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Objective: To measure and compare the incidence of cast-related pressure injuries at the heel between sponge-incorporated long leg cast and multilayer padding cast following orthopedic lower extremity surgery. Materials and Methods: Patients aged 1 to 18 years who were scheduled for elective lower extremity soft tissue surgery were recruited. They were equally randomized into two groups: sponge padding cast (Group 1) and multilayer padding cast (Group 2). A multilayer padding cast, consisting of five layers of Webril®, was applied to the heel and bony prominence areas. At the 2nd and 4th weeks postoperatively, cast-related heel pressure injuries were evaluated using the 2016 National Pressure Ulcer Advisory Panel (NPUAP) staging system. Changes in alignment and other complications were also recorded. Results: 100 patients were recruited. At two weeks postoperatively, the incidence of cast-related heel pressure injuries in Group 1 was 4/46 cases (8.7%), with all cases being stage 1. In Group 2, there were 6/54 cases (11.1%), with 3 cases in stage 1 and 3 cases in deep tissue pressure injury (p=0.479). At four weeks postoperatively, Group 1 had 6/46 cases (13%), with 4/46 cases (8.7%) being stage 1 and 2/46 cases (4.3%) being deep tissue pressure injuries. Group 2 had 6/54 cases (11.1%) (p>0.99), with all cases being stage 1. There was no statistical difference in loss of alignment. No serious complications, such as compartment syndrome or neurovascular injury, were found. Conclusion: The incidence of cast-related heel pressure injury was comparable between sponge padding cast and a multilayer cotton padding cast.

Objective: Distraction osteogenesis (DO) is a well-known technique. The traditional method utilized the lengthening frequency of four times a day (QID). Many mechanical factors may affect the DO outcome. However, the effect of distraction frequency has not been proven clinically. Therefore, we aim to investigate whether the BID and QID lengthening frequency affect the healing index and complications of the DO. Materials and Methods: We retrospectively reviewed patients who had undergone DO from 2010 – 2021. The patient was divided into BID and QID groups. Demographics, lengthening outcomes, and complications between the two groups were compared. We used the inverse probability of treatment weighting (IPTW) to determine the effect of treatment. Results: The median healing index (HI) of the patients whose lengthening was done QID is 41.36 (IQR 32.72 - 67.68) days/cm, and BID is 49.12 (IQR 35.28 - 62.54) days/cm, which did not differ significantly. The Odds ratio of achieving HI < 45 days/cm for patients receiving QID lengthening compare to BID is 1.12 (95% CI 0.31-3.99, p = 0.862 ). The IPTW did not show a difference in average treatment effects between QID and BID lengthening. The rates of minor and major complications were not significantly different between the two groups (26.1% in QID group and 32.1% in BID group). Conclusion: The frequency of QID and BID lengthening results in comparable HI and complications for patients who undergo DO. However, prospective research is needed to evaluate the effect of frequency differences in a clinical setting.

Objective: Congenital muscular torticollis, characterized by unilateral shortening of the ternocleidomastoid muscle that results in the head tilting towards the affected side, is the third most common musculoskeletal anomaly. Subjective assessment using the Lee scoring system has been the most common method for evaluating the surgical outcomes. The aim of this study was to investigate the efficacy of a novel assessment tool for scoring of functional outcomes after surgical release in congenital muscular torticollis. Methods: This study enrolled the patients aged 5-15 years who were diagnosed with congenital muscular torticollis and treated by surgical release at the Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand during 1998-2011. An image processing program was used to measure all evaluated parameters. Craniofacial asymmetry, neck rotation deficits, neck flexion/extension deficits, and degree of head-tilting were graded as poor, fair, good, or excellent by 2 observers. The results of the Lee scoring system and the new scoring system were then compared. Results: Nineteen patients (7 males, 12 females) with a mean age of 7.2±2.57 years were included. Photographs of the patients were evaluated and categorized by outcome score using both outcome scoring systems. All intraclass correlation coefficients were higher than 0.6 for both scoring systems, which suggests good inter-operator reliability (p

We report a 23 year old female who presented with a history of headache. She was admitted to a hospital in Nakornrachasrima province. Eosinophilic meningitis was diagnosed. However, releasing pressure of cerebrospinal fluid (CSF) by lumbar puncture, supportive and symptomatic treatment were performed resulting in appropriate treatment. The patient was referred to Siriraj Hospital due to the persisted headache. Multidisciplinary investigation such as imaging modalities, cytology and serological test for specific antibodies were carried out. Antibody against an A. cantonensis-specific 31-kDa antigen was detected in the serum sample obtained from this patient. In conclusion, A. cantonensis is the possible causative agent of headache in this patient.

Objective: Congenital muscular torticollis, characterized by unilateral shortening of the sternocleidomastoid muscle that results in the head tilting towards the affected side, is the third most common musculoskeletal anomaly. Subjective assessment using the Lee scoring system has been the most common method for evaluating the surgical outcomes. The aim of this study was to investigate the efficacy of a novel assessment tool for scoring of functional outcomes after surgical release in congenital muscular torticollis. Methods: This study enrolled the patients aged 5-15 years who were diagnosed with congenital muscular torticollis and treated by surgical release at the Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand during 1998-2011. An image processing program was used to measure all evaluated parameters. Craniofacial asymmetry, neck rotation deficits, neck flexion/extension deficits, and degree of head-tilting were graded as poor, fair, good, or excellent by 2 observers. The results of the Lee scoring system and the new scoring system were then compared. Results: Nineteen patients (7 males, 12 females) with a mean age of 7.2±2.57 years were included. Photographs of the patients were evaluated and categorized by outcome score using both outcome scoring systems. All intraclass correlation coefficients were higher than 0.6 for both scoring systems, which suggests good inter-operator reliability (p

Background : In patients who have symptoms of epilepsy and other neurological deficits, one of the most common parasitic infections is neurocysticercosis (NCC) caused by Cysticercus cellulosae, the larval form of Taenia solium. In order to evaluate the characteristics of this illness which define the diagnosis, we assessed clinical manifestations, a positive ELISA for cysticercosis and neurological imaging in patients suspected of having NCC at a teaching hospital. Methods : This retrospective cohort study assessed 44 patients, who had laboratory results and clinical manifestations compatible with a diagnosis of NCC, between November 1998 and November 2001. The criteria for diagnosing this illness modified from these of Del Brutto and colleagues' criteria. All patients were investigated with serum ELISA, 18 with CSF ELISA, if there was no contraindication. T. solium vesicular cyst soluble antigen was used for the detection of cysticercosis  (T. solium) antibodies by solid-phase enzyme immunoassay. 35 patients were further investigated by a computerized tomography (CT) scan of central nervous system (CNS), if the results of other investigations were inconclusive. Using these criteria, we stratified all patients into three groups: possible NCC (19), probable NCC (10), and definite NCC (15). All definite patients were further examined with ELISA for Angiostrongylus cantonensis and Western blot for Gnathostoma spinigerum in order to look for cross-reactivity of the ELISA for cysticercosis. Results : In this study, a prevalence of NCC (34.1%) in the group of patients in whom there was clinical suspicion of NCC makes us concerned that Thailand is still an endemic area for this disease. The three most common clinical presentations were seizures, neurological deficit, and signs of increased intracranial pressure. Serum ELISA showed a sensitivity of 33.3% and a specificity of 93.1%. CSF ELISA showed a sensitivity of 40.0% and a specificity of 100%. CT scan brain showed a high sensitivity (92.9%) with a modest specificity (52.4%). Cross-reaction with other parasitic proteins was found with A. cantonensis (6.7%), but not with G. spinigerum. Conclusion : NCC is still endemic in Thailand. In the approach to this illness, we conclud that the diagnosis of NCC should be based on the patient's history and physical signs in conbination with radiological and serological investigations. Moreover, in areas where A. cantonensis and G. spinigerum were also prevalent, case should be taken in the interpretation of a positive ELISA for cystercercosis because of cross-reactivity with antibodies to A. cantonensis which should be checked individually.