Five-year follow-up of prostate cancer in Siriraj Hospital.

OBJECTIVE: To determine the clinical features, tumor characteristics, and treatment outcomes of Thai men with prostate cancer. MATERIAL AND METHOD: We retrospectively evaluated the clinical features, tumor characteristics, and treatment outcomes of 95 patients who were registered in Siriraj Hospital from 1993 to 1995. A survival end point in each stage was determined. RESULTS: The mean age was 72.37. The distributions of stage were 7.5 per cent for stage A, 1.1 per cent for stage B, 67.7 per cent for stage C, and 23.7 per cent for stage D. The prognosis of a clinical localized disease appeared good. Most patients with a urinary symptom were highly associated with stage C or stage D disease and were treated by hormonal therapy. With a maximal follow-up of 60 months, the median survival of stage C and D patients was 45 and 12 months, respectively. CONCLUSION: Most Thai patients with prostate cancer were older than the life expectancy of Thai men. They presented with urinary symptoms and had locally advanced or advanced disease. With hormonal treatment, their prognoses were not impressive.

Suprapubic prostatectomy for benign prostatic hypertrophy at Siriraj Hospital during 1986-1988.

A three-year retrospective analysis of patients with benign prostatic hypertrophy being treated by suprapubic prostatomy at Siriraj Hospital during 1986-1988 was carried out in order to determine the epidemiological characteristic of diseases and the results of treatment. There were 91 patients whose average age was 70.9 years. The significant symptoms of the patients were prostatism (100%), retention of urine (36.3%) and gross haematuria (15.4%). The abnormal laboratory findings before surgery were anaemia, azotemia, serum acid phosphatase above normal value and bacteriuria encountered in 3.2, 6.5, 20.0 and 62.7 percent of the cases respectively. The significant complications were bleeding during surgery (51.6%) and wound infection (27.5%) ; the mortality rate was 2.2 percent. Most of the patients (85.4%) could be discharged from the hospital before 14 days.

Increased fibrinolysis and changes in blood coagulation during epidural block for transurethral prostatectomy.

Epidural analgesia is the choice of anesthesia for transurethral prostatectomy (TURP). Unfortunately, this technique may increase fibrinolysis as well as decrease in fibrinogen and platelets count, which might cause deleterious bleeding problem during the procedure performed under epidural block. The present study was therefore undertake to assess the degree of increased fibrinolysis and changes in coagulation profiles during epidural anesthesia for TURP. Twenty patients aged from 57 to 83 years were studied. Group 1 of 7 patients did not receive antifibrinolysin (transamin) after 20 minutes following epidural block. Group 11 of 13 patients did not receive transamin intravenously. Blood samples were drawn for euglobulinlysis time (ELT), fibrinogen, platelets, haemoglobin, prothrombin time (PT) and partial thromboplastin time (PTT). The sampling periods included pre-epidural block as baseline values, 10 and 45 minutes after epidural block and the last was obtained immediately after the completion of surgery. The study revealed the same degree of increased fibrinolysis in both groups tested ten minutes after epidural analgesia and throughout the entire operation. There were no statistical significant changes in fibrinogen level, PT and PTT. The platelet counts decreased from the baseline values in group 1 more than group 11, but the quantities were within normal ranges. The results indicated that fibrinolysis following epidural analgesia for TURP increased in the same degree in all patients if either they received transamin or not. Furthermore, the increased fibrinolytic activity did not lead to a problem of blood loss in this study.