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No. 147

Authors :

Pongtippan A, Suyabodha T, Wongmeekiat A, Kositchaiwat S, Bunyaratvej S.

Title :

Granular cell tumor of the common bile duct: a case report.

Source :

Journal of the Medical Association of Thailand. 83(Suppl 1):S7-11, 2000(Mar).

Keywords :

Granular cell tumor, Common bile duct

Abstract :

Granular cell tumors (GCTs) are uncommon soft tissue tumors, usually presenting in the skin and subcuta-

neous tissue tongue and oral cavity. We present a case report of granular cell tumor of the common bile

duct involving both extra- and intrapancreatic portions. The histogenesis appears to be related to Schwann

cells, similar to granular cell tumors of other sites, as evidenced by histologic and immunohistochemical

findings. Review of the English literature concerning biliary tract GCTs revealed a high occurrence

in African-American females in their third decade. By-pass operation to correct the biliary tract obstruction

may be appropriate, if the nature of the tumor can be obtained from intraoperative diagnosis by frozen

section.

No. 148

Authors :

Pracharktam R, Chongtrakool P, Sriurairatana S, Sathapatayavongs B.

Title :

Mycetoma and phaeohyphomycosis caused by Phialophora parasitica in Thailand.

Source :

Journal of the Medical Association of Thailand. 83(Suppl 1):S42-5, 2000(Mar).

Keywords :

Mycetoma, Phaeohyphomycosis, Phialophora parasitica, Thailand

Abstract :

Phaeohyphomycosis caused by Phialophora parasitica is rare and it has never been documented in Thailand.

The first two Thai cases of phaeohyphomycosis caused by P. parasitica were recognized in early 1990 at

Ramathibodi Hospital, Bangkok, Thailand. Both patients had underlying diseases. The fungus developed

in abscesses with pigmented mycelium at the lower extremity. Cultures from pus and tissue biopsies were

positive for dematiaceous fungi. Light microscopic features suggested P. parasitica and which was

illustrated by both scanning and transmission electron microscope. The first case was treated with itraconazole

with a satisfactory initial response. The second case was successfully treated by surgical removal of the

entire lesion.

No. 149

Authors :

Pramoolsinsap C.

Title :

Acute hepatitis A and acquired immunity to hepatitis A virus in hepatitis B virus (HBV) carriers and in HBV-

or hepatitis C virus-related chronic liver diseases in Thailand.

Source :

Journal of Viral Hepatitis. 7(Suppl 1):11-2, 2000(May).

Keywords :

Hepatitis A virus, Hepatitis B virus, Hepatitis C virus, Chronic liver disease

Abstract :

A number of studies have suggested that the clinical course of hepatitis A virus (HAV) infection is more

severe in patients with chronic liver disease (CLD). A study was undertaken to determine the impact

of acute HAV in asymptomatic hepatitis B surface antigen (HBsAg) carriers (n = 20) and patients with

hepatitis B virus (HBV)-(n = 8) or hepatitis C virus (HCV)-related (n = 4) CLD. Disease progression was

compared with that in 100 patients with isolated HAV infection. No patient with HAV infection alone

developed complications, and all recovered fully. Fulminant or submassive hepatitis occurred in 55% of

HBsAg carriers and 33% of patients with HBV- or HCV-related CLD. The mortality rate in HBsAg carriers

(25%) was not significantly different from that in the patients with CLD (33%). The seroprevalence of

anti-HAV immunoglobulin G in 820 individuals was also determined. Approximately 50% of the individuals

had acquired HAV infection between the ages of 21 and 30 years. It was demonstrated that HAV infection may

have a more severe clinical course in patients with underlying CLD, particularly among older individuals.

Vaccination for such patients should be considered.

No. 150

Authors :

Preutthipan A, Chantarojanasiri T, Suwanjutha S, Udomsubpayakul U.

Title :

Can parents predict the severity of childhood obstructive sleep apnoea?

Source :

Acta Paediatrica. 89(6):708-12, 2000(Jun).

Keywords :

Children, Diagnosis, Obstructive sleep apnoea, Severity, Apnea syndrome

Abstract :

OBJECTIVE: To determine whether parents' observations can be used to predict the severity of the

obstructive sleep apnoea syndrome (OSAS) in children. STUDY DESIGN: Sixty-five children with OSAS

diagnosed by overnight polysomnography were consecutively recruited and classified as having severe or

non-severe OSAS according to the obstructive apnoea index (OAI) and the oxygen saturation measured

by pulse oximetry (SpO2) nadir. Parents were asked to complete a questionnaire about the child's

breathing difficulties at night. RESULTS: Twenty-eight patients were classified as severe OSAS and 37 as

non-severe OSAS. There were no differences between the two groups with respect to age, sex or body mass

index. Male to female ratio was 5:1. Parents of children with severe OSAS more frequently reported observed

cyanosis (35 vs 8%; p=0.02); obstructive apnoea (60 vs 35%; p = 0.04); snoring extremely loudly (52 vs

22%; p = 0.01); shaking the child (64 vs 35%; p = 0.02); watching the child during sleep and being afraid

of apnoea (85 vs 60%; p = 0.03). However, neither any single nor combinations of observations showed high

values for both sensitivity and specificity. CONCLUSIONS: Although some parents' observations are more

frequently reported in children with severe OSAS, neither any single nor combinations of observations

accurately predict the severity of OSAS. Polysomnography is still needed to determine the severity of

obstruction.