Panjai Choochuen

Objectives: Establishing optimal sarcopenia cutoffs is essential, as L3 is not always included in CT imaging, and reference levels vary across populations. The absence of Southeast Asia-specific thresholds may lead to misclassification, highlighting the need for regionally appropriate diagnostic criteria. This study establishes population-specific sarcopenia cutoffs (T10-S1) in the Thai population and defines BMI-adjusted thresholds. It also assesses skeletal muscle index (SMI) correlations across vertebral levels to refine L3-based sarcopenia evaluation. Methods: This retrospective study analyzed 475 healthy Thai adults (aged 18-40 years) who underwent emergency department CT between January 2010 and June 2023. Skeletal muscle parameters were measured from T10 to S1 using custom software. Measurements included skeletal muscle area (SMA), skeletal muscle radiation attenuation (SMRA), SMI, and height-adjusted SMI (SMIH1). Sex-stratified analyses and correlations between vertebral levels were performed. Results: At L3, sarcopenia cutoffs using SMI and SMIH1 were 23.3 cm2/m2 and 37.1 cm2/m for females, and 31.3 cm2/m2 and 53.9 cm2/m for males, respectively. Strong correlations were observed between L3 and adjacent vertebral levels (r > 0.8), with correlation strength decreasing with anatomical distance. Application of international cutoffs to the Thai population resulted in overestimation of sarcopenia cases. BMI-adjusted variable thresholds demonstrated superior diagnostic accuracy compared to fixed cutoffs. Conclusions: This study establishes the first population-specific sarcopenia reference values for Thai adults and validates the use of alternative vertebral levels when L3 imaging is unavailable. Our findings emphasize the importance of population-specific and BMI-adjusted cutoff values for accurate sarcopenia diagnosis in Thai adults. Advances in knowledge: This study establishes the first population-specific sarcopenia cutoff values for healthy Thai adults, providing the first evidence-based reference standards for the Thai populations. At L3, the recommended cutoffs are SMI 23.3 cm2/m2 and SMIH1 37.1 cm2/m for females, and SMI 31.3 cm2/m2 and SMIH1 53.9 cm2/m for males. Strong correlations (r > 0.8) between L3 and adjacent vertebral levels validate the use of alternative assessment sites when L3 imaging is unavailable: T12-L1 for chest CT protocols, L3 for abdominal CT protocols, and L4-L5 for pelvic CT protocols. Application of Western cutoffs to the Thai populations results in significant overestimation of sarcopenia prevalence, emphasizing the critical importance of population-specific diagnostic criteria.

Background: High-flow nasal cannula (HFNC) therapy is increasingly utilized following extubation in patients undergoing cardiac surgery, due to its potential benefits in preventing pulmonary complications such as atelectasis, pleural effusion, and pneumonia. However, the comparative efficacy of HFNC versus conventional oxygen therapy (COT) in elderly patients remains unclear. This study aims to compare post-extubation pulmonary outcomes between HFNC and COT in elderly patients following cardiac surgery. Methods: We conducted a retrospective cohort study at a tertiary care hospital in Southern Thailand, including patients aged 65 and older who underwent elective cardiac surgery between December 2018 and January 2024. The primary outcome was the incidence of post-extubation pulmonary complications (PPCs) within 72 hours. Secondary outcomes included the length of intensive care unit (ICU) and hospital stays, all-cause in-hospital mortality, and atelectasis scores. Results: A total of 424 patients were included, with 212 patients in each group. HFNC therapy was associated with a significant reduction in the odds of bronchospasm (7.5% vs. 24.5%; adjusted OR = 0.22, 95% CI = 0.12–0.41). There were no significant differences between the groups in terms of reintubation rates, tracheostomy, ICU stay, hospital stay, or all-cause mortality. However, atelectasis scores were significantly improved on day 5 post-extubation. Conclusion: HFNC therapy may reduce the incidence of bronchospasms in elderly patients after cardiac surgery and significant improvement of atelectasis score at day 5. While these findings suggest a potential benefit of HFNC in postoperative care, further research is warranted to explore its long-term effects and implications for patient outcomes.

Background: Esophagogastroduodenoscopy (EGD) is vital for the diagnosis and treatment of various gastrointestinal conditions but carries a low risk of venous air embolism (VAE). We report a case of VAE during EGD, confirmed by computed tomographic pulmonary angiography (CTPA). Case: A 56-year-old male with a history of hypopharyngeal cancer underwent EGD for dysphagia-related esophageal dilation. Signs of VAE were noted, prompting swift interventions, including oxygen therapy, positional changes, and CTPA. CTPA revealed the Mercedes-Benz sign, pneumomediastinum, and a minimal pneumothorax. The patient’s oxygen saturation improved within 30 min before undergoing CTPA, and he was discharged on postoperative day 4. Conclusions: Timely recognition of VAE, resulting in appropriate interventions supported by CTPA, resulted in favorable patient outcomes.

Background: Identification of normal variations to the thoracic central venous system anatomy is essential in radiological intervention and cardiothoracic surgery to prevent complications. Purpose: To estimate the prevalence and pattern of normal variations of superior vena cava (SVC) and azygos venous system as well as factors associated with normal variations of SVC. Material and Methods: Venous-phase chest CT of 1336 patients were retrospectively reviewed. Age, sex, and underlying disease were recorded. SVC diameter and cross-sectional area were measured to evaluate for associations with normal variations. Results: The prevalence of normal anatomical variations of SVC and azygos venous system were 0.3% and 1.5%, respectively. Duplicated SVC was the most common variations. The most common variation for the azygos venous system was the connection between the hemiazygos and accessory hemiazygos veins draining into the left brachiocephalic vein (12/1336 cases, 0.9%). The median (interquartile range [IQR]) cross-sectional area compared between normal SVC (297.2 mm²) and duplicated SVC (223.5 mm²) showed a statistically significant difference ( P = 0.033). Conclusion: This study determined the prevalence of rare normal variations of the azygos venous system, a connection between the hemiazygos and accessory hemiazygos veins draining into the left brachiocephalic vein. The prevalence of normal variations of the SVC and azygos venous system in the adult Thai population was similar with that of previous publications. Cross-sectional area was the only factor with a significant association with SVC variations.