Psychogenic vomiting 1976-1981, follow-up treatment results up to 1996.
Yuwaprasart Waithayopathum, Child Psychiatric Hospital, Sumut Prakan, Thailand.
During the period from 1976 to 1981, six children suffering from severe vomiting caused by psychological problems were admitted to Yuwaprasart Waithayopathum Hospital. These patients had been admitted to general hospitals from four to over ten times for the treatment of chronic recurrent vomiting, in each case the vomiting was very severe which caused dehydration. Three cases received surgical treatment, but abnormalities in the abdominal cavity were not seen in any of them. The treatment in Yuwaprasart Waithayopathum Hospital consisted of symptomatic treatment, medication, psychotherapy, behavior therapy, recreational therapy, occupational therapy, learning in special classes and family psychotherapy. Follow-up treatment results up to 1996 (20 years). The result revealed that five patients improved and were normal with subsequent discontinuation of all medication except one female patient who had moved with her family to another country.
A randomized clinical trial comparing the efficacy of ranitidine and famotidine on intragastric acidity in critically ill pediatric patients.
Aanpreung P. Vanprapar N. Susiva C. Parkpreaw C. Boonyachart C.
Department of Pediatrics, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
We examined the efficacy of intravenous ranitidine and famotidine on raising intragastric pH in each of 10 critically ill pediatric patients. The severity of illness was assessed by using the modified zinner index score. The study had 3 phases and each phase took 24 hours. Intragastric pH was measured by continuous pH monitoring digitrapper for 72 hours. In phase 1 and 3, the patients did not receive any H2 blockers. In phase 2, they were randomized to receive intravenous ranitidine or famotidine. The majority of cases had intragastric pH < 4 in day 1 (base line). Ranitidine and famotidine increased total time of intragastric pH > or = 4 from the base line during day 2, 38.2 +/- 16.9 per cent and 60.3 +/- 24.8 per cent respectively (P0.004), but there was no statistical difference between the 2 medications in both Zinner index score 1 and score greater than 1 group (P 0.08, 0.45). Three cases in the famotidine group had successful prophylaxis with total time pH > or = 4 more than 80 per cent. Famotidine appeared to have a trend toward increasing intragastric pH in critically ill pediatric patients.
Fatal adenovirus infections in infants probably infected with HIV.
Department of Medical Services, Ministry of Public Health (In Rajvithee Hospital Compound), Bangkok, Thailand.
Adenovirus infections occur commonly in infants and children but are rarely fatal. Although immunosuppression has been associated recently with fatal outcome of adenovirus infections, reports of major morbidity or mortality caused by adenovirus infection in HIV positive patients are infrequent. This is the first report on fatal adenovirus infections in presumably HIV-positive infants in Thailand. Three infants, aged 4, 8 and 5 months, were hospitalized with diagnoses of pneumonia and ARDS, pneumonia with hepatomegaly and ARDS, and pediatric AIDS with pneumonia, respectively. All the infants died within a few weeks after hospitalization. Serologic tests revealed positive anti-HIV in all three infants. Unfortunately, no additional investigation for definite diagnosis of HIV infection was employed. Pathological findings from autopsy and post mortem needle biopsies revealed adenovirus pneumonia in the first two infants, and massive adenovirus infection of the liver in the third infant. Diagnoses were based on characteristic light microscopic pathological findings, and demonstration of viral particles arranged in crystalline arrays in the nucleus of the infected cells by electron microscopy.
The incidence of K-ras codon 12 mutations in cholangiocarcinoma detected by polymerase chain reaction technique.
Wattanasirichaigoon S. Tasanakhajorn U. Jesadapatarakul S.
Department of Surgery, Faculty of Medicine, Srinakharinwirot University, Bangkok, Thailand.
In the study, to analyse a K-ras oncogene mutated at codon 12 in 24 patients with cholangiocarcinomas, four (16.67%) of them contained this point mutation. One of 4 was peripheral and the others were hilar tumors. There was no significant relationship between mutation and clinical features in terms of age, sex, endemic area, tumor location, tumor grading and pathological features. In our study, the incidence of K-ras codon 12 mutation in Thai patients with cholangiocarcinoma was lower than that found in British and Japanese patients. The discrepancy of incidence and type of the mutations, in different races and environment probably indicates that there is/are different etiologic mechanism(s) in the pathogenesis of cholangiocarcinoma.