Clinical Spectrum and Pathology of Primary Hyperparathyroidism in Srinagarind Hospital

Background and Objective: Primary hyperparathyroidism is now being diagnosed with increasing frequency.   Simultaneously there has been an apparent change in the presentation of the disease and indication for surgery.  The aim of this study was to examine the clinical presentation and pathology of parathyroid glands for primary hyperparathyroidism.Methods : This retrospective descriptive study was carried out over 14 years,  from 1994 to 2008,  at Srinagarind Hospital,  Faculty of Medicine,  KhonKaen  University.  Information on the clinical presentation,    parathyroid hormone level, serum calcium level and pathological report of parathyroid glands was obtained from retrospective parathyroid surgical database.Results: Out of 40 patients diagnosed with primary hyperparathyroidism at Srinagarind Hospital,  there were 27 female, mean age 47.22(13 – 73) years and 13 male patients.  Bone fracture was the most common clinical presentation found in 19 patients, the second was renal calculi found in 11 patients,  one patient was presented with bone fracture and renal calculi and 8 patients were presenteded with non-specific symptoms.  Pathological reports were adenoma in 39 glands of 39 patients and hyperplasia 4 glands in one patient.  Mean serum parathyroid hormone level 481.69 pg/ml (79 - 1361.7 pg/ml)and mean serum calcium level was 12.66 md/dl (9.5-16.5 mg/dl)calcium was 12.66 mg/dl (9.5 – 16.5 mg/dl)  and levelConclusion: This study shows that severe bone disease with fractures are the most common presentation of primary hyperparathyroidism. The second is renal calculi. The most common pathological report was adenoma.Keywords: Primary hyperparathyroidism; clinical spectrum, pathology

Gallbladder Perforation :Report of 10 cases

 A Retrospective study at Srinagarind Hospital during the 5 year period of 1983-1987 , These were 10 cases of perforated gall bladders, an average of two cases per year, Five cases were free perforation with generalized peritonitis and another five were Subacute perforation with pericholecystic collection. These were 6 male and 4 female with an average age of  55.5 years. These were no serious associated diseases found on these patients. All cases had their gall bladders removed. Nine out of ten had common bile duct exploration . Two cases of tumour and 4 cases of common bile duct stone were found as the cause of obstruction. There were no perioperative-death . Only 3 minor operative complications were encountered younger age without associated disease and early cholecystectomy may be the main contribution to the good result.

Biliary Cytology of Patients with Cholangiocarcinoma in Northeast Thailand

Background: Cholangiocarcinoma, the cancer of biliary epithelium, is highly prevalent in Northeast Thailand and is associated with the liver fluke, Opisthorchis viverrini, infection and the consumption of carcinogen contaminated daily food. Diagnosis of this cancer is practically based on clinical and utrasonography. However, several markers can be used in conjunction with the standard procedure to increase diagnosis accuracy including biliary cytology as described in carcinoma of other pancreatobiliary diseases. On the basis of cancer cells can be exfoliated into the bile and they can be detected by routine Papanicolaou staining. In endemic areas of cholangiocarcinoma and opisthorchiasis, there is no report about biliary cytology and percentage of positive malignant cells presented in the bile, here we examined biliary cytology of the gallbladder and/or hepatic bile to clarify its usefulness potential for using in diagnosis.Objective: To study biliary cytology and examine Opisthorchis-ova in the gallbladder/hepatic bile in patients with cholangiocarcinoma in Northeast Thailand.Patients and Methods: Aspirated gallbladder and/or hepatic bile from 100 histological proven cholangiocarcinoma cases who admitted to Srinagarind Hospital during December 1996 to July 1998 were studied. Four Papanicolaou\’s stained smears per bile sample per case were examined for the presence of malignant or atypical cells and O. viverrini ova. Positive specimens for malignancy contained singly, numerous malignant cells and/or in three dimensional clusters. Liver fluke positive cases contained ova with distinct bilaminar walls and prominent shoulder.Results: Overall, the positivity for malignant cells and O. viverrini ova was 51 % (51/100) and 27 % (27/100), respectively. Five cases were suspicious for malignancy. Paired gallbladder and hepatic bile specimens were obtained in 32 cases. Of these, the positivity for cancer cells was significantly higher in the hepatic bile than in the gallbladder bile (2-test, p\<.01). Five cases with gallstone were negative for malignant cells.Conclusion: The results indicate that cancer cells are frequently detected in the bile, particularly in hepatic bile from patients with cholangiocarcinoma. This study implicates the potential application of biliary cytology in diagnosis of this cancer, i.e. in the bile from ERCP or duodenal drainage which is less invasive, in conjunction with other investigations in endemic areas.