d'n s Eus Yt1 {nfi fi n nr: snr oYlr {fio.:ilnarytnt u b,twa tu t anit;ilnno-un$ :J fi :i6nr: nrttfi osi'u rnv nlrfn u1fi iru eio nrlrJ fi fh6 n fr .: s-u r u: r nd o n r r n r: 6rt o.: I r n { ru ei r .: 1 l{vir a6auruein;n{rutfiasrornlunr:dunrdanrrtnfi 1uinr o"nulo,'lnl:ori {uaruG u::srGnr:. viuinur Eroufi'rato.:tdrutoiuuud'tfidonr:firro {arrJ:rudo1fi rn6fi n : urrhrufvrgrts. n: {tytv{.t : In:{nr: sir: rfri:ru, gfiooir.:.1 turj:v rvrnlvrufi .:nr:*r'lvrs unv nr ura'.:n quIt2529, 200 t',lu-|, :lflr 80 u111.1{n: u firu 6 r ua rur v d r n:-u uttm6 trtil 6rmr4ill rd o :rarlrf, ofi :*ivrnn6fi ntijuurl.:fi ofi n cir16 rs r: fi :g da':rurfi u{:Jrs:J: v tntdtfl u:J:; 6ri,qdyliluuorl ruRTilR uar r1Jt|u100 n ftrl o1T 6 fi fi il: v n unr: ninh-n6 unul-u6i n.u.drusr:fl s lutdru\dntirrdlsr:fi uorjxtfl uraurour,i ihaorpnt u b wutn ontvilnn {t dunui6o ursiruilo{ slil:1uitfit urrfiourl sr*irtda:rrir.lrj:vuuiurnr:The International Symposium on Epidemiology of Diabetes Mellitus:tungkok,27 - 29 November 1986.Communication: The Secretariat International Symposium on Epidemiology of DiabetesMellitus, P.O. Box 7 - 1006,Siriraj Post-Office, Bangkok lO7O2, Thailand-8th Asia and Oceania Congress of Endocrinology:BanSkok,30 November - 4 December 1986.Communication: The Secretariat 8th Asia and Oceania Congress of Endocrinology, C/O theEndocrine Society of Thailand, Chirapravat Building, Chulalongkorn University Hospital, Rama 4Road, Bangkok 10500, Thailand.3rd Asia and Oceania Thyroid Association Meeting:Banglrak, 5 - 6 December 1986.Following the 8th Asia and Oceania Congress of Endocrinology. Communication: The Secretariat3rd Asia and Oceania Thyroid Association Meeting, Nuclear Medicine Research l-aboratory,Section of Nuclear Medicine Department of Radiology, Siriraj Hospital Medical School, Bangkok10700, Thailand.Ith International Conference on the Impact of Viral Diseases on the Development ofAsia Countries:Bangkok, T - 13 December 1986.Communication: Dr. P. Thongcharoen, Chairman of the Host Organ2ing Committee, Departmentof Microbiology, Faculty of Medicine Siriraj Hospital, Bangkok 10700, Thailand.

Vol.3 No.2 Apr.- Jun.1986J Prapokklao Hosp Clin Med Educat Center I l5IUatoRsl-t5:luulr{dofrnrr::ot Inn-ol-orti, il:vunr curJrvfio, rJ:vfin lnurflrud, alrJfi urfnrfurrr,aIt-t9l rduunouru, 6sri lilindufelrl, rlqrda 4iurn:dicitisDemos TC, Flisak ME.AJRloirnofi{:ra.nurfifl? flu d'n u rucla {Hlf.l rirtfdru cecum fi lfl urrafi oun-uro oro ail3.: (coiledspring appearance) or nnr:onr odrs,i6srudrWCoiled-Spring Sign of the Cecum in Acute Apper,-luqi6'ruuuriuruiroroorrfi o'ldolnff 1r16rsi1.r1 niu rflunrfi?ulronoaljo,J'[fA.]fi {nol'ooon'lilud'l @ostappendectomystump), mucoc€les, tlgtf l, endometriosis$ n c r fi o o 1 R r: n 6 u n-ur o,l Ar 1 a'6i I fi' r.l n 6 ( i ntussusception)Ioufi{':.hu1ilfiornr:fild orir.:bfiorilff.:l/l fAO a ) b Lt il fi r1': r l n u fi { n r r il r fi fl rdo .11, o,J frR v nr; fi r,{ u $u uflfi'unr: rfi old6.:o n rn u {:ra mu6 r'[d'rir nr: 6n urluvr iu r-{il r u r a : r s fi lo"fu n rr orril1 o d 1 d1r qj 1o u n r: a r uru! 6 s il ufirn u'ir uu 6r, il'tilr{r'lil1u'lfitrror fi coiledspringsign oi"ru nu'jrfifi:-hud"tutt{ 14:1ufitd'fuord "*u-nio cecum 1:Jdr,rfiorJnfilrJua n ornfi ue?Tls.r1urI.rldnuyr?uqo?r ilfi o:J nfironnr:o:10drlflraqj6'ru*u6oru loanr:6nuruuufr o u m frrlu{Ll ra fi n: r uii a'i r r fl ut fG r o-R r fi u n.r n R 1?nird'orrfiidru?us3 T1u vru'jrfi coiled spring signi r ru #u n rt fi hi fi u u ri s r rrTrhjlul fd.r t r u-r u r 4 r.l uorfiu6.rcqrJ16"jrtf6s6'nrnuriror rfl udnu.,,,q*fi $i.1rirfrryro.r sign firinn:ru Inn"ot"nd n.u.ilwft diru t lt wn anmv iln m a\ o"u n qiMicroolon of Prematurig : A Form of FrurctionalObstructionAmodio J, Berdon W, Abrarnson S, Stotar C.AJR 1986; 146:239-44.nr:fi fi drldtraqjrfi nn'lrrJn6 (microcoton) fiual nl,{urldot nfl 1 rnqu n1sad1.: rdu drlfr rfi neru ileumq n q o eYufi fl ?urJ or s or n n r: 6 u sTur o r ileum (ilealnr:r^irsi'ounrfisori'irrilulffi.:dnrauz :rudrnu atresia) nr:qoCl'uorn meconium (meconium ileus)riroi'o'lf6,:rurufrr r :runu'irrflu mucocele uor6n rai o n r: fi' t{rkilu qihi fi ganglion ceil r ns (totatr :ruhifiornr'rovl: rdoor:ro#r1u6n z rdausiailr aganglionosis) dunreir.r 1 rudrddrrfl uordaild'ru nrfl urin66.lf,ufi ugru'jrfl unr: n durYufrn:rrto.: fi n r:fn ur ri.:oiru To s n r: dr dl'o rai o nr: s rueirs s r:'[fr6.:firjn6 ornRl: sn?odlurul:u uyi!'ir a tu r a'rru fi uua.:fi flnlrunfloq.: nrw{:ru.:ruleivhnr:dnurfi nrrilfi qilnduis.rrrqililfi uu rirr urdrlillulffi mr un-u 1u rd n n o o o ri a ud 1 fi ilo u : "' r, fi fi ti r rrln ur n n n a o a qicoiled-springsign nru6n to:rufiuu6oilun?1il ::y'jrl szo- r,s2o nfu drfiarnr:fr'a.16orfiau:nnnao- ,^i | tuaZ)fiorJn66u1 irilei'lrr rriu firiouod:ou cecum fi:ou unr6orurnfurior 1 11n:ralrifunr:rirsnry{f{dda.rr{0.: u n ;16'fu n r: en': o d? s n r: e run r: fi u un .r nir d rlf

I 16 ?1:d1:fludnt:dnuruunuflranJndrin I:uururarn:srjnrndrilfi g nfufi z r!.u.-i.u. zszs1"qj fi a1u o tlndfiinJrrfftjrunor'ldfu magnesium rrfi oro rrir rn fi lf rJ: r n 4'j rra Q.rfilf,ti"' o"' u.*dr do,rsulfate rfionr:fnurl:nn::firflufiu lu o :rgdlrifi n noo o d r rd'a a fil o rfi nc nt,:iulrt fi lo n r s rfi o n r: fi r:rfltornsdor16r,urfluir6 ufi'irovfifro.r6nrurnunv n:: fi uo n ro gnlrirfl u z rvi rl o r n { rfi hi rn ulf,rir 0 rlildru meconium finrr nr:n:rolo0nr:aruarrfiu srufrr,niornnoorounvlun rildfirurnlfiirsrfirrIrus.:nirdrldlraqjnu' jrvrn:rsfi 1,uroro.rdr'[d1raqjrf, n ria rnnangfiofitrun-uvtrhjnr rufio.:onrn rrfrrfilanran'irrjn6 16'rirnr:n:rodurdolousuction rectal rfi onr:fi .:nr: fiuanlo gnld a.a rviruo.r{fitrirnsldrnrlbiopsy rfioq ganglion cell uavn:roeTrs trichloroaceticacid test tfioo:ro cystic fibrosis fililr'ru'ir6 r a1 :J'l r n r: c ru dr ni a r n na o o r o rfl uc r ru q u d w o.:nu 6.:n:: fi uon ilo qn fi .:flinulfrrn qH n'jrnr: a rufir.r:rfllofiorrilfiniln6 fi s :rurrsrflurjn6l6'lunrurd'r rio.rnnooor o o:trjd''uiririal: ndutrjs-.rrn nn unvfl nToulildo.rr.irCi'o 6n r :rsfinr:vrvolordrldrafi',:ornruogn16'lou n: r ni ohJri r nrs n n'[ nr: fl o on'u,{a1, o.',rl rnr: n:r od'ru nr: a':us r: fi u rtn.: a frlil r 6.:oi'0.:'[6'fuYlu'tnilooRtu14lJfinnairfio mr;drufiaufi'l "snwll-teJt-cnlnt syndrome"finulurdnler rfiomunruoo'rn:1u.:1u$arnli6nurilrvu,nr anJ:vfio n.u.tl n a rt- ui nynt u b wa t n awv iln m dt o:u nqidrirururufir r6o'jrr.irocrfioo"'oo''rd ganglion cella'.:lil r oi q 16 ulervr o 6.:rla rir fi loi'rio r.r n'jr rJ n 61u rd nfinnoodourirnuo unc magnesium sulfate otnilr:olfi'ri r u: n ur q 16 n fi ufi rfl uu r fi n o urir fi r a .::J:: n r m u n yn firrurdato.:vrr .116uotar:16' A.:fiu{:-hatu:rsfr.:n 6inIndicatioru for and Timing of Delivery in DiabeticPregnanciesMashini IS, Fadel HE, Nelson GH, Hadi HA.Am J Obstet Gynecol 1985; 153:759-66.I $eo a etr f ;6.r'[il6r rfl uorei'olylrnrtrirfioiuei'lu nr: oy rilroodr I n Iu3ruT1U.111t tnil',tn1'fl R1*1Hil?u ttfltu114?1llYl!ulnfiio oroortfifnT udrtilu{d'runr:fiuun.:fifi 6.:n::fifi.rueifl n.a.rgza losurir{rl'rarflu z n{r 6oa)nrt rrafi o q.: 6,rar ori?ulfr meconium n qoa on rr.iru n{ru{:-hu class A 3s41'rrr un;n{u{rJrufi6o,rnt{u arunr:rirfiofiuoytdlun: dfi fihnuvnrr'fiouryirfiu6uqfi u zo :ra lunr:no oo.rtil6't4"'n"'t c,t? onlnlilrinn::nt Ina"afri rr.u. rdnlun::firun'u z i6 6arlufidinn hwututamtilnn fi tun6 tVaginal Douching as a Potential Risk Factor forornflannr1. Rnor?oln estriol (lufl,n.a. 1979-1980 111unrtufl a.ff.1e81 rfluciuurnrornd*u12. nr:f i' cardiotocograph et:to nonstressTubal Ectopic Pregnancytest LtflI contraction stress testChow W, Daling fR, Weiss NS, Moore DE, Soderstrom R. nr:nrrofi .l z if fi r?ruvirrdoorqo:rfi so-saAm J Obstet Gynecol 1985; 153:727-9.s'rJer rf tu{rJrufi fio s1t6u.q 6uuor{r1r$ class A d ilEirirnr:6nr*1uuu case control study orn I:nun:ndou'[d'rrd rosnnaoln:olrlnnoo nlrud'u{rL r r fi l,fit1 nr: aird'o or n nr: fi rn:'r fi ua n rio qn 1 ss r 1ir rdooqs uncdofir rfludu uanorniufiscnro fetalla a o r ri' u @.:fi n no o q er: rJ n 6luri: i rd s r fiu cso : r u lung maturity loal i ror ; ri'' #. r,"' rn. on r rir lecithinrflu control group fr.:rilosn'otfruJisurfiflurTul6i phosphorus concentration fii1fi6,ruei o.r ln./on.tuarq r#orfi unrirurunr:firrn:fi louit'oror{rJrufia'h:Jaoroiqrd16'uSrfi ifvir.rq rurl r rfi n rrufi ru fiu rai o rnsfi .tm: fiuo nuo gn drufunr:riruuorirurnrfioylfinnoofru firrurdauoontrj fr r z nrirurhrurr:JiuurfiuurYulu6a.l nrnrflu{:Ju class A o:lfiriurn:firo.r uoifirarqrn:fi1a{n',rlfri",grdrldolnnoo fi$uu.italnr.,udussqo s-rj o r fr til ufi r ff il ri r d u n: : fi o sfutflul: .: fl a r u r n

Vof.3 No. 2 Apr,-Jun. 1985J Prapokklao Hosp Clin Med Educat Center 117uasntqilnnaorfi oil1nuo $nrilucfl il firurn:Jrnruoqn do:rnruylr: n u: n rfi e (perinatal mortalitylilrn lr; n lfi otor?ol4tril estriol r1 nlu * nr rh nonstresstest drJnrrinv r-z n*.r oun:rdtrJrnuoqn {rlru class A uoy tz/t,ooo rr:nonoolun{ru{:-hufirate) lu:ru.:rufiryirfi'u s.o / t,ooomrrnnoaatunanr1,lur!flu6{n:;{unoao niaorqenrfi +z f:Jnrf raio dolnr:6uqdu 6rrll'irdrrurn uoyoffinr:la.:16nrufl n'l'fir?rfinn'Ifl td nlun::fi il.1'ird nlil6eTeTon dril n6fi fafl ri r1r{o ffi nr:1o.lnr:iir qyq n nooAllJOnrur^nndfio {nm Auqfiufiu oc n: v 6'u1f'nnao1. nT?01{U'jrfi lung maturity ltncillniloQnilnn'r?yra Ra.rdln r{r:rir.rd'urr u'ir finr? no nnodr.:firler d r fioruo.: estriol lun { ru{'il':a class A fair -n3 4 rnvtun {ru{:-hufi d'onnlrAusfiufoa ot r o.z$ciflonr:flTrofYlg contraction stress test rjn6 unytdnoonurrjnfi s lu z :ruhi'Hnu'rnrfisilirfasns zrnt ? o qn n1 y{ 16 nlun:: fi oir si 6 n r: j r il niufr z o ei r.r6.ro;rirslun r: r rur n: nil: ntd6qffi nr:,ua.:nr:n: I {'unr: nooo ri aud ruuoyt uyrr.:urirvia.:1u:ru.:ruddrn.jrfir11:l (fouor r z.s lun{ru{'r-ha class A unyfoua: zs 1un{ru{rJ.oduYronr:6uqfiu) fr.:drda'irnr:nrunul:nrururruorirrdtl,[t'ltflr,fl H nvl rlrirdn'tilIofi oil n 6uny rirhi'nrr ri r.:rura.:: n2. snloy{udlfr lung maturity unsfiHfi'noru 66u 6.lnoqlGnr:lor fetal distress n.:\oi uanornnr er:? oodl ilnadr.:ud.:ri $'ir 16nhi6rlun r: or r o ur nr r r 16 n lu n:: f oi'r ui 6 n r: z a ri r dubjs. fi ufrngruRl: n:?o z odr.rirruriu.jr rdn\ri6 i r rufi'u $or Rt: snl a lung maturity oirti ilra rifi rfl uj'qfi.:rirulunr: o uo'i-n urpidrs1: n rlrurrufi 6.:n:: fi'loi'6.rufi'im;fi lung maturity uiolilfi errrua. fi nrr: *vnndouornltnnluoiu16oo a rodr.rJ:vunr aril:yfio rrr.u.IUllr\:ihaart-ui nttnt u b rwutn awv tlnn it funyietr & r{rlrafi I z n {ru0;nuroril1f'nnaorl.:1io {n noosnrlutn dfi itflufio.r1frnnonlosfi'ilrnilo nnlriru rurssFood Allergy : The Major Cause of Infantileotey n:y6'uRnao Hi a in fi'ngruil $drr6 n ihlnn.irrJ n6 Colitis(macrosomia) Iosnr:n:ron1{oAfin$nyfl6urfis.: Jenkiru HR, Pincott JR, Soothill fF, Milla pJ, Harries JT.Arch Dis Child 1984; 59:326-9.o11ililq{16'r4rnr:6n:*rfi:-hurdn ou t.ro ,.rqrirn.jr r e fl:rn'jrriJ n.ff.1e77-1e8r lolfinr:uJiuurfirrnqrunr9tra :rmo.:rirhuorsdrn'ir z flrrnyrurnn.jr o flld'rlrcolonoscopy nu'jrrdnTetfl il ulcerative colitis u6o6'lfiunr:qr:ro estriol 6.: Crohn,s disease ciruiurfinr6nnr.: histology t^tuoi.:ttu6.:{rrfluorda.: tfiu.: mucosal infiltrate plasma cell un: eosinophilsrurn fl't.t colonoscopy fluifiu.: patchy untfilntl uil 6sJuurj a.: rfi I I r 6nriour6n o :ruorudrn'ir a r6ou fiornr:nruud'.:ornfu:J:svrruuri'r ornr:urutilnrurad'rornrrjduurfluldfosnc z.a lun{l{rhu class A unsfouny re.a tun{ul"i:Jrafi do {nr:AuTAu usioffi nr'rro.t respiratory urudruadar i6noru::il'ir.: + rdoudr z iJornr:nro\ildistress syndrome vru\oifasos a.e unyfouns r.s nrs u d'.: or n.:ofiil'i I nruuruir uor\ri rd n s trs ornr:nrruirdu d.:fi rfl untr nooerrioufi ruuofi udn r6fl r1il16' n i\l rur nruu frstf'urufr'r ua 60.: uEior nr: rarslil ifi atf'oo'ou',un:lilxu'jrfi respiratory distres syndrome tfio arrlr:rn5rufifi'lri qioilr s-rz 16ourfrolfr'uruir6n16n{u1u:rufi s':ro lecithin phosphorus luUro;r\oi' 2 Truflotnlr bloody diarrhea 6n r :rurfiot bloodyMnn'il o.t run./oa. uno.:'jrnr:nosousfiofi6n'jr diarrhea rfi old':'rLur:r-rnruu d'.:orn r fl trj udr rfl onr?n:?O lecithin sphingomyelin ratio r?iuo1 ioo1r41'rei'.:n 6irrarnr: qir,:"l rn rirfl fi Hrl'[:J

118 ?ltdr:qu6n1:f,nurunnuflran{ndrin l:.tr,rorurant:ilnrndrild g sfud a ril.u.-i.u. zozsrdn6ru':ururnfifi fooa alergic colitis firJ:;i6[rVjrslunraunfr, blood eosinophil ql, IgE q{noc t'{u I gE antibodies tfi q sn'irn {ufi rfl u ulcerativecolitis uio Crohn,s disease t?u1vflsfiu1uo .' ' a') ,rlutdnolr{6i'rn'jr z ilfirflu hemorrhagicolitis ar:Crrfl sfi lamrs-ur{udrYuoril1irfi on{'oo11r1:r1rd1guufirornr:ornratilrjrvfrn rnuuflru6 r.il.il n qun nnnn u h wa t a'r am v il n m it oru n ryiEditorials : Traveller's Diarrhoea don't DisregardFurazolidoneMed Prog 1985; l2t7L-72.Enterotoxigenic Escherichia coli, Shigella,Salmonella ttfl r Campylobacter rfl ue r rra qd r fr'rplait travellers diarrhoea g'l Co-trimoxazole(trimethoprim + sulphamethoxazolelf,fnurld'Hnd snriur4o Campylobacter luunoovtona.:fiud'o:ra'lufosnY 53: 1on orlrJtd"ir furazolidone nutf lfl u0'lfn u1lriu'tria[:nooolT;T?.nl[t?nlufllrfisrInguor'{ryuilnlilutttfro Campylobacter unt ShigellaDuPont HL, et al. Furazolidone versus ampicillinin the treatment of travellers diarrhea.Antimicrob Agents Chemother 1984; 26:160.rjrvfin lnrrflruA il.u.th a ry u n nt nfi u Ir tn a 1 a't nrn v il n dt o\ n $Effect of Intraverrous Immurre Globulin m Nehr'ral Killer C"cll Activity : Pmible Associrtiqr withEngelhsrd D, Waner tL, Kapoor N, fuJ Pediatr 1986; 108:7I-81.RA.Autoimmune Neutlopenie 8nd ldiopabic Thtmbocytopenianr:fnull:mnnuaufiuo6fi lrounurirTnnlfiu1ur6ooe1r (hlpogammaglobulinemia) lrnrnf,nrfi ooelufiolilvr:ruer rvrqili a autoimmune neutropeniadu turlclluldld6l4ulnsgfiudonlrnnoordoodr nnlnnr:aanqnffi*folritnlu it1o.nuir6ruXnrlnnryfiufiuhlilcnnr'riliouJdt uuiln.rf4druurllf urazolidone 1f, dr r{o\dnir onr.:loYfi nr: 6n ur uuu double-blind : til'i1'0tt1furazolidone tt03 ampicillin ornfindnsreufgorruinrFc recepton lol mononuclear phagocytes 3 t$inurun!fi'illi8 ells nonr 1 t'ls.t1u {rronunu'ir6lXuIn ngfiurtrtf natural killer activity ao.rillv{du6irutu sa:rs loglf,furazolidone too iln. ilia non$uilaonnnnon :ru.rruildilrnrrfnur{r}ruampicillin soo rR. r1n o dr1u.r lf,nnrlunr:fnur a r106rilrsrflul:nunrrirlnoqfiulurdondr o1qrvirfiurflunnl 5 lu t^ru'irfoan; s5 xo,rndxfilf, s-osfl uo;rllurflultnrnfinrfiooduBnhivnrufurazolidone ldHndnrslu ca drlll n*tfi ampicillinfl1tilq 6n r :rgrilul:fl autoimmune neutropeniateiHnrflsrfoun: gz rdonnrlirillil 72 ritll.rdenrnruosrflufouns zcr cgrfi a uJtsurfi suurfi r z tfiocioriodrfl unrruqfi nu'ir furazolidone tf,::uc trn{unr:fnurrlosn'irampicillin srufihitaHnlunrlf,ulfin z tfioo{lu{rJru e ?1sut r{ryt1{ilnaorfionduurn 3oo iln./nn./n*.r uwilrnrrn: ? e rru d'r ur u r Sn t 6 o o'tlll ri o ubiu r u nc u fr llfu rso-oo urfi HorJ:rng'ir natural killer actvity ono.tz 1u s fls {rJ'lubn autoimmune neutropenia dfi:rdrufouoy 21 : 26 lu:rofi{rhufutJ:;nruuonnaso6i1ild'lsfrlonratd':fu$rrrnro t nlu / an. HnrJ:rng'ir{1ututfint6oorfio flushing type reaction n'l.,fiu{t Srln:flndoufnurguldtse/ou.ll.lu{rhufild'tu furazolidone q.rn'jr ampicillin lu nfi.tfnr*rrlu16' o,aoo/nu.u. natural killer activitydaufnururnn'ir r,ooo LU nonltnda zoLllufrrnrnfnur eiauhnnfiurflulni6n ld{unr:fn$rdru6lryulnnqfiudonirnnanrfiondluurn soo u./flR. {ilrulilnaunuorcionr:fnur d'ru{d'rubn

Vol.3 No.2 Apr.- jun. 1986 J Prapokklao Hosp Clln Med Educat Center I 19lrdoEio steroid uffv cyclophosphamide o:ru{rlru s tu o:radsiorn 6o 16ooirrfi otilvn r uc r ru qfr utd'fuomulo 1 nfil /1:o6n6$nr*r6'rsteroid \d iha daa nt u a af TniJ 6 n 6 h w a n t aut v iln n {t 0"u n G{rhuRR. 61u?14rR fi o rfi aociau 1 rd ruduorn 6,000/ ou.r,rl. fiHnrdolqrflu$!! FSGS fi a:rufidosiour"y"lophosphamidelufiqorfio renal insufficiency 6nriountl'i-nuruflu es,ooo/nu.ilil. 1uiufi r s rad'lornlfr'grufirnoar6n luiufi zo 16-tfrsr6nntmuro soo 2:1ut4lurilur?n 12-16 fl 6.:fi r :rulilldfusr cvciln./nn.drururn6erdaond'ururci:;eiurJn6 \d6o Iophosphamideqrrufrr-lu 10 rdaudlu?urnfiorfioof,.ror.lrjnfi naturalaluh ur:hrif'trl yt.u.killer activity r:rnn'lr t,ooo LU ufi.:orn1frnll:-n:*r aha n un nmn u L iutt.tul a* v iln n #t o\nli-$s ' 2a ) - ) u!, )tol4lRlUARlilO?UYl 20 [Oftl 15.9 LU S{rljltolilRqt",e; u A,Posterior Fracture Dislocation of{udrtathe Hipr$'o.rvro na nfi 6 n o r6ous'ia rur fi f,larilu:; 6'uwithFractures of the Femoral HeadrJn6 uanornfru{?lu.nuu'.JldyiT Rt?nona.3y{ui1Epstein HC, Wiss DA, Cozen L.uonlqfl rosqlo:sfi fizunrirlfr' natural hller activityClin Orthop 1985; 201:9-17.oor o { uoi*aun'jr6 ruXuInu 6udo rfru ooo rfi oo0i'rcuu? urfsrriiur il.u. lorrt:hl4rt :ufilei';uq rmnaqr7aerln n,nfi auil nn ufi nynrr tr Ir r'ria'ril't am v iln n {t olunryi 6'ar'[oi:'unr::-nr*radr.:nrairunrfnullouiforifnt'tfiu r:losnr:6{n:rqnlri'rdrfi ra nrun*.rriudo rfl ufar{rlLate Resistanc€ to Corticosteroids in NephroticSyndromelouuornyrionrlnnro6ou type V o1il Thompsonand Epstein classification ty{:1so:litlfrrdoriioSrivastava RN, Agarwal RK, Moudgil A, Bhuyan UN. ui rr rudo n y}^r n\oi'iu dum:', r, u"' nfr t* uny oi n v1 r1finoJ Pediatr 1986; 108:66-70tr eA o tr16'6nur{rhu nephrotic syndrome 61fi{rlrulrariilnc so-50 rrsrflur?nl 1s fl nu'irfi 14lufind'un: yendulrli'n'ld nr: i'on: yon1fr r{rfi nrutu za :*rlu.:o :\6'H nd n'jr R r: a-o nr y q Rtfrfrr fi nra ra fi.r d { nril riruf rfi t o.:nr q n rfi l n: runu rir u# r nrsu firn.li 6 {nr v q nriJul:n6nunv6ooio steroid 1u.nilfl101'd'o{il?CI bi'uir fi drui 6 atfn f fi u il rai o nr:eir Ci'on: :q nlfiXtooR 2 T'rs rn:r;aroruotsr'tri61rooslfi'nrrifiods r :r8 r{rfi fir urnliln r rurr ad nR: vo nbirfrrf4uiasfin u ru:tltttn; [ilrl1ooqlo 1 t1U rrafiofirjra rz:ru rflums Blln fio:Jnfi ilnnit{fiufdronXrnrvonfiu:nfirin (arnilsd$ovu€l 4:1u orufir3rurflu nephrotic syndrome head f r a gment) fi ft ria ri ldlun r: ri r ri r eYorYo a: l^r nA - qgvi q -6o r -a fl srounuo.lsionr:fnuroim steroid u'rl{ 0.8- rfi a 6'o n'i v o nlri'rrirfi lu: rt lrufl r'r I'i r nrr 11 rilr il'o t'cra, i a'.tt v o )& |13.s fl (ro6l +.s iJ) r{oR'r:o:?orfiotqn^{u'jrri|un: r q nlri'rdr fi 6 r usi u: n o y ld'ru nd rio u n.j rfo s nr so[tuu minimal change a:ru Mesangial proliferativerusifi 6n'jrnr:f,nurd'rui6or$n rifiuilIosnr:6.rn fiu1figlomerulonephritis (MesPGN) z:to $nu ruirfi ufi u.lorir.:r6ar ui onr: rirdrCl'o nruu fi{ (16'H o6Focal segmental glomerulosclerosis (FSGS) t :tu fou oy ae) un;trJa r il1r nfl :,il6.rH nnr:tf,er::lnr rni.r'I A lle Xfl ?110 R 1 :',lu to sD2 ouuotqr ufi o rfi onr:dasia steroid ro.:u'rn::qnfrutrfi rin'ld r,r,r:r:fi nrt6onlui{nnr:ufilflu FSGS 'l6'r4rnr:snrorfiolqo*ofi 2 d"ru?ua :rs,{i{n*.iilrntiJurluu minimal changes 14u'jlln :*rlurir m : u; tu {rJT afi $fi oar1r^rn rndoulu type vdnr: fi: :u s rr nr n r: 6o Err ruH nnr:fn :ldururf, s.rnorflu FSGS frnaruo 1o''t:Jdeiuuirflu cyclophosphamider v{r 1 v ry'd ? s ilr n n d lf a s ns s o o s rfi o nr r :rian rL^r n11 :ru dilru e'tluooufluo.:sionr:fnur zlu rf,arulunrsfifi.r3o,s rluf,rlu[ijut?n1-z fl 6n o :rsfiornlrndltiJuqtrd rduunorru fl.u.

l2O 2'rtd1t{udn1:inuunn0fi rcn{ndrla I: orururon:srJnrncir ilri s sriuli z r!.u.-i.u. zszsuriria rrnr ln nr:fi {u fi a a n out'r u n'ruln u o uf u'irConsenative Treatment of Fractures and Fraotupdidocations of the Upper End of the Htunenrslruro:ro.rfr "rrfilf,q,:rfi unrr r riluoi.rf{ oclf, tYunur:rtuiinrj:; drlu odr1: fi nuinr:mo na roira nrrJuYormg TB, W.llrco WA.rfiarirf Bonefoint Surg 1985; 6I:37.:*-77.1 d:rsou'ir firrlrnrur'{tfioq{i.:1fsrt methylenechloride rilufirrh n:nrs Tosyrr ra r6nrrarur:t'r0{ludrflunrrdnur{rhuzz:ru fifin:;qnfiuBludrudfurin rflu {adr.rrd grrlia fifaln r{rafi aui r ilrirr 16'lu nrdn u1 ru uilr c Cfuilr r oo,r InglfrirRf,o{Rauncuru rulcro.rfnuf rro;rirr{udrfir a1qrodu oo fl {:J'lu oa :roldfion1r,r{sn'nfnnrrfl urrnrun30fl o lfl l,rfga rui nrBuuo illlifi sr:iru 6onn rlxlurJ?nrnrlrirfiu o.ootI (ro ppm) nfrutrirrunlufiorJnfilunXuriodr iln ua n orode u: nnrnylr {t1'{fl uncnr: ro? qriulnrorvrr: nlun:: fi rlr1flrrfl ulrJ nr urj n66nciru 6lfl ufi ua ilfu'irnrur lfi rjrrs orns r: nr tv.l6uo r6au tf,onr:u"nrarffi3qndu[lunruduuillnrl f,ia$Jnonfiucia{r6InnNeers classification {rJrutdr4rnrunlv{d1fon1su fi.rtrifuurn r{urodn 2r lu $sc n: srirfi o riafiurfl uind lqinfufnri rtr.u.iln atp mz u It wu tannt viln n {t du n rfinnr or lu lo06o'irHnn.r:{nr*lirlrolo rfia{ilrufr 1 rrr nn'l n$Du16',rlr n n'ir 60 o.tft1 ! n lt1ulil 6'1ufl fi ,trilfiad:ncldunsrxuldfiflrrrrr{uilrn Hnnr:fnr*rlddria{l)'lnnr.rutu1d'foundr oo orar hiarlr:nsnuxulildtunfi,rruiiaf,:ut nlauluintliltduil?ouncH onr:fn ur6 rfi o{rJro n1,! uxuldrn n n'jr r r o o rarr 10.r1 iliy{ u'j r {rJ r u q.r a r q f I i n: : q n du uru s r ufiu rfnReexpansion Hypotension : A Complication ofRapid Evacuation of Prolonged Pneumothoraxfanet Pavlin D, Raghu G, Roger TR, Clreney FW.Chest 1986; 89:7G74.Reexpansion pulmonary edema tfl unrrsuvr:ndauf4 rfi o1u{rJro{4 inui arirlu:io uJ oo rrurusrur: obinr::fn r*r uuurj:c il'urjrc na.rld lnntidrrr unc ror oilni orir aanadr 'trrn 15r 6.rrfl ufi vr:rufiu6!fosnc ga f,Hnnr:fnrr6riarflufiriryralo Hfr:orn lu{rlra ur l:10 o c v{ un1'lc "sho ck-like" syndromekifuqdhrnqrfl urrnr o r6ouqn6 riilurnretnu $.u.ilw dail nn ua o{ Isilfr n { It wa u t ant v il n n {t du n uir?$drsr{: ru uulei: r u sru{rl'r u e : r rrd s i n illu?i o.rrJ o orir *60rilruru nrsu drornrornloanorir s:ro rirlounr:kiriacioriurnia.rqo z :ruunvsiaXfrrir r rrs rfioDecafeination of Coffeenrt: Rrrdudrfi o . lfl r,{ u ffn u nrvi'r ldn firs fi'u6ollorrb DH.inllu:ionjon:J:;rrnr r d'rjorririaunrrfnur fiJAMA Asian edition 1985; f (11):71-72.ernnrrfi ipnn'irnr uylH.:1fi nf4rJrr a rr fl f, 1tor rr'l 6u (decafeinate coffee) r fi ofu rJ: c n ru nirtjreexpansion pulmonary edema'rir.:rdurrYu irirdlrlnffivrrfiliu nrrudl'udr unctdi:laarr: {rha4n:ru pulmonary u&rarof,nrhlfirfiorvrt.riuld'fiu Dr. Diane H (a-rs ll.rJ:ovr) snr{u r :rsiiliiilrn:rfioofi'aonMorris rflnuo'irsrrilqirfioornrfiahiuruuri fiu rrnrfrtoelr $Jra r :rsrduilnornnllnr'rlounsr ru'irCf'rrlrn; nroluaurunr:rrYn rarary{6uaon orn unaordaofiltnnt (cardiovascular collapse) 6nrrfinntudfido methylene chloride fiurfiorlrlr 2 rrsim?luynn fiau ldud lnrrsrduur^{fiu, ischemicnnnoiluuX losllier:dluluronrnronnirrJrnlnagolitis,disseminated intravascular coagulationcn.rrlrbirfi o rtc 15 duld' iiu odi4n,il.rtqrYurrn un: Ischemic necrosis:tos humeral head

Vol.3 No.2 Apr.- jun. 1986J Prapokktao Hosp Clin Med Educat CenterLZInnlnlunr: rfi onrud'ueirf,.rlilurifo r6o.irfi o louc1:J 01R:.lu\:.ru[[flvnr:dnurriou,t rruril1n1flir n r: ro r o ru rr ur e'rr ri., o o n o r nri o.r rJ o o a ri r .rd'r q Io u1. RITnOA{10.lAr:irlU1600olir.::ro15r nr:siadoldrirrnr clamp lri'rJdoraonfi1 rai onr:ot n n 1T r{rlil odluyr: t.:o n nr u fr{dil o oru 1 u o1'.) gooonfiaun'j'r 1,ooo ila. orhi{..r1fi'rfiofl.r?y reex_z. finrr:sr:rirlur6ooAroqjriou 6.:rfluruopansionpulmonary edema uoy nrr ruoi'uEi r ui o6o oolnnr?fi nr,ludalrJaauru 1 irrurYu hypoxemia gl'rilu1s. fi n r: n o 6io n 1: yl 1.01 1{1J o.:.n fi r ru rdo ri'rl orlqria qiurn: r,l.u.(Myocardial depression)il w a rp nn u b wa t u t awv iln n fi {u n u}

I22 ?r:tY1:qudn1:f,nurunnoarao{n6rin l:lilururnn:cilnrndriJfi s qfufi z tr.u.-i.tl. zszsIdln ? 01nfl u8nl: fl n ul t tvt tlu fl 'l d 9F nnu Rq,s | -Y -e"t-.-^-{l:.tuurulaull viln tnol ounutt:ru'jr.:fufi ro 4urrduf vr.fl.2s2e 6.:iufi zfiuroH yr.fl.zs2s f,fierunvr6*uflfi s uri.:oonriJuz n{ldrrnr: dnurto{fr d nttr{ndi'.:taforJ:r6uqi.s. uvrrr6raQ.rr:rn:r[ f,3nfs6 I:.:t{or!rntJdnutrn:fln:JfrriG.nulunrnitrrrr:-lfrriG nf,uvr{qi i'.:uiorJ:r6uuir4ittl *I:r?rurura::00.1 i'.:ilio:;uo.l uavl:.:r^rur-urnorlo 6'.rlion:roflfiquilylfiiufi srosguf,nr:dnlnulnlsnrssr{ro. ursultnfiarqvm d'er:fetu1fi Ir.:vtflrurn{ourun: t'nafo:J:r6uqirr. urnrfiraQln::f,nr{ r6ltoqnsfil 1:lfisrnfifinlr.:r,rururaynr:Jnrnfir {uvrqi drr5onr:6nur urnnfiuvr{qi {'ualorJ:r6uqiurmuarnqnfnrfin :J:sdrflnr:f;Ru'r 2528 rrnv'lrJ rz. urrvrfiraQtilnr::ar l:orii.raf,rr lr{rrsrrJfr 116':ru e* I:.:r tur ur ne'ir.: 1 6'.:flur nnfi uvr5uj i'rnlorJ:riuuir. urg[r^lyr6ooruri'n6 n:fiour: I:':r^tgrtrn r s. uru[ilyr6fiiyr.:ffi iln l:.ryrutuloolvnsulilavra.: i'ruforn!i'.:ulorJ:r6uqiz. ur, vrdra{.rrnsi fi o6't:r'11 I:.rnururnrauo.tluqji'.rraSotnuju:rrra fii 4rusi i'lu{orhr6uuJr +. ur rvr6ra {.:ilnr:: u 1:J q I I:.ryrurur nt6'r-s. ruvrvrfiraQrarrn ni roi qe::r^rfi o l:.:flururo r s. uruultyrdi:v grrufionr:fir 1:$,rsrurnlil't-,AAuluu,J 0.:1 ?oTolJTI6^Yl-dT4. Ltvl?lfluru.:o?.rRltfl t?lu?qJustiu1u tytn 0.114?0aytx.JtYnlt't'3v{u'lL1ns. ursunndroor iluriufisi 1:.:nururnilnrnron6'iuio::aa.lo. u'lrvr6ra€rs'i'usr r::oris*ud I: lilgruraenro 6'rhi'oo:roz. unyrdufi.JRl.rRRT qnfroiryunrilrun i'.:ni0umurunc ^ ? X - asI:.:yturlrn8. $v{Ylul4 tu {1,[19.t.: ff.nuf t:.:y{tj1lJ1 ofl 'I : rrR2rlriou i'oaioi'uvrqiro. rnrvrfiraQ.:rurfio srilnsn 1:.:nsrurnynrrJnrndr{'uvru$ 6'.rulo{'uvrujrss ou0nunr:flnu1$o{q 'tdnr:n'nurilnnuflldgrinfrfrn l:.ryrururoilrvilnrndr o-unui rj:vdril2525- d < a^

Vof. 3 No. 2 Apr.-Jun. 1986 J Prapokklao Hosp Clin Med Educat Center L23nu11r?!fllfln{ fr'ouareo{ un:alq:fllfre# il qu6R'D 6n !r1ttr'tilrJfl tF o{ nnfi n I: {r'rsrur ar'{:silnrn fir{unuj rn; mnirl r?lerlfl o{qrilu*rl:t ru I: {nrn -ulnttRn{ iirrnounol {'.:illor:cuo.: unrl:.:y{s1u1oljoirfou drrnoTrj.rfirfou i'.:rafoi'uvrui lurir.r::asr?nrd.rdr.in{uii r ::ra.jrllufi sr fiurnil u.?t.zszsfi.rfufi ao finursu l'{.fl.2s29rin{uii z ::H"ir$ufi 21 nrR1lnil y{.fl.2szeo,J?uYr 10 qalnil ?{.fl.2529rin{ufrB rru.j1lfufi r fiusruu v,a.2s2sfi.:fufi 30 ilnlrnil y{.fl.2s30-4t"ui zr tuy'tuu n.fl.252s itfufi so nqunlnun.fl.252s fifiouy{yt6*uflfi's iruru rz nu urilrflu2 n dil aantJfln:J fi rJfi \r.runlflur rrllo.r nlnirl r?sarrcr{qrurut'irlild'itirin{uii r ar nuufluut tylflutnei..tuflyn.trniuudrrnattnn.c {'.:ilfo:setaitrln{uii z{'rnfot'uvrqildfrou:r0rsrlrJfirJ6.nunrnsurrud'ldiufi za rilu1uuorirourftr losursf,usvarirourfs nrn rlufi rs f,ulnru il.fl.2s2e fi.:iufi 9 uRTroruyr.fl.2s3o fifiouy{mdfrufld s druru rz nu uri,lri]u6 n dil aanhJiln:Jfr ffi .r1un.rnff u.rru.rro.lnroin rrsar a erf q rutuvTr\rJI:.rr,r u r u 1 n! ilx1* si'.rolil iir. I:.:rqsrurmqr drrnotq,: i'luioi'unliz. T:{nururnvirtHri drrnavirlrari 6..:ufoi'urqis. I:.Jr{srurnuranrufilS drrnouunrufirdt',rraio6'uvrqia. 1:uarurnil;tril drrnarusut o-.luio{'uvrqifn10s. 1:.:ilururnr11ff fi { drrnorrrafi I {'lraioo. J:o^rgrurnrtfinil.lou drrnouunrulari'.rnioEnroJlufi s 4runrr{uf,n.s.zsso fi.:iufi o fiurnnyr.Fr.2s3o fifiouilnd#ufld s druru r z nu tru.raaRrflu z n{l bJdnuruocflnrJfrri6rulunroirrrrraq.oUI ral utii 166runrrn,:.rdrmaru;.utr u4uam? tU ru !:.ry{ulu.lortuo{ i'.:uiotraol uns1: {ilur:Jrn0:ro,i'.:fi fo sDro-

124 ?r:tlrtfludnr:f,nurrtvtnuarasrfn6rin l:lnururan:cilnrnd1iJri s ofufi z rr.u.-i.u. sogsur.:arrro3rufis rJiurfn6nqn ut.:nrrf,ur fivrfi ue6u1.rn1'r1{vrv{: 4aorirltn ur.:crrr,nd r.le6od ut{fl1')fiirm fiururll ul.:Rl?qnrrd er.:ar1q.:6ol ur.wrr6'qtd 1:ou6uj untur.:arroitpqr il?.tr.{Rl ut't1, tu n o | 4 A & ,!--.!tiilfu: t1nt't [uqt 1 $l4u.:v{u'l 1..t1 n1t11v{ 3 El': [o?uYl 1rultlul{ vr.?1.2529ur.:orrfgfl :1ty:oonfi'l urlerrtiqor vlo.:n.:urrnrro'uvrur tnlruiuut'1fl1?1{tnot oonntoourrsrrilsi uadrsiiiEr: u1.rfl1?fliln?: qt'[rrqndua:urrsrrtirtur tmufru rn: ltdrfrnrtnr:luirrurar.i.:^&ilar:Jrnrnniin z fi.:rrEifufi 1 tilllluu l,l.fl.25291.{l.rvlsail fi.:nsn ngrurarnnfin a flruhJoir:.1Eiruurtlnurul0[vrniin a T:.lttururodu4f, i"luio- ^& ,-;fuRil n{$gr'tl.tYl 1 ru1J1u1{ }1.fl.2529uour.:ruai uaoqil t6'tufirfinuturn r flrs'lrJoir:lEirruri .:t{rlfirdrnol r', u t 1:.:fl ur ur aucnuru n twtov '-)untuluR st.Jlrsl?uYl 1 1il19191{ v{.fl.2529urrdro: utiruuru ilu1u1oas'r6v{ 4 flrtlliloi r: .roir urar.i.lt{ u r ur nigrir,{ a T: .: r,rfl r ur nfi'r u tu fi o.:c, ,- ;adu1o}t.ti1 nn$flluYl 1 uJ19'lu1{ }|.ff.2529i^u1{a300 u'I.:too v{ululntrnun 2 g'Iuil1olnI:.:r,iururonrl,i::ur 6'.:utorJ:r6ur.15 fi.ruoiiufi rtill9'litu ?{.fl.2529ur.:n:inr arurJ:vfio v{u1urnit16fi 4 f,tuurornh {r^turnn r: t6 or n g u n:rt tdudu t'uaio rtui 6 lrroilufi 16 ullJluu vt.?(.2szsur.:r'ul fio6n:nirvriu nsrurnimdrq o frrulilrirs'rrrnrr nr I:rnrrrranuo{n'ru treionuo.:nrgfirrrqiiufi 21 trlrJruu v{.fl.2s2eurrc.fi'uur fiuqulnao nururnitrdu s lou\rl muf r di vr sJ r n o.J ui n r'r nr {i fl u r a r s n{ u n: n r.: n r:rurm6 I'1.:nul!loRo'r{ cir*nnr:unyt6 h.ruoiiufi zv{01'n1fllJ y{.9.2529ulau?:r,fl elruqofnrl u1uttr{m6 s ilru{nq-e ffraurornb.:- ivrsr I:{r^rururnfrrilr.r ftnlnf;rrjrr frraurdr:.turu unm6oir: r5 r{uq llne or ruriiyrur louljn nrrluilulf inulrroiiufi 1o ?rq!rn1nil fi.?t.2s2surulrni fl:Glrnnrnntn:urouv{n6 e ,Jru.&RTIJR1TIIYIilU N,IrururoqenGetf furaloqenGofi fi.:rtdl# 13 l{qumnUT{.fl.2529I:.rrnrururalil.rririouuru rryrvrd i: r tr rufi onr: fir un3$1s llfl Yl6frno16.rroi ryu: qt u:: ltriu:rrnr:ludr rruri.:ulu lll'lYl6 4fi.:ueiiufi 1 tilt 'ulu vt.fl.2s29ur.ranisfid nilnan rntul.tfll?illul afYllru: 1 nirfu:rgnr:luoir uuri.:r tsrur ntYlnfi n z fi .rueilud r nruruu Yr.6.252eI:{ilururottna.lu'r.rRl?u.iulro fiuhfurfit urrltilfutunlt1u6rrrari.:r^{ururnim6tt s fi.:ueilufi 16 ttJl*'tull vl.fl .2529I:luururo:vuo.turro:t-etut 4nfinurd t'tsrurnilrirT a louhJoir:.:6rrur.i.:r,turur nigrir,{ + I: o turur ncnnfi u d rfinnr:unn6 n:,nrrlr1 filucilufi 1 ilRilntt rt.rt.2s2e1{1.:fltJvfi rur,lnll rfirrarirdrrururn s ilroliloir: rdr urari.:r6rrarirdr^rq.rn::fi aur: nrql s enrdouuiu:iruat.: i'{ulo:;ao.: firucilufi 15 rm1nily{.fl.2529ur{r:rtis.l ururil:vtnig fiunuvrvrf s lrlrtsufi'usrrur ninsr fiunr: srr r: ilqlln nn n'rn {'rulmnrrdnolflnor,nllauilrilrufl'uon::il fi.:ueitufi 16 ltn1RUyt.fl.2529ur*iuu r::nrvlnf ?{uu1ne!1i1'{ s frru\Jfiln$rurorour,rriu i',lltlorouutix filust{ufi rotJR:lfrtj vr.fl.2529urraiqor nnqvrr4fi nururnilriil + rlrsnr:vuJl u'r ff I:.rt{ur!r nsi f,'qqr n: unr: urtvrd n1{tnil1Ioururoir: reir uur.i.n rgrur nitrivr a dranr:r'{srur nfiuroilu{4 r qlnrr{uf il.fl.2s2e

Vol. 3 No. 2 Apr.-Jun. 1986 I Prapokklao Hosp Clln Med Educat Center 125ehunurursuvrnd s drufi ri na o{n 6.rirsifufi rofiurnl u.a.2s2su1uil:ynoufio i:chytay ulsrilytd 5 ntur?rrJfirlfirTrlil I:.lvrsrur oafi .rfi :s {'lnioc.trrar flrs rjroirxoir uurirulu uyrnd s rlru arq: nr: ru fi .: rreiiud r ofiurnru fi.fl.2529l:otur urnyr: vrJn rndr tfi'unr$ur.:rqnferrl aiarlnfiufs finnrsnrndr:Io +rhorrtn:rldur{ rrirt*unr:ourrurfi ,rrJfi ffi nr:60 Inrs nr'{drfonr:fn urdrsn:s rnldfl ror.., ufi dr 1os1:.: ri nunru nrn rJ r rIo nr nttr s'ns a r a sri ru I:.: ri uunrsnlrfrrlo dnsnrnfiuuril *u + rsn.ir.rlufi' ro-rnfiurnr fl.a.2529ut,lfll?fiofl?rvr ffinleruqnrir rnr:dnur -fl no ur u-er.rlurnf,tn: 7 $nrurldrrur fiuqfnri rnc-sn: s rlrsrns-ln::ru rrirlurmornulaonr:lf,narufi rroo{lwilrsrnf,rnrr ilyu1u.r nIooqudao rfi lera{nr.:rnf,rar an{ 1 wr orn: niruuriilarfisnr nosrnf,raran{ qwrn.ln:nilurimurfrsi'rudruls ulrlsvryrds rhuarqtn:: * nirfuo:n ru6a.:nr: i'o rfi udo ruanarrfiloo{ or fia,r:J:rqru 6n1n{n:urd $u z nruyulrvrsflrsoflwrnrn: niruuriyrurfiu :yu.jrttud zr -zs:swir$ufi rr-zr fiurnl il.fl.252e.ut,rfl1?oou1,fq qr:rrutld lrorurn o rfirlu tilu1u1r vr.fl.2529nr: f,uur ri a ln r: r{ruur ui n r: r,r gr ur a r o yr.l y 6r.rlt1 u'l\rfl 'l?t{fi.Ir: eu frruroiq ufl o1R: q ilrsuirar:.:vrrrirrfufl za fiurnr yr.q.252e drfufi 4 rilnluu uuft'rtJ rfifunr: o u: run fi'nqonr: d r rfi unr: mr iifirr,-'laavr.fl . 2529'nr 1: rt^rsrurn:rtifi1ufi z louno{Sfinr drfinnu:Jfiornyyn?\rfl1rrrildt1lu1lfl'l?q!101 qralafircSrln insror:6 s Lrn: ru s udfl n o u: u u n r r{our n1: ff 1 r rr ruqr il n6.r u R.r nurlnrrofqqt qqrr:u ivruror:6 s inurfrsuurura Rnt.: 6'.ltatornui :vra'ir.:tufi 21-30 rrJuluu y{.fl.n:ril n rn fir i'uvruj ivrrn or:51u il rdrfunr:?ln:J fl ffi 2529ouelroorq:n::il fnon::il qrnrr?tR;ril unys6n::n utnsy{t nquilst'trn yra.tu1n s rtfur.lduuur:cn'ir.rfufi 2 tilt*1uu fl.q.zszs fi.rfufi so nyusrflu 6 a.rnr: firuur.nuui nr: war ur npYilralu :s u.ir,Jiudlt{.fl.2529 :utflurrar o r6ou12-16 viqunrnil yr.fl.2529 il 1:{r^tgrurn?rr;tJ{Rnundruroiqlo rturau gn6'r.r,r.h;dr nlrsrnfrn::nrdr:rlrlr:1uou:trJfrriBnr:lurlrsrnf,rn:ril los u1nn1?uy{?:Tru frrruroiru qnatn: + ilrfluiilr:no.rl:rilsruronfinrn irurTul:.:nururn:rrqi il .nur,fr'[rj unyut.:srtiuour oi.:iqn finitrnr:afi6elrsrnftn::il 1:rvrarurn:rrqi .lsra"jr.:iufi'az-r rujltluu fi.fl.2529utngnt'r:t'l mifu ilururo a rdrfunrrau:16o.:ou: rly{ur ur fl rrt:-l fr f6vrr rerr : s ra.jriud 7 ril Elrlll?{.fr.252e fi.:iufi rs fiusrsu yr.fl.2s2e eu I:{r,rur!roilfi'nfiunrrl!frrj'lrn'rvrdrl{.:nrnai nmaria urstty{rfi s rhu4rur:-r?TR:? rJ r6uvrr.rhjdn ol un, o o.rrrfi'rJrurr: n u: n rfi oru nrnirr4u:ngarec# nilsttyryrufllas# f;i:rtyru'rulailHringrfisilfion :;u.jrrlud r3 runrur{yr.fr.2sz9 fillufi 16 y{qun1nil y{.fl.2s2erurvrdnfl.rf,iffnrd r6u:r{.:f uruuilyrd a rJrun6-uirrsn::il r,rayu'rsryryrdu:i{rhsim nr: nYrfu nr:o u: ru,ri a.:qr r er c Eri nr: niqrur6ruro.r rfi a rfl urir:rrnr:fi fl r.l:: fi vrG nrnri rufudr-

126 l:d1:qudnr:inurunnonren{nirin l:otururar:cilnrndrijri g orluri z tu.u.-i.u. zozs:rtntn c6'u s- s lor g ur nli"ortnr:r't oti o.uwi.::Jtv -rm alnu i r lfi'u ruuri nur fig siur6uvr:il: nr u'l it ltfl 1{nr s nrrJuivtu'r fl 1fl ir{ yt1.:Yt: tn ilrarinsr fiu alur6uvn -iI:nr :sudrrlufi r s-r e titqunrnx il.fl.252erurvr6uQ.r$nlTtt or lnf,olsrl ursuv{Ylfi s slrsf,rfi I vrs r 16'furlulmir rru6 fi n u o{ o rfi a q lrurfi u r fi'uUltrasonography ai r.hrrrnn{rlu :;n'jrlfufi zov{qun1nil n.fl.2s2e fi$ufi ts fitnrRu vt.fl.2s2eI:uururottno.taurrfifinG r1qrur tnfrn: a I:.:rt$rurattRn.lrrir a u: u rd a r n r:1f,4 rlul: n 6o ri a vr .r rd uu r s1 o u n vl:nfirnrh ru drrlnnururnr:nfin:lils nl.tlYlv{"::cn'ir.:lud 21 -2s tillt1su ?l.fl . zs2el#lnrJfi rIfi uuoulil: un: urJ:ssunrr nlitrilriufi t:;ra'ir$ufi e-so iurRl fl.fl.2s2eI:lnururo:vuorursunn6ilTrluvr6 rofinruufi ursul{nf s 1:.rvra'rul nr i s o.r o u: u 6 a $lr1: ofi ': urlrn frn qent : u I*u r r6ou :cil'jrdufi s-zs 4unrr{uf, vt.a.zszsnr 1:.rt^rgrurafiriififiunurwrfraQ$ntiar ururrJtrsig rhrnur^nd s1:.n rfl r ur n: r o u o u ut, 6..: fins ar s n{do.lJrniufi a:cndr$ufi s 4urr{uf, il.fl.252e fi.:{ufi 30 luulaur'{.fl . 2s29 nr 1: {narurn:rtidllluflrlrotr H.rfinfnruqn firuud*nf,irn a 1:*l'{rJruln:suor aurl6ornr:lf,nolf,rrno{luahsu1ufllsln fioilouqn riT rarirrlrsu?ilr:.:11{-rnf,tn::rw nluvrtrluln ru quJnolfi tna{ T:ixurua1il1nnn:tf,lnrinmfiu ::u'jr'r{ufi t z-zt iurnnft\rJ + 1'l.tnururnunr t{rou: lrfinqer: nr: drrfiu.lrruvrr.:irtriufi z nr qu6flnou:lun:r{ruurnr:-v1.fl.2529ff 1!"rr ilqx { nglu nlnR nr.: i'uatotnqi : vu'jr llufi il1.rq!1or orurlrfin drunrilrnf,tnr o I:*21 -30 rrll*1gu lr.fl .2529yrslulR1;sor aurrttarnr:lf,nolfirrno{luCrsfifi n*r'rn6.:rruin{ o$Stsrrl fifi nuvrvri{uvnefirnf,tn::ranluflululn u qufnolfitna{ I:{ilur-n1 il1 n.rR? r[ :vra'ir.:fu fi zc- za fiural r'{.fr . zs296'anrrnn unvfifiottilfldc[gr^r: rvra;iln fifiorrvrvrfiul$ufl fi o o1Rfl rucuv{yruarner{ qwtn':rniilutivrurfii,

ChaMO1) Na,It isThebeenchlor2l Eal+ ^^IL UCIDooycanstatewell asIS ASsolution,parnamtnoaminoessentialth Vuj-Ntn2nrr]ely 1.

I-eukopenia due to radiation and/or chemotherapy.It is well known that the sctivity of oboxylaw in liver homogemte of albinorats grown on a VBr deficient regime cm be enhmced by adding VBt (or Thia'mine diphosphate, hereimfter abbrwiated TDP) to such deficient tegime or furthelincased by adding Adcnosine triphosPhate (her€inafter abbreviated ATP) to VB'(ot TDP).The exploitation of INOSIE-F has originated from a report bv BiochemicalR@m, Tokyo Agricultural Univtrsity, that when INOSTE F' instead of the rbovementioned ATP, is added to VBr (or TDP), the sme results will bt obtained'The study on clarifiotion of this mode of action is still kept going on and inpuallel thdewith, fundmental experiments have als been wnducted frompathohistologiel and biochemical viewPoints.lComposition ard PropcrtierlGensal name : InosineProptielay name : Hypoxmthine ribosideChemicalname : Hypoxanthineg-P'ribofurabinosid€?n t - o:--lStructuralformula ' UAn-1-- I THl\r'r/-N "c--c c -c-cH,gHtttllAaionslHOHOHH1. Ph.rmeologicrl rstionr(l ) Inqinr prrmrt.r lhroueh th. €llwlllt. r)12) Inqin. trk.t di?cl pr.i in tuglr mt$oli:m'l)'2)(31 lnqim raivrot .n:ym. orklizing pyruvic rid.3)There arc many reports akadymade on metabolism, its activating efiect on14) Inorinr rstivetr donely xanthinloxidu. rtc.?)heptaic function and its action on the maintemne of ATP leYel in the ells of theDone msrow md L-cells md moreovs, its action on the cirolating system has alsolreen proved sufficient, thus dtawing attraction flom the mediel profession by mdby in its application to clinics.eir uiu firJ :: n oul: n f, nrJ:i5) lnorinc trkar p.rt in tynthariring nucbotidd (or nsla6ktG) in th.cglnirm.2)llndicrtionl Lrukopenh due to radiation and/or chemotherryy.[Adminbtration and dongolUsually administer l,200ng - 1,800mg u lnoslne oraly in 3divided dorcs ps day for adults.The dosge may be incrasd or dereased suitably accotding tothc patient's agp md symptom.

Vof.3 No.2 Apt.- Jun. 1986I Prapokklao Hosp Clin Med Educat Center 127n7ruflHei7eiufi rz-zr iurnu n.R.zszg fluen::rntrrtt!trnlflt -ua!tu I:{y{ututnrxtdi.t tirrnorrrai.: f.rnion:ro leYdnor:r Hdd. I oet u. lyrjdruru so nu lnoniuhflrinr:ilnrJ [u-6n:u{riu nr : ri uunrnyr qud or rio ril : sr rI:.r-Trt'lulnlx'lrIi{{ud r rluruu lr.rf .2b2e ulunr{yrdduor InarRr:t. tr:o{{d1u.lun1:dlrunr:unn6 I: fl'rururau:crJnrndr 'i'uvrrll:-u r o u r iu u i n rn ri i o r r r : 1 u n r r,fr'q i r u rYu rla { o 1 q r ?i{ a 1 dilnnolsn ::!fl r: ui t r: rx drnln rair'ln isr,i'unu i nr rio.rnitiru runr:l: lnururan: srJnrn dr niuvru ifufr u rrulurr n.?t.zbze urue rnlS n-uf,dr::slai'ir: rl n r : r-lu io r'u vru i rfl u rJ r y r ru rij u.,u d, t'q ou.,qq'.rdnIa ul: lnu'rr'r urr rrJ n,n dr i'u vn1 "i,, nvlrflri uu r; qr{ulnn{.rii dn uoi alr io.r uncr{u niR u rJo q7u f u: :u.lortauriurriuqrnrn{arorq nr #o{il:clu z l:rnururnlr:;ilnrndll"'unui

128 21:dr:qudnr:inurunnuarcn{ndrio I:lnurural:cilnrndrilfi g sfufi z tu.u.-i.u. zrzsdud u ruuluu rt.tt.252s 'l:otururan:srJnrndr Cunqlrluurio,pnan:rtr:d utvr6n{qoru{m:;urlnln nviorqnnar:o{fl1dn:rrr:d uluunndnu'u qqurn {drurunr:1:wtururatrrarcn{rtniou u::tlrurlrautf o{ RecentAdvarsin Malada and Immunodiagncis d Tropical Diseaseor #ouJ: ;qu r 6ndrurunr:1: utoruran: ;rJnmrir lunuir-ud zs uJrluu fi .d. z6zs Rotsltulul a: ; n'uui ur:I:rnururnrgnrfu:ufruqlnn dlrdnfluqlan rdunrluqnudruuinr:rlolI: $rururarr:cilntndr tiunrli{ud s nqunrn! r{.ft.2b29 srm:dttnndrro;ridnrrnndIn:qnr:r qudnr:dnurnnnunrtnJnirln 1:ilu'luroil:cilnrn.ir iunrll r.ririrurJ:;pilrnr:J:c{riltollu utouunnd:cuufaarrvuillil: crnfi lnu ot I: ltt: u6crns{u firdnr-unqi

Vol.3 No.2 Apr.- lun. 1986 I Prapokklao Hosp Clin Med Educat Center 129{ufi ze ilqunln! yt.d.zszs olr1rduolrldnuflildaudnr:dnuruilyrualdoinAfin l:lnururan:srJnrndrr'uvrrli q{1ufi 1: {.rluu0nfi l.u ! :: uxrd druauunt4ndrrnorior drrr-n: vuo.r rfi of, nuritqnrvrr.rdruorlrourfurlufi so r{qun1nrl n.fl . 2b2e rfl u {undrur"ud"lt:fl nxo{il:su'111d rJ16nyr: vrJnrndrrdro{rir"r rldsrulrvr6ln: l-n r : d lr a i r n r : f, n ur un nd dlr4 iu r l ? r u il vt "r'ldr r lil'r rrlra1 u 6nrJ: ;nirJn l: lnoruron: ;rJnrndr t'unr1f

130 ?'l:dr:{u6n1:inururnudrcnJndrin l:.:nururou:cilnrndrijri s qfufi z r!.u.-i.rr. zszsst lf a.rq {tlu{ludogtRltufl ugt.llu: ou 3 roouOuarterly Statistical ReportDepartmentMedicineSurgeryOrthopedicRehabil itative med icineOpthalmologyOtolaryngologyPediatricPediatric patientsWell baby clinicNew bornObstetrics & GynecologyA.N.C.ObstetricGynecologyFamily planningPsychiatryDentistryOther serviceTotalNo. of Out-Patientf an. Feb. Mar.2,9111,'1654372,"1122663029195943191,076455788260s6079224213,0992,594'1,1025451,43925423s9555722969083896602s853281333911,9912,7201,2621,O271,842262300883508280'1,00439570928150193024913,153No. of ln-Patientfan. Feb. Mar.48628852't7402563193299234"1,913408279109"1618207296300't32471,912391273147225919428029s135:o1,840

Vof.3 No.2 Apr.- Jun. 1986 I Prapokklao Hosp.Clln Med Educat Center 131MinorMajorGeneral surgeryNeurosurgerYUrological surgerYOrthopedic surgeryThoracic surgeryPlartic surgeryEyeE.N.T.ObstetricGynecologyTypes of OperationNo. of Operationlan. Feb. Mar.88459't47163299321503038236939s14811267782030"t6372285€8153124211452055272722General anesthesiaRegional anesthesiaBrachial plexus nerve blockLocal anesthesiaMiscellaneousTypes of AncsthesiaNo. of Anesthesiafan. Feb. Mar.30011413135682599971115832845201s853Pathological Examination Unis lan. Feb. Mar.AutopsySurgical pathotogyPrapokklao hospitalOther hospitalsCytopathologyPrapokklao hospitalOther hospitalsClinical hematologyClinical chemistryClinical microbiologYClinical microscopyI mmunology and SerologycasescaseScasescasescasescasescasestBststeststeststEstscases164W31594449384653,1609,4302,9923,9833,1901937929287323294292,6506,6083,7853,8392,555938129388310300l02,7'197,3263,7223,8722,767

132 ?1:rtrrfiudnl:dnururnu;rcn{ndrin I:{n0rurnfi:vrJnrndrilfi s ouiufi z t!.u.-ri.u. zszsDonorBlood Banking Service Units f an. Feb. Mar.VolunteerReplacementProfessionalTransfusionWhole blood & Packed red cellWhole bloodPacked red cellLyophilized plasmaFrozen plasmaFresh frozen plasmaPlatelet rich plasmaPlatelet conoentrateCryoprecipitateLeukocyte poor bloodCompatibility testEmergency cross matchingMobile unitunitsunitsunitsunitsunitsunitsun itsunitsunitsunitsunitsunitsunitsunitsunitscase5unitstimes/month6032733307126314172't464',|62893668477235441863252332220'l22347322121,5446845433881555915433262t71825)1,006624E.K.G. recordE.K.G. monitoringFetal monitoringTypes of Special InvestigationNo. of Special InvestigationJan. Feb. Mar.1821039175105516614s6Plain studySpecial studyUpper Gl studyK.U.B. studyBiliary studyArteriogramMyelogramBronchogramMiscellaneousUltrasoundTypes of X-RayNo. of X-RayJan. Feb. Mar.1,35"19136271684't071,39779352618631071,324893232157I)90

Vol. 3 No. 2 Apr. - Jun. 1986J Prapokklao Hosp Clln M€d Educat Center 133EsophagoscopyBronchoscopyGastroscopyPeritoneoscopyCystoscopyProctoscopyColposcopySigmoidoscopyTypes of Endoscopyfan.5394159171No. of Endoscopy730211516Mar.17201'141131{rununn::Ilt.R.n.il.lt.R.:hurlorunr:hiurt1u,Joouflut:t uo1:'lrJ/sniund'nun: : u, oouflufr oiln6. f,uqor :runr:rrTrrflonttn::'ln::]Unrrqqf,u:lU / cUnr::hur:rnflu:1u/dn1::-nurl:nrJivr-ud:]Unlunn::lrl:vdujsu/:lun-unn::lo"nflu:lU5t26813s13832OOl2774ls61616456283138218317212288le5421245731014s3344230132071754slsnludnral:ilar1ntfltu.ft. n.fl.{lt.R.llsf4tu(t9t.u: r tTn:: ilpJrnn::11n: romd'lnnoora-l9tt ? t u3r:,:t suyr: lJrr: n1l't[[ruUn:OUfli?dhunur: rrrn::u9r:?0drn1il16ndhurrrn::uo-rnu.l1ud1flnu'll#acJf,'nur: ruilnnaqt 4 rtficrtflnul: tuno!qtt < |lr,trrrflnulaolJ?asun:tn: iln:.1n:,rn: ilnu/nY.rv.nu/n5.1X,fi:.t' lrflqtn'n rrnrlivru a ni.l'-liarn'nurnrling r nil Hdsruocrwuunjronor: r ni.r1,0761262922605941,63411,6342,44013074*'.'tflqrR'nurnxinu r ni.rlrtqtn'n ur nr.rlnrfn ri r ni.r9088922125857234413442,O52J2622**1,ao41002712815081,57611,5763,01114902***

134 2r:tir:(udnt:inurttvtmuarasrinirin l: lxtlruran:c'tJnrndr ilri s nfuri z tu.u.-i.u. zozs.nuflo.rn"ul:n ll.R. n.il.ail.R.l:ndoindu d.fi.li.hiindulildlodorindu fi.'f;.i.nr: nnaoolul: {nurura"lr . qY vs{nrd{r.rt}t{luqrnui0u1doinduursrn;tina

Vol.3 No.2 Apr.- Jun. t986I Prapokklao Hosp Clin Med Educar Center 135nuflanurilrlflornlf;oIt.fl.n.il.u.ft.1. l.V. fluid 11 1ilru2. Dextrose 50%3. C.P.D. solution4. Ringer lactate5. N.s.S. #rlrrarn6. Peritoneal dialysisolution7. Tuberculin test'l :1008. Tuberculin test 1:1,0009. Water for injection: ? uu'ril: rfl nrnrf; odnr 6nleinn:nn5nn:afl:afl:an:an:an:an:o9l:6,:110701003502,350.03.14250E,930.174,4O03501,5003s0.03.142so6,950.174,75050503501,2003s0570.03.147,320.17I q Yf o -nl tunlu tun'l:Hasl9qflununl:f.tanntitr i ;,duafl'lrlJocT{c[oi:cilu-olei1J',lvlu'l1lu'11180,370285,760205,39061,650219,200157,55065,880234,2401 69,360

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cTn er a Fitiun ul R't s o't Revlriroduaruo'r rio nicr uur o dl n atIssllr daaf,ra'runr nuuf,au nrtlnil"rl11tl60tlfnt. 23€l- azqil

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sieunarurj:'rrsrurduiuh rrcrunod trJ:vrnnulilu) iirnhMetheraimParlodelBellergalMosegorDihydergotw'ndnuav,U d'tutituutZaditenHydergineViskenViskaldixCafergot

siruofru"uYrulRl:o'tRDOOUA cap. (thiamphenicol 25O mg)PROPYL tab. (propylthiouracil 50 mg)NEURAGON-A tab. (perphenazine 4 mg, amitriptylineHCI 1O mg)MODIM cap. (loperamide 2 mg)SULPYRIN Ini. (dipyrone 1 gm),ro,ilunua'lvtu'luu?1.d.1.1. fI: u:vdvlfi lofl cfezalt ouurrirg:-n flao{611u nE{mvr"r 10600Irn. aas-ao8g, 466-1042, 466-gtsod

TOPICALTHERAPY FORGENITAL HERPESaEffectivelyinfection.a aa Rapidlyresolves activeresolves symptoms.Convenient to use.Su itable for self-ad m i n istration.

nalnalnlriTaugltcolo Syrupa3a1ut6tufi3 u::yt10rnr:1afrf,n ut#r aUlulnitf CrrfnUnder Licence of lstftuto BtochemicoItallano, Milan ltalya-afltfinUlsanlcu 1rnfi ou $Hd[u n:s rvt'lsa.tur:lro sahlfffrfin utdfu aU'lUmdU tqln-aUnder Lbence of Chugal pharmaceutbalGo, Ltd. lirkyo, Japanfifa - lzuauN€o - Vlbon:hud:nmr5udr riiulr"rnsrofirrrfiu u rfirfin uifir auful|ldtt ehn-nlnhaDlsolasalul6rufis ufirnralnr:la{n6in ut-tFn au'luhat drn-n{unuc'rnri's utrft autuul$Jig6eoafnt.277o2gg, 217o42g, 2Tr26sa, z,7266scrnh

Turafhi[rntrin'rst-lo-ln:VmSulnrdldoraz arnntr?dau e 1a{ruriu ) n$$a1at{rru!?{a.|ng'|? unurttau n!0tnil||nTrat 1o9oo

PROTHIADEl{. . . effbctive and well toleratedantidepressant.. . . good anxiolytic action indepression.I t. . ....lowcardtotoxtctty.. . . suitable for the elderly.. . . convenient once- a-daydosage.

PNOTHIADEHConvenientonce-aday dosagez100oEe0&F,. a'ZEEls0zeoz(JI&IE? 70;)igrfrlI] t-EPSgJ r{t5Fs0vU )-E p.m.Patigntakessingle dose ofProthiaden 75-15&ng)/I- E7 t-2 am.$hcp patternsimproved withoutned to eo-prescribehypnotics andtranquillisers-/t am. 2 p.m. E p.m. TIME(hr)Patient awakes No qeed for Patient takeswith nn sedative a day+ime next dose ofor hangover dosf Prothiadeneffects"Bffause of the high failure rate amongpsychiatric patients in taking presribed drugs,'it is a distinct advantage, in this patientppulation particularly, to have availabledosage forms of the drugs which permit onceadayratlrer than multiple dosage".Hucker H.B. er al.,1. Clin. Pharmacol., 1975, 15, 168.Itf/I>THE BOOTS CO. { TXAITRND } LTD

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&a"to$riuvprnsvrfrJ. ruei uaul6Cotulnaso'rnm51 uauart nuuqquin n?$milillrrratfnt. 3917952, 3915188' 3917936{^-tllpr.ttnsire..oFlagylOrudisOruvailDE.NOL

INFLANACDICIOFETAC S@IT'T EITTERIC€OATEO.?AB1,ETThe €ffectiw,sofe NSAIDto cnercome trpurnotb diseosesR ffi'*$ofie'urE'

KENACORT-AIftTACETOilIDERapid control of symptomsLong- actin g colticoste ruidUp to 28 dan0uration ofeffectTith(|no IniectionHAY 'iE\'EB!%"oA@@Member pharmaceuticalProducts Association

&qosriuvpnsvrfLJ. ruasHu rnfr€u'ruFina,g- b _ d E b-ljtrlclDls o'lnDl969 - g€ft auutoFqn?trTvr:. 2231011- 2,R:\tltnililfilUnl223386s{^*tCIMIDINECIMIDINEBETALOLBETALOLVERAPINllptot4r,her ooo2004001040m9.m9.m9. (Propanotol 10 mg.1mg. (Propanotot 40 mg.y40 mg.(Verapamil 40 mg.1

acts faster and stronger3oo.t 6. Topi€l corti@id. Crem and ointment. Q@pqgli9q The tolerated, Nn by children and intants. No systsic efGcts or allergicactiw subslan@ ol Si@rten is a rihalogenat€d synth€tic topical r€€dis haw b@n repsted to date lrritation d ffiive dayn6 otcorticoid, hal@etasore (0050'6). Indicationsr Skin dis@6 r€sponsiw th€ skin, itchjng, $arting and lollaculitis he rar€ly b€€n obc€red.to topical @rticoid therapy, e.g. I Crem: ,4cute rematous conditions Packs: Cream in lub6of 5 g and 30 g. Ointm€ntinlub€s of 5 9 andot wrying aetiology, such s acute @ntacl e@ma. acutg eG@rb9' 30 O. For further informalion, w package leafld.tions of endogenous ffia, nummular e@ma, sborh@icffia Ointmenti Subch@ic and chrcnb e@mdous condilaons ot alcLNr D|Ii ToF cal corticoad with broad-speclrum anlimicrobialvarying aeliology, such as chronrc conbd ffia, chronac agent. Cream. qgqpggiligq Scoden plus coniaids a trihalogenatedendogenous edzema, nummular €czeme, sborrh@ic €eeme, lichen Eynthetic lopical 6rti(id, halomet@ne (005%), snd a br€dspedrumardimicrobial agent, triclosan (1%), in a slightly acidsmdd chronicus, psoriasis vulgaris. Do6aG ild appli@tion: Apdytwi@ daily to the alfected area and gently rub in. Restridigns on iise: hvdroghilic cilin-mter mulsion. indications: In6ed (or inleclionpione)fcrms of acute walous-skin disw ol wryhg adiology.Contra-indicationst Tube.culosis ot the skin, syphililic skin afl€dions,G6hliilFii6fr6ns ol the skin, cuta@us readions to Ecination, srch as eute @ntacl wema, acute *cerbatioB of endogenousplodema, and mycotic skin inHions. Hyp€Ereitivity to one of the e@ma. nummular e@ma, *borh@ic @ema. Initial trcatmenl lorcomponenh contained in the preparation. !b!g!FELg@E In clinical highly innmed mt@tic skjn dse@s. Initial tre*nent tor highlystudi€s. Si@rten crem and oinlment haw b@n tound to be rell inimed foms ol pyoderma, eg. impetigo @ntagiffi, loiliculitis superticialis(B@khanb impeligo), qrccis barbae. edhyma, intenigo, anderylhrMa. D@ge and agDlidpn: As a rule apdy twi@ daily totni afi*ea reaiiZ g€ntiy rub infhere is rc n€ad to c@r th€ stewith a protediw d6ing; wing to the pr@nc€, or risk, of inledion,@dusiw dGings should nd be @d. Regriclions on u$: Codra.Indrcations: Tub€rculoss of the skin, syphilitic skrn atbclionq lrsh ur6infe(lio6 of the skin. cuian6us r@ctions to €@ination, andftyp€ffiilivity to one oi the mpoffi @Mined in Si@ftn plus.UMnted 6ftoc.ts: ln clini€ltdals, Si@den dus hs bsn lound to beGideiaid, m lV children and infants. Non-sp@ific irritation of theskin (mild ilarting, ikhing, and reddening) 6 @Giondy obseredand, in €.y rar€ insta@ @ntact dlergy or atroplry ol th€ skin. Nosl/dflic e{Gcis due to percutan@us ab€orpti@ of the @rti@id @m!poned rere e@untsd. t4!g Tub€s of 10 g and 30 g. For turtherinlormation, s package leafel.CIBA.GEIGY(Thailand) Limited, 4Ol1 Soi Samarnmit.Ramkhamhang Rd.,Prakanong,BangkoklO2SO Tel.3147434-9ruaor src /

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*CHom'for: intensive care,major su rgery,nosocom ial infections,sepsis,unidentified pathogens, -problem bacteria.t.2.J.4.5.o.Septicaemia, meningitisOpportunists and postoperative infections,intra-abdominal soft-tissue inf ections.perioperative prophylaxisI mmunocompromised oatientsNosocomial UTIPelvic infectionsPleuritis, complicated bronchopneumonia, bronchitiso exceptional broad spectrum o twice-a-day injection o reliable and safeHoechst @

*ClafOfarfttone or the wortd's most advanced antibioticsAntibacterial spectru mof clinically importantantibioticsKlebsiellaEnterobacterShiqellaSalmonellaProteus mirabilisGram-negativeProteus.indole+roosPseudomonasE. coliSeiratiaBacteroides tragilisHaem. influenzae, B-lact. -Haem. influenzae, B-lact.+Neiss. meningitidisGram-negativeNeisseria gon., pen.-sens.cocciNeisseria gon., pen.-resist.'iEoE:t=o)(L=o.-(F:xxlJO()o.EoEIIIoooc6oo.-q,goIIIIF-stoooq)()OIIIE xo",2 :

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