Mucinous carcinoma of the colon and rectum in Phramongkutklao Hospital.

OBJECTIVE: The objective of the present study was to compare the clinicopathological significance between mucinous carcinoma and nonmucinous adenocarcinoma. MATERIAL AND METHOD: Patients with carcinoma of the colon and rectum who had the first operation in the Department of Surgery, Phramongkutklao Hospital between 1999 and 2004 were included in the present study. Patients were divided into two groups: nonmucinous group and mucinous group. Clinicopathological data of these patients were recorded. RESULTS: Four hundred and nine patients were included in the present study. Forty four (10.7%) were mucinous carcinoma. There was no difference in sex distribution, location of tumors, depth of invasion, lymph node involvement, distant metastasis, TNM stage, lymphatic invasion, vascular invasion, perineural invasion, peritoneal seeding, curability, positive microscopic margin, and adhesion to the surrounding structure. CONCLUSION: Colorectal mucinous carcinoma had no clinicopathological difference from nonmucinous adenocarcinoma of colon and rectum.

Preoperative diagnosis of urinary bladder involvement in adenocarcinoma of colon and rectum.

OBJECTIVE: Objective of the study was to compare urinary symptoms, urinalysis, computed tomography, intravenous pyelography, ultrasonography between colorectal adenocarcinoma with urinary bladder involvement and without urinary bladder involvement. MATERIAL AND METHOD: Patients with adenocarcinoma of the colon and rectum who had the first operation between January 1999 and October 2004 were included in the present study. All patients were divided into the bladder adhesion group and nonadhesion group. Sex, sites of tumor, urinary symptoms and preoperative investigations were compared. RESULTS: 453 patients were included in the present study with 264 males and 189 females (sex ratio M:F = 1.4:1). 26 cases (5.7%) had bladder adhesion. Males had more chance of having bladder involvement. Sigmoid and rectum were the most common sites of bladder adhesion. All cases with urinary symptoms had bladder involvement. Urinalysis and computed tomography had a sensitivity of 59% and 61%, respectively. All cases whose computed tomography showed bladder involvement had bladder adhesion during surgery. Cystoscopy had a sensitivity of 75%. Ultrasonography and IVP did not help in detection of bladder invasion. CONCLUSION: History of urinary symptoms, urinalysis, computed tomography should be routinely performed in patients with adenocarcinoma of the sigmoid and rectum to detect urinary bladder involvement and to inform modes of urinary tract diversion to patients before surgery.

Comparative study between preoperative and postoperative histologic grading in adenocarcinoma of the colon and rectum.

BACKGROUND: Preoperative histologic grading was used to decide the length of the margin of resection in adenocarcinoma of colon and rectum. OBJECTIVES: The aim of the present study was to determine the accuracy of preoperative histologic grading by comparison with postoperative histologic grading. MATERIAL AND METHOD: Preoperative and postoperative histologic grading of patients with adenocarcinoma of the colon and rectum in the department of surgery, Phramongkutklao Hospital between January 1999 and October 2004 were collected and compared together using percentage and chi-square test. RESULTS: 260 patients were included in the present study. 47.3% of all cases had inaccurate preoperative histologic grading. 43% of all cases had worse differentiation. 52.7% of all cases had the same differentiation. Only 4.3% of all cases had better differentiation. CONCLUSION: Preoperative histologic grading was not accurate and could not be used in deciding the length of the margin of resection.

Comparative study between multiple and single rubber band ligation in one session for bleeding internal, hemorrhoids: a prospective study.

OBJECTIVE: The aim of this study was to compare the cessation of bleeding and the complications between multiple and single ligation using high ligation technique. MATERIAL AND METHOD: All first-visit patients with bleeding internal hemorrhoids were studied and randomly divided into multiple and single ligation groups. High ligation technique was used. Patients visited the clinic in the second week and were invited to visit the clinic or completed questionnaires after one year. RESULTS: 109 patients were included in the study. 61 patients had multiple ligation and 48 patients had single ligation. The cessation of bleeding in one week occurred in 96.7 per cent of patients in the multiple group and 79 per cent of patients in the single group (p = 0.004). There were no differences between the multiple group and single group concerning postligation pain and tenesmus (6.5% vs 2%, p = 0.532), urinary hesitancy and frequency (6.5% vs 4%, p = 0.904), and rebleeding in one year (27.9% vs 34%, p = 0.710). No major complications such as massive bleeding and pelvic sepsis were noted. CONCLUSIONS: Multiple ligation of bleeding internal hemorrhoids in one session can stop bleeding better than single ligation with no more complications.

Comparative study between polyethylene glycol and sodium phosphate solution in elective colorectal surgery.

OBJECTIVE: The aim of this study was to compare the pre-operative-post-operative complications and patients' tolerance between sodium phosphate solution (NaP) and polyethylene glycol-electrolyte solution (PEG-ES) for elective colorectal surgery. MATERIAL AND METHOD: All colorectal cancer patients treated between August 2000 and May 2001 (NaP group) who received two doses of 45 ml NaP solution with a glass of water were compared to all colorectal cancer patients between July 1997 and July 2000 (PEG group) who received 3 liters of PEG-ES. Patient tolerance, post-operative septic complications, and serum sodium and potassium before and after bowel preparation were assessed. RESULTS: Twenty five patients in the NaP group and eighty six patients in the PEG group were included in the study. Age, gender and surgical procedure were well matched. Patient tolerance to NaP was superior to PEG-ES (p=0.044). There was a significant increase in serum sodium levels (p=0.022) and a significant decrease in serum potassium levels in NaP group (p=0.018) without any clinical sequelae. 35 per cent of the patients in the PEG group had wound infection versus only 10 per cent of patients in the NaP group (p=0.021). CONCLUSION: Sodium phosphate solution was safe, rapid, well-tolerated and could be the standard pre-operative mechanical bowel preparation for elective colorectal surgery.