Tetanus after a resection for a gangrenous perforated small intestine: Report of a case

Clostridium tetani ; however, this was not identified by a culture. The diagnosis of tetanus was made only when opisthotonus in this patient became evident and normal tetanus treatment proved to be successful. (Received for publication on May 26, 1998; accepted on Nov. 6, 1998)     

Iliac osteomyelitis in a newborn: a case report

Pelvis is a rare location of the hematogeneous osteomyelitis during the newborn period. Successful cure of osteomyelitis during the newborn period is dependent on a fast and true diagnosis and on sufficient treatment. In this case report, iliac osteomyelitis of a newborn that was clinically suspected on the fifth day, was diagnosed radiologically and was found to be caused by methicillin-sensitive Staphylococcus aureus, is presented. According to our knowledge, this is the youngest osteomyelitis case in the literature and the third presented iliac osteomyelitis case of the newborn period.     

Scaphoid fracture in a patient after a fall

The patient was a 27-year-old man who was referred to a physical therapist because of persistent right wrist pain after a fall on an outstretched hand in a remote setting 3 months prior. Immediately after the injury, the patient was seen by a physician's assistant in a remote medical clinic, where right wrist radiographs were completed and interpreted as normal. Based on the history and physical exam, a potential scaphoid fracture was suspected. Therefore, the physical therapist ordered radiographs of the right wrist, which revealed a fracture through the waist of the right scaphoid with a band-like lucency.     

Transventricular mitral valve replacement in a patient with a left ventricular aneurysm: Report of a case

(Received for publication on Dec. 18, 1996; accepted on July 8, 1997)     

The occurrence of a strangulated ileus due to a traumatic transmesenteric hernia: Report of a case

(Received for publication on May 12, 1999; accepted on Jan. 7, 2000)     

Successful resection of a large hepatoblastoma in a young adult: Report of a case

Hepatoblastoma (HB) rarely occurs in adults, and very few cases of successful resection have been documented. We report herein the unusual case of a 22-year-old, otherwise healthy woman with no history of liver disease who presented with upper abdominal pain and hepatomegaly. Tests for hepatitis B virus (HBV) and hepatitis C virus (HCV) were negative, but the AFP was mildly elevated at 77 ng/ml, the normal being <20. There was no evidence of liver cirrhosis on either the laboratory or histologic examinations. A well-demarcated solid mass of 14cm in diameter, which was lobulated and partly necrotic, was detected in the liver by computed tomography (CT). The lesion was echogenic on ultrasound, slightly hypodense on CT, and mildly hyper-vascular on arteriogram. The entire tumor was resected by extensive hepatectomy preserving only the lateral segment and part of the posterior segment of the liver. Histologically, the neoplasm was diagnosed as a pure epithelial HB of the fetal type. Following the operation, the patient has been well and free of recurrence for 38 months, maintaining low alpha-fetoprotein (AFP) levels at around 5 ng/ml. To our knowledge, this is the longest reported survival of an adult following surgical resection of an epithelial HB.     

From a lab type to a product: a retrospective view on Impella's assist technology

A lab type is best described by its value as a result of its handcrafted uniqueness in small numbers. Logically, there is not one lab type like another, and the fact that it has been realized does not mean that this special effort can be easily reproduced. Furthermore, most lab types have undergone stand alone test runs revealing fingerprints rather than universal results at a 20% effort to 80% effect ratio. A product development, on the other hand, is best described by an 80% effort to 20% effect ratio in terms of measurable results. Products are producible and cost effective goods which are well documented and have undergone numerous test runs and test procedures assuring safety and quality, a basic requirement for market approval and cost effective marking. Based on the intravascular pump technology, comprising a sensorized axial flow pump with an integrated micromotor, the iterative dependence of the product development on lab types is demonstrated showing in particular the importance of having highly developed lab types before initiating the product development. By example, we demonstrated that high product quality has a greater impact on the reduction of blood damage than numerous redesigns. Reengineering issues are addressed, which are part of the product development process. Furthermore, the previously mentioned technology serves as a platform leading directly from the perioperative biventricular system to a 7 day pump as well as a miniaturized 12 Fr version.     

Ganglioglioma in a child--report of a case

A seven-year-old boy who was admitted for surgical treatment for intractable epilepsy was found to have a ganglioglioma in his left parietal lobe. Since four years old, he had been suffering from the seizure and treated with various anticonvulsants without satisfactory effects. As its frequency increased, the dose had to be increased. Thus, it was sought for the possible surgical approach. On the CT scans, an egg size low density zone without contrast enhancement was observed in the subcortical region of his parietal lobe. There was marked thinning on inner table of the skull immediately above the zone. He was operated under fronto-temporo-parietal craniotomy. When the dura matter was opened, pale cerebral cortex protruded. Complete removal of the tumor was not possible, since there was not clear boundary between the mass and normal tissue. Based on histological study, it was diagnosed as ganglioglioma, because its main body contained increased number of glia which had deeply stained ununiform size nuclei. After the operation, he showed neither motor paralysis nor sensory disturbance and was able to sustain his activity with less amount of anticonvulsant.     

Making a national donor research program a reality: Concepts for operationalizing a system

Deceased donor research remains an elusive goal for improving organ utilization and function. Many working in this field have cited the barriers that impede the conduct of such trials. Recent reports from the Academy of Medicine and individual authors provide a general framework on which a National Donor Research Program could be built. This paper provides one observer's viewpoint on how such a program could be operationalized.     

Laparoscopic Enucleation of a Pancreatic Insulinoma: Report of a Case

(Received for publication on May 14, 1997; accepted on Nov. 6, 1997)     

Idiopathic renal arteriovenous fistula demonstrating a huge aneurysm with a high risk of rupture: Report of a case

(Received for publication on June 11, 1997; accepted on Mar. 10, 1998)     

Mesh plug repair for a small incisional hernia in a cirrhotic patient with ascites: Report of a case

(Received for publication on Nov. 21, 1996; accepted on July 8, 1997)     

Closure of a pharyngocutaneous fistula using a sternomastoid muscle flap

Presented here is a case of a pharyngocutaneous fistula which was closed primarily using a sternomastoid muscle flap, without skin coverage, thus obviating the need for a three-layered closure. Providing an intermediate cover was sufficient for the closure because the mucosal lining on the inside and the cutaneous covering on the outside grew using the muscle for support.     

Non-operative management of a hepatic pseudoaneurysm and a biloma complicating a blunt abdominal trauma

Hepatic artery pseudoaneurysm and bilioma are rare complications of blunt abdominal trauma in children. We report a case in an 11-year-old patient after a hepatic and splenic blunt trauma following a car accident. The initial evolution was simple with haemodynamic stability. On Day 12, a pseudoaneurysm was discovered on an abdominal magnetic resonance imaging whereas the patient presented a major pain syndrome and an icteric cholestase. Embolisation was realised a few hours later in emergency because of a haemorrhagic shock. On Day 26, an endoscopic retrograde cholangiopancreatography highlighted two bilary leaks: one extrahepatic, the other intrahepatic. The first one was treated with a stent and the second one needed three drains: two peritoneal and one in the biloma. The characteristic of this case relies on the association of two complications. It underlines the need of multidiscipline and non-operative management of pediatric blunt hepatic trauma.     

The benefits of a hernia service in a public hospital

Summary A Hernia Service (HS) was commenced in Derriford Hospital, Plymouth, UK in May 1996 to improve patient outcome following a poor star rating for overall hospital performance in daycase hernia surgery. Between 1996 and December 1998, 576 patients, median age 65 years (range 24–88) with unilateral or bilateral inguinal hernias underwent surgical repair on the HS. During the same time period on the General Surgical Service (GSS) 1722 patients underwent surgical repair. On the HS, patients operated under local anaesthesia (LA) increased from 78.0 to 90.5%, and on the GSS use of LA increased from 7.6 to 22.4%. The percentage of daycases on the HS increased from 53.0 to 81.4% and on the GSS from 2.9 to 28.0%. The actual number of inpatient hospital days saved by the HS was 236 days in 1997 and 284 days in 1998. The potential saving was greater: in 1998 if the GSS daycase rate (28.0%) had been the same as the HS daycase rate (81.4%) 605 inpatient days would have been saved. A hernia satisfaction questionnaire was sent to a ran dom sample of 50 patients who had had their hernia repaired by the HS and 50 patients who had been treated by the GSS. HS patients experienced a mean pain score of 4,7 (range 1–10) compared to 5.7 (range 0–10) (p=0.07) for the GSS. Similarly, HS patients required less post-operative analgesia (mean 2.8 days compared to 5.9 days for the GSS group, p<0.01) and resumed normal activity at an earlier stage (mean 10.8 days compared to 17.6 days for the GSS patients, p<0.01). Instigation of a dedicated HS has improved patient outcome and substantially increased the use of local anaesthesia and the number of daycase hernia repairs on both the HS and the GSS, with substantial cost savings.     

Seroma with fibrous capsule formation requiring a surgical resection after a modified radical mastectomy: Report of a case

(Received for publication on Feb. 17, 1997; accepted on July 8, 1997)     

Chronic renal disorder after a nuclear crisis: a brief review

A present global public health concern is the adverse effect from nuclear leakage crisis in Japan. Based on the previous data on a previous famous nuclear crisis, Chernobyl crisis, the chronic renal disorder in affected population is an interesting topic in nephrology. Here, the author briefly reviews and discusses on the chronic renal disorder and nuclear denotation. Disturbance to the renal cell, alteration of renal function, and disorder of nephrological system in offsprings of exposed subjects are the three main focused topics.     

Improvement of Hemocompatibility on a Cellulose Dialysis Membrane with a Novel Biomedical Polymer Having a Phospholipid Polar Group

Abstract: To improve surface hemocompatibility on cellulose hollow fibers for hemodialysis, newly designed hemocompatible polymers with a phospholipid polar group, 2–methacryloyloxyethyl phosphory[choline (MPC) polymers, were introduced on the surface through two different methods: direct grafting of MPC on the surface, or coating of a water–soluble cellulose grafted with MPC. The MPC was polymerized using cerium ion as an initiator in the cellulose hollow fibers, and the poly(MPC) chains were grafted directly on the surface. Another modification of the cellulose hollow fibers was attempted by coating them with a water–soluble graft copolymer composed of a poly(MPC) side chain and a cellulose backbone. The coating process from an aqueous solution of the graft copolymer was very convenient, and the graft copolymer on the surface was not detached even after water circulated into the hollow fibers. These cellulose hollow fibers modified with MPC polymers displayed excellent hemocompatibility such as prevention of blood cell adhesion and aggregation after contact with blood without an anticoagulant. The permeability of the hollow fibers did not decrease as a result of these modifications. From these results, it is clearly suggested that introduction of the MPC units was effective for improving the hemocompatibility of the hollow fibers for hemodialysis.     

Veno-venous bypass without systemic heparinization using a centrifugal pump: a blind comparison of a heparin bonded circuit versus a non heparin bonded circuit

Veno-venous bypass without the use of systemic heparinization has recently become of increasing interest for application during liver transplantation and surgery on the large abdominal veins. However, possible adverse effects on blood components as demonstrated by means of hematologic and hemostatic parameters or on the occurrence of thromboembolic complications are until now not excluded. No consensus has been reached as to the efficacy of heparin coated circuits in those procedures. In the present study veno-venous bypass was performed for four hours in ten dogs using heparin coated and non coated circuits without further heparinization in a randomized blind fashion. No changes or significant intergroup differences were noted in the hematological and coagulation parameters. Macroscopic evaluation of the circuits revealed small strands of fibrin on all connector rims and clots in the center part of the pump head and at the cannula tips. The lungs showed two small emboli in large size pulmonary arteries and also two minor emboli in small size arteries. In four animals the emboli were equally divided between the two groups. As expected regarding the size of the clots no influences could be seen on hemodynamic or respiratory parameters. With Scanning Electronic Microscopy a monolayer of activated thrombocytes was observed on the surface of the bypass circuits in the coated as well as in the uncoated group. This study suggests that a veno-venous bypass without systemic heparinization is possible without serious damage to blood cellular elements or impressive activation of the coagulation system.(ABSTRACT TRUNCATED AT 250 WORDS)     

Anesthetic management in a patient with Goldenhar's syndrome using a perilaryngeal airway and a videolaryngoscope

A 5-year-old girl with Goldenhar's syndrome was scheduled for reconstruction of her left thumb. Because her preanesthetic X-p had revealed airway abnormality, difficult intubation was anticipated. After induction of anesthesia with thiamylal, the lungs were ventilated easily via a facemask. A perilaryngeal airway (PLA) was inserted after obtaining adequate depth of anesthesia with sevoflurane. Anesthesia was maintained with sevoflurane (2%) plus nitrous oxide (66%) under spontaneous ventilation. The operation was finished uneventfully. However, a re-operation was scheduled for postoperative hemorrhage on that day. In consideration of potential regurgitation of gastric content, endotracheal intubation was scheduled. Her vocal cord was confirmed with a videolaryngoscope, and she was intubated successfully. In conclusion, a PLA and a videolaryngoscope are useful for airway management of patients with Goldenhar's syndrome for whom difficulty in intubation is anticipated.