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This analysis was undertaken to see whether or not previous successful breastfeeding has any influence on subsequent breastfeeding behavior. Lactational outcomes were compared between those with and without breastfeeding experience. Methods: Amount of breast milk transferred, frequency of breastfeeding, and time spent on the breast, as well as infant's weight, were recorded on days 15, 45, 90, 1809 270, and 360 postpartum in 30 primiparae and 30 multiparae. Outcomes of the primiparae were found to be similar to those of the more experienced breastfeeding multiparous mothers with respect to infant growth, amount of breast milk transferred, and the frequency of breastfeeding or number of attachments to the breast. Though primiparae took somewhat longer to transfer similar amounts of breast milk to their infants during the initial 45 to 90 days postpartum, feed duration after 90 days was similar to that of the multiparae. Lactation performance of the rural northern Thai mothers in our sample was highly successful with or without previous breastfeeding experience. It may be that a cultural pattern of breastfeeding on demand, strong family support, and traditional practices that encourage close contact between mother and her newborn compensate for the absence of lactational experience. Unlike reports from Western countries, previous breastfeeding does not appear to be an important predictor of successful and prolonged breastfeeding in our population. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To identify prevalence of microalbuminuria and its associated risk factors including old age, hypertension, dyslipidemia, diabetic retinopathy and metabolic syndrome in diabetic patients in Lampang, Thailand. Material and method: 2231 diabetic patients at Lampang Hospital were recruited in this cross-sectional study. Eye examination, blood pressure and abdominal circumference measurements were done. Blood was collected and checked for glucose, cholesterol, and renal function. Single-spot morning urine was collected for urine albumin–creatinine ratio (UACR). UACR 30–300mg/g indicated microalbuminuria (by National Kidney Foundation). Multivariate logistic regression method including odds ratio and 95% confidence interval were used to analyze the data. Results: Microalbuminuria was found in 27% of the patients. There were clear association between creatinine clearance and microalbuminuria. Older age for every 10 years and diabetic retinopathy had relationship with microalbuminuria in overall and female patients while had no statistically significant in male patients. Conclusion: Microalbuminuria is common in Thai diabetic patients. Older age and history of diabetic retinopathy increase the risk of microalbuminuria in overall and female patients. Screening for albuminuria should be done in every diabetic patient for early prevention of diabetic nephropathy. [Copyright &y& Elsevier]

We report the angiographic and venographic findings in a case of reflex sympathetic dystrophy syndrome (RSDS) of the lower extremity. The hypervascular intraosseous lesion which initially simulated an arteriovenous malformation provides important information about the vascular nature of this lesion. [ABSTRACT FROM AUTHOR]

Background: The incidence of low birth weight (LBW) in Chiang Mai University Hospital was high., Objective: Determined the incidence and risk factors of low birth weight infants., Material and Method: The present study included pregnant women between 1989 and 1990 who attended the antenatal clinics (ANC) having a gestational age less than or equal to 24 weeks. During that period, up to delivery, clinical and other potential data namely demographic and biomedical factors, maternal status, socioeconomic factors, and nutritional factors were included. The birth weight at birth less than 2,500 gm was considered LBW., Results: Two thousand one hundred eighty four pregnant subjects who delivered live born and were still eligible, were used for analysis in the present study. The incidence of LBW was 9.2% (201/2,184). Women with body mass index (BMI) at first antenatal clinics (ANC) less than 18.5 Kg/m2 and weight gain during the second trimester less than 300 grams/week was the strongest independent risk factor for LBW (odds ratio 11.25, 95% confidence interval (CI) 5.77-21.94). The number of antenatal care less than 4, monilial vaginitis, the infestation of hookworm and strongyloides, and pregnancy-induced hypertension were independent risk factors (odds ratio 11.04, 3.14, 4.93 and 4.02 respectively)., Conclusion: The present study showed that low initial BMI, low weight gain in the second trimester, and low attendance at ANC are associated to the occurrence of LBW. The development of a scoring system for detecting high-risk of LBW in pregnant women based on a combination of antenatal factors should be pursued.

Several studies show that intrauterine nutrition restriction is associated with vascular disease. Animal studies have shown that atherosclerosis can be affected by a constrained intrauterine diet, but this relationship in humans is controversial. The purpose of this study was to investigate the relationship between maternal intake during pregnancy and carotid intimal media thickness (CIMT). We measured CIMT in 565 twenty year old young adults whose mothers, while pregnant, participated in a nutritional study during 1989-1990 at two hospitals in Chiang Mai, Thailand. Maternal diet during pregnancy was assessed by two methods in each trimester, namely, the 24 hours food recall method and the food frequency method. Carotid intimal media thickness was greater in males and participants who showed higher blood glucose, higher body mass index and higher systolic blood pressure. Maternal protein intake during the first trimester was negative correlated with thickness of CIMT (p=0.02). The mean CIMT of participants whose mothers were in the lowest quarter of the distribution of protein intake in the first trimester was 0.45 mm (95% confidence interval (CI): 0.44-0.46) more than that of those whose mothers were in the highest quarter of the distribution (0.43 mm 95% CI: 0.42-0.44). In conclusion, lower maternal protein intake during early pregnancy may increase CIMT in adolescents.

Objective: The purpose of this study was to determine the frequency of apparent stenosis of normal aortic branches in patients on first-pass gadolinium-enhanced three-dimensional (3D) MR angiography and to reproduce the same phenomenon in a pulsatile flow phantom model., Conclusion: Apparent stenosis of normal vessels on gadolinium-enhanced 3D MR angiography seen on the first-pass acquisition was observed in only a small proportion (approximately 2%) of our patients. The pseudostenosis was reproducible in the phantom model using rapid injection. A stenosis on first-pass images should be interpreted with caution. Confirmation of the findings on other sequences, such as the second-pass gadolinium-enhanced 3D MR angiography or 3D phase-contrast MR angiography, prevented overdiagnosis of significant stenoses.

Background and Purpose: A new option in the treatment of recurrent malignant glioma is surgical placement of chemotherapy-laden biodegradable wafers. We describe the CT and MR appearance of chemotherapy wafers in patients after surgery for recurrent malignant glioma, Methods: Eighteen patients had carmustine (BCNU) wafers implanted during reoperation for malignant glioma; three patients had empty, placebo wafers placed. The 21 patients had a total of 22 CT and 57 MR imaging studies. Repeat CT studies were conducted for up to 6 months, the MR studies for up to 1 year. Examinations were evaluated for attenuation on CT scans, signal abnormalities on MR images, and changing appearance during the follow-up period. Enhancement characteristics were also assessed., Results: On CT scans, 13 of 16 acute (<7 days) cases showed linear high-attenuation wafers, with three showing low attenuation. On MR images, all T1 and T2 studies performed in the acute stage showed decreased signal of the wafers. Eight of 15 studies showed a transient increase in T1 only at about 2 months. Wafers decreased in conspicuity on both CT and MR studies after 2 months. The wafers did not enhance. One postoperative tumor showed a transient increase in edema and increased enhancement at 5 weeks. The presence or absence of BCNU within the wafers did not change their appearance., Conclusion: BCNU wafers have a characteristic appearance: in the first 7 days after implantation they are linear, usually of increased attenuation on CT scans, and always show decreased signal on MR images; they do not enhance, and become less conspicuous after 2 months.

Infection by JE virus still constitutes major cause of encephalitis in Chiang Mai Area, although some cases of possible dengue encephalopathy were observed. In spite of many apparent encephalitis cases, infection of vector mosquitoes by JE virus was not demonstrated. Virus isolation from hospitalized patients showed that the principal type of dengue virus circulating in Chiang Mai in 1982 was type 1 virus. Seroepidemiological survey on healthy humans indicated that the northern part of Chiang Mai Province in the region of the Maekong Valley has not yet been invaded so much by dengue viruses, compared with the Chiang Mai Valley, where dengue infection apparently became more prevalent than 12 years ago. The survey also indicated that the spread of JE virus in the study area was not uniform. Survey on vertebrates showed that anti-JE antibodies were highly prevalent among swine, horses, mules, sheep, and dogs. On the other hand, antibody prevalence was low in monkeys, ducks, and sparrows, and was negative among chickens and lizards. IgM-ELISA appeared to help differential diagnosis on JE from dengue even when the HI test did not give positive results.

A cross-sectional study of 58 infants (age range 2-53 weeks) was carried out in a rural area of northern Thailand. Total dietary intake (energy and protein from breastmilk and supplementary food) was measured directly during continuous observation over 48 h of randomly selected study subjects in their homes. Associations between infant weight and total energy intake, total protein intake and morbidity were analysed by multiple regression analysis. Up to 6 months of age, heavier infants had larger energy intakes, when age and birthweight were taken into account. In the 7-12 months age group, heavier infants consumed more protein and had fewer respiratory infections. Weaned infants older than 6 months were significantly heavier and consumed more protein than infants of similar age who were still receiving breastmilk. The lower protein intakes of the latter infants were due to the low protein concentration of breastmilk compared with supplementary food.

Relationships between nursing patterns, supplementary food intake and breast-milk intake were examined in a group of 52 Thai babies under 1 year of age. All data were collected over two consecutive days, 24 h/day. Total sucking time (min/day) and supplementary food intake (kcal/day) were significant predictors of breast-milk intake after allowing for the age of the baby: R-squared is 0.32 for sucking time and 0.39 for supplementary food intake. The two variables were themselves correlated (r is -0.47). The number of breastfeeds per day and their mean duration was determined for each case, counting each episode of attachment to the breast as a separate feed. Number and mean duration of breastfeeds were then evaluated as predictor variables. The duration of feeds had no predictive power. Number of feeds was linearly related to milk intake and combined with age was as good a predictor of milk intake as total sucking time (with R-squared 0.34). These results suggest that a simple count of breastfeeds is as valuable as more complex measures of sucking duration in predicting to breast-milk intake.