Background Physician-to-physician teleconsultation has increasingly played an essential role in d... more Background Physician-to-physician teleconsultation has increasingly played an essential role in delivering optimum health care services, particularly in orthopedic practice. In this study, the usability of a smartphone app for teleconsultation among orthopedic specialists was investigated to explore issues informing further recommendations for improvement in the following iterations. Objective This study aimed to explore usability issues emerging from users’ interactions with MEDIC app, a smartphone-based patient-centered physician-to-physician teleconsultation system. Methods Five attending physicians in the Department of Orthopedics in a large medical school in Bangkok, Thailand, were recruited and asked to perform 5 evaluation tasks, namely, group formation, patient registration, clinical data capturing, case record form creation, and teleconsultation. In addition, one expert user was recruited as the control participant. Think aloud was adopted while performing the tasks. Semist...
Journal of the Medical Association of Thailand, Sep 1, 2012
Giant cell tumor of bone is a common benign aggressive bone tumor. Recurrent rate in the patients... more Giant cell tumor of bone is a common benign aggressive bone tumor. Recurrent rate in the patients who have the tumor with soft tissue invasion is rather high. Use of strong chemicals such as phenol and liquid nitrogen to lessen the recurrent rate might not be used in this lesion. The experiment was carried out to discover apoptotic effects of thermoablation on giant cell tumor of bone to find out a possibility to use thermoablation in the clinic in the patients with extensive lesion. Tumor cell suspension was prepared from 4 patients who had definite diagnosis of giant cell tumor of bone. The tumor cells were subjected to thermoablation at 45, 47 and 50 degrees C for 10 to 30 minutes before were cultured at 37 degrees C for another 3 days. Osteoblasts and chondrocytes from the last 3 patients were collected,prepared and underwent thermoablation in the same fashion. Apoptosis of tumor cells, chondrocytes and osteoblasts were carried out by the use of flow cytometry. Thermoablation at 47 degrees C for 30 minutes resulted in < 50% chondrocyte and osteoblast apoptosis and 70-90% tumor cells apoptosis of 3/4 patients. Thermoablation at 47 and 50 degrees C for 20 to 30 minutes has more negative effect on giant cell tumor of bone than chondrocytes and osteoblasts. Thermoablation might be a useful tool for local tumor control in the clinic.
Introduction Nucleoplasty is a minimally invasive percutaneus lumbar intervertebral disk decompre... more Introduction Nucleoplasty is a minimally invasive percutaneus lumbar intervertebral disk decompression using coblation energey. The technique is indicated for patients with contained herniated lumbar disk who are unresponsive to conservative management as an alternative treatment. Many recent literatures proved that nucleoplasty is an effective procedure comparable to the standard treatment, but its long-term result is still controversial. Objective To compare effectiveness between nucleoplasty and conventional opened diskectomy and to evaluate the economical aspects of nucleoplasty Setting Department of Orthopaedics, King Chulalongkorn Memorial Hospital. Research Design A non-randomized prospective clinical trial with full economic evaluation Patients Contained lumbar intervertebral disk herniation patients with radicular pain who had undergone diskectomy and nucleoplasty at King Chulalongkorn Memorial Hospital from 2004 to 2006 นพินธต์น้ฉบบั
740 words) Background: Infiltrative growth pattern is often observed in superficial myxofibrosarc... more 740 words) Background: Infiltrative growth pattern is often observed in superficial myxofibrosarcoma (MFS) and undifferentiated pleomorphic sarcoma (UPS). According to the past literatures, radiographic infiltration of superficial MFS and UPS on magnetic resonance (MR) images indicates a high possibility of histologic infiltration. In recent years, this growth pattern has become widely recognized as a primary risk factor for local recurrence and possibly distant metastases. However, the role of radiotherapy (RT) as adjuvant therapy remains uncertain. Questions/Purposes: The aims of this study are to clarify the efficacy of preoperative RT strategy for infiltrative MFS and UPS by examining pathologic findings and patients’ clinical outcomes, and to reveal current issues concerning pre-operative RT on infiltrative MFS and UPS. Patients and Methods: From 1996 to 2014, 252 soft tissue sarcomas diagnosed as malignant fibrous histiocytoma (MFH), MFS, or UPS were surgically treated at our ...
Background Most photography-based arc of motion measurements require human assessment and their a... more Background Most photography-based arc of motion measurements require human assessment and their accuracy depends on the observer. Objectives To develop a digital image processing technique (DIPT) for measuring elbow range of motion (ROM), and to assess its validity and reliability compared with standard methods. Methods Physiotherapists performed digital goniometer and inclinometer ROM measurements bilaterally on healthy volunteer elbows. A photographer took digital images of elbows fully extended and fully flexed 3 times using an 8-megapixel smartphone camera. Extension and flexion angles were calculated using the DIPT. Intra- and inter-rater reliability of all methods was assessed using an intraclass correlation coefficient (ICC). A paired Student's t test and Wilcoxon-signed rank test were used to assess systematic bias. A Bland–Altman plot was used to show possible range of difference between the methods. Results We measured 56 elbows from 28 participants. Intra- and inter-r...
Superficial myxofibrosarcoma (MFS) and undifferentiated pleomorphic sarcoma (UPS) are highly asso... more Superficial myxofibrosarcoma (MFS) and undifferentiated pleomorphic sarcoma (UPS) are highly associated with infiltrative growth (tail sign) and local recurrence, but the impact of preoperative radiotherapy is uncertain. Eight consecutive superficial MFS and 10 superficial UPS cases treated with preoperative radiotherapy and surgery were reviewed. Pathological response, surgical margin and magnetic resonance imaging (MRI) were retrospectively evaluated. Oncological events were reported in a descriptive form. Pathologically, nearly-complete response was observed in six UPS cases. Tail sign was pathologically detected in 13 cases, eight of which remained viable. Among the eight cases with viable tail, three cases, including two with positive margin, locally recurred. No major discrepancy was observed between tail length on pre-treatment T1-weighted post-contrast, fat-saturated MRI and pathological tail length. Tail of superficial MFS and UPS can retain viability even after radiotherap...
Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2012
Giant cell tumor of bone is a common benign aggressive bone tumor. Recurrent rate in the patients... more Giant cell tumor of bone is a common benign aggressive bone tumor. Recurrent rate in the patients who have the tumor with soft tissue invasion is rather high. Use of strong chemicals such as phenol and liquid nitrogen to lessen the recurrent rate might not be used in this lesion. The experiment was carried out to discover apoptotic effects of thermoablation on giant cell tumor of bone to find out a possibility to use thermoablation in the clinic in the patients with extensive lesion. Tumor cell suspension was prepared from 4 patients who had definite diagnosis of giant cell tumor of bone. The tumor cells were subjected to thermoablation at 45, 47 and 50 degrees C for 10 to 30 minutes before were cultured at 37 degrees C for another 3 days. Osteoblasts and chondrocytes from the last 3 patients were collected,prepared and underwent thermoablation in the same fashion. Apoptosis of tumor cells, chondrocytes and osteoblasts were carried out by the use of flow cytometry. Thermoablation at...
Clear cell sarcoma (CCS) of soft tissue is a rare melanocytic soft tissue sarcoma with different ... more Clear cell sarcoma (CCS) of soft tissue is a rare melanocytic soft tissue sarcoma with different cytogenetic and natural history than that of melanoma. Objective of this study was to determine outcome predictors in patients treated in our Institute. This objective included the effectiveness of surgical intervention and disease progression after surgery. Thirty-one patients were diagnosed at our institute with clear cell sarcoma through tissue pathology and immunohistochemistry. Patients received multimodality treatment (surgery, radiotherapy and chemotherapy). Five-year survival rates and prognostic predictors were determined. Sixteen patients were males and 15 females with a median age of 37 years (8-72-years). Twenty-eight tumors were located in extremities and 3 in the trunk area. Eight patients had metastases at their first presentation (6 local lymph nodes and 2 pulmonary metastases). Five and ten-year disease-specific survival rates were 56% and 41%. Two-year disease-specific survival rates for lymph node and pulmonary metastasis groups were 40% and 0%. All metastatic patients died within 5 years follow-up. Five and ten-year disease-specific survival rates for localized tumor cases were 72% and 53%. Male gender, less than 30-years of age, trunk tumor location and size greater than 5 cm were poor prognostic factors according to univariate analysis. Tumor location in the trunk was the only negative prognostic determinant in multivariate model. Although surgical treatment may be beneficial for tumors without systemic involvement, new chemotherapeutic agents and molecular targeted therapy should be implemented to improve the oncologic outcome in both early and late stage disease.
Introduction. Rotationplasty had been reported as a salvage procedure for many decades. However, ... more Introduction. Rotationplasty had been reported as a salvage procedure for many decades. However, this procedure has not been used for unplanned fixation for pathological fracture of osteosarcoma. Therefore, this is the first case report of rotationplasty for this particular indication. Case Presentation. We report a case of a 22-year-old Thai female patient who sustained a supracondylar fracture at the distal femur and underwent a surgical treatment by open reduction and internal fixation with a distal femoral locking plate and screws. Follow-up radiographic imaging revealed that there were abnormal osteolytic lesions, and conventional high-grade osteosarcoma was diagnosed by a pathological study. There were no distant metastases from Computed Tomography (CT) scan or Technitium-99m bone scintography. After discussing with the patient for treatment options, rotationplasty was chosen for her definitive treatment after 3 courses of neoadjuvant chemotherapy. All of the contaminated tiss...
Purpose: To demonstrate an innovative program design which combines tumor registration and electr... more Purpose: To demonstrate an innovative program design which combines tumor registration and electronic health records that suit Thai orthopedic oncologist practice. Methods: The Thai Musculoskeletal Tumor Society (TMTS) database program is a Microsoft Access database created for bone and soft tissue tumor services. Only significant parameters are recorded and all data forms are based on user-friendly concepts. Apart from exporting data to a web-based tumor registration, all input data will be utilized to facilitate complex oncology work such as printing out patient records or patient transfer forms, showing disease demographic data, retrieving particular case series, and post-operative time calculations with management planning. Results: The TMTS database program was designed for new emerging orthopedic oncology units with limited resources to possess a standard tumor database for clinical use and to promote research collaboration between small and large tumor centers. Conclusion: By...
A 34-year-old woman was diagnosed with a giant cell tumor of the right distal radius with extensi... more A 34-year-old woman was diagnosed with a giant cell tumor of the right distal radius with extensive articular invasion. After en-bloc resection of 5.5 cm of the distal radius, reconstruction was done with three-dimensional printing custom-made distal radius prosthesis. In addition, a multiligament reconstruction was done to prevent postoperative radiocarpal subluxation and imitate the native distal radius. At 18 months, the range of motion was 20° dorsiflexion, 10° palmar flexion, 10° supination, and 60° pronation. Her grip strength was 60% compared with the contralateral side. No complications were seen during this 2-year follow-up. We present the combined 3-dimensional printed custom-made prosthetic with multiligament reconstruction as an innovative method without postoperative complication at 2 years.
Background Alu is one of the non-autonomous element retrotransposons, constituting nearly 11% of ... more Background Alu is one of the non-autonomous element retrotransposons, constituting nearly 11% of the human DNA. Methylation changes of the Alu element can cause genomic instability, a hallmark of cancer development, ultimately leading to the development of cancer. Epigenetic factors may induce the aberrant methylation of Alu and also oxidative stress. However, current knowledge of Alu methylation and oxidative stress is limited. There are few studies that have evaluated Alu methylation and oxidative stress on musculoskeletal tumor progression. Therefore, the present study evaluated the status of Alu methylation in musculoskeletal (MS) tumor, adjacent tissues, and blood leukocytes from MS tumor subjects, as well as unaffected participants. Moreover, we also investigated the oxidative stress status in MS tumor subjects and the control participants and determined the correlation between Alu methylation in MS tumors and that in blood leukocytes. Methods Musculoskeletal tumors from muscu...
Background Physician-to-physician teleconsultation has increasingly played an essential role in d... more Background Physician-to-physician teleconsultation has increasingly played an essential role in delivering optimum health care services, particularly in orthopedic practice. In this study, the usability of a smartphone app for teleconsultation among orthopedic specialists was investigated to explore issues informing further recommendations for improvement in the following iterations. Objective This study aimed to explore usability issues emerging from users’ interactions with MEDIC app, a smartphone-based patient-centered physician-to-physician teleconsultation system. Methods Five attending physicians in the Department of Orthopedics in a large medical school in Bangkok, Thailand, were recruited and asked to perform 5 evaluation tasks, namely, group formation, patient registration, clinical data capturing, case record form creation, and teleconsultation. In addition, one expert user was recruited as the control participant. Think aloud was adopted while performing the tasks. Semist...
Journal of the Medical Association of Thailand, Sep 1, 2012
Giant cell tumor of bone is a common benign aggressive bone tumor. Recurrent rate in the patients... more Giant cell tumor of bone is a common benign aggressive bone tumor. Recurrent rate in the patients who have the tumor with soft tissue invasion is rather high. Use of strong chemicals such as phenol and liquid nitrogen to lessen the recurrent rate might not be used in this lesion. The experiment was carried out to discover apoptotic effects of thermoablation on giant cell tumor of bone to find out a possibility to use thermoablation in the clinic in the patients with extensive lesion. Tumor cell suspension was prepared from 4 patients who had definite diagnosis of giant cell tumor of bone. The tumor cells were subjected to thermoablation at 45, 47 and 50 degrees C for 10 to 30 minutes before were cultured at 37 degrees C for another 3 days. Osteoblasts and chondrocytes from the last 3 patients were collected,prepared and underwent thermoablation in the same fashion. Apoptosis of tumor cells, chondrocytes and osteoblasts were carried out by the use of flow cytometry. Thermoablation at 47 degrees C for 30 minutes resulted in < 50% chondrocyte and osteoblast apoptosis and 70-90% tumor cells apoptosis of 3/4 patients. Thermoablation at 47 and 50 degrees C for 20 to 30 minutes has more negative effect on giant cell tumor of bone than chondrocytes and osteoblasts. Thermoablation might be a useful tool for local tumor control in the clinic.
Introduction Nucleoplasty is a minimally invasive percutaneus lumbar intervertebral disk decompre... more Introduction Nucleoplasty is a minimally invasive percutaneus lumbar intervertebral disk decompression using coblation energey. The technique is indicated for patients with contained herniated lumbar disk who are unresponsive to conservative management as an alternative treatment. Many recent literatures proved that nucleoplasty is an effective procedure comparable to the standard treatment, but its long-term result is still controversial. Objective To compare effectiveness between nucleoplasty and conventional opened diskectomy and to evaluate the economical aspects of nucleoplasty Setting Department of Orthopaedics, King Chulalongkorn Memorial Hospital. Research Design A non-randomized prospective clinical trial with full economic evaluation Patients Contained lumbar intervertebral disk herniation patients with radicular pain who had undergone diskectomy and nucleoplasty at King Chulalongkorn Memorial Hospital from 2004 to 2006 นพินธต์น้ฉบบั
740 words) Background: Infiltrative growth pattern is often observed in superficial myxofibrosarc... more 740 words) Background: Infiltrative growth pattern is often observed in superficial myxofibrosarcoma (MFS) and undifferentiated pleomorphic sarcoma (UPS). According to the past literatures, radiographic infiltration of superficial MFS and UPS on magnetic resonance (MR) images indicates a high possibility of histologic infiltration. In recent years, this growth pattern has become widely recognized as a primary risk factor for local recurrence and possibly distant metastases. However, the role of radiotherapy (RT) as adjuvant therapy remains uncertain. Questions/Purposes: The aims of this study are to clarify the efficacy of preoperative RT strategy for infiltrative MFS and UPS by examining pathologic findings and patients’ clinical outcomes, and to reveal current issues concerning pre-operative RT on infiltrative MFS and UPS. Patients and Methods: From 1996 to 2014, 252 soft tissue sarcomas diagnosed as malignant fibrous histiocytoma (MFH), MFS, or UPS were surgically treated at our ...
Background Most photography-based arc of motion measurements require human assessment and their a... more Background Most photography-based arc of motion measurements require human assessment and their accuracy depends on the observer. Objectives To develop a digital image processing technique (DIPT) for measuring elbow range of motion (ROM), and to assess its validity and reliability compared with standard methods. Methods Physiotherapists performed digital goniometer and inclinometer ROM measurements bilaterally on healthy volunteer elbows. A photographer took digital images of elbows fully extended and fully flexed 3 times using an 8-megapixel smartphone camera. Extension and flexion angles were calculated using the DIPT. Intra- and inter-rater reliability of all methods was assessed using an intraclass correlation coefficient (ICC). A paired Student's t test and Wilcoxon-signed rank test were used to assess systematic bias. A Bland–Altman plot was used to show possible range of difference between the methods. Results We measured 56 elbows from 28 participants. Intra- and inter-r...
Superficial myxofibrosarcoma (MFS) and undifferentiated pleomorphic sarcoma (UPS) are highly asso... more Superficial myxofibrosarcoma (MFS) and undifferentiated pleomorphic sarcoma (UPS) are highly associated with infiltrative growth (tail sign) and local recurrence, but the impact of preoperative radiotherapy is uncertain. Eight consecutive superficial MFS and 10 superficial UPS cases treated with preoperative radiotherapy and surgery were reviewed. Pathological response, surgical margin and magnetic resonance imaging (MRI) were retrospectively evaluated. Oncological events were reported in a descriptive form. Pathologically, nearly-complete response was observed in six UPS cases. Tail sign was pathologically detected in 13 cases, eight of which remained viable. Among the eight cases with viable tail, three cases, including two with positive margin, locally recurred. No major discrepancy was observed between tail length on pre-treatment T1-weighted post-contrast, fat-saturated MRI and pathological tail length. Tail of superficial MFS and UPS can retain viability even after radiotherap...
Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2012
Giant cell tumor of bone is a common benign aggressive bone tumor. Recurrent rate in the patients... more Giant cell tumor of bone is a common benign aggressive bone tumor. Recurrent rate in the patients who have the tumor with soft tissue invasion is rather high. Use of strong chemicals such as phenol and liquid nitrogen to lessen the recurrent rate might not be used in this lesion. The experiment was carried out to discover apoptotic effects of thermoablation on giant cell tumor of bone to find out a possibility to use thermoablation in the clinic in the patients with extensive lesion. Tumor cell suspension was prepared from 4 patients who had definite diagnosis of giant cell tumor of bone. The tumor cells were subjected to thermoablation at 45, 47 and 50 degrees C for 10 to 30 minutes before were cultured at 37 degrees C for another 3 days. Osteoblasts and chondrocytes from the last 3 patients were collected,prepared and underwent thermoablation in the same fashion. Apoptosis of tumor cells, chondrocytes and osteoblasts were carried out by the use of flow cytometry. Thermoablation at...
Clear cell sarcoma (CCS) of soft tissue is a rare melanocytic soft tissue sarcoma with different ... more Clear cell sarcoma (CCS) of soft tissue is a rare melanocytic soft tissue sarcoma with different cytogenetic and natural history than that of melanoma. Objective of this study was to determine outcome predictors in patients treated in our Institute. This objective included the effectiveness of surgical intervention and disease progression after surgery. Thirty-one patients were diagnosed at our institute with clear cell sarcoma through tissue pathology and immunohistochemistry. Patients received multimodality treatment (surgery, radiotherapy and chemotherapy). Five-year survival rates and prognostic predictors were determined. Sixteen patients were males and 15 females with a median age of 37 years (8-72-years). Twenty-eight tumors were located in extremities and 3 in the trunk area. Eight patients had metastases at their first presentation (6 local lymph nodes and 2 pulmonary metastases). Five and ten-year disease-specific survival rates were 56% and 41%. Two-year disease-specific survival rates for lymph node and pulmonary metastasis groups were 40% and 0%. All metastatic patients died within 5 years follow-up. Five and ten-year disease-specific survival rates for localized tumor cases were 72% and 53%. Male gender, less than 30-years of age, trunk tumor location and size greater than 5 cm were poor prognostic factors according to univariate analysis. Tumor location in the trunk was the only negative prognostic determinant in multivariate model. Although surgical treatment may be beneficial for tumors without systemic involvement, new chemotherapeutic agents and molecular targeted therapy should be implemented to improve the oncologic outcome in both early and late stage disease.
Introduction. Rotationplasty had been reported as a salvage procedure for many decades. However, ... more Introduction. Rotationplasty had been reported as a salvage procedure for many decades. However, this procedure has not been used for unplanned fixation for pathological fracture of osteosarcoma. Therefore, this is the first case report of rotationplasty for this particular indication. Case Presentation. We report a case of a 22-year-old Thai female patient who sustained a supracondylar fracture at the distal femur and underwent a surgical treatment by open reduction and internal fixation with a distal femoral locking plate and screws. Follow-up radiographic imaging revealed that there were abnormal osteolytic lesions, and conventional high-grade osteosarcoma was diagnosed by a pathological study. There were no distant metastases from Computed Tomography (CT) scan or Technitium-99m bone scintography. After discussing with the patient for treatment options, rotationplasty was chosen for her definitive treatment after 3 courses of neoadjuvant chemotherapy. All of the contaminated tiss...
Purpose: To demonstrate an innovative program design which combines tumor registration and electr... more Purpose: To demonstrate an innovative program design which combines tumor registration and electronic health records that suit Thai orthopedic oncologist practice. Methods: The Thai Musculoskeletal Tumor Society (TMTS) database program is a Microsoft Access database created for bone and soft tissue tumor services. Only significant parameters are recorded and all data forms are based on user-friendly concepts. Apart from exporting data to a web-based tumor registration, all input data will be utilized to facilitate complex oncology work such as printing out patient records or patient transfer forms, showing disease demographic data, retrieving particular case series, and post-operative time calculations with management planning. Results: The TMTS database program was designed for new emerging orthopedic oncology units with limited resources to possess a standard tumor database for clinical use and to promote research collaboration between small and large tumor centers. Conclusion: By...
A 34-year-old woman was diagnosed with a giant cell tumor of the right distal radius with extensi... more A 34-year-old woman was diagnosed with a giant cell tumor of the right distal radius with extensive articular invasion. After en-bloc resection of 5.5 cm of the distal radius, reconstruction was done with three-dimensional printing custom-made distal radius prosthesis. In addition, a multiligament reconstruction was done to prevent postoperative radiocarpal subluxation and imitate the native distal radius. At 18 months, the range of motion was 20° dorsiflexion, 10° palmar flexion, 10° supination, and 60° pronation. Her grip strength was 60% compared with the contralateral side. No complications were seen during this 2-year follow-up. We present the combined 3-dimensional printed custom-made prosthetic with multiligament reconstruction as an innovative method without postoperative complication at 2 years.
Background Alu is one of the non-autonomous element retrotransposons, constituting nearly 11% of ... more Background Alu is one of the non-autonomous element retrotransposons, constituting nearly 11% of the human DNA. Methylation changes of the Alu element can cause genomic instability, a hallmark of cancer development, ultimately leading to the development of cancer. Epigenetic factors may induce the aberrant methylation of Alu and also oxidative stress. However, current knowledge of Alu methylation and oxidative stress is limited. There are few studies that have evaluated Alu methylation and oxidative stress on musculoskeletal tumor progression. Therefore, the present study evaluated the status of Alu methylation in musculoskeletal (MS) tumor, adjacent tissues, and blood leukocytes from MS tumor subjects, as well as unaffected participants. Moreover, we also investigated the oxidative stress status in MS tumor subjects and the control participants and determined the correlation between Alu methylation in MS tumors and that in blood leukocytes. Methods Musculoskeletal tumors from muscu...
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