Jehovah,s Witnesses who require operation represent a challenge to the physician because of the patient,s refusal to accept blood transfusion. An orthotopic heart transplantation was succesfully performed in a 40-year old Jehovah,s Witness without use of any blood product. During the operation, cell saver was used for shed blood and aprotinin was administered intravenously. The use of blood conserving methods, meticulous operative technique and brisk postoperative diuresis has added to the efficacy of heart transplantation in this patient. Total postoperative drainage was 860 ml and the lowest hemoglobin level was 11.8 g%. The patient recovered uneventfully and discharged on the 60th postoperative day.
Adult ; Anesthesia* ; Aprotinin ; Blood Transfusion ; Disulfiram ; Diuresis ; Drainage ; Heart Transplantation* ; Heart* ; Humans ; Transplantation

PURPOSE: To evaluate the factors which affect the success rates of endoscopic endonasal dacryocystorhinostomy. METHODS: We analyzed 74 patients (95 eyes) who had undergone endoscopic endonasal dacryocystorhinostomy in Gachon Medical School, Gil Hospital between March 2000 and March 2003, and who were followed up for at least 6 months (range 6~13 months, mean 7.4 months). Surgical procedures, success rates, and complications of endoscopic endonasal dacryocystorhinostomy were evaluated. RESULTS: The primary success rate was 88.4% (84 of 95 cases) and the final success rate was 93.7% (89 of 95 cases), after 5 successful cases were added following revision. The success rate of the group with mitomycin C was statistically significantly higher than that of the group without it, but the interval of silicone tube removal from the operation or middle turbinectomy did not have any statistically significant effect on the success rate. In order of frequency, the postoperative complications were granuloma formation, nasal mucosa synechia, silicone tube prolapse, and membranous obstruction. CONCLUSIONS: Endoscopic endonasal dacryocystorhinostomy has the advantage of a similarly high success rate with external dacryocystorhinostomy and easy reoperation when performed with adequate procedures by an expert surgeon and followed up with proper postoperative management.
Dacryocystorhinostomy* ; Granuloma ; Humans ; Mitomycin ; Nasal Mucosa ; Postoperative Complications ; Prolapse ; Reoperation ; Schools, Medical ; Silicones

Caudal anesthesia appears to be a safe and reliable technique for surgical anesthesia as well as an alternative to narcotics for postoperative analgesia for procedure below umbilicus. From January 1990 to December 1992, we examined the trend and distribution of the 1038 cases of caudal anesthesia retrospectively according to year, age, surgieal department, type of operation, operation time, local anesthetics and suecess rate. Annual numbers of caudal anesthesia increased with years and the first decade of life was the greatest number. The most common department and operation time were general surgery and 30~60 minutes. 2% or 1% lidocaine with epinephrine was the major local anesthetics used during caudal anesthesia and overall success rate was 95.5%.
Analgesia ; Anesthesia ; Anesthesia, Caudal* ; Anesthesia, Conduction ; Anesthetics, Local ; Epinephrine ; Lidocaine ; Narcotics ; Retrospective Studies ; Umbilicus

Primary cutaneous B-cell lymphomas are rare diseases comprising nodular to diffuse lymphoid cell infiltration with an overlying grenz zone and no epidermal involvement upon histological analysis. Diagnostics can become challenging when lymphomas exhibit the characteristics of both B and T-cells. Differential diagnoses may include reactive proliferations, cutaneous composite lymphomas, and transformed mycosis fungoides. Immunohistochemistry and gene arrangement tests may be beneficial to clarify the diagnosis. Herein, we report a rare case of epidermotropic EBV-positive cutaneous B-cell lymphoma along with a literature review.

Purpose: To analyze short-term changes in anterior chamber depth (ACD) immediately and 1 month after traumatic hyphema. Methods: Thirty-two patients with traumatic hyphema treated from October 2015 to July 2019 were retrospectively reviewed. Nineteen were followed-up for 1 month. The ACDs were measured using an IOL Master 500 platform and the differences between the affected and contralateral eyes immediately after trauma and 1 month after treatment analyzed. The ACD differences between the affected and contralateral eyes of those with gross and microscopic hyphema and the correlations between the ACD differences of the two eyes were analyzed by age. Results: The average age was 36.0 ± 14.2 years and 24 patients were male (75%). The ACDs of affected eyes were greater than those of contralateral eyes both immediately after trauma (3.81 ± 0.38 vs. 3.55 ± 0.43 mm; p = 0.021) and 1 month after trauma (3.73 ± 0.37 vs. 3.61 ± 0.37 mm; p = 0.001). The ACD gaps and ACD/axial length ratios (%) did not differ significantly between the injured and contralateral eyes of the gross and microscopic hyphema groups immediately after trauma (p = 0.951/0.981). The ACDs of affected eyes decreased 1 month after trauma compared to immediately after trauma (3.73 ± 0.37 vs. 3.87 ± 0.40 mm; p = 0.013). The ACD difference immediately after trauma increased significantly with older age (R = 0.387, p = 0.018). Conclusions The ACDs of eyes with traumatic hyphema increased significantly compared to those of the contralateral eyes immediately after trauma. The ACDs decreased after treatment but 1 month later were still significantly greater than the ACDs of the contralateral side.

Clear cell acanthoma is a rare benign tumor, which usually presents as a solitary erythematous to brown colored papule or nodule, with a predilection for the lower leg of t hemiddle-aged and older individuals. An 11-year-old male presented with a 1-month history of bilateral brownish colored and exudative plaques on the both areolae.Histopathologic examination showed psoriasiform proliferation of pale keratinocytes and neutrophil exocytosis. Therefore, the patient was diagnosed with clear cell acanthoma. Typically, clear cell acanthoma occurs as a unilateral lesion on the leg in an adult. However, our case shows a bilateral lesion as well as the uncommon age and site.To our knowledge, this case of bilateral clear cell acanthoma has been rarely reported in Korea. Herein, we report a case of clear cell acanthoma that occurred on both areolae in a child.

Sigmoidovesical fistula is a rare disease. Most of these patients have symptoms of chronic and recurrent urinary tract infection, pneumaturia and fecaluria. Furthermore, colorectal cancer with enterovesical fistula is very rare in the population. We have recently experienced a patient who had adenocarcinoma that originated colon along with sigmoidovesical fistula, and this was misdiagnosed as bladder cancer with urinary tract infection. We present here a case report of a 66-year-old woman who exhibited these diseases.
Adenocarcinoma ; Aged ; Colon ; Colorectal Neoplasms* ; Female ; Fistula* ; Humans ; Rare Diseases ; Urinary Bladder Neoplasms* ; Urinary Bladder* ; Urinary Tract Infections