Transperineal repair of rectourethral fistula: surgical technique and a case report.

A 60-year old Thai male diagnosed as iatrogenic rectourethral fistula. Preoperative investigation with intravenous pyelogram revealed connection between urethra and rectum. Colonoscopy also revealed fistula opening at mid-rectum. He underwent surgery via transperineal approach. Intraoperative fistula localization was performed using Methylene blue injection via foley catheter. The fistula tract was identified and divided exposing blue-staining tract. Rectal opening and urethral opening were repaired Fecal and urthral diversion were performed Postoperative period was uneventful. The final pathologic report of fistula tract was fibrosis. The perineal and rectal wounds were healed without complication. The suprapubic cystostomy catheter was removed at the end of the second month together with the colostomy closure.

Results of D2 gastrectomy for gastric adenocarcinoma: 10-year experience in Thai patients.

BACKGROUND: The therapeutic value of D2 gastrectomy in the curative treatment of gastric adenocarcinoma is controversial outside Japan. MATERIAL AND METHOD: The authors retrospectively reviewed the medical records of 97 patients with gastric adenocarcinoma who underwent curative D2 gastrectomy between October 1995 and September 2005. RESULTS: Subtotal gastrectomy was performed in 42/97 patients (43%) and total gastrectomy in 55/97 patients (57%), with an average number of 38 lymph nodes (range, 22-82) and 48 lymph nodes (range, 24-126) removed, respectively. Overall morbidity rate was 17% (16/97). There was no hospital mortality. The 5-year overall and 5-year disease-free survival rates were 59% and 46%, respectively. The 5-year disease-free survival rate for each TNM stage was 100% for stages IA and IB, 75% for stage II, 78% for stage IIIA, 28% for stage IIIB and 4% for stage IV. Of the 43/97 patients (44%) who had metastasis to the level 2 (N2) lymph nodes, 14/ 43 patients (33%) survived more than 5 years. CONCLUSION: The D2 gastrectomy can be performed with low morbidity and mortality, and may increase the cure rate and survival of Thai gastric adenocarcinoma patients, at least in experienced centers.

Dysplastic nodules and small primary carcinoma of the liver: a study detecting the early morphological changes during hepatocarcinogenesis.

OBJECTIVE: Detect the early histological changes relating to human hepatocarcinogenesis in three nodular hepatocellular lesions. MATERIAL AND METHOD: Three cases of dysplastic nodules and one of small hepatocellular carcinoma were obtained from the authors' surgical-pathology file during 2000-2005 for a histopathological study in relevance to the early changes during hepatocarcinogenesis by employing hematoxylin and eosin stain, as well as some immunohistochemical staining. RESULTS: One nodular hepatocellular lesion, diagnosed as a complex lesion of focal nodular hyperplasia contained a microscopic focus (1.5 mm in diameter) of combined hepatocellular and cholangiocarcinoma. CONCLUSION: The small dysplastic hepatocytes subjected to neoplastic transformation combined hepatocellular and cholangiocarcinoma and are the precursorial cells of hepatocellular carcinoma. Chronic viral hepatitis B or C, aflatoxin B, and nitrosamine(s), as well as some nodular hepatocellular lesions share distinct roles in the complex process of hepatocarcinogenesis pertaining to this Southeast Asian country.