Subsets of Inflammatory Cytokine Gene Polymorphisms are Associated with Risk of Carcinogenic Liver Fluke Opisthorchis viverrini-Associated Advanced Periductal Fibrosis and Cholangiocarcinoma

Opisthorchis viverrini infection induces chronic inflammation, and a minor proportion of infected individuals develop advanced periductal fibrosis (APF) and cholangiocarcinoma (CCA). Inflammatory cytokines and/or their gene polymorphisms may link to these biliary pathologies. We therefore investigated associations among cytokine gene polymorphisms and cytokine production in 510 Thai cases infected with O. viverrini who presented with APF+ or APF−, as established by abdominal ultrasonography as well as in patients diagnosed with CCA. Levels of pro-inflammatory and anti-inflammatory cytokines were determined in culture supernatants after stimulation of peripheral blood mononuclear cells (PBMCs) with O. viverrini excretory-secretory (ES) products. Pro-inflammatory cytokines, IL-1β, IL-6, IFN-γ, LT-α, and TNF-α were significantly increased in CCA patients compared with non-CCA (APF− and APF+) cases. Polymorphisms in genes encoding IL-1β-511C/T, IL-6-174G/C, IFN-γ +874T/A, LT-α +252A/G, and TNF-α−308G/A were then investigated by using PCR-RFLP or allele specific-PCR (AS-PCR) analyses. In the CCA cases, LT-α +252A/G and TNF-α−308G/A heterozygous and homozygous variants showed significantly higher levels of these cytokines than the wild type. By contrast, levels of cytokines in wild type of IFN-γ +874T/A were significantly higher than the variants in CCA cases. IFN-γ +874T/A polymorphisms were associated with advanced periductal fibrosis, whereas IL-6 −174G/C polymorphisms were associated with CCA. To our knowledge, these findings provide the first demonstration that O. viverrini infected individuals carrying several specific cytokine gene polymorphisms are susceptible to develop fibrosis and CCA.

Angiographic Features of Ruptured Cerebral Aneurysm in Srinagarind Hospital

  Intracranial  aneurysms are common. It is the most commonly encountered  aneurysms in the human body. Rupture  of an aneurysm producing intracranial bleeding is considered a medical emergency, and requires further investigation  and  management. Cerebral  angiography is still the examination of choice to confirm the diagnosis of aneurysms. In our study, 29 cases of ruptured cerebral aneurysms show no sex difference And 13 out of 29 cases are in the range of 40-60 years. The most common location of cerebral aneurysms is the anterior communicating artery aneurysms, 11 out of 29 cases. No multiple aneurysm is seen in this study. 

Etiology of dyspepsia in Srinagarind Hospital : a prospective data analysis

 Dyspepsis is an extremely common presenting symptom with a prevalence in the community of approximately 30% and may be an early symptom of a serious illness.  This prospective data analysis aims to determine the etiology of the patient who present with dyspepsia in Srinagarind Hospital.  208 patients were studied with completed a structured history questionnaire and completed investigation with complete blood count, stool examination, liver function test, HbsAg, HbsAb, ultrasonography of the abdomen and endoscopy.  The most common cause is non-ulcer dyspepsia (53.27%).  There were peptic ulcer disease in 26.44%, hepatobiliary disease in 16.83% and combined peptic ulcer disease and hepatobiliary disease in 3.37%.  Malignant cause of dyspepsia which we found in this series is tumor of the liver.

Intussusception in Srinagarind Hospital : A review of six-year period

At Srinagarind Hospital , from January 1982 to January 1988, 34 case of intussusception were studied retrospectively . Barium enema reduction were performed in 19 intussusceptions and were successful  in 6 cases or 31.58% There were 3 recurrences. Repeat hydrostatic reduction was successful in one and failed in two cases. The later two cases needed a surgical intervention and leading points were noted. Colonic perforation occurred in 6 cases. One case occurred during barium enema reduction on the third trial and leading point was noted at operation. Factor which influenced failure of the hydrostatic reduction included long duration of illness, presented of leading point and underlying colonic pathology in old age. Clinical evidence of intestinal perforation (peritonitis) or free intraperitoneal air on abdominal radiographs was the only absulute contraindication to the administration of barium enema to the patient suspected of intussusception.

Transcrectal Ultrasonography : First Experience in Srinagarind Hosptial

Objective : To study the usage of transrectal ultrasonographyDesign: Prospective, descriptive studySetting : Ultrasonography room and Surgical OPD, Srinagarind hosptial, of Medicine, Khon Kaen UniversitySubjects : Patients who had problem of prostate gland between November 1997 and September 1998Data collection : Protocol Measurement : Descriptive statistics, including number, means, and percentagesResults : There were 34 patients.  Their age ranged from 29 to 85 years (means 59.48 years). Ultrasonography Diagnoses were the same as the clinical diagnoses in every case.  Most ultrasonography diagnoses were similar to final diagnoses, except 4 cases.  Instead of BPH, one case was prostatic abscess, two cases were prostatitis, and the last was prostatic cancer.Conclusions: Transrectal ultrasonography had high efficiency to examine the pelvic organs, esp. prostate gland. Instead of blind biopsy, trransrectal ultrasonography provided visual biopsy of prostate gland.Keywords: (1) Transrectal (2) Ultrasonography

Formative evaluation for the fifth year medical student in clinical radiology by pre-test and post test

Background: Evaluation is one of the essential parts of education.  Before the academic year 2003, only final examination was used to evaluate students’ knowledge in Department of Radiology, Faculty of Medicine, Khon Kaen University.Objective: To compare students’ knowledge in diagnostic radiology between pre- and post-learning periods.Subject and Method: All the fifth-year medical students in the academic year 2003 were divided into 12 groups (10-15 per group), total 156 students.  Each group rotated to attend in diagnostic radiology for 2 weeks.  Each student was evaluated by pre- and post-tests which were the same test.Result: One hundred and fifty-two students (97.43%) showed improvement in their knowledge.  The average score of the pre-test was 6.8, while that of the post-test was 10.91.  There was no relationship between the score and final grade, except 4 students who got same score from the tests.  They also got low score from the final examination, both theory and practice sections.Conclusion: Students had more knowledge in diagnostic radiology after learning. 

Mammographic Technique from Mammography

Background: Mammography is the most effective method to screen asymptomatic women and detect early stage of breast cancer. Effectiveness of technical parameters are important for image quality such as the tube potential (kV), the tube current and time (mAs), compressed breast thickness, breast compression force, breast density categories and breast dose.Objective: To study mammographic technique from mammography.Design: Retrospective descriptive studySetting: Department of Radiology in Srinagarind Hospital Khon Kaen University.Population and Samples: One thousand and six hundred mammographic films of screening breast, who are 40 years old or older were selected.Statistical analysis: Pearson’s Correlation and percentage Results: Heterogenously dense tissue was the most common tissue type, seen on age 41-50 years. The second most common type was scattered fibroglandular densities. Extremely dense tissue was not found on age more than 60 years old. The maximum force was 45 lb on MLO view, mAs and thickness were 199 mAs and 8.2 cm on CC view respectively. High significant correlation between mAs and thickness (r=0.8078, p\< 0.05) and no correlation significant between kV and thickness, mAs and force.Discussion: The breast density change corresponding to age 2, 12. The compression force as standard force recommended by ACR and AAPM should not exceed 45 lb. The mAs has to be increased with increased breast thickness. This result is increased radiation dose, which can be reduced by increased tube potential (kV) or select Rhodium (Rh) filter or select Fix kV system (up kV from 27 to 30 kV) for large breast and breast thickness more than 6 cm6-9.Conclusions: In case of large breast with compressed breast thickness more than 6 centimeter can reduced breast dose by increase kV from 27 to 30 kV or change filter from molybdenum to rhodium in Auto kV system.