Successful transfusion-free pancreatectomy in Jehovah's Witness patients

BACKGROUNDS/AIMS: Although perioperative therapies have improved greatly, pancreatectomies still often need blood transfusions. However, the morbidity from blood transfusions, the poor prognosis of blood transfused patients, high cost, and decreasing supply of blood products is accelerating transfusion-free (TF) surgery in the patients who have pacreatectomies. The aim of this study was to assess the feasibility of TF pancreatectomies for patients who are Jehovah's Witness. METHODS: We investigated the possibility of TF pancreatectomies for the Jehovah's Witness patients undergoing pancreatectomies between January 2007 and Februay 2014. There were 4 cases of Whipple's operation, 4 of pylorus-preserving pancreaticoduodenectomy, 2 of radical antegrade modular pancreatosplenectomy and 1 of laparoscopic distal pancreatectomy. All were performed by one surgeon. RESULTS: Most of the TF pancreatecomies patients received perioperative blood augmentation and intraoperative acute normovolemic hemodilution (ANH). They received no blood transfusions at any time during their hospitalization, and pre- and intra-operative data and outcomes were acceptably favorable. CONCLUSIONS: To the best of our knowledge, this report is the first successful consecutive pancreatectomy program for Jehovah's Witness not involving blood transfusion. TF pancreatectomy can be performed successfully in selected Jehovah's Witness. Postoperative prognosis and outcomes should be confirmed in follow up studies.

Formulation Characteristics of Three Kinds of Elravie(R) Fillers / 대한피부과학회지

BACKGROUND: Hyaluronic acid (HA) is a mucopolysaccharide that occurs naturally throughout the human body, where it attaches to collagen and elastin to form cartilage, and also helps maintain the strength and flexibility of the cartilage that cushions joints. A decline in HA synthesis may lead to a variety of symptoms, ranging from joint discomfort, to wrinkles. Cross-linked HA is a viscoelastic solid that resists in vivo degradation by hyaluronidase for much longer than endogenous HA, and which is also a key ingredient in various cosmetics. OBJECTIVE: To describe our experience with three kinds of Elravie(R) fillers. METHODS: We obtained images of filler shape using a folliscope. Scanning electron microscopy (SEM) was used to compare particle sizes. Hydrophilic filler is a hydroxyl, and for this reason, we mixed the filler with water. Next, PARKER ink was added to the mixture, and viscosity and elasticity were measured using a rheometer. RESULTS: Among the tested fillers, particle size was largest in the Restylane(R) SubQ. Elravie(R) ultra volume filler was greater in volume than Elravie(R) deep line, and Elravie(R) light fillers. We confirmed Elravie(R) fillers to be hydrophilic. Elravie(R) ultra volume filler was found to have the highest viscosity and elasticity, whilst Elravie(R) light filler had the lowest. CONCLUSION: All three kinds of Elravie(R) fillers were found to be suitable for human cosmetic use.

Clinical analysis of 3rd Decade Male 47 Cases with Intracranial Tumors in Korea

The authors represented a clinical analysis of 3 rd decade male 47 patients with intracranial tumors who had been histologically confirmed after operation and biopsy at the department of neurosurgery of Capital Armed Forces General Hospital From Feb. 1985 to Jan, 1988. We classified the intracranial tumors according to Russell and Rubinstein's classification. The results were as follows: 1) Among the intracranial tumors, gliomas were found most frequently(40.4%), and followed by pituitary adenomas(19.2%), pinealomas(10.6%), osteomas(6.4%), medulloblastomas(4.3%), craniopharyngiomas(4.3%), blood vessel tumors(4.3%). Pituitary adenomas occupied 19.2% of all intracranial tumors and as a single entity these were the highest incidence. 2) Tumors of the pineal region constitutes 10.6% of intracranial tumors. It was relatively high incidence compared with other reports. 3) Intracranial tumors occurred more frequently in supratentorial region(85.1%). The most frequent location was sellar and parasellare region(23.4%), and followed by frontal(14.9%), parietal(12.7%), pineal gland(10.6%), temporal(8.5%), cerebellar region(8.5%) in order. 4) The most common duration of symptoms were within 3 months(42.6%). The main clinical symptoms and signs were headache(80.9%), nausea or/and vomiting(55.3%), papilledema(44.7%), so called symptoms triad of the brain tumor, and other ophthalmic symptoms, gait disturbance, motor dysfunction,cerebellar sign in order.

Clinical Analysis of Gun Shot and Explosive Injuried Patients of the Brain

A series of 24 cases of gun shot and explosive injuried patients of the brain is analyzed according to causes, types, operability, the relation between Glasgow coma scale(GCS) and operative mortality, associated injuries, complications and sequelae. The authors notice that gun shot and explosive injury of the brain are more worse than blunt head trauma because of injury mechanism by itself.

A Clinical Analysis of Surgically Treated Head Injury on Military Personnel

During the three years from March, 1983 to Feb, 1986, 159 cases of head injury surgically treated in the department of neurosurgery, Capital Armed Forces General Hospital were clinicostatistically analysed and discussed with the review of the literature. The following results were obtained.1) Due to the army distinctiveness, all cases were male and the age incidence was becoming maximal at the third decade. 2) Traffic accidents form by far the largest Group(38.4%), and next are, in order of incidence, accidents due to fall from height, simple fall(19%), exercise(12.6%), gun shot wound or explosive injury(9.4%) and assault(9.4%). 3) Skull fracture were seen in 115 cases(72.3%), and nearly half of those 55 cases, were linear fracture. 4) Of the 133 patients with intracranial hematoma or subdural hygroma, 88 cases(66.7%) were accompanied by skull fracture. 93% of epidural hematomas were associated with skull fracture and the most common wite of hematoma was temporoparietal area. 5) Of all cases of subdural hematoma, acute type was prevalent(59.4%) and its main site involved was temporoparietal area. 6) The associated injuries were found in 22.6% of patients. The frequent ones were facial bone fracture, upper extremity fracture, clavicle fracture, and chest injury, in order. 7) The minor head injury of Glasgow coma scale score(GCS) of 13 to 15 was 68 cases(42.8%). The moderated head injury of 9 to 12 was 28 cases(17.6) and the serve head injury of 3 to 8, 63 cases(39.1%). 8) The operation mortality was 26.8% and the good recovery was achieved 55.4% of patients. The remaining 18.8% resulted in disabled or vegetative state. 9) In the accidents of gun shot wound or explosive injury, operation mortality rate was 60%, but 5 cases(33.3%) were seen good recovery.

Transoral Fusion of the Odontoid Process Fracture

The Odontoid process fracture has been treated by prolonged external immobilization of by internal fixation and fusion. We reported congential and traumatic odontoid process fracture which were successfully treated by transoral fusion. Operative preparation, technique and postoperative management are described by in detail.

A Case of Thoracic Spinal Canal Stenosis

A compression of spinal cord or nerve roots is commonly seen sequale of acquired or congenital stenosis of the cervical of lumbar portions of the spine. The authors have treated a case of thoracic myelopathy associated with thoracic canal stenosis, which was diagnosed with thoracic myelography and thoracic C-T scan. The pathological findings was thickened ligament flavum, hypertrophied articular processes, narrow spinal canal and compression of spinal cord. It is suggested that the syndrome should be considered in any patient who has a thoracic myelopathy.

A Case of Cystic Cavernous Hemangioma

We experienced a case of cavernous hemangioma suspected to cerebral cysticecosis. The 23-year-old male patient was admitted to our hospital due to sudden severe headache and generalized tonic-clonic seizure. The computerized tomography showed multiple calcification of bilateral cerebral hemisphere, especially right, and cystic mass on right frontal area with mass effect. The mass was diagnosed cavernous hemangioma under the microscopic examination.

A Case of Oligodendroglioma in the Septum Pellucidum

The authors report a case of oligodendroglioma in the septum pellucidum. A 22-year-old male presented with symptoms of headache and decreased visual acuity. Simple skull series showed calcified density near the midline. Brain C-T scan revealed huge calcified mass involving right lateral ventricle, 3rd ventricle and obstructive hydrocephalus. The authors diagnosed oligodendroglioma in operative findings and pathologic examination.

Effects of Diphenylhydantoin on CBF, CMRO2, CMRG, and SEP in Experimental Cerebral Ischemia

Phenytoin(DPH) has been reported to be a benefit in the cerebral ischemia. To study the effect of DPH in an experimental stroke model. We subjected 45 cats to middle cerebral artery(MCA) occlusion 4 hrs after the placement of a MCA clip by a retro-orbital approach. Infarct size was determined 2 days after MCA occlusion. 20 animals served as control and received saline 2 ml bolus. All of these animal observed 1 hour, 1 day and 2 days after the removal of clip. In 20 treated animals, DPH was administered 50 mg/kg bolus every 6 hours intravenously after removal of clip. Infarct size was not significantly different between the control and treated groups. However, in DPH treated group, CBF, CMRO2, CMRG SEP were improved in early stage of ischemia.