The combined treatment of interferon alpha-2a and thymosin alpha 1 for chronic hepatitis C: the 48 weeks end of treatment results.

The efficacy and safety of IFN alpha 2a and Thymosin alpha1 combination therapy in patients with chronic hepatitis C were determined. Twelve chronic hepatitis C patients (9 M, 3F), with positive HCV-RNA and histology compatible with chronic hepatitis C were included in this open, prospective study. Each patient received a combination therapy of IFN alpha 2a 3 mU s.c. TIW and Thymosin alpha1 1.6 mg s.c. twice a week for 52 weeks. Up to the present, 11 patients are still being followed-up after the end of 52 weeks' treatment. One patient dropped out after 32 weeks of follow-up due to noncompliance. Responses to treatment were evaluated by measuring serum HCV-RNA levels determined by RT-PCR. and serum amino transferases at the end of 48 weeks of treatment (end of treatment response: ETR). There were 8 naive and 4 previously IFN treated patients with partial response with a mean age of 45.0 +/- 10.1 (mean +/- SD). The mean duration from diagnosis until treatment was 25.1 +/- 22.9 months. The mean AST, ALT, and HCV-RNA levels before treatment were 79.5 +/- 36.8 U/L, 128.3 +/- 68.5 U/L, and 3.9+1.9 x 10(5) copies/ml respectively. Serum AST, ALT, and HCV-RNA levels were significantly lower at week 24 and 48 after treatment compared to before treatment (p<0.05). Of 11 cases, complete HCV-RNA clearance at week 24 was noted in 33.3 per cent, whereas, normal alanine aminotransferase values (ALT < 40 U/L) were observed in 41.7 per cent of patients. Complete HCV-RNA clearance and normal alanine aminotransferase at week 48 were seen in 45.5 per cent of the patients. At the end of week 48, complete response occurred in 4 of 5 naive patients. Minor side effects were observed during treatment with this combination therapy and these included myalgia (33.3%), mild form of alopecia (33.3%), and weight loss (8.3%). In patients with chronic hepatitis C, Interferon alpha 2a and Thymosin alpha1 combination therapy produced a good response rate especially in naive patients with acceptable safety profile. The sustained response will be determined after the completion of follow-up for another 6 months.

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.

Intestinal microsporidiosis in HIV infected patients with chronic diarrhea in Thailand.

Microsporidia have been recognized as emerging opportunistic agents affecting multiple organs. Intestinal microsporidiosis caused by Enterocytozoon bieneusi and Encephalitozoon intestinalis is a common disease which is associated with gastrointestinal symptoms, particularly in AIDS patients. So far, information on the frequency of this enteric disease in Thailand is not available. Therefore, the present study was undertaken to investigate the prevalence of intestinal microsporidiosis in HIV infected persons with chronic diarrhea. From 1995 to 1996, multiple diarrheal stool specimens were received and examined for the presence of the organism using Weber's modified trichrome staining method and transmission electron microscopy for confirmation. Twenty-two of 66 patients (33.3%) were positive for microsporidia which appeared as pink-red spores of 0.8-1.2 x 0.7-0.9 microm with the characteristic transverse or oblique band representing the coiled polar filament. Clinical features of these patients included chronic diarrhea (100%), weight loss (100%), abdominal pain (77%), fever (36%), vomiting (36%) and anorexia (18%). Transmission electron microscopic examination of fecal specimens from the 22 patients with positive staining results revealed E. bieneusi in 18 cases.

Primary cryptococcal infection of the larynx in a patient with AIDS: a case report.

Primary laryngeal cryptococcosis was reported in a 42-year-old man with AIDS. The patient also had pulmonary tuberculosis and hydropneumothorax as a complication. Serological tests and/or cultures from blood, CSF, urine and pleural fluid were all negative for cryptococcus. He was successfully treated with oral fluconazole for 8 weeks to clear the infection and remained clear in the follow-up period 9 months after treatment.

Upper gastrointestinal endoscopy in children with recurrent abdominal pain.

Over a 3 year period from 1992 to 1995, 62 patients with recurrent abdominal pain (RAP) underwent upper gastrointestinal endoscopy showing normal findings in 30 patients (48.4%), gastroduodentis 17 (27.4%), H. pylori gastritis 11 (17.7%) and esophagitis 4 (6.5%). Duodenal or gastric ulcer was not found. This study demonstrated more evidence of increased prevalence of organic causes of RAP than previous reports. Duration of illness of more than one year and vomiting were more common in H. pylori gastritis. Other symptoms including diarrhea, constipation, nocturnal awakening and pain related to meals could not differentiate between organic and functional cause. Major cases of H. pylori gastritis and gastroduodenitis responded to triple drug therapy and H2 blockers respectively.

The upper endoscopy in upper gastrointestinal hemorrhage of children.

Between 1992-1994, 20 children aged 3 months to 16 years who were admitted to Department of Pediatrics, Faculty of Medicine, Siriraj Hospital with problems of hematemesis and melena underwent gastrointestinal endoscopy. Thirteen children developed bleeding before admission and underlying diseases in 3 of these were chronic renal failure, pulmonary TB and malignant mesenchymoma. The main causes of hemorrhage in this group were gastritis (5 cases), esophagitis (3 cases) and esophageal varices (2 cases). The underlying disease of 7 children with hemoeehage during hospitalization were blood disease, SLE with renal failure and gastroesophageal reflux. The esophagitis, candida esophagitis, and gastric esosion were the etiologies of bleeding. Nine children needed blood transfusion and one had further investigations including meckel scan, tagged red cell scan and colonoscopy. Four patients died due to sepsis. The endoscopy had the value of establishing the etiology of upper gastrointestinal hemorrhage in 19 cases.

The advantages of upper gastrointestinal tract brush cytology.

A two-year study of endoscopic brush cytology and biopsy histology was carried out in 63 patients suspected of having malignant lesions in the stomach and the eosophagus. The study was designed to evaluate the accuracy and usefulness of combined cytological examination with biopsy histological examination in the diagnosis of malignancy of the upper gastrointestinal tract. The rate of diagnostic accuracy of the combined technique was found to be high and comparable with those of other published studies. Correlations between the cytological and histological findings were observed in 52 cases (82.53%). The combined method detected malignancy in 27 cases, whereas, the brush cytology alone detected malignancy in 19 cases. The findings of our study indicate that combined brush cytology and biopsy histology under direct vision using fibrescope are of value for the diagnosis of gastroeosophageal malignancy.

Expression of c-erbB-2 oncoprotein in primary human tumors: an immunohistochemistry study.

An immunohistochemical study was performed with 130 primary malignant human tumors of breast (n = 55)..colon/rectum (n = 16), stomach (n = 19), esophagus (n = 14), lung (n = 15) and liver (n = 11) using the 21N c-erbB-2 specific monoclonal antibody to identify the tumors that over-expressed the c-erbB-2 oncoprotein. Positivity appeared as an intense brown granular staining located predominantly at the cell membrane. This occurred in 41.8% of breast carcinomas, 12.5% of colorectal adenocarcinomas. None of the gastric adenocarcinomas, squamous cell carcinomas of the esophagus, small cell lung carcinomas or hepatocellular carcinomas were positive for the oncoprotein. The result of this study suggests that over-expression of the c-erbB-2 oncoprotein is common in breast cancer and relatively rare in other malignancies examined.

Helicobacter pylori: a comparison of CLO test and Giemsa's stain with culture in dyspeptic patients.

The prevalence of H.pylori in Thailand is high compared with Western countries and is the same as in China. We suggest either rapid urease test (CLO test) or Giemsa stain to be a rapid, reliable and convenient detection method for H.pylori and is also suitable for use in follow-up studies by gastroenterologists.

Pulmonary nocardiosis in Chulalongkorn Hospital.

From 1982 to 1988, 20 patients with pulmonary nocardiosis were diagnosed at the Department of Medicine, Chulalongkorn Hospital University. The infection was found to be common in immuno-compromised hosts particularly in patients who were suffering from lymphoreticular malignancy, systemic lupus erythematosus, nephrotic syndrome, pulmonary alveolar proteinosis and in patients who were receiving corticosteroids. The clinical manifestations were usually nonspecific. Diagnosis of pulmonary nocardiosis in cases who presented with a short duration of fever and productive cough was often delayed because they were considered to have acute bacterial pneumonia. The findings on chest roentgenogram were nonspecific as nonhomogeneous airspace infiltrates, cavitary lesions, nodule, or miliary infiltrates. The complete blood count frequently showed leukocytosis and neutrophilia. The diagnosis of nocardiosis was suspected if the staining of specimens obtained from the lesions showed typically weakly gram-positive and modified acid-fast branching filament organism and the diagnosis was confirmed by culture. The skin and the central nervous system were the most common hematogenous disseminations. Sulfamethoxazole and trimethoprim in combination were the drugs of choice. The treatment for a minimum of 6 months was appropriate in order to prevent relapse. Poor prognostic factors in nocardiosis were acute infection, Cushing's disease; and disseminated infection involving the central nervous system.

Value of tissue carcinoembryonic antigen in patients with colorectal carcinoma.

The tumours of 55 patients with colorectal carcinoma were evaluated for tissue carcinoembryonic antigen (CEA) by immunoperoxidase staining. It was shown that 33/35 patients with increased preoperative serum CEA levels above 5 ng/ml had positive tissue CEA. The other 17/20 patients who had serum CEA levels less than 5 ng/ml could be demonstrated CEA in tissue. The results of tissues CEA were compared with their preoperative serum CEA levels in the pathologic grading, histologic type and staging of cancer. It was found that tissue CEA was more sensitive than serum CEA and was correlated with serum CEA in all respects. The finding in this study suggests that tissue CEA should be performed along with preoperative serum CEA in all patients suspected of having colorectal carcinoma. The postoperative serum CEA should be determined serially in the patients who have more than 5 ng/ml serum CEA and/or tissue CEA positive although their preoperative serum CEA is less than 5 ng/ml.