Management of esophagcal varices at Suratthani Hospital.

This is a retrospective study of 279 patients with bleeding esophageal varices in the medical department of Suratthani Hospital from 1 July 1996 to 30 April 2003. All patients were treated with endoscopic interventions (endoscopic sclerotherpy and/or rubber band ligation). The patients consisted of 67% men, and had an average of 54.9 years. Underlying diseases included liver cirrhosis (98.2%) and was alcoholic cirrhosis (59.5%), Child Pugh class B and C (77.7%), and EV grade III (62.1%). Clinical bleeding was considered moderate to severe upper GI hemorrhage in 64.4%) of patients. The patients were already in a high risk group, so mortality the rate was high (22.2%). Secondary prevention of recurrent bleeding with propanolol and endoscopic intervention should be widely used in general hospitals to decrease the rate of rebleeding and increase and increase early detection of esophageal varices in high risk patients.

Essential thrombocythemia.

A review of twelve cases of Essential Thrombocythemia at Suratthani Hospital, aged between 48 to 87 years old, 6 male and 6 female. The initial clinical presentations were as follows: 2 asymptomatic cases (incidentally found on routine CBC check up), 4 cases of cerebral infarction (one of them presented with paresthesia, erythromelalgia, transient ischemic attack, and a convulsion which finally progressed to cerebral infarction), 1 case with ischemic heart disease, 1 case with deep vein thrombosis of the left leg and an intramuscular hematoma of the left calf,1 case with an intramuscular hematoma of the right gluteus muscle,1 case with ischemic gangrene of the toes and an upper gastrointestinal hemorrhage, 1 case with erythromelagia with an ischemic digital ulcer and another case with a post-operative hematoma. The average platelet count was 1,524x103/ตl. The treatment regimens were Busulfan or Hydroxyurea and additional treatment with an antiplatelet aggregation agent in patients with vascular occlusive disease. The patients responded well to the treatment. Due to the long natural history of essential thrombocythemia and the leukemogenic side effects of chemotherapy, more suitable therapy is considered especially in asymptomatic patients.