Publications by authors named "Tanop Srisuwan"

14 Publications

  • Page 1 of 1

A randomized controlled trial of the effect of post-operative hand exercise training on arteriovenous fistula maturation in patients with chronic kidney disease.

J Vasc Surg 2021 Jul 24. Epub 2021 Jul 24.

Department of Physical Therapy, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand. Electronic address:

Objective: Immature arteriovenous fistula (AVF) is a critical problem in chronic kidney disease (CKD) patients after creation. Exercise with 30% maximum voluntary contraction (MVC) encourages vascular functions in other populations. It is unknown which exercise type is superior on maturation in CKD population. We compare effects of isometric- (ISM) and isotonic-hand exercise training (IST), both at 30% MVC, on AVF maturation and grip strength in CKD patients.

Methods: Fifty CKD patients were randomized into ISM program or IST program (25 per group). Each group performed exercise program at intensity of 30% MVC every day for 10 weeks. Cephalic vein (CV) and brachial artery diameters and brachial blood flows, and grip strength were measured at weeks 0, 2, 6, and 10 of program. The number of patients meeting clinical and ultrasound (US) maturation were evaluated at weeks 2, 6, and 10.

Results: At weeks 6 and 10 of the programs, ISM group had greater CV diameters (week 6, 7.1±1.2 versus 6.2±1.0 mm; week 10, 7.1±1.0 versus 6.2±1.1 mm) than the IST group. Compared to the IST, the ISM had a higher number of patients meeting US maturation at weeks 2 (IST/ISM=8/2), 6 (16/8), and 10 (21/12), and clinical maturation at week 10 (25/18). No adverse events were observed throughout the study.

Conclusions: At 30% MVC, ISM is more effective at promoting increases in cephalic vein diameter and maturation than IST. Both exercise types are feasible and safe for CKD patients after AVF creation.
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http://dx.doi.org/10.1016/j.jvs.2021.07.124DOI Listing
July 2021

May-Thurner Syndrome Is Aggravated by Pregnancy.

Medicina (Kaunas) 2021 Mar 1;57(3). Epub 2021 Mar 1.

Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand.

This study aims to emphasize that asymptomatic patients with undiagnosed and asymptomatic May-Thurner syndrome (MTS) may firstly develop severe compression during pregnancy. A 40-year-old woman, G1P0, at 22 weeks of twin gestation presented with left lower extremity edema and pain. One twin was structurally normal while the other had bilateral renal agenesis with oligohydramnios. Magnetic resonance venography (MRV) revealed severe compression of the left iliac vein by the right iliac artery without evidence of deep vein thrombosis (DVT). Conservative treatment with anticoagulant prophylaxis was instituted throughout the rest of pregnancy and postpartum period. She was also complicated with severe pre-eclampsia, a cesarean section was performed due to a prolapsed cord at 27 weeks of gestation, and she gave birth to a surviving baby weighing 1100 g. In conclusion, this case report provides evidence that pregnancy can disclose a subtle May-Thurner anatomy to be symptomatic without DVT. Successful pregnancy outcomes could be achieved with conservative treatment and anticoagulant prophylaxis.
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http://dx.doi.org/10.3390/medicina57030222DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7999580PMC
March 2021

Agreement between physical and ultrasound examination for arteriovenous fistula maturation diagnostics in Thai hemodialysis patients.

J Vasc Access 2020 Dec 25:1129729820983177. Epub 2020 Dec 25.

Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.

Introduction: Physical examination (PE) is used to determine if arteriovenous fistula (AVF) meets criteria for first hemodialysis (HD) cannulation in chronic kidney disease (CKD) with HD patients. Three ultrasound (US) based criteria are adopted to investigate maturation: : blood flow ⩾600 milliliters per minute (mL/min), vein diameter ⩾6 millimeters (mm), vein depth ⩽6 mm); : blood flow ⩾500 mL/min, vein diameter ⩾5 mm, vein depth ⩽6 mm; : blood flow ⩾500 mL/min, vein diameter ⩾4 mm, vein depth ⩽6 mm. In Thai, no study determined optimal US criteria for predicting AVF maturation measured by PE before first cannulation. This study examined the significance of these US criteria on the physical AVF maturation in Thai.

Methods: Fifty CKD patients, operated brachiocephalic AVF, were enrolled and examined on the operative day and 6 weeks afterwards. PE was evaluated by an experienced vascular surgeon, and US measurements were obtained by an experienced US technologist. Matching mature number between US criteria and PE was computed using McNemar test. Agreement between US criteria and PE was measured using Kappa. Mature and immature discrimination were evaluated by the Receiver Operator Characteristics (ROC) curve and Youden index.

Results: and had higher non-mature matching number than ( < 0.001 both). Regarding Kappa statistics, and agreed with the PE ( < 0.01 both). The ROC curve of and were 0.75 and 0.74, respectively ( <0.01 both). Youden index (maturity and immaturity discriminating performance) of both rules was 0.5 and 0.47, respectively.

Conclusion: and agreed with the PE, with the highest performance of the to predict first successful cannulation in Thai.
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http://dx.doi.org/10.1177/1129729820983177DOI Listing
December 2020

Ultrasound Use in Diagnosis and Management of Venous Leg Ulcer.

Int J Low Extrem Wounds 2020 Dec 10;19(4):305-314. Epub 2020 Aug 10.

NCD Center of Excellence, Research Institute of Health Science, Chiang Mai University, Chiang Mai, Thailand.

Leg ulcers caused by venous diseases are effectively assessed by Doppler ultrasonography. The examination provides clear anatomical and physiological information for the diagnosis, treatment planning, and real-time guiding during the surgical treatment. Diagnostic Doppler ultrasonography assesses deep, superficial, and perforator veins, starting from patency assessment by direct visualization and simply compression test. The internal flow can be assessed by pulse wave analysis, which is used for rule out downstream flow obstruction and valvular incompetence. The venous valve function of deep, superficial, and perforator systems can be evaluated by measuring the time of the retrograde flow after flow augmentation performing in the upright position. At the end of the study, the venous map will be obtained and this map will guide clinicians to target treatment where the culprit is. The ultrasound technology has made a big shift in the treatment in the venous disease. In recent years, after the evolution and wide availability of ultrasound, newer treatment modalities have emerged for venous treatment. These include endovenous thermal ablation, endovenous adhesive closure, and ultrasound-guided foam sclerotherapy. Patients no longer require general anesthesia or hospitalization. Therefore utilization of duplex ultrasound has also surged and played an essential role in both diagnosis and therapy in venous ulcer. This article has dedicated to reviewing basic anatomy, the technique in diagnosis, and treatment.
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http://dx.doi.org/10.1177/1534734620947087DOI Listing
December 2020

Conventional versus hypofractionated postmastectomy radiotherapy: a report on long-term outcomes and late toxicity.

Radiat Oncol 2019 Oct 14;14(1):175. Epub 2019 Oct 14.

Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.

Objective: We evaluated the long-term outcomes and late toxicity of conventional fractionated (CF) and hypofractionated (HF) postmastectomy radiotherapy (PMRT) in terms of locoregional recurrence-free survival (LRRFS), disease-free survival (DFS), overall survival (OS), and late toxicity.

Methods: A cohort of 1640 of breast cancer patients receiving PMRT between January 2004 and December 2014 were enrolled. Nine hundred eighty patients were treated with HF-PMRT: 2.65 Gy/fraction to a total of 42.4-53 Gy and 660 patients were treated with CF-PMRT: 2 Gy/fraction to a total of 50-60 Gy.

Results: The median follow-up time was 71.8 months (range 41.5-115.9 months). No significant difference was found in the rates of 5-year LRRFS, DFS, and OS of HF-PMRT vs CF-PMRT; 96% vs. 94% (p = 0.373), 70% vs. 72% (p = 0.849), and 73% vs. 74% (p = 0.463), respectively. We identified a cohort of 937 eligible breast cancer patients who could receive late toxicities assessment. With a median follow-up time of this patient cohort of 106.3 months (range 76-134 months), there was a significant higher incidence of grade 2 or more late skin (4% vs 1%) and subcutaneous (7% vs 2%) toxicity in patients treated with HF-PMRT vs CF-PMRT. Patients who received additional radiation boost were significantly higher in the HF-PMRT group. Grade 2 or more late RTOG/EORTC lung toxicity was significant lesser in HF-PMRT vs CF-PMRT (9% vs 16%). Grade 1 brachial plexopathy was also significant lesser in HF-PMRT vs CF-PMRT (2% vs 8%). Heart toxicity and lymphedema were similar in both groups.

Conclusions: HF-PMRT is feasible to deliver with comparable long-term efficacy to CF-PMRT. HF-PMRT had higher grade 2 or more skin and subcutaneous toxicity but less lung and brachial plexus toxicity.
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http://dx.doi.org/10.1186/s13014-019-1378-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6790998PMC
October 2019

Fornix Rupture in Duplex Kidney due to Internal Iliac Artery Aneurysm.

Case Rep Urol 2016 16;2016:5042456. Epub 2016 Feb 16.

Division of Vascular Surgery, Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand.

A 70-year-old man presented with severe pain on the right side of the abdomen for 7 days. An abdominal CT angiographic scan showed an impending rupture of a large right internal iliac artery aneurysm which compressed to a right ureter causing hydroureteronephrosis. Fornix rupture of a right duplex kidney was also detected. Selective embolization of right gluteal arteries and then ligation of the right internal iliac artery and right ureterotomy with double J stenting were performed. At the 4-month follow-up appointment, an abdominal ultrasound demonstrated a decrease in the size of the aneurysm and no hydroureteronephrosis after the removal of double J stent.
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http://dx.doi.org/10.1155/2016/5042456DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4771882PMC
March 2016

Vascular Pythiosis of the Lower Extremity in Northern Thailand: Ten Years' Experience.

Int J Low Extrem Wounds 2015 Sep 18;14(3):245-50. Epub 2015 Aug 18.

Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand Research Institute of Health Science, Chiang Mai University, Thailand

Pythiosis is a disease caused by Pythium insidiosum, a fungus-like organism. P. insidiosum is pathogenic in mammals, particularly in horses, dogs, and humans. Human pythiosis can be classified into 4 types: (1) cutaneous/subcutaneous, (2) ocular, (3) vascular, and (4) disseminated pythiosis. Vascular pythiosis is a rare disease but a serious limb- and life-threatening infection. We reviewed 22 cases over a 10-year period in Maharaj Nakorn Chiang Mai/Chiang Mai University Hospital. The survival rate was around 63.6% during our follow-up period. The only effective treatment was complete excision of the infected tissue, which was done mainly by major amputation, such as above-knee amputation. This report raises awareness of this disease, which needs preemptive diagnosis and appropriate treatment.
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http://dx.doi.org/10.1177/1534734615599652DOI Listing
September 2015

Bilateral segmental renal artery thrombosis from blunt abdominal trauma: a rare presentation.

Urol J 2014 Jan 4;10(4):1154-6. Epub 2014 Jan 4.

Division of Diagnostic Radiology,Department of Radiology, Facultyof Medicine, Chiang Mai University,Chiang Mai 50200, Thailand.

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January 2014

Endovascular aortic stenting in patients with chronic traumatic aortocaval fistula.

Ann Vasc Dis 2013 15;6(4):741-4. Epub 2013 Nov 15.

Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand ; Center for Applied Science, Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand.

This study aimed to present the treatment of a case of delay presenting of traumatic aortocaval fistula (ACF) and its effect on hemodynamic problem. A 59-year-old man was admitted to our hospital with heart failure due to a 41-year-old traumatic ACF. ACF closure was performed by endovascular aortic stenting. His hospital course after procedure was complicated by severe bradycardia and torsades de pointes and excessive diuresis. We concluded the endovascular technique provided an attractive alternative to open surgical methods for repair of chronic ACF. However, in chronic cases, complications such as severe bradycardia (Nicoladoni-Branham sign) and excessive diuresis must be anticipated.
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http://dx.doi.org/10.3400/avd.cr.13-00078DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3866366PMC
January 2014

Case series of isolated primary persistent sciatic vein.

Int J Low Extrem Wounds 2013 Sep 16;12(3):219-22. Epub 2013 Sep 16.

1Faculty of Medicine, Chiang Mai University, Thailand.

Our study aimed to present a short series on the persistent sciatic vein, a rare venous variation, without Klippel-Trenaunay-Weber syndrome and to review the anatomical consideration of deep venous systems. Four cases of lower-type persistent sciatic vein were found. A combination of May-Thurner syndrome and persistent sciatic vein was found in 2 cases. Non-hypoplastic femoral veins, normal and duplicated, were found in 3 cases. This study concluded that in this persistent sciatic vein, the associated non-hypoplastic femoral vein is not uncommon, and care must be taken about this condition during ultrasonographic examination. Unusual causes of chronic venous insufficiency and other venous anomalies should not be overlooked.
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http://dx.doi.org/10.1177/1534734613502047DOI Listing
September 2013

Idiopathic high-flow priapism in a pediatric patient.

J Pediatr Urol 2011 Feb;7(1):92-4

Division of Urology, Department of Surgery, Faculty of Medicine, Chiang Mai University, Muang, Chiang Mai 50200, Thailand.

High-flow priapism is a very rare condition in children. The most common cause is perineal trauma, which is a major cause of arterio-cavernosal fistula. A few pediatric patients have high-flow priapism without an obvious cause. There are many therapeutic modalities for this condition, depending on the etiology. We report a case of idiopathic high-flow priapism in a 6-year-old boy who underwent repeated superselective embolization.
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http://dx.doi.org/10.1016/j.jpurol.2010.09.005DOI Listing
February 2011

Pediatric renovascular hypertension in Thailand: CT angiographic findings.

Pediatr Radiol 2009 Dec 14;39(12):1321-6. Epub 2009 Aug 14.

Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.

Background: Renovascular disease is an uncommon but important cause of hypertension in children. When unrecognized and untreated, renovascular hypertension in children can have serious complications.

Objective: To review the causes of renovascular hypertension and computed tomography angiographic (CTA) findings in children and adolescents.

Materials And Methods: Twenty-eight CTAs from January 2004 to March 2008 of 23 children and adolescents with hypertension were reviewed for the causes and CTA findings.

Results: Nine of the 23 children (39%) had abnormal renal arteries with or without abnormal abdominal aortas. Four of these children had Takayasu arteritis, one had moyamoya disease, and one had median arcuate ligament syndrome. One with chronic pyelonephritis had severe stenosis of the proximal right renal artery. The other two children had renal artery stenosis with a nonspecific cause. One child with a normal abdominal aorta and renal arteries had a right suprarenal mass. On pathological examination a ganglioneuroma was found.

Conclusion: CTA can help in diagnosis of renovascular hypertension in children and adolescents. Although CTA is not a screening modality, it is appropriate in some situations.
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http://dx.doi.org/10.1007/s00247-009-1380-9DOI Listing
December 2009

Radiologic findings in tsunami trauma: experience with 225 patients injured in the 2004 tsunami.

Emerg Radiol 2007 Nov 4;14(6):395-402. Epub 2007 Aug 4.

Department of Radiology, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114, USA.

The objective of this study was to determine the spectrum of radiographic findings, frequency, and type of injuries in tsunami victims. From December 2004 to May 2005, all tsunami victims admitted to our hospital were retrospectively identified by a search of medical records. Patients who received radiologic examinations were reviewed for their radiographic findings. The authors identified 225 tsunami victims. One hundred eight victims received radiologic evaluations on admission that included 350 plain radiographs, 19 ultrasound exams, 18 computed tomography (CT) scans and 3 magnetic resonance imaging (MRI) scans. Overall positivity rate was 48% (187/390). Most common trauma involved musculoskeleton (102/187, 54.5%). Retained foreign bodies in soft tissues, pneumonia/aspiration, and tsunami sinusitis were found in 22, 28, and 31 patients (9.8, 12.4, and 13.8%), respectively. These were unique findings in tsunami trauma. Imaging played an important role in detection of these abnormalities.
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http://dx.doi.org/10.1007/s10140-007-0655-4DOI Listing
November 2007

Combined hepatocellular and cholangiocarcinoma: CT findings with emphasis on multiphasic helical CT.

J Med Assoc Thai 2007 Jan;90(1):113-20

Department of Radiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Rama VI Rd, Rajchathewi, Bangkok 10400, Thailand.

Objective: To describe CT findings of patients with combined hepatocellular carcinoma and cholangiocarcinoma (HCC-CC) in correlation with clinical data and histopathological results.

Material And Method: Ten from 31 cases whose CT study was available were reviewed retrospectively in the aspect of imaging findings, clinical data, and pathological results.

Results: Most of the tumors were hypodense solitary mass with gradually enhanced after contrast administration. Bile duct dilatation was observed in two cases. The overall CT findings were more similar to CC rather than HCC despite the pathological result showing predominant HCC component. Serum alpha-fetoprotein level was normal or mildly elevated while an elevated concentration of carbohydrate antigen 19-9 was observed. Hepatitis profiles showed positive to hepatitis B virus infection in four cases and hepatitis C virus infection in one case.

Conclusion: The diagnosis of combined HCC-CC should be considered if the tumor has similar findings to CC without bile duct dilatation on cirrhotic liver and the patient has normal or low rising of the AFP level with or without elevated CA 19-9 level. In non-cirrhotic liver, the finding is non-specific.
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January 2007
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