Siriraj Medical Journal
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Editor: Ouay Ketusinh
ISSN: 2228-8082 (Print)
Frequency: Bi-monthly
Language: English
Published by Faculty of Medicine Siriraj Hospital, Mahidol University
Peer-reviewed open access journal indexed in Index Medicus
Web site: https://www.sirirajmedj.com
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Browsing Siriraj Medical Journal by Author "Akaraviputh, Thawatchai"
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Item Aggressive treatment of malignant duodenocolic fistula: A case report.(1999-02) Akaraviputh, Thawatchai; Watanapa, PrasitMalignant duodenocolic fistula is a rare complication of gastrointestinal malignancy for which carcinoma of the ascending colon is the most common cause. A case of 39-year-old female with duodenocolic fistula caused by adenocarcinoma of the hepatic flexure was reported. Successful surgical treatment was achieved by right hemicolectomy en bloc with proximal pancreatoduodenectomy. The patient received a full course of adjuvant chemotherapy and she is now completely free of symptom and without any evidence of recurrent disease, 2 years after the resection.Item Does preoperative chemoradiation therapy in locally advanced rectal cancer increase rate of sphincter preserving surgery: A prospective clinical trial.(2006-04) Boonnuch, Wiroon; Chinswangwatanakul, Vitoon; Methasate, Asada; Akaraviputh, Thawatchai; Lohsiriwat, Varut; Lohsiriwat, DarinObjective: To evaluate the influence of preoperative chemoradiation in locally advanced rectal cancer on ability to perform sphincter preserving surgery. Methods: Between 1998 and 2005, a prospective clinical trial of preoperative chemoradiation therapy (CTX/XRT) that delivered 45 Gy in 25 fractions over 5 weeks with bolus infusion of 5-fluorouracil (200 mg/m2/day) or capecitabine (2000mg/m2/day) was given to 42 rectal cancer patients admitted to the Department of Surgery, Siriraj Hospital, Bangkok, Thailand. The pretreatment stage distribution, as determined by endorectal ultrasonography and computed tomography of the pelvis, included uT3N0 in 90.48% and uT3N1 in 9.52% of cases. Approximately 6 weeks after completion of CTX/XRT, surgery was performed in every patient. The choice of the surgical procedure was based on the surgeon’s discretion. Results: The patient population consisted of 25 males (59.52%) and 17 females (40.48%) who had a median age of 57 years (range 32-79 years). Distal border of the tumors were located at a median of 5 cm (range 2-10 cm) above the anal verge. Thirty cases (71.43%) had distal border of the tumors within 6 cm from the anal verge. The pathological tumor stages were T1N0 in 2 cases (4.76%), T2N0 in 9 cases (21.43%), T2N1 in 4 cases (9.52%), T3N0 in 12 cases (28.57%), T3N1 in 8 cases (19.05%), T3N2 in 2 cases (4.76%) and T4N0 in 1 case (2.38%). The results included 9.52% pathological complete response, 42.86% downstaging and 50% sphincter preservation rate. Of the tumors located < 6 cm from the anal verge, sphincter preservation was accomplished in 30% of the patients. The pretreatment location of distal border of the tumors (< 6 cm vs. > 6 cm from anal verge) was the only factor predictive of sphincter preservation (p < 0.001). No local recurrence was detected during the period of follow up (median 23 months). Conclusion: The administration of preoperative chemoradiation for locally advanced rectal cancer is associated with tolerable toxicity and high rates of tumor downstaging. The preoperative chemoradiation and tumor downstaging do not increase rate of sphincter preservation in locally advanced rectal cancer.Item Endoscopic endoprosthesis insertion in unresectable hilar cholangiocarcinoma patient.(2006-02) Methasate, Asada; Pongpanich, Wijarn; Akaraviputh, Thawatchai; Leelakulsolwong, Somchai; Boonnuch, Wiroon; Lohsiriwat, Varut; Lohsiriwat, DarinObjective: Hilar cholangiocarcinoma is one of the most common causes of biliary tract obstruction in Thailand. However, in most patients, the tumors are unresectable. Endoscopic retrograde cholangiopancreatography (ERCP) with endoprosthesis insertion can provide effective internal biliary drainage in these patients; however, there are still some controversy regarding the complications, success rate and technical aspect of this approach. The aim of this study was to report results of palliative endoscopic endoprosthesis insertion using plastic stents in unresectable hilar cholangiocarcinoma. Methods: We analyzed 72 sessions of ERCP with plastic stent insertion in 61 patients with unresectable hilar cholangiocarcinoma, treated at the Endoscopic Unit, Department of Surgery, Siriraj Hospital from 1999-2001. Statistical analysis were done using chi – square test. Results: In 72 sessions of ERCP with plastic stent insertion, overall successful drainage was 48 %. Early complication was found in 13 sessions (18%) with cholangitis 13.9%, pancreatitis 2.8%, bleeding 2.8% and intra-abdominal collection 2.8%. Unilateral stent insertion was done in 94% (right side 43.4%, left side 49.1%) and bilateral stent insertion was performed in 7.5%. The success rate of right duct stent insertion was 63.1% while that of left duct stent insertion was 36.4% (p<0.01). Mortality rate was 2.98%. Conclusion: Endoscopic endoprosthesis insertion using plastic stent is an effective method for palliative biliary drainage in patients with unresectable hilar cholangiocarcinoma with acceptable morbidity and mortality rate.Item Glucagonoma presenting with obstructive jaundice : A case report.(2003-02) Boonnuch, Wiroon; Akaraviputh, Thawatchai; Suwanagool, ParvineeA case report of a 2-cm glucagonoma at head of pancreas in 48-year old woman presented with obstructive jaundice. She had no manifestation of the glucahonoma syndrome. She underwent bylorus preserving pancreaticoduodenectomy (PPPP). Immunohistochemical studies revealed that this tumor was a malignant glucagonoma. She made an uneventful recovery after the operation and was discharged from the hospital without complication. Six months later, she was found to have multiple liver metastases which did not response to chemotherapy and died 11 months after the operation with liver failure.Item Laparoscopic surgery in general surgery: Where are we now.(2006-09) Akaraviputh, Thawatchai; Teeratherdtrakul, Benjawan; Chinswangwatanakul, Vitoon; Lert-akayamanee, NarongItem Oasis sharp counter.(2008-03) Tuvayanon, Warisara; Silchai, Potchanee; Akaraviputh, ThawatchaiObjective: To invent a new sharp counter device call “OASIS Sharp Counter” and evaluate the performance of the OASIS sharp counter for medical operations. Methods: We invented a new sharp counter device called “OASIS sharp counter” made from inexpensive and unused materials. The device was evaluated with a satisfactory questionnaire. Results: From the satisfactory questionnaire of 30 nurses who used this new device to count the sharps without any equipment, the statistics analysis indicate that the safety of using and the time saving in the counting process is ranked in the “Very Good” level. Conclusion: OASIS Sharp Counter is convenient, safe, and inexpensive.