Laparoscopic cholecystectomy (LC) has become the treatment of choice for patients with symptomatic cholelithiasis. About 8-15 per cent of patients with symptomatic gallstones may bear associated common bile duct (CBD) stones, The management of choledocholithiasis in the laparoscopic era remain debatable. Although pre-operative endoscopic cholangiopancreatography (ERCP) is available and highly accurate in the detection of CBD stones, its routine use is controversial because of its inherent disadvantages.The aim of this retrospective study was to generate an effective predictive model for bile duct stones detection by pre-operative ERCP.Twelve pre-operative clinical, biochemical and sonographic variables from 206 consecutive patients who underwent pre-operative ERCP with LC for gallstones with/without CBD stones from October 1998 to December 2000 were retrospectively analysed143 of the 206 patients with gallstones were found to have CBD stones. The mean age was 61 (20-93) yr old, and 55.9 per cent were female. Multivariate analysis showed a high predictive value for the presence of CBD stones in patients aged > or = 55 yr old (Odd radio (OR) 1.03, 95% confidence interval (95% CI) 1.01-1.05), jaundice (OR 2.7, 95% CI 1.7-4.8), elevated alkaline phosphatase (OR 1.002, 95% CI 1.000-1.005), CBD dilatation on ultrasound (OR 3.8, 95% CI 1.8-8) and CBD stone on ultrasound.The important clinical presentations and investigating could allow more appropriate use of pre-operative ERCP in patients who have symptomatic gallstones with a suspected CBD stone prior to cholecystectomy.
Journal Article Immune activation in human rabies Get access Thiravat Hemachudha,, Thiravat Hemachudha, ∗ 1World Health Organization Collaborating Centre for Research on Rabies Pathogenesis and Prevention, Queen Saovabha Memorial Institute, Bangkok 10330, Thailand2Chulalongkorn University Hospital, Bangkok 10330, Thailand ∗Address for correspondence and off-print requests: Professor Thiravat Hemachudha, Queen Saovabha Memorial Institute, Thai Red Cross Society, Rama 4 Road, Bangkok 10330, Thailand. Search for other works by this author on: Oxford Academic PubMed Google Scholar Taweeporn Panpanich, Taweeporn Panpanich 1World Health Organization Collaborating Centre for Research on Rabies Pathogenesis and Prevention, Queen Saovabha Memorial Institute, Bangkok 10330, Thailand Search for other works by this author on: Oxford Academic PubMed Google Scholar Praphan Phanuphak, Praphan Phanuphak 1World Health Organization Collaborating Centre for Research on Rabies Pathogenesis and Prevention, Queen Saovabha Memorial Institute, Bangkok 10330, Thailand2Chulalongkorn University Hospital, Bangkok 10330, Thailand Search for other works by this author on: Oxford Academic PubMed Google Scholar Sathaporn Manatsathit, Sathaporn Manatsathit 3Bumrasanaradura Hospital, Nonthaburi, Thailand Search for other works by this author on: Oxford Academic PubMed Google Scholar Henry Wilde Henry Wilde 1World Health Organization Collaborating Centre for Research on Rabies Pathogenesis and Prevention, Queen Saovabha Memorial Institute, Bangkok 10330, Thailand2Chulalongkorn University Hospital, Bangkok 10330, Thailand Search for other works by this author on: Oxford Academic PubMed Google Scholar Transactions of The Royal Society of Tropical Medicine and Hygiene, Volume 87, Issue 1, January-February 1993, Pages 106–108, https://doi.org/10.1016/0035-9203(93)90446-W Published: 01 January 1993 Article history Received: 04 February 1992 Revision received: 30 April 1992 Accepted: 21 May 1992 Published: 01 January 1993
Intestinal capillariasis is one of the common causes of malabsorption in the East. Reports emphasizing the roles of clinical, endoscopic and radiologic findings of intestinal capillariasis are limited.Retrospective review of medical records of 26 patients diagnosed with intestinal capillariasis at Siriraj Hospital, Bangkok, Thailand between 2001- 2013.Clinical manifestations were chronic watery diarrhea (93%), chronic abdominal pain (70%), significant weight loss (92%), hypoalbuminemia (100%; 85% lower than 2.0 g/dL), and anemia (50%). The median duration of symptoms was 5.5 months (1-60 months). Parasites were found in stool in 15 patients (57%). In patients whose stool tests were initially negative, parasites were discovered in tissue biopsy from endoscopy in 1 from 10 esophagogastroduodenoscopies (EGD), 0 from 7 colonoscopies, 3 from 5 push enteroscopies, and 3 from 5 balloon-assisted enteroscopies (BAE). Endoscopic findings included scalloping appearance, mucosal cracking, and redness of mucosa. These endoscopic findings affected mostly at jejunum and proximal ileum. They were similar to celiac disease except duodenal involvement which is uncommon in capillariasis. Three patients underwent video capsule endoscopy (VCE) and typical abnormal findings were observed in all patients. Small bowel barium study showed fold thickening, fold effacement, and increased luminal fluid in 80% of patients, mainly seen at distal jejunum and ileum. CT findings were long segment wall thickening, enhanced wall, and fold effacement. Treatment with either albendazole or ivermectin cured all patients with most responding within 2 months.In endemic area, intestinal capillariasis should be considered if patients develop chronic watery diarrhea accompanied by significant weight loss and severe hypoalbuminemia. Stool examination had quite low sensitivities in making diagnosis in our study. Deep enteroscopy with biopsy guided by imaging or VCE may improve diagnostic yield. Empirical therapy may also be justifiable due to the very good response rate and less side effects.
Background: Abdominal pain in chronic pancreatitis (CP) is difficult to treat and appropriate choice of treatment is controversial. It has been suggested that patients with CP, particularly from alcohol (ACP) with intermittent attack of abdominal pain (type A pain) should be managed conservatively because pain relief will be achieved in most cases. However, data of the efficacy of this strategy is scanty and conflicting and whether this strategy is effective or feasible in idiopathic CP (ICP) is unclear. Material and Method: Data of all patients with CP with type A pain, who were followed-up and managed conservatively during 2004-2008 were analyzed. Pain relief was defined by the absence of abdominal pain for more than 1 year. Results: Twenty-two patients were followed-up with a median duration of 31 months (range 5-96 months). The etiology of CP was alcoholic (ACP) in 12 (56%), early-onset idiopathic (E-ICP) in 5 (22%) and late-onset idiopathic (L-ICP) in 5 (22%). Alcohol abstinence was successful in every ACP patient. Overall, 18 patients (82%) had pain relief with a median duration of 39 months (range 16-167 months) from the onset of pain or 14 months (range 11-57 months) from the time of diagnosis of CP. Pain relief was achieved at a higher level mainly in ACP (100%) and L-ICP (80%) but was only 40% in E-ICP. Median duration from onset until pain relief were 28 months (range 16-167 months) for ACP, 36 months (range 16-39 months) for L-ICP and 120 months (range 42-120 months) for E-ICP. The difference was statistically significant between L-ICP and E-ICP (p = 0.036), but not between ACP and E-ICP (p = 0.13) and between ACP and L-ICP (p = 0.80). Median duration from the time of diagnosis of CP until pain relief was only 14 months for ACP, 13 months for L-ICP, but was 52 months for E-ICP. None of the patients required narcotics, endoscopic therapy or surgery. Conclusion: Conservative management was feasible and effective in most patients with CP and type A pain, particularly ACP after alcohol abstinence, and L-ICP. Conservative treatment was not effective in E-ICP. Keywords: Abdominal pain, Chronic disease, Pain measurement, Pancreatitis
AIM:To identify clinical parameters, and develop an Upper Gastrointesinal Bleeding (UGIB) Etiology Score for predicting the types of UGIB and validate the score. METHODS:Patients with UGIB who underwent endoscopy within 72 h were enrolled.Clinical and basic laboratory parameters were prospectively collected.Predictive factors for the types of UGIB were identified by univariate and multivariate analyses and were used to generate the UGIB Etiology Score.The best cutoff of the score was defined from the receiver operating curve and prospectively validated in another set of patients with UGIB.RESULTS: Among 261 patients with UGIB, 47 (18%) had variceal and 214 (82%) had non-variceal bleeding.Univariate analysis identified 27 distinct parameters significantly associated with the types of UGIB.Logistic regression analysis identified only 3 independent factors for predicting variceal bleeding; previous diagnosis of cirrhosis or signs of chronic liver disease (OR 22.4, 95% CI 8.3-60.4,P < 0.001), red vomitus (OR 4.6, 95% CI 1.8-11.9,P = 0.02), and red nasogastric (NG) aspirate (OR 3.3, 95% CI 1.3-8.3,P = 0.011).The UGIB Etiology Score was calculated from (3.1 × previous diagnosis of cirrhosis or signs of chronic liver disease) + (1.5 × red vomitus) + (1.2 × red NG aspirate), when 1 and 0 are used for the presence and absence of each factor, respectively.Using a cutoff ≥ 3.1, the sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) in predicting variceal bleeding were 85%, 81%, 82%, 50%, and 96%, respectively.The score was prospectively validated in another set of 195 UGIB cases (46 variceal and 149 non-variceal bleeding).The PPV and NPV of a score ≥ 3.1 for variceal bleeding were 79% and 97%, respectively. CONCLUSION:The UGIB Etiology Score, composed of 3 parameters, using a cutoff ≥ 3.1 accurately predicted variceal bleeding and may help to guide the choice of initial therapy for UGIB before endoscopy.
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