The Uncommon presentation of Arteriovenous fistula.

 In this case we report the presence of the uncommon occurrence of the acquired traumatic femoral arterio-venous fistula as a mass in the left lower quadrant.  The 42-year-old man shot himself accidentally at the left thigh by a rifle 20 years before and sought a folk healer.  He came to the hospital with left lower quadrant abdominal mass.  From physical examinations, there was the femoral bruit and thrill associated with the mass.  The femoral angiography demonstrated that the mass is a huge iliac vein dilatation which is accompanied with the left femoral arteriovenous fistula.  This abnormal dilatation was thougnt to be arisen from the back pressure of the arterial blood.  The patient was operated upon successfully by division of the fistula, lateral femoral venorrhaphy, and interposition grafting or femoral artery.  Immediately after the operation the mass was collapsed and the general result was good.

Esophageal carcinoma : Uncommon disease in the Northeasthern of Thailand.

 Esophageal carcinoma is one of the malignant disease commonly found in the south of Thailand.  This article is a preliminary report of esophageal carcinoma in the northeast of Thailand. A total 41 cases of esophageal carcinoma were treated at Srinagarindhospital between December, 1972 and February, 1989.  But only 25 cases whose records were available for study.  Among these patients, the ratio between male and female was 2.6 to 1 and the average age was 59.4 year-old.  All of the pateints were advanced stage (III, VI).  The common site of tumor were lower esophagus (48%).  The pathological types of our cases were squamous cell carcinoma 13 cases, adenocarcinoma 10 cases and the other 2 cases was not recorded.  Twenty-three cases was operated and 2 cases were theated by radiation.  In operated group, 2 cases died (8.1%) from esophageal perforation and anastomosis leakage.  Long term follow up (18/25 cases) there was 2 cases survived for 5 years and the other survived between one month to fifteen months.  Seven cases lost follow up postoperatively. In conclusion surgical patients who were treated by operation (19/23 or 82.9%) can be supported nutrition by mouth themselves, surgical treatment by skillful surgeon should be proper management of esophageal carcinoma even in advance cases.

Tranverse Abdominal Island Flap for Breast Reconstruction

 The psychosocial literature is replete with studies describing morbidity associated with mastectomy, “the stress of which causes considerable upset in virtually all areas of a patent’s life” Specific types of psychological distress resulting from radical surgery include clinically significant mood disturbance, decreased sexual interest and satisfaction increased self-consciousness about clothes and revealing underwear, negative changes in one’s body image, fears about recurrence and of late anxiety about the relative merits of breast reconstruciton.

Open Heart Surgery in Srinagarind Hospital

In Thailand, open heart surgery is able to be performed only in Bangkok and Nonthaburi. Srinagarind hospital, in khon kaen University, is an exceptional place to perform this type of surgery. The first open heart surgery in Srinagarimd hospital was started at 22th of February 1984 and up to 11th of August 1986, 89 patients were operated. There were congenital heart disease in 33 patients ( 37.1 % )          ( ASD secondum 20, VSD 3, VSD with PS 8, PS 1, TAPVC 1 ), with mortality rate of 6.0 % . Acquired heart diseases were found in 56 patients ( 62.9 % ) ( MS 36, MR 1, AS 4, AR 2, cardiac myxoma 3, ruptured aneurysm of sinus of Valsalva 2, bacterial endocarditis 6 ), with mortality rate of 14.3 %. The overall mortality rate was 11.2 %.    

Closed Mitral Valvlotomy at Srinagarind Hospital

 In a series of 42 patients operated upon at our hospital between October 1982 and December 1985. Of these, 38 patients (o : o = 20 : 18) underwent as elective operation and 4 patients (o : o = 3 : 1) as emergency operation. In elective group (youngest 13 years, oldest 55 years, mean 28 + 9.87 years), there were preoperative functional class (New York Heart Association, NYHA) II,III and IV in 7, 21, and 10 cases respectively. Atrial Fibrillation (AF) was found in 10/38 (26.32%) and 4/10 (40%) had clot in left atrium (L.A).Three patients had a history of embolism, but there were no clot in left atrium. Echocardiography were done in 33/38 patients. After closed mitral valvulotomy and follow up 2-36 months, post-operative class were I 28, II 9 and IV 1 (this patient had MR and AR) with low complications. The complocations were wound infection 2 patients, empyema thorasis 1 patient and MR 2 patients. Improvement of NYHA functional class was found in 37/38 (97.37%) with no mortality. In emergency group, all patients were functional class IV, postoperative mortality was 4/4 (100%). Three patients died 1-3 days after the operation and another one died from digitalis intoxication 11 day after operation. The overall mortality was 9.52%.