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  • Author: Naruemon Klaikaew x
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Background: Helicobacter pylori (H. pylori) are a major cause of chronic gastritis and peptic ulcer. This organism plays a role in gastric carcinoma and B-cell lymphoma. However, the exact pathogenesis of gastric inflammation is still unclear. Mast cells, the important inflammatory cells for allergic process, may participate in the pathogenesis of gastritis related to H. pylori infection.

Objective: Analyze the relationship between mast cell density, H. pylori intensity, histological alterations, and their severity of biopsy proven gastritis.

Methods: One hundred eleven biopsied specimens were collected from Thai patients who were diagnosed H. pylori-associated gastritis of the antrum at King Chulalongkorn Memorial Hospital between 2002 and 2005. All biopsied specimens were examined according to the Updated Sydney System. Mast cell density was evaluated by 0.1% toluidine-stained sections.

Results: The higher mast cell density was correlated with increased neutrophilic infiltration (r = 0.220, p = 0.020), chronic inflammatory cell infiltration (r = 0.381, p <0.001), and lymphoid aggregation (r = 0.271, p = 0.004). No relationship was found between mast cell density and intensity of H. pylori, glandular atrophy, or intestinal metaplasia.

Conclusion: Mast cells might take part in the pathogenesis of H. pylori gastritis.


Background: Liver is the most common distant metastasized organ in advanced colon cancer. Surgical resection of metastatic lesions would offer the best chance of a long-term survival. An accurate diagnosis and evaluation of extent of disease is crucial in the management of liver metastasis. Objective: Report a benign hepatic condition mimicking liver metastasis in a colon cancer patient. Case presentation: A 53-year-old male with an early stage sigmoid colon cancer was treated with sigmoidectomy followed by adjuvant chemotherapy consisting of 5-FU, leucovorin, and oxaliplatin for six months. Annual computerized tomography of abdomen at two years after the surgery revealed three hypervascular nodules in the liver. Investigations including MRI of the liver and whole body FDG-F18 PET/CT demonstrated evidence consistent with non-metastatic liver nodules. Liver biopsy of one of the lesions led to the diagnosis of “focal nodular hyperplasia”. Conclusion: The possible etiology, diagnosis, and further management of this benign liver tumor, the focal nodular hyperplasia became clear.


Background: Management of perihilar cholangiocarcinoma is mainly by surgery. Computed tomography is the imaging choice by which to evaluate tumor extension and resectability. However, reports concerning the accuracy of computed tomography for this purpose differ.

Objective: To retrospectively assess the accuracy of 16-detector-row computed tomography in evaluating tumor extension and tumor resectability of perihilar cholangiocarcinoma.

Method: Sixty-two patients attending our hospital from January 2004 to June 2011were included in this study. Tumor extension and resectability were retrospectively reviewed. Pathological results, diagnostic laparoscopy, and surgical findings were used as references.

Result: The accuracy for predictability of resectability was 80.7%. The accuracy of 16-detector-row computed tomography in evaluating tumor extension was; 95.2% for prediction of ductal involvement, 85.7% for prediction of hepatic artery invasion, 79.1% for prediction of portal vein invasion, 67.3% for prediction of N1 nodal involvement and 90.9% for prediction of N2 nodal involvement.

Conclusion: Good accuracy was found using 16-detector-row computed tomography in overall evaluation of tumor resectability. For tumor extension, 16-detector-row computed tomography has good accuracy except for evaluating N1 nodes.



Gastrointestinal stromal tumor (GIST) was the most common mesenchymal tumor of the gastrointestinal tract predominately occurring in the stomach. Although GIST was a rare disease, it was considered to be a life-threatening malignancy.


To explore the current status of gastric GIST in Thai patients.


The medical records of patients who were diagnosed with histologically proven gastric GIST from 2012 to 2016 in King Chulalongkorn Memorial Hospital were reviewed.


Of 22 patients, there were 14 (63.6%) females and 8 (36.4%) males with the mean age of 62.6 ± 14.8 years. The average duration before the first presentation was 12 weeks. The initial symptoms were upper gastrointestinal bleeding (50.0%) followed by abdominal pain (31.8%). Tumor mostly located at the proximal part (fundus and cardia) in 20 (90.9%) patients. At the time of the diagnosis, three patients (13.6%) had distant metastasis. Of this group, 77.3% underwent surgical treatment.


Although gastric GIST was an uncommon disease, early diagnosis and prompt treatment could save the lives of many patients.



Liver biopsy is the criterion standard to assess liver fibrosis in patients with nonalcoholic fatty liver disease (NAFLD), which is important for prognosis, whereas noninvasive scoring systems showing promise for predicting fibrotic status include aspartate/alanine aminotransferase (AST/ALT) ratio, BARD score, fibrosis–4-score (FIB-4), and the NAFLD Fibrosis Score (NFS).


To determine the accuracy of noninvasive scoring systems to predict advanced fibrosis in Thai patients with NAFLD.


A prospective cross-sectional study of Thai patients with liver biopsy-proven NAFLD during January 2009-October 2012 at King Chulalongkorn Memorial Hospital, Bangkok, Thailand. Baseline NFS, BARD, and FIB-4 calculations were used to distinguish patients with NAFLD with and without advanced liver fibrosis, using cutoffs for NFS ≥ -1.455, BARD ≥ 2, and FIB-4 >1.3 (


We included 139 patients mean age 40.95 (SD 13.3) years (47% male). Impaired fasting glucose or diabetes mellitus was found in 75, 9 showed advanced fibrosis (≥F3) by liver histology. NFS with cutoff ≥ -1.455 was determined as the best system with the highest sensitivity for identifying patients with advanced fibrosis, followed by BARD ≥2, FIB-4 >1.45, and AST/ALT ratio >0.8. Liver biopsy could potentially be avoided in >38% of patients with BARD, 46% with NFS, 64% with AST/ALT ratio, and 81% with FIB-4.


Advanced fibrosis was prevalent in 6% of our Thai patients with NAFLD. NFS had the highest negative predictive value for excluding patients with advanced fibrosis. At least 38% of patients with NAFLD could avoid liver biopsy by using the BARD system.