Biomedical subjects

P Totemchokchyakarn

Publications and source records attributed to P Totemchokchyakarn.

3 recordsLinked to original sources

PubMed1996

Mediastinal tracheostomy.

BACKGROUND: Advanced carcinoma of the lower neck with direct extension to the superior mediastinum is a major therapeutic challenge. Complete removal of the tumors requires a radical operation in order to remove the larynx, portions of trachea and esophagus, and to construct a tracheostomy stoma with intrathoracic trachea. METHODS: We present our experience and technique for removal of difficult tumors in this region and construction of mediastinal tracheostomy. A technique for reconstruction of a very short segment of distal trachea is also proposed. Twelve mediastinal tracheostomies were performed; all except 3 patients underwent total laryngopharyngectomy and resection of tumor with gastric pullup. RESULTS: There were 2 operative deaths, 1 from tracheoinnominate artery fistula and the other from cerebral infarction. Complications included pharyngeal fistula (2 patients), respiratory failure (1), and osteomyelitis of sternum (1). Postoperative survival was disease-dependent. All patients who survived the operation achieved good airway patency and relief of dysphagia. CONCLUSIONS: The method of airway reconstruction by mediastinal tracheostomy is an advance in surgical treatment of malignancies in the cervicothoracic region. By careful selection of patients, successful operation resulted in good palliation and sometimes cure with acceptable quality of life.

Adult↗

PubMed1993

Laparoscopic appendicectomy.

OBJECTIVE: To assess the feasibility and morbidity of laparoscopic appendicectomy. DESIGN: Open study. SETTING: Songklanagarind Hospital, Songkla, Thailand. SUBJECTS: 31 consecutive patients who presented with a clinical diagnosis of acute appendicitis. INTERVENTIONS: Laparoscopic appendicectomy through three abdominal punctures. MAIN OUTCOME MEASURES: Duration of operation, amount of analgesia, length of stay in hospital, and morbidity. RESULTS: Mean duration of operation was 47 minutes, median (range) length of stay in hospital was 2 (1-5) days, and there were no complications during or after the operation. CONCLUSION: Laparoscopic appendicectomy is safe, the stay in hospital is short, patients recover quickly, with little pain and the cosmetic result is good.

Acute Disease↗

PubMedDate not supplied

Cisplatinum-epirubicin chemotherapy for advanced unresectable squamous cell carcinoma of the head and neck.

Twenty-seven patients with locally advanced unresectable squamous cell carcinoma of the head and neck were offered three courses of cisplatinum and epirubicin. The purpose of this study was to evaluate the effectiveness of this chemotherapy regimen. Subsequent therapy included surgery when feasible and/or radiation therapy. Eighteen patients completed three courses of chemotherapy. Three had a complete response and 14 a partial response. Nine patients refused chemotherapy before treatment was completed. Overall response rate was 63%. Among responding patients, the initial favorable response to chemotherapy was apparent after the first course of chemotherapy. A moderate degree of nausea, vomiting, anorexia, and alopecia were the most common toxicities. Leukopenia grade 3 according to ECOG criteria (WBC 1,000-2,000/mm3) was found in 8(44%) of the 18 patients completing treatment. There was no cardiac toxicity. This regimen appears to be an effective induction chemotherapy for advanced unresectable head and neck cancer with acceptable side effects. Subsequent therapy with surgery and/or radiation can give long-term local control of disease in some patients. In a selected group of patients with smaller tumors, this treatment should have a better response rate and a favorable effect on survival. Phase III studies using this regimen should be carried out.

Adult↗