Exposure of the angle of His (AOH) with liver retraction is one of the key processes during laparoscopic sleeve gastrectomy (LSG). A new internal liver retractor, the LiVac (LiVac, Pty Ltd.) has recently been introduced. This study was conducted to evaluate the feasibility of the LiVac in LSG. We applied the LiVac in 20 patients who received LSG. The feasibility was assessed by exposure of the AOH, operation time, complications, and changes of aspartate transaminase and alanine transaminase. In all 20 patients, exposure of the AOH was successful. The mean operation time was 88 minutes. The changes in preoperative and postoperative aspartate transaminase and alanine transaminase levels were 18.6 and 9.1 U/L, respectively. There were no related morbidities. In LSG, exposure of the AOH using the LiVac was technically feasible.

Exposure of the angle of His (AOH) with liver retraction is one of the key processes during laparoscopic sleeve gastrectomy (LSG). A new internal liver retractor, the LiVac (LiVac, Pty Ltd.) has recently been introduced. This study was conducted to evaluate the feasibility of the LiVac in LSG. We applied the LiVac in 20 patients who received LSG. The feasibility was assessed by exposure of the AOH, operation time, complications, and changes of aspartate transaminase and alanine transaminase. In all 20 patients, exposure of the AOH was successful. The mean operation time was 88 minutes. The changes in preoperative and postoperative aspartate transaminase and alanine transaminase levels were 18.6 and 9.1 U/L, respectively. There were no related morbidities. In LSG, exposure of the AOH using the LiVac was technically feasible.

Allogenic peripheral blood stem cell transplantation (Allo-PBSCT) is being used to treat hematological malignancies with increasing frequency. Graft-versus-host disease (GvHD) is a complex complication of PBSCT. A 43-year-old woman came to the gynecology clinic for amenorrhea. She had been diagnosed with acute myeloid leukemia 2 years earlier and treated with induction and consolidation chemotherapy. After developing complete remission, she underwent Allo-PBSCT. When she started chemotherapy, her menstrual cycle completely disappeared. Fourteen months after menopausal hormone replacement therapy, it was discovered that her upper vaginal canal was completely obstructed. The lower vagina had an atrophic appearance. We report a rare case of partial vaginal obstruction as a complication of chronic GvHD and review the literature. We expect that this case report provides an opportunity to remind clinician of the gynecologic complications of GvHD.
Amenorrhea ; Consolidation Chemotherapy ; Female ; Graft vs Host Disease ; Gynecology ; Hematocolpos ; Hematologic Neoplasms ; Hormone Replacement Therapy ; Humans ; Leukemia, Myeloid, Acute ; Menstrual Cycle ; Peripheral Blood Stem Cell Transplantation ; Porphyrins ; Vagina

BACKGROUND: The purpose of the study was to understand how family physicians managed their primary health care centers and to identify the factors for successful management of their privative clinics. METHODS: The data was collected through individual interviews from five family physicians who operated their private clinics. All interviews were tape-recorded and transcribed into verbatim data. The data was analyzed using qualitative content analysis. RESULTS: Three major categories were identified: 1) types of physician based on major value as a doctor; 2) difficulties in operation and management; 3) desirable operating strategies for success. The first category described what kinds of value the physicians pursued as they operated their private clinics. Two different types were identified. One was intrinsic value oriented and the other was extrinsic value oriented. The second category illustrated many difficulties that family physicians faced in operating and managing their private clinics. Lack of private time, social isolation, and gap between mission and reality of practice were identified as major difficulties. Desirable strategies for the successful management were four subcategories: location; self-oriented developmental plan; specialization of the services; and activating network with larger hospitals. CONCLUSION: The results of the study would be helpful in setting up and operating private clinics through understanding the difficulties and strategies of primary physicians and recognizing mission and major value of them.
Humans ; Missions and Missionaries ; Office Management ; Physicians, Family ; Primary Health Care ; Private Practice ; Qualitative Research ; Social Isolation ; Workplace

Aortic interruption is a very rare disease that can be classified into congenital and acquired aortic interruption. Congenital aortic interruption generally implies an interruption of the aortic arch and no case of congenital abdominal aortic interruption has been reported. Acquired aortic interruption, on the other hand, can be caused by atherosclerosis, thrombosis, saddle embolism, and arteritis such as Takayasu arteritis. We experienced a case of congenital abdominal aortic interruption accompanied by one well-developed collateral flow presented with secondary hypertension in a 28-year-old female patient.
Adult ; Aorta, Abdominal ; Aorta, Thoracic ; Arteritis ; Atherosclerosis ; Embolism ; Female ; Hand ; Humans ; Hypertension* ; Rare Diseases ; Takayasu Arteritis ; Thrombosis

165Dy Hydroxide Macroaggregates(165Dy HMA) has a short half life(2.3 hours) and a size range of 3-5µm that give the advantage of reduced leakage and a shorter hospital stay. This report will show the results of a prospective open study on the efficacy and safety of 165Dy HMA in 178 knees of 141 patients with chronic synovitis refractory to conventional antirheumatic therapy. The final global assessment was classified as good, fair or poor. Extra-articular leakage of 165Dy HMA was determined by the scintigraphic evaluation of liver, groin and knee joints. The optimum radiation dose was 250 mCi. The mean follow up periods were 32.4(14-112) weeks. Thirty seven percent of the knees showed good results, 48% fair results and 15% poor results. In the knees with stage I radiographic changes, 82% showed improvement including 32% of the patients with good results. In the knees with stage II radiographic changes, 90% showed improvement including 42% of the patients with good results. The mean period of improvement for the 158 knees that responded to treatment was 41.4(24-106) weeks. Leakage of radioactivity from the injected joint was minimal. Adverse reactions were rare(radiation burn : 4 cases, transient postinjection swelling : 14 cases). In conclusion, 165Dy HMA radiation synovectomy is a safe and useful therapy for chromic synovitis of the rheumatoid knees.
Arthritis, Rheumatoid ; Burns ; Follow-Up Studies ; Groin ; Humans ; Injections, Intra-Articular ; Joints ; Knee Joint ; Knee ; Length of Stay ; Liver ; Prospective Studies ; Radioactivity ; Synovitis