Surgery of the abdominal aorta: experience of a university hospital in Thailand.

One hundred and thirty two patients who underwent aortic surgery at King Chulalongkorn Memorial Hospital, Bangkok, Thailand from January 1991 to December 2000 were studied. Twenty three patients (17.4%) were aged less than 60 years, 102 (77.3%) aged 60-80 years, and 7 (5.3%) were older than 80 years. Ninety eight patients (74.2%) underwent elective operations and 34 (25.8%) underwent emergency operations. Elective abdominal aortic aneurysms (AAA) repair was the most common indication for abdominal aortic surgery (56.0%). Eighteen patients (13.6%) underwent surgery for infected AAA. The incidence of infected AAA was 16.1 per cent among patients with AAA. Fifteen patients (11.4%) had ruptured AAA and 19 patients (14.4%) had aortoiliac occlusive disease. The overall mortality rate was 15.2 per cent. The mortality of elective aortic surgery was 5.1 per cent and of emergency aortic surgery was 44.1 per cent. The mortality of elective AAA repair was 4 per cent. Multiple system organ failure was the most common cause of death (80%), followed by acute myocardial infarction (10%) and exsanguination (10%). The authors conclude that elective surgery on the abdominal aorta is safe and should be performed when indicated to prevent the development of complications requiring emergency surgery which carries a much higher risk.

One layer continuous anastomosis of the alimentary tract with absorbable polydioxanone suture.

A prospective study using absorbable Polydioxanone (PDS) suture material in a one layer continuous technique for gastrointestinal anastomosis was conducted. There were 40 anastomoses constructed in 39 children and 61 anastomoses in 49 adults which were classified as "non-complicated anastomoses" without any clinical evidence of leakage or any other complications attributable to the anastomotic technique or to the suture materials. There were other 20 anastomoses created in 20 patients with malnutrition or those receiving chemotherapy and/or radiation or where there was tension at the anastomosis which were classified as "complicated anastomosis". Anastomotic leakage was observed in one patient (5%). The starvation period was 3.16 +/- 0.9 days compared to 3.46 +/- 1.0 days in the two layer technique "control" group. The rate of complications and the function of the GI tract in both non-complicated and complicated anastomoses after one layer continuous Polydioxanone anastomotic completion was not significantly different from those using conventional two layer anastomosis. The technique for one layer continuous suture is simple, easy and takes less time than the conventional method. This technique also theoretically provides better postoperative condition in which bowel anatomy and physiology can return to normal earlier, causing minimal tissue trauma, and less narrowing of the lumen although the evidence cannot be supported by this study. The Polydioxanone suture material is biodegraded by specific time, and hence allows normal growth of the anastomosed bowel; it is therefore suitable for both children and adults.

Monoclonal antibody (OKT3) rescue in refractory acute renal allograft rejection: report of 3 cases.

We report the first experience in Thailand with the use of OKT3 (monoclonal anti T lymphocyte antibody) in rescuing an acute rejection unresponsive to methylprednisolone pulses in 3 cadaveric renal transplant patients. The treatment regimen was 10 daily 5 mg intravenous injections of OKT3. In the first and second patients OKT3 was started on days 26 and 18 of the rejection episode. In the third one OKT3 was given when he became anuric secondary to severe acute rejection. Within 24 hours of the therapy, urine flow increased. A brisk diuresis and a decline in serum creatinine started within 4 days. The kidney function returned to normal within the 10-day course of therapy. Side effects were fever, conjunctivitis, stuffiness of nose and herpes infection.