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Objective: Determine the frequency of mutations in exon 8 of ATP7B gene., Material and Method: The exon 8 of ATP7B gene in twenty 20 unrelated Thai patients with Wilson disease (WD) was analyzed, Results: Three heterozygous mutations were identified in four patients. The Arg778Leu (G2333T) and 2299insC mutations have been previously reported. The authors also identified a novel missense mutation, Thr766Arg (C2297G). Despite the Arg778Leu mutation being common in East Asian populations, its frequency in Thais was only 5% in the presented patients., Conclusion: Sequencing of the exon 8 of the ATP7B gene is insufficient for the diagnostic service testing in Thais.

Background: Nonsteroidal antiinflammatory drugs (NSAIDs) in combination with opioids is a model of multimodal analgesia. NSAIDs have the oral and parenteral forms., Objective: The aim of the present study was to evaluate the efficacy of celecoxib compared with placebo and parecoxib after total hip or knee arthroplasty., Material and Method: A total of 120, ASA 1-2, aged 18-75 years, patients were randomly assigned to receive one of the three groups: Group I (control) received placebo (n=40), group II received 400 mg celecoxib orally (n=40) and group III received 40 mg parecoxib intravenously (n=40). The present study medication was administered I hour before surgery. All patients had access to patient-controlled analgesia (PCA) with intravenous morphine. Patients were studied at 0, 1, 6, 12 and 24 hours postoperatively for verbal numerical rating scale (VNRS), morphine consumption, satisfaction score and side effects., Results: The intraoperatively fentayl requirement were similar among the three groups (p < 0.00). Celecoxib and parecoxib significantly decreased the amount of morphine requirement after total hip or knee arthroplasty compared to placebo at 1, 6, 12 and 24 hours (p < 0.00). The celecoxib group required more morphine than the parecoxib group at 1, 6, 12 and 24 hours (p < 0.00). The VNRS score in parecoxib group was significantly lower than the celecoxib and control groups at 1, 6, 12 but not at 24 hours. The VNRS score was lower in the celecoxib group compared to the control group at I and 6 hours postoperatively (p = 0.01, p < 0. 01 respectively). The placebo group had a higher sedation score (p = 0.008) but not for nausea vomiting (p = 0.36) and pruritus (p = 0.12) compared to the treatment groups., Conclusion: Within 12 hours after total hip and knee arthroplasty, pre-operative administration of parenteral parecoxib 40 mg was more effective than oral celecoxib 400 mg and placebo in terms of morphine consumption and VNRS score.

Hepatotoxic effect related to Ganoderma lucidum (Lingzhi) mushroom powder was first described in a patient from Hong Kong in 2004. In 2005, the authors experienced a case of fatal fulminant hepatitis associated with such a preparation. Both patients had taken other therapeutic agents and traditionally boiled Lingzhi without any toxic effect. After switching to taking Lingzhi in powder form for 1-2 months, the hepatotoxic episode occurred in both patients. The toxic role of Lingzhi powder needs close monitoring in the future, especially in combination with other drugs.

Bile duct stricture, either benign or malignant, usually presented with jaundice, is a common surgical condition. Clinically the diagnosis is made empirically on the basis of clinical data and a telltale cholangiogram without histologic confirmation. Benign stricture, therefore, might be misinterpreted as malignancy. To obtain tissue confirmation, endoscopic transampullary biopsies were performed in 32 patients with clinically suspected malignant biliary stricture, between August 1997 and July 1998. Of these 32 patients, 16 patients each had biopsy-positive and biopsy-negative for malignancy. In the 16 biopsy-positive patients, 11 underwent exploratory laparotomy, and the other 5 did not. Of the 11 who were explored, 8 had histology confirmed malignancy, surgical biopsy was not feasible in the 3 remaining patients. The 5 patients who were not explored, all died within 5 months after the diagnosis was made. In the 16 biopsy-negative patients, 9 underwent exploratory laparotomy, of which 4 had malignancy confirmed histologically, 2 had no malignancy by histology but subsequently had clinical evidence which suggested malignancy, in the 3 remaining patients surgical biopsy was not feasible, however, their clinical courses suggested a benign condition. Of the 7 patients whose transampullary biopsies were negative, and who were not explored, 5 had a clinical course and evidence suggesting malignancy, of these 5 patients 4 died 1, 2, 3 and 10 months after the diagnosis, and one was lost to follow-up. The 2 remaining patients who had no clinical evidence of malignancy remained alive even 2 years after the follow-up. Of the patients who underwent exploratory laparotomy and surgical biopsy, the sensitivity, specificity, positive predictive value and negative predictive value for transampullary biopsy were 66.7 per cent, 100 per cent, 100 per cent and 31.3 per cent respectively. There were no major complications related to transampullary biopsy per se. The results suggested that transampullary biopsy is an effective and safe procedure for diagnosing malignant bile duct stricture.

Background: Roxatidine acetate is a novel H2-receptor antagonist and several studies have shown that it is effective in healing duodenal ulcers. We evaluated the efficacy of roxatidine in a non-western society with particular different features and its healing of duodenal ulcers was compared in Thailand with that of ranitidine., Method: The design was controlled, randomized, double-blind, and multicenter. The study recruited a total of 215 patients who were endoscoped at the start of the trial and then randomized to receive a single capsule of roxatidine acetate, 150 mg, or an identical capsule containing ranitidine, 300 mg, both to be taken at night. Patients were evaluated at 1, 2, and 4 weeks, including endoscopy at the last session, as well as at 6 weeks with repeat endoscopy if the ulcer had not healed., Result: Both drugs relieved pain rapidly, usually within a week, and at repeat endoscopy at 4 weeks most ulcers (78%) were healed, 77.0 and 79.5 per cent in ranitidine and roxatidine, and in those patients in whom healing was not completed the healing rate had risen appreciably to 89.8 and 93.8 per cent respectively at 6 weeks. Small ulcers tended to heal quicker than larger ones, but smoking and alcohol intake had no negative effects on the results., Conclusion: The study was valid proof that roxatidine, in a single evening dose of 150 mg, was found to be both safe and effective in the rapid healing of duodenal ulcers when compared with 300 mg ranitidine.