Hematocrit change in the patients underwent open heart surgery using priming solution without blood

 The hematocrit change during cardiopulmonary bypass and postoperative period were studied in 34 patients, 15 females and 19 males  ranging in age from 15-45 years mean 28 by using extracorporeal circulation (CPB) priming solution without blood. They were 10 patients of congenital  heart disease and 24 patients of acquired heart disease. In extracorporeal circuit, priming perfusate composed mainly of Ringer’s lactate solution approximately 1,500-2,000 ml. was reinfused in the form of pack red cells by centrifugation. The result, hematocrit change during CPB was 26-28%, after CPB 1 hour for 6 times and everyday for 7 days hematocrit was 29.67-35.50%. We concluded that hemodilution technique develop mild anemia during CPB but it was be saved for open heart surgery by requiring no blood replacement.

Ruptured Abdominal Aortic Aneurysm

 Ruptured abdominal aortic aneurysm is a life threatening condition and when occur the mortality is about 50% (15-75%),so urgent surgery should be sdvised This article reviews clinical features, diagnosis, treatment and postoperative cares fo ruptured abdominal aortic aneurysm but this can slightly reduce mortality. The best way to decrease mortality is to 1) carefully treat the patient by a close follow up using ultrasonography for the aneurysm less than 4 cm. in diameter, 2) providing elective surgery for the aneurysm of about 4-5.9 cm. in diameter, and 3) if an aneurysm is greater than 6 cm. in diameter, it should be operated in every case.

Intracardiac Liposarcoma : Report of a case

A 61-year-old woman was referred to Srinagarind Hospital Khon Kaen University because of SVC obstruction.  Echocardiography revealed a sizable tumor in RA, RV. outflow tract, main pulmonary artery and right pulmonary artery.  All parts of the tumor were successfully excised and the patient was recovered uneventfully.  The histological examination of the tumor revealed liposarcoma.  This report emphasizes that intracardiac tumor, liposarcoma, should be included in differential diagnosis of SVC obstruction syndrome.

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.

Surgical Treatment of Empyema Thoracis

 During 1982-1984} fifty-five patients with empyema thoracis were treated at Surgical Department of Srinagarind Hospital and Khon Kaen Hospital.  The chief compliants were fever (61.1%), Cough (47.06%), Chest pain (32.20%) and dyspnea (25.42%).  Postpneumonia, TB. and chest chest trauma were the main caused of empyema thoracis.  The pathogenic bacteria were Pseudomonas auroginosa (30.50%), staph.  Aureus (21.03%), Acenetobacter sp.  (8.47%) and Klebsiella sp. (6.78%) respectively.  Surgical treatment consisted of 54 decortication, 4 rib resection and 1 intercostal drainage.  There were postoperative complication in 25.4% of patients, mostly were infection and there was no death.  The average admission time was 2-8 weeks.

Large Lateral Abominal Wall Reconstruction

 Reparing of large  abdominal wall defect is still a challenging and frustrating task for reconstructive surgeon. The articles on reconstruction of large lower and central abdominal wall defect have long been published for sevesal occasios. Ohtsuka et al (1979) demonstrated the versatillity of rectus abominis myocutaneous flap, either superiorly base or inferiorly base, to reconstruct abdominal wall defect.

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%.