The Effects of Foot Reflexology for Smoking Cessation on Brain Activities with Functional Magnetic Resonance Imaging (fMRI): A Pilot Study.

Background: Foot reflexology is a treatment with the hypothesis that such massage stimulation on the feet may cause a therapeutic effect which should be helpful for smoking cessation. However, its mechanism of action in the brain of smoking people remains unknown. Functional magnetic resonance imaging (fMRI) is helpful for real-time brain activity detection. We aim to compare the brain activity effects of foot reflexology with fMRI between smoking and nonsmoking subjects. Materials and Methods: We divided participants into experimental (smokers) and control groups (nonsmokers). Both groups received similar foot reflexology under the fMRI examination. Then, we compared the mean response score in each brain area before and after foot stimulation among groups and between groups. Results: Five nonsmokers and fifteen smokers had completed the study. All participants were right-handed males, with a mean age of 38.6 years. The fMRI brain response in the areas correlated with foot stimulation, including the precentral gyrus of the frontal lobe and the postcentral gyrus of the parietal lobe, was present for all participants. The fMRI response outside the correlated area, including other parts of the frontal and parietal lobes, the temporal and occipital cortices, and the thalamus, was also found in all participants, but was not consistent. Conclusions: The fMRI of the brain is feasible and safe for demonstrating foot reflexology reactions. The response signal outside the correlated motor-sensory cortical area with foot reflexology may have clinical significance and may be helpful for smoking cessation. We suggest conducting a large-scale, randomized controlled trial to confirm these findings.

Failed conservative treatment of synchronous primary cancer of endometrium and ovary in a young Thai woman: a case report.

A case of well differentiated endometriod adenocarcinoma of the endometrium with a synchronous endometriod and clear cell adenocarcinoma of both ovaries was reported. Recently, a 28-year-old woman presented with vaginal bleeding was diagnosed to have only FIGO stage IaG1 (FIGO 2000) cancer of the endometrium. After 3 months of high dose progestin treatment, 15 cm bilateral ovarian tumors later diagnosed as FIGO stage IIIa ovarian cancer (mixed endometriod and clear cell adenocarcinoma) were detected, and later surgically removed. The patient then was started on Placitaxel/Carboplatin combination chemotherapy for 6 cycles after surgery. The synchronous cancers of endometrium and ovary are usually presented in woman with median age of 50 with obesity, diabetes, and hypertension. These low grade tumors and better prognosis are the norm in contrast to the authors' case with clear cell component and higher stage of ovarian cancer in young lean Thai woman.

Feasibility and safety of remote radiology interpretation with telephone consultation for acute stroke in Thailand.

"Telestroke" is emerging as a potential timesaving, efficient means for evaluating patients experiencing acute ischemic stroke. It provides an opportunity for administration of thrombolytic drugs within the short therapeutic time window associated with AIS. We describe our experiences of the feasibility and safety of remote radiology interpretation with telephone consultation. Thammasat Stroke Center employs a computed tomography-digital imaging and communication in medicine (CT-DICOM) image transfer by PACS (SYNAPSE-Fujifilm), providing a real-time CT image transferred directly to the stroke consultants. The patient data are communicated by traditional telephone conversation. Here, we assessed patients who received intravenous rt-PA treatment for ASI between October 2007 and January 2009. A total of 458 patients with AIS and transient ischemic attack (TIA) were admitted to a stroke unit during the study period. One hundred patients received intravenous rt-PA (21%). Median NIHSS before thrombolysis was 15 (3-34). Mean door-to-needle time was 54 minutes (15-125). Mean onset-to-treatment time OTT was 160 minutes (60-270). There were 13 asymptomatic intracerebral hemorrhages and two (one fatal) symptomatic intracerebral hemorrhages. At 3 months, 42 patients had achieved excellent recovery (mRS, 0-1) and 14 had died. Administration of rt-PA for AIS with remote radiology interpretation with telephone consultation was feasible and safe, and the system was well received. Further studies are needed to determine the benefit of this method as compared to the conventional telephone consultation alone.

The position of the lumbar vertebrae in relation to the intercrestal line.

OBJECTIVE: To determine the position of the lumbar vertebrae in relation to the intercrestal line and variation in distance between the midpoint of the L(4/5) interspinous space and the intercrestal line in varying patients age groups of Thai people. MATERIAL AND METHOD: The present study was a retrospective analysis of the antero-posterior and lateral lumbosacral vertebral radiographs of 270 patients, varying patients' age from 20 to 80 years. Intercrestal line was drawn connecting the two highest points on the iliac crests of antero-posterior radiographs. The distance from the intercrestal line to the midpoint of the L(4/5) interspinous space and L(4/5) intervertebral space were measured. The results were statistically analysed by using ANOVA testing. RESULTS: The intercrestal line crosses the midline of the posterior part ofthe lumbar vertebral column between the upper half of L4 spinous process level and lower half of L5 spinous process level, most often at the lower half of L4 spinous process level (101 cases, 37.41%). This line crosses the anterior part of the lumbar vertebral column between the upper half of L4 body level and lower half of L5 body level, most often at the upper half of L5 body level (103 cases, 38.15%). Regarding distance from intercrestal line to the midpoint of the L(4/5), interspinous space in varying patient age groups, the intercrestal line was most frequently found above the L(4/5) interspinous space in most age group (average 5.73 +/- 5.72 mm; value p > 0.05 vs. 70-80 years). For the distance from intercrestal line to the midpoint of the L(4/5) intervertebral space in varying patient age groups, the intercrestal line was most frequently found below the L(4/5) intervertebral space in all age groups (average 6.60 +/- 6.97 mm; value p > 0.05 vs. 70-80 years). CONCLUSION: The intercrestal line crosses the posterior part of the lumbar vertebral column between the upper half of L4 spinous process level and lower half of L5 spinous process level, most often at the lower half of L4 spinous process level (37.41%) and at the L(4/5) interspinous space level (27.78%). This line crosses the anterior part of the lumbar vertebral column between the upper half of L4 body level and lower half of L5 body level, most often at the upper half of L5 body level (38.15%) and at the L(4/5) intervertebral space level (32.22%). The level of the intercrestal line tends to be high in elderly patients, neutral position and the intercrestal line by palpation tends to be identified at the higher level.

The combination of body mass index and age as a new index for identifying osteoporosis in Thai postmenopausal women.

OBJECTIVE: The purpose of this study was to evaluate the application of the combination of bone mass index (BMI) and age as a new screening tool to identify osteoporosis in Thai postmenopausal women. DESIGN: Diagnostic study. MATERIAL AND METHOD: Bone mineral density (BMD) data of Thai postmenopausal women, age 40-80 years old who attended the outpatient clinic, Thammasat University Hospital, Thailand, between January 2004 and December 2008 were enrolled. The participants with history of metabolic bone disease or use of drugs associated with secondary osteoporosis and/or history of treatment for osteoporosis were excluded. Each had BMD records of lumbar spine, femoral neck and intertrochanter. The data were completely collected in all 372 women. A diagnosis of osteoporosis made according to WHO criteria. RESULTS: The prevalence of osteoporosis at lumbar spine, femoral neck and intertrochanter were 8.1%, 20.2% and 15.3% respectively. The combination of BMI and age as the index to detect osteoporosis had a sensitivity at 76.67%, 76% and 77.19%, respectively. The OSTA index at the standard cut-point of -1 had a sensitivity at 80%, 70.67% and 70.17%, respectively. Raising the cut-point to < or =0 would had a sensitivity at 90%, 85.33% and 78.95%, respectively. CONCLUSION: The application of the combination of BMI and age as a screening tool is another option to identify osteoporosis in Thai postmenopausal women. Change the cut-point of < or =0, OSTA index could improve the detection of osteoporosis at a very high level of the sensitivity.

Accuracy of the distance between suprasternal notch and superior iliac spine to determine umbilical arterial catheter length.

OBJECTIVE: The present study aimed to validate the SSSL in pre-determinating the insertional length between the sixth and tenth thoracic vertebrae (T6-T10) and examine repeatability property. MATERIAL AND METHOD: A prospective recruitment of 52 babies who were placed the umbilical arterial catheter in the NICU, Thammasat University Hospital was performed. Insertional length of the distance between suprasternal notch and superior iliac spine (SSSL) were performed. The catheter tips were verified against anatomical points on chest and abdominal radiograph. The SSSL was measured twice on each patient to indicate repeatability property. RESULTS: All babies (100 percent accuracy) were correctly placed the catheter tips at high placement (T6 to T10) at the first attempt. Repeatability coefficient for repeating measure of the SSSL was 0.7 centimeters. CONCLUSION: The SSSL is repeatable, simple, and perfectly accurate for pre-determination of the umbilical arterial catheter length to position the catheter tip at T6-T10.