Perianal block for ambulatory hemorrhoidectomy, an easy technique for general surgeon.

BACKGROUND: Hemorrhoid surgery is mostly being performed as an inpatient procedure under general or regional anesthesia. However, there was a trend toward performing anorectal surgery in an ambulatory setting utilizing local anesthesia. OBJECTIVE: To propose an easy technique of perianal block for ambulatory hemorrhoidectomy. MATERIAL AND METHOD: Between January 2004 and June 2007, 61 patients underwent hemorrhoidectomy under local anesthesia. Lignocaine with adrenaline was injected into the perianal area with an easy technique. RESULTS: Sixty-one patients with a mean age of 41 years underwent ambulatory hemorrhoidectomy. The mean operative time was 21 minutes. Almost all patients preferred to go home, 5-200 km away from this hospital, taking 20 minutes to 4 hours on transportation. CONCLUSION: An easy technique of perianal block provides availability of performing ambulatory hemorrhoidectomy under general surgeons' hands.

Helical CT assessment on hilar cholangiocarcinoma: comparison value of arterial phase and portovenous phase correlation.

OBJECTIVE: To study the correlation between the findings of hilar cholangiocarcinoma in hepatic arterial phase and portal venous phase. Attention will focus on whether the arterial phase imaging shows more detail than portal phase imaging. MATERIAL AND METHOD: Descriptive study design with retrospective data collection in Srinagarind Hospital, Khon Kaen University. CT scans of the upper abdomen of 34 patients with pathologically proven hilar cholangiocarcinoma between 2002 and 2004 were reviewed for: (1) characteristic of the tumor; (2) adenopathy, (3) arterial involvement, (4) venous involvement, and (5) degree of biliary involvement on both the hepatic arterial and portal venous phases. RESULTS: The correlation was high for characteristics of the tumor, the tumor enhancement pattern, and detection of adenopathy, degree of biliary involvement, and arterial involvement, but low for portal venous involvement which the portal venous phase detected better than the hepatic arterial phase. CONCLUSION: In hilar type cholangiocarcinoma, the portal venous phase yielded the best findings. Furthermore, it showed all findings that were seen in the hepatic arterial phase. According to the present study, the authors suggest doing a pre-contrast study then a portal venous phase imaging for evaluation and diagnosis of hilar type cholangiocarcinoma. There is no necessity to perform hepatic arterial phase in hilar cholangiocarcinoma.

5-fluorouracil and mitomycin-C: effective, low-cost chemotherapy for colorectal cancer.

OBJECTIVE: To evaluate the regimen of 5-fluorouracil (5-FU) and mitomycin-C (MMC) in terms ofresponse rate and overall survival in advanced colorectal cancer. MATERIAL AND METHOD: Between January 1993 and December 2000, 121 from 559 patients with advanced colorectal cancer were treated with chemotherapy. Bolus MMC (10 mg/m2) on first day, 5-FU (600 mg/m2/day) was given as a continuous infusion for 5 days, repeated every 4 weeks for 6 cycles. Toxicity and response were analyzed according to WHO criteria, and survival was analyzed according to Kaplan-Meier methodology. RESULTS: In the chemotherapy group (121 patients), 70 were males and 51 were females, the mean age was 52 years. The ratio of colon and rectal cancer was 0.57. Nearly all patients (88.89%) had tumors with moderate differentiation. Forty patients with liver metastasis showed an overall response rate of 45% (95% CI 35.4-54.6) with a CR in 3 (7.5%) and PR in 15 (37.5%). The median survival was 13.1 months. The regimen was well tolerated with 11.64% of patients experiencing WHO grade 3-4 toxicity. CONCLUSION: The present study has indicated a highly active, acceptable toxic, inexpensive regimen of old drugs to be used as an alternative to the more expensive combination including CPT-11 or oxaliplatin.

Prostatic abscesses: radiographic findings and treatment.

OBJECTIVE: To analyze the medical images and therapeutic strategies in patients with prostatic abscesses. METHOD: From April 1999 to August 2002, 12 patients with prostatic abscesses at Srinagarind Hospital, Khon Kaen, Thailand were reviewed The average age was 47 years (range 29 to 75). Diagnostic procedures included analysis of midstream urine, abscess fluid for pathogens and medical imaging with TRUS, CT and MRI. Therapeutic options were transrectal ultrasound-guided drainage or conservative medical treatment. RESULTS: Almost all patients had predisposing diseases. All patients showed hypo-echoic masses, plus internal septation in 5 cases. Most lesions were located at the central gland. Their sizes ranged from 0.5 to 2.75 cm (average 1.51 cm) in diameter. The main pathogen was B. pseudomallei. On TRUS imaging, patients with melioidosis had one or more hypo-echoic areas with internal septation, thickened wall and surrounding multiple small daughter abscesses. All abscesses resolved within 4 weeks, with no difference in the duration of treatment, despite different sizes or pathogens. CONCLUSIONS: Transrectal ultrasonography is useful in the diagnosis of prostatic abscess as well as in the guidance for aspiration and the drainage of such abscesses. Our data showed sonographic patterns in prostatic abscess, especially with melioidosis.

Intramural duodenal hematoma: a case report and review of the literature.

One case of intramural duodenal hematoma following blunt abdominal injury is presented. The radiographic examinations included plain abdominal films, ultrasonography, upper gastrointestinal series, computerized tomographic (CT) scan and magnetic resonance imaging (MRI). The patient was examined by gastroscopy and treated conservatively as an in-patient for 1 month. He was symptom free at the 3-month follow-up.

Descending colon obstruction caused by a parietocolic band: a case report.

A 54-year-old male who had no history of previous surgery presented with chronic intermittent constipation. A barium enema showed a 2-cm stenotic lesion at the junction between splenic flexure and descending colon. A colonoscopy revealed extra-luminal compression without mucosal lesion. Laparotomy revealed a parietocolic band compressing the proximal part of the descending colon. The band was lysed. The patient's symptom has improved since the procedure.