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The Journal of PrapokklaoHospital Clinical Medical EducationCenter
JPMCvort2No.1 Jan.- Mar.t99S
<1i
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ltil 12il1tililI il.n. - il.n. 2538
lssN0857-0914
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e nlanlsilasuranGritfioluTaurslulo
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PartialHydatidiform
Mole
{SCtafq#
For severeinfections,
Furthor information available on reouesl
HNB|
Thoi Ltd_ pho.mwaiet
&Dt.
302 Silon Rd. Bonskil 105mTeL2g-2qr
Hoechstts
StopsAnginaPectorisin 1-2minutes.
lso MackSpray
(isosorbidedinitratein an oral spray)
rapid andreliableaction
goodstability
* * **** * t # ##* * ** * +* t * * * * * * * r**** *
withB.l.D.dosage
Prevents
AnginaPectoris
lso MackRetard20 mg.
lso MackRetard40 mg.
(isosorbidedinitratein a sustainedreleasecapsule)
- convenient
B.l.D.dosage
- no peakplasmaconcentration
* * * * * #* # r#* # *+* #** *+ tt#* tt+*# #* *
Furtherinformation
available
on request
F.E.Zuellig(Bangkok)
Co.,Ltd.
10500
SilomRoad Bangrak Bangkok
Tel.2330110-29
En. 5312
Fax: 2331651
, 2383342
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The Journal of Prapokklao Hospital
Clinical Medical Education Center (ffnnC)
Editor Consultant
Prakit
Kasemsarn
Editor
Somchai
Poonawagul
Associate Editor
Ghatchawan Sompeewong
Editorial Board
Saluey
Phongpanich
Prapap
Yuthavisuthi
Prasong
Teerakidpisan
Chanya
Sathitwiriyawong
Pornsak
Nimvattanakul
Chatchai
Sawasdichai
Vithayut
Namsiripongpun
Jitti
Kositchaiwat
Rajanee
Vivatkul
Thanong
Prasanphanich
Cheocharn
Viliyaluppa
Prapassom
Kosakhan
Predee
Ngaotepprutaram
Wichai
Chucheapchuankame
Peerada
Nawakulsirinart
Daranee
Suwapun
Winai
bunchongkarn
Urai
Poonawakul
Prapas
Weerapol
Phuamchit
Chinwong
Yupin
Tongkumplala
Sudsavad
Likitwattanakul
Voranuch
Chalit
Manager
"Kosakhan
Chitcheuchun
Samnao
Sindhurat
Sirimada
Suksawasdi
Nittaya
Khantilaphan
Pleonpit
Jarupong
Chaiyasit
Bhinyovithayakul
Leelanuntawong
Sompartana Suwanachut
Orasa
Kasanotai
Nirachorn
Art
Segsom
Boonsirichai
Office address
TechnicalDepartmentof PrapokklaoHospital
Assistnnt Managers Orawan
Amphur Muang Chantaburi22000
Publication
Quartery
Owner
PrapokklaoHospital
Aungkasuwat
?'ri 6l"t
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The Journal of Prapokklao Hospital Clinical Medical Education Center
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In
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12 flult?r l il.n. - il.n. 2538
arstiry
Vol. 12 No. I Jan. - Mar. 1995
uta'l
Gontents
Page
uttrurEn-rrunas
t
uilu€rtrr'rEnrr
MESSAGE FROM THE
EOITOR
EDITORIAL
rAX
guruttri
nr:fl{ rfl:ilnr:rn gr andr
(u
Breast Feeding Promotion,
uflurnro{1n:?
Whose Role?
6^
da?a ytJvw'tur w.u.
Saluey Phongpanich M,D.
A
GV
V
uutr Sm%suu
n-r:sn
ul,o{yrr
:nrJBrir
rfioluI:wsrura
ORIGINAL ARTICTE
The Perinatal Mortality at
qa
otn il:ytllfl
Aranyaprathet Hospital
?nJnwonfrq1?yqaw.u.
Sompop
Salbactam/Ampicillin VS Cefoxitin :
11
urrJfi
firuvrfioflorf,ulunr:r.irdonaosr
ly
lthiarwachkul M.D.
Salbactam/Ampicillin versus Cefoxitin
as Prophylactic Antibiotic for Cesarean
ly
lllit?fl{11toil
Section
ilwntw qnriqnfr w.u.
Prapap Yuthavisuthi M.D.
nr:f;nurnjisurilsrilflor u{nr:#uor:rf
20
I
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iiulrirur
r.lrnn
::iffi'uhnn::ri
non-registered
andRegistered
Obstetrics
Mothers
Au!uu€
lJ1ttluutyuuun w.u.
Chirachai Nimchaiyanan M.D.
q.tuu'rtrr{rJeu
Partial Hydatidiform
Comparative Pregnancy Outcome in
28
Mole :
CASE REPORT
Partial Hydatidiform Mole:A CaseReport
:rusru{r1au1 :ru
tuf,ndwryyz,trtw.u.
Somsak Hanchoowong
M.D.
?t6rtn?nudrnr filnrru t*ilsdr asr{nfrfi n
lmns..ril'lailrvrlnrnfir
The Journal of Prapolklao
Hospital Clinical Medical Education Center
ilC u srTtCr r.n. - iLn.zsga
arsd
VoL 12 No. 1 Jan. - Mer. 1995
urir
Gontents
Fage
uun?'relfir"au"
33
REVIEW ARTICLE
Management of Menopausal V[omen
wrut ailni?attfr n.u.
-A'-
Chanya Sathitwiriyawong
RR|rlrurHrr'|
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MlacELIAilV
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dtuts utd n.v.
Umnaj Balee M.D,
u1rr'|3
INTERESTIITIGDRU6S
Hormone Replacement Therapy
e
-X
M.D.
Prasong Teerakidpisan M.D.
Hormone Replacement Therapy
?ftan1 tvtndn n.u.
Sirimada Suksawasdi B.Sc. in Pha
doarrnrr
ABSTRAGT OF JOURNAL
OUARTEBLY STATISTICAL
REFOET
r1{DtcATtoN
0ex0ph
EYE For the treaiment of Acute or Chronic non
pu,ulent coniunctivitis, btepharoconiunclivilis
and keratoconiunltivitis:
Eye-Ear
non specitic superticial ke.atitis
Oeep keratitis
Acne rosacea keratitis
Drops
coMPosllroN:
lridocyclitis
ilitd acute i(itis
OeramsthasoneO.1%
Phosphate
(As oexamelhaSone
non purulent blepharitis; scleritis; episcleritis:
sc leroconiu ncl ivitis :
ophthalmic!s-
Sodium PhosphateI
Neomycin Sultate O.5 %
(Equivalent to
Neomycin Base O.35 % )
0ph
Chfor
I
riltill
Chloramphenicol
n
W
Chloroph
for
5 mg.
irtt
dacryocystitis
oi.
;
ffi h
th*r-0ri
.. akun
O.25 % & O.5O%
Antazoline HCI
is an anlihislamineusetul tor
ocsla. allergies.
Tetrahydrozolile HCI
is a sympathomimetic.agentwhich
posses vasoconstricled aclion,
uselul lor ophthalmic decongoslion
in coniunctivitis.
Eye Orops is used
coniunctival
intections
and blepharitis,
ct&ei
keratitis,
which caused
by susceptible
organism,
corneal qlcers, Irachoma
traumatism
ot the eyes.
naoln- oouj
?-
Poly-Elph
?J'1,t4?looton
Gl a u co -Op h
Eye Drops
Ounuarrt]tailn!f0
lriiirioFrviooijar
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e maFo o.zs s: o.so rUniriqd aoo ri.o'o,
fug[!
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o.so dairitad
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ciirfi arl:anrau
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TF
lElr
-
Anlazoline HCI
O.O5%
Tetrahydrczoline HCI O.O4%
Benzalkonium Chtoride O.OiS %
Hydroxypropylmethylcellulose
Indication:
H
-
coMPostTroN
Each ml contains:
m
-
!!jqH-0ptt
Eye Drops
lilililflliltl
Timolol
E]!]B For lhe ireatment of External otitis, Catarrhal
olitis. Furuncular otitis.
Ear
I
r
Eye Orop6
m
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O@.
p6s
.ctiyit$
mic@geih
rt.fr,
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Gm*rilln,
f,tiw
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[m!a
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ar.Sl{ham
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sd
bbphartti.,
c.ued
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i.
ed
L?dilia,
luacrptibb
b
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d-rFrjitit
Waniah,
sEaE,
O6na:
2-3
to llt!
dop.
timaa
hto
th.
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.e(a)
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I dry
RhinoHist
Er
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several minules. Regeat applicaiion
lwo to thrce trmes a day-
Eya
aq@a
hsFin
cddd
Drops
Each 1OOGm. contains:
2OOm9.
Nitioturazone
Nifuroxime
375 mg.
2 Gm.
Lidocaine HCI
q.s. lOO Gm.
PEG
INOICATION
For the trealment ot Bacterial
Olilis extorna. Otitis media,
Pains in ihe Meatus.
AND DOSAG€
AOMINISTRATION
Cteanse and dry the meatus.Instil
tour d.oos in the meatus while
Foly-Oph
idft
tablets
Carbinoxaoina
talcato
rs a potant tntihistamanc
with a low incidaac€
rs a 3yopathomihctic
amina, ha3 ,i
acuon
3imilar to Ephed/rnc. srch .3 tha nasopharrngaal
ya3ocoi6tlcto.
and bronciodrtator
rclaoni.bst
relalrvelt
waater
,n rts pr!s304 ca.dtrc.
fiydraatic and cis
3timutlnl
actionr.
Congestion
RhinOffhea
A l l e t q-i c
Hay
rhinitis
tever
Each trbrer conrarn3:
P3.sdo.phedrise Htdrochtorid. - ,- _ 60 m9
c . , b r n o r a m r n c M a r c . r . . _ _ _ . _ - . _ _. _ _ - o - e
Oos.o. Ch,rdren ] tabrct3-lt,-cs roey.
adu[s.
r r a b r c r 3 - a r r m e sa d . y .
Esnta-0ph
n
$
coiFo$rTfor{:
G+ntrmbin $uli.te oqrtuetent to
o.3 s
Gcntd|ricin
lndication: For thE treatmsnt ol
intactione,causod by suscsptlbl€
microofganism,ot the €xlotnaleyo
and edng a, whirh caus€dconlunativitis, blapharitris,dacryosy8litis,
keralitls, trachoma.
Dosage:l€tl{l 1'2drops into 6ye($)
6yery{ hour8, ln E€vereintectlons,
dosagemay be ircreaagdto 2 d.opo
evsry nour.
Ointment
Eaci Gm, conlains:
Chloramphonicol1Omg. (1olo)
INOICATIOH:Chlo|oph Eye Ointfllonl i$ u3d foJ coftjufiSliv€ tnl6€.
tlons and blepharitis, K€ratitls
which ceuded by eusceptible
organisnr,comgal stcefs, tfachome,
traumatismqf lhb eyes.
DOSAGE:Apply to tho eys(s)34
timos a day, ard beforo b€d,
Eye Drop
Eya-Ear Drop
cotrPosrTtor{:
COMPO$ITION:
4.O%
S{lfamethitol
INDICATION$:Eye Acule and
Chronic int€cllon ol the sye8.
EarInl€ction ot the 6ar,otitB rn€dlaDOSAGE:Eyalnstill 1-2drops ir}lo
tie coniunctlvalsac (s) 4S timoE
a oay.
Ear lnsfil, 2.1 drops inlo lrlo ths
auditory canal /tO timcs a day.
P1rdni6donr Acetato
1%
INDfCATIOH: For treatment of
acuts or chronic non-inlecledcon.
iunciivili$.
DO$AGE:Shaketh6 boltls w6ll ehd
ihslilt 1.2 drops topicalty lnto the
coniuncliv4leac{s)4€ time6a day.
Eye-Esr DroF
coM:
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DUSTII{G POIYDER
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Gcntamicin S{ffrtc eguivafcnt to
For Acute gout Rhsumetoid arthdtig
ankylGlng srpndylliis
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$ouirdrir}r
Vol. 12 No. 1 lan. - Mar. 1995
J Prapokklao Hosp Clin Med Educat Center
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Abstract
The Perinatal Mortality at Aranyaprathet Hospltal in 't993
Sompop lthianrachkul M.D
Depadmentof Obstetrics& Gynecology,AranyaprathetHospital,
SrakaewProvince.
J Pnpkklao H@ Clin Med Educat Cents 1996:12i4-1o.
A retrospective study to find out the p€rinstal mortality r€te at Araryaprathd hospital from October
1, 1992 to September 30, 1993. There w€re 30 porinetal deatfts and 1,845 total blrtfis. Tho perft|atal
morelity rato wes re.ee/r,ooo total birtrs. Tho caus€s of perinatal deatfi werc macerated stillHrth (4o
percent), asphlxia (zs.ss percent), pramaturity (ao percent), congenital malformation (to percent) and
specific condiUons (o.ez perccnt).
The perinatal mortality rate wa8 slgnificant reduc*ion wlren fetal bir$ weight was 2,5oo grams or
mone.
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VoL. 12 No, 1 Jan. - Mar. 1995
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WigglesworthJS. Monitoring perinotol deoth. A
pothophysiologicol opprooch. Loncat r980;2:
fisrfin:ruJrsn'rfl
648-6.
lavua
lalsunrJqar uluuwns2Taa nlttllnrflu
eo
World Heolth Orgonizotion.lnternotionol
Revision.Vol 1.
Clossificotionof diseose.tcT5
HeolthOrgonizotlon,
1977.
Genevo:World
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CunninghomFG,MocDonoldPC,GontNF,Leveno
KJ, Gilstrop LC. Willioms Obstetric. teth ed.
ConnecticutAppleton& Longe,1993:'r-9.
z. World Heolth Orgonizotion. Wodd Heolth
Stofistlcol Annuol. Genevo, tPs3.
13-28.
s. nhuul nrqr4unr, rJrsn-nf lorJr;rn?3n{nof.
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2530 i 59-73,
a. World Heolth Orgonizotion.Report on soclol ond
biologlcol effect on perinoiol mortolity. Vol 1.
Budopest : World Heotlh Orgonizotion Stotisticol
PublishingHouse,tczo.
'|
t.
Poungsok S. Perinotol mortolity of singleton
pregnoncy in SoroburlHospltol1e83-1e87.
A thesis
submltted in portiol tulfilmentof the requirements
of the Moster of Science (Humon reproduction
ond populolion plonning), Foculty of Groduote
Studies,Mohldol Universw,1e8e.
Vichibondho P, PornsinghoT, PochipleuxP, et ol.
Problems of hilltrlbe people ond integroted
devefopment J Med Assoc Thoi tcat; 6ai159-73.
O-ProsertsowotP, HerobutyoY, ChoturochindoK.
The perinotol mortolfty ot Romothibodi Hospitol
1979-1985
: onotysisond lrends.J. Med AssocThoi
'1987;
70:329-30.
Vol. 12 No. 7 Jan. - Mar. 1995
I Prapokklao
11
Hosp Clin Med Educat Center
A
Gv
et
ultufigtufllJlJ
Sulbactam/Ampicillin
: slilnfiruv rfrar1a.rfru
VS Cefoxitin
[il n1t fl'tnnna0n?t?{?til?il a{
6l.vVt,
rlzvntr anrianG il.il.*
q9
Abstract
Sulbactam/Ampiciltin versus Cefoxitin as Prophylactic Antibiotic for Cesarean Section
Prapap Yuthavisuthi M.D.*
*Department of Obstetric and Gynecology, Prapokklao Hospital, Chantaburi, Thailand.
J Prapokklao Hosp Clin Med Educat Center 1995;12:11-19.
A prospective study compairing the prophylactic antibiotic for cesarean section was done
between sulbactam/ampicillin and cefoxitin. One hundred and frve pregnant women who undergoing
cesarean section were include in this study. All of them had high risks for postoperative
infection such as labour pain and membraneruptured more than 4 hours , vaginal examination3
times or more. They were randomly assigned to three cohorts. The control groups received a
single 2 gm. dose of ampicillin.The other two groups receivedeithert.s gm. of sulbactam/ampicillin
or 2 gm. of Gefoxitin intravenous after the umbilical cord was clamped. The incidence of
postcesarean endometritis was.31.4 percent in control group, but it was 11.43 percent in
sulbactam/ampicillingroup and 8.52 percent in cefoxitin group , which were statistic significance
( P < o.os ). In comparisionof sulbactam/ampicilinand Cefoxitin,there were no statisticsignificance
in incidence of postoperative infection. Within the limits of this study, it seem to conclude that
sulbactam/ampicillin' is as effective as cefoxitin in prophylaxisof postcesareaninfection.
*nd xotuf,6 -ui ndnn x [sonstut anssilnn h {unqi
t2'r,r?nrpin:,#lnallr,nnonlmia6fin btnenunn:r;ilnn#t
unrir
qrvdtvrlryo.l
ilfr n ntiufrt a.n.- fi.n.zasa
a - au
rrlurnrErirfi'nurdlfidsrfifiu
rflJilu${n{T:ounna{n'
(toxicity)riau uncldfinr:ldurilfr tytdo"
''rnoRB0nyll.nru'
tuu0lu 1{ u n1:3"t
rflr*nrJfiirrsdurnqnCldin{r{srr.t
ampbiltin
(cesarean
section)rfilduadr.rmn rY.rlurJr;rns
un::rnrhjuvw6{rflwrr
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:1o1iu
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llrndu rdo1frr6n
riio.rornfiriorird
t,du
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urdfiuutflduri
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cefoxitinrxrr:iif,r*fioufiqnGhrrdouunfiriu
morbidity)
rfiududru (
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6o
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r
ftY
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3B'-' d.rdnrflu
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^ lr r,l
t )
tu:;u; ro it u.d1dfin.tiins.rrYun{TuunfitTutfrnfihjfilornrs
(anaerobicbacteria)
n6'rdr6'o
un*dfinr:rirutJ$- louronrntrn Bacteroides
rdonrifnnnrrGor{o
iilrulr:dwilo.rrTu
riun'ir nrrhiutJfifitrs nr:6nrdolunr : eir 6'nnao
6t*ru'r1fr{rhsriouiirfi'n
nqn:nrrnfirrio.t ueiur
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enryr" 16 rru'jrrdorirlrnruqjfi'l
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e}fi rdu rJ$ftwdr p -tactamrrh ampicillin
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aAtu
r
r
iil: urnaonff
uturu fiq.rrirnfrunno
{ururiouRaae o0nqilfoToufiqiltaaul
unfirful6'n{rou.nd*u.ro
finrmrrenrrriorRaonun.uoioiinm;Iofioorr *rrdod*rfiqld'nnrurficurndurriu Haemophilus
rfinsonldr{rl:J influenzae Neisseria gononhea Enterobacter
un;iint:t:frrnio.riionrrcrouillrn
,
,
(intemal
monitoring)'-"
luTrr:'runnn
|l83 Bact€rctdesspecies":'un:ri$Ciinr*rnrnu'ir
,drdtirlttrrfi
onr:6nrfodnurisulfiurie,coti, nrr1frSulbactam
nurrninur
nrudri'uamplcillin
pneumoniae
dlrflurdouunfiriu dnd.r nr:6oc#am.ruirrrl6'nnori"ofi
Klebsietta
ar-ar
us:nn6tfiuutvir
o1fl'rfr(aerobicbacteria) un:rdsuunfiritildC.t nio6n'jrGefoxitins
ipiu6lruhdo:drur sulbactam
ld'uri anaerobicn'ludrTuampicitlinmnhnr:finnrnnno.rldrfluur
o1n1n(ahaerobic oacteria)
streptococci , Bacteroides fragilisf ottfu
fAdlyvirv,vv-
rJfiirw rf,orlorriulunr:drd'nononqnrnrluilrfot
r rfl orrTurirufi rnr r i r f,'n rujilurfiruri'uur cefoxitindlftdH nd
u'lJfi6rr* drnir'lrfl#lr+n
r{ofier
Rnonmrrnrirfra*tu
wd'aofiqnfn:auoql
iinml
urrJurfrouunrrflustuqlunr:fior#oriou
Vol. 12 No. 7 lan. - Mar. 1995
I Prapokklao
Hosp Clin Med Educat Center
13
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rn#r'fi'uyrui
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frileun{1fi2 ar16;uu.r
rJ:sfimGnT
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r:Jiuurfisu (Sulbactam5oo mg. +
Ampicillinr gm.)rrirnr.l
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t ru: vrhnI : sir qionooctq or: vTufi
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it
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amptciltin
z gm.
d.:rflunr:1fr1tjfi6'lu:t$iorls.:rTu
tunrreirn-onnoortunq'runruql(controt)
dldiru. Ampiciltin
Jp'url
"lu,
n
11n
:fil#fr'uo{Ioufi'drJrhilxr
nr:hor#sdnulffiiou
odtfiriudrdq (p=o.ooo++)
, ,l
u ys
nqril 2 tflTuU,.| sulbactam/ampicillin un;firiufid'q6onrr:Lt:luo0n5'ntsu(e =o.ozree)
a&
( P=o.osses)
dr u
1.5 gm. ilYht14tl6r
35 TlrJ
uasnlr 6or dofuHndr n"o
, i
r-t6tiJu1
s^!tl:Yufr.r
noso
nqrfi 3
Cefoxitin 2 gm. 01u1u
nl rnerro:3uuyn.rrouflflf,1?3uf,3R1'l
35?1rJrdUrTU
rir'rrbri'r6'q(p >0.os)
hjnu'i rSnrfl r nnd'r.trTilo
finunuto.r{rJruluucin;n{llnrrr.rd 1)
fir uunuJluurfisunr:6ordsts.rurfild'iu
ru'h fiarrl
r q nr:drn rrr{ luueiwnriuuJiuu
rfiuufiunrilnruqu
hi yru'ir Snrr ruunneirr fi'u1ud'ruo
(nrtr.rd s)
T;u3t?n1frq{ unneitri'uo
0Tqnrrri 1!ur[?fl''r1ro{n1:Rnoo
dr.rfiriudrri'q
rdurdu'lrTu
t
t
' t . ' - - -- du^u
ilR3n'ltnn[to'
drn:'runnchurunirgo.tnllnr?tyr1.tdo{RnooBns
tvrtitue$n8n[flu
!nu[s?rrn1?3
niromrur:irriuso.r
r6oondrnrrd16'odrunmsnr: rir6'oSrir P <o.os
vrv
riourir6'nun:if,q{iilfr
$yrrndorr:to.rnr:fr.:n:rf
uriavo{u
nJisutfisudnuawcor
srur.rdI il6ro{Rr:
{dtradriu'rGflnu.r
Control group
Sulloactam/Ampicillln
Cefoxitin
Ampiclllin z gm
'
(x = ss)
Xs SD
(tt = es)
X*.SD
(n = ss)
Xr SD
Age (yead
Parity
25.3 L 4.8
24.4 ! 4.1
25.6 ! 5.2
0.8 3 0.6
0.9 1 0.5
1 . 1I 0 . 7
Gestationalage (week)
Length of ROM (nours)
Length of labour (nourc)
3 9 . 1J 1 . 9
39.7 t 1.8
38.5 3 2.1
9.1 t. 7.2
10.4I 6.6
1 3 . 8t 5 . 8
12.5t 5.6
5.7 j 2.5
6.2I 1.8
1 1 . 9I 1 . 2
12.2 + 1.4
1 3 . 1J 5 . 4
5.9 I 2.1
Vaginalexamination
postoperativeHemoglobin(gm / 1 o o L l h 2 . 1 + 1 . 1
Ht|',lgtilE
- ririrjt#rml,rrodux + sD
- ROM = rupture of membranes
8.61 6.8
ffi
Citrobacter
,i-r
'l-
IlFnq
Haemophilut
ok
whatsequential
Ciprobay
therapy
didtous.
Ciprobay
trum
covers a broad
Nei$eria
of gram-positly.g",
and gram-negative;
pathogens, includ-1,i
ittg
multiresiqi.
' ;
tant strains.
'Ciprobay
reli::l
ably eradicates
large number'
organrsms rnvolved in hospitq$
acquired infectio
and shows bacte-
ilp
Pseudomonqs
.rl&.
:E
-
-
U
Enterobacter
tiresistant strains as well
as B-lactamase-producing
organisms such as staphylococci, Klebsiella and
Pseudomonas.
Escherichia
#
and cuts the cost to about
ii,fr.iendlV
i i U - i ^ * i . ' ?. ' . - ' .
le;:C[nethird of that involved
ln qther established
peutic regi-
Shigella
fi.ens.Further, the
I,fime
and care
[:::"^:t"ill
1:":
:"-torand nursing
staff as well as
hi;i the time and
ll'.efforts involved in
material disposal
are markedly reduced.
1l(,'.
I
t
*
Staphylococcus
g ram- p os i t i u e org a ni s nt
/]::-,
Sequential
Ciprobay
therapy: treatrnent started parenterally and continued
the oral route.
/]:-,
Z-\
\JvVv
/^\
/^\
\rv\J\/
/]:\
by
After parenteral and oral administration, Ciprobay reaches high concentrations at the site of infection.
Sequential therapy is patient-
Modern medicine harnesses the intelligence of
Ciprobay.
ff
StaphUlococcus
,.-.
Treatment with Ciprobay
makes full use of the intelligence ofan up-to-date preparation: Ciprobay attacks
the infective organism at
the base of bacterial metabolism and
prevents the function of bacterial
gyrase.
Since there is no plasmid-mediated
resistance against Ciprobay, the risk
of resistance development is low.
/4,
i4e.
Jili
-
il
Salmonella
.-ry.r.
-qE
Legionello
3@
"F"qE
't
ii-l
:.|-;
-
/
l-!
Streptococcus
G!
Haemophilue
ffi
Neicseria
(asHCI. H,0):tablets
Cipr0bat:
Ciprofloxacin
Concomitant
intakewithNSAIDS
250,500,750mg;(aslactate):
inlusi0n concentrati0n.
canprovokeconvulsions.
Transienr
fluids(50ml,100ml)100mg/200mg.Prcks:
was observed
whenadmtnrstered
Country
specilic.
Indicatiors:
Inlections riseof serumcreatinine
stmultaneouslv
wtth
(dueto sensitive
$idccll8cls:
Gl,CNS,hypersensitrvily,
organisms)
0f therespiratory
tract,middleear,sinuses,
muscut0skeletal.
eyes,kid- cyclosp0rin.
cardrovascutar
genital
(including
g0n0trhoea),
paramelers.
(gastrointes-andotherreaclions;
neysandurinarytract,
effectson bloodandlaboralory
prescribing
0rgans
abdomen
Seefull
Veryrarely:pseud0membranous
psychotrc
tinaltract,biliarytract,peritonitis),
skinandsolttissues,
b0nesandj0ints;further, information.
colilis:c0nvulsions,
ano
reactions,
septicaemia,
inlectionsin patientswith reducedhostdefence,
anaphylactic
including
andfor selective
shock;Stevens-Johnsorr
Oul otherCNSreactrons:
interstitial
nephritis,
majorliverdisorders,
decontamination.00st!0:
Depending
including
on indication,
125-750mg (oral)b.i.d.0r syndrome,
hepatic
necrosis;
impaired
100'200mg (i.v.)b,i.d.Acuteg0n0rrhoea
Kidney
lunction,
including
a iingledose0l 250mg (oral)0r 100mg photosensitivity;
transienl
l(idney
lailure,
trans.
(i.v). Reduce
doseif creatinine
clearance
below20ml/min.
Seelullprescribing
inloF ient hearingloss, ability t0 dnve 0r operate A
7/a.\
mati0n.
C0nlr,indicali0[s:
Hypersensitivity
to ciprofloxacin
0r otherquinolones.
Chilpregnancy
patients,
dren,juveniles,
and
andlactation.
Precruli0ns:
Elderly
epileptics
patients
withCNSdamage.
lhl0ncli0ns:0ral:
mineral-containing
reduce
antacids
Boad,Banglok.
serum 130/lNorlhSalhorn
absorption
of ciprolloxacin.
0ral/i.v.:CiproflOxacin
canincrease
theophylline
:
ffi
qb)
[.3,,],li#1f,',jiill'liiih',.'iiJ;ln'''''"''ttaygf
Diplococuc
Vol. 12 No. 7 Jan. - Mar. 1995
15
t Prapokklao Hosp Clin Med Educat Center
etln{fi 2 uflo{nrlrliisutfisunl?suilindouriounooo
av
d
d
gtfi
q
t
I
lil4u?uttnavnqil
uayanuorvlro{?flryry
(tt = ss)
Sulbactam/ampiciltin
(l,t = ss)
Gefoxitil
(trt = ss)
23
21
22
6
6
4
3
Gontrol
1
AntepartumComplication
- None
- PIH
- PROM
- Twins pregnancy
- Pretermlabour
1
2
- Placentaprevia
- Maternaldiabetes
2. Anesthesia
- Regional
- General
r4il1gtilq
2
1
2
2
I
1
32
31
3
4
32
- PIH = Pregnancyinduced hypeftension
- PROM = Prematureruptureof membrane
enrl{d B udn{dorj{dlunr:}iroio
{rhuusiavn{ru
CPD/failureto progress
Fetal distress
Breech presentation
Twins pregnancy
Control
(tt = as)
SulbactamlAmpicillin
(N = 3s)
Cefoxitin
(lrt = ss)
23
21
24
4
T
q
2
1
2
1
Previousc/s with PRoM
a
1
I
Placentaprevia
1
2
ilil1Utnq CPD = Cephalopelvic
disproportion
16
,]
un 72 nuun I u.n. - a.n. 2638
-dvdd
nrffirgufn'ntlnawnnoatminifrn lfinnutanfiilntnit
J
a
{r
r
I
9r1r1{n4 ilder{}ton'ltmlTatullnocoqu
Gontrol
(N = os)'
None
Febrilemorbidity
Endometritis
Wound infection
UTI
ilx1srr,rq
14
4
11
6
r
P value
Sulbactam
ampicillin
(lt = ss)
Cefoxftin
27
3
4
1
28
2
3
1
15.4f
0.73
7.64
6.77
o.00044
0.69448
0.02188
0.03395
1
2.06
0.35722
2
(N = ss)
-+ a e t r i , X ) a
fi{rhu 2 t1u liln{ilfifiii endometritis
iruriu Woundinfection
SignificanceP < o.o5
UTI = Urinary tract infection
rfiuurfisufrun{u
nrn{d b ilGrn{n'n6ordolunciudl#ur
sulbactam/Ampicntin
Controlua;nciufil#srcetoxithtrlllsutfiuufiun{u Control
None
Endometritis
Wound infection
Febrilemorbidity
UTI
Control
Sulbactam/Ampicillin
(tt = es)
(l.l = ss)
14
11
6
4
27
Gsfoxltln
(r = as)
(P value)
1
3
2
0.00151
0.0r682
0.04636
NS
28
3
I
2
0.00359
0.04145
0.04636
NS
4
NS
1
NS
P value
NS = non significance
uJilgurffsu
nlrNd 0 udn{flaRrr6srr{olu{rlaudtdiu$1sulbactam/anptcitlin
fru{rtuifidiusr cefoxitin
Gefoxltrn
Sutbactam/ampicillin
P value
(N = 3s)
None
Febrilemorbidity
Endometritis
Wound infection
27
3
4
1
UTI
NS = non significance
(iooru)
77.14
8.57
11 . 4 3
2.86
(tt = ss)
tDens
28
2
3
I
80.@
5.71
8.57
2.86
NS
NS
NS
NS
1
2.86
NS
J
Vol. 12 No. I Jan. - Mar. 1995
nf:1{ll
i
I Prapokklao Hosp Clin Med Educat Center
{
t7
or ?i
? ltdfl{n1:11'llUlT0 l1{4U?U postcesareanendometritis
Control
(tt = tt)
Sulbactam/Ampicillin
(lt = +)
5
2
J
I
No growth
E.coli
Klebsiellapneumoniae
B streptococcus
Enterococci
2
1
Cefoxitin
(tt = s)
I
I
1
a
usrd'rr:Jiuurr4uu::Hr rr nq rurd'[oifu
ur
?o't:al
Sulbactam/ Ampicillinun;n{rufildut Cefoxitin
Sulbactam rfluarp{ufro.: peniciilanic acid
a.lno1r'r.Jd6 aiy{u'i1?t{ 2 nq'il finr:fiord'o
sutphonefiqvr6'rlurirrou'lsri
do
B-lactamase
hiuflndrlrTu(e = o.rzoas)
Iounu'jr finT:6orda
nfr.:10urdouuofi ri u uayrflusr ruEI o.:nr r dou-r
tolr#ouunfiriu Sutbactam
og,iufi'uroulsf
F
Sulbactam,zAmpicillinun:iosat
8.s7tun6jufitd'iur:r
tactamase
rirt#roulmi B-tactamasetrjrrtr:n
Cefoxitinorilnhfru ritaiunr:6ordofiuzunnir6'er
tAeY''
rurrirarssrilfr
6rri:16'urrJfr
6rwfuoonqilf'tder'du
y{u?1ilTouflt
2.86 yr.l 2 nqsJ
il'tn rryu'jrnr:t#Sutbactam
durn-uAmpicilin
ruflo.t'j'ru1ilfrd':w
Sutbactam/Ampicillin
ocdrlfi'uroonqtrf*it#ouunfi
riu'[finiros?1.ril1ndil
161dsr
nlunr :r1orriunr :6ordoHfi'.r
nr r air 6'oonooqor:
jqvd
I
,Jrrt '
#.luuofirisrfiod.larnrs
(aerobicbacteria)
ttni
6n'jrurfi1frfiuoqifi":1rJ
6o nmpicittin
z sm. uflt
(anearobic
uunfiriutfiet'lrid.rornre
bacteria),'-*
16'nrndrrirrfi
urur{unr:td
Cefoxitin
z gm.
A
o'.rrrarur:fi
X
e\
iat
oldrrurl#riJuutJfi
6.:urrfiorlorfiulunrr
r il 0 B r.r0 R1 t r yt't y I u 0 ?J0,0fdu ? u n il lilt T{il q $ n
nir6'onnaoqerryr''r.i14ri''rfr'o.r
d.:linfinr::Jurfrouorn
onrsuud'rnr:r.ir6'or
sir* so.rt{luo"lr1.Jfr7 o:[fiil'i1
f
q
e
4
,
Atnv;
[ilr.lilo$nanrflu:oufl;11.43 tunqunto:uu1
v-
X
,
q
' t-
n lrry{rs [fr06i':utilqirfi 0lilfi" u (frlo growth) rfl :13'j1
r500nnn't')
ornnr:dnurtu:rgrrud nudr n.r:tf
(Aerobic
td'vrhnrrryrrndrn#fi.rr'',n.o
bacteria)
E
, Z
/
)v,X
^l ju 'J
Sutbactam
5oomg.iTrurTu
a
Ampiciilin
r gm.16'r{ad
ryr''ru1{ tT 011$J 1J1{1{UO{ tU ilt U 0n [il 1t .:0','I
n1fl
rfiuur#rrTunr:tdcetoxitinz gm. lunr:rlooriu
(Anaerobic
bacteria)dlyrlld'rj ou lunrttb^r:truoqn
nr:6qrdoqrnnlrlh6'0fl
naoqer:nrrufirfior
uo:fir
dnuauH#.:rir 6'onnooq or:mr,lu rirvia.r" ai':ur6ofi
w X X Y
uv
ldrundn'jrnr:tdAmpicilin
2 sm.idtfii'uoqjiurlogiu
!v{1![rfl?[5o1uuu Iotrfi ytln E.coli , Klebsiella
orir.ofiriudrd'ry
wfiu SutbactamrAmpicinin
6irnru1;flrr
pneumoniae, p-streptococcousfl?iltdo
fiotrirrurl#rfluutJfi6rul rfi orJo.r
rTu(prophytactic
Enterococcus tfu
nutun{rufild'iusr Gefoxitin
antibiotic)tunr : s.i
r 6'qnfloorlst?yr1.rt rirri'o.l
rdo{srnilrCefoxitin'lil'ldrunsio
r#odadufi":*-'
9J
18
nrffirguflnnFlnwunnastrtaioifrn
hwnunnwilnndt
postoperolive morbidity. Am J Obstet Gynecol
drd
t
e
Ueo
a
't987i157i794-8.
q
eh
).
I
Swortz WH, Grolle K. The use of prophyloctic
onfibiotic in cesoreon section: o reviews of
595-60e.
literotureJ. Reprod Med 198'l;26:
Cortwrlght PS,Pifiowoy DE,Jones HW et ol. The
use of prophyloctic ontibiotic in Obstetric ond
gynecology: o review. Obstet Gynecol Surv
u
rr{HU?ulril1n1TR','rne
nTl Un,]UrOYr''rn',]Tflnl'',]
Rooqqoflr'ritnfi'rfior
ehururosnu Touurirosnrflu
s n{ru"1ns35r1u n{rudr rflun{rnruqu(Controt)
z gm. rfluutJfidrwr$iorJo.rriu
w16'iu ampicitlin
lunr:ei'rfiornaoor{err
o'nz n{r osldiusulbactamz
'1984;39:537.
uis Gefoxitin2 gm.
ampicitlin1.5gm. (UruaSVN@)
tru'Jr nq'rrfi
rfluutlfr6'lrurfioflorfiuntra'rd'u
Snrt6ordoriaun'irn{ru
16iu sutoactam/ampicittin
d r a d ) y e . v l
n?uqilog1.tiluumnq [ourot{1tfl']roolso tvr:.DJo$n
'
ds
o
e
-
t
Jt
uuryirrTu
ffnrnuunletr:nrlorn-unr:6or#onlddrfi
Cefoxitin
fisrfin:ruilrvnlfl
u
294-7.
Gibbs l?S. Clinicol rbk foctors for puerperol
infection. Obstet Gynecol 1e80;ss:l78.
Repke JT,Spence MR, Cothoun S. Riskfectors in
ihe development of cesoreon sectlon Infecfion.
SurgGynecol Obstet 1984;158:1'12.
'l'1.
Hogglund l- ChristensenKV, ChristensenP, et ol.
Rlskfocfon in ceeoreon section infection .Obstet
Gynecol t983;62:145.
"t2. Duff P. Pqthophpiology ond monogemeni of
postcesoreon endometritis. Obstei Gynecol
tJ.
)qu
Howrylyshyn PA, Bernstein P, Popsin FR. Risk
foctors ossociqted wlth infectlon following
cesorectnsecflon.AmJ Obstet Gynecol l98l;139:
9.
iluruunvrrirl::fi
n tnuusru6'
flolrouq
rn#r {uvrqi
dahurunr:I:onururnn::rJn
ur^rvrriuf
rsn'ru nrfimfir ri'rrafirn{ru.rrug6a
iti n atluii1 u.n.- fr.a. zosa
qy
u:[lrnTTil ?lrnn''rTfruufrqil
un:alQ1nrnrffuo
,x
:1U.t1UU
drri'efirriuarlu
usrraror;qilu?fvrldrso{.r
u''l uNASYN@
rdarirrurlf,lunrrfinurnf.rf,
1(
Reference
1983:62.145
Johnson SK, Ohur M, Golosk RP. Prophyloctic
ontibioticin obstetrlcond gynecology.In: Zospon
FP, ChrMion CD, ecls. Controversy In obstetric
ond gynecology ttt. Philodelpho: WB Squnderc,
'r983:450.
Phelon JP, PruynSC. Prophylocticontibiotic in
cesoreon sectlon : q double blind study of
cefozolin. Am J Obstet Gynecol 1979i133?,474.
Wong R, Gee Cl, Ledger WJ. Prophyloctic use of
Cefozolin in monltored obstetric potlents
undergoing cescr€on sectlon. Obstet Gynecol
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Sweet RI. Ledger WJ. Puerperol infecflous
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Cunninghom FG, Houth JG, Strong JD, et ol.
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Goll SA. Ihe efficocy of prophylocfic ontlblotlc
in cesoreon section. Am J Obstet Gynecol
1978; l 34:506.
Gordon HR,PhelpsD, Blonchord K Prophyloctic
cesqreonsecfiononflbiotic : moternol ond neonqtol
morbidity before ond qfter cord clomping.Obstet
Gynecol 1979;53t'15'1.
Duff P. Prophyloctic for casoreqn delivery : o
simple cost-effective strotegy for provention ol
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Kreutner AK, Del Bebe VE, Delomor D, et ol.
Perioperofive cepholosporins in lhe hlgh rlsk
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o p -lociomose inhiblter ihot extends the
ontibocterlot specltum of F - loctoms : inficl
bocieriologicol chorocterizotion. Antimlcrob
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Wexler HM, Honis B, Cqrter WT ond Finegold SM.
In vitro efficocy of Sulboctom combined wlth
Ampicillin ogclnst onoerobic bocterio.
i876-8.
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Deboroh M, compoll-Richords F, Brogden N.
Sulboctom,/ompicillin. A review .of its
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onlibocteriol octivity,
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theropeutic use. Drugs 1987;33:
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multicentre study of evoluote the effect of
Sulboctom,/ompicillin combinotion on onoerbic
micro-orgonisms. J Int Med res i99o;t8:
19t -200.
Hemsell DL. Sulbqctqm/omDicillin for treotment
of polymicrobiol pelvic infections. Drugs llSo;tt:
22-5.
Crombleholme W, Lqnders D, Ohn-Smith M, et ol.
Sulboctom/omocillin versus metronidozole,/
gentomycin in lreotoment
of severe pelvic
infections. Drugs lrao;st(supplz):rr-rs.
Gonning J. A comporison of porenterol
sulboctom/ompicillin
vorsus clindqmycin/
19
gentomycin in treotment of pelvic inflommotory
diseose. Drugsl9g6;31:lt-17.
Abbossi Af, Soid A, Gober A. Intromusculor
Sulboctqm,/ompicillincombinotion theropy in
gynecologicol ond obstetricbqcterriol infections,
J Int Med Res1e9t;te:44A-eA.
25. Howrylyshyn
PA,BernsteinP,PopsinER.Shorlterm
ontibiotic prophyloxis in the risk potients
followingcesoreonsection. Am J obstet Gvnecol
'1983;45:285-9.
Gonik B. Singleversus three dose cefotqxime
prophyloxisfor cesreon section. Obsiet Gynecol
27.
1985;65:189-92.
Gibbs RS,Si Cloir PJ, Costiilo MS, Costonedo yS.
Bocteriologic 'effects prophyloxis in high risk
- 82.
cesqreon section. Obstet gynecol 1981:57:277
2A
Tmenr(uinlrFfncrunnatr7minifin
lfinnunnftilntn{t
,'
un D gilun I il.f,. - u.n. 2638
-<uad
A
€rt
v
il?rilfinuouu
414dVG
n,'tinnt/l[ilt Blt t?t8il Rail a{ n'ltm{n??R
-[uur
rnrdldur nfr nnrrdfrunfrnnrr d
6rta dnlrariuri il.u.,*
Abstract
Comparative Pregnancy Outcomes in Non-registered and
Registered Obstetric Mothers.
Ghirachall{lmduiyanan M.D.
Departmentof obstretic and Gynecology,PrapokklaoHospital,Chantaburi,Thailand.
J PrapokklaoH@p Clin Med Educat Canter1gf,4i12i2o-27.
A sfr.dy of 1oOwomen urthout antcnetal care who doliver€d at Prapokklao Hospilal from May 1,
1992, to April 30, 1993 was performod to study ttrc complication at lnuapartum and potoartum periods.
A control group consirsdng of soo womsn wiilr 4 ANC or more was uaad for comparsion. The risk of
inhapsrtum PROM and prcterm delivery in t|e study group rcra g.ez and 5.93 tmos highel than tf|e control
group. For ttp n€onates, tlrere were incHance ot low bts$ weight 2.oo timoa hlgher in the study group,
shorter gestational agea (re.ro-4.67 wks. VS. 39.9s-1.2r wts.) and longpr pedods of hospitalization (e.za7.82 dayE VS 4.16-5.26 dryn). The incklenca of perindal mortary and abandoncd neonates tonded to b€
higher in the atudy group, but no 3tatstlcal signilicanl Thc main prcbleme fior not attendlng the antenatal
cllnic were time constralnts (sa percent) and econornlc rsasons (ts percent).
*n
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Vol. 12 No. 7 Jan. - Mar. 1995
J Prapokklao Hosp Clin Med Educat Center
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J Prapokklao Hosp Clin Med Educat Center
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Vo|. 12 No. 7 Jan. - Mar. 1995
J Prapokklao Hosp CIin Med Educat Center
27
lY^
tona.|:o'l{o.t
t.
qlt,
aHgrn5nruaio,ilrrqvrnaldrviq, :Jxnrn
"arfi
1tu tl Iu
ua y n ruv. rru? vt't{ n n o n t'l n't?rvr't?n ! t n
te{nflrurnilrvrlnrndr {uvru-3fl w.A. 2s2a-2534.
rrrnrrqutinrrdnrtr unvsnrnsrfn6fin tr{nfl r!rn
nr;iln tn6'r 2fi5;si1so-s.
FosterDC,GuzickmDS,PulliomRP.Theimpqct of
perinotolcore on fetol ond neonotoldeoth rotes
for uninsuredpotients: o'nqturol experiment'in
WestVirginio. Obstet Gynecol 1ee2;7eiao-s.
Neye RL,Hqrkness
WL, UttsJ. Abruptioplocento
perinotol
ond
deoth : o prospectivestudy. Am J
Obstet Gynecol 1977
;i2ai7ao-6.
n'ruu.r er4rnuorr, rJa;ri'nr{ lo:Javra6gndrtfr.
n:rur,l.r
n'rrFr'rfl
flo.rvrlrnGnhrfror.lu:nGnranrferrur6u6.
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]Ty!^,
il??ru16n1t. nq{ rililriulun r:6'runilil11r?J
11
n n:.Jtn fl ,
2530:59-73.
12.
13.
MooreTR,OrigelW, KeyTC,ResnikR.Theperinotol
ond economic impoct of prenotol core in o
low socioeconomic populotion. Am J Obstet
Gynecol 1986;r54:29-33.
Ryon GM, Sweeny PJ,SololoAS. Prenotolcore
ond pregnoncyoutcome. Am J ObstetGynecol
'1980;
1 3 7 : 8 2 6 -1
8.
14.
't
5.
'16.
no.ioulliarlrounin nrroutis nrsnrxar6lrru4$.
uruulruoutig uriun; rdn 2tn5-253s.
Schlesselmon
JJ. Cose-control studies,design,
conduct, onolysis. New YorkOxford University
Pres, tpaz:rso.
Kliegmon RM, BehrmonRE. The fetus ond the
neonotol infont.In : BehrmonRE, Voughon VC,
Nelson WE, eds. Nelson Textbook of Pediotrics.
'r3thed. Philodelphio
: W.B.Sounderscompony,
1987:358-421.
BollordJL,Novok KK,DriverM. A simplifiedscore
for ossessmentof fetol mqturotion of newly born
infonts.J Pediotr1e79;95;769-7a.
d
oa
A
^
"!A
yilrinitvr
tmilfit {1uq1tnc.dnnil?Jqnnil1{n1twlylri.
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'18.
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25'r7.
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"nr{rnr311payrd'1
2 5 31 : 18 7 - 2 3 9 .
rfiqni nrqn.iufrfi,ln
6. rr{. rlrguroutls$d$nv
Schlesselmon
JJ. Gose-control studies,design,
r6n"[uur,ld.:
rdorutraulunlr
rvmil141unr.
Inrsnn'1614
2518141226-7.
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3
t0.
vJ
?'rfl.1'ruruo.lFlurro{n'r?rJ'rn
2526.
nttn. nE{[ytllu1r1unt,
Klein L. Nonregisteredobstetric potients. Am J
Obstet Gynecol r gzr; 10:795-802.
BruceSL,PetriRH,Choo S,WilliqmAM, lmoijuniSO.
Unregistered
obstetricpotients:foctor in perinotol
lossein regionolizedperinotolnetwork.NY stote
J Med
1979;79i137a-7.
1 1 . Leveno KJ, Cunninghom FG, Roork ML, Nelson
SD, Willioms ML. Prenotol core ond the low birth
weight infont. Obstet Gynecol ress;66:5e9-60s.
conduct, onolysis.New York: Oxford Universitv
Press,1992i17a-6.
MorrisonJ, Nojmon JM, WilliomsGM, Keeping
JD, Anderson MJ. Socioeconomicstotus ond
pregnqncy outcome. An Austrolionstudy. Br J
Obstet Gynecol 1e8ei2s1-307.
Cunninghom FG, MocDonold PC, Gont NF,
Leveno KJ, GilstropLC. WilliomsObstetricsrcth
ed. Connecticut : Appleton & Longe, rrls:
220-9.
no{ourrirlnrornic nrxourris navrtr.:dr61xu6fl.
-
v
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nr r our :ia uil ua: r6n n"ru in 4l t vr-eiufi r z- r s fi'uflr fl u
2526.4tifr'a, 2s26.
Behrmqn RE. Preventinglow birth weight A
pediotric perspective.J Pediotr ]trg5:107:BA2-5a.
28
zrrniguin',ttlna.rr,nnsf,laniaifinlfinnu.rrrnftrlntnit
fld n ntiuii t u.n. - fr.n. zsse
namufrilaa
.u
Partial Hydatidiform Mole :
rramu{fl?s l r,a
eufrndnrqgrwfil.u.*
Abstract
Partial hydaffitiorm molg : a cas€ report
SomeakHanchoowang
M.D.
Departmentof Obstetric and Gyrcology, PrapokklaoHospitalChantaburi.
J Pnpokklao Hosp Clin Mec, EctucatOenter tggo;t?za-gz
A 3z-year old Thei prognant was admltted to Prapoltklao hosdtal bccauac of tlre intrauter{ne fetal
doaft ol28 we€ks gestaUonwtththe honeycomb like dacenta. Thcprcgnancywastenninated bymisoproctd
2oo US vaginal stnpodtory. The pleccnta was hydatidiform mob pardally. Th. dcad latus appeared normal.
*n$ulrry6-uinrinnalxnutunnr:iln mh {unqi
Vol. 12 No. 7 Jan. - Mar. 1995
J Prapokklao Hosp Clin Med Educat Center
29
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I Prapokklao
rirrilu triptoidy yr''r:nlilnrrti
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Hosp Clin Med Educat Center
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q
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rrr:r:r rEiro.oo:qr ortrra
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Complete ttoU Partial hydatidiform moles
n?'liltlslnsirl:v}fdr{
fronJisurfisu
Embryoun;
amnion
2 . Cytogenetic
analysis
Histologyof
the placenta
1.
3.1 Mesenchyme
Complete mole
Partial mole
TTJTJ
fi
46,xx
rirubaqjrilu Triptoidy
Delayedmaturation
Scarcityof Hoffbauer
Less delayed maturation
No karyorrhexis
cells
RandomKaryorrhexis
duringcistern
edema to
formation
Pronounced
All villi affected
early in molar
cistern
evolution
3.2 Hydatidiform
change :
unaffectedvilli
Maze-likecisterns
(after ts weeks GA)
formation
3.3 Vascularity
of villi
3.4 Trophoblast
capillariesformed in
situ, empty of blood,
disappearwith cistern
formation
of
GrosshyPerPlasia
haphazarddistribution unrelatedto
events
mesenchymal
+. Malignancy
potential
Less pronouncedand
slower in evolution
Varyingnumberof
persistentlyimmature
Yes
Persistentand functioning
lmmaturityand focal mild
to moderatehyperplasia
mostly syncytial
"Trophoblasticinclusions"
in villousstroma
No
32
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ronffirfir{6{
'1,
Wotson EJ, Hernondez E, Miyozowo K. Portiol
Frydotidlform moles I o revlew. Obsiet Gynecol
Surv l9o7;!2:5ro-r.
Be*owlfz R$ Goldstein DP, BernstelnMR. Noturol
history of portiol molor pregnoncy. Obstet
Gynecol 1985;66:677-8r.
SzulmonAE,SurtiU. Thesyndromeof hydotldlform
mole l. Cytogenetic ond morphologic
conelotions.Am J ObstetGynecol 1978;13l:665-71.
SzulmqnAE,SurflU. Ihe syndrome of hydotidiform
mole ll. Morphologic evolutlon of the complete
ond portiol mol6. Am J Obstet Gynecol 1e7a:1s2:
20-7.
7,
Czernobilsky4 Borosh,\ Loncet M. Porliolmoles
: o clinicopqthologic study of 25 coses. Obstet
Gynecol 1982i59i25-i.
Cunninghom FG, MocDonold PC, Gont NF,
LevenoKJ,Gilstroplll LC.WlliomsObsiefics. rp ed.
Connecticut : Appleton & Longe, '1993: 749-so.
Oyer CE, Cqnick JA Mqternql serum hCG levels
in triploidy : Voilobllity ond need to consider
mofor tisue. Prenct Diogn p92i12.7-9.
RomeroR, GhidiniA $rforl M, Collen M, FisherN,
Hobbins JC. Fksttrimesterdiqgnosls of oportlol
mde wilh the combined use of ultrosound ond
chorionic villus sompling. Am J Perinotol 19g9;6:
314-5.
Vol. 12 No. 1 lan. - Mar. 1995
J Prapokklao
Hosp Clin Med Educat Center
33
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Vol. 12 No. 7 Ian. - Mar. 1995
J Prapokklao Hosp CIin Med Educat Center
45
nil#airriu Hnr
st't:t{d I Estrogen.
Doses available/unit (mg)
Estrogen
Oral
Estrone deivatives
* Conjugatedequineestrogens
Piperazineestrone
sulphate,estropipate
Estradiol and derivatives
* Estradiolvalerate
Micronisedestradiol
Estrop; and derivatoves
Estriol
Estriolhemisuccinate
Synthetic
* Ethinylestradiol
Quinestrol
injectable
* Estradiolbenzoate
Polyestradiolphosphate
* Conjugatedequine estrogen
Estrone
* Estradiolvalerate
0.3, 0.625,O.g, 1.25,2.5
0.3, 0.625, 1.25,2.5, 5
1.2
1.2
1.2
0.02, 0.05, 0.5
0.1
0.5 mglml
40 mg/z ml
25 mg/2 ml
1,2,5 mg,/ml
10,20,40mg/ml
Estradiolcypionate
Vaginal
5 mg,/ml
Estropipate
* Conjugatedequineestrogen
Dienestrol
Transdermaland percutaneous
1.5 mg/g
* tz B-estradiol
TTS
gel
* tz B-estradiol
0.625 mg/g
o . o 1 %i n e 0 g
0.025, 0.05, o.t (release ratetday)
1.5 mg/dose
a Not all of these preparationsare yet availablein all countries
* fimuturj:rrilfllnu
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46
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ild u #ud I a.n. - fi.n. zase
o
d
v
Ertrogensfilllt{ltCildrfi:U
HRT
(Adequate Estrogen Dose)
Daily dose mg (Ug)
Estrogen
Conjugatedequine estrogens
0.625
o . o l 0 - 0 . 0 1 5( r o - r s )
't-2
Ethinylestradiol
Estradiol valerate
o.ob(so)
Estradiol(Transdermal)
nr:riulflutuT ncirdqe(i4fi
Subctrtanoous implantations
nr:lf estrosens
1. n'lrn::?1u3o.ru1
riylqnrr uf,Infinhi
availabte)Io ural n r odr r ii.rlun{.ri4uilorJfisr'rrdsu
I
r
eh
(menopause)
lrnnruflufrr lduriuld conjugatedf,il'] [flilo ll{Hu',]UU',]ilT','rU
tflunrrurnfio:
estrogen(Premarin@)
lu:ruro 0.3 iln. riou
z. ruroaooldurrrYrhj$#r
ll
rivyvey,
l6rulTila1n?u(?il?u
ln?u ua?RauI lflr,1il4n 13 r60s (60 o.s,0.625,0.925un: r.zs run.)
qi^r.\a
[01u'loonlu:1ufiu1[fiuru16r(overdose) ilTo
nuiaur'lri16 (intolerance)
Percutaneousapplication of gel
n'tttiton route to{n1:l#ul (adminis-
r. 1fiurbl'ldt$1efiQnfro{ (accurate)urn
-
A
X A^
t
'r.tg$O , s , a
Uni 8'11Unnn'l{
R?1lU{71711U1
$nUU:tJ']3111^lUll
A X
tration)
oratty : rf,il route dfiuruldlrndqo
)
4vr
[5.r1UUf,!:''rRlSnYrqO
Parenterally 1. lntramuscularinjections
riuhfluueiwiu
z. nr:n:6's.tiuilrgmum (orat)progstogens
lunaufiru dJlJo.trou[60il61u
Transdermaldelivery
2. Subcutaneousimplantations
So6:
'tdnndno rTunr:iutJ:lnru(oral)
r.
"1
3. Transdermaldelivqry
4. Vaginalrings,Vaginalcreams
conjugated estrogen
9'
A',ly
4{
parenteral
tOfit0lCfgtO{
tration tllrlfgi1{ sl
oto
2. ffio?n1un1r1#u1rfiu.lfiJorrin:,
adminis-
Intrarnuscutar injections ldfisrlfruf,a
.l
m0001n
tYl''tul{
s. tfur.iruuf,! [oluloonornir{nrur'rg
(reversibb)
t6uo1fi1T
4. nqolnlTrirr tdu.l1js.r:ruuyt..|{
5. noornr:fr.rr6urrdsrornrfir blood
r. lila;ornrhraiuflf
z. lfr:rd'lurturdsohjnuhrsus 6oo;qr conoantration-time profile
6. Batn?1xhi
erhreuororur1utfi'r
rrnnruud'rdo (initiatpeak) uciilfi{qrntu:r6'u
{rl'rl rar
u i a d r l x u u fsl r r ' r u , d r r o . n o r l u u o n n l {
u1xtR0ul,''r.lo''1il1n
l9:
Vol. 12 No. L Jan. - Mar. 1995
J Prapokklao Hosp CIin Med Educat Center
g. Chronic impaired liver function
lunr:virsruror6'urra:n[sr
z. norJfin?t1::fi'j1.JU1(drug interactions)
10. Recent venous thromboembolic event
r{uuroit 9
s.t#urtururoeirfild'Holun1rinu"rrfiarorn
occlusive
dressing
?irlfiurduairu(diffusion)
fimri.l#u
tz. Undiagnosed vaginal bleeding
stratumcorneum'[6'6
z. nrttfian progestogens
e. Hndodunr:#rrn:rtf
47
ctottingfactors,
reninsubstrateflofl.l
tt.
Chronic thrombophlebitis
Progestogensuillrilu o iu (generation)
ue'in;iuo;firunoio
tipioprofileuerneir{n-uri1.:
rfiolorn
fi androgenic
activityeirlri'u
1. First generationyt?n testosterone
frar6ls:
derivatives
aynoTGrfirutot $cisst
HDL rdotornfi
oroogrfien1r:sn1uI noa.lfr
frrHri.: (skin androgenic
effectqX{r:iu noriestrel,levo"norgestrel,
initation)
tu{rJruuru:ruusifiorodrtrl'nln;nrur6o.r norethisterone,
norethisterone
acetate,ethynodiol
10. nO glucose tolerance impairment
'[6'6n'irlfiqiud:gnru
lorfirilfiraorn{'l6'
Iorruil;uaiumfiuinrufiuuflr
diacetatettfls lynestrenol
unt{u desogestrel[[ng
runuu6ll[r14u,rfiqil[xuu[ur:0u
fi androgeniceffectsthd$ilfiHndo
1 4nfl:.]mluauu norethynodrel
d
,J
u,A
YA,)
rt9.ruu''r[14il
LDLC[[n; HDLC$eiR9tTG
2. Second generation t{?n progesterone
Vaginal rings and vaginal creams
Vagenal epithelium a!$o6il estrone ufly
estradiol 16':r o riunn
n oi:ytfi'ur.noshjs*rrtrsrua
derivativesasnq TG usitdfiiledo LDL $nt HDL
cc
AA
ufrorqrn$ androgenic effect ofr rriu medroxy-
ornooiuratolutrsinsiurinrornnr:fi vaginatsecretion progesteroneacetate,didrogesterone,
progesterone
$n! vascutization
6l Hnr rl"rufludo{inur:g6'uur
[tRYmedrogestone
g. Thirdgenerationnrnor:fitro:rtrdtrail e;
1#srirrsruaufluari'r.rmn rYr::d'uurq.rrfiuhJosrfio
ornr:vio.:do (btoating)n:t?un:t?.n
al
fio;tfiorarnr:ta{ menopause
frorhrul# Estrogens(contraindications)
Triglyceride,Lde, LDL" = Low density lipoprotein
cholesterol,HDL" = High density lipoprotein
(irritability) fi androgeniceffect oirmn d.1'lilfizunsio
HDL nil.r
unrliln.ru (nervousness)
usiri'r:sd'uuror\rfiul:Jgestodine,norgestimatetrfl: tibolone (6'.:rjofO =
t. Stroke
2. Recent myocardialinfarction
cholesterol)
gnrnlfisrtJa{
3. Breast cancer
a. Endometrialadenocarcinoma
5. Other estrogen-dependent
tumours
6. Acute liver diseases
7. Pancreaticdisease
e. Gallbladderdisease
progestogens
A,UA
Iua{o1n0,]n1:1,'lntn
U.t?Ja,tprogestogens
lr;,
[ourarur:orirr0toiaLipio profite(LDt $ff; HDL)
X
-
qe
Y
"'
(dose-dependent)
d'lriuor:1#
;
c
)uo
luturoefrqofi'[6'Hn'[unr:inr*.r (towest effective
oose)6'.:$rq.fluqrrrtfi s
frunuturolfur
48
?lrffi,Winnfrnwunnanrrniadfi
n lunatu:rrlnfltlnndt
nrtl.td s {illol{grehgetot
,,
flfr n sfufi t u.n.- ii.n.zasa
Progestogens(lowest effectivc dose
of progestogens)
Daily dose mg
Progestogen
Norethindrone(Norethisterone)
Norethindronercetate (Primotut-N9
0.7-1.0
5.0
Oral Progesterone
. Didrogesterone
Medroxyprogesteroneacetate (Provera@)
dl-Norgestrel
* Norethindroneacetate (transdermal)
vq
noflRlttnulto{
HRT
r. XarltamdrCo
300
10-20
10
>0.075
0.25
2. nxltfin,rrinrnrdolc
rfthiuriuorfi{uwrirb{rlfirJhntrnrtr.rfie
disease s. guuumrlrntinruu
r. rJotfiuunginur cardiovascular
Hnr
(cvo) Iouronr;odrrfir coronaryheart disease
s.t Cyclicalty(conventionaltreatments)
(cHD)
z. rlorriu$n:inur ostooporosis
ornnr:f,nrt'tu'ir nrrtd estreogens
rflurrnr ts tdsu
rf,uradr,trdur(monotherapy)
lunsdandsnuailtcrirritou
nrfl .td r nr:f,olfiuottGn osteoporosis
Patient category
Treatment
Premenopausal
Moderate exercise
Early or artifical menopause
Oestrogen with or
without progesterone
Natural menopauseplus symptoms
responsive to oestrogens or
positive risk factors
Oestrogen plus
progesteronefor t0 years
Moderate exercise
Naturalmenopause; no symptoms ; no risk
Notreatment required
factors
Avice on lifestyle
e;nlrlfrrfi n endometrialhyperplasiail*rurarioun;
toCuotnouu 30us! breastcancer(rflsrhuriau) uddrlf cyclicatty
rdu lou3u'lrun1ufi?n,tu
menopause
aarrStvv
iloilnf, 1\rflu o1lu ruuuTullu $8l{llJll nu 0?u?t[ l^|fl progestogen 6otf, progestogen :ruhldrs
3. U't;tYr',]01n1:vasornotorsymptoms1l0il
"l
r14fJ?[g'1
luri'l.rfrrstoorourdaut:nn risk ?8.t endometrial
hyperplasiaB{
Vol. 12 No. 7 Jan. - Mar. 1995
J Prapokklao Hosp Clin Med Educat Center
49
tt
gtul{il
5 tu:gutnguolu?1r?1{1r
l1 progestogens :?ttflU estrogenso1nR1:
flnurilllt 18 rool{
at
o.tno.t:'tifr5 regimens
fi rrarur:er.lfi
qo6o
la
- qlfe estrogens
orniufi r fir zs (zs5u)
u
- qldprogestogen
orn{uftra fi,rzs(rz iu)
- 1# arugtreeorniufi zo6i so(s {u)
Estrogens ProgestogensDrug free Endometrial
(dav)
(aav)
(oav)
hyperplash(r)
25
0
30
q
25
25
10
25
12
0
5
s.z Fixed estrogen-progestogen
combinationstiJunr :ruaruestrogens
ir ruri'uprogestogens
lu oosagerormrdnnfiufrnusorifinr:lfi lumr:r.:fi o
3.3 Continuous
tearnensrihrnr:lfi esuogens
irilfiu progestogeno
ryniu firuao$rmr:rrfi z
911:1{fi 6 Fixed combination products
Estrogen + Progestogen
Bstrogens
Trade Name
Day free (day)
(company)
Day
* Cylo-
Estradiol
Progynova@
valerate2
(SheringAG)
mg (rao)
* Prempak@
Conjugated
(Wyeth-Ayerst)
* Estandon
Day
Estradiolvalerate
1zno-21s
22nd-28
2 mg+Norgestrel
(ro oays)
(z oays)
Medroxypro
12nd-21"t
22nd-2
estrogen
gesteroneacetate
(to days)
(z oays)
0.625mg
s mg (rao)
|
-t
I
(rr oays)
soo mg (tau)
1-'-21-'
Composition: 't. Estradiolbenzoate
Prolongatum@
1 mg
2. Estradiolphenylpropionate
4 mg
Testosteronepropionate
20 mg
4.
Testosteronephenylpropionate
40 mg
5.
Testosteroneisocarproate
40 mg
(organon)
Amp. t ml
Dosage and administration
? ml lM every3-4 weeks or longerintervals
* Primolial
Composition : t.
2. Estradiolvalerate
Depot@
(shering AG)
Testosteroneenanthate
Amp. 1 ml
Dosage and administration
1 ml lM every3-6 weeks
90.3 mg
4.0 mg
50
?vriltrgufin'IrflnatunnaAtrain7frn
lxwuutanwilnnffi
fld u aiufr Ll.n. - fi.a.zsea
t'ttr.rd z g$rclfis'llao estrogenuar progestogendtllrurcaull'rniu nRr
Drug
Daily dose
Oestrogens
Conjugatedequine oestrogen
Oestradiol vaterate
Ethinylestradiol
0.625mg
2mg
20 mg
Progestogens"
Medroxyprogesterone
s.to mglday for 14 days each month
OR
2.5 to 5 mg/day continuously
5 mg/day for 10-12days each month
OR
350 mg/day continously
Norethisterone
a Dose of progestogen will need to be adilusted if progestogen side
effects occur
g.a Trandermaldelivery
$n1:1{d 8
3.5 PercutaneousappticationSo'lTT{d 8
3.6 Oral contraceptives(ur'rtutu)
n'1t1,0fi a Estrogen products
Trade Name/Company
Formulations
GenericName
* Premarin@
(Wyeth-Ayerst)
Conjugatedestrogen
* EstradermTTS@
tz B-estradiol
Tab 0.3, 0.625
1.25 mg
TTS 2, 4 mg
(cioa-eergy)
Dosageand administration
Apply twice weekly
(change onec every 3-4 days)
* Gastrogel@
(piette)
Estradiol
Gel. 0.0696
Dosageand administration
Apply 2.5 gm. daily to skin (preferabte
abdomen)from day 1$ to 21o
and oral progesteronefrom day to'n
to 21"'of cycle
Vol, 12 No. 7 fan. - Mar. 1995
J Prapokklao Hosp Clin Med Educat Center
51
9^
t0nfll:0'l{o{
t. ura"nuaf crtinirfln'nf,
olurr qli'rr"mlri.
n r r r fir rufr to.l aofl ru!"r!'pr. n ruyrn n-nn'lfi n f
turivrurdsrfinrn : Text ond journol corporotron,
2536.
z. e-tifl 6urJrtrnig. Postmenopousolhormone
replocementtheropy.'lu: ronnrrilrvno:.tnrr:Jr:ql
New drugs ond novel concepts. nru:mntnrnnf
ilurifl flrnrJrdfl
$uil. zssa.
Wn
o-nriuvttt1n16
av
.
fA
d
of
o
0 y
m6[0[405il1
u6uTl
Tl16il0t1mg
a1n0l
52
?nilTryinnffnatunnuntrrn{nilfin
lxwnuranrilnm&
flii u afluiit ,r.n.- fr.n. zasa
damtdrr
l1?J$'lslfrtit
0rrs1eindiisrod,oriqrgrnofnrimd,qfinmriooinri,dilt1s{$?qa
Prognostic significance of
morphologic
changes of the corpue luteum by transvaginal
ultrasound ln early prognancy monitoring
Glock JL" BlackmanJA Badger GJ, Brumsted JB.
Obsfet Gynecol t99s;8s:s7-41.
luteum
corpus
s lu o :ru (louecas)d.tn:ro'trinu
tstu as:ru (foun;sr)
un;rfiodu
orn6'nnirsm6
dm:aetnu corpus uteum (p = 0.ol) su'tn?o.t
corpus tuteum hjaur:olf,lunr:ritutunml
#Hrracrro.:nr:#on:rri srir.rlrfinrl tdon:ronu'j'r
t
- iL!'"t
nfu,rHxcu[oYr1f
"- rt:6fl$1rfionrnmru{rfiuf
corpus luteum lunr:
to{frnuilglrngrulota{
corpus luteumfi:Jiurnrnon,io''tnn''lrot?oniturn
o:tfioHntflu nonviablepregnancytt tu zo :'tu
(laua: ss) lulnr:dfiu nonviablepregnancys tu
#rn:rf:rul u:n rYu::6'uao{Iruunr
Hnffnfsst 27 T1u (ioua; rs) ro.r{dn:'rot{uiliurntrfiudu
(p <o.or) lilrruomuffifiuf::ra'jr.rrlirurn:sal
nrr#rn::li leruvrhnr:f,nur:cil'iror6ou$urnru6.r
ttio
udouRrnrou
Tr.fl.2so6tusni ss nil d.:#ro::li corpusluteumr{u*6'uaoililu progesterone
ludrmrq +-e ftJnrf finni +s nu (lauw ez) 17-hydroxyprogesteronettcl'nunrrud'lfiuf,
dinrrficrnrourdaurrtltrd $nJronn(isuecre) rfinfiaurTu:l d'uestraootl*n#tYoottfilurou r6isu
sY.r
nfi f 1u:out6oud.rldfu clomiphene citrate dlA;u cbmiphenecitrateorfirJiuromo{ corpus
'
I nil il01n1:1J8.tn',]:t,!frrnnnuun:utnufiil:;i6
r
eZad
n1: $yr\r!r1?l
:sil nrril tfruleionr:tfi onrtdtnt:ri
Ueo
s
y
(
Iuteum un::: d'uaoiluururnn'lreoidoi.rn:rli
1u:our6ouo::rutrG
Z
t
e1:J'jr trinunml#lviuf:;ndttulotoit
viT,:rius-a iu trn;rsrcrdaon:rcnrr:6'uaaflruu
corpus tuteumriu:;6'uaoSluui,olnrrd{n::ti
progesterone, 17-hydroxyprogesteroneUn; fnr*rwtor corpus luteumhjfurt'ufriurarird
nr:yrhmu udnr:nn?rulolro{corpustuteum
estradiol
Ar
nr r tfiornr r uvLr
riouor qn:tfi e fi Jnrf filri'uf rTuTo
fiRn1:f,n1*1TlU11 nnU$310.t corpus
uonilo$n toYl10nnT1.r1?en1{5o{Rn8o2 n't.1
.
A
6l
luteum fi.rrflu macrocystic, microcystic H?a non
.
Yt tv
e
av
v
d
&
c
cystic!ilmmufnut{nnilm0{n1Tf}inlTRu8;:lou10.l
aoilruu nlTv{u nonviablepregnancy(vrr:nh,i
srm:nfi6iqo{ouorqn::fifi.:
ra srJorfi)rfiqdu
o:*r1 afindiisrod n.u.
n qil,tlagfi - u7r ?vn t',.J
[:.iruututaw;;ilrun#t
{uryi
Vol. 12 No. I Jan. - Mar, 1995
J Prapokklao Hosp Clin Med Educat Center
53
Cervical intraepithelial neoplasia in women
Efficacy of oral beta-agonist maintenance
infected with
therapy in Preterm labor : a meta-analysis
human immunodeficiency
virus:prevalence, risk factors and validity of
Macones GA, Berlin M, Berlin JA.
papanicolaousmears
Obstet Gynecol 1995:85;31
3-7.
Wright TC, Jr.,Ellerbrock W Chiasson MA, et al.
-7,
Obstet Gynecol 1994;84:591
ierqrJ:: arrir o{n''lrdnt*rrfroi rn:rrri'run
qv
^
p-agenist maintenance therapy
10in1T IT
6l
ea
nru:{vrhnr:i6'u td'ythnr:6nte1
rfru?niu [ilnlTnoqunn1:1a{ preterm labor un3oln,.lT
q
X-a
-y--.4.
o:JnAro.r
tn il{ uonolRu u{q e.td
qffinr:nr:rfion11ilfi
r{R6il1nilq$nlilrvullJ',r{
IunlTnoquCIn,lTla.t
n o u r4
o & n s 1ruf iu r J,rf n i l 1 n i l q
o n (ce rvi cal recurrentpretermlabor$flgnlTtfiru latency peroid
iqq^
intraepithelialneoplasia) (Crrrr) ttasnxlildtJvTuf 1il0[5 p-agonist maintenance
therapy
1ro.rctN ri'u:lo,t'urf,u.ooirlg
on0ooildnu'tfrn
uuri.rrioX
oduornn
ailfixrqo{ Ioutfgruriory
n
n?rr,,Bn6'0n(validity) fl a{n''tTflT?ayr1.trsfl
6ans'r medlineritauori'rfi0fi6'u'irprematuretabor
r!fl:
(eRe smea')tu{'ufrd6ordo HV Tqul6'rirnr: B-agonistreceptor[[fl: therapeuticused irruniu
q vn
^ -^
a
fl n:e'rrl.rHU?
uil ryJil6toIrdo HrV alruru 398 flu [[a5
-
vn
ira '^
X
n1: review text u:nt?ru:ru:rru 6 T1u.t-11{
rusifinr:rTooon
2 r'ru.:1u rfiooornrYorynnlrin:r.r
HtV ifru':u 3s7 ou tunT:
{rJura{.:fitil6ou6o
6nr*r{'rJr uusinsnuos't6'iunr:frunrsni n1r6lr?o frnr::rrunrry membreanerupture i.rruqi'rg
AAA
--j,6
yr''r.J
rsfldefiur (enesmear)
nl:str?oTo
unfiorrsrs q.Jlunotv{u.t 4 T''lu.t.ltt
flotil-]il1?tnt.linttuu
'
U wo
(colposcope)
un;nr:ot:ro DNA solrd'o'[risfi meta-analysis'td'drurur$rJrurzirri'u
zzo r-lu
oqga
= rrr) fifiqruarutiGerrrufi
(Centrol= 10e,treatment
runnrtiirnudr qrifinr:rfio crru tun{ru riruuo 6o membraneintact,GA 20-37wts rio4n
vt:rlti'tfrogo(humanpapillomavirus ) (HpN)
v
nv rrirfi'ufounyzo (ao,rssa)yl.t4 :']u,J'luar$nu1u1 meta-analysislou9tquality
{':jrurarflrfiG"rdr
.l
r w oiu,^
&
1un{rury'nfrfi'lilfior6a
utv rvirii'uiosnr
4 (1sl3s7) evaluateun; data abstractionleuld'€iroanillrflu
f
(odds ratio= 8,7, p<0.001)n?'llih (sensitivity) odds ratios (on) uflr risk ditference Toud
1o.rnl:qlrx86Y?u
PAP smear ryirriuioga: 81 dichotomousoutcomeso;oonrurtilu randomeffect
om ilsirty{r; (specif
icity)ryirriuYauny ez :Jo6's
rfts.r model ttfl: fixed effect moael rfruiu continuous
fi rfr6'qfirn^trria{riunr:rfiq clN donr:6ordo outcomescl#rir mean weightedaverageluusin;
HPV(oddsratios.a)nr:6or4'oHIV(oddsrario
s.s) Tlu.l1u0.lailU'lf pooled OR for preventionpreterm
nr:fifi cD4 + T-lymphocytecount rioln'jr
2oo rrad' doluTnrfio: (odds ratio 2.7) un;
Aa
delivery= r.og(iouns e5 Ct= 0.6-1.9e)pootedOR
for prevent recurrent preterm delivery = 1.05
(5oua: 9s Cl = o.ss-z.os)meanintervaltodelivery
nr:fifiorqrurnn'jr 34 il (odds ratio z.o) o.tn
^-Xa
r.{fln1T'railuo.ltru:d't'i1 nr:tf PAP smear = -0.22 oays (iaun: es Ct = 2.s+r.gg) eirniu
'[un
r :o :r oil 1nx "ril froil n 6'r ot rsn frJrn uorq n o.u-6'nr:to.lnr :; u n:n do ug a.t preterm'[oi'un
lu{'r-hufi6ordouv riro:fi:J::fiyrGnlrrfiurno
RDStil'tfinora.Jrau
5or:ni
udud
ol,rfutu'l ?rir}}a'l?[uE yr.u.
taa
nfrl$nuflfl-utnTntttJ
11t
fteed
t',JWA1U1nWJyiln I n fr1 lvnUi
-
qt
flUUflTUn1T[t
o1nn 1T:? u??ri?1u.r-'rulflrilu,l
r
^
p-agonist
maintenance therapy
nr :tfin r :inur rsus acutepreterm
rafrio'rndfi
tabor
jj
preterm delivery Unt
[?{0mAtnOqUeln1f,1,8J
nrcntguintrf,nwtmnontminilfin
IfinarutawsrJnnffi fld p aiufr t tl.n.- fi.n. zase
54
ornr:rYro
r6s{To.rpretermurnaanrtun.:ldtong child monthsun3 o.n, oirz',oochild months
therapy
termmaintenance
aroo:rirl#rfio maternal tudtqqnurt (relative
risks.22,isunsssCl o.3zglucose
intoleranceld
doo.tdtttttio:t{rsdrwrn
zz.zo)1un{udAr,dr shiseltailu'jrlri$o1n1r
ru ofo(iouw sz)fiornT:rirurnorrflurh(secretory
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Vol, 12 No. 1 Jan. - Mar. 1995
J Prapokklao
AA
lA
55
Hosp Clin Med Educat Center
qrA
?'lg{'ntd0a n'l5lffl lfgl{'lu?au 3
4
lnau
Quarterly Statistical Report
No. of Out-Patient
No. of In-Patient
Department
Oct.
Nov.
Dec.
Medicine/fiqnnr:
6,367/252
Surgeryzriotnnrr
Orthopaediczri'onnr:
Rehabilitative
medicine
Opthalmology
1,943/2,513 3 1 1 5 6 , / 1 , 6 3 12,969,/1,330
't,32O/92
1,377/ 85
1,375/69
Otolaryngology
Pediatrics
Pediatricpatients/ri'ornnr:
Well baby clinic/ri'onnr:
New born
Obstetrics& Gynecology
ri'ornnr:
A.N.C.u
Obstetric
Gynecology
Familyplanning
Psychiatry
Dentistry
5,925/294
605
Nov.
Dec.
628
562
517
577
526
199
229
198
1,081
1,248
1,136
823
784
776
43
55
51
653
620
547
35
26
47
211
203
19'l
464
493
450
476
482
459
156
142
139
70
70
62
1,686/ 184
878/923
464
't,745/725
633
1,359/647
1,623/ 182
1,673/19g
610/653
6't4/662
493
1,562/912
644
1,295/514
450
1,729/873
641
1,282/546
281
304
1,814
1,448
1,339
1,223
1,014
1,122
96
113
311
Otherservice
Total
5,375/275
Oct.
27,668
25'8,34
25,891
2,776
2,905
2,685
56
'r7r?nrryinwFfnatunnuf,'trnin6fin
binnunnflthnnffi
flii E otiuflt u.n.- fi.n. zssa
No. of Anesthesia
Types of Anesthesia
Minor
Major
Generalsurgery
Neurosurgery
Urologicalsurgery
Orthopaedicsurgery
Thoracic surgery
Plastic surgery
Eye
E.N.T.
Obstetrics
Gynecology
Investigate endoscopy
Oct.
Nov.
Dec.
191
844
249
28
87
,t:
185
902
233
42
73
241
5
68
50
22
108
40
20
151
804
232
30
75
212
4
50
41
30
85
32
13
39
42
22
113
35
18
No. of Anesthesia
Types of Anesthesia
General anesthesia
Begionalanesthesia
Brachialplexus nerve block
Local anesthesia
Miscellaneous
TypesofX-Ray
Plain study
Special study
Upper Gl study
K.U.B.study
Biliary study
Arteriogram
Myelogram
Bronchogram
Miscellaneous
Ultrasound
Oct
Nov.
Dec.
273
234
43
212
78
384
471
34
183
103
358
208
14
166
110
No.ofX-Ray
Oct
2,669
128
51
47
3
3
Ilec.
Nov.
2,819
120
43
t:
2,733
116
39
ul
2
1
:
:
:
15
189
7
136
7
151
No. of Special Investigation
Types of Special Investigation
E.K.G. record
Fetal monitoring
Oct.
Nov.
295
273
54
8'l
Dec.
243
87
Vol. 12 No. 7 Jan. - Mar. 1995
J Prapokklao Hosp Ctin Med Educat Center
No. of Endoscopy
Types of Endoscopy
Esophagoscopy
Bronchoscopy
Gastroscopy
Peritoneoscopy
Cystoscopy
Proctoscopy
Colposcopy
Sigmoidscopy
Blood banking seruice
Units
Donor
units
Volunteer
units
Replacement
units
Professional
units
Transfusion
units
Whole blood & Packedred cell units
Whole
units
Packed red cell
units
Lyophilizedplasma
units
Frozenplasma
units
Freshfrozen plasma
units
Plateletrich plasma
units
Plateletconcentrate
units
Cryoprecipitate
units
Albumin
units
Leukocyte
units
Hemoculture
units
Compatibilitytest
CASES
Emergencycross matching
units
Mobile units
times,honth
Pathological examination
Autopsy
Surgicalpathology
Prapokklaohospital
Other hospital
Cytopathology
Prapokklaohospital
Other hospital
Clinicalhematology
Clinicalchemistry
Clinicalmicrobiology
Clinicalmicroscopy
lmmunologyand Serology
57
Units
cases
CASES
cases
cases
cases
cases
cases
tests
tests
tests
tests
cases
Oct.
Nov.
Dec.
3
9
25
4
4
2
4
a:
14
57
1
t:
;
2
4
2
2
?
Oct.
14
Nov.
Dec.
787
353
434
1,114
705
*:
933
727
789
683
441
242
1
31
957
848
472
376
10
38
t:
,:
,o:
878
753
412
341
23
t:
I
4
1,36;
75
q
Oct.
I
398
335
63
553
445
1,69;
95
I
Nov.
,,,UOl
150
9
Dec.
a
3,295
'15,885
353
305
48
646
549
97
3,262
'15,124
6,695
22,124
6,090
6,233
21,380
6,198
108
43
,*
283
7'l
s83
423
160
3,29O
16,337
5,803
18,889
6 , 19 3
58
znffiiflufn'nfrnwuwnuf,trtninifinTnnarunnwilntnit
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162
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431
427
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.1',]U$l,f,nl91
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J Prapokklao Hosp CIin Med Ed,ucat Center
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Waterfor injection
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174,318
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588,565
598,765
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Reportfor Nosocomial
Infection,
Prapokklao
Hospital
Nosocomial lnfection for October-December tg94
6fl- 3y
A1167-
No. of discharge 9,236 case
lnfection rate 4.06 %
Ward
r.c.u.
Medicinet
Medicinez
Medicine3
Medicine+
Pediatric t
Pediatricz
Nursery
Pediatricspecial
Newborn
PICU
Ob&Gyn t
Ob&Gyn z
Ob&Gyns
Ob&Gyn+
Ob&Gynspecial
Orthopedict
Orthopedic2
v|tfl]*YtvrTnu
surgeryrvrilisni
Surgeryz
Surgerys
Surgerya
Kasemsan
Sawusdichai
Psychiatry
Song
Eye&ENT
Total
Patient
dischaqe
(case)
Nosocomial
infection
(case)
108
617
646
514
474
373
241
441
93
1,293
72
428
285
496
617
350
307
273
101
797
375
696
381
70
67
155
75
237
22
14
1o,582
3to
6
20
6
10
3
42
9
3
7
4
0
5
2
8
19
13
0
31
31
13
'17
2
3
0
0
0
Nosocomial
infection
(case)
32
16
7
29
7
14
3
46
16
3
8
4
0
1
2
8
21
17
0
35
35
14
19
3
4
0
0
0
Attack rate
(xl
29.63
2.59
1.08
5.64
1.47
3.75
1.24
10.43
't7.20
0.23
11.J1
0.93
0
1.41
0.32
2.28
6.84
6.23
0
7.53
9.33
2.01
4.98
4.28
5.97
0
0
0
3.54
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Number of Antibiotic Therapy in Nosocomial Infection
No. of AnUbiotics
Ward
Total
s*
r.c.u.
19
30
38
2
5
44
13
2
153
3
13
20
0
2
36
12
4
90
Medicine
Pediatric
Newborn
Ob&Gyn
Surgery
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Other ward
Total
1
I
13
21
1
6
41
9
2
5
0
6
6
4
0
24
'l
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0
0
2
32
59
a7
3
21
124
38
7
375
0
1
1
0
2
1
0
0
5
o
0
0
0
0
2
Cost of Antibiotic Used for Nosocomial Infection
Dose
Antibiotic/cost per unit
Pediatric (lCU)
inj 1 mg
Amikacinsulphate
inj 1 mg
Ampicillin-B
inj 1 mg
Ampicillin
inj 1 mg
Cefotaxime
inj 1 mg
Ceftazidime
inj 1 mg
Cloxacillin
Syr.ro,oooU
Colistin
inj 1 amp
Co-trimoxazole
mg
Fosfomycin
inj I
inj 1 mg
Gentamicin
lmipenam+cilastatin
sodium inj 1 mg
Ketoconazole(zoo)
1 tab
Medicine
Amikacinsulphate
Ampicillin
Ampicillin(zso mg)
Ampicillin(soo mg)
Aztreonam
Cefotaxime
Ceftazidime
Ceftriaxonedisodium
inj
inj
inj
inj
inj
inj
1
1
1
1
1
1
1
1
mg
mg
cap
cap
mg
mg
mg
mg
=
=
=
=
=
=
=
=
=
=
=
=
0.15
6.00
0.013
0.19
0.30
0.017
0.14
28;00
0.088
0.087
1.10
11.43
1,984 mg
baht
48
mg
baht
mg
baht
2,040
89,440 mg
baht
72,132 mg
baht
66,520 mg
baht
baht 1,260,000 U
2 amp
baht
1,400 mg
baht
baht
532 mg
14,940 mg
baht
1
tab
baht
Total
297.60 baht
288.00 baht
26.52 baht
16,993.60 baht
21,639.60 baht
1,130.84 baht
17,64 baht
56.00 baht
123.20 baht
46.28 baht
16,434.00 baht
11.43 baht
Total
25.400.77 baht
2,377.50 baht
22,100.00 baht
4s.00 baht
92.00 baht
13,515.00baht
27,180.00 baht
72,300.00 baht
58,050.00 baht
0.15
0.13
baht
baht
15r85O
't70,000
mg
mg
1.50
2.30
0.265
0.18
0.30
0.43
baht
baht
baht
baht
baht
baht
30
40
51,000
151,000
241,000
135,000
cap
cap
mg
mg
mg
mg
Vol. 12 No. 1 lan. - Mar. 1995
J Prapokklao
Antibiotic/cost per unit
Hosp CIin Med Educat Center
Dose
Cefazolinsodium
inj
Ciprofloxacin
inj
Cloxacillin
inj
(zso)
Cloxacillin
Chloramphenicol
inj
Co-trimoxazole
inj
Fosfomycin
inj
Gentamicin
inj
lmipenam+cilastatin
sodium inj
Metronidazole
Norfloxacin
Tarivid
Pen G. Sodium
inj
Piperacillin
Sodium
inj
1
i
1
1
1
1
1
1
1
1
1
1
1
1
mg
mg
mg
cap
mg
tab
mg
mg
mg
tab
tab
tab
mU
mg
0.265
3.50
0.017
1.4o
0.013
0.73
0.088
0.087
1.10
0.27
4.00
13.50
3.10
0.11
baht
baht
baht
baht
baht
baht
baht
baht
baht
baht
baht
baht
baht
baht
11,000
5,800
160,000
44
4,ooo
120
15,000
5,060
4g,2so
4
72
60
790
43,000
63
Total
mg
mg
mg
cap
mg
tab
mg
mg
mg
tab
tab
tab
mii
mg
495.00 baht
20,300.00 baht
2,720.00 baht
61.60 baht
52.00 baht
87.60 baht
1,320.00 baht
440.22 baht
47,575.00 baht
1.08 baht
288.00 baht
810.00 baht
2,449.00 baht
4,730.00 baht
Total
276,989.00 baht
4,2s0 mg
97 cap
115,ooo mg
299 cap
53,000 mg
15,000 mg
92,OOO mg
49,000 mg
3o,ooo mg
P8
cap
4 1 , O O O mg
2,600 mg
28
cap
455,OOO mg
291 cap
8
amp
416 tab
20,000 mg
41,440 mg
14,OOO mg
b8 tab
B4
tab
3,ooo mg
7
tab
509 mU
41,000 mg
14
tab
637.50 baht
145.50 baht
1,495.00 baht
687.70 baht
9,540.00 baht
2,700.00 baht
27,600.00 baht
2,250.00 baht
12,900.00baht
512.00 baht
s33.00 baht
9, t00.00 baht
924.00 baht
7,735.00 baht
1,018.50 baht
224.oo baht
303.68 baht
1,760.00 baht
3,605.28 baht
2,520.00 baht
15.66 baht
460.00 baht
4,680.00 baht
2s.oo baht
1,577.90 baht
4,5t0.00 baht
1s9.00 baht
Surgery
AmikacinSulphate
Amoxycillin(zso)
Ampicillin
Ampicillin(soo)
Cefotaxime
Cefoxitin
Ceftazidime
CefazolinSodium
CeftriaxoneDisodium
Cephalexin(zso)
Chloramphenicol
Ciprofloxacin
Ciprofloxacin(zso)
Cloxacillin
Cloxacillin(soo)
Co-trimoxazole
Co-trimoxazole
Fosfomycin
Gentamicin
Metronidazole
Metronidazole
Nalidixicacid
Netilmicin
Norfloxacin
P.G.S.
PiperacillinSodium
Tarivid
lmg
1 cap
InJ l m g
1 Cap
inj 1 m g
inj 1 m g
inj 1 m g
inj 1 m g
inj 1 m g
1 cap
inj 1 m g
inj l m g
1 cap
inj 1 m g
1 cap
inj 1 amp
inj 1 tab
inj 1 m g
inj l m g
inj 1 m E
1 tab
1 tab
tnJ 1 m g
1 tab
InJ 1 m u
inj
1mg
1 tab
InJ
o.1s baht
1.s0 baht
0.013 baht
2.30 baht
0.18 baht
0.18 baht
0.30 baht
0.045 baht
0.43 baht
4.00 baht
0.013 baht
3.50 baht
33.00 baht
0.017 baht
3.50 baht
28.00 baht
0.73 baht
0.088 baht
0.087 baht
0.18 baht
0.27 baht
2.50 baht
1.s6 baht
4.00 baht
3.10 baht
0.11 baht
13.50 baht
Total
97,606.72 baht
64
Tffinrgailnitf,nuttmnantrnfnilfinlxnnutanttJnrnit
Antibiotic/cost per unit
Ob & Gyn
Amoxycillin(zso)
Ampicillin
Ampicillin(soo)
Cloxacillin(soo)
Cloxacillin(zso)
Co-trimoxazole
Gentamicin
Metronidazole
Metronidazole
Kanamycin
P.G.S.
Orthopodic
Amikacin
Ampicillin
CefazolinSodium
Cefotaxime
Ceftriaxonedisodium
Cephalexin(zso)
Chloramphenicol
(soo)
Chloramphenicol
Cloxacillin
Cloxacillin(soo)
Clindamycin
Co-trimoxazole
Gentamicin
Metronidazole
Metronidazote(zoo)
Piperacillinsodium
Tetracychine(zso)
flii e ntiufrt u.n. - fi.n. zsse
Dose
inj
inj
ini
inj
inj
inj
inj
inj
inj
inj
inj
inj
inj
inj
inj
inj
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
i
1
1
1
1
1
1
I
1
1
1
1
cap
mg
cap
cap
cap
tab
mg
tab
mg
mg
mU
1.50
0.13
2.so
3.s0
1.40
0.73
0.087
o.27
0.18
0.01
3.'r0
mg
mg
mg
mg
mg
cap
mg
cap
mg
cap
mg
tab
mg
mg
tab
mg
cap
baht
baht
baht
baht
baht
baht
baht
baht
baht
baht
baht
136
n,o2o
335
64
118
92
9,3M
69
6,400
2,500
t
Total
cap
mg
cap
tab
ml
tab
mg
tab
mg
mg
mii
204.00 baht
3,772.60 baht
770.50 baht
224.00 baht
165.20 baht
67.16 baht
8'r2.93 baht
18.63 baht
1,152.00 baht
2s.00 baht
3.10 baht
Total
7,215.12 batrt
1,800.00 baht
1s6.00 baht
7,245.00 baht
14,220.00 baht
12,900.00 baht
992.00 baht
988.00 baht
2.60 baht
8,636.00 baht
1,288.00 baht
288.00 baht
484.72 baht
2,369.88 baht
6s8.80 baht
0.81 baht
12,320.00 baht
3.52 baht
0.15
0.013
0.045
0.18
0.43
4.00
0.013
0.65
0.017
3.50
0.48
0.73
0.087
0.18
0.27
0.11
baht
baht
baht
baht
baht
baht
mg
baht
baht
baht
baht
baht
baht
baht
baht
baht
12,000 mg
12,000 mg
161,000 mg
79,000 mg
30,000 mg
248 cap
76,000 mg
o.44
baht
8
4
cap
508,000
368
600
664
27,240
3,660
3
112,OOA
mg
cap
mg
tab
mg
mg
tab
mg
cap
Total
64.353.33 baht
13,000 mg
16,000 mg
24,000 mg
52,000 mg
8,ooo mg
109,000 mg
76,000 mg
2,400 mg
2,070.00 baht
2,o8o.oo baht
1,o8o.oo baht
9,360.00 baht
3,440.00 baht
32,700.00 baht
9E8.00 baht
8,400.00 baht
66.00 baht
t.c.u.
Amikacin
Ampicillin
Cefazolinsodium
Gefotaxime
Ceftrio<onedisodium
Ceftazidime
Chloramphenicol
Ciprofloxacin
Ciprofloxacin(zso)
inj
inj
inj
inj
inj
inj
1
1
1
1
1
1
inj 1
inj
1
1
mg
mg
mg
mg
mg
mg
mg
mg
tab
=
=
=
=
=
=
=
=
=
0.15
0.13
0.045
0.18
0.43
0.03
0.013
3.50
33.00
baht
baht
baht
baht
baht
baht
baht
baht
baht
2
tab
Vol. 12 No. I Jan. - Mar. L995
Antibiotic/cost
J Prapokklao
per unit
Cloxacillin
Co-trimoxazole
Fosfomycin
Gentamicin
Dose
inj
1
,|
inj
inj
fmipenam+Cilastatinsodium inj
Netilmycin
inj
Netromycin
inj
P.G.S.
inj
1
1
1
1
1
1
Pen V. (zso)
1
Piperacillinsodium
Hosp Clin Med Educat Center
inj
1
mg
tab
mg
mg
mg
mg
mg
MU
tab
mg
0.017
0.73
0.088
0.087
1.10
1.56
1.56
3.10
0.60
0.11
baht
baht
baht
baht
baht
baht
baht
baht
baht
baht
82,000
214
4,000
4,040
139,500
1,500
3,OOO
1,374
985
104,000
mg
tab
mg
mg
mg
mg
mg
mU
tab
mg
65
Total
j,394.00 baht
rc6.22 baht
352.00 baht
351.48 baht
153,450.00baht
2,340.00 baht
4,680.00 baht
4,259.40 baht
591.00 baht
11,44O.OObaht
Total 239.198.10 baht
Pediatric
Amikacin
Ampicillin
Amoxycillin
Aztreonam
Ceftazidime
Cefotaxime
Ceftriaxone disodium
Chloramphenicoled.
Cloxacillin
Cloxacillin
Gentamicin
inj
inj
syr.
inj
inj
inj
inj
inj
syr.
inj
lmipenam+cilastatin
sodium inj
Ketoconazole
Nalidixicacid
Norfloxacin
P.G.S.
inj
Tarivid
1
1
1
1
1
1
1
1
1
I
1
1
1
I
't
1
I
Sawusdichi
Tarivid
Kasemsan
Gentamicin
Pen V. (zso)
mg
mg
ml
mg
mg
mg
mg
vial
mg
ml
mg
mg
tab
tab
tab
mE
tab
tab
inj
'l
mg
1
tab
0.15
0.013
0,25
0.265
0.30
0.19
0.43
15.00
0.017
o.27
0.087
1.10
11.43
2.50
4.00
3.10
13.50
baht
baht
baht
baht
baht
baht
baht
baht
baht
baht
baht
baht
baht
baht
baht
baht
baht
13.50 baht
0.087 baht
0.06 baht
10,64s
28,460
60
4,800
10,320
27,439
27,000
2
38,885
1,160
3,196
5,064
4
2
101
38.8
48
2
3,680
80
mg
mg
ml
mg
mg
mg
mg
vial
mg
ml
mg
mg
tab
tab
tab
ml
tab
1,596.75 baht
369.98 baht
1s.00 baht
1,272.00baht
3,096.00 baht
5,213.4't baht
11 , 6 1 0 . 0 0b a h t
30.00 baht
661.04 baht
313.20 baht
278.05 baht
5,570.40 baht
45.72 baht
5.00 baht
404.00 baht
120.28 baht
648.00 baht
Total
31,248.83 baht
tab
27.00 baht
Total
27.OO baht
mg
tab
320.16 baht
48.00 baht
Total
36e.16 baht
66
nftnrgufnnFlnawnnuxternin1frn
Inxarunnftrhntndt
ild n atiufrt a.n. - fr.n.zssa
Antibiotic/cost per unit
New bom
AmikacinSulphate
Ampicillin
Cefotaxime
Chloramphenicoled
Cloxacillin
Gentamicin
Dose
inj
inj
inj
Syr.
inj
I
1
1
1
1
1
mg
mg
mg
1t?O
ml
mg
=
=
=
=
=
=
0.15
0.013
0.19
15.00
0.27
0.087
baht
baht
baht
baht
baht
baht
378
17,220
2,520
1
60
617.
mg
mg
mg
1J10
ml
mg
Total
(tn;eaion)u"*\'H
Numberof rotat Antibiottcs
Drug
Ampicillin
Ampicillin
Ampicillin
Amikacin
Aztreonam
BenzathinePenicillinG
Cefotadm
Cefota)dm
Cefoxitin
Cefazolin
Ceftriaxone
Ceftriaxone
Ceftrio(one
Ceftriaxone
Ceftazidine
Chloramphenical
Ciprofloxacin
Clindamycin
Cloxacillin
Cloxacillin
Co-trimoxazole
Gentamicin
Gentamycin
lmipenem+Gilastatin
Kanamycin
Lincomycin
Metronidazole
Netilmicin
Netilmicin
PenicillinG Sodium
PenicillinG Sodium
Piperacillin
Streptomycin
Spectinomycin
No
lgm
50o mg
250 mg
5OO mg
i.2 mii
t
t
gm (o)
gm (l-)
lgm
lgm
r
gm(o)
t
gm (L)
2so ms (o)
2so ms (L)
lgm
1gm
100 mg
1s0 mglml
1gm
500 mg
10
40
mg/2ml
mg/2ml
1gm
300 mg/zml
100 ml
100 mg
150 rng
1 mii
5 mii
2gm
1gm
5,700
300
1,950
620
260
90
650
910
394
2,600
760
1,938
30
40
1,559
1,2s0
40
210
6,400
850
l,ooo
1,400
12,ooo
520
250
210
1,570
100
350
3oo
2,200
340
50
2
vial
vial
vial
vial
vial
vial
vial
vial
vial
vial
vial
vial
vial
vial
vial
vial
vial
vial
vial
vld.
vial
vial
vial
vial
vial
vial
vial_
viat
vial
vial .
vial
vial
vial
Total
Total
56.70
223.86
478.80
15.00
16.20
53.68
baht
baht
baht
baht
baht
baht
844.24 baht
]wP
Cost (batrt)
85,500
4,2OO
17,550
12,300
82,420
8,550
139.650
146,510
82,740
130,000
376,2O0
620,'160
43s0
3,800
545,650
21,25O
20,240
52,500
222,800
11,200
35,000
7,000
120,000
328,900
5,000
2,400
141,300
20,500
103,900
2,7OO
44,000
86,020
400
370
3,485,060
'g?
Vol. 12 No. 1 lan. - Mar. 1995
J PrapokklaoHosp Clin Med Educat Center
67
Perinatal Mortality
October tgg+
Number of Still Birth = 1t
cases
=
Still Bitth Bate
24.2s births
Total Number of Death
11 cases
Total Number of Delivery = 453 cases
Perinatal Mortality Rate
No Age
1
2
3
4
5
6
1
8
9
10
11
37
28
43
38
16
30
21
25
34
30
22
Parity
0-0-0-0
0-0-0-0
1-0-1-1
2-0-0-0
0-0-0-0
0-0-0-0
0-0-0-0
0-0-0-0
0-0-l-0
l-0-0-1
0-0-0-0
24.28,/1,0o0births
ANC
Gest. VDRL Del.
rs(rontu)
r (:lrr.)
z (:nr.)
e (ao.)
t (rwe.)
o (:r,rr.)
o (tvie.)
12 (ro.)
o (:r,rt.)
z (:fls.)
a (oo.)
er
2a
28
2s
2s
30
33
40
27
38
44
-ve
-ve
-ve
-ve
-ve
-ve
-ve
-ve
-ve
-ve
-ve
Wt
Sex
Type of Death
M
M
F
F
M
1,750 M
F
2,500
2,850 F
F
2,060
v/E 3,ooo F
c,/s 3,500 F
NL
NL
NL
NL
NL
a/A
NL
NL
F/E
A
A
A
A
A
A
A
A
I
1,05O
1,100
1,100
1,200
't,4oo
I
I
Gause of Death
Maceratedstill birth
Specificcondition(DM in mother)
(Phcenta
Asphyxia
previa,prolapse
cord)
Macerated still birth
Maceratedstill birth
Maceratedstill bir.th
Maceratedstill birth
Maceratedstill birth
Congenital
(Hydrops
malformation
fetalis)
Congenital
(Hydrocephalus)
malformation
Congenital
(Anencephaly)
malformation
November 1994
Number of Still Birth = 2
Still Birth Rate = 4.27
Total Number of Death
2 cases
=
Total Number of Delivery
468 cases
Perinatal Moftality Rate
4.27,/1,000
births
No Age
1
2
25
20
Parity
ANC
Gest. VDBL Del.
1-o-1-1 s (rns.)
r-o-o-1 s (na.)
30
28
-ve
-ve
NL
NL
Wt.
Sex
Type of beath
1,350 M
t,7oo M
A
A
cases
births
Gause of Death
Maceratedstill bifth
Maceratedstill birth
December 1994
= I Case
Total Number of Delivery = 439 cases
Total Number of Death
= 20.50,/1Q00 births
Perinatal Mortality Rate
No Age
1
2
3
4
5
6
7
8
I
Parity
39
30
31
17
20
23
37
18
3-0-0-3
4-0-0-4
0-0-0-0
0-0-0-0
0-0-0-0
1-0-0-1
1-0-0-1
0-0-0-0
22
0-0-0-0
Number of Stiil Birth = 9
cases
Still Bitth Rate = 2o.so bitihs
ANC
Gest. VDRL Del.
e (:nr.)
z (:nr.)
Wt
Sex
32
28
t (:t^to.) 32
33
rr (:r^rr.)34
a (ro.) 43
1 (nniln) 2 8
z (se.) 33
-ve
-ve
-ve
-ve
-ve
-ve
-ve
-ve
M
C/S 3,450
B/A 1,600 M
C/S 1,050 M
NL 2,OOO M
M
NL 2,500
NL 3,700 M
C/S 1,150 M
NL 2,470 M
(no.) 36
-ve
NL
4
2,0s0
M
Type of Death
A
A
A
A
I
I
I
I
Cause of Death
Maceratedstill birth
Maceratedstill birth(Unknowncaused)
Macerated still birth
Maternal carbamate poisoning
Cong. Anomaly(Anencephag)
Asphyxia (vAS)
Prematurity(Sepsis)
Prematurity(Sepsis)
Sepsis with complex heart dis.
u. r8nd tlrnul
e, u.lgorrnfin
g.
u. rar,l.€i.OsFn
rirorfiuCrucirfiDl
4
1.
5.
u, uanlrrs
u. lurso{ thnsl
7.
u. lrrsrerfi
a. u, runlari
g.
u. ltrfrr rJuauri
E.
1tl.
u. darordudn
u, rffirt'ruarrd
1 e . u. lrrst
11.
13.
u, udrrmosl
14
1 El.
u, r,irf,rr
u. ii.r6a.rod.
u. uhdiimtfi:r
17,
rirurfirrdeurirrin
r5.
€Ro
lN
Effective and well tolerated in
respiratory tract infections
PRESCRIBII|G
IilFONNAfl
OT
Composition :
Tablet : Eachtabler contains 1.5 M.l.U. (500 mg| Spiramycin
Syrup : Each 5 mt Contains0.375 M.t.U. lt 25 mg) Spiramycin
Indications :
The indicationsare based on the antibacterialactiviw
and the
pharmacokinetlccharacteristicsof spiramvcin.Thev -take into
accountthe clinicalstudiesconductedwith this druo'and its place
in the range-of antibacteriat products currently avaiiibte. They are
limited to infectibns due to the organisms defrned above as tieing
sensitive,particularlyin the following clinicalsituations:.E.N.T;
bronchopulmonary.stomatological,cutaneous,qenital lpafticularlyprostatic)and bone infections;rhe prophytaxisoimeninj&occal
meningitisin contactsubjects;chemoprophylaxis
of recurrencesof
rneumatrc tever; toxoplasmosis in pregnant women and in
rmmunodepressed
subjects,when leukopeniacontraindicatesthe
prescriptionof pyrimethamineor a suphonamide.
Dosage & Administration
Contraindicatlons :
Allergy to spiramycin.
:
Tablets ; Adults: I tabtettaken3 time5daily.Rovamycin500 can
be prescribed safelyto pregnant women.
Children weighing more than 20 kq: I tabtet {i.e. L5
MIU)per l0 kg of bodyweighr perday. ro be div-idedin 2 or 3 doses.
For severecases{adults} : I tablet 4 times daily.
R€ady-to use syrup :_tnfan-rsand chtldren <20 kg : 50:l 00 mgl
kg !ody- weighvday I I 50, 000-300. 0 00 t.U./kg bodiyweighvdatl
tn z or 3 otvtoeoooses.
Thesedoes not need to be modified in patientswith renal impatrment, because of the absence of renal excretion of the active
molecule
Adverse Reactions / Side Effects :
Gastrointestinaleffects : nausea, vomiting and diarrhoea are unAtlergic skin reactions occur rar-ely.
loqmol
urat .sptramyctn ts remarkably well tolerated ancl serious roxtc
reacttonsare.extremelyrare. sideeffects occur in a smallproDortion
or casesano Inctude gastric upset, diarrhea and skin reattiohs such
as untcafla.
Enterit6 due to suppression of the normal bacterial flora of the
rnresnne..orstatning of teeth, common untoward reactions with
letracyciltnes, have not occurred as a result of treatment with
Spiramycin. Good toterance to this antioioiiJ nas-f,"i-n'iupo.t"o
even when given continuously for some months.
Interactlons
:
No interactions have been reponed to date, in panicular with
theophyltine and the vasoconsirictor ergot atkaloidileiqotarnrne,
dihydroergotamine).
Ctverdos-ge :
no reponed case of overdosage, shoutd this occur.
y.!!"^llulg]t
Symplomarc supportive measuresshould be taken.
Storage Conditions :
Store at room temperature.
Pack size:
Bottle of | 00 tabtets
Bottle of I OOmt.
FurtherinlormatisB available
on requesttromRHoNE-pouLENcRoRERLTD.,po. Box693BMc Banokotloooo
a,
4.,
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the normaldigestive
environment
r HighlyEtticacy
2 gm bid
Fortreatment
1 gm bid
ForMaintenance
Orifinel Researchby
CHUGAI PHARMACEUTICAL CO.,LTD. Tokyo,Japan
Furiherinlormationavailablgon request.
SiamPharmaceuiical
Co.,Ltd.
l7ll1 SOI CHOKEGHAIRUAMMITR,
vlEHAVADI-RANGSITROAD BANGKOK 10900,THAII-AND.Tel. 276tO2o
E--*.
DOSANAC'
F
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. RELIEVES
PAIN
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INFLAMMATION
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DUETO
ORALNSAIDsTHERAPY
4
F
rOR TREATMENTOF TRAUMATICINFI.AMMATIONOF TENDONS , LIGAMENTSMUSCLEAND JOINTS
SiamBheasach.Co.,
Lrd.
6ii'fn
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123 SOI CHOKECHAIRUAMMITRVIBMVADT.RANGSITBOAD BANGKOK 1O9OO,
THAILAND.TEI, 27610N
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Wide Ep€ctsumactivity against gEm
nsgalive baebria (eg. N.meningitidie
N.gononhoae and most ot Enterlbactdiac€ee)
G@d actjvity agsinst gram positive
Sfeptococci. p€.ticillines€ and
rcnpenicillina* producingslaphytocGci
PACKING500 mg. viat, 1 gm. viat.
M4or rn€Eboliteis microbktogi€l active
. -^-.
iridrn
Jtffi
Manufacturedby:Siam BheasachCo., Ltd. Bangxok,
Thaitand.
AgenrSiamPharmaceulical
Co.,Lld, Bangkok,
Thaitand.
Tet.2761o2o
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BANGKOK]0330,THAILAND,
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281863 1, 2821242, 2801527
FAX :
2810250
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