Computed tomography in opisthorchiasis.

Opisthorchiasis is a relatively common disease in the northeast of Thailand. Fifteen cases were studied by CT, revealing interesting findings: 1. Fourteen cases had abnormal liver CT. 2. Dilatation of intrahepatic biliary tree was very common, in various degrees. 3. Most patients had co-existing cholangiocarcinoma, some with peritoneal seeding and/or regional lymph node involvement. Metastases to pancreas, adrenal gland, spleen, lung and pleura are occasionally seen at initial diagnosis. CT findings are very suggestive of this disease. However, diagnosis depends on history, clinical and parasitological bases.

Spontaneous rupture of primary hepatoma: report of 63 cases with particular reference to the pathogenesis and rationale treatment by hepatic artery ligation.

Of 508 cases of primary liver cancer admitted during 1970-1978, 63 cases had spontaneous rupture of carcinomatous nodules. The association with cirrhosis among noncomplicated cases was 65% and 93% in cases with the rupture (P less than 0.001). In most instances, the presenting symptoms were not dramatic and could be indistinguishable from other uncomplicated carcinoma of the liver. Sixteen patients were treated conservatively and all died. The other ten patients who presumably bled due to coagulation defect were also given conservative treatment and the mortality rate was only 60%. Hepatic artery ligation was employed in 26 cases with 54% mortality but bleeding stopped in 92%, as compared with other conventional surgical measures such as packing, suture, and cauterization to control hemorrhage with 90% mortality rate. There is ample evidence that hepatic venous obstruction due to the tumor invasion and portal hypertension due to the pre-existing cirrhosis play important roles in the pathogenesis of spontaneous rupture of the tumor. Hepatic artery ligation is a rationale treatment because it not only cuts off blood supply to the tumor nodule which is almost exclusively nourished by arterial blood, but also reduces the degree of portal hypertension in cirrhosis.

Immunoglobulins and antibody response in children with protein-calorie malnutrition.

The immunoglobulin levels (IgG, IgA, IgM, IgD, and IgE) were studied in 28 Northern Thai children with protein-calorie malnutrition (PCM). Of these 14 had marasmus, 7 had marasmus-kwashiorkor, and 7 had kwashiorkor. The immunoglobulin levels were measured on admission and serially during 12 weeks of treatment leading to recovery. All immunoglobulin fractions either equalled or exceeded levels seen in well-nourished urban and rural Thai children, with or without infection. There was no difference in levels of IgG, IgM, IgA, or IgD in children with marasmus when compared with those who had marasmus-kwashiokor or kwashiorkor. IgA levels were higher in malnourished than control children and returned to normal with treatment. Eighty percent of the children with PCM had detectable IgD levels while 64% had detectable IgE levels as compared to none in the control groups. Ten additional children admitted with PCM and 10 who had recovered from PCM were immunized with intradermal typhoid antigen. Within 8 days a significant increase in typhoid H antibody appeared in the recovered group, while the malnourished group demonstrated no significant increase in H antibody titer.

Can the growth of a neuroblastoma be influenced by a child's nutritional state? Observations in a patient treated for kwashiorkor and later given a restricted diet.

A 17-month-old Thai female with neuroblastoma presented with an abdominal mass and the classical findings of kwashiorkor. Concomitant with effective repair of the child's protein deficit, the mass enlarged dramatically and metastases were noted. This is the first known report of such an occurrence.