Predictive factors for synchronous common bile duct stone in patients with symptomatic cholelithiasis.

BACKGROUND: Laparoscopic cholecystectomy (LC) has become the treatment of choice for patients with symptomatic cholelithiasis. About 8-15 per cent of patients with symptomatic gallstones may bear associated common bile duct (CBD) stones, The management of choledocholithiasis in the laparoscopic era remain debatable. Although pre-operative endoscopic cholangiopancreatography (ERCP) is available and highly accurate in the detection of CBD stones, its routine use is controversial because of its inherent disadvantages. OBJECTIVE: The aim of this retrospective study was to generate an effective predictive model for bile duct stones detection by pre-operative ERCP. METHOD: Twelve pre-operative clinical, biochemical and sonographic variables from 206 consecutive patients who underwent pre-operative ERCP with LC for gallstones with/without CBD stones from October 1998 to December 2000 were retrospectively analysed RESULTS: 143 of the 206 patients with gallstones were found to have CBD stones. The mean age was 61 (20-93) yr old, and 55.9 per cent were female. Multivariate analysis showed a high predictive value for the presence of CBD stones in patients aged > or = 55 yr old (Odd radio (OR) 1.03, 95% confidence interval (95% CI) 1.01-1.05), jaundice (OR 2.7, 95% CI 1.7-4.8), elevated alkaline phosphatase (OR 1.002, 95% CI 1.000-1.005), CBD dilatation on ultrasound (OR 3.8, 95% CI 1.8-8) and CBD stone on ultrasound. CONCLUSION: The important clinical presentations and investigating could allow more appropriate use of pre-operative ERCP in patients who have symptomatic gallstones with a suspected CBD stone prior to cholecystectomy.

Pancreatic cancer : From clinical to molecular aspects.

Pancreatic ductal adenocarcinoma usually has a very poor outcome. The majority of patients present late with locally advanced or metastatic disease, and only 10-20% are candidates for resection. The tumor marker CA19-9 may be elevated but is not specific for pancreatic cancer. Dual-phase spiral computed tomography is the most important imaging modality for the diagnosis of pancreatic cancer. Despite the continuing development of body imaging methods and serum determination of tumor markers, the diagnosis of pancreatic carcinoma often remains problematic. Endoscopic retrograde cholangiopancreatography is considered to be one of the most reliable diagnostic procedures for pancreaticobiliary diseases. Endoscopic ultrasonography has been developed as an intracorporeal imaging method that now provides precise ultrasonic images of the pancreas. Pancreaticoduodenectomy is the mainstay of surgical treatment which offers the only hope of cure for this disease. Biliary-enteric and gastrojejunal bypass used to be the standard operation for inoperable pancreatic cancer. Endoscopic stenting can produce good palliation of biliary obstruction. The median survival after resection is only 18-20 months and up to 50% of those who survive 5 years may die of recurrent cancer. The factors that predict recurrence and survival are the resection margin, the size of the tumor, lymph node involvement and histological appearance of the degree of differentiation of the cancer tissue. Pancreatic cancer is a consequence of stepwise accumulated genetic alterations which disturb the equilibrium of a cell by altering the relative balance between the roles of the cell cycle, differentiation and dedifferentiation, and programmed cell death (apoptosis). Multiple genetic alterations involving the activation of oncogenes (K-ras) and inactivation of tumor suppressor genes (p53, p16 and DPC4) and telomerase. The detection of early tumor, i.e., the establishment of a screening strategy, the development of adjuvant therapy and molecular approaches might provide more options and a better clinical outcome for pancreatic cancer.

The suppression of MUC1 expression in cultured cholangiocarcinoma cells using antisense MUC1 ribozyme strategy.

Ribozyme strategy has been employed to suppress the expression of target genes with a better efficacy than that of a regular antisense RNA strategy due to its favorable stoichiometry of the hybridization. A plasmid capable of controlling the expression of a portion of antisense RNA whose sequence is complementary to the 5' region of the coding sequence of MUC1 was constructed to include the requisite sequence of a hammerhead ribozyme. This plasmid is intended to suppress MUC1 expression. This novel plasmid was examined to see whether it functioned inside the harboring cell. Cultured cholangiocarcinoma cells prepared from the sediment of intrahepatic biliary fluid were employed as the transfection target since these cells have been confirmed to have high levels of MUC1 expression. The suppression of MUC1 expression in these cells after stimulation of the plasmid function for 16 h was demonstrated using flow cytometric analysis.

Causes and clinical courses of chronic diarrhoea in Siriraj Hospital.

Background : Chronic diarrhoea remains a major gastroenterological problem in Thailand Data regarding investigation, diagnosis and treatment of chronic diarrhoea varies from one country to another. Socio-economic status including sanitation and hygiene may also affect etiology and the clinical course of disease. There data may be misleading for practitioners facing the problem in Thailand. To date, few studies on chronic diarrhoea in Thailand are available. Objectives : To find the causes and clinical courses of chronic diarrhoea. To determine the frequency of various causes. Finally, to see if simple guidelines can be developed to help investigators in Thailand reach a final diagnosis. Methods : Thirty-four in-patients with chronic diarrhoea at Siriraj Hospital were worked up using a systematic scheme for evaluation of chronic diarrhoea by prospective study. Close follow-ups were monitored for an average period of six months. Results : Among the 34 cases, a definite diagnosis was reached in 21 cases (62%) : parasitic infestation seven cases (33%), carcinoma of colon four cases (19%), lymphoma there cases (14%), radiation proctitis two cases (9%), malabsorption and/or maldigestion two cases (9%), tuberculous peritonitis one cases (5%) hyperthyroidism one case (5%) and villous adenoma one case (5%). Conclusion : Our study suggests that a simple investigation using complete blood count, stool examination, and especially concentration methods and sigmoidoscopy in all patients can usually find in up to 38 per cent, while further investigations can detect causes in up to 62 per cent. Of the 13 patients for whom no definite diagnosis was reached, spontaneous remission of chronic diarrhoea was found in four cases (31%).

Eradicating helicobacter pylori and symptoms of non-ulcer dyspepsia: The effect of treatment with a combination of ranitidine and amoxicillin.

Although dyspepsia frequently occurs in general population, its causes are poorly understood. This study is aimed at determining the role of Helicobacter pylori in non-ulcer dyspepsia (NUD) and evaluating the efficacy of dual therapies for H.pylori. Two groups totaling of 39 patients with endoscopically-proven NUD participated in the study. One group, comprising of 23 patients, received 300 mg of ranitidine daily for 4 weeks together with 500 mg of amoxicillin four time a day for two weeks. The second group, comprising of 16 patients, received GacidaTM 1 tablet for 4 weeks together with 500 mg of amoxicillin four time a day for 2 weeks respectively. H.pylori status was determined by histology and CLO testTM before and in the fourth and eighth week after treatment. Thirty-six patients completed the study, 21 in the ranitidine treatment group and 15 in the GacidaTM group H.pylori was successfully eradication in 47.3 percent (9/21) of ranitidine treatment group. Symptom relief at the second and sixth weeks was significantly higher under ranitidine regimen at 90.47 percent (19/21) and 100 percent (21/21) respectively, compared with the gacida regimen at 46.66 percent (7/15) and 53.33 percent (8/15) respectively. The number of patients who were symptom-free at the sixth week of treatment was significantly higher in the ranitidine group at 71.4 percent (15/21), compared with the gacida group at 20 percent (3/15). We concluded that the ranitidine regimen can relief the symptoms of NUD patients with H.pylori infection. However, the role of H.pylori needs further studies.