Helical CT assessment on hilar cholangiocarcinoma: comparison value of arterial phase and portovenous phase correlation.

OBJECTIVE: To study the correlation between the findings of hilar cholangiocarcinoma in hepatic arterial phase and portal venous phase. Attention will focus on whether the arterial phase imaging shows more detail than portal phase imaging. MATERIAL AND METHOD: Descriptive study design with retrospective data collection in Srinagarind Hospital, Khon Kaen University. CT scans of the upper abdomen of 34 patients with pathologically proven hilar cholangiocarcinoma between 2002 and 2004 were reviewed for: (1) characteristic of the tumor; (2) adenopathy, (3) arterial involvement, (4) venous involvement, and (5) degree of biliary involvement on both the hepatic arterial and portal venous phases. RESULTS: The correlation was high for characteristics of the tumor, the tumor enhancement pattern, and detection of adenopathy, degree of biliary involvement, and arterial involvement, but low for portal venous involvement which the portal venous phase detected better than the hepatic arterial phase. CONCLUSION: In hilar type cholangiocarcinoma, the portal venous phase yielded the best findings. Furthermore, it showed all findings that were seen in the hepatic arterial phase. According to the present study, the authors suggest doing a pre-contrast study then a portal venous phase imaging for evaluation and diagnosis of hilar type cholangiocarcinoma. There is no necessity to perform hepatic arterial phase in hilar cholangiocarcinoma.

Cystic fibrosis in three northeast Thai infants is CF really a rare disease in the Thai population?

The authors report on three infants with cystic fibrosis (CF), with different genotypes, presenting with different clinical manifestations, but having similar abnormal serum electrolytes (i.e. hyponatremia, severe hypochloremia and metabolic alkalosis). Despite the diagnostic investigations, the child who presents with severe electrolyte imbalance especially persistent hypochloremia and a family history of early infant death with respiratory or gastrointestinal problems should point to a diagnosis of CF Early identification and treatment remain critical to effective management. The diagnostic tool used, especially the sweat test, is needed for diagnostic investigations in Thailand.

Reversible posterior leukoencephalopathy caused by azathioprine in systemic lupus erythematosus.

The authors report a case of systemic lupus erythematosus with posterior leukoencephalopathy who presented with headache, tonic-clonic seizure, loss of consciousness and bilateral loss of vision, after taking azathioprine for three weeks. The patient had hypertension with normal eye grounds. The brain CT showed a hypodensity lesion at both bilateral occipital lobes, mainly in the white matter The symptoms and follow-up MRI were improved after the control of hypertension and discontinuation of azathioprine.

Ultrasound screening for Opisthorchis viverrini-associated cholangiocarcinomas: experience in an endemic area.

In Thailand, liver cancer is the most common malignancy in males and the third most common among females. In the Northeast region, cholangiocarcinoma (CHCA) is the prevalent type, with Opisthorchis viverrini (OV), an endemic liver fluke, being considered the cause. We evaluated the role of ultrasound (U/S) for cholangiocarcinoma screening as part of a larger cohort to characterize the linkage between liver fluke infestation and CHCA in Khon Kaen (Northeast Thailand). Most people (77%) had normal U/S findings while only 0.5% had suspected CHCA; thus, U/S should be used primarily for those with the highest risk, presenting symptoms and/or being OV positive.

Predictive CT features in ruptured abdominal aortic aneurysm.

OBJECTIVE: To evaluate the CT findings including size of aneurysm, hyperattenuation crescent sign and focal discontinuity of mural calcification to predict the risk of ruptured aneurysm. MATERIAL AND METHOD: Records of 27 patients, who underwent Multislices Computed Tomography (MDCT) and required operative repair of abdominal aortic aneurysm from July 2000 to July 2003 were retrospectively reviewed Two radiologists evaluated the images by consensus, analyzing the aneurysm size, hyperattenuation crescent sign, and focal discontinuity of mural calcification. RESULTS: The authors found that the mean maximum AP diameters of the aneurysm in the ruptured and nonruptured group were 6.95 cm and 5.50 cm, respectively. All patients in the ruptured group had an aneurysm size of more than 5.0 cm. The hyperattenuation crescent sign and focal discontinuity of mural calcification had a high specificity for predicting ruptured aneurysm, 95% and 100%, respectively. There was statistical significant difference between the ruptured aneurysm and non-ruptured groups in the patients who had maximum aneurysm size more than 5 cm with positive hyperattenuation crescent sign (p < 0.041). CONCLUSION: A maximum size of aneurysm greater than 5 cm with positive hyperattenuation crescent sign is a suggestive sign to predict ruptured aneurysm.

Missed appointments at a tuberculosis clinic increased the risk of clinical treatment failure.

We investigated the charts of 381 new smear-positive tuberculosis patients at Khon Kaen Medical School during 1997-2001 using World Health Organization definitions to evaluate associations among treatment success or failure (defaulted, failed, died, or not evaluated) and tuberculosis clinic contact, demographics and clinical characteristics of the patients. Multinomial logistic regression was used for three-category outcome analysis: treatment success, transferred-out and clinical treatment failure. The treatment success and clinical treatment failure rates were 34.1% and 34.4%, respectively. About 46.5% and 85.8% of patients missed appointments at the tuberculosis clinic in the treatment success and treatment failure groups, respectively. The results show that patients who were absent from the tuberculosis clinic were 5.95 times more likely to have clinical treatment failure than treatment success, having adjusted for the effect of transfering-out and the effect of the treatment regimen and the sputum conversion status (adjusted odds ratio = 5.95; 95% CI: 2.99 to 11.84). The review showed that absence from the tuberculosis clinic was an independent risk factor for clinical treatment failure. We recommended that all new smear-positive tuberculosis patients should be followed closely at a tuberculosis clinic.

Singh index screening for femoral neck osteoporosis.

The present study included 130 elderly women living in Khon Kaen, Thailand, and all but one underwent both DEXA-BMD and AP radiographs of the left hip joint. The mean (SD) of age, weight, height and BMI of the 129 participants was 72.5 (5.3) years, 49.8 (10.3) kg, 1.49 (0.06) m, and 22.21 (4.13) kg/m2, respectively. The authors found both poor sensitivity and a positive predictive value for a Singh grade of < or = 4 or < or = 3 (viz. 58 and 29 or 19 and 43 percent, respectively). The ROC curve showed the poor diagnostic value of the Singh index since the area under the curve was approximately 40% the Singh index is therefore a poor screening tool for femoral neck osteoporosis.

Randomized trial of atorvastatin in improving endothelial function in diabetics without prior coronary disease and having average cholesterol level.

OBJECTIVE: The aim of this study was to determine whether HMGCoA reductase inhibitor with atorvastatin can modulate endothelial function in type II diabetics having average cholesterol and no prior cardiovascular disease. MATERIAL AND METHOD: Type II diabetics, with no prior cardiovascular events and total cholesterol at admission of < or = 200 mg/dl or LDL < or = 140 mg/dl, were randomized to placebo (n = 20) or atorvastatin 20 mg daily (n = 22) for 30 weeks. Brachial artery endothelium-dependent dilatation or flow-mediated dilatation (FMD) and endothelium-independent dilatation or nitroglycerine-mediated dilatation (NTGMD) were measured at baseline and after thirty weeks of treatment. RESULTS: Baseline clinical characteristics were similar at admission in both groups. After thirty weeks of treatment, the FMD did not significantly change in either the atorvastatin or placebo group (4.11 +/- 1.05% to 3.01 +/- 1.27% vs 5.75 +/- 1.93% to 6.45 +/- 1.41%, respectively; p = 0.46 by analysis of covariance). Similarly, the NTGM did not change in either group. CONCLUSION: The addition of HMGCoA reductase inhibitor with atorvastatin did not improve endothelial function in type 2 diabetes having average cholesterol with no prior cardiovascular disease, despite an improvement of the lipid profile.

Aortoesophageal fistula: a life-threatening cause of upper gastrointestinal hemorrhage in double aortic arch, a case report.

The authors present the case of a 2-month-old infant with double aortic arch that developed massive bright red upper gastrointestinal hemorrhage from aortoesophageal fistula (AEF) after prolonged endotracheal and nasogastric intubation. Emergency thoracotomy with AEF and double aortic arch repaired were done successfully under cardiopulmonary bypass. Due to tracheomalacia and left phrenic nerve injury, tracheal extubation could not be done until 1 month after correction of the vascular ring. The endotracheal and nasogastric tube led to fistula formation by compression of the esophageal wall against an abnormal double aortic arch. When a double aortic arch is suspected, prolonged nasogastric intubation should be avoided.

Comparison of high-resolution computed tomography with pulmonary function testing in symptomatic smokers.

PURPOSE: To compare high-resolution computed tomography (HRCT) of lungs with pulmonary function in smokers diagnosed with emphysema. MATERIAL AND METHOD: The authors retrospectively reviewed 17 patients with a history of smoking and dyspnea, who underwent HRCT of the lungs and pulmonary function testing. HRCT scores were determined and compared to pulmonary function (FEV1, FEV1/FVC, and DLCO). RESULTS: The HRCT of all 17 patients (17/17; 100%) were typical of centrilobular emphysema; with a mean score of 12.88+/-9.18 (range, 4 to 34). Decreased FEV1 (<80% predicted) was found in 8 patients (47%), decreased FEV1/FVC (<70% predicted) in 13 patients (76%) and decreased DLCO (<80% predicted) in 3 patients (18%). The severity of emphysema revealed by HRCT was inversely correlated with the pulmonary function test: DLCO (r=-0.842, p=0.000) and FEV1 (r=-0.597, p= 0.011), but not FEV1/FVC (r=-0.400, p=0.112). CONCLUSION: HRCT allows detection of emphysema in symptomatic smokers even when pulmonary function appears to be normal. The greater the involvement of emphysema revealed by the HRCT, the poorer the pulmonary function. The authors, therefore, conclude that HRCT is the most sensitive modality for diagnosing early emphysema in smokers with dyspnea.

Pleuropulmonary blastoma in a child presenting with spontaneous pneumothorax.

The authors described a 27-month-old boy with the diagnosis of pleuropulmonary blastoma who presented with spontaneous pneumothorax. The child was admitted to our hospital with the chief complaint of respiratory distress for 8 months. Initial chest X-ray revealed tension pneumothorax on the right side. After chest tube insertion to the right side, a repeated chest X-ray showed minimal pleural effusion and a mass-like lesion at the right lower lung field. Computed tomography (CT) of the chest showed a cavity with intramural mass confined in the right lower lung accompanied with hydropneumothorax. The surgery revealed a cystic and solid mass occupying the right pleural space medially displacing the right lower lung. Total removal of the mass was performed, the histopathologic findings revealed a mixed cystic and solid type of pleuropulmonary blastoma which was composed of primitive blastema with multidirectional differentiation. Combination chemotherapy consisting of vincristine, cyclophosphamide, doxorubicin and dactinomycin was administered two weeks after surgery. The child has been well for almost 6 months since the surgery, without any signs of metastasis or recurrence.