ผู้ใช้:Prof.Dr.Visith Sitprija/หน้าทดลอง
My Life in Medicine[แก้]
Born in Bangkok on June 16, 1935, I received the medical degree with gold medal award from Chulalongkorn University Medical School in 1957, and became a house officer and senior house officer of Chulalongkorn Hospital during the 2 following years. During my training as senior house officer there was an epidemic of cholera. Chulalongkorn Hospital was chosen as the base for cholera study by physicians from Walter Reed Army Hospital and Naval medical Research Unit form United States. As a senior house officer of the Medical Department I had a chance to participate in cholera research work with U.S.physicians consisting of Dr. William Beisel and Dr. Eugene Gangarosa from the Walter Reed Army Hospital, Dr. Robert Philips and Dr. Raymond Watten from the Naval Medical Research Unit. This was how I became interested in nephrology. A number of cholera patients had acute renal failure. My interest in nephrology was inspired by the collaboration with these American researchers. ARF was due to near isotonic saline loss based on stool analysis of electrolytes. Under Dr. Chanyo Benyajati, chief of the Renal Unit at the time, we had a good collaborative study with the Walter Reed Army Group. Our joint paper on cholera acute renal failure showing vacuolation of proximal tubule due to potassium depletion was published in Annals of Internal Medicine in 1959.
In 1959 I went to USA by the support of Princess Chongkolnee Watanawong for training in hemodialysis in the Department of Artificial organs under Dr. Willem J. Kolff at the Cleveland Clinic in Cleveland. I spent one year with him. It was indeed a rewarding experience to have training under the Father of Artificial Organs. My training in nephrology from 1960 to 1964 was under Dr. Joseph H Holmes at the University of Colorado Medical Center in Denver. This was through recommendation of Dr.Satoru Nakamoto. I was engaged in a study of intracranial and intraocular pressure changes induced by hemodialysis in renal failure. The study was a part of requirements for a PhD program in experimental medicine. The course work in PhD program and my research in blood brain barrier formed the basis of my continuing interest in physiology. Thanks to Dr. Holmes for allowing me to do PhD during nephrology training.
I returned to work in the Department of Medicine, Chulalongkorn Hospital, Bangkok in 1964 with a Kolff twin coil artificial kidney donated by Travenol Company. It was the first artificial kidney in the country that was successfully used. The Renal Unit of Chulalongkorn Hospital was visited by Their Majesties King Bhumibol and Queen Sirikit to see the machine. The cost of dialysis was high and was unaffordable by the low income patients. Dialysis at that time was not government supported. Peritoneal dialysis was a better alternative for treatment of acute renal failure. I had an opportunity to take care of several patients with acute renal failure due to falciparum malaria, a common problem of the country. A paper on this subject was submitted to the New England Journal of Medicine, but was rejected on the ground that malaria was not a problem in the U.S. The same paper was sent to the Lancet and was accepted with nice comments from the editor. That was the beginning of my career in nephrology. I learned that I should work on the common problems of the country and solve the problems at less cost. Tropical nephrology then became my interest, and replaced my original interest in the artificial organs and dialysis. Clinical manifestations and pathophysiology were to be defined. Through renal biopsy and simple renal physiology I studied renal involvement in a number of tropical diseases both infection and toxins including malaria, dengue, scrub typhus, leptospirosis, trichinosis, liver fluke, diarrheal and viral diseases, animal and plant toxins. In brief, I found that immune complex glomerulonephritis was common. ARF was due to renal ischemia and non specific effects of infection. Animal and plant toxins can have direct nephrotoxicity. Tropical diseases, renal physiology and pathology were put in perspective.
The finding by our group that CKD in pilgrim Buddhist monks in northeastern Thailand who consumed a daily single meal of low protein along with intense meditation progressed very slowly was fascinating. My interest extended to renal diseases related to the environment, including distal renal tubular acidosis, renal stone and sudden unexplained death (SUD) in northeastern Thailand. The roles of potassium depletion, vanadium and genetics were investigated. I went on to study the soil and vegetable composition of potassium and vanadium. The soil had high vanadium but low potassium. The vegetables in the rural northeast had low potassium content. The village people in the northeast were of low socioeconomy and consumed low potassium diet. They were hypokalemic, had low urine citrate and decreased erythrocyte Na-K ATPase. There was mutation of sodium channels in SUD and chloride bicarbonate exchange (AE1) in distal renal tubular acidosis. We found hypogastric acidity in dRTA which would require AE2 study. Problems in Northeastern Thailand are integration of potassium depletion, vanadium effects and genetic variation. With improvement of socioeconomy and better income per capita the problems are partially alleviated.
Despite the high teaching load and clinical practice to earn living due to low government salary I continued to pursue clinical research and published in international journals. My work is based on the philosophy of harmony with nature. Nephrology in the rural area is fascinating, and one can learn so much from nature and the way the body responds to the environment. It is an excellent model to understand renal diseases.
I ascended in my academic career to professor of medicine, chief of the Renal Unit and Chairman of Department of Medicine, Chulalongkorn University Medical School, published over 350 scientific papers and several book chapters, and was invited to lecture in many countries in the tropics. The concept of good, ethical and scientific service was applied to the department during my chairmanship of medicine and continued on to the present time. The concept was also introduced to the Royal College of Physicians. I organized 2 courses on tropical diseases and medicine in southeast Asia in Bangkok for the American College of Physicians. Chulalongkorn Hospital has the best Renal Unit in the country and is on the world map in tropical nephrology.
I retired from the Medical School in 1995. It is compulsory that an official retires at the age of 60. At present I work for the Science Institute (Queen Saovabha Memorial Institute) of Thai Red Cross as its Director, being in charge of biological product manufacturing, clinical service on travel medicine and animal toxins, and research in snake venoms and rabies. The institute produces snake antivenoms, BCG vaccine and rabies immunoglobulins. I continue to pursue my interest in snake venoms and animal toxins and acute kidney injury.
International Contribution to nephrology
President of Asian Pacific Society of Nephrology 1997-2000
Councillor, International Society of Nephrology 1997-2001
Chairman, ISN Commission for Global Advancement of Nephrology (Asian-Pacific Region) 1997-2005
Organizing 2nd Colloquium in Nephrology, Pattaya, Thailand 1976
Organizing 8th Asian Pacific Congress of Nephrology, 2003 Pattaya, Thailand
Collaboration with Japan Society for Promotion of Sciences in exchanging nephrologists between Japan and Program 1990-1995
Pioneering work in tropical nephrology
Membership and Fellowship
Fellow of the Royal Institute (Thailand)
Fellow of Royal College of Physician (London)
Fellow of Royal College of Physician (Edinburgh)
Fellow of Royal Australasian College of Physician
President, Royal College of physicians (Thailand)
Medical Associate of Thailand
Nephrology Society of Thailand
Asian Pacific Society of Nephrology
International Society of Nephrology
New York Academy of Science
Society of Sigma Xi
American Federation for Medical Research
Awards
Distinguish Physician Award, International College of Surgeons 1978
Distinguish Research Award, Chulalongkorn University 1978
Distinguish Physician Award, medical Association of Thailand 1985
Outstanding Research Award, Nation Research Council of Thailand 1989
Distingish International Award, National Kidney Foundation, U.S.A. 1993
Outstanding Scientist Award, Foundation for the Promotion of Science and Technology 1994
Asean Achievement Award (in Medicine) 1996