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Objective: Thyroid cancer patients treated with 1-131 are potential source of radiation exposure to relatives who are knowingly and willingly exposed to ionizing radiation as a result of providing comfort to patients undergoing I-131 therapy. This study aims to determine radiation dose received by relatives who care for non self-supporting 1-131 patients at Siriraj Hospital., Material and Method: Twenty caregivers of 20 patients underwent I-131 therapy for thyroid cancer with a standard protocol were given specific instructions with regard to radiation safety and provided with electronic digital dosimeter to continuously measure radiation dose received on daily basis, three days in the hospital. On the day patient is released, thyroid uptake estimates were performed to assess internal radiation dose received by caregivers., Results: The 3-day accumulative doses to caregivers to patients receiving 150 mCi (n = 11) and 200 mCi (n = 9) of I-131 ranged from 37 to 333 uSv and 176 to 1,920 pSv respectively depending on the level of supports required. Thyroid uptake estimates in all caregivers were undetectable. Dosimeter indicated a maximum whole-body dose of1.92 mSv was more than the public dose limit of] mSv but within the dose constraint of 5 mSv for caregivers., Discussion: Radiation dose to caregivers of a non self-supporting hospitalized patient undergoing 1-131 therapy were well below the limits recommended by the ICRP. The patients can be comforted with confidence that dose to caregivers will be less than the limit., Conclusion: This study provides guidance for medical practitioners to obtain practical radiation safety concerns associated with hospitalized patients receiving I-131 therapy especially when patient needs assistance.

Thyroid cancer patients treated with high-dose radioactive iodine (3.7-7.4 GBq) are different from other people because after the administration, the radionuclide I-131 is excreted via urine, feces, saliva and breathing, and also via exposure to other patients. Caregivers of the patient may receive higher radiation doses than normal. The purposes of this study were to estimate the total effective dose equivalent from internal and external exposure to caregivers of patients treated with high dose I-131 admitted at Siriraj Hospital, and to compare the estimated dose with the dose constraint of 5 mSv per annum for caregivers. Thirteen caregivers of 13 patients who underwent radioiodine therapy for thyroid cancers following a standard protocol were given specific instructions with regard to radiation safety and were attached to an electronic personal dosimeter and a personal air sampler pump continuously to measure received radiation dose on a daily basis over three days in the hospital. On discharge day, caregivers were asked to perform an in vivo bioassay by the thyroid uptake instrument. The results from the thirteen caregivers were divided into 3 groups. The total effective dose equivalent to caregivers of patients administered 3.7 GBq (n = 1), 5.55 GBq (n = 9), and 7.4 GBq (n = 3) were 0.159 mSv, 0.123 to 0.629 mSv, and 0.631 to 0.718 mSv, respectively. There values were well below 5 mSv per episode as proposed in the IAEA Safety Reports Series No. 63 and the ICRP Publication 103.

Objective: To compare the efficacy and cost-effectiveness of high and low dose regimens of I-131 treatment in patients with hyperthyroidism., Material and Method: One hundred fifty patients with proven hyperthyroidism were randomly allocated into the high (74 patients) and low (76 patients) dose regimen of I-131 treatment. Four patients of the high dose group and one patient of the low dose group were excluded because of lost follow-up. A gland-specific dosage was calculated on the estimated weight of thyroid gland and 24-hour I-131 uptake. The high and low I-131 dose regimens were 150 microCi/gm and 100 microCi/gm, respectively. The first mean radioiodine activity administered to the high and low dose group was 10.2 and 8 mCi, respectively. Repeated treatment was given to 25 patients of the high dose group and 40 patients of the low dose group. Clinical outcome and calculated costs for outpatient attendances, and laboratory tests together with initial and subsequent treatments were evaluated for one year after I-131 treatment. Elimination of hyperthyroidism that resulted in either euthyroidism or hypothyroidism was classified as therapeutic success. The cost effectiveness was also compared., Results: At 6 months after treatment, 45 (64.3%) patients receiving high dose and 59 (78.7%) patients receiving low dose were hyperthyroidism. Clinical outcome at one year showed persistence of hyperthyroidism in 21 (30%) patients of the high dose regimen and 36 (48%) patients of the low dose regimen. At one year post treatment, it was demonstrated that the high dose regimen could eliminate hyperthyroidism in a significantly shorter time than the low dose regimen, i.e., 259.6 days and 305.5 days, respectively, p = 0.008). For the persistent hyperthyroid patients, the average total cost of treatment in the low dose group was significantly higher than that of the high dose group, i.e., 13,422.78 baht and 10,942.79 baht, respectively; p = 0.050)., Conclusion: A high dose regimen of radioactive iodine treatment is more effective than the low dose regimen. The successful outcome of a high dose regimen occurred significantly earlier than that of the low dose regimen. For the persistent hyperthyroid patients, the average total cost in the low dose group was significantly higher than that of the high dose group.

Background: Pain is one of the most frequent and deleterious symptoms for patients with advanced cancer. Pain assessment is important because it is used for detecting severity of disease and the response to treatment. To provide the adequate treatment for pain relief in cancer patients, an assessment tool should be used for pain evaluation. Moreover, suitable tools for pain evaluation should be validated in local language to obtain better pain information., Objective: The objective of the present study was to demonstrate validity and reliability of the Thai version of the Brief Pain Inventory (BPI-T), which is a simple and concise instrument for pain assessment., Material and Method: The available data were obtained from 520 patients with cancer pain. The data included pain severity, which patients reported using Thai version of Brief Pain Inventory (BPI-T). The pain severity and pain information were reported three times with 2-week intervals between each assessment time point., Results: Factor analysis of the Thai version of the Brief Pain Inventory resulted in two factors, pain severity and pain interference, showing valid structures consistent with other language versions of the instrument. Cronbach's alphas, computed for pain interference and pain severity item were 0.88 and 0.89, 0.01 and 0.92, and 0.93 and 0.94, for first, second, and third assessment time, respectively., Conclusion: Thai version of the Brief Pain Inventory is a reliable and valid instrument for cancer pain assessment in Thailand

Objective: To cross-culturally adapt the neuropathic pain diagnostic questionnaire (DN4) to Thai language, Material and Method: Phase 1: Forward and backward translation followed by assessment of semantic equivalence. Phase 2: Testing of the questionnaire in 30 neuropathic pain patients who were seen and diagnosed by experts, followed by modifications to produce a final version., Results: All the Thai translated pain descriptors except 'tingling' got high percentages of understanding among neuropathic pain patients in the first round of testing. After some adaptation of the Thai word for 'tingling' had been made, the new translated word was retested, and all subjects doing the retest understood the word very well., Conclusion: The Thai DN4 questionnaire was systematically translated and validated. This offers a simple Thai neuropathic pain diagnostic tool for clinical use.

Objective: To examine the profile and treatment pattern of patients with neuropathic pain attending Siriraj Pain Clinic., Material and Method: A 2-year retrospective study of the prevalence of neuropathic pain, characteristics of the patients and the use of medical treatment. Records of all the patients that attended Siriraj Pain Clinic from September 1, 2002 until September 30, 2004 were reviewed., Results: One thousand three hundred and thirty patients' records were reviewed. Five hundred and three patients were diagnosed as having neuropathic pain. The prevalence of neuropathic pain at Siriraj Pain Clinic during the survey period was 37.8%. The average age of neuropathic pain patients was 54 years. The most common type of neuropathic pain was peripheral type, nerve compression in particular. The most common concomitant illness was malignant tumor. The majority of patients (71.8%) had one pain location and the most common site was the lower extremity. The main descriptions of neuropathic pain were radiating, electric shock-like, burning, numbing and shooting. Oral medication was the most common method (79%) of pain-relief treatment. Almost all of the patients (93%) had received more than one type of oral medication. The most commonly used medicine was TCA (77.1%), followed by gabapentin (35%), carbamazepine (34%) and tramadol (24.3%). Most of the pain-relief medicines prescribed at this clinic were under the recommended doses for the treatment of neuropathic pain., Conclusion: Characteristics and treatment patterns of neuropathic pain at Siriraj Pain Clinic are similar to those seen in other pain clinics elsewhere in the world. The high prevalence of neuropathic pain in the clinic indicates that this type of pain syndrome is increasingly critical to our clinical practice. More educational programs on neuropathic pain and management are needed for Thai healthcare professionals.

Neural blockade has been used as the single method to anesthetize a part of the body or used in combination with general anesthesia to lessen perioperative pain. Currently, nerve blocks are used for diagnostic, prognostic, therapeutic and prophylactic proposes for management of chronic, acute and cancer pain in a Pain Clinic. Reviewing the records of the 3,349 patients at Siriraj Pain Clinic, we found 2,662 and 687 cases had chronic and acute pain problems respectively, and only 646 patients were treated with anesthetic interventions during 1990 to 1998. They consisted of 317 male and 329 female. The techniques included stellate ganglion block, paravertebral nerve block, celiac plexus block, hypogastric plexus block, mesenteric plexus block, sacral nerve block, epidural steroid, lumbar sympathectomy, first and second thoracic sympatholysis, facet joints injection, sacroiliac joint injection, intravenous regional block with guanethidine or ketanserin, continuous opioid infusion, intravenous lidocaine infusion, and a phentolamine test. The common problems of pain included brachial plexus injury, chronic spinal pain, herpetic neuralgia, ischemic pain, central post-stroke pain, and causalgia. This retrospective review showed that 38 per cent of them reported 50 per cent pain relief with temporary effect. 34 per cent experienced good and satisfactory pain relief while 9 per cent reported excellent pain relief. 17 per cent did not gain benefit from any technique of pain relief and about 2 per cent could not be evaluated due to they did not return for follow-up. One serious complication after thoracic sympatholysis was brachial plexus injury. The neural blockade is proven to be one of the useful adjunct in the management of chronic pain but the selection of the technique is subjected to its critical appraisal.

Background: By using an external stimulus with different beat frequencies to generate an optimal brain wave pattern, binaural beat stimulation provides a similar effect to mindfulness meditation. While it has been found to have a beneficial effect in chronic pain conditions, its effect in patients suffering from low back pain has not been examined. Objective: To investigate the efficacy of binaural beat stimulation mixed with acoustic music compared to acoustic music alone in individuals with chronic low back pain. Materials and Methods: Adults with chronic low back pain were randomly allocated into two groups, where Group A listened to 20 minutes of acoustic piano music per day for 14 days, and patients in group B listened to 20 minutes of piano music mixed with 6 Hz-theta binaural beats per day for 14 days. The primary outcome was the pain score at 14 days as measured by the Thai Brief Pain Inventory (BPI). The secondary outcomes included quantitative electroencephalogram (QEEG) changes, pain interference, and changes in the Thai Hospital Anxiety Depression Scale (HADS). All participants, outcome assessors and QEEG evaluator were blinded. Results: Twelves participants were enrolled in each group. No intergroup differences were found in pain, pain interference, or QEEG measures. In addition, a significant improvement in the HADS-D (depression subscale) was found in both groups. Conclusion: The authors were unable to find a benefit to the addition of binaural beats stimulation to acoustic music in patients suffering from chronic low back pain. More studies are warranted. [ABSTRACT FROM AUTHOR]

Background: New cancer managements have improved patient survival. However, these patients can develop metastatic bone disease and present with impending or pathologic fracture. Femur is a common metastatic site of the lower extremities. Bone stabilization is a commonly performed procedure in patients with metastatic bone at the shaft and subtrochanter of the femur. Intramedullary fixation is commonly performed due to mechanical benefit and less complications. Enhanced awareness of the factors that influence early postoperative ambulation may reduce complications and improve patient outcomes. Objective: To identify risk factors of ambulatory status in patients with metastatic bone disease of the femur that were treated with intramedullary device fixation. Materials and Methods: This retrospective study included patients with metastasis lesion at the shaft and subtrochanter of the femur that were treated with intramedullary nail fixation during 2007 to 2014 at the Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand. Patients were categorized into either the early (ambulation within 3 days of surgery) or late (ambulation later than 3 days postoperatively) ambulation groups. Results: Thirty-one patients (19 females, 12 males; mean age: 54.1 years) were included. The mean postoperative pain score was significantly lower in the early ambulation group (0.8±1.1 vs. 2.1±1.1; p = 0.015). There was no significant difference between groups for MSTS functional scoring, intra-operative bleeding, intraoperative blood transfusion, or operative time. Regarding postoperative care, the early ambulation group had a significantly shorter mean length of hospital stay (p = 0.016). Conclusion: Intramedullary nailing fixation is a treatment of choice in patients with metastatic bone tumor of the femur. Lower postoperative pain score was found to be an important factor that may predict early ambulation. Early ambulation in these particular patients can provide better outcome with less complications. [ABSTRACT FROM AUTHOR]