Ulcerative colitis in Thailand: a clinical study and long term follow-up.

Ulcerative colitis (UC) is uncommon in Thailand. Few reports have been published and confirmation of the diagnosis was difficult. To make a firm diagnosis of UC in Thailand, long-term follow-up and demonstration of chronic and relapsing clinical courses should help to confirm the existence of UC in Thailand. OBJECTIVE: To review the demographic data, clinical presentation and clinical courses of the diagnosed UC cases in Thailand. MATERIAL AND METHOD: Diagnosed UC patients who were followed-up for longer than 3 months at the Diarrhea Clinic, Siriraj Hospital between 1988-2000 were included. RESULTS: Forty cases of UC were followed-up. The duration of follow-up ranged from 3-75 months (mean 27 months). Male to female ratio was 19:21 and age of onset varied from 13-77 years (mean 37.7 years). Extents of the disease was left-sided colitis in 58 per cent, left and right-sided colitis in 8 per cent, pancolitis in 21 per cent, proctosigmoiditis in 13 per cent and ileal involvement in 8 per cent. At presentation, the disease was mild in 28 per cent, moderate in 60 per cent, severe in 13 per cent and fulminant in 2. Clinical presentations were diarrhea in 97.5 per cent, lower GI bleeding in 17.5 per cent, abdominal pain in 50 per cent, fever in 27.5 per cent, weight loss in 62.5 per cent and extraintestinal manifestations in 20 per cent. Diagnoses were made in all cases by sigmoidoscopy plus barium enema or colonoscopy and biopsies were taken in all cases. Histologic findings supported the diagnoses in 69 per cent of cases. Seventy per cent responded to sulfasalazine or 5-ASA with or without corticosteroid, but in 30 per cent, azathioprine was added for a period during the treatment. Clinical courses of the diseases were chronic intermittent with remission and relapse in 44 per cent, chronic continuous activity without remission in 27 per cent, single episode without relapse in 27 per cent and acute fulminating course in 6 per cent. One patient died from fulminant pancolitis with colonic perforation. There was no colonic cancer in our cases throughout the follow-up period. CONCLUSIONS: UC is very uncommon in Thailand. Firm diagnosis of UC can be made through long-term follow-up and demonstration of chronic and relapsing clinical courses. The disease severity and extent of disease involvement was slightly different from that in Western countries. Incidence of extraintestinal manifestation was 20 per cent. Most cases responded to sulfasalazine, 5-ASA or corticosteroids.

Malignant carcinoid tumor of the appendix with liver and lung metastasis: report of a case with a high level of serum carcinoembryonic antigen.

We report elevated serum carcinoembryonic antigen (CEA) in a case of malignant carcinoid tumor of the appendix with liver and lung metastasis. A 55-year-old Thai man was found to have multiple nodules in the liver by ultrasonography. Serum CEA was 7,387.9 ng/mL (normal 0-4.1 ng/mL) leading to a clinical impression of colonic carcinoma with liver metastasis. During the investigation, he developed acute abdomen caused by ruptured acute appendicitis. Malignant carcinoid tumor of the appendix, 1 cm in diameter and located proximal to the ruptured acute appendicitis, was identified. The tumor cells showed trabecular or insular growth pattern, some nuclear pleomorphism but typically fine nuclear chromatin, frequent mitoses and focal necrosis. They were immunoreactive for antibody to chromogranin, neuron-specific enolase, CEA, and cytokeratin. Tumor metastases were discovered in the liver, right lung, mediastinal and right supraclavicular lymph nodes. Electron microscopic study demonstrated pleomorphic neurosecretory granules of the midgut type of carcinoid tumor.

Effects of cigarette smoking on duodenal ulcer healing and relapse rate.

104 duodenal ulcer patients were classified into non-smokers (76) and smokers (28). Their age range was between 14-72 years. They were randomly treated with cimetidine (28 non-smokers and 8 smokers), colloidal bismuth (27 non-smokers and 10 smokers) and sucralfate (21 non-smokers and 10 smokers). Follow-up endoscopic examination at 4, 6 and 8 weeks showed that overall healing rates were better in the non-smokers than in the smokers (64.5% against 46.4% at 4 weeks and 92.1% against 67.8% at 6 weeks) and almost all ulcers had healed at the end of 8 weeks (100% in non-smokers and 96.4% in smokers). Among non-smokers, there were no statistically significant differences in the healing rates by any medication at any period of time. Among smokers, colloidal bismuth had significant better healing rate at 6 weeks over cimetidine and sucralfate. (p = 0.04 and p = 0.041 respectively). Overall relapse rates were higher among smokers (32.1%) than non-smokers (10.5%). Of the 3 medications, sucralfate had the lowest relapse rate in both smokers (20%) and non-smokers (9.5%), while colloidal bismuth had the highest relapse rates (40% for smokers and 11.1% for non-smokers).