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Objective. To evaluate efficacy and safety of WF10 (TCDO iv solution) therapy in patients with late hemorrhagic radiation cystitis and proctitis in a long-term follow up. Material and methods. From February 1999 to July 2001, 30 symptomatic patients with endoscopically confirmed grade 2 and 3 late hemorrhagic cystitis ( n = 16) and proctitis ( n = 14) were treated with WF10. The dose was 0.5 ml/kg BW, diluted in 250 ml 5%D/W, administered by intravenous infusion over 2 h, 5 consecutive days, every 3 weeks for 2–4 cycles, combined with standard therapy. The patients were clinically followed up every 3 weeks for 3 months, then every 3 months for 1 year and then every 3–6 months. The study endpoints were immediate response with improvement to Grade 0–1 within 3 months and the incidence of recurrence to Grade ≥2 during the follow up time. Results. After completion of the WF10 therapy, 14 cystitis patients (88%) had improved to grade 0–1 hematuria, and 14 proctitis patients (100%) had improved in bleeding per rectum to grade 0–1 within 3 months. The median follow up time was 51 months. During the follow up period, among the responders, 4 cystitis patients (28%) had recurrent hematuria of grade 2 and two proctitis patients (14%) had recurrent bleeding per rectum of grade 2 and 3. No treatment toxicity was observed. Conclusion. The WF10 therapy combined with conventional treatment is simple and safe with long-term efficacy in the treatment of late hemorrhagic radiation cystitis and proctitis.

A 59-year-old man with metastatic an esophageal tumor from hepatocellular carcinoma (HCC) presented with progressive dysphagia. He had undergone liver transplantation for HCC three and a half years prevously. At presentation, his radiological and endoscopic examinations suggested a submucosal tumor in the lower esophagus, causing a luminal stricture. We performed complete resection of the esophageal metastases and esophagogastrostomy reconstruction using the da Vinci robotic system. Recovery was uneventful and he was been doing well 2 mo after surgery. α-fetoprotein level decreased from 510 ng/mL to 30 ng/mL postoperatively. During the follow-up period, he developed a recurrent esophageal stricture at the anastomosis site and this was successfully treated by endoscopic esophageal dilatation.

Background/Aims: To evaluate the outcomes of sphincter-saving operation for rectal cancer without protective stoma and pelvic drain and to determine factors influencing anastomotic leakage. Methods: We investigated 170 patients undergoing elective sphincter-saving operation without protective stoma and pelvic drain during 2003–2006 in a single institution. Early postoperative outcomes were evaluated. 17 independent patient-, tumor-, and treatment-related variables were analyzed by a multivariate model to determine their association with anastomotic leakage. Results: The patients’ median age was 64 years. Median tumor height was 8 cm (range 3–15) from the anal verge. Overall 30-day mortality rate was 1.2%. Postoperative complications were diagnosed in 38 patients (22%) including 14 cases of anastomotic leakage (8.2%), of which 10 cases (71%) required surgical intervention. Tumor height within 5 cm from the anal verge was the only independent factor for leakage (OR 4.04; 95% CI 1.25–13.08). Conclusion: A sphincter-saving operation without a protective stoma and pelvic drain can be performed safely in the vast majority of rectal cancer patients. Tumor height within 5 cm from the anal verge is an independent risk factor for anastomotic leakage. Thus, the routine use of a protective stoma and pelvic drainage might be unnecessary.

Purpose. The purpose of our study was to evaluate the short-term and long-term outcomes of emergency Lichtenstein tension-free hernioplasty for acutely incarcerated inguinal hernia. Methods. We conducted a retrospective study of patients who underwent emergency Lichtenstein hernioplasty for acutely incarcerated inguinal hernia between September 2002 and January 2006 in a major city hospital in Thailand. We analyzed the early postoperative complications and surgical outcomes. Results. All 24 patients were men, with a mean age of 53.8 ± 19.2 years (range 19–77). There was no perioperative mortality and only two postoperative complications (8.3%): a subcutaneous fl uid collection, which resolved spontaneously within 2 weeks; and a superfi cial surgical site infection, which was treated successfully by intravenous antibiotics. The hospital stay was 3.8 ± 2.1 days (range 2–12). All patients attended regular follow-up visits (mean 20.2 ± 10.7 months, range 3–43). Clinical recurrence was found in one patient (4.2%), 7 months postoperatively. Conclusion. Lichtenstein hernioplasty can be used effectively as an emergency operation for incarcerated inguinal hernia with a good outcome and an acceptably low rate of postoperative complications.

AIM: To determine the relationship between pre-operative hypoalbuminemia and the development of complications following rectal cancer surgery, as well as postoperative bowel function and hospital stay. METHODS: The medical records of 244 patients undergoing elective oncological resection for rectal adenocarcinoma at Siriraj Hospital during 2003 and 2006 were reviewed. The patients had pre-operative serum albumin assessment. Albumin less than 35 g/L was recognized as hypoalbuminemia. Postoperative outcomes, including mortality, complications, time to first bowel movement, time to first defecation, time to resumption of normal diet and length of hospital stay, were analyzed. RESULTS: The patients were 139 males (57%) and 105 females (43%) with mean age of 62 years. Fifty-six patients (23%) had hypoalbuminemia. Hypoalbuminemic patients had a significantly larger tumor size and lower body mass index compared with non-hypoalbuminemic patients (5.5 vs 4.3 cm; P < 0.001 and 21.9 vs 23.2 kg/m2; P = 0.02, respectively). Thirty day postoperative mortality was 1.2%. Overall complication rate was 25%. Hypoalbuminemic patients had a significantly higher rate of postoperative complications (37.5% vs 21.3%; P = 0.014). In univariate analysis, hypoalbuminemia and ASA status were two risk factors for postoperative complications. In multivariate analysis, hypoalbuminemia was the only significant risk factor (odds ratio 2.22, 95% CI 1.17-4.23; P < 0.015). Hospitalization in hypoalbuminemic patients was significantly longer than that in non-hypoalbuminemic patients (13 vs 10 d, P = 0.034), but the parameters of postoperative bowel function were not significantly different between the two groups. CONCLUSION: Pre-operative hypoalbuminemia is an independent risk factor for postoperative complications following rectal cancer surgery.