Adenocarcinoma of the pancreas: the clinical experience of 45 histopathologically proven patients, a 6 year study.

A retrospective study of 45 cases of adenocarcinoma of the pancreas at Chulalongkorn University Hospital from 1993 to 1998 was reviewed by clinical and histopathological criteria. Male and female ratio was 25:20. The mean age of the patients was 59.5 +/- 10.0 years. The common presenting symptoms and signs were epigastric discomfort (80.0%), weight loss (60.0%) and jaundice (51.1%). Twenty four patients (53.3%) were screened for a tumor marker (CA 19-9) and 87.5 per cent of these had high level of CA 19-9 (> 37 IU/ml). Thirty five patients (77.8%) had tumors located in the head of the pancreas. Most of the cases were investigated by using radiological imaging (ultrasonography or computerized tomography of the abdomen). Thirty five histopathological data (77.8%) were made by the operation, and the rest (22.2%) were performed by a fine needle aspiration from the pancreatic mass or liver metastasis. Whipple operation and the bypass procedure were the most common surgical procedures in our studies. Twenty five patients (55.6%) had post treatment complications from all modalities consisting of gastrointestinal bleeding, respiratory failure and infection. However, the mortality rate within 30 days postoperatively was 8.11 per cent which was due to blood loss during the operation and infections. The post treatment mortality rate from all modalities was 33.3 per cent. The average duration from the diagnosis until death was 82.3 days.

A study on the effectiveness of low-dose liquid antacid in the treatment of duodenal ulcer.

Eighty Thai patients aged 15 to 60 with endoscopic diagnosis of a single duodenal ulcer 5-20 mm. in diameter were randomized into two treatment groups. Group-A patients received hospital - made liquid aluminium – magnesium hydroxide antacid q.i.d. (30 ml. one hour after each meal and at bedtime acid neutralizing capacity 240 mEq/day). Group-B patients received a liquid placebo of similar appearance taken in the same manner. All patients were allowed additional antacid tablets as necessary for relief of ulcer symptoms. Repeat endoscopy was made after 4 weeks of treatment. Ten patients in group A and group B defaulted. The ulcer healing rates in those completing the study were 73.3 and 52.0 percent in group A and group B respectively. The study illustrates that low-dose liquid antacid taken four times daily for four weeks can be associated with duodenal ulcer healing in over two-thirds of cases, although the statistical significance over that of the placebo was not clearly demonstrated in this study with small numbers of cases. It also shows that the four-week placebo healing rate in Thai patients with duodenal ulcer can be as much as fifty percent or greater. Overall, however, patients’ compliance with a liquid medication is below expectation.

Chronic diarrhoea: a prospective study in Thai patients at Chulalongkorn University Hospital, Bangkok.

Fifty-five Thai patients with chronic diarrhoea were prospectively studied to find out the underlying causes. The aetiology was identified in 38.2%, uncertain in 29.1%, and unknown in 32.7% of the patients. In the group with a definitive aetiologic diagnosis, parasitic and infective causes were commoner than non-infective causes. Amoebiasis and giardiasis were more frequent than expected, such that empirical therapeutic trial with an antiprotozoal may be justified if initial routine investigations fail to uncover the cause of the diarrhoea. No significant clinical features were noted between the infective and the non-infective groups. Overall, repeated stool microscopy using the concentration technique was the most useful single investigation in approaching the chronic diarrhoea problem.