http://www.jmatonline.com/index.php/jmat/issue/feedJOURNAL OF THE MEDICAL ASSOCIATION OF THAILAND2024-03-19T10:01:25SE Asia Standard TimeJOURNAL OF THE MEDICAL ASSOCIATION OF THAILANDeditor@jmatonline.comOpen Journal Systems<p>All information on this website are protected. Permission to use Documents (such as journal, articles and other publications) from this server ("Server") is granted by MEDICAL ASSOCIATION OF THAILAND ("MAT"), provided that the use of such Documents from this Server will not be copied or posted on any network computer or broadcast in any electronic media. Use for any unauthorized purpose is expressly prohibited by law, and may result in severe civil and criminal penalties. Violators will be prosecuted to the maximum extent possible.</p>http://www.jmatonline.com/index.php/jmat/article/view/13950The Outcome of Manual Small Incision Cataract Surgery (MSICS) Using Ruit’s Technique in Phacomorphic and Phacolytic Glaucoma at Nan Hospital, Thailand2024-03-19T10:01:51SE Asia Standard TimeIssaranarongpan Ck_chupong@hotmail.com<p><strong>Objective:</strong> To evaluate the visual outcome and complications of manual small incision cataract surgery (MSICS) using Ruit’s technique in the treatment of patients with phacomorphic and phacolytic glaucoma.</p><p><strong>Materials and Methods:</strong> The medical records of 150 eyes in 147 patients with phacomorphic and phacolytic glaucoma who underwent MSICS by the Ruit’s technique between January 2009 and May 2022 at Nan Hospital, were retrospectively reviewed. Out of these 150 eyes from the 147 patients, 58 eyes from 58 patients missed the six-week follow-up, and 14 eyes from 14 patients had pre-operative vision impairing pathology. Records were analyzed of the patients with pre-operative, post-operative uncorrected visual acuity (UCVA), intraocular pressure (IOP), operative time, intraoperative difficulties and complications, and post-operative complications and astigmatism in the second and sixth week after surgery for the 78 eyes out of 75 patients.</p><p><strong>Results:</strong> Seventy-eight eyes of 75 patients treated by MSICS using Ruit’s technique with IOL implanted in the posterior chamber demonstrated no significant intraoperative or post-operative complications. The post-operative UCVA at the sixth-week follow-up was 20/70 or better in 76% of the phacomorphic glaucoma group and 64% of the phacolytic glaucoma group. In the sixth week after treatment, the mean post-operative astigmatism of the phacomorphic glaucoma group was –1.4±0.9 D and –1.3±0.7 D for the phacolytic glaucoma group. The mean post-operative IOP in the sixth week after surgery for phacomorphic glaucoma and phacolytic glaucoma were 10.7±3.7 mmHg and 9.8±4.3 mmHg, respectively.</p><p><strong>Conclusion:</strong> Manual small incision cataract surgery (MSICS) using Ruit’s technique is an effective method and excellent at controlling the IOP and achieving good visual acuity with a low rate of complications for patients with phacomorphic and phacolytic glaucoma.</p><p><strong>Keywords:</strong> Ruit’s technique; Manual small incision cataract surgery; Phacomorphic glaucoma; Phacolytic glaucoma</p><p><strong>DOI:</strong> 10.35755/jmedassocthai.2024.3.13950</p><p>Received 27 October 2023 | Revised 26 January 2024 | Accepted 5 February 2024</p>2024-03-19T07:06:50SE Asia Standard Timehttp://www.jmatonline.com/index.php/jmat/article/view/13951Psychometric Properties of Thai Version of Obsessive Belief Questionnaire (OBQ-T)2024-03-19T10:01:51SE Asia Standard TimeTantrarungroj TThanita.hin@mahidol.eduSaipanish RThanita.hin@mahidol.eduLotrakul MThanita.hin@mahidol.eduWisajun PThanita.hin@mahidol.edu<p><strong>Background:</strong> Obsessive Beliefs Questionnaire (OBQ) is a valid measure for assessing obsessional beliefs, which are the main symptoms of obsessive-compulsive disorder (OCD). It is translated and assessed psychometric properties in many languages, however, no valid questionnaire for assessing the beliefs related to OCD is established in Thailand.</p><p><strong>Objective:</strong> To assess the psychometric properties of the Thai version of the Obsessive Belief Questionnaire (OBQ-T).</p><p><strong>Materials and Methods:</strong> Participants include ninety-two OCD patients who were duly informed of the details of the present study. Written consent was obtained. The Obsessive Beliefs Questionnaire-44 (OBQ-44) was translated into Thai (OBQ-T) after receiving permission. Data regarding the characteristics of the participants, the OBQ-T, the Thai self-report version of the Yale-Brown Obsessive-Compulsive Scale-Second Edition (Y-BOCSII-SR-T) severity scale, the Thai Florida Obsessive Compulsive Inventory (FOCI-T), the Patient Health Questionnaire (PHQ-9), and the Pictorial Thai Quality of Life (PTQL), were collected and analyzed. Psychometric properties of the OBQ-T were tested.</p><p><strong>Results:</strong> The OBQ-T has excellent reliability with a Cronbach’s coefficient of 0.945. It has a positive correlation with the Y-BOCS II-SR-T severity scale and the FOCI, which indicates the concurrent validity of the OBQ-T. The content validity index shows acceptable content validity. The confirmatory factor analysis (CFA) and the exploratory factor analysis (EFA) were examined, and the three-factor model is most similar to the original OBQ-44, which is composed of three factors reflecting responsibility and threat estimation, perfectionism and intolerance for uncertainty, and importance and control of thought.</p><p><strong>Conclusion:</strong> The OBQ-T has an acceptable reliability and validity for the measurement of beliefs and appraisals, which are related to the pathogenesis of obsessions.</p><p><strong>Keywords:</strong> Obsessive Compulsive Disorder, Psychometric properties, Thai, Obsessional belief questionnaire</p><p><strong>DOI:</strong> 10.35755/jmedassocthai.2024.3.13951</p><p>Received 25 October 2023 | Revised 29 January 2024 | Accepted 5 February 2024</p>2024-03-19T07:23:14SE Asia Standard Timehttp://www.jmatonline.com/index.php/jmat/article/view/13952Efficacy and Safety of Cannabidiol Oil on Chronic Insomnia: The First Randomized, Double-Blind, Placebo-Controlled, Crossover, Pilot Study in Thailand2024-03-19T10:01:51SE Asia Standard TimeAiewtrakoon CDr.Chakrabongse@gmail.com<p><strong>Objective:</strong> Cannabidiol (CBD) is a non-intoxicating extract from Cannabis sativa. The advantages of CBD on sleep-wake cycle and insomnia remain sparse. The present study investigated the impact of a continuous four-week sublingual CBD intake on sleep indicators.</p><p><strong>Materials and Methods:</strong> The present study was a randomized, double-blind, placebo-controlled, crossover pilot study involving 45 chronic insomnia patients. The participants were administered medium-chain triglycerides oil soluble cannabidiol (MCT-CBD) using 1 mg/kg/dose, sublingually for four weeks, then two weeks of washout period, and a subsequent four-week placebo phase. Sleep architecture with N1, N2, N3, and rapid eye movement (REM), sleep quality (PSQI), daytime sleepiness (ESS), and quality of life were investigated.</p><p><strong>Results:</strong> Polysomnography (PSG) revealed that the total sleep time (TST), sleep onset latency (SOL), wake time after sleep onset (WASO), and arousal index were significantly improved compared to the patients who were taking placebo, while sleep structure remained unaltered. Additionally, actigraphy showed a substantial improvement in TST, sleep efficiency (SE), and SOL. The results of PSQI, ESS, and EQ-5D-5L were statistically significant and better than placebo (p<0.05).</p><p><strong>Conclusion:</strong> Continuously sublingual CBD treatment could improve sleep duration, sleep maintenance, sleep induction, quality of life, and daytime sleepiness without altering the sleep architecture in patients with chronic insomnia. No evidence of serious side-effects was found.</p><p><strong>Keywords:</strong> Hemp; CBD; Cannabidiol; Cannabis; Insomnia; Sleep</p><p><strong>DOI:</strong> 10.35755/jmedassocthai.2024.3.13952</p><p>Received 7 November 2023 | Revised 27 December 2023 | Accepted 2 January 2024</p>2024-03-19T07:46:47SE Asia Standard Timehttp://www.jmatonline.com/index.php/jmat/article/view/13953The Management and Outcomes of Surgical Sepsis in Limiting Resource during COVID-19 Pandemic2024-03-19T10:01:51SE Asia Standard TimePalitnonkiat Vttsawadde@gmail.comSuraprasert Sttsawadde@gmail.comSupsamutchai Cttsawadde@gmail.comSinghathas Pttsawadde@gmail.comPunmeechao Pttsawadde@gmail.comWilasrusmee Cttsawadde@gmail.comThampongsa Tttsawadde@gmail.com<p><strong>Background:</strong> Sepsis is a life-threatening organ dysfunction caused by the dysregulated host response to infection. Surgical sepsis is a form of sepsis that requires source control. Treating surgical sepsis patients during the COVID-19 pandemic presented several limitations, particularly in terms of source control.</p><p><strong>Objective:</strong> To evaluate the management of surgical sepsis patients at Ramathibodi Hospital by comparing outcomes before and during the COVID-19 pandemic.</p><p><strong>Materials and Methods:</strong> Retrospective analysis was conducted on patients diagnosed with sepsis in the Department of Surgery at Ramathibodi Hospital between May 2019 and April 2021. Patients were divided into two groups with Group A that comprised patients diagnosed with sepsis before the COVID-19 pandemic, between May 2019 and April 2020, and Group B that consisted of patients diagnosed with sepsis during the pandemic, between May 2020 and April 2021. Surgical sepsis patients were analyzed to ascertain the mortality rate and conduct multivariate analysis to demonstrate the association of exposure variables with the mortality rate in this group.</p><p><strong>Results:</strong> Two hundred ninety patients were included, with 145 diagnosed with sepsis in both Group A and Group B. Among them, 49 in Group A and 68 in Group B were classified as surgical sepsis. The mortality rate for surgical sepsis patients in Group A and Group B were 26.53% and 33.82%, respectively. The present study showed no significant difference between the two groups regarding mortality (p=0.399). Multivariable analysis revealed that surgical sepsis patients either not admitted to ICU or admitted for less than 15 days had a lower mortality rate (adjusted OR 0.01 and 0.12, respectively) (p<0.001).</p><p><strong>Conclusion:</strong> The limited resources during COVID-19 did not appear to impact the mortality rate of surgical sepsis patients. However, it is crucial to acknowledge that there may be other potential confounding factors that cannot be controlled. The mortality rate may differ in contexts different from the present study.</p><p><strong>Keywords:</strong> COVID-19; Surgical sepsis; Source control</p><p><strong>DOI:</strong> 10.35755/jmedassocthai.2024.3.13953</p><p>Received 13 July 2023 | Revised 3 January 2024 | Accepted 17 January 2024</p>2024-03-19T07:56:32SE Asia Standard Timehttp://www.jmatonline.com/index.php/jmat/article/view/13954Balanced Crystalloid Solution or Normal Saline in Fluid Resuscitation in Critically Ill Patients: A Meta-Analysis and Trial Sequential Analysis of Randomized Controlled Trials2024-03-19T10:01:51SE Asia Standard TimeOunhasuttiyanon AThummaporn.nao@mahidol.ac.thVareesangthip KThummaporn.nao@mahidol.ac.thChanchairujira TThummaporn.nao@mahidol.ac.thNaorungroj TThummaporn.nao@mahidol.ac.th<p><strong>Background:</strong> Both balanced crystalloid solution and normal saline are commonly used for fluid therapy in critically ill patients. However, the association between the types of crystalloid solution and patient outcomes remains inconclusive.</p><p><strong>Materials and Methods:</strong> The authors performed a search using Pubmed, Embase, and Cochrane Central Register through January 2022. Randomized controlled trials (RCTs) comparing balanced crystalloids and normal saline in non-perioperative fluid resuscitation for critically ill adult patients were included. The primary outcome was 30-day mortality. A trial sequential analysis (TSA) was performed to assess the effect of each type of fluid on the outcomes. Secondary outcomes included the incidence of acute kidney injury (AKI), renal replacement therapy (RRT), and other pre-specified outcomes.</p><p><strong>Results:</strong> Ten RCTs were identified and included 36,233 participants. Between the balanced crystalloids and the normal saline group, there were no significant differences in mortality at 30 days (relative risk [RR] 0.95, 95% confidence interval [CI] 0.89 to 1.02, I²=0), the incidence of AKI (RR 0.95, 95% CI 0.90 to 1.01, I²=0), and RRT (RR 0.93, 95% CI 0.86 to 1.01, I²=13). However, patients receiving balanced crystalloids demonstrated a significantly lower serum chloride level than the patients receiving normal saline (MD –1.95, 95% CI –3.45 to –0.45, I²=99). There was also no mortality difference in the sepsis and traumatic brain injury subgroups. The TSA confirmed the absence of an effect on mortality at 30 days and the incidence of AKI.</p><p><strong>Conclusion:</strong> In critically ill patients, the use of balanced crystalloids does not decrease 30-day mortality or the incidence of AKI and RRT. However, data in specific subgroups of patients were underpowered and further studies are required. There were signals of benefit and risk of the balanced salt solution in the subgroups of sepsis and traumatic brain injury.</p><p><strong>Trial registration:</strong> The present study was registered in the PROSPERO database, CRD42021275796.</p><p><strong>Keywords:</strong> Balanced crystalloid; Normal saline; Critically ill patients; Mortality; Acute kidney injury</p><p><strong>DOI:</strong> 10.35755/jmedassocthai.2024.3.13954</p><p>Received 16 October 2023 | Revised 22 January 2024 | Accepted 24 January 2024</p>2024-03-19T08:19:09SE Asia Standard Timehttp://www.jmatonline.com/index.php/jmat/article/view/13955Bupivacaine Local Infiltration at Trocar Insertion Sites after Gynecologic Laparoscopic Surgery: A Randomized, Double-blind, Placebo-Controlled Trial2024-03-19T10:01:51SE Asia Standard TimeNakngam Npreaprea_riiz@hotmail.comWasinghon Ppreaprea_riiz@hotmail.comRatanakaew Apreaprea_riiz@hotmail.com<p><strong>Objective:</strong> To compare local infiltration of bupivacaine with placebo for reducing pain at trocar insertion sites after gynecologic laparoscopic surgery (GLS).</p><p><strong>Materials and Methods:</strong> A prospective, randomized, double-blind, placebo-controlled trial was conducted on women who underwent GLS at Buddhachinaraj Phitsanulok Hospital, Thailand between September 2021 and March 2022. Eighty subjects were included for this trial. Bupivacaine 0.5% 10-mL was infiltrated at each port site after removing the trocars compared with placebo. Pain intensity was evaluated by visual analog scale (VAS) for four pain points including abdominal parietal pain (APP), abdominal visceral pain (AVP), and right and left shoulder pain at 2, 4, 8, 12, and 24 hours postoperatively.</p><p><strong>Results:</strong> There were no significant differences in baseline characteristics between the two groups except for parity. APP and AVP had no significant difference in postoperative pain (mean difference –0.23, 95% CI –0.58 to 0.10, p=0.169 and –0.35, 95% CI -0.72 to 0.02, p=0.063, respectively). Only mild pain, with a VAS of 0 to 2, on both sides of shoulder were found in most participants, which had no significant difference between the two groups. Opioid consumption and adverse events were also not a significant difference. Multivariate analysis showed the APP had no significant difference between the two groups after adjusting confounding factors. However, gynecologic cancer and increased age were the significant factors associated with postoperative pain (mean difference 0.60, 95% CI 0.12 to 1.08, p=0.014 and –0.02, 95% CI –0.04 to –0.01, p=0.010, respectively).</p><p><strong>Conclusion:</strong> Locally infiltrated bupivacaine at trocar insertion sites after GLS did not significantly improve postoperative analgesia.</p><p><strong>Keywords:</strong> Gynecologic laparoscopic surgery; Postoperative analgesia; Bupivacaine</p><p><strong>DOI:</strong> 10.35755/jmedassocthai.2024.3.13955</p><p>Received 30 October 2023 | Revised 22 January 2024 | Accepted 7 February 2024</p>2024-03-19T08:31:48SE Asia Standard Timehttp://www.jmatonline.com/index.php/jmat/article/view/13956Identification of Somatic Mutations in Thai Patients with Renal Cell Carcinoma Using Whole Exome Sequencing Analysis2024-03-19T10:01:51SE Asia Standard TimeApinan Tjulin.o@chula.ac.thSomparn Pjulin.o@chula.ac.thSowanthip Djulin.o@chula.ac.thPhanichkrivalkosil Mjulin.o@chula.ac.thSurintrspanont Jjulin.o@chula.ac.thPisitkun Tjulin.o@chula.ac.thOpanuraks Jjulin.o@chula.ac.th<p><strong>Background:</strong> Whole exome sequencing (WES) is increasingly used to identify genetic alterations of renal cell carcinoma (RCC). However, in Thailand, there is no report that clarifies the common somatic mutations and tumor mutational burden (TMB) in RCC. Therefore, the understanding of the tumor somatic mutational landscape could improve RCC management in the authors’ country.</p><p><strong>Objective:</strong> To perform a descriptive study to identify common somatic mutated genes and TMB in clear cell renal cell carcinoma (ccRCC), papillary renal cell carcinoma (pRCC), and clear cell papillary renal cell carcinoma (ccpRCC).</p><p><strong>Materials and Methods:</strong> The authors enrolled 13 patients, which consisted of 10 cases of ccRCC, two cases of pRCC, and one case of ccpRCC. DNA was isolated from peripheral blood mononuclear cells and tumor tissues for WES to identify tumor somatic mutations. The results were analyzed for correlations with tumor-aggressive features and compared with the public database.</p><p><strong>Results:</strong> The authors identified common somatic mutations in VHL, SVIL, MUC16, CSMD3, CSMD1, and BAP1 in the study patients. In ccRCC cases, VHL mutation was detected in 90% of the cases corresponding to its high frequency in the TCGA’s ccRCC database. In pRCC cases, KDM6A was the only common mutated gene that overlapped with the top-ten most common genes in the TCGA’s pRCC database. Somatic mutations in BAP1, SETD2, and PBRM1 were significantly associated with tumor-aggressive features in the present study. The mean TMB of ccRCC, pRCC, and ccpRCC were 2.017, 2.143, and 6.61 mutations per megabase, respectively.</p><p><strong>Conclusion:</strong> Identification of common somatic mutations and TMB in all subtypes of RCC from the present study showed the diversity of genetic alterations between Thai patients and the public database. This leads to specific therapeutic approaches for Thai patients. Moreover, the authors also detected similar associations between significant mutations reported in prior studies with the tumor-aggressive features in the present cases.</p><p><strong>Keywords:</strong> Renal cell carcinoma; Somatic mutation; Tumor mutational burden; Whole exome sequencing</p><p><strong>DOI:</strong> 10.35755/jmedassocthai.2024.3.13956</p><p>Received 19 December 2022 | Revised 22 February 2024 | Accepted 27 February 2024</p>2024-03-19T08:46:00SE Asia Standard Timehttp://www.jmatonline.com/index.php/jmat/article/view/13958Risk of Subclinical Atrial Fibrillation in Patients with Cardiac Implantable Electronic Devices after COVID-19 Infection: A Single-Center Study2024-03-19T10:01:51SE Asia Standard TimeMethavigul Kmethavigul.k@gmail.comMethavigul Rmethavigul.k@gmail.com<p><strong>Objective:</strong> To evaluate the risk of subclinical atrial fibrillation (SCAF) in patients with cardiac implantable electronic devices (CIEDs) after COVID-19 infection.</p><p><strong>Materials and Methods:</strong> The authors retrospectively enrolled patients receiving CIEDs with atrial leads at the device clinic between January 2022 and September 2023. Patients with 12-lead ECG documented atrial fibrillation, atrial flutter, or atrial tachycardia were excluded. The authors classified these patients as COVID-19 and non-COVID-19 groups. The outcome was the new onset and/or 20% increased episodes of the longest SCAF duration. The authors compared the outcome using a chi-square or Fisher’s exact test between both groups.</p><p><strong>Results:</strong> One hundred thirty-two patients were enrolled. Of the 132 patients, 44 patients were in COVID-19 group and 88 patients were in non-COVID-19 group. The average age was 67.6 years. About one-third of these patients were males. Most of these patients had hypertension and dyslipidemia. The average follow-up time was 9.3 months. Eighteen patients (40.9%) had the longest SCAF duration in the COVID-19 group, while 23 patients (26.1%) had the longest SCAF duration in the non-COVID-19 group. More patients in the COVID-19 group had the longest SCAF duration than those in non-COVID-19 group with no statistical significance (odds ratio 1.96, 95% confidence interval 0.91 to 4.21, p=0.13).</p><p><strong>Conclusion:</strong> Patients with a history of previous COVID-19 infection receiving CIEDs had no significantly increased risk of SCAF.</p><p><strong>Keywords:</strong> COVID-19; CIEDs; Subclinical atrial fibrillation; AHRE burden; Atrial high-rate episode</p><p><strong>DOI:</strong> 10.35755/jmedassocthai.2024.3.13958</p><p>Received 11 January 2024 | Revised 22 February 2024 | Accepted 24 February 2024</p>2024-03-19T09:33:32SE Asia Standard Timehttp://www.jmatonline.com/index.php/jmat/article/view/13959Gender Differences in Thyroid Notch on Computed Tomography in Thailand2024-03-19T10:01:51SE Asia Standard TimeMahachitsattaya Brajavithi.plastic.rj@gmail.comSangfai Orajavithi.plastic.rj@gmail.comPulpinyo Trajavithi.plastic.rj@gmail.com<p><strong>Background:</strong> The prominence of the Adam’s apple can cause dissatisfaction with physical appearance among transgender people. However, there seems to be no difference of the particular organ between Thai males and females.</p><p><strong>Objective:</strong> To analyze variations between the genders in the interlaminar angle (IA) and the convex distance (CD) of the thyroid cartilage. Additionally, measurements from the thyroid cartilage’s most prominent point to the thyroepiglottic ligament’s attachment point as the Notchto-Epiglottis (NTE) were compared.</p><p><strong>Materials and Methods:</strong> The present study was a retrospective cross-sectional study. Data were collected from patients that attended Rajavithi Hospital for neck computed tomography (CT) in the two-year period between 2019 and 2020. These patients were divided into two groups, one consisted of 100 males and the other of 100 females, all of whom were aged 18 to 60 years. The IA, CD, and the NTE of the two genders were analyzed.</p><p><strong>Results:</strong> The IA was measured at 65.3±9.4° for males and 88.9°±11.3° for females. The CD was measured at 9.9±2.1 mm and 7.8±1.5 mm for males and females, respectively, while the NTE was measured at 7.4±1.2 mm and 6.1±1.1 mm, respectively. All of these differences between the genders were statistically significant (p<0.001). Previous neck radiation and thyroid disease did not affect differences in the IA, CD, or NTE.</p><p><strong>Conclusion:</strong> Based on the population samples, it was observed that, in comparison to females, males exhibited a more acute IA, a notably larger CD, and a greater NTE measurement. Developing a comprehensive understanding of the thyroid notch can help to reduce the occurrence of complications in chondrolaryngoplasty.</p><p><strong>Keywords:</strong> Protuberant thyroid notch; Thyroid cartilage</p><p><strong>DOI:</strong> 10.35755/jmedassocthai.2024.3.13959</p><p>Received 7 November 2023 | Revised 27 February 2024 | Accepted 4 March 2024</p>2024-03-19T09:42:40SE Asia Standard Timehttp://www.jmatonline.com/index.php/jmat/article/view/13957Spinal Cord Infarction Following Transarterial Chemoembolization of Hepatocellular Carcinoma with Chest Wall Metastasis: A Case Report and Review of the Literature2024-03-19T10:01:51SE Asia Standard TimePraditukrit Kweerawat.sae@mahidol.eduJitprapaikulsan Jweerawat.sae@mahidol.eduThamtorawat Sweerawat.sae@mahidol.eduLimsrichamrern Sweerawat.sae@mahidol.eduSaengphatrachai Wweerawat.sae@mahidol.edu<p>Spinal cord infarction (SCI) is a rare but detrimental complication following transarterial chemoembolization (TACE). The case report presented a case of hepatocellular carcinoma (HCC) involving the lateral chest wall for which the patient underwent TACE, targeted at the right ninth intercostal artery. After the intervention, the patient fully developed complete spinal cord syndrome immediately after TACE. Magnetic resonance images of the spinal cord showed abnormal hyperintense lesions on T2-weighted images involving the anterior and central part of the 9th to 11th thoracic spinal cord, compatible with SCI. Although corticosteroids were not administered, the patient’s condition subsequently improved, being capable of walking with a gait aid. SCI after TACE is a possible disabling adverse event. To prevent this complication, the collateral vessels of the spinal arteries, such as the intercostal arteries, should be avoided. Furthermore, monitoring for the symptoms of SCI, especially in the first 24 hours after the intervention, should also be done in all TACE cases.</p><p><strong>Keywords:</strong> Spinal cord injury; Spinal cord infarction; Transarterial chemoembolization; Hepatocellular carcinoma; Case report</p><p><strong>DOI:</strong> 10.35755/jmedassocthai.2024.3.13957</p><p>Received 16 January 2023 | Revised 1 March 2024 | Accepted 3 March 2024</p>2024-03-19T10:00:09SE Asia Standard Time