Surgery in patients with congenital factor VII deficiency: A single center experience

BACKGROUND: Congenital factor VII (FVII) deficiency is a rare hemorrhagic disorder that can cause excessive bleeding during and after surgery in affected patients. The recombinant form of activated factor VII (rFVIIa, NovoSeven(R) from Novo Nordisk, Bagsvaerd, Denmark), which was developed as a second-generation bypassing agent, has recently been used in the management of bleeding for patients with congenital FVII deficiency. METHODS: We reviewed the results of 8 surgical procedures in 5 patients with congenital FVII deficiency at the Kyung Hee University Hospital, Gangdong, Seoul, Korea, between January 2008 and June 2010. We administrated rFVIIa preoperatively in six patients and postoperatively in five patients. RESULTS: Between January 2008 and June 2010 at our center, 8 operations were performed successfully and no complications were observed in the 5 patients with congenital FVII deficiency. The median level of FVII activity was 2% (range, 0.6-7%). Four orthopedic procedures, 1 tonsillectomy, and 3 dental extractions were performed. The median duration of hospitalization was 8.5 days (range, 0-15 days). rFVIIa was administered at all procedures, except the dental extraction that was performed using only antifibrinolytic agents without any replacement. No bleeding or thrombogenic complications were observed in any case. CONCLUSION: Patients with congenital FVII deficiency who require surgery can be treated efficiently and safely with rFVIIa or antifibrinolytic agents. rFVIIa was well tolerated and maintained effective hemostasis and showed good clinical outcome after the major surgery.

Laser Surgery To The Circumferential Hemorrhoids

BACKGROUND: This study was undertaken to evaluate the treatment of circumferential hemorrhoids using the CO2 laser. METHOD: Five hundred seventy-two consecutive patients with circumferential hemorrhoids(411 males, 161 females) had hemorrhoidectomy performed with CO2 laser under caudal or epidural anesthesia during the 2 year-period between July 1994 and June 1996. The follow-up period was a minimum of 3 months after hemorrhoidectomy. The standard Milligan-Morgan open technique was used for most full three-quadrant hemorrhoidectomies. For the excision of necessary piles, "core-ablation" technique was employed. RESULTS: The postoperative pain lasted for an average of 2.10 days. Comlications of hemorrhoidectomy included Postoperative skin tags, bleeding, wound infection, delayed wound healing, urinary retention and anal fistula in only a few of the cases, none of which caused any long-term problems. CONCLUSIONS: These results indicate that CO2 laser hemorrhoidectomy is feasible and safe provided it is used with care, and that it seems to cause no significant alteration in anorectal physiology.

A Case of Pneumonia due to Occult aspiration of a Twig / 결핵

Bronchial foreign body aspirations are uncommon in adults and usually have various underlying conditions, otherwise accidentally occurred in dental procedure, medical, surgical procedure. The most commonly aspirated objects were food materials, with peanuts leading the list. When bronchial foreign body was aspirated, no definite respiratory symptoms or foreign body is may not seen, then diagnosis is delayed. Therefore late complications was developed. The tendency to use fiberoptic bronchoscope for removal of foreign bodies in adults is increased. We report a rare case of bronchial pneumonia due to occult aspiration of a twig before 1 year with a review of the literatures.

The Comparison of Pathologic Findings of Colonic Polyps between Forceps Biopsy and Polypectomy / 대한소화기내시경학회지

Colonic palyps are one of the most risky factors for colon cancer. The pathology of the specimen obtained by forceps biopsy does not represent the whole specimen of the polyp obtained by polypectomy or surgery in some cases. To evaluate these pathologic differences. we analysed the 39 patients with colonic polyps who underwent forceps biopsy and polypectomy. (continue...)