12th Region Medical Journal

Assessment of Scattered Radiation around C-arm Fluoroscopy in the Operating Room at Hatyai Hospital

Wirongrong Fuangfukachorn — Fri, 13 Jun 2025 00:00:00 +0700

Background: Integrating technology to enhance the efficiency of medical services, particularly in radiographic imaging using C-Arm Fluoroscopy, is crucial. Measuring scatter radiation levels from this equipment ensures the safety of healthcare professionals.

Objective: To study the scattered radiation around the C-arm fluoroscopy machine at distances of 0.5, 1.0, and 1.5 meters, and at heights of 0.75 and 1.45 meters from the floor.

Methodology: This survey researched scattered radiation at six positions: right head, right mid-bed, right foot, foot of the bed, left mid-bed, and left head of the bed. Measurements were taken at distances of 0.5, 1.0, and 1.5 meters, and heights of 0.75 and 1.45 meters. Machine settings were 80 kVp, 3 mAs, with data collected 10 times per position. Data was analyzed using Microsoft Excel and descriptive statistics.

Results: Scatter radiation decreased with distance. The highest radiation was at 0.5 meters, especially at the left mid-bed position at both heights, with values of 6.67 µSv/h and 6.44 µSv/h. The lowest radiation was at the foot of the bed at 1.5 meters, with 0.85 µSv/h.

Conclusion: The average scattered radiation around the C-arm fluoroscopy X-ray machine, with the lowest radiation dose, is at the bed end position. This is because it is the farthest from the fluoroscopy X-ray tube, resulting in the least scattered radiation. The annual dose of scattered radiation that workers are exposed to does not exceed the limit set by the International Commission on Radiological Protection (ICRP), which is 20 mSv/yr. To ensure maximum radiation protection, workers and related personnel must wear lead aprons in areas where radiation is used.

Relationship between timing of ruptured cerebral aneurysm treatment and clinical outcome: A retrospective study

Ratikorn Somrak, Kornkanok Kaewmanee, Nareumol Anumadh — Fri, 13 Jun 2025 00:00:00 +0700

Background: Ruptured cerebral aneurysm is a neurovascular disease that cause high morbidity and mortality. Patients with ruptured cerebral aneurysm should be performed aneurysm treatment as early as possible. However, the ideal timing of aneurysm treatment (surgical clipping or endovascular coiling) is unknown and timing of aneurysm treatment may effect to clinical outcomes

Objectives: The study aimed to compared the clinical outcome of patients between different timings of aneurysm treatment at Hatyai hospital.

Methodology: A retrospective study 220 patients with ruptured cerebral aneurysm who was performed aneurysm treatment at Hatyai hospital. The patients were divided in 2 groups: early aneurysm treatment within days and delay aneurysm treatment more than 72 hours. The clinical outcomes of patients were accessed after 6 months by using the modified Rankin scale and mortality rate. For endovascular coiling and surgical clipping patients were accessed separately. The statistical methods used included frequency, percentage, Independent t-test and the Chi-square test.

Results: Functional independence or favorable clinical outcome (mRS 0-2) at 6 months between patient early aneurysm treatment and delay aneurysm treatment was 84 (70.0%) persons and 61 (76.2%) persons. There was no statistical difference in clinical outcome between patient early aneurysm treatment and delay aneurysm treatment (p = 0.210).

Conclusions: There was no statistically significant association between clinical outcome and timing of ruptured cerebral aneurysm treatment. However, the aneurysm treatment should be performed as soon as possible to prevent re-ruptured and minimized length of stay.

Concordance between of Immunohistochemistry and Dual in Situ Hybridization for Assessment of HER-2 in breast cancer in Hatyai hospital

Apiram Songsri — Fri, 28 Feb 2025 00:00:00 +0700

Introduction: Trastuzumab is a targeted therapy in the treatment of HER2-positive breast cancer that can reduce the risk of recurrence and death. However, it is associated with cardiac toxicity. In some cases, caused discontinuation of treatment. So, the accurate assessment of breast cancer prognostic markers by immunohistochemistry (IHC) is essential to identify patients that can benefit from anti-HER2 targeted therapies.

Objective: To investigate the concordance rate between immunohistochemistry (IHC) and Dual in-situ hybridization (DISH) for assessment of HER2 status in breast cancer patients of Hatyai Hospital, Songkhla province, Thailand.

Methods: This study was a retrospective study. The data that were selected according to the following criteria: (1) included breast cancer female-patients, (2) analyzed patient’s pathology reports between November 2021 to February 2024, (3) used both IHC (scoring 2+ and 3+) and DISH to identified HER2 status and (4) these techniques performed by Department of Pathology, Hatyai Hospital. 134 patient’s reports were applied in this study. The concordance between the two methods was then statistically evaluated by using kappa coefficient.

Results: Overall concordance rates of IHC 2+ and 3+ were 76.5% with a Kappa coefficient of 0.507 (p<0.001) that showed high concordance. The concordance rate was 98.5% for IHC 3+ and 47.8% for IHC equivocal 2+.

Conclusion: The concordance rate of IHC positive 3+ and IHC equivocal 2+ showed extremely high and low concordance rate, respectively. Regarding the results of IHC 3+ breast cancer patients could be immediately treated with targeted therapy (Trastuzumab) without DISH confirmation. Nevertheless, further DISH study should be limited to IHC 2+ for confirming and excluding HER2 amplification before determining to treated with targeted therapy.

Prognostic Factors Influencing Overall Survival in Patients with Locally Advanced Cervical Cancer (LACC, FIGO Stage IIB-IVA) Treated with Concurrent Chemoradiotherapy

Ascharavadee Pulsawat, Sitchuphong Noothong, Nathapol Sirimusika, Wanida Wadee — Fri, 13 Jun 2025 00:00:00 +0700

Background: Cervical cancer is a major concern in Thailand, with high prevalence and poor outcomes. Prognostic factors are diverse and complex.

Objectives: The purpose of this study is to investigate the prognostic factors that influence overall survival (OS) in LACC patients treated with concurrent chemoradiotherapy (CCRT).

Materials and methods: We conducted a retrospective cohort study involving 220 patients diagnosed with LACC patients treated with CCRT at Hatyai Hospital between 1 January 2014 and 31 December 2019. Overall survival rates at 1-yr, 3-yr, and 5-yr were analyzed, and the median survival time was estimated using the Kaplan-Meier method. The impact of various factors on OS was assessed using univariate and multivariate Cox proportional hazards models.

Results: The median follow-up time was 30.5 months. The 1-yr, 3-yr, and 5-yr OS were 74%, 46%, and 28%, respectively. The median OS was 17 months. Most patients had stage III 50.2% and squamous cell carcinoma 80.9%. After multivariate analysis, Body Mass Index (BMI) (p=0.03), stage III (p=0.001), stage IVA (p=0.036), neutrophil-to-lymphocyte ratio (NLR) (p=0.005) and platelet-to-lymphocyte ratio (PLR) (p=0.018) were significantly and independently associated with poorer OS.

Conclusion: A higher FIGO stage and elevated NLR and PLR values were associated with shorter survival. Conversely, maintaining an appropriate BMI emerged as a protective factor.

Laparoscopic Sleeve Gastrectomy for Morbid Obesity: A Comprehensive Review of Procedures and Outcomes

Ronnayong Thomtong, Araya Khaimook — Fri, 13 Jun 2025 00:00:00 +0700

Background: Nowadays, the incidence of obesity is increasing. Surgical treatment for obesity is highly effective. Laparoscopic sleeve gastrectomy (LSG) is the standard treatment. This study collected data on the treatment of patients with LSG to provide guidelines and develop the potential treatment for obese patients in Thailand.

Objectives: The purpose was to study the results of LSG for morbid obesity and the results of weight loss after surgery.

Methodology: A retrospective cohort study from the medical records of patients who underwent LSG was performed from October 2022 to September 2023. The collected data including patient’s characteristics, surgical outcomes, hospital stays, and surgical complications were recorded and analyzed by analytic statistics.

Results: A total of LSG of 21 patients were enrolled during the period. The mean age was 35.43 ± 8.18 years. The mean body weight was 108.22 ± 13.89 kilograms. The mean Body Mass Index (BMI) was 40.9 ± 5.65 kg/m². The surgical outcomes found that the average BMI tends to decrease and the percent of excess weight loss tends to increase after a longer follow-up. No intraoperative and postoperative complications were found.

Conclusions: LSG is safe and effective to serve as a definitive treatment of morbid obesity.