Outcome of treatment of rectal cancer.

To demonstrate the trend and treatment outcome of rectal cancer after the advent of adjuvant therapy, all case notes of rectal cancer patients admitted to Chulalongkorn Hospital from 1985-1994 were reviewed and cases were followed until 1996. Mean follow-up period was 685.3 days (8-3, 193 days). Most rectal tumors were Dukes' C (43.8%), well-differentiated (54.1%) and at the distal third (53.4%). AP resection remained the most common procedure before and after the advent of adjuvant therapeutic options (62.3%). Of 146 patients treated by curative operations, 60 had adjuvant therapies of which radical radiotherapy with or without chemotherapy was the most common. However, chemotherapy was increasingly employed as the neoadjuvant and as combined chemoradiotherapy. There was a preferential selection of less well-differentiated, more distal, more Dukes' C disease and younger patients for the adjuvant therapy (p < 0.05). Recurrence rate in the adjuvant group was not different from the surgery group despite significant poorer prognostic indicators (17.4% & 21.7%, p = 0.53). Mortality was higher in Dukes' B + C patients in adjuvant group (17.3% & 3.4%, p = 0.02). The outcomes were not different among Dukes' A patients. The complications; i.e. wound problems, gut obstruction; did not increase with the adjuvant treatment. No adverse effect was observed on the healing of colorectal or coloanal anastomoses in the adjuvant group.

Clinical trial of oral diosmin (Daflon) in the treatment of hemorrhoids.

A double-blind, comparative, controlled study on the effectiveness of the addition of oral diosmin (Daflon; Lab. Servier, Orléans, France) and placebo to a conservative regimen of bulk laxative in the treatment of acute symptoms of first-degree and second-degree internal hemorrhoids was undertaken in 100 patients. The diosmin and placebo groups, with 50 patients each, were comparable in age, sex, symptoms, and the severity of the underlying hemorrhoids. During the first four days, the patients received 12 tablets in three divided doses, and then they received two tablets twice daily for another 10 days. Subjective and objective changes were assessed at the 4th and 14th days of treatment. The diosmin group showed statistically significant objective improvement (P < 0.01) without accompanying subjective improvement on the fourth day. However, at day 14, there was no significant difference in either subjective or objective improvement between the two groups. Two cases in the placebo group were taken out of the trial on the fourth day owing to clinical deterioration. No side effect of diosmin was detected in this study.

Diverticular disease of the colon in a far-eastern community.

A 5-year retrospective case review and 6-month clinical observation, in a teaching and general hospital in Bangkok, Thailand, show that colonic diverticular disease is not so common as in the West and has many distinctive features. Solitary cecal diverticula are at least five times more common, accounting for about one-fourth of all diverticula of the large bowel, and show definite male preponderance and occur in younger patients. Their congenital origin is supported by the lack of association with social classes, by the finding of structural relationship with the appendix in one of the patients, and by the presence of the muscular coat. On the other hand, multiple colonic diverticulosis is essentially a disease of those above the age of 40 years and shows slight female preponderance. The diverticula appear segmental and need not originate in the sigmoid colon first. Almost all multiple diverticula show radiologic features of simple massed diverticulosis and seem to be associated with higher social classes. The differences in the pattern of diverticular disease in this series and in the West cannot be readily explained on the basis of the difference in dietary habit or psychologic stress.

Postoperative problems and management after hepatic resection for blunt injury to the liver.

The postoperative problems and management of 8 patients following right hepatic lobectomy for blunt liver injury are discussed. Multiple injury and in particular chest injury are of importance. Respiratory distress may be insidious in onset and must be anticipated. Most patients require at least temporary positive pressure ventilation. Liver regeneration is rapid and histological evidence of regenerative hyperplasia is present within 3 days of injury. Hypoglycaemia of a degree sufficient to threaten life may occur postoperatively, particularly in the first 48 hours. Jaundice may be a worrying postoperative feature, but the use of T-tube drainage after hepatic lobectomy will enable any possible extrahepatic obstruction to be excluded. Hypoproteinaemia and hypo-albuminaemia occur in the immediate postoperative period, and recovery rapidly follows the peak period of regenerative activity of the liver. Normal levels are regained by the fourth to sixth postoperative weeks. Prophylactic antibiotics have no place in the postoperative management of blunt liver injury. Haemorrhagic diathesis is common after hepatic resection and is of a complex nature. Intravascular coagulation may occur and factor V deficiency is common. The mainstay of treatment is transfusion of fresh blood.

Injuries to the liver: analysis of 20 cases.

Twenty cases of liver injury among 55 consecutive cases of abdominal injury submitted to laparotomy over a four-year period are reported. Forty-four of the cases were blunt injuries, and the cases of liver injury were in this group. Road traffic accidents accounted for 37 of the 44 cases and 17 of the 20 liver injuries. Except in two cases injury to the liver was associated with injury to other organs. Severe chest injury was found in 40% of the cases and serious skeletal injury in 45%. The overall mortality in blunt injury to the liver was 20% (4 cases) and was directly attributable to the liver injury in only one case.Liver injuries are classified as minor or major according to the depth of the wound and the associated destruction of liver tissue. Liver resection is advocated for major injuries. Right hepatic lobectomy was performed on five occasions and three of the patients survived. Death in the other two was due to associated injuries. The remarkable regenerative capacity of the liver is emphasized.