Human-elephant conflict (HEC) in India is becoming a growing health problem causing many fatalities every year. Elephants produce injuries by trampling, stomping, squeezing, tossing in the air, or crushing/targeting the head and chest commonly. The adult elephants are most aggressive in their mating season, leading to maximum incidences of HECs in this period. These attacks are mostly unprovoked, though most HECs are provoked. In this case series, the authors described the injuries sustained by three survivors in a short span of one month due to the sudden and unprovoked elephant attack. All the injuries were mild to moderate in severity and involved the chest in common. Timely rescue and prompt initiation of treatment were pivotal in their survival. The authors also want to create awareness about the mating season of elephants to minimize these unfortunate events in the future.
Animals ; Elephants ; Humans ; India ; Seasons ; Survivors

Thoracic endovascular aortic repair (TEVAR) has emerged as an effective therapy for a variety of thoracic aortic pathologies. However, various types of endoleak remain a major concern, and its treatment is often challenging. We report a case of type I endoleak occurring 19 months after zone II hybrid TEVAR. The endoleak was successfully repaired by the frozen elephant trunk technique, without removal of a previous stent graft, combined with ascending aorta and total arch replacement.
Aneurysm ; Aorta ; Blood Vessel Prosthesis ; Elephants* ; Endoleak* ; Pathology

Operations for extensive aortic aneurysm are generally performed as staged operations with or without elephant trunk technique. However, we must consider single stage replacement in cases that are unsuitable for elephant trunk technique. We report a case of successful single stage replacement of the entire thoracic aorta from the aortic valve to the level of diaphragm. The patient was a 35-year-old male who had Marfanoid features and had previously undergone replacement of the ascending aorta for aortic dissection. He recorvered without neurologic complication and was discharged on 29th day after the operation.
Adult ; Aorta ; Aorta, Thoracic* ; Aortic Aneurysm ; Aortic Valve ; Diaphragm ; Elephants ; Humans ; Male

BACKGROUND: Some patients show favorable changes in the descending aortic false lumen after conventional repair of acute type A dissection, although the incidence of favorable changes has been reported to be low. We aimed to investigate the incidence of positive postoperative changes in the false lumen and the factors associated with positive outcomes. METHODS: In 63 patients who underwent surgery for type A acute dissection as well as serial computed tomography (CT) scanning, morphological parameters were compared between the preoperative, early postoperative (mean interval, 5.4 days), and late CT scans (mean interval, 31.0 months) at three levels of the descending thoracic aorta. RESULTS: In the early postoperative CT images, complete false lumen thrombosis and/or true lumen expansion at the proximal descending aorta was observed in 46% of the patients. In the late images, complete thrombosis or resolution of the proximal descending false lumen occurred in 42.9% of the patients. Multivariate analysis found that juxta-anastomotic false lumen thrombosis was predictive of favorable early changes, which were in turn predictive of continuing later improvement. CONCLUSION: Even after conventional repair without inserting a frozen elephant trunk, the proximal descending aortic false lumen showed positive remodeling in a substantial number of patients. We believe that the long-term prognosis of type A dissection can be improved by refining surgical technique, and particularly by avoiding large intimal tears at the anastomosis site during the initial repair.
Aorta, Thoracic ; Elephants ; Humans ; Incidence ; Multivariate Analysis ; Prognosis ; Tears ; Thrombosis ; Tomography, X-Ray Computed

A 67-year-old female patient was treated with conventional total arch replacement and insertion of a stented elephant trunk (SET) graft into the descending thoracic aorta for acute DeBakey type I aortic dissection at one time. She had been treated with right coronary artery stent insertion for acute myocardial infarct 4 days earlier, and at that time, she was diagnosed with acute DeBakey type I aortic dissection from the ascending aorta to the suprarenal artery based on trans-esophageal echocardiography and aorta computed tomography. Through a median sternotomy, we inserted the SET graft through the opened aorta to the descending aorta. We also performed anastomosis between the proximal stented graft and the distal aortic arch, and then performed total arch replacement. For acute DeBakey type I aortic dissection, we report total arch replacement with insertion of a SET graft as a combination of conventional surgery and the interventional technique.
Aorta ; Aorta, Thoracic ; Arteries ; Coronary Vessels ; Echocardiography ; Elephants ; Female ; Humans ; Myocardial Infarction ; Stents ; Sternotomy ; Transplants

The criteria for a good stereoacuity test in preschool children should be easy and provide accurate measurement of stereoacuity.To determine the success rate and efficacy of stereoacuity tests, and percentage of children between age of 2 and 3 years who correctly identified shapes and symbols of each stereoacuity test, we administered the Lang, Titmus circle, Titmus, animal, Randot circle, Randot shape and Randot preschool stereoacuity test in 96 patients whose ages ranged between 2 to 5 years. The overall success rates of the Lang, Titmus circle Titmus animal, Randot circle, Randot shape and Randot preschool stereoacuity tests were 84.4%, 72.9%, 75%, 75%, 75%and 84.4%, respectively.The overall success rates of the Lang and Randot preschool stereoacuity test tended to be higher among the methods.The sensitivity of the Lang and Randot preschool stereoacuity test was 100%and best among all methods.The percentage of 2-to 3-year-olds who correctly identified the shape of star, cat, car, elephant, rabbit, hand, truck, house, tree and round was higher than that of other shapes. The shapes of squirrel, monkey, heart, E, and cross was lower than that of other shapes.The Lang or Randot preschool stereoacuity test which uses shapes and symbols readily recognizable by children was found to be easy and accurate stereotests for preschool children, especially in uncooperative 2-to 3-year-olds.
Animals ; Cats ; Child ; Child, Preschool* ; Elephants ; Hand ; Haplorhini ; Heart ; Humans ; Motor Vehicles ; Sciuridae

Complex lesions of the thoracic aorta are traditionally treated in 2 surgical steps with the elephant trunk technique. A relatively new approach is the frozen elephant trunk (FET) technique, which potentially allows combined lesions of the thoracic aorta to be treated in a 1-stage procedure combining endovascular treatment with conventional surgery using a hybrid prosthesis. These are very complex and time-consuming operations, and good results can be obtained only if appropriate strategies for myocardial, cerebral, and visceral protection are adopted. However, the FET technique is associated with a non-negligible incidence of spinal cord injury, due to the extensive coverage of the descending aorta with the excessive sacrifice of intercostal arteries. The indications for the FET technique include chronic thoracic aortic dissection, acute or chronic type B dissection when endovascular treatment is contraindicated, chronic aneurysm of the thoracic aorta, and chronic aneurysm of the distal arch. The FET technique is also indicated in acute type A aortic dissection, especially when the tear is localized in the aortic arch; in cases of distal malperfusion; and in young patients. In light of the great interest in the FET technique, the Vascular Domain of the European Association for cardio-thoracic Surgery published a position paper reporting the current knowledge and the state of the art of the FET technique. Herein, we describe the surgical techniques involved in the FET technique and we report our experience with the FET technique for the treatment of complex aortic disease of the thoracic aorta.
Aneurysm ; Aorta, Thoracic ; Aortic Diseases ; Arteries ; Elephants* ; Humans ; Incidence ; Prostheses and Implants ; Spinal Cord Injuries ; Tears

Difficulty in exposing anastomotic sites is a frequently encountered problem during surgical repair of a distal aortic arch aneurysm via median sternotomy or lateral thoracotomy. Endovascular repair has the limitation that it usually requires surgical rerouting of some of the brachiocephalic branches in order to get sufficient length for proximal fixation of the stent-graft. To take advantage of each approach, we fixed the distal end of the prosthetic graft by means of a pre-mounted metallic stent instead of performing conventional surgical anastomosis during the repair of distal arch aneurysms with using median sternotomy and hypothermic circulatory arrest. We report here on our experience with such 3 patients.
Anastomosis, Surgical ; Aneurysm ; Aorta, Thoracic ; Elephants ; Humans ; Imidazoles ; Nitro Compounds ; Stents ; Sternotomy ; Thoracotomy ; Transplants

OBJECTIVETo study collagen structure of the traditional Chinese medicine elephant skin and the proposed alternatives such as pig skin, fish scale, and antioxidant activity.

METHODOrthogonal experimental design method was employed to determine the optimal extraction condition of collagen from the elephant skin, and the structure and content of collagen of proposed alternatives were compared, their scavenging ability were determined by salicylic acid.

RESULTCollagen extracted from elephant skin with the optimal conditions was the structural integrity and good quality first time, and collagen structure of the elephant skin was similar to the proposed alternatives. Free radical scavenging capacity of collagen, values of IC50, were 0.51 g x L(-1) of elephant skin, 0.60 g x L(-1) of pig skin and 0.42 g x L(-1) of fish scale.

CONCLUSIONBy comparing and identification of proteins that the collagen of elephant skin is type I collagen, with a strong antioxidant capacity, is the active ingredients of elephant skin. It provides a further study of alternatives as an important reference.

Animals ; Antioxidants ; isolation & purification ; pharmacology ; Collagen ; isolation & purification ; pharmacology ; Elephants ; Fishes ; Skin ; chemistry ; Swine

Three reports published in the 20th century have functioned as standard guidelines for medical education: the General Professional Education of the Physician report by the Association of American Medical Colleges, Tomorrow's Doctors from the General Medical Council of the UK, and Korean Physicians for the 21st Century by the Korean Association of Medical Colleges. At the moment, a great deal of innovation is occurring in Korean medical societies. However, these innovations bring to mind the parable of the blind men and an elephant in which each blind man feels part of an elephant with his hands and misunderstands the elephant's nature because he cannot see the whole animal. In the same way, there is no comprehensive picture of 'what is the good doctor' for here and now. Korean society is changing more and more rapidly in the 21st century due to influences such as an influx of immigration and resulting multiculturalism. We could not predict these changes even in the 1990s, when Korean Association for Medical Colleges was preparing its report. In light of a dynamically changing society, we must review and revise our definitions of a 'physician for here and now' every ten or twenty years.
Animals ; Cultural Diversity ; Education, Medical ; Education, Professional ; Elephants ; Emigration and Immigration ; Hand ; Humans ; Light ; Male ; Needs Assessment ; Societies, Medical